Promote Institutional Change for Sustainability
When CAPP leaders spread their program model to reach new communities in North Philadelphia, they convened partners to discuss the program, describe how it had worked elsewhere and hear from local partners about how to tailor the program to North Philadelphia's needs. CAPP forged an agreement with the community partners: in year 1, CAPP would deliver the program; in year 2, CAPP would manage a train-the-trainer program to prepare community members to deliver the education program and conduct home visits; and in year 3, CAPP would step back and be available for technical assistance. "We've seen our asthma home visit and community education programs incorporated as parts of existing programs and local providers have sustained the programs over time by championing them with local organizations," said Dr. Tyra Bryant-Stephens.
Use Data to Demonstrate Your Program's Value-- Demonstrate the Need
CAPP is built on a network of collaborative relationships to deliver asthma care in local communities across Philadelphia. One way that CAPP's leaders leverage their community partners to achieve sustainability is by recruiting them to accompany CAPP staff on visits to policymakers. "Educating policymakers is important. If you walk into a politician's or government office with a fleet of partners in tow, it makes a powerful statement about the need for your program and the lobby that's backing it." This tactic has worked for CAPP, which has seen line item funding in the state budget for the program for two years in a row after CAPP leaders and their collaborators paid a visit to a senator.
CAPP recognized that asthma morbidity continued to rise among urban, poor and minority populations, such as those served by the Children's Hospital of Philadelphia (CHOP). CAPP sought to demonstrate the potential to improve asthma health outcomes among an inner-city, minority population by providing community-based asthma education and controlling common indoor asthma triggers.
COMMITTED LEADERS & CHAMPIONS--CREATE PROGRAM CHAMPIONS
CAPP has a number of innovative strategies for deploying champions, including recruiting parents to enroll in train-the-trainer courses. When CAPP educators identify particularly motivated parents, they ask them to become peer educators. CAPP trainers conduct a formal teaching session and then the parent-trainees accompany experienced asthma educators on at least five community education sessions where the parents buddy-teach. When the parents are ready, CAPP asks them to lead community education classes. Over the past seven years, CAPP has trained 60 parents through this program and two training program parents are now full-time home visitors on CAPP's payroll.
Let the Data Guide the Program
CAPP knew that asthma health outcomes for minority, inner-city children in Philadelphia were not improving despite the existence of accepted national standards linked to improved asthma care. To help the service population achieve improved asthma health outcomes, CAPP focused on decreasing asthma-related hospitalizations and ED visits by educating children and their families about asthma and methods for identifying and mitigating environmental asthma triggers at home.
Conduct Needs-Based Planning--Seek Input from the Community
CAPP established its program by assembling a large group of partners from the target communities and asking them what they needed and how CAPP could help. By engaging the community from the start, CAPP planted the seeds for a program that would have the support, interest and results it needed to last.
Conduct Needs-Based Planning--Meet Your Community Where It Is
CAPP learned from listening to community input that to make community asthma education programs work for North and West Philadelphia communities, classes for adults and children should run simultaneously so caregivers can avoid child care costs. Also, classes should occur in the evenings on multiple days of the week to account for people who work night shifts. Classes should be delivered in English and Spanish at several locations, such as schools, churches and local YMCAs, that are accessible by public transportation.
Collaborate to Build a System that Will Last
CAPP looked for potential partners who might help to deliver the program. "If you're addressing a real need, you will be able to find local partners who want to address it as much as you do," said Dr. Tyra Bryant-Stephens, CAPP's Program Director. "We come to the table alone most of the time and try to find other interested parties--faith-based organizations and community-based organizations. Often, we find partners already providing community services in the area and we coordinate with them for service delivery." For example, to deliver services in North Philadelphia, CAPP partners with Habitat for Humanity, the local YMCA and the school district to reach out to children with asthma and their caregivers.
HIGH-PERFORMING COLLABORATIONS--COLLABORATE TO BUILD CREDIBILITY
As CAPP prepared to spread its effective model for asthma care, the program's leaders moved into new areas by first seeking out established organizations, local leaders and local knowledge. This allowed them to tailor their asthma care model to the particular needs of their target communities and to resource their program by establishing close ties to partners willing to help deliver CAPP's program.
TAILORED ENVIRONMENTAL INTERVENTIONS-- EDUCATE CARE TEAMS ON ENVIRONMENTAL MANAGEMENT
CAPP trains home visitors, or community health workers, with exceptional relationship management skills to allow them to work closely with inner-city families to educate them about common indoor environmental asthma triggers and strategies for reducing trigger exposure at home. The relationship skills are key because the asthma home visitors need to be welcome in people's homes if they are to make home environmental management a reality for children with asthma.
Evaluate Program Implementation
CAPP's leaders knew that collecting data and demonstrating results were critical, so they built in quantitative measures to track health outcomes and qualitative measures to track how the program's work is accomplished. To capture data, CAPP spends a significant amount of time training home visitors to collect data on the home environment and patient health and quality of life. The training was critical, according to Dr. Bryant-Stephens: "You have to plan for good data collection--garbage in will mean garbage out. So, we train our home visitors. To ensure that our program was actually promoting improved environmental management, we had to train our home visitors to use the assessment forms consistently. All visitors had to respond the same way to the question, 'is the home carpeted?' when they saw a throw rug. To achieve that level of understanding, we started by simplifying our forms to include only the essential data. Then we scripted every question and worked with our home visitors to review the forms, item by item and to practice providing answers. Because we invested heavily in preparing our home visitors to capture evaluation data, we can now use the data to reliably assess the impact of our program."
Use Evaluation Data to Demonstrate the Business Case
CAPP collects hospital and ED data from providers in West Philadelphia and from CHOP; there are fewer barriers to getting the data in that region. In North Philadelphia, where it is harder to get data, CAPP relies on self-reported data collected by the home visitors, as well as medical records with caregivers' permission. CAPP uses the data to assess the impact of its efforts to educate the community, improve home environments and coordinate care with local providers on the goal of improving asthma health outcomes in underserved communities. CAPP staff also use the data in presentations to potential funders to demonstrate how they do their work, what their work achieves and the progress they are making toward reducing the burden of asthma in inner-city Philadelphia.