NCLSH: State Public Health Policies

New Report Documents State Public Health Responses to Lead-Poisoned Children

June 30, 1999 -- The Alliance for Healthy Housing (formerly The Alliance To End Childhood Lead Poisoning and the National Center for Healthy Housing (formerly the National Center for Lead-Safe Housing) announce the release of Another Link in the Chain: State Policies and Practices for Case Management and Environmental Investigation for Lead-Poisoned Children. This groundbreaking report presents timely information on state policies for environmental investigation and case management for lead-poisoned children from a survey of all 50 states and the District of Columbia. This report was made possible by a grant from the Teresa and H. John Heinz III Foundation.

Another Link in the Chain analyzes survey responses to document current case management and environmental investigation practices and to identify obstacles to providing high quality services. To help pinpoint the need for specific program improvements, the report reviews every state's progress on key indicators. The report also makes recommendations for policy and program changes at the state and national levels. This information has never before been collected and assembled in a comprehensive fashion on a state-by-state basis, or analyzed at the national level.

Another Link in the Chain's analysis of responses from all 50 states and DC reveal a number of weak links in the chain, as well as some bright spots. A sampling of key findings from the report follows:

Case management services vary widely from state to state and sometimes even within states. Just 29 states reported having written standards for case management. Surprisingly, 10 states now provide specialized cleaning to reduce lead dust hazards in some circumstances.
What constitutes an environmental investigation also varies widely, with just 35 states having written protocols. While some states continue to rely almost exclusively on XRF detection of lead paint, 33 states reported providing lead dust testing as a routine part of their investigations -- an encouraging finding that shows state programs are evolving in response to research confirming the danger of lead-contaminated dust.
The majority of state Medicaid programs have not yet established mechanisms to pay for case management and environmental investigation for lead-poisoned children, an important deficiency. For states that do have Medicaid reimbursement, rates vary tremendously, even accounting for variation in services. For environmental investigation, Medicaid reimbursement rates vary from $38 to $490; for case management, from $25 to $1,610.
Most states do not monitor the outcomes of their interventions for children or keep track of the corrective measures taken to control lead hazards in the home. Some states could not provide even basic information on the number of children needing follow-up care or the number of those who actually received services.
The majority of states do not have legal authority to order remediation of homes with identified lead hazards, even in the case of a lead-poisoned child. Almost half the states indicated that no funding is available for hazard control.

Lead poisoning is a preventable but potentially devastating disease that affects 4.4 percent of American preschoolers, or 890,000 American children. Lead poisoning can cause permanent damage to a child's nervous system, IQ loss, learning disabilities, behavior problems, and – at very high levels – coma, convulsions, and death. Usually, children are poisoned in their own homes by lead-contaminated dust from chipping and peeling paint or home improvement projects that stir up lead dust. For most lead-poisoned children, the only treatment is to identify the lead source (environmental investigation) and to take steps to protect the child from further lead exposure, which usually requires that lead hazards in the home be controlled. Most families of lead-poisoned children also benefit from case management to coordinate the necessary follow-up services.

Another Link in the Chain focuses on the services provided once a lead-poisoned child is identified, usually through the public health or environmental agency. As this report's title suggests, case management and environmental investigation are but two links in the chain for protecting children from lead poisoning. This report does not cover primary prevention (actions to prevent children's lead exposure in the first place) nor blood lead screening to identify poisoned children. Similarly, a detailed examination of corrective measures taken in response to environmental investigation and case management is beyond this report's scope.

	You may download the "Another Link in the Chain" document in Acrobat (.pdf) format. (File size 646K)
	You may download Another Link in the Chain Update document in Acrobat (.pdf) format.(File size 4,064k.)

The National Center for Healthy Housing, 10320 Little Patuxent Parkway, Suite 500 Columbia, MD 21044
410.992.0712 / Fax: 443.539.4150
Copyright © 2001, NCHHCHH, Inc.