Use of organizational change strategies and personalized agency feedback improves addressing tobacco in behavioral health outpatient treatment settings

Douglas Ziedonis¹Robert A Schnoll²Orrin Myers³Thomas Anthony Chavez⁴Amy Bachyrycz³Cesar J Ojeda¹Frank T Leone⁵Mackenzie Hosie Quinn²Prajakta Adsul^6*

• ¹University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
• ²Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
• ³College of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
• ⁴Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, United States
• ⁵Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, Philadelphia, United States
• ⁶University of New Mexico, Albuquerque, United States

Introduction: Implementing evidence-based tobacco use disorders (TUD) interventions in community mental health agencies is critical given the low adoption rates for these interventions and the high rates of TUD amongst their patients that contributes to the high morbidity and shortened lifespans. Implementation efforts require changing organizational preparedness to integrate evidencebased interventions.Purpose: When the Addressing Tobacco Through Organizational Change (ATTOC) model was evaluated in a cluster-randomized trail (with 13 clinics, 610 clients, and 222 staff) and compared to an education only intervention, ATTOC was better at having more tobacco treatment, policies, and staff skills. This paper is a secondary analysis of only the ATTOC sites and examines whether cliniclevel preparedness is associated with improvement in the number of implementation activities and estimate the combined direct and indirect impact on patient referrals to evidence-based interventions for TUD.Methods: Seven sites applied the ATTOC model over nine months, with the ATTOC Environmental Scans (ES) done at baseline, 3, 6, and 9 months to assess: (1) environment outside and within building, (2) staff training and personal tobacco use, (3) clinical TUD services and documentation, and (4) tobacco policies. Summary statistics are provided and generalized linear mixed model analyses for repeated measures assessed time trends and relationships among composite preparedness, activities and number of referrals.Results: Over 9 months, significant improvements occurred in ES composite preparedness (p<0.001) and for individual ES areas (p<0.001 for each). Eight out of 11 Dashboard items showed significant changes, including more patients treated (p=0.002), tobacco discussions (p=0.022), provision of educational brochures (p=0.034), referrals to Nic A (p<0.001), in-house groups (p<0.001) and the State Quitline (p=0.012), and documentation in treatment plans (p=0.008). Both composite Preparedness (p=0.006) and composite Activities (p<0.001) were significantly associated with the number of composite Referrals.Significant TUD intervention uptake was found overtime through the ATTOC model organizational change intervention and tracking tools.