G -- ASTHMA INTERVENTION FOR INNER-CITY CHILDREN

Notice Date

November 7, 2000

Contracting Office

Alliance of Community Health Plans, 100 Albany Street, Suite 100, New Brunswick, NJ 08901

ZIP Code

08901

Solicitation Number

200-95-0953-049

Response Due

December 20, 2000

Point of Contact

Jonathan Gelfand (732) 220-1388 ex. 15

E-Mail Address

If you have questions or would like a Microsoft Word (jgelfand@achp.org)

Description

REQUEST FOR APPLICATIONS ASTHMA INTERVENTION FOR INNER-CITY CHILDREN Alliance of Community Health Plans & Centers for Disease Control and Prevention BACKGROUND Asthma is a highly prevalent disease that affects the quality of life of many persons in the United States. Roughly one of 18 Americans has asthma. It is a major cause of emergency room visits, hospitalizations, and missed school and work days, many of which are preventable. Although the burden of asthma is especially great in urban areas with high levels of poverty and large minority populations, few interventions have been designed or evaluated specifically for these setting. One recognized “best practice” intervention is that developed through the National Cooperative Inner-city Asthma Study (NCICAS) to help control asthma. The current project will utilize the approach and findings from NCICAS as the foundation for the intervention. NCICAS was a multi-faceted, multi-modal intervention research project designed to address a wide range of problems of the child with asthma and his or her family (see Attachment A for NCICAS description). NCICAS demonstrated that an individually tailored intervention carried out by masters-level social workers trained in asthma management can reduce asthma symptoms among children in the inner city. The Alliance of Community Health Plans (ACHP) will work with Centers for Disease Control and Prevention (CDC) to identify healthcare organizations to implement and monitor the implementation of NCICAS. The project will fund intervention programs that use an asthma counselor (masters-level social worker) to tailor the intervention to the needs of individual clients, working closely with families over the period of a year, helping them address a wide variety of problems. It is estimated that 20 sites will be funded. The award will be used for the salary and specialized, structured training of a masters-level social worker to become an Asthma Counselor. The funding will also be used to pay for support staff, asthma education classes and materials for participating children and families. In addition, the funding will be applied to costs of dust mite covers, peak flow meters, and spacers for asthmatic children in situations where materials are not already provided. In-kind contributions will be expected for the Project Manager. PROJECT OBJECTIVE AND DESCRIPTION The objective of the project is to implement the NCICAS intervention, a well-researched asthma intervention to decrease symptom days in low income inner-city children ages 5-11 with asthma with the aim of improving their quality of life and decreasing unscheduled medical care visits and hospitalizations. The key component to the intervention is the use of an asthma counselor who can help tailor the intervention to the needs of the individuals, and work closely with individual families over an extended period of time. The asthma counselor will help families address a wide variety of problems in daily living and coping with both emotional and physical aspects of asthma. Extensive training will be provided to the asthma counselor including classroom work and two weeks of shadowing a practitioner who is providing state-of-the-art care to pediatric asthma patients. The project is directed toward organizations that treat low-income inner-city children, particularly those enrolled in Medicaid or the State Children’s Health Insurance Plan (SCHIP). The intervention is organized around a core, which features many features of previously tested programs of education and self-management. The core intervention takes place in the initial two months of the intervention. This element of the intervention is relatively structured, involving both group and individual training sessions with the child and family. Interventions are then tailored to the individual family, focusing on environment, school, and special adherence training, as needed. Group sessions directed toward the children are also held early in the intervention, following the core intervention activities. Finally, individual contact both by phone and in person continue throughout the intervention year, as the asthma counselor helps the family deal with problems that arise or require more intensive intervention. Over the course of the four-year project ACHP will provide project oversight and guidance to project sites. Bi-weekly conference calls will be conducted by CDC and ACHP with Asthma Counselors from the intervention sites. Sites will provide quarterly updates, including defined process evaluation measures, as provided by ACHP and CDC (see Attachment B for Evaluation Instrument). It is not the intention of this solicitation to replace existing asthma patient management programs but to appropriately supplement them or to create programs where there are none. It is also not intended that materials (e.g. peak flow meters) currently covered by existing mechanisms be paid for using grant resources. No research will be funded under this program. PROJECT DURATION This solicitation is for the first year of funding for a four-year program. With demonstration of adequate progress, funding will be renewed annually for up to a total of four years to each site. Timeline and Milestones 12/20/00 Proposals due 1/22/01 Awards made 3/01 Training Workshop – 2 to 3 day meeting for Asthma Counselors 3/01- 1/02 Conference calls every other week (Asthma Counselors and ACHP; 60-90 minutes) 3/01 Quarterly Progress Report 6/01 Quarterly Progress Report 10/01 Quarterly Progress Report 1/02 Quarterly Progress Report 1/02 Annual Meeting – Expert presentations, storyboards, lessons learned ELIGIBILITY CRITERIA Applicants may be health plans, managed care organizations, hospitals, outpatient clinics, or consortia potentially including these and other organizations. Consortia could include organizations without direct patient contact, but would have to include organizations with such responsibilities. In order to receive funding, each applicant must meet the following criteria:  Location in a large urban area;  Serve an indigent population, indicated by a least 30% of children served being enrolled in Medicaid, the states SCHIP program, or uninsured;  Provide state-of-the -art asthma management as defined in the National Asthma Education and Prevention Program (NAEPP) Clinical Practice Guidelines to all participants in the intervention (Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No. 97-4051, April 1997.)  Demonstration of an ability to enroll an adequate number of children with moderate or severe persistent asthma, according to the classification system defined in the above-mentioned NHLBI/NAEPP document: 1. an adequate number of children is defined as the ability to ENROLL AND RETAIN at least 80 English or Spanish speaking children aged 5 to 11 years old PER YEAR for a 1-year intervention period for 3 consecutive years; 2. applicants should describe the method or data system that was used to determine the number of potentially eligible children (see Attachment C for Enrollment Criteria for Participating Children)  Intervention sites will be funded and implemented in “intervention units”. An intervention unit consists of one asthma counselor and support person serving 80 eligible children with asthma and their families per year (1:80).  An intervention site must consist at a minimum of one intervention unit but may consist of multiple units. Therefore, a funded organization may have one or more intervention units. It is estimated that the total budget for ONE intervention unit will average $100,000. NECESSARY PERSONNEL 1. Project Manager An in-kind project manager (PM) will be ultimately responsible for the conduct of the intervention. The PM will identify and supervise project staff; assure (a) proper training of staff, (b) adequate enrollment in program, and (c) intervention follows the defined protocol; oversee outcome of the program based on program evaluation data. If the PM is not a physician, one with demonstrated expertise in treating asthma in children and who will be readily available to project staff must be identified to provide clinical guidance to the project manager and asthma counselor. 2. Asthma Counselor The asthma counselor is a full-time masters-level social worker. The asthma counselor will enroll participating children, assure participation of enrolled children and families in project activities; direct all group and individual sessions in manner following the protocol; work with support staff to maintain all program records; participate in training, conference calls, and meetings associated with the program; and assure quality and completeness of evaluation data. The asthma counselor will require private office space, and meeting space for up to 20 persons must be available for periodic group sessions. 