Achieving minimum standards for Australian Quitline Services

1. Achieving minimum standards for Australian Quitline Services Suzanne Stillman: Quit Victoria (The Cancer Council Victoria) Caroline Miller: The Cancer Council South Australia Catherine Mahony: The Cancer Council Queensland Helen Taylor: Queensland Health

2. Overview • Background: Australian Quitlines review 2004/05 • Key findings • Minimum standards summary • Meeting the challenges/conclusions

3. Australian Quitline 13 7848 (13 QUIT) • National number • each state and territory is responsible for the calls in their own jurisdiction • each state and territory funds the Quitline in their own jurisdiction and pays a share of the number rental • cost of a local landline call for the caller from anywhere in Australia • all callbacks are free of charge • number and Quitline logo ownedby The Cancer Council Victoria

4. Quitline number on cigarette packaging • Legislation required the Quitline number to be included on all cigarette packaging manufactured in or imported into Australia after March 2006. • The number on the packs remains the ‘old’ 131 848 number pending a review of the regulations. Both numbers go to the same answering points. • Commonwealth Department of Health and Ageing pays rental for 131 848

5. Australian Quitline services background • National Quit Group • comprises representatives from organisations responsible for implementing cessation campaigns in Australia • provides a forum for Quit organisations across Australia and New Zealand to collaborate on the development of resources and campaigns and to share cessation and campaign expertise • Quitline Managers Group • represents those organisations providing Quitline services • part of the national network

6. Background • June 2004: Review commissioned by Commonwealth Department of Health and Ageing to identify possible impact on Australian Quitline Services of the Quitline number appearing on tobacco packaging • Review undertaken by Tobacco Control Research and Evaluation, The Cancer Council South Australia • Part of the brief was to make recommendations that would enable Quitline services to deliver a responsive, consistent, evidence-based service to Australian smokers • July 2005: Final report

7. Key findings of the Review •  Australian Quitline Services • deliver a good level of service in all jurisdictions • more similarities than differences • The review made a number of recommendations including Minimum Standards for the Australian Quitline • to improve consistency of the Service • to ensure that a high-quality service is delivered to all callers, irrespective of location

8. Minimum Standards for the Australian Quitline Services • The Quit Group endorsed the recommendation • Agreement to aim for the delivery of a contemporary, best-quality, well-evaluated service, rather than be constrained by a common denominator • Working group (of the Quit Group) established to progress development • Quit Victoria, The Cancer Council South Australia, The Cancer Council Queensland, Queensland Health

9. Development of the Minimum Standards: 2006–2007 • Incorporated feedback from Quit Group and Quitline Managers • Resolutions from the Quit Group: • minimum standards are an important quality improvement mechanism which act as a means of enhancing and protecting the reputation of the Quitline. • importance of maintaining a national commitment to the standards. • importance of funders being involved with and recognising the importance of the standards. • need for regular, national evaluation on the Quitline

10. Minimum standards cover… • Opening hours, response times, hold times, answering rate • Availability and despatch times of Quit Pack • Access to counsellors, recontact times if counsellors are not immediately available, hours of counselling • Referral program from health professionals to Quitline • Tailored assistance for callers with special needs • Evidence-based counselling content and advice

11. Minimum standards cover… • Recruitment (including requirement that counsellors be current non-smokers) • Counsellor training: initial, ongoing professional development • Referral to other agencies: cessation services and cessation products • Collection of data: minimum data set • Evaluation

12. Minimum standards: example 1.1The Quitline is answered 24 hours a day 7 days a week 1.2Someone answers the Quitline number at all times. This could be a call centre agent (eg Link operator), a Quitline Counsellor or Quitline reception staff 1.3Call answered within a maximum of 5 rings 1.4The Quit Book is readily available and offered to all callers (universally) to the Quitline, irrespective of whether they are ready and willing to discuss issues more fully with a counsellor

13. Minimum standards 4.1Counselling available during minimum hours ie. business hours (0900-1700)plus out of hours as dictated by call demand and determined by each jurisdiction 5.1 A pro-active call-back service is available, which takes the caller through the process of quitting and which has a well-structured schedule according to best evidence about outcomes

14. Minimum standards: example 6.1 A referral program from health professionals and other sources is integrated that enables all health professionals to refer clients to Quitline 6.2 The referral is received in a confidential secure location 6.3 A return fax or email is made to confirm receipt of referral and scheduling of call for GP at minimum 6.4 Where desired/appropriate, a feedback loop is maintained with health professional about outcome

15. Minimum standards: example 7.1 Tailored assistance for callers with special needs is available 7.2 Tailored assistance is consistent with national protocols for: a.  Culturally and Linguistically Diverse group – linking with Translation and Interpretation Service &/or bilingual counsellors b. Callers with mental illness c. Pregnant callers – planning for pregnancy, pregnancy and post-partum d. Young callers e. Aboriginal and Torres Strait Islander callers f. Crisis calls As part of the development of Minimum Standards the Quitline Managers’ Group led the development of protocols for each of the special needs groups

16. Minimum standards: example 12.1  Initial training in smoking cessation counselling, ongoing training and updates on tobacco control that are consistent with the national protocol are in place 12.2  Counsellors’ initial training includes: • the quitting process; • the different needs of smokers at different stages of quitting; • accurate assessment of caller needs; • brief intervention skills; • callers' motivation to change; • Smoking related information and issues; • Pharmacotherapies; • Resources available; • Relapse; • Coping with staying stopped. • Callers with mental illness.

17. Minimum standards: example 15.1 A minimum data set on all calls is maintained 15.2 The minimum data set includes: a. Age b. Gender c. Postcode d. Indigenous status e. Current smoking behaviour and measures of dependence f. No. of previous quit attempts g. Nature of call h. Outcome of call (counselling, call-backs scheduled, resources) i. Callers’ special needs.

18. Challenges • Range of government/non-government agencies involved in funding and delivery of Quitline Services • Variation in level and process of sign-off by jurisdictions • Time required for some jurisdictions to feel comfortable that they could sign-off on standards • Ongoing monitoring and quality control

19. Ongoing quality control • Best achieved through a shared and transparent process • The Quit Group, through the Chair, will be responsible for ongoing monitoring and quality control through reports (as per agreed template) submitted by each jurisdiction • In this way, those jurisdictions only partially or not achieving standards are accountable to, and can be assisted by, the group

20. Conclusion • The Australian Quitline Services Minimum Standards have been signed off by every State and the Northern Territory (the Australian Capital Territory is not a signatory) • Covers more than 98% of the population • The process took longer than had been anticipated • Has been well worth the effort: greater confidence that smokers ringing Quitline will receive high quality support • Next step is the first collection of status reports • Acknowledgement to all members of the National Quit Group and the Quitline Managers’ Group