Lead Poisoning Prevention Program Evaluation_CDC/Harvard School of Public HealthMasterpiece on the Mississippi
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Harvard /CDC Lead Poisoning Prevention Program Evaluation
DATE: February 23, 2010
Public Health Specialist Mary Rose Corrigan is transmitting information regarding the
Health Services Department's participation in the CDC /Harvard School of Public Health
program evaluation course for the City's Childhood Lead Poisoning Prevention
Program.
Mi hael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Mary Rose Corrigan, RN, Public Health Specialist
Dubuque
AFAniaqtr
I r
e
2007
Masterpiece on the Mississippi
TO: Michael C. Van Millige0 Manager
FROM: Mary Rose Corrigan41, Public Health Specialist
SUBJECT: Harvard /CDC Lead Poisoning Prevention Program Evaluation
DATE: February 16, 2010
During the week of January 11 -15, 2010, the following participated in the project:
• Allison Liebhaber, Harvard School of Public Health
• Dr. Heather Davis, MD, Harvard School of Public Health
• Karin Gavin, CDC Project Officer for the State of Iowa
Dubuque
kitleg
AI4mmicaCRy
1 '
2007
INTRODUCTION
This memorandum provides information regarding the Health Services Department's
participation in the CDC /Harvard School of Public Health program evaluation course for
the City's Childhood Lead Poisoning Prevention Program.
BACKGROUND
The Centers for Disease Control and Prevention (CDC) Lead Poisoning Prevention
Branch, with the Harvard School of Public Health (HSPH), offers a two -week training
course called "Program Evaluation: The Case of Lead Poisoning Prevention Programs ".
In this course, teams of State and local public health department personnel, HSPH
graduate students, and CDC staff collaboratively develop an evaluation framework for a
specific project. The course builds program evaluation capacity with existing programs
so that programs do not need to hire outside consultants. The course also trains HSPH
students to incorporate evaluation in their careers after graduation. The collaborative
teams develop a logic model, related indicators, and an evaluation plan; State and local
public health programs then implement the evaluation plans. This course is sponsored
by the CDC and was offered to Dubuque through the Iowa Department of Public Health
Childhood Lead Poisoning Prevention Bureau.
DISCUSSION
In order to dedicate sufficient staff time and energy to the project, both for the course
and for the evaluation implementation, a Masters in Public Health intern was recruited
from the University of Iowa College of Public Health. Ben Henkel, who graduated with
an MPH from the University of Iowa in December 2009, began his orientation to our
Childhood Lead Poisoning Prevention Program (CLPPP) in December 2009. Ben then
completed the weeklong evaluation course in Atlanta with the two Harvard MPH
students and the CDC program advisor.
• Ben Henkel, MPH, University of Iowa College of Public Health intern
• City of Dubuque CLPPP staff
o Mary Rose Corrigan, RN, Public Health Specialist
o Kevin Hirsch, Lead Hazard Control Program Manager & Lead Inspector
o Kim Glaser, Lead Program Assistant
o Bob Boge, Senior Housing Inspector
• Dubuque Visiting Nurse Association
o Michelle Zurcher, RN, Case Manager
The team met throughout the week and studied Dubuque's CLPPP through meetings,
observations, tours and fieldwork (see attached Evaluation Project Agenda.)
The initial goal of the project: To determine the baseline knowledge and awareness of
childhood lead poisoning and methods of preventing childhood lead poisoning in
Dubuque County. This baseline will be used in the evaluation of future
education /awareness efforts in Dubuque County. Future education /awareness efforts
would focus on increasing testing of children for lead poisoning, reducing the number of
lead- poisoned children, and increasing lead -safe housing in the community. The tool
that is developed and the resulting implementation could be replicated in other local
lead programs in Iowa or throughout the entire state of Iowa. (see attached Abstract)
The final report was written by the Harvard MPH students and is attached. The
evaluation plan presented is a tactical, realistic approach to evaluate current CLPPP
activities and improve testing rates and knowledge of lead poisoning in the community.
Examples from the report include:
• Create a health care provider report on lead testing rates, which would provide
measurable benchmarks and incentives for the providers to improve testing.
