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“Health Starts at Home”

Asthma is the number one illness that sends Philly kids to the ER and the main reason they miss school. A CHOP program is working to change that—starting with where they live

“Health Starts at Home”

Asthma is the number one illness that sends Philly kids to the ER and the main reason they miss school. A CHOP program is working to change that—starting with where they live

For the first time in three years, Amanda Dobbs and her two sons are breathing easier. Literally.

Dobbs’ sons — Robert III, 14, and Jaxson, 3 — have asthma, and the 100-year-old Cobbs Creek home they moved into in 2019 continually exacerbated their conditions. There was mold in the bathroom and basement, holes in the ceilings and floor, a leaking air conditioning unit, two bricked-shut windows, and a back door that wouldn’t fully close. Some of Jaxson’s asthma attacks were so bad they required ER visits that turned into overnight stays.

Then, the Children Hospital of Philadelphia’s Community Asthma Prevention Program (CAPP+) stepped in. Launched in 2018, CAPP+ expands on the work Dr. Tyra Bryant-Stephens began when she created CHOP’s Community Asthma Prevention Program (CAPP) in 1997. CAPP’s mission: Improve the health and overall well-being of the one in four children in West Philadelphia diagnosed with the condition.

CAPP+ goes a step further by sending specialized contractors into homes of the patients to repair roof or plumbing leaks, replace carpets with wood flooring, seal gaps to keep out pests, remove mold — fixes that decrease or eliminate asthma triggers. The program recently finished work on its 125th dwelling. It spends on average about $14,000 on each project.

For the Dobbs family, contractors cleared out mold, sealed holes, removed potentially hazardous and irritating chemicals, and closed the door, literally, on dust. They also made other lifestyle-altering repairs. Neither boy has had a major asthma attack since.

“This has been life-changing,” Dobbs says. “I feel such a sense of relief. Everything in the house gives me a sense of relief. I was crying through the whole process.”

Bryant-Stephens says CAPP+ has followed 30 children whose families received assistance over a one-year period, and found the asthma patients have fewer nighttime symptoms, less impairment with activity, less missed school and fewer emergency room visits.

And, she says, there is a bigger impact not quantified by that data. When children miss less school, they have better educational outcomes. When they can play with friends or take up a sport, they’re generally emotionally and physically healthier. When parents don’t have to adjust their schedules to care for sick children, they’re able to work or complete other necessary tasks. Eliminating lingering house problems and improving air quality benefits everyone in the household.

“Health starts at home and improving housing can improve health,” says Bryant-Stephens. “What we’re doing is improving quality of life for everyone [in the home]. A lot of parents have said to us, We never could have done this on our own.”

The leading reason Philly children miss school

Asthma is the number one non-injury reason children visit CHOP’s emergency room. It’s also the leading health-related reason that Philly children miss school, Bryant-Stephens says — and, it disproportionately impacts children from minority or low-income households. While nationwide about nine percent of children have asthma, that percentage is more than doubled in communities like West Philly, where an estimated 25 percent of children have asthma.

The original CAPP program sends trained asthma educators into homes to provide education to caregivers and supplies to mitigate asthma triggers, including mattress covers and roach traps. It also offers community asthma education classes. Within its first year, CHOP reported that children in CAPP homes had 30 to 40 percent fewer emergency room visits and 40 to 50 percent fewer hospitalizations.

But CAPP’s in-home educators often noticed a need for larger interventions. Many of the families CAPP worked with could not afford major repairs, including mold remediation and pest removal.

“Health starts at home and improving housing can improve health,” says Bryant-Stephens. “What we’re doing is improving quality of life for everyone [in the home]. A lot of parents have said to us, We never could have done this on our own.”

“We were making progress, but the question of unhealthy homes kept coming up,” Bryant-Stephens says. “We wanted to make sure we weren’t sending [patients] back to environments that were bad for their asthma.”

