EPA and IHS Interagency Agreement for the Tribal Healthy Homes Program Presented by: Jeremy Blankenship, MPA Bemidji Area Indian Health Service Healthy Homes Coordinator Jeremy.Blankenship@ihs.gov Jeremy.Blankenship@ihs.gov

Section 1: Background and Purpose of EPA/IHS IA Tribal Housing Tribal Clinics Section 1: Background and Purpose of EPA/IHS IA Jeremy.Blankenship@ihs.gov

Nationally, All Races, 2015

By Race 13.5% 11.5% 8.3% 7.5% 5.3%

By Race 10.1% 9.0% 7.5% 4.0%

11.1% 5.2% 4.6% 4.3%

Environmental Health Objectives Healthy People 2020 Environmental Health Objectives Reduce proportion of occupied housing units that have moderate or severe physical problems Reduce blood lead levels in children Reduce indoor allergen levels Increase the proportion of homes that have an operating radon mitigation system Jeremy.Blankenship@ihs.gov

Environmental Health Objectives (continued) Healthy People 2020 Environmental Health Objectives (continued) Increase the number of new homes constructed with radon-reducing features, especially in high-radon-potential areas Increase the number of pre-1978 homes tested for lead-based paint hazards Decrease the number of homes with lead-based paint or related hazards Increase the number of Tribes that monitor diseases or conditions caused by exposure to environmental hazards Jeremy.Blankenship@ihs.gov

Effects of Poor Housing Quality on Children Lead Hyperactivity Reduced IQ Behavioral Problems Learning Disabilities Pests, CO, Mold, Smoke, VOCs Asthma Radon, Asbestos Cancer Falls, Electrical Hazards, Fire Unintentional Injury Jeremy.Blankenship@ihs.gov

Impacts of Poor Housing Quality on Children School Absenteeism Poor school performance Socialization issues Criminal Activity Add a brief description Jeremy.Blankenship@ihs.gov

Purpose of IA IHS and EPA has a shared mission of promoting children’s health and Healthy Homes Build awareness of Healthy Homes with tribal leaders, tribal housing staff, tribal health staff, and tribal residents Capacity building for solutions to reduce home related environmental exposures Promote Health, Build Awareness, Build Capacity Jeremy.Blankenship@ihs.gov

Indian Health Service Bemidji Area, Division of Environmental Health Services (DEHS) provides services for 34 Federally-recognized tribes in Michigan, Minnesota, Wisconsin, Indiana, and Illinois Area Office- Bemidji Minnesota District Offices Minnesota District Office (MDO)- Bemidji Rhinelander District Office Ashland WI Field Office Healthy Homes Coordinator – Office is in Rhinelander Wisconsin Jeremy.Blankenship@ihs.gov

EPA Region 5, Land and Chemicals Division (LCD) and Air and Radiation Division (ARD) EPA’s Current Healthy Homes (HH) Efforts EPA Pesticide Program EPA Lead Program EPA Children’s Health Program EPA Air Quality Program EPA Pesticide Program Compliance assistance FIFRA enforcement Outreach and technical Assistance (upon request) Support for Tribal Pesticide Program EPA Lead Program TSCA enforcement Lead Abatement, Renovation, and Pre-Renovation Education Program Renovate, Repair, and Paint (RRP) Training EPA Children’s Health Program Promote healthy housing Promote healthy learning environments Develop and expand capacity to improve children's environmental health (especially indoor) EPA Air Quality Program Jeremy.Blankenship@ihs.gov

Section 2: Scope of Work Develop Healthy Housing Environments Through… Healthy Homes Programs Tribal and Community Education Tribal Visits, Consults, and Assessments Section 2: Scope of Work Jeremy.Blankenship@ihs.gov

Scope of Work Healthy Homes Programs Work with IHS and Tribal health programs to increase the awareness of available resources and assistance from HH and other programs develop a comprehensive risk assessment program for homes referred for childhood asthma, lead, or other medical referrals assist with the development of procedures and protocol for HH assessments

Scope of Work (Continued) establish programs and procedures that meet EPA and HUD “Healthy Homes Program Design Components” develop a best practice and low-cost management program for hazard assessment and interventions assist in identifying type of application and chemicals used in treatment of homes establish programs and procedures that meet HUD “Healthy Homes Program Design Components” found in Section 3 of 2012 “Healthy Homes Program Guidance Manual” and for HUD’s Seven Principles of Healthy Homes outlined on page 10 of the same manual Jeremy.Blankenship@ihs.gov

Scope of Work assist with evaluating new or existing potential IPM modifications assist with developing IPM policy and procedures to be used for chemical purchasing and pest management contracts evaluate the effectiveness of projects, interventions, implementation, and improvements build local capacity to educate staff and residents about HH develop and delivering HH public-education programs IPM , We do have a designated IPM persons Jeremy.Blankenship@ihs.gov

