TEACH: Training practitioners in smoking cessation counselling

In brief

Members of the Simcoe/Muskoka Service Collaborative, part of the System Improvement through Service Collaborative (SISC) initiative, determined there was a lack of services to address the important life goals of transition-age youth with mental health and/or addiction issues. In Simcoe/Muskoka, these youth would be better served if agencies that work with them shared a common approach within an integrated system of care. To develop such a common approach, collaborative members chose to implement the Transition to Independence Process (TIP) model. This is the first time it has been implemented in Canada.

This issue of Evidence in Action looks at the Simcoe/Muskoka’s implementation of the TIP model. Evidence in Action profiles knowledge generation, exchange, and implementation activities across Ontario.

Read it below or download the PDF.

Background

Treatments to help people quit smoking are among the most cost-effective ways to reduce the risk of disease or death. The likelihood of quitting is greatest when people receive intensive support along with medications to help them quit.

Despite this knowledge, only 35% of doctors say they offer their patients help to quit smoking, citing lack of time and system support as a barrier. And although evidence shows that other clinicians (such as nurses and dentists) can be as effective as doctors in helping people to quit, they often feel they don’t have the ability and training to offer this service.

Training programs for health professionals on how to provide support and treatment to smokers are available in the United States and abroad. But until 2006, none were created to meet the specific needs of the Ontario health system. That’s when the TEACH initiative was started.

TEACH (or Training Enhancement in Applied Cessation Counseling and Health) addresses this need by combining knowledge translation with adult learning principles to address the lack of system capacity to implement evidence-based smoking cessation treatments.

TEACH participant asking a question

What is the TEACH initiative?

The TEACH project, developed and run by the Nicotine Dependence Service at the Centre for Addiction and  Mental Health (CAMH) is funded by the Ontario Ministry of Health and Long Term Care (formerly by Ministry of Health Promotion) as part of the Smoke-Free Ontario Strategy.

The project has served health professionals in over 15 different disciplines, including nurses, pharmacists, dietitians, social workers, respiratory therapists, and doctors, as well as individuals working in policy development and non-governmental organizations.

Project details

The course curriculum features evidence-based Canadian content on tobacco control science, policy, and practice relating to tobacco prevention, protection, and cessation.

A key feature that makes TEACH different from other training programs for clinicians is that it looks at the broader context of tobacco control as it relates to smoking cessation.

The core course includes training in seven key areas: assessment tools, advocacy and system-level interventions, cognitive-behavioural cessation treatment, facilitating cessation groups, motivational interventions, pharmacotherapies, and harm reduction strategies.

The certificate program in intensive cessation counseling is accredited by the University of Toronto Faculty of Medicine, Northern Ontario School of Medicine (NOSM), and University of Ottawa Faculty of Medicine.

TEACH is also accredited by the Association for the Treatment of Tobacco Use and Dependence (ATTUD), College of Family Physicians of Canada Mainpro-C, Canadian Addiction Counselling Certification Federation, Ontario College of Pharmacists, and Royal College of Dental Surgeons of Ontario.

There are three requirements to achieve a certificate:

  • An online course that takes between 6 and 8 hours to complete, and includes an interactive, moderated group discussion forum
  • A three-day classroom-based core course, and
  • A two-day classroom-based specialty course.

Traditional drumming circle as part of our Tobacco
Interventions for Aboriginal Peoples Specialty course
 

Also, participants can choose among different specialty courses that focus on specific populations, such as mental health and/or addictive disorders, chronic disease prevention, hospitalized smokers, youth, women across the lifespan, obesity and binge eating disorder, and aboriginal peoples.

The course format includes case examples, small group practice exercises and clinical simulations, live clinical demonstrations, video demonstrations, and large and small group discussion and consultation.

Participants spend at least 25% of class time on interactive, case-based practice, intended to help them adapt the knowledge to their own practices, assess issues that might make it difficult for them to implement the new knowledge, and to start selecting and adapting clinical tools and practices.

What research is the TEACH program is applying?

Curriculum materials that are based on research evidence and smoking cessation guidelines, as well as adult learning principles/practices, are presented using clinical tools, practice guidelines, and treatment algorithms. The program developers continually review recent research findings on smoking cessation strategies and update the course content so that the course materials reflect new evidence and its clinical implications.

The program’s content is adapted based on participants’ evaluations, follow-up surveys, as well as formative and summative assessments that look at the content, interactivity, and overall quality of facilitation.

According to follow-up survey responses from participants of the core course between June 2007 and January 2009, more than half of them were offering intensive individual smoking cessation sessions and 17% were offering intensive group cessation sessions. Among respondents, lack of time, client motivation, and organizational support were top three barriers to having smoking cessation sessions.1

Another important outcome for the program is that practitioners who attend the courses engage in knowledge transfer activities and share what they learned with others in their organizations and communities. According to survey results, more than 90% of respondents said they shared their new knowledge and skills with peers, co-workers, students, as well as friends and family.

Stretch break during TEACH session.

Lessons learned

Practitioners who attended the TEACH program work with many of the special populations that are known to have high rates of smoking, including Aboriginal populations, people with concurrent mental health disorders and/or comorbid chronic disease, and youth.

The classroom-based format is a cost-effective way to maximize participation and representation, and allows networking and sharing of information by practitioners who often practice in isolation.

Evaluation of the training program not only looks at how satisfied the participants are at the end of the course but also assesses how well they learned the material (using a content-based examination) and if they use what they learned in their practice.

The results suggest that exposure to new knowledge and skills, and opportunity for discussion and practice, increased practitioners’ self-assessed importance, confidence, and feasibility to implement these skills.

To find out if participants are actually using what they learned during the training course, participants are given a survey after three and six months that asks them about what practices they use with their patients, how frequently they deliver the intervention, how many of their patients have stopped smoking and for how long.

After attending TEACH, practitioners are invited to join a Community of Practice (CoP) which offers a range of activities including webinars, additional training, an email list, and toolkits designed to help maintain their practice change over time, and spread their knowledge to their colleagues. This CoP gives practitioners an opportunity to discuss challenges they may be facing in their practice and to hear suggestions from their peers.

Interactive tobacco table offers participants
information about new tobacco products from
around the world.

Changes over time

The researchers stay on top of the research and findings related to smoking cessation—whether it’s new studies on medications, policies in tobacco control that affect cessation in the province, the latest prevalence rates and statistics on tobacco, as well as other information that would be of benefit to practitioners.

Challenges and barriers

One of the challenges that the program faces is that the demand is high but spaces are limited. So there is always a wait list for practitioners who would like to sign up.

Program successes

In follow-up surveys, more than 90% of practitioners who participated in TEACH say that they have actually implemented their cessation knowledge and skills in their practice and are seeing and helping clients quit smoking. And many practitioners themselves go on to train others on the TEACH program.

Reference

1. Herie M, Connolly H, Voci S, Dragonetti R, Selby P. Changing practitioner behavior and building capacity in tobacco cessation treatment: the TEACH project. Patient Education and Counseling, 2012;86(1), 49-56.

For more information about the TEACH program please contact:

Rosa Dragonetti

Project Director

Addiction Education and Research

Center for Addiction and Mental Health (CAMH)

416.535.8501 x 7404

Rosa [dot] Dragonetti [at] camh [dot] ca

www.nicotinedependenceclinic.com

Author: Rossana Coriandoli

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