—by Paul M. Kubek and Matthew K. Weiland
Columbus, OH—The advisory committee meeting of the Ohio Tobacco and Recovery Project was held at Twin Valley Behavioral Healthcare in Columbus this past spring. Topics of discussion included the results of readiness assessments conducted by consultants, trainers, and evaluators of the Project at mental health organizations around Ohio that are thinking about or actually implementing components of the new Tobacco and Recovery model.
The assessments were conducted over several months this past winter and spring with an evaluation instrument that examines the level of organizational readiness for implementation of the model. The instrument is built upon the five stages of change, which include precontemplation, contemplation, preparation, action, and maintenance.
To date, the Ohio Tobacco and Recovery Project has engaged 35 different organizations around the state, each having expressed some interest in participating in a tobacco-cessation initiative for both their service staff and consumers. With 12 readiness assessments completed at the time of the advisory committee meeting, the results were as follows:
- Two organizations in the action stage of implementation are already utilizing several components of the Tobacco and Recovery model.
- At least five organizations are in preparation, ready to start implementing the model within six months.
- Five organizations are in contemplation, planning for implementation with their management work teams.
- An additional 18 organizations expressed a definite interest in the Tobacco and Recovery model.
"I think Ohio is leading the country by developing a model for tobacco cessation that addresses the special needs of people recovering from severe mental illness who are also dealing with alcohol and other drug-addiction problems," says Patrick E. Boyle, MSSA, LISW, LICDC, director of implementation services at the Center for Evidence-Based Practices of Case Western Reserve University.
Boyle notes that there are numerous tobacco-cessation services throughout the country, but most focus on people in the general population and/or people who are in the "action" stage of quitting tobacco use-i.e., they are not ambivalent about kicking the habit. Ohio's Tobacco and Recovery model is designed specifically for people with severe mental illness and their service providers. It addresses the needs of people in all five stages of change, and it does not exclude those who are ambivalent about changing their habits-i.e., in the precontemplation and contemplation stages.
Facilitator: Attitude & Commitment
The readiness-assessment process identified an important facilitator of implementation consistent throughout the state. When asked "Why would you want to implement the Tobacco Recovery model", one-hundred percent of the people interviewed expressed the same sentiment - "Why wouldn't we do this?"
The reason for this overwhelmingly positive response, Boyle explains, is that Ohio service providers have observed in their communities what national research has reported: a high percentage of people with severe mental illness use tobacco products and suffer negative health and economic consequences as a result. Service organizations and county boards know they can play an important role in improving physical health and well-being in their communities by utilizing a service model designed specifically for the needs of people with severe mental illness.
Challenge: Funding Concerns
A recurring topic of discussion at the advisory committee meeting was concern about how to fund tobacco-recovery services. This also rated as a major challenge to implementation during the readiness assessments. The advisory committee is committed to providing more education about Medicaid/Medicare billing. It is also committed to promoting training sessions for service providers to increase their knowledge and ability to communicate benefits information to consumers.
Challenge: Staff Buy-In
The issue of staff buy-in was also identified as a challenge in a little over 50 percent of the organizations that participated in the readiness assessments.
"A number of people who work in the mental health and substance abuse fields use tobacco products themselves, so this can become a barrier to staff buy-in," says Boyle. "The other reality is that our providers have never really been trained to address tobacco addiction. We've held on to a strong belief, as a profession, that quitting tobacco is maybe too difficult to tackle or that tobacco is one last pleasure that we shouldn't deny recovering consumers."
To counter these old beliefs and practices, Boyle cites some important facts about tobacco use:
- It contributes to early deaths. Smokers with severe mental illness die 20 to 25 years earlier than those who do not smoke.
- It complicates the ability of consumers to quit drinking alcohol and using other drugs.
- It accounts for close to 27 percent of purchases made by consumers, a majority of whom are on limited incomes.
"So it has huge implications," says Boyle. "Tobacco addiction has negative effects on health, personal recovery, medication, finances, and housing. This is information that service providers on integrated treatment teams need to make the decision to buy-into the tobacco initiative whole heartedly and to support and promote it."
Paul M. Kubek, MA, is director of communications and Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist at the Center for Evidence-Based Practices at Case Western Reserve University.