FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register

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1 FACILITATOR TRAINING DATES & LOCATIONS Wednesday, September 14, 2016 Chicago, IL Wednesday, November 9, 2016 Springfield, IL Wednesday, November 16, 2016 Chicago, IL* Wednesday, March 15, 2017 Chicago, IL Chicago: 55 W Wacker Dr #800, Chicago, IL Springfield: 3000 Kelly Lane, Springfield, IL TIME 8:30am 4:30pm COST $250 per person (Licensure Fee may also apply, review details below) *Training offered at 50% discount as part of Nobody Quits Like Chicago Cessation Awareness Week, led by the Chicago Department of Public Health. The American Lung Association unites with more than 24 other local advocacy groups to bring awareness to smoking cessation. #ChicagoQuits AGENDA About the American Lung Association Tobacco, Addiction, and Cessation Program Overview Being a Facilitator Demonstrations of the Sessions Training Review Evaluation of Training TO REGISTER See pages 2-7 for more information and to register CERTIFIED TO HELP SMOKERS QUIT! Freedom From Smoking is the American Lung Association s gold-standard smoking cessation program for adults. The one day Facilitator Training is required for those who want to lead the 7-week Freedom From Smoking clinic (in-person). Participants who successfully complete the training will be certified by the American Lung Association. The training helps future facilitators understand the quitting process as well as all components of the program. By the end of the program, participants will be able to: Define roles and responsibilities of Freedom From Smoking Facilitators Facilitate each session of the program Identify characteristics of effective group leadership and communication Implement a variety of problem-solving techniques for the clinics CONTACT Kristina Hamilton [Chicago] Lori Younker [Springfield]

2 About Freedom From Smoking Clinics FREEDOM FROM SMOKING To help adult smokers quit, the American Lung Association (ALA) offers Freedom From Smoking. The Freedom From Smoking clinic consists of 8, in-person sessions delivered by an ALA-trained facilitator in a small-group setting (usually 8 10 people). Each session uses techniques based on pharmacological and psychological principles, and methods designed to help smokers gain control over their behavior. Lectures, group discussion, and skills demonstration using a variety of evidence-based practices meet the needs of different learning styles. Learn more at SESSIONS The 8 Freedom From Smoking clinic sessions each last about 2 hours (120 minutes). However, 1½ hours (90 minutes) is an acceptable time frame when the program is conducted in a workplace setting or with less than 8 participants. Sessions shorter than 90 minutes are not recommended. The first three sessions are considered part of the Preparation Phase. Session 4 is Quit Day. The sessions that follow are the Maintenance Phase. Sessions are typically held once a week. However, Session 5 (the session after Quit Day ) should occur 48 hours after Session 4. For example, if your class is every Tuesday, Session 4 would be on Tuesday and Session 5 would be that Thursday. This helps provide extra support for the participants who just quit. Therefore, the 8 sessions occur during a 7- week period. Session 1: Thinking About Quitting Session 2: On the Road to Freedom Session 3: Wanting to Quit Session 4: Quit Day Session 5: Winning Strategies Session 6: The New You Session 7: Staying Off Session 8: Celebration CLINIC SIZE A clinic with 5 to 16 participants is best. This allows for a variety of personalities, as well as a strong supportive environment. Even if some exit along the way, the numbers are still large enough to avoid negative effects on those who remain. If 17 or more participant sign up, form two clinics. MATERIALS Participant packets must be purchased for every clinic participant. The participant packet contains a Participant Workbook and Relaxation CD (available in English and Spanish). While some clinic activities suggest using additional supplies, the Participant Workbook and Relaxation CD are the only participant materials required to conduct the clinic. Each participant packet is $25 plus shipping. 2

