Oregon

About the program

The State of Oregon received $515,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in the third funding year. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2023, to September 29, 2024.

The strategies focus on:

To learn more about these efforts in Oregon, contact the program below.

Oregon Health Authority

Environmental Public Health

Oregon Lead Poisoning Prevention Program

800 NE Oregon Street, Suite 640

Salem, OR 97301

Phone: 971-673-0440

Success story: funding year 3

Lead exposure from contaminated eczema cream in Oregon initiates nationwide product recall

Challenge

In December 2022, public health investigations of two children with higher blood lead levels (BLLs) in two separate Oregon counties identified daily use of the same eczema cream. A Vietnamese company marketed the cream for infants and young children and sold it on social media in the United States. Laboratory samples from both products showed high levels of lead (7,370 and 9,670 parts per million (ppm). These concentrations are considerably higher than the federal definition of lead-based paint. The parents of both children told public health agencies that this product is very popular within the Vietnamese community.

Intervention

After receiving initial lab results for the product, the Oregon Health Authority's Childhood Lead Poisoning Prevention Program (CLPPP) reported the results to the Food and Drug Administration's (FDA) regional consumer complaint coordinator who opened an active investigation. CLPPP provided an unopened tube of the cream to FDA, which later was reported as containing more than 10,000 ppm of lead. CLPPP worked with the local public health authorities (LPHAs) in Multnomah and Washington Counties to issue a news release and hold a media event in late January 2023. News outlets nationwide covered the event and investigation. CLPPP and its local public health partners created educational materials and social media posts in English and Vietnamese about the dangers of using this product.

Impact

CLPPP's coordination with LPHAs, rapid notification to FDA, and work with media eventually resulted in a voluntary recall of the contaminated eczema cream by the Virginia-based company that sold the product nationwide through its Facebook page. FDA posted this recall notice on February 1, 2023, which was amplified through news outlets throughout the US. The recall drove the Drug Administration of Vietnam to direct the local health departments of Ho Chi Minh City and Dong Nai Province to inspect the manufacturing facility and take product samples for heavy metal testing to ensure the safety of users and compliance with Vietnam cosmetic laws. No new lead poisoning cases related to this product were reported in Oregon.

Funding for this work was made possible in part by NUE2EH001438 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 2

Ensuring lead-exposed children on Medicaid receive recommended follow-up services in Oregon

Challenge

Over half (58%) of the children younger than age 6 years in Oregon with blood lead levels that require follow-up services are enrolled in the state Medicaid program, Oregon Health Plan (OHP). However, the Oregon Health Authority's (OHA) disease surveillance system, known as Orpheus, lacked a real-time automated process for scanning OHP records when blood lead tests were reported by healthcare providers. As a result, some children with OHP coverage who were enrolled in Coordinated Care Organizations (CCOs) were not receiving timely follow-up services. Oregon faced the following challenges:

1. Incoming blood lead test reports from healthcare providers did not include information on Medicaid status or payer information.
2. Reimbursement rates for home environmental investigations were not high enough to cover the cost of an investigation by the local public health authority (LPHA) staff.
3. Awareness among families, LPHA staff members, and providers about additional CCO services available for children on Medicaid was limited.

Intervention

To address these challenges, OHA's Childhood Lead Poisoning Prevention Program (CLPPP) partnered with several programs within the agency to ensure that children on OHP who are exposed to lead are identified and receive access to recommended services:

• Beginning in late 2021, the program worked with OHA's Acute and Communicable Disease Prevention Program to send successful test messages through Orpheus to the state Medicaid system. Along with a confirmation of OHP enrollment, the automated response also identified the child's CCO.
• In early 2022, CLPPP partnered with OHA's Early and Periodic Screening, Diagnostic, and Treatment Program to increase the reimbursement rate that CCOs pay from $200 to $600 for home environmental investigations by LPHAs. This funding level ensures that LPHAs are adequately compensated for investigations that will help to identify and reduce lead exposure sources within the home.
• During the summer of 2022, CLPPP worked with OHA's Health Policy and Analytics Division to develop a process for families with children exposed to lead to gain access to "health-related services," which are additional services provided by CCOs that are not covered by Medicaid. These include housing services and supports, such as critical repairs and environmental remediation.

Upcoming trainings for local public health personnel will ensure that these best practices are implemented. A training occurred in January 2023 that covered BLL case management protocols; 77 people attended, representing 31 of 36 Oregon county health departments.

Impact

More children enrolled in a CCO now have access to recommended services that can reduce the negative health outcomes from lead exposure. CLPPP plans to use these metrics to assess the impact of these changes:

• Percentage of the Medicaid population that is tested for lead annually
• The number of LPHA reimbursement requests for home environmental investigations
• The number of health-related services from CCOs associated with lead cases

Funding for this work was made possible in part by NUE2EH001438 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Expanding early intervention for all children in Oregon

Challenge

The Oregon Childhood Lead Poisoning Prevention Program (OCLPPP) wanted to determine the best strategy for identifying eligible children and educating families about Early Intervention/Early Childhood Special Education (EI/ECSE) services. According to the current policy under the Oregon Department of Education (ODE), only children with a blood lead level (BLL) at or above 10 micrograms per deciliter (µg/dL), which accounts for about one quarter of Oregon's higher BLL cases, are eligible to receive EI/ECSE services. OCLPPP also wanted to expand these services to children with BLLs at or above 5 µg/dL.

Intervention

OCLPPP collaborated with ODE and determined that the best strategy for identifying eligible children and educating families on the referral process was a two-part approach:

1. For medical providers, EI/ECSE information was posted on OCLPPP's website including weblinks to ODE's site.
2. For families, a letter and ODE brochure were mailed directly to families whose child was eligible according to the current policy (at or above 10 µg/dL).

In early 2019, OCLPPP used the 2012 National Toxicology Program monograph, Health Effects of Low-Level Lead, to demonstrate that sufficient evidence exists for cognitive and developmental delays with elevated BLLs less than 10 µg/dL. ODE reduced the eligibility criteria to the current CDC blood lead reference value, which now identifies every child with an elevated BLL greater than 5 µg/dL as being eligible for EI/ECSE services in Oregon. OCLPPP revised information on the program's website and held webinars to share this information with health departments. OCLPPP encourages all health department staff members that perform BLL investigations to bring along the ODE brochure for EI/ECSE referrals.

Impact

Because ODE now provides information on EI/ECSE referrals as a regular part of case management to families of children with a BLL at or above 5 µg/dL, more children are receiving these services than before the intervention.

Funding for this work was made possible in part by NUE2EH001388 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.