î ì î ì d , & o o ^ u ] v rt z Ç ] o } ] } v ] v p ] o o } v v m (yhq orz ohyhov ri ohdg lq...

$: î ì î ì D , & o o ^ u ] v rt z Ç ] o } ] } v ] v p ] o o } v v m (yhq orz ohyhov ri ohdg lq eorrg kdyh ehhq vkrzq wr diihfw ,4 delolw\ wr sd\ dwwhqwlrq dqg$
10/28/2020

1

2020 MCAH Fall Seminar - CAH Childhood Lead Poisoning Prevention Program (CLPPP) Update

October 28, 2020

Presenter: Kevin OfficerCLPPP Manager

TAKEAWAYS

1. Why childhood lead poisoning is still a concern2. Status of childhood lead in Iowa3. CLPPP Program Priorities4. Title V SPM2 – Blood Lead Testing & Follow Up

2020 Iowa CLPPP Overview

October 28, 2020 - MCAH Fall Seminar - CAH

10/28/2020

2

Why is lead poisoning still a concern?

Lead exposure to children can result from multiple sources and can cause irreversible and life-long health effects.

- 2018 Federal Action Plan



No safe blood lead level in children has been identified.– Center for Disease Control & Prevention (CDC)


10/28/2020

3


Even low levels of lead in blood have been shown to affect IQ, ability to pay attention and academic achievement.


Effects of chronic low-level lead exposure

Childhood lead exposure has been associated with:• higher absenteeism in school • lower class rank• poorer vocabulary and

grammatical reasoning scores• longer reaction time• poorer hand-eye coordination


10/28/2020

4

STATUS of CHILDHOODLEAD in IOWA


Status of Childhood Lead in Iowa

2019

Under 6 population:

255,316Under 6 population tested:

63,837 ~ 25%(26% in 2018)


10/28/2020

5

2019

Blood Lead Result <5µg/dL:

96%(61,316)

Blood Lead Result 5µg/dL or higher:

4%(2,521)



Of the under 6 population tested for lead in 2019

85%(54,432)

were 0-3 years in age.



10/28/2020

6

30000

25000

20000

15000

10000

5000

0

35000

Number of Children 1, 2, and 3 Years of Age Receiving a Blood Lead Test, 2016 - 2019

2016 2017 2018 2019




10/28/2020

7

Percent of Children 12—23 months of age Receiving a Blood Lead Test

2019 County Data


2019 County Data

10/28/2020

8


2019 County Data

CHILDHOODLEAD POISONING

PREVENTION PROGRAM PRIORITIES

10/28/2020

9

Percent of Iowa Children Receiving a Blood Lead Test

Peak Pb Risk and Exposure Ages90%

50%

60%

70%

80%

100%

2016

2017

2018

2019

Children change. So does their risk of lead exposure!Testing only at 12 months of age is not enough.

40%

30%

20%

10%

0%0 1 2 3 4 5

Age (Years)

AAP: "Blood lead concentrations of children who live in lead contaminated environments typically increase rapidly between 6 and 12 months of age, peak

between 18 and 36 months of age, and then gradually decrease."

Blood Lead Testing

Quality of Surveillance Data

Targeted Intervention

Linkage to Services

Program Goals

Increasing

Childhood Lead Poisoning Prevention Program Priorities

10/28/2020

10

• 75% statewide testing rate of children 1 and 2 years of age 1

• 75% confirmatory testing rates for elevated blood lead levels 10 µg/dL and higher, 72% in 20192

• Increase number of children with a confirmed elevated blood lead level receiving coordinated care, 100%3

Top Program Priorities



Lyon

Sioux O'Brien

Plymouth

Davis

Lucas

Black Hawk

Bremer

Grundy

Carroll

Guthrie Dallas

Sac

Clayton

Clinton

Cedar

Dubuque

Emmet

ClayPalo Alto

Henry DesMoines

Lee

Linn

Mahaska

MarshallTama

Benton

Mills

Monona Crawford

ShelbyHarrison

Cass

PolkScott

Woodbury

Fremont Page Taylor

WarrenMadison

Clarke

Greene

Calhoun Webster Hamilton Hardin

HumboldtWright

HowardOsceola Dickinson

Kossuth

Hancock

Worth Mitchell

Cerro Gordo Floyd Chickasaw

Fayette

ButlerFranklin

Delaware

JacksonJones

Muscatine

Louisa

JohnsonIowaJasper

StoryBoone

KeokukMarionAdairPottawattamie

CherokeeBuena Vista

Ida

Adams Union

Ringgold Decatur Wayne

Monroe Wapello Jefferson

Van Buren

Childhood Lead Poisoning Prevention Program 2020-2021 Service Area Map

• Primary agency bold text.• Primary agency county service area in color.• IDPH Lead Program service area non-colored counties.

Source: Iowa Department of Public Health, Childhood Lead Poisoning Prevention Program, July 2020

10/28/2020

11

Risk Based

Funding

Care Coordination

v. Service Delivery

Performance Measures &

Program Goals

FY19 Contract Changes



Risk Based

Funding

Under 6 Population

Poverty

Pre-1950 Housing

Confirmed ≥10

Confirmed ≥20

FY19 CLPPP

Updates



10/28/2020

12

CLPPPCare

Coord.

Blood Lead

Testing

Clinical Case Mgt.

Env. Case Mgt.

