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Program Details


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Practice Type: Model
Program Name: Building Effective Tobacco Treatment Services for Pregnant and Parenting Women. The House Calls Smoking Cessation Program
Organization: Ingham County Health Department
Web site: CACVoices.org
Overview: Building Effective Tobacco Treatment Services for Pregnant and Parenting Women. The House Calls Smoking Cessation Program
Year Submitted: 2011
Responsiveness and Innovation: The public health issue this practice addresses is tobacco use among low-income pregnant and parenting women. Over the past 40 years, smoking has increasingly and disproportionately become a habit of low income, less educated, and disenfranchised individuals. These individuals suffer a disproportionate burden of tobacco-related disease. In 2006, ICHD served 20,659 patients, over 14,000 of them women and 81.6% of them living below the poverty level. In the United States, smoking prevalence is higher among women living below the poverty level. Additional empirical work reports smoking prevalence as high as 44% among young women who earn a high school equivalency degree (GED) compared to 12% among female college graduates. This population also comprises the “most exploited victims of predatory marketing practices that capitalize on their lack of education and other vulnerabilities.” As a consequence, social justice and health inequity issues are inherent considerations in the use of tobacco among this population. Cessation support, including individual counseling appointments and tobacco education was offered regularly at ICHD’s prenatal clinic, but women were not taking advantage of the services.
Agency and Community Roles: ICHD developed this practice and was responsible for implementing it, adapting it as staff learned from working with clients, and sustaining it. A resident in ICHD’s Women’s Health Services health center developed and implemented the survey which identified barriers facing the women we serve. Staff completed a literature review and worked closely with a national tobacco expert to involve home-visiting staff in development of the practice. ICHD engaged in vigorous outreach in the community to raise awareness about House Calls.
Costs and Expenditures: House Calls provides home-based smoking cessation education and support to pregnant and parenting women who smoke. Services are delivered in a relationship-based model of care. The practice addresses the important public health issue of reducing tobacco use. The target population for the practice is low-income pregnant and parenting women who smoke and receive services at Ingham County Health Department (ICHD). Eighty-six percent of the 813 women receiving prenatal care at ICHD’s Women’s Health Services in 2006 were covered by Medicaid. Research has shown that persons on Medicaid smoke at higher rates than the general population. House Calls began in November 2008 with the goal of developing comprehensive, sustainable, and accountable smoking cessation services for pregnant and low-income women. Initial program objectives included developing a multi-component home-based cessation intervention, training staff, and implementing an incentive system for participants. All objectives were selected based on a literature review indicating that they were efficacious for the target population. The practice was strategically integrated into existing home-visiting services to assure its sustainability. Project objectives were attained, and the intervention was delivered to twice as many women (107) than had been projected in the first year (50). Over 200 women have now been served, and enrollment in House Calls continues. The specific factors leading to the success of the practice included: • The practice is specifically designed to address barriers identified by the target population. • The practice is integrated into existing home-visiting services predicated on a relationship-based model of care. • Vigorous outreach is used to engage community partners in making referrals. • Staff receive training to increase their knowledge about tobacco cessation support and to facilitate their confidence in delivering the intervention.
Implementation: The public health issue this practice addresses is tobacco use among low-income pregnant and parenting women. Over the past 40 years, smoking has increasingly and disproportionately become a habit of low income, less educated, and disenfranchised individuals. These individuals suffer a disproportionate burden of tobacco-related disease. In 2006, ICHD served 20,659 patients, over 14,000 of them women and 81.6% of them living below the poverty level. In the United States, smoking prevalence is higher among women living below the poverty level. Additional empirical work reports smoking prevalence as high as 44% among young women who earn a high school equivalency degree (GED) compared to 12% among female college graduates. This population also comprises the “most exploited victims of predatory marketing practices that capitalize on their lack of education and other vulnerabilities.” As a consequence, social justice and health inequity issues are inherent considerations in the use of tobacco among this population. Cessation support, including individual counseling appointments and tobacco education was offered regularly at ICHD’s prenatal clinic, but women were not taking advantage of the services.
Sustainability: Vigorous outreach was essential in establishing new relationships and helping create strong allies for House Calls. At the initiation of the project in 2008, the Medical Residents in training at ICHD were generally opposed to providing pregnant women nicotine replacement therapies (NRTs). One of the lead nurses in the project engaged in ongoing dialogue and educational discussions to increase the knowledge and awareness of the residents. Ultimately the efforts of project staff resulted in a significant shift in the medical ideology of residents as well as providers in our community. House Calls staff can now call an ICHD provider and promptly receive a faxed prescription for NRTs to assist the client in her quit attempt. Partnerships across various units within ICHD were also strengthened as a result of House Calls. In addition to stronger, more collaborative working relationships between the nurses and advocates delivering the intervention, a number of other internal collaboration were established and strengthened. WIC and Women’s Health Services were critical expansion sites for the projects, and their providers now regularly refer women to House Calls. Additional community alliances were forged with a number of diverse partners, including: • Shared Pregnancy Services • Ingham County Infant Mortality Coalition • Smoke Free Michigan • Early On (for families of children with developmental delays) • Great Start Collaborative (for families with young children) • Ingham Substance Abuse Prevention Coalition • Area OB/GYN providers Program staff presented at numerous state and national meetings, including an April 2010 presentation at the Health Education Council's national meeting focused on Achieving Health and Social Equity in Tobacco Control. Through these presentation opportunities, staff have built the reputation of this program, garnered greater visibility and positioned the department for future funding in this area. We developed the House Calls proposal with sustainability in mind and deliberately began to integrate the cessation intervention into the ongoing work of home visiting staff. Staff now consider cessation support an integral part of the services provided to the clients we serve. Staff have continued to receive various training on cessation support, as a result, staff are now more comfortable and skilled in delivering this intervention. Grant funds ended in 2010, but staff continue to provide cessation services to the women that we serve. The Carbon monoxide monitors purchased with grant funds remain an invaluable tool when used with families in their homes and at other community events. Other financial sources, including donations from area groups and businesses, have been identified to purchase participants incentives. The ICHD Health Officer is strongly committed to tobacco control and prevention, which are department priorities. House Calls has expanded the capacity of ICHD to respond to smoking cessation needs and has strengthened the overall culture of client service and collegial partnerships within the department. Staff now engage in deeper, richer conversations with clients to effectively include them in identifying and developing cessation strategies.
Lessons Learned:

 

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