title: Increasing tobacco dependence treatment through continuing education training for behavioral health professionals.
abstract: OBJECTIVE
  Few continuing education programs to train behavioral health professionals to deliver tobacco treatment services have been described and evaluated.
  
  
  METHODS
  The effectiveness of two-day training on changing practice was examined by review of clinical charts from 20 clinicians who attended in 2012. Ten medical records were randomly selected for review from each clinician's outpatient practice at a large behavioral health system. Five charts from smokers seen within six months before and after training were reviewed per clinician, for a total of 200. Records were electronically searched on "cigarette," "nicotine," "tobacco," "quit," "smoking," and "smoke." RESULTS were compared via chi square tests (all p<.05).
  
  
  RESULTS
  Almost half of the smokers indicated that they were interested in quitting, although baseline rates of tobacco use treatment were very low. Documentation of tobacco use significantly increased between baseline and posttraining, both on the problem list (35% versus 74%) and treatment plan (20% versus 60%). Also posttraining, clinicians advised significantly more outpatients to quit (9% versus 36%) or referred them to individual or group counseling. Discussion of nicotine replacement was documented more frequently in charts (10% versus 31%), and prescriptions for tobacco treatment medications increased significantly in the posttraining period, although overall prescribing remained low. The proportion of patients making quit attempts also significantly increased in the posttraining period (10% versus 39%), suggesting that providers were delivering more tobacco treatment than was reflected in charts.
  
  
  CONCLUSIONS
  An intensive training program for behavioral health professionals increased tobacco treatment and patient quit attempts. Strategies beyond training may be needed to enhance prescribing by these practitioners.
authors.affiliation: With the exception of Ms. Miller, the authors are with the Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey (e-mail: jill.williams@rutgers.edu ). Ms. Miller is with Rutgers University Behavioral Health Care, Piscataway, where Dr. Williams, Dr. Miskimen, and Dr. Minsky are also affiliated. Dr. Cooperman and Dr. Steinberg are also with the Rutgers Cancer Institute of New Jersey, New Brunswick.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Williams
authors.forename: Theresa
authors.initials: T
authors.lastname: Miskimen
authors.forename: Shula
authors.initials: S
authors.lastname: Minsky
authors.forename: Nina A
authors.initials: NA
authors.lastname: Cooperman
authors.forename: Michelle
authors.initials: M
authors.lastname: Miller
authors.forename: Patricia Dooley
authors.initials: PD
authors.lastname: Budsock
authors.forename: Jose
authors.initials: J
authors.lastname: Cruz
authors.forename: Marc L
authors.initials: ML
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D001524:Behavioral Medicine / Q000193:education*; D004496:Education, Continuing / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome