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2014 Model PracticesApplication Name: 2014 Model Practices : Kansas City Health Department : Developing Regional Collaboration for Service Provision Applicant Name: Ms. Amy Roberts Developing Regional Collaboration for Service Provision
Submitting LHD/Agency/Organization:
City of Kansas City Missouri Health Dept
Street Address: 2400 Troost Ave Suite 3400
Submitting LHD/Agency/Organization/Practice website:
www.kcmo.org Practice Contact Job Title: CLPPP Program Manager Head of LHD/Agency/Organization: Rex Archer MD Provide a brief summary of the practice in this section. Your summary must address all the questions below.
Size of LHD jurisdiction (select one):
500,000-749,999
In the boxes provided below, please answer the following:
1)Where is LHD located? 2)Describe public health issue 3)Goals and objectives of proposed practice 4)How was practice implemented / activities 5)Results/ Outcomes (list process milestones and intended/actual outcomes and impacts. 6)Were all of the objectives met? 7)What specific factors led to the success of this practice? 8) What is the Public Health impact of the practice?
1) The Kansas City Missouri Health Department Childhood Lead Poisoning Prevention and Healthy Homes program serves the
entire City, with some programs reaching beyond the city limits.For this model practice the territory expanded across the
State of Kansas.
2) The public health issue addressed is the very limited resources for lead issues in the State of Kansas. Due to lack of
assistance available to families with lead poisoned children, the toxicologist at Children's Mercy Hospital contacted this
program to provide needed services.
3) A courtesy visit model was created through a partnership with The Healthy Homes and Childhood Lead Poisoning Prevention
Program at Kansas City Missouri Health Department and the Center for Environmental Health at Children’s Mercy Hospital and
Clinics in Kansas City, MO in response to the lack of assistance families have with limited lead resources available in the
State of Kansas. The purpose of the courtesy visit is to provide families with assistance in determining the potential
source(s) of lead exposure through home visit(s)/investigation, targeted source and nutrition education, limited case
management and working with community partners and agencies to provide resources outside the scope of our process to help
prevent further lead exposure and reduce the child’s lead level by eliminating potential sources in and outside of the
home.
4) Referrals are received, appointments scheduled for staff and family, home assessment completed to include a standard
risk assessment and consultation with the family. Free lead testing kits are provided to the family during the initial home
visit/investigation that allows the family to test their home for lead contamination once the home has been thoroughly
cleaned, by the family, based off of education and guidance provided by staff.
5) The CMH medical toxicologist receives a referral from a Primary Care Provider (PCP), a local health department, or other
health provider about a child's elevated blood lead (EBL) results. The information is forwarded to the CMH Center for
Environmental Health (CEH) and The Healthy Homes and Childhood Lead Poisoning Prevention Program at the Kansas City
Missouri Health Department (KCMO-HD) for follow-up purposes.
The Lead Program Coordinator for CEH talks with the KCMO-HD about the case and devises an action plan for possibly going to
the home for a courtesy visit. CEH will take the lead on the case since CEH has a Kansas licensed risk assessor on staff.
However, CEH will work very closely with KCMO-HD since they have many years of experience with EBL cases.
The investigation identifies the sources of the lead and provides assistance to the family. Referrals to OSHA and the EPA
for investigation are made as necessary.
6) The process is meeting the objective in that families have been assisted in identifying and reducing lead hazards,
leading to the reduction of blood lead levels in affected children.
7) Success is due to the many years of experience of the risk assessors and nurses from our program collaborating with the
staff from the CMH CEH program who are licensed in the State of Kansas but lack experience as risk assessors.
