U.S. Environmental Protection Agency Region 6 Children's Environmental Health Third Annual Program Highlights Report Protecting children where they live, learn, and play October 2012 - September 2013 vvEPA Unit.::-: States. ฃ pi: Vf r o nmenta! Prat est i;@8 Agency ------- Contents Overview: Protecting Children Where They Live, Learn, and Play Background 3 Summary of Accomplishments 4 Program Components Children's Health Month 5 Healthy Schools 6 Integrated Pest Management 7 Healthy Homes 8 Addressing the Asthma Epidemic 9 Lead-Based Paint 11 Circuit Rider 12 Internal and External Partnerships Grants 13 Unfunded Partnerships 17 Collaboration with U.S./Mexico Border Program 18 Internal Coordination 19 T raining 2 0 2 ------- Children's Environmental Health (CEH): Protecting Children Where They Live, Learn, and Play EPA's Children's Health Program was established in 1997 by Executive Order 13045; Protection of Children from Environmental Health Risks and Safety Risks. In Region 6, CEH issues are addressed in the context of prevention and education programs, regulations, guidance, and outreach to targeted audiences. Regional staff provide technical expertise, participate on national workgroups, and oversee funding opportunities with partner organizations that carryout CEH projects. These program components provide parents, teachers, child care providers, doctors, nurses, and regulated entities with the tools they need to protect children where they live, learn, and play. EPA's Region 6 office covers five states in the South-Central Region of the United States-Arkansas, Louisiana, New Mexico, Oklahoma and Texas and 66 Tribal nations. Within these five states, there are over 10 million children under the age of 18.1 The infant mortality rate is greater than 7 percent per 1,000 in Arkansas, Louisiana, Oklahoma; among the highest in the nation.2 In 2013, about 12 percent of children in Region 6 were uninsured; in Texas that number is 17 percent-the highest in the nation. The percentage of children living in poverty in Region 6 is about 28 percent Lack of health insurance is a major deterrentto basic health care.3 Children that live in older homes may have a greater chance of poisoning from lead based paint. Exposure to lead is especially dangerous for children under six and it is irreversible. Early exposure can cause damage to the brain and nervous systems causing reduced IQ, learning disabilities, and behavioral problems. On a national scale, 87 percent of homes that were built before 1940 contain lead paint. In Region 6, over half of the housing stock was built prior to 1978. Recently the Centers for Disease Control lowered the blood lead reference value from lOug/dl to 5ug/dl. This is the first time the level has been adjusted in 21 years. Asthma is a chronic lung disease that inflames and narrows the airways. It affects people of all ages, but it most often starts during childhood. Severe asthma attacks may require emergency care, and they can be fatal. Asthma prevalence continues to grow. Nationally over 7 million, or 9.5 percent of children have asthma. The Regional average is higher, at more than 12 percent4 The exact cause of asthma isn't known. But, some environmental triggers are known to cause asthma such as tobacco smoke, dust mite, outdoor air pollution, cockroach allergen, pets, mold, and others. 1 From Kids Count Data Center, A Project of the Annie E. Casey Foundation, http://datacenter.kidscount.org/data/tables/103- child-population-by-ra ce?loc=l&loct=2#detailed/2/10-19,2,20-29,3,30-39,4,40-49,5,50-52,6- 9/false/867,133,38,35,18/66,67,68,69,70,71,12,72/423,424 2 http://cdc.gov/sortablestats/ 3 The federal poverty definition consists of a series of thresholds based on family size and composition. In calendar year 2011, a family oftwo adults and two children fell in the "poverty" categoiy if their annual income fell below $22,811. 4 The data are based on CDC's National Asthma Control Program. Four Region 6 states receive funding for asthma surveillance. Arkansas is not a CDC grantee and does not report any data to the National Asthma Control Program. Asthma Contacts and prevalence map found at http://www.cdc.gov/asthma/contacts/default.htm 3 ------- Summary of Accomplishments The Region 6 Children's Environmental Health Third Annual Program Highlights Report outlines key efforts by the Multimedia Planning and Permitting Division program staff and others to address environmental threats to children's health. It covers the period from October 1, 2012 to September 30, 2013. The following list is a summary of accomplishments. 486 facilities and maintenance personnel trained in Healthy School Environments in 7 venues * $1,185,432.00 awarded in grants (6 competitive, 2 unsolicited, and 4 STAG awards) to universities, Tribes and local government, and non-profit organization to address asthma and asthma disparities, indoor air quality, and lead poisoning 47 Tools for Schools/Indoor Air Quality Programs were implemented potentially impacting 35,000 students 389 school nurses, facilities and maintenance staff, IPM coordinators, environmental health and public health officials were trained at 11 venues * 20 percent of Region 6 employees were trained in Children's Environmental Health issues via the on-line training, exceeding our goal of having 10 percent trained by end of FY13 187 housing inspectors and facilities personnel, Tribal leaders, child care providers, community health workers and others were certified in Healthy Homes practices in 4 venues * 150 child care providers, parents, and environmental health specialists were trained in lead poisoning prevention and awareness* 51 programs from Region 6 are now enrolled in the online Asthma Community Network 30 Head Start and Child Care facilities were provided with information on lead poisoning prevention 5 ongoing memberships commitments are supported by staff: the county-wide Health and Wellness Alliance for Children (co-chaired sub-committee on Asthma Healthy Environments), West Dallas Coalition, North Texas Asthma Consortium, and the Region 6 Federal Partners Collaboration 500 people attended