Healthy Neighborhoods Program

State: NY Type: Model Practice Year: 2005

Niagara County’s Healthy Neighborhoods Program targets households considered to be at risk for environmental health and safety hazards in the city of Niagara Falls. The targeted area includes 14,000 households, the majority of which are renter occupied. Over 90% of the homes were built prior to 1970. The median household income is just over $20,000 and 43% of the families with related children under age 5 are living in poverty. Program personnel conduct 1,600 interviews at homes each year. During home visits potential health hazards are identified, smoke detector deficiencies are corrected, carbon monoxide levels are checked, lead poisoning prevention education is reviewed, and asthma education is provided. Other services and referrals are provided as needed. The outcome of the practice has been the improvement of the health and safety of the individuals we have seen. The key elements include a motivated and enthusiastic staff of three dedicated to improving of the lives of individuals; the active participation of students, physicians, and others from various groups and agencies in the community; and the support of the administration of the Health Department.
The Healthy Neighborhoods Program targets a number of public health issues. The core components addressed include: fire and injury prevention, lead poisoning prevention, carbon monoxide poisoning prevention, and asthma triggers and management. Target areas were chosen based on a number of criteria including the age of housing stock, the number of people living in poverty, and any other factor that may put the population at risk for negative health outcomes. The practice can resolve some issues during door-to-door visits. Others are frequently referred to other agencies or programs for resolution. The Healthy Neighborhoods Program is the first door-to-door approach in the county that is designed to improve the health and safety of individuals living in targeted areas. The program has been innovative in the number of additional services that have been provided outside the scope of the core components of the program. The program has also had active participation from students, physicians, and others while making door-to-door visits.
Agency Community RolesThe program has been able to successfully collaborate with a number of schools, agencies, programs and community resources to enhance the services that are provided. They are outlined below: Niagara University, Niagara County Community College, and Daemen College have all provided students to assist our program during home visits. The majority of the students have been nursing students, but social work students have assisted as well. Niagara Falls Memorial Medical Center has rotated physicians in the Family Practice Residency Program in our program. Physicians accompany program staff while making door-to-door visits. Outreach for Wellness in Niagara, a service of Niagara Falls Memorial Medical Center, has provided the program with over $7,000. The funding has been used for salaries and the purchase of cleaning supplies to give to parents of young children to promote lead poisoning prevention.  The Department of Pediatric and Community Dentistry, School of Dental Medicine, SUNY at Buffalo, has provided the program with several thousand toothbrushes, tubes of toothpaste and dental literature to distribute to the people we visit. Niagara Falls Fire Department has allowed the Fire Education Officer to accompany program staff during home visits. The American Lung Association and Asthma Connections have been able to provide nebulizers, peak flow meters, dust mite-proof mattress covers, pillow covers, and education to asthmatics visited by the program. Experience Works, Inc. has provided part time workers to assist the program with clerical and other duties. Niagara County Environmental Fund provided funding for the purchase of 300 garbage cans that were distributed to residents. The Niagara Gazette has published over 200 health and safety articles that were supplied to the paper by our program. The Program has worked with several Block Clubs to improve the health and safety on individuals. Initially AmeriCorp provided workers to accompany staff in the field. GuildCare and Cornell Cooperative Extension have also provided workers who have assisted the program staff us with home visits. Electricians from the International Brotherhood of Electrical Workers volunteered time and services to install motion detectors for residents. Local foundations have supplied $2,000 for the purchase of smoke detectors and other materials.  Costs and ExpendituresThe Healthy Neighborhoods Programs are funded for three years at a time. At this time Niagara County’s Healthy Neighborhoods Program is in its third year of its third funding cycle. We currently receive $133,500 per year from the New York State Department of Health. Over the past nine years the program has received over $13,500 from other agencies and foundations to assist with funding needs.  ImplementationInitially various agencies and programs were contacted to provide training, garner support, and promote collaborative activities. Three full time workers were hired with assistance being provided by volunteers and others in the community including students and physicians. Procedures were established and home visits began. Workers went out in teams of two, with at least one full time employee in each team and worked on the following areas: Fire prevention – The Niagara Falls Fire Department was contacted to assist in determining additional hazards that staff should look for in homes. During visits, smoke detectors were installed or replaced if needed, and batteries may be replaced. Fuses boxes were checked and 15-amp fuses are provided to replace inappropriate 20-amp or 30-amp fuses. Outlet and switch cover plates were provided if they are missing or broken. Bare wires, inappropriate use of extension cords, blocked exits, and other potential fire hazards are also addressed. House numbers were provided to assist emergency vehicles to find a home if there is an emergency. Furnace filters were provided and installed if needed. Although many potential hazards are corrected at the time of the visit; other hazards may be addressed with the landlord or may be referred to the Niagara Falls Building Inspection Department. Carbon monoxide poisoning prevention – Carbon monoxide levels in the homes were checked during visits. If the level is elevated, the source is determined and the hazard is corrected. At times the owner of a building or the Fire Department to may need to be called to assist us with shutting down a furnace, etc. The program has a limited number of carbon monoxide detectors that can be provided to residents at risk. Lead poisoning prevention – If there were children age 6 and under, the Childhood Lead Poisoning Prevention Program is contacted to make sure the children have been screened for lead poisoning. If they have not been screened, the Childhood Lead Poisoning Prevention Program follows-up with the families. Parents and care providers were educated on the potential sources of lead poisoning and steps they can take to reduce the risk in their home. The parents or care providers were provided with buckets, mops, liquid cleaner, sponges, gloves, and other cleaning supplies. Asthma – If there were asthmatics in the home, potential environmental triggers were identified and education is provided to assist the asthmatic and his/her family. Referrals may be made for medical insurance or primary care providers. Dust mite-proof mattress covers and pillow covers were provided if needed. Referrals were made to the American Lung Association for additional services. We also make a revisit to the homes of all asthmatics one year after the initial visit. Indoor air quality – Radon detectors were supplied at a number of homes.  Other services – If other needs were identified in the home, the program tries to assist the individual or family. Residents at each home were provided with a packet of information and a telephone directory with useful numbers. Referrals were made for assistance with utility bills, food, continuing education, the Office for the Aging, diabetes education, quit smoking programs, Medicaid, WIC, rodent control, the Community Health Worker Program, rodent control, etc. The timeline for carrying out these tasks has remained consistent. Visits were made on a daily basis, and on average the program has been able to visit people at 1,600 homes per year.
The program also receives a huge benefit from the manpower and services that are provided by the various divisions of the Health Department and by manpower and services provided by other agencies, colleges, businesses and programs. The program provides outstanding health education and services. As long as the NYSDOH continues to fund the program, it will be possible to reach the under-served in target areas to help decrease health disparities.