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

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1 A Partnership to Establish Tobacco free Mental Health and Substance Abuse Treatment Centers in Utah Claudia Bohner, MPH Tobacco Prevention and Control Program (TPCP) Utah Department of Health 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 1 Lasser K, et al (2000). Journal of the American Medical Association, 284, Gfroerer J, et al (2013). MMWR, February 8, 2013/ 62(05); Guydish J, et al (2011). Nicotine & Tobacco Research, 2011 June; 13(6);

2 Utah Data: 100% 80% 60% Current Smoking Among Utah Adults, Total and by Impaired Mental Health, (Combined Data, Age adjusted); Current Smoking by Substance Abuse Treatment Center Clients, % 40% 20% 11.3% 20.7% 0% Total mental health 7+ days not good SA treatment center clients Sources: Utah BRFSS ; Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS), 2009 Tobacco vs Other Drugs: Substance Use at Intake, Utah Treatment Center Clients ( ) Source: Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS),

3 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 3

4 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. 4

5 Implementation Phases ( ): Phase 1 - Phase 2 - Needs assessments at each of the facilities. 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 - o Current tobacco policies o Barriers to developing tobacco-free campus policies o Readiness to change policies o Client and staff attitudes about tobacco use o Need for training and technical assistance Methods: o Client focus groups (select sites) 10 completed o Key informant interviews (all sites) 50 completed 5

6 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: o Track mental health and substance abuse at intake o Ensure availability of NRT for treatment center clients o Quit Line coach training to address tobacco cessation in the MH and SA context 6

7 Phase 2: Materials Phase 2: Materials - Fighting Myths 7

8 Phase 3: Policy Development and Implementation Adopt tobacco-free campus policies Integrate tobacco cessation into treatment protocols o Tobacco use assessed at intake o NRT and counseling provided o Tobacco use addressed in discharge plan for relapse prevention o 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 8

9 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 100% 80% Percent of Utah Tobacco Quit Line Users by Self reported Mental Health and Alcohol and Drug Use Problems, Utah, July 2011 March % 40% 20% 0% mental health or substance abuse issue alcohol use drug use FY12 Part % 4.7% 5.1% FY12 Part % 5.8% 5.7% FY % 6.2% 7.3% Source: Utah Tobacco Quit Line Intake Data, July 2011 March

10 Next Steps Recovery Plus expansion to address other risk factors (obesity) and chronic diseases (cardiovascular disease, diabetes, asthma) through o Assessment o Links to resources o Follow-up Recovery Plus Documentary https://www.youtube.com/watch?v=iwiwrxeuopc 10

11 Thank you. Claudia Bohner, MPH Tobacco Prevention and Control Program Utah Department of Health 11

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