New Jersey Department New Jersey Department of Health and Senior Servicesof Health and Senior Services

Sylvia DellasSylvia Dellas

Coordinator, Child HealthCoordinator, Child Health

Has no financial interest or affiliations,Has no financial interest or affiliations,

as well as no plan to discuss either a as well as no plan to discuss either a

Non-FDA approved or Non-FDA approved or

investigational use of products or devicesinvestigational use of products or devices

Monmouth County Monmouth County Health DepartmentHealth Department

Jeryl KrautleJeryl KrautleKate AndrewsKate Andrews

We have no financial interest or affiliations, We have no financial interest or affiliations,

as well as no plan to discuss either a as well as no plan to discuss either a non FDA approved or investigational non FDA approved or investigational

use of products or devices. use of products or devices.

*EPA Lead Poisoning and Your *EPA Lead Poisoning and Your Child, EPA 747-K-00-003 October Child, EPA 747-K-00-003 October

20002000

Effects of Lead on ChildrenEffects of Lead on Children

• The long term The long term effects of lead in a effects of lead in a child can be severe; child can be severe; and may includeand may include– Learning disabilitiesLearning disabilities– Decreased growthDecreased growth– Behavior problemsBehavior problems– Impaired hearingImpaired hearing– Long term Long term

neurological neurological damagedamage

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.

CDC - Standard Surveillance CDC - Standard Surveillance Definitions and Classifications Definitions and Classifications

June 1, 2009June 1, 2009

Why amendments to N.J.A.C. Why amendments to N.J.A.C. 8:518:51

• P.L. 2003, Chapter 311 Lead Hazard P.L. 2003, Chapter 311 Lead Hazard Control Assistance ActControl Assistance Act

• Eliminate childhood lead poisoning as a Eliminate childhood lead poisoning as a public health problempublic health problem

• Set forth uniform standardsSet forth uniform standards

• Improve complianceImprove compliance

• Improve communication, tracking Improve communication, tracking prevalence and incidence, and managing prevalence and incidence, and managing casescases

N.J.A.C 8:51N.J.A.C 8:51Childhood Lead PoisoningChildhood Lead Poisoning

• Proposed readoption with amendments, Proposed readoption with amendments, new rules, and repeals.new rules, and repeals.

• Initially set to expire November 16, 2009. Initially set to expire November 16, 2009. Notice of Proposal filed to extend Notice of Proposal filed to extend expiration to May 15, 2010. expiration to May 15, 2010.

• Amend chapter name to remove “State Amend chapter name to remove “State Sanitary Code Chapter XIII”Sanitary Code Chapter XIII”

• Department staff consulted with DCADepartment staff consulted with DCA

Subchapter 1Subchapter 1

• Sets forth one location the policies, Sets forth one location the policies, guidelines, forms, assessments, and guidelines, forms, assessments, and materials incorporated by referencematerials incorporated by reference

• Adds definitionsAdds definitions

Subchapter 2Subchapter 2• Reduction of the capillary blood lead level to Reduction of the capillary blood lead level to

trigger confirmationtrigger confirmation

• Provision of case management with a Provision of case management with a confirmed blood lead level of 10 -14 ug/dL at confirmed blood lead level of 10 -14 ug/dL at least one month apartleast one month apart

• Testing of pregnant women in the householdTesting of pregnant women in the household

• Assignment of casesAssignment of cases

• Discharge criteriaDischarge criteria

Subchapter 3Subchapter 3

• DHSS reports to local board of health blood DHSS reports to local board of health blood lead levels of 10 ug/dL or greaterlead levels of 10 ug/dL or greater

• Must provide all information regarding local Must provide all information regarding local board of health actions to the board of health actions to the

primary care providerprimary care provider• Must report violations and enforcement Must report violations and enforcement

procedures to DCAprocedures to DCA• Circumstances in which electronic and written Circumstances in which electronic and written

records are maintained and releasedrecords are maintained and released

Subchapter 4Subchapter 4• Requires environmental intervention for Requires environmental intervention for

confirmed blood lead levels of 15 ug/dL or confirmed blood lead levels of 15 ug/dL or greater, or two consecutive test results of greater, or two consecutive test results of

