30, 2015 Arizona Smokers’ Helpline AnnualAprilReport Fiscal Year 2015 Impact of Media Campaigns on Call Volume Program Statistics Improving the Health of Arizonans Page 1 of 1 ashline.org Arizona Smokers’ Helpline Annual Report FY 2015 Media Campaigns’ Effect on Call Volume and Program Enrollment One of ASHLine’s key priorities is to be an accessible cessation service for tobacco users in Arizona. Media campaigns have long been an important resource for promoting the organization’s services. For instance, in fiscal year (FY) 2014, 56% of those initiating contact with ASHLine indicated that they heard about the helpline through a media advertisement on the television or radio. In Arizona, quitline promotional media are administered by the Arizona Department of Health Services (ADHS) and by the Centers for Disease Control and Prevention (CDC). Both organizations air recurring, intermittent media campaigns. ADHS funds advertisements that promote ASHLine’s quitline number directly. The CDC national campaign, called “TIPS” (Tips from former smokers), uses a national 1-800 quitline number that routes callers to local quitlines based on their area code. TIPS media feature personal accounts from former smokers that are designed to illustrate how smoking negatively affects their physical health. The most recent TIPS campaign started airing on March 30, 2015. A multi-outlet approach that includes television, radio, cinema, print and digital media forums are employed. In this brief, we are interested in exploring how the timing of these media campaigns play a role in influencing the number of people who call to avail of ASHLine’s cessation services. We examine this question by comparing ASHLine’s call volume history with the timing of television campaigns run by either ADHS or CDC. Specifically, we sought to determine whether changes in the number of incoming calls corresponds with the timing of advertisement airings and whether multiple airings and/or the overlap of ADHS and CDC media airings alters call volume. Tracking call volume is a useful measure for determining whether media campaigns succeed in directing callers to ASHLine. Results. Using FY 2014 (July 2013 - June 2014) and FY 2015 (July 2014 – June 2015) call volume data, we see that the number of calls to ASHLine was lower from July 2014 to March 2015 compared to the previous year. Around March 2015, however, the number of calls spiked and exceeded the monthly volume as compared to the same time the previous year (see Figure 1). Overlapping campaign date ranges with the FY 2015 call data, it appears that the uptake in calls—from about 200 a week to around 550 at its peak— directly followed the first ADHS media run for 2015. After three weeks the volume declined to around 400 calls a week where it fluctuated between 350 and 500 calls for the next 3 months (see Figure 2). Figure 1. Monthly Call Volume for FY 2014 and FY 2015 Number of Calls per Month 2500 2000 1500 1000 500 0 FY 2015 FY 2014 Page 1 of 9 600 500 ashline.org 0 Arizona Smokers’ Helpline Annual Report FY 2015 FY 2015 FY 2014 Figure 2. FY 2015 Calls per Week and ADHS and CDC Television Airings 600 Number of Calls per Week 500 400 300 200 100 0 ADHS Campaign CDC Tips From Former Smokers Campaign Main Points. Call volume to ASHLine more than doubled when the television advertisements first aired in March 2015, as compared to January thru March when no TV media was dispersed. This trend is corroborated by enrollment data. In January and February, approximately 15% of enrolled clients reported hearing about ASHLine from media advertisements. In March, this figure rose to 27% and peaked in April at 38%. We observed an increase of enrolled clients from March-June 2014 compared to the four previous months. Subsequent and recurrent media ads from both ADHS and CDC helped in maintaining call volumes at higher levels compared to the previous year. It is difficult to determine from these figures whether the contribution resulted primarily from ADHS media, CDC media, or a combination of both. Next Steps. It is clear that ongoing media campaigns are an important factor in maintaining high call volume and client enrollment. The timing of media releases, therefore, is an important consideration. While we are aware that increased messaging around behavior change is important to promote behavior change, it may be important to identify if there is redundancy in airing ADHS