Tobacco Treatment Specialist Certification (CTTS) Program Workshop Manual

Tobacco Treatment Specialist Certification (CTTS) Program Workshop Manual Accredited by: Council for Tobacco Treatment Training Programs (CTTTP) Association for the Treatment of Tobacco Use and Dependence (ATTUD) 2011 2016

Certification Program for TO BACCO TREAT M EN T S P E C I A L I S T S Accredited 2011 2016 Tobacco Treatment Specialist Training Program Council for Tobacco Treatment Training Programs (CTTTP) Jackson Medical Mall, Suite 611 350 West Woodrow Wilson Drive Jackson MS 39213 Tel 601. 815. 1180 Fax 601. 815. 5986 Web www.act2quit.org Email nalford@umc.edu ACT Center programs are funded in part by an appropriation from the Mississippi State Legislature, and a grant from the Mississippi State Department of Health. The UMMC School of Medicine (Department of Otolaryngology and Communicative Sciences, and the Department of Medicine) also contributes resources. Association for the Treatment of Tobacco Use and Dependence (ATTUD) The ACT Center is a program of the UMMC Cancer Institute This program was developed for the purpose of training professionals to become Tobacco Treatment Specialists. The ACT Center maintains control over the content and delivery of this workshop program. This manual is distributed to individuals who have completed this course, and should not be given to anyone who has not been properly trained. Published by: THE UNIVERSITY OF MISSISSIPPI MEDICAL CENTER 2500 North State Street Jackson, MS 39216-4505 The University of Mississippi Medical Center offers equal opportunity in education and employment and in all its programs and services M/F/D/V.

TRAINING GOAL The goal of this program is to train eligible professionals to become Tobacco Treatment Specialists, capable of delivering intensive clinical services to patients with complex presentations who use tobacco. Those services are expected to be consistent with the competency standards set forth by the Association for the Treatment of Tobacco Use and Dependence (ATTUD). TRAINING MODULES AND OBJECTIVES M-1 TREATING TOBACCO DEPENDENCE: BASIC ASSUMPTIONS AND OVERVIEW 1. Describe the components for a comprehensive approach to tobacco control 2. Describe the intensity levels and modalities of tobacco treatment approaches M-2 SYSTEM, ADMINISTRATIVE, AND PROFESSIONAL CONSIDERATIONS 3. Identify ethical / legal issues relevant to tobacco dependence treatment 4. Describe the professional conventions in providing tobacco treatment services M-3 TOBACCO PRODUCTS, USAGE AND IMPACT 5. Describe the various types of tobacco 6. Cite the primary USA prevalence rates for tobacco use M-4 APPLYING THE BIOPSYCHOSOCIAL MODEL: TOBACCO USE AND CESSATION IN CONTEXT 7. Provide a definition of the Biopsychosocial model 8. Describe the primary components of this model M-5 IMPROVING MOTIVATION FOR CHANGE 9. Cite common indicators of motivation 10. Identify the core components of motivational interviewing M-6 ASSESSMENT I: CORE FACTORS 11. Cite the core dimensions for assessment 12. Describe instruments that may be used for these areas M-7 ASSESSMENT II: ADDITIONAL CONSIDERATIONS 13. Identify other useful areas to include in a comprehensive assessment 14. Describe instruments that may be used for these areas M-8 COGNITIVE-BEHAVIORAL THERAPY 15. Identify the 3 primary types of triggers with common examples of each 16. Describe the primary behavioral and cognitive intervention strategies M-9 INTAKE SESSION OVERVIEW 17. Describe factors to consider when conducting the intake interview 18. Describe how individual factors may alter clinical presentation M-10 INTAKE SESSION EXERCISE: ADMINISTRATION, INTEGRATION, AND DELIVERING FEEDBACK 19. Describe the content to be covered during an intake session 20. Demonstrate the capacity to deliver this material M-11 GROUP THERAPY: STRATEGIC CONSIDERATIONS 21. Describe differences between group and individual therapy 22. Describe the formative stages of groups M-12 TREATMENT PROGRAM OVERVIEW 23. Describe the overall treatment program goals 24. Describe functions that are not within the scope of this program

