Asthma Action Plan for Chicago: Addressing Asthma in Englewood

Institutional partners: University of Illinois at Chicago, School of Public Health (UIC)

Medical partners: La Rabida Children's Hospital; St. Bernard's Hospital Pediatric Van; Holy Cross Hospital, Mobile C.A.R.E. Foundation, and providers in the community; City of Chicago Englewood Health Clinic

Community-based organizations: Safer Pest Control Project (SPCP); West Englewood United Organization; Children’s Home and Aid Society (CHASI); Teamwork Englewood; Chicago Asthma Consortium (CAC); Pastors of Englewood

Member organization: Illinois Chapter of the American Academy of Pediatrics (ICAAP)

The Englewood community in Chicago is located 7 miles south of downtown Chicago, west of Hyde Park, covering 20 street blocks from north to south and 22 street blocks from east to west

• Englewood has 85,504 residents, 97.8% of which are African American.
• 38% of Englewood's residents and almost 50% of its children are living below the poverty level.
• In 2003, 471 violent crimes and 924 non-violent crimes were reported per square mile.
• Asthma deaths in Illinois are the highest among African Americans in the US, while asthma related hospitalizations in Englewood and West Englewood are among the highest in Chicago- 60.2 and 71.1 respectively per 10,000 people in 2002- more than double Chicago's average of 31.6.
• Environmental challenges include the Dan Ryan Expressway, with a daily vehicle load of 300,000 running through the neighborhood and the recent reconstruction of this expressway.

Within the four year grant, Addressing Asthma in Englewood seeks to:

• Increase surveillance of asthma, enhance education about the disease, and improve access to appropriate medical management
• Develop long-term sustainable infrastructures to maintain reduction in asthma morbidity
• Establish a multi-factorial model for addressing pediatric asthma in urban settings

Objective 1: Improve access to and quality of asthma health care services for children

• Offer Zeitz Problem Based Learning training programs for community-based health care providers and hospital based health professionals to promote evidence based clinical care following NAEPP guidelines
• Form a medical network of area providers to guide strategy and create cohesion
• Provide Get in the Zone training to hospital based health providers
• Link children with asthma and asthma related symptoms with appropriate health care through case management by Community Health Educators using the Yes We Can model.

Sample process/outcome measures: decrease in symptoms and increase in knowledge among children enrolled; ncrease in appropriate use of controller medications

Objective 2: Improve knowledge about asthma among affected individuals and the general public and make schools and communities more asthma friendly

• Survey children using the Brief Pediatric Asthma Screen and deliver Open Airways for Schools in all elementary schools and high schools in the area
• Educate school personnel on asthma education and management through Asthma Management training
• Work with schools to improve indoor air quality by implementing Integrated Pest Management trainings and evaluating indoor air quality.

Sample process/outcome measures: # of children educated with OAS and Asthma Management and knowledge gained; reduction in missed school days; decreased ED usage and hospitalization of children

Objective 3: Promote asthma-safe home environments

• Community Health Educators will conduct home visits with families and perform environmental assessments, help with cost effective remediation, referrals for social services and smoking cessation and assistance with asthma care follow up.
• Offer smoking cessation clinics in traditional and nontraditional settings.

Sample process/outcome measures: # of referrals and quit rates for smoking cessation; # of households making air quality improvements; # of missed school days and parents’ work days

Objective 4: Develop long-term sustainable infrastructures to maintain reduction in asthma morbidity

• Improve awareness of how to improve air quality in schools by implementing a modified Tools for Schools, and by working with school building engineers to implement other asthma friendly interventions
• Recruit and involve community members in asthma related policy and advocacy activities.
• Through project advisory councils and outreach efforts, strengthen linkages among institutions and individuals to address the needs of children with asthma 

Sample process/outcome measures: # of referrals among schools, clincis and social service organizations

Addressing Asthma in Englewood is implementing a case management model based on Yes We Can, in which the Community Health Educator (CHE) visits the family at home for asthma education, trigger remediation and to ensure that the family has access to quality care.  In one particular family, the CHE discovered through a home visit that the child with asthma did not have a rescue inhaler, and that the family was unsure about the difference between controllers and relievers.  After educating the family on the different kinds of medications, the CHE encouraged the family to see their physician, and then followed up with the physician.   Soon after, when the family went in to see the physician, the child was unknowingly in the midst of a severe asthma-flare-up and was able to receive appropriate treatment.  Through the work of Addressing Asthma and Englewood, this family avoided an acute asthma episode and was able to access quality asthma health care services.