Springhill is a modified Therapeutic Community TC

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Springhill Smoke Free Therapeutic Community
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Background

• Giving up is easy, Ive done it a thousand
  times Mark Twain
• People with serious addiction issues most of whom
  smoke, identify with that sentiment
• Traditionally, lets deal with one addiction at a
  time
• Hawkes Bay DHB and Addiction Services first to
  take up the challenge.

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Inspiration

• Springhill is 3 month residential substance
  addictions treatment/rehabilitation service for
  15 adults.
• A therapeutic community provides an environment
  and a close knit peer group that promotes
  healing.
• A smoking culture exists at rehab as most smoke.
  
• Why would you encourage smoking?
• Springhill Mission Enabling people whose lives
  are affected by addictions to come to terms with
  and gain freedom from their dependencies.
• Many people have respiratory disorders.

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First Steps

• Began to promote smoke free by
• Pre entry encouragement
• Initial interview with smoke free worker
• NRT
• Support group and counselling
• After six months, up to half of residents smoke
  free, but they could not maintain the change
• Smoking culture still strong and relapse norm

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Smoke Free Decision Made

• Research supports giving up at rehab.
• May actually reduce relapse risk.
• Planning day September 07 decided to go smoke
  free no smoking allowed.
• Enlisted help of Totally Smoke Free DHB Project
  Manager Carleine Receveur

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Systems Firstmodel of organisational change
Education
Policy
Systems
Evidence
Patient
Intervention
Roles
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• Six Principles

• Do no harm
• Recognition of the adverse health and
  social effects of tobacco use
• Recognition of the addictive quality of
  tobacco
• Alignment with HBDHB smoke free policy and
  intent
• Alignment with other healthy living strategies
  at Springhill
• Normalising smoke free lifestyles

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Key Milestones

• Project initiation
• Position Statement for Smoke free Springhill
• Smoke free Systems Design
• Communication Plan
• Staff Education Plan
• Risk assessment
• Smoke free Systems Implementation
• Go live Totally Smoke free Springhill
• Monitoring / Reporting

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What We Did

• We surveyed referrers and clients for their
  opinions. Two negative responses from
  referrers-Clients mixed
• We spent months preparing referrers and
  prospective clients including countdown posters
• We trained four staff in NRT support
• We planned for following changes
• Shorter breaks
• Healthy snacks
• Decommissioning the Fly Pit
• Continued the smoke free support group
• Daily relaxation
• We planned for the transition including launch

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What Happened?

• I gave up smoking for a week and then they
  untied me!

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The Transition

• Considerable resistance/difficulty for 5 smokers
  in last smoking week
• Not everybody prepared well
• Launch very inspiring to all
• First week too good to be true?
• Major relapse by week 3 behind the shed
• 3 residents discharged 2 others also left

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Advantages

• Clients more focused on recovery
• Clear health benefits
• No more smoking cliques which were sometimes a
  negative influence
• No unhelpful smoking behaviours
• Some family members also give up
• Smell of smoke gone from house

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Going Forward

• Some risks were realised
• Waiting list healthy but reduced
• People smoking in an unsafe way (fire)
• Referrers preparing clients haphazardly
• Problem when clients go on leave
• Expect that risks will reduce as time passes
• We work with honest lapses
• Current clients not smoking
• New Clients seem motivated and pleased