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This spring the Building Performance Institute, Inc. (BPI) and Green & Healthy Homes Initiative (GHHI) will introduce the Healthy Home Evaluator (HHE) credential to the nation's home performance, weatherization and healthy housing workforce, with the goal of breaking the link between unhealthy housing and unhealthy families through home performance interventions. 

The credential builds upon the BPI Building Analyst or Energy Auditor certifications to verify the competencies required to conduct in-depth healthy home environmental risk assessments. The Healthy Home Evaluator assesses home-based environmental health and safety hazards and provides a prioritized list of recommendations to address those hazards.

"From identifying asthma triggers and risk of lead poisoning to testing for CO and other health hazards, tremendous opportunity exists to incorporate healthy home measures into whole house home performance assessments," said Larry Zarker, CEO of BPI. "With their expertise in whole house building science, BPI Building Analysts and Energy Auditors are uniquely qualified to do this work."

"Momentum is building for a national credential that bridges the knowledge gap between energy efficient buildings and healthy housing," said Ruth Ann Norton, GHHI President & CEO. "GHHI works with BPI Building Analysts in 25 cities to conduct healthy home assessments and interventions. Combining BPI certified professionals' expertise with healthy homes training in the HHE credential provides the workforce with a high quality, portable credential that can be recognized everywhere."

GHHI leads the national effort to integrate healthy homes and weatherization into energy efficiency work. Supported by a grant from the JPB Foundation, GHHI is working with state, county and city governments to bring whole home assessments and interventions to 300,000 low and moderate income families, by coordinating existing state and local programs and funding streams.

There is growing evidence of demand for healthy home assessments in the marketplace, particularly in the area of asthma prevention, according to a 2014 nationwide survey by the National Center for Healthy Housing. Thirteen states reported that some Medicaid reimbursement was in place for home-based asthma education, while seven states reported that one or more private payers in the state provide or reimburse for home-based asthma education. States also reported on other financing mechanisms, including hospital community benefits, social impact bonds, and state-funded programs to provide services.

"With the growing demand for preventative healthy home interventions, building a home assessment workforce that combines strong building science expertise with healthy homes principles will lead to improvements in public health, and also enhance the credibility of efforts to secure sustainable financing for such interventions," said David Rowson, Director of the U.S. Environmental Protection Agency's Indoor Environments Division. "BPI's new credential is a welcome addition to the expansion and sustainability of proven healthy homes interventions."

Registration Now Open for HHE Pilot Exam

BPI will pilot the HHE certification exam beginning April 4th at the 2016 ACI National Home Performance Conference in Austin, Texas, or at any BPI Test Center nationwide. The 50-question written exam builds upon the knowledge, skills and abilities already demonstrated by the BPI Building Analyst or Energy Auditor certifications, which are prerequisites for the HHE exam. There is no HHE field practical exam. The results of the pilot test cycle will be used to set passing scores for the national exams. 

• Written exam only
• 50 questions
• BPI Building Analyst or Energy Auditor certification prerequisite
• Exam cost: $200.00
• Take pilot exam at any BPI Test Center or 2016 ACI National Conference in Austin, TX - April 4-7, 2016

To take the pilot exam at any BPI Test Center, find a Test Center near you.

To register for the pilot exam contact BPI at pilot@bpi.org. 

HHE Certification Background

Critical technical and financial support for the development of the HHE credential was provided by the Interstate Renewable Energy Council (IREC). To develop the new credential, a team of subject matter experts in public health, building science and healthy housing convened to create the certification blueprint and job task analysis. The blueprint defines the general requirements of the HHE credential: prerequisites, exam structure and recertification requirements. The job task analysis defines what tasks the HHE will be required to perform. The certification blueprint was produced in accordance with the ISO 17024 standard.

  About the Green & Healthy Homes Initiative

GHHI is a national nonprofit dedicated to breaking the link between unhealthy housing and unhealthy families. Formerly known as the Coalition to End Childhood Lead Poisoning, GHHI replaces stand-alone housing intervention programs with an integrated, whole-house approach that produces sustainable green, healthy and safe homes. This project later became the Green & Healthy Homes Initiative directed by the Coalition that addresses the health and energy efficiency needs of a home through a holistic intervention model.  

