Healthy Androscoggin - Reducing Lead Poisonings in LewistonAuburn Final Funding Report
2/6/2015
Overview
Healthy Androscoggin’s (HA) long term goal is to reduce high rates of child
lead poisoning in Lewiston-Auburn with a strong focus on the New American
community of refugees and immigrants. In April, 2013, Shanna Rogers
resigned her position at Healthy Androscoggin and Dana Leeper was hired to
focus on reducing lead poisoning in Lewiston-Auburn. Funding from the John
T. Gorman foundation has provided numerous opportunities for Healthy
Androscoggin to approach reducing lead poisoning rates from a variety of
angles. One of our partners is the Coalition to End Childhood Lead Poisoning,
longtime leaders in reducing lead poisoning in Maryland and beyond. To learn
the best ways to educate refugees and immigrants on lead poisoning
prevention we Healthy Androscoggin staff cultural competence was assessed
the health needs of New Americans in Lewiston Auburn. Additionally,
funding allowed us to expand our Neighbor to Neighbor program, supported
landlord education and outreach, as well as outreach to legislators and
partner agencies in Lewiston Auburn and across the state.
EXPAND-mention Asmo
The Coalition to End Childhood Lead Poisoning
The Coalition to End Childhood Lead Poisoning assisted Healthy Androscoggin
in becoming better versed in lead hazard remediation. When we were first
received John T. Gorman Foundation funding the Lewiston City demolition
protocols were weak in regards to lead. The Coalition provided
recommendations on how to reduce lead dust and risk of lead poisoning
during demolitions. Many of these recommendations were recognized by
Lewiston and are now in draft demolition protocols. For the past two years
the City of Lewiston has been using the draft demolition protocols for 31
public demolitions since 2013. Since 2012, applicants for private demolitions
are given the draft private demolition protocols as a suggestion. Recently,
Dana Leeper and the Coalition to End Childhood Lead Poisoning met with the
Ed Barrett, the City of Lewiston’s Administrator, and Mr. Barrett agreed the
draft demolition protocols for public demolitions should be formally adopted
to ensure the standard for all future demolitions. The Lewiston City
Administrator will also encourage Lewiston City Councilors to still provide
recommendations for private demolitions in regards to controlling lead dust.
Mr. Barrett believes there will be no problem getting the proposal to pass.
The vote is being scheduled for February, 2015. Once passed, the potential
of lead dust exposure during demolitions will continue to dramatically
decrease.

 The Coalition to End Childhood Lead Poisoning also provided
recommendations and grant writing support for the 2012 HUD OHHLHC Lead
Hazard Control grant proposal, 2012 EPA Brownfields Assessment grant and
the 2014 HUD Lead Hazard Control Grant. In September, 2014 City of
Lewiston was awarded 3.1 million dollars in lead hazard abatement and
healthy homes funding. 225 Lewiston Auburn units and $2,300 healthy
homes funding per unit.
Community Cultural Competency
Financial support enabled Healthy Androscoggin to learn the best lead
poisoning education techniques. To assess how we can provide better
outreach and support to refugee and immigrants we are undergoing a
community and organizational cultural assessment. Beginning in May 2013,
Healthy Androscoggin and Planning Decisions held focus groups for over 40
Ethnic Somali and Somali Bantu people, including youth. Two Bates College
interns supported the Ethnic Somali and Somali Bantu focus groups.
Overall the major health problems in the Somali Ethnic and Somali Bantu
community in Lewiston-Auburn are obesity, diabetes and other weight
related issues, as well as, lack of access to dental care and accidental misuse
of medicine. An inability to speak English and unemployment has
exacerbated stress related to cultural transition. Many families also identified
bed bugs and personal hygiene as health problems. Across cultural
differences folks identified the best ways to advertise services or events are
phone calls, knocking on doors to provide face to face contact, and phone
call reminders a day before an event takes place. Other suggestions included
providing flyers in Somali and English as well as working with local mosques.
To discover what health programs currently exist in Lewiston-Auburn Healthy
Androscoggin and Planning Decisions met with 30 providers from various
social service and healthcare fields. Focus group participants included health
care providers, representatives from mental health, police departments, food
pantries, nutrition, education, employment, children and youth services as
well as three leaders among the refugee and immigrant community. All
providers were asked what programs currently serve the New American
community and how many are served with these programs. To gauge what
tactics have been used to reach the immigrant and refugee community we
asked, “what challenges exist in serving the New American community,
including what hasn’t worked? Lastly to gain understanding of what
programs and outreach is working well, we asked, “what has worked well
along with what opportunities exist?” Community leaders gave excellent
suggestions on how to better reach immigrants and refugees. Overall the
majority of providers were happy to share information and believe they can
also benefit from Healthy Androscoggin’s results of the cultural assessment.

