Transcript: Tulalip Healthy Homes Working Group Webinar Webinar Date: January 28, 2010 In other tribal departments who you think might be interested, it should be pretty straight forward. You’ll be able to open it and play it back as a Windows Media file. So, let’s see, so those are the basics of the webinar. Again with introductions, two of our main speakers today are Jerry Hause, who is a certified residential inspector for the Cowlitz tribe and a member of the tribe. Aileen Gagney with the American Lung Association and who runs the Master Home Environmentalist Program. Reva Wittenberg and Keith Zang are with the Washington State Department of Health Asthma Program. Myself, I’m the facilitator. And we have Amanda Swan who’s a student tribal intern at the Northwest Indian College, who I would like to introduce briefly. So those are our presenters. Now because there’s a large number of people who will be on the call, we don’t have time to un-mute everybody and to have them do individual introductions. So I’m actually going to go ahead and do a first quick poll basically to see who is on the call right now and where you’re from. So you’ll see this come up in a minute. Which state is your tribe or village located in? Okay, I’m going to go ahead and close, there’s a few answers still coming in so I’ll hold on a second. So I’m going to close the poll. And the results should come up for you. The majority of the people on the call right now are from Washington, but we do have probably a third of the attendees still coming on line. And the next question is which department do you represent? Environment/Natural Resource, Air Quality, if you have a specific program, Health Clinic, Housing, or Other; either a Tribal Council, School, or a Tribal Consortia, federal agency, all of those would fall under Other. Okay and I’m going to close it. So the majority of the people are actually dedicated to Air Quality that are on this call. Not dedicated to, but are focused on those issues in their department. And okay, we’ll come back. We’re going to do about five or six more questions that we are going to do in a little bit, but next I just wanted to briefly go over the agenda and what we are going to try and do in the next, well, probably 80 minutes. Just cover some background, some more polls that are coming up, some questions. From 9:20 to 10:10 we have our presentations, and then from 10:10 to 10:30 we have questions and discussions. And based on the size of the group at that point, I can un-mute and I’d like to do this if possible, except the technology can be a bit challenging to un-mute. We can basically switch to a conference call format so that people can also respond to each other’s questions. With that I do want to say that most of you are already doing some indoor air or you’ve been doing it for 10 years and you could lead the webinar or you could lead a training. So forgive me if part of this presentation is going to be something you’ve covered before, again, the goal is to get this particular weatherization plus health program, to put some attention to it. Okay, some background though, really quickly. I do want to show you just a few slides about why we’re here on this call and why we’re working on these. Basically I have a few slides about the prevalence of asthma in tribal communities and the value and effectiveness of when you do an environmental intervention-- that it does have an effect on the quality of life. And then the workgroup that I mentioned. Why, I want to talk briefly about why we are looking to put the network together and basically why we can build stronger programs and healthier communities. So for background, basically and as most of you know, there’s no one national data set that has been collected that would give us a statistically comfortable number about where asthma rates lie within the tribal community. So we have to draw from a variety of regional studies and use those and extrapolate. One of the most, probably one of the broadest studies, was done by the Centers for Disease Control. This is 2002, so the data is old, but you can see basically the tribal population has the second highest rate of asthma of any community in the U.S. So that right there tells you that, and as all of you know in your own community, it is very prevalent. But the point I also want to say again, and why we are here, is that it does go beyond asthma itself. Because there’s also people with other acute respiratory illnesses, like pneumonia, bronchitis, emphysema. You might have heard the term COPD. Those people when they are exposed to indoor air, they have an increase in the frequency and severity of their symptoms when indoor air is poor. It also, indoor air is also a factor going beyond asthma, because potentially the research is saying we could be inducing new cases of asthma that would have not been triggered. As an example, RSV, which is a type of respiratory virus, and many of you have heard about this in your communities, it’s very high in tribal infants. And when you do have RSV as much as 80 percent of the infants that have RSV go on to develop asthma. So clinically, they know that there is a trigger or a link between having RSV as an infant, and developing asthma as a child. We also know that you have certain indoor pollutants and combustion products that can exacerbate RSV. So my point here is just that not only does it create a problem for existing asthma, but we could be inducing new cases. And then finally, indoor air also affects a much broader group of other at-risk populations well beyond those with just a respiratory condition. Many of you know that diabetes and high blood pressure is also statistically much higher in tribal communities. And those, that community in particular, is more vulnerable from episodes of poor air quality. Specifically, it is associated with an increased risk of premature stroke and heart attacks during episodes of poor air quality. Some of the data that I am referring to here is specifically defining coarse particulates associated with wood smoke. But they are ozone, dust, there are a number of other contaminates that can be outdoors and in, that are risk factors for that population. So again, the point just being this is much broader than asthma. It affects many people in the tribal community. But the other point I want to make-- I think the good news is that environmental interventions and outreach have statistically substantive results in improving the quality of life for those people. The results I’m just going to show you here, this is an example. There’s hundreds of studies. This one in particular is from the Harvard School of Public Health in 2006. On your left, you see that children before any environmental intervention was done in their home, 76% reported a wheeze or tightness in their chest. That dropped after the intervention to 40%. Another common marker of quality of life is how often does your child wake up at night from asthma symptoms. Before the intervention, it was 64% and after, again, it dropped by almost half to 30%. And finally another one that is a key for kids in particular is how many reported that they actually had to slow down or stop playing because of a wheeze or tightness in their chest. And it’s an even more significant jump. Here, before the intervention it was 64% and after 26%. This is one example of a study. There are quite a few and the numbers tend to parallel these which you get a pretty significant increase in quality of life when you do a very robust environmental intervention. And I don’t mean just going in and putting in a, you know, a ventilation system, but when combined with a variety of outreach factors interventions are a very successful tool. So briefly now before I move on to Jerry, I do want to talk about the Healthy Homes, the Tribal Health Homes Workgroup. There’s really three functions that it is intended to serve. One is just like we are doing right now, a quarterly conference call/webinar with the idea being we can exchange information about programs, resources, and best practices. In the future the webinars will also feature