Influencing Healthy Homes Public Policy: Maine’s New Lead Law

This past June, the State of Maine Legislature passed LD1115 - An Act to Make the State's Standard for Lead Exposure in Children Consistent with the Federal Standard. This is groundbreaking legislation that firmly establishes the State of Maine as a national public health leader, by being the first state in the country to establish the Centers for Disease Control and Prevention’s (CDC) blood lead reference level of 5 µg/dl for children as the State’s official action level for lead environmental investigation.
The Maine CDC responds to cases where children under age 6 are identified with lead poisoning by conducting an environmental investigation in the property of the lead poisoned child. By correlating Maine’s action level for environmental investigation with the CDC reference level, Maine CDC will now be conducting environmental investigation at 5 µg/dl. Previously, the intervention threshold for environmental investigation across the State of Maine was 15 µg/dl, with the exception of five lead target areas (designated as high-risk areas of childhood lead poisoning), where the threshold was 10 µg/dl. This drop in the intervention threshold is expected to increase the number of investigations across the State by ten-fold. A greater volume of investigations will help prevent children from being poisoned with higher blood lead levels, and is one important step toward protecting Maine’s children from lead hazards.
Along with the new intervention threshold, the Bill provides new enforcement authority that has the potential to deter building owners from avoiding abatement orders. Maine CDC will now have the ability to levy fines against any individual who is in violation of the Maine Lead Poisoning Control Act, and these fines may be up to $500 per violation, per day. If there are multiple violations existing within an individual dwelling unit, a daily fine will be issued for each separate violation. All the fines collected from these violations will be deposited into the Lead Poisoning Prevention Fund to support continued lead efforts throughout the state.
In light of this major advancement, GHHI hosted a webinar to celebrate the passage of LD1115 and to discuss best practices in influencing healthy homes public policy. The webinar featured Greg Payne, Director of the Maine Affordable Housing Coalition and GHHI President and CEO, Ruth Ann Norton. This was a lively discussion that reflected on the strategies that worked in Maine, and the challenges that remain for implementation of the new law.
During the discussion, Payne explained that the successful passage of the law was largely a function of bipartisan political leadership, and the use of strategic legislative sponsors. The Bill was co-sponsored by Republican Senator Amy Volk of Scarborough, and Democratic Representative Peggy Rotundo of Lewiston. Supporting these sponsors was a network of committed advocates who testified on behalf of the bill, with no other groups offering dissenting voices. Additionally, local partners and supporters of the Bill worked diligently to educate the Legislature and the general public about childhood lead poisoning and the impact and importance of passing LD1115 for the State.
Payne went on to say that there is still more work to be done in Maine. The future success of the law will depend on diligent monitoring of its roll-out and implementation. For the law to go into effect, the first step is rule-making, to create administrative protocols for these significant changes in Maine CDC’s operations. This will be followed by the hiring of eight new lead investigators. The hiring of these positions could be held up through a number of intentional or unintentional mechanisms, making the implementation of the law difficult. Other suggestions that Payne offered were that there will need to be continued bipartisanship in the Legislature, and that the story of this new law accomplishes over time will need to be told.
Ruth Ann Norton spoke more generally about where public policy fits into a larger, comprehensive strategy for change. Policy change is essential in addressing childhood lead poisoning but it cannot stand alone. Other mechanisms for change include increased capacity for primary intervention, increased enforcement of lead safe laws, increased public education and awareness, establishing an effective relocation program, creating functional sustainable partnerships and leveraging private resources (Windows of Opportunity Comprehensive Action Plan, 2000). Norton also explained the need to bring together a network of local, state and federal partners to push change forward. Collaboration between partners is a central tenet of the Green & Healthy Homes Initiative’s model, and has been at the root of legislative progress across GHHI’s sites nationally.
For full information on LD1115, visit the Maine Legislature website. 

Controlling Asthma Improves School Attendance

Asthma is one of the most common and serious diseases affecting children. In the United States, 7.1 million, or one in every ten children, have asthma and 4.1 million experienced an attack or episode in 2011. Continuing its efforts to raise awareness about the impact of childhood asthma on school attendance, the Green & Healthy Homes Initiative (GHHI) is partnering with Attendance Works during national Attendance Awareness Month.
This event occurs each September and recognizes the connection between school attendance and academic achievement. When students miss 10 percent or more of school days, they are chronically absent. Estimates indicate 5 million to 7.5 million students in the nation are at academic risk because of their continuing absence. Absences may be excused or unexcused, but both negatively impact academic success. Chronic illnesses, such as asthma, can make the number of missed school days number skyrocket. 
Taking steps to control your child’s asthma now is one of the easiest ways to help your child’s academic success. While asthma cannot be cured, knowing its symptoms and how to prevent attacks will improve life for asthmatics and their family members.
Know the signs and symptoms
Asthma is a chronic inflammatory lung condition where the airways become blocked or narrowed. It presents as shortness of breath, tightness in the chest, wheezing and coughing. If symptoms are severe enough, your child may require medical attention to help restore normal breathing.
Identify and limit triggers in your home
Asthma can be triggered by mold, pests, dust mites, pet hair and dander, tobacco smoke and cleaning chemicals, all of which are present in homes and are responsible for 40 percent of all asthma attacks. These triggers release allergens into the air and cause an attack when breathed into asthmatic lungs.
The first step towards managing asthma is to reduce the likelihood of triggering an attack. Keep damp areas like bathrooms and basements clean, dry and well-ventilated to prevent mold growth. Do not smoke in your home. Vacuum often with a HEPA vacuum to reduce the buildup of dust mites, pet hair and dander. Ensure your home meets all eight elements of a green and healthy home to help prevent asthma attacks at home and keep your children healthy and ready to learn.
In December 2014, GHHI published a study of its work in the Environmental Justice that demonstrated the effectiveness of its evidenced-based interventions in improving childhood asthma symptoms. In May, the Environmental Protection Agency awarded the GHHI Baltimore program the National Environmental Leadership Award in Asthma Management. By addressing asthma triggers in the homes of children with chronic asthma, we have been able to reduce asthma related hospitalizations by more than 65% and emergency department visits by 28%. This study showed a 62% increase in participants reporting asthma-related perfect attendance for their child (i.e. zero school absences due to asthma episodes) as well as an 88% increase in parents never having to miss a day of work to care for a sick child with asthma.
Create an asthma action plan
Reducing exposure to asthma triggers will lessen the chance for an asthma attack, but there is always the potential of unexpectedly encountering a trigger outside the home. Pollen, strong fumes or odors and cold or dry weather can all trigger an attack. Having a plan for when your child encounters these triggers is vital. Establish an Asthma Action Plan with your child’s doctor before your child goes back to school. This document outlines your child’s triggers, the severity of their asthma, what medication to take and how often. It should be shared with your child’s school administration and nurse in case of an attack during school hours.
Many of these triggers may be encountered at school. If you have concerns about potential triggers in your child’s school or classroom, use the American Lung Association toolkit as a guide when reviewing school policies and talking to administrators. Parents can advocate for school policies that create healthy environments for learning: proper storage of food, prompt cleanup of spills and trash and the establishment of a smoke-free campus.
We invite you to help us spread awareness about the connection between asthma and school attendance before, during, and after Attendance Awareness Month. Sporadic and consecutive absenteeism are issues that must be addressed year round. Taking steps now to reduce absence due to asthma attacks will ensure your child’s success in school and your success in the workplace.

