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Examples of training background materials for telephonic tobacco cessation specialist Goal

Provide an education programme for tobacco cessation counsellors. Training will introduce and reinforce skills needed for job performance.

Training for tobacco cessation specialists should include brief intervention techniques, principles of intensive treatment models and basic motivational interviewing techniques. It should prepare specialists to respond to callers in a non-judgemental way with an understanding of each person’s readiness to quit tobacco (Table 9).

Topics

• Nicotine dependence • Tobacco-use demographic • Chronic disease and tobacco use • Clinical assessment, medication use • Counselling techniques

• Proven quitting strategies • Privacy practices, ethics • Crisis protocols

• Tobacco use among special populations (e.g. pregnant women, youth, people with chronic diseases and smokeless tobacco users)

• Customer service, professionalism • Software application skills. Expected outcome

At the end of the course, you will be able to:

• describe the epidemiology of tobacco use and the pathophysiology of tobacco-related disease; • describe and demonstrate how to apply information to educate and motivate patients to quit;

• describe how to adapt intervention for members of special populations (e.g. pregnant women, yourself, people with chronic diseases and smokeless tobacco users);

• describe the evidence base for different forms of tobacco treatment;

• describe the 5A model and the 2A and R model components and how the model integrates various treatment components between quit lines and health care;

• describe and apply the principles and practical aspects of intensive tobacco treatment behavioural counselling, including the creation of a quit plan that addresses setting a quit date, the development of coping skills for triggers/urges to smoke, tobacco-proofing the environment, and the use of social support and low-cost medications;

• describe and apply basic motivational interviewing techniques to encourage smokers who are not ready to quit;

• describe the role of low-cost medications in tobacco treatment, what medications are available, and how to screen and instruct patients in their use;

• demonstrate proficiency in delivering a tobacco cessation intervention to participants, including the provision of follow-up;

• demonstrate proficiency at simultaneous, accurate data entry and chart review;

• describe larger issues relating to helping tobacco users quit including societal policies, such as clean indoor air, tobacco price and access to treatment services, that could create barriers to success. Training programme structure

Table 9. Examples of training types and skill requirements

Mexico Tobacco Quitline: 2007 Telephone Counseling Training

Sponsored by the North American Quitline Consortium– Gary Tedeschi, lead

Context

A four-day introductory training including two days of practise for counselors. All had strong psychology backgrounds and were already providing brief phone counseling/referrals for substance use/abuse

Learning objectives

• Identify factors that affect smoking uptake, maintenance, and cessation • Articulate principles of quit-line counseling for smoking cessation

• Apply key topics for smoking cessation intervention including readiness assessment, motivational interviewing, pharmacotherapy, and relapse prevention

• Demonstrate skills required for quit-line smoking cessation counseling

• Identify critical questions/topics to include in a quit-line smoking cessation intervention • Practice and implement counseling protocol for smoking cessation.

Training type Requirements

New employee training: cessation specialist, registration staff, and supervisors

New tobacco cessation specialists, registration staff and supervisors are expected to be proficient in all the skill and knowledge areas necessary to provide safe, effective and efficient services to participants prior to assuming their duties.

Continuing education Continuing education courses that will reinforce and enhance skills needed for job performance.

Job aids Job aids (paper and/or electronic) posted to support work at point of service).

On-screen support Talking points built into the database to prompt dialogue for specific populations.

Embedded in documentation screen.

Telephone counseling training outline Day 1

• The Psychology of Smoking Cessation – Why do people smoke?

– Process of quitting – Process of relapse • How to Increase Cessation

– Increase the quit attempt rate

– Increase the probability of survival of quit attempts

• Role of the Telephone Counseling for Smoking Cessation

– Basic tenets

– Evidence of effectiveness

• Smoking Cessation for Mexican Callers

– Key consideration for designing an intervention ° Number of sessions ° Frequency of sessions ° Content of sessions • Counseling Considerations – Helping style – Counseling protocol • Helping Style – Directive vs. supportive – Expert vs. facilitator

– Ascribed credibility vs. achieved credibility – Motivational interviewing • Motivational Interviewing – Overview – Goals – Principles – Self-motivational statements

– Eliciting self-motivational statements – Example

• Counseling Intervention Content – Initial session

– Follow-up sessions • Initial Session

– Treatment overview & rationale – Motivation

– Smoking history – Quitting history

– Physical dependency considerations – Pharmacotherapy

– Environmental considerations – Familial & social support – Self-efficacy

– Self-image

– Problem solving & planning (cognitive- behavioral)

– Session summary – Setting a quit date – Tapering considerations

– Addressing follow-up calls (clients call in for follow-up)

• Demonstration Day 2

• Quit Day Session – Quitting status

– Withdrawal assessment – Pharmacotherapy review – Challenging situations – Slips & relapse – Support – Future plan

• Follow-up Session (1 week) – All topics from quit day call – Motivation

– Benefits/costs

• Follow-up Session (2 weeks) – All topics from quit day call – Self-image

• Follow-up Session (1 month/final) – All topics from quit day call – Top three triggers over time – Reflections on the process

• Recycling Sessions (>1 month from initial call/attempt) – Reassessment ° Motivation ° Planning • Demonstration • Role Playing • Special Topics – Role of the family – Home ban – Social norms – Pharmacotherapy – Physical health issues

– Psychiatric health issues

– Special populations (teen, pregnant smokers) – Risk assessment – Emergency procedures – Referral • Wrap-up Days 3 & 4 • Intervention Implementation – Role playing – Call shadowing – Call monitoring

Applying adult education principles

When developing and delivering training programs assume adults are: • autonomous and self-directed.

• goal-oriented • relevancy-oriented • practical.

Tools to involve all trainees in activities

•Objectives: ensure learning objectives are relevant.

•Organization of content: learning is easier when content and procedures or skills to be learned are organized into meaningful sequences. Learners will understand and remember meaning.

•Emotions: learning that involves the emotions and personal feelings, as well as the intellect. •Participation: on order for learning to take place, a person must internalize the information; seeing

or hearing is not enough.

•Feedback: learning is increased when individuals are periodically informed of progress. •Reinforcement: it is important for learners to receive reinforcement.

An effective lesson includes the following components.

•Preparation: preparing your learners to learn: guarantee foundation for the rest of lesson. •Presentation: providing the content the learners need to understand concepts and practice skills. •Practice and application: complete understanding has taken place only when the learner is able

to apply or transfer the learning to new problems or situations.

•Evaluation: best way to predict whether the learners can perform the task that they have been taught. Testing can be informal or formal.

The trainer’s preparation and interaction with the trainees has a big influence on the classroom interaction. There are a variety of instructional methods that can be used during a lesson. The choice of method depends on learning objectives, expected learning outcomes, and classroom conditions (i.e. size).

Learning objectives are the blueprint for ensuring that you are teaching what needs to be taught. The learning objectives describe the outcome, rather than the method. A learning objective should be worded so that observers can clearly measure whether or not the objective has been achieved.

Outcome or skill checks are the tests that tell you whether or not the learning objectives have been met. The skill checks match the objectives in the performance and conditions of the skill.

Teaching Methods • Lecture • Discussion • Socratic questioning • Independent work • Brainstorm • Demonstration • Collaborative learning

• Small group or working in pairs • Role plays

• Story telling • Case study • Simulations • Games