In Partnership with and Funded by the Arizona Department of Health Services. Office of Tobacco...

In Partnership with and Funded by the Arizona Department of Health Services. Office of Tobacco Education and Prevention Program (AzTEPP)

The University of Arizona Health Sciences Center State of Arizona © 2003

Replication to Reduce Cost and Assure OutcomesThe Arizona Certification Model

Presented by:

Louise J. Strayer, B.S., R.N., M.S. HealthCare Partnership Continuing Education & Training Unit

Lila Johnson, R.N., M.P.H., C.H.E.S. Hawai’i State Department of Health Tobacco Prevention and Education Program

Arizona Department of Health – Tobacco Education and Prevention Program

Session Objectives

1. To review the guiding principles and core components

of the Arizona Tobacco Cessation Certification model.

2. To describe content, evaluation design, and

implementation results of the Basic Tobacco

Intervention Skills Certification in Arizona and Hawai’i.

3. To compare the cost of developing/implementing the

Arizona Tobacco Cessation Certification model with a

replication/implementation experience in Hawai’i.


Mission Statement Arizona Department of Health Services

Tobacco Education and Prevention Program

Based on a belief in excellence, inclusiveness

and integrity that honors individual culture

and religious practices, the AzTEPP mission is

to protect and improve the health and quality

of life of all Arizonans by reducing tobacco

use through prevention and treatment by

denormalizing tobacco use and by reducing

exposure to environmental tobacco smoke.


Arizona Department of Health Services Tobacco Education and Prevention Program

www.TEPP.org

HealthCare Partnership Continuing Education & Training Unit

Media/PR Campaign

Community-based Local Projects

AzTEPPEvaluation Unit

Arizona Smokers’ Helpline,

Information and Internet Services

Arizona HealthLinks


Background

Arizona has a proven comprehensive tobacco

control program: Adult prevalence of tobacco use significantly

decreased in three years: from 23.1% (1996) to 18.3% (1999).

Caveats: The tobacco cessation certification model is one

component of Arizona’s comprehensive tobacco education and prevention program.

Certification is contractually mandated for funded agencies/individuals providing cessation services.


Arizona Certification Program Guiding Principles

Population-based and Inclusive All community-based Local Projects and their

cessation providers Clinicians, systems, service organizations, individuals

Capacity building and Sustainable Training-of-trainer model American Heart Association (AHA) “CPR” and

Advanced Cardiac Life Support (ACLS) model


Guiding Principles Continued…

Evidence-Based Approach Agency for Health Care Policy and Research

(AHCPR) guideline revised to reflect Public Health Service Guideline

Adapted for Special Populations

Theoretical Foundation Social Cognitive Learning Theory Adult Education Methods and Techniques

Inspire Community Participation


The goal was to increase capacity in local communities to provide effective tobacco

cessation services through;

Teaching evidence-based practices;

Conducting sound evaluation.


Continuing Education, Certification, and Training Program

CERTIFICATION Two tiers: Basic Tobacco Intervention Skills and

Tobacco Treatment Specialists Face-to-Face instruction Skills demonstration Distance learning Written examination

Offered to all AzTEPP funded community-based Local Projects

Available to all interested Arizonans


Continuing Education, Certification and Training Program

CONTINUING EDUCATION Tobacco Dependence Treatment Continuing

Education Program for Healthcare Professionals

SYSTEMS TRAINING Healthcare Workplace School


Continuing Education, Certification, and Training Program

Certificatio

n

Instructor Certification

Systems Training

Healthcare Professional

Program

Basic TobaccoIntervention Skills

Basic Tobacco Intervention Skills Instructor

Tobacco Cessation in Healthcare Systems

Tobacco Dependence Treatment Continuing Education Program

Tobacco Treatment Specialist

Tobacco Treatment Specialist Instructor

Tobacco Cessation in the Workplace

Tobacco Cessation in Schools


Basic Tobacco Intervention Skills Certification


• Purpose: prepare participants to deliver brief tobacco

cessation interventions

Adapted Basic Tobacco Intervention Skills Certification

• Native American

• Spanish Language and Culture

• Maternal & Child Health [Women, Infants and Children

(WIC)]

• Medical School and Allied Health Professionals


Content:• 4 hour course (instructor : student =1:8)

• CME/CEU approved

• Requirement of all AzTEPP funded community-based

projects

• Topics covered: Tobacco use dependence Stages of Change Public Health Service Guideline: 5 A’s

• Objectives: Assess level of readiness to quit Deliver a stage appropriate brief intervention Knowledge of resources and ability to refer



Evaluation Design:

• Knowledge (pretest, posttest: 3mos., 6mos.)

• Skills demonstrations (three stages)

• Self-efficacy (pretest, posttest: 3mos., 6mos.)

• Post-certification activities (survey: 6mos.)




