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Prevention and Treatment of Tobacco Use

Competencies
  • General
    General
    • Pre-Test Quiz
    • Registration Form Questionnaire
    • Peer Corner Forum
  • How to create an account and enroll in the course?

     

     

    • Prevention and Treatment of Tobacco Use Homepage



      This introductory course about the Prevention and Treatment of Tobacco Use provides a foundation regarding the effects of tobacco on human health, offers effective approaches to preventing and treating tobacco use, and gives opportunities to practice intervention techniques for smoking cessation.  All parts of this training are free, including registration, learning, testing, and a certificate of completion. This course is intended for medical and other clinical and public health trainees and practitioners 

      The Prevention and Treatment of Tobacco Use course is co-sponsored by the University of the Incarnate Word. Like all NextGenU.org courses, this course is competency-based, using the competencies in Tobacco Control Competencies for US Medical Students and the Core Competencies for evidence-based treatment of tobacco use and dependence. In addition, the course uses resources from world-class organizations such as the Government of Canada, the U.S. National Library of Medicine, U.S. Centers for Disease Control and Prevention, NU.S. National Institutes of Health, and the World Health Organization. The course developers are Florian Stigler MD; Kentya Ford DrPH; Salma Marani MS; Alexander V. Prokhorov MD, PhD; Valeria Reynolds MD, MPH; Hugo Rojas MD, MSc; Madison Cox MSN, RN; Juan Bravo MD; and Pablo Baldiviezo MD.


      For publications on NextGenU.org’s courses’ efficacy, see “A Novel Integration of Online and Flipped Classroom Instructional Models in Public Health Higher Education,” (2014), BMC Medical Education, “Building Public Health Capacity through Online Global Learning,” (2018), Open Praxis, or here on NextGenU.org’s publication page. Subscribe to our newsletter to be notified of future updates, new courses, and to be part of our community.

      There are 9 modules to complete, providing: 

      1. A basic understanding of the fundamentals of tobacco
      2. Insight into the epidemiology and the economic cost of tobacco use
      3. An overview of the health consequences of tobacco use
      4. Fundamental knowledge about the pathophysiology of nicotine addiction.
      5. Treatment approaches for cessation and prevention of tobacco use in adults, pediatric and special populations.
      6. An overview of the effectiveness and principles of tobacco treatment, including counselling, pharmacological treatment, and alternative therapies
      7. An awareness of public health strategies and effective control policies for tobacco prevention
      8. The skills necessary to critically appraise research evidence and the resources needed to access current information on new standards, practices and learning objectives relating to tobacco use and cessation   
      The completion time for this course is estimated at 108 hours: 41 hours of didactics and curated resources and 67 hours of work studying the resources and participating in activities to assist the student in synthesizing the materials.

      To obtain credit, the course requires completion of all case studies and peer activities. Module seven is a practicum where you will engage in seven peer activities that will require your interaction with practice patients to complete them. At the end of each lesson, there is a practice quiz. At the end of the course, after you’ve completed each lesson, quiz, and activity, you’ll have access to a final exam, and a chance to evaluate this course. Once you’ve passed that last test, you will be able to download a certificate of completion from NextGenU.org and our course’s co-sponsoring organizations (listed above). We keep all of your personal information confidential, never sell any of your information, and only use anonymized data for research purposes, and we are also happy to report your testing information and share your work with anyone (your school, employer, etc.) at your request.

      Engaging with this Course:

      You may browse this course for free to learn for your personal enrichment; there are no requirements. To register in this course for credit, it is required that learners have obtained a bachelor's degree, or be enrolled in a health sciences training program at the bachelor's level or higher.

      To obtain a certificate a learner must successfully complete

      • all the reading requirements,
      • all quizzes and pass with a 70% with unlimited attempts,
      • ll case studies,
      • all peer activities,
      • the final exam with a minimum of 70% and a maximum of 3 attempts, and
      • the self and course evaluation forms.

      To obtain credit

      • complete all requirements listed above for the certificate, and
      • your learning institution or workplace should approve the partner-university-sponsored NextGenU.org course for educational credit, as they would for their learner taking a course anywhere.  

      NextGenU.org is happy to provide your institution with

      • a link to and description of the course training, so they can see all its components, including the cosponsoring universities and other professional organization cosponsors; 
      • your grade on the final exam;
      • your work products (e.g. case study activities), and any other required or optional shared materials that you produce and authorize to share with them;  
      • your evaluations -- course, and self-assessments;
      • a copy of your certificate of completion, with the co-sponsoring universities and other organizations listed.
      To obtain a degree, NextGenU.org co-sponsors degree programs with institutional partners. To obtain a full degree co-sponsored with NextGenU.org, registrants must be enrolled in a degree program as a student of a NextGenU.org institutional partner. If you think that your institution might be interested in offering a degree with NextGenU.org contact us.

      We hope that you will find this a rewarding learning experience, and we count on your assessment and feedback to help us improve this training for future students.

      Here are the next steps to take the course for credit.

      • Complete the registration form.
      • Take the pre-test.
      • Begin the course with Module 1: Introduction to Prevention and Treatment of Tobacco Use. In each lesson, read the description, complete all required readings and any required activity, and take the corresponding quizzes.

      This course meets nationally approved standards of education developed for the addiction/substance use disorders counseling profession. This course's participants are assured that the continuing education (CE) credits provided will be accepted toward national credentialing by the NAADAC Certification Commission for Addiction Professionals (NCC AP), as well as by many of the individual state licensing/certification bodies in the addiction and other helping professions.

      • Module 1: Introduction to Tobacco Cessation

        Competency covered in this module: 86/8

        • Students should value physicians' role in tobacco smoking prevention, assessment, screening, and treatment.
        • Summarise and be able to apply valid and reliable diagnostic criteria for tobacco dependence.
        • Describe the existing objective measures of tobacco use such as CO monitoring, and cotinine level assessments.
        • Understand that a high “standard of care” depends on a team approach.
        • Students should value physicians’ and health professionals’ role in public health advocacy and participation.
        • Students should value medical practice “team approach” for tobacco smoking prevention, assessment, screening, and treatment.
        • Students should believe that tobacco cessation advice/patient-centered counseling is a learned skill and can be a highly effective skill.
        • Module 1: Lesson 1: The Role of Physicians and Health Professionals in Tobacco Prevention, Treatment and Advocacy

          Learning objectives:
          • Identify the role of health professionals in tobacco prevention throughout history.
          • Explain the value of the physician's role in tobacco smoking prevention, assessment, screening, and treatment.
          • Identify valid and reliable diagnostic criteria for tobacco dependence.
          • Recognize objective measures of tobacco use such as CO monitoring, and cotinine level assessments.
          Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 225 mins

          Click here to start this lesson

          8 URLs, 1 Forum
          • Required Learning Resources and Activities
          • One Hundred Years in the Making: The Global Tobacco Epidemic URL

            Read the entire article.

          • The “Canone Inverso”: When Tobacco was not so Bad. URL

            Read the entire article.

          • Tobacco Dependence URL

            Read the entire page.

          • The Importance of Physician Involvement in Tobacco Control URL

            Read the content under the heading "The Importance of Physician Involvement in Tobacco Control."

          • Office Visit Protocol for Tobacco Cessation Counseling Resources for helping your adult patients URL

            Read the content under the heading "The Role of Physicians….. Here's Where You Can Have an Impact" on page 2.

          • Defining Nicotine as a Drug of Addiction URL

            Read the entire page.

          • Precision Medicine for Tobacco Dependence: Development and Validation of the Nicotine Metabolite Ratio URL

            Read the entire article.

          • Biomarkers of Tobacco Exposure: Summary of an FDA-sponsored Public Workshop URL

            Read the content under the heading "Results."

          • Peer Activity: Physician’s role in tobacco smoking prevention and treatment Forum

            In this activity, you will write about what the value of the physician’s role in tobacco smoking prevention, assessment, screening, and treatment.

            • Step 1: Reflect on the readings of this lesson and choose one aspect of the physician’s role that you want to focus on: Prevention, assessment, screening, or treatment.

            • Step 2: Write a 500 to 700 words essay to share your thoughts on this topic. Focus your work on the aspect of physician’s role that is more important to you (Prevention, assessment, screening, or treatment), but also write something short about the remaining three aspects.

            • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below and complete the fields.

            • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. Besides providing your comments and suggestions on what your peer shared, ask yourself the following questions to assess a peer’s work:

              • Does my peer’s work fulfill the words required in the assignment?
              • It is clear which aspect of the physician role is more important to my peer?
              • Does my peer’s worn address all the aspects of the physician role on this topic?
          • Quiz: Module 1:Lesson 1
            Restricted Not available unless:
            • The activity Registration Form is marked complete
            • The activity Pre-Test is marked complete
            To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
        • Module 1: Lesson 2: Advocacy and Economic Cost of Tobacco Use

          Learning objectives:
          • Explain the value of physicians’ and health professionals’ role in public health advocacy and participation. 
          • Summarize the importance of a team approach to provide a high standard of care.
          • Explain the value of the medical practice "team approach" for tobacco smoking prevention, assessment, screening, and treatment.
          • Describe how information regarding the economic cost of tobacco use relates to public health advocacy and participation.
          Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 275 mins.

          Click here to start this lesson

          3 URLs, 1 Forum, 1 Quiz
          • Required Learning Resources and Activities
          • Be the Change An Interprofessional Team-Based Health Advocacy Summit URL

            Read the entire article.

          • A Team Approach: Integrating Tobacco Dependence Treatment into Routine Clinical Practice URL

            Listen to the webinar (1 hour 30 min).

          • The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence URL

            Read the entire article.

          • Peer Activity: Health professionals and economics role in public health advocacy Forum

            In this activity, you will write about the role of health professionals and the economic aspects of tobacco use in public health advocacy and participation.

            • Step 1: Write a 500 to 1000 words essay where you address the following topics:

              • How important are public health advocacy and participation in policies regarding tobacco use? 
              • Why are economic aspects of tobacco use important to influence public health policies?
              • What is your opinion regarding the value of a “team approach” on tobacco smoking prevention and treatment for the patient
            • Step 2: Submit your assignment for peer review by clicking “add a new discussion topic” below and complete the fields.

            • Step 3: Review the work of one of your peers and provide feedback by commenting on his/her post. Besides providing your comments and suggestions on what your peer shared, ask yourself the following questions to assess a peer’s work:

              • Does my peer’s work fulfill the words required in the assignment?
              • Does my peer’s work address both the importance of public health advocacy and the importance of economic aspects in policymaking?
              • How is my peer’s view on the importance of a “team approach” different from mine?
          • Quiz: Module 1: Lesson 2
            To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
        • Module 1: Lesson 3: Providing Tobacco Cessation Counseling as a Learned Skill

          Learning objectives:

          • Argue why tobacco cessation advice/patient-centered counseling is a learned and highly effective skill.
          Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 84 mins.

            Click here to start this lesson

          2 URLs, 1 Forum, 1 Quiz
          • Required Learning Resources and Activities
          • Empowering Healthcare Providers Through Smoking Cessation Training in Malaysia URL

            Read the entire article.


          • 30 Seconds to Save a Life URL

            Watch the entire video (3 min 46 sec).

          • Peer activity: Patient-centered counseling Forum

            In this activity, you make an argument about why tobacco cessation patient-centered counseling is a learned skill and can be a highly effective skill.

            • Step 1: Consider the following scenario:

              • A young physician you are mentoring is interested in working in tobacco prevention and treatment of tobacco use. However, he is concerned because he/she does not feel able to learn the skills required to do a good job in this field

            • Step 2: Write a 250 - 500 words message that you would send to this person to encourage him/her to engage with this field 

            • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below and complete the fields.

            • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. Besides providing your comments and suggestions on what your peer shared, ask yourself the following questions to assess a peer’s work:

              • Does my peer’s work fulfill the words required in the assignment?
              • If you were the young physician of the example, how would you feel by reading this message from your mentor?
          • Quiz: Module 1: Lesson 3

            To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

        • Module 2: Pathophysiology of Nicotine Addiction

          Competency covered in this module: 

          • Describe the chronic-relapsing nature of tobacco dependence, including typical relapse patterns, and predisposing factors.
          • Understand the pathophysiology (tissues, systems) of tobacco use and the mechanisms of addiction. 
          • Explain the health consequences of tobacco use and benefits of quitting, and the basic mechanisms of the more common tobacco induced disorders.
          • Understand the pathophysiology, mechanisms, and behavioral manifestations of nicotine withdrawal. 
          • Know how to intervene to help patients decrease withdrawal symptoms.
          • Describe how tobacco dependence develops and be able to explain the biological, psychological, and social causes of tobacco dependence.
          • Be able to explain the effects of tobacco use, its addictive properties, and the physiological effects of withdrawal to patients. 
          • Communicate the symptoms, duration, incidence, and magnitude of nicotine withdrawal.
          • Module 2: Lesson 1: Mechanism of Addiction

            Learning Objectives:
            • Describe predisposing factors and relapse patterns of tobacco dependence.
            • Understand how relapse patterns and predisposing factors related to tobacco dependence relapse.
            • Outline the pathophysiology of tobacco use
            • Describe the pathophysiology of tobacco addiction.
            Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 264 mins.

            Click here to start this lesson

            6 URLs, 1 Quiz
            • Required Learning Resources and Activities
            • Early Biological Factors URL

              Read the entire page.

            • Cognitive, Behavioral, and Situational Influences on Relapse to Smoking After Group Treatment for Tobacco Dependence URL

              Read the content under the heading "Results".

            • Do Predictors of Smoking Relapse Change as a Function of Duration of Abstinence? Findings from the United States, Canada, United Kingdom and Australia URL

              Read the entire article.

            • The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General URL

              Read the content under the heading "Pathophysiology of Nicotine Addiction".

            • Nicotine addiction URL

              Read the entire page.

            • Neurogenetic Determinants and Mechanisms of Addiction to Nicotine and Smoked Tobacco URL

              Read the content under the heading "Abstract", "Introduction", and "Summary and Conclusion" to understand the pathophysiology of tobacco addiction.

            • Quiz: Module 2: Lesson 1
              To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
          • Module 2: Lesson 2: Pathophysiology of Nicotine Withdrawal

            Learning Objectives:
            • Summarize the pathophysiology mechanisms of Nicotine withdrawal.
            • Identify behavioral manifestations of nicotine withdrawal.
            • Explain the effects of tobacco use, its addictive properties, and the physiological effects of withdrawal on patients.
            Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 170 mins.

            Click here to start this lesson

            2 URLs, 1 Forum, 1 Quiz
            • Required Learning Resources and Activities
            • Nicotine Withdrawal URL

              Read the entire article, except the heading "Withdrawal Syndrome in Mice"

            • How To Handle Withdrawal Symptoms and Triggers When You Decide To Quit Smoking URL

              Read the entire page.

            • Peer Activity: Addictive properties of tobacco, and withdrawal. Forum

              In this activity, you will create an educative tool for your future patients.

              • Step 1: Select your preferred format/media to create your educational tool. You can create Slides (PowerPoint presentation), a piece of writing in a Blog format(with pictures included), a trifold, a video, an infographic for social media, etc.

              • Step 2: Create a tool that explains the effects of tobacco use including its addictive properties and the physiological effects of withdrawal on patients.

              • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and paste a link to your product.
                We want to publish the best works on our website and social media, if you want your work to be published, insert a sentence about it in this forum’s post description.

              • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. 

              • S: S: Know how to intervene to help patients decrease withdrawal symptoms

                • Discuss interventions that decrease withdrawal symptoms.

            • Quiz: Module 2: Lesson 2
              To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
          • Module 3: Adult Cessation and Prevention

            Competency covered in this module: 868

            • Explain the societal and environmental factors that promote and inhibit the spread of tobacco use and dependence.
            • Understand personal and family health risks associated with tobacco use.
            • Be able to explain the risks of tobacco use, including its effect on cancer, oral disease, and the cardiovascular, cerebrovascular, respiratory, endocrine, and reproductive systems.
            • Be able to explain the risks of environmental tobacco smoke for people other than the smoker with a special emphasis on people living in a smoker’s household.
            • Understand the prevalence of tobacco use among adults, particularly among high-risk, low–socioeconomic status groups.
            • Describe the prevalence and patterns of tobacco use, dependence, and cessation in the country and region in which the treatment is provided, and how rates vary across demographic, economic, and cultural subgroups.
            • Be aware of the beneficial effects of quitting at all ages in terms of overall health, reduced risk of disease, and personal/social issues.
            • Be able to explain the benefits of quitting smoking for each major age group.
            • Understand the basic principles of patient-centered counseling.
            • Know the meaning of each effective objective and associated questions in the 5 A’s for tobacco treatment (ask, advise, assess, assist, arrange follow-up).
            • Be able to demonstrate the application of systems-based practice/practice-based learning that follows the 2000 Public Health Service guidelines.
            • Identify evidence-based treatment strategies and the pros and cons of each strategy.
            • Describe the benefits of combining pharmacotherapy and counseling.
            • Understand the transtheoretical model and its component stages of change, including readiness to quit.
            • Be able to discuss alternative therapies such as harm reduction, hypnosis, and acupuncture.
            • Provide information about alternative therapies based upon recognized reviews of effectiveness such as the Cochrane reviews and the USPHS Guidelines.
            • Describe the use of models of behavior change including motivational interviewing, cognitive therapy, and supportive counseling.
            • Be aware of an effective office visit management system that would allow time for patient-centered tobacco cessation counseling.
            • Describe and demonstrate the use of an evidence-based method for brief interventions for treating tobacco use and dependence, as identified in current guidelines.
            • Describe how to make referrals to additional resources to reduce the risk of relapse.
            • Know at least 3 sources for patient referral.
            • Demonstrate the process to make referrals to other practitioners or to recommend additional care.
            • Describe when to consult with primary medical care providers and make appropriate referrals before treatment planning is implemented. 
            • Identify community resources for referral for medical, psychiatric, or psychosocial problems. 
            • Describe resources (web-based, community, quitlines) available for continued support for tobacco abstinence for clients. 
            • Describe how to make referrals to additional resources to reduce the risk of relapse.
            • Demonstrate the ability to collaborate with other healthcare providers to coordinate the appropriate use of medications, especially in the presence of medical or psychiatric co-morbidities.
            • Module 3: Lesson 1: Epidemiology of Tobacco Consumption in Adults

