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Paulina Peters
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1 Click Welcome to edit to Master the Webinar title style Increasing Community Health Worker Impact by Partnering With Weatherization/Healthy Homes Moderator: Tracy Washington Enger, U.S. Environmental Protection Agency Presenters: Dr. James Krieger, Chief» Fifth of the level Chronic Disease and Injury Prevention Section of Public Health Seattle & King County Mr. Joel Gregory, Weatherization Project Manager, King County Housing Authority, Seattle, WA Wednesday, September 17, 2014 Webinar 2:00 3:00 p.m. EDT 1 9/30/2014 1

2 Click Purpose to edit Master of Webinar title style Learn how to improve asthma control by adding weatherizationplus-health Click to structural edit Master interventions text to styles an existing Community Health Worker (CHW) home visit program. Understand Third how level an asthma program can incorporate structural weatherization Fourth interventions level to address environmental triggers. Learn about the» Fifth organizations level an asthma program could partner with to provide weatherization. Learn how CHW-based asthma programs can be the lead-in to weatherization and healthy homes interventions. 2 9/30/2014 2

3 Click to edit Agenda Master title style 1. Describe EPA s Commitment to Reducing Asthma Disparities. 2. Presentations: Dr. James Third level Krieger, Chief of the Chronic Disease and Injury Prevention Section of Public Health Seattle & King County Mr. Joel Gregory, Weatherization Project Manager, King County Housing Authority, Seattle, WA 3. Q&A Session in AsthmaCommunityNetwork.org Discussion Forum 3 9/30/2014 3

4 Click to edit Poll Master 1 title style What type of organization do you represent? POLLING QUESTION 1 Government Agency Healthcare Provider Weatherization/HH Program Community-based Program Other 17% 35% 17% 14% 17% 4 9/30/2014 4

5 Click to edit Poll Master 2 title style How familiar are you with Weatherization Plus Health interventions? POLLING QUESTION 2 Very familiar Somewhat familiar Not familiar 19% 26% 55% 5 9/30/2014 5

6 Expanding Leadership. Spreading Best Click to edit Master title style Practices. Connecting Communities. 6 9/30/2014 6

7 Click to edit Master title style Increasing Community Health Worker Impact by Partnering With Weatherization/Healthy Homes Joel Gregory» Weatherization Fifth level Project Manager King County Housing Authority Dr. James Krieger Chief of the Chronic Disease and Injury Prevention Section of Public Health, Seattle and King County 7 9/30/2014 7

8 Click to edit Partners Master title style King Click County to edit Housing Master Authority text styles Public Health Seattle/King County National Center for Healthy Housing Highline School District Puget Sound Educational Service District Neighborhood House 8 9/30/2014 8

9 Click Funding to edit and Master Oversight title style HUD Office of Healthy Homes and Lead Hazard Control University of Washington Institutional Review Board (IRB) 9 9/30/2014 9

10 Click to edit Master title style 10 9/30/

11 Click to edit Master title style Asthma Inequities 11 King County 9/30/

12 Click to edit Master title style Highline School District 17,614 students 10 small cities 39 schools 125,000 people 70 languages Puget Sound to the West I-5 to the East SeaTac Airport in the center 12 9/30/

13 Click to edit Master title style Asthma in Highline School District Poverty 13% vs 8.4% King County Children in Poverty 19.2% vs 9.9% Asthma Third Hospitalization level 260/100K vs 192/100K 13 9/30/

14 Click Purpose to edit Master of Study title style Compare outcomes to intervention with CHW home education Click to visits edit alone Master text styles Reduce asthma triggers in low-income households w/ 1 child w/asthma Evaluate impact Fourth of level energy upgrades on child asthma outcomes Demonstrate that weatherization + asthma education has more effective, longer-lasting impact on asthma than education alone 14 9/30/

15 Click Recruit to edit and Master Qualify title style Current resident English 50%, Spanish 32%, Vietnamese 18% One child 3 to 17 years old with asthma Not participated in Healthy Homes (HH) in last 3 years Not well or very poorly controlled HUD and Weatherization income guidelines Owner of rental willing to participate 15 9/30/

16 1 CHW Click to The edit Team Master title style 1 Wx Intake person 1 Energy Auditor/Inspector 1 HH Auditor/Inspector Data Analysts: National Center for Healthy Housing Contractors: Heating, ventilation, Wx, flooring 16 9/30/

17 Click to edit Master title style Asthma Triggers: Major Cause of Asthma Dust Mites Mold Secondhand Smoke Rodents Cockroaches Irritant Chemicals Pets 17 9/30/

18 Click Substandard to edit Master Housing: title style Major Cause of Exposure to Triggers Underlying conditions increase triggers Leaks Drainage Third problems level Poor ventilation Carpeting Structural defects 18 9/30/

19 Click to edit Master title style Weatherization Measures That Address Asthma Audit Pollution Source Survey: Biological and Environmental Toxins, Education Third level Air sealing: Electrical/plumbing, floor and ceiling Ventilation: Strategize with resident Insulation: Warming surfaces prevents mold growth 19 9/30/