3. Support Staff A support person will help maintain records, make appointments and maintain calendars, follow-up on all missed appointments, provide child care for families during family sessions, and otherwise support the work of the asthma counselor. GENERAL GUIDELINES FOR PROPOSALS The entire proposal should not exceed seven pages, and should be typed single-spaced, staying within the margin limitations of 1 inch. Use a font size no smaller than 10-point. The reviewers will not read more than seven pages per proposal. Please attach the CVs or biosketch of the proposed Project Manager. If you presently have a social worker on staff who will act as the Asthma Counselor, please also submit this individual’s CV. If not, please submit a job description for the proposed position. Submit the names and titles of possible team members in the narrative section. Proposals should also include an estimated budget for the first year of the four-year planned project period based on one or multiples of an “intervention unit”. (See Attachment D for budget guidelines.) The CV, budget section and letter of support will not be restricted to the 7-page limit. However, a budget that exceeds 3 pages is probably too long. Proposals should address the following issues, as intervention sites will be selected based upon the following criteria: 1. Documentation of a sufficient number of target children in the healthcare organization (see enrollment criteria, Attachment C) based on the number of children treated at the facility in the past year who would meet the criteria; 2. Description of racial/ethnic composition of the potential target population; 3. Assurance that the asthma of all enrolled clients will be managed following the Guidelines for Diagnosis and Management of Asthma, Expert Panel Report-2, 1997 (http://www.nhlbi.nih.gov/guldelines/index.htm) and Pediatric Asthma, Promoting Best Practice, Guide for Managing Asthma in Children (http://www.aaaai.org/professional/initiatives/pediatriciasthmaguidelines/default.stm); 4. Demonstration of organizational commitment to the implementation in a letter of support; 5. Strength of the project site management plan and the availability of the project manager (PM) to the day to day oversight of the intervention (If the PM is not a physician, access of the PM and asthma counselor(s) to regular physician support); 6. Description of existing pediatric asthma outreach programs currently serving the target population that are to be supplemented (if any); 7. Planned approach to program marketing, enrollment and retention of clients; 8. Commitment and ability to hire an Asthma Counselor (MSW) within 2 months of receipt of award (if an MSW is not already on staff). 9. Availability of appropriate office space and group meeting space for the conduct of the intervention; 10. Commitment to training: assurance of participation in group training, conference calls, meetings, etc.; 11. Assurance that training based on provided curriculum will be given to any counselors hired after the initial group training; 12. Written assurance of agreement with pulmonologist for two weeks shadow training of asthma counselors with pediatric asthma patients; 13. Extent of in-kind contributions to the project, particularly contribution of any overhead expenses; 14. Commitment to evaluation; 15. Brief description of information tracking abilities (does not need to be automated)—See Attachment B for a list of Tracking Measures that will be used in the Intervention; 16. Statement of commitment to providing quarterly reports; 17. Description of any materials that are already available and covered under existing programs (e.g. dust mite covers, peak flow meter, spacers) AWARD EXPECTATIONS CDC and ACHP are inviting qualified healthcare organizations to apply for approximately $100,000 per intervention unit to participate in the first year of a four-year project. The award will supplement salary and training of an asthma counselor and support staff, training materials, patient education materials, general office supplies and materials, and dust mite covers, peak flow meters, and spacers. If the site is already providing and covering skin testing and supplies, this would be considered in-kind contributions. Consideration will be given to organizations with in-kind contributions. Upon successful completion of the first year, applicants can apply for additional funding for each subsequent year of the project. We expect to fund between 20 and 25 intervention units. An intervention site must consist at a minimum of one intervention unit (one asthma counselor, a support person, and 80 eligible children). A funded organization may have one or multiple intervention sites. INFORMATIONAL CONFERENCE CALL AND LETTER OF INTENT We will be conducting an informational conference call for potential applicants on November 28th from 1:00 pm EST – 2:00 EST. To receive the 800 number and pass-code, please RSVP no later than November 21st to Jonathan Gelfand (e-mail: jgelfand@achp.org) Non-participation in the conference call does not preclude submission of a proposal. If you intend to submit a proposal please indicate your intent via e-mail to Jonathan Gelfand at ACHP (e-mail: jgelfand@achp.org) by December 1st. Please include your organization name and location. PROPOSAL SUBMISSION In order to be considered, proposals must be postmarked or e-mailed by December 20, 2000. If you have questions please contact: Jonathan Gelfand Program Administrator Alliance of Community Health Plans 100 Albany Street Suite 130 New Brunswick, NJ 08901 e-mail: jgelfand@achp.org ATTACHMENT A NCICAS Description Phase I of the National