Tobacco-Free Behavioral Health Organization Toolkit

Transcription

1 Tobacco-Free Behavioral Health Organization Toolkit

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3 The Maine Tobacco-Free Behavioral Health Network (MTFBHN), an initiative of the Breathe Easy Coalition of Maine, is pleased to present you with this tobacco-free facility support packet. The purpose of this packet is to provide you and your providers/staff with resources and materials that will make it as simple as possible to move toward and/or implement a 100% tobacco-free policy. We hope that these materials will be helpful for all types of behavioral health providers, including in-patient and out-patient facilities, psychiatric hospitals, and clinical service providers. Tobacco use remains the leading cause of death and disease in this country with over 443,000 deaths per year, almost half of those from smokers with mental illness. The behavioral health population consumes 44% of all cigarettes consumed in the U.S. This population experiences high rates of chronic disease and on average dies 25 years prematurely. Adults with mental illness are interested in quitting smoking, however, evidence-based tobacco treatment options may not be available or addressed in discharge plans. Research indicates that tobacco treatment helps behavioral health clients address their alcohol and other drug problems as well. We hope that this support packet provides useful information as your organization transitions to a healthier environment for your employees, patients, vendors and visitors. Enclosed resources include: Recommended Timeline Template Policy Language Template Policy Enforcement Template Frequently Asked Questions Template Employee Opinion Survey Template Press Release Template Newsletter Template Letter to Employees Template Signage Template Client Nicotine Dependence Assessment All of the above are available electronically at or by contacting us at BreatheEasy@mainehealth.org and (207) MTFBHN staff are also available to provide you with technical assistance regarding policy implementation. All our services are free of charge please contact us to learn more or for assistance. Sincerely, Sarah Mayberry, Coordinator Maine Tobacco-Free Behavioral Health Network 1

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5 Infographic Learn more at: BreatheEasyMaine.org/ BehavioralHealth 3

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7 Implementing a Tobacco-Free Policy Recommendations for Implementing a Tobacco-Free Policy in the Behavioral Health Setting Implementing a Tobacco-Free Policy Establish a Policy Committee Develop a Policy Train Staff and Educate Clients Prepare for Policy Launch Implement Policy Maintain Long-Term Success Note: This flowchart is a recommendation for a successful tobacco-free policy implementation; organizations may find that all or some of these components will aid their efforts. Each phase has a suggested timeframe to complete the tasks listed, which could be implemented by an organization in a six-month or twelve-month period. 5

8 Recommended Timeline To ensure a comprehensive approach when addressing tobacco use and implementing a tobacco-free policy, it is important for behavioral health organizations to provide knowledge about the benefits of a policy and to be understanding of the concerns of staff and clients. Therefore, it is imperative that facilities: Remain a positive and visible resource. Respect the concerns of those opposed to policy. Develop a clear process that engages clients, staff and community leaders. Work to develop a shared vision of wellness and recovery. Assess the organization s readiness to implement a tobacco-free policy. PHASE 1: Establish a Policy Committee (1-2 months) 1. Establish a policy committee that will guide the tobacco-free transition and that shows broad support/commitment for the establishment of a tobacco-free environment. a. Include administrators, clinical staff, facility staff, clients, staff smokers, nonsmokers, former smokers and representatives of any officially recognized employee organization. 2. Acknowledge any challenges within your organization. 3. Identify the individual(s) who will be responsible for coordinating the implementation of the tobacco-free environment. a. Form a workgroup of individuals who will assist in the implementation process. 4. Set a specific date to be tobacco-free. a. Do not choose a holiday and be mindful of other institutional events. b. Consider a fair-weather start date if your organization chooses to replace smoke breaks with fresh air breaks or other outdoor activities. 5. Administer Employee Opinion Surveys to evaluate employee s perceived barriers of tobacco-free policy, if bothered by smoke, smoking status and willingness to quit (See template Employee Opinion Survey, pg. 17). 6

9 PHASE 2: Develop a Policy (1 month) 1. Develop three or four simple messages to explain the following (See Infographic, pg. 3): a. Why behavioral health facilities should address tobacco use. b. What the policy change will accomplish. c. The behavioral health facility s underlying concern for constituents and how the policy lines up with the organization s mission. Include success stories within messages and marketing materials i.e. Individuals with behavioral health disorders who are highly addicted to nicotine can quit, and are more likely to succeed with a combination of medications and behavioral therapy. (NASMHPD, 2007) 2. Draft a tobacco-free policy (See Template Policy Language, pg. 11). a. Define your tobacco-free campus terms: i. Include all tobacco products. ii. Define physical boundaries of campus. iii. Create a contraband policy. iv. Prohibit tobacco use in cars for clients, staff and visitors. b. Revise the tobacco policy or scent/fragrance policy to include thirdhand smoke. 3. Draft an enforcement policy (See Template Policy Enforcement, pg. 12). a. Include actions taken for violation of policy for clients, staff and visitors. 4. Announce the policy to all employees through a letter from the Chief Executive Officer or Clinical Director (See Template Letter to Employees, pg. 25). 5. Involve Human Resources to release information. PHASE 3: Train Staff and Educate Clients (2 months) 1. Develop educational materials and begin distributing to employees, behavioral health clients, community members, and guests; such as: a. Company newsletter, all staff s (See Template Letter to Employees, pg. 25). b. Signs, displays, leaflets (See Template Signage, pg. 30). 7

