1. Coalitions: Integrating Community-Based Asthma Control Strategies Jim Krieger, MD, MPH Bob Groves, MA, MPH Marielena Lara, MD, MPH Kimberly Wicklund, MPH April 2004

2. Concepts of Integration Service coordination –Consistent and coherent services –Linkage and cross-referral among providers Cross-institutional Collaboration –Shared vision –Shared resources –Exchange of data –Coordinated/joint program implementation –United advocacy Multi-disciplinary Collaboration

3. Ladder of Integration Mutual Awareness Cross-Referral Coordinated Action Joint Action Joint program development Coordinated but independent components Independent programs refer clients to each other Programs aware of one another

4. Barriers to Integration Structural –Silos –Staff not available to participate in integration work –Leadership not available to provide direction Cultural and Personal –Doing it your way –Turf and control Logistical –Working out the details –Time for communicating and coordinating Fiscal –Pressures to generate revenues –Competition

5. Overcoming Barriers: Coalitions Bring Together Sectors Safe, neutral space Forum to network and learn Common vision Leadership Coordination of resources

6. Overcoming Barriers: Coalition Steering Committees Primary mechanism for integration Decision-making body of coalition Gathering of organizational decision- makers Champion for integration Strategic planning Collaborative approach to grant-writing and new program development

7. Integrating Care For Individuals Community Health Workers –Link families with schools, childcare, health providers, public housing –Advocate for families for accessibility and consistency of services Care Coordinators –Facilitate access to services –Coordinate services across service providers –Back-up CHWs Individual Asthma Action Plans

8. Philadelphia Link Line

9. Care Coordination/Case Management Fight Asthma Milwaukee ED or clinic notifies care coordinator at local health department Coordinator arranges linkage to appropriate services –Home visits by nurse case manager: –Home visits by health department environmental inspector –Calls to encourage follow-up with medical home –Refer to parent mentor program –Refer to family asthma education –Info about childcare/school asthma education Shared evaluation and educational protocols

10. Integration Across Organizations Community Asthma Action Plan –Summary of shared vision –Developed in a participatory, collaborative process –Defines roles Multiple forums to foster integration –Coalitions as the overarching roof –Cross-project coordination groups –Learning collaboratives for clinics –Joint proposals and projects –Conferences and community meetings

11. Integration Across Organizations Common tools, guidelines and messaging –Single asthma action plan –Shared educational resources and programs –Consistent asthma control protocols and guidelines –Consistent key asthma messages

12. Integration Across Organizations: Sharing Data and Information Health Plan Data –Utilization/Registries –Pharmacy ED Data –Utilization Provider Data –Utilization/Registries

13. Integration Across Organizations Coordination of Asthma Policy/Advocacy Better Housing –Breathe Easy Units Cleaner Air –Diesel Reimbursement –Community Health Workers –Chronic disease management –Asthma education

15. Fight Asthma Milwaukee

16. Future Directions Policy and advocacy Bringing to scale Sustaining integration

17. To conclude: Integration doesn’t come easily but there are effective strategies to help get there. Paths to integration will vary by community and must fit the local landscape.