a host tribe, so be thinking about if you are interested in sharing what you are doing. And as we have today a training topic that has been selected. We also hope that we can have programs that are maybe not tribal but are doing something of relevance. Agencies, universities, we can encourage them to provide a tribal-specific adaption of their program for presentation. Another function is to have an online clearinghouse, and EPA Headquarters is actually working on a great Web site that has a lot of the material and our clearinghouse actually was in a concept format about a year and a half ago. So we may be able to dust tail with what they are doing but the idea is to have a place that you can go to where you can find indoor air outreach and educational materials you can download and use in your schools, health clinics, community centers, that are tribally relevant. And you know how to get them. It will also have a directory of Tribal IAQ contacts so that you know who to contact. A calendar or a link to existing calendars with events and training opportunities. And then ideally as we go along we will develop profiles of tribal healthy homes and IAQ projects and strategies, and specifically those where there are some evidence-based outcomes. So you are able to measure in some sense whether or not the funding and the energy had a definitive impact in the target community. And then finally partnerships is another big thing. The idea with the workgroup is that we can encourage formal partnerships with public health and housing practitioners, federal, state, and not-for-profit organizations. So that they also have a portal so that when they have resources or want to work with tribes, they can come to the workgroup and make sure they get the word out to everybody. And also to enable the participating tribes in a workgroup to have ideally better access and even earlier notification of indoor air training, funding, and technical assistance. All of you know how much lead time it takes to get a grant proposal together and how challenging it can be to get your housing relevant department in your tribe met and on the same page and put a project into place. And if we have more lead time I would like to think we would be able to have proposals in place that are more likely to get funded. So next I’m just briefly going to, we have a few more polls that I would like to do before we get started. I’ll start those in just a second. I do want to mention that we have a larger-scale survey that is an online survey that will take you about 30 minutes to fill out sent out in early February. And Amanda Swan, who I will introduce in a second after our poll, will be sending it out, distributing it to you by email, and then following up to see if you have any questions about it. And likewise if there is anything in your survey that you want to profile, you want to share online, or you want to post to the clearinghouse, she will be able to talk to you and get that information from you. So with that I’m going to go ahead and do a few more polls before we introduce Amanda and move to Jerry. Does your tribe or village currently have a weatherization program? Okay, I’m going to go ahead and look. The numbers keep changing. I’ll wait a minute. Okay, I’m going to go ahead and close that poll. And share the results. Looks like there’s actually quite a few tribes that do some that have the informal and I do imagine quite a few tribes that do some tribes that are informal who do energy audits or assessments that don’t have a dedicated program. Okay, next question. Does your tribe or village have a formal indoor air program? Okay, I’m going to close the poll in a second. And share the results. Okay, and 18% is actually higher than I thought of tribes that have a formal indoor air quality program and those in particular would be interested in profiling and getting a chance to learn more about what your program entails and what you are doing. Okay, next question. And this one, I would limit it to five choices. I had to take indoor air contaminates and group them but basically I just wanted you to get a sense of which indoor air issues are of significant concern and by all means if you feel like they are all, go ahead and check them. The idea is to get a sense of maybe-- pick the two or three that continually come up, the issues concerning your tribal housing or community. And I just think that, you guys can interrupt the results right there, but as you would imagine, mold and biological pollutants are definitely some of the most significant issues. Wood smoke. And then we have one more, one or two more questions. Next one is, did it come up? Okay if your tribe or village participates in the Workgroup, which of the following would be a priority? Hopefully you can see it. I’m not getting any angry responses, so, okay there they go. Okay, I’m going to go ahead and close that one. And the results. And these will be available later too. Especially if you are interested in the steering committee of the Workgroup to help guide our future priorities. And we have one more question. So last question before we go to our speakers, and introduce Amanda is, the workgroup will have the on-line clearinghouse of indoor air resources. Which resources would you be most likely to utilize? And I ask this question because it is likely to take six month to a year to slowly put up each of these sections, but we want to focus on those resources that are going to be most of interest or useful to you. Okay and I’m going to go ahead and close it. Okay. Looks like again it’s pretty diverse with the exception of community-based initiatives. Okay, so I think that’s about it for polls. I’m going to introduce Amanda really quickly. Amanda, if you are on the air, can you hear me? I’ll try and un-mute you. Okay, Amanda are you there? Let me see here, okay. Amanda, are you on the line? Okay, I think she is there somewhere in cyberspace but I’m not sure, let’s see. Oh no, I think she is online. Are you there Amanda? She’s just getting online. I’m going to go ahead and switch it back and try and introduce her later. I think what we’ll do is I’d like to introduce Jerry. From what I can see the screen has been switched to hers and she’s getting online right now. So Amanda if you can hear this, I’ll click back to you in a few minutes. And, let’s see here. I’m going to, alright, sorry pardon this is one of the many technical delays I expected would happen. Okay, I’m going to go ahead and introduce Jerry Hause, who is our first panelist here. Jerry, as I mentioned, he is a member of the Cowlitz Tribe and he contracts with tribes to perform energy efficiency audits as a certified inspector. His audits involve inspections of homes, using a variety of techniques and equipment to determine the energy efficiency of a structure. And on thorough audits he uses equipment such as blower doors which measure the extent of leaks in the building envelope and infrared cameras, which reveal sort of the harder to detect areas of air infiltration or missing installation. Jerry has the following certifications and recognition: he is a certified building analyst professional, a certified residential auditor, and a certified residential inspector. And since 2005, he has been the manager of the weatherization program for the Cowlitz Tribe. So I’m going to go ahead and switch over to Jerry so bare with us for a moment. Okay, Jerry are you on the line? Yes, I’m on the line, do you hear me? I sure do, and it shows everyone else does here too, so you are good to go. Good morning everybody, thank you Gillian. And I’d like to tell you a little bit about what I do. Right now I am in Neah Bay, Washington, I’m not sure if anyone is familiar with that. I’m in the most northwest corner of Washington State. I’m with the Makah Indian Tribe and I am currently doing some audits and inspections for them. I met Gillian last year at an air quality control meeting; actually it was a training in Seattle. And I kind of stumbled upon the training and thought it would be a good mix-- weatherization and indoor air quality. I find it kind of