10 c. Flyers/posters in waiting areas (See Template Signage, pg. 30). d. Flyers in appointment reminders (See Template Letter to Clients, pg. 28). e. Reminders in pay stubs for employees (See Template Pay Stub Reminders, pg. 27). f. Post notices in currently designated smoking areas. g. News releases to local media (See Template Community Release, pg. 26). 2. Conduct training sessions for all employees (See Tobacco Training and Education Opportunities, pg. 31). a. Train clinical/behavioral health staff in 5A s protocol to address client tobacco use. b. Train employees and clinicians to assess nicotine dependence in clients as part of intake process (See Template Client Nicotine Dependence Assessment, pg. 32). c. Include tobacco treatment into treatment plan. d. Include tobacco treatment in discharge plan. 3. Obtain insurance coverage of at least one tobacco treatment drug. 4. Have tobacco-free policy approved by executive board members. 5. Facilitate access to nicotine replacement therapy (NRT) for employees who use tobacco. PHASE 4: Prepare for Policy Launch (1 month) 1. Begin countdown to launch 3-4 weeks out so participants can better adjust and comply with changes. Remind staff and clients of key dates and events. 2. Prepare a fun kick-off event to celebrate the upcoming policy for employees and clients. 3. Contact, educate, and assist adjacent community neighbors in becoming part of the tobacco-free area. Consider their concerns in anticipation of the new policy and possible impact on their property (See Template Letter to Neighbors, pg. 29). 4. Prepare media releases (See Template Press Release, pg. 26). PHASE 5: Implement your Policy (1 month) 1. Make changes to facilitate the tobacco-free environment: a. Install Tobacco-Free Area or Tobacco-Free Environment or No Smoking signs (See Template Signage, pg. 30). b. Remove ash receptacles. c. Replace tobacco breaks with fresh air breaks. 8

11 2. Kickoff policy by: a. Sending out a media release. b. Conducting a ribbon cutting celebration with media coverage. c. Hanging signage with positive messages. d. Including community partners. e. Making tobacco treatment counselors available. 3. Recognize those who have helped make implementation successful. 4. Begin enforcing tobacco-free policy. f. Distributing materials about tobacco treatment resources and benefits. g. Handing out a token gift to acknowledge clients and staff who have quit tobacco or support others to quit. h. Encouraging all employees to sign in at the launch area and provide door prizes. i. Decorating with balloons and flowers. j. Having one-day amounts of NRTs available in the pharmacy. PHASE 6: Maintain Long-Term Success (Ongoing) 1. Have regular announcements reminding people of the tobacco-free policy and treatment options. 2. Train new employees to assess client tobacco use. 3. Be flexible and patient, behavior change takes time. 4. Conduct Leadership Walkabouts a few times each month at different times and days. (see pg. 22) 5. Six months after tobacco-free policy implementation, administer Employee Opinion Follow-Up Surveys (See Template Employee Opinion Follow-Up Survey, pg. 20) to evaluate: a. Employee smoking status. b. Opinion of newly implemented tobacco policy. c. Perceived impact of tobacco-free policy. d. Treatment resources used to quit. 9

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13 Template Policy Language Summary: [ORGANIZATION] is dedicated to providing its clients, staff, visitors, and vendors with a safe and healthy environment by implementing a 100% tobacco-free campus policy, effective [DATE]. Policy: [ORGANIZATION] recognizes that the use of tobacco products on our grounds is detrimental to the health and safety of everyone. This institution supports an environment where staff, clients, visitors and vendors are not exposed to the harmful effects of secondhand smoke and are supported in efforts to live tobacco-free. Preventable chronic disease is a significant contributor to early mortality in behavioral health populations. People with serious mental illness are dying 25 years younger than average, often from preventable conditions such as obesity, diabetes and heart disease. Smoking rates among persons in behavioral health populations are 2 4 times higher than the general population. Quitting tobacco is a desirable and achievable goal for behavioral health clients, which can improve health and add years to life. Therefore, [ORGANIZATION] has adopted a 100% tobacco-free campus policy, that exceeds state law (22 M.R.S.A A), effective [DATE]. Tobacco use is defined as the smoking, vaping or use of all tobacco products, including but not limited to, cigarettes, cigars, spit and smokeless tobacco, chew, snuff, snus, electronic cigarettes and other non-fda approved nicotine delivery devices. This policy prohibits tobacco use: In all facility-affiliated buildings, On all organization-owned or -leased grounds, including parking lots, In all organization-owned or -leased vehicles, And in personal vehicles used in the course of work whenever other employees or another person is in the vehicle for work-related reasons. This tobacco-free campus policy applies to all staff, clients, visitors and vendors. Policy Components Procedures: This policy will be communicated through tobacco-free signs posted at all campus entrances and throughout the facility, through staff education, including being written into training manuals and new employee orientation, and to clients through admission paperwork and discussion. Everyone is required to comply with [ORGANIZATION S] tobacco-free policy. Enforcement of this policy will follow the standard procedures of the facility. Information regarding tobacco treatment resources, such as onsite counseling and the Maine Tobacco HelpLine, will be made available for tobacco users who are interested in quitting. To help support healthy, tobacco-free lifestyles, [ORGANIZATION] will assess all clients for tobacco use at intake and address tobacco as part of a comprehensive treatment plan. 11

14 Template Policy Enforcement Accountability It is the responsibility of all staff members to enforce [ORGANIZATION] s tobacco-free policy by encouraging their colleagues, clients, visitors and others to comply with the policy. The community, staff, clients and visitors will be informed of the policy through a variety of communication methods. Policy [ORGANIZATION)] is dedicated to providing its clients, staff, visitors, and vendors with a safe and healthy environment by implementing a 100% tobacco-free campus policy, effective [DATE]. This [ORGANIZATION] supports an environment where staff, clients, visitors and vendors are not exposed to the harmful effects of secondhand smoke and are supported in efforts to live tobacco-free. Tobacco use is defined as the smoking or use of all tobacco products, including but not limited to, cigarettes, cigars, spit and smokeless tobacco, chew, snuff, snus, electronic cigarettes and other non-fda approved nicotine delivery devices. This policy prohibits tobacco use: a. In all facility-affiliated buildings, b. On all organization-owned or -leased grounds, including parking lots, c. In all organization-owned or -leased vehicles, d. And in personal vehicles used in the course of work whenever other employees or another person is in the vehicle for work-related reasons. This tobacco-free campus policy applies to all staff, clients, visitors and vendors. A. Employees Follow existing employee procedures for policy violations for staff, which may include progressive discipline. B. Clients a. All clients admitted to [ORGANIZATION] will be assessed for history of tobacco use and the need for treatment related to tobacco use. Treatment options may include nicotine replacement therapy and/or cessation education. b. Violation of this policy by clients is a treatment issue to be addressed by the treatment team. 12

15 C. Visitors and Vendors a. Signs will be posted at campus entrances and in selected locations inside and outside the facility. b. Employees who encounter a visitor who is violating the tobacco policy are encouraged to politely explain the policy to the visitor. i. Visitors who become agitated or unruly or repeatedly refuse to comply when informed of the tobacco-free campus policy may be reported to [NAME OF APPROPRIATE DEPARTMENT OR PERSONNEL]. [THE IDENTIFIED PERSONNEL] will respond to the situation as appropriate, according to their professional judgment and need to maintain a safe environment. 13

16 Frequently Asked Questions [Behavioral Health Organization] Tobacco-Free Policy 1. Why did [ORGANIZATION] implement a tobacco-free policy? Tobacco use and secondhand smoke exposure are among the country s most preventable causes of disease and death. There is no safe level of exposure to secondhand smoke. As a quality behavioral health provider, [ORGANIZATION] is committed to protecting the health of its employees, clients, visitors and vendors by providing a safe and clean air environment. Creating a tobacco-free environment and providing support for tobacco-free lifestyles through our tobacco treatment programs and activities shows our commitment to the health and well-being of our staff, clients and visitors. 2. What does the tobacco-free policy entail? The tobacco-free policy prohibits the smoking of, or use of, any tobacco products including but not limited to, cigarettes, cigars, snuff, chewing tobacco, snus and non-fda approved nicotine delivery devices, such as e-cigarettes anywhere on the [ORGANIZATION] s campus. This includes all organization-affiliated buildings, on all facility grounds, in all organization-owned or -leased vehicles, personal vehicles used in the course of work and at all [ORGANIZATION] sponsored events. 3. How will the policy be enforced? Our hope is that we can work together to enforce this policy through friendly interactions. All employees who are seen using tobacco on the premises after [DATE] will be asked to stop, reminded of the new policy and informed of tools that can ease symptoms while they are at work (See Template Policy Enforcement, pg. 12). 4. I m a tobacco user. How can I get help? We know that quitting is a process that doesn t happen the same way for everyone. Research shows that you will be most successful with a combination of support, coaching and medications. 1) Employees can talk with an administrator within their organization about available treatment options. 2) Talk with your provider. 3) Visit TheQuitLink.com, an online tobacco treatment support center sponsored by the Partnership For A Tobacco-Free Maine. 4) Call the Maine Tobacco HelpLine at for more information and free coaching. 14

