Resources

Clinical Provider Toolkit

The following resources are free for providers to use; they are the same documents we provide at our outreach visits and trainings. Please visit our Tobacco and ENDS & Vaping sections for targeted resources for clients and patients.

• The 5As Flowchart
• CAGE AID
• The 4 D’s
• Daily Coping Inventory Worksheet
• Fagerstrom Nicotine Dependence Scale
• H.A.L.T.
• Maine Tobacco Helpline Fact Sheet
• Medication Dosing Guidelines
• Open-ended Questions
• Provider Patient Online Resources
• Questionnaire Long Form
• Quitting Tobacco and Weight Gain
• Reframe Worksheet 
• Smokeless Fagerstrom Nicotine Dependence Scale
• Tobacco Diagnosis Coding
• Tobacco Use Assessment Short Form
• Tobacco Treatment Flow
• Tobacco Treatment Note Outpatient
• Tobacco Treatment Plans Behavioral Health
• Tobacco Treatment Services Guide

Behavioral Health IMAT Pilot Project and Toolkit

About the Pilot Project: Tobacco use disorder is often overlooked by behavioral health clinicians.  A proposed solution is to integrate treatment for tobacco use disorder into the treatment for co-occurring addictions and/or mental health conditions for which people who use tobacco are already enrolled. In addition to the practicality of bringing tobacco treatment to the client in their existing treatment setting, it also makes sense therapeutically given the intimate relationship between tobacco use and other behavioral health disorders.  Over the course of a 7-month pilot program, which was a collaboration between the Center for Tobacco Independence (CTI) and the MBH Biddeford Integrated Medication Assisted Treatment (IMAT) program for treating opioid use disorder, strategies to integrate tobacco treatment were implemented.

The following resources, utilized with the Behavioral Health Pilot Project, are available for download and use by providers and include materials for both providers and clients.  Additional resources can be found under the Clinical Provider Toolkit and Patient Tools section.

1. Toolkit Index
2. Assessment:
   • Assessment of Motivation Ladder
   • Sample Tobacco Assessment Questions
   • Withdrawal Self-Assessment
   • Post Tobacco Group Questionnaire 
3. Maine Tobacco HelpLine:
   • Fax Referral Form IMAT
   • HelpLine Overview for Providers
   • Maine Tobacco HelpLine Patient Fact Sheet
4. Motivation Documents:
   • Beneficial Effects of Quitting Smoking
   • Making a Choice
   • Health Consequences of Smoking
   • Harm Causally Linked to Secondhand Smoke
   • Chemicals in Cigarette Smoke
   • Financial Benefits of Quitting
   • Open-Ended Questions
   • Client Handout
5. Medication Documents:
   • Medication Dosing Guidelines
   • Cost of Tobacco Treatment Medications vs. Cigarettes
   • Over-the-Counter Nicotine Replacement Therapy (NRT)
     • Nicotine Patch
     • Nicotine Gum
     • Nicotine Lozenge
   • Prescription NRT
     • Nicotine Inhaler
     • Nicotine Nasal Spray
   • Other Prescription Medication (not containing nicotine)
     • Varenicline
     • Bupropion
6. Treatment Planning and Strategies:
   • Back Talk
   • Carbon Monoxide Monitor
   • Cigarette Log
   • Pack Tracks
   • Keeping Track
   • When Do I Use Tobacco
   • Components of a Simple Quit Plan
   • Daily Coping Inventory Worksheet
   • Dear Family and Friends Letter
   • Diagnostic Codes
   • Drug Interactions with Tobacco Smoke
   • Electronic Nicotine Delivery Systems (ENDS)
   • Getting through the Day on a Tobacco-Free Campus Poster
   • H.A.L.T.
   • Helpful Tips for Quitting Tobacco
   • I Quit Smoking and Now I Feel
   • My Medication Plan
   • My Weekly Strategies and Goals
   • Possible Nicotine Withdrawal Symptoms
   • Quitting Tobacco and Weight Gain
   • Sample Group Schedule
   • Sample Tobacco Treatment Plans
   • Sample Tobacco Treatment Goals (Long List)
   • The 4 D’s
   • The Three-Legged Stool
   • Tips for Getting through the Day Worksheet
   • Tobacco Diagnostic Codes
   • Tobacco Treatment Group – Flowsheet
   • When You Quit Smoking
   • Withdrawal Symptoms
   • You Can Quit Smoking Worksheet
   • Three Topics
   • Presentation for Clients: Thinking About Quitting Tobacco

Additional Resources:

• 2018-2019 Tobacco Treatment Training Opportunities Brochure
• Brochure: Addressing Tobacco Use in Behavioral Health Agencies – Resources from the Center for Tobacco Independence
• Maine Tobacco HelpLine: What You Need to Know Infographic
• Provider Office Poster: When You’re Ready to Quit, We Are Here to Help
  • Digital Display Poster: Full Color One Color
• Digital Display Posters – Quit Messages
  • Digital Display Quit Poster 1
  • Digital Display Quit Poster 2
• Digital Display Posters – Smoke-Free Home Messages
  • Digital Display Smoke-Free Home Poster 1
  • Digital Display Smoke-Free Home Poster 2
• Digital Display & Posters – Secondhand Smoke and Pets Messages
  • Secondhand Smoke and Pets 1 – Poster, Digital Display
  • Secondhand Smoke and Pets 2 – Poster, Digital Display
  • Secondhand Smoke and Pets 3 – Poster, Digital Display