@article{e3ee425450384ffa8148ecf1ae8d00a8,
title = "Self- Evaluation Tool to Support Implementation of Treatment for Tobacco Use Disorder in Behavioral Health Programs",
abstract = "Tobacco use in people with behavioral health conditions remain two to three times higher than the general population causing premature death and impacting recovery negatively across several domains. Intermediary organizations can provide practical tools, training, and technical assistance to help programs improve capacity to treat tobacco use. This report describes the construction and application of the Tobacco Integration Self-Evaluation Tool (TiSET) for behavioral health programs, a 20-item scale inspired by the DDCMHT and additional content from the Facility Tobacco Policy and Treatment Practices Self-Evaluation tool that one of the study authors (JW) used previously with addiction treatment programs. Completing the TiSET is an important step for behavioral health programs to evaluate their ability to effectively treat people that use tobacco. An important next step is to use those results to facilitate a quality improvement process. We include large agency example illustrating how the TiSET can be applied in real-world practice.",
keywords = "Behavioral health, Fidelity, Implementation, Intermediary, Self-assessment, Tobacco",
author = "Covell, {Nancy H.} and Forrest Foster and Noah Lipton and Emily Kingman and Jeanie Tse and Annie Aquila and Williams, {Jill M.}",
note = "Funding Information: There are several limitations worth noting. First, the instrument has not been subjected to rigorous reliability and validity testing, which was beyond the scope of what the intermediary was funded to provide. We sought to mitigate some of these concerns by modifying an established valid and reliable scale, the DDCMHT, for assessing co-occurring disorders more broadly and tailoring it for one substance, tobacco. Additionally, given that the DDCMHT and its variants have been used widely across behavioral health settings, the TiSET tool may offer program staff a familiar approach to assessing a program{\textquoteright}s compliance with specific elements of the program model. Second, while the gold standard for programs ratings is to have an objective rater visit a program and complete and assessment, (Bond & Drake, ) the TiSET is designed as a self-assessment instrument. While self-assessment might lead to bias under certain conditions (e.g., when licensing depends upon proving model fidelity), there is some emerging evidence that, when supported as part of a quality-improvement process without penalty, self-assessment and independent fidelity ratings do not differ significantly from one another (Covell et al., ,; Margolies et al., ). Further, one study demonstrated a significant positive relationship between self-reported fidelity and outcomes (employment) that was sustained for a year (Margolies et al., ). Third, the agency described herein is a large well-resourced agency. It is possible that smaller agencies with fewer resources may not have the resources to participate in a similar process, though it is also possible that greater change could be achieved with a less heterogenous group. Future studies should include smaller agencies to determine whether this approach is feasible or whether modifications are needed to support agencies with fewer resources. Finally, to date, the use of the TiSET has been supported by an intermediary organization that is funded by The New York City Department of Health and Mental Hygiene to provide free essential support to help organizations use the ratings to develop an implementation plan to enact and sustain changes. Across evidence-based practices, this support can greatly enhance successful implementation (e.g., Margolies et al., ; Cheron et al., ; Thorning & Dixon, ; Covell et al., ,). While we designed the TiSET and supporting documents to allow organizations to self-direct this process, some programs may not have the resources to proceed without external support. Additionally, in areas where intermediary assistance is not free, programs may not have the resources to pay for this support. Future studies should examine the extent to which organizations are able to use these resources to effect change in a self-directed way. Additionally, state and city governments, along with other payers, should strongly consider funding intermediaries to support their behavioral health providers implement evidence-based practices broadly, including co-occurring behavioral health and tobacco addiction. Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",
year = "2022",
month = may,
doi = "https://doi.org/10.1007/s10597-021-00890-x",
language = "American English",
volume = "58",
pages = "812--820",
journal = "Community Mental Health Journal",
issn = "0010-3853",
publisher = "Springer Netherlands",
number = "4",
}