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Connecting Health and Housing Programs: Collaborative Efforts to Improve Asthma Outcomes

Moderator: Tracy Washington Enger, U.S. Environmental Protection Agency

Presenters: Amanda Reddy and Tom Carroll, New York State Healthy Neighborhoods Program

Presenter: Margaret Reid, Boston Public Health Commission

Welcome to the Webinar

Wednesday, February 1, 2012 Webinar 2:00 – 3:00

Live online Q&A 3:00 – 4:00 on AsthmaCommunityNetwork.org

Operator Assisted Toll-Free Dial-In Number: (800) 374-0278 Conference ID: 41320169




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Introduction

Tracy Washington Enger U.S. Environmental Protection Agency

Operator Assisted Toll-Free Dial-In Number: (800) 374-0278 Conference ID: 41320169




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Purpose of Webinar

1. Learn about two exemplary models of healthy homes programs, a city-wide program and a state-wide program, that improve asthma outcomes.

2. Identify the benefits of collaborations, the characteristics of good partnerships and tips for approaching new partners.

3. Hear about outcomes and results, and how to demonstrate the value of healthy homes collaborations.

4. Learn how to start or expand healthy housing collaborations focused on improving asthma outcomes.




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Agenda 1. Introduction to the System for Delivering High-Quality Asthma Care

2. Focus on New York State Healthy Neighborhoods Program and Boston Healthy Homes Programs

3. Moderated discussion with presenters on five topics:

– Benefits of collaborating for improving asthma outcomes

– Key partners for effective healthy homes programs

– Creating effective partnerships and coordinating resources within/across agencies and sectors

– Partnerships can lead to sustainable institutional change

– Measuring results

4. Q&A Session in AsthmaCommunityNetwork.org Discussion Forum




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Do you have questions? Amanda and Margaret will be available online in the AsthmaCommunityNetwork.org Discussion Forum from 3:00-4:00 p.m. EST today to respond to questions you post in the Discussion Forum. To post a question in the Discussion Forum, follow these directions: 1. If you are a Network member, log-in to your AsthmaCommunityNetwork.org

account.

2. Under the “Interact” tab on the homepage navigation, Click on the “Discussion

Forum” link. 3. Click on the blue “post to the forum” button in the green box at the top of the

page to post your question. 4. When you have finished entering in your question, click the “Save” button at the

bottom of the page.

Questions & Answers Session on AsthmaCommunityNetwork.org Discussion Forum

Not a member? Create an account at AsthmaCommunityNetwork.org by clicking the “Join Now” link at the top of the page. Your account will be approved momentarily and you can begin posting questions.

http://www.asthmacommunitynetwork.org/�

http://www.asthmacommunitynetwork.org/interact/forum�










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Who: Champions and Leaders of Community Asthma Assets

Local Environmental

Public Officials

State Agencies

Public Housing

Schools

Non-Profits

Service Providers

Coalitions

Funders

Health Plans

Tailored Environmental Interventions

Integrated Health Care

Services




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Poll Question Audience Snapshot

Which best describes your organization?

Other Groups Represented:

•Academic Organization •Non-Profit

•Pediatric Nurse Practitioner




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EPA Award Winners

EPA’s highest recognition a program and its leaders can receive for delivering excellent environmental asthma management.

Apply by Feb. 21

www.asthmaawards.info




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New York State (NYS) Department of Health Center for Environmental Health

Amanda Reddy Research Scientist

Thomas Carroll Chief Sanitarian




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• Location: High-risk neighborhoods across NYS

• Type of Program: Local and State Public Health Department Collaboration

• Service Area: Target neighborhoods within selected urban, suburban and rural communities

• Population Served: Between 10/2007 and 6/2011, the program provided services to 58,000 residents in more than 20,000 homes in high-risk areas: • Approximately 13% of the residents had asthma, half of the households

were identified as non-white and roughly half receive public assistance.

