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MHE Program Introduction

What is the MHE Program, and Why

The Master Home Environmentalist© (MHE©) program is an innovative approach to addressing issues of indoor pollution that can damage health and the environment. It is efficient to assess exposure to pesticides, allergens, molds, tobacco smoke, lead, and home chemicals in one visit rather than through separate programs and an integrated in-home intervention may help to reduce total exposure to many pollutants.

The MHE program trains volunteers to visit homes at no cost and to assist residents in assessing and managing environmental health problems. The MHE volunteer utilizes a survey form called the Home Environmental Assessment List© (HEAL©) to identify potential problems and develop, in conjunction with the resident, an action plan to reduce exposure to pollutants. The personalized action plan can lead to steps such as use of efficient vacuums and quality door mats, shoe removal at the door, ventilation, integrated pest management, and allergen control. Most of these measures are low cost. Some measures to improve ventilation and control moisture may require some time and money to implement.

Indoor pollution has been identified by the United States Environmental Protection Agency Science Advisory Board (EPA, 1987, 1990) and the Centers for Disease Control (CDC, 1991) as a high environmental risk. And according to the EPA, currently we spend about 90% of our time indoors and our indoor air can be up to five times as polluted as our outdoor air. The problems with exposure to pollutants in the home often are not addressed due to lack of awareness of their prevalence and significance. Home pollutant exposure may result in asthma, retarded growth, learning disabilities, allergies, cancer, lung disease, symptoms of sick building syndrome, and other illnesses.. Important new information about the alarming rise in childhood asthma cases and hospitalizations has added new urgency to addressing indoor pollution.

The Master Home Environmentalist program is designed to assist people in identifying health and environmental concerns at home and to make recommendations that help them to reduce their exposure to indoor pollutants. Some of the key concepts emphasized in the program are:

Children’s Risk

• Risk is associated with the nature of a substance, its concentration, and the exposure that people have to it. A highly toxic substance can cause harm at lower levels of concentration and less exposure. Chemical sensitivity is a variable that can cause people to have problems at significantly lower levels of concentration or exposure.

• A key pathway for exposure to hazardous substances is house dust. House dust contains lead, pesticides, dust mites, and other potentially toxic substances. It can be controlled by reducing track-in and by effective and regular cleaning.

• Cleaners, paints, pesticides, and other hazardous household substances need to be chosen and managed with care. Choose non-toxic or less toxic alternatives, securely store hazardous products, and dispose of them properly, usually at hazardous waste collection sites.

• Indoor air carries dust and potentially tobacco and wood smoke and fumes from combustion appliances and building materials. Radon and outdoor pollutants can also present health risks. If an assessment of indoor air quality indicates a problem, then sources of pollutants should be controlled and proper ventilation provided.

• Biological concerns include living organisms or their waste products, as well as diseases and allergies. The best remedies are to keep humidity low, clean and maintain areas where molds and other organisms are likely to grow, and wash hands often.

• People are very sensitive to being told how to clean and maintain their homes. We need to be culturally sensitive, respond to people's needs, be aware of people's styles of learning, and work with people where they are instead of imposing an agenda on them.

• The HEAL (Home Environmental Assessment List) is a tool to assess a home situation and make recommendations for positive changes. The most important opportunities can be found where there are young children, people with allergies, the elderly, and pregnant women.

Many home environmental health issues are of special concern in low income areas, where the incidence of poisoning, lead exposure, asthma, allergies, and risks from living in older homes are greater than in other communities. Health risks from these factors are increased by the presence of other risk factors at higher levels, such as poor nutrition and infants with low birth weights.

Who, Where, and When

The MHE program originated in Seattle, serving all of King County

Early 1992 Home Toxics Task Force established (League of Women Voters, Sierra club, WEC, Audubon Society, Washington Toxics Coalition, Metrocenter, Seattle Citizens for Quality Living)

Fall 1992 Mayor’s Environmental Action Agenda and press conference kicked off program.

