Multisystemic Therapy to Reduce Health Disparities in Adolescents With Asthma

Although rates of childhood asthma are increasing worldwide, more alarming is the
disproportionate rise in rates of asthma among urban, disadvantaged, minority children.
Inner city children, particularly adolescents, also appear to be most at risk for morbidity,
mortality, and emergency department visits as a result of asthma. This may be caused by poor
illness management.

Because of the multiple factors that affect whether or not a family is able to adequately
manage a youth's asthma, educational interventions alone are typically insufficient to
reduce morbidity and healthcare utilization, particularly in high-risk urban populations. As
a result, more intensive, multi-component interventions are necessary to improve asthma
management and outcomes for those youth at highest risk. MST is an innovative, flexible,
home- and community-based family therapy that has been shown to improve health outcomes in
urban children and adolescents with other chronic medical conditions such as type 1 diabetes
and HIV infection. The purpose of this study is to determine the effectiveness of MST in
improving health outcomes and reducing healthcare costs in high-risk urban adolescents with
moderate to severe persistent asthma.

Participants will include high-risk African-American adolescents with moderate to severe
asthma. High-risk youth are defined as those with one or more hospitalizations for asthma
treatment in the previous 12 months. At a baseline hospital visit, participants will
complete questionnaires and an interview, both of which will focus on the participant's
family and asthma history. Participants will also have the option of having the study
personnel visit their home instead. Participants will then be randomly assigned to receive
either MST plus standard multidisciplinary specialty care or standard multidisciplinary care
alone.

Participants assigned to MST will attend psychological treatment sessions in their homes for
about 6 months. Treatment sessions will be attended by both children and parents, occur at a
time designated by the participants, and last about 1 hour. Participants will also complete
questionnaires about their interactions with the therapist and their satisfaction with
treatment.

Participants assigned to standard multidisciplinary specialty care alone will receive weekly
home-based, supportive family counseling for about 6 months. The treatment will provide
emotional support to the family regarding asthma, help the family spot problems in asthma
care, and address specific support that may help them with asthma management. Counseling
sessions will last about 45 minutes.

Participants in both groups will receive treatment for 6 months and follow-up for 12 months.
Participants will be evaluated at baseline and after 7 and 12 months. Families will also be
contacted during Months 3 and 9 for medical information. During the study, the medical
charts of participants with asthma will be reviewed for medical history and clinic visits.
Other medical providers who directly care for the participant's asthma (e.g., primary care
provider) may also be contacted. At the Month 6 evaluation, height and weight measurements
will be taken.

The study completion date listed in this record was obtained from the "Completed Date"
entered in the Query View Report System (QVR).

Inclusion Criteria:

- Moderate to severe persistent asthma

- African American

- One or more hospitalizations for asthma in the last 12 months

Exclusion Criteria:

- No exclusions will be made due to co-morbid mental health problems (i.e., attention
deficit hyperactivity disorder [ADHD], conduct disorder, depression, anxiety
disorder), with the exception of thought disorder (i.e. schizophrenia, autism),
suicidality, or mental retardation