Implementing a Pediatric Integrated Lead Care Management Program

No level of lead is safe in the body of a child. The state of Wisconsin experiences rates of lead poisoning above the national average of 2.5%, with certain neighborhoods in Milwaukee experiencing rates up to 26% of children with elevated blood lead levels. Lead poisoning disproportionately affects families of color and low-income families. During the COVID-19 pandemic, many children missed needed preventive care visits, and the only FDA-approved point of care lead testing device experienced a significant recall. Gaps in lead testing reached a crisis state, with an unknown number of children experiencing lead poisoning. Because of this, Children’s Wisconsin responded by establishing an Integrated Lead Program. This program provided a centralized population surveillance hub with programmatic oversight and two dedicated patient care resources, a lead nurse care manager and a care coordination assistant.  

Children’s Integrated Lead Program first focused on secondary and tertiary prevention through improvements to our lead clinical guidelines for our front-line care team members. This improved clarity of what lead testing is needed and when, as well as next steps in a patient’s plan of care based on the type of test (point of care or venous) and the level of the result. The centralized lead team began providing higher touch care management services to children experiencing lead poisoning, implementing bi-weekly case conferences with local health departments and supporting upstream social needs like transportation and food insecurity. They also began significant outreach efforts to support families to be seen for lead testing as well as overall preventive care needs. Additionally, Children’s is dedicated to supporting primary prevention strategies in the community through partnering with community-based organizations like the Coalition on Lead Emergency (COLE), a parent-led organization started by parents of lead-poisoned children to improve community outreach, education, and support.