detroit head start project an intervention to improve asthma morbidity
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Detroit Head Start Project: an intervention to improve asthma morbidity Noreen M. Clark Center for Managing Chronic Disease University of MichiganTRANSCRIPT
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