As chartered in House Bill 89 of 2019, the reconstituted Childhood Lead Poisoning Advisory Committee (CLPAC) is to investigate and report to the Delaware General Assembly findings and recommendations on items outlined in Title 16, Chapter 26 of the Delaware Code, the Childhood Lead Poisoning Prevention Act.
The reconstituted CLPAC made considerable progress from its initial meeting on September 12, 2019 throughout the remainder of the year as well as 2020, despite the COVID-19 pandemic. The advisory committee elevates the attached recommendations as the 2021 annual report released April 13, 2021.
Recommendations
Comprehensive recommendations address both primary and secondary prevention. In order to effectively lower the incidence of lead poisoning a multi-faceted approach is necessary, involving a range of interventions and policy change.
Indoor Lead Abatement – Homes, Schools
Recommendations under this and the subsequent three categories address critical primary prevention. Measures will identify, remediate, contain, seal or eliminate environmental sources of lead exposure(s).
1. All owners of residential rental properties built before 1978 must register each property annually. Assess a penalty for non-compliance.
2. Residential rental property owners shall have (for each rental unit) a one-time Lead Risk Assessment completed by an independent, accredited environmental testing and inspection company certified by the State of Delaware’s Lead Poisoning Prevention Program
3. Residential rental property owners whose properties have no lead paint hazards identified by the Lead Risk Assessment shall obtain (for each rental unit) a one-time Lead-Free Housing Certificate from the State of Delaware’s Lead Poisoning Prevention Program
4. Residential rental property owners shall cover the costs for temporary relocation of tenant(s) during lead remediation
5. Residential rental property owners shall have a one-time Lead Risk Assessment completed by an independent, accredited environmental testing and inspection company certified by
6 U.S. Department of Housing and Urban Development, Office of Lead Hazard Control and Healthy Homes. LeadBased Paint & Lead Hazard Reduction Demonstration Grant Programs. Retrieved March 12, 2021 from https://www.hud.gov/program_offices/healthy_homes/lbp/lhc.
7 New Castle County, Delaware. Lead Program. Retrieved March 12, 2021 from https://www.nccde.org/1982/LeadProgram.
8 Maine Affordable Housing Coalition. (2019). Comparative Assessment of Lead Poisoning Screening Practices in Maine & New England. Health Justice Innovations, LLC. the State of Delaware’s Lead Poisoning Prevention Program for 50% of their pre-1950 rental property portfolio structures within 5 years
6. Residential rental property owners shall have a one-time Lead Risk Assessment completed by an independent, accredited environmental testing and inspection company certified by the State of Delaware’s Lead Poisoning Prevention Program for the remaining 50% of their pre-1950 rental property portfolio structures within 10 years
7. Residential rental property owners shall have a one-time Lead Risk Assessment completed by an independent, accredited environmental testing and inspection company certified by the State of Delaware’s Lead Poisoning Prevention Program for pre-1978 rental property portfolio structures within 15 years
8. Enact legislation prohibiting owner retaliation against tenant(s) who may need to be relocated due to a property’s failed lead inspection or for reporting lead remediation violations
9. Establish an office to process registration of all Delaware pre-1978 residential rental properties, collection of related fees/penalties and/or investigation/prosecution of non-compliance. The state should establish a variety of enforcement mechanisms and resources to support this process.
10. All Divisions within the Department of Health and Social Services (DHSS) shall incorporate lead poisoning prevention and education in all contracts and programs where there is outreach in homes, including in The Low Income Home Energy Assistance Program (LIHEAP)
11. Require the Delaware Department of Natural Resources and Environmental Control (DNREC) to add lead dust testing of residential structures as part of the State Weatherization Assistance Program
12. Establish financial assistance for abatement and relocation by way of tax credits or deferred loans
13. Mandate that lead safe demolition, renovation and repair practices shall be followed by independent, accredited contractors for commercial and school properties
Outdoor Abatement
14. Conduct an epidemiological study; a retrospective, case controlled analysis using data that has been collected by the Childhood Lead Poisoning Prevention Program to date to identify priority areas of high exposure and for potential future enhanced environmental contaminant surveillance. The study will incorporate aforementioned data as well as additional datasets as needed, and should include the number of lead tests per year, location of the residences of the children with elevated blood lead levels, housing data (age of the home), income data, demographic data (race), and specific information from the Department of Public Health’s Environment tab. The study should encompass residential and non-residential environmental sources of lead, including outdoor structures, exposures from schools, soils, and other areas where children may have contact with lead or lead dust.
15. DNREC shall establish standards and a permit structure for the removal of lead paint from all outdoor structures, including bridges and utility towers, as well as the demolition of commercial and industrial buildings that contain lead or lead paint. Standards should be developed for structures that present an environmental risk due to peeling paint, and a mechanism should be established to address abandoned structures that pose a health risk. These recommendations should include best practices, including community notification, dust monitoring, soil sampling, and should apply to the removal of lead paint by any means, not just via dry abrasive blasting.
16. Establish a task force to evaluate standards for the remediation and upgrade of playgrounds and park spaces, provide for the testing of soil and painted equipment at playgrounds (state, county, municipal, school, community, day-care, and privately-owned), and remediate playgrounds with lead contamination
17. Clean contaminated soil. The EPA should collaborate with businesses to remediate dangerous conditions at and near facilities that extract lead from batteries and other electronics. HUD, the EPA, and the Centers for Disease Control and Prevention (CDC) should work with states and local governments to treat toxic soil in and around homes with non-encased lead paint.
18. Reduce air lead emissions. The EPA and other federal agencies should collaborate to curtail new discharges by reducing concentrations of lead into the environment, such as from aviation gas and lead smelting and battery recycling facilities.