the Second Annual Children's Health Fall Festival on October 5, 2012, during Children's Health Month 850 people were educated in rural communities on lead poisoning prevention and other children's health issues via the Circuit Rider program * 700 water bottles and bandanas (printed with pesticide safety messages in Spanish) were distributed to Migrant Farm Workers through the Amarillo school district's outreach program $150,000.00 of Border funds were allocated to address children's health issues in FY13 A child's health provides the foundation for their overall development. Ensuring that children are protected from environmental contaminants is central to the Environmental Protection Agency's EPA's (EPA) mission. It is EPA's mission to consider the health of pregnant worn en, infants, and. children in all activities we undertake related to human health protection. * The number of people trained in these categories will impact children's health exponentially since they are decision-makers, facilities managers, child care providers, housing officials and others. Each individual has the potential to impact hundreds of children in the coming years. 4 ------- Children's Health Month Fall Festival EPA recognizes Children's Health Month each October. On October 6, 2012, Region 6 partnered with Children's Medical Center, Parkland Health and Hospitals and the City of Dallas to bring health and wellness information to families in West Dallas. The Children's Health Fall Festival is held at the Nash-Davis Recreation center, a 12- acre campus and state-of-the-art LEED silver building. West Dallas was chosen based on the results of a community needs assessment performed by Children's Medical Center in zip codes 75211 and 75212, where families stated that they wanted more information about health and wellness. Over 500 people attended the event and 40 exhibitors provided information on health care topics, disease prevention, and education about childhood safety. Children enjoyed games, pumpkin painting, free books, healthy snacks, and sports activities. Partners requested that we continue the event and the third annual Children's Health Fall Festival was held October 5, 2013. Results for that event will be reported in nextyear's report. Outreach activities in October included: Participation in the Cook Children's Hospital Annual Children's Health Summit in Fort Worth. Participation in the Children's Environmental Health Institute's biannual symposium in Austin. Sponsoring and coordinating the Healthy Homes training for the Dallas Housing Authority staff managers, and facilities personnel in West Dallas. Participation in the North Texas Asthma Consortium's Back to School meeting by recognizing 21 schools that participated in the AQI Flag Program. They were presented with certificates of appreciation from EPA. Distribution of 20,000 lead based paint coloring books to health departments, child care facilities, Head Starts, and other organizations to raise awareness about lead based paint. Internal activities aimed at raising awareness about CEH within EPA included: Sending out an All Employee Memo from Regional Administrator, Ron Curry asking people to 1) attend the Fall Festival, 2) take the CEH training and 3) attend a presentation by Dr. Alesia Ferguson (University of Arkansas) on childhood lead poisoning. Presentation to EPA staff by Dr. Alesia Ferguson, of the University of Arkansas Medical Branch in Little Rock, an EPA grantee, focusing on her research findings on childhood lead poisoning. The Children's Health Coordinator conducted training for R6 NEPA reviewers based on the on-line CEH training module developed for EPA staff. 5 ------- Healthy Schools Protecting Children Where They Learn and Play In FY 2012, EPA released the School Siting Guidelines and the School Environmental Health Guidelines, both required by the Energy and Independence Security Act of 2007. These guidelines form the foundation for the current focus on Clean, Green, and Healthy Schools. Iflii In FY 2013, the Region 6 Schools Coordinator concentrated efforts on developing an internal schools workgroup. Across the Region, there are a num ber of programs that address children's health and environmental education where children learn. The Region 6 Schools Coordination Team (SCT) exists as an overarching organization through which all regional schools programs can leverage existing resources, events, and activities to improve school environments in the communities we serve. To date, the team has: created mechanisms for open and transparent communications through a team specific email group, share drive folder, and by holding regular quarterly meetings; developed a One EPA regional flyer highlighting key program that address environmental outcomes across all media; and provided opportunities for cross-programmatic collaboration. In addition to managing the internal group, the Schools Coordinator continued to represent EPA at multiple conferences and coordinated training events in communities in Texas and New Mexico, and via webinars for national audiences. These events resulted in training of 486 people in Healthy Schools. Chemical Management Training was presented at three venues. A total of 150 maintenance and facilities personnel were trained at these events. Gulf Coast Maintenance and Operations in Santa Fe, Texas Capitol Area Maintenance and Operations in Austin, Texas Science Teachers and Industry Conference in Houston, Texas Healthy Schools Environments Training was presented in two communities in Texas and New Mexico. A total of 60 facilities personnel were trained at these events. Healthy Schools Environments for South Texas, McAllen, Texas Zuni Healthy Schools Training, in Zuni New Mexico Two webinars were held as part of the Sensible Steps for Healthier School Environments Webinar Series. 