 Information gathered from the Ethnic Somali, Somali Bantu and provider
focus groups assisted Healthy Androscoggin in preparing community survey
questions. In November 2013, Asmo Dol and Dana Leeper worked with
Planning Decisions and the Neighborhood Housing League to survey New
Americans in the Lewiston Auburn area. The Neighborhood Housing League
hired part-time canvassers for two weeks and ended up surveying 232 New
Americans or immigrants, refugees and asylum seekers. Surveyors went out
in pairs with at least one bilingual person per pair. To simplify the survey
process surveyors used I-pads. The door-to-door survey identified the best
ways to provide outreach and education to immigrants and refugees about
lead and other health related issues.
The Lewiston Auburn New American Health Survey is in the final stages of
becoming a formal report with pictures. As soon as the formal report is
available it will be distributed to Lewiston Auburn providers, including Ethnic
Community Based Organizations (ECBO).
In September, 2014 Healthy Androscoggin was awarded a federal Center for
Disease Control Racial and Ethnic Approaches to Community Heath (REACH)
grant for a three year period. One of the grant application requirements was
that we had done a recent health survey. John T. Gorman Foundation's
funding of the Lewiston Auburn New American Health Survey was vital to us
receiving the funding and will help to improve New Americans in Lewiston
Auburn access to chronic disease prevention resources. To accomplish this,
Healthy Androscoggin will provide in depth cultural competency trainings for
seven local agencies as well as cultural competency trainings for interested
Lewiston Auburn providers. The REACH funding allowed us to hire another
staff person who is also a New American herself.
On November 13, 2014 Healthy Androscoggin held an introduction to cultural
competency and humility training for 32Lewiston Auburn providers from a
variety of organizations, including but not limited to Advocates for Children,
Maine Immigrant and Refugee Services (aka Somali Bantu Youth Association
of Maine), Community Concepts, Androscoggin Unified Emergency
Management Agency, Auburn Schools, Lewiston Schools, Coastal Enterprises,
Public Health Nurses, Patrick Dempsey Center, Tri-County Mental Health, and
Healthy Androscoggin. Saida Abdi, MSW, LCSW (Director of Community
Relations and social worker at Boston Children’s Hospital) and Molly Benson,
PhD (Associate Director for Refugee Treatment and Services at the Refugee
Trauma and Resilience Center at Boston Children’s Hospital) facilitated the
training. The first panel was on demographics, languages and cultures in
Lewiston Auburn. Panel speakers included: Julia Trujillo Luengo (Director of
Maine Office of Multicultural Affairs), David Harris (Tri-County Mental Health
Trauma Counselor), Jorge A. Acero (Maine Department of Labor Migrant and
Seasonal Farmworker State Monitor Advocate), and Hawo Abdille (B Street
Health Center employee and immigrant). The second panel focused on

 interpretation versus cultural brokers. Speakers included Fowsia Muse (local
interpreter) and Kolawole Bankole, MD, MS (City of Portland Minority Health
Program Coordinator). Sahra Odwa, a University of New England Public
Health Senior Graduate Student, and Sarah Miller, a Senior Bates student
assisted in the planning of the training. Sarah Miller created a pre and post
survey for respondents. To encourage participants to stay the whole time,
Sarah Miller received a $100 grant which she in turn purchased five $20 gift
cards to local restaurants. At the end of the training attendees participated in
a raffle to win the gift cards. All post training results were extremely positive.
One participant said they would highly recommend a program like this to
their friends, family members and colleagues. Every participant said they
would take another program like it if it were offered.
Beginning in the fall of 2014, Healthy Androscoggin began spreading our
cultural competency work with various partners. During the project period
Dana provided feedback for the Lewiston YWCA’s Muslim Women’s
Swimming Class which because of feedback has since then been changed to
a womens only swimming class with provided interpretation. Following the
project period, Dana Leeper gave a lead poisoning prevention and
introductory cultural competency training to Women, Infant, Children (WIC)
Auburn staff following the project period.
Using remaining John T. Gorman Funds, HA worked with a local advertising
company to create a 15 second multilingual video about childhood lead
poisoning prevention. The video is in the final stages of completion. When
completed, the video will depict babies of varying ethnicities. The video
message will be spoken in Somali with a caption in French and English. Funds
are supported the video to be promoted on Facebook, Twitter and YouTube.
Organizational Cultural Competency
For Healthy Androscoggin’s in depth organizational cultural competence
assessment we’ contracted with Kolawole Bankole, MD, MS, City of Portland
Minority Health Program Coordinator. During May 2013-December 2013,
Twelve HA staff participated in two cultural competency surveys to gauge the
cultural competence of HA. Results showed Healthy Androscoggin’s staff
values and attitudes and communications are high. Areas for improvement
are HA’s physical environment, materials and resources. Suggestions for
improvement included displaying flags from countries representing area
residents, displaying unique cultural pieces. Other suggestions included
increasing staff knowledge of diverse communities, develop structure for
service delivery that will allow community, inform staff of language access
and interpreters, establish a protocol for paying interpreters and translators,
as well as hiring a more diverse workforce. Lastly, one of the main
suggestions was to create a diversity think tank workgroup that would assist
in making Healthy Androscoggin more culturally competent.

