Video: Sustaining Quit for new life. Three promising case studies from 2019-2020
Smoking during pregnancy is a NSW Health priority issue. It's good news that Aboriginal mothers smoking in pregnancy has fallen by a third over the last generation. But despite this strong improvement, over 40 percent of Aboriginal women continue to smoke tobacco when pregnant. More work is needed to build on the gains made so far.
NSW Health funded the Quit for new life initiative, with the aim of embedding best practice smoking cessation in clinical services visited by women having an Aboriginal baby in a culturally responsive way.
Quit for new life is still going strong since the funding period ended in mid-2018. Recent follow-up with staff provides three promising case studies of Quit for new life service models from local health districts.
Hunter New England adopted a capacity building model. This meant that Quit for new life was integrated into routine care provided by all maternity clinicians through training and system support. So no new positions were required.
"Through our investment in existing staff, it meant that once the initial funding ceased, that initial investment resulted in ogoing best practice routine care for all of our clients into the future."
The swap to stop approach proved to be a stength of the program in Hunter New England. When clinically suitable it provided women with small realistic goals of reducing the number of cigarettes over time with nicotine replacement therapy.
"I could take one or two cigarettes a day away and replace it with nicotine, Many would come back and go. Guess what, I just forgot to have a cigarette!"
Beyond the funding period, Hunter New England decided to retain free nicotine replacement therapy under their routine annual budgeting.
"Nicotine replacement therapy has remained available for all clients attending those services and will continue to."
Northern NSW trialled an opt-out referral model. This took the form of a specialist cessation clinic offering face-to-face and phone support. All eligible women were referred, unless they chose not to be. An identified Aboriginal Midwife position supported culturally appropriate care for Aboriginal mothers. The clinic was resourced through activity-based funding.
'When a clinician sees the patient and counsels them for nicotine dependence, and then makes a note in the medical record, then that episode attracts activity-based funding. Activity-based funding will fund the program to nurses across our local health district to continue the program in the future."
The specialist clinic suited the use of a carbon monoxide breath expiry monitor. Research and clinician's experience suggested that the monitor was a valuable client engagement tool. Mothers were keen to see their CO reading which gave immediate feedback on how well they were managing their smoking.
"The feedback can engage them and initiate discussions around barriers to quit smoking."
After having limited progress with a capacity building approach, South Western Sydney moved to a referral model. In this model referrals were directed to an Aboriginal smoking cessation advisor.
"It was so popular that people were asking or calling directly for this smoking cessation advisor."
The smoking cessation advisor offered home visits as part of the program. This feature proved popular with clients providing a more relaxed atmosphere where support was given not only to the mother, but to household members as well.
"I was able to connect with the women that was more personal, and because it wasn't in a clinic setting, I believe that they were able to open up a little bit more and I could get that information and we could create those individual quit plans."
After the funding period, South Western Sydney established an ongoing Aboriginal smoking cessation advisor position to sustain Quit for new life across the District. Placement of the position under drug and alcohol services is working well.
"Since moving to drug health services, I've been able to work with the substance use and pregnancy team and be able to get another direct line of referral from those health professionals. I believe that the integration into drug health has been very positive for Quit for new life."To learn more about these case studies visit www.health.nsw.gov.au/tobacco.