Primary Prevention Strategies Handbook: Conceptual Outline Comment (Draft)

    PRIMARY 

PREVENTION STRATEGIES 

HANDBOOK 

CONCEPTUAL OUTLINE 

Comment Draft 

October 1991 

  

ALLIANCE TO END CHILDHOOD LEAD POISONING 

600 Pennsylvania Ave., S.E., Suite 100 

Washington, D.C. 20003 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 
CONCEPTUAL OUTLINE 
  

TABLE OF CONTENTS 

Introduction. vol. ie, ea ae SW Sere a ere) 

Key "Concepts «=. oi Be’ oi cis eins niintin ‘sila cet n- 9 # wo o%8 

Screening a. yin oil At dy he Tes Ne 2 

1ead Hazard ReQUCLION ovis v's wis vivid v vin. 17 

Intervention Criteria Chart and Instructions C-1 

RESON CER or ob het vl ei i, Ee SB Sel Tet 

Legislation +. 0. vk ni. LE, hie ee 27 

Education/Community Outreach /, , . 0 av wide 230 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 

CONCEPTUAL OUTLINE 
  

INTRODUCTION 

PURPOSE 

The purpose of this conceptual outline is two-fold: 1) to provide 
a framework for the Primary Prevention Strategies Handbook and 2) 
to provide an opportunity for public comment and solicit 
suggestions on the final form and content of the Handbook. 

PUBLIC COMMENT REQUESTED 

The Alliance encourages public comment on this draft of the 
Conceptual Outline. PLEASE REVIEW AND SUBMIT YOUR COMMENTS TO 

THE ALLIANCE IN THE SELF ADDRESSED ENVELOPE PROVIDED. 

PRIMARY PREVENTION STRATEGIES (PPS) PROJECT 

The Conceptual Outline is a key intermediate point in the PPS 
project. This two-year project has been funded by a grant from 
the U.S. Environmental Protection Agency. The project will 
result in the preparation of a "Primary Prevention Strategies 
Handbook" at the end of next September (1992). The purpose of 
the project is to define a primary prevention strategy and make 
recommendations for its active and effective incorporation into 
comprehensive childhood lead poisoning prevention programs at the 
state and local levels. 

The project arose out of the need to devise a new paradigm for 
childhood lead poisoning prevention based on the need to respond 
to the greatly increased number of children identified at risk by 
revisions to the Centers for Disease Control guidelines. Most 
local programs are already overstretched in attempting to deal 
with lead poisoning poisoning and will be hard pressed to respond 
to additional cases. The project intends to devise primary 
prevention strategies that take into account the limitations of 
existing resources and programs and at the same time provide the 
basis for establishing and implementing effective and 
comprehensive childhood lead poisoning programs oriented toward 
prevention. 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 

SUMMARY OF PURPOSE 

The Handbook is specifically intended to serve as a "cookbook" 
for designing and implementing local primary prevention programs 
to reduce and eliminate childhood lead poisoning. It will offer 
new productive approaches for effectively responding to the 
greatly increased numbers of children identified at risk by 
current research and revisions to the CDC guidelines. The 
Handbook will outline the critical elements of comprehensive 
model action programs for state and local governments. Recogniz- 
ing the reality of resources limitations and existing program 
gaps, the Handbook will identify initial steps to launch effec- 
tive programs and will provide practical guidance on setting 
priorities and allocating resources for maximum risk reduction 
and public health benefit. : 

TARGET AUDIENCE 

Primary Audience - State and Local decision-makers (e.g., mayors 
and city council members; governors and legislators). 

Secondary Audience - State and local program officials; 
interested public (community groups; energized individuals); 
health care professionals; Federal officials and decision-makers; 
other potentially interested professionals and business people 
(e.g., lead abatement contractors, lawyers, lenders, insurers, 
realtors). 

ORGANIZATION AND FORMAT 

Keeping its primary audience of state and local decision-makers 
in mind, as currently conceived the Handbook will be in three 
different sections or three separate volumes 

The first part of the Handbook - which evolved from the idea of 
an executive summary of the contents of the entire Handbook - 
will be designed to highlight in succinct and dramatic form the 
nature of the childhood lead poisoning problem, the urgent need 
to devise solutions, and an outline of what form a comprehensive 
childhood lead poisoning prevention should take. This part of 
the Handbook needs to have compelling illustrations and forceful 
arguments succintly expressed in order to grab the attention and 
spark the imagination of the decision-makers. 

The heart of the Handbook will be an elaborated outline of the 
elements of a Comprehensive CLP primary prevention program and 
how they should operate in coordination with one another. 

 



  

The final part of the Handbook will be a resources guide. It 
will refer to the best available literature and material on 
various aspects of CLP prevention - e.g., education materials, 

basic information about the nature of the problem, techniques and 
protocol for lead hazard reduction, etc. ad infinitum.! 

  

FORMAT OF THE CONCEPTUAL OUTLINE 

This conceptual outline consists of four basic elements that 
serve as organizing principles for the Handbook: 1) consensus 
principles; 2) innovative ideas; 3) success stories; and 4) 
program incorporation. 

Consensus: 
  

During the course of the development of the Handbook so far, 
there seemed to be a great need to articulate the consensus 
of a enlightened opinion about the causes of and solutions 
to childhood lead poisoning. It should be emphasized that 
this is not a wane distillation of the status quo, but is 
rather intended to move solutions forward by serving as a 
guide to the most current and enlightened thinking on the 

subject. 

Innovation 
  

Innovation is at the heart of the Handbook, because we need 
to devise new approaches to take account of the greatly 
lowered threshold of concern for childhood lead poisoning. 
Innovation is not intended to mean something no one has ever 
thought of before, but rather to identify those approaches 
that have been proposed but never implemented, or that 
represent extensions of or revisions to existing practice. 

  

1*The best explanation for the format might be a description 
of a process by which a CLP prevention is established. The 
decision maker becomes aware of the problem and is convinced of 
the need to take effective action to combat it and subsequently 
ask the staff to prepare the details of a program, which would 
then be enacted and implemented. The resources guide part of the 
Handbook is in essence an efficient way to make sure that the 
voluminous amount of material reviewed during the Handbook 
preparation process is not lost. The purpose of the Handbook is 
not to produce original material on all aspects of childhood lead 
poisoning, e.g., innovative and educational materials. However, 
it would be helpful to have some basic resource for the best 
available material at the time of publication. 

 



  

Success Stories 
  

The thrust of the Handbook is intended to be constructive 
and positive. Despite a cyclical failure to deal with child- 
hood lead poisoning and an historic limitation of resources, 
the Handbook operates on the assumption that it is possible 
to effectively achieve childhood lead poisoning prevention. 
As part of its approach, the Handbook intends to interject 
examples of successful programs or approaches to combating 
childhood lead poisoning. The success stories can be "small" 
and include individual or highly local efforts. The 
"Success Stories" are designed to illustrate specific 
textual points and will be placed in blocks within the text 
near the relevant points that they support. An example of 
the format will be: 

    

  

Program Incorporation 
  

Programmatic incorporation is essential to the Handbook. It 
encompasses suggestions about how to take primary prevention 
strategy elements and integrate them effectively into a 
workable program. 

