advisory committee on childhood lead poison prevention ... 2005...36% apartments 12% public...

11

Advisory Committee on Advisory Committee on Childhood Lead Poison Childhood Lead Poison Prevention (ACCLPP) Prevention (ACCLPP)

MEETINGMEETING

Nkechi Onwuche, RN, CPM, BSNNkechi Onwuche, RN, CPM, BSNProgram Manager, DC CLPPP Program Manager, DC CLPPP

22

TodayToday’’s Presentations PresentationHistoric Overview of DC CLPPPHistoric Overview of DC CLPPPPresent DC CLPPP OrganizationPresent DC CLPPP OrganizationDC Water and Sewer Authority (DCWASA) DC Water and Sewer Authority (DCWASA) PartnershipPartnership10 Essential Program Elements10 Essential Program Elements

33

HISTORIC HISTORIC

OVERVIEWOVERVIEW

http://www.revelation-today.com/Hourglass.jpg

44

PrePre--20002000In 1973, DC received funding from CDC to establish In 1973, DC received funding from CDC to establish and administer a Childhood Lead Poisoning and administer a Childhood Lead Poisoning Prevention ProgramPrevention ProgramIn 1987, In 1987, ““The Student Health Care Amendment ActThe Student Health Care Amendment Act””made lead screening a law in the District was made lead screening a law in the District was established.established.In 1999, the Stellar Database System was In 1999, the Stellar Database System was establishedestablished

55

In 2000, the Childhood Lead Poison Prevention In 2000, the Childhood Lead Poison Prevention Program was realigned into two Programs, establishing Program was realigned into two Programs, establishing the Childhood Lead Poisoning, Screening & Education the Childhood Lead Poisoning, Screening & Education Program (CLPSEP) and the Lead Based Paint, Licensing, Program (CLPSEP) and the Lead Based Paint, Licensing, Certification & Accreditation Program. Certification & Accreditation Program. In May, 2000, Ms. Nkechi Onwuche was hired to manage In May, 2000, Ms. Nkechi Onwuche was hired to manage DC CLPSEP DC CLPSEP In 2001, the CLPSEP formed the Lead Screening In 2001, the CLPSEP formed the Lead Screening Advisory Committee.Advisory Committee.In 2002, the program required all outreach investigators In 2002, the program required all outreach investigators to be certified as phlebotomists and formally adopted to be certified as phlebotomists and formally adopted venous blood draw as its only form of screening method. venous blood draw as its only form of screening method. In 2002, In 2002, ““The Childhood Lead Poisoning Screening & The Childhood Lead Poisoning Screening & Reporting ActReporting Act”” was established. This law mandates was established. This law mandates universal blood lead screening of children under the age universal blood lead screening of children under the age of six by each health care provider or facility and of six by each health care provider or facility and reporting of all blood lead results to the District by the reporting of all blood lead results to the District by the laboratories.laboratories.

Years 2000 to 2002

66

Year 2003 to PresentYear 2003 to PresentLead in Water Crisis in the District of ColumbiaLead in Water Crisis in the District of ColumbiaIn 2004, the Stellar Database System was migrated In 2004, the Stellar Database System was migrated to the LeadTrax Web Systemto the LeadTrax Web SystemIn 2004/2005, DC CLPSEP began to focus on In 2004/2005, DC CLPSEP began to focus on primary prevention activities by working with HUD primary prevention activities by working with HUD funded programs (DHCD), exchanging data with HUD funded programs (DHCD), exchanging data with HUD grantees and conducting risk assessments in homes grantees and conducting risk assessments in homes involved in the WASA lead service line replacement involved in the WASA lead service line replacement program (more on this partnership later).program (more on this partnership later).In 2005, the DC council passed a resolution to In 2005, the DC council passed a resolution to establish a Department of the Environment. As a establish a Department of the Environment. As a result, CLPSEP moved to the Department of Health result, CLPSEP moved to the Department of Health Promotions.Promotions.