Water Abatement
19. The Delaware Department of Education shall conduct routine lead testing of potable water (water fountains and drinking/cooking water) in schools and facilities utilized by children
20. The Delaware Department of Education shall appoint a member of the Childhood Lead Poisoning Advisory Committee to the oversight team for the Water Infrastructure Improvement for the Nation (WIIN) grant that is currently sampling water in Delaware public schools
21. The Delaware Office of Childcare Licensing shall require child care providers to include routine lead testing of potable water in child care centers and home based care environments as part of the lead-risk assessment
22. States and municipalities, with support from federal agencies, should fully replace lead service lines, from street to structure, that provide drinking water to homes and other locations children frequent built before the EPA banned their use in 1986
Alternate Sources of Contamination
23. Regulations shall be developed with standards and an enforcement mechanism to eliminate lead in consumer products, including those sold at Dollar Stores and import retailers based on best practices from other jurisdictions
24. DNREC shall adopt an environmental justice approach by engaging in a transparent and inclusive process to review and update standards for environmental remediation at contaminated sites (including Brownfields, SIRB, HSCA, and National Priorities List sites, among others) to incorporate cumulative environmental risk and to account for the proximity of contaminated properties to at-risk communities
25. The Delaware Sportsmen’s Caucus shall convene a task force to evaluate the potential for lead exposure through childhood marksmanship, fishing, and hunting, and shall make recommendations based on best practices to firing ranges, marksmanship programs, hunters education, and fishing programs
26. The Delaware Department of Natural Resources and Environmental Control (DNREC), Division of Fish and Wildlife shall add lead poisoning prevention to fishing and hunting manuals and training programs
27. A task force shall be established in collaboration with the Delaware Department of Labor, labor unions, police departments, firing ranges, and other stakeholder groups to design a strategy and enforcement framework to lower state thresholds for blood lead levels below current OSHA levels to prompt removal and return to work policies to reflect the Council of State and Territorial Epidemiologists (CSTE) recommendations, which uses a health-outcome based levels and has special precautions for pregnant women
Clinical
Recommendations under this category address secondary prevention; the identification and treatment of all children who have been exposed to lead. Goals include removal or abatement of lead from a targeted environment after the child is exposed and connection to appropriate educational, developmental, or health-related interventions and services.
28. Provide more point-of-care blood lead testing analyzers to increase testing and compliance rates. Place machines in state service centers, community centers, primary care offices, and shared by elementary school wellness centers (1-2 machines shared per school district).
29. Mandate universal blood lead testing around 2 years of age (21-27 months), with one catch up test before age 6 for all those with no previous tests, or whose one previous test was before 21 months of age
30. Offer incentive to providers to ensure that blood lead testing is completed, not only ordered. This could be a quality improvement project or woven into a value based payment structure as a quality metric/measure.
31. Lower the Department of Public Health’s threshold for home visits and intervention by a public health nurse from 10 µg/dL to 5 µg/dL. Delaware should align with the recommended CDC threshold of 5 µg/dL.
32. Begin case management for all children with a blood lead level equal to or higher than the current blood lead reference value as set by the Centers for Disease Control and Prevention (currently 5 micrograms per deciliter (µg/dL)). Delaware currently begins case management at 10 µg/dL10.
33. Align developmental and neuropsychological assessments and appropriate high-quality programs for children with elevated blood lead levels at lower thresholds for IDEA Part C for federal funding for pre-K intervention services from 10 µg/dL to 5 µg/dL
34. Expand the advisory committee/subcommittee membership to include expertise from the maternal health and obstetrics community to develop lead poisoning education and testing programs, including possible screening and/or testing during pregnancy
35. Refrain from use of questionnaires to identify asymptomatic children for elevated lead levels. The United States Preventive Services Taskforce (USPSTF) found that such questionnaires are not predictive and should not be used
Data
Recommendations in this category seek to improve the timeliness and public availability of data collected by the Division of Public Health with a goal of geographically targeting communities, neighborhoods, or specific locations so that resources can be better allocated for prevention.
36. Collect additional points of data at the time of a child’s blood lead test including address(es) at which child currently resides and/or spends a majority of time, and rental or owned dwelling to be reported along with blood lead test results to the Division of Public Health
37. Include blood lead level results on the DelVAX Immunization Registry, widely accessible to school nurses, school wellness and community providers
38. Enroll Delaware in the CDC Adult Blood Lead Epidemiology and Surveillance (ABLES) program
39. Produce a report with key indicators and criteria for evaluating the state’s progress on lead poisoning prevention, reduction, remediation efforts and routine reporting to be updated annually and published on the Division of Public Health webpage. A prevention scorecard
Education/Awareness
40. Ease administrative burden and punitive measures directed toward school nurses and families by educating and providing awareness as to the importance of blood lead testing for school administrators, school board associations, parent-teacher associations, pediatricians, family practice providers, nursing community, parents and caregivers
41. Conduct outreach through cultural and religious organizations on the risks of lead poisoning from products imported from certain countries, including toys, cosmetics, supplements, and food, and household items. This can should include targeted education and outreach to at-risk neighborhoods, support for cultural awareness among physicians, and increasing investigation and enforcement of small retailers.
42. Improve education for providers and caregivers/parents regarding follow-up and connection to services should a child receive an elevated blood lead test
43. Ensure findings from the Water Infrastructure Improvement for the Nation (WIIN) grant work and/or larger efforts for sampling water in Delaware public schools are presented in an appropriate format, easily understood, and shared with the public including parentteacher associations, neighborhood associations, school administration and staff, and parents and caregivers
44. Use state and local data and reports to inform policy makers, families, and advocates. Lead data should be available to all stakeholders who need information about sources of exposure, such as property-specific information on leaded drinking water pipes and lead in the water, dust, paint, and soil at or near homes, schools, and child care facilities.
