Los Angeles County, California

About the program

Impact Assessment, Inc., received $437,645 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.

To learn more about these efforts in Los Angeles County, contact the program below.

Impact Assessment, Inc.

741 Addison St, Ste B

Berkeley, CA 94710

Phone: 510-704-8624

Success story: funding year 3

Using community health workers to provide focused lead poisoning prevention education in Los Angeles County

Challenge

The Lead-Free Homes LA (LFHLA) program in Los Angeles County uses funds from a lawsuit settlement related to lead paint to address paint hazards in eligible properties. The program offers free lead-based paint hazard testing and remediation for homes of families with children younger than 6 years old, pregnant women, and families living in pre-1951 homes. Eligible properties are currently limited to those with four or fewer units, including single family dwellings. Impact Assessment, Inc. provides focused lead poisoning prevention education to LFHLA participating families, reiterates prevention steps, and, where needed, provides referrals to other service agencies. While Impact Assessment Inc. has been providing education to participants since early 2022, it was unknown whether families were taking steps to protect children at-risk because of these interventions.

Intervention

In July 2023, Impact Assessment Inc. personnel designed and developed an evaluation protocol to assess whether families had implemented any measures to protect their children from lead as a result of the education provided. A script and survey form were developed to facilitate surveying participants by phone, and a cloud-based database was developed to store survey responses. Of the 255 families that received education, 150 were randomly selected with a goal of surveying 100. Surveys were conducted between August and September 2023.

Respondents were asked

1. Whether they still live in the same home as when they received the education
2. Whether any children in the home were tested for lead after the education intervention; if yes when, and if no, why not
3. Whether any actions other than blood lead testing were made as a result of the intervention; if yes what, and if no, why not

The survey also provided an opportunity to answer questions or address new concerns about lead hazards.

Impact

Of the 100 families that previously received education and who completed the survey, 98% still live in the same home as when the education was provided. About 36% of respondents said that all children in the home were tested for lead, and 14% said some children in the home were tested. Of the families that tested children for lead, 33% indicated they made an appointment with their health care provider to have the test, 11% said the test was done as part of a routine check-up, and 6% said it was done per the parent's request during a routine check-up.

Overall, 65% of the families took one or more steps to reduce lead exposure. Almost a third (31%) reported properly cleaning up dust often, 14% covered or sealed chipping and peeling paint, 12% made repairs to the chipping and peeling paint, 11% wash children's hands after outdoor play, and 7% remove or clean shoes after outdoor play.

Additionally, a partnership offering free blood lead testing was established after outreach began. Recontacting these families allowed the program to offer the free test opportunity to those who had been educated prior to the establishment of this referral. Among respondents, 33% were eligible for the free testing program, and 9% of eligible respondents scheduled blood lead tests for children in the home.

Funding for this work was made possible by cooperative agreement number 5 NUE2EH001411-02-00 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.

Success story: funding year 2

Enhancing lead education to families with housing-based lead hazards in Los Angeles County

Challenge

Los Angeles County's Lead Free Homes LA (LFHLA) program leverages lead paint litigation settlement award funds to abate paint hazards in eligible properties. LFHLA is administered by the County of Los Angeles and supported by Impact Assessment, Inc. The program offers free lead-based paint hazard testing and remediation for homes of families with children younger than age 6 years, pregnant women, and families living in pre-1951 homes.

Eligible properties are currently limited to those with four or fewer units, including single family dwellings. Program participants receive education about lead poisoning prevention. However, many of these messages are provided in the program's informational packet, and participants may not be aware of strategies to keep their children safe from lead paint hazards in the time between enrollment and abatement. They may also be unaware of how to keep their children safe from other non-housing lead sources.