We especially solicit the reader's nomination of success stories 

and resources materials. 

PROCESS OF PREPARING THE HANDBOOK 

Public comment on the conceptual outline is an important part of 
the Alliance's preparation of the Handbook. The development 
process has emphasized collegial discussion and opinion sharing. 
As part of the process, six informal technical advisory 
committees (TAC's) were formed made up of knowledgeable people in 
particular fields. The TAC's are: Abatement; Education/ 
Community Outreach; Model Law; Resources (how to find the re- 
sources to accomplish lead hazard reduction); Screening; and 
Local Government. Consistent with the interdisciplinary approach 
to CLP that forms the core of the Handbook, it is expected that 

4 

 



  

the different TAC's will cross-fertilize, and comment 
collectively on the draft sections of the Handbook as they are 

produced. 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 
CONCEPTUAL OUTLINE 
  

KEY CONCEPTS 

In the attempt to devise a "new paradigm" for primary prevention 
and in the course of the technical advisory meetings, several key 
concepts repeatedly emerged as leitmotifs. Although this 
Conceptual Outline proposes a Handbook organization that is 
divided into the elements of a primary prevention strategies 
program -- screening, lead hazard reduction, resources, and so 
forth -- the nature of CLP prevention requires organization along 
interdisciplinary, synthetic, cross-categorical lines. As a 
result, the "key concepts" section of the handbook, should form 
its core and contain the basic ideas that should pervasively 
inform the development and implementation of primary prevention 
strategy programs. : 

  

PRIMARY PREVENTION 

o Primary prevention is the animating principle of the PPS 
Handbook. The Handbook represents an attempt to develop new 
programs and remove existing CLPP programs away from the 
circular approach of tracking and medical case management to 
a genuinely preventive effort focused on lead hazard 
reduction, and prevention of exposure in the first place. 

o History has demonstrated how very difficult it is to 
incorporate true primary prevention as a pervasive working 
concept in the ongoing operation of most CLP programs. Both 
because of resource constraints (and praiseworthy concern 
about treating existing cases of childhood lead poisoning as 
a first priority), and lack of coordination among different 
agencies and departments, the objective of prevention tends 
to get lost in the day-to-day operation of programs. The 
relationship of screening to prevention also raises 
difficult issues that must be addressed philosophically and 
programmatically. As discussed in the Screening chapter, 
below, while screening is by strict definition secondary 
prevention, it is an essential element of a primary 
prevention program. However, the screening elements of a 
program must be coordinated with the other elements - most 
notably, lead hazard reduction- to make sure that screening 
is used as an indicator and guide to lead hazard reduction 
actions. 

 



INTERDISCIPLINARY 

Oo Another informing concept of the PPS Handbook is the 
interdisciplinary focus necessary to effectively solve CLP. 
Few problems span as many fields and disciplines - medicine; 
housing; public health; environment; social action. As a 
result, the problem tends to be compartmentalized: housing 
advocates may see CLP as an environmental problem, 
environmentalist may see it as a poverty problem, public 
health officials may see it as a housing problem, etc., etc. 
in a circular definition. The lack of agency coordination 
sometimes seen in CLP prevention programs ultimately 
reflects a lack of interdisciplinary perspective. It is not 
uncommon, for example, for a (separate) municipal housing 
department to give very low or no priority to requests for 
lead-based paint inspections requested by the health 
department in cases where lead poisoned children have been 
identified. It is very rare -- to take another example -- 
for local environmental departments to be at all involved in 
lead poisoning prevention (for example, soil inspection). 
Screening itself is a primary example of the typical lack of 
interdisciplinary focus since it is rarely linked with any 
degree of directness or effectiveness to lead hazard 
reduction activities. 

REGULATION-DRIVEN 

Oo Effective solution of CLP depends in the first instance on 
existing laws, regulations, and sustained program 
development. Even though education, catalyzed communities, 
and the private sector all have key roles in the effort to 
eliminate childhood lead poisoning, an enforceable 
regulatory program is required to persuade - and in some 
instances, coerce- people to take action to prevent, reduce, 
or eliminate lead hazards. In the course of developing this 
Conceptual Outline, we have been unable to identify any 
instance where "pure" private sector involvement based on 
the operation of market forces occurred to achieve lead 
hazard reduction absent a basic regulatory program. 

One key issue raised when the problem of lead poisoning is 
viewed through the prism of an ongoing regulatory program is 
the degree to which one assigns responsibility and liability 
for the problem. The obligation to reduce lead hazards on a 
continuing and effective basis may, as a practical matter, 
be too much of a burden to place on already overburdened or 
dysfunctional families. The assumption of public 
responsibility through legal, regulatory, and program 
requirements is both ethically and practically necessary to 
the solution of the CLP problem.  



DELIVERY SYSTEMS 

oO Even assuming a populous that is well-informed about lead 
issues, lead abatement and prevention cannot be accomplished 
unless effective delivery systems are in-place and 
operating. The idea of delivery systems encompasses the 
legal and regulatory bases of programs (see Regulation- 
Driven above) and also includes procedures for achieving 
lead hazard reduction and mandating screening of children. 

OPPORTUNITY POINTS 

Oo It is important that CLP programs take advantage of all 
available opportunities to reduce hazards. This Conceptual 
outline recommends various opportunities or transaction 
points that should be integrated into an effective CLP 
prevention program. Inspection and lead hazard activities 
can be most easily accomplished, for example, when a unit is 
vacated. Thus a requirement of inspection and rigorous lead 
hazard reduction should be mandated when vacancies occur or 
when real estate is sold. To take another example, lead 
hazard reduction must be incorporated into normal housing 
transactions as recommended in the Resources chapter. 

 



MAKING LEAD ABATEMENT POSITIVE AND VALUABLE 

oO Although eliminating CLP depends in the first instance upon 
a legally authorized regulatory base, lead hazard reduction 
also needs to be presented as a positive action that will 
increase the economic and amenity value of property, as well 
as protect children. Lead hazard reduction, for example, 
might be tied into weatherization and energy improvement 
efforts, as well as more general home improvement and 
rehabilitation activities. As housing consumers become 
better informed, the marketplace should reflect the added 
value of lead-safe housing. 

SOCIETY'S SELF-INTEREST 

oO Another positive aspect of eliminating childhood lead 
poisoning is the fact that from even the hardest and most 
calculatory perspective it is essential for the U.S. to 
eliminate childhood lead poisoning prevention in order to 
increase its national productivity. The nature of CLP is 
such that it affects --often in subtle ways-- the 
intellectual growth of children. In effect, CLP reduces the 
stock of intelligence and potential productivity in the 
nation as a whole. 

