1. Baltimore’s Transition to Healthy Homes Structuring a comprehensive, community-based healthy homes effort Genevieve Birkby, MPH, MA Baltimore City Health Department Healthy Homes & Communities Division

2. Overview Describe Baltimore’s transition to healthy homes Convey opportunities, resources & barriers Discuss expansion to community- based initiatives which support healthy housing

3. 87 square miles; 650,000 people 55,000 children under 6 65% African American Median family income – $37,000 Limited affordable, healthy housing Goal - Clean, Green, Healthy Baltimore

4. Healthy Homes & Communities Division Created in May 2006 Deputy Commissioner, Dr. Madeleine Shea Mission: The Baltimore City Health Department -- in collaboration with community, city, state and national partners -- will improve the health and well being of children and their families by developing and targeting resources to make Baltimore homes lead safe, reduce home-based asthma triggers, reduce carbon monoxide poisoning, and decrease preventable home injuries.

5. Baltimore’s Housing 24% leaking roofs 53% peeling paint 38% mouse droppings 31% roaches present 50 years old on average (US is 30 yrs) 75% of rental units estimated to have lead Studies of low income housing show:

6. Lead Exposure in Baltimore The number of lead-poisoned children under age 6 in Baltimore decreased from 2,189 in the year 2000 to 626 in 2007.

7. Why Transition from Lead to HH? Declining lead cases Unmet needs in asthma prevention and control, and injury prevention Staff capacity in inspections, health education and case management Opportunity to expand public health services and impact New funding and partnership opportunities

8. Healthy Homes Demonstration Project CDC-funded; piloted in 2007 Goal to develop, implement and evaluate a model to expand an urban childhood lead poisoning prevention program into a comprehensive healthy housing program 100 initial home assessments 50 three-month follow up assessments

9. HH Demonstration Project Significant staff training (healthy homes 101; IPM; fire safety; CO etc.) Developed forms, assessments and protocols Identified relevant healthy housing resources Evaluation, evaluation, evaluation

10. Population Demographics Mean income = $576/month Average household size = 4.9 people

11. Population - Renters 56% live in rental properties  65% of renters have a written lease  Average monthly rent is $328

12. Population - Asthma 40% of households have someone with asthma or other respiratory problem 32% have child with asthma

13. Kitchens without a trash can: 28% Households reporting any pest problem: 79.5% 44% with no working smoke alarms Asthma reported: 43% No working heat: 17% Indoor smoking: 36% Results: What did we find?

14. Lessons Learned: HH Pilot One-size fits all approach? Need to weigh “comprehensive” assessment with “actionable” interventions Priority intervention areas?  Asthma? IPM? Staff  Training  Morale

15. How? Resources & Opportunities City Agencies – (DHCD, HABC, FD, PD, Health Programs, Quasi Orgs, School System) State Agencies (DHMH, MDE, DHCD) Universities (public health, nursing, psychiatry, urban planning, community law, social work, forestry, etc.) Primary Care Providers Federal Agencies (CDC, HUD, EPA) Community Based Orgs (Coalition to End Childhood Lead Poisoning, community groups, etc) National Advocacy and Training Orgs (NCHH, AHH)

16. How? Resources & Opportunities City-wide initiatives  Baltimore City Sustainability Commission  Mayor’s Cleaner, Greener Initiative  Food Policy Task Force

17. Barriers to Transition Taking programs to scale  Requires increased staff, training and supplies Lack of public investment in housing for low-income families Families “in crisis” – social issues beyond housing Resource constraints

18. Current Division Structure Four Bureaus  Lead Inspections & Enforcement  LAAP (Lead Abatement Action Program)  Asthma  Community Planning & Initiatives

19. Lead Inspections & Enforcement Registered sanitarians inspect all homes of children with elevated blood lead levels with a healthy homes approach. Issue violation notices to those homes with lead hazards 2009: Bed bug response

20. Lead Inspections & Enforcement Case management for children with an EBL or with significant lead risks Provide integrated healthy homes assessment and risk-specific advice Link families to resources needed to improve the health and safety of their housing

21. Lead Abatement Action Program Health intervention program geared towards interim control treatments of lead poisoning hazards in the home. Have completed lead hazard intervention work in over 2,500 units throughout the City.

22. Asthma Home visiting asthma programs  Enroll children ages 2- 18 who have moderate to severe asthma  Home visits from nurses and trained community health workers to assess medical and environmental needs.  Utilize a healthy homes approach.

23. Community Planning & Initiatives Community-based initiatives and evaluation  Outreach and training  Lead Safe Work Practices Initiative  Promotores program  Community Environmental Health Planning Initiative  Safe Pest Management for Health Initiative

24. Expansion to the Community Healthy Homes Healthy Homes and Communities

25. Community Approaches Response to both identified priorities and emerging needs  Promotores program – need for better engagement with the Latino community  Safe Pest Management for Health  Bed bugs!  New and creative approaches (MICA)  Asthma community education groups

26. Community Approaches Support other city-wide initiatives  Weatherization + health  Baltimore City Sustainability Commission  Redline Project

27. Safe Pest Management for Health Baltimore Housing, BCPSS Augment our IPM response within the division 35 site assessments Recommendations for city IPM contracts Bed bug subsidization program Peer education in public housing

28. Weatherization Broad-based partnership Housing; CECLP; MD Rehab., Civicworks, Rebuilding Baltimore Together Weatherization + healthy housing

29. Future Directions Healthy housing will continue to evolve Tailor according to your community’s needs – don’t take on too much Consider creative approaches and non-traditional partners