On December 11, 2008, a new kind of partnership was formed in an effort to introduce and advance tobacco cessation in the mental health and substance use communities. Building on the efforts of "It's Quitting Time L.A.!" the LA County Departments of Public Health, Mental Health, the Smoking Cessation Leadership Center, the Center for Tobacco Cessation, and the University of Colorado, Denver Behavioral Health and Wellness Center, came together to develop an aggressive yet realistic action plan. Using the performance partnership model, the group established realistic, achievable, sustainable goals and objectives and immediately began implementing their action plan. 
 
The action plan included peer advocate trainings for mental health and substance use consumers, provider training on the "Ask, Advise, Refer" (AAR) tobacco cessation protocol, and an online survey to assess mental health and substance use provider attitudes and knowledge about tobacco cessation.
 
To date, half of the goals and objectives have been met and the initiative is moving into a sustainability phase to maintain the momentum created over the past year.
 

How did they do it?

Established a Baseline: An online survey was distributed to approximately 1,000 County mental health and substance use providers. In total, 554 providers (clinician, physician, RN, LVN/psych tech, recreational/vocational rehab, substance use specialist, or community worker/peer advocate) shared their views regarding their receptivity to smoke-free policies and readiness to integrate smoking cessation interventions into existing services. Findings were used to direct the campaign provider education efforts. For the full report, CLICK HERE.

Gained Peer Support Through Contest: In an effort to raise awareness and build grassroots support, the departments of Public Health and Mental Health held an art contest for consumers to express the dangers of tobacco use. Sixteen entrants were honored at a reception and the winner was chosen by the workgroup. The art contest gave consumers a voice and outlet to express their feelings toward smoking. Kalene Gilbert, program head of the Adult Systems of Care, L.A. County Department of Mental Health, said, "It was a positive and empowering activity for both the consumers and their providers. People began to talk about smoking and its negative impact on these vulnerable communities."  Linda Aragon, director of tobacco control and prevention in Los Angeles County noted "It was also a great introduction for the Public Health staff to get acquainted with the mental health and substance use worlds."

Winning art contest design by Brenda Settles.

Educate Peers:  Four two-day trainings for mental health peer advocates and substance use counselors and providers were conducted by the University of Colorado, Denver Behavioral Health and Wellness Program team.  Started in New Jersey, The peer-to-peer quit tobacco program employs mental health peer counselors, called Consumer Tobacco Advocates (CTAs), to address tobacco among their peers. The CTAs receive intensive training and ongoing supervision.To date, 82 peer advocates, counselors, and providers have been trained and 14 peer-to-peer quit tobacco wellness programs are up-and-running in mental health and alcohol and drug treatment programs.
 
In addition, a supply of carbon monoxide monitors that are used in individual motivational interviews were given to all peer led group leaders and monthly conference calls are being held to provide technical assistance and give workgroup updates. More recently, a web forum was launched for peer advocates to communicate with each other through discussion boards, Peers can download and print curriculum handouts, view the latest news and research on smoking cessation, share pictures from the trainings, and view the latest on smoking cessation tools.

Peer Advocates role playing the group sessions from the peer-to-peer quit smoking program. Photo taken: November 2-3, 2009 Los Angeles training. 
 

Art Contest Reception hosted at the Department of Mental Health on April 20, 2009. Awardees with certificates of appreciation. In middle, winner Brenda Settles.

Educate Providers: In August 2009, the Center for Tobacco Cessation conducted four trainings over a 2-day period and equipped providers with the tools to talk to their patients about quitting smoking. Providers learned the "Ask, Advise, Refer" brief intervention method and heard about available resources such as the California Smokers' Helpline and the peer-to-peer support groups.
 
By the one-year mark, half of the action items have been completed. Tobacco cessation is being established in the mental health and substance use communities. Lessons continue to be learned and new partnerships formed among Public Health's Tobacco Control and Prevention Program, Substance Abuse Prevention and Control, and Mental Health.

WHAT IS NEXT?
 
During the next five months, the workgroup will focus on sustaining and maintaining inroads made with the mental health peer advocates and substance use providers to continue to strengthen the peer-to-peer quit tobacco program. At the same time, the workgroup will plan a clinician training for the Department of Mental Health in an effort to increase awareness of the importance of tobacco cessation among mental health consumers, provide tools (AAR) to help providers and clinicians, and dispel myths about tobacco use and health outcomes. The workgroup will also explore the possibility of a train-the-trainer peer advocate training.
 
Also, in response to requests from the field, a Spanish translation of the handouts for the peer-to-peer quit tobacco program is in the works. Soon peer advocates who work with a bilingual clientele will have cultural appropriate materials.
 
Finally, the University of Colorado Denver Behavioral Health and Wellness Program is beginning the evaluation research study of the peer-to-peer quit smoking program. Data will be collected, analyzed, and made public to demonstrate whether the peer advocate quit smoking program is effective and efficient.
 
FOR MORE INFORMATION on the Los Angeles County behavioral health tobacco cessation initiative or It's Quitting Time, L.A.!, please contact Rachel A. Tyree, Project Director, Tobacco Cessation Initiatives County of Los Angeles Department of Public Health Tobacco Control & Prevention Program at  rtyree@ph.lacounty.gov  
 
For more information on the peer-to-peer quit tobacco program, please contact: Mandy Graves May, Director of Training and Outreach, 303-724-3713 or e-mail mandy.may@ucdenver.edu.