Challenge
Asthma is a respiratory condition in which lung tissue becomes constricted and breathing becomes difficult. Triggered by allergens such as mold, dust mites, air pollution, even psychological stress, asthma cannot be cured but can be treated. With effective management, asthma patients can live full, active lives. Without effective management, the condition can be severely debilitating, permitting only limited physical activity. Incidences of childhood asthma, especially in inner cities, have increased markedly in the US in recent decades.

In August 2005, Hurricane Katrina slammed into the coast line of the Gulf of Mexico, and storm surges as high as 14 feet helped destroy the levee system protecting New Orleans, flooding as much as 80 percent of this city of 455,000 residents. Childhood asthma had long been the subject of medical research. The confusion and chaos that prevailed in the storm's wake offered a unique opportunity to study the many variables affecting the severity of childhood asthma and the effectiveness of various strategies for helping families manage childhood asthma. The City of New Orleans Department of Health and Tulane University Health Sciences Center collaborated to support the Head-off Environmental Asthma in Louisiana (HEAL) project. In part, the initiative sought to determine whether asthma morbidity in children could be decreased by implementing an adapted and enhanced (for post disaster) asthma counselor intervention that included case management and guidance for addressing environmental factors such as mold and allergens. The research was supported by public sector and private sector partners including federal and local government agencies and private foundations.

Strategy
The HEAL project recruited Ellie Thornton, founder of Visionary Consulting Partners, to assist with the design and implementation of a one year program of asthma counseling intervention for 182 children between the ages between 4 and 12 years old with physician-diagnosed moderate-to-severe asthma. Researchers met with families and asthmatic children for a minimum of 2 asthma counseling sessions, including at least one home visit, to assess environmental risk factors for asthma. These factors were abundant in the hot summer of Katrina, especially for residents living in the city's poorest and hardest-hit neighborhoods, with the least access to specialized healthcare. Through counseling tailored to the specific needs of the family, the asthma counselors were able to intervene and address many of the post Katrina risk factors for asthma morbidity. These factors include the presence of mold and other indoor allergens, access to healthcare and medicines, and health insurance coverage. Socioeconomic factors, such as the quality of housing, income levels, access to schools and social services, and even psychological factors such as stress or depression. In the process, Visionary Consulting helped design a training program to lay the foundation for a growing community of Certified Asthma Educators.

Impact
The project demonstrated the extent to which Asthma Counselors were integral in helping families in a post disaster manage their chronic disease. With Visionary's help, the HEAL project developed intervention strategies based on information collected using the Child Asthma Risk Assessment Tool (CARAT) and Environmental Risk Assessment Tool (ERAT) that included skin tests for allergens as well as home visitations. This information, collected during initial interviews, home visits, and follow-up interviews, enabled Asthma Counselors to identify individual asthma risks, personalize asthma education to address the risks and circumstances of each participant, and to guide overall intervention activities. Families were provided household cleaning supplies, guidance on mold remediation, dust mite covers, and HEPA air cleaners. Deploying trained Asthma Counselor with master's degrees across a diverse range of disciplines, HEAL demonstrated how a novel, flexible asthma counselor intervention could be implemented in a post disaster situation. Exploratory analysis of the project also indicates the impact of the HEAL intervention was on par with previous inner-city asthma studies. With HEAL's guidance, throughout New Orleans, and especially in the city's low income neighborhoods, families with a child suffering from moderate to severe asthma lived healthier, happier, more fruitful lives. Today, the city now employs four additional nationally certified Asthma Educators.

HEAL Scientific Manuscripts

1. Implementation of Evidence-based Asthma Interventions in Post-Katrina New Orleans
2. Indoor Environmental Exposures for Children with Asthma Enrolled in the HEAL Study, Post-Katrina New Orleans
3. The Head-off Environmental Asthma in Louisiana (HEAL) Study-Methods and Study Population
4. Few associations with Mold and other Allergens, etc. HEAL Manuscript