Increased # of AI/AN receiving in- home environmental assessment and trigger reduction education and asthma self-management education Increased # of tribal healthcare providers using spirometry and the measures from the EPR-3 guidelines Improvements in self-management knowledge, skills & behaviors Reduced disparities for AI/AN with asthma Reduced symptoms, ED visits, hospitalizations, missed school/work days Successful model for tribal asthma home visit program established based on lessons learned shared with other tribes and asthma stakeholders Disparities project outcomes used for Asthma Program Home Visit reimbursement work Provide train-the-trainer Master Home Environmentalist and asthma educator training to tribal staff, tobacco contractors, and community members to build tribal capacity Provide training and evaluate the use of spirometry and the implementation of the EPR-3 guidelines in tribal clinics participating in the home visits project 4. Trained Master Home Environmentalists and asthma educators working within the tribal community 3. Working relationships and processes in place for referrals and connection of environmental intervention with health care system 5. Environmental assessment and trigger reduction self management education provided 6. Increased # of tribal healthcare providers trained on spirometry and aware of the EPR-3 asthma guidelines and available tools 2. Appropriate materials developed and available to all tribes 2. Appropriate materials developed and available to all tribes Challenges with Translating Best Practices to Unique Community Settings Evaluating a tribal in-home asthma assessment project An evidence-based intervention In-home asthma assessments educate people with asthma about exposure to triggers at home, proper asthma medication use, and asthma self- management. In “The Community Guide”, the Task Force lists “Home-based multi-trigger, multi- component environmental interventions” as a recommendation for children and adolescents with asthma. The Program Washington state asthma program, funded by CDC’s National Asthma Control Program Disparities Expanded Subcomponent, contracted with a tribal clinic Asthma home visit team included a project coordinator, home visiting nurse, and two community health representatives (CHRs) Other clinic staff reviewed protocols and attended asthma trainings Community Health Representatives (CHRs) and nurses provide in- home asthma assessments Challenges with recruitment Free program Generous incentives – including a vacuum (not paid for by CDC funding) Community Health Representatives were members of the tribe Participants recruited via mail, health care provider visits, and health fairs But only 8% of those contacted enrolled in the program. Evaluation Questions Methods Document Review Staff interviews Participant surveys What did we learn? Fewer tribal clinic patients participated than anticipated Some conditions of the project made it less feasible/more difficult to implement  Changes made to the program and staff midway by Washington State Department of Health were a challenge  The clinic team was understaffed to work on the project  Staff had competing priorities  CHRs provided many services to the community, not just in- home asthma assessment What was successful? Quality of care improved Training was well received and prepared staff Participants enjoyed and benefited from program Suggestions to future programs in other Tribes  Staff must work well as a team  CHRs should have strong connection to community  Staff need enough time to be dedicated to the project  Ample training is needed Using what was learned Created an action plan linking evaluation results with changes needed and advice for future programs Findings and action plan considered when working with new tribal clinics Who do I contact with questions? Megan Mikkelsen, MPH Evaluator Washington State Department of Health Asthma Program Agency Support & Infrastructure Expertise of Professional Staff Internal Partners & Stakeholders Communication Support Internal Epidemiology Support for Surveillance & Evaluation Asthma Program Agency Support & Infrastructure Expertise of Professional Staff Internal Partners & Stakeholders Communication Support Internal Epidemiology Support for Surveillance & Evaluation Tribal Community Partners: Time and Expertise to Implement Tribal Community Partners: Time and Expertise to Implement ACTIVITIES Develop or adapt culturally appropriate materials and protocols for tribal-based asthma home visits program Work with tribe to build working relationships and processes between clinic, housing/weatherization, and other related tribal programs 1. Community trust and engagement developed Logic Model INPUTS CDC: Funding Programmatic Guidance Training CDC Project Officer Conference calls, listserv Technical Assistance CDC: Funding Programmatic Guidance Training CDC Project Officer Conference calls, listserv Technical Assistance OUTCOMES Conduct community focus groups to review materials/ obtain feedback for outreach strategy development Has capacity been sufficiently built to implement program successfully? Yes - relationships built with Community Health Advisory Council and General Council, clinic staff and CHRs trained, culturally appropriate materials created No - successful referral system not established Are the contract deliverables being met? No – 8% of individuals contacted enrolled in the program Are the expected outcomes appropriate and measureable? Yes – Indicators, outcomes, and methods consistent with other successful asthma home visiting programs Are the home visits being delivered to tribal members with moderate to severe asthma? Yes – eligible members determined through chart review and severity assessed during first visit Does the program have beneficial effects on participants? Yes – reduced asthma triggers, proper use of inhaler and controller medications, fewer restrictions from asthma, and shortness of breath Answers SHORT TERM Grant Year 1 INTERMEDIATE Grant Years 2-3 LONG TERM Grant Years 4-5