Behavioral Health

Behavioral Health Tobacco & Nicotine Treatment Resource Guide

Background on Tobacco and Nicotine Treatment in Behavioral Health in New Mexico

Overall, 22 percent of adults in New Mexico (NM) reported any tobacco use (including cigarettes, smokeless tobacco or e-cigarettes) according to the most recent data available (2016-2017). Of adults in New Mexico, 16 percent report smoking traditional combustible cigarettes and according to New Mexico’s Indicator-Based Information System (NM-IBIS), smoking rates have steadily declined since 2011 – when smoking rates were just over 20 percent.

Cigarette smoking is twice as prevalent among adults who are living below the poverty level, 20.7 percent, compared to those living above the poverty level, 10.7 percent. Medicaid recipients in NM also have doubled the rate of smoking compared to those not receiving Medicaid, 12 percent. Cigarette smokers reported poorer mental health compared to non-smokers – 30 percent versus 14 percent. Adult New Mexicans who had suicidal thoughts within the past year were twice as likely to be cigarette smokers (29 percent versus 15 percent). Also, both heavy drinking and binge drinking increase a New Mexican adults’ chances of smoking by over half: 36 percent of heavy drinkers were smokers and 15 percent were non-smokers and 31 percent of binge drinkers were smokers and 14 percent were non-smokers.

There are significant disparities in tobacco use among adults with behavioral health conditions. The following data demonstrate disparities in tobacco use for adults with behavior health conditions based on the 2016-2018 New Mexico Behavioral Risk Factor Surveillance System (BRFSS). National data used for comparison come from a 2019 Morbidity and Mortality Weekly Report (see references).

Constellation Consulting, in collaboration with the New Mexico Department of Health Tobacco Use Prevention And Control Program, has created this Behavioral Health Tobacco & Nicotine Treatment Resource Guide. This guide is available for free and as a downloadable PDF. To add resources to the guide, please email suzanne@constellationnm.com.

New Behavioral Health Online Training Modules Now Available!

In FY22, Constellation Consulting worked in collaboration with the New Mexico Department of Health Nicotine Use Prevention And Control Program and convened the Behavioral Health Advisory Council to inform tobacco and nicotine treatment processes in our state. Through the work of the Behavioral Health Advisory Council, two new online training modules are now available. Free Social Worker CEUs are available for both of these modules through June 30, 2023.

How to Effectively Integrate Brief Tobacco Interventions

There are various ways that a provider can engage in Tobacco treatment for their clients and patients. It is important that providers understand the interventions needed to support nicotine users at each quit attempt. It is important that providers also understand evidence-based interventions such as motivational interviewing or Ask, Advise, and Refer to support their patients. In addition, providers should understand what services are available to patients for the success of their quit attempts. During this training, you will be able to 1. Understand evidence-based tobacco interventions 2. Understand motivational interviewing and its importance 3. Understand how to make proper referrals to patients for treatment 4. Understand the available resources both locally and nationally Objectives are that Participants can expect to be able to: 1. Describe proven evidence-based tobacco interventions 2. Confident to make brief intervention including AAR and five As 3. Be able to describe referral processes and community-based tobacco treatment service providers 4. Provide a list of resources both locally and nationally and make recommendations based on patients' needs Visit: NMNUPAC.COM for more information 1-800-QUIT-NOW

About Our Presenters:

