The Healthy Homes Partnership: A Cooperative Extension Model

Introduction

Because quality of housing affects the health, safety, and economic, social, and psychological well-being of communities, USDA's National Institute of Food and Agriculture values the Healthy Homes Partnership, which has improved environmental decision-making skills among millions of consumers. The Partnership supports research, education, and extension programs that increase home health and safety, improve family health and build stronger communities.

Beverly C. Samuel

National Program Leader

Housing and Community Living

USDA National Institute of Food and Agriculture

The Healthy Homes Partnership was created in 1999 as an interagency partnership between the United States Department of Housing and Urban Development (HUD) and the United States Department of Agriculture (USDA) and is an outstanding example of interagency teamwork. The main Partnership objective is to synthesize federal, state, and local resources in order to further healthy housing scholarship and provide research-based education to the public. As noted by USDA Housing and Community Living (2011), consumers are inundated with information about their environment. Using a trusted delivery system, such as the Cooperative Extension Service, helps consumers improve housing outcomes. Partners are able to reach both rural and urban populations via the Extension network of Extension professionals. The Partnership is truly unique among government programs as it supports the professionals who create, translate, and deliver research-based healthy homes scholarship to consumers for a relatively small investment.

In 2009, the Surgeon General issued a call to action to promote healthy homes (U.S. Department of Health and Human Services, 2009). The Healthy Homes Partnership has provided resources and support, significantly enhancing Extension's knowledge base. Partners are permitted to focus on healthy housing as it pertains to their own area of expertise. Participants have focused their efforts on a wide range of healthy homes topics, including but not limited to, integrated pest management (IPM), energy, health (asthma, lead poisoning, etc.), home safety (family and child development programs), and water quality (Extension natural resources faculty). The content is focused on both family and consumer sciences content, in addition to agriculture and environmental science. The holistic approach allows diversity in the delivery. As discussed by Maring, Singer, and Shenassa, holistic Extension housing education has allowed for unique partnerships and collaborations (2011).

The Healthy Homes Partnership has helped Extension professionals in their job performance. By providing funds, tools, resources, and networking opportunities, partners have increased their knowledge base and professional ties. It has created a strong network of state and county level educators across the US working to improve housing outcomes.

The funding of this partnership in these stressed economic times has been beneficial to ensure the ongoing training of Extension Agents, ensuring that their materials and programs are current. The Partnership has provided a location for a collection of resources to assist citizens with methods and techniques to make their homes safer and livable. In Florida, the prevalence of IAQ (indoor air quality) issues continues to be a major topic for Extension Agents. These are issues that aren't going away.

Katherine Allen

University of Florida Extension

Suwannee County

Basic Information

In 1999, Congress appropriated funds to the United States Department of Housing and Urban Development (HUD) to "develop and implement a program of research and demonstration projects that would address multiple housing-related problems affecting the health of children" (Jacobs, Friedman, Ashley, & McNairy, 1999, p. 9). With funding support from HUD, an interagency agreement between HUD and USDA (then the Cooperative State Research, Education, and Extension Service) and now USDA-National Institute of Food and Agriculture (NIFA)) led to an interagency partnership, further known as the Healthy Homes Partnership. This Partnership began in 1999 as a means establishing the framework to deliver healthy homes programming with a particular focus on low-resource consumers. A model for this project was the highly successful Healthy Indoor Air for America's Homes (Montana State University Extension Service, 2002), funded by the U.S. Environmental Protection Agency (EPA) through an interagency agreement with USDA.

It was determined that Extension educators could deliver this education. Cooperative Extension educators provide important leadership in interagency teamwork endeavors because of their mission in delivering outreach education by working with many different agencies, local officials, and residents of communities across the country (Shelton & Sorter, 1980).

From the onset, the HUD/USDA-NIFA Partnership was unique in that it took a holistic approach to healthy housing. The project scope included, but was not limited to, housing-related health and safety issues, such as lead hazard control, indoor air quality, building structural safety, electrical safety, fire and disaster safety, drinking water safety, appliance use and care. The Partnership continues to address new issues such as household methamphetamine contamination, home energy efficiency, and the resurgence of household pests such as bedbugs.

