Programs In Northern Wisconsin Implement the Bucket Approach to Help Patients Quit

Ashland County Communicty Services Programs
Ashland County Communicty Services Programs

Two counties on the tippy top of Northern Wisconsin—along the shores of Lake Superior—have implemented the Bucket Approach for helping patients with behavioral health challenges to quit tobacco use.

The Bucket Approach, developed by retired UW-CTRI researcher Dr. Bruce Christiansen, is an evidence-based strategy to treat tobacco use among clients in a systematic, efficient way. The idea is that patients with severe mental illness, who smoke at higher rates than the general public and struggle more to quit, can be sorted by inclination to quit into “buckets” as a way to best empower them to quit. All interventions are tailored to people who smoke and are affected by mental illness and/or other addictions. The Bucket Approach Training is a FREE online training for healthcare providers that includes free CE credit.

“All Ashland Community Service Program staff and all but one Bayfield Comprehensive Community Services staff have been trained,” said Valerie Levno, Comprehensive Community Services (CCS) Administrator at Ashland County Community Service Programs. “Both counties have added questions to our assessments (at intake and annually) that utilize the Bucket Approach’s stages of change model.”

CCS are voluntary, community-based programs funded by the State of Wisconsin, in this case operated by the Ashland County Health & Human Services Department.

Levno said that staff ask every client about tobacco use. When clients report smoking, vaping, or chewing tobacco, case managers connect them with substance-use counselors or their existing therapists.

Administrative Code Chapter DHS 75.24(7) requires that, by October 1, Wisconsin behavioral health providers who treat substance use disorders formulate plans to assess and treat tobacco use and have a policy about smoke-free environments.

“Now with Chapter 75 requiring that,” Levno said, “I anticipate we’ll be making even more referrals to local substance abuse providers.”

Levno said she would recommend the Bucket Approach to her peers. While the eight-hour online training is long, the fact it’s online made it feasible by saving in travel costs and allowing them to take the training in segments, on demand, when time allowed.

“It just made sense,” Levno said. “When I saw it, this was made for us. I see the Bucket Approach as something we’re not only going to use for tobacco but could use the structure of the approach for anything in public health.”

While she acknowledged behavioral health professionals are busy, and staff were reluctant to take on “one more thing” on top of the pandemic and existing duties, they found the systematic approach helped make incorporating the Bucket Approach into standard care seamless. Plus, staff earned continuing education credits. Besides, research shows their clients are more likely to die from tobacco use than from their other behavioral health issues.

“For folks with mental illness and substance use, their life expectancy is shorter than the rest of the population and their tobacco use is higher,” Levno said. “We look at people holistically, and tobacco use is something we want to pay attention to and address.”

And while it’s difficult for many of their clients to carry hope they can quit something so addictive as nicotine, Levno said that’s where they can help.

“We carry hope for our clients in all aspects of their lives, for substance abuse recovery and recovery around trauma or mental illness. We are a firm believer that hope is one of the most important things we can bring. We can bring a relationship and we can bring hope.”