HEALTHY COMMUNITY 

Oo Ultimately, removing the hazard of lead from a community is 
part of building a healthy and empowered community. It has 
been suggested that some definition or vision of a "healthy 
community" is essential to inspiring local groups - 
especially in impoverished areas - to tackle lead hazard 
reduction as part of an overall improvement program. 

Lead hazard reduction should tie into a larger survey and 
profile of a community's needs and (often hidden) resources. 
It also is desirable to use outreach workers from the 
community itself, have the program use its resources to 
train them, and send them back into the community as a 
resource. 

 



  

Examples of programs that tie into the idea of the 
development of a "healthy community" are community 
reinvestment and employing and training community workers to 
undertake lead hazard reduction in their localities. 

COMMON LANGUAGE 

Oo One of the most important things the Handbook can do is to 
help formulate a common language to use in addressing 
childhood lead poisoning. In the Lead Hazard Reduction 
chapter, we have tried to define terms carefully so as not 
to imply that every situation requires a equivalent (and 
expensive) response or immediate full abatement. In 
conjunction with this calculated redefinition of abatement, 
we have also proposed use of the term "bioavailability" as 
an indication that the mere presence of lead is not the 
operative event, but rather the risk it presents in a 
particular situation. ; 

Careful definition in the course of establishing a common 
language should lead to common criteria. Again using the 
lead hazard reduction principles as an example, a definition 
of hazard that accommodates a hierarchy of response efforts 
can qualify both the nature of the problem and the 
effectiveness of the response. 

LEVERAGING RESOURCES 

oO Another key concept in the development of the Handbook is 
the idea of leveraging resources. This has several 
dimensions. In its program aspect, it could mean, for 
example, utilizing outreach workers with maximum utility by 
making them a "one stop" source of information about various 
social programs. 

Another example of leveraging resources is the incorporation 
of lead inspections into overall municipal and state 
inspection programs. Thus, when a housing or environmental 
inspector goes to a house or a site, inspection for lead 
should be a part of his inspection procedures. 

One further example of leveraging resources is public/ 
private partnerships to obtain the necessary resources to 
achieve effective lead reduction. 

SETTING PRIORITIES 

o Lead-based paint and other lead sources are widespread, but 
resources are limited. Monies for lead hazard reduction 
must come from all available sources - federal, state, and 
local governments; the private sector; communities; "sweat 
equity" and so forth. Programs will succeed only to the 

i0 

 



  

extent they successfully marshall resources, establish 
priorities, and make "common sense" investments and 
commitments. 

11 

 



  

PRIMARY PREVENTION STRATEGIES Handbook 
CONCEPTIONAL OUTLINE 
  

SCREENING PRINCIPLES 

1. SCREENING IS AN ESSENTIAL ELEMENT OF PRIMARY PREVENTION, EVEN 
THOUGH STRICTLY SPEAKING IT FALLS OUTSIDE THE DEFINITION OF 
"PRIMARY PREVENTION" 

Oo Primary prevention means prevention of exposure to 
lead. Secondary prevention means treatment of people 
who have been poisoned by lead and prevention of 
further exposure. Under these definitions, screening 
is secondary prevention because its goal is to diagnose 
cases of lead poisoning and provide a remedial 
response. 

Screening must be included in a lead prevention program 
for the following reasons: 

0 Screening data can help target areas for priority 
lead hazard reduction. 

0 Screening data can raise public consciousness of 
the childhood lead poisoning problem and move 
public policy toward establishment of comprehen- 
sive childhood lead poisoning prevention programs. 

0 Environmental intervention and lead hazard reduc- 
tion triggered by screening can prevent future 
cases of lead poisoning, both in the immediate 
family circle, in future occupants, and in wider 
geographical areas. 

"Anticipatory guidance" must be made a routine part of 
screening. A child's screening appointment should be 
viewed as an opportunity for education of the family 
about lead poisoning, its causes, preventive measures, 
and existing programs and resources. 

2. SCREENING MUST BE DIRECTLY RELATED TO LEAD HAZARD REDUCTION 
IN A COMPREHENSIVE AND COORDINATED CHILDHOOD LEAD POISONING 
PREVENTION PROGRAM 

oO Past screening programs have sometimes amounted to 
little more than medical "tracking" systems in which 
diagnoses of childhood lead poisoning were repeatedly 
and routinely confirmed. The link between screening 
and lead hazard reduction is the key to incorporating 

12 

 



  

screening into an effective primary prevention program 
and breaking the cycle of childhood lead poisoning in 
the individual case management system. 

Environmental intervention and lead hazard reduction 
should take place in every case. Cases of lead 
poisoned children should be traced "outward" to 
friends, relative, and places visited where exposure 
might have taken place. An appropriate level of lead 
hazard reduction should be mandated and enforced in 
every case where blood lead levels exceed CDC levels of 

concern. 

3. ANALYSIS MUST BE INTRINSIC TO THE SCREENING PROGRAM 

Oo Analysis of screening data has three basic aspects: 

o Surveillance (collection and collation of screen- 
ing data on a routine basis). 

o Reporting data back. 

o Linking data to ongoing lead hazard reduction. 
actions and activities. 

Reporting of all screening data - whether from private 
physicians or public programs =- should be legally man- 
dated. 

o The data should be reported to central reposi- 
tories at the state and local levels and also 
forwarded to CDC for surveillance programs. 

0 Data from screening should be available in 
accessible form to the community, as well as to 
the persons affected. In addition, there should be 
a state and national data base that incorporates 
information generated by screening. 

  

0 Laboratory reporting of screening data is 
essential. 

All negative results of blood lead level screening 
should be reported as well as positive results. In 
addition, the data reporting sheet should contain basic 
information on the child tested, including area of 
residence, age, sex, and ethnic identity. 

Data collection and reporting systems should be compu- 
terized and standardized. 

I 

 



  

0 Data collected by screening must be fed into the 
inspection and lead hazard reduction components of a 
comprehensive CLP prevention program on a systematic 
basis. 

0 Modern methods of statistical analysis should be 
brought into play. Screening data should be correlated 
with other data related to childhood lead poisoning 
such as age and condition of housing stock, soil, 
water, and ambient levels of lead in the vicinity, and 
any known environmental problems such as hazard waste 

sites. 

4. UNIVERSAL SCREENING MUST BE MANDATED AS PART OF A PRIMARY 
PREVENTION PROGRAM 

0 All children 6 years old and under should be screened. 
Mandatory screening should take place as detailed in 
CDC guidelines. In addition to children 6 and under, 
other priority categories of potential lead poisoning 
victims should be tested. These categories would 
include pregnant women and adults who are likely to 
secondarily expose children (e.g., adults who bring 
lead home in their work clothing). 

o In screening, venous blood samples should be used 
instead of EP (erythrocyte protoporphyrin) tests. 

