Community Coalitions: Milwaukee, WI

Doctor and patientFight Asthma Milwaukee Allies
(FAM Allies)

The Heart of a Coalition

In the proverbial village that it takes to raise a child, there are healers. In Milwaukee, Wisconsin, these healers are the individuals and organizations of Fight Asthma Milwaukee Allies (FAM Allies), a coalition of families, educators, health care professionals, community representatives, local businesses and government officials united in the fight against the chronic disease. Together they work to combat the high rates of asthma in Milwaukee through the integration and linking of medical treatment, education and community outreach and support.

Founded in 1994 as a community education program for school-age children with asthma, FAM expanded its membership, focus and activities as part of the Robert Wood Johnson Foundation’s Allies Against Asthma initiative. Under its new name FAM Allies, the coalition broadened its network of care to include case management and coordination, bringing in more partners and targeting its efforts in the central city of Milwaukee, the community with the highest asthma rates.

Building awareness and trust among residents of the targeted community was a challenge, even after all other members of the coalition were on board. “The hardest group to engage were the most vulnerable people in the community,” says John Meurer, M.D., director and principal investigator of FAM Allies. “After trying a variety of outreach strategies, we found and partnered with Family House, Inc., a grassroots agency in Milwaukee’s poorest and most disenfranchised neighborhoods.”

Through this partnership, FAM Allies was able to leverage Family House’s ties to the community and reach out to the highest risk families—and be received by them. Staffed in part by people who live in the neighborhood, Family House understands the needs of the community and saw firsthand the health care barriers these families faced everyday.

“I started reaching out to families by going door-to-door,” says Vicky Edwards, community outreach coordinator of Family House. “And soon realized that we couldn’t address asthma until we addressed other serious issues in these homes, like lack of food, warm clothing or health care, cockroach- and rodent-infested living areas, and housing needs.”

Edwards reported what she saw on these visits for FAM Allies, who gave her the resources to stock a food pantry and deal with other foundational issues that operated as barriers to keeping healthy homes. With FAM Allies, she developed a folder of information about asthma treatment and management. “Many families lacked even the most basic information about asthma and just being able to give them information helped immensely.”

FAM Allies also found funding for Family House to hire an administrative assistant, Sylvia Sharp, a client of FAM Allies, to assist with outreach, community organizing and coordination of services. With the support of clinics, home health nurses and other FAM Allies programs, Edwards and Sharp reached 242 families through asthma-related activities and individual meetings with parents. They taught these families about self-management and encouraged them to participate in FAM Allies programs and studies.

Family House established a parents’ group, a supportive network of parents of children with asthma who reached out to other parents in the area. Encouraged by the suggestions of trusted and longtime members of the neighborhood, families were much more willing to seek help and find support where they otherwise might not have.

“We’ve learned many lessons about coalition-building along the way,” says Dr. Meurer. “One of the most important is how essential it is to find an entry into a targeted community. Without the trust of our targeted clients, strong partnerships among dedicated and well-meaning organizations can only go so far.”

From Medication to Management

Sylvia Sharp knows all too well the financial and emotional cost of asthma. The mother of two young children who suffer from the chronic disease, Sharp almost lost her job from having to frequently leave work and rush to their school, which lacked authority to administer asthma medication, to give them their medicine. Things changed when Vicky Edwards knocked on her door. Edwards and FAM Allies provided the information and support Sharp needed to move from a primarily medication-focused approach for dealing with asthma to one that stressed prevention and self-management.

“For a long time, I thought medicine was the only way to help with asthma,” says Sharp. “I didn’t know there were other things I could do that would help prevent asthma attacks from happening in the first place. FAM Allies taught me about asthma triggers and steps I could take to make my home healthier. I also learned about people and places who would help me.”

It’s been two years since Sharp, who now works with Family House, started her asthma education. Today, she and her children are better able to deal with symptoms of the disease and the conditions that trigger them. Asthma management has become much more about prevention and much less about medication. Their visits to the Emergency Department have all but stopped—her daughter, who averaged two to three visits a year, has not been to the ED since she was 10; she is now 12.

And, after FAM Allies helped the Milwaukee public schools develop a new asthma management plan, which includes allowing certain students to administer their own medication, Sharp’s children are able to take their medication without her help. 