Rebecca Padilla is a respected leader in both health systems change efforts and evidence-based tobacco use disorder treatment in clinical and public health settings. Rebecca is a process expert on evidence-based recommendations, emerging trends, implementation best practices and strategies to advance health equity. Rebecca facilitates national, state and local opportunities for collaboration between multiple teams to best leverage limited staff capacity and offers educational and organizational development consulting. Rebecca expertly advises public health professionals and health systems staff on proven-effective action steps to execute activities and initiatives that result in measurable quality improvements. “Resourceful Rebecca” always focuses on strategic, innovative, forward-thinking approaches to both opportunities and challenges. Rebecca is a member of the Society for Industrial and Organizational Psychology, the American Evaluation Association, New Mexico Evaluators, the Association for the Treatment of Tobacco Use and Dependence (ATTUD), and the NM Allied Council on Tobacco, in addition to being an active committee member and volunteer for several other local, regional and national organizations. Rebecca has the following licenses and certifications: Lean Six Sigma White Belt Certification (Six Sigma Society); Social Behavioral Research (CITI Program); Certified Tobacco Treatment Specialist (Mayo Clinic); and Freedom from Smoking Facilitator – Trainer (American Lung Association). She has presented for a variety of organizations include the New Mexico Allied Council on Tobacco and the North American Quitline Consortium. She has been instrumental in the development and launch of the American Lung Association’s behavioral health provider tools including reference guide, digital toolkit, organization assessment tools, and glossary.

Natalie Pena has more than seven years experience in tobacco and nicotine treatment and control work, and is a Certified Tobacco Treatment Specialist. Additionally, Natalie specializes in strategic planning, grant management, grant writing, process/program development. Through her previous work, she has a vast understanding of health-related issues due to chronic pain and tobacco use. Her main passion is to work with nonprofit organizations to identify the gaps in processes, capacity, and sustainability and develop practical solutions. Since, Natalie has a Bachelor’s of Business Administration with a concentration in Organizational Leadership, she brings a unique insight to the non-profit world. In addition to her passion to support local non-profits, she also loves to travel. Natalie had the pleasure of living in India for a year where she learned the interworks of Non-Governmental Organizations. During this time, she dedicated some of her time to volunteering at the Snehadaan orphanage in Bengaluru, India. Natalie is exited to bring all of her knowledge and wisdom for the betterment of the community.

Understanding Nicotine Replacement Therapy and Medication Assisted Treatment

About Our Presenters:

Behavioral Health Core Group

Following the 2020 Behavioral Health Webinar Series on Tobacco & Nicotine Treatment, Constellation Consulting, in cooperation with the Tobacco Use Prevention and Control Program (TUPAC), with funding from the New Mexico Department of Health, launched the Behavioral Health Core Group as a means to continue conversations regarding best practices, resources, and training opportunities available to behavioral health professionals.

The Behavioral Health Core Group is free to all participants. For more information, please contact krista@ConstellationNM.com.

Core Group Meetings (recordings available)

Health Systems Change in New Mexico
Watch this session online: https://www.youtube.com/playlist?list=PL7ZcdN84H0DhBlxfXWE3U7sOzWwGF-fxS

Original Meeting Date: March, 2021

Presenters: Maxine Daggett, MSW, Health Systems Change Specialist and Joe Wardel, TTS, Training and Outreach Manager with the New Mexico Nicotine Addiction Treatment Services

New Mexico Health Systems Training and Outreach Program was launched in 2014 with Health Systems Change Specialists in the field.

Objectives:

Identify the problem with nicotine in behavioral health
Discuss the impact on individuals with behavioral health concerns and substance abuse disorders and how tobacco-related disease and death affect them.
Debunk myths around nicotine and tobacco use
Learn how nicotine and tobacco use affect clients and who providers should treat nicotine use.
Understand the free resources available to support clients’ efforts in treatment and cessation

Behavioral Health Webinar Series on Tobacco & Nicotine Treatment

These sessions took place May - June, 2020

Constellation Consulting, in cooperation with the Tobacco Use Prevention and Control Program (TUPAC), with funding from the New Mexico Department of Health, to reduce adult and youth tobacco use through environmental strategies, hosted the Behavioral Health Webinar Series on Tobacco & Nicotine Treatment in May - June, 2020.

Featuring content experts as presenters, this series is designed to provide attendees with information, skills, and materials for use in their day-to-day work in behavioral health treatment environments.