10 -14 ug/dL at least one month apart10 -14 ug/dL at least one month apart• All reports of blood lead tests would be All reports of blood lead tests would be

forwarded to the local board of healthforwarded to the local board of health• Conduct limited hazard assessment at planned Conduct limited hazard assessment at planned

temporary relocation with full hazard temporary relocation with full hazard assessment at planned permanent relocation assessment at planned permanent relocation addressaddress

• Provide written materials to tenants of all units in Provide written materials to tenants of all units in a multi-unit building when an EBLL is identified a multi-unit building when an EBLL is identified in one of the unitsin one of the units

Subchapter 4 Subchapter 4 continuedcontinued

• Conduct dust sampling in addition to limited Conduct dust sampling in addition to limited hazard assessment of houses that do not hazard assessment of houses that do not have a lead-free certificatehave a lead-free certificate

• Remediate nonpaint lead hazards Remediate nonpaint lead hazards • Environmental Intervention Reports must be Environmental Intervention Reports must be

provided to property owners without provided to property owners without the name of the lead burdened childthe name of the lead burdened child• Copy of Notice of Violation must be Copy of Notice of Violation must be

provided to local construction official provided to local construction official

Subchapter 5Subchapter 5

• Collection of at least one surface dust Collection of at least one surface dust wipe sample on the floor of the primary wipe sample on the floor of the primary entry way and a minimum of six single entry way and a minimum of six single surface dust wipe samples per dwelling surface dust wipe samples per dwelling

• Minimum of two samples of bare soil from Minimum of two samples of bare soil from the primary residence that is accessible or the primary residence that is accessible or poses a hazardposes a hazard

Subchapter 5 Subchapter 5 continuedcontinued

• DHSS will accept other sample collection DHSS will accept other sample collection or testing methods approved by any or testing methods approved by any government agency having regulatory government agency having regulatory responsibility regarding lead hazardsresponsibility regarding lead hazards

• Paint, soil, or dust testing methods for Paint, soil, or dust testing methods for screening purposes but be confirmed for screening purposes but be confirmed for enforcement purposesenforcement purposes

Subchapter 6Subchapter 6• Proposed to allow abatement and/or interim Proposed to allow abatement and/or interim

controls to address lead-based paint on controls to address lead-based paint on exterior surfacesexterior surfaces

• Establishes standards that the person Establishes standards that the person performing the work must follow for abatement performing the work must follow for abatement and interim controls and interim controls

• Establishes requirements for abatement and/or Establishes requirements for abatement and/or interim controls related to lead-contaminated interim controls related to lead-contaminated soilsoil

Subsection 7Subsection 7• Requires immediate relocation of Requires immediate relocation of

occupants to comparable lead safe housing occupants to comparable lead safe housing upon receipt of notice of violation upon receipt of notice of violation

• Local boards of health shall, when an Local boards of health shall, when an owner does not, perform or arrange for owner does not, perform or arrange for abatement of lead hazardsabatement of lead hazards

• Required 10 day notice to DCARequired 10 day notice to DCA• Local boards of health are responsible to Local boards of health are responsible to

monitor all lead abatement and/or interim monitor all lead abatement and/or interim controls it has orderedcontrols it has ordered

Subchapter 8Subchapter 8

• Owner is responsible for obtaining Owner is responsible for obtaining independent clearance testing within 30 independent clearance testing within 30 days from the final cleaning days from the final cleaning

• Owner is to obtain a lead hazard free Owner is to obtain a lead hazard free certificate for exterior surfaces upon certificate for exterior surfaces upon completion of exterior interim controls completion of exterior interim controls workwork

Subchapter 9Subchapter 9

• Penalties for violationsPenalties for violations• DHSS may report a health officer’s failure DHSS may report a health officer’s failure

to comply with this chapter or with an to comply with this chapter or with an order or directive of DHSS order or directive of DHSS

• Sets forth when a local board of health has Sets forth when a local board of health has to implement an abatement and/or interim to implement an abatement and/or interim controls notice or order because the controls notice or order because the property owner refuses to complyproperty owner refuses to comply

