Implementation and Outcomes of a Train-the-Trainer Program at Behavioral Health Treatment Centers as a Mechanism to Maintain Organizational Capacity to Address Tobacco Use Disorder

Abstract

Despite prior successful implementation of Taking Texas Tobacco Free (TTTF), an evidence-based tobacco-free workplace program, in local mental health authorities (LMHAs), post-implementation employee attrition necessitated continuing education on tobacco-free policies and tobacco treatment practices. Here, we report on the outcomes of a train-the-trainer program which trained “champions” to deliver tobacco cessation education at their LMHAs. Three LMHAs participated in program implementation via 10 champions, iteratively trained and coached by TTTF. Measures administered evaluated four goals: (1) increase champions’ self-efficacy in delivering trainings, (2) achieve program fidelity via TTTF staff evaluation of trainer effectiveness and knowledge increases among attending employees, (3) achieve stakeholder program acceptability, and (4) achieve program adoption via an increase in follow-up trainings. Champions’ self-efficacy increased throughout TTTF training. TTTF staff ratings of champion-led trainings met the targeted range for trainer effectiveness; employees had a 28.71% knowledge increase over baseline post-training (p < 0.001). Employees rated champions’ training delivery “very good” to “excellent”, on average; both champions and employees were, on average, “satisfied” to “extremely satisfied” with the curriculum and training received. There was an increase over baseline in trainings delivered during follow-up, and trainings increased in length and topic coverage. Ultimately, the train-the-trainer program achieved the intended goals, although not all changes were statistically significant, likely at least partially attributable to small sample sizes. Overall, these results suggest that TTTF’s train-the-trainer program was successful in its delivery and intention to build capacity for the provision of in-house tobacco education trainings to behavioral health employees/providers. However, further evaluation in additional settings, with more champions, et cetera, is necessary to validate these findings, ensure their replicability, link program implementation with reduced patient tobacco use rates, and assess long-term sustainability.

Collaborative Learning: A Qualitative Study Exploring Factors Contributing to a Successful Tobacco Cessation Train-the-Trainer Program as a Community of Practice

“…While provision of general employee and specialized provider tobacco education has been a cornerstone of the TTTF program that has successfully increased provider delivery of tobacco cessation services to clients [58], the effects of the education were continuously being lost due to high employee turnover [60,61]. The TTTF Train-the-Trainer program was developed to embed sustainable, local expertise within LMHAs on the general harms of tobacco use and how to treat tobacco dependence using evidence-based tobacco cessation interventions [18]. The program consisted of training local center volunteer program "champions"-a provider or managerial member, who was not additionally compensated-to become in-house trainers in the delivery of tobacco education training to LMHA employees to ensure that expertise in evidence-based practices for tobacco management are established and not lost to em-ployee turnover over time.…”

“…interventions [18]. The program consisted of training local center volunteer program "champions"-a provider or managerial member, who was not additionally compensated-to become in-house trainers in the delivery of tobacco education training to LMHA employees to ensure that expertise in evidence-based practices for tobacco management are established and not lost to employee turnover over time.…”

“…Main events are marked underneath in between some steps. Reprinted/adapted with permission from Ref [18]. 2021, L. R. Reitzel on behalf of all coauthors.…”

“…The main implementation barriers hindering efforts to successfully address tobacco use (cigarettes, e-cigarettes, and all other tobacco/nicotine products) among individuals with behavioral health conditions are on the provider-level and include a lack of adequate training of providers to treat tobacco dependence [2,[16][17][18][19], high provider tobacco use rates, and a host of misconceptions regarding treating tobacco and substance use and/or mental health issues simultaneously [20,21], as well as clients' ability and desire to quit smoking. Lack of behavioral health provider training and knowledge on how to treat tobacco dependence has been reported as the most common barrier to the provision of tobacco cessation treatment [17,22,23].…”

“…CoPs have the potential to bridge the gap between evidence-based guidelines and real-world practice and can achieve sustainable improvements in health care service delivery [52]. One such collaborative learning group that has established the foundation for the development and emergence of a CoP is the Taking Texas Tobacco-Free (TTTF) Train-the-Trainer program [18]. The purpose of the present study was to explore champion trainees' experiences and perspectives of the TTTF Train-the-Trainer program as an applied CoP [50], and their views on factors and processes contributing to program success.…”