Addressing Lead Poisoning Prompts Paradigm Shift in EI

By Pamela Epley

Addressing Lead Poisoning Prompts Paradigm Shift in EI

Until recently, strategies to address childhood lead poisoning have focused on prevention and a “wait and see” approach to services. Prevention initiatives include eliminating sources of lead exposure and decreasing the lead level in children’s blood.

The “wait and see” approach refers to special education services provided after a child demonstrates challenges or difficulties in school and receives a diagnosis of development delay or disability. While prevention and special education are important in addressing this environmental health hazard, they are not sufficient.

During the summer of 2019, the state Bureau of Early Intervention partnered with Erikson Institute and Legal Council for Health Justice on a pilot program that made children with elevated blood lead levels automatically eligible for early intervention (EI) services in three areas (Rockford, Cicero-Berwyn, and part of Chicago). The pilot program included

  • training service coordinators and EI providers on the common sources and effects of lead poisoning,
  • sharing information and resources regarding lead poisoning with families, and
  • providing appropriate services when children are demonstrating little to no developmental delay.

We are halfway through the three-year pilot program. We continue to assess children’s development annually after they have turned 3. We’ve already learned from the experiences of children and families as well as their EI providers and service coordinators. We hope to learn more about longer-term benefits of EI services for children with lead poisoning.

Perhaps the most important thing we’ve learned is that serving children with lead poisoning requires a paradigm shift in how we think about EI. Before the General Assembly passed legislation providing automatic eligibility to receive EI services for all children with lead poisoning, services had been limited to children with a 30% or greater developmental delay or established medical condition that put them at substantive risk for later delay.

For children demonstrating a delay, EI providers focus on supporting those area(s) of development and reducing or eliminating the delay. For children with an established medical condition, EI providers monitor their development and implement direct services when a delay becomes apparent.

This approach is insufficient to support children with lead poisoning. We must do more than respond to children’s developmental challenges after they arise. We must proactively support areas of development we know will likely be impacted by lead poisoning. Such areas include working memory, flexible thinking and problem solving, and self-control.

When EI providers work with families on how these skills can be intentionally supported through daily activities, we take advantage of the explosive brain development during the first three years to eliminate or minimize effects of lead poisoning.

This three-prong approach to lead poisoning—preventing exposure to lead, proactively supporting the skills and abilities often impacted by lead exposure during children’s earliest years, and providing special education supports to school-age children as needed—provides our best chance of helping every child reach their fullest potential..

 For more information on best practices for working with children with elevated blood lead levels, visit Best Practices for Working with Young Children with Elevated Blood Lead Levels.

Pamela Epley, Ph.D., is a clinical professor and director of special education at the Erikson Institute.

Originally written for the Illinois Early Intervention Clearinghouse Newsletter:  Spring 2021