Indiana Lead-Safe & Healthy Homes Newsletter

August 2005 Edition

Improving Kids’ Environment (IKE) and the Indiana Lead-Safe Task Force publish this newsletter

every two or three months at no charge for anyone interested in issues and events involving lead

poisoning prevention and healthy homes in Indiana.   Distribution is by email or fax – preferably

by e-mail.   Contact the editor, Janet G. McCabe, at mccabe@ikecoalition.org or 317-902-3610

if you want to contribute articles, edit the draft newsletter, contribute an article, or want to get on

or off the distribution list.  All editions are available on IKE’s web page at

http://www.ikecoalition.org/publications.htm. 

Lead-Safe Indiana Task Force – Tuesday, Sept. 20

Please join us for the Lead-Safe Indiana Task Force meeting and an EPAC Housing

and Environmental Subcommittee meeting on Tuesday, September 20 from 10:00 to

2:30 at the Environmental Management Institute on Indy’s Westside. –

5610 Crawfordsville Road, Suite 15.  The EPAC Subcommittee will meet from 10 to

12 in the morning.  The Task Force will meet from 12:30 to 2:30.  We will order

pizza for those who want to participate in both meetings.  The meetings are open to

all.  It will be a great chance to network, wrap up loose ends on the conference,

and get up to date on the latest issues.

ISDH and FSSA Sign MOU for LHD Reimbursement

On July 21, ISDH Commissioner and Medicaid Medical Director Dr. Judy Monroe

announced that ISDH and FSSA had entered into a Memorandum of Understanding

to provide reimbursement to local health departments for their case management

and environmental investigations of lead poisoned children covered by Hoosier

Healthwise.   Hoosier Healthwise is Indiana’s Medicaid and Children’s Health I

nsurance Program (CHIP).   The MOU is being finalized and IKE will post a copy

of the MOU on its website as soon as it is available. 

This MOU is a major milestone that fulfills the

agencies’ joint commitments made to Senator Gard in a joint letter on April 7. 

Under the approach, local health departments will need to submit a claim directly

to Hoosier Healthwise.   Because the claims will be paid as administrative expenses, only half of actual expenses will be paid.  However,  IKE understands that this should actually provide

more reimbursement than the traditional formula approach. 

ISDH is planning to provide training for local health departments in November –

possibly in association with the Indiana Lead-Safe and Healthy Homes Conference.

IKE is excited to see this progress.  Clearly Dr. Monroe as Commissioner of ISDH

and medical director of Medicaid played a key role.  In addition, Loren Robertson

and Michelle Milliken had the persistence to work through the details to make sure

it worked.  Thanks to both ISDH and FSSA.

IN EPAC Housing Subcommittee Presents Recommendations to EPAC

for Adoption

On July 21, The Housing Subcommittee co-chair Mark Young of IHFA presented

seven recommendations to the ISDH Lead Elimination Plan Advisory Council (EPAC)

for its consideration.  Click here for a copy of the report and recommendations.   

The recommendations are as follows:

1.        ISDH, HUD, IDEM, the office of the Attorney General with the advice and

      support of the Environmental Management Institute and Greentree should jointly

      formulate an integrated sample risk assessment form and format to help improve

      the quality and consistency of the risk assessments conducted in Indiana. 

2.       IDEM should describe its strategy to improve compliance with its risk

      assessment requirements including a description of its plans for enforcement

      to address chronically deficient reports.

3.       ISDH should coordinate with federal, state and local agencies to receive

      summaries of all risk assessments done as part of any project paid for with government funds and offer to accept any voluntary submissions of risk assessments.  ISDH should maintain this information in its database.

4.       With its database quality assurance efforts complete, ISDH should generate a new listing of houses that may have lead poisoned a child or multiple children.

5.       ISDH should review the City of Bloomington's protocol for performing risk assessments for children who have blood lead concentrations from 5 to 9 micrograms/deciliter.

