TIPS AND TECHNIQUES TO SUPPORT RESIDENTS ADAPTING TO THE SMOKING BAN IN PUBLIC HOUSING Wednesday, February 28, 2018 2-3 pm (Central) 1
Disclaimer This activity is made possible by the Health Resources and Services Administration, Bureau of Primary Health Care. Its contents are solely the responsibility of the presenters and do not necessarily represent the official views of HRSA.
Presenters Kristine Gonnella Director, Training and Technical Assistance National Nurse-Led Care Consortium Philadelphia, PA Thomas Carr Director, National Policy American Lung Association Robin Senss Director of Supportive Services, Housing Authority of Chester County Elizabeth Byrne Director, Clinical Implementation Treatment Research Institute Philadelphia, PA
Learning Objectives 1. Discuss HUD smoking ban in public housing and the response of a public housing authority. 2. Demonstrate impact of smoking ban on residents of public housing. 3. Illustrate evidence based practices for engaging residents of public housing in smoking cessation programming.
SMOKE FREE PUBLIC HOUSING: POLICY AND PROSPECTIVE Thomas Carr Director, National Policy American Lung Association 5
Secondhand Smoke A Significant Problem for Low Income Housing 2006 Surgeon General s report on secondhand smoke applies to all indoor environments i.e. there is no safe level of exposure SHS-exposed children twice as likely to miss 6 or more school days per year Even low levels of SHS exposure associated with decreased reading and math scores Smoking materials are one of the largest causes of injuries, deaths and direct property damage from fires Secondhand smoke can travel through an entire complex including ventilation systems, electrical outlets, cracks in foundation walls, pipes, plumbing and doorways. FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 6
Smokefree HUD Rule History FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 7
HUD Smokefree Public Housing Rule - Timeline HUD Rule Timeline November 2015 HUD Issues Proposed Rule January 2016 - HUD Holds Stakeholder Convening and Comment Period on Proposed Rule Closes December 5, 2016 HUD Issues Final Rule; only change from proposed rule was the addition of hookah smoking February 3, 2017 Rule Officially Takes Effect; 18-Month Implementation Period for PHAs Starts July 31, 2018 18-Month Implementation Period Ends and New Smokefree Policy is Supposed to be in Place FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 8
HUD Smokefree Multi-Unit Housing Rule Key Provisions Key Provisions Applies to all Section 9 public housing, other than dwelling units in mixed-finance buildings Prohibits smoking in the interior of buildings, including individual units, plus a 25 foot zone outside buildings All lit tobacco products included o E-cigarettes were not included, but can be added by individual PHAs PHAs would also be required to: o Document their smoke-free policies in their PHA plans, a process that requires resident engagement and public meetings o Smokefree policy would be included in a tenant's lease FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 9
HUD Smokefree Multi-Unit Housing Rule Why Include E-Cigarettes in Smokefree Policies? 1. Makes enforcement easier and less subject to confusion and discretion 2. U.S. Surgeon General: Secondhand e-cigarette emissions are not safe. FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 10
HUD Rule Implementation Lots on the Plates of Housing Authorities Help needed Don t Reinvent the Wheel Resources Exist Lung.org/Smokefreehousing Working in Coalition Will Help Organizations that serve disparate populations in the community Community Health Centers/Medical Organizations Firefighters groups/organizations Asthma coalitions/groups Involve and Empower Residents Will be more effective and successful FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 11
American Lung Association HUD Rule Implementation/Cessation Projects FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 12
Please Keep in Mind Reduced exposure to secondhand smoke is the main goal of the HUD Rule Smoking cessation an important but secondary objective FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 13
