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The Trilateral Partnership

In 1998, the chief executive officers of Rady Children’s Hospital-San Diego, Scripps Health and Sharp HealthCare (pictured right) came together to create a partnership to improve the health and well-being of children and families in San Diego. This Trilateral Partnership was formed with the belief that a significant impact on the health of San Diego County residents could be achieved through collaboration on a prevention program.

PSF - About

Capitalizing on the strengths of each health care system, sharing resources, and eliminating the duplication of services, this unprecedented collaborative among San Diego’s health care leaders led to the establishment of a “best practice” preventive health model and county-wide standard of care, much broader in scope and reach than any individual organization could have achieved.

The Partnership chose tobacco control as its focus because smoking-related health problems remain one of our community’s most pervasive health concerns, impacting all age groups from the unborn child to the elderly, and can be affected by prevention efforts.

In March of 1999, the Partnership for Smoke-Free Families Program (PSF) was launched. PSF is designed for obstetric and pediatric healthcare providers to benefit their patients by:

  • Helping pregnant women quit smoking; and
  • Reducing children’s exposure to secondhand smoke.

To meet the goal of addressing tobacco use across the childbirth continuum, the program has worked directly through the partnering organizations’ affiliated obstetricians, hospital postpartum staff, and pediatricians using office-based systems to systematically identify and treat tobacco use. PSF is a service program, based on the U.S. Public Health Service’s five-step “best practice” intervention outlined in the Clinical Practice Guideline: Treating Tobacco Use and Dependence. This intervention, known as the five “A”s, involves asking patients about tobacco use at each visit; advising smokers to quit; assessing willingness to quit; assisting smokers in quitting; and arranging for follow-up. PSF staff provides office training, education materials, relapse prevention and cessation interventions and other resources to prenatal and postpartum clinicians to implement the five “A”s.

California Smokers’ Helpline

PSF partnered with the California Smokers’ Helpline (CSH) at the University of California San Diego, and developed a new smoking cessation telephone protocol designed to meet the needs of pregnant women and mothers of young children. This protocol is currently being used across the state of California. In addition, smokers referred by PSF offices to CSH are proactively contacted to ensure that more smokers get help to quit smoking. Proactive contact means that a trained counselor at CSH will contact smokers that are referred by a PSF office – instead of waiting for patients to contact the helpline on their own. This results in higher rates of contact, and larger percentages of people who quit smoking.

Visit our California Smokers’ Helpline page to learn more about PSF and CSH.

Click here to see the PSF California Smokers’ Helpline Q & A handout.

PSF Overview

Smoking cessation provides immediate and long-term benefits for pregnant women and young children – and clinician support plays a significant role in helping patients quit smoking. Yet clinicians face many barriers to providing smoking cessation interventions for their patients, including the absence of systems to identify smokers, limited time, lack of training resulting in low confidence regarding counseling skills, lack of treatment resources, and lack of clinician incentives or reimbursement.

The Partnership for Smoke-Free Families (PSF) understands the important role of the healthcare provider as well as the many barriers and difficulties clinicians face when helping their patients to quit smoking in a busy obstetric or pediatric practice. For these reasons, PSF provides resources and support to help clinicians easily implement “best practices” recommendations to help their patients quit smoking and/or avoid tobacco exposure. PSF program components are based on the US Public Health Service’s Clinical Practice Guideline for Tobacco Use & Dependence.

Specifically, PSF provides resources to ensure that the five “A”s are adopted by obstetric and pediatric healthcare providers to:

  • Ask about the smoking status of all prenatal patients and new parents using a standard screening and referral form;
  • Advise prenatal patients and new parents to quit smoking by incorporating appropriate messages into prenatal, and well-child visits;
  • Assess smokers’ readiness to quit;
  • Assist smokers and/or family members by proactively linking them with cessation counseling at the California Smokers’ Helpline; and
  • Arrange follow-up with patients by ensuring providers discuss progress made at subsequent visits.

Click here to see the USPHS Clinical Practice Guideline: Treating Tobacco Use and Dependence – Overview of Best Practice Recommendations handout.

Click here to see the FULL USPHS Clinical Practice Guideline: Treating Tobacco Use and Dependence publication.

PSF Program Highlights

  • Between 1999 and 2011, more than 300,000 pregnant women and parents of small children were screened for tobacco use/exposure and over 55,000 were proactively referred to smoking cessation services or linked with other interventions.
  • PSF program data representing nearly 150,000 pregnant women screened county wide via the PSF prenatal tobacco screening tool show that the percentage of women in San Diego County who smoked at some point during their 1st trimester has steadily decreased from 16.62 percent in 1999 to 12.15 percent in 2009.
  • PSF prenatal data show that the exposure of pregnant women to smoke/smokers in the household also has decreased, from 22.6 percent of households with smokers in 1999 to 15.9 percent in 2009.
  • PSF produced a comprehensive manual entitled “Implementation of Pregnancy Specific Practice Guidelines for Smoking Cessation” This manual outlines the development of the program and shares lessons learned with the goal of helping other organizations to create similar programs in their own unique healthcare settings.
  • PSF has become a standard of care in San Diego County and a nationally recognized model for systematically screening and linking pregnant women and families with small children exposed to tobacco smoke with interventions. PSF provides smoking cessation services specifically for pregnant women and new parents – previously non-existent in San Diego.
  • Participating PSF obstetric and pediatric providers include solo-provider practices, private group practices, outpatient/ambulatory care centers, and non-profit community health centers. By 2005 a network of more than 600 obstetricians and pediatricians from across San Diego County participated in the program.

Click here to see the PSF Fact Sheet.

Click here to see the PSF Community Health Brief.

Click here to see the Implementation of Pregnancy Specific Practice Guidelines for Smoking Cessation technical assistance manual.

Program Update

As of July 2011, the PSF program changed to a primarily web-based program. These changes were made so that PSF could 1) continue to offer the program to healthcare providers long term, 2) improve the screening and referral process and 3) allow more offices to participate.

The program and materials are designed to be used by Obstetric and Pediatric offices. In Obstetric offices, pregnant patients should be given the Prenatal Survey/Fax Referral form at their first prenatal visit. In Pediatric offices, parents/caregivers of small children should be given the Parent Survey/Fax Referral form at their child’s 6-month well-child visit.

The PSF Survey/Fax Referral form is used to identify current smoking status and exposure to secondhand smoke. All completed surveys/fax referral forms are placed into the patient’s medical record so that the healthcare provider can review them and give appropriate advice to quit smoking, stay quit or stay away from other smokers, depending on their smoking status. When current smokers are identified by the survey/fax referral form, a copy of the form is faxed directly to the California Smokers’ Helpline by your office staff, so that trained counselors can proactively contact smokers identified by your office and help them quit smoking.

PSF provides a one-page educational flyer designed to be given to every patient. This flyer covers the risks of smoking and the harmful effects of exposure to environmental tobacco smoke. Relapse prevention education materials are also available for recent quitters or pregnant women who quit smoking when they found out they were pregnant (to help them stay quit during and after their pregnancy), and education materials outlining the harmful effects of secondhand smoke are available for women or families with household smokers.

Visit our Program Materials page to access these materials.

Contact Us

Partnership for Smoke-Free Families – Center for Healthier Communities
3020 Children’s Way, MC 5073
San Diego, CA 92123

Phone: 858-966-7585
Email: Phyllis Hartigan at phartigan@rchsd.org