The Need for Healthy Housing
Every year in the District of Columbia, thousands of children and adults suffer from serious health problems caused or worsened by environmental health hazards. Illnesses and injuries impacted or caused by an environmental hazard are far and away the number one reason why children are hospitalized in the District of Columbia. What many parents do not know is that the number one place a child is likely to be harmed by an environmental health hazard is in his or her own home. Asthma, lead poisoning, unintentional injuries and other harmful health effects can all be linked to problems within the home. The most common culprits include peeling and/or deteriorating paint, mold, insect and rodent infestation, overuse of pesticides and other chemicals, poor ventilation, water leaks, trip and fall hazards, and malfunctioning cooling and heating systems. In response to these threats, the Department of Energy & Environment (DOEE) launched the DC Partnership for Healthy Homes, an award-winning District Government program aimed at identifying and ending environmental health and safety threats, while at the same time leveraging energy efficiency improvements, in the homes of families throughout the District of Columbia.
How It Works
The Partnership, spearheaded by DOEE’s Lead and Healthy Housing Division, consists of a broad coalition of District agencies and some of the District’s most prominent medical providers, managed care organizations, non-profits and environmental health professionals. Participating health providers and social service agencies serve as front-line responders, identifying children in distress due to lead poisoning, severe and poorly controlled asthma, and/or situations in which a pregnant woman is living in a hazardous home. The front-line responders refer these families to DOEE‘s Lead and Healthy Housing Division. After an intake process, participants receive a comprehensive home environmental assessment and energy audit, family education, an asthma management diagnostic and case management coordination. Once health and safety threats have been identified and systematically documented, DOEE creates a comprehensive Technical Assistance Report that serves as a time-sensitive roadmap for the correction of identified hazards, and that details the potential health issues related to those hazards. Collaboration is also coordinated with DOEE’s Energy Administration, to ensure appropriate weatherization and other energy efficiency improvement needs are identified and provided, to the extent possible.
The Technical Assistance Report is issued to property owners and tenants, detailing the work that needs to be completed and the general, outcome-focused methodology that should be employed in making repairs. Guided by an in-house tool called the Healthy Homes Case Management timeline, case managers then steer clients and landlords through the process of making necessary home repairs and implementing behavioral changes where applicable, such as smoking cessation.
For families who own their own home, case managers provide free consultation on how to pursue safe hazard remediation privately. They connect income-qualified families to funding sources and grant programs available through District Government.
For families in public housing, DOEE works closely with the DC Housing Authority, the District’s public housing agency, to ensure their property managers follow through on the remediation of DOEE-identified hazards in a timely manner.
When landlords and property managers voluntarily opt to make repairs, which occurs in the vast majority of cases to date, DOEE provides technical assistance. In those cases where cooperation is not readily obtained, DOEE collaborates with its code enforcement partner, the Department of Consumer and Regulatory Affairs (DCRA) to ensure appropriate follow up occurs, including the assessment of fines by DCRA when landlords fail to correct identified housing code violations. This approach gives rental property owners the chance to address hazards before fines and penalties are levied, which in turn generates a climate of partnership and cooperation.
The Role of Case Managers
Case managers at DOEE are public health analysts with backgrounds in nursing, public health, social work, communications and clinical care. They are trained experts in Healthy Homes interventions, credentialed as “Healthy Homes Specialists” by the National Environmental Health Association. Some are also Board-certified Asthma Educators. For each client, they develop customized strategies for hazard elimination by conducting home visits and coordinating efforts with medical providers and any other agency involved with the family. All data collected by DOEE staff are made available to healthcare providers in support of the asthma management or lead poisoning prevention process.
After intake, case managers give families an educational presentation on “healthy homes” concepts, including how to maintain a healthy home, and conduct a visual property assessment, collecting data using a baseline assessment form. If the referral involves a lead poisoning case, DOEE lead risk assessors also conduct a comprehensive risk assessment that identifies any lead-based paint hazards, including lead-contaminated dust and lead-contaminated bare soil, and any lead-in-water issues. Moreover, for all referrals, plans are in place to conduct additional environmental sampling, including for allergens in household dust. Finally, an asthma diagnostic, based on the National Institute of Health’s core management principles, is performed to identify any asthma management problems that might exist -- from incorrect use of medical devices to potential asthma triggers related to the child’s current routine.
Once back at the office, case managers then develop a Care Plan, customized for each client and providing DOEE recommendations to avoid and/or minimize ongoing exposure risks while waiting for hazards to be addressed. After providing the Care Plan to their client, the case manager checks in on a routine basis to see how the client is doing and to monitor progress in the elimination of identified hazards.
Who Can Enroll in the Program
- Children with severe and poorly controlled asthma;
- Children less than 6 years old with a blood lead level of concern; and
- District residents with a child less than 6 or a pregnant household member, whose home contains health and safety threats.
Typically these families live in older homes where maintenance has been deferred, and that may contain one or more of the following:
- Chipping or Peeling Paint
- Mold / Water Damage or Leaks
- Pests (Insects and/or Rodents)
- Excessive Household Clutter
- Recent Renovations to Painted Surfaces
- Structural Safety Concerns
- Cigarette Use / Environmental Tobacco Smoke
- Indoor Climate Control / Ventilation Issues
What Participants Receive
- A home environmental and energy efficiency assessment
- Environmental health education
- Trainings, tools and/or supplies for reducing threats and increasing energy efficiency
- Assistance in coordinating resources
- Follow up support from DOEE staff
- Tracking through successful hazard remediation
Sharing Information &Tracking Outcomes
DOEE created an interactive webpage on home hazards to further support its Healthy Homes Program, allowing District residents to obtain information about a variety of health risks that can exist within homes. It’s accessible on the web at: dchealthyhomes.com. The DOEE programs and the DC Partnership serve not only those District residents whose homes contain hazards, but also help educate the referring agencies about the hazards found, thus resulting in a broader, District-wide understanding of the environmental health threats found in the nation’s capital, how best to prevent, identify, and eliminate them, and how to better communicate with District residents about health risks generally. Thanks to its powerful database, DOEE is able to analyze and report on the distribution of health hazards currently prevalent in the District’s housing, and is working on identifying geographic correlations and other hazard-related trends. DOEE will also publish all health-related outcomes of the Partnership’s work on the DOEE website, once a critical mass of pertinent data exists.