Wisconsin Childhood Lead Poisoning Elimination Plan 2010
Department of Health and Family Services Division of Public Health Bureau of Environmental and Occupational Health Wisconsin Childhood Lead Poisoning Prevention Program 1 W. Wilson Street, Madison, WI 53702
Updated August 2006
Wisconsin Plan to Eliminate Childhood Lead Poisoning by 2010 Table of Contents
I. Mission and Purpose Page 1 Wisconsin is committed to work to eliminate childhood lead poisoning by 2010.
II. Background on childhood lead poisoning problem in Wisconsin Page 2 Presents a summary of recent history and of current needs. Eliminating lead poisoning will result in great cost savings to the state. Although current resources focused on the problem are inadequate, once the root causes are addressed, the problem can be eliminated.
III. Extent of the lead poisoning problem in Wisconsin Page 5 a. Describes the distribution of the disease: by geography, age of child, family income, race, ethnicity and age of housing. Wisconsin has a rate of lead poisoning that exceeds the national average. Low-income children and children from racial and ethnic minority groups carry a disproportionate share of the burden. Families living in old, poorly maintained dwellings are at risk regardless of family income or family heritage.
b. Describes progress to eliminate lead poisoning in Wisconsin. Wisconsin has demonstrated good results at reducing the overall rate of poisoning.
IV. Elimination Planning Committee Process Page 15 A diverse group of experts from medical and housing fields, government agencies and community groups worked for 6 months to develop a plan to result in the elimination of childhood lead poisoning in WI.
V. Revised Strategic Work Plan 2006-2010 Page 18 A. Education of Targeted Audiences Page 18 1. Home visits to families with young children and child care providers Educate parents and care providers in their homes about lead hazards so they can act to protect children.
2. General public Educate the general public about childhood lead poisoning to raise awareness of the need and the methods to protect children from lead.
3. Policy makers and legislators Educate legislators and decision makers of the impact of lead poisoning, the cost of not addressing the problem, and what needs to be done to address the problem.
4. Property owners and construction trades contractors Develop opportunities for owners to maintain older housing and for workers who disturb lead paint to work safely. Wisconsin Plan to Eliminate Childhood Lead Poisoning by 2010 Table of Contents
V. Strategic Work Plan (continued) A. Education (continued) 5. Stakeholders Create an active advocacy for lead poisoning prevention and elimination efforts through communication with stakeholders.
B. Correct lead hazards in housing Page 31 1. Primary prevention through increased capacity of lead-safe work practices and increase in lead-safe dwellings Collaboration with local, state, and federal partners is necessary to achieve these primary prevention goals.
2. Strengthen enforcement of lead hazard reduction Strengthen enforcement so owners repair identified lead hazards in dwellings where children have been lead poisoned, including local, state enforcement and referrals for federal prosecution of disclosure rule violations.
C. Targeting high risk populations for blood lead testing Page 43 1. Establish new policies to improve age appropriate blood lead testing Multiple strategies are needed to assure that public funds are efficiently used to identify and evaluate children’s lead exposure.
2. Determine physicians screening practices Identify current practices and perceived barriers between families and health care providers that prevent physicians from providing appropriate blood lead tests for children.
3. Educate health care providers about lead screening Wisconsin needs increased physician awareness of Wisconsin blood lead screening recommendations.
4. Enhance data sharing among partners to assure that children who need blood lead tests receive these tests. Health care providers need convenient access to blood lead test data such as that provided by the Wisconsin immunization registry for immunization records. Wisconsin Plan to Eliminate Childhood Lead Poisoning by 2010 Table of Contents
V. Strategic Work Plan (continued)
D. Funding and Resources Page 49 1. Increase proportion of available funding that local communities use for lead hazard control. For many housing programs, spending priorities are locally determined. If communities know the location of high-risk housing, how readily preventable this disease is, and how housing investments save the tremendous public expense of childhood lead poisoning, they can confidently commit resources for prevention.
2. Increase total funding available for lead hazard control Wisconsin must identify and seek new and expanded resources to control lead hazards, especially in older dwellings occupied by families with young children.
VI. Implementation, Oversight and Evaluation Page 53 WI will convene a diverse committee of experts to work collaboratively to implement and to ensure the success of this plan to Eliminate Lead Poisoning in Wisconsin by 2010.
Appendices Page 55
1. Cost Savings from Preventing Childhood Lead Poisoning in Wisconsin
2. Geographic Information System (GIS) maps of three Wisconsin High Risk Communities: Milwaukee, Sheboygan and Racine
3. Wisconsin Childhood Lead Poisoning Elimination Plan Committee, 2004 – Original committee member list
4. Wisconsin Childhood Lead Poisoning Elimination Plan Implementation and Oversight Committee, 2006 – Member Contact Information List
I. Mission
Wisconsin has adopted the mission to eliminate childhood lead poisoning in Wisconsin by 2010.
Purpose
Lead poisoning of our children is a devastating phenomenon that is largely preventable. A group of concerned and committed citizens convened in 2004 including representatives of state, federal and local agencies plus advocates and family representatives. They grappled with numerous complexities regarding what causes lead poisoning and how best to manage and eliminate the factors that contribute to this problem among children in Wisconsin communities. The fact that Wisconsin exceeds the national average for the proportion of children with lead poisoning is an alarming statistic that only strengthens our resolve as a state to successfully remedy this problem. This plan intends to strategically and concisely lay out approaches that Wisconsin will take to achieve the mission and does include plans for Years 2006-2010. This plan was developed with the knowledge of today and over time will flex whether to adopt other efforts as new opportunities arise, embrace new partners, or to address new knowledge.
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II. Background on the Childhood Lead Poisoning Problem in Wisconsin
During the 1980s, evidence accumulated in the scientific community that lead was damaging to young children at blood lead levels previously thought to be safe. Because of increased information and public pressure, a new federal law (Title X Residential Lead-based Paint Hazard Reduction Act of 1992) was enacted in 1992 that committed the federal government to a much larger role in preventing lead poisoning. The law: a) requires lead safety to be addressed in all HUD housing programs, b) requires the EPA to establish standards for lead safety and to develop standards for a trained workforce, and c) requires private property owners to provide information about potential lead exposure hazards to all potential new tenants or buyers. Conceptually, Title X sets a strategic framework to address lead paint hazards by acknowledging a distinction between the presence of lead and the presence of lead paint hazards and by acknowledging a distinction between permanent and temporary measures to address lead hazards.
In 1991, the federal Centers for Disease Control and Prevention began funding Wisconsin for lead poisoning prevention activities, including blood lead testing, case management, and education. As a result of increased testing, many more Wisconsin children were identified with lead poisoning. It quickly became apparent that local health departments received insufficient resources to follow up and investigate lead hazards in the homes of all lead poisoned children.
The Wisconsin State Legislature received this information and advocacy pressure from parents and non-profit organizations, such as the March of Dimes and the Council on Developmental Disabilities. As a result, the Legislature strengthened state law and provided additional resources to enable the Department of Health and Family Services (DHFS) and local health departments to better respond to the increased need for lead poisoning prevention and follow-up services. For example, a requirement was established to report all children’s blood lead test results. Also, funding available to local health departments for lead poisoning prevention activities was increased from zero dollars to $1,200,000 annually. This funding was decreased to $879,100 annually in the subsequent state budget.
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In 1994, Wisconsin received a HUD grant for six million dollars to correct lead hazards in 511 low- to moderate-income dwellings. Wisconsin was one of 12 grantees to participate in this national evaluation project. This project required exhaustive research and multiple measures of lead dust in homes and blood lead levels of occupant children. Ultimately, Wisconsin demonstrated great success in reducing lead dust levels and protecting children from increases in blood lead levels. Since then, the State of Wisconsin and agencies in Milwaukee, Kenosha and Sheboygan have received competitive grant funds for lead hazard control efforts in private housing.
Since 2000, DHFS has developed the capacity to evaluate and interpret surveillance information such as blood lead test results; local health department case management and lead hazard property investigation reports; insurance coverage; census data, and tax assessor data to determine time trends, risk factors and program needs to strengthen the lead program effectiveness. The available data clearly demonstrate four compelling needs.
First, Wisconsin should accelerate efforts to provide blood lead tests to all children enrolled in Medicaid. Not only is this required under federal law, but if children at high risk for lead poisoning can be identified earlier, then intervention efforts have a greater probability of success.
Second, Wisconsin must recognize that currently available resources are insufficient to evaluate lead hazards in the homes of all lead poisoned children. Current state law and current funding support the local health departments to investigate only the most severely poisoned children. For example, in 2005 there were 2,788 children identified as lead poisoned in Wisconsin. However, under current state law, local health departments were required and funded to investigate the homes of only 493 or 17% of these children - those with the most severe lead poisoning.
Third, to truly prevent the disease we must focus our attention on the condition of housing units that are occupied by families with young children. We must recognize that property owners, property managers, housing industry programs, and parents have the capacity to prevent lead poisoning. We will continue to fail if we use the public health system only to develop housing interventions in response to lead poisoned children.
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Fourth, there are real economic benefits that can be realized by eliminating childhood lead poisoning beyond the fact that all children deserve to grow up lead-free. The annual cost savings to Wisconsin by eliminating lead poisoning is estimated at $14,037,259. This estimate is based on a model developed at the University of Rochester in New York, which factors in the costs of special education, medical treatment, juvenile justice, and lost future income for children who suffer from lead poisoning. (See Appendix 1 for a copy of the cost savings model.) Since the model uses data on the number of lead poisoned children that have been identified and, since testing rates for the highest risk children in Wisconsin are relatively low, this may be a conservative estimate of the cost savings that would result from elimination of the disease.
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III. Extent of the Childhood Lead Poisoning Problem in Wisconsin
Wisconsin has had a blood lead reporting law since 1994 that requires reporting of all blood lead test results. Laboratories report the blood lead test results to the Department of Health and Family Services, Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP). The WCLPPP maintains a database of this blood lead data, which consists of complete data on the children who are tested.
The rate of lead poisoning among Wisconsin children is more than twice the national average. In 2005, 3.4% of Wisconsin children less than 6 years of age who were tested had a blood lead level of 10 µg/dL or more. This compares to a national average of 1.5% in 2004 as reported by the Centers for Disease Control and Prevention (CDC).
The CDC has published national blood lead surveillance data for 42 states and the District of Columbia. According to this data, in 2004 Wisconsin had the seventh highest number of lead poisoned children when compared to other states.
Lead poisoned children have been identified in every Wisconsin county.
Figure 1 represents the statewide distribution of children who were identified with lead poisoning from 1996 – 2005. In 2005 alone, there were 2,788 children identified to have lead
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poisoning in Wisconsin. In that year, over 82,000 children were tested, which is approximately 20% of Wisconsin children less than 6 years of age.
The WCLPPP has utilized the blood lead data to identify 13 high risk communities in Wisconsin that have the largest numbers of lead poisoned children and the highest rates of lead poisoning (See Table 1). These 13 communities account for 84% of all lead poisoned children.
Table 1. Wisconsin Communities at High-Risk for Lead Poisoning; Annual Average 2003 – 2005 Community # Children (ages 0-5 # Children with Proportion of yrs.) Tested Blood Lead Levels Children with Blood >10 mcg/dL Lead Levels >10 mcg/dL Milwaukee (city) 23,271 2,151 9.2% Racine (city) 3,336 167 5.0% Sheboygan Co. 1,560 72 4.6% Beloit (city) 1,103 42 3.8% Oshkosh (city) 686 23 3.4% Manitowoc Co. 1,088 33 3.0% Kenosha Co. 1,812 51 2.8% Rock Co. 1,251 34 2.7% Marathon Co. 1,542 32 2.1% Fond du Lac Co. 1,162 22 1.9% La Crosse Co. 1,227 22 1.8% Brown Co. 3,246 52 1.6% Waukesha Co. 3,966 33 0.8% Total - High-Risk 45,250 2,734 6.0% Communities Statewide Total 82,384 3,238 3.9%
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Risk factors for lead poisoning in Wisconsin Several risk factors are associated with an increased risk for lead poisoning in Wisconsin. These factors include: • Family income • Race/ethnicity • Age of child • Age of house
Family Income. The WCLPPP uses enrollment in the Medicaid Program as an indicator of low family income since this program primarily serves low-income families. The WCLPPP has been sharing data with the Medicaid Program since 1996. Blood lead data is matched with Medicaid enrollment data. From this matched dataset, the WCLPPP determines, of the children tested, who was enrolled in Medicaid and who was not enrolled. In 2005, 60% of children tested were enrolled in Medicaid and 82% of children who were diagnosed with lead poisoning were
Prevalence of Lead Poisoning in Wisconsin Among Children Ages 0 through 5 Years 2000 Through 2005 12 Children In Medicaid or WIC Children In Neither Medicaid nor WIC
10
8
6 Percent Poisoned
4
2
0 2000 2001 2002 2003 2004 2005
Figure 2. Prevalence of lead poisoning among children ages 0-5 years by Medicaid enrollment status, 2000 - 2005
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enrolled in Medicaid. Figure 2 presents data on the rate of lead poisoning among children who were enrolled in Medicaid to those who were not enrolled. Since 1996, children on Medicaid have had consistently higher rates of lead poisoning. The risk to those children continues to be 3 times higher than to those who are not enrolled.
