In 1997, Little Sisters of the Assumption Family Health Service (Little Sisters) established the Environmental Health Services program in response to high rates of asthma among East Harlem children. The program provides a continuum of services meant to mitigate the negative effects of poor living conditions on asthma-related health outcomes. Led by a team of community health workers (CHWs), program activities include assessments of the home environment, hands-on training and education on safe and effective ways to address unhealthy living conditions, and advocacy services for tenants to get necessary repairs from housing management. In 2011, with funding from the U.S. Department of Housing and Urban Development (HUD), Little Sisters began implementation of Controlling Asthma through Home Remediation (CAHR), a demonstration of their program model, specifically targeting families living in public housing. The demonstration included an evaluation of the program by The New York Academy of Medicine (the Academy)--findings included statistically significant reductions in nighttime awakenings, emergency department visits, and use of rescue medications. As part of the evaluation, a sample of 17 caregivers participated in interviews, with questions that focused on their perceptions of program quality, impact, and lessons learned. As described in this report, caregivers noted that CHWs helped them to develop knowledge and skills to reduce household asthma triggers; in addition, CHWs and Little Sisters proved to be influential advocates, facilitating the settlement of complaints with housing management. As New York State and local health care systems adopt and promote more community-based health programs, CAHR represents a promising example of an intervention that can produce improvements in asthma-related health outcomes, while supporting grassroots efforts to create changes in policies and practice.
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