Core Competencies for Tobacco Treatment Specialists

PDF-16x16.gif AASCP Core Competency Standards PDF

Introduction

The Australian Association of Smoking Cessation Professionals (AASCP) is the peak body for the accreditation of tobacco treatment specialists (TTS) in Australia.  The Association aims to promote optimal smoking cessation practice by trained health professionals incorporating evidence-based interventions.

AASCP recognises the need for high quality training programs to address tobacco dependence and the development of national competency standards for tobacco treatment specialists to achieve this objective. 

In 2013, AASCP established the Training Review Committee to oversee the development of core competencies for tobacco treatment specialists.

The development of these core competencies involved a comprehensive review of local and international training programs, research evidence and best practice followed by other international organisations.  It included consultation with smoking cessation professionals, academics, trainers and medical advisers.

The development and review of these standards has focused on the key skills and knowledge required by health professionals delivering intensive tobacco treatment interventions in order to satisfy AASCP’s clinical membership and accreditation requirements.

AASCP’s core competencies for tobacco treatment specialists aim to ensure consistency in the delivery of TTS training programs in Australia.  These standards provide individual practitioners, training providers and strategic health authorities with a framework against which to measure current and future performance.

The standards provide training providers with the minimum core content areas and learning outcomes for the delivery of TTS training programs in Australia.

AASCP’s Training Review Committee is responsible for the review and accreditation of TTS training programs.  A training program which meets these standards will be deemed to satisfy the criteria for endorsement as an AASCP Accredited Training Program. 

Elements and Performance Criteria

ELEMENT PERFORMANCE CRITERIA

1. Knowledge of tobacco prevalence, use and harms 

Describe prevalence and patterns of smoking across different population groups in Australia and other regions.

Explain the societal and environmental factors that promote and inhibit the spread of tobacco use and dependence.

Describe the cultural, socio-economic, age and gender differences associated with tobacco use, including variations in smoking methods and prevalence between culturally and linguistically diverse (CALD) communities, Aboriginal and Torres Strait Islander populations and people with mental health and drug and alcohol issues.

Describe the adverse effects of smoking on health and premature death and the benefits of cessation at different ages.

Describe the harmful effects of smoking during pregnancy and breast feeding.

Describe the harmful effects of environmental tobacco smoke.

Describe the prevalence and methods of using electronic cigarettes and the risks and benefits of use.

Describe the prevalence and risks associated with illegal tobacco use (e.g., chop-chop).

 2. Knowledge of nicotine pharmacology, metabolism and dependence

Describe the pharmacokinetics, metabolism and neurobiology of nicotine including the upregulation of nicotine receptors.

Explain the term nicotine dependence and how it develops.  

Describe the genetic, environmental and biopsychosocial factors that contribute to nicotine dependence.

Describe the main features of the nicotine withdrawal syndrome and its time course.

Describe the common reasons smokers give for why they smoke and why it is difficult to stop.

Explain the effects of liver function on smoking and on the metabolism of certain medications.

Describe compensatory smoking in relation to reducing frequency of smoking or switching to lower tar cigarettes.

 3. Assessment

Identify evidence-based assessment tools and techniques for conducting tobacco use and dependence assessments.

Demonstrate ability to conduct an assessment interview including:

  • tobacco use history, including electronic cigarettes, chop chop and combined cannabis use
  • validated measures for assessing nicotine dependence
  • social history
  • previous quit attempts (e.g., length, methods used, successes, set backs, relapse triggers and relevance to current treatment)
  • current smoking cues and relapse triggers
  • challenges to quitting, such as weight gain and stress
  • previous use of pharmacotherapies and problems with the use of these medications
  • basic medical history and screening for psychiatric, substance use and other comorbid issues
  • current medications, especially those whose metabolism is affected by smoking
  • the need for COPD screening (e.g., respiratory function tests for smokers over the age of 35 years)
  • validated measures for assessing current motivation and confidence to quit or cut down
  • client strengths (e.g., past successful strategies, support networks, level of motivation and commitment to change)
  • smoking triggers and relapse predictors
  • risk of harm from second-hand smoke to others in the home environment
  • treatment preferences.

Demonstrate the use of the CO monitor as a motivational tool and a means of assessing and validating smoking status and determining NRT dosage.

Identify specific assessment and treatment issues for special population groups including:

  • pregnant and lactating women
  • people with mental health, drug and alcohol and other comorbid issues
  • adolescents
  • people from culturally and linguistically diverse backgrounds.

Identify situations that may require consultation and referral to other health services.

Identify medications that interact with tobacco smoke and the impact of smoking and smoking cessation on these medications.

Describe common myths reported by smokers about smoking and identify strategies to address these myths.

 4. Counselling

Demonstrate ability to establish rapport and an empathic, confidential and non-judgemental counselling environment.

Demonstrate ability to identify smoking cues and help clients to develop coping strategies for them.

Demonstrate the effective use of evidence-based counselling strategies to enhance motivation and commitment to change.

Identify and describe evidence-based behaviour change and lifestyle counselling techniques for tobacco cessation and relapse prevention.

Describe how cultural issues may affect tobacco use, dependence, cessation, help seeking behaviours and the appropriateness and inappropriateness of counselling interventions.

Describe strategies for responding to high risk client situations, e.g. psychosis, suicidal ideation.

 5. Pharmacotherapy

Identify current evidence-based pharmacotherapy treatments for tobacco cessation and emerging treatments.

Describe the benefits of combining pharmacotherapy and counselling.

Identify information relevant to current and past medical and psychiatric history and medication use that may impact pharmacotherapy decisions.

Describe the correct use, efficacy, adverse events, contraindications and known side effects for all tobacco treatment medications.

Demonstrate ability to accurately explain and make recommendations about tobacco treatment medications and assist clients in selecting and using an appropriate treatment.

Describe situations where combination and high dose medications are required to enhance the probability of abstinence.

Identify commonly held fears about tobacco treatment medications and strategies to address inaccuracies in patient information about medications.

 6. Treatment planning

Identify evidence-based tobacco treatment strategies.

Identify commonly used tobacco treatment strategies that are not supported by research evidence (e.g., hypnosis, acupuncture, laser therapy).

Demonstrate ability to collaboratively develop an evidence-based treatment plan including:

  • pharmacotherapy recommendations
  • cognitive and behavioural strategies including motivational strategies, problem solving and skills training, stress management and managing smoking cues
  • harm reduction strategies
  • relapse risk factors and prevention strategies
  • comorbid issues (e.g., drug and alcohol use)
  • other supports (e.g., online programs, telephone services)
  • consultation with other health providers regarding medications and adjustment of medications
  • reducing exposure of others to environmental tobacco smoke
  • referral pathways (as needed).
 7. Follow-up

Identify the key components of a tobacco treatment follow-up plan.

Identify when and how to adjust pharmacotherapies based on an assessment of self-reported cravings, withdrawal symptoms and CO measurement, and in accordance with current guidelines. 

Describe evidence-based cognitive and behavioural strategies for dealing with lapses/relapses and motivational issues during treatment.

Identify situations where referral may be necessary (e.g., for the treatment of comorbid issues and identify local referral options).

Evaluate treatment outcomes in accordance with evidence-based measures.
 8. Record keeping  Maintain accurate records that are appropriate to the setting in which services are provided and in accordance with professional codes of conduct.

9. Professional Development 


Maintain professional standards as required by professional licence or certification.

Identify professional development resources such as peer-reviewed journals, Cochrane Reviews, professional societies, websites and newsletters related to tobacco treatment.

Describe the implications of current research to the practice of tobacco treatment.


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