What is CLPER?
CLPER is a volunteer-based model program for the application of temporary, lead based paint hazard controls interim controls to the residences of lead poisoned children as soon as possible after medical diagnosis, preferably within 48 hours.
CLPER believes that interim control of residential lead-based paint, under existing Medicaid law, may be defined as a medical intervention, in the same way that chelation therapy and case management of elevated BLL children are defined. As such, interim controls should be a covered medical expenses. CLPER believes that interim controls should be applied by workers and supervisors, trained and permitted according to federal and state law, and that companies engaged in interim controls ought to be certified lead abatement contractors.
CLPER does not believe that interim controls are a substitute for lead-based paint abatements, the permanent elimination of lead hazards.
Click here to read about CLPER's mission to develop a community-based program, Putting the Child First, to respond on an emergency basis to the contaminated residences of lead-poisoned children.
Background and Need
The most recent National Health and Nutrition Examination Survey (NHANES III) clearly establishes that federal policy controlling lead exposure from gasoline emissions, pesticide use, drinking water and food, have been wonderfully successful in reducing blood lead levels in most children and adults. Average lead Blood Lead Levels (BLLs) are down from 12.8 mcg/dL during 1976-1980 to 2.9mcg/dL during 1988 to 1991 according to NHANES III, Phase 1. NHANES III, Phase 2 (conducted during October 1991-September 1994) shows continued progress.
Unfortunately, it also shows the continuation of the trend that BLLs of children aged 1-5 years are more likely to be elevated among those who are poor, non-Hispanic black, living in large metropolitan areas [>1 million] or living in older housing. For example, when compared with children in other categories, the risk for an elevated BLL was higher among non-Hispanic black children in low-income households who lived in housing built before 1946 (21.9 %) or built during 1946-1973 (13.7%), among children in areas with populations greater than or equal to 1 million who live in housing built before 1946 (11.5%). Overall, NHANES III data indicate that nearly 1 million children aged 1-5 years had elevated BLLs during 1991-1994.
Three fourths of all children aged 1-5 with elevated BLLs were enrolled in or targeted by Federal health care programs, specifically Medicaid, the women, infants, and children (WIC) program, and community health centers authorized under the public Health Service Act. This is important information in evaluating the potential of interim controls to address the scale of the problem. Sixty percent of lead poisoned children are Medicaid eligible. And eighty percent of children with blood lead levels =>20 mcg/dL are Medicaid eligible.
Childhood Lead Poisoning in New Jersey
Childhood lead poisoning in New Jersey's major urban centers is consistent with NHANES III data. For calendar year 1996, for example, in the city of Newark alone the number of children diagnosed with Blood Lead Levels 20 mcg/dL or more was 662. Statewide, the number of children diagnosed with lead blood lead levels requiring environmental intervention was approximately 2500. Surprisingly, since the enactment of Universal Screening in NJ the number of screenings has actually declined.
At present, there is little good data on the number of residences which are finally abated and the time it takes from inspection to abatement. What is certain is that, statewide, the number of residences abated in conformity with New Jersey law is a small fraction of the residences identified as contributing to lead poisoning.
In calendar year 1997, for example, approximately 250 residential lead abatement jobs were notified to the Department of Community Affairs for all the state. This figure is borne out by the NJ DOHs Annual Report on Lead Poisoned Children for 1998. DOH reports that 2030 AP6 forms were sent to Local Health Departments, that these resulted in 1622 environmental investigations, of which 1027 were completed. In 701 cases lead abatement of the residence was required. Of these, 251 were actually abated, representing 36% of the residences requiring abatement. No data is available for the length of time it took for these 251 abatements to take place from the date of diagnosis. No data is available for the disposition of the 64% of the units which did not apparently receive legally required abatement.
Whether the children who were poisoned by these residences finally had reduced BLLs would almost exclusively depend on the quality of case management and its reporting. If case management is comprehensive, then an intractable BLL would result in the issuance of another AP 6 the following year. Unfortunately, statistical data does not exist on the quality of case management. So there is no accurate way to assess what percentage of elevated BLL children finally have levels reduced to < 10 mcg/dL.
