1. Effective Treatment Planning
Tobacco Dependence Screening and Treatment in Behavioral Health Settings
Effective Treatment Planning

2. OBJECTIVES As a result of this training, participants will be able to:
Identify various elements of a treatment plan and how they apply to the treatment of tobacco use
Identify treatment interventions that can be utilized in the treatment of tobacco use
Complete treatment plans that effectively address tobacco use

3. AGENDA Welcome, Introductions, Goal and Objectives
Elements of a treatment plan
Tobacco use treatment interventions
Creating effective treatment plans for tobacco use
Closing

4. WELCOME & INTRODUCTIONS
Please share your:
Name
Agency
Role

5. Treatment Planning Basics
Open-Ended Questions Worksheet Activity
Explain the following:
Now everyone will do an activity to build skills in writing open-ended questions.
Asking open-ended questions can sound like an easy task, but before meeting with a client it is important to practice asking them.
We are passing out a worksheet. Every statement on the worksheet is phrased as a closed ended question. The task is for you to individually rewrite questions to make them open.
Ask participants to refer to the Open Ended Questions Worksheet.
Give them about 5 minutes to complete sheet individually.
Keep the PowerPoint slide with Open-Ended Question Stems up on the screen.
Call time and review as a large group.
If people have trouble writing open questions, ask another volunteer to share what they wrote.

6. Basis of the Treatment Plan
Based on findings in the assessment
Only areas identified as problematic are addressed
Takes into account the strengths, abilities, and preferences of the client.
Treat for as long as it takes
Developed in collaboration with the client.

7. When to Address Tobacco Use
When a client is a current tobacco user?
When the client has never used tobacco?
When the client has a history of tobacco use and last used six months ago?
When the client has a history but hasn’t used in two years?
When a client states that they don’t want to stop using tobacco?
Answers are yes, no, yes, no, yes. Cutoff for addressing tobacco is generally a year or less of discontinued use. This is in line with the definition of sustained remission in the DSM-5. It indicates less risk of resumed use. With regard to the client who does not want to stop: The treatment plan is a collaborative effort, which means that there will be negotiation involved. While the client might not want to stop using, the counselor will need to skillfully negotiate with the client how they might address the area in a way that respects the client’s autonomy while also addressing the area. An example that can be used would be a client who comes into treatment and says they don’t want to stop using substances. While it is the client’s treatment plan, the counselor will need to find a way to collaborate with the client on how to include the area on the treatment plan in a non-threatening way.

8. Purpose of the Treatment Plan
Helps organize client treatment and therefore make it more effective
Helps to justify the provision of services to payors
Allows client to be active participant in determining what and how things will be addressed during treatment
Facilitator may want to ask the participants about the purpose of the treatment plan before revealing the bullets on this slide. This will make this material more interactive.

9. Elements of a Treatment Plan
Problem Statement-Defines rationale for addressing specific area
Long-Term Goal-Represents a resolution of the problem
Short-Term Goal-Specific, measurable steps client will take to reach problem resolution
Interventions-Services counselor will provide to support short-term goal acquisition

10. Stages of Change and Treatment Planning
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
How does the stage of change a client is in impact the treatment planning process?

11. Stages of Change and Treatment Planning
The stage of change an individual is in with regard to tobacco will help determine which treatment interventions are appropriate

12. Stages of Change and Treatment Planning
Pre-contemplation and Contemplation
Motivational Interviewing
Preparation, Action and Maintenance
Pharmacological Interventions
Cognitive Behavioral Therapy
Relapse Prevention Therapy

13. Activity-Elements of a Treatment Plan
Open-Ended Questions Worksheet Activity
Explain the following:
Now everyone will do an activity to build skills in writing open-ended questions.
Asking open-ended questions can sound like an easy task, but before meeting with a client it is important to practice asking them.
We are passing out a worksheet. Every statement on the worksheet is phrased as a closed ended question. The task is for you to individually rewrite questions to make them open.
Ask participants to refer to the Open Ended Questions Worksheet.
Give them about 5 minutes to complete sheet individually.
Keep the PowerPoint slide with Open-Ended Question Stems up on the screen.
Call time and review as a large group.
If people have trouble writing open questions, ask another volunteer to share what they wrote.

14. Tobacco Use Treatment Interventions
In small groups, write down as many different interventions to address tobacco that you can think of
Be as specific as possible

15. Tobacco Use Treatment Interventions
Nicotine Gum
Nicotine Lozenge
Nicotine Nasal Spray
Nicotine Patch
Nicotine Inhaler
Buproprion
Varenicline
Be sure to point out that the reason that we are reviewing these treatment interventions is because they will be integrated into the treatment plans of various clients.

16. Tobacco Use Treatment Interventions
Motivational Interviewing
Cognitive Behavioral Therapy
Relapse Prevention Therapy
Individual Counseling
Group Counseling
Contingency Management
Peer Recovery Support
Mindfulness

17. Case Study # 1
Now let’s review a case study and work together to create a treatment plan addressing the tobacco use

18. Case Study # 2
Now you will have an opportunity to complete a treatment plan for tobacco use independently

19. Case Study # 3
Practice creating a treatment plan individually one more time using a case study

20. Thank You!
Highlights
Thank everyone for their participation and hard work.
Ask if anyone wants to share one highlight they are taking away from the training. (Time permitting)
Once everyone who wants to say something has, wrap up the training by thanking participants for being a part of the training.