Teach and Test: A Collaborative Strategy for Improving Lead Outcomes among Children in Vulnerable Communities

Background: As many as 150,000 children younger than 6 years old are tested for lead poisoning in North Carolina each year. The NC Division of Medical Assistance estimated that only 57.4% of Medicaid eligible children were tested as required for lead at 1 and 2 years old in 2017 compared to 81% of children receiving Medicaid tested as required at 1 and 2 years old in 2010. The 21,600 children enrolled in North Carolina’s Head Start programs are likely eligible for enrollment in Medicaid. In its twelve-year partnership with the North Carolina Childhood Lead Poisoning Prevention Program, the University of North Carolina’s Institute for the Environment (UNC IE) has sought to implement innovative environmental health outreach programming to inform professionals in public health and nonprofit sectors and vulnerable communities about lead and other hazards in homes.

Program background: The Teach and Test initiative began with requests for technical assistance from Head Start programs to convince parents that children should be tested at 1 and 2 years old. To inform parents about childhood lead poisoning and to get children tested, UNC IE staff sought to collaborate with local partners who had the trust of parents with children enrolled in Head Start, including the Durham County Health Department and nonprofit agencies Reinvestment Partners and the Partnership Effort for the Advancement of Children’s Health (PEACH). As a result, parents attended a one-hour workshop that included hands-on learning tools and educational materials that met varying literacy levels, while their children were being tested. Bilingual staff in the two participating Head Start sites also translated for Spanish-speaking parents. The community-based organizations informed parents of the Durham area resources available to families living in older homes and provided technical assistance after the workshops.

Evaluation Methods and Results: The metrics for the project included the actual number of children who were tested, the number of parents participating in the workshops and results of pre- and post-workshop surveys of the parents. A total of 24 children were provided with blood lead tests while a total of 17 parents participated in two lead workshops. There was an increase in the content knowledge scores on the majority of parents’ pre- and post-workshop evaluations. There was also expanded interest in testing (9) more children at other sites, which brought the total tested to 33, and in conducting additional Teach and Test sessions at more sites in Durham and neighboring counties.

Conclusions: As a result of this project, our staff has concluded that leveraging our partnerships with Head Start programs and local health and nonprofit agencies is an effective strategy for communicating information and providing a service to the most vulnerable, high-risk populations affected by lead exposures.

Implications for research and/or practice: The project serves as a model for future partnerships with local child care programs and public agencies to coordinate a multi-faceted approach to addressing this public health concern. With more than 300 Head Start providers in North Carolina, there is the potential to coordinate outreach to thousands more children and parents served by Head Start.