276 people were trained in these webinars. Assessment and Tearn Building Indoor Air Quality Tools for Schools 6 ------- Integrated Pest Management in Schools Protecting Children Where They Live and Play On 6 September 2012, the US EPA released its Strategic and Implementation Plans for School Integrated Pest Management for federal fiscal years 2012-2014 This document, and the US EPA Region 6 Pesticides Program 2012-2015 Integrated Pest Management Program Action Plan are the foundation for all Region 6 pesticide safety and integrated pest management (IPM) in schools work plan activities. Stakeholder and Regional Collaboration: The first quarterly Region 6 School IPM Collaboration Group teleconference was held on 20 September 2013. The event was attended by 10 State, Tribal, and professional organization representatives from around Region 6 representing state departments of agriculture, university extension programs, departments of health, and school IPM affiliates. The goal of the collaboration group is to build a core network of school IPM partners that can assist Region 6 target products and efforts to the needs of each community in the region, as well as, serve as facilitators for coalition building and collaboration at state and sub-region level. Additional participants for future meetings include state departments of education and pest management professional representatives. In FY 2013, Region 6 expanded its Pesticide Safety and School IPM in Indian Country outreach and consultation capacity by expanding its cooperative grant with the Eight Northern Indian Pueblo Council (ENIPC). The ENIPC provides outreach, training, and consultation to 22 Pueblos and Tribes throughout New Mexico. Region 6 and ENIPC representatives participated in three separate collaboration meetings with the Bureau of Indian Education (BIE) and Indian Health Service (IHS) regional staffs in New Mexico to facilitate coordination and synergy. As a result of these meetings, Region 6 staff developed draft school IPM policy statements and plans for BIE and opening the doors for ENIPC and IHS to identify and address IPM outreach opportunities at BIE and tribally affiliated schools and their communities. Outreach and Training activities were conducted at eleven venues. A total of 389 school facilities and maintenance staff, school nurses, IPM coordinators, environmental health and public health officials, school leaders and pest management professionals were trained and consulted at these events: Texas School Business Officials and Texas IPM Affiliate for Public Schools annual conference, San Marcos, TX Texas AgriLife Extension Center, Associate Certified Entomologist Course, Dallas, Texas Region 6 RTOC, Dallas, Texas Texas IPM Affiliate for Public Schools quarterly training, Keller, Texas New Mexico Public School Facilities Authority Semi-Annual Training Conference, Albuquerque, NM Staff Training, Santa Clara Day School, Santa Clara Pueblo, New Mexico Staff Training Santa Fe Indian School, Santa Fe, New Mexico CDC Workshop "Biology and Control of Vectors and Public Health Pests" Tahlequah, Oklahoma New Orleans Mosquito and Rodent Control Board "IPM Workshop", New Orleans, Louisiana New Mexico School Nurses Association Annual Meeting Albuquerque, New Mexico Healthy Schools Workshop, Pueblo of Zuni, New Mexico 7 ------- Healthy Homes Protecting Children Where They Live and Play Region 6 provides Healthy Homes training to support the Action Strategy for Healthy Homes drafted by the national Healthy Homes work group. The workgroup includes the Department of Housing and Urban Development, organizations within the Department of Health and Human Services including the Centers for Disease Control and Prevention and the National Institute of Environmental Health Sciences, the Department of Agriculture, the Environmental Protection Agency, the Department of Energy, the Department of Labor, and the National Institute of Standards and Technology. Training is provided through an EPA contract with the National Center for Healthy Housing and their subcontractors located within Universities and other training facilities across the nation. The trainers, who are usually nurses or public health practitioners, are certified to provide continuing education credits for participants. Training examines the role between housing and human health and is based on seven principles: I would like to say this was a real eye opening workshop for me personally. The information given can easily be taught to our home heath patients and also to our maternal-infant program patients. I can share this with the home visiting nurses and they can be more aware of environmental issues that otherwise we wouldn't think about. Thanks again for this experience. Quote from a RN Healthv Homes trainee in Arkansas / Keep it Dry V Keep it Clean S Keep it Pest-Free Keep it Ventilated J Keep it contaminant-free J Keep it safe S Keep it maintained In FY13 Participants included community health workers, facilities and maintenance personnel, child care providers, academicians, housing inspectors, parents, and others who have the responsibility of keeping housing safe and healthy for children. This year, Region 6 was able to provide four training events in three states resulting in the training of 187 people. They included: Dallas Housing Authority in Dallas, T exas (Healthy Homes for Community Health Workers] Arkansas Department of Health and the University of Arkansas Medical Branch in Little Rock, Arkansas [Essentials for Healthy Homes Practitioners) Pueblo of Zuni, New Mexico (Healthy Homes for Community Health Workersj Pueblo of Zuni, New Mexico (Essentials for Healthy for Homes Practitioners) More than 700 people have received training since 2011. This is the third year that Region 6 has promoted the Healthy Homes training through both the contract with the NCHH and through Region 6 grants. Region 6 is among the nation's leaders in providing HH training 8 ------- Addressing the Asthma Epidemic Asthma continues to be a significant issue for children's health. Nation-wide, over 7 million children have asthma. The prevalence is growing and the cause of asthma is still not known. In May, 2012 The President's Task Force on Environmental Health Risks and Safety Risks to Children released the Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities, which is an outcome of the collaborative interagency Asthma Disparities Working