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Lessons Learned from Mini-grants to Support the Development of a Healthy Homes Workforce

May 1, 2019

Can small grants enable programs to substantially increase the number of workers trained in healthy homes issues? Can this lead to more fundamental changes in policy, partnerships, or program sustainability? In the past, the National Center for Healthy Housing (NCHH) has used the mini-grant approach to encourage innovative local lead poisoning prevention and policy development initiatives. The mini-grant approach enabled organizations to pilot new programs by providing additional resources for operations, outreach to the wider community, and dedicated staff that could not be accommodated through their regular funding.In 2017 and 2018, NCHH, with funding from the W.K. Kellogg Foundation, provided competitive mini-grants for 13 communities nationally to expand the range of models and best practices for building and sustaining the healthy homes workforce. NCHH defined the "healthy homes workforce" in broad terms: individuals who provided education, repairs, referrals, or policy support to assure homes were free of environmental health hazardsthat trigger adverse health outcomes. The competition was open to governments, educational institutions, public housing, nonprofit, and tribal communities.

Montana’s Asthma Home Visiting Program

January 1, 2019

The Montana Asthma Home Visiting Program (MAP), offered by the Montana Asthma Control Program (MACP), was designed to address basic asthma pathophysiology and asthma medications, and it has a significant home environmental focus to address asthma triggers. The program includes six contacts (visits or phone calls) with a nurse or respiratory therapist provided over the course of a year. It also includes help identifying potential asthma triggers in the home, custom asthma education, educational resources and referrals to community services (e.g., weatherization services, health insurance), individual help with managing the medical system, free allergen-proof pillow and mattress covers, and free air filters for those with animals or smokers present in the home.

New York’s Childhood Lead Poisoning Primary Prevention Program (CLPPPP)

January 1, 2019

The New York Childhood Lead Poisoning Primary Prevention Program (CLPPPP) represents a paradigm shift from a child and health‐based response to a housing‐based prevention initiative. New York State's (NYS) establishment of the CLPPPP Initiative in 2007 authorized health departments to gain access to high-risk homes for the purposes of education and inspection; previously, health departments were only able to gain entry to a home if a child already diagnosed with an elevated blood lead level was known to reside there. This significant policy shift opened the door for health departments to assume a more proactive and effective approach. The CLPPP Programfunds grantees to seek to achieve five goals: 1. Identify housing at greatest risk of lead-based paint hazards. 2. Develop partnerships and community engagement to promote primary prevention. 3. Promote interventions to create lead-safe housing units. 4. Build lead-safe work practices (LSWP) workforce capacity. 5. Identify community resources for lead hazard control.

New York’s Lead Poisoning Prevention Program (LPPP)

January 1, 2019

The purpose of the New York State (NYS) Department of Health's Lead Poisoning Prevention Program (LPPP) is to detect and treat lead poisoning as soon as it occurs in order to minimize the risk of exposure. The LPPP funds county health departmentsto ensure children and pregnant women are screened for elevated blood lead levels (EBLLs); to conduct monitoring and case management of people with EBLLs, including providing home-based inspection and environmental management services;and to educate the public about lead poisoning prevention. Other state-funded services related to childhood lead poisoning primary and secondary prevention and healthy homes are subjects of additional case studies in this series.

New York’s NY Regional Lead Resource Centers

January 1, 2019

The New York State (NYS) Department of Health funds three Regional Lead Resource Centers (RLRCs) across the state to educate healthcare providers about lead poisoning prevention, coordinate clinical care of children and pregnant women with elevated blood lead levels (EBLLs), and build healthcare providers' capacity to promote lead poisoning prevention. The purpose of the RLRC program is to promote a standard of excellence in lead poisoning prevention and treatment among healthcare providers, county health departments, and communities. RLRC's primary focus is providing education for healthcare providers that care for children and pregnant women. 

Lead Poisoning Prevention Fund

January 1, 2019

The Maine Legislature established the Lead Poisoning Prevention Fund (22 MRSA c. 252 §1322-E) in 2005. The bill was the outcome of an effort led by a coalition of environmental activists. It authorizes a fee of 25 cents per gallon on all paint sold in Maine. The fee is imposed on paint manufacturers or brand label owners. It provides a waiver for payment for those who sell low quantities. Revenue from the fees fluctuated between$700,000 and $800,000 in the initial years. Revenue decreased during the recession but is currently stable at around $650,000 annually.The Lead Poisoning Prevention Fund (LPPF) is administered with the help of an Advisory Board by the Childhood Lead Poisoning Prevention Unit (CLPPU) within the Maine Center for Disease Control and Prevention (CDC) of the Maine Department of Health and Human  Services (DHHS). Resources from the LPPF are used to accelerate progress towards eliminating childhood lead poisoning in Maine through statewide and community-based  activities that enable the public to identify lead hazards and take precautionary actions to prevent exposure to lead.

