An Asset-Based Empowerment Approach to Asthma Education: Mobilizing Community Resources Through Asset Mapping Presented by: Elizabeth L. Phillips, MPH, CHES Community Health Asthma Alliance Minority Partnership (CHAAMP) Introduction Hello, we bring you greetings from the Hudson Valley Region of New York I serve as the Manager of Health Education Services for Hudson River Community Health, a network of 12 community health centers and the lead agency for the CHAAMP. The health center mission is to provide primary and preventive services to the vulnerable and underserved which include such special populations as public housing residents, migrant workers and the homeless. Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Learning Objectives Learn how to incorporate an asset based approach to problem solving or enhance asthma health education efforts. Understand the benefits of coalition building via the “asset-based” approach in the identification of individual skills and organizational/institutional resources. Build familiarity with the process of asset-based mapping and its application towards public health efforts aimed at addressing health disparities among minority populations. Participants will learn how to ….. Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Project Background Project: Community Health Asthma Alliance Minority Partnership (CHAAMP) formerly the Dutchess County Minority Asthma Alliance established in 2000, a grassroots coalition focusing on individual and community level issues associated with the burden of this national epidemic. Lead Agency: Hudson River Community Health Coalition Membership: comprised of local agencies representatives, family members, health professionals and concerned individuals. Funding Source: NYS Department of Health - Office of Minority Health. Northeast Cluster Collaboratives 1/18/05

CHAAMP formerly the Dutchess County Minority Asthma Alliance Mission To improve health outcomes and increase access to comprehensive asthma care, support and services for African American and Latino children with asthma, by working within the community to overcome the daily barriers encountered by families residing in Peekskill, Beacon & Poughkeepsie. Northeast Cluster Collaboratives 1/18/05

Asset-Based Community Development ABCD is the assessment and mobilization of these resources. An “asset map” is a display of the resources which can take place in various forms and media. Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Asset Mapping Seeing the glass half empty Clients have deficiencies and needs Seeing the glass half full Individuals with gifts/talents Coalition Strategy: Asset Mapping The initial coalition recruitment and workplan development was guided by the concept of social capital and this alternative approach to the traditional needs assessment, “community asset mapping.” The a focus is on locating community assets and services of individuals, associations, and institutions. The asset map is a focal and key referent point for the coalition’s strategic plan. Based on “Building Communities from the Inside Out” by John P. Kretzmann and John L,. McKnight as presented by Robert Francis, Executive Director of Regional Youth & Adult Substance Abuse Project (RYASAP) Bridgeport, CT. Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Seeking Solutions Needs Assessment vs. Asset Mapping Deficiency oriented identity Sets a mood of hopelessness Needs define the intervention Destroys local relationships Creates vicious funding cycle Affirms “gifts”on all levels Built on community strengths Thrives on community input Relationship driven Better use of external and internal resources Northeast Cluster Collaboratives 1/18/05

Community Assets Building Blocks Individual Residents Institutions Citizen Associations Outreach & Advocacy Visibility Marketing In-kind Support Technical Assistance e.g. Hospitals, School Districts, Universities & Libraries Skills Experiences Knowledge Outreach & Advocacy e.g. Youth, Seniors, Low-income, Disabled Outreach & Advocacy Visibility Marketing In-kind Support Technical Assistance e.g. Tenant Housing Council, Places of Worship, Artists, Merchants, Sports Groups This slide illustrates the levels at which assets can be found—they represent the 3 basic building blocks of any community Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Asset Mapping Process Helps to identify… existing community resources & services different communication strategies for working with community residents, organizations & coalition members opportunities for the coalition to promote and tell their story Prospective coalition members and allies In this context an ASSET is defined as HAVING SOMETHING THAT YOU ARE WILLING TO GIVE AWAY. ASSET MAPPING IS AN INTERACTIVE EXPERIENCE… If you don’t’ go beyond identifying assets and not willing to exchange you are not mobilizing your assets and then the mapping itself is just an exercise. Northeast Cluster Collaboratives 1/18/05

Benefits of Asset Mapping Shift in power from professionals to community Inclusiveness -- everyone has gifts Relationship building People NOT programs overcome barriers Sustainability Smaller, but better results Focus on bridging resources by developing organizers and “gappers” Based on “Building Communities from the Inside Out” by John P. Kretzmann and John L,. McKnight as presented by Robert Francis, Executive Director of Regional Youth & Adult Substance Abuse Project Bridgeport, CT. Northeast Cluster Collaboratives 1/18/05