 Since the staff cultural competence assessment Healthy Androscoggin has
made huge strides toward improving the cultural competence and humility of
our staff and partners. Foremost, we have hired two staff who identify as
New Americans. In December, 2013 Asmo Dol was hired as our cultural
liaison. In December, 2014 AnNisa Abdi, a former employee of United Somali
Women of Maine, was hired as a health promotion coordinator for our
recently awarded REACH grant. Now all staff have each met with at least
one New American partner and are continually gaining an understanding of
health disparities. To better improve their understanding providing services
to various cultures, six Healthy Androscoggin staff attended the cultural
competency training that HA sponsored. Our relationship with Ethnic
Commuity Based Organizations or ECBOs has greatly improved enabling us
to provide better resources for New Americans. Also, this partnership was a
major part of HA receiving the REACH grant. REACH grant staff are creating
cultural education opportunities for HA staff and will be reviewing HA policies
around equal delivery of services. Beginning in May 2014, HA has established
a protocol for providing and paying for interpretation and translation that is
usually always provided by local l ECBOs. For instance, any of our nutrition
materials have been translated into Somali, French and Arabic. Also, a
substance abuse and marijuana flyer was created that portrayed health
effects through pictures with limited words. For lead education funding
allowed us to purchase hundreds of N2N pictorial flipbooks that remain the
best way to teach New Americans about lead poisoning prevention.
Remaining John T. Gorman funds paid for a 15 second multilingual lead
poisoning prevention video advertisement to be created and promoted
through social media. Lastly, HA is aware our space is difficult for New
Americans and the community as a whole to access. We are hopefully
moving into a space in downtown Lewiston on Lisbon St. The location would
be in close walking distance of numerous ECBO offices and to many New
Americans who live downtown.
Neighbor to Neighbor
Financial support allowed Healthy Androscoggin to expand the Neighbor to
Neighbor (N2N) program. The goal was to train 30 immigrant and refugee
women or New Americans to become a robust volunteer community health
outreach workers (CHOW) who advocate on lead poisoning prevention, pest
prevention, substance abuse prevention and healthy eating. In total, Healthy
Androscoggin taught seven N2N classes training 315women and three men
as CHOW's in lead poisoning prevention, nutrition and tenant rights. Each
participant received a $25 gift card for food, cleaning supplies, a pictorial
flipbook and if they spoke Somali, they received Running Unleaded DVD in
Somali. Six of the seven nutrition trainings were provided by Emily Horton,
one of Healthy Androscoggin’s SNAP Nutrition Educators.

 On April 2, 2013 a N2N class trained New American women in lead poisoning
prevention, tenant rights relating to lead and nutrition. Pine Tree Legal was
on hand to speak on tenant rights and a Healthy Androscoggin Nutrition
Educator taught nutrition. Using flipbooks and cleaning supplies the CHOW
advocates each trained at least two neighbors, friends and family. A cultural
broker internship student recruited the refugee and immigrant women to
serve as CHOW’s, provided planning support and interpretation during the
training, in addition to assisting with follow-up of neighborhood education. In
total 58 refugee and immigrant women in Lewiston-Auburn received either
classroom or indirect training from CHOW’s.
On September 26, 2013 a N2N class trained 27 New American women in lead
poisoning prevention and nutrition, provided by a Healthy Androscoggin
SNAP Nutrition Educator. These women then trained 51 of their neighbors. In
total, 78 New American women were either trained directly or indirectly by a
neighbor.
On February 6, 2014 a N2N class trained 23 New American women in lead
poisoning prevention and nutrition. These women then trained 87 neighbors.
For example, one N2N advocate taught a class of 30 people at one of Somali
Bantu Youth Association of Maine’s classes. In total, 120 New American
women and men received training.
On March 27, 2014 a N2N class trained seven New American women in lead
poisoning prevention and nutrition. These women then trained 14 neighbors.
In total, 21 New American women received training.
On June 5, 2014 a N2N class trained 14 New American women and three men
in lead poisoning prevention and nutrition. These advocates then trained 30
neighbors. In total, 47 New Americans received lead poisoning prevention
and nutrition education.
On September 4, 2014 a N2N class trained eight New American women in
lead poisoning prevention and nutrition. In turn, these women trained 13
neighbors. In total, 21New Americans received direct or indirect training.
On November 11, 2014 a N2N class trained 13 New American women in lead
poisoning prevention and nutrition. These advocates then trained 18
neighbors. In total, 31 New Americans received lead poisoning prevention
and nutrition training.
By utilizing CHOW advocates the N2N program enables us to educate
hundreds of New Americans in Lewiston-Auburn on lead poisoning
prevention, pest prevention, nutrition, and other topics.

