1. Clubhouse of Suffolk: A Model Intervention for Tobacco Dependence in Individuals with Serious Mental Illness Tara Fredericks, LMSW

2. Objectives Discuss programmatic and non-programmatic strategies for addressing tobacco use in mental health settings Recognize consumers’ desire and ability to reduce or cease cigarette consumption. Identify resources to support effective tobacco dependence treatment

3. Disclosure Statement I have no real or perceived vested interests that relate to this presentation nor do I have any relationships with pharmaceutical companies, and/or other corporations whose products or services are related to pertinent therapeutic areas.

4. A Model Intervention In 2003 Clubhouse of Suffolk, Inc. was awarded a grant to develop tobacco dependence intervention strategies for individuals with mental illness.

5. Readiness Have Motivation Leadership Awareness Need Knowledge Support Direction

6. Clubhouse of Suffolk, Inc. Tobacco Model

7. Integration “that’s where we already go…” Relationships Access Language Expertise Culture

8. Services Tobacco Awareness: “Why I Smoke”Tobacco Awareness: “Why I Smoke” Individual Readiness Development and Personal Quit PlanningIndividual Readiness Development and Personal Quit Planning Cessation and Relapse Prevention GroupsCessation and Relapse Prevention Groups Peer Support GroupsPeer Support Groups

9. Tobacco Awareness

10. Community Changes Staff Development and TrainingStaff Development and Training Policy: Phase 1Policy: Phase 1 Marketing/AwarenessMarketing/Awareness “Talking About Tobacco”“Talking About Tobacco”

11. Outcomes Other Members QuitOther Members Quit Support and OutreachSupport and Outreach ReplicationReplication

12. Results The program was successfully implemented in Clubhouse of Suffolk with over 60 members participating in the Tobacco Awareness groups, approximately 20 more attending the peer groups and numerous members taking advantage of individual treatment planning to help them quit.

13. Results Of the members who participated in the Tobacco Awareness groups 36% made a serious quit attempt and nearly 24% maintained their quit time for at least 3 months. We also saw a significant decrease in the number of cigarettes smoked per day among those who made a quit attempt as well as those who did not.

14. Change in Number of Cigarettes Smoked

15. Number of Sessions Attended Chang in Cigarettes Smoked Per Day

17. Program Replication (UIBH) A total of 111 consumers engaged in group services within 6 program sites. 56% made either a quit attempt or a reduction to quit. 39% of consumers engaged in group services made a quit attempt. –30% of consumers who made a quit attempt used tobacco treatment medication(s) 17% of consumers engaged in group services reduced their cigarettes per day consumption. 30% of consumers engaged in group services utilized tobacco treatment medications. 43% of consumers attended more than one group, 13% attended 3 or more groups. 24% of consumers who attended more than one group who did not make a quit attempt reported a positive change in level of readiness to quit

18. Observations

19. There is a lack of awareness and knowledge regarding tobacco dependence in this population among professionals and service providers.

20. Staff < 10% have ever made a referral to NYS Smokers’ Quitline. 56% believe that Nicotine causes cancer.

21. Observations Time and effort must be spent addressing attitudes and beliefs regarding tobacco use within an agency for intervention strategies to be completely successful.

22. Staff 98% believe that quitting smoking is extremely or very important to an individual’s medical health, only 88% believe it is as important to mental health. 53% believe that the consumers they serve will not be able to quit regardless of support and services provided.

23. Observations There is a significant need for tobacco dependence treatment to be available at multiple levels within the mental health treatment setting.

24. Staff 50% believe that more consumers would want to quit if they had Information 67% believe more would want to quit if they had support.

25. The Healthy Body Healthy Mind Model

27. You Can Do This

28. Advertise Take the materials that we discussed today or order a poster from the NYS Smokers’ Quitline (www.nysmokefree.com) and hang it in a prominent place in your agency, where everyone can see.

29. Talk Before the end of each day have at least one conversation with one consumer about tobacco. You can talk about how smoking impacts their health, housing, finances, job or recovery.

30. Share Use the information you learned here today, or any of the resources that we’ve told you about, and present them to the other staff in your agency. Example: Show the video Smoke Alarm at your next staff meeting. (www.clubhouseofsuffolk.org)

31. Steps to Success 1.Evaluation of Agency (knowledge, attitudes and stage of readiness for change) 2.Staff Training 3.Consciousness raising activities (wellness initiative) 4.Implementation of Services 5.Re-Evaluation and policy change