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

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

3. Slide 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

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

7. Slide 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.

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

15. Slide 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. Slide 16 How do we collect the data? 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 About the "5A's"

17. Slide 17 How do we collect the data? 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) About the "5A's"

18. Slide 18 SOME RESULTS…

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

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

21. Slide 21 MCM Counseling and Motivation %

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

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

24. Slide 24 Barriers in Applying the “5A’s” %

25. Slide 25 What participating PNC providers say…

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

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

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

29. Slide 29 PNCP Barriers %

30. Slide 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. Slide 31 Photo by Brent Bradley, Oregon Scenics

32. Slide 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. Slide 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. Slide 34 Photo by Brent Bradley, Oregon Scenics

35. Slide 35 Photo by Brent Bradley, Oregon Scenics