Louisiana Childhood Lead Poisoning Prevention Program

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 • Define Childhood lead poisoning. • Recognize sources of lead poisoning. • Discuss the components of the comprehensive Childhood Lead Poisoning Prevention Program. • Describe the components of the Louisiana Childhood Lead Poisoning Prevention Program. • Determine lead screening requirements. • Determine case management requirements. • Discuss lead inspection requirements.

3. What is lead poisoning?

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

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

6. More effects of lead • behavior problems • stunted growth • other issues

7. Effects of high lead levels • damage to the nervous system, including the brain • convulsions or coma • death

8. Sources of Lead • LEAD PAINT • DUST AND SOIL • WATER • PARENTAL OCCUPATIONS OR HOBBIES • HOME REMEDIES • FOOD • OTHER

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

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

11. Hobbies may be a source of lead. • stained-glass or pottery making • fishing • refinishing furniture

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

13. Comprehensive Approach to Childhood Lead Poisoning • Assess children’s exposure to lead • Develop policies for childhood lead poisoning prevention • Primary Prevention • Secondary Prevention • Assure performance of activities to prevent childhood lead poisoning • 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. - 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 source • Rapidity of response depends on the level • Medical evaluation • Environment evaluation for sources. • Decrease risk factors – nutrition, anemia

16. Primary Objectives of Case Management • Reduce 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.

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. • 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.

18. Reporting Requirements • Physicians 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/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.

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

20. Follow-Up • Monitoring of blood lead level • Continued assessment for symptoms • Attention to nutrition and iron status • Environmental follow-up to ensure hazard reduction • Contact 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 children • Coordinating environmental investigations • Notifying parents, medical providers and property owners of investigation results • Coordinating remediation and/or abatement strategies

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

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

24. Contact UsLouisiana Childhood Lead Poisoning Prevention Program3101 W. Napoleon AvenueMetairie, LA 70001504 – 219-4413800 – 242 – 3112 www.genetics.dhh.louisiana.gov