With the State of Wisconsin's provider report card as an example, Ben Henkel
will be able to help generate and prepare these provider reports. GIS technology
will also be incorporated into these reports and other related evaluation tools.
• Tools to track and evaluate community education efforts, such as presentations
and health fair /City Expo booths. These will require some staff time in their setup
and initial implementation.
• Creating phone logs to track inquiries.
• Expanding the contractor and lead -safe worker course evaluations; along with
phone interviews and possible post - remediation blood lead monitoring of workers
to insure they are protecting themselves from lead exposures.
The week spent with the evaluation team was highly beneficial to both the students and
CLPPP staff. Program evaluation is one of the activities that generally gets little
attention or is not effectively conducted in order to improve overall programs and
activities. The discussions, written report and systematic way the students addressed
the Dubuque CLPPP and education evaluation components will be implemented by our
program. It was a privilege to have such bright and engaged students and CDC staff
visiting our community.
University of Iowa Public Health Intern, Ben Henkel, will continue to work with
Dubuque's CLPPP over the next few months to help create and implement the
evaluation tools outlined in the report. It is our goal to present this project and its
outcomes at the 2011 Iowa Public Health Association Conference.
Finally, the information compiled from this project will strengthen our upcoming HUD
Lead Hazard Reduction Program grant renewal application. Although the NOFA
(Notification of Funding Availability) has not been released, it is anticipated that HUD
will announce the new funding cycle sometime this spring. Since the City's current
Lead Hazard Reduction grant will end in March 2011, a renewal application will be
submitted.
If you have any questions, please advise.
MRC /cj
cc: David Harris, Housing & Community Development Department Manager
Kevin Hirsch, Lead Hazard Control Program Manager & Lead Inspector
Bob Boge, Senior Housing Inspector
Dubuque Childhood Lead Poisoning Prevention Program
Evaluation Plan
Prepared by:
January 20, 2010
Executive Summary
Allison Liebhaber
Heather Davis
Harvard University School of Public Health
ite
Dubuque Childhood
Lead Poisoning
Prevention Program
This document outlines an evaluation plan for the Dubuque Childhood Lead Poisoning Prevention
Program. It was developed in January 2010 as part of a joint training project in public health program
evaluation offered by the Centers for Disease Control's Childhood Lead Poisoning Prevention Program
and the Harvard School of Public Health. The program consisted of one week of evaluation training
followed by a one -week site visit in Dubuque. Dubuque CLPPP staff identified three components of their
program to be evaluated: education initiatives to the general public, to health care providers and to
contractors and workers. A logic model was developed to indicate how each of the three target areas
could result in a decreased prevalence of child lead poisoning. Within the target areas, we developed
specific indicators to answer evaluation questions that include:
1. Are testing rates increasing?
2. Is education targeting providers with low testing rates?
3. Is education increasing lead testing rates over time?
4. Has provider and community education resulted in the use of the Dubuque CLPPP as a resource?
5. Is community education reaching identified high risk groups?
6. Are targeted educational activities effective?
7. Are participants satisfied with contractor and worker training courses?
8. Has training resulted in a sufficient lead -safe workforce?
Indicators to address these questions include measuring the testing rates of specific populations,
developing a phone log to track provider and community use of the CLPPP, a provider report card to
track provider testing rates, satisfaction questionnaires distributed during targeted educational
activities, and contractor feedback to determine their experience working in the Lead Hazard Reduction
Program.
Dubuque CLPPP Evaluation Plan January 2010 Page 1 of 15
Introduction
This evaluation plan was created as part of Harvard School of Public Health's ID 295 Wintersession
Course entitled "Program Evaluation of Public Health Programs." The course included a week -long
evaluation and lead poisoning prevention training exercise held through Centers for Disease Control and
Prevention (CDC) in Atlanta, GA followed by a week -long field visit to the Dubuque Childhood Lead
Poisoning Prevention Program (CLPPP), which is a program of the State of Iowa Lead Prevention Bureau.
