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

2. Section 1: Background and Purpose of EPA/IHS IA
Tribal Housing
Tribal Clinics
Section 1: Background and Purpose of EPA/IHS IA

4. Nationally, All Races, 2015

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

6. By Race
10.1%
9.0%
7.5%
4.0%

7. 11.1%
5.2%
4.6%
4.3%

8. 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

9. 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

10. 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

11. Impacts of Poor Housing Quality on Children
School Absenteeism
Poor school performance
Socialization issues
Criminal Activity
Add a brief description

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Section 3: Description of Healthy Homes Programs

24. 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

25. 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

26. 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

27. Talk about the trainings planned in each state, offer future training
Section 4: Training

28. 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.

30. 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

31. Section 5: Grants and Funding Opportunities

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

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

34. Thank you!
Jeremy S. Blankenship Healthy Homes Coordinator Bemidji Area Indian Health Service Rhinelander District Office 9A South Brown Street Rhinelander, WI Office: