RHODE ISLAND RECIPES FOR FAMILY HEALTH

“Information is a product not a possession”

Peter Simon,MD,MPH, Assist. Medical Director

RI Department of Health

KIDSNETKIDSNET

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)

KIDSNETKIDSNET

 RI Recipe for Improving

Outcomes for Families and Communities Children

 I. Examples of success

II. IngredientsIII.Directions

IV Tips

Childhood Lead Poisoning Prevention Program Partners

DOEDHS

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- OccupiedHousing

Post-1978 Housing

LHML Visual Assessment

Finds LHFixes LH

No LH found

Hires inspector

PASSES

CoC

PO gets tech. help

PO gets $$ help

PO attends LHA seminar

Lead-FreeAssumed, unless proven otherwise

Child has significantly EBLL

Inspection offeredAccepted Inspection

PASSES Lead-Safe/ Lead-Free

LH Found

If child presents with EBLL, process is same as above

1st NoV issued

Home abated

Clearance Inspection

Case Closed

Public List

2nd NoV

Public List

LitigateRefused 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-1978

--- 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 24-26 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

44%

80%82.5% 87%

0

50

100

MCOs* RICLPPPs(prior toeffort)

Naturalincrease

After effort

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 HearingAssessment Program

Early Intervention

Lead Prevention

Newborn Blood Spot

WIC:Special

Supplemental Nutrition

Program for Women, Infants

and Children

Birth Defects

Newborn Developmental Risk

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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 Report of the

Committee on Evaluation of Children’s HealthCommittee 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 A New Model of Children ‘s Health and Its InfluencesInfluences