Waiting to Breathe Freely: CHOP Tackles Asthma Triggers in Homes

Waiting to Breathe Freely: CHOP Tackles Asthma Triggers in Homes

Waiting to Breathe Freely: CHOP Tackles Asthma Triggers in Homes

When Shaneena Stevenson gives a tour of her recently renovated home, the superlatives flow like water. “Stupendous. Great. So nice. Like a brand-new house. Wow.” Her 4-year-old daughter, Shai, pipes up with the best description of all: “Sparkly!”

The Stevensons are enjoying a gleaming new bathroom, kitchen, living room ceiling and basement flooring, thanks to renovations available through a new, innovative program from Children’s Hospital of Philadelphia, CAPP+. Those areas had been laden with mold from longstanding plumbing problems and were making Shai’s asthma worse.

Since the renovations, done at no cost to the family, Shai hasn’t had an asthma flare. “She’s been able to just take her regular preventive medicine and hasn’t needed her rescue inhaler,” Stevenson says. “I’ve definitely seen an improvement.”

That is exactly the goal of CAPP+, an extension of CHOP’s 20-year-old Community Asthma Prevention Program (CAPP). CAPP gives families that struggle to manage their child’s asthma extra support with education and help minimizing asthma triggers — environmental causes of asthma flares or attacks — in their homes. A specially trained community health worker visits the home and might advise removing carpet in the child’s bedroom, demonstrate trigger-preventing cleaning techniques, discuss pest control, or convince a child to keep one favorite stuffed animal instead of an entire menagerie.

Shai

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City partnership opens possibilities

But sometimes, community health workers see probable causes of triggers that go beyond their ability to fix. Most common is water damage — from leaky roofs, pipes or drainage systems — that leads to mold and mildew. Also prevalent are pest problems due to unsealed openings. These are repairs families don’t have the skills or the money to fix, leaving their children at increased risk for asthma attacks.

Worker painting ceiling
Renovations were done by Adkins Construction, a certified minority-owned business.

That’s where CAPP+ steps in. A collaboration between CHOP and the Philadelphia Housing Development Corp. (PHDC) — a city nonprofit program that provides free home repairs and handicap accessible modifications for low-income Philadelphians — CAPP+ fixes those bigger problems.

“CAPP+ would not be a reality if it weren’t for a partnership between Children’s Hospital of Philadelphia and the city of Philadelphia,” says CHOP President and CEO Madeline Bell. “We bring the health expertise, and they bring the housing and code expertise. Together, this makes a great partnership.”

“It’s going to give kids an environment to live in that gives them a fighting chance at having a better life than they have now,” adds Philadelphia Mayor Jim Kenney.

Asthma: the big disrupter

In addition to being the No. 1 noninjury reason for kids’ emergency department visits, asthma is the leading health-related reason children miss school, and the accumulated missed days can have a lifelong impact. Parents often have to miss work, adding additional stress to low-income families.

“We know that with CAPP alone, we see a reduction in hospitalizations by 48 to 50 percent,” says the program’s Medical Director, Tyra Bryant-Stephens, MD, “and we expect that to be even larger now that we're doing these major home repairs.”

That expectation led CHOP to invest initially in repairs to 10 homes as a pilot, thanks to a generous donation from the Otto Haas Charitable Trust. Given the success of the pilot, the hospital announced it will fund the expansion of the program to repair up 100 homes over the next year, with more to come over the next four years. Asthma outcomes of participating children will be measured to track CAPP+’s impact. Included in CAPP+ is a requirement that PHDC hire local minority- and women-owned contractors and purchase supplies, when possible, within the city of Philadelphia to advance CHOP’s commitment to economic inclusion.

Aiming for local economic impact, too

Mom and Daughter
Shai and her mom, Shaneena, enjoying Shai’s improved health.

The CAPP+ program allows us to give underrepresented small business owners and contractors a chance work on a long-term project of major significance in our community,” says Peter Grollman, Senior Vice President of External Affairs. “By making these repairs, they can benefit from a new economic opportunity while joining us in our efforts to improve the overall health of children in Philadelphia.”

Sheila Adkins, CEO of Adkins Management, a minority-certified construction company that renovated the Stevenson home, says, “We've done work for other PHDC programs, except now we're going to change the quality of life for children, which really excites me. Addressing things that could cause or trigger asthma attacks for little kids is very, very special.”

CAPP+ is one of three CHOP programs under the umbrella of Healthier Together, a community initiative that will also tackle food insecurity and access to mental and behavioral health services in West Philadelphia neighborhoods. Children’s Hospital, with the help of donors and volunteers, operates more than 100 community programs, working with other nonprofits and government agencies to improve the overall health and well-being of children.

While these innovative CHOP programs stand to have a significant impact for greater Philadelphia, for the Stevenson family, it’s personal.

