361 - Lessons Learned From Transition of Home Visiting Asthma Program into a Virtual Asthma Intervention for Youth in Foster Care

Youth in foster care face disproportionally worse asthma outcomes and greater asthma management barriers than their peers. The Illinois Department of Children and Family Services (ILDCFS) piloted a pre-COVID, nurse-led asthma home visiting program with 62 youth-caregiver dyads that resulted in a 78% reduction in ED visits. However, pandemic restrictions halted home visits and limited nurses’ availability, requiring virtual programming led by community-health workers (CHW).


Objective:

To discuss feasibility and acceptability of ILDCFS’ virtual asthma home visiting program.


Design/Methods:

Limited nursing availability and caregiver engagement prevented direct program adaptation. Thus, ILDCFS tested multiple iterations of a virtual home visiting program during August 2020-September 2022. After consulting with ILDCFS nursing staff, leadership, IT specialists, and its Foster Parent Advisory Board, ILDCFS adopted a CHW-led virtual visit, standardized with an adaptive REDcap form, for youth with recent asthma encounters.ILDCFS staff pulled Medicaid claims of asthma encounters in July-November 2022 and received referrals from its managed care organization. Caregivers of youth living in a foster home and whose medical encounter primarily focused on asthma were contacted via phone to schedule a visit. The CHW met with the youth-caregiver dyad to discuss asthma events, conduct the Asthma Control Test, review medication usage and environmental trigger management, and provide tailored asthma educational materials. After the visit, caregivers completed the Client Satisfaction Questionnaire and CHWs completed a fidelity survey.

 


Results:

ILDCFS identified 95 youth with asthma medical encounters, and 78 (84%) youth were eligible for the program. Of these eligible youth, 58 (74%) of their caregivers responded to scheduling requests, 43 (55%) of youth-caregiver dyads were scheduled, and 23 (29%) of youth-caregiver dyads completed visits. Adaptations to the current intervention were based on parent feedback from previous pilot iterations. Caregivers reported high levels of satisfaction, that the program largely met their needs, and that provided education materials were useful. CHWs reported an average session length of 34 minutes while being able to adhere to the protocol (M=34, SD = 8 minutes).


Conclusion(s):

ILDCFS virtual asthma home visiting program is feasible and acceptable to participants. Further analyses are needed to measure the impact of the program on self-reported asthma severity and number of asthma encounters of participating youth as well as to further embed the program into ILDCFS’ managed care provider.