Case Management

The Tennessee Childhood Lead Poisoning Prevention Program surveillance system alerts lead nurse case managers at the TN Department of Health when a child is confirmed with a blood lead level of ≥3.5 µg/dL.

You will receive faxed reminders regarding follow-up testing if tests are not received. The Tennessee Childhood Lead Poisoning Prevention Program case management staff is also your resource regarding medical management questions/concerns.

Referrals

The Tennessee Department of Health refers all qualified children who have a confirmed EBLL to the following services:

Community Health Access and Navigation in Tennessee (CHANT)

The Children’s Special Services (CSS) program is now part of an integrated model of care coordination called Community Health Access and Navigation in Tennessee, or CHANT. CHANT is available for families through all county health departments. The nurse case managers at the TN Department of Health will automatically refer a child with a confirmed elevated blood lead level >3.5 µg/dL to CHANT.

Your Regional Coordinator or the state case management staff is available for consultation on medical issues.

If you would like regional medical consultation and need contact information, contact: PbforMDhelp@utk.edu

Tennessee Early Intervention System (TEIS)

Tennessee Early Intervention System (TEIS) is a voluntary program that offers therapy and other services to families of infants and young children with developmental delays or disabilities. Services are provided at no cost to families. TEIS is critically important to supporting the development of Tennessee children with disabilities and developmental delays as they prepare for school.

Children Special Services (CSS)

Children Special Services (CSS) is the State Title V Program for Children and Youth with Special Health Care Needs (CYSHCN). CSS provides access to comprehensive medical care for children with physical disabilities from birth to 21 years of age. Diagnostic and financial eligibility criteria must be met to participate in the program. The CSS program is a payer of last resort. The CSS program is coordinated through all 95 health departments in Tennessee and provides resources for medical and non-medical services. Contact your local health department for information in eligibility.

Tennessee Childhood Lead Poisoning Prevention Program Environmental Investigations

What is an Environmental Investigation (EI)?

An Environmental Investigation (EI) is a state-funded procedure to determine the source of lead exposure in the home and/or other sites frequented by a child with a high blood lead level. The Tennessee Department of Environment and Conservation (TDEC) performs tests on paint, soil, water, toys, and other goods in the child’s daily orbit. A comprehensive report, detailing potential exposures, is forwarded to the child’s primary care provider from the Tennessee Department of Health (TDH), for review with the family. The TDH Regional Lead Coordinator also receives the report and will share follow-up strategies with the child’s parents/guardian.

Who is Eligible for an Environmental Investigation (EI)?

A child, aged six or under with:

– A confirmed blood lead level of 15 µg/dL or higher
– Three or more confirmed, consecutive, escalating EBLLs

Is the EI a Requirement for Eligible Children?

No, the environmental investigation is an option, not a requirement. In some cases, the exposure source may be obvious, rendering an EI unnecessary. Though not common, it is possible that the residence in question was previously tested. Some parents, for whatever reasons, may also refuse an investigation. If you have questions or concerns, discuss them with the TDH case manager.

What is the EI Process?

Download the complete flow chart explained below

Venous EBLL ≥15 or 3 confirmed escalating Venous EBLL (≥3.5) results in a row

TN CLPPP nurse case managers reach out to PCP to discuss Environmental Investigation (EI)

If the medical provider feels an EI is warranted, TN CLPPP will send him/her the REQUEST FOR EI FORM and an EI PROCESS INFO SHEET. All EIs are ordered through TN CLPPP.

TDEC assigns Investigator, and Investigator contact the family to schedule

TN CLPPP Regional Coordinator reaches out to family to explain EI Process; Documents contact in LEADTRK

TN CLPPP nurse case manager sends EI request to TN Department of Environment and Conservation (TDEC) and appropriate TN CLPPP Regional Coordinator

a. TN CLPPP Regional Coordinator reaches out to the family to explain EI process; document contact in LeadTRK

The medical provider will review with the family the EI PROCESS INFO SHEET which outlines what to expect in the EI process, and who to contact with EI questions.

TDEC Investigator performs EI to try and identify source of lead.

Samples from EI (dust, paint, soil, etc.) sent to lab for analysis

EI results sent from lab to TDEC

TDEC sends summary/full report to Tennessee

TN CLPPP sends EI report/s to medical provider and Regional Lead Coordinator.

Central office case manager reaches out to the medical provider to make sure the EI report was received and answer questions. The Regional Coordinator reaches out to the familyto make sure EI report was reviewed with doctor, provides outreach/education, and ensures that family understands results and how to avoid lead exposure. Documentation with PCP and/or family should be reported in LeadTRK. Contacts family to provide outreach/education as needed.

Case Management and Environmental Investigations