Intervention

In December 2021, Impact Assessment, Inc. and Los Angeles County Department of Public Health personnel collaborated with each other. They designed and developed protocols for improving lead education for LFHLA participants. The protocols direct the process for Impact Assessment Inc.’s outreach and education personnel to contact participants, provide focused education, refer families to other relevant service agencies, and reiterate prevention steps. A lead risk survey was also developed. It guides the focused education, inventory of existing and available educational materials, and data collection tools. In 2022, LFHLA began referring participants from across the county to Impact Assessment, Inc. for lead education interventions.

Impact

By the end of September 2022, 385 participants were referred for lead education. One hundred thirty-five participants (35%) declined any education, and 130 (34%) participants were unable to be reached. Of the 385 participants, 120 (31%) families with young children (eight of whom also had a pregnant woman in the home) received lead prevention education: five received education via a home visit, 102 received education via telephone, and 13 requested materials by mail.

Eighty-two (68%) of those that received education agreed to complete a lead risk survey about non-housing sources. The survey found that 23% had children exhibiting pica behavior, 15% give food or water to their child in handmade pottery, and 29% were currently having or recently had repairs done in their home. These findings will be used to evaluate the efficacy of educational messages for Los Angeles County, refine these messages in future outreach interventions and revisions to materials, and guide the development of new follow up strategies. Follow up strategies will include assistance with implementing behavior changes around non-housing sources and obtaining blood lead testing.

Funding for this work was made possible in part by 1NUE2EH001411-01-00 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.

Success story: funding year 1

Forming successful partnerships with community-based organizations and others to increase blood lead testing in the Los Angeles Promise Zone

Challenge

Over 1 million housing units in Los Angeles, 80% of the city's housing stock, were built before 1980 and contain lead paint. In 2014, lead paint in housing was found to be the dominant or contributing source of lead exposure in approximately 75% of the lead poisoning cases managed by Los Angeles County.

The Los Angeles Housing and Community Investment Department (HCIDLA) historically identified hazards in rental properties through its Systematic Code Enforcement Program (SCEP), housing inspection and violation tracking software, and partnerships with community-based tenant advocacy organizations. However, HCIDLA's CDC-funded lead poisoning reduction program learned through partnerships with community-based organizations focused on tenants' rights and healthy housing that screening for high-risk children was low in the Los Angeles Promise Zone. According to 2014 data, the Promise Zone is at higher risk for lead poisoning:

• 61% of the population lived in poverty, with 33% of households earning less than $20,000 per year
• 60% of families lived in rental properties, and
• 60% of the population was born outside the U.S

Intervention

With the Healthy Housing Collaborative, the program initiated two strategies to increase blood lead testing in the target community:

• Working with the Coalition for Economic Survival, Inquilinos Unidos, and Koreatown Immigrant Workers Alliance to educate parents about lead exposure risk factors in homes and the impact of lead poisoning on child development and educational attainment and refer them to AltaMed, a Federally Qualified Health Center, for a free blood lead test.
• Partnering with AltaMed and their Westlake satellite clinic near the Promise Zone to test all children under 6 years old in the target zip codes who have not been tested in the last 6 months and do not meet the clinic's regular screening criteria.

The Los Angeles County Department of Public Health agreed to enroll all children who had elevated blood lead levels (BLLs) in a county healthcare program, ensuring follow up services could be provided as needed.

Impact

The intervention resulted in 291 children referred for testing, of which 77 received testing. While only 26% of children received testing, all referred families received information about lead and its detrimental health effects through one-on-one sessions, health fairs, and community meetings. Two of the tested children had elevated BLLs. These children were previously identified as having high BLLs and were already receiving case management services from the county health department.

The expanded screening program resulted in an additional 456 children screened, and 17 had BLLs at or above CDC's blood lead reference value of 5 µg/dL. The prevalence of elevated BLLs in this population was 3.7%, which was higher than the county's prevalence. This demonstrated a need to reevaluate clinical screening tools to identify more children who have been exposed to lead.

These programs successfully addressed needs in the community—both gaps in knowledge and services—and demonstrated that housing and health indicators could be used to identify high-risk neighborhoods and other target communities.

Funding for this work was made possible in part by EH14-1408 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.