U.S. Environmental Protection Agency
Region 6
Children's Environmental Health
Eighth Annual Program Highlights Report
Protecting Children Where They Live, Learn, and Play
October 1, 2017 - September 30, 2018
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Contents
I. Region 6 Children's Environmental Health Program Summary Highlights 3
II. Pediatric Environmental Health Specialty Unit 4
III. Focus on Lead Poisoning Prevention 5-6
IV. Children's Health Symposia 7
V. Children's Health Month 8
VI. Advising and Coordinating on Children's Health Programs 9-11
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Summary of Highlights for FY18
• The Children's Environmental Health (CEH) Program met all goals stated in the War on Lead
Region 6 Action Plan.
• Under EPA funding, the PEHSU Trained 32 people in Healthy Homes, bringing the Regional total
of number (from various grantees) to 1,247 people since 2011. The vast majority, being
community health workers who each reached hundreds of families.1
• About 50 people received training at the Lead Poisoning Prevention Workshop in Las Cruces,
New Mexico.
• Over 100 people attended the Children's Health Symposium in Dallas, most receiving continuing
education credits.
• More than 1,000 Protecting Children's Health tip sheets in English and Spanish, materials on lead
poisoning prevention, and sun safety were distributed to ChildCare Group for a parent's health
fair.
• The CEH Advisor provided 1,000 copies of the Play It Safe lead poisoning prevention brochure to
Poison Control Centers in Dallas and El Paso.
• Region 6 Funded the Cherokee Nation to host the logistics and facilitation of the first Tribal CEH
Symposium in Region 6 in Catoosa, Oklahoma.
• Regions 6 and 9 issued a joint RFP awarding $224,500 supporting education on pediatric
environmental health risks to five organizations in three states.
• Region 6 came in second place, with 53 new schools registered to implement the AQI Flag
Program all located within the air quality north Texas non-attainment area. (There was actually
62 registrations, but 11 signed up after the deadline for the competition.)
• The Circuit Rider visited more than 157 entities in 108 communities in Texas, Louisiana and New
Mexico, providing educational materials on lead based paint, environmental asthma triggers,
sun safety, air quality, and other children's health issues.
1 This is the first part of an FY18/19 initiative; already 95 have been trained in October 2018 which are
not included in this year's total.
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Pediatric Environmental Health Specialty Unit: A Unique Partner
The Pediatric Environmental Health Specialty Unit (PEHSU) is a resource for pediatricians, public health
officials, school personnel, and parents to get information about children's health and the environment.
They are a key partner for the Children's Health Program.
There are ten PEHSUs in the US, one for each EPA Region. In Region 6, the PEHSU is called the
Southwest Center for Pediatric Environmental Health and it is located on the campus of Texas Tech
University Health Sciences Center in El Paso, Texas. EPA and ATSDR jointly fund the PEHSU program.
Since 1998, this network of experts has been working together to address the clinical and public health
practice of children's environmental health, devoted to the rigor of evidence-based care in academic
institutions. The PEHSUs provide clinical care to children with toxic exposures and disease of
environmental origin, which is much needed because twenty-five percent of US children live within one
mile of a hazardous waste site. They also serve as points of referral for practicing pediatricians and
other health care providers. Their mission is to:
• Educate the public about environmental exposures and health outcomes
• Reduce environmental health threats to children;
• Improve access to expertise in pediatric environmental medicine; and
• Strengthen public health prevention capacity.
Region 6 relies heavily on the PEHSU to provide logistical support for conferences as well as CEH
expertise, links to the PEHSU national network of pediatricians, and the development of promotoras
(community health worker) workshops, Healthy Homes events, and other training opportunities
throughout the year. This year, the EPA Administrator emphasized a strong push to eliminate lead
poisoning. The PEHSU assisted in working toward that goal as detailed in the following report.
The Map below shows the location of each PESHU within each EPA Region.
