Performance Measurement and A Process Evaluation Model for Smoking Cessation and Reduction In Pregnancy Treatment (SCRIPT) Programs: Documenting Fidelity of Delivery in Prenatal Care

The WV Right From The Start (RFTS) Program provides home-based, targeted case management to Medicaid-eligible clients state-wide. Designated Care Coordinators (DCCs), registered nurses and licensed social workers, provide multiple services, including tobacco treatment. The Smoking Cessation and Reduction In Pregnancy Treatment (SCRIPT) program was adopted by RFTS in 2006 as the evidence-based tobacco treatment for dissemination. A process evaluation model (PEM) was developed to assess whether SCRIPT Procedures (Guide, Video, Counseling) were being provided by DCCs with fidelity. The PEM evaluated the Program Implementation Index(PII), which is used to measure fidelity, for SCRIPT at the state, Region, and DCC level with a target implementation rate goal of 80%. Improvements to RFTS policies and procedures from 2006-10, including new assessment forms and a separate SCRIPT visit, as well as increased tobacco cessation training for DCCs, increased client exposure to SCRIPT. The state-wide PII increased from 63% in 2006 to 74% in 2010: a 13% increase in delivery of SCRIPT Procedures. Exposure to tobacco cessation Counseling (+18%), the Guide (+21%), and the Video (+21%) increased from 2006-10. Client follow-up (+17%) and follow-up CO (+20%) also increased. The RFTS-SCRIPT Program process evaluation results provide important insight into the programmatic challenges faced by a state-wide, home-based, best-practice tobacco cessation program for Medicaid-eligible pregnant women. As the role of home-based health care services expands in the U.S., these “lessons learned” are of vital importance for informing the implementation of research-to-practice programs.