Subchapter 10Subchapter 10• Sets standards applicable to Childhood Sets standards applicable to Childhood

Lead Poisoning Information DatabaseLead Poisoning Information Database

– Access and limitationsAccess and limitations

– Required trainingRequired training

– ConfidentialityConfidentiality

– User Confidentiality AgreementUser Confidentiality Agreement

– Quarterly quality assurance auditQuarterly quality assurance audit

Grantee NJDHSSGrantee NJDHSS

• Piloted lower Piloted lower EBL Action level EBL Action level to includeto include– Nurse case Nurse case

managementmanagement– Environmental Environmental

InterventionIntervention

How It All BeginsHow It All Begins

• Notification of EBL (Elevated Blood Notification of EBL (Elevated Blood Lead) is received by the health Lead) is received by the health department through Leadtrax department through Leadtrax notification, phone calls primary care notification, phone calls primary care providers and/or fax from NJDHSS LP-providers and/or fax from NJDHSS LP-11

• Confirmed leadConfirmed lead

InterventionsInterventions

• Case manager and lead inspector/risk Case manager and lead inspector/risk assessor are assigned within 24 hours.assessor are assigned within 24 hours.

• Current time frames for initial visits Current time frames for initial visits – Nurse – Nurse –

•PB 10-14 visit within 3 weeksPB 10-14 visit within 3 weeks

•Pb 15 – 44Pb 15 – 44 visit within 2 weeksvisit within 2 weeks

•Pb 45 – 69 visit within 48 hoursPb 45 – 69 visit within 48 hours

•Pb 70 or greater – visit within 24 hoursPb 70 or greater – visit within 24 hours

Intervention Time FramesIntervention Time Frames

– Inspection time framesInspection time frames•Blood Lead Over 69Blood Lead Over 69 within 24 hourswithin 24 hours

•Blood lead 45-69Blood lead 45-69 wihtin 48 hourswihtin 48 hours

•Blood lead 20-44Blood lead 20-44 within 1 weekwithin 1 week

•Blood lead 15-19Blood lead 15-19 within 2 weekswithin 2 weeks

•Blood lead 10-14Blood lead 10-14 within 3 weekswithin 3 weeks

Joint VisitJoint Visit• Goals –Goals –

– Educate parentEducate parent– Lead Hazard Assessment Lead Hazard Assessment

QuestionnaireQuestionnaire– Inspect and Evaluate potential Inspect and Evaluate potential

sources of leadsources of lead– Implement/Recommend Implement/Recommend

immediate hazard reduction immediate hazard reduction methods methods

– Possibly recommend the Possibly recommend the removal of child from removal of child from hazards/dwellinghazards/dwelling

– Identify additional locations that Identify additional locations that may be contributing sourcesmay be contributing sources

Lead Hazard Assessment Lead Hazard Assessment QuestionnaireQuestionnaire

• Grantee – draft of revised formGrantee – draft of revised form

• Case manager and inspector share Case manager and inspector share joint responsibility for this joint responsibility for this questionnairequestionnaire

• Both must sign off the areas Both must sign off the areas completed and review each others completed and review each others sectionsection

Questionnaire exploresQuestionnaire explores1.1. Background information physical characteristics and residential use Background information physical characteristics and residential use

patternpattern2.2. Previous inspectionsPrevious inspections3.3. Potential sources in the neighborhoodPotential sources in the neighborhood4.4. Hazard Assessment QuestionnaireHazard Assessment Questionnaire5.5. Visual inspection – interior & exteriorVisual inspection – interior & exterior6.6. Testing defective paint, interior, other buildings on premises, furniture, Testing defective paint, interior, other buildings on premises, furniture,

toys and play structurestoys and play structures7.7. Testing of intact paint on friction surfacesTesting of intact paint on friction surfaces8.8. Testing intact paint on chewable surfaces, if indicated by Testing intact paint on chewable surfaces, if indicated by

questionnaire or evidence of chewingquestionnaire or evidence of chewing9.9. Testing on impact surfaces, if evidence of impact damageTesting on impact surfaces, if evidence of impact damage10.10. Dust sampling of window sills and floors in rooms identified in the Lead Dust sampling of window sills and floors in rooms identified in the Lead

