Implementing CDC guidelines on lead and pregnancy: North Carolina's challenges and opportunities linking environment and maternal health programs

The publication of the CDC Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women in November, 2010 was welcomed by many in the North Carolina public health community, who long recognized the need to serve this vulnerable population. However, implementation presented both challenges and opportunities in working collaboratively across state agencies with ever-shrinking budgets. Key methods of devising a guidance implementation plan included the formation of a lead and pregnancy work group of university, environmental health, and public health staff to assess roles and gaps; creating a policy requiring screening and testing of at-risk pregnant women via local health department agreement addendums; piloting a screening questionnaire to determine risk for fetal exposure to lead; developing staff training for both environment and maternal health staff to implement a case management protocol; and producing health education materials for clients. The primary challenges of implementation were determining roles for environment and maternal health staff, developing a suitable case management protocol that included Medicaid reimbursement for services, and addressing data tracking needs with little to no new resources. Key findings of this project include a replicable method of assessing an agency's capacity to implement the new guidelines across programs, a simple case management protocol for maternal health and environmental health practitioners serving pregnant women exposed to lead, and a description of opportunities to work across programs and utilize agreement addendums with local health departments to implement a new policy.