Table 3: Levels of Care, Target Population, Goals and Interventions

Level of Care (Care Providers)	Target Population	Goals and Interventions
Level 1 (Self Management Support) By primary care	Child with relatively well-controlled asthma Family has self-management skills Relatively stable social/ psychosocial issues	Goal is to maintain family’s confidence, skills, and health status so that a higher level of care is not necessary. Interventions: Asthma self-management education: class, video, educational materials Routine care in primary care One YES WE CAN asthma clinic visit if needed
Level 2 (Basic Case Management) By the asthma team in partnership with primary care	Child with poor asthma control Family needs self-management skills Relatively stable social and psychosocial issues	Goal is to stabilize child’s asthma, promote asthma self-management, and return the child to Level 1 care. Interventions: Asthma program ± 6 months 3 asthma clinic visits ± 1 home visit by the CHW ± 3 follow-up assessment calls
Level 3 (Moderate Case Management) By the asthma team in partnership with primary care	Child with poor asthma control Family needs self-management skills Moderately complex and unstable social/psychosocial issues such as: Unstable single parent households Children raised by non-parent Immigration difficulties, etc.	Goal is to stabilize child’s asthma, support family functioning, manage social and psychological issues as possible, and to return them to Level 1 care. Interventions: Asthma program 6–12 months 3 asthma clinic visits ± 3 home visits by CHW ± 3 follow-up assessment calls Social worker consultation or referrals
Level 4 (Intensive Case Management) By asthma specialist (usually pulmonologist or allergist) and/or other specialists (social worker or mental health specialist) In partnership with the primary care provider With consultation and care from the asthma team as appropriate.	Child with poor asthma control Family needs self-management skills Highly complex and unstable social/psychosocial issues such as: domestic violence homelessness unstable or grossly substandard housing incarceration active chemical addition untreated or unstable mental illness	Goal is to stabilize child’s asthma and co-morbid conditions, support family functioning, and manage social/psychosocial issues as able. Closely manage high-risk families and high cost resources, so as to return the child to lower level of care. Interventions and referrals must be individualized on the basis of each family’s needs: Expert asthma management by an asthma specialist in partnership with the primary care provider Multidisciplinary team as available: mental health professional, social worker, community resources personnel Asthma team care or consultation