interesting that when she took the poll on the indoor air quality with people that had air quality programs that we, the Cowlitz Tribe, do not have an indoor air quality program, even though I’m an auditor, inspector for weatherization. Both of those should run hand-in-hand in my feelings about it because in weatherization, we look for reasons or problems in homes that need to be fixed and air quality is a very important part of that. We have a term that we ‘test in and we test out’ whenever we go into a home and whenever we leave the home. We deal with a lot of different needs in homes. I see they mentioned wood stoves. Here at the Makah reservation, Jim Woods introduced a wood stove change program, and it’s been quite efficient here and I know a lot of the reservations are pretty isolated from the other parts of the world. But running into problems with the electricity and losing power, so wood stoves are used quite often on reservations. And here in the Makahs, it’s a beautiful place. I’m looking out at the streets of Wanda Fuca right now, but it’s kind of in a bowl type surrounded by hills, so when the power goes out and everyone is burning wood stoves, the air quality is very smoky and it’s not very good. And when years ago, not years ago but probably within the last 10 years they started doing tests and coming up with procedures on taking care of air quality. What we do, what I do as a weatherization auditor/inspector, we go into homes and one of the first things we do is there’s three calculations that we take by the number of bedrooms in a home and the number of people in the home and the volume of the home, and we have formulas that we put together and figure out the building tightness limit. We’re out to eliminate a lot of the air leakage in homes, but we don’t want to make them so tight that any biological chemicals or anything that is stored in the home has a major effect on people in the home. So what we do is, we have a pollution source survey that we have several questions that we ask the people in the home and throughout the procedure we do a blower door test. For those of you who are not familiar, it’s a vinyl door that we put in to the front door or one of the openings in the house, one of the back doors or front door whatever we choose, and it has a fan and it depressurizes the home or pressurizes the home. And it gives us a reading of cfm’s, cubic feet per minute of air that is leaking into the home. The calculations we take gives us a number on how much air should be coming in and out of that home. And for every cubic foot of air that comes in that home, a cubic foot leaves that home. So as part of our job, we air seal and insulate and we tighten the home up but there’s a lot of things in the home that we have to be aware of that we don’t cause any problems because once we touch the home it’s our responsibility, and it should be. One thing about the homes, in most homes that you go in and do a blower door test, if you have a high reading in air leakage, we can find those air leaks with the blower door just going around and filling places that might be, you might feel there might be leaking. A lot of the times we’ll open up under the sinks and bathrooms and kitchen sink and look underneath there because a lot of times plumbers that do the piping drill a 3 inch hole to put an inch and a half pipe through there. So a lot of times those are major leaks and one big problem with those major air leaks is what people store underneath their cabinets- disinfectants, drain cleaners, and things of that sort that could be harmful in the home. So we, in the pollution source survey, we ask that question about what is stored in the home and underneath the sinks and what have you and we educate the people that those shouldn’t be stored there, but we do seal those holes up because those are major leaks. And when the air comes in under those sinks, that brings the pollutants into the house and when you are in a kitchen, you are cooking in the kitchen so these pollutants are, they can contaminate your food or people can get sick and not really realize that; it’s an educational piece. Before I started in weatherization I never really thought much about that. I’ve been doing weatherization for about four years now and I’m the only certified Native American in the state of Washington with the certification needed to do the DOE, Department of Energy weatherization program, and I’m not bragging about myself it’s just that I’m out helping other tribes and making people aware of this and trying to get programs going on the reservations. This air quality to me is very important. Talking with Gillian at this training, I can see that these should both be hand-in-hand. With weatherization out here in the Makah reservation right now there’s a lot of wood stoves. And we take and when we test the home we’re testing for carbon monoxide and with wood stoves in there we also need to check and make sure there’s enough air in the home to be burning these stoves. With this, Jim Woods that brought this stove replacement program a lot of these stoves are most of the stoves that they changed out now, I believe all of them, have air coming directly into the fire box instead of the air coming out of the home because any combustion appliance needs air to operate efficiently, and that’s air we breathe too. So that’s one of the tests we do and a lot of times there’s gas into a lot of these homes too and we have to do a worst case scenario where we turn on all the fans and check to see what our drafts are on the stoves or the appliances that are in the home to make sure we’re not getting any back drafts forward or spillage. So it can get quite technical but that’s what we do in weatherization. It’s something that a lot of people never really think about too much, it’s just an educational piece. A lot of homes have ducts for their heating systems forced air furnaces. Those ducts can leak from the crawl space and bring that crawl space air in. So we’re looking for leakages in the ducts and around the booths also. I hope Gillian is keeping track of my time. I don’t want to run over what I’ve got or, but there’s a lot of things in the home that we deal with. And I’m really glad that I was asked to be a part of this program and get with other tribes to share this information. I’ve been talking with Aileen and she does another piece on the Healthy Homes and she will be up next I believe. And she will share her knowledge with you, but mine is a little different perspective but at the same time we’re all dealing with the same air quality. So that’s basically what I do. We use all sorts of instruments to test in and out. We use moisture meters. We use infrared cameras to find water leaks or air leaks we can do that also. So we thoroughly go through the home. We’re required to put fans in homes where there are ventilation problems in bathrooms and kitchens. There’s a lot of moisture so we need to install fans and we have to test them to make sure they are pulling the right amount of air that’s required from them. And those come in to play with indoor air quality also. So that’s one of the reasons why we test in and we test out to make sure we haven’t done anything when we are leaving the home that can cause problems while we’re gone. So that’s my piece of the picture here, and I think I’ve probably covered most everything that I need to. Gillian, are you there? Yeah, Jerry can you hear me? Yes, I can hear you. Okay, there’s a bit of an echo, I don’t know if that’s on my end or yours. I hope that people aren’t hearing that. But thank you, I really appreciate your time and your expertise and I’m going to put a question out that I think everyone is wondering to which is, when you go and do these audits and you make recommendations into where the energy leaks are where there’s indoor air issues with the tribes you work with where are most of them getting the funding to then go in and pay for those upgrades or changes? A lot of the funding comes from the Bonneville Power Administration in the state of Washington. And actually Bonneville covers four different