1. 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

2. 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”

3. 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
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 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

4. 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

5. 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.

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

7. 100% DHB participation was achieved.
Implementing
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.

8. Embedding
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

9. Lasting change requires a long-term commitment.
Improving:
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.

10. 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.

12. 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

13. 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.

14. 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?

15. 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

16. 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

17. Deliver Create what will be Implementing the plan Monitoring progress
Feedback to inform and improve
Create what will be

18. 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.

19. Air Care Talk Card (side 1)

20. Air Care Talk Card (side 2)

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