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Walking along the streets in Pittsburgh’s Homewood neighborhood, A.J. Koury points to boarded-up houses and overgrowth.

“This is one square mile in Pittsburgh’s East End. It’s an interesting kind of place because it was really booming in the 1930s and ’40s, and then there was a period of rapid decline in terms of population,” says Koury, a data analyst. “Now it’s really been a place of concentrated economic disadvantage and high unemployment.”

Koury, whose background is in developmental psychology, works in the data-evaluation arm of Homewood Children’s Village. His co-workers manage on-site teams in three Pittsburgh Public Schools where most kids of Homewood attend — Faison, Lincoln and Westinghouse.

“They’re great kids who are up against some really hard things, hard things that grownups would struggle with,” he says.

HCV provides before- and after-school services, including meals as well as tutoring and mentoring; backpacks full of food for the weekend; and summer programs. It also partners with several organizations in Pittsburgh, as a convener of social services.

“We have some of the lowest [standardized] test scores in Pittsburgh,” Koury says. And, that’s why next month, HCV will coordinate lead testing in Homewood homes. Lead exposure can lead to cognitive problems, including learning disabilities.

The organization will start by handing out water-testing kits to neighborhood residents, and it has partnered with a local company to process the results. HCV will be coordinating the testing on its own because testing children, and homes, is not mandatory in Pennsylvania. And while some state health and elected officials are pushing for tighter regulations, right now if a kid gets tested, it’s because a concerned parent, pediatrician or neighborhood group like HCV pushed the issue..

The next step “of what’s probably going to be a very long process,” Koury says, will be raising grant money to perform blood tests. But the effort is worth it if there’s a chance that lead exposure is contributing to the educational shortcomings of children in the community.

A snapshot of test scores at these predominantly African-American schools in the 2015 A+ Schools report reveals that third-graders at Faison achieved just 20 percent proficiency in reading. At the high school level, at Westinghouse, 11^th-graders achieved 34 percent proficiency in literature and 17 percent proficiency in algebra.

“If it’s the case that kids aren’t doing their homework, we can address that,” Koury says. “If it’s the case that kids are being exposed to lead, all the tutoring in the world can’t help.”

No amount of lead is “useful” or “normal” for humans, says Michael Lynch, medical director at the Pittsburgh Poison Center. But unless the poisoning is acute, its effects on a person’s cognitive abilities are difficult to pinpoint over time. Exposure can lead to damage to the brain and nervous system, slowed growth, learning deficiencies and behavioral problems, as well as hearing and speech problems.

“If a 20- or 30-year-old has some deficit or a lower IQ number, going back to when they were 4 or 5, saying it was lead exposure then is a hard thing to quantify,” he says. As for sources of lead poisoning in Western Pennsylvania, he says: “It’s almost exclusively around here paint or soil or dust from construction sites or demolition sites that contain lead as the source. Water is always considered as a potential source, but still remains a small percentage of our significant exposure sources.”

Paint on old window frames was the culprit for Sarah Godwin’s family in Erie, Pa. Godwin became a parent advocate with the Lead Safe America Foundation after her 9-month-old daughter’s blood contained levels of lead.

“Our bedroom and living room tested the highest [for lead] because of opening and closing the windows [in the summer],” Godwin says about the 1923 home she and her husband bought near Erie’s Frontier Park. “It wasn’t enough dust to see, but it was enough to poison my child.”

At age 3½, and with the family since moving to Houston, her daughter’s lead levels have decreased. Godwin says her daughter is on target developmentally in spite of being treated for conditions that cause her to pull out her hair and bite her nails and fingers until they bleed, and to rarely get a full night’s sleep.

“She’s finally getting out of that. That is coinciding with her lead levels going down,” Godwin said by phone. “Developmentally, I’m not sure how she’s going to do when school starts.”

