1. CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children Resettlement Worker Module U.S. Department of Health and Human Services Centers for Disease Control and Prevention

2. Refugee Assistance: Module Outline What is the problem? Effects on the refugee population Sources of lead exposure What can you do? Resources

3. Childhood Lead Poisoning Lead poisoning is a common and preventable childhood health problem Lead is everywhere in the environment due to industrialization Lead exposure is measured in children by blood lead testing

4. Blood Lead Levels in the U.S. Population 1976-2002 (NHANES) Year Blood Lead Levels (µg/dL) 2.7 3.6 1.9 14.9

5. Why are Children at High Risk? Children’s nervous systems are still developing Young children have more hand-to-mouth activity than older children Children absorb more lead than adults

6. Children’s Health Risks Related to lead exposure Reductions in IQ and attention span Behavioral problems (e.g., hyperactivity) Impaired growth and hearing loss At very high levels, seizures, coma, and even death

7. Refugee Assistance: Module Outline What is the problem? Effects on the refugee population Sources of lead exposure What can you do? Resources

8. Refugee Migration

9. Elevated Blood Lead Levels (BLLs) in Refugee Children Newly arrived refugee children are twice as likely as U.S. children to have elevated BLLs Some sub-populations of refugee children are 12-14.5 times more likely to have elevated BLLs Data suggest that refugee children are also at risk for elevated BLLs after resettlement in the U.S.

10. Risk Factors for Elevated BLLs Among Refugees Living in older homes Presence of lead hazards Cultural practices and traditional medicines Lack of awareness about the dangers of lead Compromised nutritional status

11. Refugee Assistance: Module Outline What is the problem? Effects on the refugee population Sources of lead exposure What can you do? Resources

12. Most lead hazards come from lead paint chips that have been ground into tiny bits. These tiny bits of lead become part of the dust and soil in and around our homes. Lead Hazard Sources

13. U.S. Housing 24 million housing units (25% of the nation’s housing) have significant lead-based paint hazards 1.2 million homes with significant lead-based paint hazards housed low income families with children under the age of 6 years

14. Environmental Sources of Childhood Lead Exposure

15. Refugee Assistance: Module Outline What is the problem? Effects on the refugee population Sources of lead exposure What can you do? Resources

16. Environmental Assessment Educate population Assure medical interventions Resettlement Worker

17. Environmental Assessment The four components are: Pre-assessment Visual interior assessment Visual exterior assessment Summary assessment

18. Property Pre-Assessment Was the property built before 1978? Can the property owner provide a current certification that the property is lead safe or lead free?

19. Visual Interior Assessment Walls Windows Steps

20. Visual Exterior Assessment Exterior windows and doors Porch and/or steps Roof, gutters, and downspouts

21. Summary Assessment The summary assessment is where you will use your findings from the interior and exterior assessments to make a determination of the high risk status of the property.

22. Medical Assurance: Screening 1) Nutritional evaluations 2) Initial blood lead test 3) Repeat blood lead test

23. Medical Assurance: Screening Initial blood lead test  Within 90 days of arrival into the United States Repeat blood lead test  3 to 6 months after placed in permanent residence  Considered a “medical necessity”

24. Medical Assurance: Case Management What is case management? Who provides case management? Consult www.cdc.gov/nceh/lead for specific case management informationwww.cdc.gov/nceh/lead

25. Medical Assurance: Nutrition

26. Educate Populations Provide education to newly arrived refugee families  Routine medical care  Proper nutrition  House cleaning strategies CDC Health Education Resource Database

27. Refugee Assistance: Module Outline What is the problem? Effects on the refugee population Sources of lead exposure What can you do? Resources

28. Federal Organizations U.S. Department of Health and Human Services  Centers for Disease Control and Prevention http://www.cdc.gov/nceh/lead/lead.htm http://www.cdc.gov/ncidod/dq/  Office of Global Health Affairs http://www.globalhealth.gov/  Office of Refugee Resettlement http://www.acf.dhhs.gov/programs/orr/ U.S. Department of State  Bureau of Population, Refugees, and Migration http://www.state.gov/g/prm/

29. Additional Federal Resources U.S. Department of Housing and Urban Development (HUD)  Office of Healthy Homes and Lead Hazard Control http://www.hud.gov/offices/lead/ U.S. Environmental Protection Agency (EPA)  Office of Pollution and Prevention and Toxics http://www.epa.gov/opptintr/lead/index.html