              Learning Objectives:
              • Analyze the factors that promote and inhibit tobacco dependence.
              • Summarize the personal and family risks of tobacco use.
              • Explain risks of tobacco use, including its effect on cancer, oral disease, and the cardiovascular, cerebrovascular, respiratory, endocrine, and reproductive systems.
              • Explain the risks of environmental tobacco smoke for people other than the smoker with a special emphasis on people living in a smoker’s household.
              • Describe the prevalence of tobacco use among adults, particularly among high-risk, low–socioeconomic status groups.
              • Evaluate the prevalence and patterns of tobacco use, dependence, and cessation.
              • Analyze rates variations across demographic, economic, and cultural subgroups in connection with patterns of tobacco use, dependence, and cessation.
              Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 406 mins.

              Click here to start this lesson

              11 URLs, 1 Forum, 1 Quiz
              • Required Learning Resources and Activities
              • Environmental Influences on Tobacco Use: Evidence from Societal and Community Influences on Tobacco Use and Dependence URL

                Read the content under the heading "Determinants of Tobacco Use".

              • Predicting the Future of Smoking in a Rapidly Evolving Nicotine Marketplace URL

                Read the entire page.

              • Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth URL

                Read the contend under the heading "Large Social and Physical Environments", and "Small Social Groups".

              • Health Effects of Cigarette Smoking URL

                Read the entire article.

              • Tobacco-Related Mortality URL

                Read the entire article.

              • Smoking & Tobacco Use - Health Effects of Secondhand Smoke URL

                Read the entire page.

              • How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. URL

                Read the content under the heading "Trajectories of Smoking from Adolescence to Adulthood", and "Epidemiology of Tobacco Use and Nicotine Dependence in Adults".

              • Smoking Prevalence, Patterns, and Cessation Among Adults in Hebei Province, Central China: Implications From China National Health Survey (CNHS) URL

                Read the content under the heading "Abstract", "Discussion", and "Conclusions".

              • Patterns of Tobacco Use, Quit Attempts, Readiness to quit and Self-efficacy among Smokers with Anxiety or Depression: Findings among Six Countries of the EUREST-PLUS ITC Europe Surveys URL

                Read the entire article.

              • Advancing Tobacco Prevention and Control in Rural America URL

                Read the content under the heading "A. Tobacco Use among Rural Subpopulations" to the pages 6-12.

              • Socio-Economic Disparities in Tobacco Exposure and Use: are the Gaps Widening? URL

                Read the entire page.

              • Peer Activity: Risks of tobacco use Forum

                In this activity, you will create two educative tools for your future patients.

                • Step 1: Select your preferred format/media to create your educational tool. You can create Slides (PowerPoint presentation), a piece of writing in a Blog format (with pictures included), a trifold, a video, an infographic for social media, etc.

                • Step 2: Create two separate tools that explain:

                  • The risks of tobacco use including its effect on cancer, oral disease, and the cardiovascular, cerebrovascular, respiratory, endocrine, and reproductive systems.
                  • The risks of environmental tobacco smoke for people other than the smoker with a special emphasis on people living in a smoker’s household.
                • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and paste a link to your product.
                  We want to publish the best works on our website and social media, if you want your work to be published, insert a sentence about it in this forum’s post description.

                • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. 

              • Quiz: Module 3: Lesson 1
                To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
            • Module 3: Lesson 2: Counselling Efficacy

              Learning Objectives:
              • Recognize the health benefits of quitting tobacco use at all ages.
              • Describe the benefits of quitting smoking for each major age group.
              Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 104 mins.

              Click here to start this lesson

              3 URLs, 1 Forum, 1 Quiz
              • Required Learning Resources and Activities
              • Benefits of Quitting Smoking URL

                Read the content under the heading "Health Benefits of Quitting Smoking".

              • Smoking Cessation: A Report of the Surgeon General URL

                Read the content under the heading "Conclusions" at the end of each section on the pages, 206, 213, 270, 304, 320, and 399.

              • Smoking Cessation: A Report of the Surgeon General URL
                Read the content under the heading "Benefits of Smoking Cessation on All-Cause Mortality" on the pages 461-464.


              • Peer activity: Benefits of quitting smoking Forum

                In this activity, you will create an educational tool for your future patients.

                • Step 1: Select your preferred format/media to create your educational tool. You can create Slides (PowerPoint presentation), a piece of writing in a Blog format (with pictures included), a trifold, a video, an infographic for social media, etc.

                • Step 2: Create a tool that explains the benefits of quitting smoking for each major age group

                • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and paste a link to your product.
                  We want to publish the best works on our website and social media, if you want your work to be published, insert a sentence about it in this forum’s post description.

                • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. 

              • Quiz: Module 3: Lesson 2
                To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
            • Module 3: Lesson 3: Counselling Principles

              Learning Objectives:
              • Discuss the basic principles of patient-centered counseling.
              • Describe the meaning of the 5 A's for tobacco treatment.
              • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
              • Discuss the transtheoretical model and its component stages of change, including readiness to quit.
              • Understand alternative therapies for tobacco cessation such as harm reduction, hypnosis and acupuncture.
              • Analyze alternative therapies for tobacco cessation treatment based upon recognized reviews of effectiveness such as the Cochrane reviews and the USPHS Guidelines.
              • Understand how motivational interviewing, cognitive therapy, and supportive counseling is used to pursue behavior changes in tobacco consumers.
              • Identify an effective office visit management system.
              • Remember evidence-based methods for brief interviews for treating tobacco dependence.
              Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 338 mins.

              Click here to start this lesson

              12 URLs, 2 Forums, 1 Quiz
              • Required Learning Resources and Activities
              • Conceptualizing Patient-Centered Care for Substance Use Disorder Treatment: Findings from a Systematic Scoping Review URL

                Read the content under the heading "Abstract", and "Directed content analysis of outcomes of PCC principles"

              • Toolkit for Delivering the 5A’s and 5R’s Brief Tobacco Interventions in Primary Care URL

                Read the content under the heading "IV. The 5 A's model to help patients ready to quit", "V. The 5 R's model to increase motivation to quit", and "VI.The 5A's to avoid exposure to secondhand smoke" on the pages 11-15.

              • Treating Tobacco Use and Dependence: 2008 Update URL

                Read content under the heading "Ten Key Guideline Recommendations" on the pages 6-8 and the chapter "Clinical Interventions for Tobacco Use and Dependence" on the pages 37-60.

              • Transtheoretical Model in Smoking Cessation URL

                Read the entire article.

              • Alternative Therapies to Reduce Dependence URL

                Read the entire page.

              • Complementary Health Approaches for Smoking Cessation: What the Science Says URL

                Read the entire page.

              • Alternative Therapies and Emerging Treatments URL

                Read the content under the heading "Alternative therapies and emerging treatments".

              • Spotlight on PATH Practices and Programs Motivational Interviewing URL

                Read the content under the heading "Examples Of How PATH Programs Use Motivational Interviewing" on the pages 4-7.

              • Cognitive-Behavioral Treatment with Behavioral Activation for Smoking Cessation: Randomized Controlled Trial URL

                Read the content under the heading "Abstract", "Introduction", and "Discussion".

              • Individual Behavioural Counselling for Smoking Cessation URL

                Read the entire article.

              • Treating Tobacco Use and Dependence: 2008 Update URL

                Read the content under the heading "2. Treatment Structure and Intensity" on the pages 82-86.

              • Treating Tobacco Dependence: Guidance for Primary Care on Life-Saving Interventions. Position Statement of the IPCRG URL

                Read the content under the reading "Guidance".