5. SCREENING SHOULD BE REQUIRED AT APPROPRIATE OPPORTUNITY 

POINTS 

o Screening should be required as a condition for entry 
to kindergarten, pre-daycare, or daycare. 

o Screening should be incorporated into a standard of 
care that mandates screening at specified age intervals 
recommended by CDC. 

6. SCREENING SHOULD BE USER FRIENDLY AND PROVIDE SUPPORT AND 
EDUCATION FOR PERSONS UNDERGOING SCREENING 

0 Education about childhood lead poisoning and individual 
counseling for lead poisoned children should be an 
integral part of the screening process. 

0 Health care insurers should be legally required to 
reimburse health care providers for screening. 

14 

 



  

0 Outreach workers who do screening of families should 
also give out information about other social programs 
available and be alert to other social problems of the 
families involved. 

7. FOLLOW-UP SCREENING NEEDS TO BE DONE ON A SYSTEMATIC BASIS TO 
CHECK THE EFFECTIVENESS OF LEAD HAZARD REDUCTION STEPS. 

8. SCREENING SHOULD BE MESHED AND INTEGRATED WITH PRIVATE 

MEDICAL CARE 

0 Medical practitioners are the gatekeepers to health 
care and source identification. There is currently a 
lack of screening by private doctors. 

0 Medical practitioners should be legally required to 
screen children according to a universal screening 
schedule. 

o There is a great need for medical education and train- 
ing concerning childhood lead poisoning. 

9. EXISTING SCREENING PROGRAMS CAN BE USED AS A BASE OR 
"BUILDING BLOCK" FOR MAKING THE TRANSITION TO PRIMARY PREVENTION 
PROGRAMS 

0 Coordination of data collection in ongoing screening 
programs can define high risk areas for intensive 
primary prevention activities. 

0 Retraining of screening program personnel can effect 
primary prevention strategies by learning how to 
address low level toxicity and focusing on dust as the 
primary transmittal agent for childhood lead poisoning. 

10. LABORATORIES SHOULD BE SUBJECT TO STANDARDIZED REPORTING 
REQUIREMENTS AND SHOULD BE REQUIRED TO SUBMIT A QUALITY 
ASSURANCE/ QUALITY CONTROL PROTOCOL AND FOLLOW IT 

o Third party testing should be discouraged. In cases of 
third party testing, split samples should be taken and 
a sample submitted to the public laboratory. 

11. FURTHER RESEARCH IS NEEDED IN DEVELOPING DEVICES THAT MAKE 
SCREENING EASIER, MORE EFFICIENT, AND LESS EXPENSIVE 

15 

 



  

o A portable testing device for screening should be a 
priority for development. 

ie 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 
CONCEPTIONAL OUTLINE 
  

LEAD HAZARD REDUCTION 

1. LEAD HAZARD REDUCTION IS THE LINCHPIN OF PRIMARY PREVENTION 
AND ALL PROGRAM ELEMENTS MUST BE RELATED TO ACHIEVING IT 

o The elements of the lead hazard reduction component of a 
childhood lead poisoning prevention program include: 

o Source identification 
o Problem (hazard) definition 
0 Lead hazard reduction 

- Worker protection 
- Proper disposal 

0 Monitoring and clearance testing 
0 Follow-up monitoring 

o The core abatement and lead hazard reduction program 
elements should be directly linked to all other program 
elements. Links to screening and education are particularly 
important. 

oO Data from screening that indicates a high incidence of 
CLP in particular areas or localities should be 
correlated with housing stock (age, condition) and 
environmental conditions (soil, air, water, hazardous 
waste dumps) to serve as the trigger for systematic 
surveys, inspections, and lead hazard reduction 
activities. 

Education should be regarded as active intervention and 
in the broadest sense should range from information 
distribution to actual training. 

2. LEAD HAZARD REDUCTION ACTIVITIES SHOULD BE CONDUCTED 
ACCORDING TO A PRIORITY-BASED SYSTEM THAT FACTORS DEGREE OF RISK, 
EFFICIENT OPPORTUNITY, AND COST AND RESOURCES INTO ACCOUNT 

®) The mere presence of lead-based paint (LBP) does not 
always constitute an actionable hazard 

The goal of a CLP prevention program should be a lead 
safe house, not necessarily a lead free one. 

Inspections and lead hazard reduction should take into 
account the fact that LBP and dust are typically the 
primary source of intensive lead exposures; however, 
other sources can contribute to lead poisoning (such as 
lead in soil, drinking water, ambient air, ceramics, 
and secondary occupational exposures). 

17 

 



  

The most common cause of childhood lead poisoning is 
the ingestion of dust that has been contaminated with 
lead usually from lead-based paint. 

The definition of what constitutes risk from lead-based 
paint and other sources is critical to designing and 
implementing a priority-based CLP prevention program. 

3. ACTIVE INTERVENTION - EVEN IF IT FALLS SHORT OF COMPLETE 
ABATEMENT - IS NECESSARY IN EVERY CASE OF ACTUAL OR POTENTIAL 
CHILDHOOD LEAD POISONING 

oO 

  

The Intervention Criteria Chart at the end of this 
section attempts to graphically depict the progression 
of decision-making points and the criteria that lead to 
lead hazard reduction decisions. The chart contains its 
own explanation and illustrative guide to its use. 

4. INSPECTIONS TO IDENTIFY LEAD HAZARDS IN HOUSING ARE A CRITI- 
CAL COMPONENT OF PRIMARY PREVENTION STRATEGIES AND SHOULD BE THE 
PRIMARY TRIGGER FOR LEAD HAZARD REDUCTION ACTIONS 

(eo) Inspections play key roles in various stages of the 
process (initial inspections, re-inspections, and post 
abatement clearance inspections). 

Lead hazard inspections should be made an integral part 
of all municipal housing, health, and environmental 
inspection programs. 

Given limited resources, lead inspections should be 
based on a priority system which favors units with high 
generic risk factors, such as age and condition of 
housing stock, the geographical concentration of lead 
poisoning cases, and other relevant factors. 

The identification of a child at significant risk 
requires top priority action to identify the source or 
sources of significant lead exposures (from various 
media and various sites) and to eliminate such expo- 
sures as soon as possible. 

Every effort should be made to take advantage of oppor- 
tunity points to achieve inspections, such as permits 
for renovation projects, code violations and annual 
inspections for subsidy programs and occupancy permits. 
Change of ownership and change of tenancy provide 
special opportunities for complete inspection and 
effective lead hazard reduction. 

At a bare minimum, inspections should always include an 
assessment of bioavailable lead based on surface dust- 
wipe samples, as well as visual inspection for 
deteriorated interior and exterior painted surfaces, 

18 

 



  

with special attention to abradable surfaces such as 
windows. 

Based on knowledge of background risk factors and the 
findings of the site examination, additional tests of 
bioavailable lead in exposed paint, soil, drinking 
water and other media should be conducted. 

