Washington

About the program

The State of Washington received $662,266 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 Washington, contact the program below.

Washington State Department of Health

Office of Environmental Health Public Health Sciences

P.O. Box 47846

Olympia, WA 98504

Phone: 360-236-4280

Success story: funding year 3

Increasing child blood lead testing in Washington State Women, Infants, and Children (WIC) programs

Challenge

In fall 2022, Washington State's Women, Infants, and Children (WIC) nutrition program approached the Childhood Lead Poisoning Prevention Program (CLPPP) to help implement the federal rule requiring staff to ask about children's lead test status at yearly WIC visits. The CLPPP was excited to support WIC and increase awareness about child blood lead testing given that in 2022, just 5.3% of Washington State children younger than age six years received a blood lead test.

Intervention

WIC and the CLPPP worked together to develop presentations and materials for WIC staff to use, including questions for parents and caregivers to determine if a child has been tested for lead and if the family knew the test results. If their child did not have a test, the family would receive a CLPPP Lead Test Card. The Lead Test Card has a few simple questions about lead risk for families to fill out, including a tear-away card families can bring to their health care providers to indicate their child may need a blood lead test.

The programs held a statewide meeting in January 2023 for WIC staff, with the CLPPP Testing Promotion Coordinator presenting background information about lead, how it harms children, where exposure occurs, and why testing is vital. Additionally, WIC and CLPPP staff wrote newsletter articles for the Washington Chapter of the American Academy of Pediatrics and the Health Care Authority to inform healthcare providers of WIC's new approach to addressing childhood lead exposure. CLPPP printed and translated Lead Test Cards into 16 languages. On March 1, 2023, WIC staff began asking about lead testing during annual visits with families.

Impact

The WIC program now hands out the Lead Test Cards during every annual WIC visit. Preliminary data show this effort contributed to an average increase of 529 tests per month during March–October 2023 and 4,231 more tests in 2023 than in 2022 for the same months. This collaboration with WIC strengthened CLPPP program efforts to increase family and provider awareness of child lead poisoning, improve blood lead testing rates in Washington state, and create a strong, ongoing partnership between the state programs.

Funding for this work was made possible in part by CDC-RFA-EH21-2102CONT22 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 serve new arrivals in Washington State

Challenge

In fiscal year (FY) 2022, Washington State resettled over 4,300 refugees from Afghanistan—more than the total number over the previous 10 years. Many of the newly arriving families spoke a primary language other than English and were unfamiliar with local clinical systems. Between FY2016 and 2021, 1,925 children from Afghanistan ages 6 months to 16 years received blood lead testing. The state of Washington's action level is 5 μg/dL.

Of the children tested, 44% had a blood lead level (BLL) of 5 μg/dL or greater compared with 2.3% for other children these ages in Washington State. This rapid influx of children and families with historically high levels of lead posed a challenge to a public health infrastructure still recovering from the COVID-19 response.

Intervention

In Fall 2021, the Washington State Childhood Lead Poisoning Prevention Program (CLPPP) and Refugee and Immigrant Health Program started meeting with the Public Health-Seattle & King County (PHSKC) Refugee Screening Program, PHSKC Lead and Toxics team, King County Hazardous Waste, and medical providers to plan a coordinated response. The group prepared to support the families from Afghanistan and discussed challenges and opportunities. The group also planned for action around blood lead testing, lead case management, environmental exposure, and policy. They shared culturally and linguistically appropriate materials for healthcare provider toolkits and other information for the community partners who would connect with families.

The CLPPP case management coordinator shared translated documents and other tools with local health departments as new arrivals settled in counties across Washington. CLPPP leveraged other funds to hire a temporary case manager to help address a backlog of cases in a local health department that needed assistance.

Impact

Follow up with 111 families included providing culturally and linguistically appropriate health education materials, action plans, and connection to follow-up testing. According to preliminary data from the Refugee and Immigrant Health Program, in FY2022, 1,349 children under age 16 years from Afghanistan received blood lead testing in Washington. Results showed that 249 (18%) children had BLLs of 5 μg/dL or higher. CLPPP, local public health, and community programs strengthened working relationships and supported efforts linking families new to the United States to important local services.

Funding for this work was made possible in part by CDC-RFA-EH21-2102CONT22 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

Successful partnership with refugee health programs in Washington State

Challenge

Washington State is one of the top 10 states for refugee arrivals. In 2015, approximately 3,100 refugees were resettled in Washington State, and nearly 45% were children 18 years of age or younger. Compared with the general Washington state population, refugee populations have significantly higher prevalence of blood lead levels greater than the CDC's blood lead reference value potentially from exposures in their country of origin, including leaded gasoline, ammunition, traditional remedies and cultural items. During 2015-2017, refugees represented only 2.6% of all children tested in the state, and yet they represented 24% of the total elevated blood lead level (BLL) cases in Washington.

Intervention

Using CDC funds, the Washington State Childhood Lead Poisoning Prevention Program (CLPPP) began a data linking project in 2012 to match refugee health records with CLPPP Blood Lead Registry records to determine testing rates among refugees. The testing rate among refugees was estimated to be 13%. The Refugee Health Program revised the guidelines to strongly recommend universal blood lead testing by refugee health screening clinics to address this low testing rate.

Additionally, CLPPP and Refugee Health Programs partnered to:

• Analyze data by blood lead level, country of origin, language, and jurisdiction to identify emerging populations at risk for elevated BLLs, language translation needs, and inadequacies in follow-up.
• Offer provider education through presentations at the North American Refugee Health Conference and the Washington State Public Health Association Conference and clinical management and Refugee Resettlement Webinars. Additionally, a Grand Rounds presentation was provided by a Pediatric Environmental Health Specialty Unit (PEHSU) on lead prevention and medical management with emphasis on refugee populations was sponsored and promoted.
• Publish an issue of Epi-Trends dedicated to childhood lead prevention, testing, and treatment among refugee populations. The issue was distributed to all local health departments. In April 2019, the Refugee Health Program provided CLPPP data for the article "Blood Lead Levels Among Resettled Refugee Children," published in the journal Pediatrics.
• Partnered with the Washington State Poison Center and local refugee communities to develop health education materials in Dari, Pashto, Arabic, and Somali.
• Provide health education, assistance on home investigations to identify continued or new domestic sources, and linkages to services for communities disproportionately affected by elevated BLLs. The refugee health screening clinics also refer families to primary care providers for medical case management and scheduled retesting for children identified with elevated BLLs.

Impact

Since starting the data linking project, the testing rate has increased significantly each year to a high of 98% in 2017. The recommendation for universal testing has drastically improved testing rates, allowing for more timely identification of pediatric refugees with elevated BLLs and enabling referral to clinical case management and public health interventions.

Funding for this work was made possible in part by NUE2EH001383 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.