&EPA
United States
Environmental Protection
Agency
CASE STUDY: Children's
As an organization committed to safeguarding human health and the environment—and in response to the
growing asthma epidemic—the U.S. Environmental Protection Agency (EPA) launched a national, multi-faceted
asthma education and outreach program. As one part of this program, EPA supports performance-based asthma
in-home intervention pilot programs through Community Based In-Home Asthma Environmental Education and
Management Grants. EPA is committed to highlighting program successes through a series of case studies. This
case study—the first in the series—is intended to offer providers, health insurers, public health departments,
community-based organizations, and others with an overview of an asthma in-home intervention program.
Community (CAPP)
CAPP services primarily low-income, urban communities by providing community-based education, training, and
environmental interventions. The goal of CAPP is to decrease asthma-related hospitalizations and emergency room
visits by educating children and their families about asthma and about methods of identifying and mitigating
environmental asthma triggers in the home. The asthma in-home intervention program, described below, is a
component of CAPP's study program which evaluates environmental triggers of asthma and methods of mitigation
in the home.
What Are the Components of CAPP's Home Visitor Program?
* In-home asthma education * Mitigation of environmental triggers « Patient monitoring
• Home visits for 12 months • Symptoms diary * Follow-up referrals
* Educational materials
How are Patients and their Families Recruited?
CAPP identified approximately 100 patients between the ages of 2-16 years through CHOP's primary care center
patient database. Patients were identified tor CAPP recruitment it one hospitalization or two ER visits were
reported one year prior to the inception ot the program.
Who Conducts the Home Visits?
Lay health workers who are trained by the hospital as home visitors conduct the visits.
What Happens During a Home Visit?
Home visits are comprised of two main categories: asthma education and environmental interventions.
During the 12-month period, each family is asked to keep a diary or journal tracking a child's asthma symptoms
and medications.
Home visits are conducted weekly for 5 weeks with 1-2 follow-up visits per month for up to a year.
Education
Home visitors teach families in-depth about asthma, as well as how to:
• control a child's asthma, • identify environmental asthma triggers
* identify asthma symptoms (e.g., wheezing, shortness (e-g- environmental tobacco smoke (ETS), pet dander,
of breath) mold, cockroaches, and dust mites), and
• use asthma medication and devices.
Environmental Intervention
Home visitors show families how to reduce common indoor asthma triggers in the child's bedroom and other
places in the home as needed. The home visitors recommend relatively low-cost and low-technology interventions
that each family may easily incorporate into their lifestyles in order to reduce exposure to asthma triggers. This
may involve incorporating trigger-reducing products such as mattress and pillow covers and shades, as well as,
removing stuffed toys, clearing clutter and removing open bookshelves.
(over) Air and Radiation 6609J
EPA-402-F-02-035
December 2002
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Children's Hospital of Philadelphia (CHOP)
The following table outlines the education and intervention visit schedule.
TABLE 1. HOME INTERVENTION AND EDUCATION
Visit Education Intervention
First visit
Second visit
Third visit
Fourth visit
Fifth visit
Last visit
* Pre-tests completed to establish a baseline
on family's basic asthma knowledge
* Asthma as a disease
• Signs and symptoms of an asthma attack
• Review of medication
• Common indoor asthma triggers
(cockroaches, dust mites, mold, pet dander,
and ETS)
• Avoidance techniques
• In-depth review of asthma medications and
devices
• Medicine Action Plan
• Review of medication and devices
• Question and answer session
•Consent form signed agreeing to participate in the program
•Home assessment completed
•Roach and mice bait given with instructions on proper use
•Other methods of pest control discussed
•Dusters, mattress and pillow covers given with instructions on
proper use
•Other methods of pest control discussed
•Carpet removal or vacuum bags given
•Cockroach and pet dander avoidance techniques
•Sponge and buckets provided along with demonstration of proper
method to wash baseboards
•Trash bags, shades and shade brackets given (to reduce dust
from blinds)
4
e
How Much Does it Cost to Enroll in the Program?
CAPP provides supplies to conduct the initial intervention and follow-up and spends approximately $120 per
family enrolled in the program. This includes education materials, home assessments, and a portion of materials
necessary to implement the recommended interventions. For example, to support recommended interventions,
CAPP may contribute $30 toward the purchase of a vacuum cleaner. CAPP does not, however, fund installation costs.
How Are the Home Visits Evaluated and Monitored?
CAPP uses several criteria to evaluate and monitor the home visits. For example, CAPP tracks the child's:
• asthma symptoms
• hospital and/or emergency room admissions
* medicine use, and
• maintenance of environmental intervention.
In addition, CAPP tests pre- and post-intervention asthma knowledge.
In addition to teaching families about asthma and supervising asthma trigger removal in the homes, home visitors
are also required to document each visit in a paper chart. CAPP has implemented a system to monitor and review
patient records to look for common problems, at which time the problem can be addressed before data are entered
into the database. CAPP also provides individualized follow-up, such as referrals to social services or contacting the
primary care provider, based on findings during the home visits.
How Are Outcomes Measured?
Hospitalizations, emergency room visits, and other quality of life indicators are being tracked to demonstrate
outcomes resulting from implementation of in-home interventions.
For more information on EPA's asthma program, please visit: http://www.epa.gov/iaq/asthnia
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