Form 0920-1215 Awardee Lead Profile Assessment (ALPH) Email Survey (MS

Awardee Lead Profile Assessment (ALPA)

Att4b ALPA Email Survey 20200928

Awardee Lead Profile Assessment (ALPA) Email Survey (MS WORD)

OMB: 0920-1215

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Attachment 4b


Awardee Lead Profile Assessment (ALPA) (Email Survey – MS Word)


Form Approved

OMB No. 0920-1215

Expiration Date 02/28/2020

Below is the Centers for Disease Control and Prevention’s (CDC) annual assessment for state and local childhood lead poisoning prevention programs (CLPPPs).

You have been asked to take part in this assessment as a state or local public official operating in your official capacity as decision-maker within a CLPPP.

The purpose of the assessment is to identify 1) jurisdictional legal frameworks governing CDC-funded CLPPPs in the United States, and 2) strategies for implementing childhood lead poisoning prevention activities in the United States.

This information collection will allow the CDC CLPPP to identify specific factors that may support or hinder the efforts of public health agencies engaged in lead poisoning prevention. The information collection will inform guidance, resource development, and technical assistance activities the CDC CLPPP conducts in support of the ultimate goal of lead elimination. Assessment findings will be shared with key stakeholders, placed on CDC’s CLPPP website, and used to respond to inquiries by the public, media, and Congress.

The data will be kept secure throughout the analysis and reporting process.

This assessment should take no more than 47 minutes to complete. You may stop taking the assessment and finish it at a later time. To re-enter the web survey, the tool will provide you with a unique link and passcode for return access. Please refer to the Awardee Lead Profile Assessment (ALPA) training manual for instructions on answering each question. Each text box has a character limit of 200 characters.

Please complete the assessment by [SPECIFIC DATE TO BE PROVIDED – 2 WEEKS AFTER THE SURVEY IS SENT OUT].

Participation is required for satisfactory performance. No individually identifiable information will be requested.

If you have programmatic questions, you can contact CDC CLPPP via your Project Officer.

  1. Please choose one option below to continue:

ᴏ I agree to participate in the assessment.

ᴏ I do not agree to participate in the assessment. (END OF ASSESSMENT)


CDC estimates the average public reporting burden for this collection of information as 47 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1215).




Section 1: Program Information

  1. Program Title (ex. State Childhood Lead Poisoning Prevention Program)

Shape1





  1. City of Program Headquarters

Shape2





  1. State of Program Headquarters

Shape3



Section 2: State Program Legal Governance


a. Does your jurisdiction have state legislation mandating blood lead screening and/or testing for:

b. What strategy is the mandate based on?

c. Please specify the ages covered by your jurisdiction’s legislation.

  1. a. Medicaid-enrolled children?


Yes

No (skip to question 6a)

Unknown (skip to question 6a)

5b.

Universal screening and/or testing

Targeted screening and/or testing

Both universal and targeted screening and/or testing

Other; please specify:

_____________________________


5c.

All ages are covered

A select age range is covered, with the maximum age covered being: _____________________________

Unknown


  1. a. non-Medicaid-enrolled children?


Yes

No (skip to question 7a)

Unknown (skip to question 7a)

6b.

Universal screening and/or testing

Targeted screening and/or testing

Both universal and targeted screening and/or testing

Other; please specify:

_____________________________

6c.

All ages are covered

A select age range is covered, with the maximum age covered being: _____________________________

Unknown


  1. a. pregnant women?


Yes

No (skip to question 8)

Unknown (skip to question 8)

7b.

Screening only

Testing only

Both screening and testing

Other; please specify:

_____________________________



  1. Does your jurisdiction have state legislation mandating the existence or operation of a childhood lead poisoning prevention program?

Yes

No; it is allowed but not mandated

No; it is not allowed

Unknown



  1. Does your jurisdiction have a state reporting law for blood lead levels?

Yes

No (skip to question 10)

Unknown (skip to question 10)

9a. Please specify the ages covered by your jurisdiction’s legislation

All ages are covered

A select age range is covered, with the maximum age covered being: _______________________

Unknown

9b. Please specify which blood lead levels are required to be reported. (Select one)

All blood lead levels

Blood lead levels 5 µg/dL

Blood lead levels 10 µg/dL

Blood lead levels 15 µg/dL

Blood lead levels 20 µg/dL

Blood lead levels 45 µg/dL

Blood lead levels 70 µg/dL

Unknown


  1. Does your jurisdiction have a state electronic reporting law?

Yes

No; electronic reporting is allowed but not mandated

No; electronic reporting is not allowed

Unknown



  1. Does your jurisdiction have a state lead paint abatement and/or remediation law(s)?

Yes

No (skip to question 12)

Unknown (skip to question 12)

11a. What strategy(s) is the law(s) based on? (Select all that apply)

Regulations regarding the type of building/facility (e.g. childcare centers, Section 8 housing, rental properties, etc.)