Race/Ethnicity. Minority populations in Wisconsin share a greater burden of the lead poisoning problem. Figure 3 (below) presents data on the percent of children tested who were diagnosed with lead poisoning by racial and ethnic group. Lead poisoning rates are highest among African American children, followed by Hispanic children and Asian children. There is a high rate of poverty among minority populations in Wisconsin, especially among African American and Asian populations. Poverty rates are most likely linked to the high rates of lead poisoning that are found in these populations.
Prevalence of Blood Lead Poisoning Among Wisconsin Children Less Than Six Years Old by Race and Ethnicity 1996 through 2005
45 African American
Asian
0 40 Hispanic
35 Native American Non-Hispanic White 30
25
mcg/dL 20
15
10
Percent With Blod Lead Levels Greater Than or Equal To 1 To Equal or Than Greater Levels Lead Blod With Percent 5
0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year
Figure 3. Prevalence of lead poisoning among children ages 0-5 years by race and ethnicity, 1996 – 2005.
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Lead poisoning rates are the lowest among non-Hispanic white children and Native American children.
Age of Child. Blood lead levels tend to be highest between 18-36 months of age, when children are engaging in frequent hand-to-mouth activity and are becoming more mobile, which provides them greater access to lead hazards that may exist within their environment. Figure 4 (below) presents data on the rate of lead poisoning in Wisconsin by a child’s age at the time they were tested. The highest rate of lead poisoning is seen among 2 year olds, with only a slightly lower rate among 3-year-olds.
First Diagnosis of Lead Poisoning v. Age of Child Wisconsin 2005 4.0
3.5 3.5
3.1 3.0
2.5 an or Equal to 10 mcg/dL to 10 Equal an or 2.0 1.7 1.7
1.5 1.2
1.0 0.8
Blood Lead Levels Greater th 0.5 Percent of Tested Children WhoWere FirstDiagnosed with
0.0 LTOne One Two Three Four Five Age at First Diagnosis
Figure 4. Incidence of lead poisoning by age of child, 2005.
Current screening policy in Wisconsin includes a recommendation to test high-risk children at 1 year of age so that, if lead exposure has occurred, it can be diagnosed early and interventions can take place to reduce the blood lead level. It is also very important, however, that children be tested again at 2 years of age or later when their risk for lead poisoning may be greater. A normal blood lead test at age 1 does not mean the child is not at risk for lead poisoning later on.
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Figure 5 presents data for 2000 through 2005 on the incidence of lead poisoning among Wisconsin children by their age in months at the time of the diagnosis and the age at which children were tested. These data demonstrate that the incidence of lead poisoning peaks at approximately 23 months of age, while the largest number of children are tested at 12 months of age. There is a dramatic decrease in the number of children tested after 12 months of age, which may result in children’s lead poisoning remaining undetected because of the lack of testing at the highest risk ages.
Percent of Previously Unpoisoned Children First BLL >= 10 mcg/dL by Age in Months at The Time of Test Statewide 2000 through 2005 120000 8.0 peak occurs at appx. 23 months 7.0 100000
6.0
80000 5.0 <== percent with BLL >= 10 mcg/dL
60000 4.0 Tested
3.0 40000
2.0 mcg/dL >= 10 BLL First With Percent Number Previously Unpoisoned Children Children Unpoisoned Previously Number
20000 Number Previously Unpoisoned Children Tested 1.0
0 0.0 1
0 12 13 24 25 36 37 48 49 60 61 Age (months)
Figure 5. Number of Wisconsin children tested by age in months in 2000-2005 and percent of previously unpoisoned children first diagnosed with blood lead poisoning by age.
Age of Housing. National data have shown that children who live in old housing, where lead paint is more prevalent, are at greater risk for lead poisoning than children who live in newer housing. This same relationship is evident in Wisconsin, where 90% of lead poisoning children have been shown to live in homes that were built before 1950. The maps in Appendix 2
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demonstrate this relationship of lead poisoning to old housing in several Wisconsin communities (Milwaukee, Racine and Sheboygan).
By combining several of the risk factors that have been discussed, the impact of housing age on the rate of lead poisoning is further demonstrated. Figure 6 (below) presents data on 3 subgroups of children who were tested during 1998 – 2002. These subgroups are African American children, children enrolled in Medicaid, and all children less than 6 years of age. As the data demonstrate, the risk for children increases significantly if they reside in housing built prior to For example nearly 32% of African American children who were tested and live in housing built prior to 1950 were found to have lead poisoning as compared to 6.7% of African American children who live in housing built after 1950.
Wisconsin Children One Through Five Years Old First Diagnosed with Lead Poisoning During 2000 - 2005 Age of Primary Residence at Time of First Diagnosis v. Race and Income Status 30
African-American Children
25.0 Low-Income Children 25
All Children
20
16.9
14.8 15
During 2005, 3.4% of all 1 through 5 yr old 10 Wisconsin children tested were found to have blood lead levels Equal to 10 Microgramsper Deciliter above 10ug/dL
5 4.6 3.3
Percent of Children With BloodLevels Lead Greater Than or 2.7
0 Pre_1950 Post_1950 Age of Residence (year built)
Figure 6. Prevalence of lead poisoning among children ages 0-5 years by age of housing, race and income status, 2000 – 2005.
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High-Risk Housing in Wisconsin Based on national housing survey data, it is estimated that more than 643,000 housing units in Wisconsin have some lead hazards, of which 109,000 units have lead hazards and are occupied by children less than 6 years old. In light of this data, lead hazards will need to be controlled in a approximately 128,600 dwellings per year in order to reach the goal of eliminating childhood lead poisoning by 2010 through housing-based interventions. In contrast, Wisconsin communities renovate approximately 10,000 dwellings per year with federal funds to meet federal lead safe standards. These renovations are performed through a combination of lead hazard controls conducted in response to children with elevated blood lead levels (i.e., secondary prevention) and those performed in high-risk housing in the absence of a lead poisoned child (i.e., primary prevention). Another 5,000 old dwellings are demolished each year.
In addition to age of housing, the condition of housing is an important factor that relates to the lead poisoning risk for a young child. There is generally more lead paint found on exterior surfaces of a house than on interior surfaces. For the vast majority of Wisconsin children with elevated blood levels, local health department staff is able to identify lead-based paint hazards in the child’s primary residence. Data on housing investigations for lead poisoned children in Wisconsin demonstrate that the most common locations of lead-based paint hazards are windows, porches, and exterior surfaces. The primary cause of the hazards has consistently been found to be due to deterioration of painted surfaces. Twenty percent of children in Wisconsin with elevated blood lead levels live in homes where renovation activity has taken place. In 1997-1998, an EPA-funded survey of 3,654 Wisconsin families found renovation activity was associated with a 30% increased risk of lead poisoning.
Progress To Eliminate Childhood Lead Poisoning in Wisconsin Tremendous progress has been realized over the last several years in reducing the burden of lead poisoning in Wisconsin. See Figure 7 (below). In 1996, for example, more than 10,000 children were identified with lead poisoning. In 2005, there were 2,788 children identified with lead poisoning, while the number of children tested increased significantly over this time period.
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Number of Wisconsin Children Less Than Six years with Blood Lead Levels of 10 mcg/dL or More
12000
10575
10000 9372
7859 8000
6371
6000 5289 5103 4425 Number of Children 4000 3653 3278 2782
2000
0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year
Figure 7. Number of lead poisoned children ages 0-5 years; 1996 – 2005.
Based on the level of progress that has been realized since 1996, it’s possible to project the number of lead poisoned children that may be identified in 2010, assuming the current blood lead testing rates and level of momentum in reducing the burden of lead poisoning are maintained. According to this projection, there will be 1,300 lead poisoned children identified in 2010. See Figure 8 (below).
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Number of Wisconsin Children Less Than Six Years Who Have Blood Lead Levels of 10 Micrograms per Deciliter or Greater
12000 Number Poisoned: 1996-2005 Projected Curve at Current Momentum 11000 10575 Projected Curve to Eliminate Lead Poisoning by 2010
10000 9372
9000
7859 8000
7000 6371
6000 5289 5103 5000
Number ofChildren Number 4425
4000 3653 3278 2782 3000
2000
--1,300 1000 children
0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year
Figure 8. Number of lead poisoned children ages 0-5 years; 1996 – 2005 and projected to 2010. One factor to consider, however, is that the current rate of testing falls far short of reaching all of the high-risk children. For example, children enrolled in Medicaid are at high risk, yet less than 50% of these children are tested at ages one and two. If blood lead testing rates improve, the numbers of lead poisoned children identified will most likely increase, at least in the short-term, yet this would indicate progress in our efforts to target high risk children. In 2002, the Centers for Disease Control and Prevention estimated there were 12,400 children with lead poisoning in Wisconsin. Since less than 50% of the children enrolled in Medicaid are tested, it is possible that we are identifying less than 50% of the children who are lead poisoned.
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IV. Process of the Wisconsin Childhood Lead Poisoning Elimination Plan Committee
The Wisconsin Department of Health and Family Services (DHFS) appointed members to a Wisconsin Childhood Lead Poisoning Elimination Plan Committee, to develop a plan to eliminate childhood lead poisoning in Wisconsin by 2010. Kenneth Munson, DHFS Deputy Secretary, chaired the committee from January through June 2004. (See Appendix 3 for the members of this committee).
The Committee included 38 members with broad and diverse membership including public health, housing and policy professionals, elected officials, individuals from the private sector and community-based organizations, the Wisconsin Medicaid Program, U.S. Environmental Protection Agency (EPA) and the U.S. Department of Housing and Urban Development (HUD). Committee members included parents of lead poisoned children, advocates from target communities and minority populations with high prevalence of lead poisoning, rental property owners, real estate groups, the State Department of Insurance Commissioner and the Department of Justice. Included in the list were individuals previously involved in childhood lead poisoning prevention efforts, for example, members of the screening advisory committee. Also included were individuals who have a pivotal role in this arena in their own community. One consideration was the individual’s level of responsibility within their own organization, such as those in a position to make decisions or affect policy. Kris Freundlich of the DHFS Office of Strategic Finance provided facilitation and strategic planning support.
During the initial meeting of the committee, staff of the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) provided a broad overview of the status of the lead poisoning problem in the State of Wisconsin and the history of Wisconsin’s response to the problem. Amy Murphy of the City of Milwaukee Childhood Lead Poisoning Prevention Program shared their progress from a secondary intervention program to a primary prevention approach. Their strategic plan uses a combination “carrot and stick” enforcement/incentive system for working with rental property owners, relies on community-based organizations to maintain the city council’s political will in favor of lead poisoning prevention, and employs research-based
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methods of lead hazard reduction. Staff and committee members discussed and developed consensus concerning committee member roles and responsibilities.
Following the presentations about the status of the problem in Wisconsin and Milwaukee, the committee members responded in a large group discussion with questions and ideas and strategies for preventing the disease. Between meetings, members provided feedback on the list of strategies compiled at the first meeting. These items became the springboard for the work of the next meeting--ranking the strategies. To reach group consensus on the ranking of strategies, members discussed the strategies and voted for those that they thought would be the most effective and feasible in eliminating lead poisoning.
For the next meeting, WCLPPP staff grouped the strategies into 4 broad categories by subject matter: blood lead testing of high-risk populations; home visitation/ education; funding & resources; and legislation/policy. Committee members were assigned to one of the four groups depending on their expertise. In small group discussions, members sifted through the strategies to determine priority and feasibility and to identify what it will take to accomplish the strategies.