3 Delivering the Program: Step 1 In order to deliver the American Lung Association s Freedom From Smoking clinic, (and before attending a Facilitator Training), the proper agreement must first be signed. There are three categories of agreements: Independent, Non-For-Profit, and For-Profit. Please see the descriptions of each below to determine which is right for you. INDEPENDENT (COMMUNITY-BASED) Individuals who are not associated with an organization or own a business promoting wellness services are able to provide Freedom From Smoking as essentially a volunteer Facilitator. S/he must provide the Freedom From Smoking clinic at public community spaces and the clinics must be open to the public (so they cannot be for businesses). S/he cannot charge participants for profit beyond recovery of the expenses for participant materials. BUSINESS, NOT-FOR-PROFIT (SERVING EMPLOYEES & CUSTOMERS) Companies, hospitals, government agencies, and non-profits with the desire to provide Freedom From Smoking on a not-for-profit basis (will not make money by providing the program) must first obtain a three-year Unlimited Licensure. Obtaining this licensure requires the signing of and adherence to an agreement, as well as paying the $4,000 fee. This allows the group to provide Freedom From Smoking as frequently as desired during the three-year agreement period. Along with the use of Freedom From Smoking, the fee covers technical assistance, resources, and support from the American Lung Association over the agreement period. A 35% discount is available for military and nonprofit organizations ($2,600 fee). The Unlimited Licensure agreement must be signed, and the fee paid, in order to send an individual to a Facilitator Training. BUSINESS, FOR-PROFIT (SERVING MULTIPLE COMPANIES) Freedom From Smoking is a trademarked smoking cessation program. Organizations with the intention of providing Freedom From Smoking for profit or reselling the program (such as wellness agencies), are subject to the terms of an Authorized Provider agreement. Authorized Providers must sign an annual agreement and pay an annual fee of $4,000. Please contact Kristina Hamilton ( ) or Lori Younker ( ) with questions about determining the appropriate category for you. Once you sign your agreement, you can move on to Step 2: Getting Trained as a Freedom From Smoking Facilitator. 3

4 Delivering the Program: Step 2 ABOUT THE FREEDOM FROM SMOKING FACILITATOR TRAINING Facilitator Training is offered for individuals who want to provide in-person Freedom From Smoking clinics. This training is designed for individuals such as health care professionals, wellness coordinators, social workers, and human resource professionals interested in helping others quit smoking. This training will prepare participants to conduct the group program using the respective curriculum and materials, and help smokers understand their addiction while giving them the tools to quit. Facilitator Trainings are offered throughout the year. To register, complete the Application Form (below). Certification is valid for three years, at which time active facilitators must re-sign an agreement and complete a brief recertification webinar. FREEDOM FROM SMOKING FACILITATOR REQUIREMENTS Be tobacco-free for at least 1 year Attend the entire Facilitator Training Be experienced in and comfortable with conducting group programs Complete the Facilitator Agreement form and abide by the Agreement Conduct at least 1 clinic every 12 months Provide data to the American Lung Association for each clinic REGISTRATION FEE The cost of the Facilitator Training is $250, which covers: Training by a Certified Trainer Facilitator Guide and Participant Handbook with Relaxation CD Additional resources/information Certificate of Participation Lunch and refreshments Facilitator website access (a passwordprotected site with resources and materials) FACILITATING CLINICS AFTER TRAINING Certified Freedom From Smoking facilitators must use the American Lung Association materials for conducting the authorized program. Freedom From Smoking Participant packets, which consist of a workbook and relaxation CD for $25 plus shipping, must be purchased by the Freedom From Smoking Facilitator, or co-sponsoring organization, and provided to each Freedom From Smoking participant. Individuals or organizations may not use elements of the program as part of another program or co-mingled with another organization s program. Additional rules are outlined in the Facilitator Agreement, which must be signed at the training in order to be certified. Please see the attached sample agreement to understand facilitator expectations. 4

5 American Lung Association of the Upper Midwest Facilitator Letter of Agreement In Conducting Freedom From Smoking Programs Thank you for participating in training for the American Lung Association (ALA) Freedom From Smoking (FFS) program. Please read the following two pages carefully and acknowledge agreement by signing in the space below. SAMPLE 1. The American Lung Association of the Upper Midwest (ALAUM) upholds high standards in the training and implementation of its programs. To ensure ALA professional standards and maintain quality control of the Freedom From Smoking program, the trainee and co-sponsoring organization agree to: a. Adhere to the content and format of the program as provided by the American Lung Association. b. Be trained and certified by the ALAUM to lead or supervise the program. c. Individual or co-sponsoring organization may join with a third party, including any funding sources, in conducting Freedom From Smoking program only with prior approval by the ALAUM. A third party may not have any affiliation with a tobacco company and may not receive funds directly from a tobacco company. d. Use the ALA materials for conducting the authorized Freedom From Smoking program. Individuals or organizations may not use elements of Freedom From Smoking as part of another program or commingled with another organization s program. e. Freedom From Smoking is a copyrighted program of the American Lung Association. Therefore, registered trademark and acknowledgement that it is an ALA program must appear on any materials and promotions developed for the program. Requests for permission to use any ALA-copyrighted materials or trademarks must be approved in writing by the American Lung Association National Headquarters. 5