CategoryCategory ArizonaArizona Hawai’iHawai’i

Time Period 12/98 – 12/9912/98 – 12/99 12/02 – 11/0312/02 – 11/03

Total Participants 947947 283283

Total Certifications Issued947947 260260

Average Score on 25 Item Post-Certification Knowledge Test

90.1%90.1% 91.0%91.0%

Average Number of Partici-pants who passed the 53 Item Skills Demonstration

99.4%99.4% 91.5%91.5%


Basic Skills CertificationSelf Efficacy Measurements

1. I can accurately assess my client’s motivation to

quit.

2. I can explore issues related to smoking and

quitting, even with someone NOT INTERESTED in

quitting.

3. I can accurately assess the dependence level of

my clients.

4. I can provide clients with accurate information

regarding the health benefits of quitting.


Self Efficacy Measurements Continued…

5. I can personalize the benefits of quitting with

each individual client.

6. I can provide clients with simple advice and

instructions about nicotine replacement therapy.

7. I can help clients develop a personalized plan for

quitting.

8. I can arrange for appropriate follow-up for my

clients.

All pretest, posttest changes in self efficacy scores were statistically significant

(p<0.01)


I can accurately assess my clients’ motivation to quit.

Basic Skills Certification Pretest - Posttest Data

Definitely

Confident

Definitely Not

Confident

Average Change

AZ: 1.31

HI: 1.38

ArizonaHawai'i

Pre

Post

4.554.31

3.24

2.93

1

2

3

4

5


I can explore issues related to smoking and quitting, even with someone NOT

INTERESTED in quitting.


DefinitelyConfident

Definitely Not

Confident

Average Change

AZ: 1.26

HI: 1.33

ArizonaHawai'i

Pre

Post

4.43 4.33

3.173

1

2

3

4

5


I can help clients develop a personalized plan for quitting.


DefinitelyConfident

Definitely Not Confident

Average Change

AZ: 1.20

HI: 1.79ArizonaHawai'i

Pre

Post

4.564.51

3.36

2.72

1

2

3

4

5



DefinitelyConfident

Definitely Not Confident

I can arrange for appropriate follow-up for my clients.

Average Change

AZ: 1.55

HI: 1.68Arizona

Hawai'i

Pre

Post

4.56 4.51

3.36

2.72

1

2

3

4

5


Basic Skills CertificationParticipant Satisfaction

Selected QuestionsSelected Questions ArizonaArizona Hawai’iHawai’i

How useful were the

certification materials?

4.744.74

(SD=0.48)(SD=0.48)

4.724.72

(SD=0.55)(SD=0.55)

Was the content of the

certification course

professionally relevant?

4.424.42

(SD=0.75)(SD=0.75)

4.634.63

(SD=0.71)(SD=0.71)

How would you rate the

overall quality of the

certification course?

4.534.53

(SD=0.73)(SD=0.73)

4.704.70

(SD=0.58)(SD=0.58)


Arizona Basic Skills Participants Post-Certification Activities

(6-month follow-up)

Post-Certification Activities Post-Certification Activities ArizonaArizona

Performed at least one brief intervention.

80.9%80.9%

Made at least one referral to a local intensive cessation service or the Arizona Smokers’ Helpline.

74.8%74.8%

Average Brief Interventions conducted per month (self-report).

11,42011,420

Average Brief Interventions performed per individual (self-report).

1212


Methods & Techniques to Support Replication

• Systematic framework Algorithm Video Tapes Skills Demonstrations Client Materials Knowledge Examination

•Standardized Evaluation Process

•Web-based database


Arizona Basic Skills CertificationSpanish-Adaptation


Basic Tobacco Intervention Skills Certification Cost Comparison

ARIZONAARIZONA

Design

Development

Implementation

Revisions

Testing

FY 1 = $1.0 M

FY 2 = $1.7 M

$2.7 M

HAWAI’IHAWAI’I

Adaptation

Certification of Core Group

Implementation

Evaluation

FY 1 = $60,000


Results of Replication Initiative

The Arizona Basic Tobacco Intervention Skills

Certification Model:

Has potential for National/International adaptation/replication.

Demonstrates cost saving of replicating a tested model of certification.

Shows statistically significant and durable increases in participants’ self-efficacy.

Establishes evidence of participants transfer of learning.

Increases population exposure and therefore public health impact of brief interventions.


Number Certified in Arizona by 06/30/03:

• Basic Skills: 3,771

• Spanish Basic Skills:

75

• Native American Basic Skills: 93

• Maternal & Child Health Basic Skills: 115


In partnership with and Funded by the Arizona Department of Health Services. Office of Tobacco Education and Prevention Program (AzTEPP)

The University of Arizona Health Sciences Center State of Arizona © 2003

Louise J. Strayer, B.S., R.N., M.S. HealthCare Partnership Continuing Education & Training Unit

Arizona Department of Health Services Office of Tobacco Education & Prevention Program

Contact Information:

The University of Arizona

Mel & Enid Zuckerman Arizona College of Public Health

2030 East Speedway Boulevard, Suite 120

Tucson, AZ 85719

[email protected]

520.318.7253 x162

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