Early Childhood

With lead exposure rampant in NYC public housing, a new focus on lead’s impact on education

PHOTO: David Buffington | Getty Images

The recent revelation that New York City has allowed children living in public housing to be exposed to toxic lead could have pronounced consequences for the schools those children attend.

The dangers posed by lead poisoning, which include behavioral problems and impaired brain development, are grave and long-lasting. But studies show these effects can be mitigated with swift, early treatment. Here’s what we know about the impact of lead poisoning on student learning — and about what the city’s education department says it is doing in response to the current crisis.

‘No safe level’

Lead exposure at home can typically be traced to paint, which was manufactured with lead until the 1970s. Children are exposed to it if they eat paint chips or inhale dust from those chips.

It also exists in water that flows through lead pipes and in soil, which young children can unintentionally eat, according to the American Pediatric Association.

There is no “safe” level of lead — any exposure can have negative effects on the body.

“Once it’s in the body, it’s very hard to get rid of it,” said Morri E. Markowitz, director of the Lead Poisoning Treatment and Prevention Program at Children’s Hospital at Montefiore in the Bronx.

The effects are multipronged. Physically, anyone exposed to a high amount of lead may feel abdominal pain and constipation, according to the Centers for Disease Control and Prevention. Hyperactivity is another symptom, tough to immediately notice in young children since it’s common for them to run around, Markowitz said.

Those exposed to high levels of lead may also feel mental and psychological changes: depression, irritation and a sense of distractedness.

Depending on the severity and length of lead exposure in a child, it can result in “quite debilitating” neuropsychological effects, according to Mt. Washington Pediatric Hospital in Maryland. That includes poor performance in school and problems in developing social relationships.

Lead exposure has also been linked to misbehavior in school.

The effects of lead exposure can be minimized if a child has a nutritional diet because their bodies will absorb less lead if they’re eating other essential metals that humans need, like calcium and iron, Markowitz said.

That’s one reason why lead exposure is more likely to affect children in poorer families — lack of access to adequate or healthy food.

And poorer families can face greater obstacles avoiding led at the source, either because of a financial barrier or if the problem exists in subsidized housing.

Treatment is possible — if caught early

Lead poisoning was once thought entirely irreversible. But depending on the level of lead in a child’s blood, treatments do exist but vary, Markowitz said.

The first plan of attack is to get rid of the source so that the child is no longer ingesting lead. But this is a challenge for families who rely on public housing, where it’s beyond residents’ control to make such maintenance changes.

Another option is to reverse behavior -— stop the child from eating paint chips, for example, he said.

Children who test positive for a high amount of lead in their blood can also receive chelation therapy, Markowitz said. This medicine, taken orally, binds with the lead and leaves the body through urine.

But this medication is recommended for children who have blood-lead levels of 45 micrograms of lead per deciliter of blood or higher. A child’s blood-lead level is considered unsafe if it’s 5 mcg/dL or above, according to the Mayo Clinic.

Research has found that taking the extra step to curb children’s lead exposure even after it has happened — and monitoring their behavior and health — can actually help boost test scores.

A study published this year focused on a group of children with high lead exposure from Charlotte, North Carolina in the 1990s. They received coordinated interventions designed to reduce lead exposure, encourage  healthy habits, and provide information on nutrition, among other treatments.

For elementary and middle-school students, test scores went up moderately and they were suspended for fewer days when compared to children who didn’t get this help. The students who got treatment were also less likely to be cited for committing a crime in school. Such efforts are costly but they help avoid the need to address lead’s effects later on, which can be even more expensive.

More testing and education needed

Because of increasing evidence on lead’s negative impact on children’s development, many states have made it a priority to attempt catching lead exposure early — in part because blood tests, the easiest way to determine lead poisoning at present, typically only work for a few years after exposure.

“By the time you’re at school, the lead in the blood is gone — it’s gone elsewhere,” Markowitz said. Lead doesn’t sit “around in the blood for five years,” he said, but migrates to the bones or the brain, where lead can remain for two to three years, continuing to do damage.

