Missouri

About the program

The State of Missouri received $565,000 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 Missouri, contact the program below.

Missouri Department of Health and Senior Services

920 Wildwood Dr.

Jefferson City, MO 65109

Phone: 573-751-6102

Success story: funding year 3

Modernizing childhood blood lead testing in Missouri

Challenge

The blood lead testing guidelines in Missouri caused confusion statewide. In Missouri, testing recommendations were determined by a yearly updated map indicating high-risk areas. Children in high-risk regions were advised to be tested annually until age 72 months, while those in general risk areas should also be screened using a lead risk questionnaire yearly until the same age, with testing if necessary. Per federal requirements, children covered by Medicaid needed testing at 12 and 24 months, regardless of their location. Healthcare providers had to know the child's residence and insurance type and refer to a constantly changing map to decide if a test was necessary. Explaining these rules was challenging, and providers found it difficult to assess risk during brief office visits.

Intervention

The Missouri Childhood Lead Poisoning Prevention Program (MoCLPPP) worked with the Lead Advisory Committee from October 2022 to early spring 2023 to simplify testing recommendations. MoCLPPP staff drafted statutory language to change from a geographical reference for testing to an age-based reference. Families of all children under 4 years old will be provided lead education and offered annual testing. Revisions were made based on local health agency recommendations and public comments. A final draft was submitted to the state legislature. Subsequently, the statute changes were passed and took effect on August 28, 2023.

Impact

The new legislation raised awareness about lead throughout the state, serving as a reminder to both providers and families about the persistent threat of lead poisoning in Missouri. Streamlined blood testing criteria facilitated the development of unified messaging, simplifying the promotion of testing efforts. MoCLPPP staff, in collaboration with the Office of Public Information, developed social media content and informational materials for providers to disseminate. Furthermore, the Lead Advisory Committee is leveraging its networks to spread these messages statewide, aiming to enhance awareness. MoCLPPP expects a surge in blood lead testing rates in the upcoming year as a result of the statutory language adjustments.

Funding for this work was made possible in part by NUE2EH001461 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 2

Creating a lead advisory committee in Missouri

Challenge

When the Missouri Lead Poisoning Prevention Program began in 1994, Missouri was required to have an advisory committee on lead poisoning. As Missouri’s blood lead levels decreased, the requirement to have this committee was reevaluated, and the statute requiring an advisory committee was repealed in 2011. When CDC updated its childhood blood lead reference value (BLRV) from 5 μg/dL to 3.5 μg/dL in October 2021, Missouri decided to seek guidance and insight from partners on real world practices and challenges.

Intervention

The Missouri Childhood Lead Poisoning Prevention Program (MoCLPPP) reformed the Lead Advisory Committee with a variety of partners, including school health, managed care organizations, Medicaid, local health agencies, toxicology, pediatric environmental health specialty units, pediatricians, and community organizations. During the first meeting, held May 31, 2022, MoCLPPP provided an overview of childhood lead poisoning in Missouri, and the advisory committee identified four focus areas: data, policy, outreach, and healthy homes. The advisory committee decided to meet monthly, and subsequent meetings included goal development in two of the focus areas: policy and outreach/education. The MoCLPPP program manager refined the goals and submitted them to the committee for review.

Impact

In the short term, the advisory committee recommended revisions to statutory language that will allow for universal testing of all children in Missouri up to the age of three and recommended screening of children ages 4 and 5 with testing as appropriate. The advisory committee also recommended adopting the CDC BLRV of 3.5 μg/dL as the level for public health action and suggested a tiered approach to case management and risk assessments. The regulatory actions needed to enforce these recommended changes are underway. The long-term impacts of the Lead Advisory Committee are still under evaluation.

Funding for this work was made possible in part by 5 NUE2EH001461-02-00 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Teaching healthcare providers new techniques in Missouri

Challenge

Statewide, blood lead levels are higher than the national average, yet blood lead level testing rates are low in high-risk areas. The Missouri Childhood Lead Poisoning Prevention Program (MO CLPPP) identified the primary barrier for blood lead testing to be gaps in healthcare providers’ knowledge of blood lead testing requirements for children under the age of six and a lack of access to educational materials about lead poisoning prevention.

Intervention

MO CLPPP developed outreach materials aimed at providing information about blood lead testing requirements to healthcare providers, which were placed in healthcare clinics across the state. MO CLPPP mailed over 150 flash drives loaded with medical management guidelines, and recommendations about blood lead testing and follow-up, to pediatricians across the state. MO CLPPP also attended five conferences for healthcare professionals to promote lead poisoning prevention.

Additionally, MO CLPPP scheduled in-person training with healthcare providers across the state. Each training focused on lead poisoning prevention and increasing blood lead testing. Beginning in January 2018, MO CLPPP provided training to:

• Fifty Local Public Health Agencies with over 300 healthcare providers and Women, Infant, and Children staff members in attendance.
• Twenty case managers from all four of the Medicaid Managed Care Plans within the state.
• A large pediatric office in Kansas City with 34 healthcare providers in attendance.
• Over 100 nurses working in local health departments, medical centers, United Health Plan, Pediatric Care Network, and Priority Care Pediatrics.

Impact

In Harrison County, blood lead testing rates increased by 200% in the six months after MO CLPPP provided healthcare provider training in that area. MO CLPPP will continue to offer healthcare provider training across the state, targeting areas with low testing rates.

Funding for this work was made possible in part by NUE2EH001375 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.