South Carolina

The South Carolina’s Department of Health and Environmental Control (DHEC) Bureau of Water (BOW) was awarded a Water Infrastructure and Improvements for the Nation (WIIN) grant from EPA. The BOW hired a contractor to develop outreach materials to publicize the grant to schools and childcare centers around South Carolina. The WIIN Program planned to use these materials to describe the program, to increase interest in voluntary enrollment, and to help facilities ensure lead-safe drinking water for the children whom they serve.

Several months into the grant, BOW’s contractor had not made any progress on developing project materials. Without materials to explain the WIIN program, there were few enrollees—even for a free testing program. This resulted in delays in enrolling, testing, and addressing lead in water in childcare centers and Head Start Programs—especially in those areas self-identified as environmental justice communities. An Environmental Justice community is a neighborhood or community, where a substantial proportion of people are living below the poverty line, that is subjected to a disproportionate burden of environmental hazards. The community may also experience a significantly reduced quality of life relative to surrounding communities.

DHEC’s CLPPP partnered with BOW to jointly develop outreach materials to publicize the WIIN Testing Program and explain the risks of lead exposure. These materials provided useful information for school officials, childcare operators, and parents who might not be aware of risks associated with lead. Information about the Lead Testing in Schools and Child Care Programs Grant was added to existing CLPPP educational and outreach materials in response to a WIIN team request. During February and March 2022, DHEC WIIN personnel and CLPPP personnel worked with the agency’s Creative Services and Print Services teams on updating existing materials to promote both programs. Additionally, the creative team used artwork from a CLPPP table display to create a new rack card with step-by-step information for applying to the Lead Testing in Schools and Child Care Programs on the back.

As a result of this collaboration, there is a consistent look to the outreach materials. The WIIN Program (and other programs within the BOW such as the Office of Rural Water) has the outreach materials that it needs. The CLPPP and WIIN programs share information about each other’s work via presentations, conferences, and mailed information packets, doubling the outreach. These materials have been shared with approximately 200 schools, childcare centers, and individuals. These booklets and brochures are also available from DHEC’s Educational Materials Library, free of charge, to healthcare providers and others who request them. As an example, the “rack card” outreach product is found here: https://scdhec.gov/sites/default/files/Library/CR-013135.pdf. This collaboration has helped DHEC with the Core Strategy of “Linking Children to Recommended Services” through follow-up done when testing reveals exceedances of standards for facility water at schools, childcare facilities, or Head Start Centers.

Childhood lead exposure is often closely correlated with social determinants of health such as poverty and minority status. National data suggests that one-third of Native American children live below the Federal Poverty Level, defined as a family of four living on $26,500 or less annually, have decreased access to resources and tend to live in home built before 1978, which increases their risk of lead exposure. The Catawba Indian Nation (CIN) is the only federally recognized tribe in South Carolina. Over 3,000 enrolled members of the tribe and other Native and non-Native American family members that do not meet the strict criteria for tribal enrollment live across South Carolina. Governmental, medical, and social services for enrolled tribal members and non-enrolled family members are provided to South Carolina residents and bordering North Carolina residents by the Indian Health Services (IHS) Clinic and other governmental and non-governmental entities. However, no other governmental, philanthropic, or similar organization provides services to the CIN population on tribal lands.

The South Carolina Childhood Lead Poisoning Prevention Program (SC CLPPP) collaborated with the CIN tribal government to enhance surveillance of blood lead levels among tribal children, identify geographic areas and subpopulations at higher risk for lead exposure, and provide lead hazard education to enrolled members and their communities. SC CLPPP used CDC funds to help CIN to enhance their childhood lead surveillance and outreach activities in February 2019. These included developing educational materials, attending community events, training staff to conduct prevention activities, and establishing data sharing processes with SC CLPPP.

By September 2019, CIN staff had accomplished the following

• Obtained a list of all tribal-enrolled children younger than six years of age to initiate outreach activities.
• Met with their Head Start program director and distributed lead education at a Head Start open house.
• Identified three facilities that serve CIN enrolled members to ensure they are electronically interfaced with IHS for electronic lab reporting.
• Initiated a survey to determine the extent of existing pre-1978 housing occupied by enrolled tribal members.
• Identified seventeen pre-1978 houses that enrolled tribal members occupy and verified that nine children live in four of these households.
• Set up EPA Lead Risk Assessor training for CIN staff to conduct risk assessments on pre-1978 housing.
• Featured a public service announcement for 30 days about take-home lead in the IHS Clinic.
• Wrote an article for the tribal newsletter about health risks associated with lead exposure.
• Met with the tribal executive to obtain permission to share the database on enrolled children birth through six years of age with SC CLPPP.
• Attended the 2019 Southeastern Lead Consortium Annual Meeting.
• Distributed lead educational information at tribal community events, the IHS clinic, a tribal Back-to-School event, Little Peoples Academy, Catawba Indian Nation Family Services, and Camp Kic-A-Way.

The CIN has taken early and impactful steps to enhance surveillance, identify areas and groups at higher risk for lead exposure and provided lead hazard education to a population that has not received these services before.