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Background Information

A Fresh Start for WIC: Tailoring Smoking Cessation for WIC Participants and Their Families Laura A.Van Dyke, CSW Saint Vincent Catholic Medical Centers New York City (212)604-7572. Background Information. Saint Vincent Catholic Medical Centers (SVCMC) received a three-year grant from NYS DOH

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Background Information

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  1. A Fresh Start for WIC: Tailoring Smoking Cessation for WIC Participants and Their FamiliesLaura A.Van Dyke, CSWSaint Vincent Catholic Medical CentersNew York City(212)604-7572

  2. Background Information • Saint Vincent Catholic Medical Centers (SVCMC) received a three-year grant from NYS DOH • Three staff hired to implement smoking cessation program at system’s 9 WIC sites • WIC is a supplemental nutrition program for qualified women, infants and children

  3. Program Planning • Met with WIC site directors in each region (Brooklyn/Queens, Manhattan and Staten Island) and conducted needs assessment • Researched perinatal smoking cessation techniques • Partnered with American Cancer Society to receive training in Make Yours A Fresh Start Family (MYFSF) model and ongoing technical assistance throughout the year

  4. MYFSF Program Description • MYFSF is a comprehensive package for health care providers to assist them in counseling their pregnant and parenting clients to stop smoking • Based on U.S. Public Health Service Clinical Practice Guidelines for Treating Tobacco use and Dependence

  5. Adaptation of MYFSF for WIC Population • Met with WIC directors and nutritionists regarding capacity to implement brief cessation counseling • Collaborated with WIC staff on the development of data collection tools • Developed brochure to introduce program for WIC participants and offer phone counseling

  6. Provided 3 MYFSF Training Sessions to WIC Staff in each region • Smoking facts and figures • Smoking cessation and the process of behavior change • The 3-5 minute brief counseling technique (based upon stage of change theory and 5A’s of intervention) • Use of progress chart to track smoking behavior/ exposure to ETS • System of chart identification (red dots or log) • Role Plays

  7. Program Implementation • By Feb.1, 2002 all sites trained and ready to implement MYFSF program

  8. Expectations: • Smoking status asked at every visit and an intervention offered based on stage of smoking behavior • Materials/magazines offered to all smokers and those exposed to ETS • Efforts documented and filed in participant’s chart • Red dots used to flag charts • Follow-up at subsequent visits to facilitate movement along stages of change

  9. Technical Support Provided by Tobacco Cessation Program • Phone support to all WIC staff • Phone counseling to WIC participants seeking additional support • Participation in health fairs at WIC sites (nutrition month and breastfeeding fairs) • Attendance at WIC staff meetings • Provide educational materials (brochures, literature, videos) and varied incentives to quit smoking

  10. Relationship Building: Creating a Partnership Between WIC Staff and our Tobacco Cessation Program • Enhanced by our status as employees of SVCMC • Involved WIC directors and staff in every step of program development • Encouraged environment for open discussion of concerns • Prioritized staff recognition luncheons • Identified environmental barriers to program success (i.e. facilitated child-friendly environments)

  11. Program Assessment and Evaluation • Conducted process evaluation with nutritionists via focus groups and surveys • Conducted chart review to determine utilization of progress charts and assess follow-up

  12. Our Findings • 8 of 9 sites implemented program • 90% of nutritionists think they can have positive effect on smoker’s behavior • 60% think brief cessation counseling is an important part of their job • the other 40% indicated that it is important, but need more strategies for making time • 292 charts (of women, infants and children) were flagged as smokers or as exposed to second-hand smoke

  13. Findings (continued) • Chart review conducted on 122 of the total 292 charts • 52% asked about smoking status at subsequent visits • 48% documented that materials were provided • 56% of charts revealed some movement (micro-movement) along the stages of change (this figure includes women who spontaneously quit due to pregnancy)

  14. Barriers to Program Implementation • Limited time for counseling patients and documenting efforts due to high caseloads (1:890) • Lengthy waiting period in often crowded and chaotic environment • Nutritionists’ personal views about smoking • Introduction of new computer system (WICSYS) impedes counseling process

  15. Strategies • Modify intervention to core elements: ask, offer, document • Create child-friendly environments • Empower nutritionists • Meeting with WIC at state level to discuss problems with computer tobacco screen

  16. Ongoing Improvements • Maintain the partnership with ACS that has enabled us to achieve our success to date • Continue to build relationship with WIC staff and be responsive to their suggestions • Consultation with NYS WIC department as they pilot the MYFSF model in two WIC sites in NYS • Expansion into SVCMC outpatient clinics

  17. Special Thanks • Elena F. Deutsch, MPH, Director, Tobacco Control, American Cancer Society, NYC • Patricia M. Lamberson, MPH, Senior Health Educator, SVCMC • Lupe Flores, BA, Health Educator, SVCMC

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