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Step 1. Establish a Sense of Urgency and Preliminary Organizational Goals

Addressing tobacco addiction in mental health and addiction treatment settings requires changing the culture and recognizing the urgency of changing our practices to help individuals quit tobacco. Tobacco addiction shortens the lives of our patients/clients and staff who smoke; it causes or worsens medical diseases; and it retards recovery. As with other addictions, tobacco use is a trigger for those trying to quit because of its association with other substances. Staff and patients/clients all need to clearly understand why we must address tobacco now and how it affects both recovery and lifespan. The first step in the change process is to acknowledge the problem of tobacco, agree to change the culture, and select initial broad goals.

Change is more likely to occur if the leadership of your agency strongly and openly supports this initiative. In the ATTOC Approach, a “Champion” is selected to lead the initiative. Often one or two “co-Champions” provide additional help. The Champion / project manager helps the agency develop the initial broad goals (including patient, staff, and environment goals), a leadership team, and ongoing project management. If funds are available, the champion may

also contact / hire a consulting team to help with the whole initiative. The UMass ATTOC consultation team has helped hundreds of agencies across the nation and also worked internationally.

Once an agency’s leadership recognizes that addressing tobacco is critical to its mission of promoting well-being and recovery in its clients, the agency is ready to begin work on the major tasks included in the ATTOC intervention. The first step includes five tasks.




Task 1. Consider retaining the assistance of the UMass ATTOC consultation team.

Many agencies fintasksd it helpful to work with knowledgeable consultants who can provide technical assistance as they develop and implement a strategic plan for change.

Task 2. Identify project leader (Champion) and co-Champions.

The Agency Leader or designee must identify a project leader (Champion) and potentially one or two co-Champions to guide the change process and create a Leadership Team. It is important to inform and gain the support of key “sponsors” on the Board of Directors, Unions, staff leaders, etc. The commitment to the need for culture change at your institution should be clear and explicit. Sponsors’ support is vital for success.

Task 3. Articulate a preliminary vision for organizational change.

Champions discuss and document a tentative vision of a changed agency that addresses tobacco use and addiction. A vision describes how your organization will look in the future, including what is motivating this change. It should convey an urgency for addressing tobacco, reference the areas to change, and inspire staff.

Task 4. Identify tentative strategic goals in three areas: patient, staff, and environment.

The agency should have broad patient/client, staff, and environment goals that will lead to the development of specific strategies and tactics to achieve the goals. These goals will be refined as change moves forward and more staff become involved.

Task 5. Test goals through internal communication.

Once tentative goals are identified, these should be discussed with staff to assess readiness and ways to achieve the goals. Staff need to know why this initiative is happening, what they will do differently, and what benefits they can expect as a result of these changes.