Iím Sue Heller and I run the Manchester Ct Lead Abatement Project (LAP). Thank you for inviting me to talk about lead. I am proud to be here in the presence of so many lead gurus who have directed their own energies and staff work toward lead solutions.
Senator Reed has scheduled the first lead hearing in 10 years, another milestone in his quest to end childhood lead poisoning in real time. Senator Reed has a proud lead legacy in bills, allocations, the Medicaid mandate and the national designation of Lead Week.
What better place to be, in a hearing where rank is accorded to Senator Wayne Allard, who represents Leadville. Today, we are all from Leadville.
CTís lead muse is Senator Christopher Dodd, a long-time champion of children, housing and Medicaid. Senator Joseph Lieberman provides Connecticut with ongoing knowledgeable, substantive support to the lead issue and to projects. Our Representative John Larson actively seeks out and disseminates successful lead measures through his district.
Manchester, as a HUD grantee is lucky to have the insightful effective leadership of David Jacobs the Director of HUDíS Office of Healthy Homes and Lead Hazard complemented by valuable counsel from Ellis Goldman and Stan Galik.
Special thanks to Nick Faar, at the National Center for Healthy Housing and Don Ryan of the Alliance to End Childhood Lead Poisoning who are constant mentors.
The Town of Manchesterís sound administrative infrastructure has benefited LAP through leadership from Mayor Stephen Cassano, longtime Health Director Ronald Kraatz, and Town Managers Richard Sartor and Steven Werbner among others. There has been non-partisan support from the legislature (kudos to Representatives David Blackwell and Jack Thompson), with help from the Governorís office, and officials from the State Departments of Public Health and Economic and Community Development.
On a day when thoughtful people around the world are preoccupied with national values, security and other imponderables, itís a comfort to be able to talk about a preventable soluble problem- childhood lead poisoning.
Visitors come to Connecticut to tour historic old homes. The strength of Ctís housing market is dependent on old and attractive housing, 1,113,000 housing units were built before 1980 and 462,000 built before 1950. It is estimated that nearly 500,000 carry some lead risk, 65,000 have real hazards.
Lead safe work practices are not universally used by CT construction workers or remodelers who work on older housing, which have more weather beaten wooden construction and wrap-around porches, than in other sections of the country. Whether remodelers call what they do lead work or not, lead is involved in construction or repair of old houses; the danger is that construction can create dust and risk , in the absence of lead -safe practices. And workers in some industries bring lead dust home from work on clothes or shoes particularly hazardous if they hug their children when they come home from work before they shower and change clothes.
While blood lead screening is increasing in the large cities, not enough testing is done and too few children are screened or tested at appropriate intervals. Smaller jurisdictions do less testing so children who have low lead levels without obvious symptoms are often not identified. Medicaid children are frequently not tested despite a federal Medicaid mandate
In 1999 alone, 2017 CT children (under six years of age) were found to have blood lead levels over 10 ug/dl, a recognized level of concern and 460 over 20 ug/dl, the level that usually defines poisoning. There are many additional children with elevations who were tested in other years or have never been tested at all.
Many of the Stateís 228,000 children under six years old and particularly the 31,399 in poverty or those Medicaid-eligible are vulnerable to lead poisoning. because they move frequently from one substandard house to another.
While State regulation obligates landlords to correct home environmental conditions when a child is poisoned at a blood lead level over 20 mg/dl, insufficient cash flow in low income housing deters compliance. There are few if any financial resources to remediate housing conditions for mildly poisoned youngsters, who are not covered by regulation. Recent studies indicate that children are more vulnerable to lower and lower levels of lead even under 10mg/dl, once thought to be the upper limit of safe exposure and that poisoning is likely to be irreversible (fortunately treatable ). Therefore prevention - primary and secondary - offers the only real solution to childhood lead poisoning.
Certainly it is cheaper for both the private and public sectors to maintain existing housing stock by treating a unit preventively for lead at $2500 to $5000 a unit, than to abate at $10,000 or to replace at over $100,000, a unit.
Connecticut responds to the prevailing lead problems of old housing, ignorance of lead safety, insufficient screening and a shortage of resources.
The Health Department delivers lead information to the public through training, and widely disseminated literature and videos . Manchester has piloted many training measures for the State: lead safe practices needed to meet 1012-13 regulation, CEU licensure in day care real estate brokerage and construction contracting. The New England Lead Coordinating Committeeís Keep It Clean Campaign, which promotes lead safe work practices, was born in Manchester CT and spread quickly though the State, and region, training personnel in paint and hardware stores to help customers to address lead hazards effectively.
Some jurisdictions have succeeded in winning lead grants but some of the most leaded areas have been unsuccessful at competing for scarce federal lead funding. (Bridgeport has the highest number of lead cases in the State.)
CT has built a local network to deal with lead using municipal Health Departments and doing quarterly in-service education. The court system has been pro-active in enforcing laws. Hartford, has begun to use post office resources to generate attention and resources from stamps and cancellation messages. Hartford has also an interactive reading program for beginning readers based on lead. CT has studied blood lead screening data comparing State wide data with Medicaid data, which points to the need for remediation in Medicaid households. There are two successful lead safe houses to serve the State for relocation. They are frequently full; the lead safe houses themselves require added resources to maintain their own code-compliant lead safe conditions.
