Louisiana Louisiana Childhood Lead Childhood Lead

Poisoning Poisoning Prevention Prevention ProgramProgram

Child Care Health Consultant Video Child Care Health Consultant Video ConferenceConference

November 13, 2008November 13, 2008Presented by LACLPPP StaffPresented by LACLPPP StaffAnn Bludsaw, GSW, Case ManagerAnn Bludsaw, GSW, Case Manager

Colleen Clarke, BS, Program CoordinatorColleen Clarke, BS, Program CoordinatorNgoc Huynh, M.D., MPH, Surveillance Ngoc Huynh, M.D., MPH, Surveillance

Epidemiologist Epidemiologist Caroland Randall,BA, M.A.O.M, Environmental Caroland Randall,BA, M.A.O.M, Environmental

CoordinatorCoordinator

OBJECTIVESOBJECTIVES

1.1. Define Childhood lead poisoning.Define Childhood lead poisoning.

2.2. Recognize sources of lead poisoning.Recognize sources of lead poisoning.

3.3. Discuss the components of the comprehensive Childhood Discuss the components of the comprehensive Childhood Lead Poisoning Prevention Program.Lead Poisoning Prevention Program.

4.4. Describe the components of the Louisiana Childhood Describe the components of the Louisiana Childhood Lead Lead

Poisoning Prevention Program.Poisoning Prevention Program.

5.5. Determine lead screening requirements.Determine lead screening requirements.

6.6. Determine case management requirements.Determine case management requirements.

7.7. Discuss lead inspection requirements.Discuss lead inspection requirements.

What is lead What is lead poisoning?poisoning?

Lead is Lead is especially especially dangerous dangerous for young for young children.children.

They:They:

• are still developingare still developing• absorb it more easilyabsorb it more easily• are more likely are more likely

to put things in to put things in their mouthstheir mouths

Lead affects Lead affects the the

brain and brain and nerves.nerves.

This may cause:This may cause:

• learning problemslearning problems• physical problemsphysical problems

More effects More effects of leadof lead• stunted growthstunted growth

• behavior problemsbehavior problems• other issuesother issues

Effects of Effects of high lead high lead

levelslevels• damage to the damage to the nervous system, nervous system, including the brainincluding the brain

• convulsions convulsions or comaor coma

• deathdeath

Sources of LeadSources of Lead

• LEAD PAINTLEAD PAINT• DUST AND SOILDUST AND SOIL• WATERWATER• PARENTAL OCCUPATIONS PARENTAL OCCUPATIONS

OR HOBBIESOR HOBBIES• HOME REMEDIESHOME REMEDIES• FOOD FOOD • OTHEROTHER

Lead-based Lead-based paint paint

and lead dust and lead dust are are

the leading the leading sources.sources.• chipped or chipped or

flaking paintflaking paint• dust from dust from

deteriorating deteriorating paintpaint

• dust from dust from renovationsrenovations

Lead Lead may be may be in water.in water.

• lead plumbing lead plumbing fixtures in fixtures in your homeyour home

• lead in lead in the water the water supply systemsupply system

It can come from:It can come from:

Hobbies Hobbies may be may be

a source of a source of lead.lead.• stained-glass or stained-glass or

pottery makingpottery making

• fishingfishing• refinishing refinishing

furniturefurniture

Lead Lead may may be in be in food.food.

It can come from:It can come from:

• soil or watersoil or water

• dust on dust on hands or hands or preparation surfacespreparation surfaces

• leaded crystalleaded crystal

• lead-soldered canslead-soldered cans

• some glazed potterysome glazed pottery

Comprehensive Approach Comprehensive Approach to Childhood Lead to Childhood Lead

Poisoning Poisoning • Assess children’s exposure to leadAssess children’s exposure to lead• Develop policies for childhood lead Develop policies for childhood lead

poisoning preventionpoisoning prevention– Primary PreventionPrimary Prevention– Secondary PreventionSecondary Prevention

• Assure performance of activities to Assure performance of activities to prevent childhood lead poisoningprevent childhood lead poisoning

• Monitoring (surveillance)Monitoring (surveillance)- Monitoring children’s BLL’s- Monitoring children’s BLL’s- Monitoring for risk for lead elevation- Monitoring for risk for lead elevation

Head Start RequirementsHead Start Requirements

• It is a Medicaid EPSTD requirement that a lead It is a Medicaid EPSTD requirement that a lead screening blood test be performed to determine screening blood test be performed to determine a lead toxicity level for all Medicaid-eligible a lead toxicity level for all Medicaid-eligible children.children.- A “risk assessment” (i.e. a paper and pencil - A “risk assessment” (i.e. a paper and pencil questionnaire or parent interview) does not meet questionnaire or parent interview) does not meet this requirement.this requirement.If parents are unable to provide written If parents are unable to provide written documentation that their child received a lead documentation that their child received a lead screening test at ages, 12 and 24 months, then screening test at ages, 12 and 24 months, then CMS requires that the children receive a lead CMS requires that the children receive a lead screening blood test between the ages of 36 and screening blood test between the ages of 36 and 72 months.72 months.

