Project Descriptions:

Alameda Alliance Asthma Fair

Health and Environmental Resource Center (HERC)

Oakland Children's Hospital Emergency Department

Primary Care Asthma Education Clinic at Children's Hospital of Oakland

San Francisco Asthma Task Force

Vallejo Public Awareness Campaign

The Yes We Can Urban Asthma Partnership in San Francisco

Updated 10/28/00, Yes We Can Urban Asthma Partnership in San Francisco

THE YES WE CAN URBAN ASTHMA PARTNERSHIP IN SAN FRANCISCO

YES WE CAN received a three-year grant from The California Endowment to scale up state-of-the-art asthma treatment in our county's health safety net. The members of the YES WE CAN Partnership include San Francisco State University, City College of San Francisco, the San Francisco Department of
Public Health and its Community Health Network, the Bayview/Hunters Point Healthy Start Collaborative, the Citywide Asthma Task Force Collaborative,
the San Francisco Health Plan, Kaiser Permanente, the Mission Neighborhood Health Center, the American Lung Association and the Regional Asthma
Management and Prevention Initiative (RAMP).

The first phase of this effort will take place at the Children's Health Center at San Francisco General Hospital, which saw almost 700 asthmatic children from the southeast side last year. The YES WE CAN pilot launch date is scheduled for September 4, 2000. Our community health team model will use a four-pronged strategy:

1. Clinical Case Management: A health team composed of a clinician, clinical care coordinator and community health worker (CHW) will guide each child with asthma through a care pathway. This insures standardized approaches, quality health education, early intervention and close
   follow-up. Clinical care coordinators are registered nurses or other health professionals. They coordinate the team, provide an initial two-hour one-on-one family education session, and fast-track family access to the clinician and medications.
2. Community Health Workers (CHWs): Children live with asthma not in the doctor's office, but in their homes and communities. The CHW on the team will provide wrap-around social services, helping the family reduce asthma triggers in the home; reinforce health education; provide language translation when needed; contact the school; troubleshoot barriers in insurance eligibility, transportation and the like. To promote community economic development, CHWs will be certificated at City College of San Francisco and placed in an existing career and educational pathway. An important objective of the three-year grant is to help build the evidence base for the US health system to permanently employ CHWs as full members of health teams. We contrast this with models that deploy health workers as
   offshore adjuncts who are not integrated into the clinical team. Initially CHWs will work in English and Spanish with later expansion into using
   Cantonese.
3. A Computerized Asthma Registry/High-Risk List: Kaiser Permanente is serving as a model as we develop a computerized Asthma Registry that flags warning indicators that asthma is unstable. The health team uses these "red flags" in two ways: First, to case-find children who require proactive intervention; second, to give clinicians and provider groups feedback on their practice patterns in real time. Through provider education and practical support to health teams, we will reduce the percent of patients who appear on the Asthma Registry/High Risk List.
4. Policy and System Change: While it is common in the literature to aim interventions at changing family/patient behavior, much of the change we
   need is in the behavior of institutions and systems. For example, most health insurance covers hospitalization and treatment, but not essential prevention supplies. YES WE CAN will help organize a one-stop shop for prevention supplies and supportive services and gather evidence to change current policy. More broadly, we hope to collaborate with the CDC and
   others to implement an Asthma Report Card in which providers go on record on how they are improving the implementation of National Institutes of Health clinical guidelines.
   

YES WE CAN is actively fund-raising to expand this model to neighborhood clinics on the southeast side, including Silver Avenue Clinic, Southeast Health Center, Mission Neighborhood Health Center, Maxine Hall Health Center and the Family Health Center at San Francisco General Hospital. We also intend to expand the model to adult asthma and the other "Big Five" preventable chronic diseases such as hypertension and diabetes.

Updated 10/28/00 - YES WE CAN Urban Asthma Project

The YES WE CAN Urban Asthma Project pilot intervention at San Francisco General Hospital's Children's Health Center has begun. The pilot is based out of the Pediatric Asthma Clinic (on 6M) and includes the following components: clinical case management; home visits by community health workers to reinforce health education provided in the clinic and to assist families with environmental audits to reduce triggers in the home; and, a computerized asthma "high risk" list to identify uncontrolled asthma among CHN's pediatric patients. Identified cases of uncontrolled asthma will be referred to the asthma specialty clinic and the YES WE CAN intervention. We have hired one full time community health worker for the pilot, Arthur Hill, who has a strong background in information and referral in the African American community. We are currently hiring an additional community health worker who is bilingual/bicultural in Spanish.