Partnership Structure

Participants

Participation in the Partnership was limited to land-grant colleges and universities, citing the unique land-grant mission as critical to success. All 109 land-grant colleges and universities are eligible to participate. Program participants were solicited for quotes via the Healthy Homes listserv; many volunteered. Quotes were chosen to reflect regions and level of responsibility with Extension. Others were asked to provide quotes given recent public presentations that documented healthy homes work.

For many years, I have been an Extension Specialist at Mississippi State University Extension in Family Resource Management, mainly focusing on homebuyer education. Hurricane Katrina created an emphasis on Healthy Homes for me and with the funding provided by the HUD/USDA Healthy Homes Partnership I was able to leverage funds and create partnerships with the Mississippi Department of Health, MS Board of Realtors, the National Center for Healthy Housing, and the MS Development Authority concentrating on critical needs such as lead safe work practices in remodeling homes, mold cleanup, and overall healthy homes best practices.

Bobbie Dixon Shaffett, Ph.D.

Extension Professor, Family Resource Management

Mississippi State University

Funds Distribution

USDA served as the central distribution agency. In 1999, Wysocki contacted program leaders at the various land-grant colleges and universities for specialists and other educators involved with housing and environment outreach education. These state Extension contacts were eligible to submit proposals for the sub awards (J.W. Wysocki, personal communication, December 17, 2009). Since 1999, sub awards have been granted to successful proposals. These awards typically ranged from approximately $3,000 to $5,000. Extension professionals have used the funds as seed grants to conduct research, create programming materials, and foster relationships with stakeholders. Additionally, each year a specially funded project was selected by HUD and USDA to fulfill a critical need. The special project received more funding for a more in-depth educational program/product development.

Past and Current Management

Although HUD funds the Partnership through USDA-NIFA at the national level, colleges and have always provided management. In the beginning, the University of Wisconsin Cooperative Extension was selected to manage the project due to familiarity with healthy homes programming through coordination of the Home*A*Syst project (Eagan, 1997). In 2006, management of the Healthy Homes Partnership transitioned to Auburn University. Beginning in 2008, the administration of grants to the states also transitioned from USDA-NIFA national headquarters to Auburn University and the Alabama Cooperative Extension System (ACES). See Figure 1 for the current Healthy Homes Partnership Structure.

Figure 1.
Healthy Homes Partnership Structure

Selected Outputs: State-by-State Synthesis

Table 1 lists funded states, topics, selected partners, and selected outputs. Mold, water, integrated pest management, poison prevention, green cleaning, and others, overlap across partners. It is expected that these thematic issues will continue receiving attention among partners.

