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Building Partnerships, Changing Norms The First Five Years of the Smoking Cessation Leadership Center

Building Partnerships, Changing Norms The First Five Years of the Smoking Cessation Leadership Center. Connie C. Revell, Deputy Director Smoking Cessation Leadership Center Annual Meeting May 15, 2008. Five Years Ago. Steve arrived back at UCSF with a generous RWJF grant

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Building Partnerships, Changing Norms The First Five Years of the Smoking Cessation Leadership Center

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  1. Building Partnerships, Changing NormsTheFirst Five Years of the Smoking Cessation Leadership Center Connie C. Revell, Deputy Director Smoking Cessation Leadership Center Annual Meeting May 15, 2008

  2. Five Years Ago • Steve arrived back at UCSF with a generous RWJF grant • Center opened, staff hired • We began to form partnerships with willing organizations • Ran into some immediate barriers

  3. The Daunting Challenge in 2003 • The Clinical Practice Guideline (Five A’s) got the cold shoulder from most clinician groups • Few clinicians were intervening with smokers • Clinician smoking rates were dropping, but this had a flip side– less empathy, more stigma • Biggest barriers cited were time, knowledge, cost

  4. Three Five A’s Models

  5. The Search for a Shortcut • We began looking for simple, concrete, doable alternative to offer clinicians • Referral to quitlines made sense and was evidence based • American Dental Hygienists’ Assn. had a summit in September 2003 and created Ask-Advise-Refer; aimed to double intervention rate

  6. How to Organize? • We knew we didn’t want to form a new organization with each professional group • We needed to organize around a specific outcome (helping smokers quit and helping clinicians help them do it) • We wanted a flexible, fluid structure

  7. Luckily, There Was a Way • Performance Partnership Model • Tested way to move groups toward results without creating costly, burdensome new structures • Flexible, results-oriented approach • Based on four simple questions

  8. A Specific Kind of Partnership • Encourages use of low-cost and no-cost strategies • Action plan comes from group itself by end of summit, so process is accelerated • A way to launch a national effort • SCLC staff willing participants in each one, maintaining egalitarian approach

  9. Flexibility Was Also Helpful • We had flexibility in choosing partners and didn’t have to issue RFP’s • We only worked with people eager to work with us • We chose not to accept money from pharma companies, but encouraged funneling their funds to our partners

  10. Beginning with Dental Hygienists • Brought hygienist leaders together with elected and staff ADHA leadership and SCLC staff • Presented on quitlines BEFORE target was set • Result: Ask Advise Refer was born

  11. ADHA

  12. A Single Number • Breakthrough in 2004 with Sec. Thompson’s initiative • 1-800-QUIT NOW made marketing much easier • All 50 states now have quitlines, so Ask-Advise-Refer can be recommended for ALL clinicians • Not just physicians-- clinicians

  13. The National Card —

  14. National Cards

  15. The Decision Not to Brand • Branding consumes scarce time, energy, resources • Partners needed to own effort • Approach opened door for many whom we did not fund or provide technical assistance • Offering things for free and with no strings was very well received • Three million distributed; QUIT NOW has had one million calls, plus millions more directly to state quitlines

  16. Results of Card Survey • Many orders came from organizations describing themselves as relating to mental health ( 28%) and substance abuse (23%) • 85% said the card helped streamline their ability to assist patients with cessation • 80% said the card had increased the number of patients advised to quit by their organizations

  17. We Are Beginning to Measure Real Impact • Target: 25 to 50% of DH intervening by end of year three • Accomplished by 2006 -- • 56% of DHs intervene with their patients

  18. Proven efficacy: American College of Emergency Physicians • Multicenter pilot study of an educational and clinical tobacco control intervention ASK-ADVISE-REFER Bernstein, SL, et al, ACEP, 2006

  19. American Society of Anesthesiology Pilot Study 11 of 14 sites % Anesthesiologists referring smokers pre-op to quitlines

  20. Best Record in America:Kaiser Permanente Northern California • Worked with SCLC to get from 12.2% prevalence to 10% • At three-year mark, currently at 9.2% • A 25% drop in three years

  21. Making a Difference • AAFP’s Ask & Act Campaign • 300,000 cards distributed

  22. Ask and Act: Assessment of the AAFP’s Initiative to Promote Tobacco Cessation Counseling by Family Physicians in Delaware • There was a significant reduction in the proportion of smokers after the Ask and Act program. In addition, there was a significant increase in smoking cessation counseling by physicians after the interventions. AAFP’s Ask and Act program is an effective intervention that increases counseling for tobacco cessation, and decreases smoking rates.

