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Multilevel leadership and champions
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| • Identify and develop long-term champions who are passionate about the tobacco-free initiative and can serve as a bridge to provider groups because they are known and trusted. |
Leaders and champions are needed at all levels for collaborative initiatives to succeed and to ensure functioning program infrastructure and progress toward health goals (6,7). One program formed a leadership team that included clinical directors in substance abuse and mental health, representatives from local health departments, representatives from nonprofit organizations serving the mentally ill and substance addiction populations, champions, and clients. This team included both supporters and nonsupporters, because the program felt that “a team full of cheerleaders would not get us where we wanted to go.” The buy-in of the skeptics increased as they became informed about the excess illness and death among the mentally ill and substance abuse populations and realized that the program was focused on overall wellness. Having champions who can speak to misconceptions about clinical treatment issues was helpful in gaining credibility and support from clinical and medical directors. |
| • Institute a leadership team of multiple state agencies, which will promote cross-fertilization of ideas and provide input on how to operationalize the strategies needed. |
| • Have a tobacco-control program (TCP) staff position responsible for working closely with the substance abuse and mental health agency to keep all partners connected and to facilitate communication. |
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Collection and use of data
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| • Assess needs and support for smoke-free policies of facilities and providers through needs assessments or surveys to determine their current policies or attitudes toward agency policies. |
Data can be used in a manner that engages partners to act (6,7). The assessments were done through client focus groups and key informant interviews with staff from various publicly funded substance abuse and mental health treatment centers. These data informed TCPs of centers’ tobacco control policies, client and staff attitudes about tobacco use, readiness to change policies, and barriers they would face in becoming smoke-free; the data also provided information on current training needs of staff. These data allowed TCPs to understand the scope of the issue in their state and target their interventions appropriately. As a result, embedding tobacco use questions within the patient intake system enabled substance and mental health treatment centers to identify clients who were smokers. This identification gave TCPs the ability to track smoking, the opportunity to refer patients to the state quitline, and the opportunity to offer cessation treatments or to identify those already receiving treatment. |
| • Enhance quitline data collection to properly identify and collect data on mental health populations. |
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Planning
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| • Network with other successful programs to plan your program. |
Plans should be dynamic and evolve in response to the leadership team, context, priorities, and scientific evidence (6,7). For both state programs, a plan to work in mental health and substance abuse treatment centers, as well as relationships with potential partners, had already been developed. Therefore, the programs were able to act swiftly when the funding opportunity became available. |
| • Integrate with other chronic disease program areas to incorporate other health-related activities as part of the recovery process, such as measuring weight and height upon intake, calculating body mass index, offering nutrition classes, and creating more opportunities for physical activity. |
| • As a part of protocol planning, have a coordinator at the mental health facility who will take responsibility for registering with the quitline, coordinating counseling calls, and receiving and dispensing nicotine replacement medications. |
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Training
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| • Train mental health facility owners, managers, and staff and local health department staff on misperceptions about tobacco use among people with mental illness, tobacco cessation, and policy implementation to build the capacity of the internal staff and partners in providing a shared understanding of tobacco use among people with mental illness. |
Training, technical assistance, and follow-through are necessary to ensure the proper use of data and implementation of policies (6,7). One program used the data collected during assessments of substance abuse and mental health facilities to provide outreach and technical assistance; peer-to-peer counseling and resources were included. |
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Communication
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| • Organize a media program that promotes success stories about real clients who quit smoking while in recovery in a tobacco-free facility. |
One program had a news media event in which leadership from both the TCP and substance abuse and mental health showed their commitment to supporting tobacco cessation as a part of treatment. In addition, a website was created to focus on tobacco-cessation activities among the mental health and substance abuse population. |
