Community in Action

Omaha Healthy Kids Alliance (OHKA) is a children’s environmental health organization dedicated to improving children’s health through fostering healthy homes. OHKA developed the Asthma In-Home Response (Project AIR) program to serve children ages 18 and younger who have an asthma or asthma-related diagnosis.

Project AIR’s mission is to help reduce in-home hazards for children with asthma in the Omaha metropolitan area. By reducing in-home hazards, AIR works to improve the quality of life for children with asthma and their families by educating them on indoor environmental asthma triggers, empowering positive behavior changes, connecting them with low-cost supportive solutions, and supporting them by providing free construction services. Project AIR aims to reduce emergency department visits and hospitalizations resulting from pediatric asthma, decrease symptomatic days, improve quality of life for children and their families, and increase productivity by reducing asthma-related missed school and work days.

OHKA serves a population that is disproportionately affected by specific health outcomes and faces additional socioeconomic barriers that often take precedence over the intended Project AIR intervention. Most families in Project AIR tend to identify as Black/African American, with the second most frequent racial self-identification being Latino/Hispanic and the third most frequent group being Caucasian. The average household income of Project AIR clients is about $26,000, and the average age of houses that Project AIR families live in is 75 years old. OHKA has a wide network of community partners that assist families with challenges not directly related to their health. Assistance includes help with landlord-tenant disputes, rental assistance, job placement and food pantries. OHKA’s work is successful because of the collaborations and partnerships that have been established to assist in reducing barriers for families enrolled in Project AIR so that they are able to focus on health-related interventions.

OHKA’s Project AIR leverages key partnerships with WellCare of Nebraska (part of the managed care organization, WellCare® Health Plans, Inc.), Children’s Hospital & Medical Center (Omaha), and Boys Town National Research Hospital’s Allergy, Asthma, Immunology and Pediatric Pulmonary Clinics. In addition to formal partnerships, Project AIR provides an assigned asthma case manager, and in-home visits are performed by two OHKA staff who are trained in environmental management and asthma education. After the initial visit, each family receives a Healthy Home Report that is developed by the visiting team. This report includes a description of the home, identified home hazards, low-cost solutions, results of environmental testing and construction, and scopes of work. This document can be shared with physicians, if requested and approved by the family. In addition to a customized environmental supply kit, families often are referred to community organizations for legal and employment services or food pantry access.

Project AIR evaluates the program performance outcomes under four criteria: severity of asthma, quality of life, environmental health of the home, and behavioral changes. To assess how and where the program can be improved, Project AIR also examines internal measures, such as cost per intervention, cost of supplies, follow-up rate and dual-enrollment rate. After 12 months, Project AIR noted a significant decrease in symptomatic days, fewer missed school days, fewer emergency room visits and hospitalization rates, and a decrease in medication usage. Additionally, an evaluation of Project AIR return on investment showed for every $1 invested in a family and their home, a $1.83 return was made.

Project AIR integrates a collaborative approach to asthma intervention and diverse funding sources to create positive change in the Omaha metropolitan area. The program’s success has introduced new partnerships and improved outcomes throughout the asthma community.

Housed within the Rhode Island Department of Health, the mission of the Rhode Island Asthma Control Program (RIACP) is to reduce the overall asthma burden and asthma health disparities in the state. The program provides community-based services and interventions for children 17 years and younger with asthma in four high-poverty, urban “core cities” throughout the state, where the burden of asthma is the highest. The burden of asthma also falls disproportionately on black and Hispanic children, children in low-income households, and children living in low-income urban neighborhoods. These children are not only at high risk of developing asthma but also are at risk of having more severe asthma once the disease develops. Among children living in the core cities, the rate of primary asthma hospitalizations was twice as high compared with the rest of the state.

RIACP is well-known for its long-term partnerships with researchers and hospitals, as well as public health, housing, social justice and environmental organizations across the state, including Hasbro Children’s Hospital, St. Joseph Health Center, the Asthma Regional Council of New England, UnitedHealthcare®, and the Green and Healthy Homes Initiative. Additionally, RIACP’s efforts are focused around a collaborative approach with linkages between healthy housing, the health care sector, and other regional collaborations. RIACP’s work to reduce the asthma burden in Rhode Island is critical for developing, evaluating and sustaining the program’s strategies to expand the reach of its comprehensive asthma services. RIACP was recognized by the Centers for Disease Control and Prevention (CDC) for its reimbursement efforts and participated in the CDC’s 6|18 Initiative. Through this national leadership program, RIACP received CDC technical assistance and Medicaid support to develop a business case for the reimbursement of RIACP’s asthma home-visiting initiative, the Home Asthma Response Program (HARP).

