At a glance
CDC supports Indiana's and other state and local health departments, or their bona fide agents, through cooperative agreements to support childhood lead poisoning prevention activities. Read about the program's successes.
About the program
The State of Indiana received $633,282 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in the third funding year. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2023, to September 29, 2024.
The strategies focus on:
- Ensuring blood lead testing and reporting
- Enhancing blood lead surveillance
- Improving linkages to recommended services
To learn more about these efforts in Indiana, contact the program below.
Indiana State Department of Health
Lead and Healthy Homes Division
2 North Meridian Street 1st Floor
Indianapolis, IN 46204
Phone: 317-233-1250
Note:
Success story: funding year 3
Indiana increases blood lead testing rates through universal testing and a focus on communities at high risk
Challenge
Indiana Department of Health (IDOH) leadership determined that between 2018–2022 only about 24% of children younger than three years of age who needed a blood lead test received one each year. Healthcare professionals and providers confusion over who should be tested and when was a key contributor to this problem. IDOH then examined whether existing testing strategies were effective, especially considering Indiana's recent work to map lead exposure risk across the state.
Intervention
In 2020 and 2021, IDOH worked with the statewide lead advisory committee to establish how the state could effectively work towards lowering its blood lead level (BLL) threshold for case management and expanding testing to more Indiana children. This group provided critical insights into both issues, but really challenged IDOH to find ways to ensure healthcare professionals made extra effort to identify and test children living in communities with a higher risk for lead poisoning.
On January 1, 2023, IDOH launched universal testing requiring healthcare providers to test children at ages 1 and 2 years, or as soon as possible before the child turns 7 years old, if not previously tested. To ensure this message reached communities at highest risk, IDOH sent a guidance document to healthcare providers across the state. In addition, IDOH explained the change in Indiana through an article in the American Academy of Pediatrics newsletter. Thirdly, the agency partnered with the Hoosier Environmental Council, National Association for the Advancement of Colored People (NAACP) chapters, and Minority Health Coalitions across the state. With nearly $1M in funding from the state legislature through the Health Issues and Challenges Grant, these groups hired advocates in 10 of the communities at highest risk for lead poisoning and are working to ensure families are aware of the need for blood lead testing. Their ongoing work includes hosting lead testing at health fairs, creating public awareness campaigns with local officials, and going door-to-door with community partners.
Impact
Through October 2023, community advocates have hosted more than 100 classes or presentations for individuals in their communities on the importance of lead testing. Additionally, they hosted or staffed booths promoting lead testing at 179 events across the state. As a result, nearly 94,000 children received blood lead testing in 2023, which is an increase of more than 57% since 2022, when about 60,000 children received a blood lead test.
Funding for this work was made possible in part by NUE2EH001452 from the Centers for
Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Success story: funding year 2
Partnering to lower the blood lead action level in Indiana
Challenge
Since 2007, Indiana’s administrative code (410 IAC 29) had recognized 10 µg/dL as the “blood lead level of concern.” The Indiana State Department of Health (IDOH) sought to lower this action level since 2017. However, IDOH did not have the support required to ensure that local health departments could provide in-person case management and home risk assessment services for families of children ages 6 years and younger who are affected by lead. Aligning with CDC guidance took on additional importance following CDC’s update of the blood lead reference value from 5 µg/dL to 3.5 µg/dL in 2021.
Intervention
In 2019, IDOH and the Lead and Healthy Homes Division (LHHD) organized a diverse group of partners from across Indiana to form the Lead Advisory Council (LAC). The LAC was charged by the state health commissioner to research how Indiana might be able to lower the blood lead action level given the cost and impact of such a move. Information was collected in late 2019 on other state programs' blood lead action levels. Due to COVID-19, the project was halted in early 2020 and resumed in early 2021.
The LAC recommended that if the blood lead action level was lowered, additional resources should be provided to support case management and risk assessment. The LAC also recommended broad media outreach and a campaign focused on communities with greater lead risk. In 2021, the Indiana legislature authorized funding for identified health issues and challenges, including lead poisoning. This funding provided the required resources to support changing the administrative code and lowering the blood lead action level from 10 µg/dL to 3.5 µg/dL, which took effect July 1, 2022.
Impact
While the bulk of the additional funding went to local health departments, IDOH hired seven staff members to better assist local health departments and families with case management, surveillance, lead risk assessment, training, and service linkages. The IDOH staff has revised case management guidance for local health departments and issued new clinical guidance for providers in response to the lower blood lead action level. The number of confirmed cases receiving both case management and risk assessment support increased by 118% from Q2 to Q3 in 2022. Out of 447 cases in Q3, 160 had BLLs from 3.5–4.9 µg/dL, and 207 had BLLs from 5–9.9 µg/dL. Additionally, 367 more families were able to receive case management services including education.
Funding for this work was made possible in part by EH21-2102 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Success story: funding year 1
Collaborating with health networks in Indiana
Challenge
Many laboratories, clinics, and providers from Ascension, a large health network in Indiana, practiced inconsistent methods related to
- determining who needed a blood lead level (BLL) test
- how and where patients were tested
- and reporting BLL test results to the Indiana State Department of Health (ISDH)
Intervention
In fall 2018, the Indiana State Department of Health (ISDH) collaborated with Ascension by providing them with data reported from their clinics to allow the health network to see the varying rates of reporting, quality of data, and ability to report electronically. After understanding the challenge, Ascension's Chief Medical Officer, in conjunction with ISDH, authorized these improvements:
- Setting up electronic reporting credentials for each site and providing training on electronic reporting for partner clinics.
- Implementing a plan to purchase point-of-care blood lead testing supplies and equipment over the next two years for every clinic that serves as a primary care provider for children.
- Providing each clinic with filter paper testing supplies and allowing ISDH's laboratories to analyze those tests until each clinic has a point-of-care analyzer.
Impact
Over a one-year period from 2018–2019, electronic laboratory submissions from providers associated with Ascension increased by 67%. This represents a total of between 28 and 40 employee hours saved over the course of the year (depending on the quality of the initial submission).
Funding for this work was made possible in part by NUE2EH001379 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.