Building capacity for tobacco screening and referral to treatment in boston community health centers: A collaboration between state and city health Departments

According to the Boston 2005 Behavior Risk Surveillance Survey (BRFSS), 17% of Bostonians surveyed smoked, and 7% had diabetes. Boston BRFSS data also suggest that rates of smoking and diagnosed asthma in adult Boston public housing residents are almost twice that of residents of market rate housing. In 2006, MassHealth, the comprehensive state Medicaid plan serving low-income Massachusetts residents, instituted a comprehensive tobacco treatment benefit.

The Boston Public Health Commission's (BPHC) Asthma and Diabetes Prevention and Control Program, Boston Steps initiative and Tobacco Control Program collaborated with the Massachusetts Department of Public Health Tobacco Control Program (MTCP), University of Massachusetts Medical School Tobacco Program and MassHealth to increase capacity of Boston community health centers (CHCs) to provide screening, counseling and treatment to adult and pediatric patients and to fully utilize the new benefit.

Seventy-five scholarships were provided to Boston CHCs. Scholarships were for training in Basic Skills for Working with Smokers. Technical assistance was provided on systems to ensure screening, documentation and billing.

Funding provided by BPHC's Tobacco Control Program and the Massachusetts Tobacco Control Program was pivotal in developing a skilled tobacco treatment workforce. Collaboration of these programs provided the support, technical assistance, and resources needed to improve tobacco education, screening, and referral to treatment in Boston. Increases in screening rates are being tracked over three years, but preliminary data indicate that some health centers have successfully institutionalized tobacco screening. Challenges have included staff turnover and systems barriers including lack of electronic medical record.