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Addressing Tobacco Through Organizational Change (ATTOC) Approach

Addressing Tobacco Through Organizational Change (ATTOC) Approach

The Addressing Tobacco Through Organizational Change (ATTOC) Approach is guided by seven core strategies and a 10-step process designed to help an agency systematically improve their tobacco addiction treatment for patients/clients and change their culture to better address tobacco. The ATTOC Approach is intended to be flexible to the unique needs, resources, and goals of any organization. Each organization begins at their own starting point based on what they have already accomplished and the resources available for this initiative.

Each organization determines their own Patient/Client, Staff, and Environmental goals and how to align these goals with their mission and other work. Examples of possible agency goals in each of the three areas include:

  1. Patient/Client goals - reduce rates of tobacco addiction through improved treatment planning, referral, and treatment on site.
  2. Staff goals - reduce rates of tobacco addiction among staff; provide staff with training and support to achieve patient/client goals.
  3. Environmental goals - initially restrict tobacco use on campus to reduce Environmental Tobacco Smoke, improve health for all, and reduce triggers for those trying to quit, with a longer-term goal for a tobacco-free campus.


The ATTOC Approach includes 7 Core Strategies:

The 7 Core Strategies are used by the UMass ATTOC Consultation Team in conjunction with the agency’s Tobacco Leadership team and Champion(s) in order to prepare the agency to begin the intervention and to support them in accomplishing the 10 Steps:

  1. Meetings and activities to prepare for the start of the intervention.
  2. On-site consultation at the agency, including Environmental Scan and training.
  3. Formation of the agency’s Addressing Tobacco Leadership Group.
  4. Formation of work groups to implement the agency’s change plan and achieve their Patient/Client, Staff, and Environmental goals through specific strategies and tactics.
  5. Identification and coaching of a Tobacco Treatment Specialist(s) at the local agency.
  6. Ongoing phone consultations and emails to provide ongoing technical assistance.
  7. Web-based supports.

The ATTOC 10 Steps occur in 3 Phases

Phase One (includes Steps 1 through 5) focuses on planning for change. In this phase, the organization establishes a solid foundation for addressing tobacco addiction by identifying the leadership team and work groups that will guide it through the change process, developing goals, and adopting strategies for communicating these goals to stakeholders.
In Phase Two (Steps 6-8), the organization implements the planned changes to achieve the Patient/Client, Staff, and Environmental goals through a range of strategies and tactics.
In Phase Three (Steps 9-10), the agency integrates and sustains change by ensuring the infrastructure exists to maintain the agency’s progress over time, including developing policies and standard operating procedures to support long term change.



1. Planning Phase (Steps 1-5) - Prepare and Organize
Step 1: Establish a Sense of Urgency and Preliminary Organizational Goals
Step 2: Establish a Leadership group and Prepare for Change
Step 3: Assess Organizational Readiness and do Environmental Scan
Step 4: Develop Written Change Plan and Realistic Time-Line
Step 5: Develop Written Communication Plan and Materials to Disseminate

2. Implementing Phase (Steps 6 – 8) - Change, Integrate, and Adapt
Step 6: Implement Patient/Clients Goals: Assessment, Treatment, and Empowerment
Step 7: Implement Staff Goals: Training and Staff Recovery
Step 8: Implement Environmental Goals: End or Restrict Tobacco Use

3. Sustaining Phase (Steps 9 – 10) - Document, Monitor, and Sustain
Step 9: Document Changes in Policies and Standard Operating Procedures
Step 10: Support, Encourage, and Sustain Organizational Change