At a glance
CDC supports Vermont 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 Vermont received $545,037 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 Vermont, contact the program below.
Vermont Department of Health
280 State Dr.
Waterbury, VT 05671
Phone: 802-863-7220
Note
Success story: funding year 3
Quality improvement efforts in Vermont to improve blood lead testing rates for children who are overdue
Challenge
Lead testing in Vermont declined in 2020 and 2021 due to the COVID-19 pandemic and the Lead Care II test kit recall. Vermont law requires that all children be tested for lead exposure at ages 1 and 2 years. The percentage of 1-year-olds tested decreased by 6 percentage points from 2019 (75%) to 2021 (69%). The decrease in the percentage of 2-year-olds tested decreased by 10 percentage points from 2019 (72%) to 2021 (62%). Lead testing rates did not return to pre-pandemic rates in 2022.
Intervention
The Vermont Childhood Lead Poisoning Prevention Program (VT CLPPP) leveraged its ongoing relationship with Vermont Child Health Improvement Program (VCHIP) to provide technical assistance to pediatric practices who had 40% or more of 1- and 2-year-old patients overdue for a blood lead test in the fall and winter of 2022-23. VCHIP staff invited Blueprint Quality Improvement facilitators to join discussions with two large multi-site pediatric practices to assist them in conducting a quality improvement project to address poor lead testing. One smaller family medicine practice was also provided technical assistance to address low testing rates.
Impact
In less than a year, the percentages of 1- and 2-year-olds overdue for blood lead testing reduced by approximately 50% in two multi-site pediatric practices (December 2022 to September 2023) and one family medicine practice (October 2022 to September 2023) who were provided technical assistance and engaged in quality improvement efforts. Technical assistance revealed that one multi-site practice was testing but not reporting those data to VT CLPPP, and one multi-site practice was not testing universally. The smaller family medicine practice referred patients to an outside laboratory for blood lead testing, but most patients did not go. VCHIP worked with practices to address these issues.
Funding for this work was made possible in part by NUE2EH001426 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
Updating Vermont's pediatric blood lead testing and case management guidance
Challenge
Lead is not naturally occurring in the body, and no safe blood lead level (BLL) has been identified. Even low levels can impair development. In 2020, Vermont lowered its action level from 5 μg/dL to any detected level. The numeric detection level varies across labs. Although the state's definition officially changed, their testing and case management guidance did not.
Intervention
The Vermont Healthy Homes and Lead Poisoning Prevention Program worked with statewide partners to update Vermont's pediatric blood lead testing guidelines to be consistent with the state's definition of a BLL that requires follow-up actions. As of July 2022, Vermont's Pediatric Blood Lead Testing Guidelines require any detected and reported level of lead to be monitored.
Impact
Data on the number of additional children who have been tested because of the new guidelines are not available yet. Monitoring all detected and reported BLLs will ensure that Vermont children who have been exposed to lead will be identified earlier. This allows parents, doctors, public health officials, and communities to act earlier to reduce the child's future exposure to lead and connect them to needed services.
Funding for this work was made possible in part by NUE2EH001426 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
Vermont develops provider reports on blood lead level data to increase testing rates
Challenge
Blood lead testing rates for 1-year-olds and 2-year-olds have steadily decreased from 2014 to 2017 (82% vs. 77% and 72% to 68%, respectively).
Intervention
To increase blood lead testing rates, the Vermont Healthy Homes and Lead Poisoning Prevention Program (VHHLPPP) used CDC funds to give health care providers timely data when a child's lead test result was > 5 ug/dL, as well as supported providers in medical case management. Additionally, VHHLPPP also offered testing for Women, Infants, and Children (WIC) clients at the local district health offices when providers failed to test. In 2017, after much discussion about giving providers more timely data, VHHLPPP developed web-based reports for all providers who report childhood blood lead level (BLL) data at the patient level. The reports included:
- Individual Blood Lead Results Report – which includes all lead screening results recorded within the Shared Public Health Information eXchange (SPHINX) system for the child in a printable format.
- Practice Level Reports – users with appropriate permissions associated with a primary care practice can produce reports for their practice.
- Screening Tests Needed Report – highlights children who are due or past due for age-required screenings at ages 1 and 2.
- The Venous Follow-up Tests Needed Report – highlights children in targeted age range (under 6) and any children <18 years of age who have lead results over a specific threshold as requiring follow-up.
Impact
After developing these very basic patient-level reports, VHHLPPP decided to create more visually appealing reports that aggregate provider-level data and compare provider testing rates with the state's overall and regional testing rates in FY2019. The VHHLPPP found that providers are not regularly using web-based reports. When VHHLPPP mailed out the provider report cards, they found that providers were more receptive to the information.
Funding for this work was made possible in part by EH14-1408 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.