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									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
• Background: Australian Quitlines review 2004/05
• Key findings
• Minimum standards summary
• Meeting the challenges/conclusions
Australian Quitline 13 7848 (13 QUIT)
• National number
   – each state and territory is responsible for the calls in their own
   – 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
   – all callbacks are free of charge
   – number and Quitline logo owned
     by The Cancer Council Victoria
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
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

• Quitline Managers Group
   – represents those organisations providing Quitline services
   – part of the national network
• 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
• July 2005: Final report
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
    – to improve consistency of the Service
    – to ensure that a high-quality service is delivered to all callers,
      irrespective of location
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
Development of the Minimum
Standards: 2006–2007
• Incorporated feedback from Quit Group and Quitline
• 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
   – importance of funders being involved with and recognising the
     importance of the standards.
   – need for regular, national evaluation on the Quitline
Minimum standards cover…
• Opening hours, response times, hold times, answering
• 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
Minimum standards cover…
• Recruitment (including requirement that counsellors be
  current non-smokers)
• Counsellor training: initial, ongoing professional
• Referral to other agencies: cessation services and
  cessation products
• Collection of data: minimum data set
• Evaluation
Minimum standards: example
1.1   The Quitline is answered 24 hours a day 7 days a week
1.2   Someone answers the Quitline number at all times. This could
      be a call centre agent (eg Link operator), a Quitline Counsellor or
      Quitline reception staff
1.3   Call answered within a maximum of 5 rings
1.4   The 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
Minimum standards
4.1 Counselling 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
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
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
      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
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.
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.
• Range of government/non-government agencies
  involved in funding and delivery of Quitline Services
• Variation in level and process of sign-off by
• Time required for some jurisdictions to feel comfortable
  that they could sign-off on standards
• Ongoing monitoring and quality control
Ongoing quality control
• Best achieved through a shared and transparent
• The Quit Group, through the Chair, will be responsible
  for ongoing monitoring and quality control through
  reports (as per agreed template) submitted by each
• In this way, those jurisdictions only partially or not
  achieving standards are accountable to, and can be
  assisted by, the group
• 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

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