Group, co-chaired by EPA, HHS, and HUD. The goal of the Action Plan is to reduce the burden caused by asthma, especially among children in particular, minority children and children with family incomes below the poverty level. The plan will promote synergy and alignment across numerous Federal programs. EPA's role is to promote scientific understanding of environmental asthma triggers and present ways to manage asthma through research, education and outreach. Through our partners, we are building capacity to control asthma and manage exposure to indoor and outdoor pollutants linked to asthma, In Region 6, about 28 percent of children live in poverty and asthma rates are higher than the national average. Education about asthma prevention is imbedded into Healthy Homes and Healthy Schools as well as the dedicated asthma program. Region 6 supports several initiatives that focus on asthma disparities. The CEH Coordinator represents EPA on the Steering Committee for the Health and Wellness Alliance for Children. Convened by Children's Medical Center, the Committee is meeting over the course of a year to develop a common agenda for addressing asthma in Dallas County. The common agenda is based on the theory of collective impact. Collective Impact (as opposed to isolated impact) is a group of people from different sectors committed to a common agenda for solving a specific social problem, using a structured form of collaboration. Six months into the effort, the CEH Coordinator has agreed to co-chair the sub-committee on Asthma Healthy Environments. Region 6 funded a proposal from the Children's Environmental Health Institute (CEHI) to hold a symposium, The Environment Related to Asthma and Respiratory Disease in Pre-School and School Age Children to address gaps in asthma management. A planning meeting was held in Houston on August 28th and the symposium is scheduled for November 15th. Twenty-five stake holders from the greater Houston area have been invited to participate. An online forum, recommendations for action, and a presentation of results are planned outcomes. 9 ------- Addressing the Asthma Epidemic Region 6 funded a proposal from the North Texas Asthma Consortium to implement the AQI School Flag Program. The goal of the program is to increase awareness about the effects of air quality on respiratory health. Schools receive a set of flags whose colors correspond to the AQI Index, alerting students, staff, and the community about daily air quality. The program also provides educational materials to support participation. Approximately 70 schools in North Texas are now flying the flags. Two school districts, Denton and Colleyville, fly flags at every school. During Asthma and Allergy Awareness Month The Regional Office targets education about how to manage environmental asthma triggers in the home where children and the elderly are most vulnerable. In May, staff promoted the Asthma Community Network, which now has a total of 51 programs registered in Region 5 states. Region 6 Indoor Air Quality (IAQ) staff participated in planning activities for Dallas Asthma Day on May 19th at Christ's Foundry Methodist Church grounds. EPA partnered with The Asthma Coalition of Texas, the North Texas Asthma Coalition, Not One More Life, and Dallas Area Interfaith to provide asthma education to reduce the negative impact of the disease in medically underserved neighborhoods. Using a team of doctors, nurses, respiratory therapists and health educators, 47 parents, children and respiratory therapists received training. Region 6 IAQ staff also supported Baylor Hospital's Camp Airways Project, providing asthma education to medically underserved neighborhoods. Camp Airways is a free one- day camp to teach kids how to monitor and manage their asthma. Baylor hosted two Camp Airways this year to combine asthma education with activities for kids. Campers also receive a free peak flow meter. This year, 80 children and 12 caregivers attended the camp. In July, staff from the Indoor Air and Pesticides programs hosted an information booth and co-presented a session to 75 school nurses at the New Mexico School Nurses Association Annual Conference. In August, the Dallas Mayor hosted a Back to School Health Fair at Fair Park. The fair is a collaborative effort between the City of Dallas, Dallas area schools, public health departments, state agencies, non-profit organizations, corporations and hundreds of volunteers. EPA Region 6 Indoor Air staff provided asthma education material for the event. 10 ------- Lead Based Paint Program EPA's work to protect children and adults from lead poisoning includes implementing regulations, such as the Renovation, Repair and Painting Rule (RRP) that require lead-safe work practices in older housing and regulations that require sellers and renters to disclose the known presence of lead in older homes and apartments, known as the Real Estate Disclosure Act (1018). In addition, the lead program participates in outreach efforts throughout the year, works with States to encourage development of local authorization programs, and provides grants for implementation of lead abatement programs. The RRP became fully effective in spring 2010. It requires businesses performing renovation, repair and painting projects that disturb paint in homes and child-occupied facilities built prior to 1978 to be certified, and to use certified renovators who have been trained by accredited training providers. Currently, EPA implements this new regulation in 4 of the 5 states in the region. Oklahoma adopted the RRP in the spring of 2013 and is now authorized to run the RRP program. EPA region 6 continues to run the RRP program in Arkansas, Louisiana, New Mexico, Texas, and all tribal lands in the region. Outreach EPA national program guidance emphasizes that outreach efforts be focused on education of the regulated community. As a result, we have tightened the focus of our outreach efforts on permitting officials, professional building organizations, industry conferences, and property managers. These activities include informing them of the RRP regulatory requirements, assisting in rule interpretation, and providing guidance on how to comply. More general education and outreach is directed toward home owners, parents and others who may be impacted by renovation activities occurring in their homes or child- occupied facilities to encourage the use of RRP certified contractors. The Region 6 RRP Outreach Strategy targets contractors and their trade associations, state contractor licensing boards, city building permit and code enforcement officials, child care facility managers, apartment managers and their associations. In Fyl3, the Cherokee Nation hosted the second annual Region 6 Tribal Lead Summit in Tulsa. Renovate safely. 