A ClientGenerated Strategy for Smoking Cessation for the Severely Mentally Ill - PowerPoint PPT Presentation
1 / 36
Title:
A ClientGenerated Strategy for Smoking Cessation for the Severely Mentally Ill
Description:
Smoking as a ... dimension is more important than the specific focus on smoking per se ... participant had quit a smoking cessation group at CSI because ... – PowerPoint PPT presentation
Number of Views:167
Avg rating:3.0/5.0
Title: A ClientGenerated Strategy for Smoking Cessation for the Severely Mentally Ill
1
A Client-Generated Strategy for Smoking Cessation
for the Severely Mentally Ill
- William Collinge, Ph.D. Tom McLaughlin,
Ph.D.(c) - Univ. New England/Spurwink Center for Research
- Portland, Maine
- Sherry Sabo, Ph.D.
- Counseling Services, Inc., Saco, Maine
2
I.PROGRAMDESCRIPTION
Exploring lay epidemiology...
3
Purpose
- Employ active clients (smokers) attending a
community mental health center as paid
consultants in the conceptualization and
development of a program of support for clients
who smoke.
4
Program
- 10 meetings
- 12 CSI clients (4 men, 8 women) participated
- All smokers and members of ACT teams (Assertive
Community Treatment) - Average 5.3 sessions of attendance per client
5
Recruitment
- Clients were informed by their therapists
- Clients contacted the project manager directly
- Incentives
- Payment for their time and expertise -
10/session - Opportunity to provide authoritative leadership
in development of programming relevant to them - Paid cab fare for those who needed it
6
Consultant agreement
- All clients signed a Consumer Consultant
Agreement - Purpose of the program
- Payment arrangement
- Meeting dates
7
First session
- Review of the Consumer Consultant Agreement
- Reiteration of the purpose of the program
- Not a treatment program
- No personal or private information was sought
- No confidentiality agreement needed
- Clients are regarded as experts and that their
views and experiences of being smokers and
clients of a mental health center would be highly
valued - Introductions
- Why the project was of interest to you
- Brief comments about smoking history
8
Participant characteristics
- All were in either the contemplation stage or the
preparation stage - Several expressed their intention to use the
group to help them move toward quitting - Age at onset of smoking ranged from 5 to 20
- Several began under age 9
- Most began in their teens.
- Smoking was the norm for adults in family
background.
9
Reasons for smoking
- Chronic physical discomfort
- History of physical problems
- I want to feel better
- It helps me with my nerves (panic and anxiety
disorder) - Calms my nerves
- Helps me relax
10
Reasons for smoking
- Smoking is a stress reduction technique
- Helps me focus
- Helps me worry less, gets my mind off other
things - Pleasurable taste
- Something to do play with smoke rings,
manipulate with my fingers
11
- Its been like an old friend for 27 years
- Cigarettes wont let you down the way people
will.
12
Experiences of the social dimensions of smoking
- Vacuum of social support and connectedness for
most of their lives. - Smoking as a social lubricant
- Social connectedness and support e.g., standing
outside together to have a smoke affords a level
of intimacy and rapport.
13
- It helps me get to know people better, its a
bonding ritual. - When Im with people who are not smoking, its
easier for me not to smoke
14
Social perceptions
- Scapegoated
- Stigmatized by society
- Need for more compassion, empathy, and
understanding by non-smokers
15
Experiences with medical support
- Difficulty in accessing prescription-based aids.
- Many were given aids such as patches, cartridges
and gum - Lack of accompanying counseling or psychological
preparation or for how to use these methods
successfully - Conclusion these the aids dont work.
- Personal sense of failure
16
II.CONSULTANT RECOMMENDATIONS
- An approach that respects lay epidemiology...