Major Points to Remember about the HUD Rule Smokefree policies are about smoking, not smokers. Residents may be afraid they ll be forced to quit or move out Property managers may be afraid they ll have to evict residents who smoke Many tobacco users may decide to make a quit attempt when a property goes smokefree. Smoking cessation services and medications if possible should be available to residents. Smokers on Medicaid, Medicare and other types of insurance often have access to no or low-cost medications State phone counseling services for smokers (1-800-QUIT-NOW) sometimes provide no cost medications to uninsured persons Not every tobacco user will decide to make a quit attempt when a property goes smokefree. Some may be angry about the new policy and some just aren t ready to make a quit attempt Everyone needs to comply with the smokefree policy, even if they don t stop using tobacco Reasonable accommodations for some residents such as moving people nearer entrances or elevators can be considered FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 14
Major Points to Remember about the HUD Rule Start Early Providing ample time between announcement and implementation of the new policy gives residents time to understand the policy and adjust to it It s impossible to communicate too much about the new policy. Announce the forthcoming policy change as early as and in as many ways as possible Hold resident meetings to discuss the new policy Get residents involved in planning the launch of the policy, where signage is located, how the policy is enforced, etc Starting a smokefree multi-unit housing policy doesn t have to be expensive or lonely. Many willing partners are available in the public health community, including state and local health departments, tobacco control coalitions, voluntary health organizations and more Community partners may be able to help provide signage, cessation resources and even people to speak at resident meetings and staff events FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 15
Community Health Centers Will Be on the Front Lines Community Health Centers Provide Extensive Primary Care Services to Public Housing Residents Close to 300 health centers operate clinical delivery sites in or immediately accessible to public housing, according to the National Association of Community Health Centers Health Centers can be important partners in implementation of HUD s smokefree housing rule Because many health centers directly serve public housing residents, they can assist with providing smoking cessation services and access to medications in particular The Lung Association has worked closely with the National Center for Health in Public Housing, which provides TA to a subset of the 300 health centers above & ALA also hopes to work with individual health centers on state-level implementation/cessation projects Health Centers should be prepared for higher demand for smoking cessation assistance when HUD s final rule takes effect While smoking cessation assistance should be offered prior to implementation, when the policy changes is when demand is most likely to surge FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 16
HUD Rule Implementation - Resources HUD Website Page with Implementation Resources: https://www.hud.gov/program_offices/public_indian_housing/programs/ph/phecc /smokefree Lung Association Resources: www.lung.org/smokefreehousing Free Smokefree Multi-Unit Housing Online Course Helpful training for people new to the issue Smokefree Multi-Unit Housing Issue Brief versions in both English and Spanish National Center for Health in Public Housing Resource Page: https://nchph.org/smoke-free-public-housing-everything-need-know/ FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 17
Freedom From Smoking Voluntary, interactive and supportive Addiction-based model with behavior change focus Supports use of cessation medications Multiple options available: Freedom From Smoking in-person group clinic * Freedom From Smoking Plus Lung HelpLine * Freedom From Smoking self-help guide * * Available in Spanish FreedomFromSmoking.org 18
Finding American Lung Association Resources/Reaching Us To find our smoking cessation resources: Lung.org/ffs FreedomFromSmoking.org To find our smokefree multi-unit housing resources: Lung.org/smokefreehousing To reach your local American Lung Association office: Lung.org 1-800-LUNG-USA 19
Contact Information Thomas A. Carr Director, National Policy Thomas.Carr@lung.org (202)785-3355 20
National Nurse-Led Care Consortium Mission: Advance nurse-led health care through policy, consultation, and programs to reduce health disparities and meet people s primary care and wellness needs. Supported via a National Cooperative Agreement with HRSA to provide training and technical assistance to health centers in order to strengthen healthcare for residents of public housing.
Health Centers and Public Housing Health centers across the country provide primary care services to thousands of public housing residents, offering an extensive access point for smoking prevention education and cessation treatment for patients from these communities.
