DESCRIPTION (provided by applicant): The West Virginia (WV) Right From the Start (RFTS)-Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) Adoption Trial are: 1) to disseminate to the RFTS program two evidence-based SCRIPT methods; 2) to compare the effectiveness of the methods delivered by full-time public health staff- Designated Care Coordinators (DCCs); 3) to document the routine DCC delivery rate and cost of the methods; and 4) to document DCC adoption predictors and the RFTS adoption rates of a SCRIPT BEST PRACTICE intervention for a two year period. Our goal is to institutionalize SCRIPT as part of the RFTS Program and WV health policy, and to distribute evidence based Guidelines for SCRIPT Programs for Medicaid-supported Care" for state-level stakeholders and programs in the US. The RFTS Program, established in 1990 by the WV Dept. of Public Health, Division of Perinatal Health to improve infant and maternal health, is based on the Standards and Guidelines of the American College of Obstetricians and Gynecologists (ACOG). It is funded by Medicaid and Title V Maternal and Child Health services programs. RFTS patients receive multiple home-based interventions from a network of RNs and licensed social workers, 80 full-time DCCs, in 55 counties. In addition to their regular OB-MD/RN prenatal care, about 56% (5000/9000) of eligible patients chose to enroll in RFTS each year: 46% or 2,300 are smokers. Four Aims will be accomplished to produce valid SCRIPT patient, provider, and RFTS Adoption Rates: AIM #1) To conduct in year 1, among the population of 80 full-time RFTS-DCCs, and a representative sample of 500+ Medicaid eligible pregnant smokers, a Formative Evaluation Assessment to document current DCC beliefs about SCRIPT and counseling practices, patient beliefs and the prevalence rate at the onset of RFTS care and the normal, pre-Trial cessation and significant reduction rates during and after pregnancy; AIM #2) To conduct in year 2 a Formative Dissemination Evaluation of the Effectiveness of 2 evidence-based SCRIPT methods delivered by the 80 DCCs to 1000+ pregnant smokers: The SCRIPT BASIC Group (E1) of 500+ patients of 40 DCCs to be compared to the SCRIPT PLUS Group (E2) of 500+ patients of 40 DCCs; AIM #3) To conduct a Process Evaluation in year 2 to document the routine delivery rate, costs and cost effectiveness of the two SCRIPT Programs provided by the 80 full-time DCCs to the cohort of pregnant smokers in Aim #2; and AIM #4) To conduct in years 3 and 4 an Adoption Evaluation of the Effectiveness, Process, Cost, Predictors and Adoption rates of a SCRIPT-BEST PRACTICE (BP) Program delivered by 80 DCCs to 100.0+ smokers. These Aims have not been empirically documented for a patient/providers population of a Medicaid supported state-wide prenatal program.
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