              • Discussion forum: Affective objectives and the 5A’s for tobacco treatment

                There are eight affective objectives in this course’s curriculum:

                A.1 Student should value physician’s role in tobacco smoking prevention, assessment, screening, and treatment.

                A.2 Student should value medical practice “team approach” for tobacco smoking prevention, assessment, screening, and treatment.

                A.3 Student should value physicians’ and health professionals’ role in public health advocacy and participation.

                A.4 Student should believe that tobacco cessation advice/patient-centered counseling is a learned skill and can be a highly effective skill.

                A.5 Student should be able to empathize with addicted patients.

                A.6 Student should respect the importance of keeping current with evidence-based findings in tobacco smoking prevention and control (e.g., epidemiological, behavioral,  clinical, and policy science).

                A.7 Student should develop confidence in his or her role as knowledgeable expert and ability to effect change at community and environmental level.

                A.8 Student should appreciate that smoking cessation is a process; not all smokers are successful on first attempt.

                • Step 1: Prepare a 250 - 750 piece of writing where you describe the meaning each one of the affective objectives has for you. Include an additional paragraph of 250 words where you express the meaning that the 5A’s for tobacco treatment have for you.
                • Step 2: To post your answer, click on the button at the bottom of the screen labeled 'Add a new discussion topic'. 
                • Step 3: Comment on at least one other posting made by your peers in a respectful and professional manner. If a peer comments on your posting, please reply back. To comment, click on the particular discussion, then click on ‘reply'.
                To post your response click on the button at the bottom of the screen labeled 'Add a new discussion topic.' You will also need to comment on at least one other post made by your peers in a respectful and professional manner. If a peer comments on your posting, please reply back. To post a reply, click on the particular discussion, then click on 'reply'.
              • Peer Activity: Alternative therapies for tobacco cessation. Forum

                In this activity, you will create an educational tool for your future patients.

                • Step 1: Select your preferred format/media to create your educational tool. You can create Slides (PowerPoint presentation), a piece of writing in a Blog format (with pictures included), a trifold, a video, an infographic for social media, etc.
                • Step 2: Create a tool that explains the alternative therapies used for tobacco cessation, classify them by their effectiveness, and compare their benefits of each alternative therapy.
                • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and paste a link to your product.
                  We want to publish the best works on our website and social media, if you want your work to be published, insert a sentence about it in this forum’s post description.
                • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. 
              • Quiz: Module 3: Lesson 3
                To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
            • Module 3: Lesson 4: The Role of Referrals in Tobacco Cessation

              Learning Objective:
              • Understand how to make an appropriate referral.
              • Describe at least three sources for patient referral.
              • Create activities to collaborate with other healthcare providers and coordinate the appropriate use of medications.
              Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 54 mins.

              Click here to start this lesson

              5 URLs, 1 Quiz
              • Required Learning Resources and Activities
              • Tobacco Cessation - Adult URL

                Read this algorithm on the pages 1-5.

              • Referrals to Stop Smoking Services URL

                Read the entire page.

              • About Smokers' Helpline URL

                Read the content under the heading "What is a quitline?", "How doe SHL phone service work?", and "What is a Quit Coach?".

              • How to Quit Smoking URL

                Peruse the list of resources.

              • Integrating Tobacco Cessation Quitlines Into Health Care: Massachusetts, 2002–2011 URL

                Read the entire article.

              • Quiz: Module 3: Lesson 4
                To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.
            • Module 4: Pediatric Prevention and Cessation

              Competencies covered in this module

              • Understand the major risks of environmental tobacco smoke exposure to children in the household.
              • Understand the prevalence of smoking in the pediatric population.
              • Be able to identify developmental issues and age-appropriate interventions for tobacco treatment and provide age-appropriate anticipatory guidance through patient-centered counseling.
              • Be able to demonstrate the application of systems-based practice/practice-based learning that follows the 2000 Public Health Service guidelines.
              • Know the medical literature regarding vulnerability to tobacco use and the quick onset of addiction properties with early tobacco use.
              • Describe strategies and coping skills that can reduce relapse risk.
              • Know resistance skills to early onset of smoking with children and adolescents.
              • Know at least three sources for pediatric smoking cessation referral, including Internet resources.
              • Know at least three signs of nicotine dependence.
              • Be able to assess nicotine dependence with at least three pediatric patients.
              • Know that every child and adolescent should be asked about tobacco use.
              • Understand pediatric tobacco prevention and patient-centered tobacco counseling.
              • Be able to provide a tailored smoking prevention message based on age-appropriate concerns (e.g., the “truth” campaign).
              • Be aware of different settings of care outside the medical practice/care environment that may affect a patient’s health in a positive way and be able to tap into these external care resources for adolescents (e.g., YMCA sports activities).
              • Be aware of the need for pediatricians and other medical professionals treating a child or an adolescent smoker to encourage the patient to set a quit date.
              • Know how to counsel children and adolescents on smoking cessation and be knowledgeable about setting goals to quit with children and adolescents.
              • Be aware of the parent’s role in providing health information to their children.
              • Be able to provide tips to parents regarding smoking prevention and cessation counseling for their children.
              • Understand the role of parent modeling in shaping children’s behavior.
              • Understand the potential for adult patient-centered tobacco counseling in the pediatric arena.
              • Be able to perform the 5A’s for patient-centered tobacco cessation counseling with at least three parents.

              • Module 4: Lesson 1 Epidemiology of Tobacco Consumption in Pediatric Population

                Learning Objective:
                • Describe the major risks of environmental tobacco smoke exposure to children in the household.
                • Describe the prevalence of smoking in the pediatric population.
                • Describe the developmental issues caused by tobacco consumption in children and adolescents.
                • Describe age-appropriate interventions for tobacco treatment.
                • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
                Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson:166 mins.

                Click here to start this lesson

                9 URLs, 1 Quiz
                • Required Learning Resources and Activities
                • Children in the Home URL

                  Read the entire page.

                • Secondhand Smoke Exposure at Home among One Billion Children in 21 Countries: Findings from the Global Adult Tobacco Survey (GATS) URL

                  Read the entire article, except the content under the heading "Methods".

                • Statistics on Smoking - England , 2018 [PAS] URL

                  Read the entire page.

                • Youth URL

                  Read the entire page.

                • Vital Signs: Tobacco Product Use Among Middle and High School Students — United States, 2011–2018 URL

                  Read the entire article.

                • Preventing Smoking in Children and Adolescents: Recommendations for Practice and Policy URL

                  Read the content under the heading "Abstract", and "Products and Prevalence".

                • Nicotine and The Adolescent Brain URL

                  Read the entire article.

                • Recommendations on Behavioural Interventions for the Prevention and Treatment of Cigarette Smoking among School-Aged Children and Youth URL

                  Read the entire article.

                • Treating Tobacco Use and Dependence: 2008 Update URL

                  Read the content undr the heading "Children and Adolescents" on the pages 159-161.

                • Quiz: Module 4:Lesson 1

                  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

              • Module 4: Lesson 2: Counselling Efficacy

                Learning Objective:
                • Discuss medical literature regarding vulnerability to tobacco use and the quick onset of addiction properties with early tobacco use.
                • Analyze strategies and coping skills used to reduce tobacco relapse risk.
                • Describe the resistance skills needed on children and adolescents to avoid the early onset of smoking.
                • Identify sources for pediatric smoking cessation referrals.
                • Identify at least three signs of nicotine dependence.
                • Assess nicotine dependence in at least three pediatric patients.
                Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 110 mins.

                Click here to start this lesson

                10 URLs, 1 Quiz
                • Required Learning Resources and Activities
                • Adolescents and Tobacco: Risk and Protective Factors URL

                  Read the entire page.

                • Nicotine and Tobacco as Substances of Abuse in Children and Adolescents URL

                  Read the content under the heading "Abstract", "Introduction", and "Criteria for dependence".

                • How Can Relapse be Prevented? URL

                  Read the content under the heading "7.8.1 Keeping motivation top of mind" onwards.

                • Say No To Smoking Ammunition & Tips URL

                  Read the entire document.

                • Referrals to Stop Smoking Services URL

                  Explore the web site. It is a site that you can refer to your pediatric patients.

                • For Kids & Teens: Tobacco Education Resources URL

                  Identify appropriate referral sources for pediatric patients.

                • Referral Strategies to a Tobacco Quitline and Racial and/or Ethnic Differences in Participation URL

                  Read the content under the heading "Methods".

                • Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ) URL

                  Read the entire page, and download the questionnaire by clicking on "View Measure: PDF".

                • Quiz: Module 4: Lesson 2

                  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                • Additional Resources for Optional Learning
                • Refusal Skills Activities (optional) URL

                  These activities can help youth develop skills to refuse the use of nicotine and tobacco products.

                • Instrument: Fagerstrom Test For Nicotine Dependence (FTND) URL

                  Read the entire page and download the instrument "FagerstromTest_2014Mar24.pdf".

