Missed Opportunities

To address the shortfall in Child Lead Testing, providers need to meet families at a time and place that is convenient for parents and children

Ohio's health providers are striving to test children at well baby check ups. Still we're missing a lot of children who are not having formal medical system contacts. These are the missed opportunities!

Health providers need to be cognizant of the stresses on families living in the poorest metropolitan area in the US. Families most at risk have the fewest resources to reach out for services.

Families deserve a full court press from public heath providers.

Health departments in neighboring states are partnering with social service and child care providers and grassroots organizations to reach out to at risk families with practical services...not just brochures and billboards.

Here's some examples

Detroit Public Health Department has designed a comprehensive outreach and service collaborative combining city and grassroots service organizations. Here's an overview.

Watch the PowerPoint

A Mobile Test Van in Syracuse NY finds at risk families where they live.

Jul. 25, 2023. New mobile lead testing vehicle seeks to reach Onondaga County’s at-risk children "Onondaga County has unveiled a new mobile lead testing vehicle that can bring the quick blood tests into neighborhoods with children most at-risk for lead poisoning. Each year, hundreds of young children in the county still test positive for high levels of lead. It’s a decades-old problem that still haunts families in older homes without proper renovations. Such homes are concentrated in Syracuse’s low-income and minority communities. Get the facts about Mobile Child Testing.

Notre Dame Lead Innovation Team partners with local WIC program to identify, prevent lead poisoning in children. "When St. Joseph County residents qualify for WIC (the USDA’s Special Supplemental Nutrition Program for Women, Infants and Children), they gain access to B.A.B.E. & More, a store-like experience that allows expectant mothers and parents-to-be to redeem coupons for infant and childhood essentials like diapers and bottles. Last year, B.A.B.E. store “shoppers” were offered something new to help their families: free lead screening kits offered by the University of Notre Dame’s Lead Innovation Team. These kits allow parents to determine the risks of lead in their homes and to their children."

Cleveland could provide mobile lead testing but Dr. Margolius prefers not to....

May 22, 2025 Signal Cleveland. Need a health screening? Cleveland’s mobile health clinics will be rolling near rec centers this summer. "The clinic is equipped to offer lead testing but typically does not, Minor said. She said other organizations, like MetroHealth or primary care providers, usually do lead testing – which is typically preferred, she added. 'We really want people to be connected to their provider [and] actually get tested by their provider and make that more routine than kind of the one-offs at our mobile unit,' Minor said."

Community Events are opportunities to test children.

Every weekend from April thru October, there's a community event that attracts families with children together. Many of these events are suitable for on site testing by the City of Cleveland's Mobile Health Van. In fact, the van is present at many of these events, but there's no one on the van who is testing for lead.

Community Baby Showers sponsored by Black Child Development Institute -- Ohio are a powerful example of bringing families and babies to events where they could receive lead testing as well as medical and self-care information.

Cuyahoga Metropolitan Housing Authority sponsors Family events on a quarterly basis. CLASH is there to provide lead safety information. Last year Metro Health brought child lead testing to two of these events. This project could be expanded meet the needs of one of the most underserved communities: residents of public housing.

Tangible benefits like gift cards and home and health products are ways to bring families out to participate in community events.

Here are two examples

Dec 20, 2025.Toledo Blade Not just about the toys: Junction Coalition, partners host kids' lead screening, giveaway "Patricia Taylor only stopped by Nexus Health Care with her son Saturday for the free toys. She didn’t realize children had to get screened for lead poisoning before getting a toy — but she’s glad she did because her son, J’Saun Stephens, 8, tested positive. Get the Lead Out of the Holidays event organized by the Junction Coalition, Neighborhood Health Association, Fair Housing Center, and others."
July 25, 2023. WAER Onondaga County debuts mobile lead testing van. "According to 2021 data, about one in 10 children in Syracuse has elevated blood lead levels, which can cause major health issues, including developmental delays. That's why, says Onondaga County Health Commissioner Kathryn Anderson says as much testing as possible is imperative, especially for kids aged one to two. 'While they’re recommended to be getting blood lead screening and testing, there are gaps' she said at the van's unveiling on Monday. 'This is intended not to replace the physicians, but to fill in the gaps.' The mobile van will take scheduled appointments and walk-ins. Children will first receive a finger poke rapid test and if elevated lead levels are detected, they’ll receive blood work, says Anderson, and more."

Children in Foster Care

Are children in Foster Care given lead screening tests? Medicaid rules require testing at 12 and 24 months.

