1. Case Management 410 IAC 29-2-1 Local health officers shall ensure the provision of case management to all children under seven (7) years of age in their jurisdiction Case management means the process of providing, overseeing, and coordinating lead poisoning services outreach and identification of children with EBLL child case management service planning and resource identification child case management service implementation and coordination retesting monitoring of child case management service delivery, program advocacy, and program evaluation

2. Case Manager 410 IAC 29-1-5 “Case manager” - a person authorized by a health department and trained by the ISDH to perform case management protocols. Training within 6 months.

3. Continues….. An effective case management is ongoing communication with the caregivers and other providers. A cooperative approach to solving any problems that may arise with client. Efforts to decrease the child’s BLL. Eliminate lead hazards in the child’s environment.

4. Adequate Model !!!!!!!! An adequate model of case management has four components: 1. Client identification and outreach. (Individual assessment ) 2. Service planning & resource identification (the linking of clients to needed services).

5. Model Continues… 3. Service Implementation and coordination. 4. The monitoring of service delivery; advocacy and evaluation.

6. YOU Although environmental services may be provided by the case manager, the environmental inspector, or other program staff; the case manager is responsible for ensuring that a child receives services in a timely fashion!

7. The Team…… In most cases, a management team can best meet the needs of an individual child. The team may include the case manager The child’s caregiver Child’s primary care provider Health educator A nutritionist

8. At-risk Child 410 IAC 29-1-2 lives in or regularly visits a house or other structure built before 1978 has a sibling or playmate who has been lead poisoned has frequent contact with an adult who works in an industry or has a hobby that uses lead is an immigrant, refugee, or has recently lived abroad is a member of a minority group is a Medicaid recipient uses medicines or cosmetics containing lead lives in a geographic area that increases the child’s probability of exposure to lead

9. o ONCE AN ELIGIBLE CHILD IS IDENTIFIED, THE CASE MANAGER SHOULD DO THE FOLLOWING: *Visit the child’s residence ( and other sites where the child spends significant amounts of time) a minimum of two times Assess factors that may impact the child’s BLL (including sources of lead, nutrition, access to services, family interaction, and caregiver understanding). Oversee the activities of the case management team. Develop a written plan for intervention. Coordinate the implementation of the plan. Evaluate compliance with the plan and the success of the plan.

10. Child Case Management 410 IAC 29-1-6 Timeframe for action varies according to blood lead level Higher levels require quicker response Highest levels treated as medical emergency

11. 0-9 µg/ dL…. ….for confirmed blood lead levels between zero (0) and nine and nine-tenths (9.9)  g/dL….  Notify primary medical provider within 10 working days of receipt of test results by the local health officer.  Provide educational materials to the parents or family of the child regarding prevention of lead poisoning.  Any additional actions the local health officer believes will assist the family in preventing the child’s blood lead level from increasing.

12. 10-14.9 µg/ dL…. ….between ten (10) and fourteen and nine-tenths (14.9)  g/dL…. Notify the primary medical provider within 5 working days Begin case management services within 10 working days Ensure coordination of long-term services and retesting Arrange testing of children under 7 years old in the home Conduct an initial home visit Provide an environmental inspection and an environmental investigation

13. 15-19.9 µg/ dL…. ….(15) and nineteen and nine-tenths (19.9)  g/dL …. Notify the child’s primary medical provider within 5 days Conduct child case management services within 5 working days ensure coordination of long-term services and retesting arrange for testing of all children in the home under 7 conduct an initial home visit provide an environmental inspection and an environmental investigation

14. 20- 44.9 µg/ dL…. ….twenty (20) and forty four and nine-tenths (44.9)  g/dL …. Notify the child’s primary medical provider immediately Conduct child case management services within 5 working days Ensure coordination of long-term services and retesting Arrange for testing of all children in the home under 7 Conduct a home visit Provide an environmental inspection and an environmental investigation within five 5 days for pre 1978 dwellings

15. 45 – 69.9 µg/ dL…. …. forty five (45) and sixty nine and nine-tenths (69.9)  g/dL …. Notify the child’s primary medical provider immediately Conduct child case management services within 5 days Conduct chelation therapy, follow up venous test after 1 month Ensure coordination of long-term services and retesting Test all children in the home under 7 years old Conduct a home visit Environmental inspection and an environmental investigation within 2 working days for pre 1978 dwellings

16. 70 or µg/ dL or greater…. …. Seventy (70)  g/dL or greater…. Notify the child’s primary medical provider immediately Begin child case management services within 5 working days Conduct inpatient chelation therapy, follow up venous test after 1 month Treat child’s condition as a medical emergency Ensure coordination of long-term services and retesting Arrange for testing of all children in the home under 7 years old Conduct home visit Provide environmental inspection and an environmental investigation within five (2) working days for pre 1978 dwellings

17. >Services< A case manager should schedule an appointment with the child’s caregiver as soon as possible after being assigned the case. Where feasible, priority should be given to children with the highest BLLs and those less than two (2) years of age.

18. Initial Home Visit From Receipt Of BLL Test Result BLL (µ g/dL) Time frame /Home visit 10 – 14.9 Within 10 working days 15 – 15.9 Within 5 working days 20 – 44.9 Within 5 working days 45 – 69.9 Within 24 hours >70 Immediately If the caregiver does not have a telephone nor is at home. Leave information at door.

19. Home Visit 410 IAC 29-1-6 (2) (C) A medical, developmental, and behavioral history. Lead education, including medical effects and environmental sources. A determination of potential household exposures. An evaluation of the risk of other family members, including pregnant women. A nutrition assessment or referral for nutrition assessment. A developmental assessment or referral for developmental assessment. Referrals to other social services as appropriate.

20. Case Management Plan The case manager is responsible for developing and implementing a written management plan based on the needs assessment done at visits to the child’s home and other sites where the child spends significant amounts of time. Although all cases require a minimum of two home visits, additional visits are often necessary. Caregivers should be involved!

21. Coordination of Care * Case manager is responsible for coordinating care and ensuring all team member stay in communication and work together. * Need not directly provide all follow-up care, but are responsible that needed care is provided. * Should follow up on referrals of other problems identified during the child’s care.

22. Who and Whom An environmental inspector should also visit the child’s residence, with the case manager if possible, to conduct a thorough investigation of the site and identify sources of environmental lead exposure.

23. Case Closure…. It often takes an extended period of time to complete all the elements in a case management plan. All lead hazards have been eliminated. Appropriate long term developmental follow-up. Administratively closed.

24. Case Closure 410 IAC 29-2-4  Child has 2 confirmed tests less than 10 μg/dL in a six (6) month period  “Administratively closed” the child moves to another state (referral) the child moves to another county in Indiana (referral) child reaches his or her seventh birthday (referral) the child can no longer be located (5 attempts) case management is blocked for religious or legal reasons death of the child