Hawaii

The State of Hawaii received $427,273 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in FY 2022. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2022 to September 29, 2023.

The strategies focus on

  • Ensuring blood lead testing and reporting
  • Enhancing blood lead surveillance
  • Improving linkages to recommended services

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

Hawaii State Department of Health
Childhood Lead Poisoning Prevention Program
1250 Punchbowl St.
Honolulu, HI 96813
Phone: 808-733-9058

Success Story 2023

Implementing Rapid Changes in Response to CDC’s Updated Blood Lead Reference Value in Hawaii

Challenge

CDC updated the blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL in October 2021. In response, the Hawaii State Department of Health (DOH) Childhood Lead Poisoning Prevention Program (CLPPP) required rapid changes across multiple systems and processes to better align with the updated BLRV. Beginning January 1, 2022, the changes would ensure all children up to age 16 with initial blood lead levels (BLLs) at or above the BLRV were provided with confirmatory venous lead tests and case management services as needed. Most children tested for lead exposure were younger than age 6 years.

Intervention

The CLPPP staff implemented the following activities to rapidly update its processes:

  • Distributed updates to healthcare providers through the DOH Provider Alert Network.
  • Updated healthcare provider guidelines and educational materials on the CLPPP website.
  • Reduced the number of questions on initial phone interviews for families of children with an initial capillary result between 3.5 and 4.9 µg/dL to balance early engagement of families with the possibility of a false positive capillary result.
  • Worked with DOH public health nurses to expand follow-up with home visit clients until BLLs decline below the new BLRV.
  • Updated workflows in DOH surveillance systems to capture new cases at or above the updated BLRV.
  • Consulted with the Department of Housing and Urban Development (HUD) on the impact of the new CDC BLRV on HUD rules requiring environmental investigations in public housing.
  • Worked with laboratories to ensure the BLRV was updated on lab reports.
Impact

Laboratories, healthcare providers, service providers, and community organizations also shared information on the new BLRV with families. The interventions resulted in access to follow-up services for 102 additional children with BLL between 3.5 µg/dL and 4.9 µg/dL in 2022 (140 children with BLL above or equal to 3.5 µg/dL had previously received follow-up services). The  following actions were completed:

  • Coordinated care with 100 healthcare providers
  • Attempted contact with 96 families by phone (Six of these children received a venous confirmatory test result below the BLRV before contact was attempted.)
  • Completed 75 phone interviews and lead sources assessments with families

Funding for this work was made possible in part by Cooperative Agreement NUE2EH001450 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success Story 2021

Strengthening Lead Testing and Surveillance in Hawaii’s High-Risk Neighborhoods

Challenge

In Hawaii, most community health centers located in high-risk neighborhoods conduct blood lead testing using point-of-care machines that report the results directly in-house. In a survey conducted by a Hawaii Childhood Lead Poisoning Prevention Program (HI CLPPP) partner, doctors reported only sending results for patients with venous follow-up blood lead tests greater than or equal to 10 µg/dL to the Hawaii Department of Health. Doctors are required by state law to send all blood tests to the Hawaii Department of Health. Additionally, doctors at these health centers often did not follow protocols for determining which children should receive a blood lead test.

Intervention

The Kalihi Palama Health Center (KPHC) is a community health center located in Hawaii’s highest risk area for lead poisoning, an urban community of approximately 65,000 residents, many of whom are low-income, live in older housing, and face significant barriers to access medical services. KPHC was selected for this intervention because they were reporting the highest number of children tested with point-of-care machines and the highest prevalence of elevated blood lead levels (BLLs) compared to the state average.

HI CLPPP partnered with KPHC’s Director of Clinical Operations, their Quality and Compliance Coordinator, and several of their healthcare providers to:

  • establish a lead screening protocol following the state recommended guidelines,
  • establish a reporting system to report in-house blood lead test results from all locations to the Hawaii Department of Health, and
  • implement quality control measures to ensure continued compliance.

Through these efforts, in-house blood lead testing results at KPHC can now be added from KPHC records into a validated spreadsheet and reported directly to HI CLPPP.

Impact

From January 2018 through February 2019, KPHC reported that 895 children were tested, which is a 44% increase in children tested over that period. Over 96% of the children tested were members of minority populations: 50% Native Hawaiian or Pacific Islander, 36% Asian, and 10% Other. Many children were either enrolled in Medicaid (40%) or uninsured (18%). Of all children tested at KPHC, 2.8% had elevated BLLs, three times the state average.

Because KPHC started reporting all blood test results to HI CLPPP, all children with elevated BLLs became eligible to receive HI CLPPP’s case management services, including educational information, telephone follow-ups by a public health nurse, home visits with the public health nurse, and environmental investigations.  Improvement in screening rates and referral to follow‐up services at KPHC following HI CLPPP’s intervention will be a model for future partnerships to prevent high‐risk children who potentially have elevated BLLs from going undetected.

Funding for this work was made possible in part by the Cooperative Agreement Number [NUE2EH001360] 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.