Physician's Handbook on Childhood Lead Poisoning Prevention
Chapter Seven
Role of the Local Health Department
Role of the Local Health Department
Summary
Local Childhood Lead Poisoning Prevention Programs are conducted by county health departments or public health nursing services.
The goals of a local Childhood Lead Poisoning Prevention Program are to:
- provide blood lead screening services to children who do not receive screening through a primary care physician because the child is uninsured or underinsured;
- perform follow-up activities consistent with current CDC recommendations;
- perform environmental investigations and order abatement in accordance with state guidelines when needed;
- provide community, parental, patient and professional education about the hazards of lead exposure and prevention of lead poisoning;
- assist in the coordination of the multiple professional disciplines involved in the care of a lead poisoned child;
- track children with elevated blood lead levels to assure that appropriate follow-up activities are performed; and
- provide data to identify exposure patterns and high-risk populations to enable strategic planning for lead poisoning prevention.
Role of the Local Health Department
Management of the lead poisoned child is a multidisciplinary effort. This effort involves the services of pediatric care providers, public health nurses, environmental sanitarians and often including the efforts of social workers, health educators, parent advocates, local social services and housing agencies, abatement contractors and legal services. The local health unit's Childhood Lead Poisoning Prevention Program assists primary pediatric care providers in coordinating and tracking the care of lead poisoned patients. Good lines of communication and a collaborative relationship are needed to achieve these goals.
Local Childhood Lead Poisoning Prevention Programs are conducted by county health departments or public health nursing services or the New York City Department of Health. The county health department is a "full service" department and has the ability to conduct environmental investigations using its own staff. A public health nursing service utilizes State Department of Health district office staff to perform environmental investigations. The public health nurse can serve as a case manager and coordinate the activities and communications between pediatric care provider, sanitarians, public health staff, families and others who may be involved in a particular case of lead poisoning.
A local health department or public health nursing service can be a valuable source of professional support and collaboration for the health care provider. The local program can:
- perform public health home visits to assess the home environment and educate parents/guardians to reduce lead exposure;
- provide pediatric care provider's office staff education in capillary specimen collection procedures for blood lead testing;
- assist in tracking and follow-up of children with elevated blood lead levels;
- assist in the location of patients who have failed to keep follow-up appointments; and
- identify pediatric care providers who are willing to consult on medical management and treatment issues or accept patient referrals for treatment.
One of the most important tasks of a local health unit lead poisoning prevention program is that of the environmental investigation of the patient's primary residence and/or other secondary sites of exposure as indicated. After investigation, the local program makes recommendations for abatement of the hazards and follow-up on the abatement of the site, including administrative enforcement proceedings when needed.
Experience has shown that a coordinated effort between pediatric care providers and public health lead poisoning prevention programs is most effective in reducing children's lead levels. It is particularly important that follow-up care be coordinated between public health programs and health care providers for children with confirmed lead levels equal to or greater than 20 μg/dL.
Information shared between child health care providers and local public health programs will promote care coordination.
- For children with lead levels equal to or greater than 20 μg/dL, pediatric care providers should share with local lead programs information such as lead levels, results of tests for iron deficiency, the developmental evaluation, nutritional assessment, outpatient treatment prescribed and outcome of hospitalizations.
Information from providers will be used by the local Lead Poisoning Prevention Program to monitor the child's progress, to decide, in conjunction with providers, if further interventions are needed and to maintain an epidemiological database. The child's name and birth date and practitioner's name and address should accompany all information sent to local health units.
Local health units should share with physicians the results of family risk assessments, reports of environmental investigations, progress reports on abatement of hazards, dates of educational home visits provided to a family and reports on efforts to locate families that have failed to return for follow-up care.
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