The goal of the student work for this course was to develop an evaluation plan tailored to the Dubuque
CLPPP, which will then be implemented by the local program staff.
Overview of Program:
The Dubuque CLPPP was started in 1994 with funding from the Iowa Department of Public Health (IDPH)
to address the issue of childhood lead poisoning in the area. Since 1996 it has also held federal funding
through the US Department of Housing and Urban Development (HUD). Currently, the program is a joint
effort of the City of Dubuque Health Services Department (DHD) and the City of Dubuque Housing and
Community Development Department (DHCD). The Dubuque CLPPP is the only lead prevention program
serving Dubuque County; however its efforts focus primarily on one target area within the city of
Dubuque. The target area was selected for having the highest proportion of older homes, low and
moderate income families and children.
The Dubuque program is considered a leader in Iowa because of its close partnership between the
health and housing departments, and was in fact the first program in Iowa to form such a joint working
relationship. Although rates of childhood lead poisoning in Dubuque have been decreasing, elevated
blood lead levels and presence of lead -based hazards in homes remain a significant problem. The
percent of children born between 2002 and 2005, tested at 9 to 35 months, and identified as lead -
poisoned is 3.6 percent compared to a national average of 2.1 percent. Dubuque also has a significant
amount of pre -1950 housing with data showing that 38.9% of its housing stock dates from before 1950
compared to a national average of 22.3 %. Based on these two criteria — higher than average rates of
lead poisoning and pre -1950 housing— Dubuque meets the IDPH criteria for universal blood lead testing.
However, testing rates in Dubuque have thus far lagged those in other parts of the state. The percent of
children born between 2002 and 2005 and tested at 9 to 35 months was 55.7% compared to an average
of 65.1% statewide. Although lead screening is a requirement of the Early and Periodic Screening,
Diagnostic and Treatment (EPSDT) service under Medicaid, in Dubuque County the percent of Medicaid
children tested is actually lower (50.1 %) than the percent of non - Medicaid children tested (60.8 %) for
those born between 2002 and 2005 and tested at 9 to 35 months.
In order to address the issue of childhood lead poisoning, the Dubuque CLPPP consists of four main
elements:
Dubuque CLPPP Evaluation Plan January 2010 Page 2 of 15
1. Community and Provider Education: The Dubuque CLPPP's educational activities include booths at
community events during which informational brochures and flyers are distributed. The program
also gives away numerous other materials including paint sticks, magnets, buttons and coloring
books that contained program information. In addition, the CLPPP program has advertised through
billboards, bus advertisements, and displays in hardware stores. Other educational activities include
presentations to targeted groups such as health care providers, realtors, and child care providers.
2. Child Blood Lead Testing and Elevated Blood Lead Level Case Management: The DHD contracts with
the Dubuque Visiting Nurse Association (VNA) to conduct blood lead testing and perform case
management for children with elevated blood lead levels (EBLs). The VNA conducts free blood lead
testing as do certain employees of the DHD.
3. Contractor and Worker Training: The DHCD holds four different lead professional certification
courses in order to train a lead safe workforce. The courses offer certification in the following areas:
certified lead contractor, certified lead worker, sampling technician /visual risk assessor, inspector
II /risk assessor for contractors, and a safe work practices course. Recertification classes for these
workers are also offered every three years.
4. Lead -Based Paint Hazard Control: The Lead Hazard Reduction Program provides financial assistance
to low and moderate income homeowners and rental property owners to remediate lead -based
paint hazards in their homes. The program is specifically targeted to assist families with children
under the age of six. Recently, the maximum amount of financial assistance was increased from
$6,000 per unit to $12,000 per unit to facilitate remediation of larger and more complex projects.
