Barriers to Implementing Evidence-Based Smoking Cessation Practices in Nine Community Mental Health Sites

Himelhoch, Seth; Riddle, Julia; Goldman, Howard H.

doi:10.1176/appi.ps.201200247

Cited by 80 publications

(87 citation statements)

References 37 publications

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“…NRT is an evidence-based treatment for tobacco dependence [32,35], and its effectiveness and safety among behavioral health consumers have been demonstrated [19]. TTTF provided Spindletop a supply (total value of US$15,365) of NRTs (14 and 21 mg nicotine patches and 4 mg nicotine gum) to be distributed among consumers and staff.…”

Section: Component B: Basic Tobacco Educationmentioning

confidence: 99%

“…tobacco users with BHD [19][20][21][22]. Adding TUAs to a healthcare setting's electronic health record (EHR) has been shown to increase the identification and treatment of tobacco users [23].…”

Section: Introductionmentioning

confidence: 99%

“…Despite the benefits of comprehensive TFW programs for the individuals' health, behavioral health centers have fallen behind in the adoption of such programs. Reasons for this include the misconception that quitting tobacco among individuals with BHD would interfere with their psychiatric treatment, the high rate of tobacco use among behavioral health employees, and lack of specialized training among providers [19,26,27]. Moreover, there is limited awareness and dissemination of existing models of effective implementation as well as programs that provide practical assistance to translate scientific evidence into the successful adoption of comprehensive TFW.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a tobacco-free workplace program at a local mental health authority

Correa-Fernández

Wilson

Shedrick³

et al. 2017

Behav. Med. Pract. Policy Res.

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Tobacco-free workplace policies that incorporate evidence-based practices can increase the reach and effectiveness of tobacco dependence treatment among underserved populations but may be underutilized due to limited knowledge about implementation processes. This paper describes the implementation of a comprehensive tobacco-free workplace program at a behavioral healthcare community center in Texas. The center participated in a tobacco-free workplace program implementation project that provided guidance and resources and allowed center autonomy in implementation. Six employee-based subcommittees guided implementation of program components including consumer and staff surveys, policy development, signage, tobacco use assessments, communication, and nicotine replacement distribution. Timeline development, successes, challenges, lessons learned, and sustainability initiatives are delineated. Concerns about the tobacco-free workplace policy from the center's staff and consumers were gradually replaced by strong support for the initiative. Program success was enabled by consistent support from the center's leadership, publicity of program efforts, and educational campaigns. The center surpassed the program expectations when it adopted a tobacco-free hiring policy, which was not an initial program goal. This center's path to a tobacco-free workplace provides an implementation and sustainability model for other behavioral health community centers and other organizations to become tobacco free.

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Section: Component B: Basic Tobacco Educationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation of a tobacco-free workplace program at a local mental health authority

Correa-Fernández

Wilson

Shedrick³

et al. 2017

Behav. Med. Pract. Policy Res.

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“…Finally, previous research (Blasinsky et al, ; Gruen, Riddle, & Goldman, ) has found demonstration of positive outcomes to be a driver for sustainment of interventions, and some NPT‐based studies also suggest this is important for normalisation (Coupe, Phaff, & Nieboer, ; Lloyd, Joseph‐Williams, Edwards, Rix, & Elwyn, ). From the perspective of NPT, generating information of effectiveness during implementation and sustainment can be an important activity of reflexive monitoring since this may enhance the coherence and cognitive participation of the participants (provided that the effects are positive).…”

Section: Discussionmentioning

confidence: 92%

Sustaining an intervention for physical health promotion in community mental health services: A multisite case study