When triggered by appropriate circumstances (either 
environmental risk factors or points of opportunity, 
such as housing transactions and permits), full inspec- 
tions should be conducted. 

In addition to the components of a "basic inspection," 
full lead hazard inspections should include reference 
to historical inspection information, other inspections 
and code violations, and tests to identify the presence 
of lead in paint and other media. 

  

An integral part of the inspection program is a system 
for assuring the accuracy and validity of laboratory 
and other tests. 

Inspectors need to be licensed and free of conflicts of 
interest with cleanup contractors. 

S. 2A PRIORITY-BASED SYSTEM OF INSPECTION AND LEAD HAZARD 
REDUCTION REQUIRES A HIERARCHY OF RESPONSE 

Oo The term "abatement" should be used to describe 
measures that permanently eliminate human exposures to 
specified sources of lead. Interim measures (variously 
called "preventive maintenance"; "in-place management"; 
and interim containment”) include those steps short of 
abatement that effectively control or stabilize the 
situation to reduce lead exposures to acceptable levels 
in the short to mid-term. 

Because steps to reduce lead exposures differ as a 
function of circumstances and resources, the term "lead 
hazard reduction" should be used as a general descrip- 
tion for all cleanup efforts. 

Measures to address lead hazards may take a variety of 
forms depending on the circumstances. The response may 
range from interim risk reduction steps to abatement. 

The primary objective of lead hazard reduction efforts 
is to reduce lead dust on surfaces and to eliminate the 
sources of lead in such dust. 

In general, interim measures should include the 
provision of smooth and cleanable surfaces. 

19 

 



Interim measures must never be considered permanent 
solutions. 

The appropriate method of lead hazard reduction should 
be commensurate with the hazard. 

In cases is which interim measures are employed, 
periodic ongoing monitoring must be required as an 
integral part of the intervention. 

Some situations will present levels of risk significant 
enough to require immediate abatement, instead of 
interim measures. 

The concentration of lead in paint is only one factor 
in assessing lead paint hazards: the condition, 
accessibility, and potential for disturbance or damage 
of lead painted surfaces, are the other controlling 
criteria. : 

To the extent practicable, the selection of abatement 
techniques should minimize the generation of lead dust. 

Abatement/interim measure specifications and project 
design should take into account cleanability, energy 
conservation, long term maintenance, and increase in 
building value. Cost calculation should be done on the 
bases of life cycle costing. 

6. TRAINING AND CERTIFICATION ARE ESSENTIAL AND SHOULD BE 
MANDATED FOR EVERYONE ENGAGED IN LBP ABATEMENT 

o Lead hazard abatement activities are usually complex 
and inherently dangerous. Efforts to abate lead paint 
hazards without proper methods and training often 
exacerbate, rather than alleviate, the problem. 

Everyone engaged in LBP hazard abatement projects must 
at all times wear proper protective equipment, includ- 
ing a respirator. 

A cleanup using HEPA vacuums and trisodium phosphate 
(TSP) washes must be conducted as part of every LBP 

abatement project. 

A LBP hazard abatement project is not complete until 
the work site is inspected and passes a post-abatement 
clearance test. 

Occupants of homes undergoing significant abatement 
activities should be relocated until the home is found 
to be lead-safe through post-abatement clearance test- 
ing.  



  

0 The provision of relocation housing is an integral part 
of a comprehensive lead hazard reduction program. 

o Anyone -- contractors, supervisors, workers, property 
owners, occupants, etc. -- who undertakes lead hazard 
reduction activities must be adequately trained and 
certified. This training should include at least: 
identifying lead hazards; worker protection; occupant 
habits and protection; abatement techniques, materials 
and procedures. 

8. THE SUCCESS OF ANY CLP PREVENTION PROGRAM IS CONTINGENT ON 
THE EXISTENCE AND EFFECTIVENESS OF THE DELIVERY SYSTEMS 

0 Regulations, funding, resources and education programs are 
futile if there are not delivery systems in place that are 
appropriate to specific populations and needs. 

o The delivery mechanism should be as decentralized as 
possible. At the same time economies of scale make it 
logical to centralize some program components, e.g., testing 
laboratories, shared purchasing, expensive equipment, and 
training facilities. 

0 Following are some specific examples of delivery sys- 
tems: 

- Neighborhood-based maintenance projects 

- Consortium structure 

- Agency inspectors 

- Municipal clean-up crews 

- Private inspectors and contractors 

- Specialized crews 

el 

 



PURPOSE: This chart is an instrument DRAFT: This chart is a first draft. It is on computer 
for focusing a discussion about lead intervention; disk so changes can be made for a particular program or place. 
planning a program; for a particular house, an For changes call or write Alex G. Mendoza, 3104 Grindon Ave., 
institution or a focused program. Baltimore, MD 21214. (301) 426-3671. There will be a small fee 

for these changes. 

INTERVENTION CRITERIA CHART 
EDUCATION 

Circle which tests will be 
done, by whom, and who will 
give order to proceed. 

A particular household may have several 
triggers of or several individuals 
sharing a trigger. For example: 
two poisoned children in a 
house would be 

        
  

POISONED CHILD O TRAINING 

PREGNANCY OO : 
CHILD9MO.3YR. O Fill out 
CHILD3YR.-6YR. O) time, 

6+, ELEVATED O date and 
ATRISKOCCUPATION source. 

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EDUCATION PROGRAMS APPLICATION PROCESS MONITORING PROGRAM 

An explanation of the Description of Description of 
specific piece of liter- qualification REPLACE ALL WINDOWS, ENCAPSILAYE FLOORS WITH monitoring 

. “PERMANENT” MATERIAL PLUS 2 & 1. A 

ature or presentation and procedures programs including 
<«=THRESHoLp Nd options or source of programs qualifications, fees, 

materials. Also how available with HEP AVA PH SPRATE WASH ALL SUREALES WET CORRE. contract organiza- 
ALLIANCE TO END. CHILDHOOD LEAD. POISONING to acquire literature phone # for fur- PAINT ALL FLAKING PAINT. tion, and phone 

or schedule an event. ther information. number. 

C-1 

REMOVE/ REPLACE, STRIP, OR ENCAPSULATE WITH 

“PERMANENT” MATERIAL ALL LEAD SURFACES PLUS 3,2 & 1. 

  

       



  

INTERVENTION CRITERIA CHART 
ANALYSIS EDUCATION : i 

      

   

   

  

    

   

  

   

   
   

    

   
   

        

  

      
    

  

    
    
              
  

  

    
            

  

   

  

    
     

  

   

  

    

     

   

    

     

     

   

  

    

      

           
    

        
    

  

      
    
    
    
    
  

  

           

\ N 

oN © WW > 
N\ AS \ $4 < . 

