New Jersey Department of Health and Senior Services

1. New Jersey Department of Health and Senior Services Sylvia Dellas Coordinator, Child Health Has no financial interest or affiliations, as well as no plan to discuss either a Non-FDA approved or investigational use of products or devices

2. Monmouth County Health Department Jeryl Krautle Kate AndrewsWe have no financial interest or affiliations, as well as no plan to discuss either a non FDA approved or investigational use of products or devices.

3. Effects of Lead on Children • The long term effects of lead in a child can be severe; and may include • Learning disabilities • Decreased growth • Behavior problems • Impaired hearing • Long term neurological damage *EPA Lead Poisoning and Your Child, EPA 747-K-00-003 October 2000

4. Environmental Intervention of the Lead Poisoned Child By the end of this session you will: • Know the substantive proposed amendments to N.J.A.C. 8:51 • Know how the proposed amendments will affect local health departments.

5. Why amendments to N.J.A.C. 8:51 • P.L. 2003, Chapter 311 Lead Hazard Control Assistance Act • Eliminate childhood lead poisoning as a public health problem • Set forth uniform standards • Improve compliance • Improve communication, tracking prevalence and incidence, and managing cases CDC - Standard Surveillance Definitions and Classifications June 1, 2009

6. N.J.A.C 8:51Childhood Lead Poisoning • Proposed readoption with amendments, new rules, and repeals. • Initially set to expire November 16, 2009. Notice of Proposal filed to extend expiration to May 15, 2010. • Amend chapter name to remove “State Sanitary Code Chapter XIII” • Department staff consulted with DCA

7. Subchapter 1 • Sets forth one location the policies, guidelines, forms, assessments, and materials incorporated by reference • Adds definitions

8. Subchapter 2 • Reduction of the capillary blood lead level to trigger confirmation • Provision of case management with a confirmed blood lead level of 10 -14 ug/dL at least one month apart • Testing of pregnant women in the household • Assignment of cases • Discharge criteria

9. Subchapter 3 • DHSS reports to local board of health blood lead levels of 10 ug/dL or greater • Must provide all information regarding local board of health actions to the primary care provider • Must report violations and enforcement procedures to DCA • Circumstances in which electronic and written records are maintained and released

10. Subchapter 4 • Requires environmental intervention for confirmed blood lead levels of 15 ug/dL or greater, or two consecutive test results of 10 -14 ug/dL at least one month apart • All reports of blood lead tests would be forwarded to the local board of health • Conduct limited hazard assessment at planned temporary relocation with full hazard assessment at planned permanent relocation address • Provide written materials to tenants of all units in a multi-unit building when an EBLL is identified in one of the units

11. Subchapter 4 continued • Conduct dust sampling in addition to limited hazard assessment of houses that do not have a lead-free certificate • Remediate nonpaint lead hazards • Environmental Intervention Reports must be provided to property owners without the name of the lead burdened child • Copy of Notice of Violation must be provided to local construction official

12. Subchapter 5 • Collection of at least one surface dust wipe sample on the floor of the primary entry way and a minimum of six single surface dust wipe samples per dwelling • Minimum of two samples of bare soil from the primary residence that is accessible or poses a hazard

13. Subchapter 5 continued • DHSS will accept other sample collection or testing methods approved by any government agency having regulatory responsibility regarding lead hazards • Paint, soil, or dust testing methods for screening purposes but be confirmed for enforcement purposes

14. Subchapter 6 • Proposed to allow abatement and/or interim controls to address lead-based paint on exterior surfaces • Establishes standards that the person performing the work must follow for abatement and interim controls • Establishes requirements for abatement and/or interim controls related to lead-contaminated soil

15. Subsection 7 • Requires immediate relocation of occupants to comparable lead safe housing upon receipt of notice of violation • Local boards of health shall, when an owner does not, perform or arrange for abatement of lead hazards • Required 10 day notice to DCA • Local boards of health are responsible to monitor all lead abatement and/or interim controls it has ordered

16. Subchapter 8 • Owner is responsible for obtaining independent clearance testing within 30 days from the final cleaning • Owner is to obtain a lead hazard free certificate for exterior surfaces upon completion of exterior interim controls work

17. Subchapter 9 • Penalties for violations • DHSS may report a health officer’s failure to comply with this chapter or with an order or directive of DHSS • Sets forth when a local board of health has to implement an abatement and/or interim controls notice or order because the property owner refuses to comply

18. Subchapter 10 • Sets standards applicable to Childhood Lead Poisoning Information Database • Access and limitations • Required training • Confidentiality • User Confidentiality Agreement • Quarterly quality assurance audit

19. Grantee NJDHSS • Piloted lower EBL Action level to include • Nurse case management • Environmental Intervention

20. How It All Begins • Notification of EBL (Elevated Blood Lead) is received by the health department through Leadtrax notification, phone calls primary care providers and/or fax from NJDHSS LP-1 • Confirmed lead

21. Interventions • Case manager and lead inspector/risk assessor are assigned within 24 hours. • Current time frames for initial visits • Nurse – • PB 10-14 visit within 3 weeks • Pb 15 – 44 visit within 2 weeks • Pb 45 – 69 visit within 48 hours • Pb 70 or greater – visit within 24 hours

