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INFORMATION FOR

Yale New Haven Lead Program and Regional Treatment Center

Reducing Lead Exposure: A Qualitative Exploration of Service Providers’ Experiences Working with Families

Background

While childhood lead poisoning has been declining, it remains a persistent and preventable problem in Connecticut. The Connecticut Department of Public Health’s 2017 annual report on lead poisoning found that over 1600 children in the state had blood lead levels greater than 5 ug/dL. No level of lead in the blood of children is considered safe. Well-documented adverse health effects in children caused by lead exposure include damage to the brain and nervous system, slowed growth and development, learning and behavior problems, and hearing and speech problems. These problems can cause lower IQ, decreased ability to pay attention, and underperformance in school. In adults and children, high levels of exposure can result in neuropathy to the upper and lower extremities, especially the hands and feet, psychiatric symptoms, tremor, lead colic, nephropathies, hypertension, and anemia. Two regional lead treatment centers were established in Connecticut to provide additional guidance and assistance with clinical management to the families of lead poisoned children. One of these regional treatment centers is located at Yale New Haven Hospital in New Haven, the Connecticut city with the highest caseload. The Yale New Haven Lead Program and Regional Treatment Center offers a variety of services to support families and reduce childhood lead poisoning.

Objective

Identify strategies to strengthen the educational and outreach efforts of the Yale New Haven Lead Program and Regional Treatment Center, with attention to effective strategies used by service providers working with lead-affected families.

Methods

Methods for this project originally included interviews with lead-affected families. However, due to the COVID-19 pandemic, the decision was made to focus instead on collecting expert input using qualitative, in-depth interviews.

  • Sampling and Recruitment
    • A convenience sample was used: the clinical social worker at the Yale New Haven Lead Program and Regional Treatment Center identified potential participants for this study based on her network of professionals who work with lead-affected families.
    • The research team emailed ten of the potential participants who represented a diversity of professional roles related to families affected by high child lead levels.
    • Five participants responded and agreed to be interviewed by the research team.
    • The participants included a state-level epidemiologist, a local health department sanitarian, a pediatrician, a Nurturing Families home visitor, and a pediatric neuropsychologist.
  • Data Collection and Analysis
    • Five 30-70 minute interviews were conducted with participants via Zoom.
    • Each transcript was initially coded using Dedoose Software (Version 8.3.17) by the researcher who conducted the interview (HC or RS) who then open-coded the transcript to generate an extensive code list.
    • After reading all of the transcripts and codes, the researchers discussed the codes and themes generated from open-coding to categorize data based on themes agreed upon by both researchers.

Acknowledgments

Our project would not have been possible without the assistance of many individuals. We thank Queenie Abad for her instrumental work in the planning phase of this project, Parmida Zarei for her continued guidance and feedback, and our participants for their expertise and time.

Results

Participants shared perspectives and expertise regarding the following:

  • How service providers should frame the interaction with the lead-affected families.
  • The content of educational information that is important for providers to share.
  • The importance of buy-in and support from medical providers and pediatricians.
  • The education strategies that should be used to transfer knowledge about lead and reducing lead exposure to families, particularly given the invisibility of lead poisoning.
  • Providing tangible support to facilitate families reducing lead-exposure in their children.
  • The kinds of referrals and resources that should be provided to families.
  • The distinct needs of refugee and immigrant families.
  • The barriers and facilitators to empowering families to take action to reduce their child’s lead exposure.
  • The impact of COVID-19 on lead poisoning and screening.

I walked her [the mother] through it and she was kind of defensive at first. But then, you know, I mean, people in our position where they think that we have all this power, you know, like, yeah, we do. But, you know, like there's a way to go about it, there's a way to talk to people, you know, it's not what you say it's how you say it.

Sanitarian

The significant amounts of lead can be evident right away. In terms of a child's lack of meeting their developmental milestones. For language and for motor and for fine motor ... there's a threshold of where it's really obvious... but the ones that I worry about are the ones that fall in between. And how do we make sure we're catching them at the ages?

Pediatric Neuropsychologist

So I think one [thing] is for them to understand that they totally have a good opportunity to control what their child is getting into...

Epidemiologist

It's gotta be backed by… a professional because then they listen to it even more…. [S]ince I'm looped into the system, and I represent Yale New Haven Hospital, … that's a big plus, you know, for me to get in there. Cause they, they, they recognize that name.

Home Visitor

Recommendations

  1. General Approach to Interactions with Families: Service providers should approach families with respect and humility in order to build trust and improve family engagement with programs.
  2. Wide-spread Lead Education: Wide-spread lead education is needed in the community to alert parents to its potential harms and increase its salience as a credible threat to the health and well-being of children.
  3. Leverage Pediatricians as Key Allies: Increased lead-focused education for pediatricians could improve collaboration between pediatricians and other lead professionals to improve lead screening efforts and family’s buy-in to work with other providers to reduce exposure.
  4. Provide Tangible Solutions: Programs aimed at household-level interventions must provide accessible, affordable, tangible solutions tailored to each family’s unique situation.
  5. Refugee and Immigrant Family Needs: Collaboration with immigrant- and refugee-focused agencies in the community to educate families about the dangers and sources of lead upon arrival to the US could ease cultural barriers faced by providers working with these families and reduce lead exposure itself.
  6. Response to COVID-19: As Connecticut updates state COVID-19 policies and regulations, lead poisoning surveillance and interventions should be prioritized due to the irreversible damage of lead on child health and cognitive development.

Limitations

  • Small sample size due to reduced study team size and time constraints
  • Inability to conduct the quantitative portion of the study due to the COVID-19 pandemic
  • Participants may be bright-spot outliers and not representative of members of their respective professions

References

  1. Blood Lead Levels in Children. (2019, December 26). https://www.cdc.gov/nceh/lead/prevention/blood-lead-levels.htm
  2. Hung, T., Ortiz, D., Davila, J., Sullivan, A. (2019). CT Department of Public Health 2017 Annual Disease Surveillance Report on Childhood Lead Poisoning Prevention and Control. Hartford, CT: Connecticut Department of Public Health.
  3. Sorensen, L. C., Fox, A. M., Jung, H., & Martin, E. G. (2019). Lead exposure and academic achievement: Evidence from childhood lead poisoning prevention efforts. Journal of Population Economics, 32(1), 179–218. https://doi.org/10.1007/s00148-018-0707-y