advertisements concurrently with national (CDC) media. It will also be important to analyze program outcomes (e.g., program utilization, quit rates) based on how clients heard about ASHLine, to determine if different media content attract clients who have diverse program expectations and/or benefit from ASHLine services differently. Page 2 of 9 ashline.org *Figure for Summary of the Quarter Section Arizona Smokers’ Helpline Annual Report FY 2015 ASHLine Core Measures SUMMARY OF THE FISCAL YEAR FY 2014 FY 2015 *Figure for Summary of the Quarter Section Incoming Calls 17,328 16,503 # Referrals 9,974 10,126 Fiscal Year 2015 (FY 2015) was another strong ASHLine Core Measures year for ASHLine. The quitline received more # Quit Coaching 10,824 7,798 FY 2014 FY 2015 than 16,500 calls and enrolled almost 8,000 # Information Only 561 545 Arizonans in the tobacco cessation program. Incoming Calls 17,328 16,503 Quit Rate 37% 35% The proactive referral program has grown as # Referrals 9,974 10,126 well, partnering now with more than 1,800 healthcare professionals referring more than # Quit Coaching 10,824 7,798 10,000 individuals to ASHLine. Trainings were # Information Only 561 545 * incoming calls is from taske report provided to more than 1,450 health care Quit Rate 37% 35% providers, with a special focus on behavioral health. Important changes were made to ASHLine’s clinical services. Counselors are being trained on new protocols that will allow them to provide specialized support to high-need clients, including pregnant or postpartum women and individuals with * incoming calls is from taskePima report severe mental illness. Now that we are settled after relocating to the Abrams County Public Health building, ASHLine is looking forward to a productive year of continued innovation and quality service to our clients. COMMUNITY DEVELOPMENT HIGHLIGHTS Partner Training Program This year the Community Development Team Public-Private Partnership Referrals continued to provide training on the Ask, FY 2014 FY 2015 Advise, Refer (AAR) brief intervention process # Referrals 102 155 to health care providers and organizations interested in promoting evidence-based % Reached 92% 74% treatment to their clients. In addition to AAR, Public-Private Partnership % Reached who Enrolled Referrals 97% 88% the team provided trainings on Electronic FY 2014 FY 2015 Nicotine Delivery Systems (ENDS), submitting referrals electronically (WebQuit training), and the # health effects of tobacco use (Lunch 102 & Learn), developed Referrals 155 specifically to be delivered in employer settings to support our Public-Private Partnership pilot program. In % Reached 92% 74% FY 2015, the team delivered a total of 31 AAR trainings in medical settings to over 400 providers and a total Reached Enrolled 97%team delivered 88%8 of 50 AAR trainings in behavioral health settings to%over 1,000 who providers. In addition, the Lunch & Learn presentations to over 60 employees, as well as 2 ENDS trainings and 1 WebQuit training to over 50 providers. Promoting Health Systems Change While continuing to provide support and technical assistance to all of ASHLine’s partners statewide, the Community Development focused in FY 2015 on working with the behavioral health community. Promoting tobacco cessation within behavioral health is an ongoing goal due to disparate rates of tobacco use and tobacco-related morbidity and mortality within this population. Our team was able to work with behavioral health professionals on both the Regional Behavioral Health Authority (RBHA) level and the service provider level, growing referrals from providers each quarter this year. In Pima County, the team strengthened existing partnerships with the local RBHA—the Community Partnership of Southern Arizona (CPSA) and the core comprehensive service providers, including CODAC Behavioral Health Services, COPE Community Page 3 of 9 ashline.org Arizona Smokers’ Helpline Annual Report FY 2015 Services, Inc., La Frontera Center, and a new partner – Pasadera Behavioral Health Network. Conversely, in Maricopa County, efforts were focused on establishing relationships with the new RBHA—Mercy Maricopa Integrated Care (MMIC), as well as maintaining or re-establishing relationships with the core provider network organizations including Jewish Family & Children’s Service, Partners in Recovery, People of Color Network, and Southwest Network. Public-Private Partnership (PPP) Employer Pilot Program This year the team grew the PPP Employer Pilot Program, establishing pilot programs with 10 new employers. Through this pilot, ASHLine can assist these employees in quitting tobacco while providing employers with a “reasonable alternative” tobacco cessation program, an Affordable Care Act (ACA) requirement when a tobacco surcharge is imposed. The PPP Employer Pilot Program is a free demonstration pilot that has been in place since 2013. Each year, the program continues to grow while ASHLine works to establish required infrastructure to engage in cost-sharing opportunities created by ACA to support future sustainability. Upcoming Goals for Community Development in FY2016 In the coming year, the Community Development Team will continue to establish partnerships across Arizona and promote universal access to evidence-based assessment, treatment, and referral to services *Figures for Enrollment Team Section for all Arizonans seeking care. Particular emphasis will continue to be placed on partnerships within behavioral health and within the network of Federally Qualified Community Health Community Development and Enrollment Teams Centers (FQHCs). We also plan to expand our FY 2014 FY 2015 health systems change toolkit by developing # Referrals 9,974 10,126 new trainings and resources, including a health systems change manual to support % Reached 47% 54% partners in the field. Our goal is to use these % Reached who Enrolled 64% 48% resources to provide targeted support to # Unique Locations 791 862 providers who work with priority populations # Unique Agents 1,645 1,868 (e.g. pregnancy and postpartum, LGBTQI, etc.). In this way, we hope to increase reach among priority populations for which specialized services and support have traditionally been less available. ENROLLMENT AND SURVEY HIGHLIGHTS Improving Engagement Practices * Figures for Survey Team Section During the past year, the Enrollment Survey Team and Survey Team participated in several FY 2014 FY 2015 trainings. The goal of the trainings was to increase client involvement and improve 7-Month Quit Rate 37% Status 35% Enrollment communication at the time of enrollment. Response Rate 49% 38% Enrollment specialists learned motivational interviewing techniques related to tobacco cessation coaching and the Enrollment and Survey Team participated in skills workshops to assess client motivation, readiness to change, and interest in ASHLine’s coaching program. Trainings also touched on improving data collection processes and procedures. Finally, the team expanded its hours of operation to better accommodate evening callers. ASHLine is now open until 9:30pm on Mondays, Tuesdays, and Wednesdays. Page 4 of 9 *Data for chart below, not included in report. ashline.org Quit Rate Quit Coaching* 35% Infor On 6 *verify this Arizona Smokers’ Helpline 7-Month Follow-up Quit and Reponse Rates Cross-training Enrollment and Survey Staff To increase team efficiency and versatility, Enrollment and Survey Team began to be cross trained to administer both intake and follow-up assessments. This strategy increases the flexibility and availability of staff and reduces the burden they experience *Figures for Enrollment Team Section during high call periods. We anticipate the cross-training will be completed within the Community Development and Enrollment Teams first quarter of FY2016. FY 2014 FY 2015 # Referrals 9,974 10,126 Upcoming Goals for Enrollment and Survey % Reached 47% 54% in FY2016 % Reached who Enrolled 64% 48% # Unique Locations 791 862 Annual Report FY 2015 39% 38% 38% 37% 36% 35% 35% 34% 33% Quit Rate Response Rate In the next quarter we look forward to 1,645 1,868 to an updated software platform. The new system will allow our team to engage callers more effectively and provide cessation assessment and goal setting during the first call. As we adjust to this new system, our primary goal is to improve client engagement at the time of enrollment. #transitioning Unique Agents Enrollment Status Information Only** 6% Reached Referrals Enrollment Rate Not Enrolled 52% Quit Coaching* 94% *Data for chart below, not included in report. Enrolled Enrolled 48% 0.48 * Clients enrolled in quit coaching 0.52 program with or without Nicotine Replacement Therapy (NRT) Not Enrolled ** Clients who only requested self-help quit material Page 5 of 9 ashline.org Arizona Smokers’ Helpline Annual Report FY 2015 CLINICAL SERVICE HIGHLIGHTS Increasing Efficiency of Clinical Services * Figures for Coaching Team Section In FY 2015, the Clinical Team Coaching participated in multiple workshops FY 2014 FY 2015 that taught motivational interviewing New Clients 10,711 7,798 episode skills, directions for appropriate use % Receiving 1+ Coaching Calls 79% 80% intake d and dosage recommendations for Avg # Coaching Sessions/Exited Client 3.9 4.4 episode tobacco-cessation pharmacotherapy, and a webinar by Glaxo Smith and % Using Meds 60% 56% episode Kline to educate coaches on state-ofReached 30-Days Quit 65% the-art approaches to medication and coaching for tobacco cessation. Additionally, at the beginning of FY 2015, protocols for coaching high-risk smokers were developed and are currently being implemented. Protocols address coaching women who are pregnant or postpartum, e-cigarette users, and individuals with serious mental illness who wish to quit tobacco. The latter protocol was implemented as part of a Pfizer grant. *Data for chart below, not included 52 Improving Quality of Clinical Services 53 How helpful was Count coaching in your ef Helpful coaches 1,354 The Clinical Team began using customized coaching metrics for evaluating7 Very individual each quarter. Feedback from these reports is used to inform clinical practice for coaches and identify for 8 Somewhat Helpfulareas857 improvement. A journal club for all clinical staff was also initiated in which team 208 9 Notmembers Helpful present and discuss relevant and timely topics to inform clinical best-practices. Finally, the team initiated a multi-modal Total 2419 behavior change coaching platform to increase service reach and effectiveness. Personnel Changes How Helpful was Coaching in to Your Efforts At the end of 2014, the Clinical Team added a Spanish speaking, bilingual coach meet the needs of evening clientele. A graduate intern from the college of public health was also hired to assist in developing to Quit Tobacco? the previously mentioned priority-population protocols. The intern performed literature searches and 60% 56% interviewed coaches and topic-specific professionals to inform protocol development; the clinical manager provided oversight. 50% Upcoming Goals for Clinical Service in FY 2016 40% 35% During the next fiscal year, we will continue to develop and train staff in population-targeting protocols, 30% including cancer survivors, LGBTQI, chronic diseases, HIV/AIDS, Latino/a and American Indian smokers. Our goal is for these protocols to be integrated into ASHLine services by the end of the FY2016. We also plan 20% calls will be answered by a member of the clinical team to to re-structure inbound ASHLine calls. Inbound ensure prompt access to a quit coach and a timely start date towards an active quit for all enrolling clients. 9% 10%at least one goal towards quitting at the end of the first call. The goal will be for all enrolling clients to have Finally, SMS text messaging and a standalone, online web-quit program will be implemented in FY 2016. We believe that integrating these additional0% services within our existing evidence-based programing will Very Helpful Somewhat Helpful Not Helpful improving the reach and efficiency of ASHLine services. Page 6 of 9 ashline.org Arizona Smokers’ Helpline Annual Report FY 2015 RESEARCH AND EVALUATION HIGHLIGHTS Evaluation Projects In FY 2015, we continued our focus on creating more efficient and streamlined protocols for ASHLine by developing software codes that automatically generate evaluation reports. This allows us to increase the amount of feedback we can provide to internal and external stakeholders. For instance, we now provide quarterly reports to the clinical services team that highlight each coaches’ counseling metrics, including but not limited to, the number of clients reached, the average number of calls to each client, and so forth. We plan to continue streamlining and standardizing similar processes through the next fiscal year as ASHLine transitions to a new data collection platform. This will create efficiencies in program evaluation and quality improvement projects, allowing us to assess the effectiveness of specific program components and services at the quitline. Research Partnerships and Research Dissemination In the past year, we established productive research collaborations with tobacco researchers. As a result, ASHLine was represented at national-level tobacco conferences, including presentations at the Society for Research in Nicotine and Tobacco (SRNT), the nation’s leading peer-reviewed conference in nicotine and tobacco research. ASHLine has additionally submitted abstracts for the 2015 North American Quitline Consortium conference. Conference Presentations • • Society for Research in Nicotine and Tobacco (Philadelphia, PA) Prevalence of electronic cigarette use among callers with a mental health condition. American Society for Preventive Oncology (Birmingham, Alabama) Prevalence of electronic cigarette use among quitline callers and influence of electronic cigarette use on quit rates. New Research and Evaluation Manager During the last quarter of FY 2015, Dr. Uma Nair was hired as manager of the Research and Evaluation Team. Dr. Nair is a cancer control and prevention researcher. She has been developing an active research program focusing on health promotion and chronic disease management within the context of nicotine and tobacco dependence among underserved populations. Apart from managing the Research and Evaluation Team, Dr. Nair will direct research at ASHLine through collaborative and transdisciplinary research partnerships with tobacco and health promotion researchers at the University of Arizona as well as at other institutions. Upcoming Goals for Research and Evaluation in FY2016 Our goal for the upcoming year is to expand ASHLine’s research program by continuing to present at national conferences and publishing manuscripts based on ASHLine data in peer-reviewed journals. We will continue to build research capacity within ASHLine by expanding academic collaborations with other tobacco researchers, making the research enterprise at ASHLine competitive to seek federal, state, and foundation grants. We will also work to support the other teams at ASHLine, using evaluation and research data to (a) inform strategies that will help retain callers through our follow-up period and thereby improve response rate, (b) bolster community development efforts, (c) create standardized protocols for program evaluation and quality control, and (d) inform clinical services. Page 7 of 9 ashline.org Arizona Smokers’ Helpline Annual Report FY 2015 Annual Report Fiscal Year 2015: Program Metrics and Service Utilization Table 1. Referrals, Enrollments and Coaching Calls by County Table 2. Incoming Calls and Quit Rate County Referrals Enrollments Utilization Summary FY 2015 Apache 40 42 Cochise 294 213 Total Proactive Calls 16,503 Coconino 353 153 Total Coaching Calls 27,644 Gila 104 82 Average Calls Per Client Graham 89 54 Greenlee 7 13 La Paz 70 38 Maricopa 5,529 4,440 Mohave 354 362 Navajo 34 85 Pima 2,631 1,398 Pinal 125 370 Santa Cruz 65 49 Yavapai 242 301 Yuma 189 170 0 28 10,126 7,798 Unknown Total *from big rpt Page 8 of 9 refytdbycounty callbycountymon 4.38 35% of our clients reported being quit at 7 months Service Provider Type School/ *from big rpt Universi Referrals OB/GYN 5 Specialist 8 DOD/VA 10 Long-term Care Facility 20 ytdenroll Pharmacy Hospital, 47 ashline.org How did you hear about ASHLine? Quit Coaching 4 Community Organizations 5 Family or Friends Information Only Total very unlikely to have duplicate ranks, so this is fine for now. 305 9 314 6 754 Arizona Smokers’ Helpline 628 6 Former Client 37 791 4 17 645 5 7 Healthcare Provider 8 Media 2,675 122 2,797 1 6 Other 2,482 217 2,699 2 5 Media 1,097 3 4 Healthcare Provider Figure 1. Sources Through Which Clients Heard about ASHLine Other 954 143 9 Healthcare Provider 1 Community Organizations 3 Former Client Annual Report FY 2015 2 Family or Friends 2,675 122 2,482 Media 217 954 Other 143 754 Family or Friends 37 628 Former Client 17 305 Community Organizations 9 0 500 1000 Quit Coaching 1500 2000 2500 3000 Information Only How Heard Referral Systems and mass media campaigns generate the highest percentage Media campaigns andof referral systems generate Mass the highest percentage of enrollments. ASHLine is actively pursuing new and novelclients communityto andreach clinically-based part enrollments. media campaigns are helpful in motivating out to cessation services since they can directly influence decision-making about quitting. Smokers can gain new insights from hearing and viewing campaign messages as it pertains to their own smoking behavior. e data also show an important role of physicians in advocating tobacco cessation. Page 9 of 9 ashline.org