Ra Pe oY < S&S RS 

& a Te LOZ) 
0 

POISONED CHILD O TRAINING m] 

= PREGNANCY O m] 

=f  CHILD9MO.3YR. O $20,000+ TERT — SEPT - 

or CHILD3YR.-6YR. OO —$20,000 m] 
LA 6+, ELEVATED O = JUNE [] 

0 (SJ ATRISK OCCUPATION O L CLEAN a 

move Of H45 El poo 0 Bld 00 N e—— 8 | Rb m0 
0 PRESENTATION or —M a an A : 3 3 

PERMITPULLED O 415.000 PRE PAINT H 

Jf RENTALTURNOVER O : 
2 — 
> FORSALE O i SEPT [] 
i. OWNER REHAB OO —DEMOLITION o 
= AGE OF HOME O) — oO 

eo DETERIORATION O) = — JUNE [J 
O a 

$10,000 0 
a HE Ee ie 

 PUBLICINSPECTION O ™ x 

=4 PRIVATE INSPECTION OO) erat iba. Jo MN sae Rn liane Tag 17 BY Oo 

F-3 NEIGHBORHOOD INS. O - u] 

2 SOILPROGRAM i Oo 
 « 0 tl 

—$5,000 SEPT [J 
a as Ba i ve 

el 

wn Oo 
fe —JUNE [] 

o 
[= u] 
= —MAR [J] 

o 

EDUCATION PROGRAMS APPLICATION PROCESS Jf PEM RAGE STO On APSO WT MONITORING PROGRAM 
“PERMANENT” MATERIAL ALL LEAD SURFACES PLUS 3,2 & 1. = hl ad 

3 REPLACE ALL WINDOWS, ENCAPSULATE FLOORS WITH 

js “PERMANENT” MATERIAL PLUS 2 & 1. 

Ze : 3 : 2 ENCAPSULATE OR STRIP ALL FRICTION AND IMPACT POINTS : rea 

UNIT OF MEASURE «= THRESHOLD is Rb 3 TL RL ee 
GE re mn mt GS pm A 1 HEPA-VAC / PHOSPHATE WASH ALL SURFACES, WET SCRAPE, ees 

ALLIANCE TO END CHILDHOOD LEAD POISONING Wa i PAINT ALL FLAKING PAINT. 

    
  

    
  

C-2 

  

  
  

  

  

  

 



INTERVENTION CRITERIA CHART 
ANZ EDUCATION : : 

    
      

      POISONED CHILD 
PREGNANCY $ 

CHILD 9MO. 3YR. +8” | $20,000+ 
CHILD 3YR.-6YR. —$20,000 

6+, ELEVATED O) 
ATRISKOCCUPATION O 

INCOME O 

  

G
U
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S
 

[0]
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PRESENTATION - 

PERMITPULLED O | $15,000 
RENTALTURNOVER OO 

FOR SALE 
OWNER REHAB = —DEMOLITION 
AGE OF HOM = 

DETERIORATION (OO) = 

—$10,000 

    
        [1 

= 
eed 
ed 
Lid 

= 
=)     

PUBLIC INSPECTION (OO 

PRIVATE INSPECTION O 

NEIGHBORHOOD INS. 

SOILPROGRAM (OO 

P
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A
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Vhi+3   Bo 

& MAR [] 
a 

EDUCATION PROGRAMS APPLICATION PROCESS er ES MONITORING PROGRAM 
“PERMANENT” MATERIAL ALL LEAD SURFACES PLUS 3,2 & 1. 

                                
    

  

  

      
      

REPLACE ALL WINDOWS, ENCAPSULATE FLOORS WITH 

“PERMANENT” MATERIALPLUS 2 & 1. 
      
    
      

  

«= THRESHOLD       
        

HEPA-VAC / PHOSPHATE WASH ALL SURFACES, WET SCRAPE, 

PAINT ALL FLAKING PAINT. 
        ALLIANCE To END CHILDHOOD LEAD POISONING 
       



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 
CONCEPTUAL OUTLINE 
  

1. 

RESOURCES 

THE PROVISION OF RESOURCES FOR LEAD HAZARD REDUCTION IS AN 
ESSENTIAL PART OF A COMPREHENSIVE CHILDHOOD LEAD POISONING 
PREVENTION PROGRAM 

Oo 

2. 

In order to achieve lead hazard reduction all appropriate 
financial, human, organizational, and social resources must 
be marshalled. 

A comprehensive program should link LBP education and abate- 
ment to other more broadly recognized programs and goals-- 
such as low-income housing development, job training, neigh- 
borhood revitalization, and social investment policies. 

PROVISON OF RESOURCES FOR LEAD HAZARD REDUCTION RESTS ON A 
FOUNDATION OF STATUTORY REQUIREMENTS, REGULATORY STANDARDS, AND 
PROGRAM GUIDELINES 

Oo A comprehensive lead law and regulations should serve as the 
backdrop for all lead poisoning prevention activities: 
childhood lead screening, property inspection, assignment of 
liability, and initiatives to secure abatement funding. The 
regulatory regime should include requirements directly 
related to resources such as licensing and training require- 
ments for inspectors and abatement contractors. 

Standards and requirements need to be spelled out before 
property owners, lenders, insurance companies, realtors, or 
other private housing sector actors take positive steps 
toward lead inspection and abatement. Articulated require- 
ments provide some basis for certainity and action. In 
addition, mandated lead hazard reduction and abatement 
serves as the fundamental incentive for marshalling resourc- 
es -- especially private resources -- to achieve lead abate- 
ment. 

0 Authorizing legislation for CLP prevention programs 
should include incentives for public/private partner- 
ships and public sector participation in lead abate- 
ment. 

22 

 



  

3. STATE AND LOCAL LEAD POISONING PREVENTION PROGRAMS SHOULD BE 
BUILT UPON EXISTING CAPACITY IN THE PUBLIC AND PRIVATE SECTORS 

o There is substantial public sector capacity in many states 
and localities. The following are examples of public sector 
capacity. 

Oo 

  

Incorporating IBP policies into financial assistance 
and code enforcement programs. Many public agencies -- 
particularly at the local level-- have operating resi- 
dential loan and grant programs and code enforcement 
efforts. There are at least three ways in which LBP- 
related issues can be integrated into government pro- 
grams: (1) providing information to homebuyers, land- 
lords, residents, and contractors on LBP hazards and 
legal requirements; (2) requiring LBP testing and 
abatement as a condition of obtaining financial assis- 
tance, direct services, or permits; and (3) providing 
incentives for abatement -- for example, making abate- 
ment an eligible activity of a loan or grant program, 
providing direct inspection services, and supervising 
abatement work. 

  

  

Role of state and local HFA's. State and local housing 
finance authorities can issue tax-exempt (and, in some 
cases, taxable) bonds, the proceeds of which could be 
used to purchase below-market interest loans originated 
by private lenders. HFA's could make LBP abatement an 
eligible activity in a home improvement or acquisition- 
rehabilitation loan. Furthermore, HFA's and other 
agencies which subsidize housing development and home- 
ownership could require LBP testing and abatement as a 
condition of assistance. 

