Judy Olsen, Environmental Health Supervisor, Tacoma-Pierce County Health Department
Larry Zarker, CEO, Building Performance Institute
A collaborative healthy homes pilot in Tacoma-Pierce County, Washington yielded some promising outcomes for asthma and chronic obstructive pulmonary disease (COPD) patients. An evaluation of participants in the Pierce County Healthy Homes (PCHH) income-based weatherization program showed positive health benefits. From the initial 53 households and 78 clients, 65% of clients had improved asthma control and 70% reported an improvement in quality of life.
In 2015, the Washington State Legislature provided additional state funds to expand the Matchmaker Low Income Weatherization Program and focus on healthy homes interventions. This allowed the Washington State Department of Commerce to create the Weatherization Plus Health (Wx+H) Initiative, designed to integrate weatherization, health, and social services so that all Washington state low-income housing is energy efficient, safe, healthy and durable. PCHH was one of eight local weatherization partnerships to pilot integration approaches in 2016 and 2017.
The inability to assist families with costly environmental health concerns related to their home’s structure has been a long-time frustration of the Tacoma-Pierce County Health Department’s asthma program. Similarly, Pierce County Human Services’ (PCHS) weatherization staff experienced the frustration of being unable to assist with identified health needs. This pilot project built upon the known successes and challenges of each program. An unexpected positive outcome was the morale boost to staff from both agencies as they were able to provide more meaningful action and interventions.
How the PCHH Partnership Works
The PCHS weatherization program partnered with the Health Department’s Clean Air for Kids asthma program to create the PCHH Wx+H partnership. They developed a braided funding approach in which the Health Department’s community health workers (CHWs) and PCHS weatherization auditors defined priorities and roles. Most referrals came from within the PCHS network of clients obtaining weatherization, energy assistance or early learning services. Other referrals came through the Health Department’s healthcare provider referral network. The weatherization auditor conducted an initial pre-audit of referred homes. This included:
On completion of the pre-audit, potential Wx+H clients received referrals to the Health Department. A CHW then provided 1-3 home visits focused on:
During the grant period, Health Department and PCHS outreach and auditing staff met weekly to share information and coordinate services. Wx+H work on the homes was scheduled between 1 and 14 months after the initial CHW visit.
The Healthy Home Assessment
PCHH Wx+H auditors are certified BPI Healthy Homes Evaluators (HHE) who conduct initial audits which include the use of Air Advice monitors that measure relative humidity, temperature, carbon dioxide, carbon monoxide, particulate matter, and volatile organic compounds. HHEs provide healthy homes education, based on their observations and Air Advice results. This education includes ventilation, moisture management, household cleaning, and other healthy homes measures.
Jennifer Bayeur is a Pierce County HHE who conducts a pre-audit for weatherization applicants. Bayeur began her career in the energy-efficiency world in 2012 and earned her BPI Building Analyst certification in 2015. By 2016 she had the experience and pre-requisites needed to successfully obtain the BPI Quality Control Inspector certification. In June of 2018 she added BPI’s Healthy Home Evaluator certification to her resume.
Working with the resident, Bayeur identifies energy saving opportunities and schedules a full energy audit for a future date. At the same time, she completes the Pollution Source Survey and asks if anyone in the home has asthma, COPD, or other respiratory issues.
Bayeur uses this opportunity to provide one-on-one healthy homes education to the resident. “The Healthy Homes Evaluator training really solidified what I do and allowed me to see how the home and the occupant behaviors affect each other. You have to look not just at the house as a system, but also how the person lives in it.” Bayeur explains the BPI HHE certification prepared her to deliver not just energy savings to her clients, but also a better quality of life. She learned how to solicit household information from clients in a non-threatening way, without negative judgement. “I ask people: ‘Tell me about your house. What would you change if you could?’”
HHEs determine if the household could benefit from additional “plus health” interventions. This may include structural changes such as carpet removal and plumbing repairs, or household items like HEPA vacuums, allergen bedding covers, and green cleaning kits. Weatherization staff also work with other energy reduction programs to assist clients in comprehensive weatherization (air sealing and insulation), ductless heat pumps, minor and major repairs, and the removal of woodstoves.
CHW and HHE Ongoing Collaboration
When HHEs identify a household member with asthma or COPD, they make a referral to the Health Department’s Community Health Workers (CHW). Sometimes a CHW is the client’s first contact with the program after receiving a referral from the healthcare system. While the client works with the HHE and contractors to make weatherization and health improvements to the home, a CHW meets separately with the family to talk about managing their respiratory disease. CHWs are trusted members of the community, trained to provide health education and to support residents in making behavior change. They coordinate with the healthcare provider to review respiratory medications, make sure provider instructions are clear, and ensure each client has an asthma action plan.
Read the full article in the March digital issue of Healthy Indoors Magazine at: https://hi.healthyindoors.com/i/1095622-hi-march-2019/17