Increasing children’s access to and use of preventive health care

In spring 2002, the Blue Cross Foundation made grants to nine organizations around the state to improve access to and use of preventive medical and dental services for children and teens. Focused on the needs of immigrant communities and communities of color, the $1.4 million Growing Up Healthy program aims ultimately to improve the health of Minnesotans at higher risk for lifelong health disparities.

The grants also address specific barriers to preventive care, including limited English fluency, unfamiliarity with the health care system, shortages of health care providers (especially those who are culturally competent), cultural isolation, cultural attitudes toward preventive care and health care coverage. Recent studies indicate that American Indians, populations of color, foreign-born populations and low-income families are over-represented among Minnesota’s uninsured.

In awarding the grants, the foundation sought diversity in the types of organizations, the strategies used and the populations served. Growing Up Healthy grantees included schools, immigrant-led mutual assistance organizations, nonprofit dental providers, academic institutions, parenting support groups and health clinics.

Results of Growing Up Healthy

Growing Up Healthy reached an estimated 17,500 people in two years. In keeping with the goals of the initiative, over 90 percent of children who received or were connected with a preventive health or dental exam were in communities of color.

• Growing Up Healthy grantees served more than 6,700 children
• About one-third of these children and youth received preventive dental or well-child exams from grantees. Most of the direct services were provided to young children; 78 percent were under age 12.
• The majority of these children had never received a preventive health visit before
• 93 percent of the children who received direct preventive health or dental care services were American Indian, Latino, African immigrant, Southeast Asian or multi-racial
• At least 3,100 adolescents received outreach or referral services. