A primary goal in staffing any organization is to recruit people with the right knowledge, skills and characteristics best suited for their respective duties. When staffing a Quitline, an additional goal is to manage call handling capacity and strike a balance between ensuring that there is enough staff to respond quickly to a sudden wave of incoming calls and ensuring that staff time overall is efficiently engaged in actually helping callers and not in down-time (unproductive time). The first step in assessing the appropriate level staff numbers and types of skill-sets needed is to estimate the intensity, timing, and composition of the call volume that the Quitline is likely to receive. This can be accomplished by comparing the planned promotional effort with similar efforts previously conducted elsewhere. As most calls are generated after mass media campaigns, the media agency can advise you on the reach and impact of your campaign. They can give you advertising metrics: reach, gross ratings points (GRP) and effective reach that can give you an indication of how many people will see your promotion and how many calls may come at peak times. You can adjust your capacity accordingly.
Recruitment and selection of staff
Recruitment and selection of appropriately qualified staff will depend on the scope of service. Human Resource Planning and a thorough documentation of the selection process are carried out to ensure that recruited personnel have the necessary skills and knowledge required for their roles. Selection criteria should examine the individual background, attitudes, values, knowledge and skills. Depending on the context of each Quitline, personnel might include one or more of the following roles:
- Director and administrative manager
- Staff working for development counseling protocol, making evidence based content, training and evaluating counselors, and data management and analysis
- Telephone and computer system manager
- Public relation manager
- Coordinator of counseling
- Screeners who graduated college or university regardless of major
- Counselors who majored public health, nurse, social welfares, and other related areas
- Counseling specialists who majored in psychology, psychiatry and other special areas for in depth counseling which in under need from user
* Some of expert institution suggests tobacco cessation specialists to have a bachelor’s degree in a health-related field, such as psychology, sociology, social work, community health, or nursing. An associate’s degree may be accepted with sufficient professional experience regarding country situation.
Staffing for counseling
Quitlines do not need to be staffed with licensed/ professionally qualified counselors to have a significant effect on callers’ tobacco use. In fact, evidence for the efficacy of proactive Quitlines rests mostly on the work of paraprofessional counselors using structured protocols. Employing staff with basic counseling skills such as empathy, reflective listening, and the ability to guide clients through a structured problem-solving process appears to be key to the success of a Quitline. Whether graduate training or extensive clinical experience would impart added benefits is an open question.
There is another reason why it is fortunate that paraprofessionals work well in this position. Quitlines require their counselors to perform the same function repeatedly, and despite the variety in clients’ histories and personalities, counseling on a single behaviormodification issue such as smoking cessation can be very repetitive work. Therefore, even if they are not licensed or specialized counselors, some other qualified personnels can work as counselors on Quitline service, when organized and standardized protocol and appropriate training were given.
Some Quitlines have a triage protocol for handling calls. Intermediary call-centre agents are used as frontline staff and they screen routine inquiries (media or other people calling about non-cessation issues), passing on genuine smoker//tobacco user calls to competently trained counselors. This can increase your capacity and reduce costs.
Training of counselors
The Quitline will provide initial introductory training for counselors that will equip them to fulfill the role for which they are employed. Quitline will provide opportunities for counselors to develop their knowledge and skills with the training manual appropriate for their needs and roles they should fulfill.
Practically, Quitline counselor training could include telephone specialized counseling skills, tobacco related information, telephone and computer based application program operating skill. These training should be progressed continuously and should be conducted periodically. Some of the regions have developed basic curricula that have listed the key knowledge, skills and attitudes framework needed in a training program (example: UK HAD Standard for training in smoking cessation treatments).
Counselors/ agents who perform intake must have an excellent telephone manner, good customer service skills, and an ability to triage calls from a wide range of callers. These include tobacco users who want counseling, those who only want printed materials or referral to a local program, repeat callers who want to speak to a specific counselor, people calling on behalf of a family member, health professionals inquiring about services, students doing school projects, prank callers, and others.
Training programs cover such topics as below.
- The psychology of tobacco use and the nature of addiction.
- General principles of counseling and theories identified as being helpful in behavior modification, such as cognitive-behavioral counseling and motivational interviewing.
- Other psychological concepts considered useful in understanding tobacco cessation, such as the abstinence violation effect (AVE), a phenomenon in which a single slip triggers a full relapse due to “all-or-nothing” thinking on the part of the quitter.
- Effective case management practices, including use of protocols and tools for setting and keeping appointments.
- Health issues related to tobacco use and cessation.
- Withdrawal.
- NRT and other quitting aids.
- Effective counseling techniques, such as reflective listening and paraphrasing.
- Challenging to counsel scenario, including crisis calls, co-morbid conditions, resistant behavior and callers with psychological issues.
- Ethical and legal guidelines on such issues as mandated reporting and protecting the confidentiality of client information.
- Addressing diversity in clinical work, with respect to culture or ethnicity, education, gender, sexual orientation, religious belief, and other factors.
Supervision
Quitline will ensure provision of appropriate supervision, debriefing and support for all personnel. The goal of supervision should be to promote the quality of Quitline, to keep the optimal working conditions for the counselors (health and safety at work), and to improve the Quitline performance.
In particular, it is important to provide intensive on-the-job training for counselors that utilizes a range of instructional modalities and covers a broad range of relevant topics. Quitlines typically assign 10 to 15 counselors to each supervisor. The supervisors are responsible for ensuring adequate coverage of calls, timely case management, and high productivity among the counselors in their group. They also debrief after difficult calls. A director with expertise in mental health and/or medical issues provides oversight on the appropriateness of the Quitline’ s interventions, both across the board and in particularly challenging situations. The director and expert staff also ensure the program’s compliance with relevant ethical and legal guidelines that govern the provision of counseling services.
It is also a part of supervision to anticipate and plan how staff will handle the sudden waves or clusters of calls that will follow a TV commercial promoting the Quitline, if such ads are used.
Performance review
Each Quitline will have an annual performance review to ensure that:
- Personal performance and competencies are reviewed.
- Personal goals and objectives are reviewed and strategies are determined to achieve these goals
- Personal performance and goals are in accord with Quitline goals and objectives
Annual performance could be reviewed as followed items:
- Total number of calls including inbound and outbound call
- Quit rate achievement
- User satisfaction
- Registry rate among inbound call