Cooperative Inner-city Asthma Study (NCICAS) protocol suggested that problems in all of the following areas may be associated with the high levels of asthma morbidity: 1. Difficulties with access to high quality medical care; 2. Environmental factors; 3. Social factors such as family stress, child and parent emotional/behavioral problems; 4. Problems adhering to prescribed medical plans and appointment keeping. Accordingly, the NCICAS intervention (phase II) was designed as a multi-faceted, multi-modal intervention designed to address a wide range of problems. Because not all families will exhibit problems in each of these areas, the intervention is tailored to individual child and family needs. The NCICAS intervention abstracts and utilizes the best elements of prior interventions and expands on them. The key component to the intervention is the use of an asthma counselor who can help tailor the intervention to the needs of the individuals, work closely with individual families over an extended period of time, and address a wide variety of problems as they arise. A problem solving, empowerment approach is taken as a keynote element of the asthma counselor’s work with the family. These elements are all considered crucial in working with families as they develop skills in collaborating with their physicians in the child’s care, work with schools, and develop better strategies for care that will promote adherence to a mutually acceptable treatment program. Because inner-city asthma disproportionately affects minority children, the NCICAS interventions were designed to be culturally appropriate. The intervention is organized around a core, witch includes many features of previously tested programs of education and self-management. The core intervention takes place in the initial two months of the intervention. This element of the intervention is relatively structured, involving both group and individual training sessions with the child and family. Interventions are then tailored to the individual family, focusing on environment, school, and special adherence training, as needed. Group sessions directed toward the children are also held early in the intervention, following the core intervention activities. Particular problems that might effect treatment but cannot be dealt with directly, because of limitations in time or expertise, are dealt with through referral. Finally, individual contacts both by phone and in person continue throughout the intervention year, as the asthma counselor helps the family deal with problems that arise or require more intensive intervention. Intervention Activities Pre-core intervention activities: At the time families are enrolled in the intervention, individualized planning for the families begins. The Asthma Risk Assessment Tool (ARAT), utilizing certain clinically-relevant information, helps to identify risk factors for morbidity, high asthma symptom rates, and interference with activities fo daily life. Individualized units of intervention (special adherence, school-related treatment problems, problems with access to care, mental health referrals, smoking cessation referrals) are applied depending upon the responses to questions administered at enrollment. Core Intervention activities: The core intervention phase consists of the activities to be engaged in during approximately the first two months of the intervention. These components of treatment have been defined as “core” because they seemed essential to the intervention, forming the basis for further development in the later sessions, both group and individual. During this time, two adult group sessions and one family session for the child and caretakers are held. Adult group session I This session is designed for the primary asthma-related caretakers for the enrolled child. The session presents: 1) an overview of the nature of asthma; 2) presentation of the goals of the asthma intervention and expectations about asthma treatment, including the attainment of freedom from symptoms; 3) communicating with physicians; 4) identifying factors that start asthma attacks; 5) discussing a general problem-solving strategy which will be used throughout the intervention; 6) an overview of environmental contributors to asthma. This session, and all group sessions, involves a combination of group discussion, lecture, and role playing. Adult group session II The second group session continues with further discussion of asthma-related physiology, with the emphasis on physiological factors whose understanding seems particularly important to sustaining adherence. The remainder of the session continues to concentrate on adherence-related issues. Core individual session: This session is designed to clarify and individualize issues discussed in the first two group sessions and in the

Web Link

Click here to download a copy of the RFA (http://www.achp.org/asthmaproj/index.html)

Record

Loren Data Corp. 20001109/GSOL001.HTM (W-312 SN5061M5)