17 5. Can I use nicotine replacement therapy (NRT) products, like gum, lozenges, or patches, at work? Yes, some tobacco users may choose to use NRT products particularly gum or lozenges to manage their nicotine cravings while they quit or during work hours. If you are still smoking or using tobacco, please be cautious if you choose to use NRT at work. Taking too much nicotine by using nicotine replacement therapy while you still use tobacco can cause unpleasant side effects. If you want to use NRT at work, you may want to talk to your physician about appropriate dosing and use. 6. Isn t smoking a personal legal right? Recent court rulings maintain that smoking is a privilege, not a right. 7. How can we expect people to quit smoking, while they re quitting everything else? We are here to deal with real drugs, not cigarettes. Besides, clients don t want to quit. Even those who want to quit won t be able to. Like other smokers, smokers with mental illness are interested in quitting, and have a better chance of quitting successfully when they have access to proven treatments. Tobacco products are real drugs. They contribute to more illness and early death than any other drug, legal or illegal. As we transition to a healthier environment, we will train staff and clients about smoking, treatment options, and how smoking impacts other addictions. Evidence suggests that tobacco use actually harms recovery from the addiction to other drugs. Clients will also learn refusal skills, be able to identify triggers, and regain control if they relapse. Our organization recognizes that quitting is hard, especially in environments where tobacco use is acceptable. We hope our commitment to healthy behaviors will inspire other behavioral health facilities in our community to similarly prohibit tobacco use in hopes of promoting wellness and recovery. 8. Smoking calms down clients. When they can t smoke, won t we experience more issues? After adoption of a smoke-free policy, fewer psychiatric hospitals reported seclusion or restraint related to smoking, coercion, and smoking-related health conditions, and there was no increase in reported elopements or fires. We are carefully planning this effort so the clients, staff, and visitors here have plenty of time and support to prepare for change. We will reduce uncomfortable nicotine withdrawal symptoms by appropriately using NRT and other medications. We plan to post a countdown to our launch date in the main lobby. Meanwhile, we invite you to voice your concerns and join our team as we become tobacco-free and embrace recovery. 15

18 9. Many clients come to behavioral health facilities in crisis. These are times they most need to smoke. Won t this new policy worsen their crises? Or worse yet, people won t get help when they need it because they don t want to quit smoking. At a time of crisis, our immediate job is to deal with the crisis, not with smoking. As the person recovers, we will provide a healthy environment that promotes wellness, and being free of tobacco is part of becoming well. We will not and cannot require anyone to quit smoking for a lifetime. What we will do is provide a safe environment where clients or staff members can learn how tobacco impacts their lives and find resources and opportunities that will support them to quit. Research has not yet determined the best time to help someone quit smoking. We know, however, that the best time to encourage healthy behavior is now. 10. How do we as an organization support staff members to comply and adhere to this policy? Staff buy-in can be created through: A. Communicating the policy change openly to all staff members. B. Conducting a survey or focus group with staff members to gather feedback. C. Holding educational meetings to inform staff about the importance of discussing cessation with clients, as well as providing research related to the results of concurrent smoking cessation with addiction or mental health treatment. D. Providing an employee cessation program similar to the one offered to clients. 11. Can I use e-cigarettes? As of the date of this packet, electronic cigarettes, or e-cigarettes, are considered by the Maine State Attorney General to be tobacco products and as such are prohibited as part of our organizational 100% tobacco-free policy. 16

19 Template Employee Opinion Survey [ORGANIZATION NAME/LOGO] Employee Opinion Survey The following survey is being conducted in conjunction with [ORGANIZATION NAME] becoming a TOBACCO-FREE CAMPUS on [DATE]. Please share your honest, anonymous opinion. 1. What barriers do you see that [ORGANIZATION NAME] will face when we adopt a 100% tobacco-free policy? (Check all that apply) Employees will not follow policy Clients/visitors will not follow policy Employees will seek jobs elsewhere Clients will seek services elsewhere Policy will be too hard to enforce Visitors will not follow policy Other, please specify: 2. Please indicate the extent to which you are bothered by secondhand smoke at work. (Check all that apply) Frequently bothered Seldom bothered Occasionally bothered Never bothered 3. If you are bothered by secondhand smoke at work, in what way are you bothered? (Check all that apply) Eye, nose and throat irritation Interference with work performances Concern for long-term health Headaches Pregnancy related concerns Other, please specify: 17

20 4. Please indicate your current tobacco use status: Never smoked or used tobacco Currently smoke cigarettes Cigarettes per day Length of time you have smoked Currently use other form of tobacco Type: Amount used daily: Former tobacco user How long since you last used tobacco? For how long did you use tobacco? Approximate amount of tobacco used daily: How did you quit? 5. Are you Male or Female? (please circle one) 6. What is your age in years (please check one) Less than For current tobacco users only: Do you use tobacco at work? Yes No Do you want to quit? I want to quit I do not want to quit Maybe / Unsure Have you ever tried to quit before? Yes No Would you utilize a company-sponsored program to help you stop using tobacco? Yes No Maybe 7. If smoking were prohibited in the workplace, how would this impact the amount you currently smoke? It would not impact how much I smoke I would smoke more at home I would smoke less I would try to quit 18