Evaluation Goals
We were asked specifically to evaluate three aspects of the Dubuque CLPPP program to help determine
their effectiveness in contributing to the goal of reducing the prevalence of child lead poisoning:
• Community education initiatives
• Provider education initiatives
• Contractor and worker training programs
Development of the Evaluation Plan
This assessment involved a 5 day site visit from January 11 -15 2010 accompanied by Karen Gavin, CDC
Project Officer for the State of Iowa. Internet resources and written documents from the city and state
were reviewed prior to the visit. A teleconference with Rita Gergely (Bureau Chief, Bureau of Lead
Dubuque CLPPP Evaluation Plan January 2010 Page 3 of 15
Poisoning Prevention, IDPH) introduced the Dubuque program and its role within the State of Iowa lead
initiative. Face -to face meetings were conducted with City of Dubuque Public Health Specialist and
CLPPP Program Manager Mary Rose Corrigan, members of the Lead Hazard Reduction Program
(including Program Manager Kevin Hirsch, Lead Inspector Rick Zeller and Lead Paint Assistant Kim
Glaser), Michelle Zurcher of the Visiting Nurse Association, and Nikki Breitsprecker, GIS
Coordinator /Analyst for the City of Dubuque. Activities included observation of a community education
presentation to members of the Parents as Teachers program, a tour of the city's target area to view
lead - remediated properties, and observation of an owner - initiated home lead inspection. This final
document incorporates discussion points generated by our project presentation (Appendix A).
Consideration of Externalities
Interpreting any evaluation of the Dubuque CLPPP must incorporate the effects of a number of
significant externalities. The state of Iowa passed a law in 2007 which mandates that every child in Iowa
must have at least one documented blood lead test before starting kindergarten. Although overall
testing rates have increased since then, it is currently unknown what proportion of the increase
represents late screening at the time of school entry.
Blood lead testing data is currently managed in the STELLAR database. However in February 2010 the
state of Iowa will switch to the web -based Healthy Housing Lead Poisoning Surveillance System
(HHLPSS) database. It is anticipated that the lead information will not change significantly, but current
recommendations about data extraction will remain general at this time.
Finally, the bulk of CLPPP funds come through HUD for home lead -based paint remediation. A recent
change increased the maximum amount of funds per home from $6,000 to $12,000 per unit and the
implications of this decision on the lead- trained workforce is not yet clear. Additionally, current HUD
funds are set to expire at the end of 2010 and detailed information about requirements for the next
funding cycle is not yet available.
The Logic Model
A logic model (Appendix B) was developed to show the relationship between inputs, activities, outputs,
outcomes and impact of the program as a whole, and specifically to identify how each of the target
areas of this evaluation should work to decrease the prevalence of childhood lead poisoning in
Dubuque.
Inputs
The major inputs come from the DHD, VNA, and the Lead Hazard Reduction Program within the DHCD.
External grant -based funding to these departments is received from the IDPH and HUD.
Dubuque CLPPP Evaluation Plan January 2010 Page 4 of 15
Activities
The activities of the DHD and the VNA result in identification of EBL cases through blood tests results.
These two organizations also engage in provider education activities and community education
activities, which include targeted group presentations, advertising and brochures as described above.
The DHCD also participates in the community education activities. In addition to educational activities,
the DHCD inspects homes for lead -based paint by owner request, and conducts inspections of all houses
that have been identified as having a lead poisoned child (for this purpose defined as two tests over the
level of 15ug /dL). DHCD also conducts contractor and worker training courses as described above.
Outputs
Once a child is identified as having an EBL, case management through VNA is triggered. This includes
home visits, referrals to nutritionists and connections with developmental testing, depending on the
magnitude of the blood lead level. The activities included in provider and community education will
ideally result in parents bringing their children in to get tested or increased testing rates among
providers. In addition, another goal of community education is to increase the number of owner -
initiated home inspections due to increased knowledge about the Lead Hazard Reduction Program.
Finally, another output of the community education is an increase in the number of people engaging in
lead safe practices at home including frequent hand washing, proper housekeeping and ensuring
adequate nutrition for their children. From the housing arm of the program, the contractor and worker
training should result in a sufficient workforce to complete the necessary work to do lead remediation in
homes in a timely fashion.
Outcomes
One major outcome of the program is to decrease lead exposure among children, which is accomplished
through case management and community education promoting lead awareness, the importance of
nutrition and child -safe home practices including hand washing and proper housekeeping. Another
outcome results from the chain of events conducted by the DHCD including both owner - initiated and
EBL- initiated home inspections and training of a lead -safe workforce. Increased rates of blood lead
testing will result in identification of children with EBLs and give the program the opportunity to manage
those children through the activities previously described.
