5/22/2013 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, 2606- 2610. 2 Gfroerer J, et al (2013). MMWR, February 8, 2013/ 62(05); 81-87. 3 Guydish J, et al (2011). Nicotine & Tobacco Research, 2011 June; 13(6); 401-411 1
5/22/2013 Utah Data: Current Smoking Among Utah Adults, Total and by Impaired Mental Health, 2009 ‐ 2011 (Combined Data, Age ‐ adjusted); 100% Current Smoking by Substance Abuse Treatment Center Clients, 2009 80% 68% 60% 40% 20.7% 20% 11.3% 0% Total mental health 7+ days not good SA treatment center clients Sources: Utah BRFSS 2009 ‐ 2011; 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 (1999 ‐ 2009) Source: Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS), 1999 ‐ 2009 2
5/22/2013 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
5/22/2013 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
5/22/2013 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 - 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
5/22/2013 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
5/22/2013 Phase 2: Materials http://recoveryplus.utah.gov/ Phase 2: Materials - Fighting Myths 7
5/22/2013 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
5/22/2013 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% Percent of Utah Tobacco Quit Line Users by Self ‐ reported Mental Health and Alcohol and Drug Use Problems, Utah, July 2011 ‐ March 2013 80% 60% 40% 20% 0% mental health or substance alcohol use drug use abuse issue 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% Source: Utah Tobacco Quit Line Intake Data, July 2011 – March 2013 9
5/22/2013 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
5/22/2013 Thank you. Claudia Bohner, MPH Tobacco Prevention and Control Program Utah Department of Health cbohner@utah.gov 11
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