Transcript Document
A systems-based approach
to reduce smoking rates among people
living with serious mental illness
in the Capital District community
Project Overview
Urgency of need
Unique challenges
Benefits of improving BH response
What do we do?
How do we do it?
Framework for Tobacco-Free Organizational Change
Why now?
Urgency of Need
Smoking Prevalence by Self-Reported Mental
Health Status 2000-2001 and 2008-2009,
NYS BRFSS
“We need to quit. We really do.
It’s expensive, it’s bad for our
health, it’s killing us. I know that
there’s all these studies that show
that we die 25 years younger than
the general population, and I
think smoking certainly is one of
those factors.”
Testimony from HelpUsQuit.org
http://www.ctri.wisc.edu/HC.Providers/healthcare_mental.health.htm
Unique Challenges
Pharmacological interactions between
tobacco smoke and medications
History of social acceptability of tobacco
use within mental health settings
Higher than average smoking rate of
behavioral health staff
Persistent and inaccurate belief that
tobacco use helps to alleviate anxiety,
sadness and agitation
Common belief among some providers
and patients that successfully quitting
smoking among people living with SMI
is too difficult to achieve
Benefits of Improved Response
Saves lives
Saves healthcare dollars
Improves productivity
Nicotine Dependence is a DSM-IV Disorder
Tobacco dependence and mental illness are co-occurring
disorders
Behavioral practitioners practice psycho-social treatments
Consistent with wellness and recovery approaches
Reimbursement for treatment is improving
Williams, MD and Zeidonis, MD 2006
What Do We Do?
Elevate tobacco use as a priority
for people living with mental
illness
Integrate responses to tobacco
use in assessment, intervention
and treatment
Create an environment that
supports tobacco-free living for
both employees and consumers
How Do We Do It?
Elevate tobacco use as area of concern
• Educate agency staff, consumers, board
• Identify internal resources and strengths
• Identify needs
Plan
Integrate tobacco use responses
• Increase/improve capacity of BH providers to
respond effectively to tobacco dependence
• Revise policy and practices to include
tobacco dependence assessment,
intervention and treatment
Create supportive environment
• Make grounds tobacco-free
• Maximize incentives and access to cessation
resources
Implement
Sustain
Framework for Tobacco-Free
Organizational Change
DO
DON’T
•
Create environment in which smokers may be
more motivated to quit
•
Develop positive messaging promoting health of
•
the entire community
Focus on smokers as the “problem”
•
Integrate tobacco treatment into existing
procedures and services
•
Rely on a written policy to do the job
•
Define employee roles for supporting TF policy
•
Rely on a single source (ex: security) to “police”
the grounds
•
Maximize voluntary compliance through
education and engagement
•
Rely on enforcement of TF policies with
imposed consequences
•
Evaluate success based on organizational
efforts to support cessation
•
Evaluate success based on whether or not
smokers quit
•
Maximize availability of cessation resources for •
those who want to quit
Rely on a single source of cessation assistance
to meet needs
•
Use TF policy as a springboard for celebrating
health and wellness!
Limit your wellness initiatives to TF grounds
•
•
Focus on getting individual smokers to quit
Why Now?
Substantial resources are currently available
to guide us through this process
Community Health Improvement Plan workgroups
in Albany, Schenectady, and Rensselaer identified
tobacco use among people living with mental
illness as priority target objective
DSRIP - SPHP/Ellis have identified tobacco use
among those living with mental illness as priority
NYS OMH is currently in process of making all
state-run BH agencies tobacco-free
Capital District Tobacco-Free Coalition and Tobacco
Cessation in Health Systems Program initiated
collaboration of BH agencies in tri-county area
Available Resources
NYS Office of Mental Health
Access to online Tobacco Dependence
Trainings through The Center for
Practice Innovations (CPI) at Columbia
University
Opportunity to attain The Integrated
Mental Health/Addictions Treatment
Training Certificate from CPI at
Columbia University
Technical assistance from Adult
Services, NYSOMH
Opportunity to improve the lengths of
Operating Certificates by achieving
exemplary ratings on the Clinic
Standards
Capital District Tobacco-Free Coalition
& Center for Smoking Cessation
Coordination of regular meetings and
activities to advance the goals of the Initiative
Telephone, email or in-person technical
assistance
Provision of on-site training to mental health
care providers on evidence-based
interventions
Provision of supportive materials and
resources for both staff and consumers of
service
Hosting of centralized online resource for
Initiative-specific documents, resources, and
activities
Sample policies, sample employee/consumer
outreach materials, FAQs and timelines
No-cost tobacco-free signage for your property
Coordination of regional earned media and
events regarding Initiative, including kick-off
event or press conference as determined by
participating agencies
Progress to Date
ACMDH
Comprehensive tobacco screening integrated into intake and treatment
Staff trained on evidence-based best practices
Established workgroup committed to addressing tobacco use at their facility
Tobacco-Free grounds will be dependent upon county-wide decision to implement
policy
RCDMH
Clinic staff trained on evidence-based best practices
Discussion of improving signage and strengthening tobacco-free grounds policy
Equinox, Inc.
Making out-patient clinic grounds tobacco-free as of February 14, 2015
Working to improve access to cessation information and resources
Established workgroup committed to addressing tobacco use at their facility
Staff trained on evidence-based best practices
Rehabilitation Support Services
Actively engaged in addressing tobacco use among client population
Working towards one or two facilities going tobacco-free initially, with others to follow
Progress to Date
Northeast Career Planning
Committed to going tobacco-free (no concrete date yet)
Staff trained on evidence based best practices
Established workgroup committed to addressing tobacco use at their facility
Active Cessation group within PROS program
Unity House
Plans to make new Community Services Program building grounds tobacco-free
Participating in local DSRIP workgroup focused on promoting cessation in MH
population
Ellis Hospital Mental Health (Schenectady)
Actively engaged in bolstering tobacco-free grounds policy and increasing access to
cessation resources and support
Staff trained on evidence-based best practices
Active cessation group within PROS program
Homeless and Travelers Aid Society
Early stages of determining how our efforts can be integrated into their services