It's early morning at Wade Early Learning Center and preschoolers are working on coordination by playing a rambunctious game of rings.
Director Gloria Allen is standing nearby. She has just finished looking over a spreadsheet detailing how many of the children in her four classrooms have lead poisoning.
"It's a little scary, only because lead can cause a lot of different things for children. It can cause attention deficit, they have trouble focusing. So you want to help catch that before they get ready to go to school," Allen says.
Wade is located in Cleveland's St. Clair-Superior neighborhood - a community that could be considered the epicenter of Northeast Ohio's lead problems.
Aysha Wilburn leads the education program at the nonprofit Centers for Families and Children, which runs Wade. She says about 25 percent of the preschool's children have tested positive for more than 6 micrograms of lead in their blood - enough, health experts agree, to stunt mental development and cause behavior problems in grade school.
"But you would never know, because we don't see the effects of those children until they leave our program," Wilburn says.
It turns out, the biggest challenge in helping children who have lead in their blood, is the simple fact that you can't see that they have been poisoned.
Dr. Mary Jean Brown is chief of the US Centers for Disease Control and Prevention's lead prevention branch. She says children with high blood lead levels have less dense brains in certain areas.
"And those are the areas that are most likely to affect behavior, judgement, executive function and language development," Brown says.
At Wade, all children attending have to have lead tests. If it comes back positive, then the teackers talk to the families. Staff workers visit the homes to educate the family on how to keep lead out of their children's mouths and they talk about nutrition.
Rebekah Dorman heads Cuyahoga County's Invest in Children initiative. They hope to create a program in which doctors and parents work together to steer all lead-poisoned children to pre-kindergarten programs like Wade.
"We do want families who have a child with this extra risk to understand what that extra risk could mean to that child and why there's an even greater urgency for them to seek out the programs for their child and get the extra help," Dorman says.
That urgency is important because a young child's brain is still pliable, says Elizabeth Anthony at Case Western Reserve University's poverty center.
"Maybe we should start thinking about it as a brain injury like we would other types of brain injury where we don't accept the fact that the damage can be done and there's nothing we can do about it," Anthony says.
But there are risks to this approach too. And - as everyone working on it points out - it's better for the child to never have been exposed at all.
Consider the early evidence from a study of 600 preschool children during one year of education - some with lead poisoning and some without.
"The gains that are being made by those kids with an elevated blood lead level above five aren't enough to put them on track with their peers who didn't have, who didn't show up in our lead data," Anthony says.
In other words, high-quality preschool helped mitigate but didn't fix the harm caused by lead.
So even as the preschool initiative gets off the ground, officials in Cuyahoga and Cleveland are applying for the next round of federal housing lead abatement grants. They hope to win money to take the lead out of houses before children get poisoned.
And there are private funders talking about how requirements under the federal Affordable Care Act could help prevent poisoning. The CDC's Mary Jean Brown declined to give much detail on this effort, but did say...
"Decision makers and others in Cleveland are coming together to think about ways that they can most effectively bring the resources available through the ACA to bear on this problem."
For now, the most promising work happening in Cleveland is back at Wade - with preschool teachers like Tanisha Golding…
"You made your D! Give me a high five Dallas… "
The boy smiles big.
"You wrote your name Dallas. Did you know that? That's some big work… I was making D and down."
The little boy looks down at his page with determination. He wants to do more.