That’s why — like many states — New York requires doctors to test young children for lead exposure, Markowitz said.

New York health care providers are required to test 1- and 2-year-olds for lead in their blood. They’re also supposed to assess children no less than annually for risk of lead exposure up to the age of 6 and to decide whether they need a lead blood test.

Despite these rules, reports have found that millions of children go without getting tested. In New York State, just 55 percent of children who were supposed to undergo testing actually got it, according to a Reuters investigation in 2016 — and those who are most at risk may be the least likely to get tested, owing to inadequate access to health care or lack of knowledge about lead dangers.

Other reasons might include children missing appointments, parents not following up on test referrals from doctors, or some doctors not ordering the tests — for instance if they’re unaware of the mandates.

One clear solution could be spreading more education and awareness to parents about the importance of catching lead exposure early. To date, the Department of Education has largely focused on the risk of lead in schools, sending letters to families about detailed lead test results within its buildings.

But students are most likely to be exposed to lead outside of school — even as children are bringing the impact of that exposure to classrooms, where it has the potential to undo schools’ best efforts to boost academic success. Schools thus have an invested interest in battling the perils of lead.

The city’s education department shared with Chalkbeat a letter parents have access to, with subsections that tell parents about lead’s health effects, where it can be found, and whether a child should be tested.

But given recent revelations about widespread exposure to lead in public housing, affecting some of the city’s most vulnerable populations of students, schools may need to join the battle to combat the severe danger that lead poses to students’ social and emotional health and academic prospects.

Department officials did not respond to a follow-up question: whether students are explicitly taught in class about the dangers of lead exposure outside of school.

But similar to other research, Markowitz and his colleagues conducted their own study and found that regular intervention, including improving nutrition and reversing behaviors that reduce lead exposure, can over time reverse lead’s effects on children’s cognitive functions.

“There is the possibility that the brain can get better,” Markowitz said.

Planning mode

As lawmakers consider major preschool expansion, Colorado providers want more than just extra seats

PHOTO: Ann Schimke

With Gov. Jared Polis’ proposal for the biggest expansion of Colorado’s state-funded preschool program in its 30-year-history, many early childhood educators are cheering the possibility of 8,200 new preschool slots for at-risk children.

But they’re also asking hard questions about how providers will find the staff and space to create new preschool classrooms, and whether state leaders will reshape the program to broaden its reach and intensity. Suggestions from the field include expanding the definition of at-risk, accepting more 3-year-olds, offering more full-day slots, and rewarding top-rated providers with more money.

These discussions echo debates about preschool quality and access nationally as more state leaders prioritize early childhood education, and as public preschool programs from New York to California attempt massive scale-ups.

Research shows that early childhood programs can produce huge long-term gains for children, particularly those from low-income families. But there’s a caveat: The programs must be high-quality.

In Colorado, Polis’ preschool proposal hinges partly on his plan to offer free full-day kindergarten statewide. That’s because 5,000 of the new preschool slots would be funded with money currently earmarked for full-day kindergarten through a special pool of flexible early education dollars. Lawmakers likely won’t make final decisions on the full-day kindergarten and preschool expansion plans until late spring.

In the meantime, preschool providers are weighing the pros and cons.

One of them is Lynne Bridges, who runs a highly rated preschool designed to look like an old schoolhouse in downtown Pagosa Springs in southwest Colorado. It’s called Seeds of Learning and serves children from tuition-paying families and about two-dozen preschoolers who qualify for public dollars through the Colorado Preschool Program.

While Bridges is thrilled with Polis’ support for early childhood education, she’s frustrated, too, that the state’s preschool program doesn’t recognize top programs like hers with extra funding.

“It’s almost like this high-quality program I’ve created …. It’s my burden,” she said.

Bridges’ program holds a respected national accreditation and also has a high rating from the state through its Colorado Shines rating system. She fundraises constantly to fill the gap between her government allotment and the cost of providing preschool for her at-risk kids — the ones she said have the most to gain from a high-quality program.

