The publication A Community Guide Task Force
, a systematic literature review, recommends the use of home-based, multicomponent, multitrigger environmental interventions for children with asthma.28
According to the community guide, these interventions are thought to effectively reduce symptom days, improve quality of life or symptom scores, and reduce school absences. Although the community guide publication was unavailable during CAAC planning and implementation, staff from all CAAC sites recognized that such a FHAS intervention was needed to effectively reach and engage urban children with asthma and improve their health. While sites delivered FHAS differently, depending upon the resources in each community, each included additional nonenvironmental components, such as asthma self-management, social services, or coordinated care.
Enrolling clients in services was a challenge faced by all CAAC FHAS interventions. As each program matured, it needed to expand beyond its originally identified referral partners. When the actual number of clients fell short of initial estimates, sites had to add new referral partners, redefine contracts, and expand recruitment activities. They found that not only marketing and recruitment but also partnerships with clinical and community groups were essential for enrolling clients into the programs.
Each FHAS intervention applied a holistic approach to home-based care, often affecting the entire family by improving housing conditions and empowering the primary caregiver through increased access to care and links to additional social services. This holistic approach benefited persons with asthma in many ways, especially by linking them to, or in some instances establishing, their clinical care. By facilitating communication with healthcare providers, these links helped to integrate and coordinate asthma-care services.
Although the development of the CAAC FHAS programs preceded the release of the Expert Panel Report 3 (EPR-3) of the National Asthma and Education Program,29
many of their approaches address specific recommendations in the report’s home management guidelines. These programs provide successful real-world examples of the translation of the EPR-3 guidelines into asthma care in the community setting.
Each CAAC program effectively designed and implemented FHAS activities despite the many differences among sites. Institutionalization of components of these activities has been successful and will be sustained beyond the CAAC’s life cycle. What the CAAC sites have learned by offering FHAS to their communities provides a unique perspective for others, especially those coalitions or programs wishing to plan and implement similar activities to reduce childhood asthma morbidity.