Asthma home visits for high-risk pediatric patients with uncontrolled or poorly controlled asthma and recent history of emergency room use, led by a community health worker (CHW), have been shown to be effective in improving asthma outcomes and patient and caregiver quality of life.
In this model, CHWs work as part of the healthcare team to improve communication among patients, their families, and the clinical team, and to assess asthma triggers in patients’ homes. The intervention includes offering several low-cost items (mattress covers, HEPA vacuum, etc.), when needed, to remove the environmental triggers.
The CHW also educates patients and families about asthma self-management and double-checks their understanding of medications, reinforcing the asthma action plan created by the clinical providers. The CHW also helps to assess factors influencing patients’ ability to self-manage their care, advocates with their landlords, and links them to community resources and supports.
CHWs can be located in diverse clinical settings where they are closely integrated into the primary or specialty care clinical team, or they may work in a community-based program. Clinical settings can include community health centers, hospital-based clinics, private pediatric offices, and clinical provider groups. CHWs can be centrally managed for multiple practices. Regardless of where CHW is located, strong communication with primary care providers is a key component to the model’s success.
Training and Technical Assistance for Community Health Workers
The APCP provides a range of training and technical assistance to programs implementing asthma home visiting programs led by Community Health Workers (CHWs). These services are provided free of charge and include:
Program Start-Up Assistance — The APCP offers direct consultation and technical assistance to programs initiating CHW-led asthma home visiting for the first time, or those looking to expand or improve their programs. This technical assistance includes one-on-one consultation to assist programs in overcoming common challenges in implementation and includes strategies to maximize intervention effectiveness and reach.
The Massachusetts Standardized Asthma Home Visiting Toolkit and Protocol Manual
To ensure that CHW home visits in Massachusetts are evidence-based, the APCP has developed a Standardized Asthma Home Visiting Toolkit that encompass protocols, key educational messages, standardized environmental assessments, and standard definitions and outcome measures.
Community Health Worker-led Pediatric Asthma Home Visiting Protocol Manual — coming soon.
In addition to the Toolkit, the APCP provides extensive technical assistance to sites on the implementation of asthma home visiting programs. The APCP currently supports several statewide initiatives in the implementation of this Protocol, including those participating in the Prevention Wellness Trust Fund
Massachusetts Asthma Learning Collaborative — Programs implementing CHW-led asthma home visiting in Massachusetts are invited to participate in a Learning Collaborative focusing on quality improvement in the Institute for Healthcare Improvement (IHI) model. The learning collaborative methodology helps organizations to make sustainable changes in their policies and practices. It closes the gap between evidence-based practice and what organizations and partnerships actually do by creating a structure in which they can learn from each other and from recognized experts to make improvements.
Training: To support the adoption of evidence-based asthma home visiting practices and to meet the expressed needs of Massachusetts insurers to consider payment for asthma home visiting interventions delivered by CHWs, the APCP offers the DPH Asthma Home Visiting Training for Community Health Workers. This training was developed and implemented by the Boston Public Health Commission’s Community Health Education Center, in conjunction with the APCP.
The training includes:
- CHW training — a 4-day training on asthma intervention protocol that includes home visits, environmental assessment, and education on modifiable factors to reduce asthma triggers. Motivational interviewing techniques are also discussed.
- Supervisors’ training — a 1.5-day training to review the CHW home visitor protocol/model and the role of CHWs (includes motivational interviewing).
- Ongoing CHW support — includes quarterly, in-person support meetings.
- Field-based mentoring program for CHWs.
- Observation-based skills assessment of CHWs at the completion of the training/mentoring program.
For more information on the technical assistance available from the APCP, please contact the Division of Prevention and Wellness at Prevention.Wellness@State.MA.US