77

CURRENT CURRENT

DC CLPPP DC CLPPP

http://www.nagc.org/graphics/kids-slide2.jpg

88

DOH Health Promotions DOH Health Promotions Organizational ChartOrganizational Chart

99

CLPSEP Staff ChartCLPSEP Staff ChartNkechi OnwucheProgram Manager

Cletus IkejiSupervisorInvestigator

Charlene BarrettSupervisory Investigator

Dr. Ignatius UkpabiQuality Control

Titilola JolaoshoEpidemiologist

Angela BlackwellSecretary

Patricia JohnsonInvestigator

Olivia NorrisInvestigator

Beverly NevilleSupervisory

Health Technician

Hortencia RiosInvestigator

Yvockeea MonteiroInvestigator

VacantPublic Health

Specialist

VacantCommunity

Communication Specialist

Vacant Health Educator

Vacant Nurse Specialist

Terrence HenryProgram Support

Obiora OfforComputer Specialist

VacantCase Manager

1010

Program ComponentsProgram ComponentsEpidemiology (Data and Surveillance)Epidemiology (Data and Surveillance)Case ManagementCase ManagementQuality Control and AssuranceQuality Control and AssuranceScreeningScreeningPublic Health EducationPublic Health Education

1111

Estimated Prevalence Blood Lead Level by Ward, Estimated Prevalence Blood Lead Level by Ward, Among Children <6 Years Old in DC, CY 2004Among Children <6 Years Old in DC, CY 2004

Elevated Blood Lead Levels10 to

14ug/dL15 to

19ug/dL20 to

44ug/dL > 45ug/dL

Ward Population#

ScreenedScreening Rate/100 # % # % # % # %

1 5264 1681 31.9% 29 1.7% 7 0.4% 15 0.9% 0 0.0%2 3151 776 24.6% 13 1.7% 5 0.6% 0 0.0% 0 0.0%3 3667 1275 34.6% 5 0.4% 2 0.2% 0 0.0% 0 0.0%4 6265 2050 32.7% 37 1.8% 17 0.8% 15 0.7% 1 0.0%5 5849 1543 26.4% 35 2.3% 15 1.0% 9 0.6% 0 0.0%6 3682 1368 37.2% 30 2.2% 6 0.4% 3 0.2% 2 0.0%7 7445 1810 24.3% 24 1.3% 3 0.2% 6 0.3% 0 0.0%8 11081 1978 17.9% 19 1.0% 5 0.3% 3 0.2% 1 0.0%

TOTAL 46404 15314 33.0% 192 1.0% 60 0.4% 51 0.3% 4 0.0%

UNABLE TO GEO-CODE ADDRESS 2833

1212

Estimated Percent of Screened Children in CY 2004 with EBLL by DC Ward

1.82%

0.55%

3.03%

3.41%

3.82%

2.32%

3.00%

1.42%

2.00%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

1 2 3 4 5 6 7 8 Total

Ward

Perc

ent o

f Scr

eene

d C

hild

ren

with

EB

LL

1313

Elevated Blood Lead Level by Ward, Among Elevated Blood Lead Level by Ward, Among Children <6 Years Old in DC from 1999 to 2003Children <6 Years Old in DC from 1999 to 2003

1414

DC CLPPP/WASADC CLPPP/WASA

PARTNERSHIPPARTNERSHIP

http://www.trictrenchless.com/images/pacifica.jpg

1515

Lead Line Replacement Program (LLRP)Lead Line Replacement Program (LLRP)CLPSEP received 392 addresses that underwent CLPSEP received 392 addresses that underwent partial replacement and 569 addresses that partial replacement and 569 addresses that underwent full replacement.underwent full replacement.*Conduct comprehensive lead hazard risk Conduct comprehensive lead hazard risk assessment in preassessment in pre--1950 housing unit involved in 1950 housing unit involved in lead service line replacement program.lead service line replacement program.Provide blood lead testing the the children living in Provide blood lead testing the the children living in identified housing unitidentified housing unitAssist the families to enroll in DHCD ProgramsAssist the families to enroll in DHCD Programs

Special EarSpecial Ear--Marked ProjectMarked Project

*Replacement information as of 19th July 2005

1616

DC HOUSING CONTRUCTED PRE-1939 (N = 50,410)

8

3

5

2

4

76

1

1717

DC HOUSING CONSTRUCTED BETWEEN 1940 AND 1949 (N = 4,447)

8

35

2

4

76

1

1818

DC HOUSING CONSTRUCTED BETWEEN 1950 AND 1959 (N = 3,425)

8

35

2

4

76

1

1919

TEN ESSENTIAL TEN ESSENTIAL PROGRAM PROGRAM ELEMENTSELEMENTS

2020

DC CLPPPDC CLPPP10 Essential Program Elements10 Essential Program Elements

I. Mandated reporting of all blood lead test results from I. Mandated reporting of all blood lead test results from laboratories?laboratories?

