Community Asthma Initiative

The Boston Children’s Hospital Community Asthma Initiative (CAI) was developed to help improve the health and quality of life of children with asthma and their families. Since asthma hospitalizations and Emergency Department visits are disproportionately high for African-American and Latino children, the hospital wanted to address this important health disparity.

CAI serves children who live in Boston, are 2 to 18 years old, and have been either seen in Boston Children’s Emergency Department or hospitalized for asthma. We also accept referrals from primary care providers and asthma specialists within the hospital’s network.

Our program works with each family to understand their child’s asthma and the medications used to treat it, and to identify and reduce asthma triggers in the home and other places where the child spends time.

CAI also works with partners and coalitions to address asthma health disparities through changes in policies at the local and state levels.

New cost analyses show that health insurers and Accountable Care Organizations (ACOs) can recover the cost of programs like the CAI within three years. Learn more.

Download our Program Replication Manual.

What we do

  • We provide a series of home visits, tailored to each family’s needs and questions. We look at the child’s asthma medications with the family, talk about how they work, and find out if the parents/guardians have any questions or concerns about medications or their safety.
  • With the family’s permission we walk through their apartment together and provide suggestions about how to make their homes more “asthma-friendly.” Often this includes assisting families with poor housing conditions, such as pests or mold, by providing useful cleaning and pest control supplies, advocating with landlords, or referring to the Boston Inspectional Services Department.
  • We provide case management to help families improve housing conditions and access health insurance or other services they may need in order to control their child’s asthma.
  • We provide workshops for school, child-care, and camp staff about asthma.
  • We help connect children with asthma to programs such as the Boston Asthma Swim program. To learn more about this program, contact asthmaswimprogram@gmail.com.

Outcomes

As of December 2016, there were more than 1,769 patients who have enrolled in the Community Asthma Initiative. Their involvement led to:

  • 80% reduction in the percentage of patients with asthma-related hospitalization
  • 58% reduction in the percentage of patients with Emergency Department visits
  • 45% reduction in the percentage of patients with missed school days for children
  • 53% reduction in the percentage of patients with lost work days for parents

Policy advocacy

  • We work in coalitions to improve both housing and school environmental conditions that often trigger a child’s asthma.
  • With partners we seek to ensure that asthma education, home-visiting services, devices, and environmental supplies, such as HEPA vacuum cleaners, will be covered by health insurance, as needed.
  • We are working with other asthma home-visiting groups in the city to establish home-visiting standards and a trained workforce that can serve the diverse and multilingual community in Boston. We are also working with groups in other parts of the country to bring similar services to their communities.