Supporting youths in breaking their tobacco addiction
About the service
Allum House is a youth refuge targeting 16−21 year-olds, run by Mission Australia’s Canterbury Bankstown Youth Service. Staffed by only one worker at any given time, the five-bed youth homelessness service is located in a suburban house in a residential part of Bankstown, southwest Sydney.
Many of the young people who come to Allum House are dealing with issues such as mental illness, disengagement with education and unemployment in addition to being homeless, and many are smokers.
Allum House provides a case-managed service in a safe environment. Young people are engaged in counselling, individual meetings with the youth workers, linkages to other services, re-engagement with education and training, and assistance with job searching. Residents can stay up to three months before they are moved into independent living or are able to return home.
What was the problem?
Allum House has long had a ban on smoking inside the refuge. If residents wanted to smoke, they were previously required to go outside in the back garden or at the front entrance to the house. Staff were not allowed to smoke in front of clients and had to leave the premises if they wanted to have a cigarette.
But staff had noticed a worrying trend amongst the non-smokers and light smokers coming into the refuge:
We were seeing them come into the refuge and actually walk out smokers, when they had walked in non-smokers, or light smokers walk out heavy smokers, because of sheer social engagement and wanting to fit with the other residents.
Smoking was very much a social activity at the refuge. Groups of young people would gather in the garden for hours on end, often chain-smoking.
These observations sparked an ongoing discussion in staff meetings about how to address the problem. They were troubled that they lacked the training and resources to provide assistance to help young people cut down or quit smoking. If a resident wanted help, all Allum House could do was refer them to a GP or another service, which often resulted in the young person changing their mind or not getting help. The staff were also increasingly concerned that by not addressing smoking, they were failing in their duty of care.
Our major role and the ethos by which we work is to make sure these young people are safe and comfortable and moving into safer and healthier habits. If we’re not doing anything about smoking, it’s the same as us not doing anything if they come home drunk or taking drugs.
What did they do?
Allum House contacted Cancer Council NSW and were referred to the Tackling Tobacco program. The Tackling Tobacco team helped the service clarify their needs and their objectives, and to draft a new policy. The Tackling Tobacco program also provided staff training on NRT administration and helping young people quit smoking, and provided literature, statistics and resources that helped them to clarify the best approach. They also provided a $3,600 grant to provide residents with NRT in the introductory period.
We didn’t know what the best procedure was moving forward without the support of the Tackling Tobacco program.
The new policy comprised the following components:
Smoking restrictionsSmoking is not permitted anywhere on the premises, inside or outside, except in the designated smoking spot – a concrete slab (measuring about 1 m x 0.5 m) in the back garden. There are no chairs or benches provided, so the smoker must stand and use the ashtray provided to dispose of cigarette butts and other tobacco waste.Only one smoker is allowed in the designated smoking spot at any time. If other residents or staff are in the garden, they have to go inside in order for the smoker to have their cigarette.
Case planningAll residents (including non-smokers) complete a one-on-one session discussing tobacco use with their caseworker as part of their case planning. The caseworkers use motivational interviewing to talk about the pros and cons of smoking, reasons for quitting and steps residents could take to quit or cut down.
Nicotine Replacement Therapy (NRT)The staff have been trained to administer NRT, and the service now allocates part of its regular budget to NRT.
ConsequencesA series of graduated consequences support the policy. The first consequence is a verbal warning; the second is a consequence related to smoking (e.g. picking up cigarette butts, cleaning out the ash tray); the third consequence involves having to write and present to the house meeting something about the harms of smoking.
What was the result?
Much to the surprise of staff members, the response from residents has been very accepting. They are told prior to and at intake about the restricted smoking policy, and that they will need to talk about their smoking with their caseworker. Staff were surprised to find that many of the young people in fact wanted to do something about their smoking.
While they have had few residents quit smoking altogether, most smokers successfully cut down whilst at the refuge. But more importantly, they have halted the uptake and escalation of smoking (smoking levels are measured on entry to and exit from the service).
“The things we were looking at when we were developing a policy focused more around the kids that were social smokers, or the kids that don’t smoke, because it’s not fair when you come into an environment that is supposed to be safe, inviting and healthy for you. You’re supposed to be empowered, you’re supposed to achieve these great outcomes, but then we allow them to stand next to someone who’s smoking a cigarette.” – Phoebe, Program Coordinator
An unexpected impact has been that use of the designated smoking spot is largely self-regulated, and social influences have resulted in the spot being used less often than it might be. The residents have developed their own unwritten rule that those using the garden to socialise or play basketball take precedence over those who want to smoke. Moreover, a smoker is unlikely to ask others using the garden to leave in order for them to have a cigarette. As a result, smokers often have to go longer between cigarettes and are more likely to ask for NRT.
What factors made it work?
Allum House developed a solid understanding of the constraints, the objectives and the key behaviours that needed to change, as well as the risks. The Tackling Tobacco program was instrumental in helping the team to clarify and work through these issues.
The service did not take an ‘off the shelf’ smoking policy. Allum House has an exemption from Mission Australia’s smoke-free policy, and tailor-made their policy for their unique circumstances.
Once the senior staff worked through some options with Cancer Council’s Tackling Tobacco team, they brought their ideas to the rest of the team. Thus the entire staff was involved in drafting the policy, their needs were central to the design and they were highly supportive of the changes.
Allum House is able to offer NRT directly to residents rather than referring them to an outside service. The fact that NRT is offered easily and free of charge makes it more likely the residents will take it up.