Expand Child Lead Testing

September 23, 2022. ODH draft rules undermine child lead testing. Today, Cleveland Lead Advocates for Safe Housing has responded to a request for comments on draft regulations related to childhood lead testing from the Ohio Department of Health. Lead safety advocates around the country were excited when the CDC lowered the Blood Reference Value from 5 micrograms/deciliter down to 3.5 mg/dl. Think of the CDC Blood Reference Value as the point at which public health officials and health providers should begin treatment and pursue preventive measures with children. 

     There's just one catch to the CDC standard: the individual states (and some municipalities) need to adopt the new CDC standard. On August 24, 2022, the Ohio Department of Health issued a draft administrative rule that is WORSE than the current rule. Instead of following CDC's guidance and lowering the threshold for action to 3.5mg/dl, the draft administrative rule creates a new class of children  who test between 3.5mg/dl and 10 mg/dl as "elevated blood lead level" and then redefines "lead poisoned" from 5mg/dl to 10mg/dl and above. The net effect is that more children who are identified with lead exposure will still receive no onsite inspections of their homes to identify the sources of lead poisoning.

Read the CLASH comments in full.

Read the #1 Request for Comments re Lead Screening and Assessment

Meanwhile surrounding states are requiring Universal Child Lead Testing

October 3, 2023. Detroit Free Press. Universal lead testing requirement landmark moment for Michigan, advocates say. "Gov. Gretchen Whitmer signed legislation Tuesday that requires all 1- and 2-year-olds in Michigan to be tested for lead exposure, something advocates say is the biggest moment in 45 years to end lead poisoning. [   ] Currently, children enrolled in Medicaid must undergo testing for lead poisoning. But beginning next year, physicians treating any minor must test the minor for lead poisoning or order a lead poisoning test at 12 and 24 months. If they have no record of a previous test, they must be tested between 24 and 72 months. All four year-olds in Michigan must be tested if they live in a part of the state where they face increased risk for childhood lead poisoning. Minors must also be tested at regular intervals if they face high risk for lead poisoning such as living in a home built before 1978 or living with other minors diagnosed with lead poisoning."

Indiana requires universal testing as of January 1, 2023.

JANUARY 13, 2022. The Land. Why has childhood lead testing plummeted in Cleveland, and what can be done about it? "Sadly, however, testing has declined. For this, it would be easy to blame Covid-19, said Yvonka Hall, executive director of Cleveland Lead Advocates for Safe Housing (CLASH). The closure of schools and daycares during the pandemic resulted in more children being at home, increasing the risk of lead exposure. Additionally, the pandemic made it harder to test kids, since many testing sites were closed and primary care visits were virtual."

Possible barriers to increasing the rate of child lead testing.

• Public awareness of the need for child lead testing. CLASH will be using member and foundation funding to create a public awareness campaign to reach out to at risk families.

• Access to testing. It is not clear that there is a simple, one stop testing protocol readily accessible to families living in high risk communities.. Data from the Lead Screening and Testing Commission established by the Lead Safe Certificate Program might provide some guidance on this barrier, but it is not clear whether this commission is operating.  A recent announcement suggests that MetroHealth will be providing a one stop child testing service at neighborhood locations around Cleveland. CLASH is prepared to market these services to at risk families. 

• Hesitancy by families and providers. CLASH is gathering anecdotal information on parental and provider hesitancy around child lead testing. Hypotheses range from fear of discovery, fear of the medical establishment, fear of repercussions/stigma and more. CLASH will be partnering with Thriving Earth Exchange (TEX) to analyze the scientific studies of hesitancy and to do deep canvassing among families and child and health care providers to get more information.

CLASH recommends

1. Cleveland Department of Public Health (CDPH): Offer child lead testing at J. Glen Smith and McCafferty Health Centers, using the one-stop protocol announced by MetroHealth. Seek reimbursement from Ohio Medicaid for services delivered to Medicaid eligible children and mothers.1

2. CDPH: Place the Mobile Health Lab in service as soon as possible, providing one stop, walk-in child lead testing to families at child care and educational locations around the city. 

3. CDPH: Implement and oversee the operations of the Lead Screening and Testing Commission as authorized by the Lead Safe Certificate ordinance (747-19 pages 19). The Commission should operate in compliance with Ohio Sunshine law. 

4. CDPH: implement and oversee the Lead Safe Housing Action Board created under the Lead Safe Certificate ordinance (747-19 pages 19-20). In addition to its enumerated duties, the Lead Safe Housing Action Board should identify resources for at risk families, create procedures for addressing the needs of families with an EBLL child, and oversee a rapid response by CDPH to families with an EBLL child as authorized by §240.09(d) of the codified ordinances, even before a formal referral from the Ohio Department of Health. The Commission should operate in compliance with Ohio Sunshine law. 

5. Senior Strategist on lead: Create a Lead Outreach Team to provide reliable information to families, child and education providers.about lead hazards, the importance of timely testing, and resources to support families with an EBLL child. This team may operate in support of CDPH lead testing (stationary and mobile) and follow up services; Cleveland Water Department services to child care and education providers.

6. Senior Strategist on lead: Work with MetroHealth to assure that WIC participants receive lead tests as a part of their program.

7. Senior Strategist on lead: Work with Cuyahoga County Executive to clarify, streamline, and publicize the PRC benefits for families where a child has an elevated blood lead level (EBLL). PRC funding may be used to apply interim controls to a lead poisoned home (while the family waits for a lead risk assessment) or to relocate to a lead safe home. 

8. Senior Strategist on lead: work with Cuyahoga Metropolitan Housing Authority to set aside Housing Choice Vouchers for families with an EBLL child in the household.

9. Senior Strategist on lead: work with representatives of the Cleveland Metropolitan School District (CMSD) and the CWRU School of Nursing to expand childhood lead testing of students entering pre-K and kindergarten classes in the CMSD. 

10. Senior Strategist on lead: Explore methods for billing child lead testing services to Medicaid or private insurance providers to offset the cost of child lead testing provided by the City of Cleveland. Medicaid will pay for both capillary tests (finger prick) and venous tests (blood draw) While Medicaid requires testing at age 1 and 2 or before age 6, Ohio Medicaid will reimburse additional child lead testing. Current reimbursement rates are as follows: Blood draw (venipuncture) $2.25; Finger prick (capillary draw) –$3.63; Lead test* – $9.08 *Clinical lab rates are set at 75% of the Medicare Clinical Lab Fee Schedule.