State and Local Childhood Lead Poisoning Prevention Program

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The Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program (MACLPPP) is seeking funding from the Centers for Disease Control and Prevention as a competitive grantee. Requested CDC funds will be used to enhance our extensive childhood lead poisoning prevention program which has been a part of the Massachusetts Department of Public Health for over twenty-five years. The program includes comprehensive case management teams consisting of a nurse case manager, environmental health inspector and family advocates. These components form a cohesive design which provides families with both medical and environmental intervention as called for by the Massachusetts's Lead Law, one of the strongest primary prevention statutes in the nation. CLPPPP staff, funded by CDC, is also responsible for health education, surveillance and epidemiology, data management, program management, fiscal and information technology support. The population, geographic and economic composition of Massachusetts results in a significant lead burden for children in our jurisdiction. The 1990 US Census indicates that Massachusetts has the second highest percent of pre-1950 housing units, or 46.8% of all housing, exceeded only by New York State, with 47.1%. CDC's own data indicates that there are 58, 454 children living in poverty in Massachusetts; 36,900 of whom live in homes built before 1950. In state fiscal year 2005 there were 3,187 Massachusetts children under the age of six who had lead levels of 10 ug/dL or greater. This is a rate of 1.4%, which is comparable to the national rate of 1.6% in the 1999-2002 NHANES survey. This data on screening and incidence considered in conjunction with our housing stock and our array of both urban and rural communities absolutely illustrates the need for continued CDC support for lead poisoning prevention in Massachusetts. Funding from CDC will ensure that MACLPPP continues comprehensive efforts to provide primary and secondary prevention services to children and their families throughout the commonwealth. The need for these resources will be increased as MACLPPP builds capacity and implements a system-based framework established in our strategic elimination plan to end childhood lead poisoning by 2010. As part of this plan, the Community Mobilization Network initiatives are underway with active programs in three of our highest risk communities. In 2006, MACLPPP plans to reconvene or Strategic Advisory Committee to share the accomplishments of these communities and explore implementation options of other key initiatives. In addition to our community mobilization efforts, MACLPPP has made strides towards building in-roads with Refugee and Immigrant Health Program (RIHP), including incorporating lead-related housing issues into a required questionnaire used to identify appropriate housing when placing refugee families. Massachusetts has afforded families with comprehensive case management services since 1982. Our case management system consists of a three-tiered approach addressing the medical, environmental, and social needs of a family. Furthermore, we continue to see significant progress in primary prevention and improvement of our housing through private sector inspections and remediation, which is due in large part to the strength of our statute and regulations. MACLPPP will use the first budget period to evaluate and formalize our policies and procedures to produce a finalized written case management plan. A critical element in the implementation of many of our major initiatives in Fiscal Year 2006 will be the utilization of the electronic case management system, referred to as the Kyran application. This application allows for the collection of multiple test results for an individual child over years. Furthermore the application allows for multiple children and their corresponding blood tests to be related to an individual address. Extensive work flows for the medical, home visiting, and environmental components have been developed which permits us to track the timeliness and effectiveness of our services. Our epidemiology component continues to track linkages with our data to Medicaid data. Moreover, MACLPPP is preparing to begin a data sharing project with Massachusetts's Women, infants and Children program. MACLPPP is looking forward to developing and enhancing our application allowing greater opportunities for extensive and in-depth program evaluation and surveillance capabilities. One of these new opportunities will involve working with geocoded environmental data to generate an environmental annual report, similar to the Massachusetts Needs Assessment on screening, which will present inspectional and remediation activities by city and town. Primary Prevention efforts continue to be one of MACLPPP's great strengths. MACLPPP is currently preparing a Request for Responses to competitively procure local community-based lead poisoning prevention health education contracts. The recipients of these Lead Health Education Trust Fund contracts will be required to organize and conduct 20 health education presentations annually, attend at least 8 health fairs or other local health events, distribute lead poisoning prevention health education materials throughout their region, and to plan and carry out local Lead Poisoning Prevention Week activities. In addition to our health education activities, environmental primary prevention efforts are still vigorous. As mentioned previously, Massachusetts has a well developed private sector responsible for a significant amount of inspections and remediation work in the state. MACLPPP environmental staff provides vital technical assistance to private lead inspectors, deleading contractors, and homeowners trained and authorized to do some limited deleading activities, in an effort to ensure these activities are done in a manner that protects the public's health and meets regulatory requirements. We continue to authorize owners to do specific deleading activities following regulatory guidelines similar to the federal lead safe work practices. To date we have authorized over 6000 owners and owner's agents to undertake low and moderate risk deleading activities on their homes. MACLPPP maintains on-going partnerships with sister agencies like Medicaid, Women Infants and Children program as well as local grantees, community mobilization networks and boards of heath. Through this work we hope to achieve a solid and sustainable framework of both primary and secondary prevention measures that protects children from lead poisoning, improves our housing stock and helps us move towards the elimination lead poisoning by 2010.