The Healthy Homes Healthy Kids program aims to reduce environmental health and safety hazards in homes, help families engage in healthier behaviors, and partner with clinical teams to improve child asthma outcomes. The program provides home remediation, pest control, and education. It found a 67% reduction in hospital visits and 57% reduction in ER visits after 6-9 months. The program is cost-effective at $3,500 per unit but requires partnerships, sustainable funding, data collection, legal support and enforcement of housing standards to help more children.

2.  To maintain environments, prevent disease, and
promote public health through education and
regulation. EHS monitors, assesses, inspects, and
educates the public about vectors, food safety, lead &
healthy homes, and environmental engineering.

3. Environmental Health Services
Vector
Control
Food
Protection
Environmental
Engineering
Lead &
Healthy
Homes
Program
Pb

4. Child Asthma Hospitalization
Philadelphia (2000-2012)

5. Asthma Related ER Visits Children <
18 yrs. Philadelphia, P A
2009 10,5550
2010 9,958
PDPH Syndromic Surveillance System
PA Health Care Cost Containment Council 2010

6. •Americans spend up to 90% of their time indoors
•Indoor concentrations of most pollutants are higher than outdoor
Indoor Environment and Asthma

7. The Healthy Homes Healthy Kids
Program
City of Philadelphia Department of Public Health

8. • Collaboration with St. Christopher’s Hospital for
children with severe asthma
• Integrates clinical, environmental and educational
strategies to successfully mitigate and manage a
child’s asthma, prevent lead poisoning and address
other health and safety hazards
• Close collaboration family, medical team and HHHK
team to address housing conditions and behavior.
• Services are provided in English and Spanish in an
appropriate cultural framework.

9. 1. Reduce Environmental Health and Safety Hazards
• Repair Leaks
• Remove mold and repair water damage
• Rip up old carpeting and refinish floors
• Replace leaded windows where children can reach
• Vector Control Unit services (Integrated Pest Management)
• Energy Audit and Weatherization
2. Help Families Engage in Healthier Behavior
• Personalized Environmental Action Plan & Motivational Interviews
• Issues include: clutter, tobacco smoke, stop use of perfumes, candles,
noxious cleaning and pest control supplies
3. Partner with Clinical Team
• Biweekly calls for information sharing
• Ensure child and caregiver understand and use medication as prescribed

10. (January 2013 – December 2014) N=160

17. Activity/Personnel Cost
Remediation $ 3000
Integrated Pest Management $ 150
Staffing $ 110
Client supplies $ 200
Total Cost For HHHK Services per
unit
$3500
Weatherization (selected homes
only)
$1200

18. Outcome Pre 6-9 months
post
Difference % improvement
Hospital visits in last
6 months
1.8 0.6 1.2
(p<0.0001)
67%
ER visits in last 6
months
3.7 1.6 2.1*
(p<0.0001)
57%
Doctor visits in last
6 months
3.8 2.2 1.6
(p=0.002)
42%
Missed school days
in last 1 month
3.3 3.6 -0.3
(p=0.69)
--
Albuterol use in last
2 weeks
9.3 6.7 2.7
(p=0.09)
--
Revised 6.2.15
93 families surveyed based on per and post test questionnaires

19.  It works! It is a cost effective intervention.
 Must address both housing condition and
residents’ behavior.
 Important to involve child’s medical
providers.
 Important to allow residents to determine
their Healthy Homes priorities.
 Must be culturally appropriate and language
accessible.
 More evidence-based research needed on
reducing second hand smoke in private
homes of low income residents.

20.  Funding is needed to support program
expansion.
 Homeowners need resources to improve
housing.
 Landlords should be required to adhere to
their legal responsibilities under the
Philadelphia law.
 Retaliatory evictions are illegal and tenants
need adequate representation.

21. Next Steps-Goals to Help Philadelphia’s Children
 Partnerships
 with community organizations, health care
providers, government agencies, health insurers,
housing organizations, landlord associations and
legal services.
 Sustainable Funding
 for services and home repairs to reduce the
health and safety hazards in homes and support
families’ healthy behavioral changes.

22. Next Steps-Goals to Help Philadelphia’s Children
 Data & Information
 to develop a robust understanding of housing quality in
Philadelphia, to understand the prevalence of health and
safety housing issues and the impact on children’s health and
to evaluate the effectiveness of interventions.
 Legal Services and Other Support
 to ensure families have the legal services along with have the
information, resources, support, access to health care they
need to reduce the health and safety hazards in their homes.
 Enhanced Enforcement
 of the Health Code, Property Maintenance Code, Lead
Disclosure and Notification Law and other laws as needed to
help improve the housing conditions of children.

23. Palak Raval-Nelson, PhD, MPH
Director- EHS
Palak.raval-nelson@phila.gov