Recovery Network of Programs Inc (RNP) Tobacco Dependence Treatment Pilot

1. Recovery Network of Programs Inc (RNP)Tobacco Dependence Treatment Pilot

2. RNP RNP is located in Bridgeport, CT (Substance Abuse & Mental Health Treatment) Regional Network of Programs, Inc. (RNP) was founded in 1972 as a non-profit behavioral health care organization. Our mission is to serve the economically disadvantaged/afflicted person by using a variety of individualized and diversified approaches to person-centered care. Tobacco Dependence Treatment Pilot • Designed a manual in 2006 to offer tobacco cessation for co-occurring clients in a Psychosocial Club. • Realized interest level that clients have to reduce or quit their tobacco use. • Realized how little treatment was being provided for our population of clients. • Realized that there was an elephant in the room. RNP’s Pilot: • RNP pilot started in November 2008. • Presently we continue to assess outcomes from the pilot. • Review of outcomes will be Spring of 2011. WELCOME

3. What We Have Done • Our Progress • What We Have Learned What We Will Cover

4. ASSESSMENT • Implemented a Survey CAPACITY BUILDING • Presented Results, Surprises, Staff Buy-In • Educating staff about nicotine addiction • Recruited and trained staff PLANNING • Implemented Fagerstrom Assessment • Organized groups • Ensured resources in place IMPLEMENTATION • Started Groups – Pre contemplative, Action MONITORING and EVALUATION • Monitoring support • Evaluation – Quantitative and Qualitative SAMSHA, Strategic Prevention Framework What We Have Done

5. Implemented a Survey to RNPclients. Consisted of Ten Questions measuring: • Smoking History e.g. Have you ever thought about reducing or stopping smoking? • Prevalence e.g. How many client smoked and how much they were smoking. • Readiness to quit e.g How ready was the client to quit from (1-10) • Fearse.g.. Are you worried quitting smoking might affect your recovery? • Supports Needed e.g. Nicotine Replacement Therapies (NRT’s), Groups, Quit Line, 1:1 sessions. Assessment

6. Capacity Building: Presentation of Results

8. RNP Smoking Survey Results

9. RNP Smoking Survey Results

10. RNP Smoking Survey Results

11. RNP Smoking Survey Results

13. RNP Smoking Survey Results

14. Enzyme Levels: Non-smoker vs. Smoker

15. Brain Imaging Effects of nicotine on neurotransmitters NIDA Notes

16. People with mental illness consume 45% of cigarettes smoked in U.S. Lassar 2000 More individuals who are alcohol dependent die from tobacco-related diseases than they do from alcoholism. Journal of the American Medical Association, 1996 People with mental illness and/or substance use disorders die, on average, 20-30 years sooner than the general population. Smoking is a preventable cause. National Assoc. of State Mental Health Program Directors report, “Tobacco Free Living,” July 2007 Clients who receive tobacco cessation treatment have better substance abuse treatment outcomes. Clients are more likely to reduce their use of alcohol and other drugs and increase their rates of long-term abstinence up to 25% Journal of Drug Issues (2002) American Journal of Addiction (1997) Capacity Building:Educating staff about nicotine addiction

17. Recruited and Trained Staff Recruited Certified Addiction Counselors • Selected Staff with interest for this pilot • Staff that were able to facilitate groups Trained in two different programs: • American Cancer Society, “Fresh Start” (4 weeks) • “Learning about Healthy Living Manual” • (20 weeks) Pychoeducational • (6 weeks) Quit Component Capacity Building:Educating staff about nicotine addiction

18. Implemented Fagerstrom Assessment • Incorporated into all intakes • Presented Algorithm Demonstrated for clinicians the referral process. Organized groups • Advertise- emphasize wellness message Ensured resources in place • Accessed free resources – local, state, national • Webinars, Educational Materials, Trainings, Manuals, Innovative Ideas Web site: Smoking Cessation Leadership Program PLANNING

21. I Started Groups • Pre contemplative • Active • 14 staff members have been trained to facilitate smoking cessation groups. • Currently groups are being provided in 7 of our programs. (Expect three more to start in October2010) Implementation

22. Monitoring support • Evaluation • Quantitative • Qualitative • We continue to meet as a team on a quarterly basis. • Assess strengths, weakness & opportunities for improvements • Share Solutions, Ideas and Data Monitoring & evaluation

23. Groups Conducted in total = 68 Clients Serviced = 123 Clients Referred to Quit Line = 58 Clients that reduced tobacco use = 19 Clients that quit tobacco use = 6 Implementation Started in Late April 2010 and we currently have limited outcomes at this time. Our progress: What does the data say?

24. Lessons learned… What is working: • Support of management • Staff buy-in has increased overall in agency • Start with easy program and system changes for e.g. designated smoking areas • Trained staff • Accessing free resources • Collecting and relaying results Challenges: • Program culture • Lack of funds NRT’S Designated position • Staff attitudes • Staff leaving RNP Next Steps: • Securing Funds • NRT’s • Designated Position • Review & Revise Tobacco Polices based on what we are learning from this pilot

25. Final Thought…

26. FOR NOT If you have any questions, please contact me: Kevin Kasbarian Email: kevin.kasbarian@rnpinc.org