HARP is an evidence-based program established in 2010 to address the needs of children with poorly controlled asthma and uses certified asthma educators (AE-Cs) and community health workers (CHWs) to conduct up to three intensive in-home sessions for each child. During these home visits, AE-Cs and CHWs provide tailored educational and environmental services, including an extensive environmental assessment, asthma self-management education, and cost-effective supplies to reduce home asthma triggers. CHWs have reported reductions in environmental triggers, including mold, pests, dust, pets, tobacco smoke and chemicals. In addition, using hospital claims data, the program was able to show a 75% reduction in asthma-related hospital and emergency department costs for HARP participants. For every $1 invested, HARP participants realized a $1.33 return on investment. The program recently expanded to provide HARP home-visiting services statewide for Medicaid-enrolled children.

In 2015, RIACP and partners launched the Comprehensive Integrated Asthma Care System (CIACS) to link home-based, school-based and health systems interventions as one unified package. HARP became one of four interventions offered, in addition to the Breathe Easy at Home Project, Controlling Asthma in Schools Effectively Project, and Draw A Breath workshop program. These interventions have been implemented in the four core cities, and a CIACS Advisory Group—comprising public health professionals, asthma researchers, a nurse, CHWs, and a data manager—works collaboratively on the implementation and evaluation of asthma services. The CIACS Advisory Group is Rhode Island’s first researcher-practitioner partnership to reduce the burden of asthma in children.

RIACP has been successful in serving children with poorly controlled asthma and reducing these children’s likelihood of repeated asthma emergency department visits and inpatient hospitalizations. RIACP also has also built partnerships with local, statewide, regional and national partners to reduce individual- and neighborhood-level disparities in pediatric asthma.

The Community Asthma Prevention Program (CAPP) at the Children’s Hospital of Philadelphia (CHOP) serves low-income and under-resourced communities in Philadelphia, Pennsylvania, which have high asthma prevalence and hospitalization rates. Since its inception, CAPP has focused on fighting these disparities in childhood asthma and providing asthma self-management education in all sectors of a child’s life, including the home, community, school and health care environments.

Medical Director Dr. Tyra Bryant-Stephens leads a staff of 12 that includes a registered clinical nurse, educational coordinators, asthma navigators and lay home visitors. Coordinators oversee the programs and develop connections within the community to teach community asthma classes. The program equips families with asthma self-management education, in-home assessments for asthma triggers, remediation supplies, and connections to community-based resources to improve children’s asthma.

CAPP pursues and maintains strong partnerships to address asthma disparities in schools, homes and the community at large. CAPP’s partners include parents, the public school system, primary care providers, the public health department, managed care organizations and faith-based organizations. Building on this foundation, CAPP is now utilizing community health workers (CHWs) to connect the home, community, school and health care sectors in a research project funded by the National Heart, Lung, and Blood Institute. CAPP’s CHWs are currently among the few nationwide who are reimbursable by health insurance companies.

Twenty years after its founding, CAPP has served more than 4,000 families and conducted approximately 20,000 home visits, primary care education for more than 21 practices, asthma education for numerous school professionals, and school-based student asthma classes in Philadelphia and the surrounding area. The program has reached about 30 percent of the West Philadelphia community’s asthma population. In an evaluation of 2010-2014 data, CAPP’s program success realized a 62% reduction in emergency visits and a 70% reduction in hospitalizations.

The Philadelphia CAPP program’s success has sparked relationships beyond Philadelphia. In 2017, the Pennsylvania Department of Health, a long-time funder, requested that CAPP expand its reach to the city of Pittsburgh, Pennsylvania. Although this project is in the initial phase, stakeholders are confident that the CAPP model will have positive outcomes within this new target area.

The significance of CAPP’s work afforded the director the opportunity to participate in a roundtable discussion with President Barack Obama on climate change and public health in 2015.