1. Developing MDS Standards Bronze, Silver and Gold Standard

2. Basically Process evaluation (inputs, activities and big numbers (reach)) Outcome evaluation (changes in the smokers knowledge, attitude, motivation, behaviour and beliefs. Quit rate and efficacy Impact evaluation (bigger picture-public health (reach x efficacy) long-term prevalence rates, de-normalisation of tobacco use

3. Defining the Activity Defining taxonomy and domain knowledge Abrahams and Michie Taxonomy (what are you doing to change behaviour) What competences do staff have ( The National Training Centre & Michie Paper) * – 94 competences identified (71 individual and 23 group *Michie S, Churchill S, West R (2010) Identifying Evidence-Based Competences Required to Deliver Behavioural Support for Smoking Cessation Annals Behaviourial medicine

4. Specific focus on behaviour (B) addressing motivation (M) Provide information on consequences of smoking and smoking cessation Boost motivation and self efficacy Provide feedback on performance Provide rewards contingent on successfully stopping smoking Provide normative information about others' behaviour and experiences Prompt commitment from the client there and then Provide rewards contingent on effort or progress Strengthen ex-smoker identity Identify reasons for wanting and not wanting to stop smoking Explain the importance of abrupt cessation Measure carbon monoxide (CO) Specific focus on behaviour (B) maximising self-regulatory capacity/skills (S) Facilitate barrier identification and problem solving Facilitate relapse prevention and coping Facilitate action planning/ help identify lapse triggers Facilitate goal setting Prompt review of goals Prompt self-recording Advise on changing routine Advise on environmental restructuring Set graded tasks Advise on conserving mental resources Advise on avoidance of social cues for smoking Facilitate barrier identification and problem solving Facilitate relapse prevention and coping Facilitate action planning/ help identify lapse triggers Facilitate goal setting Prompt review of goals Prompt self-recording Advise on changing routine Advise on environmental restructuring Set graded tasks Advise on conserving mental resources Advise on avoidance of social cues for smoking Promote adjuvant activities (A) Advise on stop-smoking medication Advise on/facilitate use of social support Adopt appropriate local procedures to enable clients to obtain free medication Ask about experiences of stop smoking medication that the smoker is using Give options for additional and later support General aspects of the interaction (R) focusing on delivery of the intervention (D) Tailor interactions appropriately Emphasise choice General aspects of the interaction (R) focusing on information gathering (I) Assess current and past smoking behaviour Assess current readiness and ability to quit Assess past history of quit attempts Assess withdrawal symptoms General aspects of the interaction (R) focusing on general communication (C) Build general rapport Elicit and answer questions Explain the purpose of CO monitoring Explain expectations regarding treatment programme Offer/direct towards appropriate written materials Provide information on withdrawal symptoms Use reflective listening Elicit client views Summarise information / confirm client decisions Provide reassurance

5. Performance Numbers Performance indicators Performance measures Performance targets Overall performance Performance Indicator A Measure A1Target A1Measure A2 Performance indicator B Measure B1Measure B2 Performance indicator Z Measure Z1

6. Bronze Demographic data Reason for calling Length of call Outcomes- service given Media (where seen?) Resources posted

7. Silver Demographic data Biographical data Addiction data Motivation data Self-efficacy data Media (Where seen?) Length of Call Outcomes (in detail ) Service User Satisfaction

8. Gold Silver List Plus + Anthropomorphic (BMI) Biochemical- Lipids Glucose Ethnicity Relapse prevention data 52 week efficacy Service user satisfaction Service-reuse ( after relapse) Cost per quitter

9. Diamond! Life-long national record (travels with smoker from physician to physician) Longitudinal study 10 year results (Richard Doll & Peto) Linked to prevalence data (national surveys)

10. The future Monkeys in an Orange Grove –Henri Rousseau