If the funding for
quitlines is the backbone of our work and technology and operations the nerve
center, then the heart of quitlines must be found in the coaches/counselors
whose role it is to support, inform, and guide journies toward quitting and
health every day. We asked Stephen Michael, MS, the Director of the Arizona Smokers’
Helpline for his thoughts about what makes a good quitline coach.
The question of what makes a good coach has been a focus at
the Arizona Smokers' Helpline for over 5 years.
Regardless of how much we in the quitline community would like to find
the formula to make the coaching process equally effective no matter what coach
a tobacco user is assigned, we just cannot overlook the fact that all coaches
are not created equal and are not equally effective.
The work of Michael Lambert at Brigham Young University,
Scott Miller at the International Centre for Clinical Excellence, and Bruce
Wampold at the University of Wisconsin continue to point out that the methods,
formulas and models we use to provide treatment or coaching rarely, if ever,
demonstrate a winner amongst the group in overall effectiveness. Over and over again, we hear the same
message: "my coach made the difference." So how exactly can we narrow the gap amongst
quit coaches to maximize each individual’s potential in providing the best
support in helping tobacco users quit?
From literature reviews and program evaluations, we have
found a few items of importance when developing a great tobacco quit coach:
- a license or certificate does
not seem to give a clinical edge to a coach. Although we have found that the licensed
clinician is better prepared for documentation and ethical challenges, the
clinical outcomes we see are no better than those of the non-licensed coaches.
- great coaches are people-persons
that care about the outcomes of their clients as much, and sometimes more, than
- great coaches have incredible
listening skills. Without the
advantage of seeing the person a large part of communication is lost. The coach
needs to rely on listening for cues that might otherwise be seen in body
- great coaches understand the
addiction process. As tobacco use is a chronic relapsing condition, the
coaches with a grasp of the addiction process are better prepared to deal with a
client on the first quit attempt of their 20th quit attempt.
- great coaches review their
outcomes, ask for feedback, and most importantly use the feedback and outcomes
to improve their effectiveness.
Many coaches are open to hear feedback and look at outcomes, but take no
further steps to improve their skills.
We find that the coaches that review their clinical outcomes regularly
and listen to the feedback of their clients continue to improve on all
- great coaches have a basic
understanding of how tobacco effects the body and mind. Although this is not necessarily the most
important aspect of a great quit coach, many clients have complicated medical
issues that are driving them to quit.
- great coaches identify client
strengths during conversations that will help the tobacco user identify
past successes in quitting tobacco or dealing with other challenging situations
and maximize those strengths to make a quit work.
- great coaches are just
that.....great coaches. Anyone
who has been involved with sports, the arts, personal growth and development,
or career changes has probably had a coach that knew when to cheerlead and when
to push and challenge. A great tobacco
quit coach does the same thing.
We have found that the key element in developing effective quit
coaches is emphasizing that currently there is not one "right' way to
quit. There are still too many factors
involved in the quit process to easily identify the best way to quit that works
for all clients. We use the analogy of "quit
coach as handyman” for the quit process.
Every new quit is like a new project. The handyman's job is to have some
good assessment skills to figure out what the client wants and a tool belt to
help with the job. Every handyman might have his/her trusty five tools and not
every handyman focuses on the same five tools.
However, the tool belt has lots of other tools in case those five just
don't seem to get the job done. Every
now and then, the client might hand you a new tool and a good handyman may not
know how it works, but may include it in that job with that particular client.
Our responsibility to quit coaches is to supply them with a
tool belt and start filling it with tools.
The coach can figure out which tools fit best for them, but will keep
the rest around for the jobs when the favorites aren't working. We know that a tool belt should include tools
from motivational interviewing, goal-directed treatment and behavior change
techniques. How the coach picks and
chooses the tools for each client is truly a skill we are seeking to understand
In developing training programs for coaches, we have
recognized that far too much time has been spent on providing the coaches with
academic detailing of tobacco, medications and data collection. To provide a coach the best experience to
provide high quality and effective services, every training program should
include core modules related to telephone-based customer service, building and
maintaining alliance, advanced listening skills, motivational interviewing
basics, goal setting, and reviewing clinical outcomes. Training for coaches
never really ends. The best of the
coaches will take between 6 and 12 months just to figure out their tool belt
and get comfortable working with all they have learned in training and from
their clients. During the early months,
a quit coach needs the support of a team to reflect on cases, get feedback, and
acquire new tips to help them continue to be great coaches.
As research progresses in the development of effective
behavior change interventions, tobacco quitlines can provide a step forward in
recognizing that effective behavior change interventions are influenced by the
person providing the intervention. While
we might consider the interventionist a nuisance in research, he/she is key in
the success of those wanting to quit tobacco.
What have you learned in your training and supervision of quit coaches?
If you ARE a quit coach, what do you believe makes you most effective?