  

Dedicated revenues. Certain non-traditional methods of 
financing could be made accessible to lead abatement. 
Such sources include transaction fees, idle public 
funds and bond reserves, and escrow funds. Another 
potential dedicated revenue source would be state taxes 
on the lead industry or the use of lead. 

  

Other incentives for LBP abatement. Local governments 
could provide other financial and technical support to 
encourage abatement and the development of a private 
industry -- for example: tax breaks, fee forgiveness, 
priority use of Community Development Block Grants, and 
direction of employment/job training programs to LBP- 
related trade. Local public housing authorities 
(PHA's) could target Family Self Sufficiency programs 
(using rental assistance) to employment training in 
LBP-related trades -- as a means of developing a labor 
force and achieving economic empowerment goals. 

  

23 

 



  

4. 

There is a need for private sector capacity to undertake LBP 
inspections and abatement. To accomplish the volume of LBP 
abatement finance and work needed, a private sector industry 
must emerge. Furthermore, other actors in the housing world 
need to be familiar with LBP-related issues--for example, 
lenders, realtors, insurance firms, property appraisers, and 
property managers. The following are examples of how 
private sector capacity can be built and utilized. 

  

0 Private lenders. There may be some self-interest in 
lenders making abatement loans: prevention of 
liability in the case of properties which fall into 
delinquency, conservatorship, or lender ownership 
through foreclosure. 

o Creating a private inspection and abatement industry. 
There is too much housing with LBP for governmental 
agencies to inspect and perform abatement directly in 
all units. Every community has small and medium-sized 
businesses that when properly trained and certified 
could perform inspection and abatement services. 

  

  

0 Reinsurance. As a backstop to private insurance 
companies, the government could establish a reinsurance 
or insurance guarantee fund. 

  

o Community Reinvestment Act. State governments could 
amend their banking laws to place financing for LBP 
abatement among eligible activities that count toward a 
lender's community reinvestment goals. Regulatory 
agencies could require lenders to keep records of 
abatement financing activity. 

  

LEAD-RELATED ISSUES SHOULD BE INTEGRATED IN NORMAL HOUSING 
TRANSACTIONS 

Oo There are many decision points in housing transactions. 
They provide opportunities for addressing lead hazards. 
Examples of housing transaction decision points are: 
property inspections, loan applications, property transfers, 
permit applications, and leasing. 

Most housing transactions involve private sector actors-- 
lenders, insurance companies, appraisers, and realtors. 
Advocates or public officials could seek voluntary 
agreements with these private sector actors to incorporate 
LBP education and abatement work into housing transactions. 
Alternatively, and perhaps more effectively, public policies 
could be formulated that require the incorporation of LBP- 
related aspects in housing transactions, including: 

24 

 



  

S. 

0 Marketing. Real estate agencies could provide LBP 
  

information to potential homebuyers and renters. In 
certain rental markets, it may be an effective strategy 
to advertise available units as "lead safe" or having a 
certificate of compliance. 

0 Purchase and sales agreements. Such agreements could 
  

contain a clause making the sale contingent on the 

results of an LBP inspection. 

0 Lending. Private lenders could provide consumer 
information on the risks of lead exposure and a 
description of how their available loan financing 
might be used for abatement. 

0 Appraisal. Property value appraisers could develop 
  

standards for distinguishing properties with and 
without hazardous lead conditions. 

COMMUNITY RESOURCES MUST BE ENLISTED TO STRENGTHEN CHILDHOOD 

LEAD POISONING PREVENTION PROGRAMS 

Oo 

6. 

Community-based resources should be enlisted in the effort 
to obtain concerted governmental action on LBP or to 
encourage private sector institutions to help finance 
abatement. For example, there are still approximately 2,000 
community action agencies based in localities and 
neighborhoods. In addition, community outreach programs 
should include the encouragement and development of 
community resources for lead hazard reduction. 

THE EDUCATION/COMMUNITY OUTREACH COMPONENT OF A CLP PRIMARY 
PREVENTION PROGRAM SHOULD INCLUDE RAISING CONSUMER CONSCIOUSNESS 

oO Raising consumer consciousness is an important part of 
securing the commitment of public officials and private 
lending institutions to provide and increase abatement 
resources in the public and private sectors and for the 
development of delivery systems and community-based programs 
to achieve lead hazard reduction generally. 

o Homeowners, renters, and investment property owners may 
actively seek public and private resources for lead 
abatement once they appreciate the dangers of childhood 
lead poisoning. Consumer consciousness is an essential 
element of making the market value a lead abated home. 
Private sector institutions --like banks-- may be 
inclined to provide financing for abatement if they 
become aware of sufficient consumer demand. 

25 

 



  

7. THE ECONOMIC BENEFITS OF ABATEMENT SHOULD BE PROGRAMMATICALLY 

TIED INTO THE BROADER POSITIVE VALUES OF LEAD HAZARD REDUCTION 

SUCH AS ENERGY EFFICIENCY AND HOME IMPROVEMENT. 

o The economic value of lead hazard reduction is emphasized 
when abatement activities include a replacement of 
substandard or energy inefficient windows, doors, or other 
painted surfaces and other home improvement steps and 
procedures. 

26 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 
CONCEPTUAL OUTLINE 
  

LEGISLATION 

1. CHILDHOOD LEAD POISONING PROGRAMS MUST BE BASED ON MANDATES 

CONTAINED IN LEGISLATION 

o Even though there have been examples of successful CLP 
programs at the local level established absent any legisla- 
tion and even though mere enactment of legislation does not 
guarantee its effective implementation, statutory require- 
ments that mandate the development and implementation of a 
comprehensive childhood lead poisoning prevention program 
are the best guarantees for the continued effectiveness of 
CLP prevention efforts. 

2. CLP PREVENTION LEGISLATION MUST IDENTIFY THE ESSENTIAL 
ELEMENTS OF A PRIMARY PREVENTION STRATEGY AND MANDATE THEIR 
INTEGRATED IMPLEMENTATION 

o CLP prevention legislation should explicitly identify all 
elements of a primary prevention-based childhood lead poi- 
soning program and should mandate that they operate together 
in an effective and integrated manner. In effect, the law 
should institutionalize the interdisciplinary approach 
necessary to solve CLP. 

o The law should take into account existing programs and, 
where necessary, provide the basis for augmenting and "up- 
grading" them into genuine primary prevention programs. 

3. THE CLP PREVENTION LAW SHOULD BE ENACTED AT THE STATE LEVEL 

o The CLP law should be promulgated at the state level in 
order to establish a minimum uniformity of CLP prevention 
program requirements at the local level and to retain a 
supervisory role at the state level. 

o The law of the supervisory role of the state is espe- 
cially important in such areas as laboratory certifica- 
tion. 