Table 1.
List of Funded States, Selected Partners, and Selected Outputs

State	Topics	Selected Partners	Selected Outputs
AK	Home energy efficiency, Indoor Air Quality	Alaska Housing Finance Corporation	A Solar Design Manual for Alaska; Alaska Building Science Newsletter
AL	IPM, coordination of Healthy Homes Partnership	National Center for Healthy Housing	IPM in Multifamily Housing trainings
AR	Poison prevention	State Poison Control Center	Clean and Green educational program
CT	Reducing clutter	CT State Department of Children and Families	House Smart: Solutions for Managing Clutter
CO	Energy	CO State University Energy Supercluster	Saving Energy in my Home: Coloring and Activity Book
DE	Green cleaning, Childcare training	DE Division of Public Health, PA State	Better Kid Care in partnership with Pennsylvania State
FL	Energy, Home maintenance	State Housing Focus Team	My Florida Home Book
GA	UGA: Radon, Green cleaning	GA Department of Community Affairs	UGA Greenway: Website, Facebook, and twitter
GA	Ft. Valley State: Annual housing conference	Rural Community Partnerships	Under One Roof Housing Conference
IA	General home environment	Iowa Department of Public Health	FAQ Answer Line for Home Environments
IL	Radon, Healthy homes-general	USDA Rural Development	Website and book: 57 ways to Protect Your Home Environment
IN	Mold/disaster education	Extension Disaster Education Network	Mold Tool Kit for Extension Educators
KY	KY: waste management, IPM	American Lung Association	Home & Environment: Household Waste Management
KY	KY State: Preventive home maintenance	Partnership with University of Kentucky	Preventative Home Maintenance fact sheets with UKY
LA	Mold/building science	Louisiana Weatherization Programs	LaHouse (demonstration house)
MD	Healthy homes--childcare/HH website	Child Care Centers, Head Start	Keeping a Healthy Home-Seven Tips Made Easy
MS	Childcare, IPM	MS State University Childcare Training Program	Online training, IPM for Childcare Workers
MO	Energy, disasters, home repair	Green Building Coalition, Habitat for Humanity	Healthy Home handouts/Building Strong Families
MT	Tribal healthy homes, weatherization	HUD, National American Indian Housing Council	Tribal Healthy Homes
NE	Home maintenance, energy, mold, lead	eXtension.org	From Moisture & Mold to Healthy Homes
NH	Energy	New Hampshire Sustainable Energy Association	My Energy Plan Website
NY	Indoor air quality, energy	HUD's Healthy Homes for Healthy Kids campaign	Assessing Your Indoor Environment Teaching Guide and DVD
NC	Energy, mold, children's environmental health	Advanced Energy http://www.advancedenergy.org/	E-Conservation Program by NC State Extension FCS Program
OK	General healthy homes, disasters	SUNUP TV--Oklahoma State University	Preparing for Severe Weather Storm Shelter video
OR	Mold	Home health aides	Stamp Out Mold in Your Home (low literacy fact sheet in 4 languages)
PA	IPM, Childcare training	National Center for Healthy Housing, Cornell University	IPM in Multifamily Housing trainings
RI	Drinking water quality	Rhode Island Department of Health	Well Water Testing
SC	Aging issues, healthy homes	Clemson University Institute for Engaged Aging	Healthy Homes for Aging Populations
TN	Lead, radon, children's environmental health	TN Childhood Lead Poisoning Prevention Program	Lead Prevention and Healthy Housing newsletter (quarterly)
TX	General healthy homes	Childcare providers, English as a Second Language classes	Online training courses for Housing and Environment
VI	Water quality, general healthy homes	Healthy Homes Partnership: Caribbean HH	Virgin Islands Home and Farm Water Quality Assessment Program
VA	General healthy homes issues	Agriculture and Natural Resources Extension	Living Well newsletters
WI	Affordable housing	Family Support Centers	Needs survey for affordable housing

Selected Outputs: Booklet, Videoconference, and Website

Help Yourself to a Healthy Home Booklet

The Partnership needed an educational tool. In 1999, the University of Wisconsin facilitated the production of a research-based, unbiased booklet titled Help Yourself to a Healthy Home. This booklet is modeled after the booklet titled Home*A*Syst: An Environmental Risk-Assessment Guide for the Home (Eagan, 1997), which was produced at the University of Wisconsin. It was determined that state Extension specialists were to write the chapters of Help Yourself to a Healthy Home. Each chapter underwent a peer review process and final editing to ensure rigor.

The first edition contained five chapters: Indoor Air Quality, Lead, Drinking Water, Hazardous Household Products, and Pesticides. In 2002, four additional chapters were added: Asthma and Allergies, Mold and Moisture, Carbon Monoxide, and Home Safety. Currently, Help Yourself to a Healthy Home is in its third edition, with edits and updated research added when applicable (Alabama Cooperative Extension System, 2011). The booklet is designed to serve as a home health self-assessment tool for low-literacy, low-resource consumers. Extension faculty and staff, including paraprofessionals, use the booklet extensively during programming.

The Help Yourself to a Healthy Home booklet has been a tremendous resource for me. It is a great tool to introduce the healthy homes concept to a variety of new audiences. With multiple languages, it allows me to expand my reach to new audiences specifically Hispanic (Latino) and Vietnamese communities. When I am not teaching Healthy Homes I bring the booklet along to hand out.

Naeemah A. Raqib

University of Maryland Extension

Anne Arundel County

Help Yourself to a Healthy Home (Figure 2) is currently available in six languages: (1) English; (2) Spanish; (3) Bosnian; (4) Hmong; (5) Vietnamese; and (6) Arabic. The translations were made carefully in order to be culturally sensitive, regionally neutral, and at the same educational level as the other versions. The booklet has been adapted for use with Native American audiences. In addition, a new version for Caribbean Island populations is due to be released sometime in the next year. Future editions are in progress for Korean and Hawaiian Island populations. Also, two coloring and activity books have been developed for children to teach about healthy homes issues: Is Your Home a Healthy Home? and Saving Energy in My Home.

