Problem-Solving Skills Training to Improve Care for Children With Asthma
Condition: Asthma
MeSH terms: Asthma
Study type: Interventional

Summary: 
      The purpose of this study is to determine whether Problem-Solving Skills Training is
      effective in reducing barriers to health care and improving health-related quality of life
      for children with persistent asthma.
    

Detailed description: 
      Brief description: This 4-year research project will develop and test culturally and
      linguistically appropriate brief interventions to reduce barriers to health care for
      vulnerable children with persistent asthma.

      Background: The U.S. health system presents formidable challenges to the timely receipt of
      high quality care, especially for vulnerable children (e.g., those in families of color,
      lower SES, limited English ability). This population is at greatest risk for poor health
      outcomes. Children with asthma are an important vulnerable subgroup. Asthma, with an
      estimated prevalence of 6.9%, is the most common chronic condition in children. It is the
      most frequent reason for pediatric hospitalization and is a condition with documented
      disparities in care outcomes.

      A promising strategy for overcoming the barriers to quality care that these children
      encounter is the use of care coordinators who educate parents and children, connect the
      family with needed resources, and coordinate care from different settings. Care coordination
      has been shown effective in improving receipt of appropriate asthma services and health
      outcomes for children with asthma. Despite this evidence, there is concern that the effects
      of care coordination may not be maintained once these services end. This is particularly
      important given financial pressures to reduce the length and intensity of such services. In
      order to maintain the gains achieved during care coordination, families need to be able to
      identify and overcome barriers to care for and by themselves. This can be achieved through
      the use of Problem Solving Therapy, a documented behavioral method for teaching families the
      skills they need to resolve daily problems and improve adherence to medical regimens for
      children with chronic health conditions.

      Study Goals: The overall goal of this project is to improve the quality of care and health
      outcomes for vulnerable children with asthma. The specific aims of this two-phase project
      are:

        -  (Phase I) to adapt, in collaboration with community health workers and parents, existing
           materials to create two culturally and linguistically appropriate treatment manuals: a
           Care Coordination Treatment Manual that will standardize the delivery of culturally and
           linguistically appropriate home-based care coordination and asthma-specific education,
           and a Problem Solving Therapy Treatment Manual tailored to asthma that will include a
           detailed, step-by-step guide for implementing this approach to reduce barriers to care.

        -  (Phase II) to use the manuals developed in Phase I to perform a randomized controlled
           clinical trial to evaluate the effectiveness of two brief interventions involving Care
           Coordination and tailored Problem Solving Therapy (tPST) in improving and maintaining
           improvement in health care quality and health-related quality of life for children with
           asthma.

      Evidence for the efficacy of tPST and the availability of culturally and linguistically
      appropriate treatment manuals should spur diffusion of this innovation to other practitioners
      and programs seeking evidence-based, optimal clinical management strategies.

      Methodology:

      Phase I. Existing materials for the Care Coordination and tPST manuals will be edited and/or
      rewritten to make them specific to asthma. Then both the manuals and the proposed
      interventions will be assessed for cultural acceptability though two series of parallel focus
      groups: one for parents of children with asthma, and the other for home visitors already
      providing care coordination for families of children with asthma. The revised educational
      materials will then be translated into Spanish.

      Phase II. Children ages 2-12 years with persistent asthma and their families (n = 366) will
      be randomized into two brief interventions:

        1. tPST (six sessions) plus Care Coordination (six home visits over 3 months) versus a Wait
           List control group (usual care) to evaluate the intervention's effectiveness in
           improving outcomes 3 months after baseline.

        2. tPST versus Care Coordination and Wait List to evaluate the intervention's effectiveness
           in maintaining outcomes 9 months after baseline.
    

Intervention name(s): Problem solving skills training; Asthma care coordination; Usual Care
Intervention type(s): Behavioral; Behavioral; Other
Intervention description(s): See description in Results; See description in Results; Usual clinical care
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Asthma; Child; Problem-solving; Quality of Life; Barriers to Care