11 ------- Circuit Rider Background: Region 6 received $20,000 from EPA's Office of Environmental Justice in FY11 to fund a pilot outreach effort in the Panhandle of Texas (and some New Mexico communities}. The purpose of the Circuit Rider Project was to reach the sparsely populated, yet vast geographic region of the Texas Panhandle, which encompasses more than 25,000 square miles and has a population greater than 425,000. The area has a high percentage of pre-1978 housing stock (likely to contain lead based paint] and a significant percentage of persons living below the poverty level. The initiative was successful in reaching over 3,500 people in FY11 and FY12. In FY13, Region 6 maintained the project and sent a Senior Environmental Employee (SEE) to additional rural areas in Texas, Louisiana, and Arkansas. Distribution of EPA materials included lead planners, coloring books, information packets containing children's health publications catalogs and sample brochures, and lead poisoning prevention information. The SEE also provided contacts for the Children's Health, Lead, Indoor Air and School programs to libraries, hospitals/clinics, daycares and schools. City/county code enforcement/inspection/permit offices received lead planners, RRP literature, Small Entity Compliance Guides and posters, flyers, and counter cards as appropriate. Literature was mailed to several library locations for use in their summer reading programs, to a few schools for parent meetings, and to a couple of clinics to be used at community events. Most of the libraries, daycare centers and WIC offices received health education coloring books or sheets for daily use. At many of the libraries, WIC, and Head Start locations, EPA materials were left to be distributed to branch locations, increasing the reach of those contacts. Results: Overall, the Circuit Rider visited 121 school districts, 62 libraries, 23 clinics, 23 city offices and had a presence had 5 community events in four states. The Circuit Ride distributed 300 information packets that contained both children's health and lead-focused items for various audiences. Other major distribution pieces included 13,500 Ethan coloring books, 900 RRP booklets, 450 Lead Planners, and 300 Small Entity Guides. In total, the circuit rider has spoken with an estimated 850 people in 2013. The results of these one- on-one visits and appearances at community events (in both 2012 and 2013) have raised awareness about EPA children's health programs to potentially thousands of people in rural communities in five states. 12 ------- Partnerships Partnerships are critical in getting the message out on protecting children from environmental risks. Region 6 seeks to partner with states, tribes, local governments, universities, hospitals, and community- based organizations to leverage shared goals for protecting children from environmental health risks. Partnerships can be characterized as 1) informal, where EPA and other organizations share information, support an event, or attend periodic coalition meetings, or 2) a more formal agreement wherein EPA funds a grant for indoor air quality, schools, Environmental Justice, Environmental Education, or lead based paint In addition to spreading the word about CEH issues, these partnerships greatly contribute to annual performance measures. Region 6 has a strong network of partners working to protect children's environmental health in all five states. Indoor Air Quality Grants Texas A&M University System Health Science Center (TAMU-HSC) $50,000 (Project period: 10/1/12-9/30/14) TAMU-HSC is providing training to asthmatic children and their care givers, as well as health care professionals and nursing/respiratory therapy students on the environmental management of asthma triggers. The expected outcome is better asthma management in the community through an increased awareness and understanding of asthma; increased opportunities for asthma-related continuing education; empowerment of participants to self-manage their asthma; decreased number of hospitalizations, emergency room visits, and missed school days due to asthma attacks; and, an improved quality of life. FY13 Results: Texas A&M has provided training on the environmental management of asthma triggers to 67 asthmatic children and their caregivers, as well as 106 healthcare professionals (including physician assistants, nurses, and respiratory therapists). University of Tulsa (TU) $48,636 (Project period: 10/1/12-9/30/14) The goal is to improve indoor air quality (IAQ) for over 2,500 school staff and over 14,500 students at 34 schools in the Bartlesville Public School District (Oklahoma), Kenwood School District (Oklahoma), and North Little Rock School District (Arkansas). The North Little Rock School District will support a one-day regional symposium that will provide asthma & IAQ awareness and training to 100 additional Arkansas and surrounding state school districts. Additional, Outreach and training activities on asthma and IAQ will target approximately 50 additional school districts to implement IAQ programs, as well as involve health care providers, school personnel, educators and parents on how to reduce asthma triggers. FY13 Results: TU has conducted training and created draft IAQ Management Plans for Bartlesville and Kenwood School Districts. Planning is underway to deliver a one-day regional symposium hosted by the North Little Rock School District, the results of which will be reported in FY14. 