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Focus on Lead Poisoning Prevention
National War on Lead Initiative
In 2018, EPA announced a War on Lead. As the lead agency for the President's Task Force on Health
and Safety Risks to Children, the Administrator requested the multi-agency Task Force to accelerate
efforts to finalize the national lead strategy. After incorporating comments from each agency, the
strategy was submitted to the Office of Management and Budget with an anticipated release of fall,
2018. Region 6 responded by initiating a War on Lead workgroup on March 20thto develop a Regional
strategy to reduce childhood lead exposure. As a result, a Region 6 Draft Lead Action corresponds with
the national strategy, which will address the following goals:
• Reduce sources of lead in children's environments
• Improve identification and monitoring of lead exposure to children
• Improve the health of children identified as lead-exposed
• Communicate effectively and consistently with stakeholders about childhood lead exposure and
• Plan cross-federal research to advance our scientific understanding of the effects evaluation and
control of lead hazards in children's environments.
Lead Based Paint Program Summary
The Regional Lead-Based Paint program annually awards and oversees funding to states and/or Tribes to
implement lead paint programs and provides accreditation to lead paint training providers. It works with
building code and permitting officials regarding Renovation, Paining and Repair (RRP) Rule requirements
and encourages them to inform homeowners and contractors during the permit process. It also reaches
out to the regulated community to get RRP certified, informs homeowners to hire RRP-certified
contractors, when renovating or painting pre-1978 housing and integrates assistance into inspections
and enforcement to improve awareness and compliance with the rule.
Circuit Rider
For the past five years, the Lead Based Paint Program has supported a Senior Environmental Employee
(SEE) to visit rural areas of Region 6. This SEE Circuit Rider travels to dozens of communities each year
visiting with Planning and Zoning, Code Enforcement and Permitting Departments, public libraries,
county courthouses, US Post Offices, and WIC/Head Start locations.
This year, the Circuit Rider visited more than 157 entities in 108 communities in Texas, Louisiana and
New Mexico. In addition to visits to county and municipal offices, the Circuit Rider also represented EPA
at ten (10) health fairs and three (3) general outreach events providing educational materials not only
on lead based paint, but also on environmental asthma triggers, sun safety, air quality, and other
children's health issues.
Healthy Homes Training
In FY18 the Lead Based Paint Program provided $30,000 for the PEHSU to conduct several Healthy
Homes training events targeted to the professional community. The RRP Rule requires
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Focus on Lead Poisoning Prevention
the use of certified renovators to perform work in homes, daycares, and child-occupied facilities that
were buiit prior to 1978. Lead based paint and RRP are part of the Healthy Homes curriculum; the
PEHSU workshops focused on the need for the RRP and provided details on how to become certified.
The aim was to educate professional renovators on the dangers of renovating a pre-1978 building
without using lead-safe work practices, and to increase awareness of the availability of RRP certification
classes. Ultimately, the goal was to reduce the number of children exposed to lead based paint dust due
to renovations.
Workshops were held in Las Cruces (July 18th) and Albuquerque (August 13th) training a total of 32
participants. More workshops are planned for the fall in Texas and Louisiana.
Testing for Lead in Drinking Water in Schools
EPA is responsible for ensuring the safety of our country's drinking water, working together with Tribal
and state environmental or health agencies to accomplish this mission. Since testing is not mandatory in
R6 states, EPA is concerned about the potential for elevated lead levels in the drinking water in schools.
This is especially important since children are the most vulnerable to health risks associated with lead
exposure.
With funding assistance from EPA, the PEHSU coordinated a workshop in Las Cruces on August 3rd.
Presentations covered the 3Ts approach to reducing lead in drinking water: Training, Testing, and
Telling. The 3Ts calls for schools to launch their own proactive campaigns of education, prevention,
testing and remediation to minimize the threat of lead exposure from drinking water and to help ensure
the safety of both the children and adults that use their facilities. The PEHSU reached out to local school
districts in the Las Cruces area to attend the all-day event.
