Skip to main content

Home Visiting Collaborative Profiles

Illinois Asthma Program

The Illinois Asthma Program (IAP) has been in existence for 21 years. It is funded by the U.S. Centers for Disease Control and Prevention (CDC) and the Tobacco Settlement Recovery Funds to address asthma in Illinois. The IAP is led by the Illinois Department of Public Health and it implements the Illinois Asthma Plan. This plan was developed by key stakeholders participating in the Illinois State Plan Workgroup and focuses on action and collaboration to align with the 6|18 initiative and to accomplish the CDC sponsored national Controlling Childhood Asthma and Reducing Emergencies (CCARE) goal of reducing emergency department visits and hospitalizations due to asthma.

Various priorities, strategies, and activities are included in the plan’s framework. These components all follow the CDC’s EXHALE strategies which are:

  • Education on asthma self-management (AS-ME)
  • eXtinguishing smoking and exposure to secondhand smoke
  • Home visiting for trigger reduction and asthma self-management education
  • Achievement of guidelines-based medical management
  • Linkages and coordination of care across settings
  • Environmental policies or best practices to reduce indoor and outdoor asthma triggers

To best achieve these goals, the IAP has set the following priority areas:

  • Expanding access to and delivery of asthma self-management education in the form of a web-based program called Asthma Basics
  • Lowering absenteeism due to asthma
  • Reducing asthma-related emergency department visits, hospitalizations, and deaths
  • Increasing health equity

Home Visiting Collaborative Overview

In 2020, the Home Visiting Collaborative (HVC) began meeting virtually once a month to build individual program capacity, aide in state plan evaluation efforts, and ensure the delivery of effective asthma programs in various locations throughout Illinois.

To date, there are four state-funded programs that share common characteristics targeting children with asthma, ages 0-17, living in high burden areas of Illinois. Each of these programs collect participant data during five standardized home visits utilizing Asthma Basics for asthma self-management education, tracking referrals and referral sources, and measuring progress with the standardized Asthma Control Test. There is also an opportunity to refer participants to the Illinois Tobacco Quitline, if appropriate, throughout the five-visit model.

The five home visits per client family are shown in the diagram below. Currently, because of COVID-19, visits are occurring virtually or by telephone.

Timing of Home Visits


Demographics, Environmental Assessment, Asthma Control Test, Asthma Knowledge Quiz

2-4 weeks

Product Delivery, Asthma Basics, Asthma Control Test

90 days

Asthma Control Test, Asthma Knowledge Quiz

180 days

Asthma Control Test

1 year

Demographics, Asthma Control Test, Asthma Knowledge Quiz

Individual Home Visiting Programs

Just as an Asthma Action Plan is designed for each participating family, each of the four programs is unique.

What follows is a description of each one.

American Lung Association (ALA)

Contact Information:
Felicia Fuller, DrPH, MPH, Field Director-Health Promotions
55 W. Wacker Drive, Suite 800, Chicago, IL 60601

Areas Served: Chicago, Chicagoland, and Kankakee or other rural areas of Illinois

Years Served: Implemented home visits for the last eight years


Home visits are provided by trained ALA staff to assist families address asthma management concerns while identifying and remediating asthma triggers within their homes. During the home visit, ALA staff assesses the home environment for asthma triggers and shares information and resources with the family to reduce and/or to eliminate them. Traditionally, low-cost products are delivered to the home that help these efforts. Moreover, ALA staff develops an Asthma Action Plan with the family and reviews asthma symptoms and asthma medications.

Why it’s Unique

  • Receives most of its referrals from federally qualified health centers (FQHC) and school-based clinics, where potential participants must have uncontrolled asthma.
  • Bilingual staff available.
  • Provides incentives, like gift cards, trigger reduction products, and services, like carpet cleaning.

