Coalitions: Integrating Community-Based Asthma Control Strategies

1. Coalitions:Integrating Community-Based Asthma Control Strategies Jim Krieger, MD, MPH Bob Groves, MA, MPH Marielena Lara, MD, MPH Kimberly Wicklund, MPH April 2004

2. Concepts of Integration • Service coordination • Consistent and coherent services • Linkage and cross-referral among providers • Cross-institutional Collaboration • Shared vision • Shared resources • Exchange of data • Coordinated/joint program implementation • United advocacy • Multi-disciplinary Collaboration

3. Ladder of Integration Joint Action Joint program development Coordinated Action Coordinated but independent components Cross-Referral Independent programs refer clients to each other Mutual Awareness Programs aware of one another

4. Barriers to Integration • Structural • Silos • Staff not available to participate in integration work • Leadership not available to provide direction • Cultural and Personal • Doing it your way • Turf and control • Logistical • Working out the details • Time for communicating and coordinating • Fiscal • Pressures to generate revenues • Competition

5. Overcoming Barriers:Coalitions Bring Together Sectors • Safe, neutral space • Forum to network and learn • Common vision • Leadership • Coordination of resources

6. Overcoming Barriers:Coalition Steering Committees • Primary mechanism for integration • Decision-making body of coalition • Gathering of organizational decision-makers • Champion for integration • Strategic planning • Collaborative approach to grant-writing and new program development

7. Integrating Care For Individuals • Community Health Workers • Link families with schools, childcare, health providers, public housing • Advocate for families for accessibility and consistency of services • Care Coordinators • Facilitate access to services • Coordinate services across service providers • Back-up CHWs • Individual Asthma Action Plans

8. Philadelphia Link Line

9. Care Coordination/Case ManagementFight Asthma Milwaukee • ED or clinic notifies care coordinator at local health department • Coordinator arranges linkage to appropriate services • Home visits by nurse case manager: • Home visits by health department environmental inspector • Calls to encourage follow-up with medical home • Refer to parent mentor program • Refer to family asthma education • Info about childcare/school asthma education • Shared evaluation and educational protocols

10. Integration Across Organizations • Community Asthma Action Plan • Summary of shared vision • Developed in a participatory, collaborative process • Defines roles • Multiple forums to foster integration • Coalitions as the overarching roof • Cross-project coordination groups • Learning collaboratives for clinics • Joint proposals and projects • Conferences and community meetings

11. Integration Across Organizations • Common tools, guidelines and messaging • Single asthma action plan • Shared educational resources and programs • Consistent asthma control protocols and guidelines • Consistent key asthma messages

12. Integration Across Organizations:Sharing Data and Information • Health Plan Data • Utilization/Registries • Pharmacy • ED Data • Utilization • Provider Data • Utilization/Registries

13. Integration Across Organizations Coordination of Asthma Policy/Advocacy • Better Housing • Breathe Easy Units • Cleaner Air • Diesel • Reimbursement • Community Health Workers • Chronic disease management • Asthma education

15. Fight Asthma Milwaukee

16. Future Directions • Policy and advocacy • Bringing to scale • Sustaining integration

17. To conclude: • Integration doesn’t come easily but there are effective strategies to help get there. • Paths to integration will vary by community and must fit the local landscape.