Our ABCD Experience in Community Health Education Utilizing the asthma asset map and tapping into community member’s individual skills has increased the community’s access to culturally appropriate asthma education. How do Community assets contribute to coalition’s success in achieving its goals? Our Results Over the past three years the DCMAA has successfully mobilized and sustained a coalition membership of 41 partners. The collective efforts of DCMAA members has resulted the production of a “visual” asset map & a user friendly version to promote the exchange of skills/assets identified. It has inspired the creation of a grassroots public awareness campaign involving the local Head Start sites and public elementary schools; the implementation of a asthma care management pilot project known as the Home Asthma Intervention Resource (HomeAIR). the creation of a bi-lingual asthma newsletter reaching 2,000 households; the recruitment and training of over 25 CHW’s as asthma care partners Established an annual community wide asthma forum event During this new contract period we also experienced an increased demand for workshops and public speaking opportunities, invitations to help in the organizing of other staff training events as well. Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Assets in Action CBO’s Health Providers AmeriCorps/VISTA Citizens HeadStart/DayCare sites School Nurses Health Institutions Public Schools This is a inventory listing of our most actively used assets. How did your coalition go about identifying community assets? Immediately following our ABCD Project staff arranged meetings—with community leaders, agency staff---face to face was the way to go to begin the sowing seeds of the ABCD concept and gather inforwith community leaders, agency staff. At the initial coalition meetings –group exercises where done to illustrate the concept and presentations on the ABCD process were done periodically with community members and volunteers. Identifying of assets is an ongoing process and often happens via forma & informal conversations Is the asset resource listing kept current? Challenge as new contacts are made is a real challenge to keep the asset table current, but it is a living document that we just recently re-committed to circulate 2 x year. Overall new information that can go into the asset table is shared at coalition meetings via announcements. It represents new linkages formed as a result of our workplan and the assets we have mobilized to develop our asthma & public awareness activities One activity in particular is a result of what happens when you allow assets to work for you--- The Family Time Asthma forum is real testament to this process—it encompasses all levels, several institutions, civic associations and many individuals…. AND is has been hugely successful –funded primarily with in-kind contributions Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Assets in Action HomeAIR is an educational & environmental approach to asthma management. Based on the Community Health Worker (CHW) model to provide outreach & asthma education via home visitation. A unique health intervention that focuses on the need of health center users--pediatric asthma patients and their families. The HomeAIR team is comprised of local community residents & AmeriCorps members. With this particular activity we have an integration of both individual and institutional assets. This is illustrated in our asthma care home visiting project known as HomeAIR. The asthma care partners as individuals are really key in making a meaningful connection to our target population. They are the link between the health center (provider staff) and the community residents. As natural helpers and leaders they bring their knowledge of community services, life experiences and language skills that aid towards the improvement of the communities health status. Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 Home Asthma Intervention Resources HomeAIR HomeAIR is a project of Hudson River Community Health. An asthma care management intervention using the Community Health Worker model approach to conduct home visits. Target Population: Parents/Caregivers of Community Health Center Pediatric Patients The HomeAIR team is comprised of local community residents & AmeriCorps members referred to as “Asthma Care Partners”. HomeAIR participants either self-refer or their Primary Care Provides identifies & refers the family. Northeast Cluster Collaboratives 1/18/05