On the heels of the Flint, Mich., water crisis, and other stories of lead exposure around the country, anxiety about lead poisoning is high. Lead can occur not only in old plumbing, as in Flint, but in paint used in housing before 1978, when it was banned. Old paint can chip and dust can collect on surfaces where children play, crawl and then place toys and hands in their mouths. (The federal government outlawed lead piping or soldering on public water systems in 1986.)

In 1992, the federal government passed a lead-disclosure rule, requiring landlords and property-owners to give to renters and potential home-buyers an EPA-approved pamphlet about lead-paint hazards, and to disclose any known lead-paint hazards. The parties must sign a contract, and the renters or homebuyers have a 10-day window to decide whether they want to hire a lead inspector. (Unless there is a stronger state law or municipal ordinance in place, this is the protocol for counties and municipalities, and is the case in Allegheny County and Pittsburgh. Philadelphia landlords are subject to stricter laws.)

To actually fix a lead-paint problem, a certified renovator must be hired. A quick search on the EPA’s database shows there are 793 such contractors within a 50-mile radius of Pittsburgh. Lead abatement can cost thousands of dollars, and neither the state nor the landlord is required to pay for it.

Godwin, of Erie, says that after contractors replaced the windows, door frames and baseboards, and resealed the floors to avoid dust migration, the bill came to around $50,000. A conscientious parent — she owns an all-natural parenting store — she had the soil around the home tested as well, and the family paid for a landscaping overhaul.

Koury, of Homewood Children’s Village, says that if expensive lead abatement were required in Homewood, the HCV would need to find funding.

The federal Department of Housing and Urban Development’s national budget for lead-hazard grants is around $100 million, about $13.4 million of which is currently being used in Lawrence County, Harrisburg, Philadelphia and Erie.

“Congress sets our lead-hazard-control grants budget; the Department continues to ask for funding each year,” writes HUD’s Jereon Brown in an email.

Loren Robinson, deputy secretary of Health Promotion and Disease Prevention with the Pennsylvania Department of Health, says that the state uses its HUD money to document and monitor cases of lead exposure.

U.S. Census data ranks Pennsylvania fourth in number of houses built before 1978. Eighty-nine percent of houses in Allegheny County predate that year. Koury’s research shows that an average of 20 percent of homes in the seven Census tracts that make up Homewood predate the 1980s.

Data in the state Department of Health’s 2014 Childhood Lead Surveillance report shows that of the roughly 1 million children under age 7 in Pennsylvania, 140,524 were tested — about 14 percent. Slightly more than 13,000 of them had blood lead levels at or above five micrograms per deciliter, the Centers for Disease Control and Prevention’s reference point. The CDC lowered that reference point, from 10, in 2012, and instead of saying “level of concern,” it now says “reference value to identify children … who require case management.”

Godwin’s 9-month-old had a level of six.

In Allegheny County, 15 percent of the roughly 89,000 kids ages 7 and under were tested. More than 7 percent had blood lead levels at or above the current CDC reference point; that’s roughly 1,000 kids in the county.

So who are these 1,000 kids? Where are they living? And how are they coming in contact with lead? So far we don’t know. City Paper filed a Right-to-Know request with the state health department for a breakdown of this data by ZIP code, but has not yet heard whether the request was granted. Upon its initial inquiry, CP was told that the data were likely not on the public record because that might violate medical-privacy laws.

“It’s tough. Having universal testing will be big,” says Robinson.

That’s if it’s ever instituted.

In February, Allegheny County’s leading health official issued a call for mandatory blood lead tests for all children in Pennsylvania between the ages of 9 and 12 months, and again at 24 months.

“We think we’re under-screening for lead, particularly in a county where so much of our housing stock has lead paint. This would help us understand our baseline, which we don’t really have a handle on,” says Dr. Karen Hacker, head of the Allegheny County Health Department.

In March, state Reps. Angel Cruz (D-Philadelphia) and Michael Schlossberg (D-Lehigh County) introduced a three-bill package — House Bills 1917, 1918 and 1919 — that would mandate childhood lead-testing, tighten water-testing restrictions and require landlords to test for lead more frequently. Respectively, the bills went to the Health, Environmental Resources and Energy, and Urban Affairs committees.

