PEDIATRIC HEALTH
SA KIDS BREATHE
and its Positive Impact on Pediatric Asthma By Daniel Deane, MD
A
sthma is a complex inflammatory process. Many external factors impact asthma control and are difficult to identify in the short time frame of an office visit. All home triggers may not be revealed, nor detrimental social determinants exposed. SA Kids BREATHE (SAKB) is a free city program that provides a comprehensive assessment of the home and uncovers adverse social determinants. SA Kids BREATHE stands for Building Relationships, Effective ASTHMA Teaching in Home Environments. These children are in need of physician referrals. The heart of a successful therapeutic relationship is effective communication between the physician and the patient. The more time a physician spends with a patient, the better the outcome. The current health care environment emphasis on productivity may undermine this relationship. SAKB is not a replacement for the physician but works to reconnect patients with their caretakers and expand the physician’s impact on education. It provides insights into the home environment and shows social determinants’ detrimental impacts, which will help guide therapeutic decisions. Trained Community Health Workers (CHWs) meet the family and child where they are—in-home or virtually—to educate children and their families about effective ways to control asthma. The CHWs make five to six visits with the families over a sixmonth period. Three to four visits are at home and last for one hour. One visit is with a health care provider, and one is with the child’s school or daycare. 16
Each CHW is guided by a certified Registered Respiratory Therapist and Certified Asthma Educator with more than 30 years of experience. And, the CHWs are working towards becoming Certified Asthma Educators. The in-home visits are valuable because they offer the CHWs a chance to make assessments that are difficult in a clinic environment. They apply the Environmental Protection Agency’s Asthma Environmental Checklist to the home environment to identify and remediate triggers. They also recognize social determinants affecting a child’s asthma control and provide help and support. When the CHWs educate children and their families at their homes, it gives physicians more time to implement therapeutic changes when the patient comes to the clinic, reinforcing the bond between the physician and patient. The CHW can visit the clinic with the family, allowing for timely identification of concerning changes in their child’s symptoms. The CHW also is a direct line of communication with the school nurse. Communications with physicians and nurses can be maintained through secure email (if the clinic has capabilities), direct telephone contact and/or fax. The fundamental principles of SAKB are successful in providing self-management skills to asthma patients in similar programs throughout the country1,2 and represent the tenets of value-based care. SAKB maintains proper medication delivery skills, identifies and removes irritant and allergic triggers in the home and recognizes the contribution of allergies that may need more extensive evaluation.
SAN ANTONIO MEDICINE • September 2021
For more information about SA Kids BREATHE and to find the one-page referral sheet, please visit www.sanantonio.gov/ SAKidsBREATHE or call 210-207-7282. For secure referrals, fax 210-207-9757 or use a secure email to send to SAKidsBREATHE@sanantonio.gov. References 1. Marshall ET, Guo J, Flood E,Sandel MT, Sadof MD, Zotter JM. Home Visits for Children With Asthma Reduce Medicaid Costs. Prev Chronic Dis 2020; 17:190288. DOI: https://doi.org/10.5888/pcd17. 190288 2. Shreeve K, Woods ER, Sommer SJ, et al. Community Health Workers in Home Visits and Asthma Outcomes. Pediatrics. 2021;147(4): e2020011817 Daniel Deane, MD is a retired Pediatric Pulmonologist. He is on the Advisory Council of SA Kids BREATHE and is a member of the Bexar County Medical Society.
