Marion County, Indiana

About the program

Marion County received $312,645 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.

The strategies focus on community-based approaches for lead hazard elimination and emphasize population-based policy intervention.

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

Marion County Public Health Department

Healthy Homes, Environmental Consumer Management and Senior Care Department

3838 N Rural St. 8^th Floor

Indianapolis, IN 46205-2930

Phone: 317-221-2155

Success story: funding year 3

Marion County, Indiana, expands childhood blood lead testing

Challenge

Beginning January 1, 2023, Indiana enacted a law called the "House Enrolled Act 1313," which requires all healthcare providers to test children ages six years and younger for lead poisoning (universal testing). The new law increased the need for blood lead testing overall, especially confirmatory venous blood lead testing in all children who had capillary blood lead levels (BLLs) above CDC's blood lead reference value (BLRV).

Intervention

Marion County Public Health Department (MCPHD) staff recommended that children with an initial capillary BLL at or above 3.5 μg/dL receive an additional confirmatory venous blood test. This is necessary since a venous blood lead sample is more accurate. Case managers contacted families of children who had a capillary BLL at or above 3.5 μg/dL to urge them to bring their child(ren) to the MCPHD Verification Clinic for a confirmatory venous blood lead test. The verification clinic has been open for several years, but now more children need blood lead testing due to the state law requiring universal testing. The clinic can provide confirmatory tests that would normally require a doctor's office visit. MCPHD refers children with higher BLLs for medical intervention.

Impact

Blood lead testing at the MCPHD verification clinic increased in 2023 (221 tests) compared to previous years: 104 tests in 2019, 60 tests in 2020, 73 tests in 2021, and 132 tests in 2022. The almost doubling of testing from 2022 to 2023 when the law was passed reaffirms the importance of the verification clinic.

If families receive confirmatory test results at the clinic, they are provided with a case manager that will assist in education on lead poisoning and next steps to assist in lowering their child's BLL. MCPHD ensures the clinic can continue to provide testing with trained staff and to offer at home blood draws if the family cannot visit the clinic.

Funding for this work was made possible in part by 5 NUE2EH001424-02-00 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 2

Responding to the LeadCareABlood Lead test kit recall in Marion County

Challenge

In July 2021, Magellan Diagnostics recalled several LeadCare Blood Lead test kits due to falsely low results. On August 31, 2021, Magellan Diagnostics expanded the recall to include additional product lots. During the recall, there was a 19% decrease in blood lead testing for children living in Marion County, Indiana.

Intervention

In response to decreased testing rates during July 2021–October 2022, the Marion County Public Health Department Verification Clinic increased outreach to providers and the community by offering free walk-in lead testing every Thursday afternoon. Information about lead testing was disseminated in multiple ways. Cards containing free lead testing information were provided to families, community members, and primary care providers to share with their patients. In-person communication (at health fairs, home visits, provider offices, and clinics) was also useful in informing families and communities about lead testing. The Marion County Public Health Department and the Raphael Health Center partnered to allow program phlebotomists to work alongside clinic personnel to provide blood lead testing. Along with the steps taken above, the program staff regularly shared information with healthcare providers about recall updates and testing information.

Impact

The clinic conducted 104 blood lead tests in 2019, 60 tests in 2020, 73 tests in 2021, and 132 tests in 2022. As of July 2023, the clinic surpassed the number of tests completed in 2022. The average compliance rates for childhood blood lead testing were 52% in 2019, 56% in 2020, 55% in 2021, and 47% in 2022. Compliance rates indicate if testing is completed in accordance with Indiana statute. The state statute requires that all children enrolled in Medicaid are tested at 12 and 24 months of age. Provider report cards have a delayed reporting time of three months but have indicated a 65% compliance rate for the first quarter of 2023. The Marion County Public Health Department will continue these efforts and open an additional clinic to increase lead testing.

Funding for this work was made possible in part by NUE2EH001424-02-00 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success story: funding year 1

Greater partnership yields strong data in Marion County, IN

Challenge

CDC identifies several risk factors for childhood lead exposure, including living in housing built before 1978, living in low-income households, and being members of racial-ethnic minority groups. Many children in Marion County, Indiana, have these risk factors for lead exposure. However, in Marion County, the rate of lead testing for children ages five and younger is low (approximatively 10%). According to CDC, each lead-poisoned child can cost $5,600 in medical and special education costs. Education on lead poisoning prevention and early detection are important to reduce the potential burden of lead exposure and improve children’s opportunities to reach their full potential.

Intervention

To increase the percentage of Medicaid-eligible and other children at risk who receive testing, the Healthy Homes, Environmental Consumer Management & Senior Care Department (HHECMSC) implemented a new program to encourage healthcare providers to screen children for lead during well-child visits. HHECMSC purchased educational and marketing materials to help providers and raise awareness within the target populations. The program facilitates the review of primary care physician charts and uses a scorecard to determine the physician compliance rate of children receiving blood lead tests at the recommended ages. The program discovered that the Indiana State Department of Health (ISDH) provides compliance report cards in other jurisdictions. HHECMSC established a data use agreement with ISDH to regularly review the immunization registry and use ISDH’s report card to evaluate provider compliance.

Impact

Sharing information with ISDH will save time and money, as the new program allows HHECMSC to conduct a periodic review of children tested for lead at no additional cost to the organizations.

ISDH and HHECMSC use similar formatting for compliance reports; therefore, future data review will be easier and provide a clearer picture for Marion County and the state of Indiana as ISDH moves to provide compliance reports throughout the state. As a result of this investment, HHECMSC's return on investment gained a no-cost data collection and compliance reporting system.

Funding for this work was made possible in part by NUE2EH001361 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.