Planning Team developed program and created training

Spring 1993 First volunteer training held

Partnerships Building successful partnerships and collaborative efforts with the Environmental Protection Agency, Washington State Department of Health, Public Health – Seattle King County, City of Seattle Department of Household Hazardous Waste, University of Washington, American Lung Association (National), Washington Toxics Coalition, The Tenants Union, City of Seattle Environmental Justice Division, The International District Housing Alliance, the Community Health and Education Foundation, Community Coalition for Environmental Justice, Neighborhood House, The Urban League, Langston Hughes Performing Arts Center, The Refugee Women’s Alliance, Naturopathic physicians, allergists, energy conservationists, volunteers and communities

Expansions ALA of Oregon, ALA of Central California, ALA of North Dakota, ALA of Washington (Tacoma, Yakima and Spokane), ALA of Rhode Island, ALA of Metropolitan Chicago, ALA of Santa Clara-San Benito Counties, Idaho Division of Health, Chelan Douglas Health Department (WA), The Confederated Tribes of the Colville Reservation, Okanagan Public Health Department (WA), Thurston County Health Department (WA), The George Washington University of Public Health and Health Services; Mid Atlantic Center for Children’s Health, Metropolitan Health District of San Antonio, TX, NY City Health and Hospital Corporation; Woodhull Hospital Asthma Program

Awards 2001 ALA National designated MHE as a Best Practices Program

Received EPA 2005 Children’s Environmental Health Award

2005 Seattle City Council proclaimed May 3, MHE day

2006 Program Components (HEAL, Spanish HEAL, Do It Yourself HEAL, Do it Yourself HEAL Spanish, MHE training Manual, MHE Facilitator’s Guide, MHE Recruitment Guide protected by US Copyright

Vision: We have a common vision of the home as a safe, healthy environment for all family members.

Mission: To promote health by reducing pollutants in the home through volunteer-based education and action.

Values & Principles: We believe that:

• A healthy home environment promotes a quality life, particularly for children;

• Residents have a right to know of hazards in their home;

• A personalized approach is effective in motivating people to improve their home environment;

• Residents, through their own actions, can make changes in their home to prevent illness; and

• Volunteer outreach and education enhance health and build a strong community

Program Goals

1. To increase awareness of environmental and health risks from pollutants in and around the home.

2. To train volunteers in the knowledge required to conduct Home Environmental Assessment Lists (HEALs) that will lead to a reduction in exposures to pollutants in and around their own home and the homes of other people.

3. To organize and conduct educational outreach activities.

4. To evaluate the effectiveness of the program in reducing home exposures and changing environmental health behaviors.

Volunteers

We hold two training session a year in the spring and in the fall. We accept approximately 15 - 25 volunteers per training

The recruitment strategy begins 3 months prior to the start of class with a major publicity campaign designed to develop a large number of applications. Volunteer recruitment efforts involve a variety of methods of getting the word out

• Local media - news releases in daily papers, weekly neighborhood papers, local environmental and health organization newsletters, and on radio and TV

• Word of mouth - volunteers are our best recruiters

• Professional conferences - flyers, word of mouth at local indoor air and hazardous waste conferences

• Businesses, government agencies, universities - posting flyers and sending email announcements for employees and students

• Community - flyers distributed and posted at libraries, community centers, local health and environmental organizations

Who are the volunteers?

The program simply would not exist without volunteers. Our strong volunteer base includes people from diverse professions including: toxicology, public health, nursing, parents, home inspectors, industrial hygienists, small business owners, software developers, homemakers, allergists, physician’s assistants, interior designers, retailers, undergraduate and graduate students, retired persons, graphic artists, construction, etc.

Many volunteers have conversational language skills other than English including: Spanish, Vietnamese, Korean, Tagalog - Filipino dialect, American Sign Language, Arabic, Swedish, German, Dutch, French, Greek, Italian, Japanese. Volunteers from many diverse backgrounds are also drawn to the MHE program including: African-American, Hispanic, Vietnamese, Chinese-American, Filipino, Korean, Native American, Dutch, German, French, East Indian, and Japanese-American ethnic groups and Lesbian and Gay community members.

