The Maricopa County Justice- Involved Tobacco … · Report June –Oct 2017 Review Best Practices ... The addiction to nicotine Medications for cessation The habit of using tobacco

TheMaricopaCountyJustice-InvolvedTobaccoCessationProject

ProjectOverview

©2012BHWP©2017BHWP

Year1

June July Aug Sept Oct Nov Dec Jan Feb Mar

2017 2018

OnsiteVisit#1• Kick-OffMeeting• PilotSiteVisits

July– Aug2017

FinalActivityReport

June– Oct2017 ReviewBestPractices

GatherMaricopaBackgroundInformation

July– Aug2017 SurveyAdministrationNov– Jan2018 5-YearStrategicPlanDraft

Feb– Mar2018

MaricopaCounty– 1-YearTimeline

Apr May

Feb/March2018

OnsiteVisit#2• DraftStrategic

PlanPresentation

• StaffTraining

Apr– May2018

OnsiteVisit#3• Final

StrategicPlanPresentation

• EmployeeForum/Kick-offforTobacco-FreeGroups

ReviseStrategicPlan

June– Oct2017

Off-sitePlanningMeetingsOngoing

Webinar• ReviewSurveyData,

SiteVisitInformation• ReviewBHWP

Offerings

Oct2017

Reports• Evidence-base• Assessment/Kick-off/Site

Visits

©2012BHWP©2017BHWP

Tobacco& Justice-InvolvedPopulations

©2017BHWP

Smokingamongjusticeinvolvedindividualsisalargelyignored

publichealthepidemic

©2012BHWP©2017BHWP

SocialDeterminants:• Race/ethnicity• Poverty• Loweducationalattainment• “Underserved’healthstatus

priortoincarceration

ConditionsRelatedtoIncarceration:

• Pooraccesstocare/resources

• Multi-systeminvolvement• Negativeperceptionsfrom

healthproviders• Stigma

HigherRatesofChronicandinfectiousDiseases:• Mental

health/psychiatricdisorders

• Substanceabusedisorders

• Hypertension• Asthma• Cervicalcancer

(women)• Hepatitis• Infectiousdiseases

(HIV,tuberculosis,STIs)

PoorHealthStatus

LackofHealthEquity

IncarcerationandHealthOutcomes

©2012BHWP©2017BHWP

LeadingCausesofDeathAmongJustice-InvolvedIndividuals

Cancer*HeartDisease*RespiratoryDisease*

Liver Disease*Suicide*

*Conditionscausedorexacerbatedbytobaccouse

Suicide*HeartDisease*DrugorAlcoholIntoxication*Cancer*

LiverDiseases*

Prisons Jails

©2012BHWP©2017BHWP

RatesofTobaccoUse

74.8

25.2

GeneralPopulation

Peoplewhoaretobacco-free

Peoplewhousetobacco

80

20

CriminalJusticePopulation

Peoplewhousetobacco

Peoplewhoaretobacco-free

IntheUnitedStates,thesmokingrateamongthejustice-involvedpopulationisapproximately3times

higher thanthegeneralpopulation

©2012BHWP©2017BHWP

RatesofSmokinginMaricopaCounty

©2017BHWP

0

10

20

30

40

50

60

1957 1980 1998 2003 2008 2013

Men Women

TobaccoUseandBehavioralHealthPopulations

61-90%Schizophrenia

51-70%BipolarDisorder;49-80%OtherDrugAbuse45-60%PTSD

38-42%ADHD;36-80%MajorDepression34-80%AlcoholAbuse;32-60%Anxiety

©2012BHWP©2017BHWP

§ Smokingcessationhasnonegativeimpactonpsychiatricsymptoms

§ Smokingcessationgenerallyleadstobettermentalhealthandoverallfunctioning

CessationConcurrentwithPsychiatricTreatment

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TobaccoUse&AddictionTreatment