 Lead Poisoning Education
Funding has provided a resurgence in lead poisoning prevention education.
In Lewiston where 70% of landlords live outside the city, outreach and
education to landlords is often challenging. During the past three years local
landlord associations has been disbanded further limiting possible landlord
contact. To further educate landlords using positive role models Healthy
Androscoggin interviewed a Lewiston landlord who is Lead Renovation,
Repair and Painting (RRP) certified and has cleaned up lead in their building
before a child got poisoned. This interview was published in the September
2013issue of the Lewiston Leader, a Turner Publishing monthly newspaper. In
addition the interview was sent to local media outlets and shared on
Facebook. Additional landlord outreach and education included free
television advertising of free lead dust testing, working with code
enforcement, and numerous one-on-one meetings with landlords. In
December, 2014, after years of encouraging Lewiston Code Enforcement to
have a stronger focus on identifying lead hazards, two Lewiston code
enforcement staff attended a week long lead training. One of these code
enforcers is also on the new Lewiston Auburn Green and Healthy Homes
Initiative Triage Team discussing home inspections.
In July, 2013, Dana Leeper and Eric Frohmberg, Director of Maine CDC Lead
Poisoning Prevention Fund, gave a lead poisoning prevention overview
presentation to Lewiston City Council. Following the presentation Dana met
with Mayor Macdonald along with City Councilor and then State
Representative Nate Libby to discuss possible legislation that could be
enacted and what steps landlords can take to avoid lead abatement and if
needed what abatement funding is available for landlords and homeowners.
To further discuss possible stronger lead state legislation Nate Libby,
Lewiston City Councilor and State Representative, held a meeting with local
State Representatives, State Senators, and ME CDC Lead Poisoning
Prevention Fund staff. Lastly, the John T. Gorman Foundation played a vital
role in connecting HA’s lead poisoning prevention work to the Maine
Affordable Housing Coalition.
Cultural Liaison
The hiring of a cultural liaison was delayed to summer due Shanna Rogers
leaving and the hiring of Dana Leeper, the new health promotion coordinator
on childhood lead poisoning prevention. The cultural liaison position is
currently posted and will be filled by the middle of September 2013. The
position will be a regular part-time, 20 hour/week position. The JTG funding
supported 16 hours/week, but HA was able to leverage an additional four
hours from other funding to support the 20 hour/week position. Beginning in
August, 2013 Asmo Dol, then a Masters of Public Health internship student
from the University of New England, assisted us to further enhance our
cultural work. In September, 2013 began focusing on supporting Healthy

 Homes, Healthy Families, recruiting for and improving Neighbor to Neighbor
while also helping Healthy Androscoggin provide better outreach and
services to New Americans across all of our topic areas.
Asmo Dol played an instrumental role in determining where to survey New
Americans for the Lewiston Auburn New American Health Survey. For two
weeks in November, 2013 Asmo and Dana worked closely with the
Neighborhood Housing League and Planning Decisions to make sure we
surveyed enough individuals. For example, Asmo canvassed with the
canvassers one weekend.
In December, 2013 Asmo Dol began working 20 hours per week with Healthy
Androscoggin as the cultural liaison. Asmo recruited for and co-taught four
Neighbor to Neighbor trainings. She worked with substance abuse and
tobacco cessation staff to create a culturally competent flyer promoting the
health effects of tobacco, marijuana?, and hukkah or otherwise known as
water pipe.
In the fall of 2013, Asmo provided feedback to make the nutrition portion of
N2N more culturally appropriate. Later in the spring of 2014, Asmo
connected Dana Leeper with Learning Works. Healthy Androscoggin ended
up providing a smoke free housing multilingual class for Learning Works
attendees.
In May 2014, Asmo planned and facilitated a meeting with the Maine Office
of Multicultural Affairs and Office of Health Equity. This partnership led to
Healthy Androscoggin being awarded $7,000 from the Office of Refugee
Resettlement to provide N2N style chronic disease prevention classes for
refugees.
In June, 2014 Asmo Dol resigned from Healthy Androscoggin. She continues
to provide valuable support and insight for our outreach to New American
leaders and organizations.
Green and Healthy Homes Initiative
From 2003 to 2012, 177 Lewiston children, under age 6, had elevated blood
lead levels (>=10 ug/dL). During the same time, 362 children, under age 6,
were poisoned by lead (5-10 ug/dL). In total, 539 Lewiston children under age
6 were poisoned by lead from 2003-2012. Levels below 5 ug/dL are
presently not tracked. Healthy Androscoggin realizes that education and
outreach will not fully address the issue of why children are getting poisoned
by lead. In Lewiston-Auburn many homes are owned or rented by people with
limited financial resources. Thus, the issue is not only a lack of education but
instead a combination of many reasons including a lack of education, as well
as lack of financial resources keeping them from reducing the threat of lead

