Disease Prevention and Control
Chronic Disease Case Management (Take Charge!)
Take Charge! is a case management and education program that helps families of children with asthma, diabetes and/or obesity more effectively manage their children’s chronic health conditions. The program model is currently implemented in the medically underserved city of Compton, California, whose Latino and African American residents are disproportionately affected by these health conditions.
Through their participation in the Take Charge! asthma case management program, including the “Catch Your Breath” Asthma March in Los Angeles, many families have since become involved in other civic and environmental justice initiatives.
The Take Charge! program includes five major components:
- Family-focused in-home education and case management services delivered four to six times per year, including individualized goals and action plans to improve management and treatment of the child’s health condition
- Weekly community-based health education classes open to case-managed families and the community at large
- Health coverage enrollment and health access services to ensure that children with chronic health conditions receive appropriate monitoring and treatment
- Identifying and reducing disparities in access to health care, working in partnership with local health care providers
- Community engagement in promoting positive health behaviors and advocacy for health-related policy issues
The Take Charge! Program’s Strategies for Success
- The Take Charge!program fills a gap in communication between patients and providers; participants report that the program taught them things they did not learn from their doctors, whether because of language barriers, time constraints during their appointments, or because they were afraid to ask questions. Through their participation in the program, families have also learned critical information about their children’s or their own medications and devices (such as glucometers) that they never fully understood through standard patient education at their doctor’s office.
- The family-focused approach of the case management component of the Take Charge! program helps ensure long-term improvement in health behaviors by creating a built-in family support structure for each participant.
- The intensity of the Take Charge! program’s case management services require ongoing accountability among participants—an often vital component of effective self-management.
- The Take Charge! program reduces the utilization of emergency care for chronic conditions over the long term by improving medication management; increasing overall knowledge of the health conditions, aggravating health behaviors, and mitigating health behaviors; and by linking children and families to a medical home.
- The Take Charge! programtakes into account the generally low literacy level of our participants when delivering home-based educational services, and adapts existing patient education materials into simpler terminology both for English-speaking and Spanish-speaking clients. This practice helps make technical information on the target health conditions and their treatment and management less intimidating and more accessible to the families who needed it most but would otherwise have been the least able to understand it.
Program outcomes to date have been exceptional, particularly in their local context. Among families in the asthma case management program, for example, 94% of families reduced environmental asthma triggers in their homes; 92% adhered to children’s prescribed asthma medication regimen; and no children required an asthma-related emergency room visit, compared to 80% who sought emergency treatment in the year before enrollment.
Among diabetic and obese participants, more than 75% reported taking steps toward a healthier diet and exercising at least 30 minutes daily, compared to fewer than 30% at baseline; and 87% of diabetic participants adhered to their treatment regimens, including glucose self-monitoring, meal planning, portion control, exercise, medication compliance, stress management and standards of care. Even newly enrolled participants have implemented positive lifestyle changes such as exercising regularly, joining organized sports, cutting back on snacks and junk food, eating smaller portions and making healthier food choices.
Overall, one of the most important achievements of the Take Charge! program model is participants’ reported increases in their sense of self-efficacy—their confidence that they can effectively manage their children’s or their own chronic health conditions as a result of their participation in the program.