The details of discussion were captured and further refined by WCLPPP staff following the meeting. The strategy categories shifted somewhat, resulting in the final 4 broad areas: blood lead testing of high-risk populations; education; funding/resources; and correcting lead hazards in housing. Again in small group discussions, committee members expanded details of the major strategies to identify critical action steps and performance measures for the first year of the plan. Staff sought members’ feedback between meetings, asked for review for any critical missing information or considerations, judgements about feasibility, and other reactions.
At the May meeting, committee members discussed the next phase - implementation of the elimination plan. The discussion centered on three areas: 1. An implementation and evaluation oversight committee and what its function would be, who would serve on it, and how it would operate; 2. Implementation subcommittees with similar points of discussion; and 3. The pursuit of funding--a major issue or barrier to the work at hand.
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The discussion at the final committee meeting in June focused on issues surrounding actions to begin immediate implementation of the plan and establishing a Childhood Lead Poisoning Elimination Implementation and Oversight Committee. [See Section VI. Oversight and Evaluation for details.]
The implementation phase began in July, 2004, with subcommittees holding meetings and assigning and carrying out tasks. The first reports of those subcommittees were given at the first meeting of the Implementation and Oversight Committee (IOC) in September 2004. Meetings of the IOC continued three times per year with planning ongoing between meetings to strategically move subcommittee actions forward. (See Appendix 4 for the current list of members of the IOC.)
The workplan in this document contains the revisions for Years 2006-2010 that were submitted by the Department of Health and Family Services in a grant application to the Centers for Disease Control and Prevention in February, 2006. Wisconsin was successful in receiving stable funding to accomplish the goals set forth in this document.
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V. Revised Strategic Workplan (2006-2010) A. Education of Targeted Audiences
2010 GOAL: Target audiences, such as parents, the general public, policymakers, property owners, contractors, building inspectors, realtors, and key stakeholders, will have sufficient knowledge and motivation to take the actions necessary to eliminate lead poisoning in WI by 2010.
Strategy 1: Utilize home-based strategies to educate parents and caregivers about lead poisoning risks, prevention and screening recommendations so they can take the right protective and corrective actions.
Objective 1: By 6/30/07, the In-home Lead Poisoning Prevention Education program that provides lead poisoning prevention education for families and assesses for potential lead-based paint hazards during home visits will be adopted by other home visitor programs that see families with young children at risk for lead poisoning in 2 targeted high risk communities. (Amy, Reghan, Jodi) Activities: 1. During FY06, continue the PNCC home visit program with clients living in pre-1950 housing in Racine and Sheboygan. In Racine, if lead hazards persist after cleaning, an inspection is conducted and work orders are written to fix the hazards, regardless of a child being present in the dwelling. Racine will evaluate their PNCC initiative to determine is their education has any impact on blood lead testing, i.e., whether these children were tested and whether any elevation occurred. Sheboygan has a HUD LHR grant and will enroll properties with lead hazards into this program to remove the hazards. 2. In July - November 2006, work with the LHD nursing staff to identify other home visitor programs that reach families with young children (non-PNCC or newborn home visitation) that exist in two high-risk communities, City of Racine and Marathon County (City of Wausau). 3. In November 2006, through education, create heightened awareness in home visitors for conducting lead poisoning prevention education with their clients living in pre-1950 housing.
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4. In December 2006, provide a training event where the step-by-step protocol for teaching lead poisoning prevention techniques is taught to the home visitors. 5. By June 2007, evaluate progress made in collaborating with local home visitor programs to continue or expand efforts, overcome barriers, or pursue other agencies for potential collaboration.
Objective 2. By 06/30/07, families will be educated about lead poisoning and ways to prevent it from other educators (day care providers, HeadStart teachers, etc.), possibly including referral to local health department environmental staff to conduct home assessments. Activities: 1. During Fall 2006, create key messages for parents and caregivers, which can be used by caregivers for education. 2. By January 2007, Day Care Improvement project staff will create website links and website content changes to increase visibility of lead poisoning prevention education. 3. During FY06, provide newsletter articles about lead poisoning prevention for day care Resource and Referral Networks. 4. By March 2007, meet with director of HeadStart Association to identify and expand ways to collaborate, e.g., newsletters, staff training, parent communication, etc. 5. During FY 2006, contact home school network to identify ways to collaborate to get information to parents, such as using lead poisoning awareness curriculum.
Strategy 1 Performance Measures: 1. Increased number of agencies in 2 high-risk communities that conduct lead poisoning prevention education and assessment in the home with their clients, increased number of referrals for further inspection, increased number of families receiving in-home education. 2. Number of new programs and venues that provide education and information to parents about lead poisoning prevention; number of referrals for further inspection.
Strategy 1 - Objectives for Year 2-5: Year 2 (2007-2008)
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Objective 1: By 6/30/08, the In-Home Lead Poisoning Prevention Education Program that includes assessing lead-based paint hazards during home visits will be adopted by other home visitors in 2 additional targeted high risk communities (Sheboygan and Milwaukee). Objective 2: By 6/30/08, stay at home parents will be educated about lead poisoning issues by WCLPPP’s education of these families through web site groups, community meetings, and other organizations that serve this group. Year 3 (2008-2009) Objective 1: By 6/30/09, a state home visit protocol will incorporate prevention of lead poisoning, asthma and injury will be developed. Objective 2: By 6/30/09, education materials for families with children going to day care providers, HeadStart, and stay at home families will be more effective through their collaborative creation of education materials for their peers. Year 4 (2009-2010) Objective 1: By 6/30/10, a state home visit protocol incorporating prevention of lead poisoning, asthma and injury will be implemented in 2 high-risk communities (Milw/Racine). Objective 2: By 6/30/10, families of that have children in day care, HeadStart, or are with stay at home parents will be more effectively taught about lead poisoning issues through the teaching of the materials creation by their peers. Year 5 (2010-2011) Objective 1: By 6/30/11, a state home visit protocol incorporating prevention of lead poisoning, asthma and injury will be implemented in 2 additional high-risk communities (Sheboygan/Wausau). Objective 2: By 6/30/11, families with stay at home parents or have children in day care, HeadStart will increase knowledge about lead poisoning to community by passing along the information learned from materials developed by peers.
Strategy 2: Educate the general public about lead poisoning risks and prevention, screening and treatment to facilitate action needed to accomplish elimination.
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Objective 1. By 06/30/07, the general public will have increased awareness of childhood lead poisoning and the need for prevention in Wisconsin through media events. [Sara, Reghan, Jodi, Amy, ALCU staff] Activities: 1. From July to September 2006, work with citizen advocacy agencies and LHDs to identify families with children who are lead poisoned or those who are involved in preventing poisoning to develop their interest by participating in an event in Madison for Childhood Lead Poisoning Prevention Week. Locally arrange for busses to Madison. 2. During July to October 2006, organize speakers, media, materials for CLPP Week event in the Capitol Rotunda. 3. During July to October, coordinate a glove donation project (a pair for every child lead poisoned in Wisconsin), as done in Rhode Island, to correspond with the CLPP Week event. 4. During FY06, develop relationships with newspaper/television journalists to promote health/housing series in different markets in Wisconsin, covering local primary prevention efforts, e.g., Wausau, Sheboygan and Racine.
Objective 2. By 06/30/07, a plan to disseminate messages about lead poisoning as an environmental justice issue will be developed. [Reghan, Sara, Meredith] Activities: 1. By 09/30/06, meet with the newly hired Minority Health Officer to identify ways to collaborate. 2. By 12/31/06, in partnership with the Minority Health Officer, develop key messages on the health disparities issue in childhood lead poisoning prevalence in Wisconsin. 3. By 03/31/07, research resource materials for addressing racial disparities. 4. By 06/30/07, complete an action plan to promote lead poisoning as an environmental justice issue.
Objective 3. By 06/30/07, the Lead-Safe Wisconsin website will be widely consulted for information on the lead poisoning problem and progress being made toward elimination. (Alliance, Sara, Reghan) Activities:
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1. By 07/31/06, update the web site with the number of lead tests, poisonings, and prevalence by county, in 2005. 2. During FY06, develop a systematic method for including website URL with all communication to media, stakeholders, etc., for fullest knowledge and utility of this resource. 3. During FY06, update the web site with time-sensitive information, such as lead-related product recalls or other known sources of lead poisoning. 4. During FY06, utilize the web site as a vehicle to inform stakeholders about the progress to eliminate lead poisoning. 5. During FY06, maintain the web site by deleting broken links, updating web addresses, and removing dated information.
Strategy 2 Performance Measures: 1. Media coverage of events/efforts toward elimination; number of attendees at rally event in October; number of LHDs participating in some part of the rally for CLPP Week; number of gloves donated on behalf of children who have been lead poisoned. 2. The key messages and the plan for minority health focus of outreach/education. 3. Increase in the number of hits to the website pages on progress of the Elimination Plan.
Strategy 2 - Objectives for Years 2 – 5: Year 2 (2007-2008) Objective 1: By 06/30/08, the general public will have increased awareness of progress being made to eliminate childhood lead poisoning in Wisconsin. Objective 2. By 06/30/08, the public and the public health community will be educated about the disparity of childhood lead poisoning, which impacts children of low income families, predominantly African American children, through a partnership with the Wisconsin Minority Health Program and community-based organizations. Objective 3: By 06/30/08, the Lead-Safe Wisconsin website will develop another 5 web pages with information that will update the public on elimination of lead poisoning and other educational topics. Year 3 (2008-2009)
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Objective 1: By 06/30/09, the general public will rally at the annual media event to increase awareness of peers. Objective 2: By 06/30/09, the public and the public health community will develop education tools to inform peers of the disparities of childhood lead poisoning. Objective 3: By 06/30/09, the Lead-Safe Wisconsin website will improve the content and layout by undergoing an evaluation of its effectiveness and revamp. Year 4 (2009-2010) Objective 1: By 06/30/10, the general public will increase commitment by assisting in the coordination of the annual media event. Objective 2: By 06/30/10, the public and the public health community will develop education tools to inform peers of the disparities of childhood lead poisoning. Objective 3: By 06/30/10, the Lead-Safe Wisconsin website will increase its presence by linking with 10% additional web sites. Year 5 (2010-2011) Objective 1: By 06/30/11, the general public will increase commitment by leading the coordination of the annual media event. Objective 2: By 06/30/11, the public and the public health work force will increase awareness in their jurisdiction by applying the developed tools to educate their community. Objective 3: By 06/30/11, the Lead-Safe Wisconsin website will increase the length of the public’s visits to the web site by 10%, through a survey and revamping of the web site.
Strategy 3: Educate policymakers/legislators about lead poisoning risks and prevention, its impact on the health and well-being and prosperity of WI citizens in order to garner support for needed policies and resources.
Objective 1. By 06/30/07, legislators and community leaders will have increased knowledge of the childhood lead poisoning prevention problem in Wisconsin. Activities:
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1. By September 2006, prepare GIS maps, using local housing data and lead poisoning prevalence, according to legislative district (senate and assembly) and include maps of any large communities in region. 2. By September 2006, develop a fact sheet with key messages and information on numbers of children poisoned in district over last decade. 3. By September 2006, provide information on locally controlled CDBG funds and state budget funds for preventing lead poisoning. 4. During Fall 2006, distribute maps and fact sheets to each legislator individually. Enlist help of legislators on Elimination Plan committee to speak with their colleagues about the maps and the prevalence of poisoning in Wisconsin. 5. During Fall 2006, have advocates invite their legislators to attend the rally at the Capitol during CLPP Week.
Objective 2. By 06/30/07, citizens from high-risk communities will communicate with their state legislators and policy makers about the impact of childhood lead poisoning on families. (Alliance, Reghan) Activities: 1. By October 2005, planning committee members will meet with community-based organizations that are active in advocacy efforts at the local level to develop strategic plans to inform legislators that prevention is cost effective and to advance legislative interest in eliminating lead poisoning. 2. During 2005-6, share these legislative district maps and fact sheets with community leaders and advocates in targeted high-risk communities. 3. By October 2006, develop talking points citizen advocates can use when communicating with their legislators. 4. During FY06, meet with members of the Public School community to identify ways to collaborate in eliminating lead poisoning since it has such serious effects on learning.
