III.	PROMOTING TOBACCO CESSATION

L	See also, Preventing Youth Initiation section and Environmental Tobacco Smoke section for additional cessation information.

1.	Identify the 3 - 5 largest health insurance plans currently available to residents in your county and the number of members in your county served by each plan.  For each plan, determine whether cessation services are covered or partially covered for plan members.  Specify the type of cessation service covered and the number of cessation (quit) attempts covered by the plan.

Health Plan Name	#  of Members
(in your county)	Cessation Services Covered (Yes/Partial/No)	Type(s) of Cessation
Service Covered	Number of Quit
Attempts Covered	

					

2.	Which of the health insurance plans, if any, have done/are doing outreach (consumer education campaigns, support for policy advocacy actions, media campaigns, etc.) in your county on tobacco-related issues?

Health Plan Name	Type of Outreach	Date(s) of Outreach	

			

3.	Describe the cessation services that are currently offered in your county.  Please visit, in the least, the agencies that are listed at the end of this document. (make additional copies or add rows as needed). 

Cessation
Program Name	Provided By	Location	Contact Name 
& Phone Number	Type of Cessation Services
& Target Group2	Cost	

				

		

				

		

				

		

4.	Describe the Intake and Referral processes that are currently offered in your county (make additional copies or add rows as needed). 
1	In the Notes you may provide information about the agency’s willingness to provide any of these systems in the future or if the agency is willing to collaborate in other ways.
1	Please see the next page for a list of agencies to visit.

Agency Name	Location	Contact Name 
& Phone Number	Intake system Asks about use	Client is Assessed	Client is Referred 
(to whom?)	Client is provided services
(describe in table 3 above)	Is the facility 100% smokefree (inside)?	Notes	

							

		

							

		

							

Please visit each of these agencies to complete Tables 3 and 4:

Hospital
Low-income clinic
Doctor’s offices
Dentist’s offices
Substance Abuse Treatment Centers (Mental Health Centers)
Pharmacies
Church organizations
Local Department of Family Services office
Public Health office
Best Beginnings and WIC
Local counselors
Schools including technical colleges, junior colleges, “night schools,” and the University
5.	
Community Coordination Meeting

A.	Please record information about meetings held with community partners to discuss the community’s cessation needs.  These meetings should include presentations by key agencies to record and discuss what areas in the community are covered and which ones are not. Attach minutes of these meetings which include a list of the people who attended with the name of the agency represented.  

Note: These meetings are one place to gather and discuss information needed for this entire report.  However, agencies that do not attend should be visited so that a comprehensive assessment will take place.

Date	Number of people attending
(attach minutes)	Summary of topics discussed	Plan of action or results of meeting	Notes	

					

					

TIPS:

1	This is a great opportunity for media coverage.  
o	Advertise the meeting before hand. 
o	After the meeting, do a press release telling who was there and what you learned.  
1	Ask each person to bring a summary or samples in writing, if available.
1	Make sure to promote these services: 
o	Wyoming Quit Tobacco Program  1-877-wyo-quit
o	Wyoming Quit Line 1-866-wyo-quit
o	Wyoming Quit Net http://wy.quitnet.com 
1	Make sure that providers are told about the Provider Directory at  
o	http://wdh.state.wy.us/SAD/Docs/Tobacco/Tobacco_Cessation_Services_Directory.pdf 
                            (also see http://wdh.state.wy.us/SAD/Cessation.asp)

The County Plan should consider how or why changes have occurred in the information reported and how these can become more efficient in the future.