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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
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
©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
©2012BHWP©2017BHWP
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
©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.
©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
TobaccoCessationInterventionsinCommunityCorrections
Interventionssignificantlyincreasereadinesstoquitscores,quitattempts,andquitratesforindividualsincommunitycorrections
§ Tobacco-FreeGroups§ NicotineReplacementTherapy(NRT)§ MotivationalInterventions/MotivationalInterviewing(MI)
§ CognitiveBehavioralTherapy(CBT)
©2012BHWP©2017BHWP
Patient-CenteredMedicalNeighborhood:InnovativeServiceDelivery
Anypointofservicecanbecomethehubofcare
©2012BHWP©2017BHWP
AContinuityofCareModelforJusticeInvolvedIndividuals
Jails
Prisons
CommunityRe-EntryWellnessProgramming
Tobacco-FreeAdvancedTechniquesfor
ProvidersandPeers
In-reach
©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
www.bhwellness.org
BHWP_UCDBehavioralHealthandWellnessProgram