ManagementManagement

• The most important step is The most important step is identification of source and identification of source and separation of child from the sourceseparation of child from the source

• Rapidity of response depends on the Rapidity of response depends on the levellevel– Medical evaluationMedical evaluation– Environment evaluation for sources.Environment evaluation for sources.

• Decrease risk factors – nutrition, Decrease risk factors – nutrition, anemiaanemia

Primary Objectives of Case Primary Objectives of Case ManagementManagement

• Reduce the child’s blood lead level Reduce the child’s blood lead level (BLL) below the level of concern (BLL) below the level of concern 1010µg/dLµg/dL

• Give the highest priority to children Give the highest priority to children with both the highest BLLs and those with both the highest BLLs and those less than 2 years of age.less than 2 years of age.

Client Identification and Client Identification and Outreach for Case Outreach for Case

ManagementManagement• Lead poisoning risk assessment (screening Lead poisoning risk assessment (screening

questionnaire) – assess level of poisoning questionnaire) – assess level of poisoning threat on all children beginning at six months threat on all children beginning at six months of age and each medical screen through age of age and each medical screen through age six years.six years.

• Blood lead screening – begin with any “yes” Blood lead screening – begin with any “yes” answers on risk assessment, then screen answers on risk assessment, then screen yearly as high risk. If low risk screen at one yearly as high risk. If low risk screen at one and two years of age.and two years of age.

• Counsel parents on lead poisoning prevention Counsel parents on lead poisoning prevention at each visit.at each visit.

Reporting RequirementsReporting Requirements

• Physicians are required to report blood lead Physicians are required to report blood lead levels that are 15 ug/dL or greater immediately levels that are 15 ug/dL or greater immediately to LACLPPPto LACLPPP

• Physicians are required to submit Environmental Physicians are required to submit Environmental Lead Investigation Form immediately to Lead Investigation Form immediately to LACLPPP with Blood lead levels that are 15 LACLPPP with Blood lead levels that are 15 ug’dL-19 ug.dl after 2 venous tests or ug’dL-19 ug.dl after 2 venous tests or >> 20 ug/dL 20 ug/dL

• Follow CDC Summary Chart Lead Poisoning Follow CDC Summary Chart Lead Poisoning Management to determine when a child needs to Management to determine when a child needs to repeat a blood lead level test, when to make a repeat a blood lead level test, when to make a referral, or when an environmental inspection is referral, or when an environmental inspection is needed.needed.

Required Reporting Required Reporting InformationInformation

• Complete LACLPPP Lead Case Reporting Complete LACLPPP Lead Case Reporting form, then fax to 504-219-4452form, then fax to 504-219-4452

• Complete the Request for Environmental Complete the Request for Environmental Lead Investigation form if needed, then Lead Investigation form if needed, then fax to 504-219-4452fax to 504-219-4452

• Forms can be obtained from OPH website Forms can be obtained from OPH website – – http://www.genetics.dhh.la.govs.dhh.la.gov

Follow-UpFollow-Up• Monitoring of blood lead levelMonitoring of blood lead level• Continued assessment for symptomsContinued assessment for symptoms• Attention to nutrition and iron statusAttention to nutrition and iron status• Environmental follow-up to ensure hazard Environmental follow-up to ensure hazard

reductionreduction• Contact provider to ensure child is in care, Contact provider to ensure child is in care,

provide health education materials to provide health education materials to family/guardian and physicians as neededfamily/guardian and physicians as needed

Environmental Case Environmental Case Management definedManagement defined

• Following - up on Following - up on eligibleeligible children children• Coordinating environmental Coordinating environmental

investigations investigations • Notifying parents, medical providers Notifying parents, medical providers

and property owners of and property owners of investigation results investigation results

• Coordinating remediation and/or Coordinating remediation and/or abatement strategiesabatement strategies

Environmental Environmental Investigations/Investigations/

Environmental Risk Environmental Risk AssessmentsAssessments• Visual InspectionVisual Inspection

• An Extensive An Extensive Questionnaire Questionnaire

• Dust, soil and paint Dust, soil and paint sampling (if sampling (if chipping) chipping)

• Investigation Report Investigation Report – Results & AnalysisResults & Analysis– Hazard Control PlanHazard Control Plan

• Cost Estimates of Cost Estimates of Hazard ControlsHazard Controls

Most Common Sources of Most Common Sources of Lead PoisoningLead Poisoning

Identified Lead Sources

Dust17%

Soil18%

Paint43%

Miniblinds14%

No Source8%

DustSoilPaintMiniblinds

No Source

Sources of childhood lead poisoning identified and recorded through lead inspections & risk assessments (1999 – 2003) through the Office of Public Health

Contact UsContact Us

Louisiana Childhood Louisiana Childhood Lead Poisoning Lead Poisoning

Prevention ProgramPrevention Program3101 W. Napoleon 3101 W. Napoleon

AvenueAvenueMetairie, LA 70001Metairie, LA 70001

504 – 219-4413504 – 219-4413800 – 242 – 3112 800 – 242 – 3112

www.genetics.dhh.louisiana.gwww.genetics.dhh.louisiana.govov