Oregon Smoke Free Mothers and Babies Project

1. Oregon Smoke Free Mothers and Babies Project Lesa Dixon-Gray, MSW, MPH Office of Family Health (503) 731-8606

2. Oregon is working towards improving the health of pregnant women and their babies

3. Smoke Free Mothers and Babies Project • A collaborative partnership including: • Public Health Maternal and Child Health Nurses/Maternity Case Managers • Prenatal Care Providers (OB-Gyns, CNMs, Family Practice Physicians) • Oregon Quit Line

6. What is our System for Delivering the “5 A’s”? Prenatal Care Providers Maternity Case Management Oregon Quit Line

7. Who are Maternity Case Managers? MCM’s are public health nurses, social workers, and other professionals trained to address the non-medical needs of pregnant clients who have risk factors that often contribute to poor pregnancy outcomes. Their goal – healthy outcomes for families.

9. Prenatal Care Providers • 160 OB-GYNs, CNMs, Family Practice Providers in 10 Counties, Comparison and Intervention Groups. • Comparison Group becomes Intervention Group over time. • Participating PNC providers receive “5A’s” training, fax information from MCMs and the Quit Line, materials and cessation info from SFMB.

10. Oregon’s Quitline System • Public/Private Partnership • Available for free for ANY Oregonian • Coordinated effort to encourage Statewide use: • DHS Tobacco Prevention and Education Program • DHS State Medicaid Office and MCO Partners • Tobacco Free Coalition of Oregon • Fax Referral Procedure – Currently used in several Program Evaluations and Clinical Trials

11. What is Smoke Free Mothers and Babies Project? • Focus on system change • Behavior change of MCMs and PNCPs • MCMs and PNCPs use all the "5A's" • Intervention is focused on low-income pregnant women via MCM system and Medicaid • Collaborative approach between State MCH, State Tobacco Program, State Medicaid Program, Local Public Health Departments, Private Providers, Managed Care, MOD, and ACS

12. What do we want to do? This intervention is designed to increase the use of the “5A’s” by the Oregon Maternity Case Management providers and Prenatal Care Providers (PNCPs), i.e. OB-GYNs, CNMs

13. Project Strategies and Activities • Provide Leadership at the State and Local levels • Provide Strategies for Improvement to MCMs and Providers • Build Community Linkages and Partnerships with Community Organizations • Encourage Continuity of Care • Provide a Registry at the State and Local levels • Provide feedback mechanisms to MCMs and Providers for quality improvement

14. Our intervention: How do we do it? An Example… OFH activity Site activity MCM/PNCP outcomes Train at least one MCM per site • Increased use of 5A’s • Increased referrals to QL • Increased coordination of • activities with PNCPs. Client outcomes • Increased smoking • cessation rates • Increased rates of • successful referrals • to QL MCM train MCM Train at least one PNCP recruited by MCM • Increased use of 5A’s • Increased referrals to QL • Increased coordination of • activities with MCMs. Train PNCP staff PNCP staff train their PNCP

15. How do we do it? • Phase 1: Intervention group of MCMs Intervention group of PNCPs Comparison group of PNCPs • Phase 2: Same intervention group of MCMs Expanded intervention group of PNCPs Smaller comparison group of PNCPs • Phase 3: Intervention expanded to all PNCPs

16. How do we collect the data? About the "5A's" • From the client: (via MCM) FAIR form (5 As at MCM visit) PNCP FAIR form (5 As done by PNCP) • From the client (directly from client): Postpartum survey

17. How do we collect the data? About the "5A's" • From the MCMs: 3 Surveys (baseline, 12-month follow up, 24-month follow up) • From the PNCPs: intervention and comparison 3 Surveys (baseline, 12-month follow up, 24-month follow up) • From the Quit Line: Fax Referral Forms (ongoing basis)

18. SOME RESULTS…

19. MCM Delivery of the "5A's":What they ALWAYS Do! %

20. MCM Delivery of the "5A's":ASSESS %

21. MCM Counseling and Motivation %

22. Does your agency follow the recommended tobacco cessation guidelines? %

23. Familiarity with the "5A's" Process %

24. Barriers in Applying the “5A’s” %

25. What participating PNC providers say…

26. PNCP Delivery of the "5A's":What they ALWAYS Do! %

27. Does your office follow the recommended tobacco cessation guidelines? %

28. Familiarity with the "5A's" Process %

29. PNCP Barriers %

30. Barriers to the Process • Severe State and Local Funding Cuts • Loss of State Tobacco Program • Quit Line loss • Provider contact • Data collection • “Buy-in” among disseminated MCMs

31. Photo by Brent Bradley, Oregon Scenics

32. Lessons Learned • Public Health and Private MD Practice operate in different systems. Public Health needs to learn their lifestyle. • Persistence! • Need for Collaborative Partners • Documentation issues

33. Recommendations • A Case Management System as a vehicle to incorporate and provide the “5A’s” • A three prong approach for dissemination; one system doesn’t have total responsibility for an intervention • Support to Primary Provider System is a necessity in dissemination and implementation of the “5A’s”. • The Public Health system needs greater focus on developing strong links with private providers.

34. Photo by Brent Bradley, Oregon Scenics

35. Photo by Brent Bradley, Oregon Scenics