6 f. No portion may be copied or reproduced in any way, without express permission of the American Lung Association National Headquarters. g. Training materials are the property of the certified facilitator conducting the program and cannot be duplicated or distributed to others. h. Facilitators must be a nonsmoker or ex-smoker and must not have used any form of tobacco in at least twelve months. 2. The Freedom From Smoking program, services and materials of the American Lung Association are offered to the public for a not-for-profit basis. Therefore: a. Individuals or their organizations may not offer the Freedom From Smoking program for profit. b. Trained individuals or organizations must be non-profit or working on behalf of a company providing a health program for its employees and their families. c. Individuals and their organizations must adhere to the agreed upon program fees. SAMPLE d. If Freedom From Smoking is offered in a for profit workplace, a Corporate Letter of Agreement must be issued. Only the ALAUM can negotiate the Corporate Agreement. e. Compensation for facilitator cannot exceed $100 per clinic session ($800 per program) f. Trained individuals must advise the ALAUM of all programs delivered. 3. Protocol of data collection and reporting: a. Facilitators are required to use the appropriate evaluation materials and forms throughout program implementation. b. The following forms should be submitted to the ALAUM local office in a timely manner: i. Preliminary Report Form (prior to program) ii. Material Order Form (prior to program, prefer at least two weeks) iii. Final Report Form (within two weeks following final session) iv. Participant Consent Forms (within two weeks following final session) c. In all cases, when conducting programs, personal information including names and addresses of program participants must be kept confidential. 4. ALA is committed to research in the broad area of lung health. Therefore: 6

7 a. Research projects using Freedom From Smoking are acceptable with prior approval from the American Lung Association of the Upper Midwest and National Headquarters. b. In all cases, when conducting research, personal information including names and addresses of program participants must be kept confidential. c. Trained individuals should use the appropriate evaluation materials when conducting research throughout program implementation. All evaluation results should be forwarded to the ALAUM. ALAUM staff will submit to ALA appropriately. 5. Trainee or co-sponsor hereby indemnify and hold harmless the ALAUM and ALA from and against any claims, proceedings, lawsuits or other liabilities, costs or expenses, including legal fees, arising out of or attributable to acts, or omissions to act, of the trainee or co-sponsor. 6. Freedom From Smoking Facilitator Certification is valid for three years from the date of the training. a. Certification period: (training date) to (expires). SAMPLE b. Facilitators must maintain current certification in order to conduct programs. FACILITATOR NAME: FACILITATOR SIGNATURE: DATE: ALAUM REPRESENTATIVE: DATE: This is a legally binding document. Please retain a copy for your records. The original copy will be kept on file at the local American Lung Association of the Upper Midwest office. The American Lung Association of the Upper Midwest will be responsible for data reporting to ALA National Headquarters. 7

8 FACILITATOR TRAINING APPLICATION FORM Registration is required to attend. REGISTRATION DEADLINE is two weeks before scheduled training date. Training will take place as scheduled only if the participant minimum is met. Confirmations, including directions, will be ed prior to the training. Please contact Kristina Hamilton ( ) or Lori Younker ( ) with questions. APPLICANT INFORMATION Name Organization Mailing Address Credentials City State Zip Code Phone Cell Phone I have been tobacco-free for at least 12 months Yes No Dietary Needs Fax FREEDOM FROM SMOKING IMPLEMENTATION PLANS TRAINING DATES Please indicate your implementation category: Wed, Sept 14, 2016 (Chicago) Independent (community-based) Wed, Nov 9, 2016 (Springfield) Business, Not-For-Profit (for employees/customers) Wed, Nov 16, 2016 (Chicago) Business, For-Profit (serving multiple companies) Wed, March 15, 2017 (Chicago) I am interested in providing clinics as a representative for the American Lung Association Detailed description of how Freedom From Smoking will be used: REGISTRATION PAYMENT ($250 Facilitator Training Fee per Person) Check enclosed (write check #): Credit Card Name on card Type Card # Expiration 3-digit code SUBMIT APPLICATION & PAYMENT BY MAIL, FAX, OR TO: American Lung Association in Illinois Attn: Freedom From Smoking 55 W. Wacker Drive Suite 800 Chicago, IL Fax: Kristina.Hamilton@Lung.org CANCELLATION POLICY Registration cancellation must be communicated to the American Lung Association at least 7 days before the training date in order to receive a refund. No other refunds will be granted. The American Lung Association reserves the right to cancel or postpone any training. In this event, we will fully refund the registration fee, but are not responsible for related costs to participants. 8