17
Program philosophy
- Support group for people who smoke rather than
a smoking cessation program - Need social support in a more general sense, and
smoking reduction or cessation is unlikely to
happen without a great deal of support. - When support is present, the intention and
commitment to quitting can then grow stronger
over time
18
- The social support dimension is more important
than the specific focus on smoking per se - Unconditional acceptance, interpersonal safety
- Non-competitive, non-shaming, non-confrontive,
and non-pressuring - Conservative of praise as well, so as not to
engender shame or embarrassment when people
backslide - Spontaneous reinforcement of one another
19
Format
- All of the participants had prior experience in
AA or other addiction treatment approaches
similar to the AA model. There was a very strong
consensus that something similar to the AA model
(but not exactly) would be a good place to start
for a smoking cessation program. - Confidentiality agreement
20
Eligibility
- Participation in the program would be open to
people who are at any stage of the Stages of
Change model in relation to smoking.
21
Goals
- Cutting down rather than quitting completely
- No pressure or expectation to quit
- People can fall down and not feel ashamed
22
Buddy system
- A buddy system could be used as an alternative to
a sponsor system. - Mutual support between meetings
- Do not smoke together and do not smoke while
talking with each other on the phone
23
Educational component
- Guest speakers and multimedia presentations
- Strong visual messages are helpful for motivation
to cut down or quit - Objective information about the effects of
smoking. - Group members choose guest speakers
24
Educational topics
- How smoking affects medication
- How much nicotine dependence is psychological
versus physical? - How can you change the thought patterns?
- What are the different strategies available
different things work for different people - Stress reduction techniques
25
Other support
- Medical support should be available
- Concerns about side effects should be addressed
- Other modalities of support massage, bodywork,
acupuncture, other complementary therapies, and
counseling
26
Co-facilitators
- Co-facilitated by a paid peer and a professional
counselor - At least equal in responsibility for leading
- Peer leadership important
- Keep the discussions supportive
27
- Do NOT try to motivate people to quit smoking.
- (One participant had quit a smoking cessation
group at CSI because she had been asked to report
a count of how many cigarettes shed had that day
and felt ashamed.) - Facilitators must be unconditionally accepting
and non-judgmental.
28
Agency role
- Open-ended and permanent commitment by the agency
- People will need to be able to come and go and
come back a few months later - People might come to 10-15 meetings, quit
smoking, slip, and come back. - Clinician should have this responsibility built
in to his/her caseload, regardless of how many
people show up. (Grant funding?) - Provide transportation to the meetings.
29
III.OUTCOMES
30
Participant outcomes
- Several participants came to the consulting group
looking for support to stop or reduce smoking. - Gail quit completely by the fifth session and had
remained smoke-free at the tenth session - This is the group that helped me the most to
quit smoking. It was the fact that we agreed that
we didnt have to quit, there was no pressure.
31
- Jane reported by the tenth session that she had
cut down and never expected to - We just sat around and talked, there was no
stress in the group. The group had no
expectations of success. Ive quit smoking in my
bedroom and in common areas of the house. I only
smoke in the bathroom now. Ive gone from a pack
a day down to six on a good day, twelve on a bad
day. My grand daughter (three year old who lives
with her and accompanied her to the meetings) is
the love of my life, Im doing it for her, also
because of this group.
32
Consensus
- Being able to just talk, with no pressure or
expectations, enabled the consultants to explore
their own intentions in a way which apparently
enabled those intentions to strengthen.
33
Conclusions
- A positive and supportive group process naturally
brings out peoples tendency to move toward
health, even in relation to smoking. - In the absence of any expectation to quit or
reduce smoking, the intention and desire to do so
seemed to grow. - Several had significant reductions and one was
smoke-free for the last five weeks. - Participants spontaneously created the type of
environment they were envisioning for a future
program and reaped the benefits of it.
34
Conclusions (contd)
- Participants felt they know what they need, and
it is not a formal or highly structured or
professionalized smoking cessation program per
se. - The climate of unconditional positive regard, no
expectations, and simple exploration of their
experience had the paradoxical effect even in
participants who did not expect or believe they
were capable of those feelings.
35
Future directions and challenges
- Currently experimenting with implementation
- WINGS (Wellness Inspiration Networking Groups for
Smokers) - Relationship with the new Collaborative Care
Project - Considering a two-level approach
- WINGS
- Structured smoking cessation program adapted for
clients with persistent mental illness
36
Fini
Recommended
CrystalGraphics Presentations