Regulations regarding the condition of the building/facility (e.g. pre-1978, 2 square feet of deteriorating paint, etc.)

Regulations regarding contractors and/or workers that perform abatement

Other; please specify:__ _________________________________________________________________


11b. What triggers the law(s)? (Select all that apply)

Presence of children

Blood lead level

Other; please specify:__________________________________________________________________________

11c. Please specify which age range triggers the law(s). (Select one)

Children 1 years of age

Children 2 years of age

Children 3 years of age

Children 6 years of age

Children 16 years of age

N/A

Other; please specify:___________________________________________________________________

11d. Please specify which blood lead levels trigger the law(s). (Select one)

All blood lead levels

Blood lead levels 5 µg/dL

Blood lead levels 10 µg/dL

Blood lead levels 15 µg/dL

Blood lead levels 20 µg/dL

Blood lead levels 45 µg/dL

Blood lead levels 70 µg/dL

N/A

Section 3: Local Program Legal Governance

  1. Are you a local health department or their bona fide agent?

Yes

No (skip to section 4, question 21)



  1. Do any of your jurisdiction’s local legislations regarding childhood lead poisoning prevention differ from your state legislations?

Yes

No (skip to section 4, question 21)



  1. Does your jurisdiction have local legislation mandating blood lead screening and/or testing for:

  1. What strategy is the mandate based on?

  1. Please specify the ages covered by your jurisdiction’s legislation.

  1. a. Medicaid-enrolled children?


Yes

No (skip to question 15a)

Unknown (skip to question 15a)

14b.

Universal screening and/or testing

Targeted screening and/or testing

Both universal and targeted screening and/or testing

Other; please specify:

_____________________________

14c.

All ages are covered

A select age range is covered, with the maximum age covered being: _____________________________

Unknown


  1. a. non-Medicaid-enrolled children?


Yes

No (skip to question 16a)

Unknown (skip to question 16a)

15b.

Universal screening and/or testing

Targeted screening and/or testing

Both universal and targeted screening and/or testing

Other; please specify:

_____________________________

15c.

All ages are covered

A select age range is covered, with the maximum age covered being: _____________________________

Unknown


  1. a. pregnant women?


Yes

No (skip to question 17)

Unknown (skip to question 17)

16b.

Screening only

Testing only

Both screening and testing

Other; please specify:

_____________________________




  1. Does your jurisdiction have local legislation mandating the existence or operation of a childhood lead poisoning prevention program?

Yes

No; it is allowed but not mandated

No; it is not allowed

Unknown



  1. Does your jurisdiction have a local reporting law for blood lead levels?

Yes

No (skip to question 19)

Unknown (skip to question 19)

18a. Please specify the ages covered by your jurisdiction’s legislation

All ages are covered

A select age range is covered, with the maximum age covered being: ___________________________________

Unknown

18b. Please specify which blood lead levels are required to be reported. (Select one)

All blood lead levels

Blood lead levels 5 µg/dL

Blood lead levels 10 µg/dL

Blood lead levels 15 µg/dL

Blood lead levels 20 µg/dL

Blood lead levels 45 µg/dL

Blood lead levels 70 µg/dL

Unknown



  1. Does your jurisdiction have a local electronic reporting law?

Yes

No, electronic reporting is allowed but not mandated

No, electronic reporting is not allowed

Unknown



  1. Does your jurisdiction have a local lead paint abatement and/or remediation law(s)?

Yes

No (skip to question 21)

Unknown (skip to question 21)

20a. What strategy(s) is the law(s) based on? (Select all that apply)

Regulations regarding the type of building/facility (e.g. childcare centers, Section 8 housing, rental properties, etc.)

Regulations regarding the condition of the building/facility (e.g. pre-1978, 2 square feet of deteriorating paint, etc.)

Regulations regarding contractors and/or workers that preform abatement

Other; please specify:__________________________________________________________________________

20b. What triggers the law(s)? (Select all that apply)

Presence of children

Blood lead level

Other; please specify:__________________________________________________________________________

20c. Please specify which age range triggers the law(s). (Select one)

Children 1 years of age

Children 2 years of age

Children 3 years of age

Children 6 years of age

Children 16 years of age

N/A

Other; please specify:___________________________________________________________________


20d. Please specify which blood lead levels trigger the law(s). (Select one)

All blood lead levels

Blood lead levels 5 µg/dL

Blood lead levels 10 µg/dL

Blood lead levels 15 µg/dL

Blood lead levels 20 µg/dL

Blood lead levels 45 µg/dL

Blood lead levels 70 µg/dL

N/A


Section 4: Program Surveillance and Prevention Strategy

  1. For the following populations, does your jurisdiction practice a blood lead screening and/or testing strategy that is different from your jurisdiction’s mandate?