Sinai Urban Health Institute (SUHI)

Contact Information:
Julie Kuhn, MSW, Manager, Business & Operations – Community Health Innovations
1500 S. Fairfield Ave., Chicago, IL 60608

Areas Served: Chicago and suburban Cook County

Years Served: 21 years

Affiliated with Sinai Chicago: Mount Sinai Hospital, Holy Cross Hospital, Schwab Rehabilitation Hospital, Sinai Children’s Hospital, Sinai Community Institute, Sinai Medical Group


Since 2000, SUHI has implemented and meticulously evaluated a series of seven comprehensive interventions aimed at decreasing asthma-related morbidity and improving the quality of life of inner-city children and adults with asthma and their families. Programs have employed an evidence-based intervention and a well-established community health worker (CHW) model. The CHW model is at the heart of each of SUHI’s tested asthma programs. Interventions have varied in length from three months to one year, with three to six home visits by a trained CHW over that interval. Whenever possible, CHWs are recruited from the specific communities targeted by the interventions, which focus on asthma education, trigger reduction, and asthma management. Evaluation findings have indicated that emergency department visits and hospitalizations have decreased by about 70% and Quality of Life scores have improved significantly. Cost savings have been substantial, ranging from $2.33 to $7.79 per dollar spent.

Why it’s Unique

  • Bilingual CHWs available.
  • In addition to intensive training in asthma, CHWs participate in a 40-hour training encompassing CHWcore competencies, such as motivational interviewing, adverse childhood experiences (ACEs), andcultural humility. Prior to embarking on home visits, they are evaluated using a three-level role-playevaluation process.
  • CHW training is provided by the Center for CHW Research, Outcomes, and Workforce Development(CROWD). CROWD grew from SUHI’s vast leadership implementing and evaluating CHW interventions,and in the hiring, training, and deployment of CHWs. Through CROWD, SUHI supports health plans,health systems, organizations, and research studies in hiring, training, supervising, and evaluatingCHWs.

Southern Illinois University-Edwardsville (SIUE)

Contact Information:
Jerrica Ampadu, PhD, RN, CCP, Director of the We Care Clinic
601 James R. Thompson Blvd., Building D, Suite 2015, East St. Louis, IL 62201
618-650-3988 (Edwardsville), 618-482-6942 (East St. Louis)

Areas Served: St. Clair and Madison Counties

Years Served: 7

Affiliated with Southern Illinois University-Edwardsville School of Nursing


For six years, asthma home visits have helped residents in and around Edwardsville and East St. Louis to control their asthma through the WE CARE clinic employing advanced practice nurses, certified health coaches, social workers, pharmacists, and collaborating physicians. This clinic serves patients ages 2 and up, specializing in primary care needs, including chronic disease management, and provides “holistic, culturally competent care.” The clinic’s asthma-specific program, Asthma Trigger Assessment Program (ATAP), is offered through the clinic. ATAP employs a full-time health educator to improve patient access to care.

Why it’s Unique

  • Receives most of its referrals from primary care doctors and the Allergy and Asthma Foundation offers interpreter services.
  • Visits involve air quality readings and focus on respiratory health issues as a whole.
  • WE CARE clinic offers guidelines-based coordinated care on a weekly basis.

Southern Illinois University- School of Medicine (SIUSOM)

Contact Information:
Matthew J. Yarnell, DHA, MBA, Director at the Office of Community Care
201 N. Walnut St., Springfield, IL 62794

Areas Served: Sangamon County

Years Served: 6

Affiliated with SIU Medicine, Memorial Medical Center, St. John’s Hospital, and Springfield Clinic


SIUSOM services Sangamon County. This area has one of the highest rates of asthma and asthma-related hospitalizations in all of Illinois. The Children’s Asthma Program, offered by SIUSOM, targets the community’s most vulnerable children and seeks to improve childhood asthma morbidity rates and quality of life. The program created a community coalition to identify children most at risk for asthma and those who missed school due to their asthma. These children are eligible for the program’s services, which “provide a medicine and home-based trigger reduction strategy to improve their health outcomes.” SIUSOM’s asthma program takes a holistic approach by utilizing CHWs to conduct home visits and the program does not set limits on the number of visits allowed.

Why it’s Unique

  • Trains community health workers (CHWs) through the Expanding Community Health Outcomes (ECHO) program.
  • Delivers Asthma Trigger Mitigation Tool Kits that may include items like mattress covers and HEPA-filtered vacuums.
  • Offers interpreter services.
  • Developed the Environmental Assessment Application for smart phones.
  • Has strong partnerships with local churches.
  • May also link participants to local food bank.