Family Advocacy: Connecting Families with Services They Need Most

Families are the heart of the Green & Healthy Homes Initiative (GHHI). Our organization works collaboratively with families experiencing unhealthy housing conditions to ensure that they have the opportunity to thrive in a healthy and safe environment. Strategies to create a healthy and safe home include a combination of the following:

Lead hazard remediation within the current home

Relocation to lead-safe or lead-free housing

Asthma trigger reduction

Weatherization and energy efficiency upgrades

Repair safety hazards and structural defects

Health education and skill building

Case management including referrals and resources

Tenant’s rights assistance and legal services

Property owner assistance

Basic needs referrals

Energy assistance referrals
GHHI Baltimore's Family Advocacy Services (FAS) Department ensures that every family is directed to the most helpful information, education and services to address their needs through careful case management. Families come to GHHI through many avenues including referrals from clinical partners, community partners, outreach events, self-referrals, government partners and neighbors and friends. The client services coordinator leads each referred family through the intake process—a survey of questions about their family, home and health—to ensure that they receive the most appropriate services as quickly as possible.
Through FAS, we connect clients to programs and services that address their specific needs. Typically, families referred to GHHI have a child with an elevated blood lead level (EBLL) or asthma symptoms that are potentially linked to the home itself and/or behaviors exhibited in the home. FAS works closely with the family and landlord to ensure that the family’s current home becomes healthy or that the family is relocated to a healthy home. Lead poisoning still continues to be a serious health concern for children ages 0-6 and pregnant women. FAS case managers and family advocacy attorney explore all options to ensure that the home environment is safe and healthy.
We have had the privilege of helping a number of families with a child that has an EBLL. The services provided are based on then individual and unique needs of families. Last year we met an amazing mom who had just learned that her son had lead poisoning. Jessica was referred to GHHI Baltimore by Hopkins Children’s Harriet Lane Clinic because her three-and-a-half year old son Kamari had an EBLL of 13 µg/dL. Jessica was also seven months pregnant and essentially homeless—she constantly moved from home to home of friends and family, and all those homes contained lead paint hazards. She needed to secure a safe home for her son and her unborn child that was lead safe, yet she had little to no income since she was unable to work during the last months of her pregnancy.
GHHI Baltimore was able to provide the family with a referral for an Emergency Housing Choice Voucher through a collaboration with the Housing Authority of Baltimore City. We worked with her to secure a home and negotiate the lease and security deposit with her landlord. The home was certified lead-free and had a current lead certificate this ensured that her son and her new baby daughter were in a healthy and safe home. FAS staff also provided her with education on nutrition and cleaning techniques to help lower her son’s existing lead level. After three months of teamwork she is in a safe and healthy environment and Kamari’s lead level has dropped to 8 µg/dL. GHHI Baltimore will continue to provide her with support and case management as she adjusts life as a tenant including budgeting and bill paying skills, cleaning and nutrition, job training and job searches and applying for social services as appropriate.
Jessica also participates in the GHHI Baltimore’s First Book program in which Kamari received his first home library (eight books). We explained the importance of reading to and with Kamari on a regular basis. Lead poisoning has a number of adverse effects including developmental delays and learning disabilities as well as other physical and behavioral symptoms. Strategies such as reading with your child can begin to reverse these devastating effects and start the healing process. According to Jessica, Kamari “is progressing a lot,” is now more interested in reading and is starting to point out the pictures and name the items in the books.
GHHI Baltimore provides comprehensive services to families in need of healthy housing. For more information about our services please call 410-534-6447 or email at If you are a community or clinical referral partner please call or email to receive information on our online referral page and password. 

Join Us in the Call for Climate Action

There is an undeniable need to take meaningful action to combat climate change. To date, there are no federal limits on how much carbon pollution existing power plants can dump into the air. Carbon pollution causes climate change and a host of extreme threats to public health.

This is why the Environmental Protection Agency (EPA)'s Clean Power Plan, which is days away from finalization, is so vital. It sets the first ever federal limits on carbon pollution from existing power plants, invests in clean, renewable energy and boosts cost-saving energy efficiency. EPA's plan would prevent thousands of asthma attacks, deaths, heart attacks and general hospital admissions every year.
Making buildings more energy efficient is the least expensive way to meet pollution reduction targets under the new standards. Efficiency investments in housing not only produce substantial energy savings but lead to better health and more disposable income for residents, and create jobs for local communities. Energy efficiency is one of the eight elements of a healthy home.
The plan is estimated to provide up to $93 billion in climate and public health benefits. The EPA projects that the new standards could help avoid up to 6,600 premature deaths and up to 150,000 asthma attacks in children annually by 2030. It will also help prevent thousands of heart attacks, hospital admissions, and missed work and school days every year.
Climate change is not a future generation's problem. It affects our communities and our health each and every day, and we need to take advantage of the opportunity presented by the EPA to solve it. We urge congress to make the call for climate change now.
To show your support for investments in energy efficiency, sign on to ramp up resources for energy efficiency in affordable multifamily housing.


