Developing Regional Collaboration for Service Provision

State: MO Type: Promising Practice Year: 2014

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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. 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.

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Kansas City Health Department
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Developing Regional Collaboration for Service Provision
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. 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. 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. 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. 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. 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 notbe able to identify the source of lead and reduce the hazards - leading to further harm to the children
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.
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.
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 received 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 radioactive 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.
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. Partner collaboration lessons include making sure that you have a memorandum of understanding (MOU) with the partners. This practice is better that what existed - no services at all for EBL children in Kansas. 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. 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.
 
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