Healthy Homes

Department of Public Health, Seattle & King County

Purpose:

To help children with asthma reduce the frequency and severity of their asthma attacks through providing their families with education and resources to make their homes asthma-friendly and to keep asthma under control 

Target Population:

Children with asthma in the Seattle and King County region; households were eligible for enrollment in the study if they included at least one child between the ages of 4 and 12 with diagnosed asthma, their income was below 200 percent of the 1996 federal poverty level or the children were on Medicaid, and the primary caregiver spoke English, Spanish or Vietnamese

Program Goals:

• To reduce exposure to asthma triggers and other indoor environmental risks

• To focus on education and participant action to empower individuals

Years in Operation:

1997 - 2001

Results:

Of the 1,116 children identified with asthma and their 714 caregivers, the study reached 274 eligible and interested families. A total of 214 families completed the study (110 in the high- intensity group and 104 in the low-intensity group). Households with children with asthma who received multiple visits from community health workers (CHWs) and asthma-reducing resources used significantly less urgent health services and had improved caregiver quality-of-life scores relative to households that did not receive these resources. Days of asthma symptoms also decreased more in the high-intensity group, although the difference between the high-intensity and low-intensity groups did not differ greatly. Additionally, missed school or child care and the need for asthma medications decreased only in the high-intensity group.

The high-intensity group showed more behavior changes than the low-intensity group, such as reducing dust exposure and adopting the use of bedding encasements. Additionally, urgent care costs were less in the high-intensity group than the low-intensity group during the two months before the exit interview.

Funding:

The first two approaches of the Healthy Homes project were funded through the National Institute of Environmental Health Sciences. The third approach was funded by the U.S. Department of Housing and Urban Development.

Key Partners:

Partners for Healthy Communities; American Lung Association of Washington; the Apartment House Association of Washington; the Center for Multicultural Health; Engineering Plus; Group Health Cooperative of Puget Sound; the League of Women Voters of Seattle; Public Health - Seattle and King County; Washington Toxics Coalition; University of Washington

What Works and Why:

The Healthy Homes project worked because the study chose a low-income population that needed help in overcoming barriers to effective asthma treatment for children and in identifying multiple triggers of asthma inside the home. Additionally, the CHWs were able to share culture and life experiences with the families involved, and educate them about common asthma triggers. 

Structure and Operations:

Healthy Homes uses three different approaches to improve asthma control.

• Utilize a "community asthma nurse" who provides patient education, training in self-management, case management and review, and the development of an asthma action plan.
• Provide in-home outreach, education and resources (bedding covers, vacuums, cleaning supplies, etc.) to address environmental triggers in addition to all aspects of the community asthma nurse intervention. Reinforce self-management techniques, medication use and provider-patient communication. CHWs provided in-home outreach also.
• Add structural remediation of housing for conditions that increase exposure to asthma triggers. On average, each unit cost about $3,000, which was supplemented by funds from weatherization and other local housing programs.

Participants in the study were randomly assigned to a high-intensity (multiple interventions) or low-intensity (minimal interventions) group. With the high-intensity group, CHWs created an environmental home assessment on the first visit. Each finding from the assessment generated prioritized actions for participants. Then, the CHW made an additional four to eight visits to the home throughout the year. The low-intensity group received only one CHW visit over the year, and it included the home assessment. After the one-year assessment, the low-intensity group received the same full package of resources as the high-intensity group.

Barriers to Success:

Barriers to the success of the Healthy Homes project include the stresses of setting boundaries with participants, and dealing with their difficult life situations. Another barrier to this program was that the CHWs spent a lot of time traveling to and from homes and carrying heavy equipment. Another barrier was the recruitment and retention of participants. However, at the completion of the one-year program, 226 (82 percent) of the original 274 eligible and interested families remained in the program.

More Information:

http://www.metrokc.gov/health/asthma/healthyhomes/overview.htm

Download:

Download this program information in PDF format.