RWJF Community Health Leader Fights Asthma in East Harlem, Door to Door
In May, the U.S. Department of Housing and Urban Development (HUD) awarded a multi-year grant to an asthma prevention and treatment program run by 2008 Robert Wood Johnson Foundation Community Health Leader Ray Lopez of New York City. Lopez is the director of environmental health services at the Little Sisters of the Assumption Family Health Service in New York’s East Harlem. The grant award is shared with the New York Academy of Medicine.
Ray Lopez: Our mission is to serve children in East Harlem by helping their families treat and prevent asthma incidents. Asthma rates are unusually high in New York City in general, and the problem’s even more acute in Harlem, the South Bronx and Central Brooklyn where there are all kinds of environmental factors in children’s homes. We’re focused on children in public housing, where there are a number of problems. A lot of the apartments have mold that has grown as a result of leaks, and they’ve also got a lot of cockroaches, and mice, which all contribute as well. What we do, and what this grant will help us do a lot more broadly, is to get treatment for the kids, but also to go into their apartments and get to work on reducing the environmental factors. Sometimes that means identifying moisture sources and safely cleaning the mold. Sometimes it means pressing the city’s housing authority to do major work. Sometimes it involves teaching the adults in the family about the safe use of pesticides and cleaning products. For each family we visit, we work with them to create an individualized service plan, and then we focus on remediating the asthma triggers.
Teaching is a major part of this, too, and the plan is to teach by showing and doing. Families are enrolled with us for a year, and by end of year, we hope they will have accumulated skills to manage these problems on their own in the long-term. It’s a three-year project, in all: two-plus years working with the families, and then a final phase that consists of data analysis and policy initiatives led by the New York Academy of Medicine.
HCB: And then what’s the plan with the data and the analysis?
Lopez: The plan is to build the business case for this kind of intervention, and then to persuade insurance companies and providers that it’s worth the investment to them to spend a little money up front to prevent asthma incidents, rather than paying for them in the emergency room.
HCB: How do you plan to identify children and families for the program?
Lopez: Any children who live in two specific zip codes in East Harlem are eligible. That takes in tens of thousands of apartment units. And, unfortunately, 15 to 25 percent of school-aged children here have asthma, so there’s no shortage of need. We’re part of a wider provider network – the Harlem Asthma Network, and we collaborate with the East Harlem Asthma Center for Excellence. They identify and refer children, depending on their specific needs. Also, we have regular communication with the hospitals and clinics in the area, and we look for referrals from them as well. And we’re not just sitting back and waiting, either. We have a public housing development right across the street from us, and we’ll be knocking on doors there.
HCB: What kind of training does this require?
Lopez: You know, it’s a fairly new field. I was trained by a certified industrial hygienist who did a lot of pro bono work for us. And I’m taking a “healthy homes” exam sponsored by the National Environmental Health Association that should give us an actual credential, which we expect will help with future funding. And then I’m training our staff.
That particular training is in abatement, as you’d guess, but some of the other trainings focus on core competencies that community health workers should possess: communicating with families, listening to them, figuring out what their strengths and needs are, and identifying strategies for changing their behavior – with pesticide use, for example – when that’s needed. And there’s also a community organizing and leadership development component to this service model that requires training. In addition to the case work, we try to identify residents who have an appetite for working with others toward a greater good, and then support them in doing some tenant organizing. It’s really about trying to support people to be more self-sufficient, more active in public to get what they feel they need. Not just in their apartments, but in their building and on their streets.
HCB: How long have you been doing this work?
Lopez: I have been doing this work for ten years. The Little Sisters of the Assumption Family Health Service has been working on asthma since 1997. Our program is part of the Little Sisters’ visiting nurse department. The nurses saw the need for someone to focus on the home environment, because their role is to provide asthma and medication education, and to try to make sure families followed through with their prescriptions, and so on. So they created this community health worker position to focus on the home environment to teach families how to handle them and to engage building managers to perform structural repairs.
HCB: Spell that out for us, would you please. What kind of repairs do you mean?
Lopez: We focus on repairs that improve air quality and make it safer for children--conditions such as damaged windows and doors, faulty electricity and missing or faulty smoke and carbon monoxide detectors are some of the things that are reported and tracked until repairs are completed. We also make sure that plumbing leaks are repaired and ventilation systems are in working order.
A common and extremely difficult example that we deal with on a regular basis is families living on the top floor of their building. Many buildings in this neighborhood are old and deteriorating, so families are living beneath a leaky roof or a defective “building envelope.” These structural problems allow moisture into the unit, from snow, rain or from condensation. These conditions lead to very serious moisture and mold problems, which can trigger asthma. When we encounter these situations we immediately work on minimizing resident exposure to mold, but it’s tough because we know it will take months or even years before resources are gathered to perform that kind of expensive repair. Furthermore, we know that if one roof in a development is in this condition, it is likely that others in the development are, too. These families will inevitably be in these units for an extended period of time without a structural repair. So when we find these cases, we push the housing authority to try to get things rolling. We’ll provide high-capacity air cleaners, and if it’s possible, we’ll encapsulate the damaged area with a special paint, so the mold won’t re-grow. And there have been a handful of cases where a family was transferred to another apartment. But it all takes a while; the process is very slow.
HCB: Has the RWJF Community Health Leaders program played a role?
Lopez: Absolutely. Recognition from RWJF really helped push our work to the next level. I think it played a role in getting the grant from HUD, and it has definitely helped me leverage other funding as well. It also helped me get the attention of the city and various agencies and politicians. Shortly after I was named a Community Health Leader, I was nominated and appointed to be part of the city’s bed bug advisory board, and I’m pretty sure that was related to the visibility from the Community Health Leader program and their support of my bed bug program. So it was a big boost for us.