YES WE CAN Children’s Asthma Program

This case study was prepared for CDC by Dr. LaMar Palmer of MAS Consultants. The purpose of the case study is to share the experience of one community as they attempt to address the problem of asthma. It does not represent an endorsement of this approach by CDC.

YES WE CAN Children’s Asthma Program: Background

In the late 1990s, the total population of the Bayview/Hunters Point area of San Francisco California was just over 27,000 people of diverse ethnic backgrounds and an African-American majority. Fifty-two percent of the households were classified as having low – or very low – incomes, and the neighborhood housed two power plants, a sewage treatment plant, and most of the city’s diesel yards and industrial sites. In 1996, the Bayview/Hunters Point Healthy Start Collaborative conducted a preliminary needs assessment in the community’s elementary schools reporting 17% of respondents with a child ever diagnosed with asthma, (Epps-Miller and Legion, Condition Critical, 5/19/99). A follow-up survey authored by Dr. Tomas Aragon (San Francisco Department of Public Health) and Dr. Kevin Grumbach (University of California San Francisco), found a prevalence rate of 15.5% and documented the fact that Bayview adults and children with asthma had four times the state rate of hospitalization (Bayview Hunters Point Community Health and Environment Check Up, May 17, 1997. San Francisco Chronicle 6/9/97).

In response to these Bayview/Hunter Point asthma health reports, Community Health Works of San Francisco initiated the YES WE CAN Children’s Asthma Program at San Francisco General Hospital as a medical/social care model for a clinic-based, community-focused, team-based asthma intervention. As of May 2004, the YES WE CAN Children’s Asthma Program has operated in three San Francisco clinics that care for low income inner-city children. In addition to the clinic at San Francisco General Hospital, YES WE CAN operated children’s asthma clinics at the Mission Neighborhood Health Center, and the Excelsior Health Center, a satellite facility of Mission Neighborhood. The approach has been documented in Managing Childhood Asthma: the YES WE CAN Toolkit. This report will describe this program and the process of its development in detail. It will also provide a clear picture of the medical/social care model in action.

Community Health Works was founded in 1992 by San Francisco State University and City College of San Francisco to address health inequalities by linking academic institutions with communities. Community Health Works is based at SFSU’s Department of Health Education and CCSF’s Health Science Department. The organization’s focus is on public health and primary care for low-income and immigrant communities. Its goals are to eliminate health inequalities and to diversify the public health and primary care workforce. Asthma was an obvious disease to be addressed by this group.

As the lead organization for YES WE CAN, Community Health Works is the catalyst and prime mover in promoting the program, acquiring the funding, and generating the tools necessary to replicate the program. There was sufficient scientific evidence that assuring medical care consistent with the National Heart, Lung and Blood Institutes’ National Asthma Education and Prevention Program (NAEPP) guidelines in conjunction with case management would lead to improved health for children with asthma in San Francisco. Rather than designing a controlled study, practices known to be effective would be implemented along with a solid evaluation of the Program.

The YES WE CAN model blends "best practices" from the experiences of its founding partners. Community Health Works had experience in team staffing patterns including community health workers. Kaiser Permanente of Northern California (KP/NC) had expertise with methods of intense case management and risk stratification. The program also incorporated methods of clinical quality improvement pioneered by the National Initiative for Children’s Healthcare Quality (NICHQ), and innovations developed at San Francisco General Hospital Pediatric Asthma Clinic.