In addition, participants also learned about the RRP and health
impacts of lead based paint and heard from speakers from the
New Mexico Department of the Environment and the Health
Department. About 50 people received training.
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Children's Health Symposia
Continuing an initiative started in 2015, Region 6 funded another CEH Symposia in 2018, bringing the
total number to three in Texas. The first in El Paso, the second in Brownsville, (2016) and the third in
Dallas September 13-14, 2018. More than 100 people attended the two-day event, held at the Double
Tree Hotel. Regional Administrator Anne, Idsal offered opening remarks. Sessions included topics on
lead poisoning prevention, integrated pest management, primordial health care, arsenic, and other
impacts on children's health.
Participants traveled from all over Texas to attend—from El Paso to Tyler and Lubbock to Brownsville.
There were also at least two out-of-state participants, and speakers came from Boston, San Francisco,
Washington, DC, and Dallas to present. Attendees included nurses, pediatricians, social workers, child
care providers, community health workers, nurse practitioners, toxicologists, public health professionals
and they represented state health agencies, hospitals, universities, and non-profit organizations.
Results
In addition to the 100 people who attended, many of who received continuing
education credits, there were several positive outcomes from the event that
contributed to building partnerships.2
First, the Children's Health Program developed a new relationship with Child
Care Group, an organization that operates six child care centers with a focus on
early education, a parent support program, and provider training. EPA provided more than 1,000
children's tip sheets in English and Spanish, materials on lead poisoning prevention, and sun safety.
ChildCare Group will give the materials to parents during their home safety fair at Bachman Lake at the
end of September. Second, the Dallas Housing Authority invited EPA staff to participate in the National
Night Out event on their Lake West campus combining a safety event with children's health.
We also met with the University of Texas at El Paso to learn more about their efforts to prevent lead
poisoning, shared information about potential grant opportunities, and provided Healthy Homes
curriculum materials for their community outreach. We also connected with Texas A&M Transportation
Institute and discussed plans to meet in the fall to learn about their school environmental health study.
We connected with the US Department of Health and Human Services Regional Health Administrator
on a potential MOU, and Texas Department of State Health Services on their lead poisoning prevention
program. Finally, the Poison Control Center requested 1,000 copies of the Play It Safe lead poisoning
prevention brochure.
In a similar vein, Region 6 also funded the Cherokee Nation to host the logistics and facilitation of the
first Tribal CEH Symposium in Region 6 to be held in Catoosa, Oklahoma in October (FY19). Two more
symposia are also being planned for Louisiana and Arkansas within the next two years, rounding out a
target of holding at least one symposium in every Region 6 state over a 5-year period.
2 Attendees included 106 the first day and 96 on the second day.
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Children's Health Month - A Banner Year
Each October, EPA places special emphasis on children's health events to recognize Children's Health
Month. In FY2018, Region 6 was keenly focused on developing a joint RFP with Region 9 to announce
the availability of funds for CEH projects that target communities along the US/Mexico Border; this was
the first time in many years that the CEH program received funds to be able to announce a significant
RFP. A Series of CEH symposia in California and Texas helped to lay the foundation for cementing key
partnerships with the Region 6 Pediatric Environmental Health Specialty Unit, EPA's Region 9 Children's
Health and Border programs, the Office of Children's Health Protection (OCHP) and the Office of
International and Tribal Affairs. Proposals were reviewed in September and selected during Children's
Health Month.
That relationship resulted in OCHP providing $70,000 in additional funding for Regions 6 and 9 to be
used to support prenatal environmental health education, healthy childcare education, environmental
health youth summits, and pediatric environmental health risks in southern California, Arizona, New
Mexico, and Texas communities. The Regions added additional program resources to the OCHP money
with the goal of leveraging the funds to award more grants. The outcome of our efforts resulted in a
leveraged funding amount of $224,500 being awarded to the following five organizations.
