Building Resilient Families Project

Description

To address higher-than-state-average smoking rates in Yuba County, California, the community-based organization First 5 Yuba County received a California Tobacco Control Program grant in 2020 to implement a comprehensive five-year initiative focused on Federally Qualified Health Centers (FQHCs) and home visiting programs.

This approach integrated tobacco screening, referral, and cessation support into healthcare settings serving Medi-Cal (California's Medicaid program) populations and into home-based services supporting vulnerable families with young children. First 5 Yuba County worked with the partners to develop protocols, training, and a replicable toolkit to reduce tobacco exposure for priority populations including children, pregnant women, and low-income families.

Services offered

The project focused on helping organizations screen for tobacco use and secondhand and thirdhand smoke exposure (residual nicotine and other chemicals on skin, hair, clothing, furniture, and other surfaces) and connect tobacco users to cessation services.

FQHC services:

• Integrated tobacco screening and referral protocols into electronic health records (EHR)
• Provided technical assistance including EHR workflow development, reporting guidance, and staff training
• Developed educational materials in English and Spanish
• Implemented Ask-Advise-Refer model aligned with United States Preventive Services Task Force guidelines
• Supported adoption of comprehensive tobacco-free policies for campus operations, human resources procedures, and patient screening

Home visiting and family-serving agency services:

• Trained staff to screen for tobacco use and secondhand/thirdhand smoke exposure in home environments
• Developed protocols for addressing tobacco exposure with families in trauma-informed ways
• Connected families to cessation resources through motivational interviewing techniques
• Supported agencies in formalizing tobacco screening and intervention protocols
• Assisted a domestic violence shelter in implementing tobacco-free campus policies and screening procedures

Both service tracks emphasized relationship-based implementation and sustainability planning through policy change and professional certification of local providers as Tobacco Treatment Specialists.

Results

In five years, Yuba County achieved tobacco cessation engagement rates that exceeded both state and regional averages. Partner FQHCs successfully integrated standardized tobacco screening and referral protocols into their EHR systems, with direct quitline referrals increasing 55%.

Across family-serving agencies, over 40 home visiting staff participated in comprehensive training on tobacco screening and motivational interviewing techniques. Two home visiting agencies formalized written protocols for tobacco screening and referral, and post-training surveys showed increased staff confidence in identifying tobacco users and connecting them to cessation resources. Staff reported that families were open to receiving cessation support when offered by their trusted home visitor, highlighting the effectiveness of relationship-based intervention approaches.

The initiative also supported a domestic violence shelter in adopting comprehensive tobacco-free policies spanning campus operations, human resources procedures, and client screening protocols.

The project produced a replicable implementation toolkit.

Challenges

Staff turnover affected follow-up activities and data collection. In addition, rural areas often have limited access to cessation resources.

Replication

Connect with local health departments and state and national organizations and resources related to tobacco cessation or family wellness. Hold in-person meetings and regular check-ins to build relationships and trust with partner agencies. Invest in staff training that covers basic information about tobacco and its health risks, the Ask-Advise-Refer model to connect clients to cessation support, and motivational interviewing to guide clients in making their own decisions. Kick It California offers free training and webinars to support this work.

Update intake forms and screening tools that patients or clients already complete to include questions about tobacco use. Include all tobacco products and use accurate terminology so clients understand the risks. For example, when discussing e-cigarettes or vaping products, explain that they produce aerosol, not water vapor. Ask if, where, and how often children are exposed to tobacco smoke and if caregivers wash their hands and change clothes after using tobacco.

Make sure materials and services reflect the specific communities you serve, including the languages used and the communities' values. Remember that traditional or ceremonial tobacco use in many tribal communities is different from commercial tobacco use. Avoid judgmental language about tobacco use. Consider conducting surveys with patients or clients to gauge reactions to tobacco policy signs and cessation resources, then adjust the language accordingly.

Monitor key indicators such as training participation, screenings completed, referral rates, and success stories. Celebrating milestones helps maintain momentum and demonstrates impact to interested parties.

Contact Information