Bucket Approach Reaches More than 1,300 Providers

Bucket ApproachThe Bucket Approach online training—designed to teach behavioral health providers how to help their clients quit tobacco use—has enrolled more than 1,300 providers from 48 states and 11 countries who have rated it an 8.4 out of 10, according to a new paper published in Community Mental Health Journal. More than 447 people completed the entire online training.

More than 695 Wisconsin providers have enrolled in the course. The approach has also reached Guam, Puerto Rico, Australia, Brazil, Canada, India, Kenya, Lebanon, Malaysia, Switzerland, and Tunisia.

Researchers said that’s important because, while the quit rate for people with no mental illness is 22 percent over three years, it’s lower for people with behavioral health issues. For example, the quit rate drops to 18 percent for those with alcohol abuse or dependence, 16 percent for those with major depression, 15 percent for those with other drug addiction, and 13 percent for those with schizophrenia.

“Within the context of providing evidence-based tobacco dependence treatment through the healthcare system, the large number of Bucket Approach enrollees speaks to behavioral health clinicians as underserved professionals and, through them, an underserved population,” said retired UW-CTRI Distinguished Researcher Dr. Bruce Christiansen, who created the Bucket Approach.

Beacon House
Staff at Beacon House took the online Bucket Approach training and secured a mini-grant to implement it.

The premise for the Bucket Approach 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 readiness to quit into “buckets” as a way to best empower them to succeed. All interventions are tailored to people who smoke who also cope with mental illness and/or other addictions. The Bucket Approach Training is a FREE online training for healthcare providers that includes 8.25 free continuing education credits.

However, only seven percent of trainees said the credits were their primary motivation for taking the course. More than 37 percent said they wanted to learn more about how to treat tobacco dependence, and 25 percent wanted to learn how to help clients quit smoking.

“I think this is interesting because it speaks to behavioral health clinicians’ strong desire for this training,” Christiansen said.

“The Bucket Approach training is an excellent resource for behavioral health providers to learn how to help their client’s quit tobacco,” said Karen Conner, who manages the Wisconsin Nicotine Treatment Integration Project (WiNTiP). “Because the training is online, providers can complete the training at their own pace. The training will be especially beneficial for those providers who, under the revised Wis. Admin. Code Chapter DHS 75 revision, are required to assess their patients for concurrent tobacco use disorder.”

Bucket Approach by profession

Here’s a breakdown of the trainees by career focus:

  • Behavioral health, 65%
  • Medicine in general, 15%
  • Tobacco control, 11%
  • Other, 9%
Ashland County Communicty Services Programs
Ashland County Communicty Services Programs

Of those who worked in behavioral health, the researchers reported that 45 percent worked in a treatment setting that treats both mental illness and substance use disorders; 39 percent in a treatment setting that treats only mental illness; nine percent in a treatment setting that treats only substance use disorders; five percent work in behavioral health but not in a treatment setting; and three percent work in another type of treatment setting.

Approximately 70 percent were front-line staff and 10 percent were administrators. About 90 percent offered outpatient care, 65 percent day treatment, 30 percent residential, 23 percent inpatient and 15 percent detox (and some offered more than one of these levels of care).

“A fair number of enrollees were certified tobacco treatment specialists (CTTS),” Christiansen said. “This was unexpected and underscores the value of this training to even seasoned clinicians.”

The approach, offered via eight hours of online training on demand, is designed to be straightforward, practical, and adaptable. Before training, only 18 percent felt confident they could treat tobacco dependence. Afterward, 40 percent felt prepared.

Trainees like Valerie Levno, Comprehensive Community Services (CCS) Administrator at Ashland County Community Service Programs, have appreciated the opportunity to take the free online training, and the need for it.

“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,” said Levno. “We look at people holistically, and tobacco use is something we want to pay attention to and address.”

Online availability of the Bucket Approach is funded by the Wisconsin Division of Care and Treatment Services and Tobacco Prevention and Control Program. Donna Reimer, the grant administrator and co-author of the paper, and Keri Schneider, the contract administrator, serve on the WiNTiP Steering Committee.

“We thank Donna, Keri, Vicki Huntington and everyone at the state for all their support and collaboration to make the Bucket Approach available online and free for clinicians,” Conner said.

Christiansen B, Riemer D, Conner K, Fiore MC. (2022) The Bucket Approach: Developing and Implementing an Online Training Program in Tobacco Dependence Interventions Tailored for Behavioral Health Clinicians. Community Mental Health Journal. Online September 2022.