Addressingtobaccodependenceduringtreatmentforothersubstancesisassociatedwitha25%increaseinlong-termabstinenceratefromalcoholandothersubstances

©2017BHWP

DesiretoQuit

Forthoseincommunitycorrections,morethan

50%ofsmokersindicatedinterestinreceivinghelpif

itwereavailable

©2012BHWP©2017BHWP

MaricopaCounty– ReadinesstoQuit

5%

10%

15%

20%

25%

30%

BlackCanyonBuildingSampleatDrugCourt

GarfieldProbationCenterSMIProbationers

ProbationServiceCenterWesternRegionalCenter

©2012BHWP©2017BHWP

(Ineedto)findanotherhabit

Showmesomesmokingcessationtechniques

Ihavetriedseveraltechniquestostop,noneof

themhaveworked

I'mnotsurewhatservicesareavailable

It’shardtoquit

97%ofindividualsstartsmokingagainwithin6monthsoftheirrelease

TobaccoCessationInterventions

©2012BHWP©2017BHWP

TobaccoDependenceHasTwoParts

Courtesy of the University of California, San Francisco

Tobaccodependenceisa2-partproblem

Physical Behavior

Treatment Treatment

Theaddictiontonicotine

Medicationsforcessation

Thehabitofusingtobacco

Behaviorchangeprogram

Treatmentshouldaddressboththeaddictionand thehabit.

©2012BHWP©2017BHWP

TobaccoCessationMedications

§ Nicotinegum§ Nicotinelozenge§ Nicotinepatch§ Nicotinenasalspray

TheonlymedicationsapprovedbytheFoodandDrugAdministration(FDA)fortobaccocessationare:

§ Nicotineinhaler§ BupropionSRtablets§ Vareniclinetablets

©2012BHWP©2017BHWP

TobaccoDependenceHasTwoParts

Courtesy of the University of California, San Francisco

Tobaccodependenceisa2-partproblem

Physical Behavior

Treatment Treatment

Theaddictiontonicotine

Medicationsforcessation

Thehabitofusingtobacco

Behaviorchangeprogram

Treatmentshouldaddressboththeaddictionand thehabit.

©2012BHWP©2017BHWP

MotivationalInterviewing

Planning

Evoking

Focusing

Engaging

©2017BHWP

BehaviorChangeInterventions§ Cognitive-BehavioralTherapy§ Clinicianadvice§ Individualcounseling

⎻ >4sessions⎻ >10minutes

§ Psycho-educationalgroups§ Peersupport§ Tailoredself-helpmaterials

©2012BHWP©2017BHWP

DIMENSIONSAdvancedTechniquesPrograms

§ Evidence-basedtobaccocessationandWellBodyprograms

§ Initiallydevelopedin2006§ Theprogramssupporthealth

behaviorchangethrough:- Motivationalengagement- Groupprocess- Communityreferrals- Educationalactivities

©2017BHWP

TobaccoCessationResource

©2017BHWP

TobaccoCessationInterventionsinCommunityCorrections

Interventionssignificantlyincreasereadinesstoquitscores,quitattempts,andquitratesforindividualsincommunitycorrections

§ Tobacco-FreeGroups§ NicotineReplacementTherapy(NRT)§ MotivationalInterventions/MotivationalInterviewing(MI)

§ CognitiveBehavioralTherapy(CBT)

©2012BHWP©2017BHWP

Patient-CenteredMedicalNeighborhood:InnovativeServiceDelivery

Anypointofservicecanbecomethehubofcare

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SequentialInterceptModel

©2012BHWP©2017BHWP

AContinuityofCareModelforJusticeInvolvedIndividuals

Jails

Prisons

CommunityRe-EntryWellnessProgramming

Tobacco-FreeAdvancedTechniquesfor

ProvidersandPeers

In-reach

MaricopaCountyAssessmentofHealthServices

©2017BHWP

MaricopaCountyAssessmentofHealthServices

§ Usedtogaugeanagency’scurrentengagementinevidence-basedhealthandwellnessactivitiesandservices

