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 the client.
• 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 language.
• 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 measures.
• 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 more scientifically.

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?