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—by Paul M. Kubek

The State of Ohio's commitment to helping people with substance use disorders and mental disorders reduce and eliminate the use of harmful tobacco products entered a new phase on December 7, 2007 with the Tobacco Cessation Kick-Off Event, which was held at Southeast, Inc., a community-based behavioral health care organization in Columbus.

The Kick-Off was designed to introduce community-based and hospital-based behavioral health care organizations to a new service model being designed and disseminated by the Center for Evidence-Based Practices at ÐÇ¿Õ´«Ã½ in Cleveland. The model is being implemented in partnership with the Ohio Advocates for Mental Health (OAMH). Over 50 people from all five regions of the state attended the event, including administrators, program managers, direct-service providers, consumer advocates, tobacco-initiative advisory committee members, and county and state-level policy makers.

The new service model, entitled Tobacco and Recovery, builds upon the successes and lessons learned by seven service organizations that participated in Ohio's two-year tobacco cessation pilot initiative funded by the Ohio Tobacco Prevention Foundation. The new model also builds upon the strengths of tobacco cessation programs implemented in other states. In addition, it incorporates core components and implementation strategies of the Integrated Dual Disorder Treatment (IDDT) model, an evidence-based practice that is being disseminated by the Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE)—a program of the Center for EBPs at Case.

Stages-Of-Change Enhances Long-Term Outcomes

The new model takes a stages-of-change approach to helping all consumers with severe mental illness and direct-service providers embark on a tobacco recovery journey: it even addresses the needs of those who are not yet ready or reluctant to begin. Most cessation programs are designed primarily for individuals who are willing and able to take action.

The stages-of-change approach is based upon research which demonstrates that change occurs incrementally over time. Thus, big changes like sobriety, mental health symptom management, and kicking the habit of smoking or chewing tobacco are built upon a series of small, incremental changes over time. There are five stages of change: pre-contemplation, contemplation, preparation, action, and maintenance.

Organizational Change Inspires Clinical Change

The new tobacco recovery model also promotes organizational structures that facilitate improved clinical outcomes. For instance, organizations that commit to implementation adopt workplace policies that promote health and well-being and prohibit direct-service providers from smoking during the workday and with consumers onsite at the organization and offsite when in the community. The organization also adopts standardized screening and assessment for tobacco use among consumers. In addition, the model encourages organizations to develop partnerships with community stakeholders, such as health departments and lung, cancer, and heart associations. An analysis of Ohio's pilot tobacco cessation programs showed that organizations with such partnerships were among the most successful.

NEXT STEPS

Discussions among participants and presenters at the Kick-Off Event in December are helping the Center for EBPs—and the Ohio SAMI CCOE—enhance strategies for providing technical assistance (consultation and training) for implementation.

The Center is conducting readiness assessments at service organizations that have expressed an interest in tobacco recovery. The Center will work first with organizations that have implemented and are utilizing the IDDT model. These organizations are familiar with such implementation tools as a fidelity scale and fidelity-review process, both of which are included in the Tobacco and Recovery model. A readiness assessment helps organizations identify existing facilitators for implementation as well as potential barriers. Some questions asked in a readiness assessment include the following:

• Does the organization have a standardized screening and assessment tool to help identify consumers who use and/or have an addiction to tobacco products?
• Are direct-service providers equipped with motivational interviewing skills to identify accurately each consumer's readiness to change? Do they have the skills to help work with consumers in each stage of change?
• Does the organization have a policy that prohibits service providers from smoking and chewing tobacco during work hours and with consumers onsite and offsite?

Keynote Speakers At Kick-Off Event

Ohio Department of Mental Health

• Sandra Stephenson, director
• Lon Herman
• Dushka Crane-Ross

Ohio Department of Alcohol and Drug Addiction Services

• Angela Cornelius, director
• Brad DeCamp

Center for Evidence-Based Practices at ÐÇ¿Õ´«Ã½ & Ohio SAMI CCOE

• Patrick E. Boyle, director of implementation services
• Ric Kruszynski
• Deb Hrouda
• Jeremy Evenden

Ohio Advocates for Mental Health

• Doug Devoe, director

CORE COMPONENTS OF THE MODEL

• Consumer choice is paramount
• Stage-wise approaches
• Motivational interventions
• Education
• Strong connection with medical professions, psychopharmacology (medication interventions)
• Focus on health and well-being

Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at ÐÇ¿Õ´«Ã½. Patrick E. Boyle, MSSA, LISW, LICDC, director of implementation services, contributed to this story.