Advocating for Automatic Eligibility for Early Intervention Services for Children Exposed to Lead

Abstract

Lead poisoning remains one of the most prevalent and preventable environmental health hazards affecting children. Low-level lead exposure has been shown to significantly increase the risk of learning disabilities, behavioral problems, and developmental delay. It also has substantial social implications as lead toxicity disproportionately affects children from low-income, ethnic minority households. Early Intervention (EI) is a state-based federal program (Part C of the Federal Individuals with Disabilities Education Act) created to support the development of children from birth to age 3 years who are experiencing or who are at risk for developmental delay. In 2016, an Illinois EI and Lead Workgroup was established to address the best practice of offering EI services to children who have been exposed to lead. This work serves as a template for advocates and health providers in other states to establish automatic eligibility for EI services at low levels of lead exposure, while also demonstrating the capacity to serve these children without overwhelming the state's EI system. [ Pediatr Ann. 2018;47(10):e413–e418.]

Receipt of Early Intervention Services Before Age 3 Years and Performance on Third-Grade Standardized Tests Among Children Exposed to Lead

“…8 A number of states provide EI services to children with elevated BLLs, although typically only for children with higher exposure levels. 24 Our research suggests that children exposed to lead would benefit from careful monitoring and timely referral for evaluation for programs such as EI. In 2019, NYC lowered the automatic referral threshold for EI from 15 μg/dL to 5 μg/dL.…”

“…However, the eligibility for supplemental educational services for children exposed to lead is being considered. 24 Such services as early intervention (EI) programs are mandated under the Individuals with Disabilities Education Act for children younger than 3 years with disabilities or developmental delays. Services range based on the state and needs of the child.…”

“…8 A recent commentary advocated for the inclusion of children with BLLs greater than 5 μg/dL. 24 Early intervention has been shown to be effective overall, with a 2007 US national study documenting improved functioning among children who received services. 25 To our knowledge, no studies have determined if children exposed to lead benefit from these types of services.…”

Environmental contaminants and child development: Developmentally‐informed opportunities and recommendations for integrating and informing child environmental health science

“…Empowering caregivers to act collectively on behalf of children is a component of early relational health (Willis & Eddy, 2022 ). Children are at unique risk for environmental threats, and collective action can be critical in advocating for policies to reduce impact of exposures, such as ensuring access to high‐quality childcare and/or EI services (Hamp et al., 2018 ; Hanna‐Attisha et al., 2022 ). Environmental health literacy, or the knowledge and skills needed to take action based on environmental health data, is a foundational step toward advocating for community and policy changes to protect CEH (Finn & O'Fallon, 2017 ; Gray, 2018 ; Nutbeam, 2008 ).…”

Children With Autism Spectrum Disorder and Lead Poisoning: Diagnostic Challenges and Management Complexities

“…Indeed, there has been a recommendation that all children with an elevated BLL receive Early Intervention Program services. 52 Some children with ASD, recognized or unrecognized, may not be getting ABA special educational services for which they are qualified and deserve.…”