Under NJ law "abatement" is understood to mean the comprehensive and permanent control of lead based paint both in the interior and exterior of the residence. Abatement, more often than not, does not take place for many months after medical diagnosis and the municipal inspection of the residence. Lead abatement is now a regulated industry in the state and despite the fact that lead poisoning affects all socio-economic groups to some degree, childhood lead poisoning remains a disease of urban and rural poverty. Lead abatement contractors do not come cheap. It is doubtful that an unsubsidized marketplace will ever provide an effective solution to childhood lead poisoning.
Thus the lead poisoned child is often left in an environment of continued exposure despite the efforts of the medical community and the local health departments to provide parents and landlords information on the usefulness of interim controls.
Interim controls, as distinguished from abatement controls, are by definition temporary, partial solutions to remediation of lead based paint hazards. Nonetheless, interim controls are capable of significantly reducing the burden of lead containing dust and paint chips during that period when abatement is either being planned voluntarily by the building owner or mandated through the municipal courts. At present there is no realistic mechanism by which interim controls can be expertly applied in a timely manner to the residence of a lead poisoned child. At best the parent(s) and building owners are informed about housekeeping procedures but are provided no real demonstration of the actual control techniques.
CLPER defines interim controls according to the HUD Guidelines For the reduction of Lead Based Paint, 1995 to include dust remediation, paint stabilization, reduction of friction surfaces, the alteration of occupant use patterns that result in the generation of lead dust, occupant education, and environmental monitoring. In addition, CLPER has developed a number of inexpensive, specialized control techniques. Subject to scientific verification, CLPER believes its interim control program, as applied by skilled, permitted workers, is capable of reducing a childs exposure to lead for a period of at least six months.
At the heart of this proposal is church and community volunteerism. Through the Newark Partnership for Lead Safe Children, CLPER has contacted several church and community based service organizations. These organizations have shown a willingness to convey to their constituencies the nature of the childhood lead poisoning problem and to enlist volunteers.
Volunteers would be trained in professional lead control techniques and agree to provide their labor on a volunteer basis. There are many for profit training centers with NJ Department of Health approved lead abatement courses, which have indicated their willingness to work with CLPER to provide the appropriate training. This training can lead to worker permitting by the NJ DOH, a state requirement for lead abatement work. Thus for some volunteers there might be the added incentive of receiving a lead worker permit and work experience that could result in commercial employment in the industry.
How CLPER Would Work
CLPER would set itself up as a Clearinghouse to take calls from the medical community or from the residents of dwellings where lead poisoned children were identified. Preference would be given to the children with the highest BLLs. CLPER would be responsible for organizing a crew of four trained and NJ DOH permitted volunteers who would spend 8-12 hours engaged in interim controls. CLPER Risk Assessor personnel would develop an interim control protocol for each residence.
These controls would include: dust remediation with TSP washing and HEPA vacuuming and paint stabilization. The work of the volunteer crew would be supervised by NJ DOH permitted Lead supervisors or inspector/risk assessors. All residences which have undergone interim control treatment would be tested by a certified lead abatement inspector/risk assessor to determine lead dust levels before and after treatment. BLLs of children occupying these treated residences would be tracked through case management, providing assurance of the continued efficacy of the program.
There is every expectation that the application of interim controls would prove an effective tool in the reduction of children's elevated blood lead levels which have resulted from residential exposure to lead based paint and lead containing dust. In January of 1997, a study was conducted under the auspices of Rutgers University which identified a number of Jersey City children with blood lead levels between 10 and 19 mcg/dL of blood. Regular and precise cleaning methods were applied to the residences of these children by trained workers.
The CLEER study proves that blood lead levels may be reduced by as much as 34% through regular home cleaning. CLPERs interim controls which go far beyond cleaning ought to produce even superior results.
Goals of the Program
The primary goal of the program should be to establish a Model Program for the Application of Interim Controls to the Residences of Lead Poisoned Children. The number of residences treated with interim controls would be extremely limited, in relation to the number of residences identified as needing treatment, at the startup phase of the program. The goal is to establish a model, efficiently running program based upon a volunteer effort.
Concurrent with the development of the Model Program funding should be sought from CDC and private foundations to continue and expand the effort. The scientific demonstration of the programs effectiveness will assure the acceptance of interim controls as reimbursable under Medicaid.