Salt Lake County, Utah

About the program

The State of Salt Lake County received $337,645 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 Salt Lake County, contact the program below.

Salt Lake County Lead Safe Housing Program

2001 South State Street

Apt S-2100

Salt Lake City, UT 84190

Phone: 385-468-4892

Success story: funding year 3

Increasing lead education and reducing lead exposure among refugees in Salt Lake County

Challenge

Per capita, Salt Lake County already had a large refugee population before a 375% increase in arrivals between 2021 to 2023. Many refugees arriving in the county had high blood lead levels (BLLs) and were often placed in older housing and had other lead exposures. In fiscal year (FY) 22, 74% of children under 6 years old with BLLs that exceeded the blood lead reference value (3.5 μg/dL) in Salt Lake County were refugees. Refugees are often unaware of the dangers posed by lead and lack resources to prevent exposure which leads to continued high BLLs in this population.

Intervention

In 2023, Salt Lake County Health Department (SLCoHD) developed a three-pronged plan to prevent refugees from being exposed to lead in their new environments: providing lead education home visits, making referrals for home remediation services, and working with refugee resettlement agencies to offer lead education to their clients.

To ensure success, the health department engaged many partners in this effort. SLCoHD formed a partnership with the two primary refugee resettlement agencies in the state, the International Rescue Committee (IRC) and Catholic Community Services (CCS). These entities supplied the health department with contact information for refugee families so that SLCoHD staff could complete educational home visits during which refugee families learned about lead and ways to prevent exposure. Partners reviewed health department educational materials to ensure that they were culturally, linguistically, and reading-level appropriate. They also worked with SLCoHD to assess and address the families' social determinants of health needs and offered other resources. SLCoHD also partnered with several other county agencies. Salt Lake County's Lead Safe Housing Program (LSPH), that provides no-cost home lead remediation services to all that qualify, took referrals whenever the family lived in a home built before 1978, when lead was banned in residential paint, or if there was a suspicion of lead contamination in the dwelling. The Mayor's Office of Diversity and Inclusion donated translation services. Through the New American and Refugee Office, SLCoHD provided educational materials to be distributed at events and locations frequented by refugees.

Impact

The families of 36 refugee children received an educational home visit in FY23. CCS and IRC provided critical lead education to their clients and have agreed to expand this effort. All refugees living in dwellings older than 1978 or those where lead contamination is possible, have been referred to LSHP for a home remediation assessment. KSL News, a media outlet with the largest listening audience in the state, published a story focusing on lead poisoning in the refugee population. This story provided a platform for SLCoHD to raise awareness of this issue among refugees and the general population.

Building trusting relationships with refugee resettlement agencies and leaders and members of refugee communities will help continue SLCoHD's efforts to serve this population as all share the goal of promoting their health and well-being.

Funding for this work was made possible in part by 5 NUE2EH001431-03-00 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

Clinical partnerships to improve blood lead testing rates in Salt Lake County

Challenge

It is important that all children are tested for lead poisoning at their 1- and 2- year-old well-child checks. However, only 1.3% of children younger than 6 years of age were being tested for lead in Utah in 2019. Over 30% of homes in Salt Lake County were constructed before the 1978 ban on lead in residential paint. Further, the CDC updated its blood lead reference value (BLRV) from 5 μg/dL to 3.5 μg/dL in October 2021. More children younger than age 6 years are expected to have blood lead levels (BLLs) at or above this action level and will require care management for lead exposure. Healthcare providers in Salt Lake County need education about lead poisoning prevention to increase the number of children who are tested for lead poisoning.

Intervention

Since October 2021, the Salt Lake County Health Department (SLCoHD) has provided education about lead poisoning prevention to physicians and staff members in seven county clinics. In collaboration with the Utah Lead Coalition, SLCoHD updated several clinical resources such as a lead exposure questionnaire, parents' guide to lead poisoning, and lead testing and treatment guidelines to reflect CDC's updated BLRV. In January 2022, SLCoHD provided these updated clinical resources and further information about the change in the BLRV to over 40 clinics in Salt Lake County. SLCoHD has also worked with the Utah Lead Coalition to update their website to include the most up-to-date information about lead poisoning prevention.

To increase the number of children tested for lead poisoning at their 1- and 2-year-old well-child checks, SLCoHD invited more than 40 individual clinics to participate in a lead poisoning prevention quality improvement project to serve children younger than age 6. For participating clinics, SLCoHD provided point of care machines (LeadCare II AnalyzersA), education to physicians and staff members, and help with creating and implementing policies and workflows to increase lead testing. The project also ensures that children who have a BLL ≥ 3.5 μg/dL are connected to valuable resources such as the Lead Safe Housing Program and SLCoHD Home Visiting Program.

Impact

The three clinics initiating continuous quality improvement projects in 2022 and who submitted complete follow-up data have shown a 260% increase in capillary blood tests (443 baseline vs. 1,152 post-intervention) and a 405% increase in venous testing (39 baseline vs. 158 post-intervention). SLCoHD has invited other clinics within the county to participate in the project and will continue to form new clinical partnerships.

Funding for this work was made possible in part by Childhood Lead Poisoning Prevention and Surveillance of Blood Lead Levels in Children CDC-RFA-EH21-2102 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

Physician education and outreach in Salt Lake County

Challenge

According to the Utah Department of Health, approximately 3% of children ≤6 years of age have been tested for blood lead levels (BLL) in Utah. Additionally, according to Intermountain Health, only 20% of Medicaid accountable care organization patients are currently tested compared to the national average of approximately 70%.

Intervention

The Salt Lake County Lead Safe Housing Program partnered with the Utah Lead Coalition, Utah Physicians for a Healthy Environment (UPHE), and a private practice pediatrician to develop a Lead Exposure Resource Guide for physicians working with families at risk for lead exposure. The Resource Guide included the following streamlined, straightforward guidance:

• A personalized letter from physician peer,
• A childhood lead risk questionnaire,
• A quick guide for lead testing and treatment,
• A parent handout for children with elevated BLLs; and,
• An informational flyer to connect at-risk families with Salt Lake County's free lead remediation program.

UPHE helmed the project and collaborated with partners on content, design, and printing. The packet was printed and mailed to 1,169 pediatricians, pediatric sub-specialties, and general care practitioners in the Salt Lake Valley. UPHE staff members made follow-up calls and emails to ensure receipt of packets, answer any questions, and further emphasize the importance of blood lead level testing.

Impact

Routine blood lead testing and reporting has become a more common practice among physicians in Salt Lake County. Testing and reporting of blood lead levels for children under 5 years increased substantially from 2015 to 2019, with 1,500 children tested in 2015 and over 19,000 children tested in 2019. Two of the largest pediatric providers in the county began testing children routinely with similar efforts spreading to smaller family practice offices in the county. Additionally, one of the largest pediatric providers in the county, the University of Utah, partnered with the county health department on several projects to increase blood lead testing for children and provide financial incentives to some offices.

Funding for this work was made possible in part by NUE2EH001365 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.