A Partnership to Establish Tobacco free Mental Health and Substance - - PDF document

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Claudia Bohner, MPH Tobacco Prevention and Control Program (TPCP) Utah Department of Health

A Partnership to Establish Tobacco‐free Mental Health and Substance Abuse Treatment Centers in Utah

Background:

• Cigarettes smoked in the U.S. by individuals with a mental

health disorder: 44%1

• Smoking prevalence among population groups with mental

health issues: 36%2

• Smoking prevalence among individuals with alcohol and

drug use disorders: 65%3

• New York has tobacco-free publicly funded SA treatment centers

1Lasser K, et al (2000). Journal of the American Medical Association, 284, 2606-

2610.

2Gfroerer J, et al (2013). MMWR, February 8, 2013/ 62(05); 81-87. 3Guydish J, et al (2011). Nicotine & Tobacco Research, 2011 June; 13(6); 401-411

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11.3% 20.7% 68% 0% 20% 40% 60% 80% 100% Total mental health 7+ days not good SA treatment center clients

Current Smoking Among Utah Adults, Total and by Impaired Mental Health, 2009‐2011 (Combined Data, Age‐adjusted); Current Smoking by Substance Abuse Treatment Center Clients, 2009

Sources: Utah BRFSS 2009‐2011; Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS), 2009

Utah Data:

Substance Use at Intake, Utah Treatment Center Clients (1999‐2009)

Source: Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS), 1999‐2009

Tobacco vs Other Drugs:

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Conclusions:

• Smoking rates among clients of Utah’s publicly

funded SA and MH treatment centers are extremely high.

• Utah’s SA and MH treatment centers serve an

estimated 15-20% of Utah’s smokers

• Population is underserved due to
• tendency to ignore treatment for tobacco

addiction in SA and MH clinic settings

• need for specialized tobacco treatment options

Planning Stage:

1. Partnership: Utah Division of Substance Abuse and Mental Health (DSAMH) and TPCP 2. ARRA funding (tobacco policy change): create tobacco-free policies for Utah’s public mental health and substance abuse treatment centers 3. Three key project objectives:

• Integrate tobacco cessation into treatment protocols
• Establish tobacco-free campus policies
• Decrease tobacco use among clients and staff

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Recovery Plus Leadership Team (2010):

• Utah Division of Substance Abuse and Mental Health (DSAMH)
• 15 Publicly Funded MH/SA Treatment Centers
• Utah Department of Health, TPCP
• 12 Local Health Departments
• Treatment Center Clients
• Advocacy Groups
• Department of Corrections

Vision:

Recovery Plus is an initiative to promote health and wellness in people with mental illness and/or substance abuse. With support, education, and treatment, people can and will recover from symptoms of mental illness and addictions, including tobacco dependency.

Rules:

• No one will be denied treatment because of their

tobacco use.

• Assessment, education, treatment planning and

NRT will be provided to all clients as appropriate.

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Implementation Phases (2010-13):

Phase 1 - Needs assessments at each of the facilities. Phase 2 - Staff training; providing resources to address challenges Phase 3

• Policy development and implementation

Phase 4

• Follow-up: tracking and supporting policy

enforcement during annual site assessments

Phase 1: Needs Assessments

Objectives: Assess -

• Current tobacco policies
• Barriers to developing tobacco-free campus policies
• Readiness to change policies
• Client and staff attitudes about tobacco use
• Need for training and technical assistance

Methods:

• Client focus groups (select sites) – 10 completed
• Key informant interviews (all sites) – 50 completed

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Phase 1: Needs Assessment Results

Clinic Assessments:

• Smoking rates: staff 4-17%; clients 60-68%
• Tobacco policy change means “culture change”
• Education needs are highest among staff members
• Staff concerns about enforcement; losing clients;

funding for treatment and NRT Clients:

• High awareness of health benefits of quitting
• Fears about consequences of not quitting

Phase 2: Providing Resources and Staff Training

• Outreach and education
• Training plan (Peer-to-Peer Tobacco Recovery

Program)

• Changes to Utah Tobacco Quit Line protocols:
• Track mental health and substance abuse at intake
• Ensure availability of NRT for treatment center

clients

• Quit Line coach training to address tobacco

cessation in the MH and SA context

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Phase 2: Materials

http://recoveryplus.utah.gov/

Phase 2: Materials - Fighting Myths

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Phase 3: Policy Development and Implementation

• Adopt tobacco-free campus policies
• Integrate tobacco cessation into treatment protocols
• Tobacco use assessed at intake
• NRT and counseling provided
• Tobacco use addressed in discharge plan for

relapse prevention

• Support offered through cessation classes
• Uniform signage
• Track policies in statewide policy matrix

Phase 4: Policy Enforcement

• Tobacco policy review is integrated in annual

DSAMH site visits with local treatment centers

• Review of policy enforcement
• Technical assistance

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OUTCOME (March 2013)

100% of Utah’s publicly funded SA and MH Treatment Centers have comprehensive tobacco-free policies that include -

• A tobacco-free campus
• Tobacco addiction addressed in treatment protocols
• Tobacco use tracked in data collection

Utah Tobacco Quit Line Data

Percent of Utah Tobacco Quit Line Users by Self‐reported Mental Health and Alcohol and Drug Use Problems, Utah, July 2011‐ March 2013 Source: Utah Tobacco Quit Line Intake Data, July 2011 – March 2013

mental health or substance abuse issue alcohol use drug use FY12 Part 1 47.2% 4.7% 5.1% FY12 Part 2 48.0% 5.8% 5.7% FY13 49.5% 6.2% 7.3% 0% 20% 40% 60% 80% 100%

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Next Steps

Recovery Plus expansion to address other risk factors (obesity) and chronic diseases (cardiovascular disease, diabetes, asthma) through

• Assessment
• Links to resources
• Follow-up

Recovery Plus Documentary

https://www.youtube.com/watch?v=IwiWrxEuOpc

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Thank you.

Claudia Bohner, MPH Tobacco Prevention and Control Program Utah Department of Health cbohner@utah.gov