Multisystemic Therapy to Reduce Health Disparities in Adolescents With Asthma
Multisystemic Therapy to Reduce Health Disparities in Adolescents With Asthma
Asthma is a chronic lung disease that inflames and narrows the airways. Symptoms can include
 recurring periods of wheezing, chest tightness, shortness of breath, and coughing. Minority,
 inner city teens are at increased risk for complications from the disease, possibly because
 of poor illness management. The purpose of this study is to test the effectiveness of
 Multisystemic Therapy (MST)-an intensive, home- and community-based psychotherapy-for
 improving asthma management and overall health and for reducing healthcare costs for inner
 city African American teens with asthma.
Although rates of childhood asthma are increasing worldwide, more alarming is the
 disproportionate rise in rates of asthma among urban, disadvantaged, minority children. Inner
 city children, particularly adolescents, also appear to be most at risk for morbidity,
 mortality, and emergency department visits as a result of asthma. This may be caused by poor
 illness management.

 Because of the multiple factors that affect whether or not a family is able to adequately
 manage a youth's asthma, educational interventions alone are typically insufficient to reduce
 morbidity and healthcare utilization, particularly in high-risk urban populations. As a
 result, more intensive, multi-component interventions are necessary to improve asthma
 management and outcomes for those youth at highest risk. MST is an innovative, flexible,
 home- and community-based family therapy that has been shown to improve health outcomes in
 urban children and adolescents with other chronic medical conditions such as type 1 diabetes
 and HIV infection. The purpose of this study is to determine the effectiveness of MST in
 improving health outcomes and reducing healthcare costs in high-risk urban adolescents with
 moderate to severe persistent asthma.

 Participants will include high-risk African-American adolescents with moderate to severe
 asthma. High-risk youth are defined as those with one or more hospitalizations for asthma
 treatment in the previous 12 months. At a baseline hospital visit, participants will complete
 questionnaires and an interview, both of which will focus on the participant's family and
 asthma history. Participants will also have the option of having the study personnel visit
 their home instead. Participants will then be randomly assigned to receive either MST plus
 standard multidisciplinary specialty care or standard multidisciplinary care alone.

 Participants assigned to MST will attend psychological treatment sessions in their homes for
 about 6 months. Treatment sessions will be attended by both children and parents, occur at a
 time designated by the participants, and last about 1 hour. Participants will also complete
 questionnaires about their interactions with the therapist and their satisfaction with
 treatment.

 Participants assigned to standard multidisciplinary specialty care alone will receive weekly
 home-based, supportive family counseling for about 6 months. The treatment will provide
 emotional support to the family regarding asthma, help the family spot problems in asthma
 care, and address specific support that may help them with asthma management. Counseling
 sessions will last about 45 minutes.

 Participants in both groups will receive treatment for 6 months and follow-up for 12 months.
 Participants will be evaluated at baseline and after 7 and 12 months. Families will also be
 contacted during Months 3 and 9 for medical information. During the study, the medical charts
 of participants with asthma will be reviewed for medical history and clinic visits. Other
 medical providers who directly care for the participant's asthma (e.g., primary care
 provider) may also be contacted. At the Month 6 evaluation, height and weight measurements
 will be taken.

 The study completion date listed in this record was obtained from the "Completed Date"
 entered in the Query View Report System (QVR).
Inclusion Criteria:

 -  Moderate to severe persistent asthma

 -  African American

 -  One or more hospitalizations for asthma in the last 12 months

 Exclusion Criteria:

 -  No exclusions will be made due to co-morbid mental health problems (i.e., attention
 deficit hyperactivity disorder [ADHD], conduct disorder, depression, anxiety
 disorder), with the exception of thought disorder (i.e. schizophrenia, autism),
 suicidality, or mental retardation