A Fresh Breath (Richmond Magazine)

By Tharon Giddens

Michael Schechter is on a mission to help kids with asthma breathe easier.

It’s a matter of life or death.

Schechter, chief of the division of pulmonology medicine in the pediatrics department of the VCU School of Medicine, moved here four years ago from Atlanta. In his first year here, two children died from complications of asthma in the metro Richmond area. He’d only known of two deaths in seven years in Atlanta, a significantly larger city, he says. He also noted that there seems to be more children seen in emergency rooms and hospitalized with flare-ups of the disease in the Richmond area.

“I was struck, if not shocked by what was going on here in regards to asthma,” he says.

The city consistently placed in the top tier as one of the worst metro areas for asthma in rankings from the Asthma and Allergy Foundation of America. Richmond was second on its list for 2015, the most recent year for rankings. Asthma affects about 8.5 percent of children in the United States, but affects twice as many black children as white children.

It can’t be cured, but it can be managed and treated.

There are numerous factors that can trigger asthma, including dust mites, pollen, mold, pet dander, cockroaches and rodents, smoke, chemicals and air pollution, exercise, and respiratory woes.

Economic and social disparities also come into play.

Schechter cites factors such as low expectations from families, poor insurance, lack of transportation and poor housing affecting management of asthma in children in inner-city Richmond. A child may, for example, only be seen by health care workers when they are in crisis in an emergency room, or at a clinic instead of being managed consistently by the same team and building a “positive, trusting relationship,” Schechter says.

He wanted to provide more of a continuum of care for the kids, and in 2015 he helped create You Can Control Asthma Now (UCAN). The program focuses on providing solid medical care that's personalized and relationship-based while also addressing social issues that affect health.

The program also offers help with scheduling and transportation, self-management education and support, and screening and follow-up for any concerns regarding factors such as food and housing, mental health, and advocacy.

The name UCAN sends a positive message to families and promotes higher expectations, says Schechter.

He’s following 400 children, mostly recruited through the hospital. Many were frequent visitors to the emergency room and were referred by ER physicians, and others were already patients of the clinic.

He’s currently crunching numbers to show the impact of UCAN. He says he expects to show the program results in reductions in emergency room visitation and hospitalization and improved asthma control. It also helps reduce the number of schooldays missed by the children and work time lost for their parents and other caregivers, he says.

Respiratory illnesses are the most common cause of hospitalization of children, and UCAN has cut the hospitalization rate in its children by half, Schechter says.

The program earned the Children’s Hospital at VCU a National Environmental Leadership Award in Asthma Management from the U.S. Environmental Protection Agency. The award was presented in May and was one of three for 2017.

There are other initiatives underway in the city to curb asthma in children.

The Richmond City Health District announced earlier in July that it has received $100,000 in cash and $250,000 in technical help from the Sorenson Impact Center to conduct a feasibility study and work with stakeholders to explore ways to use a process known as Pay for Success in dealing with childhood asthma.

The project leader for the city is Joshua Ogburn, the director of the University of Virginia’s Pay for Success Lab. He says it’s just at the concept stage at this point. “We’re trying to find out if the promising idea has some legs to it,” he says.

Pay for Success involves outcomes-based contracting for funding.

Under the traditional grant process, if you developed a promising program to treat asthma, you would receive payment up front, says Ogburn, but under the Pay for Success arrangement, payment is based on the outcome of the program. Factors to be considered are how to proceed in the most effective way, without duplicating efforts and attaching payments to outcome goals as determined by stakeholders.

Ogburn says that the process generally works by finding philanthropic investors to provide money up front, and then having some other entity pay it back if the outcomes are met.

“The concept has the potential to help find better ways to address problems,” he says.

Asthma control is part of the focus of the Green and Healthy Homes Initiative, a national program to promote eco-friendly, energy-efficient and healthy homes for low- and moderate-income households.

Richmond's Healthy Homes Coalition in June initiated the six-month process to participate in the initiative. There are 25 cities in the program, and Richmond would be the first in the commonwealth to join.

Through the initiative, the Healthy Homes Coalition will seek to coordinate services and reduce redundancies. Other participating programs include Bon Secours Health System, UCAN, the Richmond City Health District, Healthy Homes Initiative, the Richmond City Office of Sustainability, the Richmond Regional Energy Alliance, ProjectHomes, the city building commissioner and building maintenance operation, the city’s economic and community development office, city redevelopment and housing authority, the weatherization office of the state housing and community development department, and Rebuilding Together-Richmond, Family Lifeline/CHIP.