Public Health In Public Housing: Improving Health .

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National Heart, Lung, and Blood InstituteEducation Strategy Development WorkshopSUMMARY REPORTPublic Health in Public Housing:Improving Health, Changing LivesU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNational Heart, Lung, and Blood Institute

National Heart, Lung, and Blood InstituteEducation Strategy Development WorkshopSUMMARY REPORTPublic Health in Public Housing:Improving Health, Changing LivesU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESNational Institutes of HealthNational Heart, Lung, and Blood InstituteAdministrative Use OnlyAugust 2005

ContentsAcknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ivExecutive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vDay 1: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Opening Session: NHLBI Remarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Setting the Stage:An Overview of Public Housing and Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4Public Housing and Public Health:Public Housing Perspectives for Resident-Focused Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . .7Making Public Health and Clinical ConnectionsTo Address Health Disparities: Clinicians’ Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9Public Health Programming in Public Housing:Presentations From the Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Day 2: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29“Dream Team” Breakout Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Pearls of Wisdom: Things To Consider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30Preparation for the Breakout Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Charge to the “Dream Team” Breakout Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31“Dream Team” Scenarios and Frameworks Summary Findings . . . . . . . . . . . . . . . . . . . . . . . . . . .32Adjournment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45A. Workshop Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46B. Workshop Objectives (Days 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50C. Global Workshop Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51D. Participants List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52E. Breakout Group Discussion Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57For More Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .inside back coverContentsiii

AcknowledgementsThe NHLBI would like to thank all workshopparticipants, panel speakers and moderators,and breakout group facilitators and reporters forcontributing their expertise, ideas, and experiences in public health and public housing programs to the Education Strategy DevelopmentWorkshop Public Health in Public Housing:Improving Health, Changing Lives, May 5-6,iv2004 (see Appendix A: Workshop Agenda,Appendix D: Participants List, and AppendixE: Breakout Group Discussion Instructions fora listing of names). Special thanks is given toCarol Payne, U.S. Department of Housing andUrban Development and Dr. Samuel B. Little,Washington, DC Housing Authority, for theircontribution to the planning process.Public Health in Public Housing: Improving Health, Changing Lives

Executive SummaryThe National Heart, Lung, and Blood Institute(NHLBI) hosted the Education StrategyDevelopment Workshop: Public Health inPublic Housing—Improving Health, ChangingLives on May 5–6, 2004, at the NatcherConference Center on the campus of theNational Institutes of Health (NIH) inBethesda, MD. The purpose of the Workshopwas to hear from both public health and publichousing professionals regarding public healthstrategies they have found to be effective inpublic housing communities. The Workshopfocused on the (1) health conditions: asthmaand cardiovascular disease (CVD) and (2)opportunities to improve the health of residentsin public housing settings. On the first day ofthe Workshop, the guest speakers presenteda picture of the public housing setting andshared their perspectives about best practices,lessons learned, and opportunities for reducingthe prevalence of CVD and asthma in publichousing. On the second day, participantsapplied the information shared on Day 1 andtheir collective experiences and knowledge to create scenarios and frameworks that could be usedto plan future asthma control and cardiovascularhealth programs in public housing settings.tives and identify opportunities to incorporatepublic health activities in new and/or existingresident services programs; to understand theimportance of integrating clinical and publichealth strategies to address health disparities;to create innovative “best practice” approaches(scenarios) based on lessons learned fromconducting community health programsin public housing and/or related settings; andto engage participants in facilitated exercises tostimulate creative ideas and interactive discussion.Dr. Samuel Little from the Housing Authorityof Baltimore City and Mr. Ron Ashford fromthe U.S. Department of Housing and UrbanDevelopment HOPE VI Community andSupportive Services in Washington, DC,provided an overview of public housing,describing the socioeconomic characteristicsof public housing residents and the problemsfacing them—including health problems suchas CVD, asthma, and obesity. There wasdiscussion of the HOPE VI program, an effortof the U.S. Department of Housing and UrbanDevelopment (HUD) to transform publichousing. It was suggested that HOPE VI needsto do more in the area of health. These remarkswere followed by a series of panel presentations.Day 1Dr. Barbara Alving, Acting Director of theNHLBI, welcomed the participants andexplained the purpose of the Workshop—tobuild on efforts to reach out to people living inpublic housing and help them take better careof themselves and their families.Dr. Rob Fulwood, Senior Manager for PublicHealth Program Development of NHLBI’sOffice of Prevention, Education, and Control(OPEC) described the office’s responsibilities fortranslating and disseminating scientific results toformats for the public, patients, and physicians.He also reviewed the Workshop’s global objectives: to provide participants with a “portrait”of the public housing setting; to share perspec-Panel 1. Public Housing and Health: PublicHousing Perspectives for Resident-FocusedProgramsPanel 1 focused on programs that would helptransform residents’ attitudes toward health andwellness. Carol Payne of the U.S. Departmentof Housing and Urban Development moderated this session. Panel members spoke fromtheir experience in public housing addressingthe topics of building partnerships, engagingpublic housing residents, and promotingprograms in public housing. Irma Gorham(City of Paterson, NJ, Housing Authority);Dr. James Krieger (Seattle-King CountyHealthy Homes Project); Pamela Taylor(National Organization of African AmericansExecutive Summaryv

