The California Smokers’ Helpline: Counselor Training & Counseling Protocol April 20, 2010

1. The California Smokers’ Helpline: Counselor Training & Counseling ProtocolApril 20, 2010 Presented by: Gary J. Tedeschi, PhD University of California, San Diego

2. Topics • Counselor training • Clinical supervision & continuing education • Theoretical approach to helping • What’s in a call? • Simulated counseling session excerpts

3. Clarification of Terms • Counselor (or Consejero) • Used at CSH since 1992 with all English & Spanish speaking clients • No obvious negative reactions • Possibly due to less-stigmatizing climate in CA • Advisor • Currently used at CSH with Asian language clients • “Counselor” associated with serious psychiatric issues • Quit Coach or Tobacco Treatment Specialist • Currently used at many quitlines in the U.S. • May convey the psycho-educational nature of service © California Smokers’ Helpline

4. Counselor Training • Training schedule • 48-hour, in-house training • Four evenings a week • Four hours per training session • 1-month apprenticeship © California Smokers’ Helpline

5. Training Program • Presentations • Group discussion & small group activities • Video tapes/DVDs • Live demonstrations • Audio recordings • Counselor shadowing • Role playing • Readings (training manual, articles) © California Smokers’ Helpline

6. Training Program(cont.) • Week 1 • CA tobacco control & the Helpline • Scientist-practitioner model • Telephone counseling for smoking cessation • Counselor shadowing • Principles of counseling © California Smokers’ Helpline

7. Training Program(cont.) • Week 2 • Introduction to screening (intake) • Counseling protocol - Initial call • Counseling protocol - Follow-up calls • Case management issues © California Smokers’ Helpline

8. Training Program(cont.) • Week 3 • Special topics • e.g., motivation, planning, relapse prevention, physical & mental health and smoking, multiculturalism & diversity in counseling, pharmacotherapy • Risk management • Introduction to evaluation © California Smokers’ Helpline

9. Training Program(cont.) • Final week • Role playing with veteran counselors and supervisors • Learning assessment • Apprenticeship • 1 month following training © California Smokers’ Helpline

10. Clinical Supervision • Weekly group supervision • Case presentations • Training videos • Group process • Research updates • Individual supervision • Call monitoring, recording, & review • Debriefing as needed © California Smokers’ Helpline

11. Continuing Education • In-service presentations by Helpline staff • In-service presentations by outside experts • Email updates on developments in the field • Advanced seminar © California Smokers’ Helpline

12. How Do We Help Smokers Quit?

13. Theoretical Framework Social Learning Theory Motivational Interviewing Cognitive-Behavior Therapy © California Smokers’ Helpline

14. CSH Theoretical Framework • Social Learning Theory (SLT) • Smoking is a learned behavior that can be unlearned • Increase self-efficacy and self-regulation • Motivational Interviewing (MI) • Help clients resolve ambivalence • Empower clients to choose change • Cognitive-Behavioral Therapy (CBT) • Help clients try new behaviors & change thoughts • Create a solid quitting & relapse prevention plan © California Smokers’ Helpline

15. Counseling Intervention Philosophy • Encourage quit attempts (Multiple attempts are the norm; keep trying!) • Prevent relapse © California Smokers’ Helpline

16. Protocol Change Principles • Encourage quit attempts • Nonspecific counseling effects • Hope, rapport, motivation, self-efficacy, social support, ambivalence, & accountability • Proactivity • Addresses client ambivalence, reduces attrition, provides social support, creates accountability • Specific counseling effects • Share knowledge, assist with planning © California Smokers’ Helpline

17. Protocol Change Principles(cont.) • Prevent Relapse • Relapse-sensitive call scheduling © California Smokers’ Helpline

18. Relapse-Sensitive Scheduling 100 80 60 40 20 0 Percent abstinent 0 1 3 7 14 30 Days after quitting Source: Zhu & Pierce (1995), Prof. Psych. Res.& Practice, 26, 624-625

19. Protocol Change Principles(cont.) • Prevent Relapse • Relapse-sensitive call scheduling • Motivation assessment • Plan revision as needed • Self-image • Perseverance © California Smokers’ Helpline

20. Counseling Protocol • Initial Call • Approximately 35 minutes long • Preparation to quit • Proactive Follow-up Calls • 5 calls, 10-15 minutes long • Relapse sensitive schedule • Relapse prevention © California Smokers’ Helpline

21. What’s in a Call?

22. First Session • Treatment overview & rationale • Motivation Source: Zhu S-H, Tedeschi GJ, Anderson CM, Pierce JP. J Couns Devel 1996;75;93-102.

23. Top Motivators to Quit • Health • current illness or fear of illness • Social • includes quitting for family members and responding to nonsmoking norm in CA • Cost • e.g., tax increase = call increase

24. First Session (cont.) • Self-efficacy • Self-image • Planning • Call summary • Setting a quit date • Addressing follow-up calls • Treatment overview & rationale • Motivation • Health considerations • Smoking & quitting history • Quitting methods • Environmental considerations Source: Zhu S-H, Tedeschi GJ, Anderson CM, Pierce JP. J Couns Devel 1996;75;93-102.

25. Proactive Follow-up Sessions • Quit status • Withdrawal review • Pharmacotherapy review • Challenges & smoking events (slip or relapse) Source: Zhu S-H, Tedeschi GJ, Anderson CM, Pierce JP. J Couns Devel 1996;75;93-102.

26. Top Relapse Triggers • Highly emotional situations • Being around smokers • Alcohol

27. Proactive Follow-up Sessions (Cont.) • Motivation & self-efficacy • Support • Planning for future • Self-image • Quit status • Withdrawal review • Pharmacotherapy review • Challenges & smoking events Source: Zhu S-H, Tedeschi GJ, Anderson CM, Pierce JP. J Couns Devel 1996;75;93-102.

28. Simulated Counseling Session

29. Counseling Protocol Summary • 1 planning call (30-40 minutes) • Up to 5 follow-up calls (10-15 minutes) • Help clients to: • Identify a strong reason (motivation) • Bolster belief in ability (confidence) • Develop a solid plan (skills) • Adopt a new view of self (self-image) • Keep trying (perseverance) © California Smokers’ Helpline

30. Thank You!! Contact: Gary Tedeschi, PhD 858-300-1044 gtedeschi@ucsd.edu