DATE: August 23, 2016
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Retroactive Amendment to Agreement with the California Department of Public Health Childhood Lead Poisoning Prevention Program
RECOMMENDED ACTIONS:
TITLE
1. Approve and authorize the Chairman to execute retroactive Amendment I to Agreement No. 14-646 with the California Department of Public Health, an increase of $361,556, for the Childhood Lead Poisoning Prevention Program, effective July 1, 2016, increasing the maximum for the three-year term of July 1, 2014 through June 30, 2017 ($3,466,810).
2. Adopt a Budget Resolution increasing the FY 2016-17 appropriations and estimated revenues in Public Health Org 5620 in the amount of $121,666 (4/5 vote).
3. Approve Amendment to the Salary Resolution (Appendix C), adding one (1) Environmental Health Specialist and one (1) Health Education Specialist to the Public Health Org 5620, effective August 29, 2016.
REPORT
Approval of the recommended actions will allow the Department of Public Health to utilize additional California Department of Public Health (CDPH) funding to provide enhanced case management, environmental assessment services to children with lead poisoning at the State defined lower blood lead levels, and increase community health education. The added Childhood Lead Poisoning Prevention Program monies will add two positions and offset existing Health Realignment funded positions in the Department to assist with implementation of the new requirement and related services and supplies.
ALTERNATIVE ACTION:
There are no viable alternative actions. Should your Board not approve the recommended actions, funding will not be fully utilized and would be returned to the State. Children identified under the newly approved limits or at risk of lead poisoning in the County would receive the same level of service under the previous guidelines; however, additional children under the new lower threshold would not be addressed under the new criteria.
RETROACTIVE AGREEMENT:
The draft budget Amendment was received from CDPH on June 7, 2016 as part of the State FY 2016-17 Budget. The State Budget was signed by Governor Brown on June 27, 2016 and confirmation was received from the State on July 13, 2016. This recommended Amendment is retroactive to July 1, 2014.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The Agreement increases funding ($361,556) in year three of the approved contract. The maximum compensation for FY 2016-17 is $1,394,936; $3,466,810 for the term. The total full year cost of the requested new positions for salaries and benefits include $73,269 for the Environmental Health Specialist and $70,516 for a Health Education Specialist; the total for the remainder of FY 2016-17 will be $121,666 ($61,998 for the Environmental Health Specialist and $59,668 for the Health Education Specialist). Approval of the second recommended action will increase the FY 2016-17 adopted appropriations and estimated revenues in the Public Health Org 5620 by $121,666 to fund the positions for the remainder of the fiscal year. The remaining amount of the increase ($239,890) will be used to fund increased services and supplies for outreach and to offset existing realignment funded positions in implementing the new requirement. Sufficient appropriations and estimated revenues are already included in the FY 2016-17 adopted budget of the Public Health’s Org 5620 for the remaining amount. The Agreement also limits indirect cost recovery to 15 percent of salaries and benefits, so the remaining indirect costs ($18,323) will be covered by Health Realignment.
DISCUSSION:
The County has received State funding for the Childhood Lead Poisoning Prevention Program (CLPPP) case management, environmental and surveillance activities since 1991. On October 28, 2014, your Board approved Agreement No. 16-646 with the California Department of Public Health for the Childhood Lead Poisoning Prevention Program. The mission of the State and Department of Public Health Childhood Lead Poisoning Prevention Program is to eliminate childhood lead poisoning by identifying and caring for lead burdened children and preventing environmental exposures to lead. No safe blood lead level for children has been identified. Lead is a highly toxic heavy metal that affects virtually every system in the body when ingested. Children, especially those under age six, are at greatest risk for lead poisoning. The neurological effects of lead poisoning are permanent; while treatment can reduce blood levels, it cannot reverse the harmful effects of the poisoning. In a young child, this can result in life-long learning and behavioral disabilities.
The recommended Amendment includes the amended language from the Childhood Lead Poisoning Prevention Branch (CLPPB) with CDPH in the Scope of Work to reflect changes in the definition of child lead-exposure and child lead-poisoning. The recommended changes include:
• case management to children identified in the lower blood lead levels;
• environmental investigation to homes of children in the lower blood lead levels;
• higher surveillance of children with a blood lead level greater than 4.5 ug/dL (micrograms/deciliter); and,
• increased public education on lead.
Over 20,000 adults and children are routinely screened for lead in the County annually. The County CLPPP monitors on average 4.5% of those cases, as they fall at or above the blood lead level required for intervention. The requested additional staff to manage the added lower blood lead level burdened children will allow the County to intervene earlier in the exposure period to provide education, environmental assessment and lead identification, and to decrease the potential detrimental effects of lead poisoning.
Department discussions with CLPPB have been on-going for implementation of the contract changes in year three of the contract. CLPPB has indicated that the scope of work and funding changes will extend into future contracts.
With your Board’s approval, the salary resolution amendment will add one (1) full time Health Education Specialist (HES) to support education in the home for parents of children exposed to lead. The HES will also educate families on how to minimize exposure to lead and the consequences of lead poisoning. This work will be done under the direction of a Public Health Nurse. Additionally, one (1) additional Environmental Health Specialist (EHS) will support the environmental investigations for newly identified cases. The EHS will sample and test possible lead exposure with testing equipment. Where high levels of lead are found, the EHS will work with the property owners and contractors to have the lead exposure reduced by removing it or rendering it inert.
The CLPPP is being awarded additional funds to provide increased surveillance and case management of children exposed to lead. Without approval from the Board, these children will not receive the increased level of intervention as other children in the State of California.
REFERENCE MATERIAL:
BAI #55, October 28, 2014, Agreement No. 16-646
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I with CDPH for CLPPP
On file with Clerk - Budget Resolution
On file with Clerk - Salary Resolution Amendment (Appendix C)
CAO ANALYST:
Sonia De La Rosa