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Open Access Adapting and Evaluating Implementation of a Tobacco-Free Workplace Program in Behavioral Health Centers

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Objectives: State-administered community behavioral health centers (CBHCs) rarely treat tobacco dependence, despite high client tobacco use. Using a mixed-methods approach we examine the adaptation and implementation of an evidence-based tobacco-free workplace (TFW) program in 2 CBHCs (17 individual clinics). Methods: Varied data collection included pre- and post-implementation leader, clinician, and staff surveys; pre-, mid-, and post-implementation staff and client focus groups; and monthly implementation logs. The RE-AIM framework guided translation of behavioral interventions into sustainable practice. Results: Pre- to post-implementation increases were seen in training receipt among clinicians and employees. Both CBHCs adopted a 100% TFW policy, integrated tobacco screenings into routine practice, and delivered evidence-based practices (EBPs). Qualitative methods enlisted key stakeholders contributing towards adapting program strategies to local contexts, addressing barriers, adjusting tobacco screening administration, and understanding reasons for success or failure to implement specific components. Conclusions: Program implementation at both CBHCs increased organizational capacity in the provision of EBPs to treat tobacco dependence through successfully meeting the majority of our RE-AIM targets. Findings contribute to the development of flexible strategies and interventions responsive to variable implementation contexts and barriers; enhancing the effectiveness and sustainability of a TFW program.

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Keywords: BEHAVIORAL HEALTH; MIXED METHODS; TOBACCO CONTROL

Document Type: Research Article

Affiliations: 1: Isabel Martinez Leal, Senior Researcher Social and Behavioral Science, University of Houston, Department of Psychological, Health, and Learning Sciences, Houston, TX, United States;, Email: [email protected] 2: Tzu-An Chen, Research Assistant Professor, University of Houston, HEALTH Research Institute, Houston, TX, United States 3: Virmarie Correa-Fernández, Assistant Professor, University of Houston, Department of Psychological, Health and Learning Sciences, Houston, TX, United States 4: Kathy Lee, MD candidate, Long School of Medicine University of Texas Health Science Center, San Antonio, TX, United States 5: Daniel P. O'Connor, Professor, University of Houston, Department of Health & Human Performance, Houston, TX, United States 6: Bryce Kyburz, Taking Texas Tobacco-Free Program Manager, Integral Care, Austin, TX, United States 7: William T. Wilson, Director of Population Health (retired), Integral Care, Austin, TX, United States 8: Teresa Williams, Director of Clinical Services, Integral Care, Austin, TX, United States 9: Lorraine R. Reitzel, Professor, University of Houston, Psychological, Health and Learning Sciences, Houston, TX, United States

Publication date: November 1, 2020

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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