1. MJ Harris/BCHD/NACCHO presentation/January 2004 The Baltimore City Health Department’s Childhood Asthma Program Presented to: the NACCHO MCH Emerging Issues Conference January 22,2004

2. MJ Harris/BCHD/NACCHO presentation/January 2004 Components of the Childhood Asthma Program Four aspects  Baltimore Asthma Surveillance System  Home Visiting Program  Community Outreach and Education  Coalition building

3. MJ Harris/BCHD/NACCHO presentation/January 2004 Two Components to be discussed Today Baltimore Asthma Surveillance System (BASS)  Started in 2000  Analyzed data from 1993-1998  Databases used: Maryland HSCRC/collaboration with community partners(eg.academic institutions) Home Visiting Program  Model developed and implemented in 2001  Referral base established  Methods used to promote ‘By- in’ of new community partners  Establishment of enrollment policies procedures including Open ended enrollment

4. MJ Harris/BCHD/NACCHO presentation/January 2004 The BASS/History  The original data compiled from existing data sources  Indicators included: hospitalization rates, emergency department rates, demographics  Spanned period from 1993-98  Compiled by BCHD in conjunction with NASA, U Maryland, Johns Hopkins and others

5. MJ Harris/BCHD/NACCHO presentation/January 2004 Elements Guiding Decision for Characteristics of Dataset  Feasibility:How “do-able” is it?  Uniformity  Validity  Non-duplication  Economy  How retrievable is the data?  Can it be collected on an ongoing basis

6. MJ Harris/BCHD/NACCHO presentation/January 2004 Goals/Concerns/Focus of the Surveillance System  Prevalence  Incidence  Etiologic factors  Measurement of disease severity: disease burden

7. MJ Harris/BCHD/NACCHO presentation/January 2004 What is our ultimate goal for the BASS?  To discern factors affecting in order to make an impact  To guide population and individual interventions  To diminish disease burden

8. MJ Harris/BCHD/NACCHO presentation/January 2004 Home Visiting Program  Under Bureau of Child Health and Immunization/Division Maternal Child Health  Funded since FY 2000 by Title V block grant  One of four components of overall program  No overlap with other components

9. MJ Harris/BCHD/NACCHO presentation/January 2004 Home Visiting Program  Key aspects:  Individual assessments and interventions  Three separate assessment instruments utilized, Household Asthma Screening Survey, Nursing Assessment, and Quality of life Survey  Partnering with community collaborators  Education, follow up

10. MJ Harris/BCHD/NACCHO presentation/January 2004 Home Visiting Program  This is a service to the community  Referral focuses on the child and the entire family unit and includes all factors affecting the child’s disease process/holistic approach!  Follow up is key  Links to other existing community partners are of primary importance

11. MJ Harris/BCHD/NACCHO presentation/January 2004 Childhood Asthma Home Visiting Program Client Focus   Symptom control   Medication compliance   Recognition of triggers   Trigger control   Use of spacers and inhalers

12. MJ Harris/BCHD/NACCHO presentation/January 2004 Home Visiting Program Issues for Outcomes Measurement  Severity of disease, baseline and ongoing  Symptom days and medication usage  Nature of emergency department visits  Scores on Quality of life instrument

13. MJ Harris/BCHD/NACCHO presentation/January 2004 Home Visiting Program/other considerations for success  Buy in’ of primary caregivers  Contact with medical providers  Higher ‘maintenance’ families need higher level of intensity, very individualized approach  Children not dropped from program until over age, move from city, or unable to maintain contact

14. MJ Harris/BCHD/NACCHO presentation/January 2004 Contact Information  Mary Jo Harris, RN, MS Coordinator Childhood Asthma Program, Baltimore City Health Department Maryjo.harris@baltimorecity.gov 410.361.9645