Model Nicotine-Free Policy

Step 1 of 8 - Agency Information

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Please take a moment to download our full version of the Model NFP for reference.

Agency Name(Required)

Short Form Agency Name(Required)

Show Version and Revision Info

Yes

Version(Required)

Date: (rev.)(Required)

History

Approved By(Required)

As of what date will this new policy go into effect?(Required)

MM slash DD slash YYYY

Organization Logo

Accepted file types: jpg, jpeg, png, Max. file size: 1 MB.

If empty, the BH Wellness logo will be used.

Include Rationale Summary(Required)

Yes

Include Brief Policy Description(Required)

Yes

Include Table of Contents(Required)

Yes

Nicotine-Free Policy Rationale(Required)

Yes

Nicotine-Free Policy Statement(Required)

Yes

Policy Scope(Required)

Yes

Enforcement of Violations(Required)

Yes

Key Dates(Required)

Yes

Associated Policies

Employee Progressive Disciplinary Process

Employee Dress Code, Fragrancy Free Workplace

Drug-Free Workplace

Contraband and Searches

Definitions of Key Terms(Required)

Yes

Definitions to Include(Required)

Electronic devices

Nicotine tobacco products

Pharmacotherapy

Property grounds

Staff member

Violation

Enforcement Protocols of the NFP(Required)

Yes

Communication, Education, and Training(Required)

Yes

Select Communication, Education, and Training options(Required)

Signage declaring…

The NFP will be posted…

The NFP will be communicated…

Current staff…

Current and new staff…

Job announcements…

Clients will be informed

The website of…

NFP, Associated Procedures(Required)

Yes

Addressing Reported NFP Violations(Required)

Yes

Addressing NFP Violations Discovered Through Searches(Required)

Yes

Select Addressing Observed NFP Violations entries

Assess your own…

Approach the individual(s)…

Introduce yourself and…

In a respectful way…

Inform those in violation…

Variations

If the individual is not a client…

If an individual violating…

Select Variations(Required)

Visitors who violate…

All staff are expected…

Clients who violate…

If an individual violating… variations(Required)

Client refusal…

Staff member…

Visitor/Other…

Progressive Disciplinary Action for Staff Violations(Required)

Yes

Included Staff Violations(Required)

First Offense - Verbal intervention with the staff member and a review of the nicotine-free policy as presented in the staff information packets will occur. The staff member will be clearly informed that it is expected that no further violations will occur and the verbal warning/intervention will be noted in the staff member’s records. Additionally, the staff member will be informed of the nicotine treatment services available.

Second Offense - A second violation will prompt the supervisor to have the staff member sign a written notice of their violation, which will be filed in the staff member’s records. The expectation that no further violations will occur will be reiterated. Again, the staff member will be informed of the nicotine treatment services available.

Third Offense - A third violation will prompt the supervisor to present a written Memorandum of Expectation to be signed and filed in the staff member’s records. This document will clearly state the expectations and consequences for any further policy violations and clarify that such behavior may result in further disciplinary action that may affect pay, status, tenure, and/or possible termination. Again, the staff member will be informed of the nicotine treatment services available.

Fourth Offense - A fourth violation will prompt the supervisor to evaluate the need for the initiation of disciplinary action that may affect pay, status, tenure, and/or include termination. Based on the supervisor’s discretion, a final written Memorandum of Expectation will be used to document the violation and to document that another violation will result in termination. This document will be signed and filed in the staff member’s records. Again, the staff member will be informed of the nicotine treatment services available.

Progressive Disciplinary Action for Client Violations(Required)

Yes

Included Client Violations(Required)

First Offense - Verbal intervention with the client and a review of the nicotine-free policy as presented in the client information packets will occur. The client will be clearly informed that it is expected that no further violations will occur and the verbal warning/intervention will be noted in the client’s records. Additionally, the client will be informed of the nicotine treatment services available.

Second Offense - A second violation will prompt the responsible party to have the client sign a written notice of their violation, which will be filed in the client’s records. The expectation that no further violations will occur will be reiterated. Again, the client will be informed of the nicotine treatment services available.

Third Offense - A third violation will prompt the supervisor to present a written Memorandum of Expectation to be signed and filed in the client’s records. This document will clearly state the expectations and consequences for any further policy violations and clarify that such behavior may result in dismissal from services. Again, the client will be informed of the nicotine treatment services available.

Fourth Offense - A fourth violation will prompt the responsible party to evaluate the need for dismissal from services. Based on the responsible party’s discretion, a final written Memorandum of Expectation will be used to document the violation and to document that another violation will result in dismissal from services. This document will be signed and filed in the client’s records. Again, the client will be informed of the nicotine treatment services available.

Opening Paragraph(Required)

Yes

Opening paragraph items to include

To promote the health and well-being of our clients and staff and to support the nicotine-free policy, [SHORT FORM] offers a variety of services designed to treat nicotine dependence.

Upon presenting at our facilities, all clients will be given a nicotine use screening and assessment of readiness to quit use.

New hires and existing staff members will receive the nicotine use screening and assessment.

For all clients and staff members who report nicotine use, nicotine treatment services will be offered.

These services may include a brief motivational intervention and/or referral, access to individual and/or group counseling sessions, and FDA-approved pharmacotherapy options.

Nicotine Use Screening and Assessment(Required)

Yes

Nicotine Treatment Services(Required)

Yes

Include Nicotine Treatment Services

include "The nicotine use screening and assessment process described above will precede nicotine treatment services and identify clients and staff members who may be interested in receiving them." in first paragraph

include Brief Intervention section

include Individual Counseling for Clients section

include Group Counseling for Clients section

include the Pharmacotherapy section

Supportive Staff Services(Required)

Yes

Education and Training on Nicotine and Nicotine Treatment(Required)

Yes

Education and Training on Nicotine and Nicotine Treatment selections

All staff members will receive basic education and training about nicotine products and the nicotine-free policy.

New staff members will be informed about the nicotine-free policy prior to beginning their employment.

Additionally, staff will be trained to deliver a consistent message to clients about the dangers of nicotine use and the health benefits of quitting nicotine to support the nicotine-free policy.

Admissions staff will learn to administer the nicotine use screening and assessment process and to follow up with a brief intervention for all individuals who report current nicotine use.

Designated clinical staff members (e.g., Tobacco Treatment Specialists) will receive further training in order to offer more extensive nicotine dependence treatment, including conducting individual counseling, group counseling, and pharmacotherapy recommendations and prescriptions.

Education and training will include common treatment methodologies, including Motivational Interviewing and Cognitive Behavioral Therapy.

Nicotine Treatment Services for Staff(Required)

Yes

Untitled

Human Resources will work with the organizational insurer to ensure nicotine cessation services are benefits included with every employer-sponsored plan.

Human Resources will work with the insurer to clearly describe the nicotine cessation benefits and the process for activating those benefits.

Human Resources or other relevant groups may incentivize staff members to use nicotine cessation benefits.

Human Resources will also work with the organization’s Employee Assistance Plan (EAP) provider(s) to identify nicotine cessation benefits covered under that contract.

Human Resources will work with the EAP provider(s) to clearly describe the nicotine cessation benefits and how to activate them.

Human Resources will communicate these benefits and the associated processes to staff regularly.

Human Resources will provide information to the staff on how to enroll in the state tobacco quitline.

Include this version of the Notice and Acknowledgement as a supplement to the NFP? (Residential)

Yes

Include this version of the Notice and Acknowledgement as a supplement to the NFP? (Inpatient)

Yes

Name

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