Strategy 3 Performance Measures:
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1. Senate and Assembly district maps; fact sheet; level of funding information; feedback received from legislators or others after having received this information, such as requests for more information, meetings, etc.; number of legislators in attendance at rally. 2. Increase in collaboration/communication with advocates; evidence that advocates have communicated with legislators/policymakers such as legislative efforts enacted.
Strategy 3 – Objectives for Years 2 – 5 Year 2 (2007 – 2008) Objective 1: By 6/30/08, legislators and community leaders will have the ability to educate their peers through tools that are developed by WCLPPP. Objective 2: By 6/30/08, citizens from high-risk communities will increase presence through organized group work. Year 3 (2008 – 2009) Objective 1: By 6/30/09, legislators and community leaders will the have greater knowledge of lead poisoning issues important to their constituents by an organized community letter writing campaign. Objective 2: By 6/30/09, citizens from high-risk communities will increase presence by forming an advocacy group that will have a more organized structure. Year 4 (2009 – 2010) Objective 1: By 6/30/10, legislators and community leaders will cast informed votes on bills that effect lead poisoning prevention through contact from constituents and WCLPPP. Objective 2: By 6/30/10, the high-risk advocacy organization will increase its presence by getting involved in committees that will have an effect on lead poisoning issues, which includes the Implementation and Oversight Committee. Year 5 (2010 – 2011) Objective 1: By 6/30/11, legislators and community leaders will be educated on the issues of lead poisoning, potential effect of bills, and the size of the issue in their communities through periodic mailings from constituents that includes this information. Objective 2: By 6/30/11, the high-risk advocacy organization will increase its presence by its leadership in the coordination of the annual lead poisoning prevention event, communication with legislators, and other group approach activities.
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Strategy 4: Educate Housing professionals (e.g., contractors, housing inspectors, rental property owners, realtors, weatherization and housing agency staff, etc.) about regulations affecting their professions and protective practices that should be undertaken.
Objective 1. By 06/30/07, housing inspectors’ knowledge of lead hazards and methods of correction will be increased. (Reghan, Alliance) 1. Building inspectors o During FY06, the Elimination Plan Education Subcommittee and the Correcting Lead Hazards in Housing Subcommittees will identify and develop a partnership with the agency that coordinates the annual training of building inspectors to include assessment of lead hazards as a routine inspection item and if identified, addressed as a code violation. o During FY06, meet with the Eau Claire Health Department to discuss the model inspection program and develop a plan to market it to other health departments. 2. Home Inspectors o During FY06, present at the bi-annual Wisconsin Association of Home Inspectors (WAHI) conference to identify barriers and solutions to commercial housing inspectors identifying lead hazards in routine home inspections. o During FY06, post items in WAHI monthly newsletter about lead poisoning prevention, disclosure rule, legislative actions affecting homeowners. 3. Section 8 Inspectors o During FY06, present at the Fall and Spring meetings of the Wisconsin Association of Housing Authorities (WAHA) to request that Section 8 housing be inspected by certified lead risk assessors and that lead paint hazards be a top priority during inspections. o During FY06, work with HUD to get key messages about lead into envelopes with subsidy checks for Section 8 property owners.
Objective 2. By 06/30/07, rental property owners will have increased knowledge of lead-safe work practices, disclosure rule and legislative actions affecting rental property. (Reghan) Activities:
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1. During FY06, post items on lead poisoning prevention, the Disclosure rule, and available trainings in monthly newsletters for Apartment Owners Associations. 2. During FY06, as legislative actions, such as a window replacement bill, that affect property owners arise, notify the apartment associations’ presidents and request that they put the notice out on their listserves and request action from their members. 3. During FY06, property owners notified of lead hazards in their property through the PNCC and Newborn home visitation programs will be strongly encouraged by LHD staff to apply for lead hazard reduction funding. 4. During FY06, in Rock County 90 property owners will be trained in lead poisoning prevention and 4 will be trained in LSWP as part of their contract with the State. 5. During FY05, in conjunction with the ALCU and the NPCA, LHD lead program staff in 4 communities will host a lead-safe work practices training for area contractors, property owners and property maintenance personnel.
Objective 3. By 06/30/07, day care inspectors will work in collaboration with local partners to address lead hazards in day care settings. Activities: 1. During FY06, respond to requests from day care inspectors for lead check swabs and literature for in-home day care providers in pre-1950 housing. 2. During FY06, post items in Day Care Regional monthly newsletters about lead poisoning prevention, disclosure rule, legislative actions affecting homeowners. 3. By December 2006, pilot an MOU between the local health department (City of Racine) and DHFS day care inspector to share information about homes with lead hazards and possible sources of funding for lead hazard reduction. 4. In Fall 2007, if successful, disseminate MOU model at the regional meetings of day care inspectors.
Strategy 4 Performance Measures: 1. Number of seminars presented to building, home and Section 8 inspectors. 2. Number of rental property owners who advocate for legislative actions.
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3. Number of requests for materials and assistance with day care inspections; successful process established for developing an MOU; interest in MOUs generated at regional meetings.
Strategy 4 – Objectives for Years 2 – 5 Year 2 (2007 – 2008) Objective 1: By 06/30/08, increase awareness of weatherization agency staff about the need for using lead-safe work practices on rehabilitation projects. Objective 2. By 06/30/08, increase landlord and property maintenance personnel knowledge of lead-safe work practices for property renovation and maintenance. Objective 3: By 06/30/08, increase knowledge of housing inspectors (building inspectors, day care inspectors, home inspectors, about lead hazards: (1) where hazards are most commonly found in homes in WI, (2) what conditions create them, and (3) why identifying and remedying lead hazards should be part of their regular practice – i.e., the devastating effects on young children and our society. Year 3 (2008 – 2009) Objective 1: By 06/30/09, increase awareness of weatherization agency staff about the need for using lead-safe work practices on rehabilitation projects. Objective 2. By 06/30/09, increase landlord and property maintenance personnel knowledge of lead-safe work practices for property renovation and maintenance. Objective 3: By 06/30/09, increase knowledge of housing inspectors (building inspectors, day care inspectors, home inspectors, about lead hazards: (1) where hazards are most commonly found in homes in WI, (2) what conditions create them, and (3) why identifying and remedying lead hazards should be part of their regular practice – i.e., the devastating effects on young children and our society. Year 4 (2009 – 2010) Objective 1: By 06/30/10, increase awareness of weatherization agency staff about the need for using lead-safe work practices on rehabilitation projects. Objective 2. By 06/30/10, increase landlord and property maintenance personnel knowledge of lead-safe work practices for property renovation and maintenance. Objective 3: By 06/30/10, increase knowledge of housing inspectors (building inspectors, day care inspectors, home inspectors, about lead hazards: (1) where hazards are most commonly
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found in homes in WI, (2) what conditions create them, and (3) why identifying and remedying lead hazards should be part of their regular practice – i.e., the devastating effects on young children and our society. Year 5 (2010 – 2011) Objective 1: By 06/30/11, increase awareness of weatherization agency staff about the need for using lead-safe work practices on rehabilitation projects. Objective 2. By 06/30/11, increase landlord and property maintenance personnel knowledge of lead-safe work practices for property renovation and maintenance. Objective 3: By 06/30/11, increase knowledge of housing inspectors (building inspectors, day care inspectors, home inspectors, about lead hazards: (1) where hazards are most commonly found in homes in WI, (2) what conditions create them, and (3) why identifying and remedying lead hazards should be part of their regular practice – i.e., the devastating effects on young children and our society.
Strategy 5: Educate and inform stakeholders, such as LHDs, Implementation and Oversight Committee and subcommittee members, DHFS staff, housing agencies, community-based organizations, weatherization agencies, health care providers (HMO, MA, WIC), of the progress of the Elimination Plan.
Objective: By 06/30/07, stakeholders will be informed about activities critical to the Elimination Plan and areas for collaborative action. (Alliance, Sara, Reghan) Activities: 1. By July 2006, create a listserve with stakeholders for whom we currently have email addresses. 2. During FY06, send out a periodic newsletter with subcommittee progress and accomplishments, and local initiatives. 3. During FY06, organize the tri-annual Implementation and Oversight Committee (IOC) meetings by coordinating logistical details (location, food, AV, materials), communicating with members and other guests, following up after meetings (mail materials to those unable to attend), and maintaining current contact lists.
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4. During FY06, work with the stakeholders to coordinate public awareness of the addition of a resource on the WCLPPP web site, which lists properties that are found to have lead poisonings.
Strategy 5 Performance Measures: Log of listserve emails calling for action and evidence of response from stakeholders; effective IOC and subcommittee meetings; number of hits on the website page that lists properties with hazards that have not been fixed by the property owner after more than a year.
Strategy 5 – Objectives for Years 2 – 5 Year 2 (2007 – 2008) Objective 1: By 6/30/08, stakeholders will increase their involvement in the prevention of lead poisoning by participating in events that the Education Subcommittee sends as regular notices. Year 3 (2008 – 2009) Strategy 5 Objective 1: By 6/30/09, stakeholders will increase their commitment to the prevention of lead poisoning by the 10% increase in stakeholder membership on the Education Subcommittee. Year 4 (2009 – 2010) Objective 1: By 6/30/10, stakeholders will increase their commitment to the prevention of lead poisoning by another 10% increase in stakeholder membership on the Education Subcommittee. Year 5 (2010 – 2011) Objective 1: By 6/30/11, stakeholders will increase their commitment to the prevention of lead poisoning by another 10% increase in stakeholder membership on the Education Subcommittee.
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B. Correct Lead Hazards in Housing 2010 Goal: Identify and control lead hazards in high-risk housing where children under the age of six reside or spend a significant amount of time.
Strategy 1: Achieve primary prevention by: 1) increasing capacity for doing lead-safe work, and 2) increasing the number of lead-safe units where children spend significant amounts of time, through collaboration with local, state and federal partners.
Why is this important? Current data demonstrate that residence in older dwellings and rental properties is associated with increased probability of lead poisoning. As Wisconsin identifies major risk factors in housing, communities can more effectively target limited resources for prevention activities. The majority of children with lead poisoning live in homes built before 1950. Only when these lead hazards are controlled, can the disease be prevented.
Objective 1.1: By 6/30/07, use data that identifies risk factors as tools to direct limited resources to dwellings most likely to poison children. (Jeff, Joe) Activities: 1) By 6/30/06, DHFS will complete statistical analysis of Wisconsin dwellings to evaluate and quantify risk factors associated with increases in blood lead test values. 2) By 12/31/06, DHFS will disseminate the analysis results to housing agencies and local health departments. These risk profiles will allow for identification of housing most likely to poison children so communities know where to focus their limited resources. 3) By 6/30/07, local health department and local housing staff will use the analysis for targeting HUD funding and CDBG funding. Performance Measures: Identified and quantified relative contribution of lead poisoning risk factors. Dwellings most in need of corrective action are targeted and remediated.
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Objective 1.2: By 6/30/07, increase the capacity of local housing agencies and local health departments to evaluate and remediate properties where child are expected to spend significant amounts of time. (Amy, Reghan, Jodi, Joe, ALCU) Activities: 1) By 7/31/06, WCLPPP staff will develop a Performance Based Contracting Template Objective for local health departments to select during negotiations for the CY2006 contract year. The template objective would focus on collaboration between local health departments and local housing agencies to develop or adapt a local inspection program that requires (a) keeping paint intact in older homes and (b) using lead safe work practices during home maintenance. 2) By 7/31/06, through the Performance-Based Contracting process, DHFS will provide financial support to local agencies to strengthen the local housing construction permit process as a vehicle to promote lead safe standards, both for training workers and for improving housing conditions. For example, municipalities could require and provide lead safe worker training for contractors who obtain permits to do work that would disturb painted surfaces in pre-1950 dwellings. 3) By 6/30/07, the Correcting Lead Hazards in Housing subcommittee will organize a “Health and Housing Summit” and convene opportunities for building collaborations between local health departments and local housing departments in three high risk communities. 4) By 6/30/07, DHFS and local health departments will develop partnerships with other programs that inspect homes including: (a) local building inspection programs, (b) housing authorities that inspect dwellings enrolled in the Section 8 tenant based rental assistance program, and (c) staff responsible for evaluating child care facilities or homeless shelters. 5) By 6/30/07, DHFS will evaluate and improve training that improves the capacity of staff who inspect properties for programs such as federal Section 8 or state child care licensing to recognize lead based paint hazards that need corrective action. 6) During FY06, addresses of children with EBLLs will be provided quarterly to the HUD Milwaukee office for statewide dissemination to housing authorities of federally subsidized housing, as required under HUD 1012 Lead-Safe Housing Rule 24 CFR 35.1225. Performance Measures: Development of a Performance Based Contracting template objective for collaboration between local health and local housing. Specifications developed for a “Health
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and Housing Summit.” Increase number inspections of child-occupied facilities. List of EBLL properties submitted to the HUD Milwaukee office.
