Noreen M. Clark, Ph.D. Myron E. Wegman Distinguished University Professor Director, Center for Managing Chronic Disease University of Michigan DETROIT.

Noreen M. Clark, Ph.D.Myron E. Wegman Distinguished University ProfessorDirector, Center for Managing Chronic DiseaseUniversity of Michigan

DETROIT HEAD START ASTHMA PROJECT:DETROIT HEAD START ASTHMA PROJECT:“An Intervention to Improve Asthma

Morbidity and Asthma Health Care Use Among Low-Income Urban Preschool

Children”

This study was funded by the Center for Disease Control and Prevention: Community-Based Participatory Prevention Research. #R06/CCR521533-01

Head Start 9th National Research ConferenceJune 23-25, 2008

Belinda Nelson, PhDPresenter/Project Director

Background:

• Asthma is the most prevalent chronic condition of childhood

• Children most affected by asthma are low-income minority children who live in large cities

Prevalence of Asthma and Asthma AttacksAmong Children 0-4 Years (2001-2003)

Source: National Surveillance for Asthma—US, 1980-2004, MMWR, October 2007/Vol.56/No.SS-8, DHHS, Centers for Disease Control and Prevention

Health Care Utilization for Asthma

Source: Morbidity and Mortality Weekly Report, October 2007/Vol.56/No.SS-8, DHHS, Centers for Disease Control and Prevention

Why Focus on Head Start?

• Based on demographic profile: Head Start children are at high risk

• Few interventions focus on the youngest children with asthma

COMMUNITY PARTNERS

• Detroit Department of Human Services

• Detroit Henry Ford Hospital

• Six Detroit Head Start Agencies

Hartford Southeast

New St. Paul Vistas Nuevas

United Children and Families

Order of the Fishermen

DETROIT HEAD START STRUCTURE

Grantee

Delegate Agency

Content Area Coordinators

Agency Director Clerical Staff

Family ServiceWorkers

Center Admin.Teachers

Support Staff (cooks, etc.)

PURPOSE

The primary purpose of the project was to engage Head Start personnel and families in efforts to improve the management of asthma symptoms among children enrolled in Head Start and to develop a program that specifically addresses the needs of this population.

OBJECTIVES

• Identify Head Start children with asthma• Provide training for Head Start staff in

asthma management• Provide educational information for

Head Start families• Evaluation of the intervention and the

collaboration• Dissemination of findings for community

partners and Head Start families

Screening and Recruitment

Asthma Health Screening

(n = 3254)

Children identified with asthma symptoms

(n = 888)

Baseline Interviews

(n = 675)

Continued on Next Slide

Intervention and Follow-Up

Physician Led:

Comprehensive Asthma Management Training Session

Asthma Educators:

Continued Training and Support

Head Start Educators and Staffn=175

Parents receive assistance with asthma management

(Educational handbooks, presentations, help from Head Start staff)

Follow Up Interviews

(n=487)

Criteria Used to Identify Children with Active Asthma Symptoms

Summary CriteriaDiagnosis & Symptoms

Diagnosis and 1+ symptoms any number of days in past yr.

Diagnosis & Prescription

Diagnosis and prescription

Non-Exercise Symptoms

3+ non-exercise symptoms, each 5+ days in past yr.

Exercise Symptoms

2 exercise symptoms, each 5+ days in past yr.

Nighttime Symptoms

Nighttime symptoms 3+ times per month

Source: NAEPP Guidelines

Asthma Prevalence Among Detroit Head Start Children

Characteristics of Children and Caretakers in Detroit Head Start Asthma Project

Final Sample(N=487)

Child Characteristics:Age 3.9Female (%) 56.0

Ethnicity %African American 85.0Hispanic/Latino 6.0Other 9.0

Diagnosed w/ asthma 67.1Rx for asthma 74.3

Primary Caretaker %Relationship to child: Mother 88.7 Father/Grandmother 10.2

Continued on Next Slide

Educational Level of

Caretaker

%

<High School 16.6

High School/GED 36.6

Voc/Tech /Some College

37.0

College Degree/Adv Degree

9.8

Annual Household Income

%

<5,000 15.3

5001 – 20K 40.1

20,001 – 40K 25.5

>40K 19.1

Characteristics of Children and Caretakers in Detroit Head Start Asthma Project

Asthma Severity Status

Annual Symptom Days

Asthma Attacks

Asthma Health Care Utilization

Intervention Control

Baseline Follow-Up

Baseline

Follow-Up

Caretaker ever asked doctor about asthma(%)

73.0 85.2 .000 79.5 84.1 ns

Doctor/Clinic Visits #

3.26 2.33 .006 3.05 2.82 ns

Continued on Next Slide

Intervention Control

Baseline%

Follow-Up%

Baseline%

Follow-Up%

≥ 1 ED Visits 43.9 31.3 .000 37.7 24.6 .001

≥1 Hospitalizations

15.2 9.0 .006 11.5 5.7 .031

Asthma Health Care Utilization

Caretaker Level of Confidence in Head Start

(1=not at all confident, 2=not too confident, 3=somewhat confident, 4=very confident)

Intervention, 3.47

Intervention, 3.57

Control, 3.61

Control, 3.37

3.25

3.3

3.35

3.4

3.45

3.5

3.55

3.6

3.65

Baseline Follow Up

p=.082 p=.010

Intervention

Control

Summary:

• Children in the intervention group experienced significant improvement on two measures of asthma morbidity: symptom days and visits to the doctor

• Intervention caretakers showed an increase in help-seeking behavior by asking the doctor about asthma

• Intervention caretakers demonstrated a significant improvement discussing their child’s asthma with Head Start personnel

• Intervention caretakers were more likely to identify Head Start as a source of knowledge and support for asthma management

Lessons Learned

• Development of “buy-in” and community trust was a lengthy process

• Teaching staff have many existing demands that competed with project goals

• Establishing proficiency in screening for children with asthma prior to asthma management training is beneficial

What Was Helpful?

• Maintaining flexibility in setting time lines to assist Head Start achieved goals

• Identification of Head Start personnel who were highly motivated

• Working with Head Start on activities other than asthma (e.g. community health fair, Health Advisory Committee)

• Encouraging the peer-relationship with Head Start staff in decision-making