When a patient shows up at Children’s Mercy Hospital suffering from a severe asthma attack, the hospital is ready to do more than just treat the illness. The child’s home may get a checkup as well.
A team of environmental health specialists from the Kansas City, Mo.-based hospital’s toxicology and environmental health section visits the homes of children hospitalized with a serious case of asthma or other respiratory infection. They are trained to identify potential triggers for the illness.
The environmental team also works with several area school districts and organizations in the community to address indoor environmental exposures, and has trained hundreds of building and other professionals to observe and characterize potential problems through its “Healthy Homes” program.
“We look at the environmental problems, contaminants and hazards that contribute to making children’s health worse, and we are solving those problems by making their health and welfare better,” says Kevin Kennedy, the hospital’s environmental health director. He is one of four environmental hygienist on the Healthy Homes team that includes two environmental coordinators and a community health specialist.
Many things in the home contribute to asthma attacks. Dust mites and mold top the list, along with furry pets, smoke, cockroaches and airborne fragrances and chemicals, Kennedy says. As many as 1 in 10 American kids has asthma, according to the American Academy of Pediatrics.
The Healthy Homes program began in 1995 focused mostly on home assessments for Children’s Mercy patients with asthma. Today, the program includes other environmental hazards such as lead-based paint and carbon monoxide. The hospital’s environmental specialists can visit more than 200 homes a year in the 15-county metropolitan area encompassing the two Kansas Citys of Missouri and Kansas.
A hospital physician or practitioner at one of Children’s Mercy’s 25 clinics typically will refer a patient to Heathy Homes. The hospital classifies asthmatic patients as high-risk cases based partly on how frequently they visit the hospital or emergency department (ED) and their need for prescription drugs and related therapies.
A possible candidate for a home assessment could be a child who goes to the hospital or ED within a year of previously being admitted for asthma. That will prompt the hospital to query child and family about their home environment. As part of a brief survey, they will be asked questions, like, for example, “Has there been any moisture leaks in the house during the past week … month … three months?” The family’s response will help the hospital determine if and how to intervene.
Sometimes, the intervention may be just calling families or sending them information on how to keep the home safe. Or an environmental hygienist “may walk through the home and educate the family about environmental triggers associated with asthma,” Kennedy says.
When environmental specialists do a walk-through and observe serious issues in the home, Kennedy says they will get out what family members sometimes call “ghostbusters gadgets” to measure things in each room like indoor air quality, moisture, dust and allergens, as well as go through a safety and injury-prevention checklist.
Kennedy wants to provide a complete picture of environmental health as it relates to safe and healthy living. “The visit to the home is your opportunity to advocate on a host of potential health and safety risks,” he says. “We look at the house as a whole system and not as a single individual source of a hazard or pollutant.”
There can be several home visits over the course of six months. The assessment concludes with recommendations for eliminating exposure to asthma and allergy triggers and maintaining a safe, healthy home.
Most families genuinely want to change their environment and heed the recommendations, Kennedy says. The hospital connects families to a range of nonprofit and government agencies and businesses partners who can help them address problems in their homes.
The home assessments are free to the families. Children’s Mercy has relied on grant funding from a number of sources – including the Robert Wood Johnson Foundation, the Centers for Disease Control and Prevention and the Department of Housing and Urban Development – to help pay for the costs of home-based interventions. The hospital’s Medicaid managed care organization also covers home assessments for Children’s Mercy patients.
Healthy Homes is about “finding upstream solutions to chronic health issues,” Kennedy says. “Let’s find the root cause and source of the health condition. Patients will have a chronic disease but it may be so much easier to manage because they have paid close attention to what those exposures might be. And then you’ve made a difference in someone’s life.”