Presentation to Cleveland City Council, Public Health Committee April 23, 2018 Atty Client Privilege 1
Slides • Terms • Steps after Receiving Referral • PHLI Investigation • Complete the Report • Violation Notices Leading to Placarding • Case Management • Status/Number of Cases 2
Terms • Elevated Blood Lead Levels – EBL – amount of blood found in a child’s (0-6 years) blood after a blood draw. CDC states there is no safe level of lead. All test results are set to ODH, uploaded into HHLPSS Database, sent to DAs. 10+ case : triggers a mandatory referral to CDPH for a PHLI. CDC defines these children as ‘lead • poisoned.’ It’s the number of micrograms per deciliter of lead. 5-9 case : considered a level of concern. CDPH is notified and expected to contact family to fill • out a questionnaire – used to help identify lead sources. It’s the number of micrograms per deciliter of lead • Lead Risk Assessment – Specific inspection of property which includes dust wipe tests of deteriorating surfaces. • Lead Risk Assessor – professionals who meet the federal requirements/ credentials to inspect homes for lead. • Public Health Lead Investigation – PHLI: a thorough, scientific investigation of a property where children reside to identify potential source of lead poisoning. Includes questionnaire, Lead Risk Assessment, interaction with family. Written into OAC. • Public Health Lead Investigator – PHLI: Must have numerous credentials and trainings. Written into OAC. • Case Management – A specific function that is focused on working individually with the family and affected child. Includes coordinating social services, connecting to resources, testing, hospital cases and engaging the medical community, education and collecting information pertinent to the case and uploading into Database. • HHLPSS – State Database of all impacted children/addresses. 3
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How Do Children Get Lead Poisoning? • Most children get lead poisoning from living or staying in older homes that have lead paint. Many homes built before 1978 have lead paint on the inside and outside of the structure. • When old paint cracks and peels, it makes lead dust. • Most children get lead poisoning from swallowing lead dust on their hands and toys. • Lead is also found in: • Soil, toys and toy jewelry, some candy/spices and folk medicine • Work places - auto repair, construction and plumbing 6
How to know? • A lead test is the only way to know if a child has lead poisoning. • A venous blood sample provides the most accurate results. Finger stick samples can be misleading. • The test measures how much lead is in the blood. • Most children do not look or act sick if they are lead poisoned. • The levels and amount of lead in the blood can increase or decrease • All venous test results are sent to the Ohio Department of Health (ODH). They upload into the HHLPSS System based on address at time of test. 7
Steps After Receiving a Referral 1. CDPH is notified through HHLPSS Database • Name of child, pediatrician, address, phone, EBL level 2. Staff reviews for correctness 3. Make first contact attempts to reach parent/guardian • Call and send letter(s) to all known numbers/addresses • Call after 5pm • Verify with Health Check Coordinator (County) • Verify with Pediatrician • Go to property, leave door tag if no answer. 4. Send letter to Property Owner • To gain entry if no compliance with tenant 5. If contact is made • Complete required ODH questionnaire • Schedule appointment for PHLI Investigation 8
PHLI Investigation Greetings and Introduction to the Parent/Guardian • Tour of the home including all areas where children have access including exterior play areas • Review and finish PHLI questionnaire with Parent • Draw a complete floor plan of the home including documentation of all windows doors and closets • Do a surface by surface XRF testing of all painted surfaces inside and outside the home. Document all • deteriorated paint and painted friction surfaces Fill out the Visual survey of the home using notes from your XRF testing. • Organize a list of dust sample locations and conduct wipe sampling of 5 rooms, windows and floors • (carpet) in each room for a total of 10 wipe samples. Include a blank sample for the lab. Take soil samples outside of any noted bare areas around the home as well as bare soil around • children’s play areas. Take photos of all four sides of the exterior of the home and any deteriorated surfaces within the • home. Review the findings of the XRF testing with the Parent/Guardian and go over any final questions. • Discuss the Local HUD grant information and give them a copy of the application to fill out. While with the family, instruct them on interim controls they can do to prevent child from getting • poisoned Wet mopping and wet dusting – do not use products such as Pledge • If vacuuming, use a HEPA (High Efficiency Particulate Air) Vacuum which has sophisticated filtering system • Advise of interim controls – to block children from accessing problematic areas. • 9