21 8. What do you think would help you quit using tobacco? (check all that apply) Smoking cessation classes Incentive program Quitting with a friend/spouse/co-worker Educational information on how to quit Maine Tobacco HelpLine Medication aids ( ) (Nicotine Replacement Therapy) Nothing I will quit on my own I m not interested in quitting Comments: Thank you for your cooperation and for sharing your opinion! 19

22 Template Employee Opinion Follow-Up Survey [ORGANIZATION NAME/LOGO] Employee Opinion Follow-Up Survey (implement 6 12 months after policy adoption.) The following survey is being conducted in conjunction with [ORGANIZATION NAME] becoming a TOBACCO-FREE CAMPUS on [DATE]. Please share your honest, anonymous opinion. 1. Please indicate your current tobacco use status: Currently smoke cigarettes Currently smoke pipe/cigar Currently use other tobacco. Please state: Former tobacco user (stopped before the policy was adopted) Former tobacco user (stopped after the policy was adopted) Never smoked or used tobacco 2. What is your opinion of the tobacco policy at your workplace? Not strict enough Reasonable Too strict 3. What is your opinion of secondhand smoke? (Check one) Definitely harmful Probably harmful Not harmful Not sure Please answer the following questions if you used tobacco at the time the tobacco policy was implemented: 4. Have you enrolled in the tobacco treatment program offered at [ORGANIZATION NAME]? Yes, I have enrolled. No, I have not enrolled. 20

23 5. How has the tobacco policy impacted your use? (Check all that apply) I use tobacco less overall. I use tobacco less at work. I use tobacco more at home. It has not impacted my use. I am trying to quit. I use tobacco more overall. I use tobacco more at work. I use tobacco less at home. I quit using tobacco. I only use tobacco outdoors. 6. What resources have you used? (Check all that apply) Cessation classes/support group General educational materials Nicotine replacement therapy Maine Tobacco HelpLine ( ) 7. What other resources/support would you find helpful? Comments: Thank you for your cooperation! 21

24 Leadership Walkabouts To encourage adherence and support of [ORGANIZATION s] tobacco-free policy, Leadership Walkabouts will be conducted throughout the campus. These walkabouts will require two administrative leaders to walk about the campus and approach staff, visitors and clients using tobacco to request compliance with the policy. Leaders will be given Walkabout Kits, a tip sheet and scripts to explain the importance of adherence of the tobacco-free policy to individuals who are using tobacco on the property. These walkabouts will be conducted periodically by two different leadership members and it is recommended that senior leaders be paired with non-senior leaders. These walkabouts will continue until [ORGANIZATION] administration sees that a 100% compliance rate with the tobacco-free policy has been met. Leadership Walkabout KIT: Palm cards (template script regarding the policy) Sugar-free hard candy Tip sheet with enforcement guidelines and several scripts (following page) Map of designated leadership walking routes around the campus Important Notes: 1. At a minimum, leaders are expected to sign up for 2 one-hour sessions (60 minutes to provide time for conversations). Create a timesheet for leaders to sign up. We recognize these conversations may be difficult and thus completing this activity in pairs will provide support for success. Please make every effort to stick to your scheduled time and minimize rescheduling. If you cannot make your scheduled time, please swap out with a colleague and let [NAME] know by at [ ]. 2. Please approach individuals who are using tobacco on property or adjacent sidewalks and educate them about our tobacco-free policy property in a friendly and welcoming manner. [ORGANIZATION] has provided a map regarding property boundaries (Organization should develop property boundary map for leaders). 3. Sample scripts for these conversations are on the TIPS sheet. Please note the messaging when approaching on property versus off property. Handout palm cards and offer a piece of sugar-free candy as you are talking with the individual. Let them know about [ORGANIZATION s] separate lists of treatment resources for employees and clients. Remember, the outcomes we are seeking through walk abouts are providing education and setting consistent expectations. Keep the conversation brief, thank them and walk away. It is not your responsibility to make the individual stop their tobacco use. 4. The benefit you will gain from the walkabouts includes being a role model in our organization and meeting community members who use our services. 22