Vicki Legion, Community Health Works of San Francisco

DEVELOPMENT OF THE SAN FRANCISCO ASTHMA TASK FORCE

The San Francisco Collaborative has been working for years to identify best practices, resources and programs that can be used to help manage asthma. The collaborative is a large network of providers, advocates and programs working together to help educate and inform communities on practices and tools that may provide for optimal management of asthma. The steering committee of the collaborative was recently formed in response to a call for a citywide Asthma Task Force by Supervisor Alicia Becerril in 1999. The steering committee is currently drafting the legislation to officially create this task force.

Members of the collaborative represent all of the various asthma activities in the city. For example, these programs include several pilot programs that were brought to a Bayview Hunter's Point School, Dr. George Washington Carver Elementary School. After several public hearings and grassroots organizing regarding the impact of the environment on the health of that community and the apparent prevalence of asthma from a community perspective, the Health and Environmental Resource Center was set up in Bayview Hunter's Point with an asthma education and awareness program. Another active participant is The YES WE CAN Urban Asthma Partnership, recently funded to provide improved clinical management. Other programs developed to educate both providers and communities included a presentation to local health centers on asthma management in the primary care setting.

The first event of the collaborative was a community forum/press conference on May 3, 2000 (World Asthma Day) at the San Francisco Main Library. The event was covered by KRON-4, Channel 14 representing the Latino news media, both spent a considerable amount of time with the program interviewing forum participants. A grass roots media-activist with a regular public access station program recorded a portion of the forum that will air on his program. Many educational resources were distributed, including asthma educational videos in multiple languages and a manual of asthma resources in San Francisco. Press conference and forum goals were met.

Goals (outcomes) of the Forum:

• To inform the general public that asthma is a chronic condition that can be managed
• To provide access to clinicians, elected officials, civic leaders that are able to deliver this message to care providers of people with asthma in all communities
• To provide resource tools to the general public to assist them in asthma management in the form of a directory and informational kit.

Supervisor Alicia Becerril, representatives from Senator Burton's office, Congresswoman Pelosi's office, and Governor Gray Davis' office were present. Prior to the event, Supervisor Becerril read her proclamation into the record at the regular Board of Supervisors meeting. On May 3, 2000 Proclamations were received from the S.F. Board of Supervisors, the Mayor's Office, Senator Burton and co-presented by Senator Speier, Assemblypersons, Migden and Shelley. 94 advocates for asthma education and awareness were provided with certificates of appreciation from Senator Burton's office. A very special thanks goes to California Pacific Medical Center and Sherry Sherman, Ph.D. Director of Community Benefits for her support of this event. CPMC provided the wonderful lunch.

Kathy Perry, Kaiser

ALAMEDA ALLIANCE ASTHMA FAIR

The Alliance held its Asthma and Allergy health fair on Saturday, April 29, 2000 at Lake Merritt Park and Garden Center, located 666 Bellvue Avenue in Oakland from 11 am to 3pm. It was a very successful event! We had over seven hundred participants and 40% were Alliance members. We also received notable media coverage from KTVU Channel 2.

The event focused on asthma and allergy education and prevention through interactive learning exhibits, wellness contests and workshops. The educational activities included asthma workshops, to provide education on warning signs of asthma, the nature of the disease, the need for follow up therapy and proper medication and inhaler usage. We had over hundred volunteers including pharmacists, pharmacy students, youth groups, and health educators.

The event was a collaborative effort between American Lung Association, Summit Medical Center's Ethnic Health Institute Asthma Sub Committee,

(Programs continued)

Children's Hospital, Alameda County Public Health Department, Oakland Boys and Girls Club and Dr. Michael LeNoir, Pediatric Allergy Specialist.

The Alliance has received sponsorship from Glaxo Wellcome Pharmaceuticals, Rhone-Poulenc Rorer Incorporated, Wallace Laboratories, Hoeschst Marion
Roussel, Inc. and Pfizer Incorporated.

Zandra Washington, Alameda Alliance

VALLEJO PUBLIC AWARENESS CAMPAIGN

On May 1, 2000, the American Lung Association of the East Bay hosted a news conference in Vallejo for World Asthma Day. The conference was a kick-off to the ALA’s educational campaign, consisting of Vallejo bus ads, radio PSAs and public information packets in English and Spanish. The message to the public is to inform people with asthma that suffering is needless, particularly with new treatments. Part of the impetus for the campaign was data that indicate a high rate of hospitalization for asthma in Vallejo, coupled with survey results from a conference of leading Northern California asthma experts indicating that one-third of medical practitioners do not follow revised NIH guidelines on asthma treatment.

A county transit bus was present at the conference, visibly displaying the bus ads. Also present were children with asthma, Dr. Hal Farber, Solano County Health Department and ALA staff, and a few media representatives. There were several articles generated from the conference and many requests from the general public for the information packets.

