PROVIDENCE – Ten months ago, Mark Kravatz gathered about 100 of the faithful – college interns, government officials, and community advocates – at Rhode Island College to announce the beginning of a low-key, bottom-up effort to launch the R.I. Healthy Homes Initiative, a collaborative framework “to align, braid and coordinate” an evidence-based, community approach to public health and housing in Rhode Island.

The effort was based upon the initial success of a pilot project in Providence funded by the Green & Healthy Homes Initiative, based in Baltimore, Md.

“For the 135 homes we renovated in [the Olneyville neighborhood] in Providence, we were looking at key deliverables for that work – showing a reduction in hospital visits for asthma, reducing the energy usage, reducing the chronic absenteeism in school due to asthma, and improving the health and safety of the homes,” Kravatz told ConvergenceRI at the time. 
[See link to ConvergenceRI article below.]

Saving money, Kravatz had continued, is an important economic piece of this work. For children with asthma, who repeatedly need treatment at the emergency room, spending a lot of money, getting prescriptions for an asthma inhaler, only to be sent back to homes where there may be many asthma triggers, which cause a repeat the cycle, drives up medical costs.

“Our goal is to reduce those triggers in [the children’s] homes,” he said, saving money for the parents – and for the health care delivery system.

Kravatz called himself an “outcome broker,” saying that his job was “to broker multiple on-the-ground resources to work more collectively.”

A new beginning
On Sept. 12, the faithful gathered once again for the official launch – at the R.I. State House – of the R.I. Alliance for Healthy Homes, with the ambitious goal to improve the health, safety and energy efficiency of all Rhode Island homes.

This time, they were joined at the podium by a plethora of public and private leaders who have bought into the new alliance: Sen. Sheldon Whitehouse, Marty Nee from the U.S. Department of Housing and Urban Development, Rep. David Cicilline, Rep. Jim Langevin, State Senator Juan Pichardo, R.I. Attorney General Peter Kilmartin, Commissioner Marion Gold of the R.I. Office of Energy Resources, Ana Novais of the R.I. Department of Health, who serves as executive director of the Division of Community, Family Health and Equity, Allison Rogers, director of policy at the R.I. Department of Administration, Richard Godfrey, executive director of Rhode Island Housing, Neil Steinberg, president and CEO of the Rhode Island Foundation, Elizabeth Tobin-Tyler, chair of the Steering Committee of the R.I. Alliance for Healthy Homes, and Ruth Ann Norton, president and CEO of the Green & Healthy Homes Initiative.

The vision of the newly launched R.I. Alliance for Healthy Homes is “to serve as the state’s resource to identify measurable solutions through the existing healthy housing resource infrastructure.”

The effort is being underwritten with support from the Rhode Island Foundation and the R.I. Attorney General’s office.

As Kravatz told ConvergenceRI in an interview the day before the launch: “I don’t know of anyone who says they want families living in unhealthy housing.”

Managing resources and expectations
Kravatz, when asked what the biggest take away from the State House event was, talked about the importance of setting up a clear, concise, transparent business plan for the work ahead.

“What we did was to present a clear and concise process for setting up a structure and a business plan for this work,” Kravatz said. “That’s the take-away. We created a transparent, open process, from day one. Here is an entire map, these are the deliverables.”

The big lesson, Kravatz continued, is: “Do what you say you’re going to do, and get it done on time.”

Managing what Kravatz described as a “huge group of people” who are part of the Alliance’s coalition required a lot of process, reasoning and patience.

Moving forward, Kravatz detailed the Alliance’s strategy: four action teams, each with three goals, deliverables to be met by June 1, 2015. “We have some groundwork to do, to understand, what’s in our pantry, what are the resources we have available, and them mapping them,” he said.

The four action teams – focused on policy, workforce, research and data – will be tasked with defining healthy housing in Rhode Island, comparing it to national healthy housing standards and identifying the gaps that exist.

As a first example, he shared a flow-chart map of the “Housing Rehab System of Rhode Island,” comparing the pathways to get from unhealthy to healthy in the public and private financing streams.

