1. Noreen M. Clark, Ph.D. Myron E. Wegman Distinguished University Professor Director, Center for Managing Chronic Disease University of Michigan DETROIT HEAD START ASTHMA PROJECT: “An Intervention to Improve Asthma Morbidity and Asthma Health Care Use Among Low-Income Urban Preschool Children” This study was funded by the Center for Disease Control and Prevention: Community-Based Participatory Prevention Research. #R06/CCR521533-01 Head Start 9 th National Research Conference June 23-25, 2008 Belinda Nelson, PhD Presenter/Project Director

2. Background : Asthma is the most prevalent chronic condition of childhood Children most affected by asthma are low-income minority children who live in large cities

3. Prevalence of Asthma and Asthma Attacks Among Children 0-4 Years (2001-2003) Source: National Surveillance for Asthma—US, 1980-2004, MMWR, October 2007/Vol.56/No.SS- 8, DHHS, Centers for Disease Control and Prevention

4. Health Care Utilization for Asthma Source: Morbidity and Mortality Weekly Report, October 2007/Vol.56/No.SS-8, DHHS, Centers for Disease Control and Prevention

5. Why Focus on Head Start? Based on demographic profile: Head Start children are at high risk Few interventions focus on the youngest children with asthma

6. COMMUNITY PARTNERS Detroit Department of Human Services Detroit Henry Ford Hospital Six Detroit Head Start Agencies HartfordSoutheast New St. PaulVistas Nuevas United Children and FamiliesOrder of the Fishermen

7. D ETROIT H EAD S TART S TRUCTURE Grantee Delegate Agency Content Area Coordinators Agency Director Clerical Staff Family Service Workers Center Admin. Teachers Support Staff (cooks, etc.)

8. PURPOSE The primary purpose of the project was to engage Head Start personnel and families in efforts to improve the management of asthma symptoms among children enrolled in Head Start and to develop a program that specifically addresses the needs of this population.

9. OBJECTIVES Identify Head Start children with asthma Provide training for Head Start staff in asthma management Provide educational information for Head Start families Evaluation of the intervention and the collaboration Dissemination of findings for community partners and Head Start families

10. Screening and Recruitment Asthma Health Screening (n = 3254) Children identified with asthma symptoms (n = 888) Baseline Interviews (n = 675) Continued on Next Slide

11. Intervention and Follow-Up Physician Led: Comprehensive Asthma Management Training Session Asthma Educators: Continued Training and Support Head Start Educators and Staff n=175 Parents receive assistance with asthma management (Educational handbooks, presentations, help from Head Start staff) Follow Up Interviews (n=487)

12. Criteria Used to Identify Children with Active Asthma Symptoms SummaryCriteria Diagnosis & Symptoms Diagnosis and 1+ symptoms any number of days in past yr. Diagnosis & Prescription Diagnosis and prescription Non-Exercise Symptoms 3+ non-exercise symptoms, each 5+ days in past yr. Exercise Symptoms 2 exercise symptoms, each 5+ days in past yr. Nighttime Symptoms Nighttime symptoms 3+ times per month Source: NAEPP Guidelines

13. Asthma Prevalence Among Detroit Head Start Children

14. Characteristics of Children and Caretakers in Detroit Head Start Asthma Project Final Sample (N=487) Child Characteristics: Age3.9 Female (%)56.0 Ethnicity% African American85.0 Hispanic/Latino6.0 Other9.0 Diagnosed w/ asthma67.1 Rx for asthma74.3 Primary Caretaker% Relationship to child: Mother88.7 Father/Grandmother10.2 Continued on Next Slide

15. Educational Level of Caretaker % <High School16.6 High School/GED36.6 Voc/Tech /Some College 37.0 College Degree/Adv Degree 9.8 Annual Household Income % <5,00015.3 5001 – 20K40.1 20,001 – 40K25.5 >40K19.1 Characteristics of Children and Caretakers in Detroit Head Start Asthma Project

16. Asthma Severity Status

17. Annual Symptom Days

18. Asthma Attacks

19. Asthma Health Care Utilization InterventionControl BaselineFollow-UpBaselineFollow-Up Caretaker ever asked doctor about asthma (%) 73.085.2.00079.584.1ns Doctor/Clinic Visits # 3.262.33.0063.052.82ns Continued on Next Slide

20. InterventionControl Baseline % Follow-Up % Baseline % Follow-Up % ≥ 1 ED Visits 43.931.3.00037.724.6.001 ≥1 Hospitalizations 15.29.0.00611.55.7.031 Asthma Health Care Utilization

21. Caretaker Level of Confidence in Head Start

22. Summary: Children in the intervention group experienced significant improvement on two measures of asthma morbidity: symptom days and visits to the doctor Intervention caretakers showed an increase in help- seeking behavior by asking the doctor about asthma Intervention caretakers demonstrated a significant improvement discussing their child’s asthma with Head Start personnel Intervention caretakers were more likely to identify Head Start as a source of knowledge and support for asthma management

23. Lessons Learned Development of “buy-in” and community trust was a lengthy process Teaching staff have many existing demands that competed with project goals Establishing proficiency in screening for children with asthma prior to asthma management training is beneficial

24. What Was Helpful? Maintaining flexibility in setting time lines to assist Head Start achieved goals Identification of Head Start personnel who were highly motivated Working with Head Start on activities other than asthma (e.g. community health fair, Health Advisory Committee) Encouraging the peer-relationship with Head Start staff in decision-making