              • Module 4: Lesson 3 Counselling Principles with Children and Adolescent

                Learning Objective:
                • Identify the reasons why every child and adolescent should be asked about tobacco use.
                • Describe tobacco prevention techniques.
                • Summarize patient-centered tobacco cessation counselling strategies in pediatric patients.
                • Create an age-appropriate smoking prevention message.
                • Describe the positive effect of care settings outside the medical practice/care environment.
                • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
                • Identify the need for pediatricians and other medical professionals treating a child or an adolescent smoker to encourage the patient to set a quit date.
                • Describe counseling strategies for smoking cessation on children and adolescents.
                • Recognize how to set goals for smoking cessation in children and adolescents.
                Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 242 mins.

                Click here to start this lesson

                7 URLs, 1 Forum, 1 Quiz
                • Required Learning Resources and Activities
                • Physician Tobacco Screening and Advice to Quit among U.S. Adolescents – National Survey on Drug Use and Health, 2013 URL

                  Read the entire article.

                • Preventing Smoking in Children and Adolescents: Recommendations for Practice and Policy URL

                  Read the content under the heading "Table 4: Counselling around the health effects of smoking in different age groups".

                • Counseling About Smoking Cessation URL

                  Read the entire webpage, enter the "Counselling Techniques" resources and review each of them.

                • Community-Based Interventions to Decrease Obesity and Tobacco Exposure and Reduce Health Care Costs: Outcome Estimates From Communities Putting Prevention to Work for 2010–2020 URL

                  Read the entire article.

                • Treating Tobacco Use and Dependence: 2008 Update URL

                  Read the content under the heading "Type of Clinician"on the pages 87-88.

                • Counseling About Smoking Cessation URL

                  Read the Content Under the Heading "Get the why, When, and How of Helping Patients Quit in this Infographic", and "Supporting Youth Who are Addicted to Nicotine: Advice for Pediatricians".

                • Assessing the Quality of Goal Setting in Behavioural Support for Smoking Cessation and its Association with Outcomes URL

                  Read the entire article, except the content under the heading "Methods".

                • Peer Activity: Prevention messages Forum

                  In this activity, you will create an educational tool for your pediatric patients.

                  • Step 1: Select your preferred format/media to create your educational tool. You can create Slides(PowerPoint presentation), a piece of writing in a Blog format(with pictures included), a trifold, a video, an infographic for social media, etc.

                  • Step 2: Create tools with tailored smoking prevention messages based on age-appropriate concerns. 

                  • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and paste a link to your product.
                    We want to publish the best works on our website and social media, if you want your work to be published, insert a sentence about it in this forum’s post description.

                  • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post. 

                • Quiz: Module 4: Lesson 3

                  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

              • Module 4: Lesson 4 Counseling, Efficacy and Principles with Parents

                Learning Objective:
                • Recognize the parent’s role in providing health information to their children.
                • Explain to parents how to provide counseling regard smoking prevention and cessation counseling for their children.
                • Identify the role of parent modeling in shaping children’s behavior.
                • Identify the role of adult patient-centered tobacco counseling in the pediatric arena.
                • Carry out patient-centered tobacco cessation counseling performing the 5A’s.
                Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 64 mins.

                Click here to start this lesson

                5 URLs, 1 Quiz
                • Required Learning Resources and Activities
                • Keeping Your Kids Tobacco Free URL

                  Read the entire page.

                • Teen Smoking: How to Help Your Teen Quit URL

                  Read the entire page.

                • Parenting Styles as a Tobacco-Use Protective Factor among Brazilian Adolescents URL

                  Read the content under the heading "Abstract"

                • Pediatricians’ Offices Can Help Parents Quit Smoking, Study Shows URL

                  Read the entire webpage to understand the role of adult tobacco counseling in the pediatric arena.

                • Treating Tobacco Use and Dependence: 2008 Update URL

                  Read the content under the heading "Clinical Interventions for Tobacco Use and Dependence" on the pages 37-43.

                • Quiz: Module 4:Lesson 4

                  To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

              • Module 5: Pharmacology Mechanisms as a Tobacco Cessation Strategy

                Competency covered in this module: 
                • Identify evidence-based treatment strategies and the pros and cons for each strategy.
                • Understand the pharmacological mechanisms of the full range of pharmacotherapy available for tobacco treatment, including the use of nicotine replacement and antidepressants.
                • Describe the use of combinations of medications and higher dose medications to enhance the probability of abstinence.
                • Understand the advantages of pharmacotherapy over other cessation strategies (e.g., cold turkey).
                • Describe a plan for follow up to address potential issues including negative outcomes.
                • Understand patient instructions for effective use of pharmacological forms of tobacco cessation.
                • Provide information on correct use, efficacy, adverse events, contraindications, known side effects and exclusions for all tobacco dependence medications approved by national regulatory agencies.
                • Provide appropriate patient education for therapeutic choices and dosing for a wide range of patient situations.
                • Identify second-line medications and be able to find information about them as needed.
                • Be able to demonstrate application of system-based practice/practice-based learning that follows the 2000 Public Health Service guidelines.
                • Understand how to assess and tailor the type of pharmacotherapy and the dose appropriate to individuals.
                • Identify possible adverse reactions and complications related to the use of pharmacotherapy for tobacco dependence, making timely referrals to medical professionals/services.
                • Demonstrate ability to address concerns about minor and/or temporary side effects of these pharmacotherapies.
                • Describe specific treatment indications for special population groups (i.e. pregnant women, adolescents, young adults, elderly, hospitalized patients, those with co-morbid psychiatric conditions).
                • Understand the basics of insurance reimbursement, coding, and other entitlements (e.g., Medicaid) for tobacco cessation treatment.
                • Describe how patients can explore reimbursement for treatments.
                • Understand available over-the-counter medications (e.g., NRT) and their relative costs.
                • Module 5: Lesson 1: Pharmacological Mechanisms of Available Medication for Tobacco Cessation

                  Learning Objective:
                  • Describe the pros and cons of evidence-based tobacco use treatment strategies.
                  • Summarize the pharmacological mechanisms of the full range of pharmacotherapy available for tobacco treatment including the use of nicotine replacement and antidepressants.
                  • Recognize the advantages of pharmacotherapy over other cessation strategies.
                  • Understand the main components of a follow-up plan to address potential issues, including negative outcomes.
                  Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 444 mins.

                  Click here to start this lesson

                  7 URLs, 1 Quiz
                  • Required Learning Resources and Activities
                  • Interventions for Smoking Cessation and Treatments for Nicotine Dependence URL

                    Read the content the heading "Pharmacologic Treatments".

                  • Current and Emerging Pharmacotherapeutic Options for Smoking Cessation URL

                    Read the entire article.

                  • Antidepressants for Smoking Cessation URL

                    Read the content under the heading "Abstract", and "Plain language summary".

                  • Association Between Duration of Use of Pharmacotherapy and Smoking Cessation: Findings from a National Survey. URL

                    Read the entire article except the content under the heading "Methods".

                  • The Effects of Tobacco Use on Health URL

                    Read the entire article.

                  • Health Promotion Methods for Smoking Prevention and Cessation: A Comprehensive Review of Effectiveness and the Way Forward URL

                    Read the entire article.

                  • Interventions for Smoking Cessation and Treatments for Nicotine Dependence URL

                    Read the content under the heading "Emerging Intervention Approaches".

                  • Quiz: Module 5: Lesson 1

                    To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                • Module 5: Lesson 2: Principles of Effective Use of Pharmacotherapy Strategies

                  Learning Objective:
                  • Describe patient instructions for the effective use of pharmacological forms of tobacco cessation.
                  • Explain all relevant information on tobacco dependence medications approved by national regulatory agencies.
                  • Understand the importance of second-line medications to quit smoking and also be able to find information on these as needed.
                  • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
                  • Discuss how to tailor pharmacotherapy to the needs of each individual.
                  • Apply your knowledge about pharmacotherapy for tobacco dependence to address possible adverse reactions and complications.
                  • Contribute to knowledge-based ideas regarding temporary side effects of pharmacotherapies.
                  • Analyze how treatment indications differ according to special population groups.
                  • Summarize the basics of insurance reimbursement, coding, and other entitlements for tobacco cessation treatment.
                  • Identify available over the counter medications and their relative costs in your area.
                  Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 603 mins.

                  Click here to start this lesson

                  18 URLs, 1 Quiz
                  • Required Learning Resources and Activities
                  • Nicotine Dependence Treatment URL

                    Read the content under the heading "Counselling".

                  • Nicotine Replacement Therapy for Quitting Tobacco URL

                    Read the entire page.