“There’s only so much money to be had in a rural community,” Bridges said. “This shouldn’t be me laying awake at night trying to help these families.”

The $111 million Colorado Preschool Program serves about 21,000 preschoolers statewide — most of them 4-year-olds in half-day slots — as well as 5,000 kindergarteners in full-day programs. Most of the program’s slots are offered in public school classrooms, though some are in community-based facilities.

On average, providers get about $4,100 per state preschool slot, though the amount varies based on a district’s size, share of low-income students, and cost of living.

Jennifer Okes, chief operating officer at the Colorado Department of Education, said the state’s finance formula allocates preschools half per student of what’s earmarked for first- through 12th-graders.

That formula doesn’t account for preschool quality, she said.

“I guess you could take preschool funding out of [the Public School Finance Act] and fund it separately. That would be a big statutory change.”

A separate state program that provides subsidies to help low-income families pay for child care works the way Bridges wishes the Colorado Preschool Program did, but it’s governed by a different state department and set of rules.

Leaders in the suburban Westminster school district north of Denver, where three-quarters of preschoolers are funded through the Colorado Preschool Program, said Polis’ proposal fits with the district’s own plans to expand early childhood options.

“I’m all for it,” said the district’s Early Childhood Education Director Mat Aubuchon, of the state preschool expansion. “I’m just curious what latitude we’ll get as districts.”

Aubuchon said if the state funds more slots, he hopes more can be merged to create full-day preschool slots. Currently, state rules allow only a small fraction of slots to be combined.

In addition, he wants more leeway in the state’s primary eligibility criteria, which gives preference children from low-income families, those in unstable housing, or who have speech or social difficulties, among other factors.

“I would like to see a little bit more pre-academic stuff in there,” said Aubuchon.

For example, children likely to be at risk for later reading struggles, based on results from a pre-reading assessment, should be given greater consideration, he said.

Aubuchon said if Polis’ plan comes to fruition, he’d like at least 100 to 150 more state preschool slots — maybe more if districts get additional flexibility to make full-day slots. He said the district will likely be able to find space for additional preschool classrooms.

Christy Delorme, owner and director of Mountain Top Child Care in Estes Park in northern Colorado, would like more state preschool slots, too.

She knows some commercial child care centers aren’t happy about Polis’ preschool expansion plan “because it takes away those paying slots,” but said she thinks it’s a good idea.

“Most parents can’t afford child care,” she said. “The more kiddos we can get into early education programs the better off our society will be.”

Delorme doesn’t have the room for a new classroom at Mountain Top, but like Aubuchon, wants the option to create full-day slots for the children she’s already serving. Currently, the 10 children in half-day slots funded by the Colorado Preschool Program rely on scholarships from a local nonprofit to stay at Mountain Top all day. If they become eligible for full-day state slots, that scholarship money could be rerouted to at-risk 3-year-olds,

One challenge that many preschool providers will face if there’s a sudden influx of new state-funded preschool slots will be hiring qualified staff for new classrooms.

That very problem is what led Bridges, of Seeds of Learning in Pagosa Springs, to cut her program down from four classrooms to three a few years ago. Turnover was high and she couldn’t find reliable substitutes.

With the switch to three classrooms, she also raised wages. Today, a lead teacher with a bachelor’s degree makes about $22 an hour, competitive pay in a community where her workers sometimes used to leave for jobs at the local Walmart. Today, Bridges has no problem with turnover.

Delorme, whose teachers start at $15 to $17 an hour, agreed that the field’s low pay makes it tough to find qualified staff.

“Education in general, it’s hard to recruit, but does that mean I wouldn’t want to expand my program because of that?” she said. “No.”

Race for mayor

How to help Chicago’s younger learners? Mayoral frontrunners skip a chance to say.

PHOTO: Stephanie Wang

The challenge of mending and strengthening Chicago’s network of care and education for its youngest residents defies instant solutions, but four candidates for mayor agreed Monday on one point: The city needs to care for its child care centers rather than imposing more burdens on them.

And the city should include those crucial small businesses, which often anchor neighborhoods, in its growing pre-kindergarten system.