GHHI Pay for Success Projects Kick Off in Salt Lake City

Salt Lake City is buzzing with excitement over Pay for Success (PFS). The GHHI PFS team traveled to Salt Lake City on June 26 to kick off its asthma-focused PFS feasibility study and was met with a crowded room of interested community leaders. GHHI team members present were President & CEO Ruth Ann Norton, Vice President of Policy and Social Innovation Michael McKnight, Social Innovation Specialist Trent Van Alfen, Senior Associate for Research, Policy and Environmental Health Science Brendan Brown and Pay for Success Project Lead Eric Letsinger. GHHI is also conducting groundbreaking feasibility studies in four other cities with funding from the Corporation for National and Community Service’s Social Innovation Fund.
Over the course of the next year, GHHI will work with awardees in the five cities to assess the feasibility of a PFS partnership involving home-based interventions to reduce asthma in low income communities and generate cost savings for healthcare organizations. By June 2016, GHHI will complete an analysis for project partners and investors to use in determining if they want to move forward with a PFS transaction similar to the one GHHI is developing in Baltimore.
The purpose of this kick off meeting in Salt Lake City was to establish a common understanding of the PFS feasibility study among all the project stakeholders—healthcare organizations, service providers, as well as government and university departments. The convening allowed everyone to get on the same page regarding roles, responsibilities, goals and potential resources for the project. The quality of discussion and amount of business cards being passed back and forth were good indications that the Salt Lake partners were taking ownership of the project, making connections and striving to make it successful. By the end of July, GHHI will have conducted similar kick off meetings with the other four PFS awardee cities.
University of Utah Health Plans and the Salt Lake County Office of Regional Development are the two PFS feasibility awardees in Salt Lake City. They brought in several professionals and organizations for the site visit who may potentially become involved in the project, including representatives from Green & Healthy Homes Initiative Salt Lake, University of Utah Department of Pediatrics, Salt Lake Valley Habitat for Humanity, Salt Lake County Health Department, Utah’s Pediatric Improvement Partnership (UPIQ), the Policy Innovation Lab at the University of Utah and the Salt Lake County Mayor’s Office.
It seemed to be perfect timing for this asthma-focused PFS feasibility study. The county’s Health Department recently received a grant to provide home- and school-based asthma education; UPIQ is developing its leadership in quality improvement for clinical asthma management; and University of Utah’s Department of Pediatrics is conducting studies fostering empirical evidence for the ability of home-based interventions to reduce asthma triggers. Representatives from all of these initiatives expressed that they would like to be involved with GHHI’s PFS work whether as direct partners in service provision or as resources in knowledge sharing throughout the project. Multiple people throughout the day said they were “so pumped up!” about this project and the feeling was contagious.
Utah is one of the leading states in Pay for Success—in large part due to the attention Salt Lake County Mayor Ben McAdams has given to the field. Mayor McAdams joined us for lunch on June 26 and offered several great insights. His office is currently conducting three PFS projects focused on maternal/child health, criminal justice and homelessness. Another one of the Social Innovation Fund PFS grant awardees, the Policy Innovation Lab, is located in Utah and is also conducting several PFS feasibility studies out west. A representative from the Lab discussed their work to the group and expressed their willingness to collaborate and share knowledge with GHHI as they both seek to advance the PFS field nationally.
One of the major highlights of the day was when GHHI President & CEO Ruth Ann Norton presented Mayor McAdams with a GHHI pin and thanked him for his support. The Mayor touted the outstanding reputation and track record of GHHI and discussed the enormous potential Pay for Success represents for improving social outcomes. He joined everyone else in saying that he was “pumped up!” 



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