Objective 1.3: By 6/30/07, increase affordable lead abatement insurance premiums for contractors to increase the capacity to evaluate and remediate properties where child are expected to spend significant amounts of time. (Amy, ALCU) 1) By 7/31/06, contact certified lead abatement contractors to collect info about range of rates for insurance premium costs to be insured for lead-based paint abatement. 2) By 8/30/06, compile a list of insurance companies that carry special insurance for lead abatement activities. 3) By 6/30/07, bring together players in the insurance issue for lead-based paint abatement, to problem-solve the discrepancy between high insurance rates for general contractors and those for more highly trained professionals. 4) By 6/30/07, educate insurance companies about lead abatement practices versus remodeling and renovation and the need to reduce premiums for certified lead abatement contractors. Performance Measures: A 5% increase of insurance companies offering policies at lower rates. Increase in the number of certified lead abatement companies.
Objective 1.4: By 6/30/07,an increase in the number of home visitor programs offering lead education will increase the capacity to evaluate and remediate properties where child are expected to spend significant amounts of time. (Amy, Reghan, Jodi) 1) By 6/30/07, apply a home visit standard that provides lead poisoning prevention education for families and assesses lead-based paint hazards during home visits to any home visit program in 2 targeted high risk communities in Wisconsin. 2) During FY06, continue the PNCC home visit program with clients living in pre-1950 housing in Racine and Sheboygan. In Racine, if lead hazards persist after cleaning, an inspection is conducted and work orders are written to fix the hazards, regardless of a child being present in the dwelling. Racine will evaluate their PNCC initiative to determine if education results in children being tested, and whether any blood level elevation occurred. Sheboygan has a HUD LHR grant and will enroll properties with lead hazards into this program to remove the hazards.
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• In July - November 2006, work with the LHD nursing staff to identify what home visitor programs exist in the City of Racine and Marathon County. • In November 2006, a survey that was developed for the Waukesha initiative with home visitor program staff will be distributed statewide to determine if there is interest in other community home visitor programs in learning more about lead poisoning and how to incorporate lead education into home visits. • In December 2006, when interest for learning more about lead poisoning is identified, arrange for a training event where the step-by-step protocol can be taught to the home visitors. • In spring 2007, WCLPPP will provide training and supplies for high-risk communities for use by individuals conducting the revised home visit standard: (1) cleaning supplies; 2) funds for dust wipe sample analysis and/or lead check swabs, (3) education materials for property owners. • By June 2007, evaluate progress made in collaborating with local home visitor programs, including HeadStart to continue or expand successful efforts, overcome barriers, or pursue other agencies for potential collaboration. Performance Measures: Lead education incorporated into home visitor program in 2 targeted high risk communities in Wisconsin.
Objective 1.6: By June 30, 2007, increase the number of lead-safe units by 10,000. (Amy, Joe, Reghan, Milwaukee, Racine) Activities: HUD LEAD HAZARD REDUCTION FUNDS 1) During FY06, using HUD LHR funds, the State of Wisconsin will complete LHR in 110 dwellings in the Cities of Kenosha, Racine, Waukesha and other areas of the state, the City of Milwaukee will complete LHR in 1,000 dwellings, and the Sheboygan County Health Department will complete LHR in 100 dwellings. • HUD Protocol Step 1: Properties will undergo a risk assessment with systematic assessment of lead hazards via visual inspection and dust wipe testing. Step 2: Lead hazards reduction is completed by certified lead abatement contractors. Step 3: Clearance protocols are conducted to establish that the property is lead-safe.
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CDBG COLLABORATION 2) During FY06, using CDBG or other housing rehab funds in entitlement communities (some that are high-risk) such as Appleton, Fond du Lac, Oshkosh, Racine, Kenosha, Superior, Wausau, a minimum of 8,800 dwellings will be rehabbed. Depending upon the dollar amount of the rehab project, a risk assessment is conducted and clearance standards must be met upon completion of the work. Depending upon the dollar amount of the rehab project, a risk assessment is conducted and clearance standards must be met upon completion of the work. 3) By 6/30/07, the Waukesha Family Collaborative will collaborate with the Waukesha CDBG office to focus funding towards lead hazard reduction in high risk housing. Through this relationship, a “Lead-Safe Zone,” project will be developed and distributed to other high-risk communities. 4) By 6/30/07, a focused resources pilot project will be developed and implemented in 2 high- risk communities to increase the number of properties where lead hazards are evaluated and remediated. (Amy, ALCU) • By 7/31/06, a database for collecting unit-specific information will be developed. • By 8/30/06, the focused resources pilot projects will be developed. • By 6/60/07, the focused resources pilot projects will be implemented in collaboration with partners in the City of Racine and the City of Wausau. LEGISLATION 5) During FY06, IOC members will support and act on legislative and administrative rule changes that require lead-safe work practices and training for workers who do paint disturbing activities in buildings constructed before 1978. 6) By 6/30/07, the US EPA Renovation & Remodeling rule, when finalized and approved, will be used to draft DHFS administrative rule changes to be consistent with the federal rule. Performance Measures: A table that includes: the number of properties receiving lead hazard remediation with CDBG funds, remediation with HUD Lead Hazard Reduction Funds, owner funded remediation and housing.
Objectives for Year 2 (2007-2008)
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Objective 1.1: By 6/30/08, the number of properties made lead-safe, where children spend significant amounts of time away from their primary residence will be increased. (i.e., daycares and foster homes) Activities: 1) By 12/31/08, investigate the means by which to approach inspectors of foster homes. Objective 1.2: By 6/30/08, increase the capacity of local housing agencies and local health departments to evaluate and remediate properties where child are expected to spend significant amounts of time. Activities: 1) By 12/31/07, hold a Local Health / Local Housing Summit 2) By 6/7/08, local weatherization program staff members who administer the state’s HUD grant, will attend one of five trainings focused on lead-safe work practices. Objective 1.3: By 6/30/08, increase affordable lead abatement insurance premiums for contractors to increase the capacity to evaluate and remediate properties where child are expected to spend significant amounts of time Activities: By 6/30/08, a statewide lead abatement insurance policy will be researched and pursued. Objective 1.4: By 6/30/08,an increase in the number of home visitor programs offering lead education will increase the capacity to evaluate and remediate properties where child are expected to spend significant amounts of time. Objective 1.5: By 6/30/08, the number of lead-safe units will be increased by 20,000 from FY 06. Objective 1.6: By 6/30/08, an “Intact Paint” standard will be developed to increase the number of lead-safe properties where child are expected to spend significant amounts of time. • By 6/30/08, expand the use of local ordinances to require owners to perform preventive maintenance. • By 6/30/08, DHFS will evaluate and recommend statutory changes to prevent lead poisoning. DHFS staff will evaluate primary prevention legislation in other states such as Massachusetts, New Jersey, Ohio, Maryland. Among the changes DHFS will consider is a requirement that owners of high-risk 50 year-old housing ensure that all paint is intact
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in 50-year-old dwellings. Another change that would help prevent lead poisoning would be to replace the word “demolition” with the word “renovation” in Chapter 254.179 (3). • By 6/30/08, evaluate and strengthen local inspection programs that can address the need for owners to keep painted surfaces intact in older homes and to use lead safe work practices during home maintenance. • By 6/30/08, recommend legislative changes or changes in administrative rules to create a statewide requirement that all owners of high-risk, i.e., 50 year-old, housing ensure that their properties have intact paint. Objective 1.7: By 6/30/08, the focused resource pilot project will be implemented in two additional high-risk communities.
Objectives for Year 3 (2008-2009) Objective 1.1: By 6/30/09, the number of properties made lead-safe, where children spend significant amounts of time away from their primary residence will be increased. (i.e., daycares and foster homes) Objective 1.2: By 6/30/09, increase the capacity of local housing agencies and local health departments to evaluate and remediate properties where child are expected to spend significant amounts of time. Objective 1.3: By 6/30/09, additional partners and resources that can increase the number lead- safe housing will be committed to furthering the effort to eliminate childhood lead poisoning. Objective 1.4: By 6/30/09, the focused resource pilot project will be implemented in two additional high-risk communities. Objective 1.5: By 6/30/09, the number of lead-safe units will be increased by 30,000 from FY 07.
Objectives for Year 4 (2009-2010) Objective 1.1: By 6/30/10, the number of properties made lead-safe, where children spend significant amounts of time away from their primary residence will be increased. (i.e., daycares and foster homes)
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Objective 1.2: By 6/30/10, increase the capacity of local housing agencies and local health departments to evaluate and remediate properties where child are expected to spend significant amounts of time. Objective 1.3: By 6/30/10,an increase in the number of home visitor programs offering lead education will increase the capacity to evaluate and remediate properties where child are expected to spend significant amounts of time. Objective 1.4: By 6/30/10, the focused resource pilot project will be implemented in two additional high-risk communities. Objective 1.5: By 6/30/10, the number of lead-safe units will be increased by 40,000 from FY 08.
Objectives for Year 5 (2010-2011) Objective 1.1: By 6/30/11, the number of properties made lead-safe, where children spend significant amounts of time away from their primary residence will be increased. (i.e., daycares and foster homes) Objective 1.2: By 6/30/11, increase the capacity of local housing agencies and local health departments to evaluate and remediate properties where child are expected to spend significant amounts of time. Objective 1.3: By 6/30/11,an increase in the number of home visitor programs offering lead education will increase the capacity to evaluate and remediate properties where child are expected to spend significant amounts of time. Objective 1.4: By 6/30/11, the focused resource pilot project will be implemented in two additional high-risk communities. Objective 1.5: By 6/30/11, the number of lead-safe units will be increased by 9,000 from FY 09.
Strategy 2: Strengthen enforcement of lead hazard reduction in dwellings where children have been lead poisoned.
Why is this important? Currently, after a child is identified with an elevated blood lead level, (a venous blood lead level of 20 micrograms per deciliter or more or two venous blood lead levels
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of 15 micrograms per deciliter or more) it takes about three years for the child’s blood lead to return to a level less than 10 micrograms per deciliter. In the cities of Racine and Milwaukee, local ordinances contribute to more rapid compliance than elsewhere; but in the rest of Wisconsin, only half of Wisconsin property owners correct identified lead hazards within 260 days after local health department investigations identify lead hazards in their properties.
Objective 2.1: By June 30, 2007, reduce the time it takes for property owners to repair lead hazards that have been identified in their properties by 20% from FY05. Activities: LOCAL ENFORCEMENT 1) By 12/31/06, LHDs will submit local lead ordinances to DHFS and DOJ for analysis and distribution to other LHDs that will increase and strengthen effective local enforcement options. 2) By 12/31/06, a guidance manual for local health departments to use when collecting evidence in lead poisoning cases will be developed in cooperation between DHFS and DOJ staff. This manual will explain the proper procedures and documentation needed to prosecute a delinquent property owner who is not in compliance with lead hazard reduction work orders. 3) By 12/31/06, WCLPPP and ALS staff will develop and present training at the annual certified lead hazard investigator refresher training that will stress to property owners the need to reduce imminent lead hazards in housing of children with elevated blood lead levels. During the refresher training, LHD staff will be provided information on how to forward potential violations of local ordinances to local housing enforcement authorities. 4) During FY 06, LHDs with overdue properties will refer owners of those properties to the county district attorney for prosecution. STATE ENFORCEMENT 5) By 12/31//06, owners with properties that have identified lead hazards, and are at least one year past the due date given by the local health department for lead hazard reduction work orders, will be posted to the DHFS website – Delinquent Property Owners. This list will prompt property owners to take immediate action in fixing the lead hazards in their properties. WCLPPP staff will promote the Delinquent Property Owners webpage and
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coordinate the posting of delinquent property owners with local health department staff to make sure the properties still have lead hazards. 6) During FY 06, a list of properties that have outstanding orders for lead hazard reduction and that have been associated with more than one lead poisoned child will be developed. This list will be used to target local, state and federal legal counsel enforcement efforts for violations of lead ordinances, statutes and rules. 7) During FY06, LHDs will refer cases of potential retaliatory evictions to the WI Department of Agriculture, Trade and Consumer Protection, to make a complaint against the owner for violation ATCP 134.09(5) (a), if the tenant believes they were evicted for a reported violation of a building or housing code to any governmental authority. Department of Agriculture, Trade and Consumer Protection (DATCP) administrative rule ATCP 134.09(5) (a) gives protection to tenants against retaliatory eviction. Performance Measures: Quarterly and annual case management and lead hazard reduction tracking reports will be on file, data on interventions provided will be tracked in STELLAR, data will be reviewed and evaluated, and trends in timeliness of follow-up interventions will be provided to local health departments. Lists of delinquent properties and potential violations of federal and state rules will be analyzed and provided to necessary local, state and federal agencies.
