Background: In 1999, many neighborhoods in Providence had more than 50% of children under the age of six years with elevated blood lead levels (greater or equal to 10ugm%). The City had no resources to assist in abatement of lead hazards or to increase knowledge in several immigrant and inner city communities about the health effects of lead poisoning or methods to keep children safe in a lead contaminated environment. Health services were accessible and screening, diagnosis and medical management of the severely lead poisoned children (greater or equal to 20ugm%) was the responsibility of the State Health Department. There were limited federal HUD funds available through the Health Department but not enough to abate significant numbers of homes and were prioritized to address homes of severely poisoned children.

The City did not have a separate health department or health policy, and as a result, was not in the position to compete for its own HUD funding.

Policy Solution: Build local capacity to finance lead hazard abatement in Providence and improve outreach to recent immigrants and inner city residents with young children using existing and new local, state and federal funding.

Policy Development Process:

The Mayor's Policy Office, in consultation with the Health Department, wrote a brief outlining the invisible but palpable dangers of lead poisoning on the lives of young children. They requested that the Mayor appoint a commission (or task force) with the mission to investigate, define and develop recommendations for the implementation of a program that will educate or raise awareness about the problem of lead poisoning and assist homeowners and families living in the homes found not to be lead safe with housing remediation to make homes lead safe for families with children.

The brief also recommended that the commission be composed of diverse members of the community including those affected by the dangers of lead poisoning (parents, community activists, tenants, homeowners, etc.) as well as experts in housing rehabilitation, medicine, education, historic preservation, community planning and clergy active in the most endangered neighborhoods of the city.

Action steps taken:

1. The Mayor appointed a large commission of city residents, as well as several national experts in the field of lead poisoning and housing remediation, to begin the study, recommendation and implementation process.
2. The Mayor's Policy Office (one person with administrative support), Health Department staff ( two persons and others as needed) and lead city not-for-profit agencies with expertise in lead abatement and education work (Childhood Lead Action Group and Greater Elmwood Housing Network), as well as the HELP Coalition (a not-for-profit agency composed of city colleges and universities focused on community action to benefit residents in lieu of taxation) took the lead in dividing the large commission of more than 70 people into smaller committees, each with a clear mission that would be part of making Providence a lead safe city.
3. The Policy Office held a public gathering of commission members where the City engaged in a discussion about the organization of the commission and how to meet the goal of a lead safe city. The outcome of the gathering was the establishment of a Leadership Team composed of representatives of key city not-for-profit community agencies in housing, health and education, and several subcommittees composed of representatives from entities such as Education, Housing/ Rehabilitation and Funding Committees. In addition, the group selected a chair or chairpersons for each subcommittee and for the entire leadership team and developed a set of organizational principles which defined the relationships for and between the groups and the leadership team.
4. Clarity of expectations for all participants was critical. To secure well-supported meetings and outcomes, members of the city policy staff and health department participated in several or all meetings as support staff members. In addition for both education and housing remediation, Brown University Urban Studies Program and Health Department researchers provided the teams with the necessary research to support their deliberations and final recommendations, insuring that they were based on data.
5. Additional geo-mapping research was provided by the Providence Plan, an organization which focuses on issues that arise in urban communities. One staff member created city neighborhood maps which clearly noted the presence of lead not only in the inner city areas but throughout the city due to the history of wood frame housing. The mapping, however, also indicated a strong tendency to see the historic wood frame housing of the city as a far greater danger in sections of the inner city where neglect had resulted in peeling paint, leaky roofs and general lack of maintenance which is conducive to the existence of lead in soil and homes in general.
6. Research collected from Brown University students and Health Department researchers, as well as Providence Plan staff was used as part of the Reporting Out Sessions scheduled by the Mayor on a regular basis to keep the community involved and educated about the work and progress of the commission. As he became more informed about the status of lead poisoning in the city, the Mayor became a powerful advocate for education and housing remediation.
7. The information gathered was assembled in attractive, readable packets and shared with the City Council members. This information revealed this was a citywide problem, deserving their political support as well as neighborhood action. Additional information was made available to the City Council by policy staff if so desired.
8. Policy staff, in collaboration with the Health Department staff, was involved in the lead abatement discussion and with the commission at the state house to ensure that the city information was a part of the larger statewide and national dialogue on lead abatement and education.
9. The commission was in close touch with the Conservation Law Foundation in Boston, the EPA and HUD offices in Providence and Boston, and the National Center for Lead Safe Housing in Maryland, which later became the National Center for Healthy Housing. Members of these organizations visited Providence to share their experiences and knowledge and served as important collaborators in finding ways to move Providence from being the lead poisoning capital of the USA to being a lead safe city.
10. One member of the policy staff was in constant communication with committee chairs, the leadership team and participating community agencies to ensure the flow of information between the different arms of the commission and to make sure that leaders of the city and state were advised of progress made and proposed remedies. Communication, open discussion, and press conferences to inform and share ideas were a critical ingredient in the success of the program.
11. Final recommendations for the lead abatement program to make homes lead safe, and for community education to protect families from lead poisoning were made by the Commission in a public presentation. Following that, the City's Policy Committee wrote the first HUD proposal on behalf of education and housing rehabilitation and received almost four million dollars in support of the proposed program. A second proposal was sent to HUD in collaboration with the National Lead Safe Housing team. This proposal expanded the scope beyond lead to other environmental dangers which contribute to the rise of asthma and other health problems among young children. This proposal was also successful and worked in tandem with the HUD proposal. Three years later the program was refunded by HUD to continue the work begun by the Commission.
12. Work was subcontracted by the city to community agencies with a proven track record. At the same time, city departments for housing codes, inspections and planning worked with the community agencies under the umbrella of the Providence Neighborhood Housing (PNH). PHN is an independent not-for-profit organization that has a working relationship with the city. PNH also served as the fiduciary agency for the lead safe grants.
13. The implementation is ongoing, but has been challenging, even though all of the players were at the table at the time of research, deliberation and decision-making. The not-for-profit partners were unprepared for the expectations and increased service requests. Within a year, all parties developed systems of working together for the benefit of the community.
14. The city has learned a lot about community engagement and working with the community as equal partners. That process continues today.

Lessons Learned:

1. Establish broad and diverse representation on the leadership team and committees. Include community members in equal numbers to provide consultation and direction.
2. Establish a leadership team to facilitate large meetings and share information with the public and various constituents - from housing to medicine - and education to policy making. Underscore the importance of committee leadership to ensure strong and equal components that take a holistic approach to a complex problem
3. Listen to community experts and policy makers as you develop recommendations and a plan to change the quality of life for many people. Make connections, create networks, and again, listen to ensure problems are addressed fully and thoroughly.
4. Communication is critical. Develop organizational principles that become the rules of engagement and serve as a bridge for constructive effort.
5. Reassure the community and commission participants that this work will be implemented. Ensure that the leadership publicly supports the work.
6. Do not overestimate the readiness of the not-for-profit sector to scale up the work in the community. Although they have the best of intentions, they are not always ready to expand overnight. It takes time to align the efforts of the non-profits, city departments, and policy makers.
7. Develop a team that will regularly monitor the program and issue public reports to the community regarding successes and challenges.
8. Monitor short-term goals and the long-term mission to keep people alert and engaged in the process.