HEALTH AND HOUSING Collaboration at LAST :

1. HEALTH AND HOUSING Collaboration at LAST: The LEAD ABATEMENT STRIKE TEAM Philadelphia Department of Public Health Carla Campbell, MD, MS; Robert Himmelsbach, BA; Peter Palermo, MS; and Richard Tobin, MS, MPA

2. Pre-Collaboration:Extent of the Problem Housing in Philadelphia: • 590,071 occupied units^ • 92% built pre-1978; 72% pre-1960^ • 57% of pre-1978 units (310,000) occupied by low-income residents* • 60% of pre-1960 units (250,000) occupied by low-income residents* ^ 2000 Census * 1990 Census

3. Year 1995 1997 1999 2001 Total Tested 30,183 33,587 31,498 46,367 Total > 10 g/dL 9,554 9,652 5,898 5,395 % > 10 g/dL 32 % 29 % 19 % 12 % Philadelphia Children Tested with Confirmed Blood Lead Level 10 g/dL

4. CLPPP Functions:Pre - LAST • Medical Case Management • Inspection • Issuance of Orders to Remediate Lead Hazards • Re-Inspection • No Further Action if Property Owner Un- Responsive

5. Problems With Enforcement Pre - LAST • Court-ordered lead hazard control (LHC) to be done by City without prioritization or resources • No resources for BSR (basic system repair) and resident relocation, often prerequisite to LHC • Fear of creating more homelessness and property abandonment • Backlog accumulated of 1400 properties with lead hazards • New cases continued to add to backlog (about 768 from 4/1/2002-10/23/2003)

6. CLPPP Functions:Post - LAST • Medical Case Management • Inspection • Issuance of Orders to Remediate Lead Hazards • Re-Inspection

7. CLPPP Functions:Post - LAST • Property Owner Responsive: • Visual and DW Compliance and Clearance by Owner or City-Directed LHC • Property Owner NOT Responsive: • LEAD COURT PROCESS • LHC BY OWNER OR CITY-INITIATED • VISUAL AND DW CLEARANCE

8. Lead Abatement Strike Team: Creation • Strong community advocacy for increased enforcement and funding for LHC • Concern about the large backlog of cases • Increased interest in problem from City Council members and Health Commissioner • Commitment for increased funding ($ 1.5 million) and activity around this issue

9. Lead Abatement Strike Team: Organization • Partner Agencies meet Bimonthly • Policy Meetings • Decisions made about New Policies, Programs, and Direction of Group • Program Operations Meetings • Review Process to Accomplish Goals, address obstacles and GET WORK DONE • MDO Office Coordinates the Collaboration

10. Lead Abatement Strike Team: Collaboration ALPHABET SOUP OF INVOLVED AGENCIES • PDPH—HEALTH DEPT. • OHCD—HOUSING & COMM. DEVELOP. • PHDC– PHILA. HOUSING DEV. CORP. • PHA– PHILA. HOUSING AUTHORITY • OESS/OAS—EMERGENCY SERVICES AND SHELTERS • DHS—DEPT. OF HUMAN SERVICES • L & I—LICENSES AND INSPECTIONS • CITY LAW DEPARTMENT

11. LAST Policy Group

12. Why Have Collaboration ? • Some goals can’t be accomplished without it • EX: Basic System repair work (OHCD, PHDC) preceding lead remediation work (PDPH) • Resident relocation (OESS) • Pooling of resources from different agencies • Sharing of expertise, knowledge of staff from different agencies • Look at problem from different perspectives • Landlords can’t play one agency against the other

13. Philadelphia Lead Court

14. Philadelphia Lead Court • Created in 11/02 for code enforcement of both backlog and new cases • Court scheduled for three sessions a week, typically 25 cases/session • Deputy City Solicitor (DCS) and the CLPPP Program Manager represent the City • Defendant interview before start of court, we try and set agreements of when they will get the work done • This special court is one of the most efficient/effective courts in the City

15. Lead Risk Assessment (RA) • Always triggered by presence of a child with an EBL • Performed by staff who are PA-Certified Lead Risk Assessors • Full set of surface-by-surface readings • Note condition of surfaces • Paint intact or defective? • Surface easy-to-clean?

16. Violation Notices • PDPH issues Orders to the property owner to Remediate the lead hazards within 10 days. • Owner required • remediate deteriorated lead paint • make all surfaces smooth, tight, and easy-to-clean • Ownership determined by: • resident interview • electronic record search of Phila. Water Dept. and L & I databases

17. RA Follow-UpNon Compliance Inspected 10 days after OL; if non-compliant: • No-compliance letter, which includes notification of additional legal action: • PDPH may remediate hazard and bill owner • Lead Court • L & I notified of Violation – owner rental license revoked: • Tenant can stop rent payment • Landlord cannot evict tenant • Copy pertinent case information sent to the Law Department