states. I get some funding from DOE, the Department of Energy, or from the state Department of Commerce. And there’s grants out there now from the ARRA (American Recovery and Reinvestment Act) money that I’m pursuing and looking to get some of that. A lot of people use their housing and the Cowlitz Tribe has funding and they use that or I can use that if there’s things in the program that my weatherization money doesn’t cover. So that’s a nice mix. A lot of times, like if I go into a house and put in insulation in the attic and it needs a roof, the housing can put a roof on there and I can insulate because we don’t want to do any weatherization repairs that will be ruined in the near future. Okay, great, well thank you Jerry. So I’m going to briefly introduce Amanda Swan who is the intern who will be contacting everybody about the survey and then we’ll go to Aileen. So briefly I’m going to switch it over to Amanda really quickly to say hi. Good morning, can you hear me? I can hear you just great Amanda and it looks like everybody else can. Great, I switched over, I apologize for the, I had a headset on prior told me to call on my phone. But anyway, I’m a Junior at the Northwest Indian College and what I’ve been doing is researching and exploring sustainable practices for tribal communities. So I think this is going to be a good fit for me. And I’m a member of the Shaw Creek Tribe out of Montana. And I’m very excited about the idea of working to provide Native Americans and their children with good indoor air quality. Okay, great, and Amanda is a great fit for the program and now that you know her, she is the person who will be contacting you probably first by email and then possibly by phone to follow up. So thank you Amanda and we look forward to working with you. Jerry, are you still there? Yes, I am. Can you mute your line? I’m hearing the production of people in Makah working in the background. I’m wondering if you can mute your line when we put Aileen on here in a minute. I will try to do that, I’m in an unfamiliar office. If you can, exactly. Alright, Aileen Gagney is going to, while you are working on that Jerry, Aileen Gagney with the American Lung Association is now going to talk about the plus health side of a program. Aileen has, some of you might be familiar, they have a Master Home Environmentalist program. She has been running the problem for over 13 years. And basically it’s a very comprehensive framing where they cover moisture and biological contaminants, lead, toxicology, cultural diversity, secondhand smoke, asthma, so a wide range of topics. The training is normally a very robust six month program. What she has done to combine it with weatherization is condense it into a two day format where anyone who gets trained in this with your tribe would learn to recognize hazards, chemicals, mold, air pollutants. They would be able to tell occupants or work with housing on how to use low-cost or no-cost methods to reduce those risks. And basically teach them about the health hazards and how they relate to their health and asthma. The Master Homes program was recognized in 2005 with the Children’s Environmental Health Excellence award, which is a very prestigious honor. And Aileen has been a champion for as long as I have known her and to get the plus health team with weatherization is a great use of limited resources because you have someone going into the home who can address both issues which overlap. So on that note I’m going to go ahead and hand it over, I think her slide is on the screen. So, Aileen? Good morning and thank you Gillian. Welcome everybody and yeah the Master Home Environmentalist program, what we do is we train people and evidently hoping to train people who already go into the homes to really be able to identify anything and everything in the home that could be making people sick. So we talk about asthma and we talk about the triggers of asthma. We talk about moisture and biological contaminants, so that’s your mold. I know that everyone has a huge mold problem around in Region 10 it’s insidious, it’s really dangerous. We also talk about secondhand smoke or tobacco smoke. We also talk about an introduction into toxicology. So toxicology is about dose and response. Why children tend to be much more affected by chemicals and things than adults do. We also talk about household chemicals that you could find in the home and we could give you alternatives for these things. So instead of using bleach or any number of components, white vinegar and baking soda works great to clean with and it’s also a lot less expensive. We also talk about different pests in the home, not just pets, pests. Certainly, cockroaches, mice, rats, how to eliminate or reduce them. Natural lawn and garden care, so things that we use outside can also affect our indoor air quality. So and then we talk about indoor air quality and ventilation. So I’m really glad Jerry is doing this and is so concerned about indoor air quality while he is doing his weatherization and energy work because as we tighten these homes up, the biggest issue might be bringing fresh air in, because once you tighten thing up you have to have to make up that good air. You have to bring more good air in. So and if you don’t what happens is that you get a lot of mold and other toxins in the home also. So looks like from what I read before in the polls- mold, dust, pollen, dust mites, and wood smoke and rodents seem to be your biggest issues. Wood smoke is a huge problem. It is also incredibly dangerous for you and your lungs. It contains a lot of carcinogens and what we want to do, and I’m really glad that Jim Woods with the Makah tribe is doing this change out program. The EPA certified wood stoves put out a lot less pollutants and particles. And it’s those particles that we’re really, really concerned about. So, we work with you to help your clients or your tribal members to create healthier homes. We spend 90% of our time indoors and our indoor air can be 5 times as polluted as our outdoor air. So what I have on the screen there is an example of the two-day training. So we spend a good half hour maybe even more on asthma and allergies, and we look at all these subjects and we do a pretty in-depth review of them. And also on day two, we actually go into a residence and walk through, and I train you on how to see these things and how to see better. And we work on things, and we come up with three things that the resident can do that are low-cost and no-cost, because if it’s too expensive people won’t do it. And if you give people a laundry list of things, it becomes overwhelming. So that’s what we do, and I would be happy to take any questions. And Gillian, if you have anything else you’d like to add to that? Just thanks to Aileen. It sounds like the echo is on my end. I took the course 10 years ago or more I think ironically before I discovered my two oldest kids had asthma. So I didn’t realize what a help it would be. But Aileen, maybe you could mention too that you can, how you would basically, the forms you would use even if the person who attends this training from their tribe can provide some forms and some basic training to other people in their clinic or in their schools so that they know how to walk into a house and at least use the form. I guess it’s a self-administered here, right? Can you talk about that? There’s the form called the Do It Yourself Home Assessment and it’s a do it yourself heal. What it is is it actually lists, it asks a lot of questions, certainly about the resident’s nearby environment, dust and lead, moisture, indoor air, hazardous household products, and then it actually gives you action plans or things you can do to help remedy those issues. So it’s very, very handy and it can be handed out and given out to anybody and they can actually do this in the privacy of their own home. They don’t have to have anybody come in with them, but it helps them actually sort of evaluate their home for the toxins or the unhealthy air that’s in the inside. And Aileen, in the homes in some of the homes in the communities there’s a