6.       IDEM should provide EPAC with basic statistics on the number of active risk assessors and the quality of risk assessments based on its call-in of recent risk assessments.

7.       Recognizing the significant benefits of the Office of Attorney General’s commitment, ISDH should, in cooperation with other agencies, determine whether the state is on a trajectory to realistically achieve the goal of eliminating lead poisoning by 2010 and, if reaching the goal is not likely, determine if legislation proactively requiring testing and remediation of lead hazards in rental property is required.

The most significant recommendation is the last one.  In essence, the subcommittee is saying Indiana’s short-term objectives do not appear to be on a path to achieve its goal of virtually eliminating lead poisoning.  The subcommittee is asking EPAC to find out ISDH’s assessment of the situation and seriously consider the bold step of requiring proactive assessments and remediation of lead hazards in rental property.

Thanks to a motion by Dr. John Ellis, EPAC decided to ask the state agencies for written feedback on the recommendations by August 22 and to hold a special meeting on September 15 from 10 to 12 to decide how to handle them.  Stay tuned!

IN EPAC Evaluation Subcommittee Reports Need to Revise Plan

The EPAC Evaluation Subcommittee identified two serious problems with the Lead Elimination Plan approved by ISDH and CDC in 2004.   Click here for a copy of its report.  The two problems are:

1.                    Unstated Assumptions for Goal Measurements:  The measurements for achieving the goal of eliminating lead poisoning as a public health problem by 2010 are based on absolute numbers of children at various levels of poisoning.  As stated, the goal could be achieved by testing fewer children.  While Long-Term Goal B does state the need to have tested a certain percentage of children in different groups, the assumption of the number of tests and demographics of the children tested should be integrated explicitly into the measurement for the Final Goal.

2.                   Disconnect Between Short-Term Objectives and Long-Term Goals:  As the measurements for the Long-Term Goal for “Increased Number of Dwellings and Child-Occupied Facilities Identified/Tested/Made Lead-Safe” are stated, it is highly unlikely that fully implementing the short-term objectives will achieve the stated measures for the long-term goals. 

Assuming steady progress over the six years between 2005 and 2011, Indiana would have to conduct 104,800 risk assessments in 2005.  Each of the 202 currently licensed risk assessors would need to be conduct more than 52 risk assessments a year.  The best estimate is that there were at most 500 risk assessments done in Indiana in 2004 with at most 15 risk assessors working full-time and many currently do no risk assessments each year.  Using HUD’s reimbursement cost for a risk assessment of $350, the cost would be $36.7 million per year.  Each year Indiana does not meet this rate results in a greater burden in future years.

Similar problems are present with the measurements of units made lead-safe.  Using HUD’s estimate published in 2002 that 25% of all housing (not just housing built before 1960 or 1940), 125,000 housing units would need to be made lead-safe by July 1, 2011.  That is probably 100 times greater activity than Indiana saw in 2004. 

Indiana needs to reconcile this disconnect or acknowledge that accomplishing the objectives will not be enough to meet the long-term goals.  It can reconcile the disconnect by lowering its goals or by upgrading – and achieving – its short-term objectives.

As noted above, EPAC decided to ask the state agencies for written feedback on the recommendations by August 22 and to hold a special meeting on September 15 from 10 to 12 to decide how to handle them.    

Seven Indiana Organizations Apply for HUD Grants

Maria Larson of ISDH reported that seven Indiana organizations applied for eight lead hazard reduction grants from HUD in June.  MCHD applied for two grants.  HUD should announce its decision in September or October of 2005.  Last year nine organizations applied but all were denied in a seriously flawed process.   

·         Fort Wayne Allen County Health Department requested $429K for lead outreach. 

·         City of Bloomington asked for $795K for lead hazard control.

·         The Cities of Gary, East Chicago and Hammond teamed to ask for a $3 million Lead Hazard Reduction Demonstration Grant.  They were able to secure a $5.1 million match thanks to contributions from local banks and landlords.  HUD only required a $0.75 million match.

·         Marion County Health Department applied for a $3 million lead hazard control grant and a $4 million demonstration grant.  It provided a $3.75 million match primarily from the matching contributions of landlords.  HUD only required $1.3 million in match funds.  MCHD also reported that landlords had identified more than 800 units to be cleaned up.

·         Housing Authority of South Bend applied for a $2.2 million lead hazard control grant. 

·         Vigo County Health Department applied for a $575K lead outreach grant.

The application from the Cities of Gary, East Chicago and Hammond was particularly important since they secured significant commitments from banks in a partnership effort.  And like MCHD they challenged local landlords to put up matching funds to clean-up properties.   They leveraged the Attorney General’s offer to pursue litigation against recalcitrant landlords into proactive commitments by progressive landlords.  Yes!

IDEM Reduces Risk Assessment Errors  significantly

For the third year in a row, IDEM asked risk assessors in June 2005 to provide a copy of their two most recent risk assessments.  Indiana regulations require risk assessors to respond to the request.   

Late in 2003,  76 of 221 licensed risk assessors responded to IDEM’s request.  They submitted 128 reports.  IDEM reviewed half of them and found that 88% were deficient.  The most common error was that 59% of the reports failed to include detailed descriptions of any of the following:  abatement options, interim controls, maintenance options and/or monitoring.  IDEM provided general follow-up guidance to all and specific guidance to authors of the deficient reports.

Late in 2004, IDEM made a similar request.  55 of 185 licensed risk assessors submitted reports.  50 risk assessors failed to respond.   IDEM reviewed 50 of the reports and found 9 to be deficient.  IDEM issued violation letters to the nine authors.   Click here for a copy of IDEM’s report summarizing its work.

Although you can’t compare the 2003 and 2004 results directly without knowing more about which Risk Assessors responded and which reports IDEM reviewed, there clearly is increased awareness among risk assessors about how to complete reports properly.  Congratulations to IDEM and licensed risk assessors.  Reducing the rate of deficient reports so substantially  in one year is a major accomplishment!  It will be interesting to see how they did in 2005.  Thanks to Janusz Johnson and John Clevenger for their work.

Changing Faces

·         IKE Brings on Janet McCabe at its New Executive Director.  On June 6, Janet G. McCabe became IKE’s executive director.  For the past five years, she was the Assistant Commissioner for the Office of Air Quality at the Indiana Department of Environmental Management.  She was a branch chief at the office for seven years before becoming Assistant Commissioner.  Indiana’s lead-based paint activities licensing program reported to her at IDEM.  She will continue to have an active role in lead poisoning and healthy homes issues at IKE complementing it with a focus on air pollution issues.  Click here for a copy of IKE’s announcement of her appointment. 

·         IKE’s Tom Neltner moves to National Center for Healthy Housing.  Effective August 1, Tom Neltner moved from Improving Kids’ Environment to be the Director of Training and Education at the National Center for Healthy Housing in Columbia, MD.  You can reach him at tneltner@centerforhealthyhousing.org.

·         HUD’s Mary Ellen Burke moves to Denver Office:  Mary Ellen Burke has been the point person for HUD’s Indy office for several years.  She has served as co-chair of EPAC’s Housing Subcommittee.  She has been an active and constructive participant in meetings and discussions.  She has worked with HUD-funded agencies to work o compliance problems.  And she has managed several innovative pilot projects.  The bottom line is that she has been there with ideas, effort and results.  In August, she will be moving to HUD’s Denver office.  We will miss her!

·         Allen County’s Loren Robertson moves to ISDH.  Loren Robertson has been the long-time administrator of the Fort Wayne – Allen County Health Department.  In that role, he has been a key player implementing the vision of Dr. McMahan – the department’s chief health officer – to eliminate lead poisoning.  In June, he became an Assistant Commissioner at the Indiana State Department of Health overseeing the childhood lead poisoning prevention program (and much more).  Kids are already starting to benefit based on the ISDH-FSSA MOU described above. 