8) The public health impact is to provide a vital service in an unserved area. Without this assistance, families might not
be able to identify the source of lead and reduce the hazards - leading to further harm to the children Supplemental materials:
You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles etc. (Please use one of the following: pdf; txt; doc; docx; xls; xlsx; html; htm)
Model Practice(s) must be responsive to a particular local public health problem or concern. An innovative practice must be 1. new to the field of public health (and not just new to your health department) OR 2. a creative use of an existing tool or practice, including but not limited to use of an Advanced Practice Centers (APC) development tool, The Guide to Community Preventive Services, Healthy People 2020 (HP 2020), Mobilizing for Action through Planning and Partnerships (MAPP), Protocol for Assessing Community Excellence in Environmental Health (PACE EH). Examples of an inventive use of an existing tool or practice are: tailoring to meet the needs of a specific population, adapting from a different discipline, or improving the content.
In the boxes provided below, please answer the following:
1)Brief description of LHD – location, jurisdiction size, type of population served 2)Statement of the problem/public health issue 3)What target population is affected by problem (please include relevant demographics) 3a)What is target population size? 3b)What percentage did you reach? 4)What has been done in the past to address the problem?5)Why is current/proposed practice better? 6)Is current practice innovative? How so/explain? 6a)New to the field of public health OR 6b)Creative use of existing tool or practice 6b.1)What tool or practice did you use in an original way to create your practice? (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, a tool from NACCHO’s Toolbox etc.) 7)Is current practice evidence-based? If yes, provide references (Examples of evidence-based guidelines include the Guide to Community Preventive Services, MMWR Recommendations and Reports, National Guideline Clearinghouses, and the USPSTF Recommendations.)
The Kansas City Missouri Health Department serves all of the City of Kansas City, Missouri, with a population of 457,551. The city covers a jurisdiction of 314.95 square miles. This model practice expands the coverage to the whole state of Kansas which adds 81,758.72 square miles. Population served is children six and under with elevated blood lead levels.
The problem is a lack of services/assistance for families in the State of Kansas with lead poisoned children.
Target population is children with an elevated blood lead, estimated to be approximately 3000 in the state, who are not able to access adequate assistance within the state (this is 1.5% of children five and under in KS).
The percentage reached is difficult to determine since the project has just begun and has provided resources to only five families thus far, but the impact could be substantial particularly given that of the five families reached, two involved OSHA referrals and investigations that impacted over 100 persons.
Previously, the CDC was able to provide state funding for childhood lead poisoning services - now many states are having a difficult time or are unable to provide services for EBL children.
It would be wonderful if the CDC was able to restore funding to the states but in the meantime this is a solution that is providing a necessary service to some of the families in Kansas that would otherwise go without services.
This model practice is innovative in that it serves families across a state line in a un-served area. It is not a normal practice for a local health department to cross state lines and provide services. There are some barriers, eg. the risk assessors are not able to take the XRF across state lines, making their years of experience invaluable in investigation.
Evidence based practice demonstrates that comprehensive case management is the most effective way to identify lead hazards and appropriate treatment and follow up for lead poisoned children. This regional approach makes use of existing resources to provide services in unserved areas and build capacity and partnerships that are invaluable for all involved. Overflow Responsiveness - 1 Overflow Responsiveness - 2 Overflow Responsiveness - 3 The LHD should have a role in the practice’s development and/or implementation. Additionally, the practice should demonstrate broad-based involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.
In the boxes provided below, please answer the following:
1)Goal(s) and objectives of practice 2)What did you do to achieve the goals and objectives? 2a)Steps taken to implement the program 3)Any criteria for who was selected to receive the practice (if applicable)? 4)What was the timeframe for the practice 5)Were other stakeholders involved? What was their role in the planning and implementation process? 5a)What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) 6)Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Else, provide an estimate of start-up costs/ budget breakdown.
The goal of this practice to provide a vital service to EBL children in a geographic area where the service is otherwise unavailable.
