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A Community Health Worker Program to Address Indoor Environmental Triggers for Childhood Asthma in East Harlem Public Housing: Implementation and Outcomes.

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Presentation on theme: "A Community Health Worker Program to Address Indoor Environmental Triggers for Childhood Asthma in East Harlem Public Housing: Implementation and Outcomes."— Presentation transcript:

1 A Community Health Worker Program to Address Indoor Environmental Triggers for Childhood Asthma in East Harlem Public Housing: Implementation and Outcomes Ray López 1 ; Anne Bozack, MPH 2 ; Tongtan Chantarat, MPH 2 ; Linda Weiss, PhD 2 1 Environmental Health & Family Asthma Program, LSA Family Health Service 2 Center for Evaluation and Applied Research, The New York Academy of Medicine

2 Family Asthma Program Community Health Worker home visits focus on housing conditions and family habits that may affect a child’s asthma Services include: –Repeated CHW home visits over a 1 year period –Case management –Remediation to improve indoor air quality and eliminate asthma triggers –Hands-on training for caregivers –Allergy control and pest management products –Tenant organizing and advocacy

3 CAHR – Controlling Asthma through Home Remediation Expansion of the Family Asthma Program Funded HUD’s Office of Healthy Homes and Lead Hazard Control Families living in East Harlem public housing with children 17 and under with severe or persistent asthma Referrals from health care providers, asthma specialists, and other community organizations Evaluated by The New York Academy of Medicine

4 Housing Conditions Before

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6 Remediation Process

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11 Housing Conditions After

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13 Evaluation measures -Changes in household condition -Changes in caregiver knowledge -Changes in child’s health -Resources for implementation Mixed methods utilizing -Assessments at baseline, 3, 6, and 12 months: CHW visual assessments of housing conditions Caregiver surveys of housing conditions Caregiver surveys of child’s health -Caregiver satisfaction surveys and qualitative interviews -Program and administrative records Evaluation Overview

14 Children (N = 152) n(%) Age, Mean (SD)8.34(4.52) Gender Female74(48.7) Male78(51.3) Race/Ethnicity Hispanic/Latino74(48.7) African American52(34.2) Mixed Race16(10.5) Other or unknown10(6.6) Households (N = 98)n(%) Number of children enrolled per family 164(65.3) 222(22.4) 34(4.1) 48(8.2) Years at address, Mean (SD)10.3(9.25) Baseline Characteristics

15 Asthma Symptoms

16 Medication and Health Care Use

17 Housing Conditions

18 Advocacy Quarterly meetings with NYCHA & residents known to LSA to address repairs. Co-chair of NYCAP’s Environment Committee −Template letter for physicians −Know Your Housing Rights “Breathless” Documentary on Dateline NBC

19 NYCHA v. Baez Settlement Americans with Disability Act December 2012: Request for Accommodation June 2013: Negotiations with NYCHA December 2013:Reached Settlement April 2014:Settlement Certified by judge May 2014:Implementation begins

20 Discussion Unique program characteristics -Implemented by CHWs -In-home remediation and training There’s a difference between briefing you and actually sitting you down and showing you what you’re supposed to do…I like the hands-on. -Advocacy I had to go into Housing court and they helped out. I wouldn’t have gotten a lot of things done [without] the letters that [the EHW] wrote to me.

21 Discussion Challenges -Difficulty reaching referral targets -Referred families residing in private housing (not eligible) -Engaging families and following-up with families Structural deficiencies limit environmental improvements: policy changes are critical for program success Limitations -No control group -Effects of NYCHA settlement not known Sustainability -Need for CHW services to be reimbursable

22 Contact Information Ray López, Director Environmental Health & Family Asthma Program Little Sisters of the Assumption Family Health Service (646) Anne Bozack, MPH, Project Director Center for Evaluation and Applied Research New York Academy of Medicine


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