• The New Mexico Department of Health $50,000
• Texas Tech University Health Sciences Center El Paso (TTUHSC EP) and
The University of Texas Rio Grande Valley School of Medicine (UTRGV) $45,000
• Texas A&M University School of Public Health $45,000
• The Mariposa Community Health Center $45,000
• The Sonora Environmental Research Institute $39,500
Quantitative Measures from these grants will be counted toward FY19 results.
Looking forward to FY19
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Region 6 already has several events lined up for October (FY19):
October 10 EPA will participate in the Dallas Housing Authority's National Night Out/Children's
Health Awareness event at the Hamptons at Lake West campus in west Dallas on
October 10th and will share children's health materials with local residents.
October 11 Provided sun safety materials for first graders at Mary Moore Elementary in Arlington.
October 12 The PEHSU will sponsor a training for community health workers in El Paso.
October 18 Representatives from EPA's lead based paint program will be present at the Kerr County
Employee Health Fair in Kerrville, Texas.
October 16-18 EPA will sponsor a Tribal Children's Environmental Health Symposium focusing on
protecting children where they live, learn, and play in Catoosa, Oklahoma.
October 25 Region 6 staff will present children's health at an HHS Federal workgroup meeting
October 28 To raise awareness during Lead Poisoning Prevention Week, EPA staff will be in
Nacogdoches, Texas at Healthy Halloween children's health event.
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Advising and Coordinating on Children's Health Programs
One of the Children's Health Advisor's roles is to ensure children's environmental health messages are
incorporated in programs across the Region and to coordinate with programs where they is a nexus with
CEH. Environmental Education, US/Mexico Border, Environmental Justice, Tribal, Drinking Water, and
other programs frequently touch upon CEH issues.
OCHP
The Advisor continues to attend monthly CEH national calls, coordinates with other senior agency CEH
leaders, and advises newer Regional Coordinators. In 2018, she consulted with Region 6 staff and HQ
management to overcome Regional contract obstacles to obtain logistics support from a national
contract for the Tribal Summit to be held in Region 6 in October.
Air Quality
The CEH Advisor was one of several Region 6 employees who attended a half day focus session hosted
by the City of Dallas' Office of Environmental Quality (OEQ) and the Nature Conservancy on Friday,
November 17, 2017. They were seeking input to address the challenge of childhood asthma and poor
air quality in the Dallas area. The session, attended by key stakeholders considered the concept of a
collaborative research and implementation initiative to monitor local air quality at DISD schools with
known high rates of asthma, related absenteeism, and a plan to study the impacts of proposed
interventions. (Note: In the summer of 2018, there has been some follow up initiated).
For two years in a row, the CEH Advisor enrolled the Region in the
springtime AQI Flag Program Challenge. Last year, Region 6 placed third
in the national competition to secure as many new schools as possible in
the program. In FY18, Region 6 came in second place, with 53 new
schools registered to implement the AQI Flag Program all located within
the air quality north Texas non-attainment area. (While the actual
number of registrants was 62, only 53 registered prior to the deadline.)
During the summer, the Advisor coordinated with OAQPS, ATSDR, the PEHSU, and OCHP related to the
release of Ethylene Oxide. OAQPS requested assistance with communicating health risks associated with
the release of this chemical which was noted to be higher in in some regions as recorded in a recent
report than in previous reports.
Environmental Education, Earth Day and Border
This spring, CEH Advisor volunteered to read grant proposals and recommend funding to support the
Environmental Education Program. CEH had an exhibit for Earth Day at Fair Park. Five staff from the
Multimedia Division set up or volunteered to staff a booth the weekend of April 20-22, 2018. The
Children's Health program coordinated logistics for the event.
The Advisor also met several times with the US/Mexico Border program to share information about on-
going CEH Border work and to ensure CEH was included as a fundamental strategy in addressing
Border 2020 goals.
