### KID S FIRS T Lake Count y Communit y HealthProgra

m SDM S Documen t I D 202019 0 13 0 Wes t 9t h Stree t

Leadville , C O 8046 1 (719 ) 486-353 8
Apri l 29 , 200 4

Ms
. Rebecc aThoma s Remediatio n Progra mManage r U.S
. Environmenta l Protectio n Agency , Regio n 8 99918 t hSt
. Denver , C O 8020 3 Subject : Lak e Count y Communit y Healt h Progra m

Transmitta l o f

th e Repor tprepare d b y th e Independen tRevie w Pane l Dea r Rebecca : O n behal f o f th e Kid s Firs t

Wor k Group , pleas e fin denclose dth e report prepare db y th e Independen t

Revie w Pane l fo r

th e Lak e Count y Communit y Healt hProgra m(LCCHP)
. Th e Independen t

Revie w o f

th e LCCH P wa s conducte do n Octobe r 3 0 an d31 , 200 3 an dth e repor t prepare db y th e Independen t Revie w Pane l (IRP) , entitle dIndependen t Revie w Pane l Response s t o Ke y Issues/Questions , wa s submitte do n Decembe r 3 , 2003
. I n accordanc e wit hth e Scop e o f Wor k prepare dfo r

th e independen t

review , th e Kid s First/LCCH P Wor k Grou p (Work

Group ) ha s reviewe dan ddiscusse dthi s report an di s no w formall y transmittin g th e repor t t o th e EP A alon g wit hWor k

Grou p comment s an drecommendation s regardin g th e ongoin g implementatio n o f th e program . Th e IR P Repor t

contain s th e followin g information : A n introduction , briefl y explainin g th e histor y an devolutio n o f

th e LCCH P an dth e independen t revie w process ; summarie s o f th e qualification s an dexperienc e o f th e pane l member s an dfacilitator ; asummar y o f th e independen t revie w process ; an dresponse s t o th e lis t o f ke y issues/questions , whic hwer e provide dt o th e IR P i n advanc e o f

th e review
. Attachmen t

A t o th e repor t

contain s supplementa l informatio n provide db y th e IR P an dreference di n thei r responses . A s part o f th e Work Group' s revie w process , th e Wor k Grou p requeste dclarificatio n fro mth e IR P regardin g severa l o f

th e revie w pane l comment s presente di n thei r Decembe r

200 3 report . A conferenc e cal l wit hal l o f th e pane l member s wa s conducte do n Januar y 29 , 200 4 t o discus s alis t o f clarificatio n items , whic hha dbee n transmitte dt o th e pane l member s prio r t o th e call
. A documen t containin g th e clarification s an dcomment s provide db y th e IR P wa s developed
. Thi s document , entitle dWor

k Grou p Request s fo r

Clarificatio n an dSummary o f Pane l Responses , ha s bee n include da s Attachmen t B t o th e IR P Report
. Th e Wor k Grou p ha s no w complete dthei r revie w o f th e IRP.' s report

an di s providin g comment s an drecommendation s t o th e EP A i n Attachmen t C t o th e IR P Report
. Pleas e not e tha t

bot hAttachment s B an dC ar e structure di n aforma t simila r t o th e Lis t

o f Ke y Issues/Question s originall y provide da s par t o f th e charg e t o th e revie w pane l an dreiterate di n th e response s provide db y th e IR P i n thei r Decembe r

3 , 200 3 report . Eac hquestio n i s numbere di n accordanc e wit hthi s format , wit harestatemen t o f th e origina l question , followe db y asummar y

In association

with: U.S . Environmenta l

Protectio n Agenc y Colorad o Departmen t o f Publi c Healt han dEnvironmen t Lake County Nursing Service 

# ASARC OMs
. Rebecc aThoma s

Apri l 29 , 200 4 Pag e 2

o f th e panel' s response , an dth e Wor k Group' s comment/recommendatio n o n tha t topic
. Attachmen t

D t o th e IR P Repor t

contain s th e Scope o f

Wor k fo r th e independen t

revie w an dth e Lis t o f Ke y Issues/Questions , bothprepare db y th e Wor k Grou p t o hel p guid e thi s revie w process . Th e panel' s repor t

provide dth e progra mwit hanumbe r o f thoughtfu l an dconstructiv e comment s an drecommendations
. Althoug hth e Work Grou p comment s an drecommendation s ar e detaile d i nAttachmen t

C , th e followin g point s ar e presente dt o highligh t som e o f th e IR P comment s an d suggestion s tha t

th e Work Grou p consider s t o b e significant , a s w e continu e th e proces s o f implementation , evaluatio n an dimprovement : Dat aManagemen t

an dStatistica l Analyses :

• Amon g th e most

significan t

o f th e IRP' s comment s wa s th e observatio n tha t whil e th e mea n bloo dlea dconcentratio n i s declining , th e calculate dpercentag e o f participant s wit hbloo dlea dlevel s greate r tha n 1 0 an d1 5 ug/d l (P1 0 an dP I 5) , respectively , ha s no t

significantl y decline dover time , particularl y i n Statistical Uni t 1. As aresul t

of thi s observatio n andothe r comment s provide dby the IRP regardin g dat amanagemen t

an devaluation , th e Work

Grou p i s developin g astep-wis e approac ht o furthe r

evaluat e an dpotentiall y identify th e lea dsources , o r combinatio n o f lea dsources , tha t

ma y b e determinan t

factor s i n children' s bloo dlea dlevel s withi n th e site
. Performanc e Standards :