Impact
All of the demonstrated inputs, activities, outputs and outcomes should ultimately result in the
Dubuque CLPPP's stated goal of decreasing the prevalence of childhood lead poisoning (defined as a BLL
greater than 10ug /dL).
Dubuque CLPPP Evaluation Plan January 2010 Page 5 of 15
Indicators and Data Sources
A variety of indicators are suggested to measure the grantees' success in achieving the outputs and
outcomes suggested by the logic model for the three areas we were asked to assess.
Overall Impact of Education
Are testing rates increasing?
To determine whether the educational activities performed by the Dubuque CLPPP are having an
impact, it is necessary to first determine what the testing rates are and whether they are increasing. If
testing rates are staying steady or decreasing, that provides a good indication that the education
campaigns aimed at increasing testing rates are not being effective. Testing rates already exist in the
STELLAR database (soon to become HHLPSS), but it would be helpful to keep biannual reports of testing
in further detail to determine if there are geographic pockets of children being missed and the trend of
testing rates in the targeted high risk areas of the program, such as the Washington Neighborhood.
Another important indicator to track is the average age of children tested and the age of children having
their first test. It is far more important to test children at younger ages such as one or two rather than at
five or six. If testing rates are increasing overall, but not among younger children, that is an indication
that the message, while having an effect, may not have the impact intended by the CLPPP program.
Another important measure to track is the rates of testing among the Medicaid population. Given that
children on Medicaid are a high risk population who should all be tested given the EPSDT regulations,
knowledge of testing rates among this population is important.
In generating these detailed reports, it would be helpful to Zink to outside data sources and resources.
Census data could be used to determine the total number of children in the city and when utilized in
conjunction with STELLAR /HHLPSS data, can provide information on the percent of children being tested
in different areas of the city. This would provide guidance on where educational activities should be
targeted in the future. The City of Dubuque's GIS technology could be used to improve the quality of
the mapping of this information. One request which arose during our site visit was to have maps
showing numbers of lead- poisoned children produced on an annual basis to display as part of the
education initiatives.
Community Education
Has community education resulted in use of the Dubuque CLPPP as a resource?
Community education consists of broad educational initiatives aimed at the general population and
specific programs for smaller target groups. Success reaching the population as a whole can be gathered
by tracking 'hits' to the City of Dubuque websites for information on lead through both the health and
Dubuque CLPPP Evaluation Plan January 2010 Page 6 of 15
i
housing department pages. This could be done quarterly and volume could be observed for any
correlation with large public- education campaigns such as new billboards or bus advertising campaigns.
Creation of a standardized CLPPP telephone log would allow tracking of incoming calls to the Health,
Housing, and Visiting Nurse Association Departments for lead information. Microsoft Access allows
creation of a user - friendly data entry form and the data is easily available in spreadsheet form for
analysis. By asking each caller a simple question, such as "How did you hear about us ?" the CLPPP will be
able to get an idea of which of their educational materials are generating calls.
Is community education reaching identified high risk groups?
Community education can also be evaluated by determining whether efforts are reaching the highest -
risk groups. This first requires establishing and maintaining a database of all education activities,
including presentations given to targeted groups. At each community educational opportunity, the
CLPPP booth could have a sign -in sheet for all individuals who stop by the booth for information on lead
poisoning. Another option is for CLPPP staff to keep track of the number of people contacted. This
would give information on how many people specifically received information about lead as compared
to the number of people who attended the event overall. Another possibility would be to ask a few
further questions about address or number of children in the house during the sign -in process to
determine if the CLPPP message is reaching the high risk population. This approach may be more useful
for citywide events and less so for events held specifically in the target area.
In addition, a brainstorming / planning session can systematically identify additional target groups and
high -yield community events. One such group which is currently not being addressed is tenants living in
homes undergoing a property owner- initiated lead assessment. An easy solution would be to leave
some lead safety information with CLPPP contact information for all tenants at the time of home
inspections.
