East Harlem Asthma Center of Excellence

Introduction

Asthma is one of the most common chronic diseases in children, affecting more than ten million people in the United States. It is also the main cause of morbidity in the adult population. In the early 1970’s, the United States and several other countries such as the Great Britain, New Zealand, and Australia began to experience the alarming increases in asthma-related deaths. While there were significant advancements in medical therapy and an excellent understanding of the disease, mortality, and morbidity related to asthma, have continued to rise in the last three decades. Epidemiological research evidence from recent studies suggests that the rising trends have affected the population unequally, with prevalence rates rating as high as 25% in some communities (CCHED, 2000, p. 2). Self-reported Africa-Americans, Puerto Rican ethnicity, and high poverty rates are the main risk factors for asthma in the US. These disproportionalities affect children of color and those from low-income neighborhoods. The inequalities are mostly brought up by factors such as the differences in the quality of housing in the different neighborhoods, exposure to pests at home, the environment, as well as the ability to access quality health care services (Matsui, 2016, p.16). Most of these factors are related in certain neighborhoods in New York such as East Harlem.

Asthma in children is characterized by hyper-reactivity and irritation of the air passageways when exposed to specific factors, including cigarette smoke, air pollution, and psychological factors such as violence and stress. Most of the common symptoms of this illness include shortness of breath, wheezing, and in some cases coughing. Asthma is the leading cause of school absenteeism for children. In addition, parents or those tasked with caring for such children may end up missing work. An asthma attack can result in ED visits, admission to hospitals and may even lead to death in extreme cases. Appropriate asthma management necessitates controlling and avoiding elements that may trigger an attack, efficient management of symptoms, as well as a proper use of medicine.

East Harlem is a low-income region in New York City predominantly occupied by the Hispanic community and African-Americans. It has one of the highest asthma hospitalization rates in the US standing at ten times more than that of the entire New York City. Children who are living in East Harlem experience high rates of ED visits and hospitalizations related to asthma. In the last three years, the rate of hospitalizations for asthma-related cases have been more than two times among children between the ages of five and twelve in East Harlem as compared to those in the rest of New York City (Afzal, 2016, p.12). Relatedly, so has been the case of asthma-related EDS.

In 2008, The New York Department of Health committed itself to serving children living in East Harlem affected by asthma through the foundation of the East Harlem Center of Excellence. Back then, among children between the ages of five and fourteen, East Harlem had the highest rates of hospitalizations and ED visits related to asthma in New York City. Besides, East Harlem has the highest rates of asthma-related cases; children in the region also experienced many social challenges and inequalities. For instance, almost half of the children between the ages of five and twelve lived in poverty. Moreover, one would only stock 8% of the household items which was the third lowest in New York as such living families would do less when it came to maintaining their houses. In such cases, they lived at the mercies of their landlords. This is evident since 20% of the homes back then had more than three maintenance deficiencies with one out of every two housed having cockroaches (Corburn & Porte, 2006, p.170).

The East Harlem Asthma Centre of Excellence is a place-based program comprised of multiple components all designed with the aim of addressing asthma at all levels. The components include the Harlem Asthma Network, the Asthma Counselor program, environmental services, outreach, and education, as well as the research and evaluation. EHACE has established partners aimed at reaching children of East Harlem in all settings and thus having a presence in the community (Center, 2000, p. 6). Moreover, any community member is allowed to freely walk in the center and inquire about any asthma-related services. The center has also established relationships with schools within the neighborhood whereby school nurses refer children who have issues with asthma in their program. The center’s asthma counselors are highly professionals trained to address all clinical factors related to asthma. The counselors are also social workers, hence they are not only able to tackle clinical factors related to asthma, but also can tackle the social factors associated with the disease. One of their core points of focus is the prevention of asthma symptoms as well as teaching appropriate and effective asthma management.

EHACE has reduced children absenteeism in school due to asthma-related reasons. Before the implementation of the program, most children who had asthma in East Harlem would miss an average of two to three days per week. After the center was opened, it is evident that absenteeism in school related to asthma significantly reduced to only 1 to 1.5 days per week (Afzal, 2016, p. 44). However, the statistics used to get the average rate of absenteeism has several barriers since it is not specific to asthma-related school absenteeism or specific to EHACE program. All the same, the most important fact is that the program has significantly reduced the rate of school absenteeism related to asthma.

EHACE has also played an essential role in improving the community’s quality of life. There has been a significant drop in the mortality rates in children as well as a decrease in the reported exacerbation symptoms.