M-13 PHARMACOTHERAPY I: BASIC CONCEPTS 25. Identify the types of medications used in tobacco treatment 26. Describe usual usage for each M-14 TREATMENT SESSION 1 27. Describe the content to be covered during treatment session 1 28. Demonstrate the capacity to deliver this material M-15 TREATMENT SESSION 2 29. Describe the content to be covered during treatment session 2 30. Demonstrate the capacity to deliver this material M-16 PHARMACOTHERAPY II: ADVANCED CONSIDERATIONS 31. Describe emerging trends in pharmacologic treatment 32. Cite the various forms of harm reduction M-17 PHARMACOTHERAPY CASE PRESENTATIONS 33. Assist in the development of a pharmacologic treatment plan M-18 TREATMENT SESSION 3 34. Describe the content to be covered during treatment session 3 35. Demonstrate the capacity to deliver this material M-19 TREATMENT SESSION 4 36. Describe the content to be covered during treatment session 4 37. Demonstrate the capacity to deliver this material M-20 TOBACCO TREATMENT RESOURCES 38. Describe additional resources to enhance specific treatment needs M-21 MAINTAINING ABSTINENCE 39. Describe common high-risk situations 40. Describe the Abstinence Violation Effect M-22 TREATMENT PROGRAM EVALUATION: EVALUATING THE EFFECTS OF INTERVENTIONS 41. Cite the reasons for conducting routine program evaluations 42. Describe the advantages and disadvantages M-23 TREATMENT SESSION 5 43. Describe the content to be covered during treatment session 5 44. Demonstrate the capacity to deliver this material M-24 TREATMENT SESSION 6 AND FOLLOW-UP 45. Describe the content to be covered during treatment session 6 and follow-ups 46. Demonstrate the capacity to deliver this material M-25 DATA COLLECTION, STORAGE AND ANALYSIS 47. Describe methods for gathering and utilizing data

CTTS WORKSHOP AGENDA TIME MODULE LOCATION DAY 1 Treatment Perspective and Background Information 8:00 8:30 Welcome and Introductions 8:30 10:15 1 Treating Tobacco Dependence Workshop Manual B: slides 10:15 10:30 Break 10:30 12:00 2 System, Administrative, and Professional Considerations Workshop Manual A: slides, pp9, 12-13, 14-16 12:00 12:45 Lunch 12:45 3:30 3 Tobacco Products, Usage and Impact Workshop Manual B: slides 3:30 3:45 Break 3:45 5:00 4 Applying the Biopsychosocial Model Workshop Manual A: slides DAY 2 Clinical Foundations I 8:00 9:45 5 Improving Motivation for Change Workshop Manual A: slides 9:45 10:00 Break 9:45 12:00 6 Assessment I: Core Factors Workshop Manual B: slides 12:00 12:45 Lunch 12:45 2:45 7 Assessment II: Additional Factors Workshop Manual B: slides 2:45 3:00 Break 3:00 4:00 8 Cognitive Behavioral Therapy Workshop Manual A: slides 4:00 5:00 9 Intake Session Overview DAY 3 8:00 10:00 10 Intake Session Exercise 10:00 10:15 Break Clinical Foundations II Workshop Manual A: pp17-21 Therapist Manual: pp4-8 Workshop Manual A: p8 Therapist Manual: pp5-8 Case Handout 1 10:15 12:00 11 Group Therapy: Strategic Considerations Workshop Manual A: slides 12:00 12:45 Lunch 12:45 1:30 12 Treatment Program Overview and Special Considerations Workshop Manual A: slides 1:30 2:45 13a Pharmacotherapy I: Basic Concepts 2:45 3:00 Break 3:00 4:00 13b Pharmacotherapy I: Basic Concepts 4:00 5:00 14 Treatment Session 1 Demo (a) CO Measurement, (b) Medications Review, (c) Learned Addiction, (d) Individual Goal Setting Workshop Manual B: slides Clinical Reference Guide Workshop Manual B: slides Clinical Reference Guide Therapist Manual: pp9-17 Participant Manual: pp3, 4-11