Are targeted educational activities effective?
For educational presentations to targeted groups, distribution of a post- session questionnaire would
help determine how effective the presentations are and whether there are areas for improvement. The
questionnaire would include questions regarding the applicability to the presentation to the work of the
group, how clearly the information was presented and suggestions for improvement. This questionnaire
could also include a question such as, "Are there any other groups you suggest we speak with about
childhood lead poisoning ?" This could yield new ideas and target groups that may not have been
considered by the CLPPP. The CLPPP could also keep track of how many participants are present at each
presentation.
Provider Education
Is education targeting providers with low testing rates?
Dubuque CLPPP Evaluation Plan January 2010 Page 7 of 15
Is education increasing lead testing rates over time?
The goal of evaluating the provider education is to determine whether education is targeting providers
with low testing rates and whether provider education is increasing lead testing rates over time.
Gathering this information lends itself to the creation of a provider report card. These report cards could
be used for tracking by the CLPPP as well as distributed to providers to increase their knowledge of their
own testing rates. Dubuque can look to the CLPPP program in Wisconsin for guidance where a provider
report card has already been developed and implemented. Opportunity exists also to identify provider
'champions' by forming a working group to explore the best way to establish the program and to
determine which information will be the most helpful. Reports could include the number of children
tested, average age of children tested (if available), number of children having their first test and
detailed information on each provider's EBL cases. It is important throughout this process to ensure that
providers are aware of the CLPPP as a resource to assist with proper case management should a child
with EBL be identified.
Has provider education resulted in use of the Dubuque CLPPP as a resource?
Another indicator of the effectiveness of provider training is the use of Dubuque CLPPP resources by
providers. The primary way to measure this is through provider phone calls to the health department
and VNA. These will be tracked through a standardized phone log (as mentioned above) denoting
whether the caller is a provider and how they heard about the program.
Is CLPPP optimizing opportunities for provider education?
Finally, evaluating provider education will require a search for under - utilized opportunities for
interaction. One example of a potential missed opportunity is when lab reports of children tested
through the VNA are forwarded to physicians. Simply including a copy of the letter sent to parents could
act as an educational tool for physicians unsure of how to follow -up an elevated blood lead result, and
act as a reminder of the CLPPP as a source of additional information. Another provider group which
could be targeted is dieticians.
Contractor and Worker Training
Are participants satisfied with the training courses?
Has training resulted in a sufficient lead -safe workforce?
Is lead remediation being done properly?
Assessment in this area can first focus on satisfaction of course participants. A course evaluation form is
provided in the instructor materials, and the first step is to make sure it is used regularly and that the
results are systematically examined. A second indicator is whether courses and certifications have
actually resulted in sufficient numbers of lead -safe workers to match demand. Indicators are the
Dubuque CLPPP Evaluation Plan January 2010 Page 8 of 15
number of individuals attempting to register for the course and placed on a waiting list, the number of
bids for lead remediation projects and the percentage of certified contractors who actually participate in
CLPPP projects (excluding one -time home renovators). A third indicator is whether there is retention of
the workforce. Refresher course participants can be asked general questions about their satisfaction
with the program to date and reasons for continuing to participate. Certified individuals who are not
participating in lead remediation can be contacted by phone to ascertain reasons for their lack of
participation. A final indicator is whether the lead remediation is being done properly. Inspection
failures and reasons for failure should be documented. Also CLPPP may wish to entertain the idea of
post - remediation blood lead monitoring of workers to ensure they are protecting themselves from lead
exposures.
Future Directions
At this point the Dubuque CLPPP is operating at full capacity with respect to owner - initiated home
inspections and is optimizing use of HUD funding. Thus efforts can focus on the need for appropriate
child blood lead testing. A potentially effective trigger for physicians would be to print a reminder about
blood lead testing directly on provider blood slip requisitions. To the best of our knowledge this has not
been attempted in other programs.
Also this report coincides with an imminent change of child blood lead testing database from STELLAR to
the web -based HHLPSS system which is due to come on -line in February 2010. This might provide an
opportunity for further collaboration with those in charge of the database and with GIS programmers to
provide the CLPPP with richer data resources that will help define program successes and further refine
the program's approach to achieving its goals.
