RHODE ISLAND RECIPES FOR FAMILY HEALTH “Information is a product not a possession” Peter Simon,MD,MPH, Assist. Medical Director RI Department of Health KIDSNET

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) KIDSNET

RI Recipe for Improving Outcomes for Families and Communities Children I. Examples of success II. Ingredients III.Directions IV Tips

Childhood Lead Poisoning Prevention Program Partners DOE DHS HRC AG’s Office MCO’s CBO’s Contractors Medical Community SNT’s Inspectors DOA Advocates DEM NELCC EPA City/Town Officials Legislators Laboratory RI Department of Health Environmental Health Family Health

Affordable Available Unavailable Unaffordable Housing unit receives CoC or LS/LF certificate Unaffordable & Unavailable Affordable Unavailable Available Many factors influencing changes in housing market… Isolating the impact of Lead Safety Efforts will be difficult (1) Logic Model - Assessing the Impact of Lead-Safety Efforts on the Housing Market Housing unit not known to be lead- complaint

Pre-1978 Rental Housing Pre-1978 Owner- Occupied Housing Post Housing LHML Visual Assessment Finds LH Fixes LH No LH found Hires inspector PASSES CoC PO gets tech. help PO gets $$ help PO attends LHA seminar Lead-Free Assumed, unless proven otherwise Child has significantly EBLL Inspection offered Accepted Inspection PASSES Lead-Safe/ Lead-Free LH Found If child presents with EBLL, process is same as above 1 st NoV issued Home abated Clearance Inspection Case Closed Public List 2 nd NoV Public List Litigate Refused or can’t access property Case “closed” (2) Logic Model - The Path to Lead Compliance * The City of Providence also offers inspections when a child’s BLL is 10-14mcg/dL. pre1978, P=O pre-1978, rental post May occur, after series of steps Key Fails PO fails to comply with LHML, no child with significant EBLL Fails

Enhancing Lead Screening Partnering with MCOs Three-month birth cohorts of 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.

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

Rhode Island Department of Health Vital Records Home Visiting Pediatric Providers Immunizations RIHAP: Rhode Island Hearing Assessment Program Early Intervention Lead Prevention Newborn Blood Spot WIC: Special Supplemental Nutrition Program for Women, Infants and Children Birth Defects Newborn Developmental Risk KIDSNET

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) % IFSP’s that include all appropriate specialties (EI Data – not yet available) Several Health Care Coordination Questions from SLAITS Survey

Bateson, Gregory, Steps to an Ecology of Mind

Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Report of the Committee on Evaluation of Children’s Health Board on Children, Youth and Families National Research Council Institute of Medicine

A New Model of Children ‘s Health and Its Influences