Advancing the Role of Community Health Workers: Engaging State Medicaid Offices to Develop State Plan Amendments Regarding the Preventive Services Rule Change

January 1, 2019

Community health workers (CHWs)1 provide services that address the social and environmental determinants of health, including preventive home- and communitybased health services (HCBS). Often as members of medical teams, CHWs are a vital part of the healthcare workforce in the vast majority of states, yet few state Medicaid programs reimburse even a portion of this work.2, 3, a Despite their rhetorical popularity, mostCHWs continue to rely upon unpredictable and often insufficient financial support.A new pathway of reimbursement for CHW services through Medicaid emerged in 2014. Before the Centers for Medicare and Medicaid Services (CMS) updated the regulatory definition of preventive services, preventive services could only be provided by physicians or other licensed practitioners (e.g., chiropractors or registered nurses). This "preventive services rule change" gave states the option to reimburse nonlicensed practitioners, including CHWs, for preventive services recommended by a licensed practitioner. In effect, the preventive services rule change enables states to include CHWs, as defined by the state's requirements for education, training, or credentialing, as qualified providers ofcertain preventive services under Medicaid.

Massachusetts’ Get the Lead Out Loan Program

January 1, 2019

The Get the Lead Out Loan Program of Massachusetts healthcare reform legislation (Section 197E of Chapter 111 of the Acts of 1993) seeks to "assist residential property owners in financing the abatement and containment of lead paint hazards throughout the Commonwealth." Through MassHousing, the administrative agency, low-cost deferred  financing is available for one-to-four-family homes to address lead-based paint hazards either owned by a low- to moderate-income owner-occupant or in which low- or moderate-income tenants reside. The loans are managed by local rehabilitation agencies (LRA). One hundred percent of the financing available under this program must be used for lead-based paint abatement activities.

Massachusetts’ Lead Education Trust Fund

January 1, 2019

The Lead Education Trust Fund (LETF) of Massachusetts healthcare reform legislation (Section 22 of Chapter 482 of the Acts of 1993) introduced a surcharge and fees on certain professionals to fund the Department of Public Health (DPH) to provide lead paint poisoning prevention and treatment education, and training of lead paint inspectors and homeowner training. DPH provides home visits to children with elevated blood lead level (EBLL), provide community-based health education, and (in specific instances) assign cases of children with lead poisoning to specially employed code enforcement lead inspectors.

Multnomah County Lead Poisoning OR Prevention Program

January 1, 2019

The Multnomah County Lead Poisoning Prevention Program is jointly funded by the Portland Water Bureau (PWB), State of Oregon Health Authority, and Multnomah County. The program works in partnership with other community groups and government agencies in the greater Portland metropolitan area to eliminate lead poisoning and make Multnomah Countyhousing lead-safe. Services provided include The Leadline, a telephone information and referral line for questions about lead, lead testing, and lead in drinking water; Community outreach and education, including participation in community health fairs and community presentations; Home investigations for families who have children with high blood lead levelsto assist with identification and reduction of exposure to lead; Lead screening for children and those at greatest risk for lead poisoning; and Coordination of services with other agencies to create an efficient program designed to prevent lead poisoning from all sources.

New Jersey’s ReHEET (Residential Health, Energy, and Environmental Transformation)

January 1, 2019

Isles, Inc. operates a project called ReHEET (Residential Health, Energy and Environmental Transformation) with funding from the New Jersey Neighborhood Revitalization Tax Credit (NRTC). ReHEET was created to pilot the joint provision of weatherization, structural repair, and healthy homes services in Trenton. The program collaborates with community groups to identify old, substandard, leaky homes in the Trenton region. It tests and repairs occupied homes for energy and health hazards. ReHEET received funding from 2010-2016 and completed 179 units over this period. 

Washington’s Enhanced Weatherization Plus Health Pilot Program

January 1, 2019

In 2015, the Washington State Legislature passed House Bill 1720 (HB 1720), which expanded the purpose of theMatchmaker Low-Income Residential Weatherization Program to include healthy housing improvements. The Enhanced Wx+H pilot represented a new approach to leveraging state and local resources and support to expand measures and services available through Low Income Weatherization. One long-term objective was to develop integrated service models eligible for reimbursement from Medicaid or other sources that engaged medical and public health services.