The idea of creating an annual community -wide report card as a means of communicating successes and
challenges with respect to child blood lead testing and home lead hazard remediation was raised. This
could be released in conjunction with other lead awareness events.
As a final consideration, thought should be given to an approach to education for families with children
whose blood lead level falls between 5- 10ug /d1. Research suggests this group of children may well be at
increased risk and they are currently not targeted by the program.
Conclusions
The Dubuque CLPPP has done a significant amount of work in its attempt to reduce childhood lead
poisoning. The educational activities —for providers, the community and contractors — undertaken by
the program are important steps in the process of achieving the CLPPP's stated outcome. Greater use of
data and systematic records by the program could help leverage these activities to have an even greater
impact or provide valuable information on which ones are not as effective. Ideally, an evaluation of the
Dubuque CLPPP Evaluation Plan January 2010 Page 9 of 15
educational aspects of the program will help the CLPPP focus its limited resources on the most effective
methods to enact behavior change and ultimately reduce the prevalence of lead poisoning in Dubuque.
Acknowledgements
Thank you to the Center for Disease Control Childhood Lead Prevention Poisoning Program and the
Harvard School of Public Health for the opportunity to participate in this program. Special recognition to
the contributions of Dr. Marc Mitchell and Mary Jean Brown for their instruction and guidance. Thank
you to CDC Program Officer Karen Gavin who facilitated the on -site assessment and to Rita Gergely for
orienting us to the State of Iowa Lead Prevention Program. CLPPP Intern Ben Henkle provided a link to
the Dubuque CLPPP during our first week in Atlanta and was present for the entire site visit. And a very
special thank you to all of the Dubuque CLPPP Program Staff in the Departments of Health, Housing, and
Visiting Nurse Association for sharing their knowledge with us during our visit.
Dubuque CLPPP Evaluation Plan January 2010 Page 10 of 15
Appendix A: Presentation to Dubuque CLPPP 15 Jan 2010
Evaluation Plan
t
Dubuque Childhood
lead Poisoning
Prevention Program
WC Leaf wevartion Program Evauaion Prepared by Allison IA:F aber
H a l y a r d Sdsuol of Public Health PODS Heather Owns
15 tannin; 2010
WC Prole Offrer Karen Garin
Project Objective
• Joint Initiative of CDC's Childhood Lead Poisoning
Prevention Program and the Harvard School of
Public Health
• Develop expertise in Program Evaluation
• One week classroom session in Atlanta, GA
• One week on -slte visit to develop evaluation plan
HARVARD
SCHOOL 04
I ^J ?f li III Al ill
Egj
Education
Are Testing Rates Increasing?
• Data already exists in STELLAR (HHLPSS) database
• Number of children tested
Address of children tested (target area)
Average age of children tested
• Number and age of children having their FIRST test
Medicaid status
• Link to additional data sources / GIS mapping
• % children tested
• % tested by area
Outline
• Project Objective
• Logic Model
• Evaluation Target Areas and Indicators:
— Community and Provider Education
— Contractor and Worker Training
• Future Directions
• Discussion
Logic Model
INPUTS
ACTIVITIES OUTPUTS OUTCOMES IMPACT
• Tracking Lead Program website visits
• Housing& Health
• Tracking Phone Calls through standardized
telephone log
Community Education
Has Community Education Resulted in Use
of Dubuque Child Lead Poisoning
Prevention Program ( CLPPP) as a Resource?
Dubuque CLPPP Evaluation Plan January 2010 Page 11 of 15
Phone Log
Date:'
Name:
Phone Number.
Reason for call:
How did you hear about us?
Word of Mouth
Brochure
Advertisement on Bus /Billboard
Doctor's Office
Workshop or Seminar
Health Expo or Fair
Other:
Community Education
Are Targeted Educational Activities
Effective?