                  • Varenicline for smoking cessation: a narrative review of efficacy, adverse effects, use in at-risk populations, and adherence URL

                    Read the content under the headings "Abstract", "Introduction", and "Adverse events and FDA warnings".

                  • Prescription Drugs to Help You Quit Tobacco URL

                    Read the entire pharmacologic product guide.

                  • Medications / Pharmacotherapy URL

                    Read the entire page.

                  • Treating Tobacco Use and Dependence: 2008 Update URL

                    Read the content under the heading "Recommendations Regarding Individual Medications: First-Line Medications" on the pages 108-123.

                  • 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment URL

                    Read the content under the heading "Pharmacotherapy Recommendations" on page 13.

                  • Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice URL

                    Read the content under the heading "Safety and tolerability of nicotine replacement therapies", "Safety and tolerability of bupropion", and "Safety and tolerability of varenicline".

                  • Adverse events of smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes in the Food and Drug Administration Adverse Event Reporting System, 2004−2016 URL

                    Read the content under the heading "Results", and "Discussion".

                  • Smoking cessation therapy during pregnancy URL

                    Read the entire article.

                  • Clinical Pharmacology in Old Persons URL

                    Read the entire article.

                  • Interventions for smoking cessation in hospitalised patients URL

                    Read the entire article.

                  • Treatment of Substance Abusing Patients with Comorbid Psychiatric Disorders URL

                    Read the entire article.

                  • Healthcare financing systems for increasing the use of tobacco dependence treatment (Review) URL

                    Read the entire document.

                  • Coverage for Tobacco Use Cessation Treatments URL

                    Read the entire page.

                  • Coding reference URL

                    Read the entire document.

                  • Nicotine Replacement Therapy for Quitting Tobacco URL

                    Read the content under the heading "Types of nicotine replacement therapy".

                  • Dispelling Myths about Nicotine Replacement Therapy URL

                    Read the entire document.

                  • Quiz: Module 5: Lesson 2

                    To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                • Module 6: Special Issues Related to Tobacco Use

                  Competency covered in this module: 
                  • Be able to demonstrate the application of systems-based practice/practice-based learning that follows the 2000 Public Health Service guidelines.
                  • Understand the risks and benefits of smoking in common cultural groups and family structures.
                  • Describe specific treatment indications for special population groups (i.e. pregnant women, adolescents, young adults, elderly, hospitalized patients, those with co-morbid psychiatric conditions).
                  • Understand the range of risks related to smoking during pregnancy.
                  • Be able to demonstrate the application of systems-based practice/practice-based learning that follows the 2000 Public Health Service guidelines.
                  • Understand the high risk of relapse for postpartum women who stopped smoking while pregnant and who have recently delivered their children.
                  • Describe specific treatment indications for special population groups (i.e. pregnant women, adolescents, young adults, elderly, hospitalized patients, those with co-morbid psychiatric conditions).
                  • Understand the safety of using NRT and bupropion HCl in pregnant women.
                  • Understand barriers to smoking cessation, including weight gain, stress, and smokers in family and close social circles.
                  • Make effective treatment recommendations for non-cigarette tobacco users.
                  • Module 6: Lesson 1: Issues of Culture, Gender, Age, and Family

                    Learning Objective:
                    • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
                    • Describe the risks and benefits of smoking in common cultural groups and family structures.
                    Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 53 mins.

                    Click here to start this lesson

                    2 URLs, 1 Quiz
                    • Required Learning Resources and Activities
                    • Treating Tobacco Use and Dependence: 2008 Update URL

                      Read the content under the heading "Clinical Issues for Specific Populations" on the pages 148-156.

                    • A Social Network Family-Focused Intervention to Promote Smoking Cessation in Chinese and Vietnamese American Male Smokers: A Feasibility Study URL

                      Read the entire article except the content under the heading "Methods".

                    • Quiz: Module 6: Lesson 1

                      To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                  • Module 6: Lesson 2: Pregnancy-Related Issues

                    Learning Objective:
                    • Summarize the risks related to smoking during pregnancy.
                    • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
                    • Describe the risk of relapse on postpartum women who stopped smoking while pregnant.
                    • Discuss the safety of using Nicotine Replacement Treatment and bupropion HCl in pregnant women.
                    Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson:152 mins.

                    Click here to start this lesson

                    6 URLs, 1 Quiz
                    • Required Learning Resources and Activities
                    • Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review URL

                      Read the entire article.

                    • Treating Tobacco Use and Dependence: 2008 Update URL

                      Read the content under the heading "Pregnant Smokers" on the pages 165-173.

                    • Reducing Postpartum Smoking Relapse in New York State URL

                      Read the entire document.

                    • I Was a Full Time Proper Smoker”: A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum URL

                      Read the content under the heading "Synopsis", "Background", and "Conclusion".

                    • Pharmacological interventions for promoting smoking cessation during pregnancy (Review) URL

                      Read the entire article.

                    • Smoking cessation strategies in pregnancy: Current concepts and controversies URL

                      Read the entire article.

                    • Quiz: Module 6: Lesson 2

                      To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                  • Module 6: Lesson 3: Barriers for Tobacco Cessation

                    Learning Objective:
                    • Recognize the 2000 Public Health Service guidelines recommendations for treating tobacco use and dependence.
                    • Describe common barriers to smoking cessation.
                    • Understand the different forms of presentation of tobacco products to make effective treatment recommendations for non-cigarette tobacco users.
                    • Explain methods for avoiding weight gain, and stress.
                    Approximate time required to complete the readings (at 144 words/minute) and assignments for this lesson: 323 mins.

                      Click here to start this lesson

                    8 URLs, 1 Forum, 1 Quiz
                    • Required Learning Resources and Activities
                    • Treating Tobacco Use and Dependence: 2008 Update URL

                      Read the content under the heading "Weight Gain After Stopping Smoking" on the pages 173-176.

                    • Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia URL

                      Read the entire article except the content under the heading "Methods".

                    • Change in anxiety following successful and unsuccessful attempts at smoking cessation: cohort study URL

                      Read the entire article.

                    • Social influences on smoking cessation in mid-life: Prospective cohort of UK women URL

                      Read the entire article.

                    • The Influence of Peer Behavior as a Function of Social and Cultural Closeness: A Meta-Analysis of Normative Influence on Adolescent Smoking Initiation and Continuation URL

                      Read the content under the heading "Abstract", and "Discussion".

                    • Non-cigarette tobacco products: What have we learned and where are we headed? URL

                      Read the content under the heading "Overview of non-cigarette tobacco products".

                    • Non Cigarette Tobacco Products (NCTP) and Electronic cigarettes (e-cigs) URL

                      Read the slides 79-101.

                    • Peer activity: Methods for weight gain and stress management Forum

                      In this activity, you will create an educational tool for your future patients.

                      • Step 1: Select your preferred format/media to create your educational tool. You can create Slides(PowerPoint presentation), a piece of writing in a Blog format(with pictures included), a trifold, a video, an infographic for social media, etc.

                      • Step 2: Create a tool that explains the methods for avoiding weight gain, and stress during a tobacco cessation attempt.

                      • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and paste a link to your product.
                        We want to publish the best works on our website and social media, if you want your work to be published, insert a sentence about it in this forum’s post description.

                      • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post.

                    • Additional Resources for Optional Learning
                    • Social Smoking URL

                      Read the entire article.

                    • Quiz: Module 6: Lesson 3

                      To access the quiz, click on the name of the quiz provided above. On the following screen, click the "Preview quiz now" button to respond to the questions.

                  • Module 7: Practicum

                    Competencies covered in this module

                    • Be able to use patient-centered counseling with at least 3 patients and include pharmacological therapy.
                    • Plan-individualised treatments that account for patient assessment factors identified during the intake assessment and history gathering.
                    • Demonstrate establishing a warm, confidential, and non-judgmental counselling environment.
                    • Summarise and be able to apply valid and reliable diagnostic criteria for tobacco dependence.
                    • Demonstrate the ability to gather basic medical history information and conduct a brief screening for psychiatric and substance abuse issues.
                    • Identify information relevant to a client’s current and past medical, psychiatric, and smoking history,(including past treatments) that may impact pharmacotherapy decisions.
                    • Be able to practice patient-centered counseling with at least 3 patients.
                    • Demonstrate competence in at least one of the empirically supported counselling modalities such as individual, group and telephone counseling.
                    • Provide culturally competent counselling.
                    • When given three different patient scenarios, be able to identify the patient’s stage of change and perform an appropriate patient-centered interview.
                    • Demonstrate the effective use of clinically sound strategies to enhance motivation and encourage commitment to change.
                    • Identify personal risk factors and incorporate into the treatment plan.
                    • Be able to provide at least three patients with appropriate referrals.
                    • Be able to employ culturally competent and family-sensitive patient-centered tobacco treatment strategies with at least three patients.
                    • Provide information that is gender, age, and culturally sensitive and appropriate to learning style and abilities.
                    • Demonstrate effective counselling skills such as active listening and empathy that facilitate the treatment process.
                    • Be able to demonstrate patient-centered counseling skills taking into account barriers to quitting with at least three patients.
                    • Demonstrate the ability to conduct an intake assessment interview including:
                      i. tobacco use history
                      ii. validated measures of motivation to quit
                      iii. validated measures for assessing tobacco use and dependence
                      iv. current challenges and barriers to attaining permanent abstinence
                      v. current strengths to support abstinence.
                      vi. prior quit attempts including treatment experiences, successes and barriers
                      vii. availability of social support systems
                      viii. preferences for treatment.
                      ix. cultural factors influencing making a quit attempt

                    • Be able to perform patient-centered counseling with at least three parents regarding the effect of smoking on their children.
                    • Be able to perform the 5A’s for patient-centered tobacco cessation counseling with at least three parents.
                    • Collaboratively develop a treatment plan that uses evidence-based strategies to assist the client in moving toward a quit attempt, and/or continued abstinence from tobacco.
                    • Be able to provide parents who smoke with information about the most effective quitting strategies
                      In collaboration with the client, identify specific and measurable treatment objectives.

                    • Be able to perform tobacco prevention patient-centered counseling with at least three children.
                    • Be able to perform tobacco prevention patient-centered counseling with at least three adolescents.
                    • Be sensitive to issues of child and parent confidentiality.
                    • Demonstrate an ability to respond to high-risk client situations.
                    • Describe and use a code of ethics established by your professional discipline for tobacco dependence treatment specialists if available.
                    • Be able to discuss vulnerability to tobacco use and quick onset of addiction with early tobacco use with at least three children and three adolescents.
                    • Be able to assess nicotine dependence with at least three pediatric patients.
                    • Be able to discuss the use of resistance skills when smoking is offered or part of the patient’s environment (e.g., peer pressure, parents smoke) with at least three children and three adolescents.
                    • Be able to provide patient-centered tobacco counseling to pregnant women at least three times.
                    • Be able to provide patient-centered counseling at least three times to women who stopped smoking and who have recently delivered their children.

                    Click here to start this module

                    1 Page, 7 Forums
                    • Competencies covered in this module Page

                      Click here to find the competencies covered in this module.

                    • Peer Activity: Culturally competent and family-sensitive patient-centered tobacco treatment strategies. Forum

                      In this activity, you will use the information of the three patients you interviewed to employ culturally competent and family-sensitive patient-centered tobacco treatment strategies

                      • Step 1: Listen to the recording of your patient’s interview and read your notes about it.

                      • Step 2: Apply what you learned in this lesson to develop a culturally competent and family-sensitive patient-centered tobacco treatment plan for each of your three patients.

                      • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below, and complete the fields. A peer will provide you feedback about your treatment plan.

                      • Step 4: Review the work of one of your peers and provide feedback by commenting on his/her post.

                    • Peer activity: Forum

                      In this activity, you will assess nicotine dependence in 3 case studies for pediatric patients. These case studies were adapted from ASH Scotland, The Royal Australian College of General Practitioners, the AlbertaQuits Cessation Supports/Services, and the Journal of Medical Case Reports. For this, you will need to use the Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ) tool.

                      • Step 1: Read the following case studies:

                        Case Study 1: 

                        GM is 17 years old; she has been referred by her GP to assess her cannabis and tobacco dependency, which she had turned to since she was 13 years old because of sexual abuse as a child, her dyslexia and bullying at school. She has a history of self-esteem issues and self-harm. In fighting back against people, due to her insecurities, she had developed aggressive tendencies and had become isolated and withdrawn. 

                        She admits that right after waking up she has a joint (cannabis cigarette), a cigarette, and very little breakfast. She had been underweight and very malnourished. She was, however, motivated to work on improving her health and lifestyle and in particular her cannabis dependency. 

                        Alcohol, tobacco, and cannabis as well as long bouts on her PlayStation were part of her coping strategy but she acknowledged that these needed to be tackled, she has a 60-a-day cigarette dependence and she inhales quite often. Her main concerns were regarding sleep. Cannabis was used as an aid to sleep and to relax and she wondered if less cannabis might result in heavier drinking or insomnia. 

                        She has been suspended 2 times from school for smoking cigarettes inside the building; she explains that it is impossible to refrain from smoking even when she knows the school rules forbid it, also because she usually smokes more at the beginning of the day. She has also been making attempts to quit smoking, has tried patches, as yet unsuccessfully but shows a commitment to reduce her smoking further.

                        Case Study 2: 

                        JD, currently 18 years old, started smoking at 17 years old; he tried his first cigarette during a youth group event, where a friend taught them how to inhale. A week after that event he was already smoking over 20 cigarettes a day. He has most of the cigars after waking up, even more than 10 before he has a cup of coffee.  

                        He admitted craving for this substance to the extent of doing dirty jobs for people to sustain the habit and neglecting other previous forms of enjoyment, such as watching television with family members.

                        He identifies himself as the kind of person who always goes out in any situation to have a smoke, even when sick in bed he can´t stop himself from smoking. He has tried several times to quit on his own, but now he is asking his General Practitioner for help.

                        Case Study 3: 

                        A 17-year-old is brought to a psychiatric hospital with a 5-year history of tobacco smoking and delinquent behaviors; he has been expelled from school because of consuming and sharing tobacco inside of the school. He lives with his mother who is of low socioeconomic status; she has a busy schedule and works full time. There is no history of mental illness or substance abuse in the family.

                        He was first introduced to tobacco smoking by his friends at age 12 years. He gradually stepped up his use from one cigarette/day over the next 2 to 3 years to approximately 20 to 30 cigarettes per day to sustain the relaxing and stimulating effect, he admits he inhales always, to get the ¨maximum effect¨. He has had several unsuccessful attempts at controlling the amount he took in a day despite the knowledge of its harmful consequences. His longest period of abstinence was 3 months in a rehabilitation center which was approximately 3.5 years ago. He had once experimented with cannabis and alcohol, but he never enjoyed these substances and so did not continue.

                        Two months ago he progressively neglected his personal hygiene and food, became emaciated to the point he could not even leave the bed, and spent more time cigarette smoking (that is, smoking continuously); he decided to seek medical attention at this time. 

                        Before he started smoking cigarettes, he was described as an easy child, quite cheerful, and an outgoing person who enjoyed the company of other children.

                      • Step 2: Using the Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ), identify the level of dependence according to the score you calculated for each case. Create an assignment that contains the level of dependence according to the mFTQ and the mFTQ score for all 3 case studies. Justify your results.

                      • Step 3: Submit your assignment for peer review by clicking “add a new discussion topic” below. 

                      • Step 4: Review the work of one of your peers by asking yourself the questions listed below and comment on their post stating that their post meets these requirements.

                        1. Did my peer use the Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ)?
                        2. Did my peer provide scores for each of the 3 case studies provided in step 1?
                        3. Did my peer assess the level of dependence for each one of the 3 case study?
                        4. Did my peer justify his results for each case study?
                    • Peer Activity: Providing counseling to parents who smoke Forum

                      For this activity, you need to identify practice patients to apply what you learned in the previous modules. You will find the relevant module and lesson related to each element of this assignment in parenthesis, please review them before the interviews.

                      • Step 1: Identify three practice patients that:

                        • Smoke
                        • Have children
                        • May benefit from a counseling session

                      You can work with patients in your clinical practice. However, if you are not currently working with patients, you can invite friends or relatives that fulfill the requirements stated above.

                      • Step 2: Invite your patients to separate counseling sessions. You need to explain to them that this is part of your training, that you will need to take audio recordings from the interview, and that their privacy will be protected. For the counseling session use the BTS Quality Improvement Tool for Smoking Cessation except the E section.

                      • Step 3: Apply your knowledge on patient-centered counseling with each one of the patients and make sure to include ALL of the following:

                        • Practice patient-centered counseling (M4L3)
                        • Identify and be sensitive to cultural and family special situations of your patients (M5L1)
                        • Talk with your patients about barriers to quitting (M5L3)
                        • Talk with your patients about the effect of smoking on their children (M6L1)
                        • Perform the 5A’s for patient-centered tobacco cessation with your patients (M4L1 and M6L4)
                        • Provide them information about the most effective quitting strategies (M6L1)
                      • Step 4: Use your recordings and notes to write a summary of each of the counseling sessions.