People volunteer for various reasons including: their health has been personally affected by indoor pollutants (allergies, asthma, chemical sensitivities), they are interested in protecting children’s health, enjoy volunteer work and teaching others, want to increase their knowledge base, exploring environmental careers.

Approximately 70% women, 30% men

20% high school and/or some college, 55% Bachelor's degree, 25% Masters degree or above

Applications and interviews

Volunteers complete an application form. We look for people who demonstrate an ability to work effectively with others, who have a strong interest or passion in the issues, and are interested in doing volunteer outreach.

Applications are screened and the top candidates are interviewed. Interviews are informal, they are a chance for them to get to know the program in greater detail and for us to get to know them. We pay close attention to candidates’ interpersonal communication skills, especially their listening skills and their ability to develop rapport. The interview process has been effectively used to weed out those who have lower levels of commitment to the outreach portion of the program. We select approximately 15-25 volunteer per class. We have found that this size allows for volunteers to get to know each other and allows most volunteers time to share their experiences with their pees (especially at the snack break!).

Training

Volunteers are not trained as professionals, but have the ability to identify areas of concern, to suggest low cost/no cost methods for reducing indoor pollution, and to recommend that people contact experts where significant areas of concern have been identified. They are educators and resource people.

We have created a solid volunteer training model. The training is a 35 hour evening session over 10 weeks which includes technical topics as well as interpersonal communication and hands-on experience with the Home Environmental Assessment List. The volunteer training manual is given to each volunteer and is designed to be used as a reference in outreach activities. The manual includes chapters covering toxicology, environment (outdoor air, solid waste, and water), lead, dust, hazardous household chemicals, moisture, biological contaminants, allergies and asthma, and indoor air pollution.

Sample Training Schedule

Tues. 3/7/06 6:30-9:00 Introduction to the MHE Program

Tues. 3/14/06 6:30-9:00 Moisture & Biological Contaminants

Tues. 3/21/06 6:30-9:00 Toxicology and Lead in the Home

Tues. 3/28/06 6:30-9:00 Communication & Behavior Change

Tues. 4/4/06 6:30-9:00 Natural Lawn Care

Dust in the Home

Sat. 4/8/06 9:00-3:00 Asthma/Allergies Overview

HEAL Overview & Home walk thru

Tues. 4/11/06 6:30-9:00 Environmental Justice

Tues. 4/18/06 6:30-9:00 Household Chemicals

Tues. 4/25/06 6:30-9:00 Landlord Tenant Right & Responsibilities

Second Hand Smoke

Sat. 4/29/06 9:00-3:00 Indoor Air Quality & Ventilation

IAQ Home Walk Through

Tues. 5/2/06 6:30-9:00 Community Outreach

HEAL Training & Scenario’s

Tues. 5/9/06 6:30-9:00 MHE Graduation

The class trainers are experts in their given field. The instructors include: two air quality engineers/scientists, University of Washington Dept. Professor, Washington Toxics Coalition Staff Scientist, Public Health – Seattle King county staff, a Toxicologist, the Executive Director of the Tenants Union, and the American Lung Association of Washington Asthma and Environmental Health program staff and volunteers.

By the completion of the training we want the volunteers to have a solid background and understanding of pollutant sources found in homes, skill in identifying potential concerns and practice making recommendations to residents on how to reduce their exposure to pollutants in home. We want the volunteers to be comfortable with the HEAL and process, have knowledge of community resources, awareness of what motivates people to change, an appreciation of the challenges in making personal changes, and effective communication skills.

Volunteer Development and Management

Volunteers are asked to make a commitment of 35 hour outreach for program within one year, which includes completing at least five HEALs

Volunteer appreciation events- continuing education, chance to meet other volunteers, to learn new or brush up on topics, build camaraderie, share experiences

Quarterly Volunteer newsletter - sharing noteworthy info, feature articles on topics of interest, sharing vols’ experiences, special project updates, etc

Management - PTE manages public requests for HEALs, speakers, etc with volunteers

HEAL

HEAL is the Home Environmental Assessment List, a survey volunteers use to in assessing home toxic exposures and pollutants and in setting priorities for action. We also call the home visit itself a HEAL. The purpose of the HEAL is to identify ways in which a home can be made more healthy.