Recorded Sessions

The ‘Why’ Factor
Watch this session online: https://www.youtube.com/playlist?list=PL7ZcdN84H0DhBlxfXWE3U7sOzWwGF-fxS

Presenter: Chad Morris, PhD., Professor Psychiatry and Director, Behavioral Health and Wellness Program, University of Colorado, Anschutz School of Medicine

Tobacco or nicotine treatment is critical to the recovery of persons with mental illnesses and addictions. This population is at multiplicative risk for nicotine use, has greater difficulty quitting smoking, and consequently, has a higher risk for tobacco-related death and disability. The majority of nicotine users with behavioral health conditions want to quit smoking and can quit nicotine when they have access to proven psychosocial and medication treatments. At the same time, these individuals are likely to need tailored supports and services. Dr. Morris will outline the challenges these nicotine users face, as well as evidence-based responses interdisciplinary providers and agencies can consider.

Objectives:
- Describe the unique challenges and opportunities which persons with behavioral health conditions present.
- Detail how tobacco/nicotine policies treatments is key to overall recovery and health goals.
- Review evidence-based resources and tools that assist behavioral healthcare agencies to integrate nicotine treatment into daily clinical practice.
- Learn about NM and national specific data and resources.

Stronger Together – A Systems Change Case Study
Watch this session online: https://www.youtube.com/watch?v=VGurfPmcGYs

Presenters: Esther Hoang, Cessation Specialist, Tobacco Use Prevention and Control Program (TUPAC) New Mexico Department of Health; Kara Kikuchi, Manager, Optum; Susanne Cress, Health Systems Change Specialist, Optum

Addressing nicotine addiction is a key component to recovery and can be a priority for every care provider, particularly when given the right resources. This session will discuss systems change to include nicotine substance use interventions as part of treatment planning and the resources available to support New Mexico behavioral health providers in adopting these activities. These activities include free QUIT NOW and DEJELO YA services (English and Spanish, respectively). The Tobacco Use
Prevention and Control program (TUPAC) also offers free online training specifically for behavioral health providers, “Treating Nicotine Dependence in Behavioral Health Settings”. This training describes how tobacco impacts behavioral health and how to provide a brief tobacco intervention with patients. The Health Systems Change Training; Outreach Program is a free consultation, training, and technical assistance program to systematically and routinely identify tobacco users, advise them to quit, and refer those ready to quit to appropriate treatment resources, such as the New Mexico Nicotine Addiction Treatment Services. Using a case study example, the presenter will explore one hospital’s initial and continued efforts to incorporate nicotine addiction treatment practices across all departments to support clients/patients in enhancing resiliency and self-efficacy.

Objectives:
- Outline the tobacco and nicotine addiction treatment resources available to behavioral health providers.
- Describe the value and impact of systems change for nicotine addiction treatment in behavioral health settings.
- Learn about a psychiatric hospital’s journey in health system change within both inpatient and outpatient settings. Including successes, challenges, and opportunities for growth.
- Translate the learnings from a psychiatric hospital’s systems change work to how this can be nicotine substance use can be addressed in a private practice.

Nicotine Abuse is Substance Use
Watch this session online: https://www.youtube.com/watch?v=fKxPfT8OQhM&list=PL7ZcdN84H0DhBlxfXWE3U7sOzWwGF-fxS&index=3&t=0s

Presenters: Chad Morris, PhD, Professor Psychiatry and Director, Behavioral Health and Wellness Program, University of Colorado, Anschutz School of Medicine; and Jeff Holland, LCSW, Director, Endorphin Power Company

Smoking combustible tobacco products remains the leading cause of death and disability in the U.S., with at least 480,000 dying annually due to smoking related causes. While approximately 14% in the U.S. smoke, the rate of smoking among persons with substance use disorders is at least three times this rate. Some studies have found that 97% of individuals in methadone or buprenorphine treatment smoke. Dr. Morris will discuss the shared biological and behavioral underpinning of nicotine addiction and other substance use disorders. He will detail how co-treatment can increase psychiatric and polysubstance use outcomes and suggest low burden strategies for integrating tobacco and nicotine use treatment into behavioral health and addictions treatment settings. Complementing Dr. Morris’ overview, in our ‘Voices from the Field’ segment, Jeff Holland, LCSW Director of Endorphin Power Company, will present and share how the use of co-treating nicotine and other addictions works within EPC.