Linda Weiner, ALA

OAKLAND CHILDREN’S HOSPITAL EMERGENCY DEPARTMENT

The Emergency Department at Children’s Hospital Oakland is a 17 bed 24 hour center that averages approximately 28,500 visits per year. An estimated 13% of visits are for acute exacerbations of asthma, and an estimated 40% of these visits are among children less than five. The Patelco Asthma Unit was dedicated in February 2000 and will not be fully operational until July 2000. When fully operational, the Unit will operate approximately 12 hours per day. This unit has five beds and is equipped with complete cardiopulmonary monitoring, and an extensive library of patient and parent educational materials. Thus the unit affords the opportunity not only to treat an acute exacerbation of asthma without inpatient admission but also affords an opportunity for parent education and adjustment of outpatient therapy to bring it in line with national clinical practice guidelines, thus addressing two of the underlying causes of acute decompensation - compliance and suboptimal therapy.

Mary Rutherford, Children’s Hospital

Health and Environmental Resource Center - (HERC)

The Bayview/Hunters Point Health and Environmental Resource Center (HERC) officially began its work on November 20, 1999. HERC's mission is to improve the well being of the residents in the Bayview Hunters Point community in addressing the high incidence of asthma, breast, cervical and prostate cancer, and their environmental concerns. Bayview Hunters Point currently bears the burden of San Francisco's hazardous and toxic waste sites for over 150 years. This area contains one-third of the city's hazardous sites with over 700 hazardous sites, 350 underground petroleum storage tanks and two super-fund clean up sites, including the naval shipyard. Many of the residents in Bayview Hunters Point believe that these hazardous waste sites are the result of environmental racism, which can be linked to the high incidence of diseases and poor health among the members of this under-served community. In addition, findings of two important surveys "Condition Critical" conducted by Bayview Hunters Point Healthy Start Collaborative and San Francisco State University "Yes We Can" and the "Community Health Survey" conducted by the Health Environmental Assessment Project/Task Force substantiate the need for a HERC in Bayview Hunters Point. The survey findings indicated that many of the respondents were experiencing an overwhelmingly high incidence of asthma and asthma liked symptoms. HERC is funded by the Department of Public Health to mobilize and empower the members in taking part in participatory community action. HERC's "Breathing Counts Program" provides school-based asthma education, community presentations, workshops and trainings. HERC collaborates with residents, health professionals, community-based organization, primary care provides in order focusing on community empowerment through health education, awareness, promotion, and primary prevention. On August 7-11, 2000 HERC sponsored a one-week summer day camp for children with asthma in conjunction with many of its collaborative partners. The goal of the asthma camp was to dispel myths negatively impacting asthmatic children and families. Students received health education, nutritious breakfast and lunch, literature classes, fitness and much more. Recently, HERC formed a partnership with San Francisco Housing Authority to provide on site health education, resources, and referrals to low income residents.

HERC's Satellite Office is located at Alice Griffith Housing Site, 2 Cameron Way, San Francisco, CA 94124. The Grand Opening/Open House and Celebration will be held on Monday, November 20, 2000. HERC's main office is located at 6301 Third Street, San Francisco, CA 94124. The phone number is 415-467-0254.

Linda Mack-Burch, Bayview Hunters Point Health and Environmental Resource Center

Primary Care Asthma Education Clinic at Children's Hospital of Oakland

The Ambulatory Care Center at Children's Hospital Oakland provides approximately 10,000 primary care visits per year. The majority of patients are insured by Medi-Cal or one of the Medi-Cal managed care plans. A recent survey indicated that 911 of the clinic's patients have asthma. A new development at the Center is a Primary Care Asthma Education clinic. The purpose of the clinic is to provide three consecutive visits of intense asthma education for patients followed in the Ambulatory Care Center. The target population for the clinic includes any child recently hospitalized or seen in the Emergency/Urgent Care Departments for asthma, but may include recently diagnosed or stepped up patients as well. Patients are referred to the Asthma Education Clinic by their Children's Hospital primary care provider. The clinic meets on site at Children's Hospital Oakland Ambulatory Care Center, 5220 Claremont Ave. Currently patients are seen one afternoon a week. Patients have an initial 45 minute visit followed by two 20 minute sessions. The clinic is staffed with a medical assistant, and 2 pediatric nurse practitioners. There is also an onsite pediatrician. At the first visit to the Asthma Education clinic the child is assessed using the NIH Asthma Severity tool. The children and families seen at the clinic receive teaching via a variety of modalities including: hands on models, videos, pictures, interactive games, written materials and traditional one on one teaching sessions. Information covered in the teaching sessions include, basic asthma facts, roles of medications, device and monitoring skills, environmental control measures, and the asthma management plan. There are plans for group sessions during the evenings and/or weekends targeting specific groups i.e. teens, foster care providers etc.

Mindy Benson, Children's Hospital Oakland