Cuyahoga County Foster Care Statistics:

In 2024, Cuyahoga County Children Services had custody of 2,145 youth. Of these

443 were reunified.
12 were placed in legal guardianship.
182 were in the custody of a relative.
178 were adopted.
811 were waiting to be adopted.
124 aged out.
395 were in a foster care or group home placement.

https://fosteractionohio.org/wp-content/uploads/2025/04/2025-legislator-one-pager-cuyahoga.pdf

A related foster care concern is the presence of lead in a foster care home. State Regulations are pretty vague

Rule 5101:2-7-12 | Site and safety requirements for a foster home. Ohio Administrative Code 5101:2 Chapter 5101:2-7 | Foster Care

Effective: June 15, 2020 Promulgated Under: 119.03 PDF: Download Authenticated PDF

(A) A foster home and all structures on the grounds of the home shall be maintained in a clean, safe, and sanitary condition and in a reasonable state of repair. A home shall be a house, mobile home, housing unit or apartment occupied by an individual or a family.

(1) A home is to be free of peeling or chipping paint.

(2) If a potential lead hazard is identified, the recommending agency is to make a referral to the appropriate agency.

Challenges: Are inspectors RRP trained? Are reports produced? To whom are referrals made when visual inspections indicate possible lead hazards?

WIC Moms and Babies should be tested for lead. Alas, the National WIC program does not require or provide funding for lead testing.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age 5 who are found to be at nutritional risk.

The WIC program aims to safeguard the health of low-income women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.

Each month, on average, more than 13,000 participants receive WIC benefits in Cuyahoga County. Source: https://www.metrohealth.org/en/community/public-health-programs/nutrition-program-women-infants-children

While WIC does not fund child lead testing, there is no legislative or regulatory barrier to promoting child lead testing for moms and babies enrolled in the program. The National WIC Association has address this need in THE ROLE OF WIC IN LEAD SCREENING and the Legal Counsel for Health Justice has published Making the Case for Use of Federal WIC Funds to Conduct Blood Lead Testing

Two examples of working with WIC

Central Michigan District Health Department routinely does lead screening on Medicaid-eligible children in the WIC program. Lead testing can also include non-WIC participants in the event of a lead exposure in the community. This screening is done by a finger prick. If a child has high lead levels (>3.5 micrograms/dL), follow up testing, education, and resources will be provided.
12/9/2024 WIC Program Partners with Lead Poisoning Prevention Program to Expand Testing. This initiative, which leverages Medicaid Quality Improvement funding, aims to expand access to lead testing for vulnerable populations and improve health outcomes for children across the region. Since August 2024, WIC clinics in Ohio, Monongalia and Marion Counties have joined Harrison County in offering lead testing. In just three months, these counties collectively performed more than 353 lead tests, with 56 already completed in November alone. This builds on Harrison County's two-year track record of offering lead testing, a program initiated in response to the 2021 water crisis. 'Our WIC clinics are uniquely positioned to provide lead testing to families who might not otherwise have access,' said Heidi Staats, West Virginia WIC Director. 'This partnership not only strengthens our ability to protect children from lead exposure but also reinforces WIC’s role as a critical health resource for families. By expanding testing, we’re taking an important step toward healthier futures for the communities we serve.' The partnership began in July 2022 when Harrison County WIC leveraged Medicaid funding to cover clinic personnel time and testing supplies. This initiative has since proven critical, with Harrison County achieving the highest percentage of children under 72 months tested for lead in the state, according to the WV Childhood Lead Poisoning Prevention Project (CLPPP) 2023-2024 data.

Test children entering Pre-K or Kindergarten

Ohio and Medicaid require that children who have not been tested before age 6 should be tested. CLASH recommends that school site testing is important for 3 reasons

Children who were tested at age 1 and 2 may have been exposed to lead hazards when the family moved or when the toddler was in a child care setting.
Lead exposure is cumulative. Children who have had small doses of lead before 6 may have EBLL by the time they are entering school.
Identifying children will EBLLs when they enter school will give educators the opportunity to design educational programs to address cognative deficiencies.

Here's what we know

CMSD tested water in schools in 2016 and found in-school water sources had measurable levels of lead. Their 2016 test results were removed from the CMSD webpage need to be retested and addressed. These systems should be periodically retested on a regular basis.
Resume child lead testing for kindergarten and pre-K enrollees. In 2017 the City of Cleveland, the Frances Payne Bolton School of Nursing at CWRU and the Cleveland Metropolitan School District collaborated to test children coming into pre-K and Kindergarten. The program was discontinued in 2020 because of the Pandemic and never resumed. CDC and National Association of School Nurses recommend this program
Click here for more background on school lead testing in other communities.

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