Smoking rates are higher than the average among people who are already facing social and economic disadvantage – more than twice as high for people with a mental illness and single parents, more than three times as high for Aboriginal and Torres Strait Islander people, and with more than 77 per cent of people who are homeless also being smokers.
The community sector has an important role to play in reducing smoking rates among disadvantaged Victorians. In this guest blog Carla Seymour from Hanover describes how they have worked with Quit Victoria to support people accessing their services to reduce smoking.
Heroin and other illicit drugs have long been the concern of the community – whereas legal drugs like tobacco are largely considered to be non-problematic in comparison.
Working as a drug and alcohol worker in the homeless sector, I see the impact that smoking has on the already vulnerable people I support.
The combination of smoking, transient living and the use of other drugs substantially increase the risk of poor physical and mental health – particularly for people experiencing homelessness. Numerous clients of mine have had emphysema and difficulty with wound healing and infections, all of which could be linked to their smoking. The addictive qualities of tobacco are well known – I’ve seen people shoplift, fight and engage in sex work to get access to tobacco.
When I was given the opportunity to work alongside Quit Victoria on a project which aimed to provide smoking care to some of the most disadvantaged people in our community, I was excited by the prospect.
I was keen to not dismiss the idea as ‘too hard’, or focus on the multitude of other barriers our clients face. In doing so, make decisions for the clients in terms of assuming whether or not they would like support around their smoking.
Staff surveys: the first step to improving smoking care at social and community organisations
It can be difficult to know where to start implementing a smoking care program, especially when you do not have a clear picture of staff attitudes and experiences in delivering smoking care.
The pilot program was run at Hanover’s Southbank site, an inner city crisis accommodation service that works with people experiencing homelessness, many affected by drug and alcohol addictions, and with complex physical and mental ill health.
Hanover worked with Quit to look at ways of supporting staff to help their clients in stopping smoking. As part of this, Hanover’s Southbank site took part in a pre-pilot survey.
To get a better picture of staff attitudes to providing cessation assistance to clients at Hanover Southbank a survey was conducted. Staff’s own smoking behaviours and their perception of client smoking behaviour and staff training needs were also assessed.
More importantly, and not surprisingly the survey found that Hanover clients are interested in cutting down or stopping smoking with staff reporting more than a third of clients had already expressed an interest in reducing or stopping smoking. This showed that a smoking care program was feasible and would be useful to clients. Key findings from the staff survey are:
1. The majority of Hanover staff believed they should be providing smoking care:
Although the majority of staff surveyed (96 per cent) agreed that clients had a right to smoking care support and that smoking increased their clients’ disadvantage (92 per cent), very few staff recorded new clients’ smoking status or asked if they were interested in cutting down or stopping smoking on a consistent basis.
My team at Hanover estimated that 70-100 per cent of clients smoked. This indicated that all participating staff worked with smokers as part of their role.
It became clear that it was necessary to put in place systems and processes to support the team to deliver smoking care to our clients.
2. Staff need more training to deliver smoking care to clients.
The majority of staff rated their level of knowledge and skills in providing smoking care advice and support to clients as moderate. More than 80% of staff said they were interested in training on methods for stopping smoking, medication available and tailoring advice on stopping smoking to clients.
Quit Victoria has since run a training session for Hanover staff on how to provide this advice.
3. Significant barriers to stopping smoking for clients
There were, however, a number of issues that were viewed as presenting considerable challenges to the program. High levels of dependence on nicotine, clients having more pressing needs and strong pro-smoking cultural norms among clients, were among the identified challenges.
The second phase of the project began last month with all clients being asked if they were interested in talking about smoking. Staff used a brief intervention model to help their clients by:
- asking if they were interested in talking about their smoking,
- providing brief advice, a starter kit and a Quitline referral,
- following up with them to learn how it went and what could be done better.
Participating clients will also see a GP or nurse and PBS-subsidised nicotine replacement therapies will be provided free for up to 12 weeks.
The staff surveys not only gave a better insight into the extent to which clients would benefit from support workers being trained to provide smoking care, it also allowed staff to address and discuss some of the perceived project barriers in designing a smoking care program.
Following the program
Since the trial, the Hanover team have put more emphasis on assessing and working with residents of Hanover on their smoking needs. Support workers have started to ask people if they smoke during initial assessment and most of the team are happy and able to support and refer clients to appropriate services such as Quitline.
There is still a long way to go towards creating cultural change within the homelessness sector. It will take continuous work on the issue to get staff and clients to see smoking as a serious issue which needs to be addressed, though Hanover is moving in the right direction. Since the project the clients are being given better information and access to support which should hopefully see many more clients of Hanover address their smoking in the future if they make the choice to cut down or quit.
The project finished in 2014 and achieved many positive outcomes and transferable learning for the sector more broadly.
Hanover is a leading Melbourne based community agency providing services to Victorian experience housing crisis or homelessness. Hanover’s Southbank site is a 50 bed adult inner city crisis accommodation facility. The majority of people at Hanover Southbank have very specific needs – some may have slept rough, some experience mental and physical illnesses and many have significant barriers to accessing services.
About Carla: Since completing her degree in Social Policy and Sociology at the University of Bristol, Carla has dedicated her career to working with disadvantaged people. She currently works as a Care and Recovery Coordinator at Hanover Southbank – leading a team dedicated specialist drug and alcohol workers at Hanover’s adult crisis accommodation service in Southbank. Carla has been working within the homelessness sector in both the UK and Australia for the last 9 years. She has specialized in working with people who have experienced histories of trauma, mental health conditions and drug and alcohol dependencies.