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This podcast forum is brought to you to share expertise and insights within our integrated delivery system to help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights. Here's your host, Melanie Cole.

Melanie: Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole. And today, we're discussing the Pediatric Asthma Symposium, Perspective and Resources for Pediatric Asthma. Joining me in this panel are Nick Quealy-Gainer, he's a social worker in the Community Health Initiatives at the Carle Foundation Hospital; and Jeslyn Roat, she's a social worker with the Carle Foundation Hospital covering outpatient clinics. Thank you both so much for joining us today.

So Jeslyn, I'd like to start with you. Tell us a little bit about how social determinants of health affect many children with asthma.

Jeslyn Roat: Social determinants can be many different things. And there are several that specifically come to mind, especially dealing with the pediatric asthmatic population. Some of those translate to other diagnoses as well. You've probably heard of many of them. So typical resources that people need, housing, something like that. Access to food or food insecurity can definitely affect children that are struggling with asthma. Education and health literacy, both of the child and the family, their socioeconomic status. If they have money to afford prescriptions and make it to doctor's appointments and things like that. There are always racial and ethnic disparities that families are going to be facing that affects their treatment process, their ability to obtain what they need to take care of their kids, as well as psychosocial stress. Any of those stressors can definitely affect whether or not a patient is able to get the care that he or she needs.

Nick Quealy-Gainer: I'd like to add. So one of my roles with the community health initiatives is on the mobile health clinic and we park that clinic in a lot of lower income neighborhoods or neighborhoods that may have substandard housing with poor environmental health, which really contributes to that social determinant of health, housing insecurity, and living in those neighborhoods with higher pollution rates, with higher traffic areas. And a lot of them are near the highways in the area where there's mold in the home or other poor environmental health, and that can certainly contribute to asthma and other respiratory disorders for the children and families growing up in these neighborhoods in these communities.

And then we also screen for other adverse childhood experiences or ACEs when we're on the mobile clinic, looking at some of those traumatic events that children experience before they're the age of 18. So things like housing and food insecurity, but also child abuse and neglect, violence in the community and in the home. And we see from evidence and research that all of these experiences for children lead to chronic illnesses, such as asthma, heart disease, diabetes, things like that. So those are all things that we're trying to address for our pediatric patients.

Melanie: Well then Nick, as we're talking about the factors that contribute to healthcare disparities in children with asthma, data's shown that people from racial and ethnic minority groups are less likely to receive preventive healthcare. And across the board, we've seen various ethnic groups face a disproportionate health burden. So as you're telling us about some of those factors that you've noticed with the mobile clinic, expand a little bit more about what you've seen and how this outreach gets to those people. How have been outcomes? What have you seen with these unique individuals, especially when it comes to asthma as you've mentioned in some of these areas with pollution and no access to healthy foods, things like that? Speak of what you've seen and how your outcomes have been with this clinic.

Nick Quealy-Gainer: Well, that's certainly been one of our primary missions and visions with this mobile health clinic, is to bring healthcare services and social services out of the typical brick and mortar buildings, hospitals, and clinics, and bring these services to people's communities where it's most convenient and giving the best access to care for them. And we certainly had some targeted communities in the area that we were hoping to be able to serve, that had higher rates of barriers to receiving services, higher rates of some of the conditions that we were hoping to be able to treat, less access to primary care and pediatric care.

And so far, we've been very successful in being able to serve a lot of these populations that we've been hoping to be able to serve. Our role as social workers in some of these communities is to make sure that we can do everything we can to reduce these barriers to their care. So not just bringing the care to them, but making sure that they can get to followup appointments if we're making referrals to specialists like the pediatric specialist that Jeslyn works with. Making sure that they have access to insurance if they're coming to us and they're uninsured. We're going to see them, but if they need a referral, they may not be able to be seen. So we're screening for eligibility for insurance, and then helping them apply for insurance while they're there scheduling a followup appointment. Letting them know that there's transportation to get to these appointments if they're needing followup visits or to get to the pharmacy. And we can work with their insurance or work with the community to get them the transportation that they need, so that's not a barrier for them.

So those are all things that we're working to address while they're there to be seen by our providers. As social workers, we're there to work with them and to connect them to these services as well.

Melanie: Jeslyn, as we're talking about how social work can assist patients and their families, and Nick just mentioned a few of those ways, speak about some of the factors unique to your region. Are there factors that could improve the care of students with asthma in the school system? The social work programs, do they work with the parent only with the school systems? Tell us a little bit about how you all work together, and a very multidisciplinary approach as there are probably many people involved.

