The Council for Tobacco Treatment Training Programs is recognizing programs that excel in meeting the highest training standards in preparing and developing professional Tobacco Treatment Specialists. One program will be chosen each month for the award, and will be highlighted with a citation, as well as recognition on the Council's website.

Small group work during a June 2019 training

Program Name: Duke-UNC Tobacco Treatment Specialist (TTS) Training Program

Contact email: cttsprogram@duke.edu

How long has the program been operating? Since 2016

Number of specialists who have completed the program? 633

What have specialists who have completed your program stated in evaluations?
Here are some statements from participants in our 2020 virtual trainings:

"As a former smoker, I wasn't sure I was the right person to try and help others quit. But the education and expertise provided through the Duke-UNC TTS  Program has given me the confidence to know I am capable of helping others looking to make positive changes in their health and in their lives. I can't wait to get our program started."

"I can use all aspects of this program to prepare respiratory therapy students to be effective in tobacco cessation. It will also help me when I speak to middle, high school and community college students when speaking with them regarding tobacco and vaping. I can also use this in my PRN job as a RRT at a small community hospital with many disparities."

Successful course completion! (October 2019)

"The parts that were most valuable to me were the breakout sessions, especially those on the last day of the training. I also enjoyed the situation examples which use real life examples of how to practice what we were taught."

"The entire training was valuable. Overall, I appreciated learning about the impact of tobacco use on the body, the NRT, and resources available to people who are interested in quitting."

 "The TTS virtual training was a great experience and I learned a lot. Being all the way in Hawaii it is not always easy to have access to courses and training. The Duke-UNC TTS staff made this possible and I am grateful that I could accomplish this training which was important to the organization and myself."

How do you tailor your program to keep learners engaged with the content and materials?
We tailor both the content and delivery of our curriculum to maintain participant engagement in our virtual trainings. We look closely at each specific participant cohort--where they are from, their organizational affiliations, what skills they indicate they most want to learn in the course--and we are able to customize the small group breakout sessions throughout our virtual classes (using Zoom breakout rooms). For example, in our fall 2020 training, we had a sizeable cohort of individuals working in tribal health. We engaged our state's American Indian TTS to facilitate breakout groups specifically addressing the unique needs of tribal communities. In this way, our TTS participants have opportunities to learn from experts in these specific areas and a space to practice applying the skills that they will bring back and use in their own unique communities.

We also pay close attention to how we structure our virtual sessions. Our virtual sessions run for half days scheduled over the course of two weeks to allow participants--mostly busy healthcare professionals--to manage other work or family obligations. We recognize that Zoom fatigue is a real issue these days, so we are intentional about keeping our virtual sessions highly interactive. Our online course portal, which is available to students for several weeks before and after the virtual sessions, provides an opportunity for students to engage with the curriculum over an extended period of time, as well as connect offline with course faculty and other participants.

Describe your program outcomes in one word. Stellar!

What do TTS participants report gaining from the program?
Participants report gaining confidence to implement the skills they have learned into their own practice. Participants also gain an understanding of the nuances and complexity in treating tobacco use and emerge with an understanding that treating tobacco use is not a "one size fits all" endeavor.

What makes your program stand apart? What is unique about it?
The Duke-UNC TTS Training program, offered each year in March, June, and October, combines the skills of three organizations that, taken together, help clinicians, health systems, and public health professionals provide tobacco treatment at the individual, systems, and population level.  Dr. James Davis and his team from Duke have demonstrated excellence in research and teaching pharmacotherapy methods for tobacco cessation. Dr. Adam Goldstein and his team from UNC Family Medicine have a 20-year history and solid track record of providing, teaching, advancing, and evaluating the integration of evidence-based tobacco treatment methods into health systems. Sally Herndon and team at the Tobacco Prevention and Control Branch, NC Division of Public Health, places these intervention strategies within the history, culture, and context of population-based policy, systems, and environmental change. We also provide all program participants with our 450-page training manual co-authored by our faculty and other experts in the field as a durable resource.

Is your program accomplishing its intended results?
Our program began with a desire to "raise the bar of tobacco treatment" for North Carolina residents and help them to actually experience success in their attempts to quit tobacco use. Historically, tobacco treatment was being provided to residents of North Carolina by a variety of healthcare providers, and treatment ranged from just a brochure to comprehensive treatment with medications and counseling. By providing this tobacco treatment training program in our state initially, we would be able to promote the Standard of Care in tobacco treatment for anyone who sought assistance.

We are unequivocally on the right track to accomplish our lofty goal! More than 600 health care providers throughout North Carolina, across the US, and even internationally have attended our training. In North Carolina, we promote the Standard of Care with our program endorsement, and many see this promise come to life. Key Medicaid representatives have attended the training and will use the Standard of Care as a quality measure when looking at tobacco treatment plans required by the Medicaid MCOs. We have targeted and trained behavioral healthcare providers, dentists, pharmacists, prescribers, prenatal/pregnancy care nurses and managers, health departments, respiratory therapists, nurses, and even health educators. We are creating a statewide network of tobacco treatment programs and providers and will even be able to triage residents who use tobacco to face-to-face group and individual programs through QuitlineNC, our state quitline.

We have more work to be done, as North Carolina still has 1.5 million people who smoke and 14,200 state residents dying each year as a result, but the Duke-UNC TTS Training Program is up to the task!

Name one challenge your program encountered and overcame.
The Duke-UNC TTS Training Program is highly interactive and gives participants knowledge and skills-based practice. When the COVID-19 pandemic hit, we were tasked with maintaining the dynamic, interactive nature of our in-person training in a 100% online format. The blended format that our team developed--a combination of online, asynchronous video modules and virtual, synchronous sessions with our course faculty--has helped us maintain those features while actually improving our course. Our virtual format has also increased access to this course not only for NC practitioners but for practitioners across the U.S. and internationally.

What else should we know?
We are piloting a new series of one-day advanced trainings designed for physicians, physician assistants, nurse practitioners, pharmacists, and behavioral health providers who work with tobacco use treatment. The courses, which provide CME, are ideal for individuals who have already received training as a TTS and wish to deepen their knowledge. Our first 2021 one-day training offerings are Tobacco Dependence Pharmacotherapy (March 25) and Intensive Behavioral Approaches to Tobacco Treatment (May 4).

Thank you for your continued excellence!