Related: Why Rahm Emanuel’s rollout of universal pre-K has preschool providers worried

At a forum Monday at the University of Chicago on the topic of early childhood education, candidates addressed how city government can stitch together a stronger early learning system. Chicago’s mayoral election is Feb. 26.

Chicago is in the first year of a four-year universal pre-kindergarten rollout, and the city’s next mayor will determine much of the fate of the program. About 21,000 children have enrolled out of an estimated 45,000. And cost estimates are now north of $220 million, much of it federal and state money earmarked for early childhood expenditures. But the mayor can direct how that money is spent.

The forum attracted four candidates: former federal prosecutor Lori Lightfoot, former Chicago schools CEO Paul Vallas, state representative and former teacher La Shawn K. Ford, and John Kozlar, a University of Chicago graduate who, at 30, is the youngest candidate in the race.

Four candidates considered front-runners — Toni Preckwinkle, Susana Mendoza, Bill Daley and Gery Chico — didn’t attend. Nor did six more of the 14 candidates.

All of the mayoral candidates who answered said they would continue to support Chicago’s universal pre-K expansion but did not specify how.

The event was organized by Child Care Advocates United, a statewide alliance of child care providers who banded together four years ago when the state budget crisis was forcing many providers and child care agencies to cut back or close.

The central topic of conversation was how city government can build a stronger early learning system. Several questions revolved around issues faced by for-profit and nonprofit day care owners and preschool operators who are facing teacher shortages, budget pressures, and a churn of students. Some advocates say Chicago’s rollout of universal pre-K has made a operating a difficult business even more tenuous, as they lose children and revenue to Chicago Public Schools.

A Chalkbeat analysis of data published last week showed that public school preschool programs are at 91 percent capacity, while one in five seats at community-run preschools and centers is empty.

The candidates Monday offered different suggestions for alleviating the pressure.

Related: Care about schools? Read Chalkbeat Chicago’s voter guide to the mayor’s race. 

“We have to end this fight between Chicago Public Schools and (community) providers. It is killing an industry,” said Ford, a state legislator who described the budget pressures many providers faced under former governor Bruce Rauner, when Illinois did not pass a budget for more than two years.

A September report from the Illinois Department of Children and Family Services, which tracks openings and closures among licensed daycare facilities, shows a loss of 3,400 licensed facilities statewide from 2010 to 2018.

“Chicago Public Schools cannot do (preschool) cheaper, and it cannot do it better,” said Vallas, also a former budget director for the city of Chicago, who has put out a detailed prenatal-to-preschool platform that starts with universal prenatal care and a detailed menu of services and supports for children birth to age 5.

“The challenge with the universal pre-K program that Rahm Emanuel and (schools chief) Janice Jackson rolled out is that there was no engagement with community-based providers,” said Lightfoot, who questioned the timing of the May 2018 announcement just weeks before a Chicago Tribune series cast a spotlight on a pattern of mishandling student sexual abuse cases in the K-12 system. “This program was ill-conceived and rolled out in spring to be a distraction to the sex assault investigation about to be unveiled by the Tribune.”

At the forum, held in the auditorium of the Logan Center for the Arts at the University of Chicago, Vallas also spoke about creating incentives to entice more prospective teachers into the field, including grow-your-own programs that target parents.

He also described a system of startup grants and opportunity zones that would make it easier for new businesses to take root and tax breaks for providers who serve a variety of children well.

Ford advocated pressuring state legislators to increase reimbursement rates to providers, which could be used to increase teacher pay, and setting aside tax-increment financing, or TIF, dollars for early childhood businesses. And Lightfoot talked about converting some of the schools that Chicago has closed into job training and early childhood centers.

“The policy that has been rolled out is not equitable and not sustainable,” she said of Chicago’s universal pre-K rollout. “We need to work in partnership with our communities.”

Are you ready to vote on Feb. 26? Find everything you need at Chi.vote, a one-stop shop for the Chicago election — Chalkbeat Chicago is a partner.