Objective 2.2: By June 30, 2007, state and local agencies will increase the number of referrals made to federal agencies for potential violations of the federal disclosure rule in high-risk properties. Activities: 1) During FY 06, DHFS will share a list of potential federal disclosure violations with the US Department of Housing and Urban Development (HUD) and the US Environmental Protection Agency (EPA) staff that have the responsibility to follow up to investigate if owners have complied with federal disclosure rules. DHFS will also send this list of properties to other collaborating partners, such as the DOJ for enforcement action, to ensure that the owners of these properties do not continue to ignore their responsibilities. 2) By 12/31/06, a question will be added to the Environmental Investigation form that will prompt the risk assessor/hazard investigator to ask if the family received the “Protect Your
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Family from Lead in Your Home” pamphlet during a routine EBLL investigation. WCLPPP will track the number of referrals made to federal, state and local housing enforcement agencies, by local health departments, for potential violations of the HUD Disclosure Rule. By 12/31/06, an event code will be added to the STELLAR database for tracking how the family answered the question of whether or not they received the “Protect Your Family” pamphlet. By 6/30/07, assess the trends of reported non-compliance with the Disclosure Rule. 3) During FY 2006, local health departments will refer potential violations for the federal Disclosure Rule to the federal agencies that enforce it. Performance Measures: A report of potential violations of the HUD Disclosure rule for EBLL properties will be compiled and on file. List of potential violations are submitted to HUD and EPA regional offices.
Objectives for Year 2 (2007-2008) Objective 1: Objective 2.1: By 6/30/08, reduce the time it takes for property owners to repair lead hazards that have been identified in their properties by 40% from FY05. Objective 2: By 6/30/08, state and local agencies will increase the number of referrals made to federal agencies for potential violations of the federal disclosure rule in high-risk properties.
Objectives for Year 3 (2008-2009) Objective 1: Objective 2.1: By 6/30/09, reduce the time it takes for property owners to repair lead hazards that have been identified in their properties by 60% from base year FY05. Objective 2: By 6/30/09, state and local agencies will increase the number of referrals made to federal agencies for potential violations of the federal disclosure rule in high-risk properties.
Objectives for Year 4 (2009-2010) Objective 1: Objective 2.1: By 6/30/10, reduce the time it takes for property owners to repair lead hazards that have been identified in their properties by 80% from base year FY05. Objective 2: By 6/30/10, state and local agencies will increase the number of referrals made to federal agencies for potential violations of the federal disclosure rule in high-risk properties.
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Objectives for Year 5 (2010-2011) Objective 1: Objective 2.1: By 6/30/11, reduce the time it takes for property owners to repair lead hazards that have been identified in their properties by 100% from base year FY05. Objective 2: By 6/30/11, state and local agencies will increase the number of referrals made to federal agencies for potential violations of the federal disclosure rule in high-risk properties.
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C. Target High-Risk Populations for Blood Lead Testing
2010 YEAR GOAL: Target high-risk populations for blood lead testing, including: • Assure age-appropriate testing of all children enrolled in Medicaid • Provide blood lead testing for all children who are uninsured or under-insured
Strategy 1: Establish New Policies that Improve Age-Appropriate Blood Lead Testing of High Risk Children.
Objective: 1. Improve blood lead testing of children enrolled in Medicaid through utilization of data from HealthCheck performance reviews and the Medicaid blood lead testing registry.
2. Provide financial incentives for age appropriate testing of children enrolled in Mediciad.
3. Explore the feasibility of requiring that institutions or programs serving children under 6 years of age in the city of Milwaukee obtain written evidence that each child has obtained a blood lead test or is exempt from obtaining one.
Activities: 1. By July 2006, the Medicaid Program will utilize HMO encounter data, fee-for-service claims, and the blood lead testing registry to develop individual Medicaid provider blood lead screening profiles for providers who have seen at least 50 children in the past year. Summary reports of provider performance will be distributed to the Chief Medical Officers of the HMOs and the local health departments. 2. By August 2006, the DHFS will mail the lead screening profiles to Medicaid providers throughout the state. 3. By 6/07, the Medicaid Program will implement a pay-for-performance policy that provides financial incentives to HMOs that meet or exceed lead testing benchmarks. 4. By June, 2007, the City of Milwaukee will determine the feasibility of implementing a policy requiring blood lead testing prior to entry into day care.
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5. During FY2006, the DHFS will distribute CDC funds to local WIC projects in high-risk communities to provide blood lead testing for uninsured and underinsured children.
Performance Measures: 1. Individual Medicaid provider blood lead screening profiles will be developed and distributed statewide.
2. The Medicaid Program HMO contracts will be revised to include annual lead testing benchmarks with a provision for financial incentives when benchmarks are met or exceeded.
3. A report of the feasibility of a day care screening requirement for the city of Milwaukee will be available.
4. Contracts will be developed with local WIC projects for testing uninsured children.
Strategy 2: Determine physicians screening practices and identify barriers to screening.
Objective: Attitudes, beliefs, practices and barriers to blood lead screening Wisconsin physicians will be determined by surveying Medicaid providers who provide health care to young children and through the use of chart audits.
Activities: 1. By January 2007, chart audits will be completed for physicians at the Downtown Health Center (DHC) in Milwaukee to determine their blood lead screening practices and the barriers to testing. Findings of this project will be used to develop targeted educational interventions to eliminate the barriers.
2. By 6/30/06, data from the DHC chart audits will be compiled by the MCW, and a summary report developed to include survey results, conclusions, and recommendations.
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3. During FY06, the DHFS will collaborate with the Centers for Disease Control and Prevention to distribute a survey to Medicaid providers in Sheboygan and Janesville. The purpose of this survey will be to gather information concerning providers’ beliefs, barriers, knowledge, and cues to action, to testing Medicaid children for lead poisoning.
4. Data from the CDC survey will be compiled by the CDC and a summary report developed, including conclusions and recommendations.
5. By July 2007, the DHFS and committee members will convene a meeting of representatives from HMOs, the state Medicaid Program, physicians, and other health care providers to discuss barriers to blood lead testing, as determined by the DHC and CDC surveys, and to identify methods to address these barriers.
Performance Measures: 1. Chart audits will be completed at the Downtown Health Center regarding blood lead screening practices. 2. A summary report of chart audits at the Downtown Helath Center will be available. 3. A Survey will be completed with Medicaid providers in Sheboygan and Janesville. 4. A summary report of the survey will be available. 5. Relevant partners will discuss barriers to blood lead testing and propose recommendations to address barriers.
Strategy 3: Educate physicians on the need for screening and current screening recommendations.
Objective: 1. Wisconsin physicians who provide services to young children will be aware of current Wisconsin blood lead screening recommendations and treatment protocols for children who are identified with lead poisoning.
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Activities: 1. By August 2006, the Wisconsin Medicaid Program will distribute physician blood lead screening profiles to Medicaid providers. These screening profiles will contain data for individual physicians on the extent of Medicaid-enrolled children in their practice who have received an age-appropriate test.
2. The Wisconsin Medicaid Program will distribute summary reports of individual Medicaid provider performance to the Chief Medical Officers (CMOs) and quality improvement staff of the Medicaid HMOs and to local health departments (LHDs). These profiles will be described as health care provider performance measures. Through these profiles, providers will be able to compare their screening rates to Medicaid policy and to their peers. (See Strategy 1.)
3. In partnership with LHD staff, HMO quality improvement staff, physician advocates, and nursing students, contact providers with high testing rates to gather evidence-based best practices for assuring that Medicaid-enrolled children receive age appropriate testing.
4. In partnership with LHD staff, HMO quality improvement staff, physician advocates and nursing students, contact providers with low screening rates to discuss the need to improve their testing rates and strategies that can be used to accomplish this.
5. By 6/07, develop and conduct an evaluation to determine the effectiveness and outcome of the MA provider lead screening profiles.
6. By December 2006, submit a manuscript to the Wisconsin State Medical Journal for the environmental medicine issue. The content will include a discussion of the extent of childhood lead poisoning in WI, current screening requirements and recommendations, extent of age-appropriate testing among high-risk children in Wisconsin, elimination strategies, etc.
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7. Conduct presentations at grand rounds, e.g. Children’s Hospital of WI, and other meetings attended by physicians, nurses and other health care personnel, such as the annual meeting of the Wisconsin Chapter of the American Academy of Pediatrics.
8. By June 2007, based on the completion and receipt of evaluation data from the Ohio CLPPP on the effectiveness of the Ohio Physician Lead Assessment Network and Education Training (PLANET) program, the committee will determine the appropriateness and feasibility of implementing this program in WI.
Performance Measures: 1. Blood lead screening profiles will be distributed to Medicaid providers, with summary reports distributed to Medicaid HMOs and LHDs. 2. Evidence-based best practices will be developed for improving blood lead testing of Medicaid children. 3. Evidence-based best practices to improve testing will be communicated to providers will low testing rates. 4. An evaluation of the lead screening profiles will be conducted; data will be available to relevant partners and used to improve the profiles. 5. An article will be published in the Wisconsin State Medical Journal regarding childhood lead poisoning prevention. 6. Committee members will conduct presentations at grand rounds and other meetings. 7. The committee will explore the effectiveness of the Ohio PLANET program and the feasibility of implementing this program in WI.
Strategy 4: Enhance data sharing capabilities between critical partners regarding blood lead testing of children.
Objective: 1. Provide physicians with easy access to their patients’ blood lead test results through the Wisconsin Immunization Registry (WIR), which is a secure HIPAA-compliant environment.
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Activities: 1. By December 2006, the WCLPPP, Wisconsin Immunization Program and Wisconsin Medicaid Program will finalize the development of a blood lead application that will use the functionality of the WI Immunization Registry (WIR) to provide access to blood lead results to health care providers through the WIR web portal.
2. Beginning January 2007, blood lead data will be uploaded to the new blood lead application on a weekly basis for read-only access to health care providers throughout Wisconsin. The WCLPPP will grant role-based access to users. Non-health care providers, such as HeadStart agencies, will have access to only blood lead test dates, not results.
Performance Measures: 1. A blood lead software application will be developed to allow access to blood lead test results through the WI Immunization Registry. 2. Blood lead data will be uploaded to the new blood lead application on a weekly basis for read-only access to health care providers.
Year 2-5 Objectives: 1. The WI Medicaid Program will implement a policy of providing incentives for blood lead testing by distributing financial rewards to HMOs that meet or exceed annual lead testing benchmarks. 2. The Medicaid provider blood lead screening profiles will be updated and distributed on an annual basis with outcome evaluation conducted annually. 3. Blood lead test results will be available in near real-time to health care providers using the web-based WI Immunization Registry. 4. Data from the Medicaid provider survey will be utilized to improve the effectiveness of outreach and education strategies to providers.
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D. Funding and Resources
2010 GOAL: Develop resources to control lead hazards in a minimum of 109,000 housing units.
Strategy 1. Increase the proportion of available funding that local communities devote to lead poisoning.
1-5 Year Objectives 1. Monitor the amounts and uses of current HUD funds to Wisconsin communities, especially the extent to which HUD funds are used to renovate housing and control lead hazards in rental occupied and owner occupied housing. 2. Provide information to focus attention of decision makers including mayors, city and county board members, and housing agency staff on the value of renovating older housing and controlling lead hazards in older housing. 3. Increase public participation in setting priorities for the 22 WI jurisdictions that routinely receive HUD funds (CDBG and HOME program entitlements). Increase public demand throughout WI for safe housing, especially for children. 4. Increase proportion of HUD CDBG funds in WI communities dedicated to renovation and lead hazard control for both owner occupants and rental housing.