Objectives:
- Describe the bio-psycho-social factors that lead to nicotine and other drug addiction.
- Detail the barriers and facilitators to co-treatment of nicotine and other drugs.
- Review proven steps New Mexico’s behavioral health agencies can utilized to decrease unnecessary death and disability, and assist individuals work toward their recovery goals.
- Learn about NM and Endorphin Power Company.

Talk About Rural - Challenges for Nicotine Treatment in Rural New Mexico and How to Overcome Them
Watch this session here: https://www.youtube.com/watch?v=tEJ3WMjW0kY&list=PL7ZcdN84H0DhBlxfXWE3U7sOzWwGF-fxS&index=3

Presenter: Chad Morris, PhD, Professor Psychiatry and Director, Behavioral Health and Wellness Program, University of Colorado, Anschutz School of Medicine; New Mexico presenter to be announced

The extensive burden of harm caused by tobacco use disproportionately falls upon rural communities. In New Mexico, people in rural settings exhibit higher tobacco use across a spectrum of subpopulations, including among persons with behavioral health conditions. Rural communities face numerous tobacco-related disadvantages including, less access to healthcare, insufficient transportation, fewer treatment resources, and less access to supportive technology. At the same time, despite their heterogeneity, rural communities have common characteristics that may facilitate tobacco and nicotine use treatment. Dr. Morris will discuss how to amplify the strengths and resiliency of rural New Mexico in meeting the needs of vulnerable populations. Complementing Dr. Morris’ overview, in our ‘Voices from the Field’ segment, a New Mexico rural agency will share how they are addressing community treatment needs.

Objectives:
- Describe the unique challenges and opportunities in providing tobacco and nicotine use in rural New Mexico, specifically to persons with behavioral health conditions.
- Explore evidence-based methods for increasing the visibility, acceptability, and accessibility of tobacco and nicotine treatment in rural New Mexico.
- Hear practical tips for treatment from a New Mexico service agency.

Bonus! Billing!
Watch this session here: https://www.youtube.com/watch?v=7upMm1Oaz-U&list=PL7ZcdN84H0DhBlxfXWE3U7sOzWwGF-fxS&index=4

Presenter: Chad Morris, PhD, Professor Psychiatry and Director, Behavioral Health and Wellness Program, University of Colorado, Anschutz School of Medicine; Steve DeSaulniers, Behavioral Health Program Manager, Provider Network Services of BlueCross BlueShield of New Mexico

Smoking-related diseases are a leading cause of death among individuals with mental illnesses and substance use disorders. Nicotine addiction can be effectively treated in a behavioral health setting and is considered a billable service by Medicare, Medicaid, and many commercial insurance carriers. Yet, behavioral health agencies have often chosen not to provide nicotine
addiction treatment due to lack of compensation. Dr. Morris will discuss the strategies and tools which will allow New Mexico behavioral health providers to successfully bill for critical nicotine addiction treatment, including necessary documentation and billing codes. In our ‘Voices from the Field’ segment, New Mexico billing experts will also describe state specific guidance for getting reimbursed.

Objectives:
- Describe how lack of compensation is a significant barrier to behavioral health agencies offering nicotine addiction treatment.
- Detail billing documentation requirements and important distinctions for New Mexico behavioral health providers.
- Review New Mexico resources and tools that will assist behavioral healthcare agencies to integrate tobacco cessation into daily clinical treatment.

Please utilize these slides (.pdf) as a resource for behavioral healthcare providers to bill for smoking cessation counseling services. They are generously provided by Steve DeSaulniers, Behavioral Health Program Manager, Provider Network Services of BlueCross BlueShield of New Mexico. Thank you!