resistance as you know. People may have sick kids, but they also have a real resistance to letting someone come in and literally inspect their home. But you’ve been working on these issues for years, how do you help people overcome that so that you can help them or what approach do you take? Well in that case, what I do is, nobody likes a sick kid. Everybody is concerned about the health of their child. So by speaking with them and saying these are easy things that you can do that will help your child. Even opening the window and getting fresh air can actually help. And then giving them the Do It Yourself home assessment, they can do it at their own speed and their own time in their own way. And then certainly they can actually go back to the person who actually gave them the form and ask them what questions they have if they have any. We also have all sorts of resource guides. We have a brochure of green cleaning recipes we can hand out. We have booklets and brochures on the effects of wood smoke, the effects of household chemicals. So there’s lots of resources that can be available that are available for people. Okay, and then one final question. How effective would you say, you don’t have to cite any statistics it can be anecdotal, but in the work that you do in going into homes, especially where children live with asthma, what kind of results do you see? When people make the behavioral changes, not necessarily you know the larger changes, but even just behavioral changes? Well, in the third quarter of 2009 in 92% of the homes we went into, people made a behavioral change. And that can be as simple as opening up the windows, removing your shoes at the door, dusting more frequently, vacuuming more frequently, things like that. Simple things. And then my one final question, anyway, elders I mean for me the children that have asthma but elders can have so much they can have a compromised immune system and possibly lung disease and maybe hypertension. And they are a community that is very high risk because of that. Can you just talk briefly about some of the risks you’d see that they might be exposed to? I’m asking this because I also want to get tribal council support, and I want tribes to be able to convey to their council that there’s a much broader population in their community who are affected by this in a very substantial way. The elders certainly because their immune systems are compromised and they are older and as you get older you tend to get more allergies or COPD or emphysema, and air quality is a huge issue for these folks. So whatever we can do to help them improve their air quality. And I know it’s a little bit more tricky with the elders because they don’t move as quickly, there are safety issues involved, so we also start looking at whether the carpeting in the home is tight so there is no trip hazard. We help them with easy things they can do, easy, easy, because if it is difficult than nobody will do it. That’s great and you are absolutely right, the safety issues are one and mobility and all of that. So, okay. Well, thank you to Aileen too. As you can all tell, she’s got again it’s an award winning program. It’s been tried and tested and done for so long that it’s just a great way. It’s a great tool whether you do it as a stand-alone or whether you work with a weatherization person or someone who does an audit and you go into the home together. It is a great tool, so thank you to Eileen and to Jerry. So we have one more presenter who is going to briefly talk about, he’s Keith Zang from the Department of Health. And again, I know this is Washington State and many of you are on the call from Oregon and Alaska today, but I’m just, Keith I’m going to switch it over to you here. And it might just be audio, let’s see here. So basically the Department of Health in their asthma program they really work on improving the quality of life by reducing asthma triggers in the environment and by helping people learn to manage their asthma and address indoor air. But this year, in 2010, the asthma program is going to be working with a few Washington tribes to try and do an asthma home outreach program and to reduce asthma related health disparities. It’s a pilot program in one that I think it will be interesting for other tribes to see whether that targeting outreach specifically to asthma how it works. So Keith are you on the line? I am can you hear me? I can, you are on live. Okay great. I don’t have anything to show. I’m just going to describe our program and kind of what we are doing, what we’re up to here. I’ll just give you a little background on myself. I worked 23 years with various tribes. I started in 1987 as an environmental health specialist in South Dakota with the Yankton and Santee Tribes. I worked 16 years with the Quinault Indian Nation as an environmental health specialist. So I’ve done a lot of the indoor air quality work that we’re talking about today. I have experience in seeing the changes that can be made just by simple education. So I think this is a great opportunity in working with impromptu communities. With the state asthma program here, we do have a CDC grant and one of things we are going to be working on is developing a sustainable model for tribal asthma homes visits program. So we’re going to be funding one tribe, we have enough money to fund one tribe; in setting up an evidence-based, basically a home visit program. So we are going to be working on that in the next few months. We have hired another person her name is Marci Getz and she has not yet started but she will be starting in February. And she is coming from Alaska, has a lot of experience there. So we are looking forward to beginning and implementing that. There will be a lot more information about that coming up in the near future. Another thing we are going to be doing is also building skills and capacities within Washington tribes to address asthma. And some of that is going to be around training. And one of the things we are going to be doing is Asthma Month which is in May. We’re going to have some trainings that we are sponsoring, and one of the those is the Master Homes Environmentalist training. So we are hoping that anybody who is in Washington who is on this call today can sign up and we’ll be sending out a lot of that information in the near future. That’s going to be through our resource center through the state. We have a resource center that will set up the training and get that all organized. Like I said, that will all be coming up, that information. So hopefully everybody on the call can sign up and learn how to do this work if you haven’t done it before. So that’s basically where we are at at this point. And we will be doing also some technical assistance to anybody who needs it, and we also will be doing more training, more onsite visits. So that’s about what I have. Thank you Keith. It’s great that you have that tribal background and that you are going to be a resource for tribes. And I did want to ask you what you have CDC funding to do the pilot program in Washington State with one tribe, but as you develop will you be able to share your results you are going to document as you do the pilot, sort of the outcomes, the results, is that right? Absolutely, all of the data that we get, all of the results and what not, will be available to everybody. Okay, and will you have, I guess specifically one of the things that would be nice to be able to share with tribal council to get support and would be good to include for tribes to include in grant proposals is that for each home are you going to take quantitative measurements of the conditions with someone with asthma? As I showed in the slide earlier, for example where we showed the percent reduction in symptoms before and after an intervention, will you be able to produce slides or information like that so that we can also show in a tribal setting how those interventions-- whether or not they were successful. Yeah, absolutely. everything that we do we are going to develop materials that would be able to be used throughout Washington and probably anywhere else that