Health Services for Children with Special Needs, a local HMO Assesses Lead Hazards in a Medicaid Eligible Population of Developmentally Disabled Children
Home Intervention Components
Home Visiting Team:
This program is being sponsored by Health Services for Children with Special Needs, a local health maintenance organization providing services to a Medicaid eligible population of developmentally disabled children in the District of Columbia. The intent is to assess the home environments of children for lead hazards and environmental asthma triggers. These children are considered at high risk because of the age of the housing and the income status of the families. Additionally, there is evidence that developmentally disabled children may be at higher risk for environmental exposure due to behaviors such as pica and prolonged mouthing behaviors common in early childhood. Blood lead testing is mandated by law in the District of Columbia. A team consisting of a licensed practical nurse, an outreach worker and an environmental specialist visits the homes of identified families. Families are selected based on the age of the child and compliance with a well child visiting schedule. Families whose children are less than six years of age and who have been noncompliant with lead testing receive the home intervention.
In Home Training:
Training is provided to the child's primary caregiver during the home visit. Training consists of the following components:
• Lead in the home environment
• Health Effects of Lead in Children
• How to do a dust wipe sample
• Common Household Environmental Health Exposures
• Common asthma triggers in the home environment
• Simple, inexpensive steps parents can take to reduce exposures
Blood Lead Testing:
After receiving a blood lead order from the primary care physician, a licensed practical nurse draws the blood lead samples from the child during the visit and counsels the appropriate family member about lead and the effects it can have on children and the importance of testing. The nurse also tells the families when to expect blood lead test results and what will happen depending upon whether the test is positive or negative. If additional laboratory studies such as sickle cell are needed blood for those can be drawn at the time the blood lead is drawn.
Dust Wipe Test and Visual Assessment: The outreach worker conducts a visual assessment of the home for lead and asthma. Dust wipe samples are taken from appropriate locations (usually the child’s bedroom and a common area where the children spend a lot of leisure time). This includes any place where there may be visible chipping or peeling paint. The family receives literature on lead and asthma that has been produced by a federal agency and additional material extracted from those documents that is low literacy.
Laboratory Analysis:
Both blood lead samples and dust wipe samples are analyzed by accredited laboratories. Positive blood lead sample results (greater than 5-10 micrograms per deciliter) are reported to the DC Childhood Lead Screening and Prevention Program in the District of Columbia Department of the Environment for follow-up and subsequent risk analysis. Positive dust wipe samples are followed up with a phone call or follow up visit to families so that they can receive guidance about reducing dust levels in the home. The primary care physician is notified of the results of environmental sampling.
Parent Training:
Families are given an option of attending additional more in depth training on lead poisoning prevention or environmental asthma triggers in a group setting on an evening or on Saturday, with child care provided, to ensure families ease of participation.
For more information, contact:
Janet A. Phoenix, M.D., M.P.H., Project Consultant
Assistant Professor, George Washington University School of Public Heath and Health Services
Dept of Environmental and Occupational Health
japhoenix@aol.com or eohjxp@gwumc.edu