About Our Presenters

Chad Morris, Ph.D. is a clinical psychologist and Professor of Psychiatry at the University of Colorado- School of Medicine. At CU he is the Director of the Behavioral Health; Wellness Program and Wellness Leadership Institute. He is the principal investigator of over 100 projects and studies exploring the effectiveness of organizational, psychosocial, and pharmacologic
whole health and tobacco cessation strategies across over 40 states and internationally. His work has focused on the needs of persons with mental illnesses and addictions, individuals who are homeless or at risk for homelessness, justice involved individuals, pregnant and perinatal mothers, rural and frontier residents, and at-risk youth. Dr. Morris also specializes on the work and well-being of professionals including healthcare providers, medical students, public health staff, peer specialists, correctional officers, educators, and U.S. district judges. Dr. Morris is a seasoned Motivational Interviewing trainer and member of the MI Network of Trainers (MINT). As the Vice President of Spark Inspiration, Dr. Morris also offers corporate wellness solutions.

Jeffrey Holland is a Master’s level Clinical Social Worker. He is a native New Mexican and grew up in Albuquerque’s International District. He started volunteering with North Americas 1st syringe exchange program in the mid 90s and has been involved in the substance abuse field, at various levels, for 20+ years. This includes, harm reduction, detox, advocacy, case management, affordable housing, and therapy. He has been with Endorphin Power Company (EPC) for over 10 years and has been the Executive Director for over 8 years. He is passionate about helping others and hopes that EPC continues to have a positive impact in the recovery community and Albuquerque in general.

Dr. Kara Kikuchi has over 13 years of experience in tobacco cessation and control. Serving as Manager of Training and Outreach Programs since 2015, she is responsible for the development and implementation of new programs and leads a team of System Change Specialists to meet training and outreach contract requirements. Kara is a supervisor, primary care physician, and educator. She earned a Naturopathic Doctorate from Bastyr University and Bachelor of Sciences degrees in Biology and Anthropology from the University of Utah.

Susanne Cress is a Health Systems Change Specialist who works with healthcare providers from all disciplines throughout the state of New Mexico. She holds a Master of Science in Clinical Psychology and specializes in working with individuals who are
challenged with severe and persistent mental illness and medical co-morbidity. Her work involves tailored instruction as it relates to best-practice clinical guidelines for behavioral and educational intervention with connection to nicotine cessation resources along with facilitation of systems change that promotes efficacious and sustainable programs to address nicotine dependence. She works within the spectrum of health-care service delivery from large, multi-disciplinary hospitals and community-health organizations to small, single provider clinics operating within for-profit and non-profit business models – in both rural and urban settings.

Esther Hoang, MPH has over 10 years’ experience working in primary care and ocular health settings and has 8 years’ experience in public health with a primary focus on tobacco use prevention. In 2011, Esther began her public health work at the New Mexico Asian Family Center educating the community on the harmful effects of tobacco use within the Asian and Pacific Islander (API) community. Mainly, she was both the facilitator and coordinator for Mosaic Voices, a network to not only examine social determinants of health that lead to tobacco use within the API community, but to also implement cultural events to increase the knowledge and awareness around the issue of tobacco use. She moved on to working for Optum in 2014, as a Health Systems Change Specialist, working closely with various provider champions from FQHC, rural clinics, critical access hospitals, Indian Health Services, and oral health clinics to develop policies, protocols, and robust tobacco treatment referral systems to the QUIT NOW and DEJELO YA services. In 2017, she joined the New Mexico Department of Health’s Tobacco Use Prevention and Control (TUPAC) Program as the Cessation Specialist overseeing both the Nicotine Addiction Treatment Services and Health Systems Change Training & Outreach Program. She received a Bachelor of Arts degree in Psychology at the University of Kansas in 2007 and a Master’s degree in Public Health at the New Mexico State University in 2013.

For more information, contact suzanne@ConstellationNM.com.

The Behavioral Health Webinar Series on Tobacco & Nicotine Treatment and the Behavioral Health Core Group is funded by the New Mexico Department of Health Tobacco Use Prevention and Control Program.