in Housing); Harry Karas and Martha Benton(Resident Advisory Board of the HousingAuthority of Baltimore City and Hope Villagein Baltimore); and Jack Cooper (MassachusettsUnion of Public Housing Tenants, Dorcester,MA) were panelists. They described theirorganizations’ programs, partnerships, targetpopulations, and strategies.The panel came to several conclusions: Residents are the experts; this expertiseneeds to be recognized. Policies are needed to address healthdisparities. Cultural sensitivity is important, especiallywhen addressing diet and language in publichealth activities. HUD and the U.S. Department of Healthand Human Services should join efforts.One way is to create a health line itemin public housing operating budgets. Relationships are crucial to obtainingprogram funding; potential partners includehousing authorities and faith- and communitybased organizations.Panel 2. Making Public Health and ClinicalConnections To Address Health Disparities:Clinicians’ PerspectivesPanel 2 included four clinicians who discussedhow their organizations have implemented programs to address health disparities. Dr. MeganSandel, from the Boston Medical Center,described asthma rates in Boston’s publichousing. She described how environmentalasthma triggers in some public housing unitswere driving requests for transfer to public housing units free of these “triggers.” A collaborativeof several organizations and groups establisheda Public Housing Transfer Policy Workgroup toaddress environmental asthma triggers in publicvihousing to mitigate the rates of public housingtransfer requests. Dr. Marielena Lara, representing Allies Against Asthma in Puerto Rico,described this community-centered coalitionthat has had early success in promoting asthmacontrol in a housing project. Dr. James Krieger,representing Seattle and King County PublicHealth, described the Healthy Homes projectin Seattle, which offers an in-home educationprogram, as well as several other projectsin Seattle that aim to improve clinical care.Dr. Henry Dethlefs, representing the HealthDisparities Collaborative in Omaha, describeda project in Omaha’s One World CommunityHealth Center that focuses on improving healthoutcomes in patients with chronic disease bychanging provider practice behavior and systemsand improving community relations.Panel 3. Models To Promote Healthy Lifestylesin Public HousingPanel 3 speakers described programs that havebeen successful in promoting healthy lifestylesin public housing. Dr. Jeanne Taylor, a healthcare consultant from Global Evaluation andApplied Research, and Anita Crawford,representing the Roxbury ComprehensiveCommunity Health Center (RoxComp) at theOrchard Park Housing Development in Boston,described the RoxComp program. RoxCompwas awarded a HUD grant to upgrade thecenter and worked with the tenant associationand residents to determine health care servicesneeds. Myron Bennett, representing HealthyCMHA (Cuyahoga Metropolitan HousingAuthority), described this community partnership that promotes health and wellness in48 housing developments in Cleveland. Thisprogram has implemented a multiculturalhealth promotion/wellness model, which focuseson increasing awareness, implementing healtheducation and, lifestyle enhancement programs,and creating cultural change opportunitieswithin the community to improve health.Staci Young, of the Medical College ofPublic Health in Public Housing: Improving Health, Changing Lives

