May is Mental Health Awareness Month, and The Wisconsin Department of Health Services has awarded a grant to UW-CTRI Researcher Dr. Bruce Christiansen to extend his Bucket Approach to help behavioral-health patients quit smoking. The Bucket Approach, developed jointly by the state’s Bureau of Prevention Treatment and Recovery (BPTR) and UW-CTRI, is an evidence-based tobacco treatment that has been tailored for behavioral-health clinicians and their patients.
The approach acknowledges that these clinicians have limited time while their patients coping with a mental illness and/or other addictions need more time, support, and resources to quit tobacco use.
The online Bucket Approach training deployed in October 2019. UW-CTRI and the Wisconsin Nicotine Treatment Integration Project (WiNTiP) promoted the online training to Community Support Programs (CSPs) and Comprehensive Community Services Programs (CCSs) across Wisconsin. Enrollees can earn up to 8.25 Continuing Education (CE) credits from the UW School of Medicine and Public Health by completing the training. To date, 92 CSP/CCS staff have enrolled in the training and 37 have completed it.
But enrollment has slowed in recent weeks and early anecdotal evidence suggests that those trained are not fully utilizing the Bucket Approach within their CSP/CCS. Moreover, CSPs/CCSs are not making the system changes necessary to fully implement and sustain the Bucket Approach on a program-wide basis. These outcomes probably reflect competing demands from other programs—and now the COVID-19 pandemic.
“Apparently, it isn’t as easy as ‘Build it and they will use,’” Christiansen quipped.
Smoking Prevalence Reflects the Severity of the Mental Illness
To boost the reach and implementation of the Bucket Approach, Christiansen and his team will implement five tactics:
1. Bucket Approach Exposure Seminar. Once the pandemic concludes, Bruce and the outreach staff will conduct three seminars across the state to introduce behavioral-health clinicians to the Bucket Approach. These three-hour seminars are intended to create a desire to enroll in the online Bucket Approach training.
2. Outreach to CSPs and CCSs. Four UW-CTRI regional outreach staff—Kris Hayden, Amy Skora, Allie Gorrilla and Sarah Thompson—will reach out to behavioral health providers at these facilities throughout their part of the state. Outreach staff will offer support and help to remove identified barriers.
3. CSP/CCS “Bucket Approach Integration Awards.” In recent years, modest integration awards from the WiNTiP program to behavioral-health organizations yielded tremendous results. Many of the early adopters who integrated tobacco treatment into their standard behavioral healthcare began as WiNTiP award recipients. For some CSP/CCSs, a very modest amount of money is all that it takes for tobacco to rise to the top of the list for clinic initiatives and for concrete implementation steps to be made. Such steps can snowball into full system changes. UW-CTRI will develop a Bucket Approach Integration Award ($4,000 per grantee) based on the highly successful, similar WiNTiP program.
4. Testimonial Videos. Videos of CSP/CCS clients who have quit (and the clinicians who have helped them) can deliver powerful messages to address clinician barriers to receiving training, to using the Bucket Approach interventions, and to advocate for system change. Christiansen will work with Chris Hollenback, UW-CTRI’s communications director, to produce and disseminate these videos.
5. Expanded Consumer Role. Conceptually, consumers could play a highly effective role in the adoption of the Bucket Approach by CSPs/CCSs and other treatment programs that serve those with significant/persistent mental illness. Doing so is consistent with the principles of recovery, client empowerment, and patient-centric care now embraced in behavioral-health treatment models.
“I want to recognize and thank the Bureau of Prevention Treatment and Recovery for funding these activities,” Christiansen said. “Making this a priority reflects their understanding of the devastating burden tobacco use is for people coping with a mental illness.”