Fighting lead poisoning: Frances Payne Bolton School of Nursing, partners to screen school children

The Frances Payne Bolton School of Nursing at Case Western Reserve University, bolstered by a grant from the Elisabeth Severance Prentiss Foundation, has launched a pilot program to help address what program director Marilyn “Lynn” Lotas called a “crisis of lead exposure among Cleveland’s children.” The “Partners in Health” program is a collaboration of the School of Nursing, the Cleveland Metropolitan School District (CMSD), the City of Cleveland Department of Public Health and the MetroHealth School Health Program. The program seeks to increase the percentage of young Cleveland school children screened for dangerous blood-lead levels from the current level of about 33 percent to 80 percent by 2019. "We have got to get these kids tested,” said Lotas, an associate professor at the school. “We are going to lose another generation if we cannot test and treat this group of children.” The City of Cleveland ranks among the nation’s worst for childhood lead exposure, according to the Ohio Department of Health (ODH). Cleveland Mayor Frank Jackson has said he believes that testing the city’s children for lead is critical for early intervention. Many children are not tested for lead or, if tested, are not treated. A 2015 ODH study reported that as many as 65 percent of children at risk for lead poisoning in the City of Cleveland were not screened for blood-lead levels. Among those screened, an average of nearly 13 percent had dangerous levels of lead in their blood, Lotas said. “This partnership helps to ensure that students are not only being screened, but those that are identified as having high lead levels are properly referred and connected to necessary health services that will benefit both health and education outcomes,” said Vanessa Maier, medical director of MetroHealth’s School Health Program. The goal of Partners in Health is to establish a sustainable program to annually test students from ages 3 to 5 years old enrolled in CMSD Pre-K and kindergarten programs. Children with high lead levels will be referred for further treatment as needed. The program will begin with three schools and grow each year. "This is significant," said Deborah Aloshen, CMSD director of health and nursing services. "A whole community is coming together to help children who have been affected by exposure to lead." Families of children with high lead levels will also receive information on how to reduce lead exposure in their home and will be referred for lead abatement in their house or apartment, where appropriate, Lotas said.

Cleveland’s lead crisis

There is no acceptable level of lead in the bloodstream, but the Centers for Disease Control has found that children with blood-lead levels of at least 5.0 micrograms per deciliter (mcg/dL) are significantly more likely to suffer the effects of lower IQ levels and academic achievement. By that measure, the City of Cleveland is in a lead crisis—at least among its most economically disadvantaged families. In most cases, that means black and Hispanic children living in Cleveland’s poorest neighborhoods. Partners in Health targets children ages 3 to 5 because rapid brain development and frequent hand-to-mouth contact at that age makes them especially vulnerable to the effects of lead. Potential sources of lead exposure include deteriorated lead-based paint, lead dust, soil, food, water or toys containing lead.

Program details

The program, supported initially by the $300,000 Prentiss Foundation grant, will begin with about 100 children in three schools being screened by undergraduate students this year. Graduate students will then provide outreach to families and schools with affected children. “Another goal of this program is to expand the public health knowledge and experience of our nursing students,” Lotas said. “Addressing a major public health problem, while also working closely with these children and their parents, is an invaluable experience. We have dedicated students studying health care in the Cleveland area and we can help close the gap on the lead problem.” The program will expand to additional schools in subsequent years with the goal of annually screening all CMSD pre-K and kindergarten students. The program builds on relationships established through a previous Prentiss Foundation-funded project, “Nursing in Cleveland Schools,” which, from 2010-15, provided health screenings to more than 33,000 CMSD school children while providing vital public health experiences for over 1,200 nursing students. The Elisabeth Severance Prentiss Foundation is a charitable trust dedicated to supporting and advancing health care, mainly in Greater Cleveland. The foundation awards grants aimed at improving health-care quality or delivery, for programs which provide access to health care to the underserved or indigent, or for medical research. For more information, contact Mike Scott at mike.scott@case.edu or 216.368.1004. This article was originally published Sept. 11, 2017.