‘An uphill battle’: Lead poisoning stunts students’ learning while Cleveland leaders fail to tackle lingering problem
‘An uphill battle’: Lead poisoning stunts students’ learning while Cleveland leaders fail to tackle lingering problem
CLEVELAND, Ohio -- In recent years, thousands of children started kindergarten in Cleveland public schools already poisoned by lead, which threatens their chances to achieve and poses steep challenges for the district charged with educating them.
More than a quarter, 25.7 percent, of the kindergartners screened had a history of lead poisoning at or above the level where public health officials recommend action, researchers at the Center on Urban Poverty and Community Development at Case Western Reserve University found.
A staggering 93.5 percent of them had some exposure to lead, which even at low levels can damage a developing brain and cause educational, behavioral and health problems, according to the Centers for Disease Control and Prevention.
Children exposed to lead are more likely to have a raft of issues that demand heightened attention from the teachers and additional resources from the school district, said Robert Fischer, co-director of the center and co-author of the report.
In 20 of the schools that could be a third to almost half of incoming students, which could translate to classrooms that are hard for teachers to manage and students who have poorer educational results, he said.
“It’s an uphill battle on the individual child level and an undue burden in the schools,” Fischer said.
The percentage of lead poisoned-children entering kindergarten at the 67 schools varied from building to building, from a high of 46.7 percent at Iowa-Maple Elementary in Glenville to 7.6 percent at Campus International School downtown, which also enrolls children who live outside of Cleveland.
Is your child at risk or lead poisoned? Click here or scroll to the bottom of the story for resources.
The report, which looked at 10,397 kindergartners enrolled from 2014 through 2017, includes only the Cleveland district, not charter, parochial or private schools.
About 84 percent of the children had at least one lead test.
Cleveland Superintendent Eric Gordon said the report, which he supported, provides a much better sense of the “footprint” of lead exposure among students and in individual schools, even though it likely underestimates the true magnitude of the challenge the district faces.
“When you look at the map,” Gordon said. “None of it looks pretty.”
It will lead to concrete action, though, Gordon said. It has to because lead exposure doesn’t affect only the schools.
“There are huge social implications in our city,” he said.
School buildings with the highest proportions of poisoned kindergartners appear to reflect high concentrations of lead exposure in the surrounding neighborhood, especially on the city’s East Side.
Schools in Glenville, St. Clair-Superior, Buckeye-Woodhill, Broadway-Slavic Village and Stockyards had the greatest number of students exposed to the toxin, which is often found in older homes where paint has deteriorated.
“The evidence to the rational mind says it is in the civic interest to prevent this,” Fischer said.
But that hasn’t happened.
For more than three years, government officials, community leaders and other stakeholders have publicly and privately discussed potential ways to prevent lead poisoning among Cleveland’s children.
Leaders appear to agree on what must be done: Toxic older housing has to be remediated.
But there’s no consensus on how to do it.
City legislation introduced in 2017 that would require rentals be “lead safe” never got a hearing, and a plan to fund remediation in 10,000 homes in neighborhoods with the highest levels of lead poisoning failed to garner widespread support.
A Cleveland Foundation-funded report completed in May found that community stakeholders — which included the city of Cleveland, Cuyahoga County, the Cleveland Clinic and University Hospitals — could not “coalesce” around a remediation strategy paid for with social bonds.
A page from the Third Sector Capital Partners report paid for by The Cleveland Foundation. Public Record
As contemplation has dragged on, thousands more Cleveland children, at least 4,400, were poisoned at or above the CDC’s threshold of 5 micrograms per deciliter and will enter school in the coming years at a potential disadvantage.
A fight in Flint to help students
Retired neuropsychologist Theodore Lidsky served as an expert in a lawsuit filed on behalf of children exposed to lead during the water crisis in Flint, Michigan, and recently moved to the Cleveland area. Prevention of lead poisoning is best, he said, but without the proper response once children are affected, “generations of kids are just flushed down the toilet.”
That’s what lawyers from the Education Law Center and the American Civil Liberties Union of Michigan said they sought to prevent when they filed the 2016 lawsuit to force the state education department and school districts that serve Flint to provide federally required educational assessments and supports for more than 30,000 school-age children.
Without aggressive measures, they argued, Flint would become a “national symbol of the irreversible consequences when government at all levels abandons its children.”