“We had 55 research interns from Brown University working for us over the past two summers,” Kravatz said. “They mapped out the entire healthy housing system, [what it takes] to go from an unhealthy home to a healthy home. It’s a pretty eye-opening map.”

More than just mapping the process, the interns also created a databank, collecting information from the 140 agencies and organizations that do work with healthy housing in Rhode Island. “If a municipality has a loan product for housing repair, the student interns would get information on the loan rate, where to get an application, who the contact person was,” Kravatz said.

All of that information will be compiled in an easy-to-access database, wikihousing.org.

Wikihousing
The new Rhode Island database, wikihousing.org, will eventually link to other Green & Healthy Homes initiatives being done in 20 other cities, including Atlanta, Baltimore, Buffalo, Chicago, Cleveland, Denver, Detroit, Dubuque, Jackson, New Haven, Philadelphia, and San Antonio, creating a national database of resources.

“There’s no Library of Congress or other information available in the U.S.,” Kravatz said. “We’re trailblazing a bit.”

The new database, which will launch by the end of this fall, will be open-sourced and available to families; a big part of the goals of the action teams will be direct evaluations and recommendations for improving and enhancing wikihousing.org, according to Kravatz.

Focus on outcomes
In Rhode Island, part of the first-year efforts by the policy group would be looking at whether there needed to be new legislation defining standards for mold-free housing, one of the triggers of asthma attacks.

As part of the ongoing work during the past year to launch the Alliance, Kravatz said that there was a recognized lack of “collegial community” among contractors. To remedy that, the Alliance will facilitate and convene a regulator “best practices” session, where contractors can meet and talk about best practices on topics such as energy efficiency.

In addition, the Alliance’s workforce group will also create a “career ladder” project, from entry-level to business owner, identifying all the certification and training needed to move up the ladders, as well as identifying the training providers.

“There are redundancies in training, major gaps in training, and little or no certification of training in Rhode Island [for mold removal and remediation],” Kravatz told ConvergenceRI. “So, how do we increase awareness for the general public? It’s also important for contractors to be trained [properly] for such hazardous work.”

Connecting the dots to health, education
From its work nationally, the Green & Healthy Homes Alliance has focused on the cost impact of asthma – both in education and health metrics.

“The number-one health reason why kids are absent from school is asthma,” Kravatz said. “It’s a clear opportunity for health care providers to direct people in need to housing-related resources to clean up that home.”

Kravatz said that they had been working with Memorial Hospital to begin thinking about how they can identify “super utilizers” for asthma and help direct people to those services.

“Instead of that kid going to the emergency room and just getting an inhaler, an inhaler that empties in a month, this is about getting to the root core of the issue, healthy housing,” Kravatz said.

Kravatz said that he was optimistic that the Alliance would meet its goals. “What I feel confident about is that enough people have recognized the social impact of unhealthy housing.”

Had any of the gubernatorial candidates – Fung or Raimondo – reached out to Kravatz yet?

Kravatz reframed the question by saying: “We have a collaboration of advocates, community organizations and state agencies. It will be really important for the new leadership to learn about these efforts,” he said, adding that he looked forward to the conversation.

Social determinants of health

The chair of the R.I. Alliance of Healthy Homes is Elizabeth Tobin-Tyler, a lawyer who teaches both law students and medical students about health disparities and social determinants of health.

“In my work on lead poisoning, I have focused on healthy housing being the most critical determinant of health,” Tobin-Tyler told ConvergenceRI.  Much of the work, she continued, focused on looking at “system barriers and enforcement issues” to provide remedies for families.

Her work with the Alliance fit well within Tobin-Tyler’s interdisciplinary, collaborative approach. “It’s data- and evidence-based policy, looking at where the gaps are, and having everyone at the table,” she said, praising the coordinated, sophisticated approach.

“It’s looking at early intervention and prevention and root causes, rather than looking at the problems at the other end,” she continued.

Tobin-Tyler said that the partners around the table and the breadth of people engaged should help to steer the initiative through any leadership and personnel changes that will come with the November election.

“We have to have concrete, achievable goals for the first year, particularly for the first year,” she said. “That’s always the challenge of having a large coalition of people working together.”

The transparent sharing of information across silos, Tobin-Tyler continued, is a key ingredient of success.