MDPH Needs Assessment (presented by Terry Mason)


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Presentation from Terry Mason on the needs assessment that she conducted for the Massachusetts Department of Public Health regarding sustainable asthma home visiting interventions. (Presented at the annual meeting of the Asthma Regional Council of New England on June 13, 2013 in Shrewsbury, MA)

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  • MDPH Needs Assessment (presented by Terry Mason)

    1. 1. Terry Mason, PhD Independent Policy Research Consultant Presented at the Annual Meeting of the New England Asthma Innovations Collaborative (NEAIC) June 13, 2013
    2. 2. Asthma Regional Council N.E. promotes “Healthy Homes” Growing evidence cost effectiveness of home-based asthma interventions NEAIC Healthcare Innovation model includes community health worker home visitors
    3. 3.  READY Study (Reducing Ethnic/Racial Asthma Disparities in Youth): MDPH, Boston Medical Center, and Baystate Medical Center in Springfield (funded by HUD/NIEHS)  Model = trained community health workers, multiple home visits • assessment of home environmental triggers • advice and tools to reduce exposures • advocating for improved housing • improving communication with health care providers • raised expectations of parents  Significant improvement in asthma symptoms, reduction in hospitalization and ER use  Outcomes consistent w similar studies – Seattle Healthy Homes, Boston Children’s Hospital pediatric asthma intervention research
    4. 4.  MDPH implemented similar model w CDC funding --Asthma Disparities Initiative  MDPH partners w numerous organizations around state: clinicians, CBOs, Boston Public Health Commission engaging CHWs in asthma home visiting with pediatric asthma patients  If CHW’s “reimbursed” in future, what infrastructure needed to support their preparation and employment?  Interested payers asked Asthma Program to think more about CHW training, skill assessment, and identification and recruitment  NEIAC is supporting a smaller, more focused assessment with payers in other New England states
    5. 5. • How to strengthen and expand availability of CHW asthma home visitor training? • Identify methods to assess CHW skill attainment • Assess supervision and other institutional supports needed to promote the success of the CHW component of the intervention • Identify feasible methods to assist payers/providers to locate and recruit asthmatrained CHWs
    6. 6.      Asthma-trained CHWs Massachusetts CHW training center directors Health payers, ACO Medical Staff Online resources Training & certification programs ◦ Tobacco specialists, substance abuse, nurses  Clinical and administrative supervisors in MDPH – funded programs
    7. 7.  Overall, positive feedback on training [24 hr classroom, 2 day refresher course @ 6 months, ongoing support] • Include more case studies and Motivational Interviewing (prepare CHWs for diversity in circumstances) • Include mentorship phase, post-classroom training • Develop a network of asthma-trained CHW preceptors • Make CHW core competency training a prerequisite for asthma training • Explore hybrid training (in-person plus online) and apprenticeship (DOL approved for CHW occupation)
    8. 8.  Promote sustainable funding for CHW core competency trainings • funders should require grantees pay % $ for training  Encourage existing & future community-based CHW training centers to attain academic credit for classroom and field trainings  Explore circumstances under which providers or payers (MassHealth) might subsidize CHW asthma training
    9. 9.  Develop performance-oriented assessments • Scenarios, case examples written or oral • Preceptor evaluations • Final home visit observation check-off • Develop a pilot to examine feasibility of preceptor phase and other features of skill assessment • Feasibility/logistics of preceptor phase for nonasthma employed CHWs?
    10. 10.  Consider second-tier of MA state CHW certification for specialized or generalist chronic disease prevention and self-management skills  Promote with new Massachusetts CHW Board of Certification (Chap 322, Acts of 2010)
    11. 11. Promote Role of Asthma Teams • Direct supervisor relationship key • BUT – put CHW role in team perspective • Team response necessary for desired outcomes Educate Payers & Providers • Distinctiveness of CHWs (expertise not primarily academic) • Nature of CHW contribution (relationships, communication, reinforcement, home environment) Recruit Thru Training Registries • Encourage MA CHW regional training center database updates, & privacy protection • Requires financial resources
    12. 12.  Ideal is asthma team (including CHW) within medical/health homes • BUT not always feasible (#s, $)  Explore community/regional CHW home visiting collaborative • Offer supervision, other expertise (T.A.) • Promote intervention standardization • Serve as referral agency • Example: Boston Public Health Commission • Challenge: integration with medical home
    13. 13.  Recommendations  Promote coverage for supervision meetings, in addition to CHW home visiting services  Ensure asthma home visiting intervention is part of medical home and ACO initiatives  Promote, evaluate other intervention models in which CHWs address multiple chronic diseases or different age groups
    14. 14. NEAIC is interested to learn more about what you are thinking about the topics presented in this needs assessment, particularly in financing CHWs for asthma home visiting. Given that each of the New England states are in different places in this process, we would like to know:  What questions/thoughts do you have in response to the findings and recommendations in the MDPH needs assessment?  Do you have recommendations for moving this policy agenda forward?  Do you have suggestions about questions we may ask healthcare payers to learn about opportunities and challenges to promoting the use and financing of CHW asthma home visiting?