                      • Step 5: Based on your recordings, notes, and summaries prepare a paper that contains ALL of the following:

                        • Identify each patient’s state of change (M4L3)
                        • A prescription with instructions to provide pharmacological therapy for each patient. You should NOT give this prescription to the patient; it is only for learning purposes. When you prepare any kind of prescription, make sure to be sensitive to family and special cultural situations, as well as the economic situations of your patients. (M3L2)
                        • Referral indications for each of the patients. This is only for learning purposes. (M4L3)
                      • Step 6: Prepare your assignment for upload. Include the product of your work in a single document and in the order stated below:

                        • Identify the patient using only the initials of his/her name (John Smith = JS)
                        • The summary of the counseling session
                        • Each of the points required in step 6 (State of change, prescription, and referral)
                        • Repeat the format for each patient
                      • Step 7: Upload the recording of the counseling sessions. You can upload it in this forum, to google drive, or any other service of your choice (Paste a link here if you upload it to any cloud service, and make sure it is visible for people with the link). If the recording was made in a language other than English, please state the language in the file’s name. 

                      • Step 8: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and upload or paste a link to your product.

                      • Step 9: Review the work of one of your peers and provide feedback by commenting on his/her post. Besides providing your feedback, evaluate the following in your peer’s work:

                        • Did my peer interview three patients that fulfill the requirements of this task?
                        • Are all the points required in step three present in my peer’s summary?
                        • Are all the points required in step five present in my peer’s work?
                    • Peer Activity: Providing counseling to children. Forum

                      For this activity, you need to identify practice patients to apply what you learned in the previous modules. You will find the relevant module and lesson related to each element of this assignment in parenthesis, please review them before the interviews.

                      • Step 1: Identify three children whose parents agreed for you to give them counseling regarding tobacco use prevention. 

                      • Step 2: Explain the parents that this is part of your training, that you will take audio recordings from the interview, and that their privacy will be protected.

                      • Step 3: Apply your knowledge on patient-centered counseling with each one of the patients and make sure to include ALL of the following:

                        • Patient-centered counselling (M6L1)
                        • Vulnerability to tobacco use and quick onset of addiction with early tobacco use (M6L2)
                        • Resistance skills when smoking is offered or part of the patient’s environment (M6L2)
                        • Make sure to be sensitive to issues of child and parent confidentiality (M6L1)
                      • Step 4: Use your recordings and notes to write a summary of each of the counseling sessions. Identify each patient using only the initials of his/her name (John Smith = JS). Your summary MUST include each of the points stated on step 3.

                      • Step 5: Upload the recording of the counseling sessions. You can upload it in this forum, to google drive, or any other service of your choice (Paste a link here if you upload it to any cloud service, and make sure it is visible for people with the link). If the recording was made in a language other than English, please state the language in the file’s name. 

                      • Step 6: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and upload or paste a link to your product.

                      • Step 7: Review the work of one of your peers and provide feedback by commenting on his/her post. Besides providing your feedback, evaluate the following in your peer’s work:

                        • Did my peer interview three pediatric patients?
                        • Are all of the points required in step three present in my peer’s summary?
                    • Peer Activity: Providing counseling to adolescents Forum

                      For this activity, you need to identify practice patients to apply what you learned in the previous modules. You will find the relevant module and lesson related to each element of this assignment in parenthesis, please review them before the interviews.

                      • Step 1: Identify three adolescents whose parents agreed for you to give them counseling regarding tobacco use prevention. 

                      • Step 2: Explain the parents that this is part of your training, that you will take audio recordings from the interview, and that their privacy will be protected. For the counseling session use the BTS Quality Improvement Tool for Smoking Cessation except the E section.

                      • Step 3: Apply your knowledge on patient-centered counseling with each one of the patients and make sure to include ALL of the following:

                        • Use the Scoring the Strengths & Difficulties Questionnaire to perform a brief screening of psychiatric issues, analyze the results using this tool. You can download these resources in different languages by clicking here. 
                        • Patient-centered counselling (M6L1)
                        • Vulnerability to tobacco use and quick onset of addiction with early tobacco use (M6L2)
                        • Resistance skills when smoking is offered or part of the patient’s environment (M6L2)
                        • Make sure to be sensitive to issues of child and parent confidentiality (M6L1)
                      • Step 4: Use your recordings and notes to write a summary of each of the counseling sessions. Identify each patient using only the initials of his/her name (John Smith = JS). Your summary MUST include each of the points stated on step 3.

                      • Step 5: Upload the recording of the counseling sessions. You can upload it in this forum, to google drive, or any other service of your choice (Paste a link here if you upload it to any cloud service, and make sure it is visible for people with the link). If the recording was made in a language other than English, please state the language in the file’s name. 

                      • Step 6: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and upload or paste a link to your product.

                      • Step 7: Review the work of one of your peers and provide feedback by commenting on his/her post. Besides providing your feedback, evaluate the following in your peer’s work:

                        • Did my peer interview three pediatric patients?
                        • Are all of the points required in step three present in my peer’s summary?
                    • Peer Activity: Providing counseling to pregnant women Forum

                      In this activity you need to identify practice patients to apply what you learned regarding counseling and pregnancy-related issues.

                      • Step 1: Identify three practice patients that are pregnant. It is not relevant if they are smokers or not.

                      You can work with patients in your clinical practice. However, if you are not currently working with patients, you can invite friends or relatives that fulfill the requirements stated above.

                      • Step 2: Invite your patients to separate counseling sessions. You need to explain to them that this is part of your training, that you will need to take audio recordings from the interview, and that their privacy will be protected.

                      • Step 3: Apply your knowledge on patient-centered counseling with each one of the patients. Make sure to tailor your counselling session to the patient’s tobacco history (current smoker, former smoker, or never smoked).

                      • Step 4: Use your recordings and notes to write a summary of each of the counseling sessions.

                      • Step 5: Upload the recording of the counseling sessions. You can upload it in this forum, to google drive, or any other service of your choice (Paste a link here if you upload it to any cloud service, and make sure it is visible for people with the link). If the recording was made in a language other than English, please state the language in the file’s name. 

                      • Step 6: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and upload or paste a link to your product.

                      • Step 7: Review the work of one of your peers and provide feedback by commenting on the post. 

                    • Peer Activity: Providing counseling on the postpartum period Forum

                      In this activity you need to identify practice patients to apply what you learned regarding counseling and pregnancy-related issues.

                      • Step 1: Identify three practice patients who stopped smoking at pregnancy and who have recently delivered their children.

                      You can work with patients in your clinical practice. However, if you are not currently working with patients, you can invite friends or relatives that fulfill the requirements stated above.

                      • Step 2: Invite your patients to separate counseling sessions. You need to explain to them that this is part of your training, that you will need to take audio recordings from the interview, and that their privacy will be protected.

                      • Step 3: Apply your knowledge on patient-centered counseling with each one of the patients. Make sure to address the risk of relapse on postpartum women who stopped smoking while pregnant.

                      • Step 4: Use your recordings and notes to write a summary of each of the counseling sessions.

                      • Step 5: Upload the recording of the counseling sessions. You can upload it in this forum, to google drive, or any other service of your choice (Paste a link here if you upload it to any cloud service, and make sure it is visible for people with the link). If the recording was made in a language other than English, please state the language in the file’s name. 

                      • Step 6: Submit your assignment for peer review by clicking “add a new discussion topic” below, complete the fields, and upload or paste a link to your product.

                      • Step 7: Review the work of one of your peers and provide feedback by commenting on his/her post. 

                  • Module 8: Health-Care Workers Training for Tobacco Cessation


                    Competencies covered in this module:

                    • Be aware of successful anti-tobacco initiatives outside the clinical setting, including legislative, policy, media, and partnership building.
                    • Understand the influence of the media on tobacco use, behavior, and attitudes toward tobacco.
                    • Describe the implications and utilize the regulations that apply to the tobacco treatment setting (confidentiality, HIPAA, work site-specific regulations).
                    • Be able to demonstrate awareness of key public health strategies and advocacy processes for tobacco prevention.
                    • Be aware of current international policy recommendations for curtailing tobacco use.
                    • Demonstrate an awareness of restructuring of health systems, including reimbursement required to have an effect on optimal cessation practices.
                    • Have the ability to articulate the role of organization, practice, and individual in affecting tobacco policy.
                    • Know resources (or how to access resources) for current information on new standards, new practices, and learning objectives.
                    • Be able to demonstrate sources/skills that enable medical professionals to keep current with tobacco information and trends.
                    • Be able to demonstrate critical appraisal of intervention modalities.
                    • Be able to demonstrate the application of systems-based practice/practice-based learning that follows the 2000 Public Health Service guidelines.
                    • Be aware of the evidence concerning the effectiveness of practice systems (e.g., chart stickers, reminder systems).
                    • Be able to measure clinicians’ actions (i.e., tracking systems) so they are held accountable.
                    • Develop and implement a protocol for tracking client follow up and progress.
                    • Maintain accurate records utilizing accepted coding practices that are appropriate to the setting where services are provided.