25 Leadership Walkabouts Tips & Scripts Special thanks to TIPS for Ensuring Adherence to the Policy Use palm cards: Business-sized cards are available to help you when approaching someone smoking or using tobacco on our grounds. Simply hand a card to the individual and explain they may not be aware of our tobacco-free policy. Be positive, not confrontational. Keep it simple. You are letting people know about the policy and asking them to put out the cigarette (or other tobacco) or to smoke somewhere else. Explain that the policy is for health and safety reasons. Address the behavior, not the person. Once you have informed the person of the policy, thank them and move on. Do not watch the person s ongoing compliance, explain the policy once. If the person is unwilling to comply, do not argue. Tell them you would appreciate it if they would put out their cigarette. Thank them for respecting the policy and walk away. Please remember, you are not there to make anyone quit tobacco. If there is a safety or security concern, call [NAME] at [###-####]. SCRIPTS for Approaching Tobacco-Users On the Grounds Hi there. You may not be aware that we have a new tobacco-free policy. For the health and safety of our patients, visitors, and employees, all of our grounds and parking areas are tobacco-free. If you wish to continue your tobacco use, we ask that you please leave the grounds. Off the Property As part of our new tobacco-free campus policy, we are asking everyone to consider our neighbors when smoking off the property. The relationship with our neighbors is important. It would be good if you found a different place to smoke. When the Policy is Questioned We are not telling anyone to quit tobacco. We are asking everyone to respect our policy and not smoke or use tobacco while here on the property. This is about protecting people from secondhand and thirdhand smoke. We also need to support our patients and employees who are trying to quit. As a healthcare organization, we cannot allow any smoking or tobacco use on the grounds. Using an E-cigarette (visitor) I am sorry Sir/Madam, electronic cigarettes are not allowed inside the building or outside on the grounds. They are considered a tobacco product and are prohibited under our Tobacco-Free Policy. If you would like to use some nicotine replacement you can ask for more information at the outpatient pharmacy window or check with a member of your care team. (if applicable) Visitor Expresses Concern Over the Policy I understand this is a stressful time for you, and I am sorry. If you feel that you need to smoke or use tobacco, we ask that you leave the property. We can t make any exceptions. We do appreciate your respect for our policies. 23

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27 Template Letter to Employees [ORGANIZATION NAME/LOGO] To all community members, physicians and staff, [ORGANIZATION] is committed to improving the health of our clients and staff and recognizes the importance of providing a clean air environment for employees, clients, vendors and visitors. Therefore, as of [DATE], [ORGANIZATION] will be implementing a tobacco-free policy on all campus facilities. Tobacco use remains the leading cause of death and disease in this country with over 443,000 deaths per year, almost half of those from smokers with mental illness. The behavioral health population consumes 44% of all cigarettes consumed in the U.S. This population experiences high rates of chronic disease and on average dies 25 years prematurely. To assist those who may want to quit using tobacco, [ORGANIZATION] offers [Provide list of services offered at organization]. If you have questions about the tobacco-free campus policy, please contact [Name], Human Resources, at [Phone]. Sincerely, Policy Awareness Components CEO 25

28 Template Community Release [CURRENT DATE] Program Contact: [Name], [Phone] New Tobacco-Free Policy at [ORGANIZATION] Paves the Way for Health and Recovery On [DATE], [ORGANIZATION] will take an important step in supporting the health of its employees, clients, vendors and visitors by ensuring a clean air environment through the adoption of a tobacco-free policy. Tobacco use remains the leading cause of death and disease in this country with over 443,000 deaths per year, almost half of those from smokers with mental illness. The behavioral health population consumes 44% of all cigarettes consumed in the U.S. This population experiences high rates of chronic disease and on average dies 25 years prematurely. As we transition to being a tobacco-free environment, we will offer a complete tobacco treatment program for clients and employees. The policy change will be effective [DATE]. 26

29 Template Pay Stub Reminder IMPORTANT REMINDER [ORGANIZATION] Will become a tobacco-free facility and campus on [DATE] An employee tobacco treatment program is available to assist you in this change. Contact [NAME] at [ ] for more information about available resources. This policy will be enforced by all managers and supervisors. Thank you for your cooperation as we transition to a clean air environment. 27

30 Template Letter to Clients To Our Clients: Beginning on [DATE], [ORGANIZATION] will adopt a campus-wide tobacco-free policy. This policy means that clients, visitors, employees and physicians are prohibited from using any tobacco products inside company vehicles, buildings, in parking lots, or on facility grounds. Tobacco use remains the leading cause of death and disease in this country with over 443,000 deaths per year, almost half of those from smokers with mental illness. The behavioral health population consumes 44% of all cigarettes consumed in the U.S. This population experiences high rates of chronic disease and on average dies 25 years prematurely. Therefore, to further promote wellness and recovery, [ORGANIZATION] is adopting a tobacco-free policy. Upon your admission to [ORGANIZATION], the admissions staff will ask if you use tobacco. Initial assessments will be conducted to assess tobacco use. Our clinicians will work with you to address your tobacco use when you are ready. If you choose to quit or reduce your tobacco use, our trained behavioral health providers can provide you with the tools to support treatment. Thank you for your cooperation with this [ORGANIZATION] policy as we transition to a clean air environment for employees, clients, vendors and visitors. Sincerely, CEO or Clinical Director 28

31 Template Letter to Neighbors DATE NAME ADDRESS CITY, STATE ZIP Dear community member: Effective [DATE], [ORGANIZATION] will take a proactive step to provide a healthy environment by implementing a tobacco-free policy on our campus. The policy will apply to all employees, clients, vendors and visitors. This means as of [DATE], no tobacco use of any kind will be permitted inside buildings, in parking lots, or on facility grounds. We have spoken with employees and clients about being respectful of neighbors and are confident that most will exercise consideration of you and your property. Though we do not endorse it, some employees may leave the campus to use tobacco products. If any staff behaviors, whether related to smoking or not, becomes a problem for you, your employees or those with whom you live, please contact [NAME] at the number below. As a behavioral health care provider, [ORGANIZATION] s mission is to provide treatment for persons with behavioral health conditions and promote their wellness and recovery while promoting health. We are not requiring employees or clients to stop using tobacco as a means of creating a healthier environment for all who use our services and who work here, we are requiring them to refrain from tobacco use on our campus. We appreciate your help and support as we prepare for this transition to a healthier air environment on [DATE]. Sincerely, Name of Administrator Title Organization Telephone 29

