HPHI - Project Activities

	Healthy Public Housing Initiative - Intake Process for Intervention Study

By Genevieve Howe and H. Patricia Hynes
Boston University School of Public Health

Background:
The Healthy Public Housing Initiative (HPHI) is an innovative community-university-city collaborative that was formed to address the epidemic of childhood asthma in Boston public housing. The HPHI partners include the Tenant Task Forces at West Broadway and Franklin Hill, the Committee for Boston Public Housing, the Boston Housing Authority, the Boston Public Health Commission, Boston University and Harvard University Schools of Public Health, and Tufts School of Medicine.

Community Health Advocates (CHAs), who are themselves residents of public housing communities, have been trained to document the health status of children with asthma throughout the HPHI research project, during which improvements will be made in their apartments, such as environmentally-sound pest control. This multi-partner project and study is unique in that the Community Health Advocates not only fill the critical role of linking members of community organizations, city agencies, and universities with public housing residents but are also the field researchers. The project aims to demonstrate the asthma health benefits of environmental interventions and to document lessons learned for replication in public housing communities across the country. At the same time, we will document the knowledge, skills, and abilities gained by the CHAs through rigorous training and through their jobs as community health researchers and promoters.

In December 2002, the project awarded certificates to twelve Community Health Advocates for completing 40 hours of training in asthma health, community organizing, and advocacy. At that time, the Community Health Advocates were already working with 40 families, representing 53 asthmatic children, in the Franklin Hill, West Broadway, and Washington Beech public housing developments of Boston. The CHAs continue to identify and recruit additional families who have children diagnosed with asthma and who are interested in participating in this study.

The Intake Process:
Interested parents and children spend about two hours at an evening “intake” session. Approximately four to six families can be enrolled in the study during each intake session. Childcare, food, and beverages are provided. A number of steps take place during the “intake.”

Each family is assigned to work with a particular CHA. An identification number is assigned to each family so that anonymity can be maintained. Spanish speaking families are matched with Spanish-speaking CHAs, or interpreters if necessary. All of the forms and questionnaires are available in Spanish and English.
The assigned CHA further explains the study, the roles and responsibilities of the parents and children, and reads the corresponding consent forms to the parents and children who are 8 years of age or older. The families are invited to ask any questions they may have. Given their understanding and agreement to participate in the study, the parent(s) and older children sign two copies of the consent forms (one for them and one for study files). [The consent forms are called “assent” forms for children 8 years and older.] This step may take about ½ hour.

Intake Health Questionnaire, which addresses the medical history of each child in the family, including current use of asthma medications. The families are asked to bring with them all asthma medications currently taken by the child/children. The questions address the child’s general health from birth, environmental exposures in the home (i.e. smoking, pets, dust), the child’s physical activity, health insurance, family doctors, medication compliance, perceptions about asthma and about the family’s community, etc.
Monthly Quality of Life Questionnaire for the parent, which assesses how the child’s asthma affects the quality of life of the primary caregiver. Questions address the parent’s level of concern over the child’s asthma, how the asthma affects the family’s life, the support of family and friends available to the parent, and the parent’s self-esteem.
Monthly Quality of Life Questionnaire for the parent about children 7 years of age and younger. Questions address the frequency of asthma symptoms in the past week and impacts on the child such as loss of sleep, frustration, limitations on activities, etc.
Monthly Quality of Life Questionnaire for children 8 years of age and older. These questions are asked directly to the child. They are identical to the questions asked about the 7 and younger children’s quality of life in the preceding week.

The study nurse, Kristen Welker-Hood of BUSPH, explains proper use of the peak flow meter and issues one to each child for use in the study.
Kristen Welker-Hood performs a spirometry test on each child to measure his or her current lung function. She also explains to each child how to do the test properly, because each child will later do the test at home once every 2 months.
The CHA schedules the first home visit with each family within two weeks of the intake session. Each family receives the initial stipend check.
Consent Forms are delivered to BUSPH and Intake Forms go to the Harvard School of Public Health.