DCAC ©DCAC 2002 Organizing a Sustainable System of Care for Children with Asthma DC Asthma Coalition Lisa A. Gilmore, Project Director

DCAC ©DCAC 2002 The Vision Focus on modeling effective interventions for inner-city asthma populations Define and measure three key outcomes: reduced ER and hospital visits, reduced school absences, improved quality of life for children and their caregivers Foster partnerships for collaborative interventions Use collaborative case management to reach kids through core institutions: hospitals, clinics, family health centers, schools, daycare, places of worship, rec. centers, public housing Measure: study participant outcomes, coalition process and activities, community outcomes, degree of family empowerment

DCAC ©DCAC Strategic Pillars Direct individual interventions 229 study participants (400 before attrition) Referrals primarily from case-management based partners (e.g., family health centers, clinics, mental health centers) Extensive home visit and follow-up program Asthma Management Plan developed, implemented, and shared Extensive data sharing among partners Targeted education Targeted education (workshops, staff training, more) Comprehensive community-wide education campaign Electronic platform for tracking and collaboration Public policy

DCAC ©DCAC 2002 Key Challenges Developing and implementing a comprehensive action plan Developing means for measuring success, and for coordinating activities

DCAC ©DCAC 2002 The Process 1.Build a coalition consensus 1.Build a coalition consensus on intermediate outcome objectives (e.g., all study participants receive home visits and case worker support) 2.Develop a comprehensive flow chart 2.Develop a comprehensive flow chart to map mechanisms for implementing agreed objectives 3.Implement each element 3.Implement each element of the overall strategic map, in conjunction with key partners and using a wide range of community resources 4.Measure and track all activities 4.Measure and track all activities to support development of best practices model

DCAC ©DCAC 2002 Home Visits. Summary Slide DCAC Asthma Action Plan Home Visits. Summary Slide Asthma Management Plan (AMP) Medical plan (from MD) Communicated to other partners Schools Daycare, etc Tracking: Interim database + Electronic Tracking System Partner agencies Other sources Referrals Parent signs releases Initial home visit Interventions (see slide 3) Type III Participant Type II Participant Type I Participant Check in by phone Check in: phone One follow-up visit Check in: phone Two follow-up visits Subsequent contacts Annual assessments External link Planning Initial home visit Subsequent contacts Tracking Meets study criteria Outward referral Fails criteria CHWs, Asthma Counselors Assessment (see slide 2) Ongoing assessments and event monitoring Parent support groups and other resources

DCAC ©DCAC 2002 Enroll in OAS Pre- screening DCAC Asthma Action Plan The Schools All kids Possibly asthmatic OAS: six-week program on behavior mod. for kids Full doctor screening Allergy specialist Recruit into study Camp Happy Lungs Howard U. Study School Administration Medical Action Plan Asthma Diagnosis Training OAS Training Asthma Training Nurses + Asst.Prin. Event response plan Nurse response Back-up response Environment School assessment Limited remediation plan Remediation action Policy Action Items: Kids and meds. in schools Getting Medical Action Plan into school records Policy on donations to schools Allergy policy Initial response plan – all teachers Legend: All Some Major component Large Bold Individual Activity Program Front-line teacher response Tools for Schools Schools

DCAC ©DCAC 2002 Measuring Success 1.Participant outcomes: Measurable improvement in ER/hospital visits, school absences, quality of life 2.Process outcomes: a)Measure interventions by DCAC staff – home visits, participant training sessions, staff trainings, AMP development process b)Measure coalition participation: meetings attended, staff committed to DCAC initiatives, education partnerships, etc. c)Measure improved self-management of asthma 3.Community outcomes 3.Community outcomes : Measure increased awareness of asthma, and community responses for addressing it (e.g., school response plans) 4.Policy outcomes: a)Measure development of specific policy objectives (e.g., medication available in schools) b)Measure extent to which desired policy changes are addressed by policy makers and are then successfully adopted

DCAC ©DCAC 2002 Tracking and Measurement Electronic Tracking System Patient data DCAC counselors Coalition process and activities ER Clinics Aggregate data Model Daycare Head Start Schools Partner agency case workers Other data sources Environmental Demographic Economic

DCAC ©DCAC 2002 Process and Philosophy 1.Based entirely on coalition-building principles 2.Extensive partnerships and outreach 3.Coordinating use of others’ resources 4.Deep consultation and consensus building 5.Substantive and substantial participation in planning and decision-making by coalition partners 6.Careful planning a key condition for effective action 7.“What gets measured gets done” – commitment to comprehensive tracking and evaluation