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33 Tobacco Training and Education Opportunities Maine CDC Partnership For A Tobacco-Free Maine Maine CDC Partnership For A Tobacco-Free Maine (PTM) is the Maine State tobacco prevention and control program. Its mission is to reduce death and disability from tobacco use among Maine citizens by creating an environment supportive of a tobacco-free life. Trainings and events are ongoing. For more information: Maine CDC Partnership For A Tobacco-Free Maine Key Bank Plaza 4th Floor 286 Water Street Augusta, ME ptm.dhhs@maine.gov Center for Tobacco Independence The Center for Tobacco Independence (CTI) is supported by PTM and brings together a team of highly qualified individuals who focus on linking tobacco users to the most effective methods to quit. The Center provides direct treatment services, offers consultation for health systems and employers, conducts research, and educates health professionals about tobacco dependence and treatment. For more information: Center for Tobacco Independence 110 Free Street Portland, ME Treatment Components 31

34 Template Client Nicotine Dependence Short Assessment Client Nicotine Dependence Short Assessment [ORGANIZATION NAME/LOGO] Client Name: Date: 1. Does client use tobacco? (check answer) Yes (continue to question #2) No. Have you every used tobacco? YES NO If YES, when did you quit? 2. How long has(did) client use(d) tobacco? years months 3. What form(s) of tobacco does(did) client use? (check answers) Cigarettes Chewing/Smokeless Tobacco Pipe/Cigar Other: 4. Is client interested in quitting tobacco now? Yes No Possibly/Would consider learning more Thank you very much. Please bring this to your appointment. Developed by MaineHealth Center for Tobacco Independence on behalf of the Maine CDC, Department of Health and Human Services, Partnership For A Tobacco-Free Maine, revised 4/4/14 32

35 Items and Scoring for the Fagerstrom Test for Nicotine Dependence on Cigarettes QUESTION ANSWER SCORE Within 5 minutes 3 How soon after you wake up do you smoke your first cigarette? 6 to 30 minutes 2 31 to 60 minutes 1 After 60 minutes 0 Do you find it difficult not to smoke in places where smoking is not allowed, i.e. at the hospital, at the library, in cinema, etc? Which cigarette would you be the most unwilling to give up? Yes 1 No 0 The first one in the morning All others in the day 0 1 More than 30 3 How many cigarettes a day do you smoke? 21 to to or less 0 Do you smoke if you are so ill that you are in bed most of the day? Yes 1 No 0 Total Score Scoring: 0 2 Points = Mild Nicotine Dependence 3 6 Points = Moderate Nicotine Dependence 7 10 Points = Heavy Nicotine Dependence Name of Staff Member Completing Assessment: Next Steps/Referrals: Scheduled Follow-Up: 33

36 Template Client Nicotine Dependence Long Assessment Patient ID # Name: Date of Birth: Age: Address: Phone number where we can reach you: Can we leave a message at these phone numbers? Yes No Primary Care Medical Provider: Other Providers: Pharmacy: Marital Status: Married Divorced Remarried Single Other Date: Alternate phone: Insurance: Employed? Yes No Are you a veteran? Yes No Would you describe yourself as gay, lesbian, bisexual or transgender? (please circle if applicable) Please check which group or groups best describes you: Hispanic Asian White Native Hawaiian/Other Pacific Islander Black/African American American Indian/Alaskan Native Other For each question below, please check the best answer in the answer column 1. How soon after you wake up do you smoke your first cigarette? 2. Do you find it difficult to refrain from smoking in places where it is forbidden, i.e. in church, at the library, in cinema, etc.? 3. Which cigarette would you hate most to give up? 4. How many cigarettes/day do you smoke? 5. Do you smoke more frequently during the first hours after waking than the rest of they day? 6. Do you smoke if you are so ill that you are in bed most of the day? Answer Column Within 5 minutes 6-30 minutes minutes After 60 minutes Yes No The first one in the morning All others 10 or less or more Yes No Yes No Points Scoring: 0 2 Points = Mild Nicotine Dependence 3 6 Points = Moderate Nicotine Dependence 7 10 Points = Heavy Nicotine Dependence 34

