By Claire Richmond

If your home environment is not healthy, you cannot be healthy: mentally or physically.

Think about it. You spend half of your day (or more!) in your home. If it’s not healthy, you probably aren’t either. That’s why I’m thrilled to manage Healthy Homes Des Moines (HHDSM), an asthma program that gets to the source of what’s making children in our community sick.

HHDSM started as a pilot program called Healthy Homes East Bank, which targeted three low-income neighborhoods with a history of health disparities. Just weeks after launching in the East Bank, our hospital partners demonstrated a strong need for our services across all of Des Moines rather than a single zip code. On March 1, we were proud to announce our re-launch as “Healthy Homes Des Moines.”

Two important factors took the program from concept to action: voices from the community were heard by local leaders, and agencies across sectors including housing, health care, neighborhood revitalization, and education agreed on a solution to produce a shared vision of a healthier community.

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We knew we needed expertise in several areas to make a home-based asthma intervention possible. To be successful, we wanted involvement of hospital partners (UnityPoint Health—Des Moines, Broadlawns Medical Center, Mercy Medical Center), Des Moines Public School nurses, community organizers (Viva East Bank!), the Polk County health department, healthy homes contractors (Polk County Public Works), and community health workers (Visiting Nurse Services of Iowa).

An implementation award of $250,000 provided by the BUILD Health Challenge matched the funding from the local health systems, and by July 1 of last year, we were ready to get started.

To leverage the resources of all partners, Healthy Homes Des Moines uses a five-step process:

  1. Identify children with chronic asthma
  2. Assess health hazards in the home
  3. Provide asthma education
  4. Make necessary home repairs
  5. Conduct follow-up evaluations

Local health care providers and Des Moines Public School nurses identify families with children whose uncontrolled, persistent asthma is likely the result of household conditions. Polk County Healthy Homes inspectors visit their homes and determine if repairs can be made to improve indoor air quality for residents. Once home improvements are complete, families receive supplies to maintain a clean home free of asthma triggers like mice, cockroaches, dusty old carpet, and moisture, and the provider who referred the family to HHDSM gets an update. Two months later, HHDSM follows up with families to see how their children are doing.

If we can prove that this program works, not only will we be improving the lives of many families throughout the Des Moines area, we will be saving them (and the health care system) a lot of money. It’s far less expensive to repair a home than pay for multiple visits to an emergency department for uncontrolled asthma.

That’s why data management is so important for making the case for HHDSM. We can’t rely on anecdotal evidence that families are happier, healthier, and avoiding unnecessary hospitalizations. We need cold, hard numbers.

We hired a third-party evaluator, the Child & Family Policy Center, to analyze and synthesize data to collect demographic information and answer questions like “How efficient is our five-step process?”, “Is the cross-sector relationship among the partners operating as effectively as possible?” and “Are these families paying less in medical bills as a result of our intervention?”

In the nine months HHDSM has been up and running, some compelling data has already emerged.

  • The majority (80%) of Healthy Homes Des Moines participants are boys, and the average age is six years.
  • One-third of participants are children who are white, one-quarter are children who are black, one-quarter are Hispanic or Latino children, and the remaining 17 percent of children referred to the program are Asian.
  • Eighty-percent of children in the program receive their health insurance coverage through Medicaid, 10 percent receive coverage through hawk-i, and 10 percent have private insurance.

These data do not reflect the ethnic make-up of the city of Des Moines; rather, they mirror the demographic composition of its low-income neighborhoods. These data are not proof of a causal relationship, but they speak to our hypothesis that low-income minorities are at a higher risk for developing asthma in our community.

Des Moines, IA - Claire Richmond blog

Asthma represents a significant burden among the participating families. Approximately 80 percent of parents or guardians reported that their children experienced asthma symptoms during the previous four weeks, but less than half reported having an asthma action plan in place. Sixty percent of referred families reported relying on urgent care facilities and/or emergency department visits for health care, even though 100 percent reported having a medical home.

Referred families reported three asthma-related emergency department visits on average over the previous six months. It is estimated that each asthma-related emergency department visit costs approximately $430 for children on Medicaid in Iowa. For the ten families referred to Healthy Homes East Bank, the earlier, smaller version of Healthy Homes Des Moines, that represents a cost of almost $13,000 over the past 6 months.

Expanding our reach from the East Bank to all of Des Moines allows us to have a broader impact and show Des Moines the importance of healthy communities in treating chronic conditions. I believe with continued investment in HHDSM, we will be able to improve asthma rates in children and preserve housing that is not only affordable, but healthy.

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About the Author

Claire Richmond is the project manager of Healthy Homes Des Moines, a coalition of non-profit and hospital partners focused on minimizing determinants of pediatric asthma in Des Moines. She received her M.P.H. in community health and her M.S. in urban planning from the University of Iowa. Richmond serves on the board of the Des Moines Health Center, chairs the Greater Des Moines Age-Friendly City Infrastructure Committee, and is a 2016 National Leadership Council fellow.