Relevance

Lead poisoning remains the most significant environmental threat to the health of America’s children, affecting as many as 535,000 infants and youngsters under the age of six. While lead exposure can result in a number of physical grievances, its most damaging effects are wreaked upon a child’s developing brain. The neurological assault sustained during lead exposure can permanently impair a young child’s intellectual capacity, resulting in learning deficits, memory difficulties, behavioral problems, reduced IQ, and associated social functioning ills. The burden of lead poisoning is borne not just by afflicted children and their families but by society as a whole. Lead poisoned children are often disruptive in the classroom, require special education services, and—if they graduate from high school—take longer to do so than their age cohorts. There is a long association between lead poisoning and crime, often violent in nature, and a lifetime of reduced earnings related to their neurological deficits. Because babies and young children can be lead poisoned without showing outward signs of illness, the recommendation from the CDC, the American Academy of Pediatrics, and the Tennessee Department of Health is screening at the ages of 12 and 24 months, when brain development is still ongoing (through age five-six), and additional exposures can be halted. Despite decades of education and outreach, the most effective way to ensure parents seek screening for their children is the recommendation/insistence of their pediatric provider. UT Extension, in its partnership with the TN Department of Health, continues to seek new ways to encourage pediatric providers to conduct and report lead screenings for the children in their care.

Response

A medical provider’s world is fraught with challenges and conflicts. The time allotted for a consultation in the modern practice is rarely adequate to address all the concerns, answer all the questions, urge all the wellness options that the health professional would desire. While this is true for all medical caregivers, it is particularly exacerbated in the world of pediatrics. First-time parents may be nervous and needy; the patients themselves cringe and cry and kick, and some families are resistant to anything that may cause their children pain—or perceived pain. While initial lead screenings require no more than a mere finger prick, many parents do not see the value in a test for a condition about which they know little or nothing. Pediatric providers themselves may have a less than stellar background in environmental health and a bit of skepticism as to the value of screening children for what they may erroneously perceive as a largely vanquished health problem. In order to keep Tennessee pediatric professionals invested in the importance of lead screenings and to render the ability to counsel patients as simple as possible, UT Extension launched this year, as one component of its partnership with the Department of Health’s Childhood Lead Poisoning Prevention Program (TN CLPPP), the digital Providers’ Toolkit, instantly accessible on tablets, I-Pads, or cell phones. This online resource is a “one-stop shop” designed specifically for pediatric providers, so they can educate themselves and their patients on all aspects of lead poisoning. The site also includes contact information for key members of the TN CLPPP team, order forms for free publications and in-service trainings offered by UT Extension, and a narrated PowerPoint on how to handle the children whose screening results are elevated. For many pediatric professionals, they may have screened children for years without experiencing a child with an elevated blood lead level. The Providers’ Toolkit gives them the confidence to proceed in their patient care and the email addresses and phone numbers they can rely upon for assistance. Through its broad network with environmental and child-serving agencies across the state, the toolkit’s availability has been heavily promoted.

Results

As everyone knows, the coronavirus pandemic has negatively affected almost every aspect of daily life, disturbing—inordinately—routine and preventive medical care. Environmental health/lead poisoning professionals particularly feared the deleterious effects that could result from children spending more, or all, of their time in homes that contain lead-based paint (the chief source of childhood lead exposure). Lead screenings, in fact, became more, rather than less, imperative in light of COVID-19. Nevertheless, lead poisoning programs across the country braced for the decimation of screening rates that they were certain would ensue. Tennessee, as confirmed by the CDC and HUD’s Office of Lead Poisoning Prevention and Healthy Housing, was among the three states in the nation whose screening rates declined the least in the last three quarters of 2020. In a year when other outreach methods, such as presentations at conferences for professionals and parents, exhibits at health fairs and the like, were not possible, the release of the Providers’ Toolkit assumed greater prominence than it might have otherwise. To be certain, TN CLPPP’s stellar record of community relations and outreach all contributed to withstanding the pressures of 2020, but it seems apparent that this effort to develop materiel and foster goodwill with the state’s pediatric providers was integral to preserving screening rates to a better-than-anticipated degree. From a quantitative standpoint, the Providers’ Toolkit has enjoyed more than 1,700 views since its premier on April 20, 2020. Thanks to the FCS IT team of Karen Sergent and Cris Miramontes for their guidance and assistance with the technical aspects of the project.

Public Value Statement

A wide range of estimated returns on investment are associated with the costs of preventing lead poisoning – or discovering lead poisoning in earliest childhood, before extensive and irreversible neurological damage has ensued. The widely published (most recently in the October 2020 Green and Healthy Homes® Initiative “Return-on-Investment Calculator for Lead Poisoning Prevention”) confirms a “$17 to $221 [return on each dollar] to society.” These savings represent educational dollars that would otherwise be expended on special education services, behavioral interventions, and protracted years in the educational system, savings on medical costs related to the physical and psychosocial ramifications of lead poisoning, and savings to the criminal justice and penal system for the costs associated with apprehending and housing legal (and often violent) offenders. Lead poisoning can be a huge detriment to the quality of life. Its victims suffer physical ills, such as malaise, sleeplessness, anemia, digestive disorders, and kidney disease. Its effects on the central nervous system include hearing problems and both fine and gross motor skill impairment. The neurological damage can manifest itself in irritable and violent behaviors. As a result, lead poisoning victims and their families suffer both financially and socially. Preventing lead poisoning is a “win-win” for individuals and society alike, and the most immediate, most compelling soldiers in this ongoing battle are the pediatric practitioners. Helping support their efforts can make a difference, as 2020 has demonstrated.