Carstensen¹,

Kousgaard

Burau³

2018

Health Soc Care Community

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There is a growing body of literature on sustainability, but its definition and the factors that affect it are not well understood. This paper focuses on the sustainment of health promotion interventions in community mental health organisations, where the institutional context has been found to play an important role. Normalisation Process Theory (NPT) was used to characterise the extent of sustainment of health promotion interventions and to identify important factors that influence it. The study builds on a previously reported qualitative multiple case design focusing on four Danish community mental health organisations. We aimed to include cases (provider organisations) with varied political‐administrative contexts that were expected to impact sustainment. Data included 27 semistructured interviews with managers and frontline staff. The analysis adopted a thematic approach combining within‐case and cross‐case analysis. One important factor contributing to sustainment was the high degree of coherence generated during and after implementation. Perceptions of meaningfulness and formal tools for external accountability such as municipal activity plans also stimulated the cognitive participation of management and staff in sustaining the intervention. On the practical level of collective action, working with health promotion in a continuous way was particularly supported by two formal tools: internal health policies and municipal activity plans. Sustainment was further aided by reflexive monitoring based on ongoing informal assessments, supplemented by information required for status reports to the municipality on individual users and information from the annual individual user health checks. Future studies should adapt NPT to a broader range of cases to assess more thoroughly its contribution to the literature on sustainment. Future interventions need to pay closer attention to securing continuous and active local management support as well as to political‐administrative contexts as potential external drivers of sustainment.

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“…However, smoking rates for BHCs remain relatively static, and significantly higher, at 35.8% [9]. Practice guidelines [2,10,11] recommend that smokers with and without behavioral challenges receive the same evidencebased-practices (EBPs) [12] proven effective in helping individuals in both groups to successfully quit smoking [13,14] at the same rates [15,16]. Nonetheless, BHCs are less likely to quit smoking compared to those in the general population [1,3] despite research showing equally high motivation to quit among both groups [17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

Leal

Chen

Correa-Fernández

et al. 2020

Preprint

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Background: Behavioral health treatment centers (BHTCs) rarely implement existing evidence-based practices for treating tobacco dependence, despite high rates of tobacco use among their clients. Taking Texas Tobacco Free (TTTF) has successfully targeted this disparity by delivering an evidence-based, multilevel, tobacco-free workplace program providing policy implementation and enforcement, education, provider training in tobacco screenings and treatments, and nicotine replacement therapies (NRT) to BHTCs across Texas. We describe a mixed methods design used to conduct a formative evaluation process to adapt implementation strategies to local contexts, evaluate program outcomes and characterize processes influencing program implementation in two BHTCs serving 17 clinics.Methods: Varied data collection included pre and post-implementation leader, provider, and staff surveys; and pre, mid, and post-implementation provider, staff and consumer focus groups. During implementation, data were collected via various logs (tobacco screenings, NRT delivery) to monitor program content delivery. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guided translation of behavioral interventions into sustainable practice.Results: While program implementation varied between each BHTC, all clinics adopted a 100% tobacco-free workplace policy, integrated tobacco screenings into routine practice, delivered evidence-based interventions, dispensed NRT to consumers and staff, and increased provider knowledge on how to address tobacco dependence. Pre, mid, and post-implementation qualitative findings served to: 1) develop program strategies and materials adapted to local contexts and populations and address barriers; 2) adjust delivery systems of key components to enhance implementation; 3) understand reasons for success or failure to implement specific practices; and 4) reveal program integration into clinic culture, enhancing sustainability.Conclusions: Implementation of TTTF at both BHTCs increased organizational capacity in the provision of evidence-based practices to treat tobacco dependence through successfully meeting most of our RE-AIM targets. Mixing methods involved program adopters and recipients as collaborators directly shaping core interventions to their individual context and needs, thus increasing program fit, ownership, adoption and sustainability; closing the gap between research and practice. These findings contribute to the development of flexible strategies and interventions capable of addressing variable implementation contexts and barriers, thus enhancing the effectiveness and sustainability of a tobacco-free workplace program.

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Barriers to Implementing Evidence-Based Smoking Cessation Practices in Nine Community Mental Health Sites

Abstract: Mental health clinicians working in community mental health settings were not consistently providing evidence-based smoking cessation interventions. Barriers appear to be modifiable through training and education.

Cited by 80 publications

References 37 publications

Implementation of a tobacco-free workplace program at a local mental health authority

Implementation of a tobacco-free workplace program at a local mental health authority

Sustaining an intervention for physical health promotion in community mental health services: A multisite case study

Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

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