Dallas, Marengo, Perry, and Wilcox counties, part of the Black Belt (so named for its rich, dark soil), are four of the poorest counties in Alabama. They also have one of the highest rates of childhood asthma—nearly 12% compared to the state’s 8%—and are severely underserved when it comes to medical care. Two of the counties don’t even have a pediatrician.
Yet just 4% of the more than 5,000 patients seen at Children’s of Alabama’s specialty asthma clinic hail from those areas. “We realized these kids weren’t getting to us for help,” pediatric pulmonologist Isabel L. Virella-Lowell, M.D., said. “But Medicaid data showed a high number of asthma-related claims from the area. So we knew there was a gap.”
One reason is distance, with families having to drive up to three hours to reach Birmingham. Thus, many children receive care only during asthma flare-ups at urgent care clinics or emergency rooms rather than ongoing, preventive treatment, said Children’s and University of Alabama at Birmingham (UAB) Pediatric Asthma Program Director Teresa G. Magruder, M.D. Without a primary care physician overseeing their child’s asthma, families find themselves caught in a cycle of crisis-driven care.
So instead of hoping kids will come to Birmingham, Virella-Lowell and Magruder are bringing their expertise to the Black Belt. Their mission: Improve those dismal asthma statistics by engaging the community at a grass-roots level.
The initiative began when Children’s and UAB infectious disease specialist Claudette Poole, M.D., spent time in the area studying water sanitation and parasites. She kept hearing about an asthma crisis and recruited Virella-Lowell and Magruder.
The three applied for and received a Health Resources and Services Administration (HRSA) grant, which provides salary support for the core team along with local community and health care partners. It also helps fund the virtual continuing medical education (CME) Project ECHO sessions, health fairs, and supplies such as spirometers and educational materials.
Magruder and Virella-Lowell stress the community-based approach of their efforts rather than having Children’s swoop in for just a few months. “We are really trying to improve the capacity of the community and their understanding of delivering asthma care in their own communities,” Magruder said. That means educating the frontline people caring for children, including school nurses, teachers, daycare workers, and parents, while providing access to subspecialty care for the severe high-risk patients.
“Our goal is to raise the level of asthma care across the state,” Magruder said, “not just at Children’s, but everywhere kids need it.”
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As the mental health crisis continues across the country, children and teens are in greater need of mental health services than ever before. In many cases, the first person to recognize the child’s need is a teacher. But the teacher may not always know how to help. That’s why Children’s of Alabama recently expanded one of its mental health programs to offer training for school personnel.
The program, Pediatric Access to Telemental Health Services (PATHS), has been around since 2019. Children’s established it—with support and funding from the Alabama Department of Mental Health (ADMH)—in response to the need for more mental health services, especially in rural areas. The initial goal was to help primary care providers understand how to help patients who present with mental health concerns. Through the program, Children’s mental health professionals offer consults or education for providers or even telehealth appointments for their patients.
PATHS has since expanded into urban areas, and now, thanks to the extension of a Health Resources and Services Administration (HRSA) grant, Children’s is offering support to school systems across the state.
“This is an important step for our program,” PATHS director Margo Harwell said. “Because they see students daily, school personnel play a critical role in identifying early signs of mental health concerns in students.”
To see how the program works, click here.
The Because We Care Questionnaire initiative rolled out across the hospital for inpatients and clinic visits via MyChart, MyChart Bedside, or eCheck-in For All. This technology allows patient families to self-report needs and barriers to care they are facing. Notifications are sent to the social work team when needs are reported, which allows social workers to follow up with families and provide resources to address barriers related to food insecurity, transportation needs, and housing instability.
Because of this initiative, we are more proactively addressing barriers to care for the families we serve.