37 1. How old were you when you first tried tobacco? 2. How old were you when you started smoking or using chew regularly? 3. Please check the kinds of tobacco you use now: Cigarettes Pipe Hookahs Cigars Blunts Chew/Spit or Snus E-cigarette Other 4. How many other tobacco users live with you? (Do not include yourself) Who? 5. Do you sometimes awaken at night to smoke? Yes No 6. How many times have you quit for at least 24 hours? 7. a. What was the longest amount of time you were able to go without smoking or using tobacco? b. When was that? 8. When was the last time you tried to quit smoking or using tobacco? 9. What medications have you used in the past to stop smoking or using tobacco? Please check all. Nicotine Patches Nicotine Gum Nicotine Lozenge Nicotine Inhaler Nicotine Spray Bupropion (also called Zyban or Wellbutrin) Varenicline (Chantix) Other 10. If you have quit before, what things triggered you to return to smoking or using tobacco? Please check all that apply Stress Boredom Social situations Withdrawal symptoms Being around other smokers Weight problems Urges to smoke Drinking alcohol I don t know A crisis Other 11. What things do you like about smoking? 12. What harmful or negative effects has smoking caused you? 13. What reasons do you have for wanting to quit? 14. What worries or concerns do you have about quitting? 15. Please list any spiritual or cultural issues that you would like us to know about that are important to your smoking or your quitting. 16. On a scale of 1 to 10, how important is it for you to quit tobacco use? Please circle your answer: Not very important Very important On a scale of 1 to 10, how confident are you in your ability to quit tobacco use? Please circle you answer: Not very confident Very confident

38 18. Do you exercise every week? Yes No IF Yes, how often? (Circle the best answer) Always Sometimes Rarely IF Yes, what do you usually do for exercise? 19. What are your hobbies or special interests? 20. What is your view about your current weight? Is it: Just right? Too low? Too high? 21. Please list any alternative treatments you regularly get, such as acupuncture. 22. Do you drink caffeinated beverages (such as coffee, tea, colas)? Daily Sometimes Seldom Never 23. Would you say, in general, your physical health is (check one) Excellent Good Fair Poor 24. Would you say, in general, your mental health is (check one) Excellent Good Fair Poor 25. Are you currently being treated for chronic pain with medications, such as narcotics? Yes No 26. Do you currently drink alcohol? Yes No IF Yes, how much per week? 27. Do you currently use any street drugs or other medications that change your mood? Yes No 28. Have you had repeated episodes of anxiety that interfere with your day to day activities? Yes No 29. During the past month, have you been bothered by: a. Having little interest or pleasure in doing things? Yes No b. Feeling down, depressed or hopeless? Yes No Please list all medication you take, including over-the-counter, herbs and supplements. Allergies & reactions 36

39 Please review these conditions, and check all that apply. Heart attack, angina chest pain Heart disease High cholesterol High blood pressure Irregular heart beat Stroke Diabetes Cancer Hepatitis Tuberculosis Pregnant/breast-feeding Asthma Emphysema, COPD, bronchitis Cough or phlegm Shortness of breath Stomach ulcers Stomach stapling/banding Heartburn Eczema/skin conditions Dentures/tooth problems Pain problem Eating disorder Seizures (for any reason) History of brain injury ADD ADHD Anxiety or panic disorder Depression Schizophrenia PTSD Other mental health condition Other Other comments Thank you very much. Please bring this to your appointment. Developed by MaineHealth Center for Tobacco Independence on behalf of the Maine CDC, Department of Health and Human Services, Partnership For A Tobacco-Free Maine, revised 4/4/14 37

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41 Tools & Resources LOCAL Breathe Easy Coalition The Breathe Easy Coalition seeks to decrease exposure to secondhand smoke through voluntary tobaccofree policy adoption. Currently, the Coalition provides various resources and technical assistance to promote tobacco-free environments in colleges, hospitals, behavioral health facilities and multi-unit housing throughout the state of Maine. Maine CDC Partnership For A Tobacco-Free Maine Maine CDC Partnership For A Tobacco-Free Maine (PTM) is the Maine State tobacco prevention and control program. Its mission is to reduce death and disability from tobacco use among Maine citizens by creating an environment supportive of a tobacco-free life. MaineHealth/Center for Tobacco Independence The Center for Tobacco Independence (CTI) is supported by PTM and brings together a team of highly qualified individuals who focus on linking tobacco users to the most effective methods to quit. The Center provides direct treatment services, offers consultation for health systems and employers, conducts research, and educates health professionals about tobacco dependence and treatment. The Maine Tobacco HelpLine Supported by the Maine CDC Partnership for A Tobacco-Free Maine, the Maine Tobacco HelpLine answers your questions and offers friendly support to those who are thinking about quitting or who are ready to quit smoking, or those who want to help a friend or family member quit Project Integrate Project Integrate works to identify and address barriers to integrating effective tobacco treatment into behavioral health, mental health and substance abuse treatment modalities. Project Integrate also works to link providers with existing tobacco-free policy resources and trainings. Some behavioral health specific materials have been developed and are available on the website Tools & Resources

42 The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to DHHS ADA Compliance/EEO Coordinators, 11 State House Station 221 State Street, Augusta, Maine 04333, (V), (V), TTY users call Maine relay 711. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request. 40