Wisconsin) described a community healthadvocate program in a housing developmentin Milwaukee. This program trains advocatesto provide services and programs for residentsin the areas of education, safety, and socialactivities. Ms. Carol Payne, representing theBaltimore Office of the U.S. Department ofHUD, described the Healthy Hearts in PublicHousing NHLBI-funded CVD EnhancedDissemination and Utilization Center (EDUC)in Baltimore, a program that has helped to raisecommunity awareness about CVD throughtraining and hiring public housing residentsas community health workers (CHWs).Panel 4. Integrated Chronic Disease ModelsPanel 4 speakers discussed programs that provide integrated chronic disease control. HenryTaylor, representing the University of Illinois atChicago Mile Square Health Center, describedhow this Center provides quality health servicesto a diverse urban community by linking publichousing residents to primary care and socialservices. Patricia Hynes, representing BostonUniversity’s School of Public Health, describedBoston’s Healthy Public Housing Initiative,which works to improve home environmentsfor better respiratory health. The program trainsresidents at home to serve as community healthadvocates. They conduct surveys of housing andhealth conditions and collect environmentalsamples and data as well as educate communityresidents on asthma management strategies andintegrated pest management (IPM). The YESWE CAN program in San Francisco wasdescribed by Dr. Mary Beth Love from SanFrancisco State University and Arthur Hill,a community health worker (CHW) in theYES WE CAN program. This coalition of 17organizations has developed a medical/socialmodel for chronic disease management inchildren that includes roles for the clinician,clinical care coordinator, and CHW. TheAsthma Ambassador Project was described byJudith Taylor-Fishwick and Lilly Smith of theCenter for Pediatric Research, Eastern VirginiaMedical School/Children’s Hospital of theKing’s Daughters in Norfolk, VA. This projectidentifies and evaluates the needs of disadvantaged asthmatic children living in public housingin the Hampton Roads area of southeasternVirginia, using a case finding approach and layhealth workers (Ambassadors) who provideoutreach and education at the public housingcommunity.Day 2Dr. Janice Bowie, of the Johns Hopkins UniversityBloomberg School of Public Health, facilitatedthe “Dream Team” Breakout Sessions. To begin,participants shared thoughts and conclusionsabout strategies and best practices for asthmaand CVD programs discussed during Day 1.Then Dr. Bowie held a discussion on whatprogram planners should consider in the areasof community partnership and involvement,implementation, and sustainability, and sheprovided questions to consider in program planning. Next, she asked the four breakout groupsto identify effective strategies in prevention andtreatment of asthma and CVD in public housing, and to consider global factors associatedwith community partnership and involvement,implementation, and sustainability. In the firsthour, each group would develop two scenariosthat identify and define a problem related toasthma or CVD in terms of issues, needs,and concerns; the population to be reached;the rationale for selecting the problem; andpotential barriers and opportunities for resolution. The next hour would focus on constructing a framework/approach for solving at leastone of the scenarios. The groups were askedto define specific objectives and strategies, keystakeholders, the materials/tools/resources thatwould be needed, and how outcomes wouldbe tracked and measured. Other assignmentswere to determine the extent to which theproject components form an integrated approachand to construct a “pictorial display” of theExecutive Summaryvii

approach with all the relevant elements toshow connectivity.“Dream Team” Scenarios and FrameworksSummary FindingsGroup I—CVD focused on multiethnicintergenerational families in public housingand the impact of CVD on them. The group’sscenario addressed residents’ problems andneeds by developing an inclusive strategy thatinvolves various segments of the target community to reduce CVD disparities in a high-riskpopulation. The main opportunity to solvethe problems discussed was to create links withpower brokers in the community and withorganizations such as social service agencies,churches, schools, and the public housingdevelopment residential association. Goalswere to enhance awareness of CVD disparities,increase awareness of CVD morbidity andmortality among the target populations, andempower community residents in the targetpopulation. Approaches were to create aresident association and a health committee,hire and train a CHW to educate the community, hold community forums that involveresidents, encourage residents to serve on theboards of community organizations, involveresidents in the planning process, and providethem with incentives.Group II—Asthma developed a scenario thatincorporated the problem of asthma in publichousing in two contexts: by each residentemergency asthma case and by the factors inpublic housing that trigger asthma symptomsin the resident population with asthma. Thescenario involves 30 resident families, with50 children, who were considering suing theHousing Authority and HUD for very detrimental conditions in their housing units. Thegoal was to address the environmental conditions associated with asthma: mold, insectinfestation, dust, overcrowding, and lack ofcleanliness. This scenario was an opportunityviiito build community-based coalitions (amongresidents, the Housing Authority, local proactivegroups, the local community, and governmentofficials) that would focus on each individualasthma emergency case and the conditions inthis public housing development that contributeto asthma. The solution to the problem involvesa triaging process which employs environmentalassessment and clinical evaluation.Group III—CVD and Asthma viewed theproblems of CVD and asthma in public housing as being interrelated since these chronicdiseases have common factors that eithercontribute to or exacerbate these diseases.Participants created a fictitious scenario todescribe how conditions in public housingmay impact asthma. They described an old andovercrowded public housing building situatedin a closed-in environment, isolated, and havingpoor-quality services, little transportation, and aculturally diverse population. They assessed thatin this scenario CVD and asthma would beprevented or lessened by addressing disease riskfactors, environmental and psychosocial factors,and barriers. The scenario provides an opportunity to build partnerships with the communityand to utilize CHWs. Activities to addressCVD and asthma include holding meetings,classes, and workshops; providing culturallyappropriate health information; and ensuringtransportation to access health servicesand stores that sell healthy food/products/medications. They recommended tools tosupport activities, including a Web-basedclearinghouse with links to existing resources.Group IV—CVD and Asthma felt that theprogram should target oppressed, intergenerational, multiethnic residents who are at higherrisk for CVD and asthma. The roots of asthmaand CVD start in youth and continue duringone’s lifetime, and one is never too old tochange health habits. The group concentratedon health education and nutrition and thusPublic Health in Public Housing: Improving Health, Changing Lives

CVD init

National Institutes of Health (NIH) in Bethesda, MD. The purpose of the Workshop was to hear from both public health and public housing professionals regarding public health strategies they have found to be effective in public housing communities. The Workshop focused on the (1) health conditions: asthma and cardiovascular disease (CVD) and (2)

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