Manchester has used the 325 dwellings abated with HUD lead money as laboratory cases to pilot innovations. We have moved closer to prevention by invoking 4 different levels of lead intervention, reducing average unit costs for abatement to less than $8000 from the $11,500 it cost us in 1997 (in a range of $1000 to $12,000 now). (Around the State costs are generally much higher, but will probably drop with experience). LAP generates local economic development by identifying and launching business opportunities presented by lead to local construction contractors, workers and suppliers. We have developed a local economic sector of the construction industry devoted to lead along with customized training for thousands of participants from various population groups, thereby building local capacity to deal with lead in many quarters.
Certified job training and placement has aided hundreds of construction workers, many underemployed or unemployed. We have used lead funds to trigger home ownership for 14 low income first-time home buyers affecting about 30 households. Manchester has been able to meet Town Community Development and housing affordability objectives as we spend HUDís abatement money. We combine Community Development Block Grant funds (CDBG) and other dollars and policies to effect comprehensive, integrated rehabilitation in a single scope of work to carry out Town community investment objectives.
LAP developed a lead insurance pool, which induced construction contractors to engage in abatement. Because of our excellent experience rating, the insurance industry extended coverage to more contractors and lowered annual premiums to an affordable $6000- $8000 from $18,000 to $24,000 it charged earlier.
We continually export our local experience to other communities, the region and the State. LAP won a National Best Practices Award and a local Customer Service Award, LAP was cited for cost-effectiveness, education, prevention capacity building and creativity But this is not sufficient to fulfill our mission to make Manchester a lead-safe community Dollars are needed to complete our work and institute more preventive measures earlier to target needy households, before a child is poisoned.
Manchester recently spearheaded LAMPP, Lead Action for Medicaid Primary Prevention, which was jump-started by Senator Dodd early in its development less than two years ago. The Senator responded to the opportunity to ensure the maximum potential for Medicaid children who are more vulnerable to lead risks and other compromising conditions. The exposure given through Senator Doddís interest expedited LAMPPís development and encouraged participation.
LAMPP will rehabilitate lead hazards in residential units that house Medicaid youngsters around the State. Children under 6 years of age with mild elevations of blood lead will be referred by Medicaid Managed Care health providers so that their homes can be treated with preventive, low cost, cost-effective lead treatment measures. Window repair or replacement, paint stabilization and grass seeding will be complemented by home environmental assessments and education for parents and landlords.
The State just allocated $200,000 a year for a 2 year pilot. Local contributions will come from existing lead and housing programs, private participation, State bonding, Medicaid, Medicaid providers, hospitals etc. and, if we are properly persuasive, from the federal government. LAMPP is operated by the Connecticut Childrenís Medical Center.
LAMPP was spawned by State lead entities under auspices of the Get the Lead Out Coalition, public and private sector health and housing entities collaborating with property owners, hospitals, non-profits, public agencies and legislators from both sides of the aisle. LAMPP is modeled after Manchesterís LAP, itself a collaborative effort.
LAMPP will address lead poisoning which disproportionately affects Medicaid recipients -poor youngsters who live in older housing.
- Improve health of Medicaid children- who are most at risk.
- Invest in affordable housing and home environmental conditions thereby aiding occupants, owners and neighborhood residents.
- Pilot for Medicaid as an approach to meet the letter and spirit ot its federal Medicaid mandate.
Based on what weíve learned, what must be done to solve lead poisoning?
-Devote more funds to deal with children at risk who are not poisoned, continuing to react to those already poisoned. Prevention measures in needy households cost less.
Judicious management can shorten the solution period and broaden the impact of expenditures permitting economy and cost-effectiveness, simultaneously promoting economic development and housing improvement.
-Increase blood lead screening and use the data dynamically to guide remediation. Pinpoint Medicaid youngsters who are disproportionately at risk and for whom the federal Medicaid mandate can provide a functional and financial lever.
- Target money to vulnerable but not yet poisoned youngsters at an early age. LAPís early action alternatives are directed at lead-safety for newborns encouraging nursery preparation and prenatal education for parents. LAP is partnering with a target neighborhood elementary school to formulate a curriculum to educate children, their parents, and teachers .
-Lower costs as we gain more knowledge from best practices, research, and equipment.
--Economic incentives must be identified to encourage repair as opposed to replacement, because routine repair can be cheaper.
--Demonstrate to owners how a turnover strategy, to treat units, between tenants, preemptively quickly and cost-effectively, can pay off.
--Demythologize lead treatment: itís costs and its liabilities, by demonstrating cost-effective remediation.
-Listen to affected constituencies to respond to concerns by parents, landlords, construction contractors, real estate market participants, and health providers.
--Convey information customized on a need to know basis to attract audiences.
--Increase outreach and marketing to broaden the constituency for lead.
--Find private sector partners so lead safety can evolve from an iffy supposition for them into an ongoing sound investment maintenance strategy recognized by the real estate market.
-Upgrade rehabilitation skills - teaching remodelers about lead safe practices and expedite remediation with help in relocation, etc. Offer technical aid widely, encouraging those who can afford to remediate themselves.
Programs like ours can only remediate an infinitesimal (3% percent) of the real needs. With additional dollars wisely used and carefully targeted we can satisfy the necessary demand for assisted remediation. (LAP has only been able to abate 368 units out of 680 applicant units of the estimated 13,250 dwelling units in need in the target area) Early prevention can deter the lifelong neurologic impairment of kids, preclude even more costly treatment of poisoned children and their households and stem the need for expensive special education and behavioral intervention necessary once a child is poisoned. Well managed, the strategy can be implemented in a few years with compound benefits: healthier children, sounder housing and improved neighborhoods.
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