20 Community Click to edit Health Master Worker title style and Energy Audit/HH Home Visit CHW one of four visits House complete energy audit + deeper checking for moisture/mold/dust Dust collection 20 9/30/

21 Click to Interventions edit Master title style Weatherization Roach abatement Rodent abatement Heating system overhaul Carpet to hard surface floor Mold removal Ventilation 21 9/30/

22 Click Community to edit Master Health title Workers style Bringing Asthma Control Home 22 9/30/

3-5 visits over 1 year Community Health Worker Click to edit Master title style Home Visits Assessment Asthma control Trigger control actions Home environment Self-management knowledge and skills

23 3-5 visits over 1 year Community Health Worker Click to edit Master title style Home Visits Assessment Asthma control Trigger control actions Home environment Self-management knowledge and skills Self-management support Trigger control Medication use Self-monitoring and action plan Working with medical provider Linkage to primary care Tenant-landlord communication Social support Advocacy/referral (housing, food, furniture, jobs, etc.) 23 9/30/

24 CHWs and Their Click to edit Master title Clients style 24 9/30/

25 Click to edit Master title style What is a Community Health Worker? Frontline public health worker Trusted member with close understanding of community Bridge between health & social services Fourth and community level Builds individual» and Fifth community level capacity by increasing health knowledge and self-sufficiency A CHW is different from other health professionals: Hired primarily for understanding and connection to populations served Works a significant portion of the time in the community 25 9/30/

Click Community to edit Master Health title Workers style Lay people from the community Share culture, language and life experiences Second with level clients Personal Third experience

26 Click Community to edit Master Health title Workers style Lay people from the community Share culture, language and life experiences Second with level clients Personal Third experience level with asthma Skilled at building trusting and supportive relationships with clients Bridge between community and service providers Receive rigorous and standardized training 26 9/30/

27 Healthy Homes Outcomes Click to edit Master title style Urgent Care Use % with 1+ episodes high intensity low intensity Symptoms decrease by 25+ days per year Quality of life increases Urgent health care use decreases 30-70% Caretaker knowledge and actions increase Exposure to triggers decreases 27 9/30/

Click to Costs edit Master and ROI title style Costs of asthma

ug: $2,160/year Xolair: $10,400 - $20,800+ High vs.

$189 - $721 Medicaid Demonstration Project Preliminary Analysis

28 Click to Costs edit Master and ROI title style Costs of asthma treatments Home Visits: $1,341/year Inhaled Steroids: Fluticasone 110 ug: $2,160/year Xolair: $10,400 - $20,800+ High vs. Low Intensity Fourth level projected over 4 years (HH-I) Net savings: $189 - $721 Medicaid Demonstration Project Preliminary Analysis (annual) Net savings: $14 - $634 ROI: 1.3 Cost-effectiveness: $18 per symptomfree day 28 9/30/

29 Click to edit Master title style Before After 29 9/30/

30 Click to edit Master title style Before After 30 9/30/

31 Click to edit Master title style Examples of New Flooring 31 9/30/

32 Click Average to edit Master Cost per title Unit style Click to edit Master Single text Family styles Apartment Weatherization $4,181 $2,243 Healthy Homes $3,103 $3,005 CHW + Supplies $405 $ /30/

33 Click Cost to Range edit Master ($/dwelling) title style Click to edit Apartment Master text styles Second HH level Wx Total HH Wx Total Min $460 Third level $0 $460 $0 $225 $225 Single-Family Med $2,414 $1,357 $3,888 $2,330 $7,097 $10,587 Max $7,490 $6,612 $12,596 $7,149 $16,928 $21, /30/

34 Click Visits to and edit Data Master Collection title style Type Click of Datato edit Master text Enroll styles Signed Consent & HIPAA Visit Mo 0 Visit 1 Mo 0.5 Visit 2 Mo 1 Visit 3 Mo 4.5 Exit Visit Mo 12 Home Environ Chklist X X Health Interview Survey X X Wx Audit/Interior Sketch Allergen Sample Collection X X Education/Supplies X X X Weatherization Work Rpt X X X 34 9/30/

35 Click to edit Master title style Education Components & Supplies 35 9/30/

36 Click to edit Master title style Weatherization + Health Work Top Third 5 level HH Tasks Top 5 Weatherization Tasks Bathroom fan timer 85% Insulate hot water pipes 63% Summary Replace carpet 63% Combustion safety test 45% Replace bathroom fan 70% Reduce air infiltration 45% Install CO detector 45% Install CFLs 40% Install smoke detector 20% Weatherstrip doors 35% 36 9/30/

37 Click Asthma to edit Triggers Master Found title style Study Group: Outcome CHW + Weatherization + HH Baseline % Exit % Change % Baseline % Comparison Group: CHW Home Visits Exit % Change % Pet Mold Cockroach Rodents Smoking Trigger Uncontrolled /30/