27 

 



  

* The reader is referred to the State Model Law, also enclosed 
as a comment draft in this envelope, for an example of 
legislation mandating a CLP prevention program. 

28 

 



The state law should generally preempt less stringent 
requirements at the local level. At the same time, it 
should retain the authority of existing departments and 
inspectors. 

4. THE LAW SHOULD ESTABLISH A FUND TO BE USED IN FINANCING 
ACTIVITIES RELATED TO THE CLP PREVENTION PROGRAM EFFORT AND LEAD 

HAZARD REDUCTION 

The law should provide an opportunity for establishing a 
special fund into which identified sources of money should 
go, including fines and mandatory fees for screening and 
training and certification. Monies from the fund should be 
dedicated to providing CLP prevention program support. 

5S. THE LAW SHOULD INCLUDE FULL INSPECTION AND ENFORCEMENT 

PROVISIONS 

o The law should take a "carrot and stick" approach that 
includes mandatory requirements, as well as incentives to 
achieve lead hazard reduction. 

6. THE LAW SHOULD ALSO INCLUDE INCENTIVE PROGRAMS FOR ENGAGING 

THE PRIVATE SECTOR AND MARKET FORCES IN FINANCING AND EFFECTING 

LEAD HAZARD REDUCTION 

o Some examples of incentive programs that could be incorpo- 
rated into legislation are given in the Resource chapter, 
above. 

THE LAW SHOULD PROVIDE FOR MANDATORY EDUCATION AND COMMUNITY 
OUTREACH AS AN INTEGRAL PART OF A PRIMARY PREVENTION PROGRAM 

o Public awareness and community participation is the driving 
force behind the establishment, continuation, and effective- 
ness of CLP prevention programs. 

 



  

PRIMARY PREVENTION STRATEGIES HANDBOOK 

CONCEPTUAL OUTLINE 

EDUCATION/COMMUNITY OUIREACH 

  

1. EDUCATION/COMMUNITY OUTREACH IS AN ESSENTIAL ELEMENT OF A 
COMPREHENSIVE CLP PREVENTION PROGRAM 

2. ONE OF EDUCATION'S PRIME ROLES IS TO BREAK MYTHS THAT IMPEDE 
EFFECTIVE SOLUTIONS TO CLP 

o Among the myths that must be broken are: 

o that the victim is to blame for being poisoned. 

0 that only poor minority children living in 
dilapidated housing become poisoned. 

o that it is one agency's or one program's sole 
responsibility to solve the lead issue. 

3. CLP EDUCATION MUST TAKE DIFFERENT FORMS FOR DIFFERENT 
AUDIENCES IN DIFFERENT SITUATIONS 

0 Education must be presented in many modalities, visual, 
written, or auditory, in order to be effective. 

0 Education must be geared to the level of literacy 
and characteristic modes of receiving information 
for each target audience. Conversely, education 
material should not condensend by assuming a lower 
level of literacy and comprehension within a given 
community or group than is warranted. 

o Education and educational materials must be multi- 
cultural and sensitive to the educational background, 
values and styles of the community and cultures within 
a community because no culture is monolithic. 

o Examples of modes and materials of community 
education include: 

- Material development 
Flyers 

- Handouts 
- Principles of making handouts 
- Video 
- Journal articles 

30 

 



White papers 
Conference proceedings 

4. CLP EDUCATION MUST BE POSITIVE AND AIMED AT DEFINING A 

HEALTHY COMMUNITY, I.E. HOW A LEAD-FREE SOCIETY LOOKS AND 

RESPONDS 

0 The issue of poverty, racism, and inequality in 
exposure to toxics should be raised and discussed. 

5. EDUCATION SHOULD NOT BE DIDACTIC, BUT RATHER SHOULD HELP 
FOSTER COMMUNITY AND INDIVIDUAL SELF~SUFFICIENCY AND INVOLVE 
PEOPLE IN MAKING DECISIONS THAT AFFECT THEIR LIVES 

0 All people who are at-risk of lead poisoning should 
receive materials and programs as part of an active 
intervention program to prevent CLP. 

6. THE CLP PREVENTION AGENCY SHOULD USE ITS EXPERTISE AND 
RESOURCES TO EDUCATE THE PUBLIC ABOUT CLP 

0 An agency-sponsored public information campaign to 
increase citizen awareness and catalyze citizen action 
about CLP prevention should include the following 
elements. 

o The health dangers of lead poisoning, including 

- Risk communication concerning the actual 
hazard presented by lead in different 
situations 

  

How to protect self and children from lead (during 
pregnancy, childhood, and work) 

How to pay for screening and treatment (gaining 
access to public programs to support lead 
poisoning prevention) 

Information about lead hazard reduction: 

What is lead hazard reduction and what are 

the applicable techniques 

What programs for abatement training and 
certification are offered by state and local 
government 

How to choose and evaluate an abatement 

contractor 

51  



  

0 Description of sources of lead in the home and 
neighborhood and region 

o Explanation of federal, state and local laws and 
regulations on lead 

0 Citizen's rights (e.g., entitlements, tort claims, 
citizen's suits) 

0 Tenant's rights 

o Descriptions of ways to coordinate efforts with 
housing groups and methods of linking agencies 
such as housing, environment, health, human 
services, education, universities, and advocacy 
organizations 

0 Information about CLP and its prevention should be 
institutionalized into school curricula: 

lo] An awareness campaign in the schools 

o A curriculum review of materials and curriculum K- 
12 

0 Adult training, continuing education courses, 
college and university courses. 

o Screening programs, especially those in higher risk 
neighborhoods should be conducted in concert with 
public education campaigns. 

0 CLP education programs should include neighborhood 
outreach in the form of: 

o Presentations/lectures 
0 Forums /meetings 
0 White papers/policy roundtables 
o Projects 
0 Conferences/fairs 

0 An agency should initiate a process to identify which 
communities to enter with educational materials and 
programs. 

0 The interagency group or agency should develop 
criteria for choosing which communities will be 
entered. 

o The group or agency should develop a community 
profile and define the nature of the community's 
needs. 

32 

 



  

Educational resources within a community should be 
determined through a needs assessment and 
community profile. 

An educational plan and educational style should 
be tailored to fit the community profile. 

An implementation plan should be prepared that 
provides educational support for the community and 
an active role for the community in CLP 
prevention. 

The education plan should be evaluated by both the 
community and the interagency task force. 

A protocol should be developed for entering a community 
to establish a community-based CLP prevention program. 

Technical assistance should be provided to communities 
upon request. 

Coordinated in-service training should be conducted for 
outreach workers and program people in housing, youth 
and family services. 

Community outreach workers should be hired and trained 

from communities at risk. 

oO The outreach worker should serve as the basic 
access point for information about all available 
social programs and should be the "point person" 
for a program's educational efforts. 

0 The outreach worker should be role oriented 

instead of task oriented and trained in 
communication and advocacy. 

33