State Rep. Matthew Baker (R-Bradford), who chairs the Health Committee, says mandating testing is a “complicated issue” and would need to be discussed with the Environmental Committee.

“I am very cautious about mandates on health-care professionals,” Baker writes via email. “Pediatricians are well versed in screening for lead exposure and can do so if they know or suspect the patient lives in a home that previously had lead paint.” He also raised concerns about the expense of testing.

As for a timetable, he says his staff is reviewing the bill package, and they have only received two inquiries about the legislation “so it does not seem to be a high priority at this point in time.”

Jeffrey Sheridan, press secretary for Gov. Tom Wolf’s office, wrote in an email that the governor “supports universal, mandatory lead testing statewide and is ready to work with the legislature to move mandatory lead testing legislation through the Pennsylvania House and Senate.”

However, state Rep. John Maher (R-Allegheny), who chairs the Environmental Committee, expressed concern about the threat of lead exposure.

“I’m determined that we will hold hearings soon, and I hope that we can better understand the sources of the problem and the possible solutions with an eye toward passing legislation in the fall,” he said by phone in May. “This is an issue of immediate importance … it’s not an issue of partisan discussion.”

Hearings haven’t been scheduled yet. Maher says the committee is trying to find scientists who are proverbially “not carrying water for anybody.”

State Rep. John Petri (R-Bucks) chairs the Urban Affairs Committee where HB1919, regarding landlords testing for lead, currently resides. He did not respond to multiple phone calls.

Landlords whom City Paper spoke to expressed concern and confusion over a bill that would require them to test for lead each time a new tenant signs a lease.

But Schlossberg, whose district includes Allentown — where the highest percentage of kids in the state tested for elevated blood lead levels in 2014 — says lead paint that was once painted over could chip again.

“Since it hits renters, it tends to affect poorer residents, and in cities most of the time residents are minorities,” he says.

Currently the onus to test children for lead is on pediatricians.

The American Academy of Pediatrics does not support universal testing, except in “high-prevalence areas,” like places with older housing stock. Other risk factors that the organization deems a reason to test 1- or 2-year-olds include if they are recent immigrants, refugees or adoptees, and if a child lives in poverty.

This is the stance that HUD and pediatricians like Dr. Joseph Aracri, chair of pediatrics for Allegheny General Hospital, support.

His private practice in Green Tree sees about 8,000 children from around the city. He says his office automatically screens for lead at age 9 months, but says the prevalence of lead is very low in Allegheny County.

“I’ve only seen a couple kids over the past 20 years that have been high,” he says. Those children were adopted from China, where he says lead can be found in pottery and paint.

Asked if he supports universal testing, he says, “It’s inexpensive, it doesn’t hurt the kids. I’d be in agreement for it. We run [the test results] in our office.”

According to the state’s health department, the number of children ages 7 and under tested has increased about 7 percent since 2013; and, blood lead levels at or above the CDC’s reference point has decreased about 7 percent.

When a child tests high, Robinson says, the DOH sends community-health nurses to educate the families about lead risks and other household dangers. At most, the department has 160 community nurses, each funded to address various health issues, not just lead.

While bureaucracy continues, Koury and the other employees at Homewood Children’s Village see older housing stock and troubled schools up close on a daily basis. To them, it’s worth it to raise their own grant funding to find out whether lead is hurting the cognitive abilities of the neighborhood kids.

“We’re basically turning over every rock,” Koury says. “I know people say, ‘It’s not the water, it’s more [the] paint.’ [Or they say,] ‘It’s not paint, it’s more [the] air quality.’ There are different schools of thought. Here’s my thinking: If we can eliminate one possible avenue, then why wouldn’t we? We’re looking at mentoring, tutoring, lead, asthma rates. We’re looking at everything because we’re trying to see the [whole] kid.”