Last updated: October 2023

Author: You First Program, Vermont Department of Health

This performance measure helps assess performance based on quantity; a higher percentage is better.

You First is a prevention program funded by the Centers for Disease Control (CDC) that works to remove barriers that may prevent Vermonters from getting important health screenings related to breast, cervical, and heart health. You First pays for screening services and works to increase access to screening for breast cancer, cervical cancer, and cardiovascular disease risk in Vermonters. You First serves Vermonters in need of screening who are at or below 250% of the Federal Poverty Level and are uninsured or underinsured.

In order to increase the reach of the program and to work with potential and current members in their own communities, You First has contracted with Federally Qualified Health Centers (FQHCs) and the Vermont Coalition of Clinics for the Uninsured (VCCU) to hire community health workers. Community health workers are tasked with outreach to the larger community in an effort to increase the Pap screening rates in their service areas, as well as finding and enrolling eligible Vermonters into the program and navigating them through the screening process. Additionally, You First partners with Planned Parenthood of Northern New England to increase screening rates in their seven Vermont clinics and non-clinical partners like the Pride Center of Vermont to reach LGBTQ+ communities.

You First is guided by the Unites States Preventative Services Task Force (USPSTF) cervical cancer screening guidelines which recommend screening every 3 years with cervical cytology alone in individuals aged 21 to 29 years. For individuals aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).

• Centers for Disease Control and Prevention
• Planned Parenthood of Northern New England
• Vermont Coalition of Clinics for the Uninsured
• Rutland Free Clinic
• Greater Bennington Community Services
• People’s Health & Wellness Clinic
• Northern Tier Center for Health
• North Star Health
• Community Health Centers of Burlington
• Pride Center of Vermont
• Vermonters Taking Action Against Cancer (VTAAC)
• Vermont Cancer Registry

You First follows the CDC’s Community Preventive Services Task Force recommendations for implementing evidence-based interventions to increase cancer screening, which include patient and provider-oriented interventions.

Patient-Oriented Interventions

Client (patient) reminders

• Offer to schedule cancer screenings for a patient during a clinic visit.
• Contact patients to schedule screenings.
• Send reminders about appointments and tests.
• Provide support to help patients overcome barriers and prepare for tests (like colonoscopies).

Reducing structural barriers

• Reduce paperwork.
• Help patients schedule appointments.
• Offer screening at more locations.
• Expand clinic and screening hours.
• Provide transportation.
• Provide translation services.
• Provide childcare.

Other client-oriented interventions include the use of small media (like videos, brochures, or newsletters) and one-on-one or group education to motivate people to get screened. Health care systems can also give vouchers, reimburse costs, or reduce co-pays to remove economic barriers for patients.

Provider-Oriented Interventions

Provider reminders

• Put stickers or notations on the medical charts of patients or program electronic health records to send alerts to providers to discuss screening with patients.
• Every day, print a list of patients who are due for cancer screening.

Provider assessment and feedback

• Track screening numbers for clinics and individual providers.
• Review clinic policies and practices.
• Tell providers how many of their patients get screened and receive follow-up care.