Asthma Summit Op-Ed

There is no justifiable reason why the children in our communities should not be able to breathe. The culprit of this suffocation, you ask? Asthma. As if this prospect is not startling enough, the roles of race/ethnicity, poverty, and urban dwelling as risk factors for higher asthma-related morbidity only exacerbate this reality (Milligan et. al, 2016). In the context of our local community, Wards 7 and 8, located in SE Washington, DC have endured this disease burden of childhood asthma for far too long. Ankoor Shah, the medical director of the asthma clinic at Children’s National Hospital in DC, states that childhood asthma “disproportionately affects poor, urban minority children. And the severity is worse, specifically when you think about Wards 7 and 8,” (Baskin, 2019). Additionally, children ages 4-15 in Wards 7 and 8 have some of the highest Emergency Department visit rates for asthma in the district (Children’s National, 2017). Challenged by a multitude of gaps, notably in healthcare access and education, the tool we propose to address this is bestowed in the power of community health workers (CHWs) as community health advocates (CHAs) and supportive student educators (SEs). The implementation of a hybrid model of individualized care helps breathe life back into the asthmatic children in our community.

Our innovative two-pronged approach sits at the heart of meeting patients and caregivers where they are at — combining education, resources, and community in a holistic model to improve care for children with asthma. The first part of this model is centered on the implementation of permanent, full-time CHAs in high-need schools in Southeast Washington, DC. Such CHAs will serve as a powerful tool to link families to resources and educate students on all-things asthma. CHAs will engage the entire school community in ongoing education surrounding asthma: triggers, medication technique and adherence, and exacerbation protocols. With introductions made at parent-teacher meetings, CHAs will serve as a trusted point-person to assist caregivers in obtaining health insurance, help with assistance programs applications, and connect with legal aid for housing concerns. As a permanent employee, CHAs will follow up with caregivers to ensure their successful connection to resources. As asserted by researchers authoring “Community Health Workers: Connecting Communities and Supporting School Nurses,” CHAs are the leaders needed to help schools address complex health challenges (Boldt et. al, 2021).

The hallmark of successful leaders, though, are their support networks, which alludes to the second part of our model: volunteer SEs. The vital work of CHAs will be supplemented by student volunteers and interns lecturing on various educational topics or assisting with resource connection and logistics. Both new CHAs and volunteers will receive training from the Association of Asthma Educators, which organizes their training modules into a high-quality CHA curriculum and Asthma Educator Certification Courses (AAE, 2022).

Furthermore, compensation for full-time CHAs can be paid through governmental grants such as the DC Preventive Health and Health Services Block Grant that funds program areas such as Pediatric Asthma Outcomes and Community Health Improvement Planning (DC DOH, 2021). If additional support is needed, program directors can look toward alternative private and public grants for asthma initiatives as well as appeal to philanthropic foundations.

The final recommendation includes implementing a protocol for continuous evaluation of the proposed two-pronged model. Such evaluative tools can include, but are not limited to, surveys to be filled out by students and families, data gathered on asthma exacerbation rates before and after program implementation, and assessments that accompany each educational module during CHA and SE training.

Fortunately, the CHA model has been widely implemented and proven successful in countless health sectors nationwide. This demonstrates promise in the expansion of the CHA role to reach schools where students suffer the consequences of inadequate asthma healthcare. In fact, according to data posted by the U.S Bureau of Labor Statistics in May 2020, Washington DC had one of the highest Location Quotients of CHWs in the country (U.S. Bureau of Labor Statistics, 2020), indicating that this industry is already deeply established in DC (Emsi Burning Glass, 2020).