Los Angeles County

Los Angeles County’s Lead Free Homes LA (LFHLA) program leverages lead paint litigation settlement award funds to abate paint hazards in eligible properties. LFHLA is administered by the County of Los Angeles and supported by Impact Assessment, Inc. The program offers free lead-based paint hazard testing and remediation for homes of families with children younger than age 6 years, pregnant women, and families living in pre-1951 homes.

Eligible properties are currently limited to those with four or fewer units, including single family dwellings. Program participants receive education about lead poisoning prevention. However, many of these messages are provided in the program’s informational packet, and participants may not be aware of strategies to keep their children safe from lead paint hazards in the time between enrollment and abatement. They may also be unaware of how to keep their children safe from other non-housing lead sources.

In December 2021, Impact Assessment, Inc. and Los Angeles County Department of Public Health personnel collaborated with each other. They designed and developed protocols for improving lead education for LFHLA participants. The protocols direct the process for Impact Assessment Inc.’s outreach and education personnel to contact participants, provide focused education, refer families to other relevant service agencies, and reiterate prevention steps. A lead risk survey was also developed. It guides the focused education, inventory of existing and available educational materials, and data collection tools. In 2022, LFHLA began referring participants from across the county to Impact Assessment, Inc. for lead education interventions.

By the end of September 2022, 385 participants were referred for lead education. One hundred thirty-five participants (35%) declined any education, and 130 (34%) participants were unable to be reached. Of the 385 participants, 120 (31%) families with young children (eight of whom also had a pregnant woman in the home) received lead prevention education: five received education via a home visit, 102 received education via telephone, and 13 requested materials by mail.

Eighty-two (68%) of those that received education agreed to complete a lead risk survey about non-housing sources. The survey found that 23% had children exhibiting pica behavior, 15% give food or water to their child in handmade pottery, and 29% were currently having or recently had repairs done in their home. These findings will be used to evaluate the efficacy of educational messages for Los Angeles County, refine these messages in future outreach interventions and revisions to materials, and guide the development of new follow up strategies. Follow up strategies will include assistance with implementing behavior changes around non-housing sources and obtaining blood lead testing.

This success story was supported by the Cooperative Agreement Number 1NUE2EH001411-01-00, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Over 1 million housing units in Los Angeles, 80% of the city’s housing stock, were built before 1980 and contain lead paint. In 2014, lead paint in housing was found to be the dominant or contributing source of lead exposure in approximately 75% of the lead poisoning cases managed by Los Angeles County.

The Los Angeles Housing and Community Investment Department (HCIDLA) historically identified hazards in rental properties through its Systematic Code Enforcement Program (SCEP), housing inspection and violation tracking software, and partnerships with community-based tenant advocacy organizations. However, HCIDLA’s CDC-funded lead poisoning reduction program learned through partnerships with community-based organizations focused on tenants’ rights and healthy housing that screening for high-risk children was low in the Los Angeles Promise Zone. According to 2014 data, the Promise Zone is at higher risk for lead poisoning because

• 61% of the population lived in poverty, with 33% of households earning less than $20,000 per year,
• 60% of families lived in rental properties, and
• 60% of the population was born outside the U.S.

With the Healthy Housing Collaborative, the program initiated two strategies to increase blood lead testing in the target community:

• Working with the Coalition for Economic Survival, Inquilinos Unidos, and Koreatown Immigrant Workers Alliance to educate parents about lead exposure risk factors in homes and the impact of lead poisoning on child development and educational attainment and refer them to AltaMed, a Federally Qualified Health Center, for a free blood lead test.
• Partnering with AltaMed and their Westlake satellite clinic near the Promise Zone to test all children under 6 years old in the target zip codes who have not been tested in the last 6 months and do not meet the clinic’s regular screening criteria.

The Los Angeles County Department of Public Health agreed to enroll all children who had elevated blood lead levels (BLLs) in a county healthcare program, ensuring follow up services could be provided as needed.

The intervention resulted in 291 children referred for testing, of which 77 received testing. While only 26% of children received testing, all referred families received information about lead and its detrimental health effects through one-on-one sessions, health fairs, and community meetings. Two of the tested children had elevated BLLs. These children were previously identified as having high BLLs and were already receiving case management services from the county health department.

The expanded screening program resulted in an additional 456 children screened, and 17 had BLLs at or above CDC’s blood lead reference value of 5 µg/dL. The prevalence of elevated BLLs in this population was 3.7%, which was higher than the county’s prevalence. This demonstrated a need to reevaluate clinical screening tools to identify more children who have been exposed to lead.

These programs successfully addressed needs in the community—both gaps in knowledge and services—and demonstrated that housing and health indicators could be used to identify high-risk neighborhoods and other target communities.

Funding for this work was made possible in part by EH14-1408 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.