Coordinating Healthy Homes with Energy Programs Program Design

Coordinating Healthy Homes with Energy Programs Program Design

Coordinating Healthy Homes with Energy Programs Program Design and Performance Measurement Considerations Matthew Lyons APPRISE Incorporated Presentation Objectives 1. Understand potential benefits of healthy homes coordination 2. Review steps to consider when planning a healthy homes coordination project 3. See an example of the evolution of a healthy homes coordination project

4. Identify lessons learned to design, track, and evaluate healthy homes outcomes in an energy program 2 Reasons to Invest in an Energy Plus Health Model Reduce energy efficiency deferrals Generate referral sources Leverage additional funding streams Resolve inefficiencies in service delivery Provide more comprehensive service delivery Improve energy and non-energy participant outcomes 3 Energy Plus Health Process Improvements Fragmented Programs Jane Applicant: High Energy Bills

Roof Leak Chipping/Peeling Paint Heating System Broken Schedule Home Repair Audit Reapply for Weatherization Select / Assign Contractor Complete Lead Abatement Apply for Weatherization Submit CDBG Documentation Complete Loan

Closing Select / Assign Contractor Submit WAP Documentation Apply for CDBG Home Repair Complete Roof / Heating Repairs Conduct Audit & XRF Testing Schedule Energy Audit Defer Applicant Repair Issues

Apply for Lead Abatement Submit Lead Documentation 4 Energy Plus Health Process Improvements Coordinated Programs Jane Applicant: High Energy Bills Roof Leak Chipping/Peeling Paint Heating System Broken Integrated Home Retrofit Plan Contractor Assignment

Apply for Housing Services Comprehensive Home Audit Loan Closing* Submit Unified Application Submit Required Documentation Home Retrofit 5 Energy Plus Health Process Outcomes Leveraging Increased investment in households served Increased organizational resources

Deferral rates Less households denied weatherization services Lower energy auditing costs Time efficiencies Reduced staff hours on duplicative activities Reduced processing time to receive program services 6 Energy Plus Health Client Outcomes Higher energy savings Repairs that reduce air infiltration Improvements that facilitate effective weatherization Improved health and safety Mitigating lead paint hazards Reducing home asthma triggers Reducing home falls/injuries Reduced expenses Lower energy bills Emergency room visits, hospitalizations, and nursing home placements

Improved home comfort Activities of Daily Living Home heating/cooling temperature Physical and mental health 7 Energy Plus Health Objectives Maximize Health Impacts Target populations with health Comprehensive Service problems Delivery Target interventions that Address barriers to weatherization address health outcomes Facilitate improved energy savings Reduce participant transaction costs 8

Challenges Creating an Energy Plus Health Model Restrictions in uses of energy efficiency funding Lack of alignment between funding streams Lack of alignment between agencies Separate intake, assessment, and contracting Data tracking limitations 9 Energy/Healthy Housing Design Framework Planning Steps Design Questions Needs Assessment What are the needs of the eligible and participant populations? Funding Research

What funding sources are available that serve the needs of the population? Resource Analysis How does available funding meet the needs of the population? Organizational Management What are the roles, rules, and relationships for resource coordination? Low-Risk/High Yield Opportunities What are near-term, mutually-beneficial opportunities for service coordination? What are long-term opportunities to improve the System Building Strategies efficiency and effectiveness of energy/health

interventions 10 Energy/Healthy Housing Needs Assessment Housing Health Own / rent Single family / multi-family Housing age Asthma Falls/injuries Lead paint poisoning Energy Critical Needs Heating fuel type Energy usage

Energy burden Home energy service Housing affordability Health costs Demographics Energy Efficiency Deferrals Income Financial capacity Vulnerable populations Mold and moisture Structural problems Water leaks 11 Funding Research Funder Descriptions

Weatherization Assistance Program Energy Efficiency and Conservation Block Grant Healthy Homes Demonstration Grant Lead-Based Paint and Lead Hazard Reduction Demonstration Grant HOME Community Development Block Grant Choice Neighborhood Grants Health and Human Services

Low Income Home Energy Assistance Program CDC Lead Poisoning Prevention USDA Rural Repair and Rehabilitation Loans and Grants Utilities, State and Local Government, Philanthropy Ratepayer-funded low-income programs State housing trust funds Non-profits Municipal bonds

Foundations Department of Energy Housing and Urban Development 12 Resource Analysis Resource Assessment Funding Rules Area of Analysis Funding

Implementation Gap Analysis Income limits Allowable activities Block grant vs. categorical grant Loans vs. grants Fed vs. state vs. local vs. non-profit vs. utility Application and documentation requirements Underwriting guidelines Contractor assignment/selection Are funding sources sufficient to meet the needs of the population? What additional funding is needed? What changes in how funding is administered are needed? 13 Case Study: City of Baltimore Summer 2009 - $15.7 million ARRA

weatherization award to Baltimore City Increased production goals from 100-200 units/year to 2,400 units over 3 years In the first year of ARRA implementation, 64% of households were deferred from weatherization due to health and safety issues. 14 Baltimore City Housing Quality Issues Baltimore City Energy Audit Outcomes FY 2010 Weatherized 1.08% 2.76% 23.57% Deferred - Roof Leak 36.29% Deferred - Moisture/Mold

