Quality of Early Childhood Health Care in the Los Angeles Healthy Kids Program

Quality of Early Childhood Health Care in the Los Angeles Healthy Kids Program Prepared for: Prepared By Moira Inkelas and Patricia Barreto The University of California at Los Angeles July 2007 The University of California at Los Angeles The Urban Institute 2 Abstract The Los Angeles Healthy Kids program was created in 2003 to provide health insurance to uninsured children ages 0–5 years in families with household income below 300 percent of the federal poverty level (FPL) who are ineligible for SCHIP or Medicaid. A quality of care survey sampled parents of 538 children ages 12–72 months enrolled in the program for at least one year, with a response rate of 91 percent. Parents reported whether they discussed their young child’s development and received recommended content of preventive care. Results show that quality of preventive care for children in Healthy Kids has similar patterns as care for children in low-income households, both in California and nationally, based on the 2003 National Survey of Children’s Health. Among children with a recent preventive care visit, parents of only 31 percent of children in the Healthy Kids survey were asked about their concerns, and only a quarter received information about their specific concerns. Content of preventive care is well below American Academy of Pediatrics (AAP) recommendations, although it is consistent with statewide and national levels of care. Given that parental concerns about health and development are predictive of later learning and developmental problems, more systematic elicitation and discussion of concerns is an important area for strengthening care quality. Acknowledgments This report presents data from the Healthy Kids parent survey developed by the Urban Institute and Mathematica Policy Research. The authors thank Ian Hill of the Urban Institute for content review and Louise Palmer of the Urban Institute for analysis of the Healthy Kids survey. The authors are grateful for the direction and support provided by Will Nicholas, our project officer at First 5 LA. 3 Introduction The Los Angeles Healthy Kids program was created in 2003 to provide health insurance to uninsured children ages 0–5 years. A year later, the program was expanded to cover older children, ages 6 through 18, as well. The program covers children in families with household income below 300 percent of the federal poverty level (FPL) who are ineligible for Healthy Families and Medi-Cal. First 5 LA funded Healthy Kids to improve health and well-being for young children. While insurance coverage should improve access to medical care for acute illnesses as well as chronic care, First 5 LA hoped to improve access to and the quality of preventive care as well. Because primary care for children ages 0–5 years provides important opportunities for preventive health care as well as early identification of problems with health, learning, and development, there is value in understanding the extent to which health care priorities of prevention and health promotion for young children are being met. Background In addition to medical check-ups and immunization, preventive care for young children focuses on identifying developmental concerns and providing parents with information on an array of topics,1 including anticipatory guidance about what behaviors to expect in young children and parental education to emphasize the importance of positive, development-promoting activities, such as reading to their child regularly. Developmental monitoring, which includes routinely asking parents during well-child visits about any concerns they have regarding the child’s growth, learning, and development, helps clinicians to prioritize guidance and counseling to meet the parents’ needs. Discussing parental concerns is also important for identifying issues within the family or about the child as early as possible. The Healthy Kids parent survey provides the first information in Los Angeles County on the quality of health care for young children, including developmental monitoring and screening and the content of anticipatory guidance. This survey creates an opportunity to compare the experience of Healthy Kids enrollees with other subgroups of young children using recent state and national surveys. Data and Methods The Healthy Kids parent survey was developed by the Urban Institute and Mathematica Policy Research, Inc. The survey is part of a multiyear evaluation of the Healthy Kids program in LA County and aimed to demonstrate the impact of Healthy Kids on a range of child health measures. The survey was fielded at two points in time: Wave One data collection occurred from April through December 2005, and Wave Two data collection occurred from May 2006 to January 2007. This analysis focuses on established enrollees from Wave 1 of the survey. The sample for Wave 1 included children ages 12–72 months who either were enrolled in Healthy Kids during the mont