Evaluating Maine’s Lead Education Project

1. Evaluating Maine’s Lead Education Project Presented by: Teresa Hubley, Ph.D., M.P.A MaryAnn Amrich, R.N. What is the Lead Education Project? This project is a partnership between the University of Southern Maine’s Institute for Public Sector Innovation (IPSI) and the Maine Childhood Lead Poisoning Prevention Program (MCLPPP) conducted from 1999 to 2002 through CDC funding What were the goals of the project? Increase the use of primary and secondary prevention measures for childhood lead poisoning by raising the awareness of parents, health care providers and child care workers regarding their importance.

2. Background Issues Government Services MCLPP provided health care education and case management. Other agencies (DEP, MSHA, etc.) provided complementary services (licensing, enforcement, environmental education, etc.). State law requires all test results processed by HETL and investigation over 20ug/dl. Recommended Blood Lead Testing Rates CDC sets requirements. Children < 6 are most vulnerable. Children should be tested at 1 and 2 if at elevated risk. Most poisoning is due to exposure to deteriorating lead paint. A study found Maine testing rates in 1999 near 11% and no geographical pattern. Rates were low for Medicaid, the only population found at statistical risk.Screening is required by Medicaid. Redefining Case Management Using Public Health Nurses and private inspectors to deliver care and providing services at lower levels of exposure

3. Education Program Content • Educational Partnerships • Brochures • Mailing Campaigns • PSA’s • Newsletter • Trainings • Displays and Presentations • Website • http://www.state.me.us/dhs/bohdcfh/led/index2.htm Lead is a problem Lead is a problem in Maine Lead hurts children You can do something about lead

4. Measures of Effectiveness The RE-AIM Model(Glasgow, et.al.,1999 AJPH 89(9)) • Reach • Efficacy • Adoption • Implementation • Maintenance Blood Lead Testing Rates(Efficacy, Adoption, Maintenance) Program Measures(Reach and Implementation) Number of items Sent Trainings and other Public Presentations Case Management Reports Qualitative and Anecdotal Data Partner Activity

5. Blood Lead Testing Rates Ages <6 More mail, PHN Training, MMAF Rpt, Newsletter PSA’s, Website 1st Mailings, brochures partnerships

6. 2001 AGES Testing Rates % Blood Lead Levels  10 ug/dl 1 38.4 % 5% 2 15% 6.7% Blood Lead Testing Rates for Ages 1 - 2

7. Program Measures • Number of Items Sent (70,611) • Number of persons (380) requesting items beyond the “basic three” • Trainings (89 PHN/CHN, 117 HeadStart, 400 total) • Case Management reports (90% in 3 days of target) • 147 cases 20ug/dl and above, 84 at 15-19, 214 at 10-14 • Qualitative (PSA calls [29], Nurse Surveys [22], Supervisor surveys[7], [Family Surveys [52], Focus Groups [3]) and Anecdotal Evidence (various)

8. Other Activities • PCPIP Medicaid Incentives • MKRBU Physician Trainings (110) • MELAP and HomeDepot project • DEP and MSHA Lead Safe Renovators

9. Outcomes and Further Needs Outcome: Blood Lead testing rate rises 3.1% and new case management policies are institutionalized, with 298 cases below 20 ug/dl being served for the first time. Needs • Reinforce Public Health Nursing’s Role in prevention • Support Medicaid’s role in promoting testing • Show General Public how to adopt prevention measures • Refocus local efforts • Promote program services • Determine the appropriate screening rate • Promote screening of 2 year olds