Problem-Solving Skills Training to Improve Care for Children With Asthma

Brief description: This 4-year research project will develop and test culturally and
linguistically appropriate brief interventions to reduce barriers to health care for
vulnerable children with persistent asthma.

Background: The U.S. health system presents formidable challenges to the timely receipt of
high quality care, especially for vulnerable children (e.g., those in families of color,
lower SES, limited English ability). This population is at greatest risk for poor health
outcomes. Children with asthma are an important vulnerable subgroup. Asthma, with an
estimated prevalence of 6.9%, is the most common chronic condition in children. It is the
most frequent reason for pediatric hospitalization and is a condition with documented
disparities in care outcomes.

A promising strategy for overcoming the barriers to quality care that these children
encounter is the use of care coordinators who educate parents and children, connect the
family with needed resources, and coordinate care from different settings. Care coordination
has been shown effective in improving receipt of appropriate asthma services and health
outcomes for children with asthma. Despite this evidence, there is concern that the effects
of care coordination may not be maintained once these services end. This is particularly
important given financial pressures to reduce the length and intensity of such services. In
order to maintain the gains achieved during care coordination, families need to be able to
identify and overcome barriers to care for and by themselves. This can be achieved through
the use of Problem Solving Therapy, a documented behavioral method for teaching families the
skills they need to resolve daily problems and improve adherence to medical regimens for
children with chronic health conditions.

Study Goals: The overall goal of this project is to improve the quality of care and health
outcomes for vulnerable children with asthma. The specific aims of this two-phase project
are:

- (Phase I) to adapt, in collaboration with community health workers and parents,
existing materials to create two culturally and linguistically appropriate treatment
manuals: a Care Coordination Treatment Manual that will standardize the delivery of
culturally and linguistically appropriate home-based care coordination and
asthma-specific education, and a Problem Solving Therapy Treatment Manual tailored to
asthma that will include a detailed, step-by-step guide for implementing this approach
to reduce barriers to care.

- (Phase II) to use the manuals developed in Phase I to perform a randomized controlled
clinical trial to evaluate the effectiveness of two brief interventions involving Care
Coordination and tailored Problem Solving Therapy (tPST) in improving and maintaining
improvement in health care quality and health-related quality of life for children with
asthma.

Evidence for the efficacy of tPST and the availability of culturally and linguistically
appropriate treatment manuals should spur diffusion of this innovation to other
practitioners and programs seeking evidence-based, optimal clinical management strategies.

Methodology:

Phase I. Existing materials for the Care Coordination and tPST manuals will be edited and/or
rewritten to make them specific to asthma. Then both the manuals and the proposed
interventions will be assessed for cultural acceptability though two series of parallel
focus groups: one for parents of children with asthma, and the other for home visitors
already providing care coordination for families of children with asthma. The revised
educational materials will then be translated into Spanish.

Phase II. Children ages 2-12 years with persistent asthma and their families (n = 366) will
be randomized into two brief interventions:

1. tPST (six sessions) plus Care Coordination (six home visits over 3 months) versus a
Wait List control group (usual care) to evaluate the intervention’s effectiveness in
improving outcomes 3 months after baseline.

2. tPST versus Care Coordination and Wait List to evaluate the intervention’s
effectiveness in maintaining outcomes 9 months after baseline.