Approve and authorize: (1) the Chairman to sign a retroactive amendment to the California Department of Public Health Agreement #14-10052, increasing revenue by $47,305 (from $157,641 to $204,946) for the period July 1, 2014 through June 30, 2017; and (2)  The Health and Human Services Agency (HHSA) Director, or HHSA Branch Director, to sign prospective and retroactive minor amendments during the term of the agreement that result in a net change in compensation of no more than $41,000, and other documents related to the agreement (including retroactive) that do not result in a substantial or functional change to the original agreement in compliance with Administrative Policy 6-101, Shasta County Contracts Manual.

Approval of the First Amendment with the California Department of Public Health (CDPH) will allow HHSA-Public Health to receive additional funds and comply with the new lower blood lead level thresholds as established July 1, 2016 by CDPH.  The change in these thresholds allows for services to be provided to more children exposed to lead, further preventing the effects of lead poisoning on children’s development, thus the increase in compensation.

While childhood lead poisoning has declined in the United States over the past 20 years, it continues to be an important health problem.  It is most harmful to children under age six because it is easily absorbed into their growing bodies, and interferes with the developing brain and other organs and systems.  Lead exposed children tend to display learning and behavior problems.  High levels may even cause retardation and death.  Pregnant women and women of childbearing age are also at increased risk because lead ingested by the mother can transfer to the fetus. According to the Centers for Disease Control and Prevention (CDC), there is no safe level of lead in the body; the results are irreversible, and preventing lead poisoning in a child can prevent learning and behavioral issues in teens and adults and decrease school drop-out rates and aggressive behavior.

California Health and Safety Codes established the Childhood Lead Poisoning Prevention Program (CLPPP)   to address childhood lead poisoning.  California Department of Public Health (CDPH) has provided funding to Shasta County since Fiscal Year (FY) 1999-00 to reduce childhood lead exposure by gathering and analyzing information, providing outreach and education, coordinating medical follow-up, and identifying potential lead sources in an exposed child’s environment.  During the next three years, local strategies for decreasing exposure and incidence of childhood lead poisoning will continue to include:  Improved detection of lead-poisoned children by assuring that at-risk children receive blood lead screening tests at an appropriate age; Maintenance of a surveillance system for lead levels in children; Providing outreach and education to families of high risk children in conjunction with other Public Health Programs such as Maternal, Child and Adolescent Health (MCAH), Supplemental Nutrition Program for Women, Infants, and Children (WIC), and Child Health and Disability Prevention Program (CHDP), and through community agencies such as Shasta Head Start and other caregivers; Providing lead education materials to agencies that enforce housing and building standards in an effort to support lead reduction in older housing; and Providing case management activities to families of children identified as having elevated blood lead levels.

On July 1, 2016 California lowered the blood lead level in the definition of a child with elevated blood levels, increasing our opportunity to intervene and prevent or lower the risk of developmental problems.  The standard was lowered from one single Blood Lead Level (BLL) measurement of 20 micrograms of lead per deciliter of blood (mcg/dL) or higher, or two consecutive BLL measurements of 15 mcg/dL or higher to a single blood lead level (BLL) higher than 14.5 mcg/dL or persistent BLLs higher than 9.5 mcg/dL.  This will increase the number of children that receive case management services from two to about ten cases per year based on historical data. Additionally, children with BLL of 4.5 mcg/dL or higher will receive interventions appropriate for their measured lead exposure. These interventions include activities ranging from health education about nutrition, reminders to re-screen, and could include environmental investigation and public health nurse case management. This change is in response to evidence showing that BLL as low as 5 mcg/dL contributes to adverse outcomes in neurodevelopment including an association with ADHD, speech, language and cognitive deficiencies. We have no historical data to estimate the numbers of children with BLL of ≥ 4.5 to 14.4 who will be receiving basic graded intervention.  This increased funding will allow us to provide services to a larger number of children with lower levels of lead exposure and prevent or lower the risk of developmental problems.

Minor adjustments to this agreement may be necessary to most effectively implement the proposed activities.  An efficient way to make these modifications is to authorize the Director of Health and Human Services or Branch Director to sign amendments for budget modifications in an amount to not exceed $41,000 or minor program changes based on the needs of the target population.

Alternatives include not approving the First Amendment to the agreement with CDPH, or not authorizing the HHSA Director or a Branch Director to sign future amendments. 

HHSA-Public Health will continue collaboration with Environment Health, local health care providers, City of Redding Housing Authority, Shasta County Housing Authority, Shasta Head Start, as well as public and private social services agencies to carry out local childhood lead poisoning prevention activities.  County Counsel has approved the amendment as to form.  Risk Management has reviewed and approved the amendment.  The recommendation has been reviewed by the County Administrative Office.

This funding is a mix of State and Federal Title XIX Matching Funds.  Funding for this agreement is included in the FY 2016-17 Adopted Budget.  There is no additional General Fund impact with approval of the recommendation.