Year One Activities 1. By November 2006, WCLPPP will distribute reports to WI entitlement communities from HUD’s data base showing the funds used for renovation and number of dwellings renovated. Baseline data (using three years 2002-2004) showed 8,600 dwelling units renovated per year statewide. WCLPPP will invite local agencies to edit these data, to make corrections and to provide case studies of projects that have protected children from lead hazards. 2. By January 2007, WCLPPP will distribute reports to elected officials and to administrative staff in housing and community development agencies describing (1) local lead poisoning prevalence using maps and other data and (2) how locally controlled funds
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for WI entitlement jurisdictions have been used to improve housing conditions and housing opportunities and to control lead hazards in housing. WCLPPP will calculate and distribute information describing the difference between each local jurisdiction’s estimated needs (number of units with lead hazards occupied by young children from low income families) and achievements (the number of dwellings known to meet HUD standards for lead safety). 3. By July, 2006, WCLPPP will request from HUD CDBG agencies in WI, a schedule of dates and opportunities for public participation in setting housing priorities for that jurisdiction. The key dates include (1) setting the action plans for the next year, (2) describing the previous year’s accomplishments and (3) setting priorities for the next five years through the consolidated housing plan process. 4. By October, 2006, WCLPPP will provide information to participants in the WI Elimination of Lead Poisoning Planning (IOC) group and to state wide advocacy and service organizations including Children’s Health Alliance of WI, WISCAP, and the WI Council on Children and Families describing opportunities for public participation for all the CDBG program jurisdictions in WI. 5. By June, 2007, WCLPPP will support property owners, parents and advocates with updated information about local lead poisoning and housing conditions as they put forward their spending priorities for local community development and housing funds.
Objectives for Years 2 through 5, (July 2008 through June 2011) 1. Continue to monitor HUD funded lead hazard control and renovation projects and to seek clarifications and examples of success stories from local agencies as examples of progress towards Eliminating Lead Poisoning in Wisconsin. 2. Continue to report to elected officials and grassroots organizations on changes in local lead poisoning prevalence rates and reports on funds spent per community on lead hazard control and housing renovation and as percentage of locally available HUD funding. 3. On an annual basis, describe for each WI entitlement jurisdiction the differences between need for number of dwellings needing lead hazard control and number of units in which lead safe renovation or lead hazard control have been conducted.
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4. Continue to distribute the dates for public hearings and deadlines for public comments on local CDBG annual action plans, annual reports and five year consolidated plans.
Strategy 2. Increase the total amount of funds available in Wisconsin for lead poisoning prevention and lead hazard control through traditional and new sources.
1-5 Year Objectives 1. Identify partner organizations and leaders committed to seek funding for lead poisoning prevention. 2. Develop and support work groups to seek new funds such as a Housing Trust Fund. 3. Identify potential funding sources and models for implementing new funding. 4. Develop applications for new funding. 5. Create public support to establish new funding mechanisms. 6. Implement new lead hazard control and housing renovation programs. 7. Publicize successful models.
Year One Activities 1. By July 2006, WCLPPP and Wisconsin Community Action Program Association (WISCAP) staff will seek partners interested in establishing a Housing Trust Fund (HTF) such as was recommended in the 2004 Report to the Governor, “Preserving Wisconsin’s Quality Affordable Rental Housing”. The invited stakeholders will include agencies and organizations providing housing services, child advocates and groups representing low- income, disabled and rural populations, Realtors, builders, renovators, commercial lenders, rental property owners, and faith-based organizations. 2. By October, 2006, the HTF work group use a consensus decision making model to create a proposal for a HTF for WI that will include these key components (1) a sustainable funding source or sources, (2) a description of the appropriate uses and purposes for these funds, (3) method(s) of distributing funds, and (4) identifying an agency or agencies to administer the funds and accept loan repayments. By December, 2006, HTF work group members will begin to strategically address factors supporting or opposing a WI HTF.
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3. By November 2006, Milwaukee HTF advocates will identify and secure a funding source for a Milwaukee HTF with support from WCLPPP, WISCAP and other EP partners. 4. By November, 2006, HTF work group members will evaluate work to date and will make a decision about how to sustain the HTF work group through membership dues. 5. By August 2006, WCLPPP will identify other funding sources for lead poisoning prevention and lead hazard reduction such as grants from government agencies, (e.g., HUD) university based foundations (UW Partnerships for Health) or other philanthropic, charitable or research foundations. 6. June 2007, WCLPPP will identify two community groups or agencies willing to apply for new or renewal grant opportunities such as HUD lead hazard control funds or UW Wisconsin Partnership for Health grants. WCLPPP staff will provide data, writing support and editing to assist organizations that apply for such funding. 7. During FY July 2006-June 2007, Elimination Plan Partners support initiatives for new funding, e.g., Window Replacement Loan bill introduced to the WI legislature in 2006. 8. By June 2007, WI will begin one new program to control lead hazards in WI housing. 9. By June 2007, WI will publicize the successes and barriers to success in creating lead safe housing at a public conference such as WI Look Out for Lead (LOFL) conference.
Objectives for Years 2 through 5, (July 2008 through June 2011) 1. WCLPPP, WISCAP and other EP partners will continue to support legislative initiatives designed to increase the available lead poisoning prevention funding, particularly funds for lead hazard control and renovation activities. 2. Milwaukee Housing Trust Fund advocates will continue to monitor the progress towards creating and implementing a Milwaukee HTF and will continue to advocate for a HTF. 3. WCLPPP, WISCAP and other partners will continue to seek funds from federal grants and philanthropic organizations for lead hazard control. 4. HTF advocates will develop resources to sustain the ongoing campaign to increase public support for a statewide HTF. 5. WCLPPP will promote successful models that bring new resources for housing renovation including addressing lead hazards and will support other agencies to reproduce these successful models.
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VI. Oversight and Evaluation IMPLEMENTATION AND OVERSIGHT COMMITTEE (IOC)
Representatives: ▪ Predominantly members of the original elimination planning committee ▪ Other critical partners [See Appendix 5 for the current list of members of the IOC.]
Purpose: ▪ The purpose of the committee is to provide the leadership and action to implement and evaluate progress for ongoing reporting required by the CDC grant.
Responsibilities ▪ Provide leadership in global oversight of efforts to achieve lead poisoning elimination goal ▪ Evaluate success of elimination efforts ▪ Develop new partners and supports that advance lead elimination efforts ▪ Revise and update elimination plan ▪ Advise implementation subcommittees ▪ Serve on implementation subcommittee(s) ▪ Advance lead elimination activities within own organizations
Chairmanship Two co-chairs; one public and one private sector
Frequency of meetings Three times a year
Implementation Subcommittees will be formed to advance activities related to the plan subcommittees goals surrounding: ⇒ Education ⇒ Funding and resources ⇒ Lead hazard control ⇒ Targeted screening
Number of implementation Will flex as needed depending on activities underway subcommittees and frequency of meetings Leadership of Each subcommittee will, at a minimum, designate one chair who will take implementation the lead for convening subcommittee meetings, advancing activity, and subcommittees reporting progress at full committee meetings. Representatives of goal ▪ Subset of the LPIOC subcommittee members ▪ Other strategic partners as identified by the oversight committee / subcommittee members ▪ Temporary representatives/consultants for special projects/efforts
Responsibilities of ▪ Responsibility for ensuring that their plan goal activities are subcommittee members implemented and achieved ▪ Oversight of state activities in their goal area ▪ Enhance coordination and expansion of efforts ▪ Outreach to new partners ▪ Report on activities / results at full oversight committee meetings
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Committee administration ▪ Develop agendas and identify/ gather relevant materials tasks for full committee ▪ Conduct planning to most efficiently conduct committee business ▪ Develop progress tracking approaches ▪ Identify and develop ideas to present to full committee to remedy organization problems / roadblocks
Responsibility for ▪ DHFS staff conducting full committee ▪ Co-chairs administration tasks ▪ Interested committee members ▪ Possibly a managing staff person if funding obtained (e.g. grant / other)
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APPENDIX 1
Cost Savings from Preventing Childhood Lead Poisoning in Wisconsin
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Summary of the Savings Accrued by Eliminating Lead Poisoning in Wisconsin
Benefit Estimate of Comments Annual Benefit Increased earning $8,334,511 Strong correlation between lead poisoning and potential lowered IQ; lowered IQ results in reduced income over a lifetime. Reflects 6.75% state income tax on lost revenue. Neonatal Unquantified Difficult to quantify for both epidemiological mortality and ethical reasons. Health care – $424,550 Does not include lead-related problems such as direct treatment behavioral difficulties. Health care – long Unquantified Includes hypertension, stroke, and term effects osteoporosis. Special education $1,336,955 Probably vastly underestimates costs because does not include needs of children with BLL under 25 µg/dL. Juvenile $3,941,233 Does not include costs other than residential Delinquency treatment. Criminal justice Unquantified If effects of lead on juvenile delinquency carry through to adult behavior, costs could dwarf the juvenile costs. State $1,004,100 Rough estimate of costs of grants to counties infrastructure for lead prevention work and $125,000 allocation to 16th Street Community Health Center. This amount does not include the 1.4 FTE with the Wisconsin Childhood Lead Poisoning Prevention Program nor costs of the Asbestos and Lead Section and the Lead- Free/Lead-Safe Registry. Legal liability of Unquantified Only a small number of cases have been municipalities settled to date; however there is a much larger potential for future cases.
Total Annual Savings to Wisconsin: $14,037,259.60
This information was developed using Wisconsin data for 2002 and the methodology from Long- term costs of lead poisoning: How much can New York save by stopping lead?, 2003, Katrina Smith Korfmacher, PhD, Environmental Health Sciences Center, University of Rochester.
