1. Louisiana Childhood Lead Poisoning Prevention Program Child Care Health Consultant Video Conference November 13, 2008 Presented by LACLPPP Staff Ann Bludsaw, GSW, Case Manager Colleen Clarke, BS, Program Coordinator Ngoc Huynh, M.D., MPH, Surveillance Epidemiologist Caroland Randall,BA, M.A.O.M, Environmental Coordinator

2. OBJECTIVES 1.Define Childhood lead poisoning. 2.Recognize sources of lead poisoning. 3.Discuss the components of the comprehensive Childhood Lead Poisoning Prevention Program. 4.Describe the components of the Louisiana Childhood Lead Poisoning Prevention Program. Poisoning Prevention Program. 5.Determine lead screening requirements. 6.Determine case management requirements. 7.Discuss lead inspection requirements.

3. What is lead poisoning?

4. Lead is especially dangerous for young children. They: are still developingare still developing absorb it more easilyabsorb it more easily are more likely to put things in their mouthsare more likely to put things in their mouths

5. Lead affects the brain and nerves. This may cause: learning problemslearning problems physical problemsphysical problems

6. More effects of lead stunted growthstunted growth behavior problemsbehavior problems other issuesother issues

7. Effects of high lead levels damage to the nervous system, including the braindamage to the nervous system, including the brain convulsions or comaconvulsions or coma deathdeath

8. Sources of Lead LEAD PAINTLEAD PAINT DUST AND SOILDUST AND SOIL WATERWATER PARENTAL OCCUPATIONS OR HOBBIESPARENTAL OCCUPATIONS OR HOBBIES HOME REMEDIESHOME REMEDIES FOODFOOD OTHEROTHER

9. Lead-based paint and lead dust are the leading sources. chipped or flaking paintchipped or flaking paint dust from deteriorating paintdust from deteriorating paint dust from renovationsdust from renovations

10. Lead may be in water. lead plumbing fixtures in your homelead plumbing fixtures in your home lead in the water supply systemlead in the water supply system It can come from:

11. Hobbies may be a source of lead. stained-glass or pottery makingstained-glass or pottery making fishingfishing refinishing furniturerefinishing furniture

12. Lead may be in food. It can come from: soil or watersoil or water dust on hands or preparation surfacesdust on hands or preparation surfaces leaded crystalleaded crystal lead-soldered canslead-soldered cans some glazed potterysome glazed pottery

13. Comprehensive Approach to Childhood Lead Poisoning Assess children’s exposure to leadAssess children’s exposure to lead Develop policies for childhood lead poisoning preventionDevelop policies for childhood lead poisoning prevention –Primary Prevention –Secondary Prevention Assure performance of activities to prevent childhood lead poisoningAssure performance of activities to prevent childhood lead poisoning Monitoring (surveillance)Monitoring (surveillance) - Monitoring children’s BLL’s - Monitoring for risk for lead elevation

14. Head Start Requirements It is a Medicaid EPSTD requirement that a lead screening blood test be performed to determine a lead toxicity level for all Medicaid-eligible children.It is a Medicaid EPSTD requirement that a lead screening blood test be performed to determine a lead toxicity level for all Medicaid-eligible children. - A “risk assessment” (i.e. a paper and pencil questionnaire or parent interview) does not meet this requirement. If parents are unable to provide written documentation that their child received a lead screening test at ages, 12 and 24 months, then CMS requires that the children receive a lead screening blood test between the ages of 36 and 72 months.

15. Management The most important step is identification of source and separation of child from the sourceThe most important step is identification of source and separation of child from the source Rapidity of response depends on the levelRapidity of response depends on the level –Medical evaluation –Environment evaluation for sources. Decrease risk factors – nutrition, anemiaDecrease risk factors – nutrition, anemia

16. Primary Objectives of Case Management Reduce the child’s blood lead level (BLL) below the level of concern 10µg/dLReduce the child’s blood lead level (BLL) below the level of concern 10µg/dL Give the highest priority to children with both the highest BLLs and those less than 2 years of age.Give the highest priority to children with both the highest BLLs and those less than 2 years of age.

