KHSA/UCLA Health Care Institute

Pilot Project – Final Report

July 2006

 

Background

 

Seven Kansas Head Start programs participated in a pilot of the UCLA Health Care Institute (HCI), a project designed to increase parent health literacy and reduce unnecessary emergency room and clinic visits.  In a three-year demonstration project in Head Start programs across the U.S., UCLA reported a 48% decrease in ER and a 37% reduction in clinic utilization.  

 

In the fall of 2005, the Kansas Head Start Association (KHSA) received funding to support a pilot HCI project in Allen, Douglas, Johnson, Shawnee and Wyandotte Counties.  The desired outcomes of the project were to:

 

·        Increase parents’ knowledge about how to treat their children’s minor illnesses and injuries;

·        Increase parents’ confidence in caring for their children’s health;

·        Reduce the number of days missed from school and work because of illness;

·        Reduce unnecessary use of emergency rooms and clinics.

 

The seven pilot programs are:  Community Action (Topeka), Community Children’s Center (Lawrence), EOF Head Start (Kansas City) Olathe Head Start, Project EAGLE (Kansas City), SEK-CAP Head Start (covering Allen County) and Sheldon Head Start (Topeka).

 

Project Partners

 

Partners who have provided funding and support for the pilot project are:  The Centene Foundation for Quality Healthcare (Indianapolis); REACH Healthcare Foundation (Merriam, KS); Health Care Foundation of Greater Kansas City; H & R Block Foundation (Kansas City); First Guard Health Plan (Kansas City); the Head Start State Collaboration Office (Topeka) and Kansas Medicaid.   Kansas Medicaid is contributing a 100% match of all private funds raised for the HCI over a two-year period, up to $100,000 per year. 

 

Methodology

 

A team from UCLA, headed by Dr. Ariella Herman, who designed the HCI, presented a two-day training to 35 staff and parents from the seven programs on October 6-7, 2005.  The session addressed strategic project planning, marketing, staff motivation and a mock parent training.   The pilot programs began planning their own parent trainings during the session.  KHSA then followed up with each program to support and reinforce the initial planning.   KHSA also provided a copy of the book “What To Do When Your Child Gets Sick” for each parent and some incentives for the training, including car booster seats and first aid kits.

 

Programs were asked to work within their communities to develop support and secure additional incentives such as health supplies.  Parent trainings were scheduled from mid-January to mid-February 2006.

 

Results

 

987 parents signed up for the seven parent trainings, and 761 (77%) participated. Programs reported that barriers to participation included weather (one program’s training was scheduled on a Saturday morning following a winter storm), transportation and child care.  Several programs were able to offer transportation and child care; however, given that all the parent trainings were scheduled on Friday evening or Saturday, these services represented a significant additional cost. 

 

Parents completed pre-training and post-training questionnaires about their sources of health information and help.  They also completed the same questionnaire at the end of the project, upon completion of their third followup visit with staff.  The following graphs compare results before parents participated in the training and three months after the training:

 

•         When asked where they would first go for help when their child is sick, only 3% said they would consult a health book prior to the training, while 45% gave that answer three months later. 

•         Before the training, 40% of parent would first go to a doctor or clinic, compared to only 16% three months after the training—a 60% reduction. 

•         Similarly, while 4% would go first to the ER before the training, only 1% would do so three months later—a 75% decrease. 

 

 

•         When asked what they would do in the case of specific symptoms—temperature of 99.5, vomiting, earache and cough, parents were much more likely to consult a health book first and less likely to go first to a doctor, clinic or emergency room.  For example, if their child had vomiting for one day, only 4% of parents would have consulted a health book before the training, while 35% would take that action three months after the training.  Before the training, 47% would have gone to a doctor, clinic or ER first, compared to only 17% after. 

•         Staff also reported a significant reduction in average days children missed from school and days their parents missed from work due to their children’s illness.  Before the training, the average school days missed was 1.4, while three months later, it dropped to 1.0—a 29% decrease.  Work days missed decreased from .5 to .3, or 40%. 

 

 

 

Staff also reported a reduction of 39% in the number of actual visits to the doctor or clinic three months after the training, and a 40% decrease in visits to the emergency room. 

 

Using an average doctor visit cost of $62 and an average ER cost of $350, the potential savings to Medicaid if all parents in the pilot programs were trained would be over $638,000 annually.

 

In addition, 85% of parents reported having more confidence in their ability to take care of their children’s health after the training, and 92% of the parents had used the book within the three-month post-training period. 

 

 

Qualitative Results

 

  • Every program reported that parents (and staff) love the book and the training session.  Pre- and post-training survey data reveals the effectiveness of the training in increasing parents’ awareness, knowledge and confidence in referring to the book when their children are ill or injured. 
  • Programs also noted that the project generated excitement among their staff, despite the additional work involved.  This is a hands-on opportunity with immediate rewards, which is a great motivator for staff as well as parents.
  • Programs were very successful in securing community donations and participation in the training.  One program’s gift incentives included two computers and a washer/dryer.  Another partnered with their local hospital to present the training.
  • One program had significant interest in offering the training to the whole community.
  • The following are specific comments from programs’ qualitative evaluation of the parent trainings:
    • Parents loved the book.
    • Parents were so excited and stayed involved during the entire training.
    • Giving a stipend for child care worked out great for us.
    • Parents really valued the information.
    • Families were very engaged in this training.  They asked questions and readily answered questions asked by presenters.
    • Staff observation informs our practice by indicating those parents who have literacy issues or need additional assistance in using this resource.
    • Staff were able to address health-related questions at the followup home visit.
    • The activity in which parents took their own temperature was a big hit.  It may seem like an easy thing, but some parents are too embarrassed to ask for help and did not know how to use the thermometer.
    • Our program added a health fair to the HCI, which was also a big hit.
    • Sample parent quotes:
      • “I don’t have to go to the ER as much any more.”
      • ”I don’t have to call the doctor as much because this book gives a lot of information.” 
      • “I read the book all the time.”
      • “I check the book, and that way I don’t worry with his symptoms.”
      • “Love the book, have shared it with neighbors, and they want to know if it is available for sale.”

           

 

Next Steps

 

Six of the seven pilot programs are planning to offer the HCI again in the fall of 2006.  One is not able to implement it this next year because of other project commitments, but plans to resume the training in 2007.  Pilot programs have met since the conclusion of the first-year HCI to share learnings and plan for their next round.

 

Through the Medicaid match, KHSA is expanding the HCI to seven additional Kansas Head Start programs in 2006.  These programs were chosen based on their interest in the HCI and their commitment to offering the parent trainings, securing community support and participating in the research component of the project.   They participated in a train-the-trainer conference with UCLA on June 19 and 20. 

 

With the 14 programs now licensed to offer the HCI, almost 5,000 Kansas Head Start families are eligible to participate—or 63 % of total families served by Head Start in the state. 

 

In fall 2006, KHSA will be adding a research component in which actual Medicaid data will be compared prior to and after the training.  KHSA is partnering with the Kansas Health Institute to conduct this research.