  1. How does your jurisdiction’s practiced blood lead screening and/or testing strategy differ from your jurisdiction’s mandate? (Select all that apply)

  1. What barriers does your jurisdiction face when practicing blood lead screening and/or testing strategies? (Select all that apply)

  1. a. Medicaid-enrolled children less than 6 years (72 months) of age?


Yes

No (skip to question 22a)

Unknown (skip to question 22a)


21b.

Specific interventions are triggered at a lower blood lead level than what is mandated

Specific interventions are triggered at a higher blood lead level than what is mandated

Focus is on targeting younger children

Other; please specify:

_____________________________

21c.

Resources for childhood lead poisoning prevention program

Resources for screening and/or testing

Working with providers

Education and/or outreach to providers

Education and/or outreach to public

Education and/or outreach to targeted populations

Accessing Medicaid program data

Other; please specify:

_____________________________

  1. a. non-Medicaid-enrolled children less than 6 years (72 months) of age?


Yes

No (skip to question 23)

Unknown (skip to question 23)

There is no mandate for non-Medicaid-enrolled children less than 6 years of age (skip to question 23)


22b.

Specific interventions are triggered at a lower blood lead level than what is mandated

Specific interventions are triggered at a higher blood lead level than what is mandated

Focus is on targeting younger children

Other; please specify:

_____________________________

22c.

Resources for childhood lead poisoning prevention program

Resources for screening and/or testing

Working with providers

Education and/or outreach to providers

Education and/or outreach to public

Education and/or outreach to targeted populations

Accessing Medicaid program data

Other; please specify:

_____________________________


Section 5: Primary Prevention Strategy

  1. Does your childhood lead poisoning prevention program conduct any of the following primary prevention activities? (Select all that apply)

Link families with young children at high risk for lead poisoning to housing inspection and environmental intervention resources before a child’s blood lead level becomes elevated

Evaluate lead-safe housing status of the community by conducting systematic environmental investigation activities (such as lead dust wipes, visual inspections, paint chip and soil analysis) based on the high-risk status of the housing (i.e. pre-1950 housing in poor condition), compiling those data in an electronic format, and developing an ongoing evaluation component

Have codified specifications for lead-safe housing treatments

Lead hazard identification has been incorporated into ongoing housing code or other inspections as a result of

partnerships with housing agencies

Assure that policy changes needed to promote childhood lead poisoning prevention and lead-safe environments are recommended and supported with data

Collaborate with other agencies and organizations and incorporate lead poisoning educational information into

other health, housing, and community services that reach high-risk families

Conduct family and community education that support primary prevention activities

Conduct professional health education, risk communication, and/or training activities to increase lead poisoning

prevention awareness

When a child is identified with an elevated blood lead level, require that environmental testing of adjacent units is conducted

Require that housing units identified previously as sources for lead exposure for child are prioritized for remediation

Lead-safe training sessions occur at least quarterly

Provide resources to help families reduce lead hazards in their homes

Require that all lead abatement contractors are certified and that all renovation and other contractors who work in pre-1978 housing are trained in lead-safe work practices

Replace lead service lines

None of the above



  1. Has your jurisdiction’s childhood lead poisoning prevention program developed a lead elimination plan or goal?

Yes

No (skip to question 25)

Unknown (skip to question 25)

24a. Does your jurisdiction’s lead elimination plan have any measures? (Select all that apply)

Quantifiable standard

Timeline for goals

Other; please specify:__________________________________________________________________________

None of the above

24b. Does your jurisdiction’s lead elimination plan include any of the following components? (Select all that apply)

Primary prevention plan

Testing and/or screening plan

CLPPP workplan

Laws/regulations and/or policy plan

Other; please specify:__________________________________________________________________________

None of the above



  1. Does your jurisdiction’s childhood lead poisoning prevention program target high-risk areas and/or populations?

Yes; Our jurisdiction targets both high-risk areas and populations

Yes; Our jurisdiction targets only high-risk areas

Yes; Our jurisdiction targets only high-risk populations

No

Unknown



  1. Does your jurisdiction publish GIS maps of high-risk areas and/or populations for public use?

Yes, GIS maps of both high-risk areas and populations are published

Yes; GIS maps of only high-risk areas are published

Yes; GIS maps of only high-risk populations are published

No

Unknown

Section 6: Program Services


Section 4: Program Services Answer Key

I: 5 µg/dL

II: 10 µg/dL

III: 15 µg/dL

IV: 20 µg/dL

V: 45 µg/dL

VI: ≥70 µg/dL

VII: Not applicable


At what confirmed blood lead level do you initiate the following actions according to your jurisdiction’s case definition for elevated blood lead level for children less than 6 years (72 months) of age?

