Puerto Rico Childhood Asthma Network/La Red de Asma Infantil de Puerto Rico

La Red's project area is the Luis Lloréns Torres community in years one and two and the Manuel A. Pérez community in years three and four:   

Luis Lloréns Torres community:
Residents: 8,807 (Covers 83 acres of land in San Juan)
40% of population 18 or younger
79% of population with average yearly income <$10,000
41% crude estimated lifetime prevalence of childhood asthma

Manuel A. Pérez community:
Residents: 5,743
41% of population 18 or younger
84% of population with average yearly income <$10,000
46% crude estimated lifetime prevalence of childhood asthma

Across both communities…(sample of 629 children)
71-80% of all children with asthma had an attack within the past year
45-51% of children had an ED visit related to asthma in the past year
68-71% of identified children do not have regular provider for asthma

(as of 2004)

At the end of the four year grant, La Red de Asma Infantil de Puerto Rico, expects the following:

• To expand, strengthen and broaden the scope of previous interventions conducted by the Alianza Contra el Asma Pediátrica en Puerto Rico’s (Allies Against Asthma in Puerto Rico) by incorporating evidence-based models and new activities in schools and the community
• To serve as a local island model for a community-based health care and environmental intervention that improves childhood asthma outcomes and is sustainable

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

• Adapted Yes We Can treatment protocol provided at the clinic and the home by a “Community Asthma Team” including a primary physician, a nurse, and a community health worker
• Risk assessments (including asthma severity, symptom control, allergic skin testing, and direct evaluation of the home environment)

Sample process/outcome measures: documentation of key lessons and strategies; ongoing review by advisory board; pre/post parent survey at baseline and after 12 months

• “Community Asthma Team” incorporates ICAS home educational and intervention module and provides mattress/pillow covers
• Home-based education to promote environmental control is targeted according to exposures and documented allergies

Sample process/outcome measures: baseline and follow-up survey measures of environmental exposures including home checklist and dust samples 

Objective 3: Make schools more asthma friendly

• Train teachers and school personnel in both housing projects to implement  Open Airways in 4th, 5th, 6th grades to all children

Sample process/outcome measures: number of children and teachers completing asthma trainings

Objective 4: Promote linkage of key stakeholders and integration of services in the community

• Strengthen La Red Advisory Board to promote linkages among stakeholders by recruiting new members
• Strengthen Community Advisory Group in Luis Lloréns Torres by recruiting new members and meeting regularly
• Establish a Manuel A. Pérez Community Advisory Group to ensure successful cultural adaptations and promote engagement of community leaders in implementation 

Sample process/outcome measures: active minutes of meetings including action iems and feedback; list of desired, exisiting and recruited Manuel A. Pérez Luis Lloréns Torres Community Advisory Group members 

Objective 5: Be sustainable beyond MCAN funding

• Develop a revised sustainability plan based on current needs, opportunities, strategies, and incorporate feedback from key players 

La Red de Asma Infantil de Puerto Rico working with the Puerto Rico American Lung Association decided to implement Open Airways in grades 4-6th to all children, not just children with asthma.  The Open Airways curriculum was designed for children with asthma; however, the La Red team felt that the unusually high prevalence rates of asthma on the island as well as the difficulties in identifying children with asthma within the school system warranted this modification to the Open Airways model.    One noteworthy anecdotal success of this modified program model- a child who attended Open Airways at school was able to recognize potential asthma symptoms in his brother.  He informed his mother, and gave her information on La Red.  After an initial clinical assessment, the child was enrolled in the program, and now the family is working together to manage the child's asthma.