Inner City Asthma

Implemented in El Rio Santa Cruz Community Health Center, Tucson, Arizona by MAS Consultants Inc., P.O. Box 5130 Aiken, South Carolina 29804.

This case study was prepared for CDC by Dr. LaMar Palmer of MAS Consultants. The purpose of the case study is to share the experience of one community as they attempt to address the problem of asthma. It does not represent an endorsement of this approach by CDC.

Inner City Asthma: Program Components

The program was designed to engage all participants in common education and to give the AC the latitude to tailor portions of the intervention to the needs of the children and their families. The AC’s responsibility was to work closely with the affected families for a year after the core intervention to help them to gain better control over the children’s asthma. A brief explanation of these various program components follows.

Asthma-care Plans

Previously reported asthma interventions that employed an asthma specialist working with a nurse case manager were found not to be cost effective. NCICAS researchers did not want to circumvent or interfere with established doctor-patient relationships. Rather, they wanted study families to be able to work with their primary-care physicians to acquire their asthma medicine prescriptions and to obtain asthma action plans for the children. To achieve these ends, the AC educated families on how better to communicate their children’s health condition to their doctors and to take steps to acquire an approved action plan from the doctors. Both in the group and in individual education sessions the AC reviewed the objectives with the caretakers and worked with the families to achieve them.

Referrals

Inner-city children and their parents live in highly challenging, difficult environments. Families often face economic uncertainty and live in homes or apartments with poor ventilation and high levels of allergens. Frequently, these children have multiple caretakers and little continuity of health care. Many factors disrupt everyday life, and often health-care concerns are overshadowed by more immediate problems. The AC, skilled at providing the caretakers with referrals to existing community resources for such issues as smoking cessation and psychological and social concerns, worked to help parents cope successfully with this adverse environment. The referral effort was an important component of the program that enabled caretakers to better focus on the skills and behaviors needed to control the child’s asthma.

Environmental Interventions

All families were given pillow and mattress covers for their children’s beds and were encouraged to minimize exposure to environmental tobacco smoke and pets. For children with a positive cockroach skin test result, the families were instructed on ways to reduce cockroach food sources and received two professionally applied insecticide treatments.

Tailored Interventions

After the core intervention, the AC and caretakers met in person at least once every 2 months for a year, and they spoke on the telephone on the alternate months. The number of times they talked, as well as the length of contacts and the content of those discussions, were based on the family’s asthma risk profile as assessed by the Asthma Risk Assessment Tool (ARAT) and other problems or issues that developed. The ARAT, derived from the baseline assessment, included information on exposure to allergens, allergen sensitivity, smoking, access to care, adherence, and measures of adult and child mental health. The ACs were allowed the flexibility to determine the number of contacts with the family on the basis of the family’s unique needs. These included helping the family better adhere to medicine, improving the environmental conditions in the home, avoiding asthma triggers, or communicating more effectively with the doctor.