About The Partnership Against Lead (PAL) Project

Title: PAL (Partnership Against Lead) Project

Source of Funding: HRSA (MCH Bureau)

Amount: $562,000/5years

Period: March 2002 – September 2007

The PAL (Partnership Against Lead) Project is a five-year project funded by the U.S. Department of Health and Human Services (DHHS) Maternal and Child Health Bureau. This was one of 13 projects funded among the 65 proposals that were submitted nationwide and is the first in the Miami area besides the award made to the Miami Dade County Health Department for its Childhood Lead Poisoning Prevention program by CDC. The PAL Project addresses childhood lead poisoning in four high-risk communities in inner city Miami Dade County. It provides services to the residents of Liberty City, Little Haiti, Overtown and Little Havana in Miami-Dade County.

The goals of the PAL Project are: 1) to motivate health care providers and other health care settings to routinely screen children under six years of age for lead poisoning; 2) to establish a partnership among providers, health care professionals, educational institutions, and other community based organizations and individuals to provide the necessary initial and follow-up services to at-risk children; and 3) to educate children and parents to decrease exposure in the home due to unawareness of sources.

The main objectives are to increase lead screening among the children population in the communities that have been identified as high-risk in the County due to risk factors such as old housing stock, number of children, poverty levels, number of lead poisoning cases and low screening rates and to increase community awareness of the problem.

2) Project Abstract

PROBLEM: From 1997 to 2001, according to medical billing data provided by the Agency For Health Care Administration AHCA) Freedom Software, only 23.2% of 54,342 Medicaid-eligible children were screened for lead poisoning in the at-risk communities of Little Haiti, Liberty City, Overtown, and Little Havana in Miami-Dade County. For the last five years, approximately 500 cases of lead poisoning have been reported annually to the Miami-Dade County Health Department. From 1999 to 2000, 174 cases of lead poisoning were among children who lived in Liberty City, which represented 18% of all county cases. Similarly, 50 cases were reported among pediatric Little Haiti residents (5% of all county cases), 71 cases in Little Havana (7% of all county cases), and 9 cases in Overtown (1.9% of all county cases). More than 30% of cases occur in these communities. Screening rates in the zip codes of these communities ranged from 15.7% to 38.7% for children under 6 years of age. These communities have been identified at-risk areas for lead poisoning because of risk factors such as percentage of housing units built before 1950, poverty levels, income levels, number of children under 6 years of age, and number of children enrolled in Medicaid. The disparities observed are result of a high percentage of linguistically isolated households and other culturally associated factors that need to be addressed.
GOALS AND OBJECTIVES: The goals and objectives of the “PAL Project” are: 1) To motivate health care providers to routinely screen children under 6 years of age for lead poisoning following the recommendations made by the Centers for Disease Control and Prevention. “PAL Project” proposes to engage individual providers of the community or those of clinics or other agencies that have decided to support the project’s goals to provide information and training concerning the risks associated with lead poisoning to parents of at-risk children during the five-year project period; 2) To establish a partnership among providers, health care professionals, educational institutions, and other community organizations and individuals to provide the necessary initial and follow-up services to at-risk children. Every organization will actively participate in the dissemination of education and promotion of screening for lead poisoning in the target areas. The Project will promote and support culturally appropriate interventions that will be adopted by these institutions so that the interventions are sensitive to cultural barriers; 3) PAL Project proposes to educate children to decrease exposure in the home due to unawareness of sources and hand-mouth behaviors. Project personnel will work with pre-schools and day-care centers to incorporate lead poisoning education in their curricula. The objective of the PAL Project is to encourage increasing screening of Medicaid-eligible children under six years of age by 50% by the end of the five year project period (February 28, 2007). The baseline number is 23%.
METHODOLOGY: The PAL Project proposes to motivate providers to use a risk assessment questionnaire to be embedded into the initial evaluation of a child. Project personnel will review the questionnaire and contact at-risk children for outreach activities based on the parents’ responses in the questionnaire. Providers and all participating agencies and organizations will have immediate access to educational materials about lead poisoning and children as well as referral resources, should the client be interested in the home-educational visit provided by the outreach workers of the Project. Educational institutions and day care centers will take part in the education of the children (4 to 7 years of age) by implementing into their daily activities educational tools regarding lead poisoning. These educational interventions, focusing on primary prevention, are all relatively simple and cost-effective methods to increase screening and promote healthy lead-free communities. All materials will be available in English, Spanish, and Creole.
COORDINATION: The PAL Project is a result of numerous entities of diverse backgrounds that have demonstrated a concern for the disparities of health, to include lead poisoning, among residents of Little Haiti, Liberty City, Overtown, and Little Havana. The risk for lead poisoning is very high in these areas and the detrimental health effects that can occur as a result of exposure are immeasurable. The project’s goal is to promote collaboration through linkages and affiliations, particularly between agencies and health delivery systems, to share the responsibility of reaching the Healthy People 2010 goal of eliminating lead poisoning. Participating entities include but are not limited to the Florida Pediatric Society, Miami Dade County Health Department, the Association of Haitian Physicians Abroad, the Community Action Agency, Weed and Seed, and numerous clinics in the targeted areas such as Liberty City Health Services Center, the Guardian Health Center, Peñalver Clinic, and the pediatric mobile units from Jackson Memorial and Miami Children’s Hospital.
EVALUATION: Evaluation will focus on four primary questions: 1) Can a risk assessment questionnaire be successfully integrated into the providers’ routine practice? 2) Can educational tools be successfully incorporated in pre-schools and day-care centers to educate children on the lead poisoning issue and its prevention strategies? 3) Is door-to-door canvassing an effective method to increasing awareness of lead poisoning among the parents of at-risk children? 4) Is a comprehensive educational intervention a cost-effective method to increase screening for lead poisoning in at-risk communities?
TEXT OF ANNOTATION: The PAL Project will motivate providers and other health care service agencies to screen children less than six years of age for lead poisoning. Strategies include: a comprehensive educational program, training, ongoing consultation, public education campaigns, and door-to-door canvassing.

3) Project Highlights

The project educates parents of at-risk children. A total of 500 parents have been educated during parent meetings at various locations. During these presentations, educational brochures and other outreach materials were also distributed

In addition to educating parents, a total of 500 children have been educated at participating schools and daycare centers though the Know Lead Children’s Interactive Educational Program. The education sessions focused on teaching parents and children how to identify lead in the home, the importance of hand washing, and the important role of the diet in combating childhood lead poisoning.