2004 Model Practice Application (Public)

Niagara County Childhood Lead Poisoning Prevention Program

Niagara County Health Department

The Niagara County Childhood Lead Poisoning Prevention Program provides case management where children are under the age of six and have elevated venous blood lead levels (20mcg/dl or greater). In addition to monitoring the child’s progress, case management includes:

• Educating parents.
  
  
• Acting as a liaison between the regional lead poisoning center, the child’s physician, and parents.
  
  
• Having a public health technician conduct XRF analysis inspection of the child’s environment.
  
  
• Assuring that the lead source is remediated.

In addition to case management, the program provides educational material and offers home visits to parents whose children have milder blood lead elevations in the 10-19 mcg/dl range.

The outreach component of the program targets the following groups: medical professionals (pediatric and family practitioners, their staff and ER personnel), parents of children under age six, daycare staff, and landlords. Outreach activities include annual mailings and trainings to medical practices, presentations at daycares to parents and staff, monthly visits to WIC sites, attendance and display at health fairs and summer activities, and professional assistance on Head Start Advisory Boards. The health department staff have written brief news releases and appeared on cable TV programs with messages about the dangers of environmental lead and the need to test children for blood lead elevations. The software, Leadtrac, enables staff to enter and monitor results of blood lead levels drawn on all children under age six in the county. It also helps to assess progress.

Lead poisoning can have devastating effects on a child’s health and development, so the health department works to prevent it and to lower existing blood lead elevations. Staff members look at all areas of responsibility (parent, physician, landowner, and local health unit), learn about ongoing litigation regarding the paint industry, and stay current on sources of lead poisoning. To help prevent lead poisoning, the New York State Department of Health is continually working to give counties improved tools, especially related to software, mandatory lab reporting, and outreach.

The health department collaborates with insurance providers on outreach activities and plans door-to-door activities with the Healthy Neighborhood Program, such as distributing of cleaning supplies and children’s education videos. Staff members assist the county attorney’s office in planning and attracting attendance at seminars that involve speakers from many community agencies. The coordinator of the Lead Poisoning Prevention Program collaborates with the Early Intervention Program to ensure that affected children receive developmental evaluations and follow-up programs as needed.

The program is funded by a grant from the New York State Department of Health. Monies (approximately $68,000 annually) support wages for a half-time clerical support person ($12,000) and a three-quarter-time RN ($34,000). Remaining monies support promotion/outreach ($800), travel/mileage ($2,000), attendance at conferences ($500), procurement of two XRF analyzers ($6,000), office supplies and copier rental ($500), postage ($1,000), and lab processing of blood samples and supplies for blood drawn in the clinics ($900). Office space and environmental personnel costs are funded through county and Article 6 monies.

New York State Department of Health analyzes data and publishes a statewide report on lead testing rates through the state, county by county. This publication is entitled "Protecting Our Children from Lead: The Success of New York’s Efforts to Prevent Childhood Lead Poisoning." The last report was published in 2001 and a new one is in progress. This data allows tracking of progress. According to the last report, approximately 66% of Niagara County children are in compliance with CDC and American Academy of Pediatric guidelines for lead testing.

LeadTrac also helps to assess progress. The health department uses it to evaluate the effectiveness with various educational and outreach activities such as health fairs and door-to-door outreach with newly obtained lab results. New York labs must by law report all lead test results on children under age six to the New York State Department of Health who emails these results for entry into the LeadTrac database.

Another means to evaluate the progress is through visits to pediatric offices. Program staff are able, once again using LeadTrac, to determine the effectiveness by comparing the number of children from individual practices tested prior to the visit with test results from subsequent visits.

A population that frequently changes residences is always a challenge. When reminder letters are mailed to parents, the health department often receives them back as undeliverable. Switching pediatricians is also common and hinders adequate and timely testing. Another challenge is emphasizing the importance of having children screened at ages one and two. Some parents put this at their end of their list of things to do. Furthermore, some physicians do not realize that two-year olds can be at risk for lead poisoning.

• Understand your state’s regulations on screening children for lead and how they compare to CDC and ACIP guidelines.
  
  
• Research model programs.
  
  
• Determine how you will receive test results and what mechanism(s) will be used to track lead levels and related data.
  
  
• Determine basic supplies and necessary personnel.
  
  
• Assess financial resources and means of obtaining funding.
  
  
• Educate the staff.