Steps to Better Breathing: A Home-care Approach to Managing Childhood Asthma in Vulnerable Populations in a Steps to a HealthierNY County

Steps to Better Breathing is a low-cost, successful approach to improving asthma management and minimizing exposure to triggers in children aged 0-18. Based on best practices, the program consists of three home visits by a Certified Home Health Aide or Nurse Practitioner. It is offered in four languages, English, Spanish, Creole, and Yiddish, in order to reach Rockland County's diverse populations. To evaluate the program, children over the age of five and their parents are surveyed at visit 1 and visit 3 using two evaluation tools; one assesses knowledge and comfort in managing asthma and the other measures asthma control during the past two weeks. Results from the first two years of the program were analyzed using two-tailed paired sample t-tests. Respondents (n=85) demonstrated significant positive changes on items related to understanding of their asthma (all items on the parent survey and 6 of 9 items on the child survey). In addition, respondents reported significantly reduced inhaler use, sleep disruption and activity limitation in the previous two weeks. Results indicate that a home-based asthma education program can significantly improve asthma management among high-need children, which has been shown to reduce emergency room use and unplanned doctor visits. Due to its success, the program has been adopted by a local Medicaid Managed Care plan, extending the program's ability to reach underserved populations. Strategies for evaluating and ensuring sustainability of home-based education programs will be discussed.