Asthma Friendly Home Project
Our efforts with home visiting will contribute to health equity by mitigating early-life risk factors for children in underserved communities, and also giving them key skills to help manage asthma symptoms they already have. This is in line with our efforts in schools, but has the additional advantage of allowing us to reach children who may miss large amounts of school days because of poorly controlled asthma symptoms.
Consequently, our AFHP can help to create better opportunities for children who come from high-risk communities because the ability to stay enrolled in and succeed at school is the number one predictive factor for upward social and economic mobility. Because children with asthma may also spend a lot of time at home, promoting asthma-friendly environments can also help young people to achieve better physical health outcomes over the long term.
In Florida, we aim to focus intensively on the specific cultural and contextual factors that contribute most prominently to marginalization of groups at high risk for poor asthma outcomes. These include, but are not limited to: racial discrimination, language barriers, income and wealth disparities between people of different cultural backgrounds, and poor housing quality in lower-resource neighborhoods.
With the AFHP, we intend to reach children whose asthma results in frequent hospitalization. By consequence, we are hoping to reach children whose asthma frequently keeps them out of school, limits their opportunities to socialize with peers, and/or creates barriers to active play. We are focusing strongly on children with very poorly controlled asthma in low-income and culturally marginalized communities. Because of overarching structural inequalities that limit access to and utilization of chronic disease management services, as well as high correlation between living in low-resource neighborhoods and being exposed to persistent asthma triggers, this is the best strategy for reaching a large population of children with poorly controlled asthma as well as making a substantial difference in quality of life.
Stage of Development
The AFHP is new for the 2014-2015 program year, and is currently transitioning from the planning stage to the implementation stage. The program builds on a variety of asthma care and management activities that have been in place at MCH for many years, and engages asthma education staff who have a history of working with the hospital. However, the home visiting component itself is new.
- The first component of the AFHP is assessment of potential participants. MCH takes the lead on this activity, scanning records for children who visit the emergency room and/or experience hospitalization for their asthma.
- After discharge, MCH case managers follow up with families to schedule a visit from a DOH home inspector. The inspector visits the family at a time of their choosing, and offers recommendations for mitigating identified triggers, keeping in mind any resource constraints families may experience in implementing these suggestions. The inspector then assesses families’ interest in having an asthma educator come to their homes.
- Interested families proceed to scheduling visits with contracted asthma educators, who then communicate with case managers about their interactions with participating families. During their final visit to a given family’s home, asthma educators administer a survey developed by the evaluators. This survey assesses parents/guardians’ perceptions of the program and its impacts, as well as their overall satisfaction with the process.
- Throughout the program, MCH staff will share data with the FAP and external evaluators on a monthly basis. FAP staff will review these data to populate program reports and share progress with CDC funders. Evaluators will analyze the data to generate insight about the program implementation process, as well as outcomes from home visiting activities.