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Housing-Related Health and Safety Hazard Assessment

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Housing-Related Health and Safety Hazard Assessment 4 Housing-Related Health and Safety Hazard Assessment Resident Interviews Purpose Past Experience Interviewer Staffing Interviewer Training Interview Documentation Quality Control/Quality Assurance Managing Confidential Data and Resident Concerns for Privacy Interview Tools Interview Data Security Visual Assessment Purpose—Identify Housing Defects and Causes Limitations of Visual Assessment and Training Needed Scope Sequencing Areas Healthy Home Rating System Specific Housing Conditions to Assess Visually Prioritizing Visual Assessment Results Environmental Sampling and Measurements Environmental Sampling Methods— General Considerations Energy Audits page 65 page 66 Housing-Related Health and Safety Hazard Assessment 4 ousing conditions should support the health and well-being of its residents; Hthey should not cause injuries or illness. This simple principle lies at the heart of healthy housing initiatives and recognizes interactions Key Messages between housing and disease, injury, and •• There are three primary ways of identifying overall well being. Identifying unhealthy housing housing health and safety problems: conditions is a prerequisite to correcting them resident interviews, visual assessments, and before they negatively impact health. environmental sampling. Visual assessments are the foundation of the assessment This chapter provides an overview of inspection process, while environmental sampling is and assessment methods, highlights specific usually limited because of cost constraints. tools, and lays the foundation for effective and efficient interventions addressed in •• Interviews with residents should be Chapter 5. Home-based health hazards can conducted by skilled individuals. The be assessed by: (1) collecting information interview can help to inform the visual on occupants’ health and housing concerns assessment and environmental sampling, as during resident interviews; (2) performing a well as provide an education opportunity. visual assessment; and (3) for some hazards, •• Program staff performing these functions collecting environmental measurements and must be trained to carry them out properly, samples (Figure 4.1). The visual assessment is understand how to work as an integrated the cornerstone of the assessment process and team, and know when to refer a problem to can be conducted alone or in combination with a more highly trained professional. the resident interview and/or environmental •• Numerous interview and visual assessment tools have been developed. In general, new programs should not change validated, Figure 4.1 Assessment Methods evidence-based tools. Use of common tools ensures consistency. There are three approaches to identifying health and safety hazards in the home •• The visual assessment covers moisture, environment: ventilation, safety (injury) hazards, combustion safety, pest problems, and •• Resident Interviews. cleanliness. It usually begins with the •• Visual Assessment. exterior site (including garages), building •• Environmental Sampling and Building exterior, common areas (if any), building Performance Testing. equipment rooms, building penetrations and proceeds finally to living areas. Housing-Related Health and Safety Hazard Assessment page 67 measurements. Environmental sampling should deteriorated state that it cannot be restored to a be used judiciously as it can be costly. The healthy living environment. Done properly, hazard Department recognizes the need for local assessment provides the foundation for detailing jurisdictions to tailor programs based on priorities which interventions need to be prioritized based and end users. While programs are encouraged on consultations with construction and housing to use the best tools to meet their needs, the rehab specialists. (Figure 4.2). Department is requiring grantees of the Healthy Homes Production Grant program to use HUD’s Healthy Home Rating System in an effort to Resident Interviews standardize assessment criteria. In order to be considered healthy, a home must support Purpose the health and well-being of its residents, and Although some assessments are performed in protect against harm caused by health and vacant housing, most take place in occupied safety deficiencies. Unless common assessment housing units. Gaining the residents’ perception of criteria are used, these definitions are subject to the home environment and their health concerns interpretation and wide variability in practice. are important sources of information and engages Assessing and remediating health and safety them in creating and maintaining a healthier living risks in housing includes recognizing hazards, environment. A useful checklist for residents is assessing their importance, and controlling or available at: http://www.surgeongeneral.gov/ a eliminating them. Proper assessment of hazards topics/healthyhomes/checklist.pdf. Residents’ can help your program move to an evidence- based selection of intervention priorities and aAn additional item not included on the checklist is maximize the impact of limited resources for ascertaining the thermal comfort of the occupants where housing interventions. It can also enable you there may be excess heat or cold due to the lack of to determine when a housing unit is in such a proper insulation or inadequate heating/air conditioning. Figure 4.2 Assessing Building Deficiencies and Outcome Visual Inspection Construction and Rehab Interview Specialist Analysis of Building Deficiencies Environmental Sampling/Buildling Prioritized Performance Treatment Testing Strategy Note: The Prioritized Treatment Strategy reflects the focus of your program (e.g., asthma, energy efficiency, injury prevention) as well as other factors such as identifying imminent health hazards and risks to occupants, resources, intervention costs, and their relation to housing value and level of deterioration. page 68 Housing-Related Health and Safety Hazard Assessment input can help focus the subsequent visual •• Behavioral information (88 percent); assessment and environmental measurements •• Health data (83 percent); and that, in turn, will determine intervention priorities. •• Household/resident/family characteristics Resident interviews that gather information on (81 percent). health and environmental problems are useful aids but should not replace a thorough visual Data were collected most commonly on asthma, assessment. Resident interviews can provide emergency department visits, doctor visits, and an important opportunity to educate residents health-related absences from school or work on what they can do to improve and maintain (see Figure 4.3). These health data sets are often a healthy home. Skilled interviewers not only used to assess child and caregiver quality of life. collect data but provide information to residents Self-reported data, collected using a validated that can motivate and reinforce good health instrument during an interview, contain valuable behavior and discourage unhealthy practices. information on health status and have proven to be an acceptable way to assess health outcomes Past Experience associated with housing improvements. The report, An Evaluation of HUD’s Healthy Interviewer Staffing Homes Initiative: Current Findings and Outcomes,1 examined over 50 Healthy Homes Consider carefully who will conduct the grantees from the first four rounds of grant interview, keeping in mind the program design funding (1999–2006). It found 83 percent of and local resources. Interview staff can be these programs routinely conducted multiple health educators, community health workers, assessments and interviews of clients. Resident community organizers, nurses, social workers, assessments and interviews usually focused environmental health specialists, health on behavioral information (such as smoking inspectors, housing code inspectors, physicians, or cleaning habits), health data (such as or other medical care providers. asthma symptoms), household/resident/family characteristics, and the client’s knowledge of Community health workers and organizers are specific subject matter. The top three types of outstanding resources for education and many data routinely collected as part of the baseline aspects of research studies. All data collectors interview were: should be trained in how to protect confidential Figure 4.3 HUD Healthy Homes Programs and Type of Data Collected (n=52) 100 87 80 73 60 54 54 50 40 38 27 21 20 Percentage of Grantees of Percentage 12 0 Asthma ER visits Doctor Absences Allergies Blood-Pb Resp. Injuries Poisonings visits levels conditions Types of Health Data Collected Source: An Evaluation of HUD’s Healthy Homes Initiative pp. 17–18 and A11–15. Housing-Related Health and Safety Hazard Assessment page 69 information. It may be difficult for residents to role playing, an explanation and practice of share sensitive information with anyone other standardized methods of documentation, and than an objective professional. cultural competence. The training should also teach interviewers and other healthy homes Many healthy homes programs use a team professionals to understand the limits of their approach to conduct the assessment—with expertise, such as when to refer a suspected a health services staff person conducting the problem to a structural engineer or medical interview and a housing services staff person professional (see Figure 4.5). conducting the visual assessment. Some programs have integrated these functions within one person’s job responsibilities with Interview Documentation appropriate
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