Research reported on this website was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) under Award Number R01HD066219. The content is solely the responsibility of the authors, and does not necessarily represent the official views of NICHD or National Institutes of Health.
Glenn Flores, M.D.
Professor-
Acknowledgements
Contributors
- Glenn Flores, M.D.
- Mike Lee, M.D.
- Mark DeHaven, M.D.
- Hua Lin, Ph.D.
- Candice Walker, Ph.D.
- Marco (Tony) Fierro, BA
- Kenneth Massey, BA
- Monica Henry, BS
- Alberto Portillo, BS
- Janet Currie, Ph.D.
- Rick Allgeyer, Ph.D.
Funding
Supported in part by Award #R01HD066219 (to GF) from Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Content is solely responsibility of authors, and does not necessarily represent official views of NICHD or the National Institutes of Health
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Background
Uninsured children in United States
- Having no health insurance has profoundly negative impact on children’s health, healthcare, and mortality, but 4.8 million US children uninsured
- Between 64-72% of uninsured US children eligible for but not enrolled in Medicaid/CHIP
- Among low-income children, 84% Medicaid/CHIP eligible but not enrolled
Impact of having no health insurance: uninsured children
- No usual source of medical care
- No regular physician
- Greater access and financial barriers to health care
- Higher unmet needs for medical care and prescriptions
- Less likely to make routine healthcare, dental, and eye examination visits
- Half as likely to have medical homes
- Not up-to-date on immunizations
- Twice the odds of avoidable hospitalization
Racial/Ethnic Disparities
- Minority children experience substantial health-insurance disparities
- Only 4.9% of white children uninsured, compared with 5.1% of African-American and 9.6% of Latino children
- Latino and African-American children account for 53% of all uninsured children in America, but only 48% of total population of US children
- Latino and African-American children comprise 70% of low-income children without insurance
Uninsured Children in Texas
- Texas “minority majority” state; racial/ethnic minorities comprise 55% of all Texans
- Texas has highest number and third highest proportion of uninsured children in our nation, with more than 1 in 12 children without health insurance
- Texas has had consistently high proportion of uninsured children since 1998
Uninsured in Dallas County, TX
Dallas County, TX, ideal setting for studying uninsured minority children, because:
- Texas has highest proportion and number of uninsured of any state in America, at 19% and five million, respectively
- Texas has highest number of uninsured children (783,938)
- 9% of children in Dallas County are uninsured, compared with 9% in Texas and 6% in US
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Program Overview
Kids’ HELP definitions and aims
- Kids’ Health Insurance by Educating Lots of Parents
- Randomized controlled trial of effects of Parent Mentors on insuring minority children
- Primary aim: To evaluate whether Parent Mentors more effective and cost effective than traditional Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment methods in insuring eligible, uninsured Latino and African-American children
Secondary Aims
To examine whether insuring previously uninsured children results in:
- Improved health status
- Improved quality of life
- Improved access to healthcare
- Reduced unmet healthcare needs
- Improved quality of pediatric care
- Improved parental satisfaction with care
- Reduced parental-reported financial burden
- Fewer missed school days
- Fewer missed parental work days
What are Parent Mentors?
Experienced parents who already have child covered by Medicaid or CHIP
Why Parent Mentors?
Parent Mentors (PMs) are a specialized form of Community Health Workers (CHWs) in which parents of children with particular health condition or risk leverage relevant experience, with additional training, to assist and counsel other parents of children with same condition or risk.
Parent Mentor Responsibilities
- Provide information on types of insurance programs available for children and application process
- Provide information and assistance on insurance program eligibility requirements
- Complete child’s insurance application together with parents and submit application for family
- Act as family advocate by liaison between family and Medicaid and CHIP
- Contact Medicaid/CHIP program representatives to correct situations in which child inappropriately deemed ineligible for insurance or had coverage inappropriately discontinued
- Assist with completion and submission of applications for renewal of child’s insurance coverage
- Teach about importance of medical homes and taking active role in pediatric care
- Address social determinants of health (poverty, food insufficiency, etc.)
Parent Mentor Screening and Recruitment
PM eligibility criteria included:
- Latino or African-American race/ethnicity
- Primary caregiver for ≥1 child covered by Medicaid/CHIP for ≥1 year
- Residing in or near a zip code within one of five Dallas regions with the highest proportion of uninsured and low-income children
- English proficiency, and if Latino, bilingually fluent in English and Spanish
- Has a phone
- Available time/commitment to assist families with obtaining Medicaid/CHIP for their uninsured children (therefore, not employed or attending school full-time, and has no children ≥2 years old)
- Able to attend a one time two-day training session
- History of on-time arrival to clinic appointments
- Has trusting and long term relationship with Clinic staff
Parent Mentor Characteristics
- Of 31 PM candidates interviewed, 15 chosen to be PMs
- 100% female
- 60% African-American; 40% Latino
- 33% married and living with spouse
- 87% high-school graduates
- 60% unemployed, 40% employed part-time
- Mean number of children = 3
- Mean annual family income = $20,913 (range: $2,400-75,000)
Parent Mentor Training
- Two-day interactive training session
- Ten sections
- Why health insurance is such an important issue for American children
- The Kids’ HELP program
- Being a successful PM
- PM responsibilities
- Medicaid and CHIP
- The application process
- Next steps after obtaining Medicaid/CHIP coverage
- Importance of medical homes and taking active role in pediatric care
- Study paperwork
- Sharing experiences
- Manuals provided in English and Spanish
- Evaluation
- 8-question demographic survey of PM and children
- 33-item pretest to assess PM knowledge and skills for 9 sections of training
- 15 true/false statements
- 18 multiple-choice
- Scored on scale of 1 to 100 points
- 46-item posttest:
- 33-items pretest items (ordered differently)
- 13 Likert-scale questions on training satisfaction
- Training overall
- Relevance of topics to participants needs
- Materials received and value in preparation for session
- Skill-based training emphasizing interaction and participation
- PM’s ability to apply knowledge and skills to help parents
- Learning one thing to enable greater effectiveness
- Sufficient time to cover session content
- Materials increase efficiency
- Comfort addressing problems of target families
- Knowledge and professionalism of instructors
- Instructors stimulating an interest in materials
- Ten sections