  23. Dissemination to the States • Web site, articles, presentations key • State affiliate organizations of national groups can help • Free technical assistance and burgeoning array of tools can help • Some examples….

  24. Kentucky, Arizona, Colorado, Iowa, New York…

  25. Goal: Increase the percentage of practicing hygienists who routinely address tobacco dependence with their patients to at least 50% • Log in to Win competition • Results • Out of 10,000 RDH, 67,000 Quitline Referral cards in circulation in dental practices throughout NYS • 130 practicing dental hygienists in New York State reported more than 4,600 interventions with patients who use tobacco and referrals to the NYS Smokers’ Quitline.

  26. Referrals by Type to the California Smokers’ Helpline, 2004-2007

  27. The VA Project • Year 3 of a three-year grant from VA to SCLC • Aim was to promote quitlines within the VA • 2 pilot hospitals • 32 facilities distributed cards, using posters, card holders for both patients and providers • 400,000 cards in distribution at the end of the campaign to over 158 facilities

  28. Business and Labor • We knew we had to address cost and coverage questions • Make It Your Business was one way • Hospitals as employers was another • Spreading these exemplary models • Issuing a challenge to specific labor groups

  29. Publications and Presentations

  30. Publications and Presentations

  31. Publications and Presentations • Our partners have flooded the journals and newsletters with articles over the last five years • This has helped raise awareness dramatically

  32. Publications and Presentations

  33. Publications and Presentations

  34. Other Avenues of Our Approach • Focusing on specific sites • Cities, states

  35. Performance Partnerships- LA County Help 200,000 (out of a million) smokers quit over 3 years (2010 goal)

  36. Primary Measure • Reduce 19.1% adult smoking prevalence to 14% by year 2010.  • Reduce 21.7% teen smoking prevalence to 16% by year 2010. • Increase quit attempts from 60% to 80% by year 2010. • Secondary Measure • Double call utilization of quitlines (currently at 0.50%) each year for next three years.

  37. Goal to decrease state smoking prevalence to 15% by 2010 • With a stretch goal of 12% by 2012

  38. Legacy Ups the Ante • Suggested we work with mental health • Provided additional funding starting in 2006

  39. NASMHPD, Medical Directors Council • From 41 to 100% of state psychiatric facilities will be smoke free • Currently, one facility per month is going smoke-free– now over half • SCLC underwrote creation of tool kit to aid process

  40. The New Frontier– Behavioral Health • A new partnership begun in 2007 • National Mental Health Partnership for Tobacco Cessation and Wellness • 28 Organizations now represented • New tools available, such as psychiatric hospital smoke-free toolkit and mental health provider toolkit • Quitlines and primary care working to coordinate better with mental health population

  41. What the Partnership Has Done • Raising awareness and recruiting interventionists– expanding the initiative • Shifting norms– slowly– away from laissez faire • Marketing quitlines to staff • Regularizing communication • Starting to mainstream cessation in mental health – “Smoking Cessation is Part of Recovery”

  42. Overall Themes in the First Five Years • Action plans all have many categories in common • Every group wants to deal with students as well as established clinicians • With associations, involvement of both staff and officers is key • Within every clinician group, there are people who have worked on this issue for years– how do we find and empower them?

  43. More Themes • In the future, our partners will have to provide TA • With so many tools now available, the movement can begin to move ahead on its own with proper communication • Cessation is no longer the poor stepchild of tobacco control • MH/SA is surging ahead in importance for cessation

  44. Refining, Increasing TA • We and our partners need to broaden the reach of our technical assistance • SBIR grant can be helpful • How can partners reach more clinicians within their various organizations? • How can SCLC support their efforts?

  45. The Road Ahead • Vision of a cross-disciplinary cadre of cessation leaders in each state • Example of California • CAPA • CDHA • Diabetes Educators • Respiratory Therapists • CSH, TCS

  46. Opportunity Knocks: The End Smoking X Prize • The successful team will help a minimum of 25,000 smokers quit for at least one year and have a 20% success rate • Prize is $20 million first place, $5 million second place and $10 million in assorted bonus prizes • Five-year competition sponsored by the X Prize Foundation

  47. SCLC’s Potential Role • We might facilitate the creation of a successful team from among our partners • We can urge as many partners as possible to participate • Could there be a team like the Clinicians’ Consortium for Tobacco Intervention, drawn from our partners?

  48. Challenge • Let us begin to create a cadre of tobacco cessation interventionists in all 50 states

  49. What We Hope Lies Ahead • All the available tools are being widely used, and new ones are under development • Local initiatives everywhere are reaching low-income smokers and those with MH/SUD • Prevalence is plummeting • Our success at home is not being translated to disaster overseas

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