The HEAL is designed to be used by a volunteer in conjunction with residents. The volunteer and resident may sit down at the kitchen table to go over the HEAL questions and/or they may take a walk through the home to identify potential concerns. Once the home has been assessed the volunteer reviews the issues of concern with the resident and encourages specific behavior changes. The recommended behavior changes are presented to the resident in a Home Action plan checklist.

Two additional contacts with the resident make up the follow up component of the HEAL. Volunteers are asked to check back with the residents two weeks after the visit to answer additional questions and to encourage suggested changes. At six weeks after the HEAL visit, MHE program staff calls the resident to respond to any questions and to collect data on actions that the residents have taken as a result of the HEAL intervention.

The HEAL form is divided into sections:

• Background information: age ranges of residents, health symptoms, age of home, why they requested a HEAL

• Dust and lead control

• Moisture problems

• Indoor Air

• Hazardous Household Products

• Home Action Plan

Outreach

Marketing - Media, word of mouth, referrals (med clinics, EPA, WTC, health dept)

volunteers write press releases, develop press kits (including taking photos) make contact with media, work with reporters to publicize program

Speakers Bureau – Workshops and Health Fairs

Powerpoint presentations on: MHE overview, Indoor air, Dust, Moisture and mold, household hazardous chemicals

Community events - Staff an interactive Household Hazardous Waste education exhibit designed to involve school age children, Staff MHE exhibit, with colorful, eye-catching table top display at neighborhood health fairs

Special Projects – ‘Little Lungs Breathing’ a modified workshops on indoor air quality to child care providers, HEALs for child care centers.

Evaluation

A University of Washington study of homes visited by Master Home Environmentalist volunteers found that the visits led to changes in people’s behavior to improve the home’s environmental health. Three months after the volunteers’ visits, 32 out of 36 households had made at least one positive change while only four households made no change.

Households made more changes when visited by volunteers wit more experience, The more recommendations the volunteer made, and the more likely the family was to make a behavior change. All 36 thought the HEAL visit was beneficial and would recommend the visit to their friends and families.

The results of this study were published in Environmental Health Perspectives, October 1997, pp.1132-1135, titled ‘Behavioral Changes Following Participation in a Home Health Promotional Program in King County, Washington’.

CAFK Master Home Environmental Program Effectiveness Evaluation: Families

Perceived Benefit of the Home Environmental Assessment Visit Janet Primomo Oct. 3, 2001

Families who request a Home Environmental Assessment are asked to participate in the evaluation study to determine behavior change and perceived benefits of the intervention. Between 1998 and December 2000, a total of 58 families completed both the Intake and Follow-up surveys. The summary below is a preliminary report on data analyzed.

Asthma severity was reported on a total of 46 children (Q # 7). Of those with a rating of asthma severity, 26% (n=12) of the children had mild asthma (wheezing, cough, one to two attacks a year); 43% (n=20) had moderate asthma (seasonal with weather changes and colds, 3-4 attacks per year); and 30% (n=14) had severe asthma (requires hospitalizations, school absences, activity limited, more than four attacks per year). Fourteen children had been hospitalized or had gone to the emergency room in the past year for asthma. Twenty children took medications on a daily basis for their asthma.

95% (n=55) of families found the home environmental assessment visits useful in helping them understand sources of asthma and allergy triggers.

Regarding behavior change, 94% (n=54) of families made at least one of the changes recommended by the volunteers. Most important, 87% (26 of the 30 families who responded to the question) reported that the home environmental visit made improvements in their child’s asthma or allergies.

The results of this study were presented at the ATS Conference 2003 and Chest Conference 2003.

For more information please contact:

Aileen Gagney

Asthma and Environmental Health Program Manager

American Lung Association of Washington

2625 Third Ave. Seattle, WA. 98121-1200

206.441.5100

agagney@

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