Results Miller School of Medicine

See: Flores G, Walker C, Lin H, et al. A successful program for training parent mentors to provide assistance with obtaining health insurance for uninsured children. Academic Pediatrics 2015;15(3):275-81.

PM significantly improved knowledge and skills scores

Mean pre-training score = 62 (range: 39, 82)
Mean post-training score = 88 (range: 67, 100); 2 perfect 100 scores
26-point improvement (P <.01)
By test section: improvements in 6 of 9 sections
Greatest magnitudes of increase by section:
- 57% increase for Medicaid and CHIP
- 33% increase on importance of health insurance
- 33% increase on importance of health insurance
PM Satisfaction Survey
- High levels of satisfaction for all 12 components
  - 85% very satisfied/satisfied for comfort addressing problems of families with whom PMs work
  - 100% very satisfied/satisfied for remaining (11) components
- Feedback
  - Areas for improvement:
    - More attention to co-pays
    - Training materials
  - Best features
    - Training effectiveness
    - Tools and materials
    - Small groups

Participant Recruitment
Recruitment occurred at variety of sites throughout community
- Supermarkets
- Department stores
- Dollar stores
- Goodwill stores
- Restaurants
- Public libraries
- Community centers
- Food banks
- Health fairs
- Boys and Girls clubs
- YMCAs
- Churches
- Schools
- Community clinics
- Day-care establishments
- Laundromats
- Apartment complexes
- Housing projects
- Homeless Shelters
- WIC centers
Recruitment Site Map

N=97

Enrollment Protocol
- Uninsured, Medicaid/CHIP-eligible Latino and African-American children recruited at community sites and randomized to:
  - PMs
  - Control group
- Setting: 7 Dallas communities with highest proportion of uninsured and poor minority children
- Recruitment occurred at 97 community sites, including supermarkets, department stores, libraries, Goodwill stores, food banks, health fairs, churches, schools, and housing projects
Parent Mentor Assignment
For participants randomized to intervention group:
- PMs met with families in their homes and at community sites and contacted them regularly via phone, e-mails, and texting
First Home Visit
- 3-5 days after recruitment, participant’s home visited by PM
- PM provides support to family and information from Texas Health and Human Services Commission (THHS), and begins application process with family
First Home-Visit Checklist
- Completed by PM during first home visit and given to research staff
- Topics covered:
  - Medicaid/CHIP education
  - Application requirements
    
    Parent employment
    
    Income and assets
    
    Supporting documents
  - Application submission
  - Social support
Evaluation
- Medicaid/CHIP-eligible L and AA children/parents were recruited at 97 Dallas community sites
- Randomized to PMs or control group getting traditional Medicaid/CHIP outreach
  - PMs were experienced parents with ≥1 Medicaid/CHIP-covered child
  - Received 2 days of training
  - Assisted families for 1 year with
    
    Medicaid/CHIP eligibility
    
    Applications
    
    Retaining coverage
    
    Medical homes
  - Outcomes:
    
    Obtaining coverage
    
    Time to coverage
    
    Parent satisfaction
    
    Cost-effectiveness
    
    10 healthcare measures, monitored monthly for 1 year by blinded assessor
Intervention Group: PM Phone Calls
Monthly Phone Call by PM
- Parent Mentors call each family monthly to complete monthly telephone checklist
- Checklist of covered topics:
  - Application: completing, supporting documents, and submitting
  - THHS Response: approved, denied, need additional information, or challenged decision
  - Next steps (when approved): select plan, healthcare provider, and pharmacy; schedule appointments; and, when necessary, report changes in income
  - Annual coverage renewal: completing renewal application, copying supporting documents, and submitting
Control Group
- Participants randomized to control group received traditional outreach and enrollment from THHS
  - Advertisements on radio, TV, and sides of buses, and posters in federal and municipal buildings
  - Website – English and Spanish
  - 211 – phone service
Monitoring Outcomes
- Both intervention and control-group families received monthly evaluation phone calls by research staff blinded to group allocation
- Outcome Measures:
  - Health insurance – proportion of children with coverage
  - Number of days from study enrollment to obtaining coverage
  - Episodic coverage – proportion of children who obtained but then lost coverage before study termination
  - Parental satisfaction with process of obtaining coverage (whether or not child ultimately covered)
  - Medical costs and cost effectiveness
  - Health status
  - Quality of life
  - Access to healthcare
  - Unmet healthcare needs
  - Quality of pediatric care
  - Parental satisfaction with care
  - Parental-reported financial burden
  - Missed school days
  - Missed parental work days
  - Out-of-pocket costs

Results

PM significantly improved knowledge and skills scores

Participant Recruitment

Recruitment occurred at variety of sites throughout community

Recruitment Site Map

Enrollment Protocol

Parent Mentor Assignment

First Home Visit

First Home-Visit Checklist

Evaluation

Intervention Group: PM Phone Calls

Monthly Phone Call by PM

Control Group

Monitoring Outcomes