Summary

FAM Allies brings together community-based agencies and individuals to work as a coalition to improve quality of life for children with asthma and their families. Led by Children’s Hospital and Health System, FAM Allies links and integrates services and programs where children, parents, caregivers and medical professionals learn about and manage asthma, including schools and child-care centers, hospitals, clinics, community centers, parishes and homes.

FAM Allies is a county-wide coalition comprised of more than 100 health care professionals, community representatives, local businesses, government officials and family members, including: Children’s Health Education Center; Children’s Hospital of Wisconsin; Children’s Medical Group; Children’s Health Alliance of Wisconsin; National Outcomes Center; Milwaukee Public Schools; Boys & Girls Club of Greater Milwaukee; Medical College of Wisconsin Department of Pediatrics; Family House; American Lung Association of Wisconsin; Aurora Health Care; Wheaton Franciscan Health Care; City of Milwaukee Health Department; Wisconsin Department of Health and Family Services; Milwaukee Area Health Education Center; and 16th Street Community Health Center.

Strategies and Programs

  • Care coordination and case management: Developed a standardized protocol to assess the needs of children with asthma in their homes. Programs include the Milwaukee Healthy Homes Demonstration Project and Emergency Department Allies research study.
  • Clinical quality improvement: Designed programs for health care providers who diagnose and treat asthma. Programs include Physician Asthma Care Education (PACE) seminars for primary care physicians and nurses treating asthma.
  • Family and community education (some programs provided in Spanish and English): Provided programs and training sessions to help people in the community and schools understand and manage asthma. Programs include Asthma Basics for Schools, Asthma Care at Childcare and Asthma 101 for community members.

Children and Families Served

FAM Allies targeted children and families in the central part of the city of Milwaukee, where 70 percent of the children hospitalized for asthma live. During the period of the RWJF support, the coalition reached 7,000 families in this community. Today, the program continues to serve an average of 1,500 children, families and community members annually.

Results

  • Expanded networks. FAM Allies expanded its network of partners, involved more stakeholders and made tremendous inroads into the community.
  • Improved quality and management of clinical care. The coalition developed a sustainable strategy for asthma management that is still in use today. Through clinical quality improvement programs, FAM Allies:
    • Trained 21 general pediatricians, four nurse practitioners, 16 nurses and 35 other clinicians in asthma management and 47 physicians and 28 nurses in tobacco counseling to prevent and alleviate harm to children caused by secondhand smoke in the home;
    • Taught 26 nurses how to guide families through asthma management;
    • Reached 25 clinicians through Physician Asthma Care Education (PACE) seminars; and
    • Educated 36 pharmacists about asthma management.
  • Reduced symptoms and increased confidence.
    • Between 2000 and 2002, FAM Allies contributed to a 40 percent decrease in child asthma ED visits and hospitalization rates and a significant decrease in persistent asthma symptoms among families involved with the Allies.
    • After being part of the Healthy Homes project for 12 months: asthma symptoms in children decreased from 74 percent to 36 percent; 66 percent of caregivers saw an improvement in their overall asthma-related quality of life; 67 percent saw emotional improvements; and 54 percent of children increased their activity.
  • Enhanced education and care in schools.
    • Between 2002 and 2006, FAM Allies programs educated more than 7,000 people during 12,500 encounters.
    • Surveys of teachers at schools involved with FAM Allies reported the following improvements:
      • Asthma knowledge increased from 41 percent of teachers receiving a passing grade to 54 percent;
      • The percentage feeling at least somewhat confident increased from 47 percent to 58 percent; and
      • Asthma-friendly school practices increased from 48 percent to 70 percent.

Costs

$1,700 per year for environmental services for each client in the Healthy Homes project.

Lessons Learned

  • Build on the strengths and resources of all coalition members and those found in the community.
  • Use in-kind support whenever possible.
  • Identify a specific target area on which to focus efforts.
  • Disseminate knowledge and findings to all partners.
  • Target specific populations in a concentrated geographic area to achieve the most effective outcomes.
  • Engage families in decision-making and problem solving.
  • Work to eliminate the root causes of poor asthma control, such as lack of knowledge, unsafe home environments, nicotine addictions and barriers to medical care and medications.