Implementing Community Health Worker Models: A Bottom-Up Approach to Improving Pediatric Asthma Care

The Problem: Pediatric Asthma Disparities

Childhood asthma is a serious and costly public health concern. One out of every ten children in the U.S. is affected by asthma, making it the most common chronic childhood disease (CDC, 2013). Unfortunately, children with the highest rates of asthma are living at or below the federal poverty level (12%), and often their families do not have the financial or educational resources to obtain high quality, culturally sensitive healthcare (Forno and Celedon, 2012; Rossier Markus and Artis, 2011). Barriers to obtaining quality asthma care include low literacy levels on health, limited access to culturally competent care, and lack of health insurance.  In addition, children living with chronic conditions are significantly driving up U.S. healthcare costs. The Environmental Protection Agency reports that asthma accounts for $56 billion of annual healthcare spending, including direct medical costs from hospital visits and indirect costs such as lost school and parent workdays (EPA, 2012).

The Solution: Implementation of Community Health Worker Models  Screen Shot 2016-02-10 at 10.48.56 AM

One promising solution to combatting the prevalence and rising healthcare costs associated with pediatric asthma is the utilization of Community Health Workers (CHW) in high poverty and marginalized communities. A CHW, defined as a “frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served,” serves as a liaison between the patient and health/social service agencies (APHA, 2015). CHW models enhance individual and community capacities by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy (Sinai Urban Health Institute, 2014). 

The Affordable Care Act recognizes CHWs as integral members of the healthcare
workforce, particularly for their role in Screen Shot 2016-02-10 at 10.49.09 AMlinking clinical and community resources for patients and their families. One of the most important features of CHW models is that they utilize a bottom-up approach to improving care delivery and patient outcomes. CHWs strengthen already existing ties and relationships with community networks, as they generally reside in communities where they work and understand the social context of their patient’s lives (CDC, 2015).

CHWs are closely involved in the on-the-ground implementation and day-to-day operations of pediatric asthma CHW models. Oftentimes CHWs are responsible for conducting home-visits with patients and their families, helping to review medication use, assessing home environments to identify and reduce common asthma triggers, offering educational asthma management techniques and resources, and attending healthcare appointments with families. In some cases, CHWs serve as an advocate in other community settings (e.g., schools, child-care providers, housing authorities); other times CHWs are members of a structured healthcare team. Given their ability to reach community members at a relatively low cost, CHW models have been proposed as a cost-effective means for improving care coordination and improving health outcomes among low-income families.  A key challenge to integrating CHWs into service delivery and payment systems is a general lack of understanding among providers and policymakers about the potential roles and responsibilities of CHWs, effective techniques for sustainability of CHW models, and improved healthcare and social costs associated with the CHW model (California Health Workforce Alliance, 2011).

Community Health Worker models are an important community-based strategy to improve pediatric asthma health outcomes, increase access to culturally competent healthcare, and reduce healthcare costs. The establishment of an infrastructure for a CHW workforce, including appropriate funding and training opportunities, is critical to educating and providing culturally competent asthma care for risk children and their families, as well as reducing the prevalence of asthma in particularly vulnerable communities.

Jessica Levin Rittner
MPP/MBA ’16
Children, Youth, and Families Concentrator

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