  1. Administrative

Action

Mandated

Blood Lead Level

Practiced

Blood Lead Level

Phone call

27a. ___________

27b. ___________

Mail letter and/or brochure

27c. ___________

27d. ___________

Refer patient for services

27e. ___________

27f. ___________

Begin coordination of services

27g. ___________

27h. ___________

  1. Assessment and Remediation of Residential Lead Exposure

Action

Mandated

Blood Lead Level

Practiced

Blood Lead Level

Inspection of the child’s home and other sites

28a. ___________

28b. ___________

Obtain a history of the child’s exposure to potential lead hazards

28c. ___________

28d. ___________

Measure environmental lead levels in the home and other sites

28e. ___________

28f. ___________

Educational interventions to reduce ongoing exposure

28g. ___________

28h. ___________

Abatement interventions to reduce ongoing exposure

28i. ___________

28j. ___________

  1. Medical Assessment and Interventions

Action

Mandated

Blood Lead Level

Practiced

Blood Lead Level

Caregiver lead education (nutritional and environmental)

29a. ___________

29b. ___________

Follow-up blood lead monitoring and testing

29c. ___________

29d. ___________

Complete history and physical exam

29e. ___________

29f. ___________

Complete neurological exam

29g. ___________

29h. ___________

Labwork (e.g. hemoglobin or hematocrit, iron status)

29i. ___________

29j. ___________

Temporary measures for lead hazard reduction

29k. ___________

29l. ___________

Permanent measures for lead hazard reduction

29m. __________

29n. ___________

Neurodevelopmental monitoring

29o. ___________

29p. ___________

Abdominal x-ray with bowel decontamination

29q. ___________

29r. ___________

Chelation therapy

29s. ___________

29t. ___________

  1. Nutritional Assessment and Interventions

Question

Mandated

Blood Lead Level

Practiced

Blood Lead Level

Diet evaluation

30a. ___________

30b. ___________

Referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

30c. ___________

30d. ___________

Referral to nutritionist

30e. ___________

30f. ___________

  1. Developmental Assessment

Question

Mandated

Blood Lead Level

Practiced

Blood Lead Level

Conduct developmental assessment

31a. ___________

31b. ___________

Refer for diagnostic evaluation for neurodevelopmental issues

31c. ___________

31d. ___________

Refer for early intervention/stimulation programs

31e. ___________

31f. ___________


  1. Are any of these actions implemented by all or some local health departments rather than at the state health department level?

Phone call

Mail letter and brochure

Refer patient for services

Begin coordination of services

Caregiver lead education (nutritional and environmental)

Inspection of the child’s home and other sites

Obtain a history of the child’s exposure to potential lead hazards

Measure environmental lead levels in the home and other sites

Educational interventions to reduce ongoing exposure

Abatement interventions to reduce ongoing exposure

Follow-up blood lead monitoring and testing

Complete history and physical exam

Complete neurological exam

Labwork (e.g. hemoglobin or hematocrit, iron status)

Temporary measures for lead hazard reduction

Permanent measures for lead hazard reduction

Neurodevelopmental monitoring

Abdominal x-ray with bowel decontamination

Chelation therapy

Diet evaluation

Referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Referral to nutritionist

Conduct developmental assessment

Refer for diagnostic evaluation for neurodevelopment issues

Refer for early intervention/stimulation programs

None of the above (skip to question 34)



  1. Are action(s) implemented by the local health department at a different blood lead level than levels set by the state health department?

Yes, the actions are implemented at a lower blood lead level

Yes, the actions are implemented at a higher blood lead level

No, the actions are implemented at the same blood lead level



  1. Does your program receive Medicaid reimbursement for any of the following lead poisoning prevention related services? (Select all that apply)

Phone call

Mail letter and brochure

Refer patient for services

Begin coordination of services

Caregiver lead education (nutritional and environmental)

Inspection of the child’s home and other sites

Obtain a history of the child’s exposure to potential lead hazards

Measure environmental lead levels in the home and other sites

Educational interventions to reduce ongoing exposure

Abatement interventions to reduce ongoing exposure

Follow-up blood lead monitoring and testing

Complete history and physical exam

Complete neurological exam

Labwork (e.g. hemoglobin or hematocrit, iron status)

Temporary measures for lead hazard reduction

Permanent measures for lead hazard reduction

Neurodevelopmental monitoring

Abdominal x-ray with bowel decontamination

Chelation therapy

Diet evaluation

Referral to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)?

Referral to nutritionist

Conduct developmental assessment

Refer for diagnostic evaluation for neurodevelopment issues

Refer for early intervention/stimulation programs

None of the above











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