A Community Health Worker Program to Address Indoor Environmental Triggers for Childhood Asthma in East Harlem Public Housing: Implementation and Outcomes Ray López1; Anne Bozack, MPH2; Tongtan Chantarat, MPH2; Linda Weiss, PhD2 1 Environmental Health & Family Asthma Program, LSA Family Health Service 2 Center for Evaluation and Applied Research, The New York Academy of Medicine

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

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

Housing Conditions Before

Housing Conditions Before

Remediation Process

Remediation Process

Remediation Process

Remediation Process

Remediation Process

Housing Conditions After

Housing Conditions After

Evaluation Overview Evaluation measures Mixed methods utilizing 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

Baseline Characteristics Children (N = 152) n (%) Age, Mean (SD) 8.34 (4.52) Gender Female 74 (48.7) Male 78 (51.3) Race/Ethnicity Hispanic/Latino African American 52 (34.2) Mixed Race 16 (10.5) Other or unknown 10 (6.6) Households (N = 98) Number of children enrolled per family 1 64 (65.3) 2 22 (22.4) 3 4 (4.1) 8 (8.2) Years at address, Mean (SD) 10.3 (9.25)

Asthma Symptoms

Medication and Health Care Use

Housing Conditions

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

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

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.

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

Contact Information Ray López, Director Environmental Health & Family Asthma Program Little Sisters of the Assumption Family Health Service rlopez@lsafhs.org (646) 672-5233 Anne Bozack, MPH, Project Director Center for Evaluation and Applied Research New York Academy of Medicine abozack@nyam.org 212-822-7253