Data Collection Pre Survey HomeAIR Revisited Changes in Intervention Delivery: HomeAIR needed to be responsive and flexible to families needs in a proactive manner. Flexibility in the delivery of HomeAIR services meant condensing home visit structure as necessary---by meeting with families on 2 visits instead of 3. Proactive in not relying on providers to refer families and enable parent to sign up directly. Changes in Data Collection Survey Pre survey questions were unclear to interviewer & the family members. Questions were reworded to make it more user friendly to improve the usefulness of the information. Data Collection Pre Survey Original Q. Does your child use a Peak Flow Meter? If yes :_____________predicted measurement ___________actual measurement Revised Q. Does your child use a Peak Flow Meter at home? If YES, what is their personal best reading? ________ OR______ I do not know. Our hope is that this new format of delivering the HomeAIR program is that the participants will perceive this streamlined version as less of a time commitment / less intrusive. The HomeAIR forum is meant to offer enhanced educational opportunity for both the provider and the family to have “air” questions in a supportive group atmosphere. Goal is to educate families and guide them in how to take action in making changes to control asthma. Data Collection Pre Survey Q. Does your child use a Peak Flow Meter? If yes :_____________predicted measurement ___________actual measurement Revised Q. Does your child use a Peak Flow Meter at home? If yes, what is their personal best reading? ______ do not know. What would you like to be able to do that you currently can’t do because of your/your child’s asthma? Q. What activities would you do differently IF your child didn’t have asthma? Q. # of nights awakened with asthma symptoms? ____ Is your child able to sleep through the night without coughing, wheezing, or feeling short or breath? Yes___ ___No If no how many nights does the child wake up with these symptoms? _____ Program Delivery From 3 visits to 1 visit plus community ed forum Northeast Cluster Collaboratives 1/18/05

Northeast Cluster Collaboratives 1/18/05 HomeAIR Revisited Other Proposed Changes: Conduct group asthma education workshops—HomeAIR Forums. The sessions will be led by asthma care partners & Pediatric Department providers at the community health center (to be piloted in Fall 2004). HomeAIR Forums will be open to the general public The anticipated benefits for HomeAIR participants will be the group experience & exchange of information via facilitated discussion on the basics of asthma. Home AIR participants will then be offered the opportunity to sign up for a 1 time home assessment conducted by the asthma care partner. Incorporate participant evaluation of HomeAIR forums with pre/post tests. Home Assessments will be available to all participants; maintain use of pre/post asthma data collection surveys. Northeast Cluster Collaboratives 1/18/05

Chronic Care Model Components the community…CHAAMP Coalition self-management support… Home AIR Assessment the health system….BOD monthly reports; Strategic Plan; Use of PDSAs decision support…Asthma Action Plan clinical information systems…PECS as of 11/04 Excerpted from http://www.improvingchroniccare.org/change/model/components.html Overview of the Chronic Care Model The Chronic Care Model identifies the essential elements of a health care system that encourage high-quality chronic disease care. These elements are the community, the health system, self-management support, delivery system design, decision support and clinical information systems The Organization of Care (the health System) refers to things we have done system wide. Some of the things this refers to are the monthly BOD reports on the activities around the care model-including the asthma program. Other things are the use of the care model as an overall organizational strategic plan. We also use PDSAs for all of our quality improvement work. The Care Model is integrated into the Orientation of every staff member in HRCH. delivery system design…HomeAIR pilot, CHW’s Northeast Cluster Collaboratives 1/18/05

Roadblocks on the Journey Resistance from deficit oriented people Competing initiatives Conflicting priorities Temptation to act alone Motivation & Uncertainty The first year was most difficult there was some resistance—which was later overcome with persistence. Much of the challenge is maintaining a sense of hope, not every building block or asset may be actively mobilized but overtime we have been able to recognize the benefits. The individual assets are a precious resource…difficult to obtain right away. Unlike working with the local institutions the individual’s assets are less obvious and requires a higher investment in terms of time to build a relationship. *manpower (PT coalition members with FT tasks) *money (would have liked more time to tailor paper survey or developed a more comprehensive asset map) Northeast Cluster Collaboratives 1/18/05

Learn By Doing -stay positive & don’t give up -persevere, even if it doesn’t start out well -get people to see dream & make it come true -be willing to ask -feed the vision -innovation means taking risks establish trust and respect -   establish a mission statement -   motivation leads to sustainability    -   exchange assets - promote networking STAY FOCUSED TRUST THE PROCESS In retrospect –the ABCD approach is best learned by doing This journey has helped to open us up as individuals and as a coalition that everyone needs to be viewed as a resource to the possibilities in examining how a community can effective impact health disparities by making use of what is in it’s possession. -These statements came from coalition members –as we reflected on what this time together has taught us Northeast Cluster Collaboratives 1/18/05

Thank You. Mobilizing Community Resources Through Asset Mapping Presented by: Elizabeth L. Phillips, MPH, CHES Community Health Asthma Alliance Minority Partnership (CHAAMP) Northeast Cluster Collaboratives 1/18/05