Adapting and Evaluating Implementation of a Tobacco-Free Workplace Program in Behavioral Health Centers

Abstract

Objectives: State-administered community behavioral health centers (CBHCs) rarely treat tobacco dependence, despite high client tobacco use. Using a mixed-methods approach we examine the adaptation and implementation of an evidence-based tobacco-free workplace (TFW) program in 2 CBHCs (17 individual clinics). Methods: Varied data collection included pre- and post-implementation leader, clinician, and staff surveys; pre-, mid-, and post-implementation staff and client focus groups; and monthly implementation logs. The RE-AIM framework guided translation of behavioral interventions into sustainable practice. Results: Pre- to post-implementation increases were seen in training receipt among clinicians and employees. Both CBHCs adopted a 100% TFW policy, integrated tobacco screenings into routine practice, and delivered evidence-based practices (EBPs). Qualitative methods enlisted key stakeholders contributing towards adapting program strategies to local contexts, addressing barriers, adjusting tobacco screening administration, and understanding reasons for success or failure to implement specific components. Conclusions: Program implementation at both CBHCs increased organizational capacity in the provision of EBPs to treat tobacco dependence through successfully meeting the majority of our RE-AIM targets. Findings contribute to the development of flexible strategies and interventions responsive to variable implementation contexts and barriers; enhancing the effectiveness and sustainability of a TFW program.

Organizational Characteristics and Readiness for Tobacco-Free Workplace Program Implementation Moderates Changes in Clinician’s Delivery of Smoking Interventions within Behavioral Health Treatment Clinics

“… 9 , 11 Other possible explanations include the lack of training to address nicotine dependence, competing clinical priorities, and the prevalence of tobacco use among clinicians in behavioral health treatment clinics. 8 , 12 , 13 Ultimately, these misbeliefs and challenges to treatment implementation contribute to substandard care for nicotine dependence in BHC patients in behavioral health facilities. Moreover, they stand in stark contrast to research showing that behavioral health patients and the clinicians who treat them report a pressing need for proper tobacco cessation services and training.…”

“… 9 TTTF has been implemented in hundreds of behavioral health treatment clinics across the state of Texas and has significantly increased their capacity to deliver evidence-based tobacco cessation care to their patients. 12 , 13 , 15 , 16 It is important to note that the implementation of programs with elements similar to those in TTTF have also shown promise in improving clinician efforts to deliver tobacco cessation treatment. 17 , 18 …”

Addressing Smoking Cessation among Women in Substance Use Treatment: A Qualitative Approach to Guiding Tailored Interventions

“…However, participants’ experiences and recommendations on what they need to quit smoking are supported by the TTTF program and have been successfully implemented by our program partners [ 32 , 36 , 37 ], which is aligned with the recommended components of a women-centered approach to tobacco cessation [ 13 , 60 ]. Researchers advocate that smoking cessation interventions for women experiencing disadvantages should: (1) be tailored to women’s needs; (2) focus on building confidence and motivation; (3) incorporate social justice issues; and (4) adopt a holistic and comprehensive approach [ 13 ].…”

“…Our comprehensive program focuses on treating tobacco dependence among groups experiencing disadvantage with the highest smoking rates and need for assistance in quitting. To date, TTTF has been successfully implemented in 300 mental health centers [ 30 , 31 , 32 , 33 , 34 , 35 ] and has recently expanded into 30 standalone SUTCs/community centers [ 36 , 37 , 38 ], four of which serve women only and are the subject of this report.…”

Readiness for implementation of smoke-free work hours in private companies: A qualitative study of perceptions among middle managers

“…This amount of time averages to about 7.5 hours a day despite minor differences in how breaks are placed and paid; for example, only during the self-paid lunch break is in some workplace 'legal' to smoke doing work time. Previously research primarily focused on the effectiveness of different kind of smoking or tobacco: ban, policies, legislation, restriction, law and rules at workplaces [3][4][5] , and some provided information on how these strategies were implemented [13][14][15][16][17] . The smoke-free strategy is a much stricter prevention method than former strategies that prevented smoking at most locations and not during work hours.…”