Program Overview




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• We are a healthy homes program that seeks to reduce the burden of housing related illness and injury, especially among vulnerable populations in NYS • Homes in high-risk areas are identified through a

combination of door to door canvassing and referrals

• Homes are assessed and interventions (education, referrals and products) are provided based on specific problems identified during the home visit

• Centrally managed at the state level, but services are delivered through local programs

Program Overview




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• The major activities our program pursues to drive toward our target outcomes include:

– Integrated clinical services: strategic local partnerships with clinical organizations

– Tailored environmental interventions: built upon existing successful healthy homes program

– High performing collaborations: state health department is uniquely positioned to facilitate partnerships and streamline communication and evaluation activities

Activities and Outcomes




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Collaborations and Partnerships

Asthma Control Program Healthy Neighborhoods Program

Tobacco Control Program Center for Environmental Health

Center for Community Health Office of Health Insurance Programs

Asthma Partnership of New York

STATE

Regional asthma coalitions Managed care plans

Hospitals and urgent care centers Providers and practices

School nurses Office of Health Insurance Programs

Bureau of Chronic Disease Prevention

CLINICAL/ REGIONAL

LOCAL

NYS Healthy Neighborhoods Program Providers and practices

Hospitals and urgent care centers Managed care plans

School nurses Community foundations and

organizations and many others




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• Data used dynamically to monitor progress and refine the approach

• State-led evaluation streamlines resources, allows for comparisons and spreading of best practices

• Scannable form and automated reports

• Use of supplemental data collection as appropriate

Evaluation




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Selected outcomes (stratified on recruitment approach)

Among homes with problems identified at the initial visit, we have seen significant improvements in the presence of triggers, self-management and medication usage and short-term asthma morbidity, including the following selected outcomes:

Problem identified at initial visit Improvement at revisit

TRIGGERS

Evidence of smoking in the home 11-16%

Mold 45-59%

Cockroaches 42-56%

SELF-MANAGEMENT

Does not feel asthma is well-controlled 39-63%

Lacks knowledge of personal triggers and trigger avoidance strategies

39-100%

MEDICATION (previous week)

Did not take controller medication every day 40-100%

Used quick-relief >2 times 21-30%

MORBIDTY (previous 3 months)

Days with worsening asthma Up to 3.5 fewer

Days missed of work/school/daycare Up to 2 fewer




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Sustaining the vision…




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Sustaining a presence in the community

No sales persons No peddlers

No Jehovah Witnesses

(We have our own religion)

Will accept only if from the Niagara County Health

Department – Healthy Neighborhoods Department

(Left) Excerpt from a letter sent to the NYS Healthy Neighborhoods Program (Right) A sign posted on the door of a Niagara Falls residence, January 2009




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www.health.ny.gov/health_care/medicaid/redesign/docs/health_disparities_report.pdf

Sustaining focus on mission creates lasting changes




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Boston Public Health Commission Healthy Homes Program

Margaret Reid, Director, Division of Healthy Homes and Community Supports




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Program Overview • Nation’s first city health department

• Mission: A safe and healthy home for all residents

• Long term focus: Addressing conditions that trigger asthma – Asthma hospitalization rate for Black and Latino

children is three to four times the rate for White children

• Successful city partnerships for asthma: – Healthy Pest Free Housing Initiative – Breathe Easy at Home – Boston Smoke-Free Homes




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Boston Housing Context • City population: 617,594

• Total housing units: 277,949

– 81% multi-unit

– 37.3% homeownership rate

• Boston Housing Authority: city’s largest landlord

– 12,000 public housing units

– 27,000 residents

– 38% Latino, 26% Black, 19% White, 16% Asian

– Average annual income of $12,000




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Boston Surveillance Data

Health Condition

Public Housing and Rental Assistance

Non-Public, Non-Rental Assistance

Current Asthma 23.1% 14.8%

Current Smoker 24.9% 13.3%

High Blood Pressure 32.8% 22.1%

Diabetes 11% 4.4%

DATA SOURCE: Boston Behavioral Risk Factor Survey 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health

DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office




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Healthy Pest Free Housing Initiative

• Too many complaints about pests – Boston Housing Authority – City Inspectional Services

Department • Too much money spent without

results • Seemed like an insurmountable

problem for Boston Housing Authority to tackle alone




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Cockroach Work Orders by Development




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Breathe Easy at Home Program

• Joint Program: Boston Public Health Commission and Boston Inspectional Services Department

• Web-based referral system

– Clinicians can request home inspections for asthma patients

– Inspections address exposures that trigger asthma and are covered by sanitary codes for housing

• Since 2006, Breathe Easy at Home has provided services to nearly 1,000 Boston households with asthma




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• Clinicians receive case updates by email

• System encourages clinicians to discuss environmental asthma triggers with their patients

Breathe Easy at Home Program




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16

60

128

176 182

171

219

0

50

100

150

200

250

Num

ber

Year

Breathe Easy at Home Case Referrals 2005-2011

2005 PILOT

2006 LAUNCH

2007 PT Coordinator

2008 FT Coordinator

2009

2010

2011




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Boston Smoke-Free Homes

Boston Housing Authority took the lead to address resident complaints and relocation requests

2009 Smoke-Free Pilot

2010-11 Resident surveys and public process for Boston Housing Authority Smoke-Free Policy

2012 Policy takes effect

http://www.bostonsmokefreehomes.org/Pages/About-Us.aspx�




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Boston Smoke-Free Homes 2010-2012

• Provide technical assistance and training for developers and landlords to increase smoke-free housing options – Engage tenants, connect with cessation

resources

• Work with city of Boston housing departments to provide incentives for smoke-free homes




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Boston Smoke-Free Homes

• Smoke-Free Homes Website

• Smoke-Free Homes Registry

• Public awareness campaign




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Lessons Learned • Partnerships

– Make it possible to reach more people

– Help establish model health-promoting practices

• Existing relationships – Set foundation for new initiatives

– Support creativity in advancing a common agenda and position you for opportunities

• Core vision that is reliable over time – Leads to sustaining impact

• Engage partners in design – Collaborate to establish objectives




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Creating effective partnerships and coordinating

resources within/across agencies and sectors.

Healthy Housing Programs: Discussion Topics




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Measuring results

Healthy Housing Programs: Discussion Topics




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Conclusion of the Webinar

Post your questions now on

AsthmaCommunityNetwork.org

Connecting Health and Housing Programs: Collaborative Efforts to Improve Asthma Outcomes

Moderator: Tracy Washington Enger, U.S. Environmental Protection Agency

Presenters: Amanda Reddy and Tom Carroll, New York State Healthy Neighborhoods Program

Presenter: Margaret Reid, Boston Public Health Commission





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Do you have questions? Amanda and Margaret will be available online in the AsthmaCommunityNetwork.org Discussion Forum from 3:00-4:00 p.m. EST today to respond to questions you post in the Discussion Forum. To post a question in the Discussion Forum, follow these directions:

1. If you are a Network member, log-in to your AsthmaCommunityNetwork.org account.

2. Under the “Interact” tab on the homepage navigation, Click on the “Discussion Forum” link.

3. Click on the blue “post to the forum” button in the green box at the top of the page to post your question.

4. When you have finished entering in your question, click the “Save” button at the bottom of the page.

Questions & Answers Session on AsthmaCommunityNetwork.org Discussion Forum

Not a member? Create an account at AsthmaCommunityNetwork.org by clicking the “Join Now” link at the top of the page. Your account will be approved momentarily and you can begin posting questions.








Documents

Welcome to the Webinar Click to edit Master title style...Click to edit Master title style • Click to edit Master text styles – Second level • Third level – Fourth level »