13 ------- Partnerships Southeastern Louisiana University (SLU) $38,000 (Project period: 10/1/11-9/30/13) The SLU project targets Tangipahoa Parish, schools and homes to develop management plans to address indoor air quality (IAQ). It targets a minimum of 50 schools, and 30 households and stakeholders from the community will be invited to participate. All participants will be trained on the relationship between poor IAQ, asthma and other respiratory diseases, with a focus on the unique vulnerabilities of children. Education and training will focus on sustainable IAQ management practices, methods to control and prevent poor IAQ, and develop indicators to assess progress of the IAQ management plans. FY13 Results: Project received a 6 month extension due to a change in staffing, in order to fulfill all commitments. IAQ Coordinators for each implementing campus have committed to sustaining their efforts beyond the life of the assistance agreement Final project activities are underway, with results to be reported by December 31, 2013. University of Tulsa (TU) $50,000 (Project period: 10/1/11-9/30/13) FY13 Results: TU has completed walkthrough assessments for the remaining 24 campuses in Houston Independent School District (TX), Sapulpa Public School District (OK), and Morrison Public School District (OK). All districts now have a draft IAQ Management Plan, which addresses several items found during the assessments, most notably clutter, ventilation, effective cleaning, and integrated pest management Final project activities are underway, with final results to be reported by December 31, 2013. Lead Abatement Grants Region 6 provided grants totaling $898,384 for implementation of the lead abatement program (a separate program from RRP) in authorized states and tribes, including Arkansas, Oklahoma, Texas and the Cherokee Nation.5 Activities funded by these grants include: maintaining the appropriate infrastructure to successfully administer and enforce the lead abatement program; providing training for lead inspectors; conducting outreach; conducting inspections of contractors engaged in lead-based paint abatement activities, and taking appropriate enforcement action when needed. The Oklahoma grant covers RRP activities as well. Additionally, grants totaling $75,602 for vulnerable populations were provided to: 5 Region 6 implements the abatement program in New Mexico, and Louisiana does not take a grant.) 14 ------- Partnerships Baylor University ($25,602) (Project Period: 10/1/12-3/31/2014) Baylor University is addressing lead exposure awareness in McLennan County, Texas. They designed, and are implementing outreach model pamphlets for educating environmental health inspectors, community health educators, childcare facility employees, and health care providers at a nonprofit clinic. FY13 Results: Baylor's team has held five training events, training 80 professionals (60 child care workers, 13 child and family advocates, and 7 environmental health specialists) and 40 parents in lead poisoning awareness and prevention. These trainings also resulted in the distribution of 2128 educational brochures to parents of at-risk children in McLennan County. Louisiana Department of Health and Hospitals (LDHH) $50,000 (Project Period: 10/1/12-8/31/14) FY13 Results: LDHH has disseminated outreach materials such as the Center for Disease Control Blood Lead Levels Fact Sheets and coloring books to educate child care facility managers to 24 Head Start Centers and 6 day care facilities in New Orleans. LDHH has sent a total of 1,234 letters to parents of children residing in Orleans Parish with blood lead levels between 5 -9.9 ng/dL, as well as a copy of the CDC Blood Lead Levels in Children Fact Sheet. A total of 392 children with blood lead levels 10 ng/dL and above throughout the State have been provided follow-up by and sent lead information by LDHH Case Manager. LDHH is planning to meet with the Home Builder's Association of Greater New Orleans to expand partnering efforts. LDHH is distributing 1,378 information sheets on lead, renovate, repair and paint fact sheets in New Orleans and surrounding areas. Lastly, LDHH and the City of New Orleans Code Enforcement will collaboratively distribute educational materials on proper renovation techniques to residents. 15 ------- Partnerships CookChildrcnV # ฎ Jjt ฎ UAMS V. LMVUcSCTY Of UJXANSAS CHILDREN VOKMIOtCAl SOENCES States, Tribes, and Municipalities: Region 6 strives to work closely with state departments of health and environment, local governments, and Tribal health and environmental departments. Region 6 has funded grants with the City of Houston, Louisiana Department of Health and Hospitals, the State of New Mexico Environment Department, and the Oklahoma Department of Environmental Quality. We have provided scholarships for representatives from these states (NM, TX, OK, LA) to attend EPA national workshops in Washington, DC. and have worked to establish relationships with our state counterparts in all Region 6 states. Region 6 provides grants to Tribes and also offers technical assistance, mostly in the form of workshops to Tribes who request EPA expertise. Worthy of note, is the strong partnership developed with the Pueblo of Zuni Pueblo in 2013 supporting the Agency's KPI project. West Dallas Community Coalition: Staff continues to attend monthly coalition meetings in West Dallas resulting in long-term, established relationships with Parkland Health and Hospital System, Dallas Housing Authority, YMCA, Children's Medical Center, University of Texas Southwest Medical Center, and others. Outcomes have led to Healthy Homes training events, children's health festivals, training opportunities for EPA staff, and participation in policy-setting workshops with the Dallas County Health Department and the Health and Wellness Alliance for Children. The South West Center for Pediatric Environmental Health (SWCPEH) at University of Texas Health Science Center at Tyler: The SWCPEH is one of 10 organizations nation-wide commonly known as a PEHSU.6 The PEIISUs provide ongoing technical expertise for pediatric environmental health. EPA staff have access to these medical and public health professionals, and we maintain a strong and collaborative partnership. Most recently, we collaborated on a citizen concern about a water quality issue. The PEHSU supports EPA conferences, webinars for CEUs, trains health care professionals, and is a vital medical resource for environmental issues. In addition, they provide outreach independently, collaborate with poison control centers, ATSDR, conduct presentations and trainings, and we coordinate on planning to address children's health throughout the Region. 