In March 2018, the case was partially settled with an agreement that gave Flint children access to baseline screenings to measure their development and spot any potential learning issues.
Dr. Mona Hanna-Attisha, the whistleblower pediatrician who first drew attention to the city’s water crisis, at the launch of the Flint Registry in 2018. Children on the voluntary registry will have access to early developmental and neuropsychological screenings through a partial lawsuit settlement with the state education department and the school districts that serve Flint. Bronte Wittpenn | MLive.com Bronte Wittpenn | MLive.com
Participation, through a voluntary registry, is open to all Flint children potentially exposed to lead because blood tests for the toxin tend to underrepresent actual exposure.
Lead is eliminated from the blood fairly quickly, within about a month, but can remain in the brain, where it can cause damage for up to two years, said Lidsky, who is retired but worked for free on the case.
Read Lidsky’s Flint report
Initial evaluations aim to identify “red flags” that could indicate cognitive deficits, learning disabilities or behavioral issues.
Children with signs of those issues will have access to comprehensive neuropsychological testing to help ascertain what areas of the brain might be damaged.
That level of testing, available early and repeatedly as a child gets older, is possible because the state agreed to pay $4.1 million to help staff and support the Neurodevelopmental Center of Excellence in Flint, which started operating in November.
The settlement money also will pay to train teachers and administrators to recognize signs that a child might have been affected by exposure to lead and how to make referrals for assessments.
The unresolved part of the lawsuit seeks to ensure that much-needed resources are in place to support the children identified through assessments as having learning or behavioral issues, said Gregory Little, chief trial counsel with the New Jersey-based nonprofit Education Law Center.
Since the water crisis, Flint schools have seen an increase in the need for special education and a decrease in the number of students who are “reading proficient” in third grade.
Whether lead exposure has a direct link to student achievement in Cleveland was not part of the recent report from CWRU.
Past CWRU research did find that lead-poisoned children were less likely to be “kindergarten ready” than their non-poisoned peers. In that study, which included 13,000 children who were at highest risk for poisoning in 2003-2004, almost 40 percent of them were exposed to the toxin by kindergarten, a level which has since declined, likely due to public health efforts.
The Plain Dealer analyzed CWRU’s recent report, along with data gathered as part of the state’s Third Grade Reading Guarantee program, and found a relationship — too strong to be random — between the percentage of children poisoned in a school and that school’s performance on tests that students take to measure reading ability.
On average, for each 10-percentage-point increase in the number of students with lead exposure at or above the CDC threshold in a school, there was a 6.5 percentage-point decrease in the number of students who passed the third-grade reading test.
Those results show a pattern similar to research of academic outcomes in Chicago, Detroit and Rhode Island, which found lead-exposed students scored lower on reading-readiness assessments and standardized reading and math tests.
It’s clear, Little said, that the issues in Flint are the “tip of the iceberg.” The assessment protocol designed to help children there, he said, could become a model for the rest of the country, particularly in places where lead poisoning is still severe.
School district’s ‘next logical step’
As far back as a decade ago, experts cited lead exposure as a major factor that placed Cleveland students at risk for academic and behavioral problems.
The issue was identified as part of an audit and subsequent report by the American Institutes for Research, which followed a shooting at SuccessTech High School. It noted then that levels of lead poisoning in Cleveland were the highest recorded in the country at the time.
Since then, the district created and implemented what it calls a social-emotional learning curriculum. It’s a sweeping effort to help students bolster conflict-resolutions skills and regulate behavior through in-class exercises that teach coping skills. The method also sought to limit discipline, such as suspensions, as punishment.
Those efforts surely have benefited some students with behavioral issues due to lead exposure, as well as ones who have witnessed violence or experienced other trauma, Gordon said.
Cleveland Metropolitan School District CEO Eric Gordon speaks at a board meeting. Gordon supported a recent study that looks at the level of lead poisoning in school buildings. Patrick O’Donnell, The Plain Dealer
Still, he said, more must be done to address the underlying problem of lead exposure. And that means the district has to take a more aggressive stance in school buildings with high levels of children exposed, and in rallying the wider community.
“It’s the next logical step,” he said.
At this point, though, the district hasn’t developed a policy or set of procedures regarding children who may be affected by lead.
It also doesn’t have a set way to inform teachers of lead-testing results or to obtain students’ lead screening information from parents or physicians, outside of its prekindergarten programs, where it is required for enrollment.
