Title V Transformation Tools
Recommendations to Support NPM 14 – Smoking
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Significance. The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this NPM as follows:
Women who smoke during pregnancy are more likely to experience a fetal death or deliver a low birth weight baby. Further, secondhand smoke (SHS) is a mixture of mainstream smoke (exhaled by smoker) and the more toxic side stream smoke (from lit end of nicotine product) which is classified as a "known human carcinogen" by the US Environmental Protection Agency, the US National Toxicology Program, and the International Agency for Research on Cancer. Adverse effects of parental smoking on children have been a clinical and public health concern for decades and were documented in the 1986 U.S. Surgeon General Report. The only way to fully protect non-smokers from indoor exposure to SHS is to prevent all smoking in the space; separating smokers from non-smokers, cleaning the air, and ventilating buildings do not eliminate exposure. Unfortunately, millions (more than 60%) of children are exposed to SHS in their homes. These children have an increased frequency of ear infections; acute respiratory illnesses and related hospital admissions during infancy; severe asthma and asthma-related problems; lower respiratory tract infections leading to 7,500 to 15,000 hospitalizations annually in children under 18 months; and sudden infant death syndrome (SIDS). Higher intensity medical services are also required by children of parents who smoke including an increased need for intensive care unit services when admitted for flu, longer hospital stays; and more frequent use of breathing tubes during admissions.
Background. The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures (NPMs) for the 2015-2017 grant cycle. In order to effectively address the NPMs, MCH professionals need to think about not only the evidence and strategies to make change, but also the capacity of the workforce to carry out these activities. These lists identify online learning materials, resources, and evidence-based strategies and programs to support the knowledge sets and skills needed to advance each NPM.
Introduction. Six skill sets have been identified by the National MCH Workforce Development Center to support implementation of this NPM: (1) population health; (2) strategic planning and program design; (3) strategic alliances and effective partnerships; (4) consumer engagement and cultural and linguistic brokering; (5) policy and program implementation; and (6) communication.
In addition, two knowledge areas specific to the NPM topic area have been highlighted that are keyed to the evidence base and promising practices: (1) tobacco background, recommendations, and guidelines and (2) tobacco policies and strategies.
The MCH Navigator, in collaboration with the Center, has developed this crosswalk to guide MCH professionals to online learning opportunities and implementation resources to support these skill sets.
Please click on the Read More buttons below for additional information, learning materials, and implementation resources. You can also email us with suggestions for additions.
Six skill sets have been identified to support implementation of this NPM:
1. Population Health
A renewed focus on MCH population health is key to achieving the NPMs in the era of health transformation. These skills enable Title V professionals to analyze how program interventions and their related health outcomes are distributed among a state’s MCH population. Population health skills complement all of Title V’s work, including program design and implementation, strategic partnerships and communication.
- Ability to conduct surveillance of tobacco use during pregnancy and adolescence that allows public health practitioners to understand and respond to disparities in smoking rates
- Ability to develop estimates of death rates and implications based on tobacco use rates
- Ability to calculate quality-adjusted life years (QUALYs) to quantify impact of tobacco use in local communities
The MCH Navigator has developed a number of resources on Smoking.
2. Strategic Planning & Program Design
Effective strategic planning and program design require the ability to base programs on defined goals and desired outcomes. Strategic planning should include a monitoring and evaluation system to track and monitor progress and inform program alterations as needed. Program design skills must ultimately be coupled with implementation, where program design is carried out.
- Ability to effectively leverage home visiting and other programs for which Title V has authority as a way to assess and address household tobacco use
- Ability to apply the socio-ecological framework to smoking during pregnancy and household smoking
3. Strategic Alliances & Effective Partnerships
The wide array of stakeholders and partners in the field of MCH, from providers and insurers to women and children, require a set of skills in strategically aligning Title V goals with those of their partners. In the Title V world, there is an increasing interest in engaging unlikely or nontraditional partners to achieve the NPMs. The skills in this category take that into account and include unique partner groups linked to this measure.
- Ability to collaborate to promote policy solutions with public housing officials, Medicaid and other payers for secondhand smoke interventions
- Ability to address economic interests related to tobacco use among various stakeholders
- Ability to effectively negotiate and utilize conflict resolution skills to support local partners in enforcement of smoke-free areas
4. Consumer Engagement/Cultural & Linguistic Brokering
Consumers are arguably the most important stakeholders in MCH work, thus skills in consumer engagement and cultural and linguistic brokering are essential to moving the needle for each NPM. In some cases, consumer engagement includes negotiating with other stakeholders on behalf of MCH populations. Closely linked with this skills category are skills in communication and strategic alliances.
- Skills to engage consumers in needs assessment regarding tobacco and alternative tobacco delivery use
- Ability to effectively engage youth as peer educators for tobacco prevention efforts
5. Policy & Program Implementation
These skills ensure that MCH priorities are integrated into all aspects of policy and program implementation, as well as ensuring that policies and programs selected are well-aligned with NPMs and other MCH program goals. Implementing policies and programs with fidelity also requires skills in the implementation science drivers: technical and adaptive leadership; selection; training; coaching; systems intervention; facilitative administration; and decision support data systems.
- Ability to ensure health care providers have access to tools and best practices regarding tobacco use/reduction/cessation and are trained to use the tools in an evidence-based manner
- Skills to ensure high quality tobacco counseling is embedded in programs for which Title V has authority
- Skills to support robust and effective referral systems for tobacco cessation, especially for pregnant women
- Skills to effectively use electronic medical records for tobacco screening
- Skills to develop memoranda of understanding with Medicaid and other payers to develop policies that reduce tobacco exposure
- Ability to navigate political sensitivities around tobacco use and find common ground for action
Communication skills support the creation and delivery of effective messages between MCH professionals, professional and community partners, and populations served by Title V. Effective communication ensures the delivery of appropriate messages to audiences in the way that they were intended and is key to all aspects of MCH work. These skills are linked closely with skills in strategic partnerships and cultural and linguistic brokering.
- Skills to communicate effectively with tobacco users
- Ability to build capacity at local level to facilitate coalitions of partners to mobilize tobacco prevention and control messages
- Ability to communicate with policymakers about health and financial impacts of secondhand smoke exposure and pregnant women’s tobacco use
- Ability to work with young adults as part of preconception health campaigns
- Ability to effectively reach young adults with tobacco messages specific to their local community and demographic profile
In addition to skills, each NPM requires a knowledge base that will help Title V progress effectively in the measure. Knowledge should be considered at the foundation of achieving all measures.
1. Tobacco Background, Recommendations & Guidelines
- Knowledge of health risks and costs of tobacco exposure
- Knowledge of benefits of reduction/elimination of tobacco exposure for pregnant women, children and families, including secondhand smoke exposure among children
- Knowledge of trends and health impacts of alternative tobacco delivery systems such as e-cigarettes
- Knowledge of state/territory supportive services available to MCH populations such as quitlines
- Knowledge of tobacco reduction/cessation tools and strategies, including their strengths, weaknesses and contexts for use
- Knowledge of historical and cultural context of tobacco use in a given geographic area
2. Tobacco Policies & Strategies
- Knowledge of policy and environmental strategies that reduce smoking rates among adolescents and pregnant women, and the relative effectiveness of these policies
- Knowledge of essential components of the Affordable Care Act (ACA) and other state and federal policies that facilitate access to tobacco treatment services for pregnant women, such as reimbursable counseling in prenatal care settings by Medicaid and other payers
See other online learning resources related to health transformation, collected in the Health Transformation Learning Laboratory.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 88.