HealthSpark: Health Access for Children in Federally-Subsidized Child Care

Preschool children are at risk for developing health problems that affect school readiness
and that lead to significant health conditions through adulthood. Several decades of research
have demonstrated that early identification and intervention is the best approach to ensuring
healthy, successful children and adults. Despite advancements in our understanding of child
health, large gaps in services continue; especially for children in poverty and for
ethnic/racial minorities. National data supports the persistence of health disparities among
children.

In May 2004, the HealthSpark team began to collect data from the parents, child care center
directors, and local pediatricians in the two targeted communities. The HealthSpark I sample
included 681 assessments of parents with children ages three or four years old, 53 child care
center directors, and 30 primary care pediatricians. The parent assessments were conducted in
person at the child care center. Additionally, in September 2004 four focus groups were
conducted in the three primary languages of the communities, English, Spanish, and Creole. A
content analysis was done on these sessions to determine the most prominent issues in each
location.

Prevalence rates for obesity (38.0%) and asthma (29.3%) among the children the team surveyed
were well above the national averages (20% and 7.4%). Despite high rates of health problems,
roughly 10% of families reported not being able to get medical care for their child when they
needed it, compared to the national average of 1.7% and a state of Florida average of 3.0%.
HealthSpark also discovered that 20.9% of children are not properly restrained in motor
vehicles. This statistic raises particularly high concern due to the fact that motor vehicle
accidents are a leading cause of death among children and proper restraint in a vehicle is
one step towards overcoming this statistic.

Access to health care is especially important for children with special health care needs. Of
the total population, 8.7% need or use more medical care, mental health, or educational
services than the average child. While this is low in comparison to the national average
(12.8%), it still accounts for a significant portion of the population and demonstrates the
need to ensure all children have appropriate access to care. Even though the majority of the
children HealthSpark surveyed had some form of health insurance, 11.3% did not have any. This
number is higher than the national average (9.5%) and raises concern over why specific
barriers to access healthcare have not been broken down. During focus group sessions, parents
described what specific issues were preventing them from either accessing medical care or not
getting their children enrolled in the proper insurance program; these problems varied by
region. Families located in the Allapattah/Model City region have access to Jackson Memorial
Hospital and clinics but described long waiting times before they were able to see a
physician. In contrast, families in Homestead/Florida City had more prevalence of uninsured
children and are limited by their lack of access to transportation. Few families have cars
and many described having to walk several miles in order to use public transportation. Many
parents are not satisfied with the quality of healthcare their children are receiving,
especially for families in the Homestead/Florida City area. Among the 43 healthcare
professionals who deliver most of the pediatric primary care in these communities, 42.9% are
not board-certified and only 26.2% are members of the American Academy of Pediatrics.

In HealthSpark I, we discovered child health issues existed in large part because of the lack
of care and resources families in Miami-Dade County are receiving. However, even if every
family had access to a high quality pediatrician the health of children in these two areas
would not immediately improve. Interventions with a high level of collaboration among child
care centers, pediatricians, and health educators will be the first step to improving the
health of children within these two communities. In HealthSpark II, the intent is to
demonstrate that improved coordination and cooperation among professionals and families will
improve child health. The resources already exist in each community. In the initial
HealthSpark survey, a network of child care centers and pediatricians interested in improving
the health environment of the children in their community were identified. The HealthSpark
team plans on helping these professionals come together and form a relationship that will
improve and address the health needs of families.

Inclusion Criteria:

- Children ages 3 - 5 years, enrolled in one of the designated SPARK child care centers

Exclusion Criteria:

- Children under the age of 3 years or over the age of 5 years

- Children whose parents do not want to participate

- Children whose child care centers do not want to participate