TIME MODULE LOCATION DAY 4 Delivering the Intervention I 8:00 9:30 15 Treatment Session 2 Demo (a) Health Risk, (b) Habitual Behavior, (c) Behavioral Coping, (d) Scheduled Rate Fading Therapist Manual: pp18-24 Participant Manual: pp3, 12-18 9:30 9:45 Break 9:45 11:30 16 Pharmacotherapy II: Advanced Considerations 11:30 12:15 17 Pharmacotherapy Case Presentations 12:15 1:00 Lunch 1:00 2:30 2:30 2:45 Break 2:45 4:15 18 Treatment Session 3 Demo (a) Relaxation, (b) Cognitive Coping, (c) Individual Goal Setting 19 Treatment Session 4 Demo (a) Problem Solving 4:15 5:00 20 Tobacco Treatment Resources DAY 5 Delivering the Intervention II Workshop Manual B: slides, p23, 24, 26 Clinical Reference Guide Workshop Manual B: slides Case Handout 2 Therapist Manual: pp25-33 Participant Manual: pp3, 19-26 Therapist Manual: pp34-41 Participant Manual: pp3, 27-33 Workshop Manual B: p3 Websites 8:00 9:00 21 Maintaining Abstinence Workshop Manual A: slides 9:00 10:00 22 Treatment Program Evaluation Workshop Manual A: slides 10:00 10:15 Break 10:15 11:45 11:45 12:15 23 Treatment Session 5 Demo (a) Abstinence Violation Effect, (b) Relapse Crisis Debriefing 24 Treatment Session 6; Follow-Up Demo (a) Individual Goal Setting 25 Final Issues a. Data Collection, Storage, and Reporting 12:15 1:00 b. Clinic materials c. Exam d. Disclosures Tear Sheet 1: Tobacco Treatment Session Summary Tear Sheet 2: Medication Screening Form Tear Sheet 3: Medication Request Form Tear Sheet 4: Patient Satisfaction Form Case Handout 1: Intake Cases Case Handout 2: Pharmacotherapy Cases Therapist Manual: pp42-50 Participant Manual: pp3, 34-39 Therapist Manual: pp51-54, p55-57 Participant Manual: p3, 40-43, 44-52 Tear Sheets 1-4 Database Disclosure Forms

WORKSHOP FACULTY THOMAS J PAYNE, PHD Thomas J Payne PhD is a tenured Professor in the Department of Otolaryngology and Communicative Sciences, School of Medicine, and Associate Director of the ACT Center for Tobacco Treatment, Education and Research at the University of Mississippi Medical Center. He is a clinical psychologist, and has been involved in clinical, research, and educational aspects of behavioral medicine for 25 years. He has trained many clinical psychologists in his previous role as supervisor and Associate Director of Training at the Jackson UMMC / VAMC Psychology Residency Consortium. Dr. Payne has been instrumental in developing clinical treatment and training programs to help patients quit tobacco use. He has provided direct services or clinical supervision in the treatment of thousands of patients. He is widely published in this area, with topics spanning the genetics of nicotine dependence, cue reactivity, applied clinical factors, health impact of tobacco use, and public health considerations. He has been a Principal Investigator or Investigator on several NIH-funded (NIDA, NCI, NHLBI) and pharmaceutical industry sponsored (IIR; clinical trials) studies addressing tobacco use and treatment program dissemination, as well as psychosocial factors in heart disease and stroke among African Americans (Jackson Heart Study). Dr. Payne provides scholarly reviews for various journals / funding agencies / organizations / states, and has sat on a number of editorial boards. He is a fellow in the Society of Behavioral Medicine, was awarded the status of Knowledge Opinion Leader by Pfizer Inc., and has received the Gold Medallion Excellence in Research award from UMMC. Dr. Payne is President-Elect for the Association for the Treatment of Tobacco Use and Dependence (ATTUD), past Vice-President and Communications Chair, and sits on various committees. Disclosure: Dr. Payne receives his primary financial support from the University of Mississippi Medical Center, the Mississippi State Department of Health, and the Mississippi State Legislature. Current grant funding is from the FDA CTP and NIH (NHLBI). HOLLY H PEEPLES, MD Holly Peeples is a licensed family physician who completed her MD and residency in family medicine at the University of Mississippi Medical Center. She has been Board Certified in Family Medicine since 1987. She holds the rank of Associate Professor in the Departments of Family Medicine and the Department of Otolaryngology and Communicative Sciences, and has hospital staff appointments at the University of Mississippi Medical Center and Mississippi Baptist Memorial Hospital in Jackson Mississippi. She is a member of the American Academy of Family Physicians and the Mississippi State Medical Association. She has held various positions with the Mississippi Heart Association (State Representative), American Cancer Society (Chair of Professional Education) and Mississippi Tobacco Coalition. She has served as a co-investigator on a number of clinical trials. In addition to her clinical responsibilities through the Department of Family Medicine, she serves as the medical director for the ACT Tobacco Treatment Clinic, and conducts Tobacco Treatment Specialist workshops. Disclosure: None.

