State and Community Based Childhood Lead Poisoning Prev & Surveil of Blood Lead

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The Indiana Childhood Lead Poisoning Prevention Program (ICLPPP) is located within the Community and Family Health Services Commission of the Indiana State Department of Health (ISDH). This program began in the early 1980s and has received Centers for Disease Control and Prevention (CDC) support since the 1998-1999 funding year. ICLPPP accepted the CDC challenge to eliminate childhood lead poisoning by the year 2010 utilizing a holistic approach to eliminating Indiana?s considerable lead hazard issues. ICLPPP will work to implement the State?s elimination plan. The plan allows for continuous evaluation and mid-course corrections to ensure that program goals are achieved. Indiana has determined that the key components necessary to establish a comprehensive lead poisoning prevention program statewide include: development of strong codes at the local level; addressing housing with lead hazards including requiring clearance; increasing testing of at-risk children; providing surveillance data to communities; and supporting the network of services of case management needed to protect children already poisoned. This plan encompasses rural, suburban and urban areas throughout Indiana, but concentrating its efforts on areas identified as posing the greatest threat to the highest number of at-risk children. Through the evaluation of Hoosier data specific to Indiana, ICLPPP determined hazard specific target areas based on risk factors. Factors proving the greatest risk of lead poisoning include: housing built prior to 1950, of which Indiana ranks 11th in the nation for prevalence; child population, poverty, and Medicaid based on 2004 census data; estimated 520,805 child population under the age of 6 o 23% of these children living in poverty; 48% enrolled in Medicaid for any period of time within the year ; minority disparate population (African-American, Hispanic, and refugee populations); the Hispanic population has increase by 117% in the past decade; the African-American population while not increasing in size, does show the greater increase in EBLLs when compared to all other races; refugee population (631) consists of 39% children. Based on the data collected and analyzed, the ICLPPP lead poisoning prevention program emphasizes a geographical targeted community approach to produce the greatest reduction in lead poisoning in Indiana. This community approach plan includes the following components: statistical mapping to predict geographical areas having potentially higher rates of lead hazards and children at-risk, targeted environmental investigation and primary prevention efforts, targeted blood testing of at-risk children, medical management, laboratory support, case management, development of a housing database, maintenance of a childhood lead testing database, public and professional education, and community empowerment through resource development and local task force groups. By analyzing geographical and demographical information and targeting areas most at risk, ICLPPP examined the combination of pre-1950 housing, children living in poverty, Medicaid eligible children, and testing rate. The analysis consistently indicated eight counties, Marion, St. Joseph, Allen, Elkhart, Delaware, Vanderburgh, Vigo, and Lake. Including these eight counties in the grant, covers 42 percent of all children under six years old, 47 percent of all pre-1950 housing, 54 percent of all Medicaid children and 77 percent of all minorities, and 73% of EBLLs. As discussed above, these eight counties also contain 93 percent of Indiana refugees. ICLPPP has identified three additional target areas on which to concentrate funding and efforts. ICLPPP proposes adding the local health departments, Delaware, Elkhart, and Vigo, that service those additional areas to the five health departments, which receive passthrough funds from the current CDC grant. The addition of these counties will ensure that 54% of the children at risk will be targeted for primary prevention and secondary prevention activities. Indiana?s primary prevention approach includes concerted efforts to address lead hazards in areas and audiences at highest risk. Capacity to identify housing-based lead hazards and remediate those hazards is increasing with increased awareness of the prevalence of hazards and the need for lead safe practices. ICLPPP?s proactive education, screening, and case management plans address diverse and wide ranged audiences. Through these plans, ICLPPP provides data, primary prevention guidance, lead safe practices information, testing and medical management recommendations for healthcare providers, case management instruction, professional training and public awareness and education targeted to high-risk areas and audiences. ICLPPP has made significant progress in building a solid foundation and comprehensive network of strategic partners throughout the state. Even considering a dedicated professional staff ICLPPP has recruited to combat childhood lead poisoning prevention in Indiana extending the program further than expected. These efforts are multiplied through the incredible assemblage of stakeholders accepting to eliminate lead poisoning of Indiana?s children. ICLPPP will continue its collaboration with its strategic partners and will be diligent in revitalizing efforts to eliminate childhood lead poisoning. Indiana demonstrates both the need for additional funding and the capacity to meet the challenges facing childhood lead poisoning prevention programs in 2007. The needs have been identified, the vision is implemented, and the challenge accepted. Through the continued support of CDC, both through funding and guidance, Indiana will succeed in its goal to eliminate lead poisoning by 2010.