RHODE ISLAND RECIPES FOR FAMILY HEALTH

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RHODE ISLAND RECIPES FOR FAMILY HEALTH

• Information is a product not a possession
• Peter Simon,MD,MPH, Assist. Medical Director
• RI Department of Health

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About The Ocean State

• Population of 1 million
• Birth cohort of 14,000
• No Local or County Health Departments
• Health services provided by private physicians,
  community health centers, hospitial clinics
• Ranked first lowest percentage of uninsured
  population (6.4)
• 2.4 of children under 18 with no health
  insurance
• Medicaid Managed Care (RIteCare)

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 RI Recipe for Improving Outcomes for Families
and Communities Children I. Examples of
successII. IngredientsIII.DirectionsIV Tips
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Childhood Lead Poisoning Prevention Program
Partners
Inspectors
MCOs
Contractors
Medical Community
Family Health
AGs Office
HRC
Laboratory
DHS
DOE
DEM
RI Department of Health
DOA
EPA
NELCC
Environmental Health
SNTs
City/Town Officials
CBOs
Legislators
Advocates
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(1) Logic Model - Assessing the Impact of
Lead-Safety Efforts on the Housing Market
Many factors influencing changes in housing
market
Affordable
Unavailable
Housing unit receives CoC or LS/LF certificate
Available
Affordable
Available
Unaffordable
Housing unit not known to be lead-complaint
Unavailable
Unaffordable Unavailable
Isolating the impact of Lead Safety Efforts will
be difficult
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(2) Logic Model - The Path to Lead Compliance
Key
pre1978, PO pre-1978, rental
post-1978 --- May occur, after series of steps
PO gets tech. help
PO gets help
PO attends LHA seminar
Pre-1978 Rental Housing
Fixes LH
Finds LH
PASSES
Hires inspector
CoC
LHML
Visual Assessment
No LH found
Case Closed
Fails
PO fails to comply with LHML, no child with
significant EBLL
Public List
LH Found
1st NoV issued
Pre-1978 Owner- OccupiedHousing
Public List
Child has significantly EBLL
Accepted
Inspection
Inspection offered
2nd NoV
Refused or cant access property
Litigate
Home abated
Clearance Inspection
Case closed
PASSES
Lead-Safe/ Lead-Free
Fails
Post-1978 Housing
Assumed, unless proven otherwise
Lead-Free
If child presents with EBLL, process is same as
above
The City of Providence also offers inspections
when a childs BLL is 10-14mcg/dL.
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Enhancing Lead Screening Partnering with MCOs

• Three-month birth cohorts of 24-26 month old
  children actively enrolled in a managed care
  product.
• MCO sends to RICLPPP a data file containing
  enrollees with no evidence of lead screening
  claims in MCOs records.
• Data is searched against the RICLPPP data.
• Verified list of unscreened children is sent to
  MCOs.

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Impact on Screening Rates
The screening rate of 44 identified through the
MCOs claims data is an underestimate due to
delays in billing of claims. Source RI
Childhood Lead Poisoning Prevention Program
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Medical Home Indicators for Coodinated Care

• children in the EI with IFSP, discharged to
  SpEd, for whom an IEP is developed (EI Data)
• kids in EI and WIC who were never screened for
  lead (KIDSNET)
• children with Hearing loss enrolled in EI
  (KIDSNET/Newborn Hearing Screening)
• IFSPs that include all appropriate specialties
  (EI Data not yet available)
• Several Health Care Coordination Questions from
  SLAITS Survey

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Bateson, Gregory, Steps to an Ecology of Mind
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Childrens Health, The Nations WealthAssessing
and Improving Child Health
Report of the Committee on Evaluation of
Childrens Health
Board on Children, Youth and Families National
Research Council Institute of Medicine
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A New Model of Children s Health and Its
Influences