 or if necessary removing lead from their buildings, among many other factors
including cultural implications, access to healthcare, etc. One thing is
certain, however; the housing stock must be improved. In certain areas of
Lewiston half of residents live below the federal poverty line and as many as
one in four are unemployed. Nationally, low-income households spend 14%
of their income on energy costs compared to 3.5% for other households. The
lack of financial resources limits many tenants on how much money they can
afford to pay for cleaning supplies while more landlords are unable to afford
to maintain their property, let alone pay for lead abatement.
Through Healthy Androscoggin’s work to reduce lead poisoning we’ve also
identified other home health issues in Lewiston-Auburn, which require
financial resources to assist in eliminating the problems. These include mold,
pests, air quality and asthma triggers causing health related costs and
invariably leading to school absenteeism due to health. In 2012, Central
Maine Medical Center had 431 patients re-visit the Emergency Room because
of asthma like symptoms. Among asthma episodes 40% are caused by
triggers in the home. Some include mold, cockroaches, tobacco smoke and
chemical odors. If homes had fewer or no asthma triggers the rates of
asthma Emergency Room re-visits would likely decrease. Some homes and
apartments also have trip and fall hazards that affect our elder and disabled
populations.
The growing concern for the Lewiston-Auburn’s community health has led
Healthy Androscoggin, Community Concepts, the City of Lewiston, and the
Maine Center for Disease Control to explore the process of making LewistonAuburn a Green and Healthy Homes Initiative site. In June 2013 Steven
Johndro, Dana Leeper and Shanna Cox (Rogers) from Community Concepts,
attended a Green and Healthy Homes Initiative (GHHI) Conference in
Providence, Rhode Island. The conference provided detailed information on
all aspects of the GHHI. Those who attended were also able to make
connections with sites across the country while furthering relationships with
GHHI staff. Following the conference Healthy Androscoggin and a
representative from the city of Lewiston have started discussing site funding
options with a GHHI staff person. Following the conference, Healthy
Androscoggin, Community Concepts, the City of Lewiston, and the Maine
Center for Disease Control partnered on organizing a GHHI Roundtable on
September 5, 2013. Various community members attended and Mark
Kravatz, then Outcome Broker of GHHI Providence, RI. The Roundtable
discussed the logistics of blending funding and working with local
government and agencies to increase healthy housing using GHHI initiatives.
The goals of the meeting was to provide an opportunity for Lewiston-Auburn
government, agencies, organizations and stakeholders to learn what is
already being done, what needs to be in place to provide healthy homes, to
engage with one another, and to ultimately identify what is needed for each
organization to be able to commit to this new approach.

 Starting in the fall of 2013, a GHHI LA Planning Team was started and began
meeting monthly. Around the same time, a GHHI LA Steering Committee was
formed. The Steering Committee would meet quarterly. These groups created
the compact for GHHI Lewiston Auburn and planned a press conference to
highlight the first compact signatories. There are 16 compact signatories to
date and an additional two organizations have expressed interest in joining.
In addition, the GHHI LA Planning Team and Steering Committee created the
foundation for pay and job requirements of the future Outcome Broker. In the
spring of 2014, the John T. Gorman Foundation funding coupled with funding
from a few other partners paid for the Coalition to End Childhood Lead
Poisoning to assist the City of Lewiston in the writing the Housing and Urban
Development Lead Hazard Control Grant application. In September 2014, the
City of Lewiston was awarded the HUD Lead Hazard Control grant, a three
year grant totaling 3.1 million dollars which will provide lead abatement
funding for up to 225 units and up to $2,300 in healthy homes funding per
unit.