1. Michele Borgialli, MPH, MSW EBL Environmental Investigations

2. EBL Environmental Investigation Certification and Protocol History  First EBL protocol - 2004  Became Michigan law in 2005  EBL certification required to respond to a child lead poisoning case to identify the sources of poisoning  Certification test – since 2006  Risk Assessor cert prerequisite  Mostly local health department staffers  Infrequent communications  Identified lead program gap to address

3. What are we doing about it?  Surveying Environmental Investigators June 2009June 2009 Sent out 80 surveysSent out 80 surveys 23 are inactive (retired, switched jobs)23 are inactive (retired, switched jobs) 25 respondents (44% response rate)25 respondents (44% response rate) Continue to follow up w/ non-respondersContinue to follow up w/ non-responders

4. Investigator Survey Content  Frequency of service  Investigator behaviors – sampling, XRF usage, communications  Technical proficiency – training, computer skills  Protocol and EBL report improvements  Assistance and training needs from MDCH  General feedback to MDCH

5. What else are we doing about it?  Technical assistance communications 2008 – 162008 – 16 2009 to August – 172009 to August – 17  Field consultations – on-site training 2008 – 32008 – 3 2009 to August – 42009 to August – 4  Full EBL Environmental Investigations 2008 – 172008 – 17 2009 to August – 62009 to August – 6  EBL Report Reviews and Feedback 2008 – 32008 – 3 2009 to August - 42009 to August - 4

6. That’s nice…anything else?  George Williams Analyzing monthly reporting and MDCH Lead Lab data – sampling trendsAnalyzing monthly reporting and MDCH Lead Lab data – sampling trends Requesting specific EBL reports for courtesy review and feedbackRequesting specific EBL reports for courtesy review and feedback  Sampling quality/quantity  Occupancy use patterns  Completion of household questionnaire Contacting all EBL InvestigatorsContacting all EBL Investigators  George has his calendar today!

7. More Compliance Assistance  EBL report feedback Mostly by teleconferenceMostly by teleconference Some by site visit, requested by either partySome by site visit, requested by either party Rarely by comparison inspectionRarely by comparison inspection  On-site field or office consultation  Telephone/email consultation  MDCH XRF Quick-Loan  Voluntary Meeting – Dec 7, 8, or 9  Mandatory Meeting – March 2010

8. Goals to Shoot For…  Respond to everyone who requests compliance assistance  Revise the EBL report and update protocol  Increase communications with local health departments  Respond to EBL survey needs assessment  Transition from compliance assistance to enforcement focus by March 2010  Increase the Medicaid reimbursement rate from $200 to $800

9. Who you gonna call? George Williams 989.430.0085 WilliamsG10@mi.gov Michele Borgialli 517.335.8948 borgiallim@mi.gov