Jeslyn Roat: Yes, definitely. So, as Nick mentioned previously, there are several different ways that we can assist or things that we can kind of filter for to see if a social work consult would be beneficial. I'm fortunate to have some great pediatric pulmonologists that I work with hand in hand and some nurses that do a great job of screening for some of those things and then contacting me to get ahold of these families, to meet with them during appointments and things of that nature. So I'm very fortunate in that we have a pretty solid interdisciplinary team here at Carle. And then yes, there's definitely some outreach to the schools as well.

So our primary thing that I would mention here, along with making sure that there are no barriers to actually getting them to the appointments, the transportation or financial resources or helping them get insurance and kind of navigate that field is also providing education about what asthma is and the importance of it, importance of keeping up with your medications. A big issue is lack of health literacy. So trying to explain to these families the importance of obtaining your prescriptions and honestly like how a pharmacy works, that once you get this prescription today, you have to go back and you have to refill it. You have a certain amount of refills and then you need to call the doctor's office.

So really just encouraging them to reach out to us at any point in time when they're confused about this or if their prescription shows up as $200, but they have insurance and they can't afford that. Giving social worker a call or the doctor a call. He's going to reach out to me and we're going to try to figure out what's going on with insurance. Maybe the pharmacy doesn't have the right information or maybe the wrong prescription was given and another substitute for that same type of drug could be given that is actually covered by their insurance. So a lot of different problem-solving as far as that goes.

But again, a big education piece between the doctor, myself and the nurse to just really try to help these families know that this is something that's important, and this is something that we can help with, pretty much all aspects around it. So encouraging them to not be afraid to reach out to us, that we're an approachable community that's just trying to get together and really help their kiddos out while they're struggling with this chronic illness.

As far as the connection with the school goes, some kids obviously have a much more severe level of asthma and that level of education also needs to be shared with the school. Every school system has a registered nurse that works for their school system. So communicating the information with them, making sure that the kid has appropriate prescriptions. Sometimes they need to be prescribed two inhalers, one to keep at home with them at all times and one that never leaves the school, things like that. So just communicating with the nurse at the school, communicating with the kids' teachers, especially PE teachers, just to make sure that if you see these symptoms coming from the patient, then something really needs to happen. And to know that this is actually a chronic illness that this kiddo struggles with that needs to be taken seriously rather than undermined or just not really accepted coming from a small kid.

So the communication piece between the school is very important as well. I think that all starts with the education of the parents and of the child, obviously, depending on their age level. And then that kind of becomes a team effort between parents, doctor's office and the school in order to just make sure that the kid has what he or she needs and that everybody is kind of working together to make sure that we all understand and are on the same page.

Melanie: So Nick then, as she's talking about working with pediatric asthma, how might these healthcare disparities occurring in children with asthma affect them as they grow into adulthood? What can we do at a system level to try and rectify some of these disparities?

Nick Quealy-Gainer: The providers and team, the integrated medical team that Jeslyn mentioned, the providers, nurses, social workers, are all working to stay in constant communication and working with the children as they're growing up, to constantly educate them and reeducate them as they develop throughout different stages into adulthood, to explain that this is something that can be controlled and that hospitalizations and asthma attacks and ED utilization is preventable if symptoms are recognized ahead of time and can be controlled. And I think that the providers and social workers, especially in the clinic and hospital side, do an excellent job of that.

What we see a lot with children and even teenagers and into adulthood is insurance and financial barriers continue to be a barrier to them in accessing the services and care that they need. So a constant sort of education and checking in with these patients as they come in whether it's through our mobile clinic or I know that they do this in the hospital and clinic side as well, is educating them that, "Yes, you may have insurance for your visit today. But if you need to be seen in six months or a year, you need to--" Especially if it's Medicaid insurance, educating them and making sure that they know that there's a renewal process that they have to go through each year in order to stay insured. And that all children here in Illinois should have insurance through Medicaid if they can't get it through an employer or through private insurance.

So that's a big thing that we're always enforcing and encouraging, is to stay on top of those renewals and to make sure that they can continue to have that coverage because we see that where maybe their asthma is being controlled really well while they have the insurance, but then they lose it and they don't know how to get it back or there's a large gap in coverage and suddenly they can't get the prescriptions that they need from the pharmacy anymore, because they're not going to be able to afford the out-of-pocket costs. Or they can't get in to see their pulmonologist or their pediatrician any longer until they can get back on that coverage. So that's a big part of what we try to do, is let them know we can help you get this insurance coverage now, but there's a process that you're going to have to sort of stay on top of to make sure that you can continue to have access to these care. And that will be available on the mobile clinic and the social workers within the clinics and the hospital to support them through that process if they need it.