Hazard assessment questionnaire as play areas, hiding areas or areas Hazard assessment questionnaire as play areas, hiding areas or areas where the child is most likely to come into contact with dustwhere the child is most likely to come into contact with dust

11.11. Soil sampling when indicated by questionnaire, of bare soil – min. of 2Soil sampling when indicated by questionnaire, of bare soil – min. of 212.12. Evaluation of exterior – “if no lead hazard found in interiorEvaluation of exterior – “if no lead hazard found in interior13.13. Testing of soil, if no lead hazard found in interior or exteriorTesting of soil, if no lead hazard found in interior or exterior14.14. Other possible sources as indicated by questionaireOther possible sources as indicated by questionaire

– Nonpaint lead hazardsNonpaint lead hazards– Other sitesOther sites

Lead Paint HazardLead Paint Hazard

• Common Routes of Common Routes of ExposureExposureWindow sills and Window sills and

wellswellsImpact and friction Impact and friction

surfacessurfacesAreas of chipping Areas of chipping

and peelingand peeling

DustDust

• SamplingSampling• Sampling equipment – LIFT Sampling equipment – LIFT

grantgrant• LHD collect single surface LHD collect single surface

paint and other surface paint and other surface coating samples in coating samples in conformance with sampling conformance with sampling procedures found in HUD procedures found in HUD guidelinesguidelines

• Shall collect dust wipe Shall collect dust wipe samplessamples– One sample on floor of the One sample on floor of the

primary entrance wayprimary entrance way– Minimum of six samples Minimum of six samples

per dwellingper dwelling

WaterWater

• Municipal WaterMunicipal Water

• Well – case in Well – case in HowellHowell

• Plumbing pre-1984Plumbing pre-1984

SoilSoil

• EPA guidelines with EPA guidelines with action levelsaction levels

• RemediationRemediation– Remove or interim Remove or interim

controlscontrols

Occupational/HobbiesOccupational/Hobbies

• SinkersSinkers

• Work clothes Work clothes

• Stained GlassStained Glass

• Furniture Furniture refinishingrefinishing

• Shooting rangesShooting ranges

Other sourcesOther sources

• CosmeticsCosmetics• Home remediesHome remedies• HerbalsHerbals• SpicesSpices• CandyCandy• Cooking Cooking

vessels/utensils/storagvessels/utensils/storagee

• ToysToys• FurnitureFurniture• And the list goes onAnd the list goes on

Immediate Hazard Reduction Immediate Hazard Reduction MethodsMethods

• Duct tapeDuct tape

• Moving furnitureMoving furniture

• Cleaning methodsCleaning methods

• Hepa-vaccuum - Hepa-vaccuum - loansloans

Interim Controls - ExteriorInterim Controls - Exterior

• Paint stabilizationPaint stabilization

• SidingSiding

• Aluminum WrapAluminum Wrap

Importance of Nurse Case Importance of Nurse Case Manager/Lead Inspector/Risk Manager/Lead Inspector/Risk

Assessor CommunicationAssessor Communication• Case management visitsCase management visits

• Departmental differencesDepartmental differences

• Difficulties with harassing/evicting Difficulties with harassing/evicting tenants tenants

• Work has begunWork has begun

• Resident movedResident moved

Importance of Nurse Case Importance of Nurse Case Manager/Lead Risk Assessor Manager/Lead Risk Assessor Communication (con’t)Communication (con’t)• Exchange of information regarding Exchange of information regarding

sources, drug activity, sources, drug activity, developmental issues, parenting developmental issues, parenting issuesissues

• Don’t limit visits to environmental Don’t limit visits to environmental and/or nursing issues. and/or nursing issues. Communication is the key to the best Communication is the key to the best outcome for the childoutcome for the child

Owner/tenant notificationOwner/tenant notification• Owner – NOV certified letter with DCA Owner – NOV certified letter with DCA

approved contractors, readings, dust wipe approved contractors, readings, dust wipe sample results and copies of Chapter XIII sample results and copies of Chapter XIII (NJAC 8:51) and DCA NJAC Chapter 5:17 with (NJAC 8:51) and DCA NJAC Chapter 5:17 with 10 days to reply10 days to reply

