How Home Visits are Changing Asthma Outcomes in Florida

Happy ChildrenMold—just one of Hurricane Irma’s severe and long-lasting after-effects—continues to be a problem for Floridian families, particularly those with children with asthma. Homes with mold can cause children to suffer severe and chronic asthma attacks. But too often, the financial burden of mold-removal is more than families can afford. When these families don’t receive the help they need, children’s health suffers.

This is what Health Educator Consultant Marissa Roberts, MPH, saw happen with a young family in Orlando. Roberts, who works on the Florida Department of Health’s Children’s Medical Services Managed Care Plan (CMS Plan) team, works with families whose children have chronic and serious conditions, such as asthma.

“We recently discovered that one of our families had visible mold in their apartment since returning home after Hurricane Irma,” says Roberts. “The mother asked the apartment’s management to fix it but was told that she would have to cover the cost of replacement. There was no way for her to quickly come up with that kind of money and her son, who had asthma, was left in an unhealthy environment.”

Roberts learned about the family’s predicament because Florida's CMS Plan has recently started partnering with the Orange County Health Department to provide home visiting services to Orlando members and their families. Establishing a home visiting protocol is one of multiple strategies Florida health plans are testing as part of a quality improvement Learning & Action Network. The Network is led by NICHQ and the Florida Department of Health and aims to improve asthma outcomes.

“Home visits give us the opportunity to assess a child’s physical environment, a critical social determinant of health,” says Roberts. “For the family in Orlando, the home visit helped us identify the mold and then support their efforts for removal. The Orange County Health Department’s environmental specialist issued an official report that confirmed the mold growth; the family then showed a copy of the report to the leasing office and management replaced the carpet.”

Without the home visit, the test would never have been done and the child may still be living in a condition that was detrimental to his health. Stories like this one highlight the significant impact home visiting programs can have on improving asthma outcomes, especially when they target families with limited income and resources.

“Asthma emergency room visits are a key indicator of poor asthma control and we know they disproportionately affect children whose families are under financial duress,” explains NICHQ Senior Project Manager Sandra Widland, MPH. “We also know that home visiting is a proven method for addressing those families’ asthma-related needs. That’s why a home-visiting program supported by a Medicaid managed care plan has so much potential for improving asthma outcomes; it brings effective support to the population most in need.”

What makes an asthma-improvement home visiting program from a Medicaid managed care plan so effective?
  • Home visiting is a proven way to addressing the social determinants that exasperate asthma symptoms.
  • Care plans are already working with the populations most affected by those social determinants.
  • Care plans have an established relationship with families. 

Certain environmental hazards, like mold or older carpets that collect dust, are more common in low-income areas. Environmental specialists are trained to recognize these hazards and support families in removing them. Families also receive free asthma-friendly cleaning products at each visit, which can help prevent asthma symptoms and may encourage families to complete the home-visit program.

“Families might struggle to get time off work or to cover the cost of traveling to their child’s provider,” explains Melissa Dancel, BSN, RN, Community Health Nursing Consultant for the CMS Plan. “By bringing families the services they need, and working around caregivers’ work schedules, we remove another potential barrier of care for families with limited resources.”

Home visits bring critical asthma self-management education right into families’ homes. An educational specialist attends each home visit, and assesses individual self-management, including instructions on administering asthma medicine and counseling on an individual education plan that can be shared with the physician and the child’s school. Along with the convenience of meeting at home, the visits also help families learn about asthma care in a less stressful setting, as opposed to a doctor’s office, hospital or emergency room.

While the benefits of home visiting are significant, families may still feel uncomfortable about participating, Dancel cautions.

“When you go into someone’s home, you’re entering their personal space. This can be overwhelming for families, especially if they don’t know you or if they feel judged. By having our care coordinators call families to introduce the home visiting program, we attempted to put families at ease right from the start,” says Dancel, “which made them more likely to participate.”

Each child on the CMS Plan has an individual nurse care coordinator, known in some other plans as a case manager, who works diligently to ensure the child is receiving the best care possible. The care coordinator engages in regular calls and conversations with the child’s parent or guardian and works to form a relationship as a trusted advocate for the family. 

While the CMS Plan’s home visiting program is still in its initial stages, both Dancel and Roberts are optimistic. The completion rate for participating families is at 100 percent and families have expressed their enthusiasm about the program during follow-up outreach calls.

“Right now, we’re only working with families in Orlando, but we’re hoping to build momentum,” says Roberts. “Families are telling us we’re helping them; that means we need to expand this program, reach more families and help more children.”

Interested in finding out more about how the other health plans’ improvement efforts are progressing? Sign up for NICHQ news to keep track of other successful strategies for improving asthma outcomes.