• Johnna S. Murphy, MPH, Boston Medical Center • Eugene Barros, BA, Boston Public Health Commission • Sherry Dong, MPA, Tufts Medical Center National Healthy Homes Conference Nashville, TN May 28 th , 2014 Expanding Home Visiting to Other At-Risk Populations: Asian Americans and Other Populations Not Well Connected to the Medical Home 1
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Johnna S. Murphy, MPH, Boston Medical Center Eugene Barros, BA, Boston Public Health Commission
Johnna S. Murphy, MPH, Boston Medical Center Eugene Barros, BA, Boston Public Health Commission Sherry Dong, MPA, Tufts Medical Center. Expanding Home Visiting to Other At-Risk Populations:. Asian Americans and Other Populations Not Well Connected to the Medical Home. - PowerPoint PPT Presentation
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• Johnna S. Murphy, MPH, Boston Medical Center• Eugene Barros, BA, Boston Public Health Commission• Sherry Dong, MPA, Tufts Medical Center
National Healthy Homes ConferenceNashville, TN
May 28th, 2014
Expanding Home Visiting to Other At-Risk Populations:
Asian Americans and Other Populations Not Well Connected to the Medical Home
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1. Engage & leverage culturally specific neighborhood and community partnerships
2. Train inspectors
3. Early Warning System (to assist tenants in maintaining their housing)
4. Healthy Homes for Children with asthma in high risk populations (education & interventions)
5. Landlord Engagement and legal advocacy
• How can asthma home visiting programs (delivered by a Community Health Worker) reach underserved populations?
• How do we engage families who are hard to reach, such as those not connected to a medical home or those who are linguistically isolated?
• How do we retain these families within a program? 3
Evaluate two models of recruitment for an asthma CHW home visiting program:
•Tufts Medical Center (Tufts MC) targeted Chinese through Tufts MC
•BPHC targeted families who might not have a medical home by recruiting through housing support programs
Funded by HUD and EPA: Primary Grantee=Boston Public Health Commission, with support from Boston Medical Center and Tufts MC
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What is a CHW?American Public Health Association:
Is a trusted member of, or deeply understands, the community served
Is a liaison between health and social services and the community
A CHW builds individual and community capacity through:
Outreach Community education Informal counseling Social support Advocacy
BPHC CHW Nathalie Bazil demonstrates proper use of spacer in Boston home
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CHWs and Asthma Home Visits
• CHWs deliver asthma and medication education in the home
• CHWs offer advice and tools for reducing asthma triggers
• CHWs provide referrals and advocacy
• Studies support effectiveness of multi-component home visit interventions in improving asthma outcomes and reducing urgent care use.
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• CHW asthma home visiting programs have historically been successful in Boston
• Evidence supports strong clinic integration and communication between families, CHWs, and providers
• Challenges include recruiting and retaining hard to reach families• Those not connected to a clinic or
medical home• Those linguistically or culturally
isolated from providers
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•BPHC utilized trusted community and housing partners and integrating referral into existing systems:
• Breathe Easy at Home-a web based system that allows health care professionals to directly refer to inspectional services
• Metropolitan Boston Housing Partnership-a city wide Section 8 administrator that reaches thousands of low income tenants each year
•These programs referred families to BPHC for a BPHC CHW delivered home visiting intervention
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•Asian immigrants tend to underutilize health care services
•often lack the information necessary to practice preventive health maintenance.
•cultural differences and linguistic barriers, financial concerns, such as lack of health insurance.
•> 50% of Boston Chinatown residents are non- or limited-English proficient
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• part of The Asthma Prevention and Management Initiative launched by Tufts MC and the Floating Hospital for Children
• aims to improve the outcomes of children with asthma and decrease utilization of acute care services for asthma-related problems.
• Families were recruited through Tufts MC pediatric clinics (strong ties to the medical home)
• CHW and program manager was from the community and understood culture and local resources
• CHW fluent in Cantonese, Mandarin, and English
• But what about families not connected to a medical home?10
CHWs conducted surveys and environmental assessments:
• environmental triggers (measured by dust, mold, pests, pets, smoking, and chemical use)
• Asthma Control Test
-health care utilization
-quick-relief and controller use
-symptom days
• Perceived Stress Scale 11
Both Tufts MC and BPHC CHWs provided the same intervention:
•3 protocol defined home visit interventions and 1 follow up phone call
•support and education on home maintenance (including house cleaning)