YES:YES:Section 2003 subsection (c ) of the Lead Poisoning Screening Section 2003 subsection (c ) of the Lead Poisoning Screening and Reporting Act of 2002 the law states as follows:and Reporting Act of 2002 the law states as follows:““The laboratory that performs the tests pursuant to subsection The laboratory that performs the tests pursuant to subsection (b) of this section shall forward all test results to the health(b) of this section shall forward all test results to the healthcare provider or facility where the blood sample was taken and care provider or facility where the blood sample was taken and to the Mayorto the Mayor””

2121

II. Viable data management system containing medical and II. Viable data management system containing medical and environmental data?environmental data?

YES:YES:The CLPSEP LeadTrax system has the capability to manage the The CLPSEP LeadTrax system has the capability to manage the medical and environmental datamedical and environmental data


http://www.michaelmccafferty.com/TripleMonitor-big.jpg

2222

III. Mandatory dust wipe testing and clearance standards met III. Mandatory dust wipe testing and clearance standards met following abatement or remodeling work?following abatement or remodeling work?

YES: YES: Required activities for dust wipe testing and clearance Required activities for dust wipe testing and clearance standards are set in accordance with the steps set forth at 40 standards are set in accordance with the steps set forth at 40 CFR 745.227, and Section 35.1340 of the Final New HUD CFR 745.227, and Section 35.1340 of the Final New HUD Regulation on LeadRegulation on Lead--Based Paint Hazards in Federally Owned Based Paint Hazards in Federally Owned Housing and Housing Receiving Federal Assistance.Housing and Housing Receiving Federal Assistance.


2323

IV. Regulatory authority to require abatement of lead IV. Regulatory authority to require abatement of lead hazards in housing units containing children with hazards in housing units containing children with elevated blood lead levels? elevated blood lead levels?

YES:YES:This regulatory authority is found in LeadThis regulatory authority is found in Lead--Based Based Paint and Control Act of 1966, effective April 9, 1977, Paint and Control Act of 1966, effective April 9, 1977, as amended by D.C. Law 15as amended by D.C. Law 15--347, effective April 12, 347, effective April 12, 2005. 2005.


2424

V. Statutory protection for clients from retaliatory eviction oV. Statutory protection for clients from retaliatory eviction or r discrimination related to disclosure of lead hazards?discrimination related to disclosure of lead hazards?

YES YES -- ““Rental Housing Act of 1985Rental Housing Act of 1985””This law established that when a tenant has made a witnessed This law established that when a tenant has made a witnessed oral or written request or complaint and/or contacted oral or written request or complaint and/or contacted government officials concerning existing violations of the government officials concerning existing violations of the housing regulations, this tenant is protected from any housing regulations, this tenant is protected from any retaliatory action by their landlord.retaliatory action by their landlord.


2525

VI. Targeted screening plan oriented to high risk populations?VI. Targeted screening plan oriented to high risk populations?

YES:YES:Several methodologies corresponding to the recommendations of Several methodologies corresponding to the recommendations of the CDC are aimed at those residents who are at greatest risk othe CDC are aimed at those residents who are at greatest risk of f lead poisoning.lead poisoning.We used our database to stratify by Wards the areas with highestWe used our database to stratify by Wards the areas with highestprevalence rates. prevalence rates. Census data was analyzed focusing on the Wards with the greatesCensus data was analyzed focusing on the Wards with the greatest t number of houses built prenumber of houses built pre--1978, pre1978, pre--1950, socioeconomic factors, 1950, socioeconomic factors, housing environment characteristics (e.g. waste sites), occupatihousing environment characteristics (e.g. waste sites), occupational onal hazards, race, and ethnicity.hazards, race, and ethnicity.Reviewing the Census data and comparing it to our database helpsReviewing the Census data and comparing it to our database helpsto validate the blood lead data collected. to validate the blood lead data collected. Data collected for 2002 showed that Wards 1,4,5 and 6 had the Data collected for 2002 showed that Wards 1,4,5 and 6 had the highest percentage of prehighest percentage of pre--1950 housing, thereby supporting the 1950 housing, thereby supporting the prevalence data collectedprevalence data collected


2626

VII. EPA authorized licensing, certification and VII. EPA authorized licensing, certification and accreditation program for lead hazard Professionals accreditation program for lead hazard Professionals and firms?and firms?

YESYESThis program is operated by the LeadThis program is operated by the Lead--Based Paint Based Paint Management Program of the Environmental Health Management Program of the Environmental Health Administration.Administration.


2727

VIII. Case management protocols at all levels for children with VIII. Case management protocols at all levels for children with elevated blood lead levels?elevated blood lead levels?

