The Baltimore City Health Department’s Reducing Asthma Disparities (RAD) initiative takes a real-life approach to asthma intervention by visiting homes of families with children who have moderate to severe asthma.
Community health workers (CHWs) are at the heart of the outreach program. They focus on reducing environmental triggers and improving medication compliance for approximately 150 children who are enrolled in RAD.
Families receive six home visits from community health workers in six months, a follow-up visit at one year, and phone calls in between. The initiative is funded by a three-year transitional research grant provided by the Centers for Disease Control and Prevention, according to Kate Scott, MPH, BSN, RN, who serves as RAD’s director.
The CHWs are trained and supervised by a community nurse asthma program manager, Scott said. They complete a two-day healthy housing practitioners course and receive monthly updates on integrative pest management measures. They also observe the dynamics of children with asthma and their parents at the University of Maryland Hospital for Children’s Breathmobile, and participate in weekly staff meetings.
The CHWs learn to disseminate health information at the appropriate literacy level to participating families. During the first home visit, they start with a thorough review of the child’s prescribed asthma medications.
“We ask the families to bring all the meds: every Advair®, every Flovent®, every albuterol, every ProAir®, every Ventolin®, every nebulizer they can find,” Scott said, “We say bring it all, bring it all.”
Sometimes, the CHW discovers that the child is taking multiple overlapping medicines prescribed by different physicians or has the same medicine with different dose strengths. The CHW documents this on an encounter form that is faxed to the child’s health care providers – pulmonologist, allergist, primary care doctor – with a cover sheet asking for clarification on which asthma controller medicines the child should use regularly and which rescue medications the child should have on hand.
The CHW also checks a list of prescription dates and how many doses are left at each home visit to ensure the medicine is being taken and the prescriptions are being refilled as necessary.
“If there is a real problem with meds, for example, lapse in insurance is pretty common, a nurse manager can jump in and help the family get back on track,” Scott said.
An advantage of performing home visits is the CHWs see firsthand any environmental triggers that need to be addressed. More than 50 percent of the children RAD serves live in homes with roaches, mice, and individuals who smoke in the home.
The CHWs instruct families to encase mattresses and pillows to help reduce children’s exposure to allergens. They coach parents about smoking only outside the home. And they facilitate integrative pest management, such as by calling landlords if there are holes around pipes where roaches or mice can creep in.
With refrigerators and kitchen cabinets nearby, the workers also promote family discussions of healthy eating habits for children with asthma. For example, a section of the CHWs’ teaching manual describes how a diet low in vitamins, especially vitamins C and D, and high in fat is associated with an
increase in asthma symptoms.
“There’s also information about how the risk of developing asthma increases with an increase in obesity,” Scott said. “The workers talk about balanced meals, describe healthy options like low-fat dairy products fortified with vitamin D, and help link families to the farmers’ markets in the area.”
They debunk myths that children with asthma can’t safely exercise. “Our CHWs encourage parents to connect with parks and recreation centers where their children can participate in sports and other activities,” Scott said.
By empowering families, RAD’s CHWs are an important ally in asthma education and care coordination. They help to ensure that children’s asthma action plans are integrated into families’ daily life and supported by community resources.
“The bonds they form with families and what they’re able to accomplish in the home is very satisfying to all of us,” Scott said.
Sandy Keefe, MSN, RN, is a frequent contributor to ADVANCE. Kristen Ziegler can be reached at email@example.com.