Air Quality
Flag Program
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learn more at:
w.gov/ftag
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Advising and Coordinating on Children's Health Programs
Drinking Water
In FY18 the Drinking Water Program tested Tribal schools and Head Start facilities for lead in drinking
water. After the testing, an email was sent that gave the facilities an advance update of the results. The
email will be followed up with a formal letter to the Governor with the paper copy of the lab results. The
CEH Advisor is listed in the letter as the contact for questions for parents or community members.
Facilitation and Presentations
On April 4th, the CEH Advisor facilitated a first-ever bi-regional (R6/R9) children's health/border
conference call. The purpose of the call was to create a synergy and open the lines of communication
between grantees who are working across three states (TX, NM, AZ) on children's health issues-lead,
asthma, integrated pest management, and reducing exposure to hazardous chemicals-to introduce
Region 6 and Region 9 grantees to each other, and to share training curriculum and other resources.
Five grantees, Regional children's health and border staff, and headquarters were all represented on the
call. Grantees requested EPA create a digital space to collect/share CEH curriculum. The next call will be
in 3-6 months, dependent upon grantee's request.
On July 11th, Region 6 and 9 staff co-presented during an ORD webinar on CEH initiatives on the US-
Mexico border from 2014 thru 2018. The presentation covered the symposia in 2015 and 2016, Healthy
Homes training, vector-borne illness training and the activities of the CEH grantees.
On August 28th, the CEH Advisor presented the success of the Region 6 strategy to promote the AQI Flag
Program on a quarterly national webinar, describing how our approach garnered dozens of new
registrations during the spring challenge.
Coordinating with External Partners
The PEHSU continues to be a key partner for Region 6 and in FY18, they hosted a series of Healthy
Homes events and Promotora workshops focusing on lead poisoning prevention. The course is designed
for environmental health professionals, community health workers, school health workers, housing
advocates, code enforcement inspectors, and other public health front line workers.
July 18 Healthy Homes in Las Cruces, NM 20 community health workers attended
August 13 Healthy Homes in Albuquerque, NM 12 people attended
October 12 Promotora Workshop in El Paso 85 registered as of October 1st
Additional workshops are in development for FY19 in Louisiana and Arkansas.
The City of Dallas has always been a partner for CEH initiatives. On July 9, Region 6 lead and CEH staff
met with Bob Curry, Code Compliance Manager for the City of Dallas to discuss ways city code can
support children's environmental health and lead poisoning prevention. Mr. Curry was asked to present
his approach to Healthy Homes during the CEH Symposium in Dallas on September 15th.
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The Health and Wellness Alliance for Children (HWAC), a division of Children's Health Hospital has been
a significant partner with Region 6 for several years. Region 6 Children's Health Advisor met with
Respiratory Therapist during the last week in January to re-connect on children's health initiatives. As a
result of the meeting, Children's Health was a key participant in the CEH Symposium in Dallas later in the
year facilitating the continuing education credits and providing two presenters for the training.
Region 6 HHS Administration for Children and Families Working Group hosts a quarterly meeting in
which the CEH Advisor participates. While the meetings were suspended for most of 2018, the ACF has
requested to meet with EPA in late October to learn more about ways in which to collaborate.
In late summer, the Children's Health Staff attended a brief meeting and bus tour of the Trinity Park
Conservancy's office and planned park area for the 200-acre Trinity Park. The CEH Advisor was invited
because of her ongoing partnership with the Health and Wellness Alliance for Children (She served as
co-chair of the HWAC's Asthma sub-committee with current Conservancy CEO, Brett Brown). The
Conservancy plans to hold several community workshops and would like for EPA to participate.
Finally, the CEH Advisor was featured for the CEH Symposium in the September edition of the Region 6
internal Weekly Newsletter and also on the main EPA intranet page at the beginning of Children's
Health Month.
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