Jeslyn Roat: Right. And I would also add to that, Nick, the education piece again of, as the patients are growing older, we're walking alongside them to help them understand what their treatment looks like. We want them to take autonomy as soon as possible and recognizing your symptoms and being able to properly use their inhalers or whatever medications they're on.

And along with the insurance side of things, as they grow up, they're understanding as well, that once you're an adult or as you're transitioning to an adult, you need to know these things, X, Y, and Z, about insurance and financial assistance or prescription assistance and fill in the blank and that there are people that can help you with that such as Nick or myself, the other social workers, both in the hospital and in the clinics at Carle. So again, just creating that autonomy as they're growing older and educating them and preparing them to be able to take care of themselves as they transition to adulthood.

Melanie: What great points you both just made. Really important information. I'd like to give you each a final thought here. So Jeslyn, how and when should other providers refer to social work so that they can really know that their patients are well taken care of, their patients with asthma, specifically their pediatric patients, just speak to other providers for a minute about when you feel it's important they refer.

Jeslyn Roat: I always vote on the side of over-refer, because if there's not an actual issue there, we'll figure it out and we can move on from there. But if there is an underlying issue that we don't know about and we're never notified about the patient, then there's really no way for us to identify that there's a problem in place that could potentially be fixed by some resource or some education or something along those lines. I always encourage people to reach out to their social workers. We're everywhere. We're kind of hidden in some ways, but as far as the mobile clinic goes, Nick is right there on site and is able to help those people that come into the clinic.

All of the outpatient clinics have their own social workers. And then the inpatient side, every floor has their own social worker. If somebody is out, we're covering for each other. So anywhere at any given time, you can most likely find a social worker that covers your department. And if not, you can always reach out to our leadership to find out who specifically covers your department. You can send things in Epic to the social services basket, and things like that. And if it's an outside provider thing, they can always get ahold of social work on the outpatient side just by giving us a call, and talking through the situation.

So there are a lot of different ways to get ahold of us. And again, I would definitely recommend to over-refer. Sometimes, just in any type of referral, we learn so much more about the patient and these other barriers that they're facing that we can help address that's going to help their overall well-being, their overall socioeconomic status, access to healthcare, and just improve their lives if we are able to reach out to these people facing these health disparities and be able to identify those issues and help them to be connected with resources that can fix some of those problems or at least educate them about how to do some of that on their own too.

So again, over-refer, reach out at any point in time and one of us somewhere would be happy to walk through that and help our patients in the best way that we can.

Melanie: Nick, last word to you as we're finishing up perspective and resources for pediatric asthma, what else would you like to mention? Any thoughts, advice? Please just finish it off for us.

Nick Quealy-Gainer: Sure, thank you. I would just like to share a bit more information and I know that this is going to be touched on in other aspects of the symposium is the mobile health clinic here at Carle and our role with the launch of the Pediatric Asthma Specialty Clinic that is launching this summer where we will be holding these specialty clinics at our various locations and including some new locations. And then also a lot of the really exciting partnerships that we've been able to form over the years with schools in the area, whether it's Champaign, Urbana Schools, Rantoul, Danville, Bloomington. A lot of our locations that we have Carle Clinics and Carle patients, we are also working with the school districts to have back to school events throughout the spring, summer, into the fall, where a lot of times we'll have school nurses, social workers, staff onsite during these events to get their students and families referred to us, make sure they're seen for their school physicals, sport physicals immunizations. But then we're also having these conversations about some of the chronic conditions that these students are having to make sure that the school staff and nurses and social workers are all aware and everybody's on the same page and communicating and collaborating to best serve and make sure that these kiddos are healthy while they're in school. And they can be in sports and have the protections and equipment and supports in place for them to be able to do that in a healthy and thoughtful way.

So we're really excited about the specialty clinics that we're going to be doing this year and into the future. So if you don't already have it anywhere on the symposium website or information for this recording, the website for the mobile health clinic is carle.org/mobilehealthclinic. And that has all the information about the clinic as well as our calendar of events and locations.

Melanie: Thank you both so much. What an educational episode this was. Thank you for joining us. That concludes concludes this episode of Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle-sponsored educational activities, please visit our website at carleconnect.com for more information. Thank you so much for listening. I'm Melanie Cole.