I developed the Is Your Home a Healthy Home? Coloring and Activity Book to be a children's version of Help Yourself to a Healthy Home. It illustrates a boy and a girl exploring their house for potential hazards. The information is presented in a fun way. Children are encouraged to talk to parents about their discoveries.

In Colorado, Extension agents present workshops to adults who are welcome to bring their children. The children are supervised in a neighboring room and are given the activity book and Healthy Homes Partnership crayons. The workshops have been very effective for both adults and children. Other states are now using the activity book in a variety of ways, including making them available at county fairs.

Ken Tremblay, Ph.D.

Extension Housing Specialist

Colorado State University

Figure 2.
Help Yourself to a Healthy Home

Prior to 2006, the University of Wisconsin distributed 160,000 copies of the Help Yourself to a Healthy Home booklet. Since 2006, Auburn University has distributed over 130,000 copies of the booklet and other Healthy Homes marketing materials (exhibits, bookmarks, etc.).

This publication complies with Section 508 of the Rehabilitation Act. Individuals with disabilities can access the printed booklet and the electronic version on the Web. Printable versions of the booklet are available on the Healthy Homes website www.HealthyHomesPartnership.net. It is not possible to estimate the number of copies printed from the website. Since 2000, Help Yourself to a Healthy Home has been selected each year for inclusion in the Consumer Information Center Catalog.

Healthy Homes Videoconference

A Healthy Homes videoconference was held March 27, 2003. Expert university educators used case studies and responded to questions by callers to provide information on integrated pest management, mold, and asthma allergens. Approximately 3,000 persons viewed the broadcast transmitted to 281 sites nationwide, including 81 HUD offices.

Website and Other Media

The Healthy Homes Partnership maintains a website available to the public and practitioners, http://www.HealthyHomesPartnership.net (Auburn University, 2011). This website serves as a clearinghouse and resource for both consumers and educators.

Since 2006, when Auburn University revised the website, it has recorded over 65,000 hits. In the spirit of embracing new technology, the Partnership has recently launched a Facebook page.

Selected Outputs: Research, Resources, and Networking

Leveraging Resources: Selected Examples

Partners are able to use healthy homes funds to leverage additional resources. Since the dollar value of the awards is typically low, Extension professionals have used the funds as seed grants. For example, Mississippi State Extension leveraged funds from the US Environmental Protection Agency (EPA) and the National Center for Healthy Housing (NCHH) to conduct a Community Health Workers Course to the Choctaw Indian Reservation. Trainers used the Native American version of Help Yourself to a Healthy Home and provided copies to participants.

Funds have been spent to create or enhance specific programming materials. For example, a DVD about healthy homes practices with an accompanying workbook/teaching guide Healthy Homes: Assessing Your Indoor Environment (Figure 3).was developed by Cornell University with special project funds. Montana State University Extension received special funding to create the Native American version of the Help Yourself to a Healthy Home booklet. In 2010, special funds were allocated to Tohn Environmental Technologies to develop an outreach project that merged healthy homes and weatherization initiatives in New Hampshire communities. The University of New Hampshire Cooperative Extension partnered in this project.

Figure 3.
Healthy Homes: Assessing Your Indoor Environment

Creating a Network of Healthy Homes Professionals

The Healthy Homes Partnership has been widely embraced by Extension educators at the local level. In 2009, 34 state Extension programs, including the University of the Virgin Islands Cooperative Extension Service, participated in the Healthy Homes Partnership through the various land-grant colleges and universities. Funds have been spent to strengthen relationships between and among partners. For example, grantees have been encouraged to use funds to travel to the annual Housing Education and Research Association conference. Here, partners have presented scholarship attributable to Healthy Homes Partnership funding.

Partners are free to use materials to promote healthy living conditions in whatever ways are best for them, including holding workshops, producing publications and teaching guides, and coordinating a variety of other healthy housing related activities. A number of train-the-trainer sessions targeted to community-based organizations have been conducted, as well. Importantly, the Healthy Homes Partnership Exhibit has been displayed at several national conferences.