18. Law Complaint

19. Due Process • Complaint filed with the Court Administration; a hearing date is set • Complaint (hand) delivered to owner • Owner ordered to appear in court or face significant fines • Complaint contains copies of the CLPPP’s original order letter, no compliance letter, and other official letters, eliminating the “I never got it” argument

20. Lead Court (old)

21. Defendant Interview

22. Lead Court • Court Order Form (McJustice) – all usual court decisions pre-printed • Solicitor requests by number • Judge checks appropriate box, enters next court date specified and signs order. • Clerk date stamps document, copy is made in court and given to the defendant with explanation

23. Lead Court • Solicitor asks the court for certain set judgments and usually 30, 45, 60 or 90 days to complete the work. • Provided work is continuing, each new court appearance may generate another order to “keep up the good work” and another 1, 2 or 3 month extension. • Length of time given dependent on rate of work, BLLs of and presence of children, etc.

26. Status of Lead Court CasesFor the period 11/5/2002 thru 11/5/2003 • 1,821 Cases logged by Law Dept. to be processed for court filing. • 1,460 Cases filed with the court (includes cases heard & re-listed) • 1,406 Cases scheduled for hearings • 1,274 Cases heard in court (includes cases heard & re-listed) • 752 cases ended through court action • 489 have been brought into compliance • 93 have been found vacant and referred to Licenses and Inspections • 165 have been given to the Health Department for LHC • 5 ended for other reasons • Therefore 522 cases are still in the legal process (“returning for status”)

27. Continuing Evaluation of Lead Court Dust/Blood Results • Ongoing analyses of BLL and dust lead levels post LHC • Properties repaired by the Health Department experienced 30% fewer failures in post-repair lead dust loading tests than properties repaired by their owners. • Among failed areas, the mean dust sample test results in owner-repaired homes exceed the EPA standard by significantly more than in city-repaired homes. • Preliminary BLL analyses show that in children aged 25-36 months living in properties that have come into compliance through Lead Court, post-hazard-control blood lead levels decrease less in residents of owner-repaired properties than in residents of CLPPP-repaired properties.

28. LAST InitiativeLead Hazard Control

29. LHC Barriers (Pre-LAST) • $$$ • BSR • Relocation • Certified Lead Abatement Contractors • Protocols and Infrastructure • Dangerous Properties

30. LAST LHC Infrastructure • $ 1.5 million for LHC • Six PA-certified lead abatement contractors under contract with CLPPP for LHC • Two CLPPP LHC crews • BSR through PHA & PHDC • Relocation (by OESS) – 11 “Safe” houses • L & I Inspection of Dangerous Properties

31. Clients • Court-ordered (166 since 11/02) • Pre-Court • Owner-occupied CLPPP EBL cases at time of non-compliance re-inspection (300 / year) • Grant Applicants (100+)

32. Protocol – Contractor • PA-Certified • Have multiple PA-certified crews • Agreed to a set price list • Have adequate insurance • Paid after CLPPP RA OK and Dust Wipe Test • Not paid for additional cleaning if dust wipes fail clearance

33. Protocol – Work Evaluation • Property evaluated by CLPPP: • Surfaces / areas / fixtures measured • Treatment determined for each surface / area / fixture • Written Work Specification Report: • List of specific treatment for each surface / area / fixture • Cost for each treatment • Basic System Repairs completed prior to work • Relocation Coordinator notified if relocation needed • Case assigned to next available Contractor, or CLPPP Crew

34. Lead Hazard Control Work Typical work: • Surface Paint Stabilization • Replace Windows and Doors • Luan / vinyl tile floors • Complete in 2 weeks • Must pass Dust Clearance (by CLPPP) • Typical costs for LHC: $ 6,000 - $ 16,000

35. LAST Accomplishments • 2001 – 159 Properties received LHC work • 131 by Owner • 28 by City crew ----------------- (LAST Initiative started 4/1/2002) ----------------- • 2002 – 332 Properties received LHC work • 232 by Owner • 38 by City crews • 62 by CLPPP Contractor • 2003 – 510 Properties received LHC work • 395 by Owner • 19 by City crews • 96 by CLPPP Contractor • Total LAST Tally : 819 properties serving 1118 children in 18 month period (340% increase)

36. Why Did This Collaboration Work ? • Strong support from Mayor and Health Commissioner • Managing Director’s Office mandate • Different agencies within city government urged to use 3 Cs: • Communication • Collaboration • Cooperation • Staff Dedication

37. Benefits of LAST Process • Much improved enforcement • Dramatic increase in properties receiving lead hazard control • For every City dollar spent $2.50 worth of LHC achieved by private home owners • Infrastructure ready for Successful Grant Applications and Primary Prevention

38. For More Information: Philadelphia Department of Public Health Childhood Lead Poisoning Prevention Program 2100 W. Girard Avenue PNH - Bldg #3 Philadelphia, PA 19130-1400 Phone: 215-685-2788 Fax: 215-685-2978 Carla.Campbell @ Phila.gov Robert.Himmelsbach @ Phila.gov Peter.Palermo @ Phila.gov