• Provide info on DCA funding sources Provide info on DCA funding sources

• EPA regulation regarding notification for saleEPA regulation regarding notification for sale

• Code enforcement is notified to hold coCode enforcement is notified to hold co

• Tenant – notified inspection completed, lead Tenant – notified inspection completed, lead found, areas, advise hand wash, dietary, found, areas, advise hand wash, dietary, cleaningcleaning

Contractor Meeting/Phone Contractor Meeting/Phone CallCall• Review inspection report with the Review inspection report with the

contractorcontractor• Scope of work submitted for review Scope of work submitted for review

– I’ll do the best I canI’ll do the best I can– I’ll tryI’ll try– Paint with encapsulatePaint with encapsulate– If SOW is approved letter to owner, If SOW is approved letter to owner,

contractor and local construction officialcontractor and local construction official

This is where it falls apartThis is where it falls apart

• ExpensiveExpensive– Current funding Current funding

sourcessources

• Landlord wants to Landlord wants to evictevict

• Owner occupiedOwner occupied

• ForeclosuresForeclosures– Dealing with banksDealing with banks

ExpensiveExpensive

• DCA abatement fundingDCA abatement funding

• Relocation Fund – DCARelocation Fund – DCA

• Local and county affordable housing Local and county affordable housing fundsfunds

Owner doesn’t respondOwner doesn’t respond

• 10 days after 10 days after receipt of letterreceipt of letter

• Issue summonsIssue summons– Chapter XIII – Chapter XIII –

8:51-6.2 8:51-6.2 (exterior) and (exterior) and 8:51-6.3 8:51-6.3 (interior)(interior)

EvictionEviction

•Can not evict Can not evict as an as an abatement abatement methodmethod

Owner OccupiedOwner Occupied

• Allowed to do work themselvesAllowed to do work themselves

• Increased risk of exposure to Increased risk of exposure to themselves and the childthemselves and the child

• Long time frame – drag onLong time frame – drag on

• Chapter XIII – 8:51-7.1 – health dept Chapter XIII – 8:51-7.1 – health dept responsible for abatementresponsible for abatement

ForeclosuresForeclosures

• Bank not Bank not foreclosing due to foreclosing due to leadlead

• Tied up in court for Tied up in court for long periodslong periods

• Important to put a Important to put a hold on the COhold on the CO

Other sourcesOther sources

• Causative factors – Causative factors – water leakwater leak

• Lead Recall BookLead Recall Book• Imported cosmetics, Imported cosmetics,

candy, pottery, candy, pottery, cooking utensils, cooking utensils, furniture etcfurniture etc– Chapter XIII (NJAC Chapter XIII (NJAC

8:51 4.2 9d and 8:51 8:51 4.2 9d and 8:51 6.5)6.5)

Occupations/HobbiesOccupations/Hobbies

• Removing the sourceRemoving the source– Recent poisoning – lead workers with Recent poisoning – lead workers with

the car seatsthe car seats– Right to KnowRight to Know– OSHA for workersOSHA for workers– All else fails Criminal Code 2c – All else fails Criminal Code 2c –

Endangering the Welfare of a ChildEndangering the Welfare of a Child

Partners Partners

• Model Cities – local ordinancesModel Cities – local ordinances• Code EnforcementCode Enforcement• Building DepartmentBuilding Department• Neighborhood Perseveration/ Historical Neighborhood Perseveration/ Historical

PreservationPreservation• DCADCA• EPAEPA• Law EnforcementLaw Enforcement• Consumer Affairs (State and local)Consumer Affairs (State and local)• Prosecutors/JudgesProsecutors/Judges• Public AdvocatePublic Advocate

Where do we go from here?Where do we go from here?

– Right now working Right now working in reactive way – in reactive way –

– Future- Intervene Future- Intervene and prevent lead and prevent lead exposureexposure

– Primary prevention Primary prevention – CDC, HUD and – CDC, HUD and NJDHSS moving to NJDHSS moving to Healthy HomesHealthy Homes

Questions?Questions?