wants to use it. So it will all be there. Great, okay. Thank you Keith. And again, let’s see, where’s my notes? I’m so interested in the speakers that I forgot where I was at. We’re basically about to finish up. We do have 25 minutes left of questions and a couple more polls. What I’m going to do is if you want to use I can either un-mute everyone let me take a look here. I’m going to go ahead and do one last poll. At this point I need to change it back to me, then I’m going to open it up as a conference call so that anybody, so that we can have a dialogue with each other. So if you bare with me for a second. So I think I did most of the polls. After hearing this and working on the workgroup. There should be a poll in front of you right now basically asking for the workgroup which subcommittees would you be interested in participating on and/or helping to lead as well? In the steering committee we are forming basically to have a group of tribes charter and set priorities for the first year. Policy and Advocacy is about getting more funding and more training and communicating the extent of the issues in tribal housing. Technical solutions is of course about IAQ investigations and assessments. And then Outreach and Education is as it sounds, is getting the word out to the tribal community and to the families and homes. So I’m going to go ahead and close that poll. It’s still changing. I’m going to wait a second. Alright, I’m going to close it. And I’ll share the results; this is more on my end so I know where we have support. It looks like a lot of you are interested in Outreach and Education which is great because that is one of the most immediate things you can do to see results and to work with your community. But I will hopefully when you exit the webinar today after our discussion, there will be two questions. One is was this useful? What would you like to see next? Kind of basic. And the next one is if you’ll identify which of those and your name and contact information so that we can follow up after the call. So with that I’m going to, the screen is up, but I’m going to un-mute. So if you are on phone some of you might be on a speaker, let’s see how well this works. I may have to individually un-mute. Some of you are not on audio if you are on the phone, but gradually you’ll start to. I’m sorry, I’m sure there’s one button that un-mutes everybody but I can’t find it. So the options I’m having to go through with all of your lines here to un-mute here. We’re almost there. Okay, most of you are un-muted. I’ll go ahead and open it up for questions for Jerry or Aileen or for Keith for that matter about the program. Does anyone have any questions? This is Jack Mulder with the Umatilla Tribe near Palatine, Oregon. I’m a CTUIR (Confederated Tribes of the Umatilla Indian Reservation). And on some of the polls the appropriate answer for us has been that we don’t know. So, you might include that on the poll. I also have a question about or just wanted to make a note about the complications that can arise, as they say. You do want outside air going to a burner, to a wood burner stove or something. That would diminish the smoke from outside going back into your house. However, what that does, it seals up your home and actually increases the possibility of generation of mold. Is that correct? Jerry, do you want to address that? Jerry might be muted Jack, let me just take a look here. He’s muted. Sorry Jerry, hold on a second. Okay, Jerry are you on the line? Jerry? Jack you know what I’m so sorry I think I had Jerry muted and I’m not sure if he can hear at this point. So can I direct that question to him separately? Because I think it’s a key safety question too. So I will follow up with that. Jack how did you answer then when we didn’t have ‘don’t know’? How did you answer on that? One poll I didn’t answer at all. I didn’t put an answer there. Okay, okay. And do you have a weatherization anybody who does energy efficiency audits that you are aware of? We have conducted audit requests. One of the school buildings on the reservation, we did a cursory inspection and then they brought in an outside contractor and did a complete mold survey and they came up with a report so no, the tribe does not have a designated program for air quality. Do you have me now? I do. Hi, sorry about that. This is Jerry; did you want me to answer that question? Yeah, Jack brought up a good point about air filtration with a wood stove. Well, that’s one of the reasons we test the tightness limit of a home. And when we do homes, we do several things. When you bring the air in its not that the home is not taking the air, the stove’s not taking the air from inside of the home. So we test the home to find out what our MVL, minimum ventilation limit, and we also install fans and we also pressure balance. I didn’t want to get too technical about that, but a lot of times mold is not thought of in this sense that when you close a bedroom door there’s a certain amount of pressure in your bedrooms or any of the rooms you have doors to. One thing we do when we go into the home when we do a blower door test is we take a pressure reading for each room. If a room has nothing but positive pressure it in, there is no ventilation or not enough ventilation and we have a certain number that we strive for that we will have to fit. We’ll undercut the door or put a vent above the door some way to bring some air in there to get that balanced out and that can be a part of mold which most people don’t think about. As far as bringing the air into the stove, no that’s not going to cause you a mold problem. That’s a good question. But there are several things that the weatherization program looks at and tests for when it comes to those molds. Molds can be caused from several different, different things. As a matter of fact, I’m working on a home up here in the Makah, and they have mold in the ceiling and they have enough installation in the attic and normally that would be the problem because it’s cold. But the vents, they’ve got bird stop vents that come in the side of your house above just above your roof line and they are supposed to be baffled with cardboard so that air doesn’t go into the installation it goes above to your roof and ventilates the attic itself. Well they’re not baffled correctly so that air is going right directly into that installation which is causing it cold and the inside of the bedroom is warm and so that cold air on the surface of the ceiling and the warm air in the bedroom is causing condensation which causes mold. So what we do in weatherization is kind of a private detective investigation where we’re trying to solve those problems and there are definitely times where we scratch our heads trying to figure out what we need to do next. But yeah, that’s a very good question. There’s several solutions to do mold and mold is a very big issue but the pressure balancing is something I didn’t mention and people, you can pressure balance a room but if a person throws a carpet in there after you’ve done the test all of a sudden that room isn’t breathing like it should. So that can cause mold. This is Aileen. If you’ve got mold you have too much moisture. So it’s also looking at the habits in your home and how do you reduce the amount of moisture in the home. She is absolutely right on that. When you have mold the first thing you have to do is eliminate the moisture. We eliminate the moisture, the source, and that is exactly right. There’s moisture coming in from somewhere, you got to find out where. Yeah, exactly right, and you don’t clean it with bleach. Soap and water. Jack, thanks for your question, and anybody else have questions for Aileen, Keith, or for Jerry? I had a question. Can you hear me? Just great, yeah. Oh okay, yeah, this is Libby Nelson and I’m with the Tulalip Tribe. And I lived many years in Alaska, and I’m just thinking that in general is a very leaky house even though its cold the healthiest indoor air quality? And then does it become just a matter of trading off weatherizing and making something warm enough that you can heat it efficiently