2018

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.

The Pediatric Asthma and Allergy Clinic (PAAC) at the Children’s Health Center (CHC) at Zuckerberg San Francisco General Hospital (ZSFGH) is located in the Potrero Hill neighborhood of San Francisco, California. Created in 1999 in response to San Francisco’s unusually high pediatric asthma hospitalization rates, PAAC soon became the first subspecialty clinic housed within the CHC at ZSFGH. Over the years, PAAC has grown to provide comprehensive asthma and allergy care, case management, and focused education for families across San Francisco Department of Public Health (SFDPH) clinics. It also participates in asthma research efforts through its affiliation with the University of California, San Francisco (UCSF). A reflection of its surrounding community, the PAAC population is approximately 62 percent Latino, 18 percent black and 12 percent Asian, with a strong presence of immigrant families from diverse ethnic backgrounds.

As a university-affiliated public hospital serving low-income Hispanic/Latino and African-American children, ZSFGH PAAC was selected by Yes We Can: Creating an Urban Asthma Partnership to develop a comprehensive medical/social model for pediatric asthma care housed within the CHC primary care medical home. This partnership placed community health workers (CHWs) in the center of health care delivery and became the foundation of PAAC clinic services, which have grown to include legal consultation, behavioral health support and housing advocacy.

PAAC aims to provide patients with culturally sensitive and evidence-based asthma and allergy care while treating these patients and working with their families in the context of their environments. The program emphasizes individualized treatment and education, case management and family support, and home and school trigger reduction. The ability to provide quality wraparound services is due in large part to PAAC’s committed staff of physicians, nurse practitioners, nurses, CHWs and community partners. As the clinic has grown, PAAC’s CHWs have spearheaded outreach efforts to the most vulnerable community groups. To increase asthma knowledge and improve access to care, the CHWs provide trainings to foster care parent groups, daycares and schools, public health nurses, and local community organizations. PAAC also is a site of robust research in asthma prevention and intervention through its affiliation with UCSF and SFDPH.

All of PAAC’s efforts have paid off, yielding a 40 percent reduction in asthma hospitalizations in a review of data from 2015 through 2016. Qualitatively, there are many indicators of positive asthma outcomes. The number of caregivers able to appropriately describe controller and rescue medication use, as well as escalation of dose and when to seek appropriate emergency care, during a follow-up phone call at the 2 week interval has increased.

PAAC is increasingly involved in the support and development of local legislation benefiting children with asthma. In the past year, PAAC has contributed to important legislation, including a ban on smoking in public housing and a current bill to allow Medicaid reimbursement for CHWs during home visits and education. PAAC continues to advocate for environmental and social policies that promote a healthy community and a reduction in asthma prevalence.