Eliminating Childhood Lead Poisoning in New York State by 2010
V. Proposed Strategies for New York State
Focus Area Two: High-Risk Populations
Surveillance data for New York State clearly document that lead hazards and risk for childhood lead poisoning are not evenly distributed statewide. Communities with the highest proportions of pre-1950 housing stock and low-income minority populations face the highest burden of childhood lead poisoning. At the same time, we know that elimination of lead hazards and childhood lead poisoning in the highest-risk communities is especially challenging due to a wide range of other community factors. Poverty, unemployment, low educational attainment, limited availability of affordable housing, and scarcity of financial resources for property maintenance and improvements all contribute to the challenge of preventing exposure to lead hazards and eliminating childhood lead poisoning. While elimination of childhood lead poisoning will require a variety of statewide actions, these disparities are unlikely to be remedied without more intensive efforts targeting communities at highest risk.
Reduction of disparities will require a combination of state and local activities that address multiple aspects of lead poisoning prevention. The cornerstone of the proposed strategy is the development or strengthening of regional and local coalitions in high-risk communities around the state. Through community coalitions, local organizations and stakeholders can work together effectively to mobilize support, leverage maximal resources, and develop and implement specific action steps — including many of the action steps outlined elsewhere in this plan - to accomplish change at a local level. The success of childhood asthma coalitions and ACT for Youth community partnerships in New York State in achieving meaningful change supports the decision to utilize community coalitions as a pivotal strategy for elimination of childhood lead poisoning in high-risk communities.
Goal 1: Community-level disparities in childhood lead poisoning are reduced through intensive lead elimination activities targeting the highest risk communities in New York State.
Objective 1: Communities with the highest burden of lead hazards and childhood lead poisoning will be identified and targeted for intensive intervention.
- Develop a tool for selecting and prioritizing communities on the basis of risk for lead exposure and/or burden of childhood lead poisoning. The methodology used in the recent lead data report can be applied or modified for this purpose. This method identified 36 zip codes with incidence rates more than three times the statewide average, which collectively account for over 40% of elevated blood lead level reports in the state.
- Apply tool on annual or other regular interval to identify target communities for intensive intervention. Incorporate target status in eligibility for various funding or technical assistance opportunities supported by the Department of Health and its partners (for example, the Healthy Neighborhoods Program and lead poisoning prevention coalition activities)
Objective 2: The Department of Health will support the formation of childhood lead poisoning prevention coalitions (or, in the case of existing coalitions, will help strengthen coalitions) in targeted high-risk communities.
- The Department will develop a mechanism, including funding, to promote the development and support the activity of community coalitions in targeted high-risk communities. Funded coalitions will outline a plan for convening appropriate local partners and addressing target areas in their region. All funded coalitions must have their county health department as a full member.
- Contracts between the Department's Childhood Lead Poisoning Prevention Program and local health units in target counties will be amended to require participation in the local coalition.
- The Department will provide guidance and technical assistance to coalitions to support activities, including dissemination of "best practices" from and other innovative strategies from NYS communities and other states.
- The Department will develop and disseminate to coalitions print and other materials that can be used to promote lead poisoning prevention activities in local communities.
Objective 3: Childhood lead poisoning prevention coalitions will develop and implement a range of local strategies to accomplish elimination of childhood lead poisoning in high-risk communities.
- Coalitions will engage appropriate local partners needed to ensure coalition effectiveness. Regional Resource Centers, local health departments, local departments of social services, local housing authorities, code enforcers, parents, advocacy groups, landlords, tenant organizations, researchers, local Healthy Neighborhood Program staff, community-based non-profit affordable housing organizations, and other stakeholders should be included in coalitions.
- Coalitions will work to enhance residential risk assessment activities in target communities. Coalitions will be encouraged to apply or support partner organization applications for additional funding through the Healthy Neighborhoods Program to support expansion of intensive risk assessment and related educational activities.
- Coalitions will work to maximize resources for lead hazard reduction, including federal grant programs and enforcement of federal housing policies. Coalitions will be encouraged to apply or support partner organization applications for all available funding sources to subsidize remediation of residential lead hazards, including the federal HUD lead hazard reduction program.
- Coalitions will mobilize local support and resources to ensure that the state's Uniform Property Maintenance Code related to peeling and chipping paint is enforced. A targeted outreach effort will be undertaken to educate property owners on the NYS Property Maintenance Standard, which requires that all paint surfaces be maintained free of chipping and peeling conditions, as well as on safe and effective techniques for correction of the underlying cause of paint deterioration. Training will be offered to appropriate parties to ensure that findings specific to lead hazards are recognized, and appropriate interventions pursued.
- Coalitions will be directed to pursue a variety of additional local strategies to augment the broader strategies outlined in the statewide elimination plan with technical assistance from NYSDOH. Coalitions may select specific activities presented by NYSDOH, or may propose their own activities to match local needs and resources. Example activities include:
- Disseminating innovative educational messages to parents in the community, with an emphasis on using methods demonstrated to effect behavior change (e.g. modeling, hands-on skills training, etc) and on incorporating messages into existing venues where parents are likely to be most receptive to information.
- Offering additional training on lead safe work practices to homeowners, landlords, and local builders/contractors.
- Reinforcing messages directed to both families and health care providers related to requirements for blood lead screening.
- Ensuring that all community providers who work with children age 0-6 are maximizing opportunities to identify blood lead screening results, and make referrals for appropriate follow-up when needed. Such parties may include primary care providers, childcare providers, Head Start/Early Head Start programs, and WIC clinics.
Objective 4: At a state level, the Department of Health will play a leadership role in working with other governmental agencies to ensure coordination of activities related to childhood lead poisoning prevention, and to maximize opportunities for prevention and intervention.
- NYSDOH will take a leadership role in coordination and collaboration with other agencies to ensure that opportunities to support elimination of childhood lead poisoning are maximized. A collaborative effort between the agencies will result in broader outreach and promotion of uniform messages regarding screening blood lead levels, assessment of potential lead hazards, and safe and effective methods to correct the hazards.
- NYSDOH will act as a resource to other agencies for information on lead and current state and federal regulations. NYSDOH will develop and disseminate print materials, provide training and technical assistance, and offer ongoing consultation to other agencies.
- The Childhood Lead Poisoning Prevention Program will seek to leverage maximal financial and non-financial resources for elimination of lead poisoning by linking this elimination plan to other planning processes in the state, including the evolving Early Childhood Strategic Plan and the state's Medical Home Initiative.
- NYSDOH programs will explore opportunities for sharing financial and non-financial resources to jointly support promising strategies. For example, the Healthy Neighborhoods Program administered by Center for Environmental Health will be expanded to serve target communities identified for lead hazards (see above) and to incorporate specific strategies for reduction of lead exposure risks (see additional information under next section).