Problem/Objective: To describe a facilitated TA model to assist eight Massachusetts Community Health Centers (CHC) to implement institutional changes to promote tobacco dependence treatment, as recommended by the USPHS Clinical Practice Guideline. CHCs provide health care for low socio-economic status groups and racial and ethnic minorities and present significant opportunities to intervene with patients' tobacco use and to reduce health disparities.

Methods: The Massachusetts Tobacco Control Program awarded short-term grants and piloted a technical assistance model with 8 CHCs to support systems improvements and to increase utilization of a new Medicaid smoking cessation benefit. A technical assistance model and evaluation framework were developed to address six steps in a complete tobacco use intervention/referral process with feedback loop and performance measures for each step.

Results: Each CHC identified areas for systems improvement by completing a self-assessment checklist of its current capacity to address tobacco use; ensured that a manager with authority to modify CHC forms or records was assigned to the project; and agreed to accept assistance from MTCP's technical assistance (TA) contractor. The TA provider and an independent evaluator hired for the project worked closely with each CHC project team to develop a workplan and “process map,” including baseline and performance measures for each desired systems change. Supporting and inhibiting factors that influence CHC adoption of evidence-based system improvements were identified.

Conclusions: A facilitated change model was effective in supporting systems changes in health centers.