Deferred - Other Structural Deferred - Electrical/Lead/Asbestos/ Pests 36.29% 15 Managing Baltimores Energy Plus Health Initiative Leadership Team Management Network Operating Network Partners and Stakeholders Core city health and housing agencies Non-profit healthy housing leader Philanthropic convener Partner and funding identification

Policy and system change Referral processes Case tracking Audit/scope coordination External collaborators Intersection of energy/healthy housing with other program services 16 Low-Risk/High Yield Coordination Opportunities Baltimore City CDBG Renovated Homes + Weatherization Leverage recently renovated homes likely eligible for weatherization Weatherized Homes + Lead Hazard Reduction Leverage WAP data to target lead paint home visits and abatement Senior Home Repair Services + Weatherization Leverage community organizations to coordinate senior home repairs and weatherization

17 Service Coordination Components Baltimore City Referral Form Standardized method for agencies to refer clients to partnering agencies Screening Tool Assessment tool for identifying needs and eligibility for households with complex needs LIGHT Team Network of agencies that meet regularly to manage interagency coordination opportunities LIGHT Database

Database to track client information across multiple agencies 18 Referral Form Client Priorities 19 Referral Form Housing Priorities 20 Screening Tool Assessing Housing Needs Housing Building Structure

Plumbing/Sewerage Mold/Moisture Energy Usage Out of fuel/Utility disconnect Heating system broken Asthma Child with asthma / Adult with respiratory problems Pest infestation ER visits, school/work days missed, hospitalizations Lead Paint Aging in Place Child blood lead level testing Housing age Chipping/peeling paint Trip/fall hazards in home

History of falls / hospitalizations / ambulatory aid Activities of Daily Living 21 Screening Tool Examples Client Prioritization 22 Screening Tool Examples Available Programs 23 LIGHT Team Members Housing Rehabilitation Baltimore Housing Office of Rehabilitation

Neighborhood Housing Services of Baltimore Park Heights Renaissance Energy Weatherization Assistance Program Fuel Fund of Maryland Baltimore Energy Challenge Health Green and Healthy Homes Initiative Baltimore City Health Department Healthcare Access Maryland Older Adult Services Comprehensive Housing Assistance Civic Works Johns Hopkins School of Nursing Tax/Financial/Legal Services

Baltimore CASH Campaign Bar Association of Baltimore Public Justice Center 24 Shifting from Coordination to Integration 2009 Testing referrals with core stakeholders 2010 Standardized referral form; expand partners 2011 Merge Wx/Lead/Rehab under single agency 2012 Integrate application processing functions 25

Integrated Application Apply for Services, Not Programs Housing Rehab Roof Plumbing Structural Water/Sewer Electrical Health/Safety Lead Hazards Heating System Accessibility Modifications Energy Energy efficiency 26

Comprehensive Home Assessment & Contracting Inspection Client Interview Demographic information Lead hazards Asthma Indoor pollutants Indoor hazards management Safety & injury prevention

Energy Audit Lead paint CO / Smoke / Fire Safety Mold / Moisture Electrical / Structural Hazard Child Safety Stairs / Railing Safety 27 Coordinated vs Integrated Interventions Jane Applicant: High Energy Bills Roof Leak Chipping/Peeling Paint Heating System Broken Coordinated Services Home Repair Contractor

Lead Abatement Contractor Weatherization Contractor Integrated Services Roof Replacement Lead Abatement Single Contractor Heating System Replacement Weatherization 28 Lessons Learned Energy Plus Health Planning

Balance community needs and program resources Geographic targeting Population targeting Find Mutually Beneficial Partnerships Start with easy wins Positive branding encourages agency participation Create venues to resolve policy and operating issues 29 Lessons Learned Energy Plus Health Data Tracking Identify priority populations for healthy homes enhancements Asthma school days missed, emergency room visits, hospitalizations Fall/Injury Activities of Daily Living, number of past falls Lead Paint age of housing, children in home, blood lead levels Triage client needs Weatherization only Weatherization plus healthy homes enhancements Resolve housing repair needs prior to weatherization

Establish method for evaluating pre- and post-outcomes Updates to data tracking system Methods for capturing energy, health, and housing data Controlling for exogenous influences 30 Lessons Learned Energy Plus Health Process Changes Service Coordination Identify funding to support interagency coordination Develop standardized referral processes Establish assessment tools and data tracking that make coordination more efficient System Changes Consider long-term strategies to align application and documentation processes Assess procurement and training opportunities to facilitate integrated home assessments and retrofits 31 Lessons Learned

Energy Plus Health Performance Measures Reduction in deferrals Pre-/post- health outcomes Energy savings Financial benefits Staff time/cost savings Customer processing times Leveraged funding for comprehensive services Baltimore City Energy Audit Outcomes FY 2018 1.08%

2.76% 23.57% 36.29% 36.29% 32 Matthew Lyons APPRISE Incorporated [email protected] 609-252-8014 33

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