place-based approach to improve asthma and health in public housing

Place-Based Approach to Improve Asthma and Health in

Public Housing

Presented by–the Boston Housing Authority-Ketsy Carballo and John Kane and Boston Medical Center-Johnna Murphy

National Healthy Homes ConferenceMay 28, 2014HUD Grant # MAAIH0002-11

Health in Public Housing• Approximately 3 million people live in

public housing across the nation; about 850,000 children or 41% (and many more live in leased housing)

• Source: CLPHA – HUD Resident Characteristics Report as of April 2006

Boston Housing Authority

• Largest housing authority in New England• Largest property owner in Boston• 9% of Boston residents in BHA housing

(over 50,000 residents)

HUD and BHA 2010 – 2014 Strategic Plan

• Utilize HUD assistance to improve health outcomes

• Strengthen and expand the BHA’s health and wellness initiatives such as those established through the Partners in Health and Housing Prevention Research Center

Partners in Health and Housing• Behavioral Risk Factor Surveillance

System (BRFSS)• Are you a public housing resident or live

in subsidized housing such as Section 8?

Health in Public Housing

• City of Boston – comparing Boston residents with Boston public housing residents

• More diverse, more non-US born, lower education, lower income, fewer married

• Source: Boston Behavioral Risk Factor Surveillance System 2006 and 2008, Boston Public Health Commission

Fair or Poor Self-Rated Health by Housing Status, Boston Adults,

2006 and 2008 Combined

33%31%

10%

0%

10%

20%

30%

40%

BHA Rental Assistance Non-PH

Per

cent

of A

dults

DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health CommissionDATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

Poor Mental Health by Housing Status, Boston Adults, 2006 and 2008

Combined

DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health CommissionDATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

Current Smoking by Housing Status, Boston Adults, 2006 and 2008 Combined

DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health CommissionDATA ANALYSIS: Boston Public Health Commission Research Office

Asthma in United States

• Number of people diagnosed with asthma has been growing

• Approximately 1 in 12 Americans have asthma (about 25 million people)

• Source: CDC, May 2011

Asthma in New England• Rates of asthma in New England are higher than

other parts of the country (9.7% compared to 8.1%)

• Lifetime Asthma Rates for MA was 14.5% as of 2006

• Source: Asthma Regional Council: Living with Asthma in New England, Feb 2010 report

Asthma Triggers

Indoor Triggers: – Mold and Mildew– Dustmites– Pet Dander– Outdoor Air coming

in your windows– Smoking– Nitrogen Dioxide– PESTS

Health in Public Housing

Lenox Camden

• Built 1939/1949• ~ 58% Hispanic and 30% Black• ~375 units• ~650 people• ~$13,000 avg.• ~40% age 0-18

Alice Taylor

• Built 1951• ~ 48% Hispanic and 45% Black• ~366 units• ~850 people• ~$15,000 avg.• ~36% age 0-18

Project LEAP

Public Housing Community Health Workers: A Place-Based Approach to Improve Asthma, General Health

Living Environmental Assessment Project

= Project LEAP

Project LEAP• Partners with Boston Medical Center and the

Boston Public Health Commission• HUD Grant # MAAIH0002-11• 3 Years• Enroll 160 families

Project LEAP

Goals and Objectives:

• Effect of CHW in Place-Based Model• Reduce Exposure to Triggers• Home-based Asthma Environmental

Education

Project LEAP

Timeline:• 2012 – Training• 2013 – Outreach• 2014 – Ongoing• 2015 - Completion

Project LEAP

Community Health Worker Training: Community Health Education Center

(CHEC) 7 Core Sessions: • Assessment, Leadership, Outreach

CHEC 7 Health Modules:• Mental Health, Family Planning,

Emergency Preparedness

Project LEAP

Training continued:• IPM in MultiFamily Housing• Essentials of Healthy Housing• Institutional Review Board• Asthma Training in Worcester• BPHC shadow staff• Asthma Home Environment Training in RI• Learn and Teach About Asthma

Project LEAP

• Reina Sanchez “Project LEAP is a very good program . They helped me out and still are. I am satisfied.”