Data Mgt.

Education &

Outreach

Training



BLL Testing

• ↑ 12-35 mo. testing

• ↑ under 6 tes ng

Clinical Follow-

up

• 95% - 20+ Confirmed

• 75% - 10+ Confirmed

• 75% -10 to 14 FU


Program Goals



10/28/2020

13

Clinical Services

• 95% - 15+ HNV• 95% - 15+ Nutrition• 100% - 20+ Med. Evaluation• 100% - Refer 20+ Dev.

Assessment• 95% - 20+ Receive Dev.

Assessment

Environ. Services

• 100% - 20+ EBL investigation• 100% - 2x 15-19 EBL

investigation• 95% - 30 day EBL inspection

FU• 100% - Annual EBL

investigation FU


Program Goals



TITLE V SPM2 –BLOOD LEAD TESTING & FOLLOW UP


10/28/2020

14

MCEH/CLPPP CoIIN – Lead

Exposure Project

Improve Coordinated Care Systems

Decrease lead exposure, Increase

coordinated care Iowa Team –

Studying Care Coordination & BLL testing at County Level


Title V SPM2 – blood lead testing & follow up

Background – CoIIN Project Participation in 3-Year Maternal & Child Health CoIIN

Project Collaborative Improvement and Innovation Network

Funding: Department of Health & Human Services

To support and improve coordinated systems of care within states to address the needs of maternal, infant, and child populations within those states that are at risk for or experience exposure to lead.



10/28/2020

15

Background – CoIIN Project Goals

1. Decrease maternal and child morbidity and mortality associated with exposure to lead.

2. Increase the number of infants and children that have access to a system of coordinated care to address their needs due to lead exposure.

Effect change through: Quality improvement strategies and Collaborative impact



CoIIN Project Activities Clinic Survey of BLL Testing Practices

1. Surveyed: 7 large medical network clinics, 6 small rural clinics

2. Survey results: o No difference in between large network and small rural

clinics.o Within one major network at least three different BLL

testing guidelines were being used.o Majority of respondents had EMR system for follow up

reminders



10/28/2020

16

CoIIN Project Activities Clinic Survey of BLL Testing Practices

3. Barriers included:

Parental compliance with follow through of lab orders

No POC system (LeadCare II) on-site for testing

No further testing required if initial BLL low & no change

in environment (providers/parents)



CoIIN Project Activities Clinic Pilot Study

1. 3 Federally Qualified Health Centers: Urban and Rural Practices

2. Pilot Process: o Increase blood lead testing of children 12-35 monthso Every opportunity – well visit, sick visit, medication,

chronic condition, etc.o For each child ages 12-35 months seen, but not

tested, identify the reason they were not tested.o Pay for Performance Incentive



10/28/2020

17

CoIIN highlighted the need for increased testing for 1 and 2 year olds – esp. Medicaid eligible children

Adopted State Performance Measure 2: Percent of children ages 1 through 2 years, with a blood lead test in the past year.

Environmental scan to assess provider practices

Require testing of 1 and/or 2 year olds if a low testing county. Goal 75%-1y.o. & 40%-2y.o.

Require collaboration with local CLPPP or IDPH

Health Equity



Title V Needs Assessment

10/28/2020

18

Questions


Kevin Officer, CHCCLPPP Contract Manager(515) [email protected]


10/28/2020

19

Child’s Age Blood Lead Testing Recommendation

36 – 60 months of age

o Check whether the child has had recommended lead testing at every contact

o Provide lead testing for children if testing was not done at 1 and 2 years of age or if test history is unknown

o Provide confirmatory (venous) testing if a prior capillary test was abnormal

o Test children with past exposure as recommended based on prior test results

o Assess* whether the child has a higher than average risk of exposure to lead and test as appropriate, at least annually.

*Assessment tool (risk questionnaire)



Promoting Lead Testing at ALL Child Visits

Child’s Age Blood Lead Testing Recommendation

0-less than 12 months of age

Assess* the child’s need for early testing

12-35 months of age

o Test every child at 1 and 2 years of ageo Check whether the child has had recommended

lead testing at every contacto Consider interim testing if there are elevated

exposure risks* o Provide confirmatory (venous) testing if a prior

capillary test was abnormalo Test children with past exposure as recommended

based on prior test results

Promoting Lead Testing at ALL Child Visits



10/28/2020

20

Eng

Sp

Brochures


Updated Web Content & Layout

10/28/2020

21

Educational Videos

• Increase number of children tested between 12 and 36 months of age 1

● Update blood lead testing guidelines and recommendations

● Updated educational materials on blood lead testing

● Developing educational and training videos for local public health and providers

Top Program Priorities in 2019

10/28/2020

22

● Increased outreach and training to medical providers

● Coordinated outreach by local CLPPPs to medical providers

● Increased collaboration between IDPH, Iowa Medical Association, and AAP

• Increase confirmatory testing for elevated blood lead levels2


10/28/2020

23

● Modified local CLPPP contracts to focus on care coordination, not direct delivery of services

● Restructured grant to focus more on performance rather than activity

● Instituted performance measures

• Increase percentage of children with a confirmed elevated blood lead level receiving coordinated care3


î ì î ì d , & o o ^ u ] v rt z Ç ] o } ] } v ] v p ] o o } v v m (yhq orz ohyhov ri ohdg lq...

Documents