·         IHFA’s Kim Wize moves to Indianapolis Housing Agency.  While Executive Director at the Indiana Housing Finance Authority, Kim Wize has been a strong supporter for lead poisoning prevention efforts in Indiana providing critical funding for the conference.  She has moved to the Indianapolis Housing Agency where she will be deputy director.

IN EPAC Learns of Progress and Considers Proposals

On July 21, the ISDH Lead Elimination Advisory Committee (EPAC) met under the leadership of HUD’s John Hall to track progress implementing Indiana’s Virtual Elimination of Lead Poisoning Plan.  EPAC’s next meeting is Thursday, October 13, 2005. 

EPAC members heard from:

·         Dr. Monroe, ISDH Commissioner, about her commitment to reducing lead poisoning and progress that ISDH and FSSA have made in recent months.   

·         Tim Junk of the Office of the Attorney General, who explained the offer by the Attorney General to file suit against landlords who fail to respond to health department orders to cleanup property where children have been lead poisoned or are living with lead hazards.  The AG has not received any referrals yet.  But IKE’s Tom Neltner reported that the program has already begun to shift landlord’s perspectives on the need to clean-up their property.

·         Dave McCormick of MCHD and Maria Larson of ISDH provided an update on HUD grant applications.  Seven organizations applied in 2005. 

·         Jo Rhodes of ISDH announced that she had articles about lead poisoning prevention in Indiana that local programs can reprint.  Contact her at 317-233-1294 or jrhodes@isdh.in.gov.    

·         Wayne Syvinski of ISDH reported that copies of the Lead Screening Requirements and Medical Management Recommendations are available in a multi-colored, easy-to-use, poster or one-page format.  Contact him at (317) 233-5605 or click here for a copy.  It will be posted on ISDH’s webpage soon.

·         Linda Baker of Centene is chair of the Screening Subcommittee.  She reported on efforts to recruit other managed care organizations and to better integrate lead screening with Indiana’s new immunization tracking program.  Contact her at (317) 684-9478 or lbaker@centene.com.

IN Conference Update – Who & When

Planning for the 2005 Lead Safe and Healthy Homes Conference is well underway and promises to be a great opportunity to network and learn the latest, in session tracks focusing on Healthy Homes, Healthy Kids, Policy and Technology, and opportunities for discussion with plenary session speakers and other presenters.  A sample of topics, to peak your interest, includes:

·         Lead Poisoning 101

·         Successes and Strategies for Successful Applications for HUD Grants

·         Exterior Treatment and Soil Cleanup—Best Practices

·         Case Management in Action

Dr. Judith Monroe, Commissioner of ISDH, will provide the keynote address.

Thanks to ISDH, HealthVisions Midwest, Marion County Health Department, and the Environmental Management Institute who have already agreed to provide generous sponsorships.  Other organizations interested in sponsoring the conference, which allows us to make sure that everyone can attend who wants to, should contact Janet McCabe at mccabe@ikecoalition.org.

A brochure will be coming out soon, but mark your calendars now for November 8 and 9 at the Marten House Hotel in Indianapolis (same location as last year).

Vigo County Red-Tags Another Property

In response to particularly high blood lead levels in a child, the Vigo County Health Department red-tagged another apartment building when the landlord appeared unwilling to take the positive steps needed to address the lead hazards.  Once the property was declared uninhabitable, the landlord began to take affirmative action.  IKE is pleased to see the health department act quickly and decisively to protect kids in Terre Haute.

Check Out New Resource for Affordable Housing

Check out www.indianahousingnow.org to help residents find affordable and accessible housing for rent or for sale.  It is a good resource as you help residents find alternative housing.  Unfortunately, the service does not make sure the property is free of lead hazards or other environmental threats. 

IKE Joins in Notice of Intent to Sue EPA on R & R Rule

On July 6, IKE signed onto a notice of intent to sue the Environmental Protection Agency for its failure to implement its statutory mandate to regulate renovation and remodeling activities.  Public Employees for Environmental Responsibility (PEER) is the lead organization on the notice.  Ten other organizations signed the notice including Indy’s Organization for a New Eastside.

