Correspondence between

Ok, thanks. | will ernad her tonight to set something up.

Hi Nancy and Karen, One of our nurses working in Lead Case Management came to us concerned that you might not know the roles of Genesee County staff in the case management realm. If you have questions regarding budget or contract issues, that should be brought to myself or Jori. If you have questions regarding clients that would go to Sherry, Kim or Jan. If there are concerns about implementation process please discuss with Jori. | hope this is helpful. Thanks, Toni Towel LaRocca MS, RN Director of Nursing Services Genesee Courly Health Deparment 810.237 4644 tlarocco@achd us ¢ BAD MOPS, Zz 2 oS eneage, oe , , 3, fe Cat Oe" o te, ee whe a friend Geolfiade n seated : aw So eer DORE RHE, f +, , RE CMEake *NOTICE: This ened, inchulig att geidressee and may contain o not the intended reciolent, any dis gsedion in redian fthe contants ins e-mail in ersy, please act destroy al copies. Thank you. closure, use, distr inis e-mad is sin me vig o-mall and permane nly eu and @ the org For @ copy of u + Practices, contact the Health Cepartiment or vi Health Cepartments Notice of informatio! he Health Depariment’s website ath xxxEND_PAGE:dhhs03_b0591_2009_2010_2

And if you can itemize what the materials are please.

lL agree with Toni - the case management contract with GCHD will be based on actual elevated levels (e.g. Priority 1), and CM will do outreach to those kids. They will not be offering CM to children who don't have a test showing an elevated level (e.g. Priority 2 and 3). xxxEND_PAGE:dhhs03_b0552_1920_1929_05 001925 However, if kids from Priority level 2 or 3 DO have an elevated level, that would bump them up into Priority 1. Nancy Sent from my iPad

At ane point, we mentioned doing a lead fair at the farmer's rnarket, but Toni followed up and the farmer's market folks were not interested | think secondary to some recent water-related pratests, fights, etc (the market is below our clinic}. We will dadly sae patients at cur clinic, but ave just fer blood work, we try to be theiy medical home. Mona Hanna-Attisha MD MPH Director, Pediatric Residency Program Hurley Children’s Hospital at Hurley Medical Center Assistant Professor, Department of Paediatrics and Human Development Michigan State University College of Human Medicine Office: $10-262-7257 mhannal@hurleyme.com

Hi Mora, {thought af one point you had offered that testing could be offered out of the Hurley clinic at the Farmer’s Market? | may have misunderstead that. That's why we listed ii— and can delete that caolurnn if that isn't an option.

great format. xxxEND_PAGE:dhhs02_b1070_3737_3738_1 003738 the "letter to families" column says throughe AUR i think the first “encouragas" should nat b: thera, it’s like that for whole column. The Hurley clinic is not open te the public. [t is the same as any primary care clinic. That column should be removed. Mayhe it should he replaced by the “Health Department" since that is another site for tasting. Mona Hanna-Attisha MID MPH Director, Pediatric Resiclancy Program Hurley Children’s Hospital at Hurley Medical Center Assistant Professer, Department of Pediatrics and Human Gevelapment Michigan State University College of Human Medicine Office: 810-262-7257 mbannal @hurleyme.corm

Hi all — we’ve been bouncing this around, in terms of format, think this captures what we have talked about. Please take a look, share comments/questions on format, content, etc. Thanks! Nancy xxxEND_PAGE:dhhs03_b0537_1876_1876_1

Hi all —- we’ve been bouncing this around, in terms of format, think this captures what we have talked about. Please take a look, share comments/questions on format, content, etc. Thanks! Nancy xxxEND_PAGE:dhhs02_b1070_3737_3738_2

Hi all — warted to senda quick upelate, and thanks far all the quick wark on the Parent and Provider letters. We reviewed all of the edits, some conflicting, and had ta make some choices for what to include ar not. The edited docurnents are now on our rragram Sharepoint site: e blue navigation bar, go to Warkgroups & Toolkits Click on FLINT WORKGROUP Click on Draft 2 documents - and look for the specitic folder, Jennifer Eisner from our Communications office is copied on this ernail, and is reviewing the materials now for approval. Nancy

{think that we are being responsive and we need to work hard to educate ail concerned. There are clinics that are an option as well as the medical horne. This is a knee jerk reaction.

Ro you have his direct nurber?

Yes, and Nick doesn't disagree, but getting out there and testing may be the need to deal with high levels of compaunity strass----did you ever get to talk to Tawwab? He didi not respond te mry cail--—-

interesting. Go these people understand that the half-life of lead in blood is only 1-2 months? What is the purpose of having these kids testing ~ normal levels may be falsely reassuring and it’s highly unlikely that we will pick ug many ESLLS in this school age population. There are aise issinss of consents, release of info to PMDs, follow-up, ete. But peaole want something done, and they want something done fast. People are understandably mad. fini just not sure if this is the best option, but there may be no choice.

Importance: High Folks, Got off the phone with our Director. He is pushing to have on-site lead testing at schools, particularly the 3, in addition to getting primary care providers involved. Pushing to have that done SOUN, Imagine sending horne permission slips on a Monday and attesting on a Thursday. Could get mass volunteers to help. His words! fwill need to get on the phone with a few politicians early this afternoon bout this as well. | will get back to you all.

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My edits on provider letter. Couple comments: e §6ofHd CDC recommend that we screen all kids up to Syrs? Should this be dene annually now? e §=6inthe letter ft says, that if the level is fess than S, we should recheck in 3-6 months? Not sure we need to de that?? Tier tks arte ineletemet nnn escent Sent: Wednesday, October 21, 2015 11:05 AM

Thanks Toni, we appreciate the comments and will use them! Sent from my iPad

Hi all ~ draft letters for Providers and for Parents in Flint are posted in our Sharepoint folder called Flint Workgroup. We put them in both Word and pdf formats, to assure you can open them. They are rough drafts, so nlease do add/suggest language where there are clacenolders. Appreciate if you can review and make comments/suggest edits. To find the letters: On the dark ilue navigation bar, click on Workgroups & Toolkits CHck on the FLINT WORKGROUP folder Nancy

| agree--- with caveat's CDC jsut provided---we can't do much but to ensure that they are not drinking the water (and ingesting any other sources of lead). FYI, that was the FASTEST response | have ever gotten out of CDC!!!

Great article, In box 1, lead in water is a risk factor and “blood lead testing should be performed Ifa single risk factor is identified at the earliest contact.” So | would take this at first contact with OB, blood lead should be done and education on nutrition and vitamins, ete. Gur QB's don't know this, This need to be shared.

Let me check with our ATSDR doc, Mark Johnson (Boy there are a lot of Marks...)---because | wonder if the concerns for Flint beg the question. However, | have no idea what the medical removal for lead is for a pregnant women, is that chelation, and is it the same as a child? Anyway, | will follow up with him now.

| dort think anyone knows to test pregnant women. Should we develop a separate communication to O8’s? As @ secondary research project, we will be tested maternal lead at delivery and cord blood lead. But the above sounds fike tt should be a recomraended screening???

Any lead test and level gets sent into the CLPP, from my understanding. Nancy, have you seen any uptick in pregnant women being tested out of Flint? Eden