In-Home Asthma Program

Helping Worcester-area families breathe easier — one home at a time.

“Addressing asthma only at an annual physical isn’t enough. We must be proactive, meet families where they are, and support them with ongoing education and resources.”

Beverly Nazarian, MD | Pediatric primary care physician at UMass Memorial Medical Center

How the Program Works

Families are referred by pediatricians or pulmonary specialists based on a child’s asthma severity. Once enrolled, a community health worker visits the home up to three times over six to eight months, helping families with:

  • Identifying and reducing asthma triggers
  • Demonstrating proper inhaler and spacer use
  • Advocating for safe and healthy housing through legal assistance in collaboration with the UMass Medical-Legal Partnership at Community Legal Aid
  • Providing supplies like hypoallergenic bedding or cleaning products

Family-Centered Support Services

In addition to asthma care, our community health workers provide:

  • Social Drivers of Health (SDOH) screening: Help with applying for utility assistance, provides information on food pantries and other resources to help with food insecurity, and SNAP education
  • Housing assistance: Support with Common Housing Application for Massachusetts Programs (CHAMP) and Section 8 applications, housing inspections and advocacy
  • Education advocacy: Support for school enrollment and conflict resolution with districts
  • Support for basic needs: Through partnerships with organizations like El Buen Samaritano, we are able to provide essential support - including food, hygiene supplies, clothing, baby items, and more to individuals and families in need. 

“My purpose is to help — not shame. I’m here to stand beside families and advocate for what they need."

Stephanie Mesa | Outreach liaison and community health worker at UMass Memorial Medical Center

Program Impact – Fiscal Years 2024 and 2025 (FY24 and FY25)

As of Fiscal Years 2024 and 2025, the program has served a total of 84 families.

How to Qualify

Here are some common referral criteria for our program:

  • Recent hospital admissions or emergency department visits for asthma
  • Poorly controlled asthma despite using inhaled steroids
  • Frequent use of rescue inhalers or oral steroids
  • Environmental concerns reported at home (mold, pests, carpets, smoke)
  • Missed school due to asthma symptoms
  • Difficulty using inhalers correctly despite prior education
  • Low Asthma Control Test (ACT) score

Partnering for a Healthier Future

This program is part of a broader Pediatric Asthma Intervention Initiative, involving community partners to address asthma through a multipronged approach — clinical care, legal aid, school coordination and home-based services (housing).

Together, we’re reducing school absenteeism, emergency department visits and hospitalizations due to poorly controlled asthma.
 

Ready to Get Help?

If your child has asthma and you're concerned about managing it at home, talk to your doctor about a referral to our program through the Pediatric Pulmonary Division at UMass Memorial Medical Center.

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