22. Intervention Time Frames • Inspection time frames • Blood Lead Over 69 within 24 hours • Blood lead 45-69 wihtin 48 hours • Blood lead 20-44 within 1 week • Blood lead 15-19 within 2 weeks • Blood lead 10-14 within 3 weeks

23. Joint Visit • Goals – • Educate parent • Lead Hazard Assessment Questionnaire • Inspect and Evaluate potential sources of lead • Implement/Recommend immediate hazard reduction methods • Possibly recommend the removal of child from hazards/dwelling • Identify additional locations that may be contributing sources

24. Lead Hazard Assessment Questionnaire • Grantee – draft of revised form • Case manager and inspector share joint responsibility for this questionnaire • Both must sign off the areas completed and review each others section

25. Questionnaire explores • Background information physical characteristics and residential use pattern • Previous inspections • Potential sources in the neighborhood • Hazard Assessment Questionnaire • Visual inspection – interior & exterior • Testing defective paint, interior, other buildings on premises, furniture, toys and play structures • Testing of intact paint on friction surfaces • Testing intact paint on chewable surfaces, if indicated by questionnaire or evidence of chewing • Testing on impact surfaces, if evidence of impact damage • Dust sampling of window sills and floors in rooms identified in the Lead Hazard assessment questionnaire as play areas, hiding areas or areas where the child is most likely to come into contact with dust • Soil sampling when indicated by questionnaire, of bare soil – min. of 2 • Evaluation of exterior – “if no lead hazard found in interior • Testing of soil, if no lead hazard found in interior or exterior • Other possible sources as indicated by questionaire • Nonpaint lead hazards • Other sites

26. Lead Paint Hazard • Common Routes of Exposure • Window sills and wells • Impact and friction surfaces • Areas of chipping and peeling

27. Dust • Sampling • Sampling equipment – LIFT grant • LHD collect single surface paint and other surface coating samples in conformance with sampling procedures found in HUD guidelines • Shall collect dust wipe samples • One sample on floor of the primary entrance way • Minimum of six samples per dwelling

28. Water • Municipal Water • Well – case in Howell • Plumbing pre-1984

29. Soil • EPA guidelines with action levels • Remediation • Remove or interim controls

30. Occupational/Hobbies • Sinkers • Work clothes • Stained Glass • Furniture refinishing • Shooting ranges

31. Other sources • Cosmetics • Home remedies • Herbals • Spices • Candy • Cooking vessels/utensils/storage • Toys • Furniture • And the list goes on

32. Immediate Hazard Reduction Methods • Duct tape • Moving furniture • Cleaning methods • Hepa-vaccuum - loans

33. Interim Controls - Exterior • Paint stabilization • Siding • Aluminum Wrap

34. Importance of Nurse Case Manager/Lead Inspector/Risk Assessor Communication • Case management visits • Departmental differences • Difficulties with harassing/evicting tenants • Work has begun • Resident moved

35. Importance of Nurse Case Manager/Lead Risk Assessor Communication (con’t) • Exchange of information regarding sources, drug activity, developmental issues, parenting issues • Don’t limit visits to environmental and/or nursing issues. Communication is the key to the best outcome for the child

36. Owner/tenant notification • Owner – NOV certified letter with DCA approved contractors, readings, dust wipe sample results and copies of Chapter XIII (NJAC 8:51) and DCA NJAC Chapter 5:17 with 10 days to reply • Provide info on DCA funding sources • EPA regulation regarding notification for sale • Code enforcement is notified to hold co • Tenant – notified inspection completed, lead found, areas, advise hand wash, dietary, cleaning

37. Contractor Meeting/Phone Call • Review inspection report with the contractor • Scope of work submitted for review • I’ll do the best I can • I’ll try • Paint with encapsulate • If SOW is approved letter to owner, contractor and local construction official

38. This is where it falls apart • Expensive • Current funding sources • Landlord wants to evict • Owner occupied • Foreclosures • Dealing with banks

39. Expensive • DCA abatement funding • Relocation Fund – DCA • Local and county affordable housing funds

40. Owner doesn’t respond • 10 days after receipt of letter • Issue summons • Chapter XIII – 8:51-6.2 (exterior) and 8:51-6.3 (interior)

41. Eviction • Can not evict as an abatement method

42. Owner Occupied • Allowed to do work themselves • Increased risk of exposure to themselves and the child • Long time frame – drag on • Chapter XIII – 8:51-7.1 – health dept responsible for abatement

43. Foreclosures • Bank not foreclosing due to lead • Tied up in court for long periods • Important to put a hold on the CO

44. Other sources • Causative factors – water leak • Lead Recall Book • Imported cosmetics, candy, pottery, cooking utensils, furniture etc • Chapter XIII (NJAC 8:51 4.2 9d and 8:51 6.5)

45. Occupations/Hobbies • Removing the source • Recent poisoning – lead workers with the car seats • Right to Know • OSHA for workers • All else fails Criminal Code 2c – Endangering the Welfare of a Child

46. Partners • Model Cities – local ordinances • Code Enforcement • Building Department • Neighborhood Perseveration/ Historical Preservation • DCA • EPA • Law Enforcement • Consumer Affairs (State and local) • Prosecutors/Judges • Public Advocate

47. Where do we go from here? • Right now working in reactive way – • Future- Intervene and prevent lead exposure • Primary prevention – CDC, HUD and NJDHSS moving to Healthy Homes

48. Questions?