In response to the notice as well as pressure from Senator Barak Obama of Illinois, EPA announced on July 22 that it would initiate rulemaking as part of a comprehensive training and education package in December 2005. 

ISDH Rules – Where Do They Stand? 

ISDH is working hard on draft rules to respond to the mandates of SEA-538, which addresses blood lead test reporting and case management for lead poisoned children. A draft is expected to be submitted to the ISDH Executive Committee.  The ISDH Executive Committee sets the public health rules for Indiana.

New Resource for Healthy Homes

The National Healthy Homes Training Center is funded by a grant from the Centers for Disease Control and Prevention to develop the infrastructure and resources to help states, cities, and community-based organizations effectively identify and address housing-related hazards.  The Training Center will help build capacity and competency among health, environmental and housing practitioners and promote cross-disciplinary activities. One of the first steps in meeting this goal was the development of a two-day training program. For further information contact Bill Menrath at bill.menrath@uc.edu or visit the following website:

Mark Your Calendars

§         Lead-Safe Indiana Task Force Meeting in Indy.  All are welcome to attend these meetings to discuss lead poisoning and healthy homes issues across Indiana.  It is a great networking and planning opportunity.  Contact Janet G. McCabe at mccabe@ikecoalition.org or at 317-902-3610 for details.  All meetings will be at the Environmental Management Institute, 5610 Crawfordsville Road, Suite 15.  We will try to coordinate the meetings with Indiana EPAC’s Housing Subcommittee meetings.

o        Tuesday, September 20 – 12:30 to 2:30 (moved from September 13)

o        Tuesday, December 6 – 10:00 to 2:00 (likely combined with EPAC Housing Committee meeting)

§         Indiana Lead Elimination Plan Advisory Committee (EPAC) in Indy.  The committee is charged with advising ISDH on the state’s implementation of the state lead elimination plan.  The meetings are open to the public.

o        Thursday, October 13 – 10:00 to 12:00 at HUD’s Offices at 151 N. Delaware St., Suite 1200

o        Housing and Environmental Subcommittee – Tuesday, September 20 from 10:00 to 12:00 at Environmental Management Institute, 5610 Crawfordsville Road, Suite 15.

§         Training

o        Free EPA & HUD-Approved Lead Safe Work Practices Course.  Contact Masimax at leadsafetraininginfo@masimax.com or go on-line at www.leadsafetraining.org.  

§         Chicago on August 11

§         Evansville on November 5, contact Trina Schaefer at 812-429-1395

o        Accredited Lead Training at the Environmental Management Institute in Indy.  Contact EMI at 800-488-8842 or www.envtlmgmt.org.

§         Mold Remediation – July 26 to 28 and December 12 to 14

§         Lead Abatement Supervisor Initial – August 22 to 25

§         Lead Inspector / Risk Assessor Initial – September 26 to 30

§         Lead Abatement Worker Initial – October 25 to 26

§         Lead Abatement Worker Refresher – October 27

§         Mold Awareness – November 21

§         Lead Inspector / Risk Assessor Refresher – December 6 & 7

§         Lead Abatement Supervisor Refresher – December 8

§         Conferences

o        Indiana Lead-Safe and Healthy Homes Conference in Indianapolis on November 8 and 9, 2005

Thanks for improving kids' environment!  If you have any questions or comments about this newsletter, IKE, or the Indiana Lead-Safe Task Force, contact Janet G. McCabe at mccabe@ikecoalition.org, 317-902-3610 or 1201 N. Central Ave., #9, Indianapolis, IN  46202.  If you need more information on national events, check out the Alliance Alert Newsletter at www.afhh.org and click on newsletter.

IKE publishes a newsletter on a regular basis that describes IKE’s efforts beyond healthy homes and lead hazard control.  Contact Janet G. McCabe at mccabe@ikecoalition.org