but still letting in air sources to keep that air flow going? And I’m still not sure on how you go about doing that in a very cold climate. So I guess it would be interesting to hear some specific examples. Okay Jerry go ahead. What you really want to do is have a home tight. Even though the air changes you don’t run into the problem on leaky homes but you got a huge electricity bill. And it depends on what you have that’s where the air is leaking into that room. Some places in Washington State there’s radon in the crawlspace and if your floor is leaking, that radon is coming into the home. So you really don’t want that. A theory in weatherization for new homes now is that they build them tight and ventilate right. We put in continuous run fans to make up the air changes that’s needed in the home and you’re better off, at least in my opinion, to tighten the home up and ventilate it right. This is Aileen. I totally agree. The issues are, you want to be able to control the air and you also want to be able to filter the incoming air. So that you aren’t just, if you have a leaky home, if the neighborhood upwind of you starts to burn wood, you are going to get that wood smoke in your home. So we want a nice, tight home for a lot of reasons but we also want to make sure we have clean, good air coming in. So how do you do that without it costing you too much? Does it get fairly sophisticated in having to get good air flow? It depends on what you are looking for. It doesn’t get really sophisticated. A continuous run fan, if a home is too tight, they run continuously and in the weatherization program we’re required to have noise limit on them, which is 1.5 sounds which is really quiet; you can’t hardly hear the fan. And they have to pull at least 50 cfm . On a continuous run fan they run 30 cfm per minute and when somebody goes into that room, whether it be the bathroom or utility room or wherever that is, that fan will ramp up to whatever cfm you want it to run on for a certain about of time. There’s a timer inside of it and there is also cfm in there so you can adjust the flow and you can adjust the time that it runs. Because a lot of times, especially in bathrooms, most people, and I’m as guilty as anybody else, when you take a shower you turn the light and the fan on when you get done you turn the light and the fan off. In the weatherization program we are required to put those fans on a 60 minute time switch, not that they have to run 60 minutes, but the fan should run at the very least 20 minutes after a shower. One of the statistics I heard is that it takes 45 minutes for the moisture to get off of the walls after you are done showering. So you’ve got to run it longer. So when you tighten things up, yes you are going to save money in terms of your heating bill and the fans don’t pull that much power, so actually in the long run you are going to be saving money. Do we have anybody from Alaska on the call? We were on a call I guess a couple weeks ago with some tribes who had already done some mold and moisture remediation and addressed the ventilation issues. Is anybody from that call or on the call either from Alaska or part of that particular discussion? I wasn’t part of that call but Peter O’Bay of Alaska. I have a question for Jerry. Yes. What about people who want to dry their clothes in the house and then you are having the moisture? It’s really not a good thing to dry clothes in the house. I know that you are limited in what you can do if you do do that, I wouldn’t suggest doing it because that moisture is going to go somewhere. Right, that’s what my concern was. Right. So if you had to do that, you are going to need to ventilate or I’m not exactly sure there’s definitely got to be something to take care of that moisture because there’s a lot of moisture in drying your clothes inside. And I know being in Alaska that you are pretty limited. You can’t put them outside and if you’re not fortunate enough to have a dryer then that does create a problem that you are going to have to get rid of that moisture because it’s got to go somewhere. I run into several situations where they’ve had mold and moisture problems and they have fish tanks and we have a relative humidity light switch that will tell you the temperature and relative humidity and if they crank the heat up in the house and that tank keeps losing moisture, that moisture is going to go somewhere and it’s not outside. So that could be a big problem there. I’m not exactly sure the answer to that. I know that if you have to dry them inside you need to be aware that that moisture is going to go somewhere in the home. You can rinse them, go ahead. One thing that I suggest is if you hang your clothes in the bathroom and operate the fan while they dry. And that’s what I meant you know the people turn their kitchen fan on or whatever because you aren’t hanging them in the bathroom there’s not enough room. Because I have to say 110 pound bottle of propane up here because we all have propane dryers that’s like $150. And to dry clothes you have to separate them somehow. So what if you say that you put them in the dryer for half the time whatever you need to get most of the dampness out, then hung them. That would help. That would certainly help. I’m just thinking of ways to do that because fuel is really quite expensive up here and it’s not going down like it is down there. Yeah exactly, and I think Aileen touched on a pretty important deal-- a bathroom with a fan would be a good place to do it. You want to move that moisture out if you are going to dry them indoors. One thing we check on in weatherization too is making sure that those bathroom fans are vented to the outside not just up into the attic so they ventilate right. There’s so much moisture in the attic, yeah. Yeah, if you take that warm air the air from inside the bathroom where you are ventilating it, you’ve got a cold rift deck; you are going to have mold in your attic also. Right and when it’s 20 or 30 below people aren’t really excited about when you talk about putting that thing on in the bathroom for an hour. That’s blowing all of that heat in your house out. If you are going outside when it’s 40 below outside and look at the vent, man it’s putting out some steam. Yeah, there’s a trade off to a lot of that stuff. You don’t want to be putting your heat outside and that is one of the reasons why we tighten the home so that you aren’t losing that heat. You want to keep that heat in. And there is a limit you know on the amount of people that are in a home. On reservations a lot of times one of our calculations is bedrooms plus 1 times a certain number. But a lot of times there a term called “couch surfing” so a lot of times there might 8 people in the home. So you’ve got to have 15 cfm’s per person in a home. So that number changes a lot and you can get mold just from the number of people in there because each person puts off a lot of moisture with breathing, and cooking, and showering, and everything else. And you’ve got kids in the house running around. Exactly. It’s an issue we have to look in to. Yeah, that’s a tough situation. It’s a balancing act between losing your heat and getting mold developing. Right and do we want to stay warm or do we want to get sick. That’s right. Thanks for your question and your insights too. We have a question from Les Higgins and I wanted to put it out for everybody because it’s a great question and Aileen and Jerry and I might take a crack at it. He asked what is the best way to poach, not to poach them excuse me, to approach tribal housing and get them on board to change construction and cleaning practices, especially since they’ve been doing it for decades. And I think it’s a huge issue Les, and I also wanted to say that one of the things that I do, assessments, I’ve done a few in schools, a few houses here and there, a few buildings, but a lot of times the maintenance people when you are just in the room with them they get it because they have been exposed to the fumes from whatever they have been cleaning or the mold because they are the ones, especially with