Responding to Asthma as a public health problem

1
Responding to Asthma as a public health problem

• Partnering to develop and implement a countywide
  asthma plan to improve the quality of life for
  people with asthma
• Erica L. Fishman, MSW, MPH
• Karen A. Monsen, PhD, MS, RN Debra
  L. Lee, BA, LSN, PHN

2
Washington Co. Dept of Public Health and
Environment

• The story begins One public health nurse with a
  passion for improving the quality of life for
  people with asthma mobilized a public health
  department.

3
Where Does Asthma Fit?

• Asthma is a growing public health concern but
  where does it fit in the context of a local
  public health program?
• It is a disease that crosses many programs
  family health nursing, disease prevention and
  control, elderly and disabled case management,
  health promotion, environmental health, WIC,
  EPSDT, and administration.

4
Who Are Our Partners?

• Centers for Disease Control and Prevention
• Minnesota Department of Health
• American Lung Association

5
Theoretical Frameworks

• CDC asthma program framework
• Minnesota State Asthma Plan Strategies for
  Addressing Asthma in Minnesota
• Public Health Interventions Document
• Public Health Core Functions

6
CDC components of an asthma program

• Partnerships
• Interventions
• Surveillance
• Communication
• Evaluation
• Sustainability
• Program Drivers Data and disparities

7

• CDCs National Asthma Control Program supports
  the goals and objectives of Healthy People 2010
  for asthma to reduce the number of deaths,
  hospitalizations, emergency department visits,
  school or work days missed, and limitations on
  activity due to asthma

8
Minnesota Department of Health (MDH) Asthma
Program

• Funding from Centers for Disease Control and
  Prevention (CDC)
• Planning grant awarded October 1999 for 3 years
• Developed state specific strategic plan
• Implementation grant awarded October 2002 for 5
  years Addressing Asthma from a Public Health
  Perspective

9
(No Transcript)
10
Core Functions of Public Health
Core Functions of Public Health

• Assessment
• Policy Development
• Assurance

11
Assessment Activities

• In November of 2005, the Washington County Public
  Health and Environment Asthma Work Group was
  formed to define their departments role in
  responding to asthma as a public health problem
• Comprised of representative from each Department
  team
• Also included representation of the Minnesota
  Department of Health Asthma Program and the Metro
  Asthma Coalition

12
Gaps Identified and Addressed

• Gaps identified in areas of general knowledge,
  health practitioner knowledge, community
  resources available, and environmental assessment
  capacity.
• The department addressed these gaps using
  existing environmental health staff, community
  health staff, and allocation of "seed" funding

13
Policy Development Activities

• Engaging Partners
• The efforts of the Department in turn engaged a
  broad and expanding network of partners to
  participate in disseminating best practices for
  asthma management, and leveraged additional
  resources from public and private entities to
  expand the reach of these efforts.

14
Coalition Partners

• Department environmental and community health
  staff,
• school nurses from five school districts,
• Lakeview Hospital Physicians,
• Pediatric Home Services,
• Minnesota Department of Health,
• Minnesota Asthma Coalition,
• East Central Minnesota Asthma Coalition,
• Minnesota Environmental Initiative-Project Green
  Fleet,
• WIC,
• EPSDT staff,
• people with asthma or their family members

15
Public Awareness

• Public Service Announcements
• Webpage
• Worksite Health Promotion flyers
• Displays specific to audience

16
Assurance Activities
Training the Workforce

• Provided training to 65 staff from community and
  environmental health to ensure a basic
  understanding of asthma and environmental
  factors
• A certified asthma educator (AE-C) who is skilled
  at providing home environmental assessments
  conducted an all-staff in-service

17
Managing Asthma in Minnesota School Personnel
Trainings

• For school nurses, health assistants, or anyone
  providing asthma care to students

18
www.winningwithasthma.org

• Promoted online asthma training to 500 coaches
  with Minnesota Department of Health tracking and
  conducting evaluation

19
Professional Education

• In collaboration with Minnesota Asthma Coalition
  and American Lung Association of Upper Midwest
  held a Asthma for Busy Pharmacist training
• Met with local physicians to make aware of the
  initiative
• Provided information on asthma at provider
  meetings

20
Child Care Trainings

• Presentations to day care and foster care
  providers by University of Minnesota and Bethel
  University nursing students.

21
Environmental Interventions

• Home visits, environmental assessments, asthma
  action plan promotion and products to families in
  need supplies and education to school nurses

22
Indoor Air Quality Management Plan

• State law requires school districts to develop
  Indoor Air Quality (IAQ) Management plans.
• IAQ training for Environmental Health Staff
• Training and technical assistance to school
  districts
• Environmental Walkthroughs of all school
  buildings to identify potential asthma triggers

23
Retrofitting School Buses

• Minnesota Environmental Initiatives (MEI)
  Project Green Fleet retrofitting school buses to
  reduce diesel emissions
• 23 school buses to be retrofitted South
  Washington County MN School District 833
• Blue Cross Blue Shield grant to retrofit
  Headstart buses
• Plans to retrofit County trucks and heavy
  equipment

24
Evaluation

• Positive Health Outcomes One of the goals of
  the project is to develop a method to use the
  Omaha system to measure community based asthma
  initiatives. The Omaha System is a
  research-based, comprehensive and standardized
  taxonomy designed to enhance practice,
  documentation, and information management.
• The home intervention component will be evaluated
  by collecting baseline and post intervention data
  on a variety of factors including
  hospitalizations, emergency department visits,
  missed school days and Quality of Life
  indicators.

25
Moving forward

• A hopeful ending to our story School
  nurses, coaches, day care providers, and families
  report that were Catching Our Breath now, in
  Washington County, Minnesota

26
For more information

• Erica Fishman
• Minnesota Department of
• Health Asthma Program
• Golden Rule Building
• 85 East 7th Place
• P.O. Box 64882
• Saint Paul, MN 55164-0882
• 651-201-5899
• erica.fishman_at_health.state.mn.us
• http//www.health.state.mn.us/asthma

• Karen Monsen
• Washington County Public
• Health and Environment
• 14949 62nd St. N.
• Stillwater, MN 55082-0006
• 651-430-6697
• karen.monsen_at_co.washington.mn.us
• http//www.co.washington.mn.us/info_for_residents/
  public_health