17. Client Identification and Outreach for Case Management Lead poisoning risk assessment (screening questionnaire) – assess level of poisoning threat on all children beginning at six months of age and each medical screen through age six years.Lead poisoning risk assessment (screening questionnaire) – assess level of poisoning threat on all children beginning at six months of age and each medical screen through age six years. Blood lead screening – begin with any “yes” answers on risk assessment, then screen yearly as high risk. If low risk screen at one and two years of age.Blood lead screening – begin with any “yes” answers on risk assessment, then screen yearly as high risk. If low risk screen at one and two years of age. Counsel parents on lead poisoning prevention at each visit.Counsel parents on lead poisoning prevention at each visit.

18. Reporting Requirements Physicians are required to report blood lead levels that are 15 ug/dL or greater immediately to LACLPPPPhysicians are required to report blood lead levels that are 15 ug/dL or greater immediately to LACLPPP Physicians are required to submit Environmental Lead Investigation Form immediately to LACLPPP with Blood lead levels that are 15 ug’dL-19 ug.dl after 2 venous tests or > 20 ug/dLPhysicians are required to submit Environmental Lead Investigation Form immediately to LACLPPP with Blood lead levels that are 15 ug’dL-19 ug.dl after 2 venous tests or > 20 ug/dL Follow CDC Summary Chart Lead Poisoning Management to determine when a child needs to repeat a blood lead level test, when to make a referral, or when an environmental inspection is needed.Follow CDC Summary Chart Lead Poisoning Management to determine when a child needs to repeat a blood lead level test, when to make a referral, or when an environmental inspection is needed.

19. Required Reporting Information Complete LACLPPP Lead Case Reporting form, then fax to 504-219-4452Complete LACLPPP Lead Case Reporting form, then fax to 504-219-4452 Complete the Request for Environmental Lead Investigation form if needed, then fax to 504-219-4452Complete the Request for Environmental Lead Investigation form if needed, then fax to 504-219-4452 Forms can be obtained from OPH website – http://www.genetics.dhh.la.govForms can be obtained from OPH website – http://www.genetics.dhh.la.gov http://www.genetic

20. Follow-Up Monitoring of blood lead levelMonitoring of blood lead level Continued assessment for symptomsContinued assessment for symptoms Attention to nutrition and iron statusAttention to nutrition and iron status Environmental follow-up to ensure hazard reductionEnvironmental follow-up to ensure hazard reduction Contact provider to ensure child is in care, provide health education materials to family/guardian and physicians as neededContact provider to ensure child is in care, provide health education materials to family/guardian and physicians as needed

21. Environmental Case Management defined Following - up on eligible childrenFollowing - up on eligible children Coordinating environmental investigationsCoordinating environmental investigations Notifying parents, medical providers and property owners of investigation resultsNotifying parents, medical providers and property owners of investigation results Coordinating remediation and/or abatement strategiesCoordinating remediation and/or abatement strategies

22. Environmental Investigations/ Environmental Risk Assessments Visual InspectionVisual Inspection An Extensive QuestionnaireAn Extensive Questionnaire Dust, soil and paint sampling (if chipping)Dust, soil and paint sampling (if chipping) Investigation ReportInvestigation Report –Results & Analysis –Hazard Control Plan Cost Estimates of Hazard ControlsCost Estimates of Hazard Controls

23. Most Common Sources of Lead Poisoning Identified Lead Sources Dust 17% Soil 18% Paint 43% Miniblinds 14% No Source 8% Dust Soil Paint Miniblinds No Source Sources of childhood lead poisoning identified and recorded through lead inspections & risk assessments (1999 – 2003) through the Office of Public Health

24. Contact Us Louisiana Childhood Lead Poisoning Prevention Program 3101 W. Napoleon Avenue Metairie, LA 70001 504 – 219-4413 800 – 242 – 3112 www.genetics.dhh.louisiana.gov