tips and techniques to support residents … · robin senss director of ... 1.discuss hud smoking...

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TIPS AND TECHNIQUES TO SUPPORT RESIDENTS ADAPTING TO THE

SMOKING BAN IN PUBLIC HOUSING

Wednesday, February 28, 2018

2-3 pm (Central)

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

Thomas CarrDirector, National Policy

American Lung Association

Kristine GonnellaDirector, Training and Technical

AssistanceNational Nurse-Led Care Consortium

Philadelphia, PA

Elizabeth ByrneDirector, Clinical Implementation

Treatment Research InstitutePhiladelphia, PA

Robin SenssDirector of Supportive Services,

Housing Authority of Chester County

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.

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SMOKE FREE PUBLIC HOUSING: POLICY AND PROSPECTIVE

Thomas CarrDirector, National Policy

American Lung Association

FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 66

• 2006 Surgeon General’s report on secondhand smokeapplies 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.

Secondhand Smoke A Significant Problem for Low Income Housing


Smokefree HUD Rule History


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


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 includedo 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


HUD Smokefree Multi-Unit Housing Rule

Why Include E-Cigarettes in SmokefreePolicies?

1. Makes enforcement easier and less subject to confusion and discretion

2. U.S. Surgeon General: Secondhand e-cigarette emissions are not safe.


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


American Lung Association – HUD Rule Implementation/Cessation Projects


Please Keep in Mind

Reduced exposure to secondhand smoke is the main goal of the HUD Rule

Smoking cessation an important butsecondary objective


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


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


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


• 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/

HUD Rule Implementation - Resources

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• 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

Freedom From Smoking®

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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

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Contact Information

Thomas A. CarrDirector, National Policy

[email protected] (202)785-3355

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

Housing Authority

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

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

FQHC

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

©Treatment Research Institute, 2012

3/19/2018

Smoking CessationHow your entire team can effectively serve

residents of public housing

Elizabeth Byrne, MA, LPC, Clinical Implementation Manager



3/19/2018

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.”


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Support Patient Smoking Cessation Using The 5 Senses


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What are patients seeing?

Display CDC TIPS and Quitlineposters in the waiting room and treatment rooms

Include questions about smoking behaviors on any check-in paperwork


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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.


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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?


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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?


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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.


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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!


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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


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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


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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

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

Questions?Thank you!

Elizabeth Byrne

Clinical Implementation Manager

[email protected]

215-399-0980 ext 107


3/19/2018

Q&A

tips and techniques to support residents … · robin senss director of ... 1.discuss hud smoking...

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