Asthma is the most common cause of hospitalization in children other than infections. The Health People 2000 initiative to reduce asthma hospitalizations was NOT met. Minority, inner city children, particularly adolescents, appear to be most at risk for high morbidity and mortality. Poor illness management is thought to be a primary driver of asthma morbidity and mortality. Yet, there are very few randomized controlled trials with inner city adolescents with asthma. Because of the complexity of asthma management and the associated barriers, intensive, multi-component interventions are needed to improve outcomes among those at highest risk. The investigators have adapted Multisystemic Therapy (MST), an innovative home- and community-based psychotherapy, to successfully improve treatment adherence and outcomes in urban pediatric medical populations. The objective of the present study is to utilize MST to improve asthma management and to reduce health care utilization (emergency department visits and hospitalizations) among high risk African American adolescents (ages 12-16) with moderate to severe persistent asthma. High risk is defined as having >=2 emergency department visits or >= 1 hospitalizations in 12 months). Additional aims are to determine the stability of MST's effects over a 12 month interval and to determine cost-effectiveness of the intervention. Families will be recruited from the only university-affiliated medical center in Detroit, Michigan. Detroit has the highest percentage of African Americans of any major city in the United States. The experimental design for the proposed study is a randomized controlled trial with 170 high risk African American adolescents with moderate to severe persistent asthma, 85 of whom will receive standard multidisciplinary specialty care (control condition) and 85 of whom will receive this care plus MST. Families will complete an initial data collection session (baseline), a 7-month post-test designed to coincide with treatment completion, and a subsequent post-test at 12 months after baseline. If successful, this intervention will provide immediate assistance to a vulnerable population disproportionately affected by asthma and may reduce costs of care for this high risk population. While asthma is the second most common cause of hospitalization in children, minority, inner city teens are at increased risk for complications from the disease. We are testing the effectiveness of an intervention for inner city African American teens with asthma using Multisystemic Therapy?an intensive, home- and community-based psychotherapy. If successful, this intervention will improve asthma management and overall health, as well as reduce healthcare costs for this vulnerable population disproportionately affected by asthma.
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