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.

What We Have Done

Our Progress

What We Have Learned

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

Implemented a Survey to RNP clients.

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)

Fears e.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.

RNP 2008: % of Client's That Smoke Regularly

91.05%

88.00% 87.62%

85.44%83.91%

82.84%

72.18%

69.63%

50%

60%

70%

80%

90%

100%

Horizons(257)

MBC (25) NewProspects

(105)

KTC (975) CHS (1454) RCS IOP(134)

RAP (151) RCS OP(619)

% Smoke Regularly

Data Source: DMHAS DPAS Data Base 19.7% of Americans reported smoking regularly in 2007. Source: CDC "Morbidity and Mortality WeeklyReport".

RNP 2008: % of Client's That Smoke RegularlyBy Gender

91.96% 92.00%

87.65%

92.86%

87.36%

72.73%

88.89%

63.64%

83.93%

66.02%

71.07%

78.57%

82.46%

85.08%87.68%

83.64%

50%

60%

70%

80%

90%

100%

Horizons (250) NewProspects

(105)

KTC (848) CHS (1347) RCS IOP (154) MBC (29) RCS OP (602) RAP (125)

Women

Men

Data Source: DMHAS DPAS Data Base

Smokers by gender overall: Women 86.78% Men 80.64%

RNP: 2008 Smoking Survey

47.87%

27.01%

12.80% 12.32%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Daily Weekly Monthly Yearly

How often do you think of stopping?

N= 211 responses

RNP: 2008 Smoking Survey

34.88%

65.12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

yes no

Interested in attending smoking cessation group

N= 215 responses

RNP: 2008 Smoking Survey

15.28%

4.63%6.48%

8.80%

24.54%

7.41% 8.80%6.94%

2.78%

14.35%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

One Tw o Three Four Five Six Seven Eight Nine Ten

Level of motivation to quit (1 low est)?

N= 216 responses

RNP: 2008 Smoking Survey

29.89%

61.96%

8.15%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Group NRT Other

Support needed to stop nicotine use

N= 184 responses. Other included: stopping on ow n, money,individual counseling, and MET.

RNP: 2008 Smoking Survey

29.03%

70.97%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

yes no

Worried quitting smoking may affect recovery

N= 217 responses

Enzyme Levels: Non-smoker vs. Smoker

Brain Imaging Effects of nicotine on

neurotransmitters

NIDA Notes

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)

Recruited and Trained StaffRecruited 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

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

IStarted 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 October 2010)

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

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.

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

FOR NOT

If you have any questions, please contact me:Kevin Kasbarian Email: kevin.kasbarian@rnpinc.org