6 The Pediatric Environmental Health Speciality Units (PEHSUs) are funded by the Agency for Toxic Substances and Disease Registry and the EPA through a cooperative agreement with the Association for Occupational and Environmental Clinics. 16 ^ DEPARTMENT OF HEALTH | T lite [ill University tulsa Eft rr\A$ NEW ME HHHHHH HEALTH mPEHSU ------- Partnerships Children's Environmental Health Institute (CEHI): CEHI was established in 1999 to identify, validate and develop solutions to address adverse health effects to children from exposure to hazardous environmental substances. EPA has been working with CEHI for several years, participating in planning meetings, sharing resources, and most recently providing funding for the asthma symposium to be held on November 15, 2013 in Houston. Region 6 Federal Partners Collaboration: This workgroup is hosted by HHS with HUD, DOL, and EPA participating in quarterly meetings. Collaboration with this group has resulted in better communication between the HHS's Tribal grants program under the Administration for Children and Families, (ACF) Brownfields, the Children's Health Program and others. EPA presented the CEH program this spring at the ACF Tribal Summit and invited collaboration on Healthy Homes training. EPA also attended the HHS Faith and Community Health Summit on October 24, 2013. Cook Children's Hospital: Region 6 maintains communication with Cook Children's Hospital supporting their community health assessment initiative. In the past we have attended a Think Tank collaborative effort and provided comments on Childhood Asthma: A Guide to Action. In October 2012, staff participated in their annual meeting in Fort Worth. In February, the Children's Health Coordinator invited Cook's VP to provide a presentation on their groundbreaking work on the CEH Regional Coordinators national conference call. North Texas Asthma Consortium (NTAC): NTAC is composed of Individuals, Parents, Healthcare Professionals, and Students with the common goal of raising awareness about Asthma in North Texas and to assist those with Asthma realize optimal health and quality of life. EPA staff attends NTAC monthly meetings. In October, EPA staff recognized those schools who supported the AQI Flag Program by thanking them for their dedication to the children of North Texas and presenting a certificate to each school who participated. Children's Medical Center: A long-time partner, Children's received an indoor environments grant from EPA about 5 years ago. Since that time, our partnership has grown. Children's has provided space and helped to promote a Healthy Homes training for health care professionals in 2012 and they serve as a partner, along with Parkland and the City of Dallas for the Children's Health Fall Festival. Recently, they invited the Children's Health Coordinator to participate on the Health and Wellness Alliance for Children and to act as co-chair for the Asthma Friendly Environments working group. Southern Area Health Education Center: Housed at the University of New Mexico, the SoAHEC is our newest partner. The Border 2020 Program provided a grant this year to train Promotoras and others in communities (colonias) where environmental health risks to children are especially prevalent Results from this grant will be reported in 2014. 17 ------- US/Mexico Border Program The IJS-Mexico Border 2020 program has made children's environmental health a priority for the projects they fund in FY13. Region 6 continues to partner with the Border Environmental Cooperation Commission to manage the process of awarding grants to organizations that serve a bi-national audience. Funded projects in FY13 include grants to universities, cities, and non-profits for outreach and education along the Border from Deming New Mexico to Harlingen, Texas. City of Laredo was funded for $25,000 to focus efforts on a Children's Environmental Health Initiative in FY12/13. Materials were developed specifically for the targeted audience to be used in school outreach and home assessments. Outreach was conducted in colonias, homes, hospitals, and schools. The project was completed in May and reached approximately 5000 children. Plans are underway to train physicians who may treat children poisoned or exposed to hazardous chemicals. University for Texas Health Science Center at San Antonio received $50,000 to conduct trainings for community health workers (promotoras) in Harlingen and Laredo. To date 36 promotoras have been trained in environmental exposures. Texas A&M Health Science Center School of Public Health was funded for $50,000 to establish an epidemiological database, and to develop a standard protocol to identify common health and environmental indicators to better target priority areas where children could be most at risk. Region 6 recently announced an award of $25,000 to the New Mexico State University's Southern Area Health Education Center for training in several communities along the U.S. Mexico Border. In FY13, Border 2020 funded EL Moscas in Laredo and Beyond. EI Moscasy los Pesticidas [The Fly and Pesticides] is a humorous and interactive play developed by Region 6 in 2009 to increase awareness about pesticide safety for agricultural workers and to prevent "take-home" exposure to their families. Under this grant, the United Independent School District (UISD) and Migrants In Action (MIA) partnered with the US-Mexico Border program to bring performances of "EL Moscas" to Laredo, and South Padre Island at the Association for Migrant Educators of Texas Annual