Clinician Training in the Adaptation of a Comprehensive Tobacco-Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed

Abstract

Tobacco use is exceedingly high among those who are homeless or at risk of homelessness but not commonly addressed by clinicians. Taking Texas Tobacco Free (TTTF) is a tobacco control program that addresses known clinician barriers to intervention (e.g., low training receipt, limited resources). Here, we examine the process and outcomes of TTTF’s adaptation within four agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N = 68) to assess changes in training receipt, knowledge, and intervention behaviors, relative to program goals. Results indicated significant gains in clinicians’ receipt of training in 9 (of 9) target areas (p’s ≤ 0.0042) and a 53% knowledge gain (p < 0.0001). From pre- to post-implementation, there were mean increases in the use of the 5As (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (p’s ≤ 0.0491). All program goals, except gains related to advising smokers to quit and the use of specific interventions (behavioral counseling), were met. Overall, TTTF improved clinicians’ capacity to address tobacco use among homeless and vulnerably housed individuals and can serve as a model for tobacco control efforts in similar agencies.

Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers

“…Regardless of the clientele or specificity of the non-nicotine substance use treatment provided within the participating centers, the training of clinicians on the use of the five As was invariant, as too was its intended application across patients. The Taking Texas Tobacco Free program also sponsored clinicians to obtain specialized trainings (i.e., Certified Tobacco Treatment Specialist training and Motivational Interviewing); these components of the program are detailed elsewhere [ 33 , 34 , 35 , 38 , 39 , 40 ]. Each participating center could avail themselves of these specialized trainings, which had a much broader scope than training on the five As.…”

“…Taking Texas Tobacco Free has been implemented throughout Texas in behavioral health treatment settings and substance use treatment centers [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Implementation outcome data have supported significant increases in tobacco-related knowledge among employees, increases in clinicians’ self-reported use of the five As, and increases in organizational capacity for tobacco intervention provision to patients [ 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 ]. The five As are an evidence-based, brief tobacco cessation intervention that has been recommended in clinical treatment guidelines [ 29 , 42 ].…”

Organizational-Level Moderators Impacting Tobacco-Related Knowledge Change after Tobacco Education Training in Substance Use Treatment Centers

“…Other prior work suggests that training improves attitudes about tobacco intervention; increases confidence and willingness to treat tobacco; and increases belief that employees have a role to play in tobacco control in the context of treating SUDs [ 23 ]. Ultimately, these factors likely contribute to whether or not clinicians provide tobacco interventions for patients and may affect all employees’ willingness to implement and uphold a tobacco-free workplace policy [ 23 , 25 , 37 , 41 , 42 , 43 ].…”

“…The training included education on the dangers of tobacco use, the addictiveness of nicotine, the prevalence of tobacco use among individuals with non-nicotine substance use disorders, the tobacco industries’ targeting of individuals with behavioral health needs, and empirically-based methods to address tobacco use disorder (including the importance of tobacco-free workplace policies and how to uphold them). Several other components of the TTTF program were enacted thereafter as detailed elsewhere [ 14 , 28 , 29 , 34 , 35 , 36 , 37 , 38 ], including sending program champions to Certified Tobacco Treatment Specialist trainings, Motivational Interviewing trainings, etc., but are not the subject of this report. Program champions are individuals who are identified by the center to lead and be the primary contact for implementation of the tobacco-free workplace program within their center.…”

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

“…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.…”