A tele-mentoring tobacco cessation case consultation and education model for healthcare providers in community mental health centers

Abstract

Smoking prevalence among individuals with mental and behavioral health needs is considerably higher compared to the general population, but evidence-based smoking cessation therapies are underutilized in mental and behavioral healthcare settings, despite the fact that these treatments are both safe and effective. The goal of this paper is to present the background, design and pilot of Project TEACH (Tobacco Education and Cessation in the Health System) developed to improve clinical practice by offering specialized training in the provision of smoking cessation interventions to care providers in community mental health centers in Texas. This is achieved through engaging the expertise of clinicians at the MD Anderson Cancer Center’s Tobacco Treatment Program and disseminating this expertise to care providers by means of a novel tele-mentoring approach called Project ECHO (Extension for Community Healthcare Outcomes). Evaluation of our pilot ECHO training project demonstrated that the training was very well received and resulted in self-reported enhancement of the providers’ professional practice. This is the first project to extend the collaborative ECHO model to train healthcare providers in smoking cessation. This approach has potential to reduce smoking rates among smokers with mental and behavioral health needs, and consequently contribute to the prevention of cancer and other chronic diseases in this vulnerable population.

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

“…17,36,38,39,51,52,56,71 In a subset of assessments, knowledge surveys were constructed by the authors and administered. 15,23,26,39,41,47 The authors found significant improvements in objectively measured content knowledge. By contrast, a cluster randomized controlled trial on chronic pain education did not show knowledge gains among ECHO participant clinics compared with nonparticipant clinics.…”

“…Change in confidence and self-efficacy focused on whether providers reported greater confidence in ability to diagnose and/or treat patients following EELM participation. 17,23,26,30,32,34,41,48,51,52,56,71 Metrics along these lines were reported in most studies, ranging from selfreported changes following participation, 32 to within-subjects change from baseline to endline, 48 to between-subjects comparisons in perceived competence, 30 including in one randomized controlled trial (RCT). 26 In most instances, results were positive and significant; a notable exception came from the RCT on chronic pain management.…”

An Evaluation of An Extension for Community Healthcare Outcomes (ECHO) Intervention in Cancer Prevention and Survivorship Care

“…However, not having cases from Spokes to present was a struggle to the program, which was also described in an ECHO program about tobacco cessation. 14 It is important to note the PCPs' resistance to the didactics component in the original ECHO model in the context of cancer control, which to our knowledge was not previously reported in any context. Of note, the cancerrelated ECHO programs in previous literature have a narrower focus or was a one-time training outside of the United States.…”

“…Of note, the cancerrelated ECHO programs in previous literature have a narrower focus or was a one-time training outside of the United States. [12][13][14][15] Unlike the non-PCPs, some PCPs felt they did not have a big knowledge gap in the didactics content on cancer control. They thought guidelines have a limitation on recognizing the nuances of individual health and social circumstances in their practice.…”

“…11 Early evidence of the feasibility of the ECHO model as a cost-effective intervention on speci c cancers in the United States and on general cancer-related topics overseas are emerging. [12][13][14][15]…”