buildings and schools, they get it. They felt it in their lungs, eyes burn, nose has a response. So really you take a few minutes to listen to them and to explain what is going on and they are totally on board with you. The difficulty of course then is that that doesn’t mean they have the resources to change what they buy, how they clean, how they ventilate. But at least you have someone to start with on board who recognizes the connection between what they are breathing and their house. And also I have worked with everybody from the housing managers to maintenance staff and I do get support but because they have limited funds, usually a quite a bit of housing to do, I find that for me the most effective is to find out how we can use their existing programs like a weatherization or help them to make their tribal housing stock cleaner, more energy efficient and better health. That’s just the approach I take, which is let’s make sure when we do energy efficiency and weatherization we are also helping to maintain your housing stock. So that you have to put less money into maintenance and repairs. So that would be my first response. Aileen or Jerry? I think just making the connection between housing and health is crucial. A lot of people they don’t feel well when they are in their home and they feel better when they leave their home. Let’s start talking about it, but I think you’re right the people that are doing the work once they know it, they get it. In weatherization we have a couple phases, and we have an energy conservation education and that touches on a lot of that. Air changes and whatever you are breathing, whatever happens to be in the home, is very important because you need to have a certain amount of air changes in the home. And you want to make sure the air that is coming in the home is air you want to breathe not underneath the sink where the chemicals are if that happens to be the case. Or lifestyles, people have different lifestyles. I find a lot because I run a strictly low-income, Native American weatherization program that a lot of the housing stock on reservations being a sovereign nation you will get these people who come build these houses and excuse the expression or the way I explain this, they build them and they grab the dollar and run. And there’s a lot of unhealthy stuff that they do because they don’t have to follow codes. That’s one of my goals to get somebody on each reservation that can quality control or inspect these buildings and stuff before they leave because I run into several homes that have bathroom fans that don’t ventilate to the roof, dryers that are ventilated to the crawl space, that’s unhealthy air that’s going to cause deterioration of your foundations and your roof and what have you. So Jerry how have you with your own tribe, the Cowlitz, how have you been able to, what approach have you taken with that? You’ve talked about getting a certification but generally in getting that support, I guess. The Cowlitz Tribe, we’re in southwest Washington. We are one of the few tribes that doesn’t have a reservation. So I work with all different-- I can work with any Native American that enrolled in a tribe. That’s one of the requirements, the enrollment card. So I get, I’m out all over the place. I can work anywhere in the state with my certification. And I take trainings; I take a ton of trainings. With everything the technology and stuff is changing so much but the instruments and the tools that we use we can do some pretty good exploring on what needs to be done or what we can do. We don’t always get it right the first time, but we got a pretty good point at it. I work with CAP agencies, community action programs, that have been doing weatherization for 30 years and I’ve got 3 or 4 agencies that I call on the phone quite often and ask for their advice because they can give me some good advice. I’m not an expert at it, but I do have a little knowledge in it. And everything is changing; it’s a continuing evolving wheel. Jerry, this is Jack Mulder again with the Umatilla Indian Reservation. Hi Jack. Yes, Jerry you said that you are licensed with the state of Washington? I’m BPI certified. Building Analyst Professional. That is a requirement to weatherize with state or federal funding. What is the, do you work out of the state of Washington let’s say here in Oregon? There’s a gentleman, do you know Jody Burns? Excuse me, Jody Hill. He is from the Burns Paiute Tribe. Jody Hill? Yes. Him and I are pretty good friends and he started about the same time I started. And he started a weatherization program over there. They are a very small tribe, but he’s got certifications for Oregon State. The certification I got-- the national recognized certification. It was a requirement I had to have to use the state funding. Bonneville doesn’t require it, but state funding does. Okay and Jody Hill is with what tribe now? He is with the Burns Paiute Tribe in Burns, Oregon. Maybe if there is some way I can get a hold of you I have his number but I don’t have it handy. He is very knowledgeable on this. And Jack I did want to mention too that the circuit rider and funding we have for Jerry is going to enable us to go to different regions so we might be able to ideally schedule one in Oregon too whether we are on site with your tribe or nearby close enough that if you want to have 2 or 3 maintenance and housing staff come attend, it wouldn’t be more than 1 or 2 hours. So we would like to make that possible. And Jerry really quickly before we finish up too, can you describe how you train because you have people go shadow you when you go do the circuit rider you are going to lead so that you may not have the equipment but they know how to do weatherization. I go in and basically show them how I audit, what we do, what we are looking for. These people, the Makahs have some people here that are pretty knowledgeable they just don’t have their certification. And in order to do an audit or an inspection you have to have that certification. When I go to wherever I’m going, I was in Yakama last week with the Yakama Nation, these people follow me when I do an audit, and I show them and explain to them what I do and share what I know with them because they have a circuit rider that you talked about training in Bellingham that I go to quite a bit. And I work with a lot of tribes. I try getting it out. I’ve actually worked with tribes from California, Idaho, Oregon, Washington helping them get programs started because Native Americans have been, I use the word neglected, with programs and the state doesn’t get to a lot of these places like Nia Bay that’s route so I can come up here. It was a 5 or 6 hour drive for me to come up here and work with these guys. I did audit for them and they do the work. They have people who can do the work. They know they got the specifications and I’ll be called back to inspect it. So we are getting things done and that is what it is all about. Great, I think Jerry this is great. I’m sure all of you echo that we are really fortunate to have Jerry’s experience with weatherization and knowing tribes as well as he does to be able to now have the resources to share that. And to combine with Aileen, I’m really excited about it. So anyone else? We have two minutes left. I again just want to say thanks to everybody. Please answer the questions they will just take you a minute or two when we click close or it will click it for you. And keep your eye out for an email from Amanda Swan who is going to be contacting you to get more information about what you want to see next in a webinar, what your priorities would be for the workgroup. And I think that’s it. Thank you everybody and again thanks to the speakers. Thank you and Jack are you still there? Yes I am. Can I get a phone number for you Jack and I can get some information from you or… Yes sir, that’s 501-429-7422. Okay, I will be here with the Makah through this week but I’ll be back at my office next week and I will try and get you some information. That would be great, thank you very much Jerry. You are welcome. Thanks everybody. Page 1 of 31