Advancing Primary Prevention of Childhood Lead Poisoning in Ohio Gabriella Celeste, JD Co-Chair, Ohio Lead-Free Kids Coalition (OLFKC) Policy Director, Schubert Center for Child Studies, Case Western Reserve University Lead Solutions Summit Cleveland, Ohio June 21, 2019
We Know How Children Are Exposed to Lead “Deteriorating lead-based paint and its resulting lead dust are the most common causes of elevated blood lead levels in children in Ohio.” ODH Other sources include: - Soil contaminated by lead dust particles - Water from lead pipes and/or fixtures
Home Risk Factors If you answer “yes” to any of these questions, please consider having your home tested for lead: - Are there visible paint chips near the house ( pre-1978 ), fences, garages, or play structures? - Is your home located near a lead-producing industry (battery plant, smelter, radiator repair shop, etc.)? - Is your home located near buildings or structures that are being renovated, repainted, or demolished ? https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/childhood- lead-poisoning/about-lead/
Leveraging a critical public moment... Rachell Dissell, Brie Zeltner, The Plain Dealer (October 2015) Photo credit: Lisa DeJong/The Plain Dealer
Coalition- Building: Growing social capital for policy change...
Highlighting & Translating Relevant Research to Build Case for Prevention & Early Intervention
Building Defining (& Refining) Political the Social Problem... Will... “For every $1 spent controlling lead hazards, at Engaging least $17 returned (and as stakeholders... much as $221) in health - Pediatricians benefits, increased IQ, - Researchers higher lifetime earnings, tax revenues, lower special - Housing specialists education costs and reduced - Early care workers criminal activity.” - Public health staff - Social policy experts and Crafting State - Families, etc. Policy Solutions: Prevention & ...to inform policy Supports ideas.
OLFKC 1. Broaden impact of SCHIP Lead Hazard Control Program State Budget 2. Create a Primary Prevention of Child Lead Poisoning Policy State-Local Demonstration Grant Proposals in 3. Increase access to effective lead screening & testing with targeted strategies the Ohio 4. Strengthen enforcement of current lead inspection Children’s laws with increased resources Budget 5. Prevent further harm by ensuring access to developmental and behavioral supports like early intervention 6. Convene a state task force to develop a comprehensive primary prevention plan
Coordinating with Child-Focused Partners to Build Case for Prevention & Early Intervention
Using “wins” as building blocks for further policy & systems change...
Early Intervention IDEA Part C Services (0-3):* Why Automatic Eligibility for Children with EBLLs Matters * Starting July, 1, 2019 – • Parents can request EI supports ODH will • send EBLL tests results to DODD
“School-Age” Services for Developmental Delays Child with identified disability/delay may receive: - IEP with IDEA Part B (ages 3-5) and Part C supports; include “related services”: - Behavior & curriculum intervention specialists - Speech-language pathologists - Augmentative communication specialists - Occupational & physical therapists - Behavior Intervention Plan (BIP) – focus on positive behavioral supports - “ Transition services ” to ensure necessary supports upon leaving school - Special legal protections
Supporting Political Leadership for Policy Change...
State Budget FY20-21 Update* • CHIP lead abatement program sustained ($10M over the biennium*) • Workforce development of lead specialists ($450,000 new funding) • New funding for early intervention supports to aid in new coverage for children with EBLL ($23.7M) • New lead tax credit (up to $10,000/7 years) can incentivize private sector investment in lead safe housing ($ 5M permitted in abatements/FY) • Screening & testing strategies with ODM’s focus on pediatric CPC and potential changes to MCO contracts performance measures * RRP (Renovation Repair & Painting Rule) Amendment
Ohio Dept. of Medicaid FY20- 21 Budget Priorities Lead Testing & Hazard Control » Partner with health care providers & MCOs to advance appropriate blood lead testing » Grow multi-agency efforts to increase reporting to ODH’s Lead Poisoning Surveillance » Work with ODH to use Medicaid dollars to perform environmental lead risk assessments in homes where kids with EBLLs » Work with DODD to ensure EBLL children have access to early intervention programs » Reenergize ODH partnership on lead hazard control/ abatement initiatives through the Children’s Health Insurance Program (CHIP) Health Services Initiatives program
Renovation, Repair, Painting (RRP) rule & prevention opportunity: Why RRP is Important - Renovations in pre-1978 structures can disturb painted surfaces which can create lead paint chips and dust - Lead dust can harm workers as well as children and others if they bring dust home on work clothing - Lead safe work practices are doable and prevent exposure
Source: USEPA Region 1 Guidance on EPA’s RRP Rule (June 5, 2019)
Renovation, Repair, Painting (RRP) Rule: What RRP Requires for Who WHO must follow RRP? Anyone hired to perform work in pre-1978 home or child-occupied facility (6sq.ft. of surface or more) WHAT does RRP Require? • Firm Certification* • Individual Renovator 8 hr Training & Certification* • Notify homeowners/tenants of lead hazards • Follow Lead-Safe work practices • Keep RRP records for 3 years *Must renew every 5 years
USEPA’s RRP Brochure must be provided in advance to home owners, tenants, child care operators and/or parents of children under 6 in child care facility.
Renovation, Repair, Painting (RRP) What “Lead Safe” Work Practices Requires... 1. Assume or test to determine if the job involves lead-based paint 2. Safely set up work site & Post signs defining the work area 3. Use dust-minimizing work methods & contain area ( 4. Dispose of waste in accordance with law 5. Leave the work area clean If you think a worker is not doing what he is supposed to contact landlord and/or local health or building department. Call EPA hotline 1-800-424-LEAD (5323)
Ohio Benefits with RRP Authority - Advancing Prevention - Customer Service for Contractors with ODH Training & On-Going Guidance - More reasonable & equitable fees - Lower & more appropriate penalties - Keeping Ohio Dollars in Ohio - Advances primary prevention
OLFKC Call to Action State Budget & Beyond • RRP Rule Enforcement – Transferring Authority to Ohio • Preserve current investment, ensure effective implementation, and convene a state lead task force to build a robust comprehensive lead prevention roadmap • Coordinate with other child-related priorities : infant mortality, home visiting, safe & affordable housing and other social determinants of health. • Support local, innovative public-private partnerships prioritizing primary prevention as models for Ohio What do you think should be other state priorities for future action...? Contact OLFKC Co-Chairs: Patricia Barnes, patricia.barnes@ohhn.org or Gabriella Celeste, mgc36@case.edu
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