Innovative strategies to engage urban school systems in evidence-based interventions and asthma care coordination: The Philadelphia Merck Childhood Asthma Network (MCAN) experience

Background: The Philadelphia MCAN Project has developed a school-based asthma program that integrates evidence-based interventions (EBIs) with case identification and care coordination for public school children with asthma.

Purpose: To examine strategies for overcoming barriers to implementing large-scale asthma interventions in the urban public-school setting.

Significance: Despite the fact that asthma remains a leading cause of school absenteeism nationally, there are few EBIs that address asthma in the school setting. Significant barriers to school-based program implementation can limit the development and propagation of new evidence-based models. More discussion of strategies to overcome these barriers is needed.

Methodology: Case study analysis coupled with process and outcome data from an intervention targeting 16 Philadelphia School District schools located in 4 sections of Philadelphia.

Findings: Initially, the Philadelphia MCAN Project experienced barriers to program implementation including: lack of engagement on the part of staff, faculty, students and parents; scheduling challenges due to competing educational priorities; and limitations set by administrative staff. The MCAN project instituted innovative strategies to address these barriers such as more personalized and flexible programming, a new incentive structure, a nurse-based partnership, and the institutionalization of school responsibilities. As a result, case identification response rates increased from 36% in the first three target schools to 70% in the three final schools.

Conclusions: Building relationships, identifying barriers, and addressing them in collaboration with school staff greatly increases likelihood for success. Lessons learned from this intervention can be helpful to others implementing asthma EBIs and public health programs in schools.