Indeed, this HIA was conducted from September to November 2017 by:

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Despite several challenges in assisting children affected by asthma in East Harlem, the EHACE program has several positive outcomes. Data from the New York Department of Health Epi Data Brief currently indicate that, the Asthma Counselor Program has managed to reach more than 1400 children between the ages of five and twelve. Most of these children are either Latino or Black with almost half of them living in public housing. Worth noting is that 85% of the children are born and live in East Harlem. Since the program was incepted back in the year 2008, more than five hundred children have graduated from the center.

When it comes to asthma control, the HIA has had several exciting results. For instance, parents of students who graduated last year reported that the average times their child had coughing, shortness of breath, or wheezing had reduced by half, that is from 3.4 days to 1.7 days. In terms of the number of times a child was woken up due to the above symptoms, the number of nighttime awakenings reduced from 2.9 to 2.5. Relatedly, the number of times a child missed school due to asthma-related reasons decreased significantly, hence reducing the days spent out of school due to asthma. Also, the number of times that a parent or a child’s caregiver misses work due to their children experiencing the symptoms also reduced significantly (Corburn & Porte, 2006, p.18). Finally, the number of EDs and hospitalizations among school children in East Harlem related to asthma also decreased.

The HIA outline highlights the main elements of the paper. In particular, it will discuss

• The prevalence of Asthma in East Harlem for children aged between five and twelve years.

(Reviewing District 4 and 11)

• Amount of ED visits for children with asthma exacerbation
• The days missed school due to reasons related to asthma
• Days parents/caregivers miss work due to asthma-related issues in their child
• Education system provided by EHACE both to parents and children

Recommendations

Despite the fact that EHACE plays a vital role in assisting children living with asthma and their parents, there is always a place for improvement. As such, the center should improve on some of the programs as recommended below. To begin with, the DOH should have more public information on EHACE statistics. This will help in making appropriate inferences on the correlation between asthma and other factors related to the disease.  For instance, the department should include the correlation between school absenteeism and symptoms of asthma exacerbation.

Follow up Visits With Graduates

The program should ensure that children who graduate from the center are followed up for a specified period until the child’s parent or guardian and the asthma counselor are satisfied that the right steps are being followed. It would be of no essence for a child and parent to go through the whole program and then fail to follow up and find out whether the program is of any benefit. The center’s counselors should make sure that the children and their parents attend at least semi-annual seminars to see the progress they are making. By so doing, the center will manage to pick out children whom they think require extra assistance as well as commend those who have managed to go through the process.

Interdisciplinary Education on Asthma Prevention Following CDC protocolshere

Research has demonstrated that interdisciplinary education would play a huge role in the management and prevention of chronic diseases such as asthma following CDC protocols. All school nurses should have a comprehensive review of the disease and should work hand-in-hand with the center. As such, this will link the schools with the programs in a more convenient way as the nurses will be able to communicate much often with the counselors in the center. For instance, in a case where a nurse may experience some difficulties attending to a child, he/she may refer the child to the center (Matsui, 2016, p. 66). Moreover, the interdisciplinary education will enable them to familiarize themselves with the services offered at the center and as such give the same services in their places of work which, in this case, is the schools’ health centers. Such nurses will make efforts to create a safe and supportive environment for children with asthma.

Following the CDC protocols, the nurses will be able to establish and support systems for children affected by asthma in their respective places of work. They will also be able to provide school health and mental services such as counseling services for students with asthma. Such nurse will also make sure that the schools in East Harlem play their role of providing a safe and healthy school environment aimed at reducing asthma triggers. Finally, they will be able to coordinate the efforts of the family, school and the entire community to effectively manage asthma exacerbation symptoms and reduce school absences among students with asthma.

EHACE Should Send Stats to DOH Monthly or Every Six Months

It is recommendable that EHACE sends stats to the Department of Health after every six months. As earlier discussed, this will enable the DOH to have the most recent data on asthma in school children between the ages of five to twelve in East Harlem. Therefore, the department will get to know the important factors related to the disease such as the area or schools with the highest rate of absenteeism due to asthma and act accordingly (Corburn & Porte, 2006).

With the above recommendations, EHACE will go a long way in decreasing the effects of asthma to all the parties involved. The number of school days missed by children with asthma will reduce and as such the children will have a smooth learning process. Besides, the number of working days missed by parents or guardians of children with asthma will also reduce giving them enough time in their workplaces. The number of ED visits for children with asthma exacerbation will also decrease. Finally, the education system offered to parents, and the children will also be more efficient and successful.