Presentation from Terry Mason on the needs assessment that she conducted for the Massachusetts Department of Public Health regarding sustainable asthma home visiting interventions. (Presented at the annual meeting of the Asthma Regional Council of New England on June 13, 2013 in Shrewsbury, MA)

1. Terry Mason, PhD
Independent Policy Research Consultant
Presented at the Annual Meeting of the
New England Asthma Innovations Collaborative (NEAIC)
June 13, 2013

2. Asthma Regional Council N.E. promotes
“Healthy Homes”
Growing evidence cost effectiveness of
home-based asthma interventions
NEAIC Healthcare Innovation model
includes community health worker home
visitors

3. 
READY Study (Reducing Ethnic/Racial Asthma Disparities in Youth):
MDPH, Boston Medical Center, and Baystate Medical Center in
Springfield (funded by HUD/NIEHS)

Model = trained community health workers, multiple home visits
•
assessment of home environmental triggers
•
advice and tools to reduce exposures
•
advocating for improved housing
•
improving communication with health care providers
•
raised expectations of parents

Significant improvement in asthma symptoms, reduction in
hospitalization and ER use

Outcomes consistent w similar studies – Seattle Healthy Homes,
Boston Children’s Hospital pediatric asthma intervention research

4. 
MDPH implemented similar model w CDC funding --Asthma
Disparities Initiative

MDPH partners w numerous organizations around state:
clinicians, CBOs, Boston Public Health Commission engaging
CHWs in asthma home visiting with pediatric asthma patients

If CHW’s “reimbursed” in future, what infrastructure needed to
support their preparation and employment?

Interested payers asked Asthma Program to think more about
CHW training, skill assessment, and identification and
recruitment

NEIAC is supporting a smaller, more focused
assessment with payers in other New England states

5. • How to strengthen and expand availability of
CHW asthma home visitor training?
• Identify methods to assess CHW skill
attainment
• Assess supervision and other institutional
supports needed to promote the success of the
CHW component of the intervention
• Identify feasible methods to assist
payers/providers to locate and recruit asthmatrained CHWs

6. 




Asthma-trained CHWs
Massachusetts CHW training center directors
Health payers, ACO Medical Staff
Online resources
Training & certification programs
◦ Tobacco specialists, substance abuse, nurses

Clinical and administrative supervisors in MDPH
– funded programs

7. 
Overall, positive feedback on training [24 hr classroom, 2 day
refresher course @ 6 months, ongoing support]
• Include more case studies and Motivational Interviewing (prepare
CHWs for diversity in circumstances)
• Include mentorship phase, post-classroom training
• Develop a network of asthma-trained CHW preceptors
• Make CHW core competency training a prerequisite for asthma
training
• Explore hybrid training (in-person plus online) and apprenticeship
(DOL approved for CHW occupation)

8. 
Promote sustainable funding for CHW core
competency trainings
• funders should require grantees pay % $ for training
 Encourage
existing & future community-based CHW
training centers to attain academic credit for
classroom and field trainings
 Explore
circumstances under which providers or
payers (MassHealth) might subsidize CHW asthma
training

9. 
Develop performance-oriented assessments
• Scenarios, case examples written or oral
• Preceptor evaluations
• Final home visit observation check-off
• Develop a pilot to examine feasibility of
preceptor phase and other features of skill
assessment
• Feasibility/logistics of preceptor phase for nonasthma employed CHWs?

10. 
Consider second-tier of MA state CHW
certification for specialized or generalist chronic
disease prevention and self-management skills

Promote with new Massachusetts CHW Board of
Certification (Chap 322, Acts of 2010)

11. Promote Role of
Asthma Teams
• Direct supervisor
relationship key
• BUT – put CHW
role in team
perspective
• Team response
necessary for
desired outcomes
Educate Payers
& Providers
• Distinctiveness of
CHWs (expertise
not primarily
academic)
• Nature of CHW
contribution
(relationships,
communication,
reinforcement,
home environment)
Recruit Thru
Training
Registries
• Encourage MA
CHW regional
training center
database
updates, &
privacy
protection
• Requires
financial
resources

12. 
Ideal is asthma team (including CHW) within
medical/health homes
• BUT not always feasible (#s, $)

Explore community/regional CHW home
visiting collaborative
• Offer supervision, other expertise (T.A.)
• Promote intervention standardization
• Serve as referral agency
• Example: Boston Public Health Commission
• Challenge: integration with medical home

13. 
Recommendations
 Promote coverage for supervision meetings, in addition
to CHW home visiting services
 Ensure asthma home visiting intervention is part of
medical home and ACO initiatives
 Promote, evaluate other intervention models in which
CHWs address multiple chronic diseases or different age
groups

14. NEAIC is interested to learn more about what you are thinking
about the topics presented in this needs assessment, particularly
in financing CHWs for asthma home visiting. Given that each of
the New England states are in different places in this process, we
would like to know:

What questions/thoughts do you have in response to the
findings and recommendations in the MDPH needs assessment?

Do you have recommendations for moving this policy agenda
forward?

Do you have suggestions about questions we may ask
healthcare payers to learn about opportunities and challenges to
promoting the use and financing of CHW asthma home visiting?