Healthy Homes Partnership Outcome Measures

Since inception, grantees have been required to fulfill obligations and submit quarterly reports to provide accountability for the Healthy Homes Partnership. States were required to reapply each year, as the competitive process was renewed on an annual basis. Any state that did not fulfill its obligation was not eligible to reapply, and their funds were distributed to states that had performed duties as expected. Certainly, states were encouraged to apply and successfully complete projects as a means of building healthy homes education momentum.

Selected Measurable Outcomes

Table 2.
Number of Persons Reached as a Result of Healthy Homes Partnership

Year (FY)	Consumers Reached	Professionals Reached
2007	2,273,880	2,589
2008	1,433,871	8,017
2009	3,450,419	11,653
2010	10,496,148	3,828

As a result, in 2010 alone, more than 16,000 homes were tested for radon; 1,164 families reduced the level or radon in their homes. More than 14,000 people reduced lead exposure in their homes; about 9,000 residents installed carbon monoxide alarms; 719 "poison-proofed" their homes; and 619 installed smoke detectors. This Partnership improves individual and family health and reduces health care cost for families, communities, and the nation.

Future Endeavors

Implications for Extension

The main implication for Extension is that the Partnership demonstrates agency desire and ability to collaborate, thus strengthening consumer education via Extension. The Healthy Homes Partnership is an example of a community outreach education project sustained with a little money for many years. Carroll, Gross, and Leist observe that sustainability is part survival and part success (2003). The Healthy Homes Partnership exhibits survival in that the program continues after 10 years. The program also exhibits success in that Healthy Homes has been integrated into other Extension programming leading to measurable outputs, as evidenced in Tables 1 and 2.

As noted by Maring et al., many state and local health departments are moving from models of lead hazard control to more holistic healthy housing (Maring et al., 2011). Health departments, housing authorities, and subsequently Extension educators, have adopted a multifaceted approach, addressing topics ranging from lead poisoning prevention to integrated pest management. Extension professional engaged via the Healthy Homes Partnership are in a unique position to facilitate holistic healthy homes programming on the local level. The Partnership will continue in this direction, applying a holistic approach to healthy housing.

The Healthy Homes Partnership is looking to the future. HUD's Healthy Homes Strategic Plan (2009) specifically calls for a building a national framework by fostering partnerships for implementing a healthy homes agenda as the first goal in guiding activities. Extension has and will continue to be part of this framework. As suggested by Carroll et al., targeting efforts based on the program core and team talents of Extension educators helps to ensure Partnership sustainability.

References

Alabama Cooperative Extension System. (2011). Help yourself to a healthy home (3rd ed.). Auburn: AL: Author.

Auburn University. (2011). Healthy homes partnership. Retrieved from: http://www.healthyhomespartnership.net/Pages/default.aspx

Carroll, J., Gross, M., & Leist, R. (2003). Comprehensive model for sustaining community projects. Journal of Extension [On-line], 41(6) Article 6FEA3. Available at: http://www.joe.org/joe/2003december/a3.php

Eagan, D. J. (Ed.). (1997). Home*A*Syst: An environmental risk-assessment guide for the home. Madison, WI: University of Wisconsin.

Jacobs, D. E., Friedman, W., Ashley, P., & McNairy, M. (1999). The Healthy Homes initiative: A preliminary plan. Washington, DC: U.S. Department of Housing and Urban Development.

Maring, E. F., Singer, B. J., & Shenassa, E. (2011). Healthy Homes: A contemporary initiative for Extension education. Journal of Extension [On-line], 49(2) Article 2FEA9. Available at: http://www.joe.org/joe/2011april/a9.php

Shelton, H. W., & Sorter, B. W. (1980). Improving interagency teamwork. Journal of Extension [On-line], 18(6). Available at: http://www.joe.org/joe/1980november/80-6-a3.pdf

U.S. Department of Agriculture Housing and Community Living. (2011). Healthy homes initiative. Retrieved from: http://www.csrees.usda.gov/nea/family/in_focus/housing_if_healthyhomes.html

U.S. Department of Housing and Urban Development. (2009). Leading our nation to healthier homes: The healthy homes strategic plan. Washington, DC: Author.