• Database of all Targeted Education Activities
• Number of Attendees
• Satisfaction Questionnaire
(Applicability /Clarity /Effectiveness)
Provider Education
Has Provider Education Resulted in Use of
Dubuque CLPPP as a Resource?
• Tracking Phone Calls
• Correlation with Education Activities
• Standardized Telephone log
Dubuque CLPPP Evaluation Plan January 2010
Community Education
Is Community Education Reaching
Identified High Risk Groups?
Database of all Community Education Activities
• Recording number of individuals reached
• Sign - in sheet with record of address
Brainstorming to Identify high risk groups and track
time of last contact: Parent and child groups, daycare
centres, community centers, civic groups, etc.
• Tenants in homes being assessed for lead
Brainstorming to identify opportunities to spread
message: Lead Awareness week, Health Fairs, Expos, etc.
Is education increasing lead testing rates
over time?
Is education targeting providers with low
lead testing rates?
• Measure through development of a standardized
Provider Report Card:
Number of children tested
Average age of children tested
Number of children hating their FIRST test
• Detailed information on elevated blood lead level (EEL)
cases
Is CLPPP Optimizing Opportunities for
Provider Education?
• Brainstorm for underutilized opportunities
• Provide physkian with copy of letter sent to parents fcr
children tested through Dubuque Visiting Nurse
Association (VNA)
Provider Education
Provider Education
Page 12 of 15
•
Contractor and Worker Training
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Are participants satisfied with training
courses?
• Review of course evaluations
41 IP
Contractor and Worker Training
Has training resulted in retention of a lead -
safe workforce?
• During recertification courses, ask about satisfaction
with lead remediation projects to date
o For contractors and workers who have certified and
not participated, brief phone call to assess
satisfaction with training and barriers to participation
Future Directions
• Lead "Reminder” on blood requisition forms
• HHLPSS / GIS coordination
41 v
Dubuque CLPPP Evaluation Plan January 2010
Contractor and Worker
Has training resulted in a sufficient lead-
safe workforce?
• Track number of bids for kad remediation projects
• Track number of partkipants and course waiting lists
• Percentage of certified contractors who participate in
program activities (exclude one -time home renovators)
Contractor and Worker Training
Is lead remediation being done properly?
• Track Number of failed inspections and reason for
failure
• Follow blood lead levels of lead- remediation
workers
Discussion
Allison Liebhaber
allison.liebhaber@gmail.com
Heather Davis
heather_s_davis @yahoo.com
Thank you Karen, Ben and the entire
Dubuque CLPPP program for your time
and hospitality!
Page 13 of 15
Group Photo at Dubuque CLPPP Presentation 15 Jan 2010
L -+R: Ben Henkle, University of Iowa Public Health Intern with City of Dubuque
Rick Zeller, Lead Inspector
Allison Liebhaber, Harvard School of Public Health
Heather Davis, Harvard School of Public Health
Karen Gavin, CDC Project Officer for the State of Iowa
Kim Glaser, Lead Program Assistant
Mary Rose Corrigan, Public Health Specialist for the City of Dubuque
Bob Boge, Housing Inspector Supervisor
Michelle Zurcher, Dubuque Visiting Nurse Association
Kevin Hirsch, Lead Hazard Program Manager and Lead Inspector
Dubuque CLPPP Evaluation Plan January 2010 Page 14 of 15
Appendix B — Logic Model
Logic Model
INPUTS ACTIVITIES OUTPUTS OUTCOMES IMPACT
City of
Dubuque
Health
Services
Department
Dubuque
Visiting
Nurse
Association
City of
Dubuque
Housing and
Community
Services
Department
EBL Case
Identification
Provider
Education
Community
Education
EBL- Initiated
Home
Inspections
Contractor
and Worker
Training
Case
Management
Child -Safe
Practices in
the Home
E
Increase
Blood Lead
Testing
EBL
Identification
and
Management
Owner -
Initiated
Home
Inspection Decrease
Home Lead
Hazards
Sufficient
Lead -Safe
Workforce
Decrease Lead
Exposure
Decrease
prevalence
of
childhood
lead
poisoning
Dubuque CLPPP Evaluation Plan January 2010 Page 15 of 15