Partnerships to Support Implementation FQHC Operate health centers serving neighborhoods with dense public housing and facing disparities in access and outcomes. Provide comprehensive health care and health promotion on-site and through housing authority events. Provide enrollment assistance Housing Authority Provides space for smoking cessation programming. Provides outreach to bring in new patients through public events, distribution of materials Tenant council representatives serve on HC Board
HOUSING AUTHORITIES GOING SMOKE FREE
STEPS FOR IMPLEMENTING A TOBACCO/SMOKE FREE POLICY Meet with key management personnel Survey residents Establish a timeframe for change Make policy choices gain Board approval Educate residents of the benefits of a smoke-free environment Provide Quitline information and cessation services to residents who would like to quit Adopt new policies for leases and house rules Promote and enforce tobacco/smoke free policies
BENEFITS OF TOBACCO/SMOKE FREE POLICY Protection from secondhand and thirdhand smoke Protect employees Protect tenants Especially elderly and vulnerable youth Protect visitors, family, friends and contractors Market Advantage housing that smells of tobacco smoke are harder to sell and rent Reduced Costs Reduced Fire Risks Positive Modeling Legal Liability
ANNOUNCEMENT OF TOBACCO FREE POLICY
Additional Thoughts Before & After Implementation Third Party Management Reduction in turnover costs Smoke free community vs. smoking area Grandfathering current residents Reasonable Accommodations Managing the change and positive results
Smoking Cessation How your entire team can effectively serve residents of public housing Elizabeth Byrne, MA, LPC, Clinical Implementation Manager 3/19/2018 Treatment Treatment Research Research Institute, Institute, 2013 2012
Who provides the help? Patient Centered Medical Homes are the ideal partners to support smoke-free living in public housing. Cessation Support can (and should) come from everyone on the clinic team: Primary Care & Behavioral Health Clinicians Nurses & Social Workers Medical Assistants & Front Desk staff The unified message should be: When you re ready, we can help. Cutting back is an EXCELLENT start. 3/19/2018 Treatment Research Institute, 2012
Support Patient Smoking Cessation Using The 5 Senses 3/19/2018 Treatment Research Institute, 2012
What are patients seeing? Display CDC TIPS and Quitline posters in the waiting room and treatment rooms Include questions about smoking behaviors on any check-in paperwork 3/19/2018 Treatment Research Institute, 2012
What are practitioners saying? How are the questions about smoking being asked? What types of side conversations can patients overhear? Ensure ALL medical staff are using encouraging words and are able to offer specific suggestions on how patients can cut down or quit. 3/19/2018 Treatment Research Institute, 2012
Are you enforcing the no-smoking ordinances in your city around entrances? Do your patients have to walk through smoke to enter your building? Can patients smell smoke on your employees? 3/19/2018 Treatment Research Institute, 2012
Are there hands-on activities for patients to get involved in? Do you have a peer-support model in place where patients can strive to become leaders in their community? 3/19/2018 Treatment Research Institute, 2012
Are you offering additional support and programming for weight management? Do you have a registered dietician on staff to work with patients who are trying to quit? Provide handouts to encourage healthy eating choices. 3/19/2018 Treatment Research Institute, 2012
Collaboration Collaboration is excellent for community building. Look for opportunities to expand partnerships. Work with gate keepers to help you navigate incredibly large systems. Think outside the box! Keep moving when you ve been blocked. Be clear and transparent about your agenda. Don t give up! 3/19/2018 Treatment Research Institute, 2012
Health Centers & PHA Working Together Strengths: Direct access to all residents Possibility for location of programming in house, no travel needed Challenges: Multiple layers of bureaucracy Lack of privacy for patients Competing agendas 3/19/2018 Treatment Research Institute, 2012
How Do We Do This Sustainably? Work it into the primary care visit (3-5min) Utilize your Behavioral Health Consultant (10-20min) Train interns to run small cessation groups (45-90 min) Possible groups: Public Health, Nursing, Social Work, Counseling, Psychology, Adult Education There are plenty of open access curriculums available to use for free The CDC TIPS campaign has multiple free resources Reach out to your local health department for potential community partnerships 3/19/2018 Treatment Research Institute, 2012
Do What You Can! Every bit of psychoeducation and reinforcement you can provide patients is helpful and makes a difference. This includes harm reduction, stages of change, NRT options, patient literature Start with something simple and make it happen this month don t wait for the perfect solution. Posters Ask staff if anyone is interested in getting involved Distribute questionnaire for patient interest in a class CDC Tips From Former Smokers Campaign 3/19/2018 Treatment Research Institute, 2012
CDC Tips From Former Smokers Free materials to download like: low-res TV, print, radio, online, and out of home ads Continuous loop videos PSAs in Spanish and English about quitting smoking and secondhand smoke Print ads with stories from real people your patients can relate to www.cdc.gov/tobacco/campaign/tips/ 3/19/2018 Treatment Research Institute, 2012
Questions? Thank you! Elizabeth Byrne Clinical Implementation Manager ebyrne@tresearch.org 215-399-0980 ext 107 3/19/2018 Treatment Research Institute, 2012
Q&A 3/19/2018 Treatment Research Institute, 2012