• Th e Work

Grou p i s please dtha t

th e IR P conclude dtha t

th e methodolog y develope d fo r evaluatin g th e performanc e o f th e program , wit hrespec t

t o th e establishe d Remedia l Actio n Objectives , ar e appropriat e an dvali dan dtha t th e outcome-base d goal s establishe db y th e progra mar e reasonable
. Annua l Report :

• Th e Work

Grou p recommend s adoptin g severa l o f th e IRP' s recommendation s regardin g improvement s t o th e Annua l Report
. Thes e recommendation s includ e th e preparatio n o f

a n executiv e summar y o f

th e report , th e presentatio n o f dat atrend s ove r multipl e years , an dth e evaluatio n o f additiona l data , sucha s hemoglobi n versu s bloo dlea dlevels
. Outreac han dEducation :

• Th e IR P provide dman y insightfu l suggestion s regardin g ways t o improv e educatio n an doutreac heffort s aime da t increasin g participatio n i n th e program . Whil e th e programi s currentl y enjoyin g goo dparticipatio n an dconductin g wha t th e Wor k Grou p consider s effectiv e recruitment , th e specifi c strategie s recommende db y th e IR Pwil l b e considere db y th e progra mshoul dprogra mparticipatio n declin e i n th e future
.
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. Rebecc aThoma s

Apri l 29 , 200 4 Page S
Bloo dLea dProgram : I n additio n t o evaluatin g th e potentia l associatio n betwee n hemoglobi n an dbloo d lea dlevels , th e Wor k

Grou p i s als o adoptin g th e recommendatio n o f distributin g iro n supplement s an dvitamin s t o selec t progra mparticipants
. Samplin g an dRemediatio n Methods :

• Al l o f th e IRP' s comment s regardin g samplin g o r remediatio n method s hav e bee n carefull y considere db y th e Work Group
. Considerin g thes e comment s an d reviewin g certai n procedure s containe di n th e LCCH P Wor k Pla n ha s resulte di n th e developmen t

o f severa l propose drevision s t o th e Work Plan
. Th e Wor k

Grou p wil l transmi t t o EP A arecommendatio n t o approv e thes e propose drevision s unde r separate cover . Trigge r Levels :

• I n additio n t o respondin g t o th e lis t o f Ke y Issues/Question s develope db y th e Wor k Group , th e IR P als o provide dcomment s regardin g th e program' s trigge r levels
. Whil e thi s issu e wa s outsid e th e scop e o f th e independen t

revie w process , th e Work Grou p ha s considere dan ddiscusse dth e comment s an dsuggestion s provided
.

• Th e program' s sit e specifi c actio n level s o r trigge r level s tha t

guid e th e Wor k Group' s recommendation s fo r remedia l actio n fo r

variou s media , wer e develope da s aresul t o f site-specifi c studies , includin g th e Baselin e Huma n Healt hRis k Assessment , an destablishe di n th e Recor do f Decision
. Th e Work

Grou p understand s tha t

becaus e the y wer e develope dspecificall y fo r thi s site tha t

som e o f thes e trigge r

level s "d o no t

mirro r Nationa l standards" , a s state db y th e IRP
. Recognitio n o f

thes e difference s an dth e uniqu e natur e o f thi s progra m(wit hrespec t t o othe r Superfun dremedies ) le dt o th e developmen t o f th e outcome-base d(i.e. , bloo dlead-based ) performanc e standards
. Th e Wor k Grou p i s committe dt o th e diligen t executio n o f

thi s remedy
. Throug hobjectiv e revie w o f th e progra mresult s an dimplementatio n o f

additiona l dat aevaluatio n strategies , som e develope da s a resul t o f thi s revie w process , th e Work Grou p wil l continu e t o work toward s identifyin g th e determinan t factor s affectin g children' s bloo dlea dlevel s a t thi s site. Th e LCCH P Work

Grou p ha s taske dth e Performanc e Standard s Workin g Grou p wit hdevelopin g acost-effective , step-wis e strateg y t o investigat e determinant s o f elevate dbloo dlea dlevels
. Onc e apropose dstrateg y ha s bee n developed , th e Wor k Grou p wil l presen t

amor e detaile drecommendatio n t o th e EP A o n thi s topic
.

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. Rebecc aThoma s

Apri l 29 , 200 4 Pag e 4

Th e Wor k

Grou p respectfull y request s tha t EP A concu r

wit hth e recommendations , provide da s par t o f thi s transmittal , regardin g th e ongoin g implementatio n o f th e LCCHP
. Finally , th e Wor k Grou p woul dlik e t o than k th e member s o f

th e IRP , th e IR P facilitator , th e LCHH P staff , loca l communit y leaders , th e CDPHE , an dth e EP A fo r thei r participatio n i n thi s proces s an dfo r thei r dedication , thoroughness , an dconstructiv e comment . W e believ e th e revie w proces s an d adoptio n o f

th e attache drecommendation s wil l resul t i n improvement s i n th e LCCHP , an dhel p expedit e achievin g th e program' s publi c healt hgoals
.

Sit e Manage r ASARC O Incorporate d

Rus s Alle n Projec t Manage r Colorad o Departmen t

o f Publi c Healt han dEnvironmen t

<Ji mMarti n Lak e Count y Commissione r O n behal f o f Lak e Count y

enclosure s
cc : Jan e Mitchell , CDPH E Lak e Count y Boar do f

Count y Commissioner s Georgin e Bogovich , Lak e Count y Departmen t o f Huma n Service s Bu dElliott , Mayo r

o f Leadvill e Joh n Faught , Joh n Faugh t & Associate s Dary l Longwell , MF G Am y Morrison , MF G Bil l Brattin , Syracus e Researc hCorporatio n

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