Tennessee

The State of Tennessee received $350,000 through cooperative agreement EH21-2102 from the Centers for Disease Control and Prevention (CDC) in FY 2022. The funds address childhood lead poisoning prevention and surveillance programmatic activities being conducted from September 30, 2022 to September 29, 2023.

The strategies focus on

  • Ensuring blood lead testing and reporting
  • Enhancing blood lead surveillance
  • Improving linkages to recommended services

To learn more about these efforts in Tennessee, contact the program below.

Tennessee Department of Health
State Childhood Lead Poisoning Prevention Program
710 James Robertson Pkwy
64 Andrew Johnson Tower
Nashville, TN 37243
Phone: (615) 532-8462

Success Story 2023

Using Vital Records Matching to Reduce Missing Demographic Data in Tennessee

Challenge

Historically, the Tennessee Childhood Lead Poisoning Prevention Program (TN CLPPP) has had difficulty identifying race-based disparities in lead testing and blood lead level rates due to high percentages of children missing race information in the surveillance database, LeadTRK. Race was missing for 72% of the 498,145 Tennessee children younger than age 6 who received a blood lead test from January 1, 2015–September 30, 2022. From 2019–2021, about 39% and 87% of all submitted results for children younger than age 6 listed race as “unknown” for provider-submitted LeadCare II results and laboratory-submitted results, respectively. High levels of missing race data made it difficult to identify discrepancies in lead exposure burden and testing access along racial lines. Reducing missing race data would provide valuable insight into existing barriers to health equity and allow the program to formulate strategies to overcome them.

Intervention

The TN CLPPP epidemiologist matched records in LeadTRK with birth file records accessed through the Tennessee Office of Vital Records for 2009–2021 to populate the race variable. Comparing race data from birth file and LeadTRK among 110,060 matched records with known LeadTRK race indicated the following discrepancies in the race variable: 6% for White, 4% for African American/Black, 1% for Asian, 0.5% for American Indian/Alaska Native, and 0.7% for Native Hawaiian/Pacific Islander. TN CLPPP decided to replace race information in LeadTRK with data from the birth file for all successfully matched records, based on the belief that race information in the birth file is more accurate than that reported by providers and laboratories.

From 2015–September 30, 2022, a total of 379,029 (76%) children were successfully linked to a birth file record. Among these children, 268,969 (71%) had unknown race in LeadTRK. After matching, 89,065 children had unknown race in LeadTRK, which accounted for only 18% of all children during 2015–2022.

Impact

By populating the LeadTRK race field with the values from the birth file records, TN CLPPP was able to reduce the number of children with an “Unknown” race value by 75%. This resulted in a significant improvement in data completion and will allow TN CLPPP to analyze racial disparities in exposure burden and access to testing. Going forward, TN CLPPP will perform quarterly data matches to maintain the integrity of LeadTRK race data for newly tested children. TN CLPPP anticipates that this new procedure will create exciting new opportunities for focused outreach and efficient resource allocation to populations who are at higher risk throughout the state.

Funding for this work was made possible in part by 1 NUE2EH001434-01-00 from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the CDC; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Success Story 2021

Establishing a Referral System to Early Intervention Services in Tennessee

Challenge

Traditionally, the Tennessee Childhood Lead Poisoning Prevention Program (TN CLPPP) nurse case managers only contacted the primary care providers of children with elevated blood lead levels (BLLs) greater than or equal to 5μ/dL to provide CDC recommended guidelines for follow up blood lead testing. However, they did not have direct contact with early intervention services. Furthermore, TN CLPPP staff were unaware that a child with an elevated BLL greater than or equal to 10μg/dL met the diagnostic criteria for infants and toddlers to be enrolled in the Department of Education’s Tennessee Early Intervention System (TEIS), as mandated in Part C of the Individuals with Disabilities Education Act (IDEA). Since 2013, an average of 244 children per year under the age of three had elevated BLLs greater than or equal to 10μg/dL in Tennessee. Children with elevated BLLs may have had limited access to specialized resources, such as early intervention services due to underreporting.

Intervention

TN CLPPP worked with TEIS to develop a protocol for nurse case managers to refer children with confirmatory blood lead tests greater than or equal to 10 μg/dL to TEIS and establish a data exchange procedure that ensures staff from both programs can adequately fulfill and receive each data request.

Through this exchange, TN CLPPP compiles quarterly lists of referrals and submits them to TEIS. Based on the results of the child’s developmental assessment and medical records, TEIS determines if the child is eligible to receive early intervention services through TEIS. Eligible families have the option to enroll their child in the voluntary TEIS program up to the age of three.

Impact

From September 30, 2018, to August 31, 2019, TN CLPPP submitted nine monthly TEIS referral lists, including referrals for 48 children that met diagnostic criteria for early intervention services. Since this collaboration, TEIS staff are more knowledgeable about childhood lead exposure and its toxic effects, and TN CLPPP has established a formal partnership with TEIS to continue referring children.

Funding for this work was made possible in part by the Cooperative Agreement Number [NUE2EH001385] from the Centers for Disease Control and Prevention (CDC). The views expressed in this material do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.