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Behavioral Health and Wellness Program
University of Colorado Anschutz Medical Campus
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DIMENSIONS: Motivational Interviewing for Behavior Change
Level I (Introductory)
Level II (Intermediate)
Level III (Advanced)
DIMENSIONS: Tobacco Free Program
DIMENSIONS: Well Body Program
Rocky Mountain Tobacco Treatment Specialist Program
RAISE Families for Health
All Upcoming Trainings
Projects
CO-CARES
Integrated Addiction and Whole Health Treatment
Whole Health Innovation
Collective Impact for High Public Service Utilizers
Justice-Involved Tobacco Cessation
Innovative Technical Assistance Model
Specialized Tobacco Cessation Programs for Colorado Pharmacists
Build-a-Clinic (BaC)
National Behavioral Health Network for Tobacco and Cancer Control
Clinical Edge Webinar Series
COVID-19 Protect | Me You Us Community Initiative
COVID-19 Protect | Me You Us KIDS Community Initiative
LA County Tobacco Cessation Services
RAISE Families for Health
Research
Integrated Addiction and Whole Health Treatment
Early Adversity and Health Behaviors Study
Collective Impact for High Public Service Utilizers
Community Corrections Tobacco Cessation Study
RAISE Families for Health
National Jewish Rural Quitline Evaluation
Tobacco Free Policy Study
Recovery Support: “It Takes a Library”
Healthy You, Healthy Baby
Incredible Years® Infant and Toddler Programs
Resources
Fact Sheets and Reports
Toolkits
DIMENSIONS: Tobacco Free Toolkits
DIMENSIONS: Well Body Toolkits
Webinars
Clinical Edge Webinar Series
Videos
Conversations for Change Series
Pursuit of the Three C’s Series
Model Nicotine-Free Policy
Login
Home
About Us
Our Team
Publications
Services
Partners
Trainings
DIMENSIONS: Motivational Interviewing for Behavior Change
Level I (Introductory)
Level II (Intermediate)
Level III (Advanced)
DIMENSIONS: Tobacco Free Program
DIMENSIONS: Well Body Program
Rocky Mountain Tobacco Treatment Specialist Program
RAISE Families for Health
All Upcoming Trainings
Projects
CO-CARES
Integrated Addiction and Whole Health Treatment
Whole Health Innovation
Collective Impact for High Public Service Utilizers
Justice-Involved Tobacco Cessation
Innovative Technical Assistance Model
Specialized Tobacco Cessation Programs for Colorado Pharmacists
Build-a-Clinic (BaC)
National Behavioral Health Network for Tobacco and Cancer Control
Clinical Edge Webinar Series
COVID-19 Protect | Me You Us Community Initiative
COVID-19 Protect | Me You Us KIDS Community Initiative
LA County Tobacco Cessation Services
RAISE Families for Health
Research
Integrated Addiction and Whole Health Treatment
Early Adversity and Health Behaviors Study
Collective Impact for High Public Service Utilizers
Community Corrections Tobacco Cessation Study
RAISE Families for Health
National Jewish Rural Quitline Evaluation
Tobacco Free Policy Study
Recovery Support: “It Takes a Library”
Healthy You, Healthy Baby
Incredible Years® Infant and Toddler Programs
Resources
Fact Sheets and Reports
Toolkits
DIMENSIONS: Tobacco Free Toolkits
DIMENSIONS: Well Body Toolkits
Webinars
Clinical Edge Webinar Series
Videos
Conversations for Change Series
Pursuit of the Three C’s Series
Model Nicotine-Free Policy
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Step
1
of
8
- Agency Information
12%
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
No
Include Brief Policy Description
(Required)
Yes
No
Include Table of Contents
(Required)
Yes
No
Nicotine-Free Policy Rationale
(Required)
Yes
No
Nicotine-Free Policy Statement
(Required)
Yes
No
Policy Scope
(Required)
Yes
No
Enforcement of Violations
(Required)
Yes
No
Key Dates
(Required)
Yes
No
Associated Policies
Employee Progressive Disciplinary Process
Employee Dress Code, Fragrancy Free Workplace
Drug-Free Workplace
Contraband and Searches
Deselect All
Definitions of Key Terms
(Required)
Yes
No
Definitions to Include
(Required)
Electronic devices
Nicotine tobacco products
Pharmacotherapy
Property grounds
Staff member
Violation
Deselect All
Enforcement Protocols of the NFP
(Required)
Yes
No
Communication, Education, and Training
(Required)
Yes
No
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…
Deselect All
NFP, Associated Procedures
(Required)
Yes
No
Addressing Reported NFP Violations
(Required)
Yes
No
Addressing NFP Violations Discovered Through Searches
(Required)
Yes
No
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…
Deselect All
Select Variations
(Required)
Visitors who violate…
All staff are expected…
Clients who violate…
Deselect All
If an individual violating… variations
(Required)
Client refusal…
Staff member…
Visitor/Other…
Deselect All
Progressive Disciplinary Action for Staff Violations
(Required)
Yes
No
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.
Deselect All
Progressive Disciplinary Action for Client Violations
(Required)
Yes
No
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.
Deselect All
Opening Paragraph
(Required)
Yes
No
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.
Deselect All
Nicotine Use Screening and Assessment
(Required)
Yes
No
Nicotine Treatment Services
(Required)
Yes
No
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
Deselect All
Supportive Staff Services
(Required)
Yes
No
Education and Training on Nicotine and Nicotine Treatment
(Required)
Yes
No
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.
Deselect All
Nicotine Treatment Services for Staff
(Required)
Yes
No
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.
Deselect All
Include this version of the Notice and Acknowledgement as a supplement to the NFP? (Residential)
Yes
No
Include this version of the Notice and Acknowledgement as a supplement to the NFP? (Inpatient)
Yes
No
Name
This field is for validation purposes and should be left unchanged.
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