Anna Pease and Stephanie Cowan Smokefree Children Peer education to assist hospitals in promoting smokefree air for children Key point: peer education specific to paediatric settings The purpose to support staff in paediatric settings with education to address children's SHS exposure The programme is designed as peer education that is, colleague to colleague rather than delivered by an expert. Consultation has involved many people working in paediatrics with Nelson/Marlborough DHB the trial site National roll-out planned for spring with three regional workshops to “educate the educators” These people will link as the Smokefree Children network Developed by Education for Change which has various other programmes for addressing smoking, especially in pregnancy and where there are young children Anna Pease and Stephanie Cowan Education for Change September, 2007 www.efc.co.nz

Our networks are our “net-worth” Acknowledgements The Smokefree Children Network and their managers Dr Philip Pattemore, Paediatrician, our champion Nelson Marlborough DHB for the development phase The Paediatric Society of NZ, especially President, Nick Baker, and Anne Feld for their support DHB Smokefree Co-ordinators for their systems support Our funders, the Ministry of Health Our networks are our “net-worth”

The size of the problem Number 1 Not fair Burden >90 000 185 000 main cause of preventable death and disease for NZ children Not fair greater for young (<3 yrs), Maori, Pacific or children from low income families Burden 50% of SIDS Deaths 14% all paediatric admissions 1,500 glue ear ops/year 15,000 asthma attacks/year >90 000 Smoke- exposed children Smokefree children 185 000 Key points: Effects are many and varied, far- and wide-reaching Breastfeeding smoking women less likely to breastfeed and/or for long slower let down, reduced milk supply, reduced prolactin Hospital admissions admission in the first year of life is 1.5 times more likely if mother smoked in pregnancy (Christchurch data) 14% of all admissions in the first year of life would be avoided if no mother smoked in pregnancy SHS a contributor to about 7000 infant admissions per year (pc Dr Philip Pattemore 30% increased paediatric admissions in winter months (A total 275 000 pre-school children live in NZ) Ref: Trying to Catch Our Breath: the burden of preventable diseases in children and young people. (2006). The Asthma and Respiratory Foundation of New Zealand. Children are not equally healthy

Recording of child’s smokefree status Staff reporting asking 2004 National Assessment paediatric departments have the lowest rates of identifying and recording patient smokefree status mis-match between what staff perceive to be usual practice and what is actually recorded Recording of child’s smokefree status whole hospital staff surveys to assess smokefree attitudes and clinical practices Staff reporting asking Audit of notes Christchurch (2004) 62% 17% Starship (2001) 26% 13% Ref: Cowan and Langley (2004) Report: identifying and addressing exposure to smoking for patients in New Zealand hospitals, Education for Change

It is “a little and often by many over time” that works. Design Principles The needs of children are urgent Education + Systems = Best practice Brief intervention works Child focussed “Air Care” approach Appreciative Inquiry It is “a little and often by many over time” that works.

Evaluation is built into every phase. Three Phase Programme Implementing 1 Embedding 2 Improving 3 Evaluation is built into every phase.

100% DHB participation was achieved. Implementing - 2006 Hospitals commit to Smokefree Children initiative Programme launched at regional workshops Peer education sessions and Air Care discussions implemented Report to Education for Change on progress 100% DHB participation was achieved.

Embedding - 2007 Goal set for achieving 100% identification of smokefree child status in every hospital in NZ Smokefree Children Care Pathway (or similar) implemented as systems support for this goal Ongoing staff education and monitoring of ID rates embedded into systems

Lasting change requires a long-term commitment. Improving: 2008 - 2010 Systematic audits carried out to monitor the 100% standard for identifying child smokefree status Improvement targets set for increased rates of smokefree children Local data aggregated to form a national evaluation of Smokefree Children Lasting change requires a long-term commitment.

New Zealand is a nation that makes children a priority. Results so far One year later: 896 paediatric nurse colleagues attended education 126 sessions held nationally (7 participants/session) 68% DHBs completed expectations Peer Responses New Zealand is a nation that makes children a priority.

Appreciative Inquiry Appreciative Inquiry (AI) is a organisational development process or philosophy that engages individuals within an organisational system in its renewal, change and focused performance. Used in Smokefree Children, and underpins all EFC Programmes

AI is a particular way of asking questions and envisioning the future that fosters positive relationships and builds on the basic goodness in a person, a situation, or an organisation. In so doing, it enhances a system's capacity for collaboration and change.

What is the best of what is? Discover What’s working well? Where is there success? What makes it work well? What is the best of what is?

Envision processes that will work well in the future Dream Imagine the best outcome What would it look like? Who would be there? What would they be doing? Envision processes that will work well in the future

Plan and prioritise processes that will work well Design What’s the first step towards the dream? Where can we start? Who else needs to be involved? Plan and prioritise processes that will work well

Deliver Create what will be Implementing the plan Monitoring progress Feedback to inform and improve Create what will be http://en.wikipedia.org/wiki/Appreciative_inquiry http://appreciativeinquiry.case.edu/

Whole Family Smokefree Air Care Logic Direct Approach Indirect Approach Air Care Planning Discussion Families discuss smokefree Protect a child’s air Referrals to Smokefree support Whole Family Smokefree Smokefree Children is a “whole family” approach.

Air Care Talk Card (side 1)

Air Care Talk Card (side 2)

protect a child’s air protect a child Smokefree Children protect a child’s air protect a child Thank you.