A 2015 report by the CDC’s National Center for Environmental Health recommended both of those measures.
Gordon said the district plans to start asking parents who are enrolling their child in the district for consent to screen children for lead or to get screening records, with parents having the ability to opt out if they choose.
That will help the district move more quickly to support the needs of those children and families, he said.
The report, aside from allowing the district to better study the problem, provides leverage to seek additional support, Gordon said, whether from federal or community grants, Medicaid or the Say Yes to Education initiative the district expects to roll out in 2019.
Conversations among school nurses and psychologists about how the school district should follow up on lead testing results were underway prior to the CWRU report, sparked by a new in-school lead screening program.
Last year, a pilot of the program in four schools found about 11 percent of unscreened 3- to 5-year-olds tested above the threshold set by the CDC.
This year, the program run by the Frances Payne Bolton School of Nursing at Case will expand to serve half of the district’s schools with children in that age group.
Cleveland health department’s lead poisoning expert, Theresa Davis-Bowling trained the district’s school psychologists last year to recognize the effects of lead poisoning and how to obtain students’ lead-poisoning records from the city, said LaKesha Buggs-Hall, who supervises the district’s 67 full-time and 11 part-time school psychologists.
Theresa Davis Bowling, a lead prevention specialist with the Cleveland Department of Public Health, draws a vial of blood from a child at St. Martin de Porres Family Center in 2017. Gus Chan Gus Chan Gus Chan
The district plans a similar training, by city or county health experts, for its early-childhood teachers this winter, a spokesman said. No date has been set.
Evaluation and intervention
For Cleveland students, known lead exposure doesn’t automatically trigger an evaluation for learning or behavioral issues.
In 2015, the CDC report said all lead-exposed children should be screened using neuropsychological evaluations. The school district typically starts to assess a student after a parent or teacher notices a problem, and routine classroom interventions, such as a high dose of one-on-one tutoring, haven’t helped.
When a problem arises, a parent would be asked about lead exposure or other issues that might contribute to the child’s issues, Buggs-Hall said.
That information helps with a child’s individual assessment, which could involve a wide variety of tests and measurement tools available to the district to figure out why a child might be struggling, she said.
If initial classroom interventions don’t help, and evaluations point to a disability, special-education services can be provided, through what’s called an Individual Education Plan, or IEP, or, less often, through a 504 plan, which outlines how a student must be accommodated, said Mary Ann Teitelbaum, the district’s manager for psychological services.
In the 67 schools that serve students in kindergarten through eighth grade, the district said it evaluated 618 children for special-education services and 575 of those students qualified for the services, which can cost as much as $8,500 per student each year.
For the district, Teitelbaum said, it’s more of a problem-solving process, involving parents, teachers and doctors, than an effort to get to the root cause of the learning problem.
“It doesn’t matter if an issue, like impulsivity, is caused by trauma or lead poisoning, we have to address it,” she said.
Gordon said he would ask the district’s experts to further study and weigh in on whether the any changes in the current evaluation process are needed.
Lidsky hasn’t examined Cleveland’s process, but he firmly believes that doing early evaluations as basic triage for children exposed to lead, or any potentially brain-damaging event, is warranted.
“That’s just the first step,” he said.
Even the more-precise, CDC-recommended neuropsychological testing can be done economically, Lidsky says.
The cost for the daylong evaluation, which can be up to $2,500, can be reduced if school psychologists, trained technicians or even graduate students are used to administer and score the tests, which is done using a manual. The results then can be reviewed by neuropsychologists.
In Cleveland, as in other districts, it could be difficult to find resources to routinely assess all children exposed to lead but, “difficult isn’t a reason not to do the right thing,” Gordon said.
The cost of waiting
CWRU’s researchers this year will continue to trace, through records, the progress of Cleveland’s lead-poisoned children
That includes examining their educational progress and whether poisoned children are more likely to have juvenile court involvement and how much money they earn compared to non-lead-poisoned peers.
Cleveland or any other city that might view the problem as intractable, Lidsky said, should ask: “How successful is what they are doing now? Does it seem to be working?”
If upfront costs loom large, research shows they are even more enormous down the road as students struggle to learn, drop out, or are expelled and end up in the criminal justice system or in low-wage jobs.
“You can pay now,” he said. “Or pay a lot more later.”
Where to get help.