Conference-the Laredo performance had an audience of over 8Q0--where hundreds of educators gather to learn about creative and innovative ways to reach out to the migrant working community. There were three performances in October targeting students, parents and the general public. The actors in the play are children who have worked with their parents in the agricultural fields across the nation. El Moscasy Los Pesticidas was also hosted by the UISD and MIA in January at the Zapata-Kennedy Elementary School in El Cenizo, Texas. The play was performed by UISD high-school students to an audience of about 100 people. EPA staff provided outreach material to the school for use when interacting with farm worker families and to distribute pre-and-post evaluation forms to the audience. You can view a video clip of the play at http: / /www.voutube.com /watch?v=GiOyMOpiYlA 18 ------- Internal Coordination The Children's Health Coordinator works internally across Regional program offices to make sure children's health issues are incorporated in all Regional actions. Highlights include the following: In FY13, the Children's Health Coordinator worked with the Office of Environmental Justice to support the EJ/CEH Cross Cutting Strategy. Both the Children's Health and Schools Coordinators worked closely with the EJ team to support the Regional KPI project. Healthy Homes and Healthy Schools training opportunities were provided to residents of the Zuni Pueblo over a period of several months. EPA provided logistical and technical support to reach over 100 members of the Zuni Tribe. The Coordinator works closely with the Border 2020 Program on an ongoing basis. The Coordinator reviews grants from the Border program and provides technical assistance on children's environmental health-related grants. In 2013, the Border program funded a Healthy Homes grant through BECC to fund the Southern Area Health Education Center at the University of New Mexico to provide training in several Colonias along the Border. Also in FY13, the Coordinator met with NEPA staff to host a walk-through of the on-line Children's Health training and to provide boiler plate language that NEPA reviewers could request be included in pertinent Draft Environmental Impact Statements. A CEH/NEPA training is planned for December to provide reviewers with additional tools for accessing children's health data. The Coordinator met with staff in the Water Division to discuss possible drinking water contamination in two incidences in Oklahoma this year. One incident involved a citizen complaint and involved children's health questions. The UT Southwest Center for Pediatric Environmental Health was involved as well as representatives from ATSDR. ATSDR recommended the citizen consult a local a physician who specializes in pediatric environmental health. The other incident involved a boarding school on Tribal lands where children were potentially at risk from drinking water with high levels of DBPs. The Drinking water program is currently addressing the issue. The Coordinator receives updates from the Regional Science Council (RSC) and each October works with the RSC liaison to schedule a presentation related to children's environmental health. This year, Dr. David Sterling of the University of North Texas Health Science Center spoke about his research on asthma in the school environment It was attended by 20 EPA staff as well as staff from Children's Medical Center. In August, the Children's Health Coordinator met with ORD to propose a RARE project that would support asthma research along the US/Mexico Border. The project was submitted along with several other Regional proposals. No final selection has been made. Finally, the Coordinator represents Region 6 internally to the national program office in the Office of Children's Health Protection (OA) as well as to external stakeholders across the Region. 19 ------- Children's Health Training In early FY13, OCHP launched the children's environmental health on-line training and made it available to all employees. The Region 6 Children's Health Coordinator served on the national workgroup to develop the training. The EJ/CEH Crosscutting Fundamental Strategy sets forth the goal of having 10 percent of EPA staff trained by September 2013. The Children's Health Coordinator initiated several activities to meet this goal. Led the National Environmental Policy Act review team through the training to raise awareness about CEH issues, and discussed ways of how children's health protection may be incorporated into their review of environmental impact statements. Promoted the training to staff across the Region via CEH email lists and personal appeals. The Regional Administrator sent out an All Employee Memo endorsing the training and encouraging all staff to complete it. Region 6 is currently among the Regions with the most staff who have completed the training with 20 percent of Regional staff and managers now more aware of children's health issues. The Children's Environmental Health Training is available via EPA's eLearning Skillport site. Training can be accessed via the following link: https://epa.skillport.com/skillportfe/assetSummaryPage.action?assetid= scorml2 epa epa ceh fv!2 fgc enus External Workshops In addition to promoting CEH training to staff, the Children's Health Coordinator also seeks to stay current on emerging issues that impact children's health. The Coordinator regularly participates in educational webinars, and when possible attends lectures and workshops that pertain to CEH. Workshops attended this year include: Health Statistics on the Web, taught by Cheryl Rowen, Consumer Health Coordinator, National Network of Libraries of Medicine, South Central Region, held atUT Southwestern Medical Center Library on June 20, 2013. Understanding Preconception Health and Health Care, a presentation by Hani Atrash, MD, MPH, from the Division of Health Start and Perinatal Services Maternal and Child Health Bureau Health Resources and Services Administration Department of Health and Human Services held at UT Southwestern Medical Center on December 11, 2012. 20 ------- |