38 King Click County to edit Weatherization-Plus Master title style Caregiver quality of life improved significantly more in study group (p = 0.002) Triggers decreased more in study group (p = 0.089) 38 9/30/

39 Click Reported to edit Master Outcomes title style Cleaning results similar in study to comparison Weatherization likely reduced asthma triggers Dust mite allergen levels Moisture and water damage Modest decline rodents IPM not a formal part of Wx + Health 39 9/30/

40 Click Strengths to edit and Master Limitations title style + High retention rate + Availability Second of comparison level group + Serving vulnerable populations + Agency knowledge - Small sample size - Restricting qualifications - Not randomized - Limited repair funding in Wx 40 9/30/

41 Click to edit Master title style What have we learned from visiting 1,400+ homes? 41 9/30/

Click Implementing to edit Master Home title Visits style Visitor: CHW with caseload of 50-60 clients Click Shares culture to edit and Master life

structured work environment, activity monitoring, Fourth clinical level backup Client: Poorly controlled asthma Number of visits: Initial and 3

42 Click Implementing to edit Master Home title Visits style Visitor: CHW with caseload of clients Click Shares culture to edit and Master life experiences text styles Personal or family experience with asthma Well trained: 40 hours initial training, weekly in-service training Well supervised: structured work environment, activity monitoring, Fourth clinical level backup Client: Poorly controlled asthma Number of visits: Initial and 3 follow-up Visit Content Assessment Medical self-management skills Trigger reduction self-management skills Effective communication with medical provider 42 9/30/

43 Click to Policy edit Master Priorities title style Home visits for all low-income people with uncontrolled asthma Inclusion as a covered benefit by health plans Incorporation into medical homes Certification of community health workers Development of community capacity to provide home visits What else? 43 9/30/

ACA Click Emerging to edit Opportunities Master title style ACOs and CCOs aligning incentives for use of CHWs? Second level Prevention and Public Health Fund funding?

44 ACA Click Emerging to edit Opportunities Master title style ACOs and CCOs aligning incentives for use of CHWs? Second level Prevention and Public Health Fund funding? Community benefits Fourth level funding? Patient-Centered Medical Home integrate CHWs? More CMS Medicaid regulation reimburse for preventive services by unlicensed professionals (including CHWs) recommended by licensed professional Health Impact Bonds 30-day readmission penalty What else? 44 9/30/

45 Click to Conclusions edit Master title style Improved coordination between weatherization and public health programs may result in greater improvements in both the home Second and level the health of children with asthma. 45 9/30/

46 Click to Information edit Master title style Available upon request: questionnaires, article, brochures Joel Gregory 700 Andover Park West, Suite D Tukwila, WA joelg@kcha.org 46 9/30/

47 Click to edit Master title style Discussion with DR. JAMES KRIEGER & MR. JOEL GREGORY 47 9/30/

48 Click to edit Master title style Exploring Weatherization + Health in Your Community What tips Third can level you offer about the day-to-day leadership and communication Fourth between level your organizations that contributed to making this an» effective Fifth level project between two publicly funded programs? 48 9/30/

49 Click to edit Master title style Exploring Weatherization + Health in Your Community What do Third you suggest level are steps health and HH professionals can take at the Fourth local, level state, regional and national levels to carry your results forward to other communities? 49 9/30/

Click to edit Poll Master 3 title style Based on what you learned in

you prioritize text styles for your program?

Health program Develop or improve our current partnerships Improve our

50 Click to edit Poll Master 3 title style Based on what you learned in the webinar, which of the following Click to actions edit will Master you prioritize text styles for your program? POLLING QUESTION 3 Develop or improve our current Weatherization Plus Health program Develop or improve our current partnerships Improve our data collection and evaluation methods Other None of the above 14% 3% 14% 16% 53% 50 9/30/

51 Click Additional to edit Master Resources title style EPA s Click Asthma to edit Change Master Package: text styles changepackage EPA s Value Third Proposition level Toolkit: valueproposition Community Health Worker Training Resources: Weatherization Plus Health Podcast: / /30/

52 Click to edit Master title style Conclusion of the Webinar Increasing Community Health Worker Impact by Partnering With Weatherization/Healthy Homes Moderator: Tracy Washington Enger, U.S. Environmental Protection Agency Presenters: Dr. James Krieger, Chief of the Chronic Disease and Injury Prevention Section of Public Health Seattle & King County Mr. Joel Gregory, Weatherization Project Manager, King County Housing Authority, Seattle, WA 52 9/30/

Community Health Workers Bringing Asthma Control Home. Jim Krieger, MD, MPH APHA Annual Meeting 2013

Community Health Workers Bringing Asthma Control Home Jim Krieger, MD, MPH APHA Annual Meeting 2013 Acknowledgements Community Health Workers o Carol Allen o Michelle DiMiscio o Cindy Mai o Maria Martinez