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Best Practices

Setting up processes to maximize on clients’ motivation to quit:

  • Providing Nicotine Replacement Therapy (NRT) during Tobacco Use Assessment (TUA)
    • “When they’re going through the intake process, we have an RN there or a nurse that conducts the smoking cessation assessment at that point…she has a dialogue going on with them and they have a choice right then if they want to quit smoking. She has NRT (Nicotine Replacement Therapy) at that point and if the client desires to quit then she can start them at that point right there. And they can leave that day with NRT. That’s been very, very, very, very successful…Even if we have a client that smokes and they can’t smoke while they’re in intake we have the gum available for them and it’s almost like a test as well to see if they like the gum or they would like to quit smoking.” (Debra, Program Manager-Spindletop)

  • Incorporating tobacco cessation into a whole health assessment:
    • “So we came up with a whole health assessment form where we look at different risk factors and we listed the smoking as a risk factor. And we simply ask them do they use tobacco products. And if they say yes, we ask them how many and then we ask them the magic question: Are you ready to quit?...We discuss the health benefits for them that do decide to quit and I also talk about the risk factors for those who may not be ready to quit.” (Tina, Peer Specialist Supervisor-Spindletop)

  • Tailoring services to facilitate and support individual clients in quitting:
    • “So when we receive the email that people are interested in quitting, they’re added to the interest list. And at first, we weren’t sure how many people would be interested in quitting but we have over 200 clients right now on the interest list waiting for services. And what the services include - is 3 months’ worth of free NRT…We also do a CO (carbon monoxide) monitor test every week, which I’ve found to be very motivational for people. Because they come in and they know they’re going to have to breathe into that monitor, and everyone will know what they’ve done that week and it’s been really motivational for them…so we work with them throughout the process and talk about how we hopefully want them to quit and if they haven’t we’re talking about plans with working with either the Quitline or Medicaid to continue getting the NRTs.” (Molly, Wellness Coordinator-Heart of Texas Region MHMR)

 

Overcoming misconceptions through education and training:

  • “When we started the initiative, it was amazing how wrong we were as mental health professionals because many of us have been in this field a long time and we always assumed that our clients didn’t want to stop smoking because they couldn’t or if they did their symptoms would get worse. We never even thought to ask them and once we realized our clients [were open to quitting] we really just asked them and they did not want to continue smoking. They were on fixed incomes, they were miserable, they were like being held in bondage by the cigarettes. And once we became an instrument to help them, a lot of the clients were quite successful.” (Debra, Program Manager-Spindletop)​
  • “I think that education is key. There are a lot of misconceptions out there about tobacco use and about the treatment of it – so making sure that people have the information on how to do it and the benefits of it has been key for us…we also do the training at the new employee orientation, which I think is very beneficial because you get people on board right when they start working here and making sure that we’re all on the same page…to me it’s the education and having staff trained – it’s huge. (Molly, Wellness Coordinator-Heart of Texas Region MHMR)​
  • “Also - the other part of that, I know we saw it on our substance abuse unit sometimes, like the old school substance abuse counselors thought they can’t quit both at the same time. Yes they can if they have the tools and the products. Even the counselors learned, yes you can stop drugs and cigarettes at the same time.” (Debra, Program Manager-Spindletop)

 

Integrating tobacco assessment into practice:

  • “When we do the assessment, we try to look at all of the areas where we are concerned about risk factors whether it’s your mental health or your physical health. So when our consumers come in a lot of the things that we try to get them to see, if they are smokers, we try to get them to look at the damage that smoking can do to their health….Part of us being healthy is taking care of our body…So you start working out, you quit smoking, then 9 times out of 10 you’re blood pressure is going to go down. We try to get them to look at all the benefits of them actually quitting smoking for themselves.” (Tina, Peer Specialist Supervisor-Spindletop)

 

Maximizing opportunity through accountability:

  • “I’ve had clients tell me different things, one – having that accountability, knowing they have to come in every week and talk about how everything is going and breathe into the CO monitor has been really motivational and gives them the extra “umph” to help quit. So I think that has been really beneficial, but I think for us, the difference is for us in the individual [counseling] they’re getting the free NRTs. When in the groups, we’re trying to find other ways, as they may not always have access to the free NRTs.”(Molly, Wellness Coordinator-Heart of Texas Region MHMR​​
  • “I think, too, having that interest list and knowing that: Hey, there are so many other people waiting for the service, and I have the opportunity now. And many clients have been on the waiting list for a while that when they have that chance, they know – OK, let’s try to do this because the opportunity has presented itself.” (Molly, Wellness Coordinator-Heart of Texas Region MHMR)   

Being Non-Judgmental

  • “I think if we don’t learn anything else in this initiative, we have to meet people where they are and lift them up and not beat them down. And, because, it’s amazing what a little encouragement can do, and zero judgement.” (Debra, Program Manager-Spindletop)

 

Practicing Empathy:

  • “Definitely there’s this one slide in the presentation that you provided us with, that asks the staff to approach the client in a very non-confrontational manner and to remain empathetic and to try to really communicate interest with the client and try to identify with them in the way that you want to talk to them like they’re a person. You don’t want to go and scold them and tell them to put out the cigarette. You don’t want to be demanding just because you want them to follow the policy. I always tell them [the staff] that it’s best practice to go up to them [tobacco users] and to be empathetic and to understand where they’re coming from and to understand that this is a mental health facility.” (Raquel, Substance Abuse Counselor-Border Region Behavioral Health Center)​
  • “I’ve had several really good reports of people being able to actually quit smoking, a lot of what I run into is those that quit smoking for a month, for 2 months then they fall off the wagon. You know what, they come back they feel so bad about the fact that they relapsed. One of the goals that I try to impress upon my peers is that if you fall off the wagon you get back on… I praise them and I pat them on their back and I try to get them to understand that what they’re doing is very important and that they should be praised because quitting smoking cigarettes is a hard thing to do. I don’t care what nobody says…So one of the things we do is we always try to empower our people.” (Tina, Peer Specialist Supervisor-Spindletop)

Helping Provide Perspective:

  • “Anything you weren’t born doing, you can quit. It’s just a matter of what you use to help you to quit. (Tina, Peer Specialist Supervisor-Spindletop)

  • ​“I always let them know to never be discouraged…that just because you have one lapse doesn’t mean that you should just drop everything and decide not to quit that these lapses are normal, that it’s a process in getting over an addiction. So he’s still trying to quit so it’s working.” (Raquel, Substance Abuse Counselor-Border Region)​
  • “Our consumers are already beat down, they’re beat down by life and their diagnosis a lot of times, and for them to be talked down to is like almost their norm. And we take success where we find success at whatever level it may be someone who is smoking 4 packs of cigarettes every day cut down to 2. That’s a celebration….” (Debra, Program Manager-Spindletop)