1. CHW Working Group Asthma Guidelines Working Group 7.16.2014

2. CHW Working Group The CHW Working Group will guide the activities of the CHW Coordinating Center at Sinai, ensuring the integrity of the CHW training, hiring and intervention process. 2

3. CHW Working Group Members NameRoleInstitution Helen Margellos-AnastChairSinai Cort LohffMemberCDPH Molly MartinMemberUI Health Valerie Press Nicole Woodrick Member U of C Jessica RamsayCHW Trainer/ Intervention Director Sinai Kenneth SoyemiMember Stroger Janet FloresMember Lurie Children’s 3

4. CHW Working Group Responsibilities Assist with Year 1 focus groups  Finalize the home visit intervention protocol, building off of existing protocols (Sinai’s, Molly’s, etc.)  Participate in the identification, selection and development of appropriate education and support materials to be provided to clients  Development of ED discharge packet  Participate in the recruitment of CHWs  Train CHWs  Supervise CHWs  Develop Quality Assurance activities and protocols  Monitor intervention progress  Consult with Asthma Guidelines Working Group 4

5. List of Documents for Discussion Components of overall CHW Home Visit MOP CHW Home Visit Protocol Teach to Goal MOP (Medication Use) Home Environmental MOP Home Trigger Assessment Home Environmental Checklist Patient Educational Handouts - Triggers CHW Curriculum 5

6. CHW Home Visit Protocol Guides CHWs as they complete the asthma education portion of each home visit, ensuring a certain level of consistency Follows the proposed home visit schedule: Visit 1: 2-3 days post ED discharge Visit 2: 2 weeks post ED discharge Visit 3: 1 month post ED discharge Visit 4: 3 months post ED discharge Visit 5: 6 months post ED discharge 6

7. CHW Home Visit Protocol Visit #Timing of VisitFocus 12-3 days post EDCHICAGO Trial overview, asthma basics, medication purpose and use, 504 plan 22-weeksHome environmental walk-through, triggers and avoidance strategies, green cleaning techniques 31-monthReview of asthma basics, medication purpose and technique, Asthma Action Plan (AAP) 43-months2 nd home environmental walk-through, triggers, review of medication use 56-monthsReinforcement of all education provided, final home environmental walk-through 7

8. At all visits: Behavior Change Plan, outline specific short-term goals for family to work towards by next visit, will be collaboratively created. Reviewed and updated at each visit Referrals will be made as necessary (e.g., complex housing issues, social services, etc.) Medication technique will be assessed and re-taught as needed Home Visit Inhaler Assessment and Education Protocol: Teach To Goal (TTG) Checklists CHW Home Visit Protocol 8

9. Teach to Goal MOP Overview of TTG Tailored, pt-centered Device technique checklists Objective measures MDI/Diskus/Twisthaler/ Turbohaler/ Nebulizer TTG @ each visit Patient/Parent Additional info Cleaning technique Medication dose tracking sheet 9

10. Home Environmental MOP Created in partnership with Asthma Guidelines WG Outlines specific procedures to be taken by CHWs to address triggers identified during the Home Environmental Assessment (HEA) HEA – thorough walk-through of the home environment conducted by CHW – emphasis on child’s bedroom, kitchen, living room and overall cleaning techniques and frequency 10

11. Home Environmental MOP HEA to be conducted at 2-week, 3-month & 6-month visits MOP focuses on primary triggers: cockroaches, rodents, tobacco smoke Secondary triggers: mold and dust mites Begins with shortened overview of protocol and education points for each trigger, then refers to pages with further detail on procedures to address each trigger All other triggers included in appendix 11

12. Home Environmental MOP Patient Educational Handouts – Triggers One for each of the primary and secondary triggers Provide overview of: Why each is a trigger What to look for/pictures of trigger Advocates for allergy testing Action steps to avoid trigger Will also have other patient handouts regarding other triggers (CHW WG to finalize) 12

13. CHW Curriculum CHW “bible” of information – does not include procedures Used as a guide for the CHW training process – all topics in the curriculum are covered in training Supplements the CHW MOP – acts as a reference for more detailed information on all educational topics covered in home visits 13

14. CHW Curriculum Divided into 8 sections, Asthma and CHW Core Skills: CHW Background Asthma Basics Asthma Education and Devices Motivational Interviewing Patient Self-Management and Goal Setting Patient Documentation: How to write case notes Collaborating with Medical Professionals 14

15. For discussion Layout of the CHW MOP Suggestions for making it more user-friendly? Frequency of Home Environmental Checklist Currently at 2-week, 3-month and 6-month visits – ok? Provision of spacers Will we be providing spacers at home visits or will this happen at ED discharge? Others? Comments/suggestions? 15

16. Questions/Comments? 16