“What makes the CAPP+ program so amazing is the heartfelt genuineness of it,” says Stevenson. “It was all about, ‘How can we make this better for you and your family?’ There’s no judgment. It was only, ‘This could be a problem, so let’s fix it.’ It’s all about how to improve your child’s health, which is fantastic.”

Watch the following video to learn more about how CAPP+ is making a difference for children like Shai.

  • Repairing a Home, Improving a Child's Health: CAPP+

    Shaneena Stephenson, Shi's mother: Shi was diagnosed with asthma about two years ago. It's scary because she's 4 now, but she still can't really explain, "I can't breathe.”

    Peter M. Grollman, Senior VP of External Affairs, CHOP: One in 4 children in West Philadelphia have asthma. The Community Asthma Prevention Program is a long-standing program where community health workers are going into homes and they're really proving that they're actually keeping kids out of the hospitals by reducing the triggers of asthma. And so to that end, when we looked at CAPP Plus, we thought we could do much, much more by really going deep into the homes and looking at mold, looking at water intrusion.

    Tyra Bryant Stephens, MD, CHOP: We’ve seen things that are really out of our control that requires professional home repairs.

    Madeline Bell, President & CEO, CHOP: We see so many children coming for Emergency Department visits, hospital admissions for asthma. This kind of program gets us one step closer to making them healthier without ever bringing them to a doctor's office.

    Tyra Bryant Stephens, MD, CHOP: We do know that with CAPP alone, we see a reduction of hospitalizations, from 40 to 50%, and we expect that to be even larger now that we're doing these major home repairs.

    Shaneena Stephenson, Shi's mother: My initial reaction when I learned about the CAPP Plus program, I was ecstatic. Carmen is my asthma care coordinator. She told me that she can come out and do a home visit and look over the house to see what thing can be done in the house to help manage her asthma.

    So when Carmen told me that they would do a lot of the renovation for free, to help Shi's asthma, I said, “OK, that's great, sign me up, I'm definitely for it.”

    Carmen Perez, Asthma Navigator: Being a single mother with three children, she didn't have the finances to do the repairs herself so we thought she was a great candidate for this project.

    Madeline Bell: CAPP Plus would not be a reality if it weren't for a partnership between Children's Hospital of Philadelphia and the City of Philadelphia. We bring the health expertise and they bring the housing and zoning and code expertise, so together this makes a great partnership.

    Peter M. Grollman: We sat down with Philadelphia Housing Development Corporation in the City Planning Department, and we had a discussion about housing and the social determinants of health. There's much more to health issues than meets the eye. Poverty can be a problem; poor housing can be a problem.

    Kevin Bane, Asst. Program Manager, Phila. Housing Development: We thought this would be a good way for us to partner with CHOP and the community as a prevention program repair low-income Philadelphian homes. We're really excited about the opportunity to work with CAPP Plus and to help the children of Philadelphia.

    Miguel Torres, PHCC: Hello how are you?

    Shaneena Stephenson: Hi.

    Miguel Torres, PHCC: Miguel Torres from PHDC. Here to do the inspection?

    Every house, within this program will be different.

    Robin Miccio, Program Manager, CHOP: Partnering with PHDC is gonna to be amazing because they're able to go into the homes and address some of these triggers: mold, dust, pests. It's really going to make a huge difference for families.

    Sheila Adkins, President & CEO, Adkins Management: I am the CEO and founder of Adkins Management Inc. We are a minority-certified company who has been doing business with PHDC for more than 18 years.

    Madeline Bell: It was very important to us that we promote a program that promoted jobs in the community.

    Peter M. Grollman: We see CAPP Plus as an opportunity to address the inclusive economy, to put people to work.

    Kevin Bane: There's a lot of minority-owned businesses and women-owned businesses that are in the Philadelphia area that are just looking for an opportunity to show what great jobs they can do.

    Sheila Adkins: We're doing something that's going to change the quality of life for children which really excites me.

    Jim Kenney, Mayor of Philadelphia: Kids are affected with asthma spend a lot more time out of school, which means they don't progress as much as their peers. It's gonna give kids an environment to live in, that gives them a fighting chance at having a wonderful life, having a better life than they have now.

    Shaneena Stephenson: When she has asthma flare-up, it's very scary, but to have a plus like this, a benefit of the program that will help you to make it less likely to have flares? It's great. I feel like the air feels better. She has not had an asthma flare-up since. She's been able to just do her regular preventive medicine without having to use her rescue inhaler.

    Peter M. Grollman: We're investing dollars in CAPP Plus because we have the evidence that this will work and achieve great outcomes. We think with philanthropic support, think with public support, we're gonna be able to sustain this work for years to come.

    Shaneena Stephenson: I cannot be more satisfied with anything. Seeing her just being able to run and crawl and jump and roll around with the puppies and all of that, makes me feel so great.

    What do you like about the kitchen?

    Shi: Sparkly.

    Shaneena Stephenson: Yeah, it’s sparkly. I love it. I love everything that they did.
Transcript Transcript