HealthSpark: Health Access for Children in Federally-Subsidized Child Care
Condition: Asthma; Obesity; ADHD
Study type: Observational

Summary: 
      HealthSpark is a community-based research network of childcare centers designed to improve
      the health of children in Miami-Dade County. HealthSpark is the health component of SPARK
      (Supporting Partnerships to Assure Ready Kids), a community coalition led by the Early
      Childhood Initiative Foundation to improve school readiness in Allapattah/Model City and
      Homestead/Florida City, two underserved Miami-Dade County communities. The goal of
      HealthSpark I is to identify the health and healthcare needs of preschool children, then help
      translate evidence-based intervention into community programs.
    

Detailed description: 
      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.
    

Observational model: Case-Only
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Children aged 3-5 years who are enrolled in federally-subsidized early care and education
        centers in underserved communities in Miami-Dade County
      
Keywords: child care centers; community based research; behavioral health; health literacy; unmet healthcare needs