Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Pilot Study (Preprint)

BACKGROUND Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well-positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. We describe the protocol for a pilot study of an implementation intervention designed to overcome provider- and organizational-level barriers to delivering evidence-based smoking cessation treatment in community mental health clinics. This study aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. OBJECTIVE This study aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. METHODS We are using a pre/post observational design to examine the effects of an implementation intervention designed to improve mental health providers’ delivery of four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status; (2) assessment of willingness to quit; (3) behavioral counseling; and (4) pharmacotherapy prescribing. To overcome key barriers related to providers’ knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including: (1) real time and online training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention’s effects on providers’ knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers’ perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers’ implementation of the evidence-based smoking cessation practices. RESULTS The study is ongoing CONCLUSIONS In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients CLINICALTRIAL This study was prospectively registered in clinicaltrials.gov: protocol record NCT04796961. Registered on March 15, 2021