The Baltimore City Health Department’s (BCHD) Childhood Lead Poisoning Prevention Program works to reduce lead poisoning in the City of Baltimore through primary prevention, lead testing, home visits and case management, advocacy, and aggressive enforcement of the city’s lead laws.

From 1992 to 2016, there has been a 97% decrease in children who tested positive for elevated blood levels in Baltimore City. This extraordinary achievement has been due to the hard work of BCHD and our partners, including the Baltimore City Department of Housing and Community Development, the Maryland Department of Health, the Maryland Department of the Environment (MDE), Green and Healthy Homes Initiative, and many other public and private partners.

Prevention

Lead poisoning is preventable. No child should be lead poisoned—that is the aim of BCHD and our partners. BCHD employs a multi-faceted approach to increase community knowledge through geographically targeted outreach, prevention education, and strategic partnerships.

In an effort to reduce the number of children with lead poisoning in the City, BCHD offers primary prevention services in which community health workers conduct preventative home visits to low-income pregnant women and/or families with children under the age of 6, to assess potential lead hazards in the home. Participating families receive referrals to legal and financial resources to address lead hazards as well as education and supplies for other home environmental health issues. Prevention visits also offer the opportunity to educate parents about blood lead testing requirements for children.

BCHD also conducts Healthy Homes Gatherings – an interactive intervention for small groups held in the community. The gatherings offer lead poisoning prevention education and teach community residents how to advocate for quality rental units by filing notices of the defect. Conducted in neighborhoods with high levels of lead-poisoned children, Healthy Homes Gatherings are scheduled in coordination with Head Start Centers, Judy Centers, Family Support Centers, and Community Centers.

BCHD provides education and services to high-risk populations and in non-traditional settings such as Community Action Centers, recreation centers, early childhood sites, homeless shelters, work readiness sites, and social service providers such as Goodwill, through our partnerships with managed care organizations (MCOs), medical providers, Park West Medical Systems, Total Health Care, Baltimore Medical System, Healthcare for the Homeless, Department of Social Services, and others. 

In 2007, BCHD began random lead testing of children’s jewelry products. Since then, nearly 350 items have been tested and nearly 50 violation notices have been issued.   

Testing

BCHD conducts outreach and education to promote blood lead testing for all children ages one and two, as mandated by the state and the Baltimore City Health Code. Testing labs send all results to the Primary Care Provider and any level of 5 micrograms per deciliter (ug/dL) and above is sent directly to BCHD and MDE.

BCHD employs a multipronged approach to increase testing in Baltimore City:

• Administering on-site point of care testing,
• Increasing partnerships with MCOs and engaging Federally Qualified Health Centers (FQHCs)
• Collaborating with medical providers
• Providing education for new doctors at local hospitals

Point of Care (POC) testing is provided to a patient at the time and place of care and, in combination with other measures (outreach to providers, use of POC tests in community settings), has been shown to increase the rate of lead testing for children. BCHD offers POC blood lead testing in the community at health fairs and other events, providing the opportunity to serve a large population. POC testing is now also offered through various BCHD programs. For more information, contact the Case Management Supervisor at (443) 984-2460.

Engaging with Baltimore City health care providers is key to increasing blood lead testing rates. BCHD works closely with case managers at MCOs and partners with them to provide outreach to clients who have not met lead testing requirements. BCHD provides FQHCs with protocols and procedures for lead testing and provides their patients with lead testing information. Education is also provided to physicians through Grand Rounds informing providers of the importance of lead testing.

Home Visits and Case Management

BCHD offers services to families with children who are lead poisoned, which are anchored on preventing further exposure to lead. In 2012, Baltimore City became the first jurisdiction in the state to decrease the level for intervention from 10 ug/dL to 5 ug/dL, and began outreach to families of children with blood lead levels between 5 and 9 ug/dL. Contact is initiated based on lab results from MDE, and families are offered telephonic or in-person education and case management services. Using both approaches allows families to receive an individualized scope of work and extensive education about lead, potential lead hazards, cleaning, nutrition, referrals to social and environmental programs, and case management. Cases remain active for at least six months and families are provided re-testing reminders.

Advocacy

 BCHD routinely participates in advocacy efforts to assess the status and accelerate the pace of eradicating lead paint poisoning in Baltimore City and Maryland as a whole and working to achieve consensus on the coordinated roles and investments required to spare Baltimore’s families and children from another generation of this devastating and preventable disease.  In 2016, Former Baltimore City Health Commissioner Dr. Leana Wen testified in front of the Baltimore City Council and the Maryland General Assembly, advocating for Baltimore’s families and children. In recent years, there has been a push to lower the State of Maryland reference level to 5ug/dL, which BCHD has supported vigorously.

Litigation

BCHD’s state-licensed Environmental Health Specialists issue legally binding violation notices to owners of property with lead violations. They provide landlords and homeowners with specific orders of what work must be completed on their property and they perform a mandatory re-inspection before the affected family is allowed to return to the home. The City of Baltimore Childhood Lead Poisoning Prevention Program attorney will take legal action when abatement is not completed in a timely matter.

FAQs on Lead and Lead Poisoning

What is lead?

Lead is a poisonous metal that was used in building construction and in the making of other household paints prior to 1978. Even though its use was banned, lead still remains a hazard in many places. When something with lead in it starts to deteriorate, it becomes dust, which is poisonous if you breathe it or eat it. Learn more about lead, where it can be found, and the symptoms and effects of lead poisoning.

Who should be tested for lead poisoning?

Baltimore City Health Code mandates the testing of all Baltimore children for lead poisoning at ages 12 and 24 months of age and the reporting of test results to the Baltimore City Health Commissioner. For more information on lead testing.

What do I do if I am concerned my child has been exposed to lead?

If you think your child may have been exposed to lead, call your physician and ask them to perform a lead test. If you don’t have a pediatrician, call the Baltimore Health Care Access hotline at 410-649-0500 (Spanish and English speaking). This hotline will assist with insurance and other community health resources. For more information about lead testing, including where you can take your child to be tested, please contact the Childhood Lead Poisoning Prevention Program at (443) 984-2470. 

How can I prevent lead poisoning?

• Consult a physician to administer a blood lead test for children 1-6
• Keep your home free of chipping and peeling paint
• Keep your home free of dust
• Frequently wash your hands
• Wash toys and pacifiers that children often put in their mouth
• Practice good nutrition
• Use a HEPA vacuum when available

How can I find out if a building has outstanding lead violations?

BCHD keeps a list of properties with existing lead violations. For more information on properties with lead violations, on buying/renting homes that are lead safe, and more.

Resources:

Baltimore City Health Department - Lead Program
7 East Redwood, 3rd Floor, Baltimore, MD 21202
Phone (443) 984-2460