- DrugCourt - MOSAIC(Durango/Estrella- HopeLives - VeteranProgramming

(TowersJail)§ Helpfultoidentifyexistingresourcesand

opportunitiesthatcanbeleveragedfortobaccocessationactivities

©2017BHWP

Pre-Contemplation

Anorganizationmaynotbeawareof,ormaynotbeconsideringthisprogramming

Contemplation

Anorganizationmaybeawareoftheneedforthisprogramming,butmaynotbepreparingtomoveforward

PreparationAnorganizationisawareoftheneedforprogrammingandistakingstepstoimplement

ActionAnorganizationisreadytoimplementprogrammingoverthenextthreemonths

Maintenance

Anorganizationhasimplementedprogrammingandiscontinuingtorefineandimprove

©2017BHWP

I.HealthEducationandSupportHealtheducationandstafftrainingonwellnesstopicsarebeingprovidedacrossagencies

Opportunities:Developanddistributeadditionalwellnessmaterialstodistribute

©2017BHWP

II.HealthScreening& TreatmentPlanningScreeningisoccurring,althoughsomeagenciesmaybereceivingscreeninginformationfromothersources

Opportunities:Implementadditionalscreeningservicesrangingfromhealthrisksandsymptomsofchronicillness

©2017BHWP

III.SubstanceUseScreeningandTreatmentPlanning

Allagenciesreportthattreatmentplanningforchronichealthconditionsandmentalhealthconditionsisoccurring

Opportunities:Implementsubstanceusescreeningservices,includingtobacco,foragenciesthatdon’thaveaccesstothisinformation

©2017BHWP

IV.OnsitePsychosocialServices

MotivationalInterviewingisbeingusedacrossallsites,andgroupcounselingisalsowidelyused

Opportunities:Addadditionalindividualand/orgroupcounselingservices

©2017BHWP

V.CommunityReferralsGreatwork!Communityreferralsforwellnessservices,substanceusetreatment,andmentalhealthservicesarecommonlyoccurringacrossagencies

Opportunities:IncreaseAshLine referralsforfreetobaccocessationcounseling

©2017BHWP

VI.PeerServicesThereisvariabilityacrossagenciesintheuseofpeersforprovidingsupportservices,includingmentalhealthandsubstanceuserecovery

Opportunities:Considertheroleofpeersascareextendersandasnavigators

©2017BHWP

VII.TobaccoControlPolicyGenerallythereisstrongtobaccocontrolpolicyacrossmostagencies,includingtobacco-freeworkplace,signage,andcessationsupportforstaff

Opportunities:Strengthenenforcementandcomplianceaswellastobacco-freepolicyexpansions

©2017BHWP

VIII.MeasuringOutcomesThereisvariabilityacrossagenciesinthemeasurementanddocumentationofhealthindicators

Opportunities:Buildamoresystematicprocessofdocumentinghealthstatusforjustice-involvedindividuals

©2017BHWP

Summary§ Surveyresultsmayhelpstimulatediscussionofstrengths

andopportunitiesaspartoftheSOaR activity

§ Surveyresultswillalsoguidediscussionandplanningatindividualsitevisits

§ TheStaffKnowledgeandBehaviorsSurvey willremainopenforadditionalparticipantsuntilAugust15th

- Pleaseremindyourstaffthatresponsesarebothanonymousandcriticallyimportantforunderstandingtheactivities,goals,andcultureofeachagency

BehavioralHealth&WellnessProgram

[email protected]

www.bhwellness.org

BHWP_UCDBehavioralHealthandWellnessProgram

SOaR:Strengths,Opportunities,andResources

©2017BHWP

SOaR DefinitionsCharacteristicsofyouragencythatcouldsupporttheproject

Elementsofyouragencyenvironmentthatcouldsupporttheproject

Agencyassetsthatmaybeusedtosupporttheproject

Strengths

Opportunities

Resources