Lessons Learned About the Implementation and Sustainability of a Community-Driven Asthma Intervention in Public Schools.

BACKGROUND: Racially minoritized and economically disadvantaged children are disproportionately affected by asthma and often receive less or lower quality care. This paper describes the implementation of a community health worker (CHW)-delivered program in the School District of Philadelphia, asthma management challenges in under-resourced schools, and provides potential solutions.

CONTRIBUTIONS TO PRACTICE: Implementation outcomes for two school-based interventions were evaluated to inform sustainment. Ten school nurses and administrators participated in semi-structured interviews about intervention experience, sustainment, resource gaps, and supports needed to continue the interventions. The research team observed intervention delivery and rated fidelity. Medication management, education, and coordination costs for nurses and CHWs were estimated and annualized over a 180-day school year. Interviews identified five themes: (1) barriers, (2) facilitators, (3) recommendations, (4) successes/impacts, and (5) sustainment. Lesson fidelity was measured across 7 schools and varied across lessons. CHW (≈$3366/school) and nurse costs (≈$1620/school) differed by over $70,000.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Care coordination, community partnerships, and reimbursement for CHW-supported programs in public schools should be instituted to implement and sustain asthma interventions and improve care access for racially minoritized and economically disadvantaged children.

CONCLUSIONS: Despite nurses' and/or administrators' satisfaction with the intervention, it was not sustainable without CHWs.