Place-Based Approach to
Improve Asthma and Health
in Public Housing
National Healthy
Homes
Conference
May 28, 2014
HUD Grant #
MAAIH0002-11
Presented by–the Boston Housing
Authority-Ketsy Carballo and John
Kane and Boston Medical CenterJohnna Murphy
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
40%
33%
Percent of Adults
31%
30%
20%
10%
10%
0%
BHA
Rental Assistance
Non-PH
DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS),
Boston Public Health Commission
DATA 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 Commission
DATA 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 Commission
DATA 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 followup if needed
Project LEAP
Home Visits / Incentives: 4th contact
• Phone call or Visit
• Repeat of survey questions
• Measures sustainable change after
program
Project LEAP: Data
Study data collected on
Ipads using REDCap
• Stands for Research
Electronic Data Capture
• Secure, firewalled webbased application
• Allows for validated
data entry
Project LEAP
Key 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 LEAP
Preliminary 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 LEAP
Preliminary Perceived Stress Results
Perceived Stress Scale: Designed to tap how
uncontrollable and unpredictable subjects find their lives
13=average
Perceived Stress Scores, Visit 1,2, and 3
40
35
30
25
20
15
N=91
N=63
N=47
10
5
0
Visit 1
Visit 2
Visit 3
Project LEAP
Preliminary 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.
Percentage of Families with Asthma Triggers on Visit 1
100
80
60
58.51
38.3
40
30.85
24.47
20
4.26
2.13
0
Pests
Dust
Chemicals
Pets
Smoking
Mold
Project LEAP
Preliminary Asthma Trigger Results
Average trigger score by visit
6
5
4
3
2
1
0
Visit 1
Visit 2
Visit 3
Percent chemical use by visit
50
40
30
20
10
0
Visit 1
Visit 2
Visit 3
Project LEAP
Other Measures Collected
•
•
•
•
•
•
•
Clutter
Leaks, holes, etc
Heating Concerns
Asthma Medication Use
Smoking Habits
Allergies
Cats are like Potato Chips…
Work Orders
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