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CMSD students to be tested for lead poisoning



CMSD is teaming up with Case Western Reserve University and a band of community organizations to take on lead poisoning, a persisting public health crisis affecting children in Cleveland and across the nation.

Faculty at CWRU's Frances Payne Bolton School of Nursing have received $300,000 in funding from the Elizabeth Severance Prentiss Foundation to support initiating a lead screening program.

The project was developed by the Partners in Health, a collaboration that includes the nursing school, CMSD, the Cleveland Department of Public Health, the Office of Mayor Frank Jackson and MetroHealth. It's being led by Lynn Lotas, associate professor at the nursing school, and Deborah Aloshen, CMSD director of health and nursing services, as a part of their 15-year partnership focused on improving the health of children in CMSD.

Beginning in April, CWRU nursing students will visit four District schools to test the blood lead levels of students ages 3 to 6. The testing, which requires parental consent, is considered to be the pilot for a program that is expected to expand to the entire District over the next two years.

The pilot schools are Scranton, Fullerton, Mound and Michael R. White. 

Only a small fraction of children -- about a third -- who are at risk for lead poisoning in the Cleveland area are screened for lead, according to a 2015 analysis conducted for The Plain Dealer. Another study found strikingly high rates of elevated blood lead levels in children who were tested in three Cleveland neighborhoods: Glenville (26.5 percent), St.Clair–Superior (23.4 percent) and Collinwood (20.3 percent.)

“We’re trying to put a stop to a serious problem that’s been affecting our students’ education and quality of life for years,” Aloshen said.

Children can get lead poisoning after exposure to lead-based paint, contaminated soil and water that flows through lead pipes. The effects of lead poisoning can be devastating and include developmental delays, learning difficulties, behavioral problems and speech and language deficiencies. 

The problem is thought to be widespread in Cleveland because about 90 percent of the housing stock in the city was built before 1978, when the United States banned the manufacture of lead-based house paint.

Early identification and treatment of lead poisoning reduces the risk that children will suffer permanent damage. Treatment begins with removing the child from the sources of the lead. Medication can remove lead from the body.

The testing will start with children ages 3 to 5 because that's when children are at the highest risk for lead exposure, Aloshen said. Young children engage in the most hand-to-mouth activity and have the most rapidly developing nervous system.

Children enrolled in Medicaid are required to receive blood lead screening tests at ages 1 and 2, but they are still at risk for lead poisoning as they grow. It’s especially important to keep testing children who frequently move from one home to another, which is common in Cleveland, Aloshen said.

Students who have been screened for lead recently, based on their health records, won't be tested. For those who haven't been tested recently, school nurses will seek parental permission for a finger prick blood test. Tests that come back positive for lead will require a follow-up test with blood drawn from a vein by experienced graduate nursing students who will also be involved in parent outreach and education.

CWRU nursing professors Lotas and Peg DiMarco have helped lead the charge alongside Aloshen and recently completed training for the nursing students who will complete the initial screenings. The team is making sure children who have high lead levels -- experts define this as 5 micrograms of lead per deciliter of blood -- are not only properly diagnosed but that they also receive follow-up services.

“There’s a futility in finding kids with high lead levels and then putting them back in the same environment to be exposed again,” Lotas said.

The first step will be to refer the child to a healthcare provider if they don’t already have one.

When children with lead levels above 10 micrograms per deciliter of lead in blood are identified, the Cleveland Department of Public Health will be responsible for assessing the lead levels in the home. In addition, the Partners in Health project is partnering with other organizations who are working in communities to assist with lead abatement.

Graduate nursing students will be accompanied by community members, many of whom are CMSD parents, and representatives from the Greater University Circle Community Health Initiative who will help build trust with families and provide important context about neighborhoods.

Parents will also have the opportunity to receive legal advice from the Legal Aid Society of Cleveland about concerns that might pop up when their child is found with high lead levels.

“It’s a difficult thing for some parents to find out that their child has been exposed to lead. They might have concerns about eviction or losing their child,” Aloshen said. “It’s very rare for this to actually happen, but we want to have lawyers on hand to reassure families.”

All three women emphasized the importance of the testing program for Cleveland’s children and the city’s future. DiMarco said her involvement in the project has been largely motivated by her experience treating children for lead poisoning in Cleveland since 1975.

“I have practiced in this field for a long time, and I’ve seen what can happen to kids with high lead levels,” she said.

Parents at the four pilot schools should expect to receive a form from their child's school and will have to provide signed consent if their child is to be tested. If they don't receive the form, they may contact the school nurse for a copy.

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