NURS 4212 Week 10 Population Intervention Plan Example

Population Intervention Plan: Increasing Blood Lead Testing Among Young Children in Portsmouth's Oldest Housing

Student Name

College of Nursing, Walden University

NURS 4212: Population Health Nursing

Instructor Name

Month Day, Year

Population Intervention Plan: Increasing Blood Lead Testing Among Young Children in Portsmouth's Oldest Housing

This plan responds to the third community nursing diagnosis from the Portsmouth assessment: risk of elevated blood lead levels among young children, related to old housing and high poverty. It is written in the order a health department reviewer would read it: population, goal, objectives, activities, logic model, evaluation, timeline, partners and sustainability.

Population

The population is children younger than six living in census tracts 32, 34, 35 and 37 in Portsmouth, Ohio. These four tracts were chosen because they combine the city's oldest housing with its deepest poverty. In each, at least 97% of housing units were built before 1980 and between 42% and 73% before 1950, and between 37% and 49% of residents live below the poverty line (U.S. Census Bureau, 2025). Federal rules ended the sale of lead-based paint for homes in 1978, and homes built before 1950 are the most likely to contain it in high concentrations. Between 47% and 74% of households in these tracts rent, so many families cannot make repairs on their own.

The American Community Survey estimates about 840 children under five across the four tracts, which suggests roughly 1,000 under six. Tract margins of error are wide, and the true figure could be several hundred higher or lower.

The problem this plan addresses is testing. No blood lead level in children is known to be safe, and the pediatric policy statement on lead puts primary prevention first, by removing hazards from housing, while using blood tests to find children already exposed (Council on Environmental Health, 2016). The CDC's blood lead reference value, which flags children whose levels fall in the top 2.5% of the national distribution, was lowered to 3.5 micrograms per deciliter in 2021 (Ruckart et al., 2021). A child who is never tested cannot be identified or followed. Testing coverage for the four tracts will be taken from the Ohio Department of Health's childhood lead poisoning surveillance data, requested as the plan's first step; that figure is the baseline for Objective 1.

Goal

Every child under six in Portsmouth's oldest, poorest neighborhoods is tested for lead on schedule, and every child with an elevated level receives follow-up and a home investigation.

Objectives

Objective 1. By December 31, 2028, at least 80% of children who turn two years old during 2028 and live in tracts 32, 34, 35 and 37 will have had at least one blood lead test by their second birthday. Data source: Ohio Department of Health childhood lead surveillance, matched to tract by address. Baseline: 2026 coverage for the same tracts, obtained before launch.

Objective 2. By December 31, 2028, 100% of children in the four tracts with a confirmed blood lead level of 3.5 micrograms per deciliter or higher will receive a nurse home visit within 30 days of the confirmed result. Data source: the health department's case management records. Baseline: the proportion visited within 30 days during 2026.

Objective 3. By June 30, 2029, 90% of homes identified through home visits as containing lead hazards will have been referred to housing code enforcement or the state lead hazard control program, with a documented response. Data source: referral log shared between the health department and code enforcement. Baseline: none exists, since no shared referral log is kept; the first six months of the log will establish it.

Activities

Testing outreach at nutrition program clinics. Families with young children in these tracts regularly visit the WIC clinic. Nurses will check each child's testing status at WIC certification visits and offer a capillary test on site or a same-week referral.

Testing outreach at childcare centers and early learning programs. Nurses will hold testing days with parental consent, and send testing reminders home with children who are due.

Primary care reminders. The federally qualified health center and pediatric practices will receive monthly lists of children in the four tracts who are due for testing, built from surveillance data.

Home visits for children with elevated results. A public health nurse will visit within 30 days to review nutrition, hygiene and sources of exposure, and to arrange an environmental investigation of the home.

Referral to housing code enforcement. Because household education and dust control alone have not been shown to lower children's blood lead levels at the population level (Nussbaumer-Streit et al., 2020), each identified hazard will be referred for enforcement or for repair funding, and the referral tracked until the landlord or owner responds.

Logic Model

Table 1

Logic Model for the Blood Lead Testing Plan

Evaluation

Process measures show whether the plan was delivered: the number of children whose testing status was checked at WIC visits, the number tested at childcare sites, the number of due lists sent to practices, the proportion of elevated results followed by a home visit within 30 days, and the number of hazard referrals sent and answered. These will be reviewed quarterly.

Outcome measures show whether delivery made a difference: testing coverage by age two in the four tracts (Objective 1), timeliness of follow-up (Objective 2), and resolution of referred hazards (Objective 3). Over a longer horizon, the proportion of tested children with levels at or above the reference value will be tracked, although rising testing may at first reveal more elevated levels rather than fewer. That early rise should be read as the plan finding children, not as a failure.

Timeline

First quarter of 2027: obtain baseline data; sign agreements with WIC, childcare programs and code enforcement. Second quarter: train nurses and begin WIC outreach. Third quarter: add childcare testing days and primary care due lists. From 2028: full operation, with quarterly process review and an annual outcome report. First half of 2029: final evaluation against all three objectives.

Partners

The Portsmouth City Health Department leads, with the Scioto County Health Department for families near the city line. The WIC program provides the main testing contact. Childcare centers and early learning programs host testing days. The federally qualified health center and pediatric practices receive due lists and complete tests. Portsmouth code enforcement receives hazard referrals. The Ohio Department of Health supplies surveillance data and lead hazard control resources.

Sustainability

The plan is designed to outlast its first two years. WIC testing checks can become a standard part of certification visits, and due lists can be generated automatically once the data link with the state is built. The shared referral log with code enforcement costs little to keep. The most fragile element is nurse time for home visits, which will need a stable line in the health department budget. One caution frames the whole plan: the national preventive services task force found insufficient evidence to recommend routine blood lead screening for all asymptomatic young children (US Preventive Services Task Force, 2019). This plan targets children at clearly higher risk because of their housing, and it pairs testing with action on the homes themselves, which is where lasting prevention lies.

References

Council on Environmental Health. (2016). Prevention of childhood lead toxicity. Pediatrics, 138(1), Article e20161493. https://doi.org/10.1542/peds.2016-1493

Nussbaumer-Streit, B., Mayr, V., Dobrescu, A. I., Wagner, G., Chapman, A., Pfadenhauer, L. M., Lohner, S., Lhachimi, S. K., Busert, L. K., & Gartlehner, G. (2020). Household interventions for secondary prevention of domestic lead exposure in children. Cochrane Database of Systematic Reviews, (10), Article CD006047. https://doi.org/10.1002/14651858.CD006047.pub6

Ruckart, P. Z., Jones, R. L., Courtney, J. G., LeBlanc, T. T., Jackson, W., Karwowski, M. P., Cheng, P.-Y., Allwood, P., Svendsen, E. R., & Breysse, P. N. (2021). Update of the blood lead reference value: United States, 2021. MMWR: Morbidity and Mortality Weekly Report, 70(43), 1509-1512. https://doi.org/10.15585/mmwr.mm7043a4

U.S. Census Bureau. (2025). American Community Survey 5-year estimates, 2020-2024 [Data set]. https://data.census.gov/

US Preventive Services Task Force. (2019). Screening for elevated blood lead levels in children and pregnant women: US Preventive Services Task Force recommendation statement. JAMA, 321(15), 1502-1509. https://doi.org/10.1001/jama.2019.3326