Project LEAP: 1st Visit• Informed Consent &

Surveys• Environmental

Assessment• Tupper Ware • Healthy Homes

Book (Eng/Span)• Work Order

assistance if needed

Project LEAP: 2nd Visit

• Education & Surveys• Environmental

Assessment • Cleaning Supplies /

Recipes• Trash Can with Lid• Glue Trap / Roach

Monitors if needed

Project LEAP: 3rd Visit• Education and

Surveys• Environmental

Assessment • HEPA vacuum /

Swiffer Mop• $20 gift card• Work Order follow-

up if needed

Project LEAP

Home Visits / Incentives: 4th contact • Phone call or Visit• Repeat of survey questions• Measures sustainable change after

program

Project LEAP: DataStudy data collected on

Ipads using REDCap

• Stands for Research Electronic Data Capture

• Secure, firewalled web-based application

• Allows for validated data entry

Project LEAPKey Measures:• Environmental triggers (pests, mold, pets,

chemicals, smoking and pesticides)• Stress (Perceived Stress Scale) • General Health and Wellbeing (Wellbeing

Scale)• Asthma Control (Asthma Control Test)• Hospitalizations and urgent care and ER

visits

Project LEAP: Preliminary Demographics

95 residents have completed at least one visit

Gender:• 79% female• 21% male

Race/Ethnicity:• 46% Hispanic• 39% Black (Not Hispanic)• 6% White (not Hispanic)• 1% Asian• 14% Don’t know or Refused

Education:• 39% did not graduate high school• 35% high school graduate or GED• 26% at least some college

Age:• Average age=50• ranges from 22-74

Project LEAPPreliminary Asthma Results, Visit 1

• 39 Asthmatics Total

• 37% (30) homes with at least 1 asthmatic

• 31% well controlled asthma, 28% not well controlled, 41% poorly controlled

• 23% reported an asthma related hospital visit

• 28% reported an emergency or urgent care visit

Project LEAPPreliminary Perceived Stress Results

Perceived Stress Scale: Designed to tap how uncontrollable and unpredictable subjects find their lives

13=average

05

10152025303540

Visit 1 Visit 2 Visit 3

N=91 N=63 N=47

Perceived Stress Scores, Visit 1,2, and 3

Project LEAPPreliminary Asthma Trigger Results

An overall asthma trigger score is determined by any presence or reporting of mold, pests, dust, strong smelling chemicals, pets, or smoking.

58.51

4.26

38.3

24.47

2.13

30.85

0

20

40

60

80

100

Pests Dust Chemicals Pets Smoking Mold

Percentage of Families with Asthma Triggers on Visit 1

Project LEAPPreliminary Asthma Trigger Results

0

1

2

3

4

5

6

Visit 1 Visit 2 Visit 3

Average trigger score by visit

0

10

20

30

40

50

Visit 1 Visit 2 Visit 3

Percent chemical use by visit LEAP teaches healthier cleaning alternatives!

• Clutter • Leaks, holes, etc• Heating Concerns• Asthma Medication Use• Smoking Habits• Allergies • Work Orders

Project LEAPOther Measures Collected

Cats are like Potato Chips…You Can’t have Just One!

Project LEAP

Work Orders: 52• 14 pest; • 11 mold and mildew; • 5 plumbing leak; • 22 other• “I have nothing negative

to say about Project LEAP. It is a very good program.”

Project LEAP

CHW Assistance: 95 enrolled• Education: Environmental Triggers• Work Orders• Advocacy – Social Services• Referral free local resources• Continued Support-Phone call away• Follow up

Project LEAP

Lessons Learned:• Work Order System• Place-Based

recruitment-benefits and challenges

• Employee / Resident CHWs

Place-Based Approach to Improve Asthma and Health in Public Housing