NATALIE W GAUGHF, PHD Dr. Gaughf is the Director of the Office of Academic Support (OAS) for the University of Mississippi Medical Center (UMMC), an associate professor in the Department of Family Medicine, and a psychologist. Dr. Gaughf coordinates and provides academic consulting services to UMMC students, residents, fellows, and faculty, which include skill development necessary for academic achievement and professional development. She administers the university peer-tutoring program and manages academic accommodations for the institution. Dr. Gaughf supervises psychology fellows in the Department of Family Medicine Primary Care Health Psychology Fellowship and contributes to the design and implementation of curriculum for both psychology fellows and family medicine residents. Dr. Gaughf s research and professional interests include academic support, medical education, health psychology, behavioral health, and tobacco use and dependence treatment. She serves as past-president of the Mississippi Psychological Association and is actively involved in state and national efforts related to the role of psychologists in health care and other industry. Dr. Gaughf received a PhD in psychology from the University of Southern Mississippi. She completed the Doctoral Residency Program at the VA Gulf Coast Veterans Health Care System and the Health Psychology Postdoctoral Fellowship in Primary Care in the Department of Family Medicine at the University of Mississippi Medical Center. Disclosure: Dr. Gaughf receives her primary financial support from the University of Mississippi Medical Center. In addition, she has received grant funding from Pfizer, and accepted consulting fees for speaking engagements. CHRISTINE E SHEFFER, PHD Dr. Sheffer is an Associate Medical Professor in the Department of Community Health and Social Medicine at Sophie Davis School of Biomedical Education at the City College of New York, and a licensed clinical psychologist in NY. She is the current Treasurer-Elect of the Association for the Treatment of Tobacco Use and Dependence (ATTUD), Chairperson for the Training Issues Committee of ATTUD, and prior Vice-President of ATTUD, having served on the Board of Directors since 2007. Dr. Sheffer is also the executive director of ATTUD s Council for Tobacco Treatment Training Programs and was instrumental in developing this accreditation program in 2008. The Training Issues Committee is currently working on developing an ATTUD TTS certification program. An important area of concentration her clinical and research work is disseminating high quality, evidence-based treatment for tobacco dependence. She has developed and directed statewide treatment programs and developed and conducted programs that train health care providers in both brief and intensive treatments for tobacco dependence. Another area of focus is socioeconomic disparities in tobacco dependence treatment outcomes and improving treatment outcomes for tobacco users of lower socioeconomic status. Dr. Sheffer is also exploring the use of brain stimulation techniques to improve the efficacy of tobacco dependence treatments. Disclosure: Dr. Sheffer receives her primary support from CUNY. She has received research funding from the National Institutes of Health (NCRR, NIDA, NCI), Clearway of MN, and Pfizer, Inc.