Clinical Settings

This focus area is dedicated to enhancing the approaches to care and prevention from pediatricians, family doctors, and care coordinators. Below are strategies and ways to take action.

Prevention & Remediation

Action 1

Provide training for pediatricians, family doctors and care coordinators.

Best Practices for Providing New or Expanded Training:

  • Host trainings directed at public health professionals, clinical providers and other prevention partners about childhood lead prevention, policies and interventions.
  • Use a variety of methods including webinars, videos, online training modules, one-to-one public health detailing, Grand Rounds presentations, and training at medical and public health association meetings.  Here is an example training.
  • Here is a family story about why improving provider education can lead to earlier testing, early and effective interventions, and the coordinated care families need.

  • Increase testing by creating clinical pilots to increase blood testing 12-35 months old.
  • Link Medicaid data to assess screening rates and gaps in provider reporting. Mississippi used Medicaid audit data to select areas for public health detailing to providers.
  • Here are some tips for leveraging Medicaid and CHIP programs and here is an infographic on how lead exposure and poisoning is a health equity issue, and the role that state Medicaid agencies and other systems play in reducing exposure to improve health outcomes.

Identification & Exposure

Action 1

Increase testing and reporting.

  • Require laboratories to electronically submit all blood lead test results to local and state health departments within a week of the result so the information can be aggregated to assist with prevention and response efforts.
  • Create provider report cards on blood lead testing rates. Here is an example report card.
  • Offering blood lead testing through mobile health units at clinics to improve access for at-risk populations. Pennsylvania facilitated partnerships between Head Starts and FQHCs to complete onsite blood lead testing. See their case study here.
  • Providing universal testing guidelines to providers. Here are example guidelines.
  • New Jersey implemented a tier system of recognition for the top screening pediatricians, and provided outreach to those with low rates per the state’s universal lead testing law. See the case study here.

  • Send letters to all OB-GYN and Women, Infant and Children (WIC) clinics, explaining the importance of environmental history, providing lead prevention education and administering blood lead screening tests. Here is a sample letter.
  • Illinois surveyed OB-GYNs to help update and improve guidelines, educational materials and trainings.

  • Iowa and Pennsylvania partnered with FQHCs on pilots to increase testing.
  • Louisiana partnered with a WIC clinic on a pilot, and more than tripled their initial testing goal!

Treatment and Mitigation

  • Have a statewide policy or program in place for blood lead testing and intervention to ensure everyone is on the same page.  Learn more about existing lead-related policies and policy resources here.
  • Distribute quick guides or references to providers.
  • Share web guides for maternal and childhood lead exposure.

  • Work with providers, case coordinators, case managers, and WIC programs to counsel families on nutrition if a child does not have adequate iron, calcium and Vitamin C intake. Here is a sample poster and video.
  • Provide parents with education and resources on the emotional toll of lead poisoning. Connect them to family partners, and family led organizations like Family to Family Health Information Centers, and Children and Youth with Special Health Care Needs Programs.
  • Distribute educational documents on follow-up care for children who are identified with EBLL.

  • Use surveillance data to monitor when children are being exposed to lead from candy, health remedies, or cosmetics, and provide guidance to physicians in those areas. 
    • Include related questions on prenatal and childhood lead risk questionnaires distributed to providers.
  • Provide materials in multiple languages and consider telling stories and important messaging with pictures.

  • Louisiana partnered with Crescent City WIC on a pilot to increase testing, outreach, and services. See their case study here.


  • In 2019, Illinois lowered the EBLL for which public health interventions are initiated for children. See full case study here.

  • All participating states require lead to be a reported disease. Iowa for example, has Administrative Code 641 Chapter 1 that requires all blood lead test results be reported to the Iowa Department of Public Health Bureau of Environmental Health Services (IDPH EHS) to monitor lead exposure in Iowa. See an example of reporting requirements here.