Rhode Island Coordinates Statewide Efforts to Address Lead Exposure in Maternal and Child Health Populations

October 11, 2018 | ASTHO Staff

Oct. 11 is Children’s Environmental Health Day, a day to raise awareness around children’s health issues, share successes and new initiatives, and discuss ongoing challenges. Children continue to face high rates of chronic diseases and developmental disabilities linked to environmental exposures. One of the harmful environmental exposures that state health agencies have prioritized is lead.

In the United States, half a million children between ages one and five have blood lead levels at or above 5 μg/dL, the reference level CDC recommends for public health action. About 3.6 million families with a child under six live in an environment that EPA considers hazardous for exposure to high levels of lead. For children, lead exposure can contribute to brain and nervous system damage, slowed growth and development, learning and behavioral issues, as well as hearing and speech problems. In order to mitigate the lifelong consequences of childhood lead exposure, states must take a comprehensive, coordinated approach to reduce lead exposure in maternal and child health (MCH) populations.

ASTHO recently contacted the Rhode Island Department of Health (RIDOH) to understand how the state is working to reduce childhood lead exposures and conduct lead case management. The Center for Healthy Homes and Environment coordinates statewide efforts to eliminate lead poisoning and reduce lead exposure, including efforts to increase childhood lead screening, implement universal blood lead screening requirements, collect blood level tests through an automated system, refer children with elevated blood lead levels (BLL) to non-medical case management, and offer comprehensive environmental inspection of homes.

RIDOH has been successful in getting many families to return to their healthcare provider for confirmation testing within 90 days if the first test indicated elevated blood lead levels. However, this is only the starting point. RIDOH links all children with venous BLL greater than 5 μg/dL with non-medical case management. Non-medical case management includes at least one home visit, as well as educational materials and connections to other services such as housing and urban development programs for lead abatement, early intervention, and weatherization, in addition to neurodevelopment centers and services through the USDA’s WIC program. This is a gateway for making contact with other families with lead poisoned children and building a network of support.   

Partnerships are another key to success. To enhance its program, RIDOH is working with primary care providers, the Childhood Lead Action Program, Housing Works RI, and the RI Alliance for Healthy Housing. Together, they are collaborating to provide services and implement primary prevention measures to eliminate lead poisoning and increase screening rates in Rhode Island.

Currently, ASTHO is a partner on the Maternal and Child Environmental Health Collaborative Improvement and Innovation Network (CoIIN). The CoIIN is a cross-sector group working to build state capacity to increase the number of infants and children that have access to a system of coordinated care to address lead exposure and prevention in MCH populations. By August 2020, the 10 participating states will identify sources of lead exposure for MCH populations, develop or update state plans, and demonstrate improvements in various lead exposure metrics. State teams are currently identifying areas for improvement and innovation and beginning to test changes on a small scale. State teams are expected to form two pilot sites that touch at least two of the CoIIN’s primary drivers (e.g., clinics/healthcare facilities, housing, products/industry, childcare/schools, or community). This type of collaboration is meant to remove systemic barriers to change. A key component of this CoIIN is collaboration and shared learning between individuals involved in testing the change and those impacted by the change. State teams are encouraged to engage families in their work and consider how these families are uniquely qualified partners to help shape systems-level policies.  

This community engagement work is further supported by ASTHO’s 2019 President’s Challenge, “Building Healthy and Resilient Communities.” The challenge highlights the importance of supporting investments in community-led, place-based approaches, including opportunities to address lead exposure in MCH populations. ASTHO, NACCHO, and the U.S. Surgeon General’s office will help health officials achieve the goals of the 2019 President’s Challenge by focusing on measurable outcomes. Through this partnership, ASTHO hopes to promote positive social connectivity, uniting community members to build social capital and improve resilience so that communities can resist, respond to, and recover from adversity, including events like childhood lead poisoning.