In 2017, CHOP and partners including nonprofits Rebuilding Together Philadelphia and Habitat for Humanity won a $250,000 national grant from the BUILD Health Challenge. CHOP matched that grant, and CAPP+ began work the next year. After a short Covid pause, the partnership continues today, with support from CHOP’s Healthier Together, a five-year, $25 million initiative launched in 2019 to address the social determinants of health in three zip codes — 19139, 19143, 19104 — closest to its campus.

“I never believed it was the color of skin creating these health disparities and we had to look deeper and harder at what the real issues are,” Bryant-Stephens says. “What drives me and motivates me is finding and reducing those barriers that prevent children with asthma from achieving their best health.”

The most affordable home is the one that already exists

Partnering with CHOP means organizations like Rebuilding Together for Philadelphia and Habitat for Humanity can help people who might not have been on their radar.

“We get to expand the reach of our impact when we target people whose homes are detrimental to their health,” says Kyonne Isaac, homeowner services manager for Habitat for Humanity Philadelphia. “We’re not only immediately helping alleviate the children’s conditions, but also helping build the resiliency of the family to do things in the future.”

Philadelphia is unique in that most residents own their homes. At 53 percent, according to a 2020 analysis by the Pew Charitable Trusts, home ownership here “is higher than in most large cities in the Northeast and Midwest,” says Isaac. But even without mortgages, many families with lower incomes struggle to stay on top of home repairs, which allows one small hole to grow into a major problem. Still, it’s quicker and easier to make repairs on existing homes before they become uninhabitable than to build new ones.

“Housing affordability isn’t just for first-time home buyers,” Isaacs says. “The most direct affordable housing in this city is keeping people in their homes.”

Stefanie Seldin, president and CEO of Rebuilding Together Philadelphia, says her organization often works in households that need more than what a contractor can provide. Before Rebuilding Together partnered with CAPP, Seldin recalls working in the home of an asthmatic boy and his elderly great-grandmother. He’d been hospitalized twice the week before the agency visited their home. Some on her team noticed that the grandmother had jumbled the boy’s prescriptions with her own, and that someone else in the house was a smoker.

“[Those sorts of issues] are not in the scope of a home repair provider, but it is the work of a community health worker in the CAPP+ program,” Seldin says. “Now we can help kids like [this] with more than just repairs.”

Robert III, 14, and Jaxson, 3

In 2019, when Dobbs and her sons moved into their home, the problems weren’t just dust, mold or pest related. Almost every room had at least one hole in a wall or ceiling. Some floors were unstable. The kitchen was unusable, so Dobbs, a trained chef, prepared meals using a slow cooker and a portable cooktop and washed dishes in the bathroom sink. That meant the boys’ favorites — meatloaf and lasagne — were out of the question, and Dobbs said she didn’t even consider frying anything in her close quarters.

But it was her best and only option. She was recently divorced and could live cheaply in the family home.

“It was tough cooking sometimes on the burners, a pain in the neck, but some good things came out of it. I learned to make meatloaf in the crock pot,” she says. “It helped me learn new ways to do stuff.”

The CAPP+ team spent about a month addressing all of the problems in Dobbs’ home with no charge to her. The program even sent the family to an airport hotel for about four days so they could escape the construction dust. (“The boys were so excited,” Dobbs said.)

While life is easier, it’s not easy. Still, Dobbs said, it’s looking up. “Things can be pretty stressful, getting the kids from one place to the next, schools and doctors, and sometimes, once in a while, there are concerns about getting food on the table,” Dobbs says. “But I’m just trying to be the best mom possible to my boys.”

Jaxson was recently accepted into an autism support class. Robert is about to start high school.

“You don’t realize how much you take for granted or how much you have until you don’t have it and then you get it back,” Dobbs says. “I am so thankful for this phenomenal program, not just for the care my children have received, but even me, as a mom, I’ve never felt more cared for.”



Photo by KristyFaith via Flickr

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