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APPENDIX 2
GIS Maps of 3 of Wisconsin’s High-Risk Communities:
Milwaukee, Racine and Sheboygan
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APPENDIX 3
Wisconsin Childhood Lead Poisoning Elimination Plan Committee, 2004
Original Committee Member List
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Wisconsin Childhood Lead Poisoning Elimination Plan Committee
Munson, Kenneth Wisconsin 1 W. Wilson Street Madison 608/266-9622 [email protected] Department of Health P. O. Box 7850 53707-7850 CHAIR and Family Services Freundlich, Kris Wisconsin 1 W. Wilson Street Madison 608/266-9240 [email protected] Department of Health 53702 FACILITATOR and Family Services Anderson, M.D., Henry A. Wisconsin Division Bureau of Environmental Madison 608/266-1253 [email protected] of Public Health Health 53702 1 West Wilson Street, Rm. 150 Bartkowski, D.P.H., John 16th Street 1337 South 16th Street Milwaukee 414/672-6220 [email protected] Community Health 53204 [email protected] Center Berlan, Bob U. S. Department of Wisconsin State Office/CPD Milwaukee 414/297-3214 [email protected] Housing and Urban 310 West Wisconsin Avenue 53203 ext. 8100 Development Bybee, Dave Southern Wisconsin 4915 Vrana Lane Racine 262/681-7233 [email protected] Landlord Association 53405-1035 Carr, M.D., Richard Wisconsin Division Wisconsin Medicaid Program Madison 608/266-9743 [email protected] of Public Health 1 West Wilson Street, Rm. 372 53702 Carty, Denise Wisconsin Division Minority Health Office Madison 608/267-2173 [email protected] of Public Health 1 West Wilson Street, Rm. 218 53702 Clippert, Thomas City of Beloit 100 State Street Beloit 608/364-6710 [email protected] Housing Office 53511 Coggs, The Honorable G. 6th Senate District Room 22 South, State Capitol Madison 608/266-2500 [email protected] Spencer P. O. Box 7882 53707-7882 [email protected] [email protected] Coons, Margie Wisconsin Division Wisconsin Childhood Lead Madison 608/267-0473 [email protected] of Public Health Poisoning Prevention Program 53702 1 West Wilson Street, Rm. 150 Cranley, Martha Wisconsin Council 16 North Carroll Street, Suite Madison 608/284-0580 [email protected] on Children and 600 53703 ext. 321 Families
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Darrow, Dale U. S. Department of Minnesota HUD Office Minneapolis 612/370-3000 [email protected] Housing and Urban 920 Second Avenue South, 55402 ext. 2280 Development Suite 1300 Gomez, Jorge Commissioner of 125 South Webster Street Madison 608/267-1233 [email protected] Insurance 53702 Gordon, Brenda Sherman Park SPCA PAL Milwaukee 414/444-9803 [email protected] Community 3526 W. Fond du Lac Avenue 53216 Association Hippensteel, Dale Sheboygan County of Division of Public Health Sheboygan 920/459-4382 [email protected] Human Services 1011 North Eighth Street 53081-4043 Hubler, The Honorable Mary 75th Assembly Room 119 North, State Capitol Madison 608/266-2519 [email protected] District P. O. Box 8952 53708 [email protected] Jauch, The Honorable Robert 25th Senate District Room 19 South, State Capitol Madison 608/266-3510 [email protected] P. O. Box 7882 53707-7882 [email protected] Katcher, M.D., Murray Wisconsin Division Buruea of Family and Madison 608/266-5818 [email protected] of Public Health Community Health 53702 1 West Wilson Street, Rm. 243 Kilde, Peter West Central WI 525 Second Avenue Glenwood City 715/265-4271 [email protected] Community Action P.O. Box 308 54013-0308 Agency Latorraca, Donald Wisconsin 17 West Main Street Madison 608/267-2797 [email protected] Department of Justice 53702 Link, Tony Wisconsin Division of Energy Madison 608/261-8149 [email protected] Department of 101 East Wilson Street 53702 Administration Murphy, Amy Home Environmental Milwaukee Health Department Milwaukee 414/286-8028 [email protected] Health 841 North Broadway Street – 53202 1st Floor Obletz, Cynthia 16th Street 1337 South 16th Street Milwaukee 414/672-1315 [email protected] Community Health 53204 Center
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Puentes, Ramona 16th Street Southside PAL Milwaukee 414/672-1315 [email protected] Community Health 1337 South 16th Street 53204 ext. 241 Center Ries, Leo Local Initiatives 161 West Wisconsin Avenue Milwaukee 414/273-1815 [email protected] Support Corporation Suite 3008 53203 Schirmer, Joe Wisconsin Division Wisconsin Childhood Lead Madison 608/266-5885 [email protected] of Public Health Poisoning Prevention Program 53702 1 W. Wilson Street, Rm. 150 Slota-Varma, M.D., Catherine Shoreview Pediatrics 2315 North Lake Drive Milwaukee 414/272-7009 [email protected] 53211-4516 Also State Medical Society Staff, Rick Wisconsin Realtors 4801 Forest Run Road Madison 608/242-2265 [email protected] Association 53704 Werth, Ann Community City of Wausau Wausau 715/261-6686 [email protected] Development 407 Grant Street 54403 Wiebenga, Marlyse U. S. Environmental 77 West Jackson Boulevard Chicago 312-886-4437 [email protected]. ProtectionAgency Mail Code DT-8J 60604 gov Wilson, Marti Wisconsin 201 West Washington Avenue Madison 608/266-5842 [email protected] Department of 5th Floor 53703 Commerce
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RESOURCE STAFF Bruce, Shelley Wisconsin Division Bureau of Occupational Health, Madison 608/267-0928 [email protected] of Public Health Asbestos and Lead Section 53702 1 W. Wilson Street, Rm. 139 Esser, Linda Wisconsin Office of the Secretary Madison 608/266-9622 [email protected] Department of Health 1 W. Wilson Street, Rm. 650 53702 and Family Services Havlena, Jeff Wisconsin Division Wisconsin Childhood Lead Madison 608/266-1826 [email protected] of Public Health Poisoning Prevention Program 53702 1 W. Wilson Street, Rm. 150 Ishado, Sara Wisconsin Division Wisconsin Childhood Lead Madison 608/267-3901 [email protected] of Public Health Poisoning Prevention Program 53702 1 W. Wilson Street, Rm. 150 LaFlash, Susan Wisconsin Division Wisconsin Childhood Lead Madison 608/266-8176 [email protected] of Public Health Poisoning Prevention Program 53702 1 W. Wilson Street, Rm. 150 Otto, Bill Wisconsin Division Health Hazard Section Madison 608/266-9337 [email protected] of Public Health 1 W. Wilson Street, Rm. 150 53702 Rossow, Amy Wisconsin Division Wisconsin Childhood Lead Madison 608/261-6375 [email protected] of Public Health Poisoning Prevention Program 53702 1 W. Wilson Street, Rm. 150 Sieger, Tom Wisconsin Division Bureau of Environmental Madison 608/264-9880 [email protected] of Public Health Health 53702 1 W. Wilson Street, Rm. 150 Walsh, Reghan Wisconsin Division Wisconsin Childhood Lead Madison 608/261-9432 [email protected] of Public Health Poisoning Prevention Program 53702 1 W. Wilson Street, Rm. 150
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APPENDIX 4
Wisconsin Childhood Lead Poisoning Elimination Plan
Members of the Implementation and Oversight Committee (IOC), 2006
Page 67 Wisconsin Childhood Lead Poisoning Elimination Plan IMPLEMENTATION AND OVERSIGHT COMMITTEE 11/01/06 Sieger, Tom Wisconsin Division Bureau of Environmental and Madison 608/264-9880 [email protected] of Public Health Occupational Health 53702 CO-CHAIR 1 West Wilson Street, Rm. 150 Slota-Varma, M.D., Catherine Shoreview Pediatrics 2315 North Lake Drive Milwaukee 414/272-7009 [email protected] 53211-4516 CO-CHAIR Also State Medical Society Freundlich, Kris Wisconsin 1 W. Wilson Street Madison 608/266-9240 [email protected] Department of Health 53702 FACILITATOR and Family Services Antholt, Steve Wisconsin Division Bureau of Environmental and Madison 608/261-4949 [email protected] of Public Health Occupational Health 53702 FUNDING CO-CHAIR 1 W. Wilson Street, Rm. 139 Anderson, M.D., Henry A. Wisconsin Division Bureau of Environmental and Madison 608/266-1253 [email protected] of Public Health Occupational Health 53702 1 West Wilson Street, Rm. 150 Berlan, Bob U. S. Department of Wisconsin State Office/CPD Milwaukee 414/297-3214 [email protected] Housing and Urban 310 West Wisconsin Avenue 53203 ext. 8100 Development Blanks, Deborah Social Development 4041 N. Richards Street Milwaukee 414/906-2700 [email protected] Commission 53212 Bruce, Shelley Wisconsin Division Bureau of Environmental and Madison 608/267-0928 [email protected] of Public Health Occupational Health, Asbestos 53702 and Lead Program HOUSING CO-CHAIR 1 W. Wilson Street, Rm. 139 Budde, Andy Milwaukee Heath Home Environmental Health Milwaukee 414/286-2962 [email protected] (Representing the WI Department 841 North Broadway Street – 53202 Environmental Health 1st Floor Association – WEHA) Carns, George Children’s Health 1533 N. RiverCenter Drive Milwaukee 414/390-2180 [email protected] Alliance of 53212 Wisconsin Carr, M.D., Richard Wisconsin Division Wisconsin Medicaid Program Madison 608/266-9743 [email protected] of Health Care 1 West Wilson Street, Rm. 372 53702 Financing Clippert, Thomas City of Beloit 100 State Street Beloit 608/364-6710 [email protected] Housing Office 53511
Page 68 Wisconsin Childhood Lead Poisoning Elimination Plan IMPLEMENTATION AND OVERSIGHT COMMITTEE 11/01/06 Coleman, Katina Lisbon Avenue 4145 W. Lisbon Avenue Milwaukee 414/934-8540 [email protected] Neighborhood 53208 Development Coggs, The Honorable G. 6th Senate District Room 22 South, State Capitol Madison 608/266-2500 [email protected] Spencer P. O. Box 7882 53707-7882 [email protected] [email protected] Cooley, Gwendolyn Wisconsin Environmental Protection Unit, Madision 608/261-5810 [email protected] Department of Justice 17 W. Main Street 53707-7857 P.O. Box 7857 Coons, Margie Wisconsin Division Wisconsin Childhood Lead Madison 608/267-0473 [email protected] of Public Health Poisoning Prevention Program 53702 1 West Wilson Street, Rm. 145 Duffey, Ada Milwaukee Lead and 2223 South Kinnickinnic Milwaukee 414/481-9070 [email protected] Asbestos Information Avenue 53207 Center, Inc. Evanson, Marty Wisconsin 201 West Washington Avenue Madison 608/267-2713 [email protected] Department of 5th Floor 53703 Commerce Fernholz, Marcia City of Racine Health 730 Washington Avenue Racine 262/636-9496 [email protected] Department 53403 Garrett-Thomas, Deborah Wisconsin P.O. Box 7868 Madison 608/266-6789 deborah.garrettthomas@wisconsin. Department of 101 East Wilson Street, 6th 53707-7868 gov Administration, Floor Division of Energy Gerlach, Mary Jo Milwaukee Heath Home Environmental Health Milwaukee 414/286-2547 [email protected] Department 841 North Broadway Street – 53202 SCREENING CHAIR 1st Floor Gramling, Ben Lead Poisoning Sixteenth Street Community Milwaukee 414/672-1315 [email protected] Prevention Program Health Center 53204 1337 South 16th Street Halverson, Jon Lead-Safe Services 3095 County Road II, #36 Larsen 920/836-1880 [email protected] 54947 Hill, Amy Wisconsin Division Wisconsin Childhood Lead Madison 608/261-6375 [email protected] of Public Health Poisoning Prevention Program 53702 HOUSING CO-CHAIR 1 W. Wilson Street, Rm. 145
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Hippensteel, Dale Sheboygan County Division of Public Health Sheboygan 920/459-4382 [email protected] Human Services 1011 North Eighth Street 53081-4043 Horan, Dick Assurance Inspection PO Box 620593 Middleton 608/827-6761 [email protected] Services 53562-0593 Jauch, The Honorable Robert 25th Senate District Room 19 South, State Capitol Madison 608/266-3510 [email protected] P. O. Box 7882 53707-7882 [email protected] Jones, Bob Wisconsin 1310 Mendota Street Madison 608/244-4064 [email protected] Community Action Suite 107 53714 Program Layde, M.D., Margaret Downtown Health 1020 N. 12th Street Milwaukee 414/277-8909 [email protected] Center 53233 Mokler, Mike Mokler Properties, 1117 W. New York Avenue Oshkosh 920/235-6470 [email protected] Inc. 54901 m Mormann, Doug LaCrosse County 300 North Fourth Street LaCrosse 608/785-9872 [email protected] (Representing WI Public Health Department 54601-3299 crosse.wi.us Health Association – WPHA) Ordinans, Karen Children’s Health 1533 N. RiverCenter Drive Milwaukee 414/390-2194 [email protected] Alliance of 53212 Wisconsin Otto, Bill Wisconsin Division Health Hazard Section Madison 608/266-9337 [email protected] of Public Health 1 W. Wilson Street, Room 150 53702 Rabbitt, Jim Wisconsin Division of Trade and Madison 608/224-4920 [email protected] Department of Consumer Protection 53708-8911 Agriculture, Trade 2811 Agriculture Drive, PO and Consumer Box 8911 Protection Reinen, Michelle Wisconsin Division of Trade and Madison 608/224-4988 [email protected]. Department of Consumer Protection 53708-8911 us Agriculture, Trade 2811 Agriculture Drive, PO and Consumer Box 8911 Protection Schirmer, Joe Wisconsin Division Wisconsin Childhood Lead Madison 608/266-5885 [email protected] of Public Health Poisoning Prevention Program 53702 FUNDING CO-CHAIR 1 W. Wilson Street, Rm. 145
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Schubert, Sara Milwaukee Health Home Environmental Health Milwaukee 414/286-8028 [email protected] Department 841 North Broadway Street – 53202 1st Floor Theo, Mike Wisconsin Realtors 4801 Forest Run Road Madison 608/242-2265 [email protected] Association 53704 Walsh, Reghan Wisconsin Division Wisconsin Childhood Lead Madison 608/261-9432 [email protected] of Public Health Poisoning Prevention Program 53702 EDUCATION CHAIR 1 W. Wilson Street, Rm. 145 Werth, Ann City of Wausau 407 Grant Street Wausau 715/261-6686 [email protected] Community 54403 Development Wiebenga, Marlyse U. S. Environmental 77 West Jackson Boulevard Chicago 312/886-4437 [email protected]. ProtectionAgency Mail Code DT-8J 60604 gov Zweifel, Pirkko Child Care Section Department of Workforce Madison 608/261-4595 [email protected] Development 53707 201 E. Washington Avenue, PO Box 7972
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