  About the Building Performance Institute

BPI is the nation's premier building performance credentialing, quality assurance and standards setting organization. BPI develops technical standards using an open, transparent, consensus-based process built on sound building science. BPI is approved by the American National Standards Institute, Inc. (ANSI) as an accredited developer of American National Standards and as a certifying body for personnel credentials.

For more information on GHHI, visit www.greenandhealthyhomes.org. 

For more information on BPI, visit www.bpi.org/pros.

- See more at: http://www.greenandhealthyhomes.org/media/press-releases/ghhi-bpi-introduce-healthy-home-evaluator-credential

The following highlighted best practices are based upon a literature of recent CHW cost-effectiveness research. The purpose is to draw out CHW program elements that have been found important to success and, where available, to cost-efficacy. It should be noted that the research, particularly in the United States, is only recently emerging. Most of what is available is focused on populations who face health disparities due to racial, ethnic, immigration, and language barriers; often within urban contexts, as opposed to the low-income, rural populations such as comprise a large sector of potential need in Maine.

The literature review drew upon multiple sources. Identification of research articles were conducted through searches of the PubMed database, maintained by the National Library of Medicine. Searches for abstracts used the following key terms:
1) CHWs and the chronic disease topics (limited to last 10 years, and NOT including developing countries).
2) CHWs in general and cost studies (also 10 years, NOT developing countries).
3) Health literacy and cost studies.

Abstracts were reviewed to identify those most closely related to the focus and aims of the four CHWI pilot sites. This includes research on CHWs with relation to asthma, breast cancer screening, and falls prevention and more generally CHWs and older adult chronic disease self-management. Note that there are many terms for CHWs, including Promotores (who typically work within Latino communities), that frequently appear in the literature. The list of sources that speak directly to one of the topics were narrowed down to identify those indicating positive health outcomes associated with CHW interventions. To identify further findings on cost-effectiveness, overview reports of the Centers for Disease Control, MA Department of Public Health, Annual Review of Public Health, and Agency for Healthcare Research and Quality were reviewed.

Relevant research on some of the desired topics was not found; yet it may be emerging. We describe what is currently available, and in some cases describe benefits from similar programs that did not include CHWs but may offer insight into what the benefits of a CHW program may offer (falls prevention, adult asthma). Most of the studies on these health topics that cite positive health outcomes with community health workers do not analyze cost-effectiveness. Some refer to "reasonable costs" without going into detail, or being "more cost-effective" than another referenced approach. Those specifically about cost-effectiveness were largely found to be diabetes and mammography interventions, and also cost-effectiveness of employing CHWs broadly across an entire city (Denver and NYC).

Fifty studies were compiled into a matrix which summarized conclusions and indicated whether each of the selected studies demonstrated health outcomes, cost outcomes, and/or focused on non-English speakers. The matrix was then used in order to pull out those studies that had the most relevant focus and these were reviewed in greater depth in order to compile the following summary findings to reflect upon key areas: a) linking to a primary care provider and b) referrals to services, c) patient self-management, d) appropriate Emergency Department (ED) use, e) patient satisfaction, f) successful CHW integration into care/service teams, g) replicating evidence-based models (EB) with fidelity, and h) elements vital to cost-effectiveness. Further findings specific to CHW services and older adults, asthma, and breast cancer screening are highlighted. Some areas of focus that were hoped to shed light upon were not observed, including details of impacts upon social determinants of health. Also focal areas on 1) patient self-management education specific to older adults and 2) medication reconciliation were not found; however these populations and activities are included within the general research on patient self-management and of medical management. Older adults or seniors were being served by 74% of the CHW programs across New England that were surveyed as part of the ICER review (Institute for Clinical & Economic Review, 2013).

Note that ICER did not find it possible to compare all studies in order to identify precisely which are the key characteristics of CHW interventions associated with positive results. Studies in their review, as in those we examined, simply did not include adequate descriptions of important aspects of CHW interventions. Those characteristics we have noted are simply a listing of what was gleaned from individual studies.

The review pulls key points and findings of interest from the full list of 50 articles reviewed. In some cases direct quotes from the research are used, and in others, key findings are summarized. Findings are bulleted in an attempt to make the review succinct and hone on key points.