Scope of Work Tribal and Community Education Assist Tribes to coordinate and manage training programs that will allow staff to meet and comply with EPA or best practices for lead assessment, remediation, indoor air quality (IAQ), HH, radon, IPM etc. ensure that IHS and Tribes develop the capacity and infrastructure to train others from within their own programs hold at least one training a year in each State so Tribes maintain currency in all aspects of HH and children’s health Tribal Education – Health Fairs, Individual Education, Tribal meetings/one tribe education, housing staff training Jeremy.Blankenship@ihs.gov

Scope of Work Tribal Visits, Consults, and Assessments Assisting IHS and Tribal health programs to… establish assessment programs for HH, asthma, lead, IPM, and children’s health establish local HH programs providing long-term infrastructure development that addresses staff competency, resident education, evaluation of housing conditions, and effective maintenance programs development of HH projects that interact with community health, environmental health, community development, and new and existing housing projects Identify overlooked areas that may contain exposure sources environmental hazards Jeremy.Blankenship@ihs.gov

Scope of Work Assisting IHS and Tribes to…. to develop a resource manual for Tribes to establish a local HH program or use an existing resource and modify it to fit the needs or the Tribes deal with lead issues in homes, drinking water, or other locations evaluate buildings or prospective buildings being purchased or remodeled for lead paint, IAQ, mold and moisture issues, radon and other environmental hazards provide public education and awareness program for lead issues, IAQ, mold and moisture issues, radon and other environmental hazards and information about the programs and services provided Jeremy.Blankenship@ihs.gov

What does the Healthy Homes Coordinator mean for you Conduct home assessment Healthy Homes related training Assist with remediation and remodel plans Resident education Assist with finding funding Grant writing Policy development Technical assistance Develop more Jeremy.Blankenship@ihs.gov

Section 3: Description of Healthy Homes Programs Jeremy.Blankenship@ihs.gov

8 Elements of a Healthy Home Dry Clean Contaminant Free Pest Free Safe Energy Efficient Well Maintained Well Ventilated 8 Elements of a Healthy Home Jeremy.Blankenship@ihs.gov

HH Program Logic Model Inputs Activities Outcomes Impacts Training Testing Equipment HH Trained Staff Referral Process Activities Screening ID Children w/ Asthma or EBBL Interview Referral HH Assessment Family Education Mitigation Outcomes Lead Sources Removed Mold Removed Allergens Mitigated IPM EBLL Reduced Asthma Controlled Impacts Improved Long Term Health of Tribal Residence Improved Housing Quality This is a simple Model Jeremy.Blankenship@ihs.gov

Interventions with “sufficient evidence” to indicate efficacy in improving health Multi-faceted tailored asthma interventions Integrated Pest Management (pest/allergen reduction) Moisture intrusion elimination Radon air mitigation through active sub-slab depressurization Smoking bans Functional smoke detectors Lead hazard control Pre-set, safe temperature hot water heaters Housing Choice rental voucher program Nation Center For Healthy Homes. Housing Interventions and Health: A Review of Evidence. 2009, Accessed July 07, 2017 Jeremy.Blankenship@ihs.gov

Talk about the trainings planned in each state, offer future training Section 4: Training Jeremy.Blankenship@ihs.gov

Healthy Homes Training Institute for Tribal Environmental Professionals, Northern Arizona University, Grant Funded EPA Indoor Air Quality in Tribal Communities (Level 1) Indoor Air Quality (IAQ) Diagnostic Tools (Level 2) Online Course : Tribal Air Quality, Radon, Building Science Review, Climate Change Essentials for Healthy Homes Practitioners. For health and housing professionals seeking a solid understanding of Healthy Homes programs and principles. The course helps prepare students for the Healthy Homes Specialist Credential exam. Jeremy.Blankenship@ihs.gov

Jeremy.Blankenship@ihs.gov

Healthy Homes Training The National Healthy Homes Training Center & Network , Grant Funded HUD/EPA Essentials for Healthy Homes Practitioners Prepares housing professionals for Healthy Homes Specialist Credentials Essentials for Healthy Homes Practitioners. For health and housing professionals seeking a solid understanding of Healthy Homes programs and principles. The course helps prepare students for the Healthy Homes Specialist Credential exam. Nation Center For Healthy Homes. Housing Interventions and Health: A Review of Evidence. 2009, Accessed July 07, 2017 Jeremy.Blankenship@ihs.gov

Section 5: Grants and Funding Opportunities Jeremy.Blankenship@ihs.gov

Grant Funding Sources G. Mittlestaedt, NW Tribal Healthy Homes Working Group

Addition Funding Opportunity Tax credit funding for home improvement Energy/weatherization grants Low income housing funds Homeowner assistance funds Rural development loans and grants Jeremy.Blankenship@ihs.gov

Thank you! Jeremy S. Blankenship Healthy Homes Coordinator Bemidji Area Indian Health Service Rhinelander District Office 9A South Brown Street Rhinelander, WI 54501 Office: 715-365-5120 Jeremy.Blankenship@ihs.gov Jeremy.Blankenship@ihs.gov