Past Home-Based Services Demonstration Projects
Using the MDH model for delivering asthma home-based services, these projects demonstrated that low-cost targeted interventions decrease daytime and nighttime symptoms as well as asthma patients' functional limitations, and utilization of health services. Home-based services also increased school attendance for those enrolled in the projects and an overall improvement on quality of life measures. In addition, these projects resulted in a positive return on investment by keeping children healthy and out of the emergency room and hospital.
These demonstration projects included partners from the Bois Forte Band of Chippewa, and local public health agencies (LPH) in Anoka, Dakota, McLeod, and Ramsey Counties as well as the cities of Minneapolis, and Bloomington.
Project 1: Reducing Environmental Triggers of Asthma Home Intervention (RETA) 2004-2006
MDH partnered with Pediatric Home Service (PHS), an independent home health agency, to conduct a U.S. Environmental Protection Agency grant-funded project. RETA provided 64 families with family-specific asthma education and appropriate materials to minimize or eliminate exposures to environmental allergens and irritant triggers of asthma. Home services were provided by a Respiratory Therapist who was also a Certified Asthma Educator (AE-C) from PHS.
Observations by PHS included:
- Some children were on the wrong asthma medication; for example one child was using a rescue inhaler 6 times a day, when the child really needed a daily controller inhaler.
- Asthma Action Plans (AAPs) are a powerful tool but they were not routinely available in the home making it more challenging to access and utilize the plan.
- Home services empowered families to advocate for themselves to work with their landlords to address their rental housing issues.
The most common products supplied to participants were air cleaners, vacuum cleaners, and pillow/mattress covers. The most common environmental concern was secondhand smoke with nearly half of the children (48%) regularly exposed. This project explored the hypothesis that by addressing environmental factors at home through inexpensive, uncomplicated interventions, the quality of children's lives - through fewer hospitalizations, fewer emergency department visits, and fewer missed school days - can be enhanced. MDH also sought to demonstrate potential cost savings to health plans by providing these in-home environmental interventions.
Project 2: Communities Reducing Environmental Triggers of Asthma (CRETA) 2008-2009
The CRETA project was a follow-up to the RETA project. The primary difference between the two projects was the use of public health nurses instead of a respiratory therapist/certified asthma educator for the in-home asthma education, home environmental assessment and placement of allergen-reducing products in the homes. The communities in which these interventions were offered also differed from those in RETA.
The MDH Asthma Program received a grant from the Beverly Foundation to expand the RETA project to different geographic areas (one urban and one rural LPH agency) and cultures (tribal). Two public health agencies (Bloomington, McLeod County) and Bois Forte Tribal Government implemented asthma home services based on previously successful RETA interventions. Staff from each agency completed an asthma educator course provided by the American Lung Association in Minnesota. Pediatric Home Service (PHS), conducted field training for each agency, who then accepted and screened program referrals, scheduled home visits, conducted the home assessments, provided asthma education, and collected data on behalf of their agency.
Key lessons learned from the CRETA project include:
- Community buy-in is necessary to be successful at carrying out recruitment efforts.
- More time to allow for relationship-building and evaluation was needed.
- Identifying children with asthma and maintaining a referral stream can be challenging since children in these communities are cared for by a wide network of providers that may not engage in regular communications with public health agencies.
- There were challenges in purchasing, storing, and assembling vacuum cleaners and other allergen reducing products.
Patient recruitment was a major challenge for the CRETA project due to a lack of community connection and an extremely short project timeline due to the funding criteria. Despite these challenges, CRETA provided 35 children with patient-specific asthma education and a environmental assessment, with allergen-reducing products provided when needed. CRETA showed promising results but needed more time to show its true capabilities in the varied communities.
Project 3: Reducing Environmental Triggers of Asthma (HUD-RETA) 2012- 2014
Following the CRETA project, MDH received a 3-year grant from the U.S. Housing and Urban Development (HUD) focused on providing home-based services to children with asthma living in Section 8 multi-family housing. HUD-RETA provided an opportunity to replicate and expand upon past successful intervention projects.
The objectives of the project included the following:
- Reducing or eliminating environmental triggers of asthma in the home
- Improving health outcomes for children with asthma; and
- Improving asthma self-management skills through in-home education
By serving as a technical support and mentoring resource, the MDH Asthma Program aimed to increase the number of local public health staff trained to provide in-home asthma education, medical management, and to conduct environmental assessments for asthma triggers found in the home.
MDH partnered with local public health agencies in Anoka, Dakota, and Ramsey Counties and the cities of Minneapolis and Bloomington. Through this project, over 200 enrollees were provided with asthma education and environmental home assessments which included providing families with allergen-reducing products when needed.
HUD-RETA emphasized the value of partnering with established community-based organizations. MDH also partnered with WellShare International, a Minneapolis non-profit health organization that works to reduce health disparities by reaching underserved communities. WellShare Community Health Workers (CHWs) helped by identifying and recruiting families who had children with asthma living in the Riverside Plaza public housing complex. CHWs were particularly valuable in making connections with families in this neighborhood, as many had limited English language skills. Those connections built trust in the community and increased understanding of who would benefit the most from asthma home-based services.
Demonstration project challenges and successes:
Each of these projects had challenges but all were successful in reducing symptoms of asthma and reducing the number of school and/or work days lost due to asthma. Each project also resulted in a positive return on investment (ROI) demonstrating that not only can asthma home-based services improve the quality of life for children, and their families, but financially, these services are cost effective.
RETA , CRETA, and HUD-RETA helped build capacity to provide asthma home-based services by training and connecting public health nurses with clinic and hospital systems. Through newly forming colloborations and partnerships, some agencies continue to create referral pathways and processes with clinics and providers in their community. In many cases, the clinic or hospital had little to no connection or interactions previously with LPH. These projects provided the groundwork for further collaboration between community based health systems and LPH.
- Asthma: Home-Based Multi-Trigger, Multicomponent Environmental Interventions - Children and Adolescents with Asthma. The RETA project was identified by the Centers for Disease Control and Prevention (CDC) as an evidence-based project and results from RETA are included in the CDC’s Community Preventive Services Task Force’s body of evidence to recommend.
- Health Risks of Secondhand Smoke - MDH Tobacco Prevention and Control
- Secondhand Smoke - Center for Disease Control and Prevention (CDC)
- Smoke-Free, Tobacco-Free Places: Housing - Public Health Law Center
- Smoke-Free Public Housing: Healthier and Safer Living for Minnesotans
- Minnesota Clean Indoor Air Act