The practice was initiated when the medical toxocoligist at the Pediatric Environmental Health Specialty Unit (PEHSU) contacted the Kansas City Health Dept Childhood Lead Poisoning Prevention Program to find out if there was any way to assist families in Kansas whose children have very high blood lead levels. This lead to a courtesy visit model created through a partnership with The Healthy Homes and Childhood Lead Poisoning Prevention Program at Kansas City Missouri Health Department and the Center for Environmental Health at Children’s Mercy Hospital and Clinics in Kansas City, MO in response to the lack of assistance families have with limited lead resources available in the State of Kansas. The purpose of the courtesy visit is to provide families with assistance in determining the potential source(s) of lead exposure through home visit(s)/investigation, targeted source and nutrition education, limited case management and working with community partners and agencies to provide resources outside the scope of our process to help prevent further lead exposure and reduce the child’s lead level by eliminating potential sources in and outside of the home. In terms of cost, equipment, transportation and staffing were considered. In terms of costs for replication, this project made use of existing resources and was treated as a collaborative training and capacity building exercise. However, future cases will need to consider most likely, a combination of in-kind donations, insurance reimbursement, grant funding or fee for service.
Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
In the boxes provided below, please answer the following:
1)What did you find out? To what extent were your objectives achieved? Please re-state your objectives from the methodology section. 2)Did you evaluate your practice? 2a)List any primary data sources, who collected the data, and how (if applicable) 2b)List any secondary data sources used (if applicable) 2c)List performance measures used. Include process and outcome measures as appropriate. 2d)Describe how results were analyzed 2e)Were any modifications made to the practice as a result of the data findings?
The initial objective was to provide emergency resources for lead poisoned children in an unserved area. Project partners discovered they were clearly able to develop a functioning regional partnership of local, private and federal agencies who could work together to provide a needed service for these children.Dust sample evaluation showed significant decrease in lead hazards in the homes of families who recieved services. The blood lead levels of the children showed an overall decrease. The federal OSHA investigations are currently ongoing but will clearly result in an increase in safety knowledge in the companies involved.There is also an increase in knowledge in the partner agencies regarding state and federal guidelines for transporting radioactivie equipment, collaborating across state lines, as well as general lead poisoning assessment, treatment and follow up. The process allowed the major partners, the Kansas City, MO Health Department and The Children's Mercy Hospital, to develop procedures and protocols for future collaborations and also helped begin work to develop MOUs with other partner agencies such as the The Kansas Department of Health and the Environment and the Douglas County KS Health Department. In addition, communication and referral pathways were established between the KCMO Health Department and the Douglas County KS Health Department and the Regional OSHA offices.
Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that stakeholders are invested in its maintenance and to ensure it is sustained after initial development. (NACCHO acknowledges fiscal crisis may limit the feasibility of a practice’s continuation.)
In the boxes provided below, please answer the following:
1)Lessons learned in relation to practice 2)Lessons learned in relation to partner collaboration (if applicable) 3)Is this practice better than what has been done before? 4)Did you do a cost/benefit analysis? If so, describe 5)Sustainability – is there sufficient stakeholder commitment to sustain the practice? 5a)Describe sustainability plans
1) Lessons learned - it is illegal to take an XRF across the state line, this limits the tools available for the risk assessors in the field. 2) Partner collaboration lessons include making sure that you have a memorandum of understanding (MOU) with the partners. 3) This practice is better that what existed - no services at all for EBL children in Kansas.4) cost benefit analysis: the five investigations performed cost approximately $2,000 total. The cost of untreated lead poisoning is estimated to be $40,000 per child ($40,000x 5= $200,000). This is in addition to the cost savings in health care for the workers and families in the two companies identified whose safety practices resulted in workplace exposure and take home contamination.
5) sustainability- this project is an easily sustainable project and model that has multiple applications and is built on communication and making use of existing resources. This project has the added benefit of providing capacity builging and teaching opportunities and the opportunity to improve efficiencies within the partner agencies as well. All stakeholders are committed to continuing the improving the partnerships in the time to come by developing MOUs,contracts and other formal processes. Please identify the topic area(s) the practice addresses. You may choose up to three public health areas:
Practice Category One:
Maternal and Child Health Public Health Infrastructure Are you a previous applicant?:
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