Complete the Report – if Lead is Found • Create and send a 3 day notification letter to the Owner of the property inspected to notify them of the inspection conducted and the forthcoming report. • Fill out the chain of custody for all samples (dust, soil) and mail samples off to the lab. • Create and upload the PHLI initial report into the HHLPSS system as well as entering the necessary inspection dates and outcome into the HHLPSS system. • Download all data from the XRF machine into the computer; upload data into the HHLPSS system. • Begin writing the Lead Inspection and Risk Assessment report while awaiting lab results for soil and dust samples • IF applicable write Lead Hazard Control Orders on the property for any Lead Hazards noted • Fill out a method of selection form for the Homeowner to give to the Abatement contractor chosen to do the repairs on the home • After all reports are completed and reviewed and signed, upload them into the HHLPSS system and mail out a copy of the following : Parent/Guardian and Home Owner 10
Violation Notices • Lead Hazard Control Order • Provides owner 90 days to remediate • Owners may request up to three 90-day extensions • Warning Letter- issued before 90 day expires • Notice of Non-Compliance and Orders to Vacate • Placard 11
Case Management 10+ Cases 1. A case is generated from the HHLPS system at Ohio Department of Health (ODH) then sent to the local jurisdiction. 2. A child with a lead level of 10> and patient demographics is sent from Ohio Department of Health (ODH) to the local jurisdiction where the child currently lives. 3. Once the child’s lead level and demographic information is received by Cleveland Department of Public Health (CDPH) it is entered into an excel spread sheet for tracking purposes. 4. After the child’s lead level and demographic information is entered into the spreadsheet it is then assigned to a Case Manager, Public Health Lead Investigator (CDPH) or Contractor. 5. All lead poisoning cases are assigned to the Case Manager for follow-up service which may include home visit, telephone interview or referrals to other agencies. 6. All cases are assigned to a Public Health Investigator (CDPH). 7. All parents of children with a lead level of 10> are sent a letter explaining that their child has an elevated lead level, telephone call and information packet. 12
Case Management 10+ Cases 8. If contact can be made with the child’s parent then it is recommended to complete the combined (inspection and case management) questionnaire and schedule inspection for PHLI when possible. 9. If unable to make contact with the child’s family there needs to be a minimum of three attempts to contact for Case Management and five for Investigations. 10. Initial letter sent, telephone call, telephone/letters to physician, letter to property owners, second attempt to contact letter, hang tag left at the primary residence and certified letter. 11. To close out the case for a lead poisoned child there need to be three attempts to contact the parent. Initial letter sent, telephone call, hang tag left at the primary residence, second attempt to contact letter and certified letter. 12. Upon completion of the home visit, inspection, telephone interview, referrals or any correspondence it is to all be recorded in the data bases. 13. All file cabinets that contain patient/child information should be kept locked. 14. All paperwork pertaining to a lead poisoned child needs to be uploaded into the HHLPSS data base Ohio Department of Health (ODH) Investigation bureau and the Case Management section within twenty-four hours Case Manager monitor child’s EBL until age 16 or EBL falls below 10. 13
Referrals 2003-2018 2003- 2013 2014 2015 2016 2017 2018 4/17/2018 Referrals Referrals Referrals Referrals Referrals Referrals Contacted 201 32 Risk Assessment Completed 145 0 1 5 7 2 Lead Hazard Control Order Issued 52 15 30 109 139 18 First, Second or Third Extension 3 2 14 8 12 0 Closed Cases Notice of non-compliance 33 52 11 10 3 0 Closed Cases other reasons 10,682 392 332 309 146 16 TOTAL 10,917 461 389 442 508 64 14
How to help 15
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