1. Implications and Limitations The Asthma H.E.L.P. program demonstrates that an asthma management program can be integrated into the casework process of a community agency in which social workers have received asthma education. Such an integrated program impacts the process of care with regard to the usage of asthma action plans, bed covers, and long term controller medications. It also appears to decrease the use of emergency department visits and hospitalizations, reducing the cost of care for families and third party payers. These implications are limited by the inconsistency of findings between sites and cohorts, the small sample sizes, and the inability of social workers to use the checklist consistently at all visits. Annual cohorts of approximately 60 children at two sites of a community agency receive visits throughout the year. The population includes children in two St. Louis inner-city areas whose parents sought assistance through the community agency. Information is gathered about their behavior at each visit by an asthma-educated social worker through a detailed checklist, and their quality of life through the annual administration of a Juniper Scale. Three years of data have been collected. Dependent variables include: (1) use of the emergency room (ED), (2) use of a hospital, (3) use of a controller medication, (4) presence of an asthma action plan, (5) presence of a bed cover and (6) the Juniper Scale. The intervention, Asthma H.E.L.P., provides families with support in the home setting regarding health care and asthma, environmental triggers, and suggestions for prevention of asthma episodes, ED visits, and hospitalizations. Support is accomplished through home visits, advocacy, and related casework, but also through support groups and educational opportunities. Analysis compared percentage differences in dependent variables across three visits for each site, cohort, and those who completed or failed to complete the checklist. As it was difficult to control the content of individual visits by the social workers, data was analyzed from the two perspectives of site and start date with Asthma H.E.L.P. We analyzed data with chi square tests and estimated odds ratios for the six key Asthma H.E.L.P. outcome variables. The Asthma H.E.L.P. intervention significantly impacted the process of care and the use of health services but not Juniper quality of life scores. There was increased use of asthma action plans, bed covers, and long term controller medication for both sites and cohort 1. Site A created Asthma H.E.L.P. and implemented it for several years prior to contact with the CASL project, and had better results generally than Site B. The impact of the program appears to result from the use of the checklist across visits rather than the completion of the checklist. In sum, the program is affecting the asthma management behaviors of children and these behavior changes have translated to significant reductions in ED and hospital use but not improved quality of life. St. Louis Regional Asthma Consortium http://www.asthma-stlouis.org Asthma H.E.L.P. (Health Care, Environment, Learning, Prevention) is Catholic Charities Community Services’ (CCCS) outreach and casework program to support families with children and adults who have asthma. CCCS is an agency of the Archdiocese of St. Louis. Implementation of Asthma H.E.L.P. was expanded as part of the Controlling Asthma in St. Louis (CASL) project, a component of the Controlling Asthma in American Cities project (CAACP) instituted by the Centers for Disease Control and Prevention (CDC). Support is accomplished primarily through home visits and related casework but also through support groups and educational opportunities provided at two agency sites. Asthma H.E.L.P. provides support to families struggling to survive in poverty where the primary concerns are obtaining and maintaining shelter, food and utilities. Staff efforts are directed toward aligning asthma with the other critical issues in family life. Conclusion Acknowledgements The project was funded through a cooperative agreement with the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services under program announcement 03030. Background Study Design and Analysis The study assesses the effects of a community agency intervention, Asthma H.E.L.P., on asthmatic children’s process of care, health services use, and perceived quality of life. Research Objective Statistically significant improvements occurred between the first and third visits for the combined populations of sites A and B in the use of asthma action plans (p=.001) and the use of bed covers (p=.03). Emergency department visits due to asthma declined for the combined population of sites A and B consistently across visits (p=.03). For both sites, children at the third visit are almost 6 times less likely to be hospitalized due to asthma. At Site A, no child is hospitalized due to asthma by the third visit. Long term controller usage increased significantly (p=.04) for the combined population between the first and the third visits with 54% of children using a long term controller at visit 3. For children in cohort 1 (both sites), there was statistical significance for the presence of an asthma action plan (p=.001) and bedcover (p=.02) between visits 1 and 3. Long term controller usage also increased significantly for cohort 1 between visits 1 and 3. Emergency department visits and hospitalizations due to asthma declined consistently across visits for cohort 1and cohort 2 with no children going to the hospital or ED at visit three in cohort 2. For children with persistent asthma, 68.2% are on a long term controller (p =.01). Only 12.6% were hospitalized due to asthma. 43.4% of children with persistent asthma have an asthma action plan. Yearly Juniper quality of life scores for sites A and B improved consistently but not significantly (site A, 5.27, 5.40, 5.87; site B, 4.35 to 4.46). Quality of life scores for cohort 1 were inconsistent and not significant (4.90, 4.86, 5.32). Scores for cohort 2 decreased significantly; however the n for the final year (n = 20) was small (5.35, 4.47). Principal Findings ² Asthma H.E.L.P.: Assessing the effects of home visits by asthma-educated social workers on children’s health outcomes Richard S. Kurz, PhD,¹ Mary E. Homan, MA,² Sharon M. Homan, PhD,² Kristin D. Wilson, MHA,² Michelle Sunshine-Hankins, MSW, LCSW,³ Jamie Saunders, MSW 4 Contributors’ Institutions University of North Texas School of Public Health, Fort Worth, Texas Saint Louis University, School of Public Health, St. Louis, Missouri Catholic Charities Community Services at Midtown, St. Louis, Missouri Catholic Charities Community Services at St. Jane Center, St. Louis, Missouri