Case Management ProtocolCase Management ProtocolReferral of blood lead test result from laboratoriesReferral of blood lead test result from laboratoriesClassify results according to blood lead levelsClassify results according to blood lead levelsIdentified cases will enable CLPPP track high priority areas andIdentified cases will enable CLPPP track high priority areas andenhance secondary trackingenhance secondary tracking


2828

CharacteristicsCharacteristicsNumber of Cases for Number of Cases for

which Data are which Data are Available Available

PercentagePercentage

Housing Ownership 93 59% Renters41% Owners

Type of Housing in which Child Resides 76

53% Single Family Home36% Apartments12% Public Housing/Section 8

Months Living in the House 74

18% 3 months or less9% 4 to 6 months

31% 7 to 12 months35% 14 to 45 months

Location of Deteriorated Paint

95 (interior)93 (exterior)58 (multi-family common

area)

57% Interior49% Exterior60% Multi-family common area

Recent Renovation or Paint Removal 92 39% Reported redecoration or paint removal

Possible Parental Occupational Exposure to Lead

8818% Possible exposure (7 construction

workers, 2 painters, 1 auto worker, 1 not specified)

Visible Dust in Unit 92 55% Dust Observed

Industrial Hazards within 1 mile of dwelling 88 19% Located within 1 mile

History of Lead Poisoning in Family or Neighborhood 87 25% History of Family or Neighborhood Lead

Poisoning

Risk Factors as Reported at Initial Home Risk Factors as Reported at Initial Home Visit (N=132)Visit (N=132)

2929

IX. Develop and maintain formal partnerships with housing IX. Develop and maintain formal partnerships with housing agencies, children services agencies, community groups, agencies, children services agencies, community groups, policy makers, parents, health professionals, medical services policy makers, parents, health professionals, medical services provider organizations, and property owners? provider organizations, and property owners?

YES:YES:The following is a list of participants in the DC CLPSEP Lead The following is a list of participants in the DC CLPSEP Lead Advisory Committee: EPA, Managed Care Organizations Advisory Committee: EPA, Managed Care Organizations ((MCOMCO’’ss), D.C. Department of Health (DOH), Department of ), D.C. Department of Health (DOH), Department of Housing and Community Development (DHCD), ChildrenHousing and Community Development (DHCD), Children’’s s National Medical Center (CNMC), D.C. Medical Assistance National Medical Center (CNMC), D.C. Medical Assistance Administration (MAA), United Planning Organization (UPO), Administration (MAA), United Planning Organization (UPO), Maternal and Family Health Administration (MFHA), Alliance for Maternal and Family Health Administration (MFHA), Alliance for Healthy Homes (AFHH), Howard University (HU), American Healthy Homes (AFHH), Howard University (HU), American Academy of Pediatrics, DC Chapter, Georgetown University Academy of Pediatrics, DC Chapter, Georgetown University Hospital and Coalition to End Childhood Lead Poisoning.Hospital and Coalition to End Childhood Lead Poisoning.


3030

X. Develop, implement and evaluate a written plan to accomplish X. Develop, implement and evaluate a written plan to accomplish the elimination the elimination of childhood lead poisoning by 2010?of childhood lead poisoning by 2010?

YES:YES:The five objectives are: The five objectives are:

To divide DC Lead Screening Advisory Committee into subgroups suTo divide DC Lead Screening Advisory Committee into subgroups such as ch as enforcement, lead hazard control, screening, literature review aenforcement, lead hazard control, screening, literature review and nd recommendationrecommendationTo maintain a district surveillance system for effective utilizaTo maintain a district surveillance system for effective utilization of resources tion of resources To educate and train the targeted population on lead hazard contTo educate and train the targeted population on lead hazard control measures rol measures To initiate court action against landlords who are repeat offendTo initiate court action against landlords who are repeat offenders ers To build infrastructure by merging and establishing To build infrastructure by merging and establishing MOUsMOUs and and MOAsMOAs with leadwith lead--related programs related programs

While the plan identifies specific short and long term strategieWhile the plan identifies specific short and long term strategies, as progress is s, as progress is evaluated and successes and barriers are identified, these stratevaluated and successes and barriers are identified, these strategies may egies may change or be rechange or be re--prioritized. prioritized.

Activities of this plan will be evaluated on a quarterly or yearActivities of this plan will be evaluated on a quarterly or yearly basis, with the ly basis, with the results presented to the Lead Screening Advisory Committee (LSACresults presented to the Lead Screening Advisory Committee (LSAC) and the ) and the Department of Health for consideration and rapid adjustment of pDepartment of Health for consideration and rapid adjustment of procedures if rocedures if justified. justified.


advisory committee on childhood lead poison prevention ... 2005...36% apartments 12% public...

Documents