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BeBetter Networks is proud to build on the work of pioneers in the field of smoking cessation. Our innovative products and services help you and your agency improve the lives of clients and staff in the same way: as partners. The following are excerpts from an interview with the dedicated people behind ground-breaking work in smoking cessation at the New York-based Clubhouse of Suffolk. Bernadette Cain served as grant project director developing, implementing and evaluating a smoking cessation program in populations of serious mental illness for Clubhouse of Suffolk. She holds an MBA, with additional experience in healthcare management, and now operates her own business, Training For Change, which consults other agencies in developing smoking cessation programs. Tara Fredericks, MSW, is the acting project director for smoking cessation at Clubhouse of Suffolk, where she also contributes to the organization’s programs for general wellness. Diane Mills consults Clubhouse of Suffolk and other smoking cessation programs. She has 34 years experience as a curriculum specialist, educator and administrator. Q: Can you talk briefly about the background of smoking cessation and the program you’ve developed? BC: We’ve been working on our program for over five years. The grant was awarded for designing, implementing and evaluating a program. We rolled it out here and have since brought it to other agencies to see if we could replicate the results. At the end of it all, we saw some significant changes in the number of cigarettes smoked, the number of quit attempts and moves in the stages of consumers’ readiness for change. There’s also been outside analysis of our programs, of which the results have been published in journals, so that we’ve received further grants to take the model we developed and train other providers with it. Q: What was the hardest part about getting a smoking cessation program going? TF: We really have the benefit of hindsight now, from all the agencies we’ve taken the program to since. But the barrier that any agency will face — and there are more that will be agency-specific — is their stage of readiness. If an agency has done a lot of staff development, if there’s good buy-in from the administration, with resources for training and staff time allotted, if they’re already running psycho-social group programs — all those things put them in a better position. But all those things can be developed. I think the biggest barrier is just developing the buy-in. The feedback we receive is that, once an agency has the tools and training, staff members are really able to roll out services and get something going. It’s about developing readiness. Q: What should agencies expect trying to develop that buy-in? TF: Agencies always need to anticipate resistance. If it was easy, if there were no barriers, well, every clinic and center would already be doing it. There has to be recognition of the need for commitment — long-term — for training and follow-up. The other barrier we come across often in day-treatment settings: engaging the lower-motivation smokers, the people who have no interest in quitting. They need to be addressed differently, because they’re in different stages. BC: Most people you get when you start are in the “preparation” stage. They’re contemplating it. Once you saturate that group, it can be difficult to engage the lower-motivation people. What happens, though, is that people in the group, in the program, they start sharing information with each other. TF: Another barrier, especially for agencies that don’t have a mandated smoke-free policy from a parent organization or the state, is staff who smoke. A larger barrier is that, quite often, the staff smoke with the client and it’s not a differentiated activity (something done away from the client). We find a lot of resistance in this situation; they can become defensive or feel like they don’t want to participate or promote the education needed. You have to really work and give them alternatives to participate without feeling hypocritical. BC: There has been a shift in the last five years among professionals, though, a real focus on wellness and recovery. In one case, the staff was resistant and felt hypocritical, and the first step was just asking the staff not to smoke with clients. The shift will be gradual, and I think the time is right to start implementing this type of program. TF: One other issue can be access to tobacco treatment meds. We thought it would be a huge barrier because we didn’t have anyone that could prescribe meds at Clubhouse. Patients were using community physicians and clinics. But it hasn’t been an issue at all, because we have the training and the tools to help. We’re lucky in New York, because Medicaid provides good coverage on this. But coverage varies by state, so that’s something agencies should look into. Q: Were there any pleasant surprises once the program got rolling, benefits you hadn’t expected? TF: When we first evaluated the program, we evaluated participants as part of their formal groups, but we didn’t think to evaluate the impact on the rest of the community. It turned out that we had a large showing of people who reduced their numbers of cigarettes smoked and some even quit — and they never even joined the smoking cessation group. They got the information from their peers, and it was a result of culture-changing activities. BC: We also initiated a less-formal peer group which attracted the more-reluctant people. Some just won’t go to formal classes. But they’ll go to be with or support a peer, and then all that information and support is there. Sometimes they’ll go through a life event that makes them ready for change, and the culture is right there. The consumers really help each other. We even see smokers helping out other people with quitting. DM: And that’s what we have to focus on — knowledge is power. We do pre- and post-tests with all the groups, and we definitely see a shift in attitudes, whether it’s the staff or the clients. We do training for staff to become leaders in this, showing them how to get the ball rolling. What participants learn that they didn’t know before is really amazing, and it gets them from resistance to the next level of readiness for change. It’s amazing the misinformation that’s prevalent, too. Some staff even thought that nicotine was a carcinogen, and so they didn’t want to use nicotine replacement medications. Q: Were there moments of, “Wow, that was easier than I thought it would be”? DM: Initially for us, trying to figure out a way to deliver the nicotine replacement medications, I anticipated a major problem because of the number of psych medications clients might already receive. But it hasn’t been a problem. TF: We thought the prescribers would be more resistant. But the way we addressed it was to do some education workshops and presentations for community physicians and psychiatrists. And prior to that, we focused our education on the consumers and the staff. That way, if the consumer got resistance from a prescriber, our case manager had the basic knowledge and could educate them. We even developed a form letter that the consumer can take to the physician that says, “I’m informed, I’m committed to quitting and these are the meds I’d like to use and why.” Q: What advice would you give to the counselor or facility administrator who’d really like to get a smoking cessation program going at her agency? TF: Have the staff and consumers watch our video. DM: The Video really makes an impact because it puts the responsibility on the mental health community. It compels people to take responsibility. TF: We have steps to follow, if someone’s serious about smoking cessation. The video is a tool to start conversation in the community and get a feel for where people are. Then you move forward with training, and identify the enthusiasts and the lead staff. They’ll come out in those conversations. |
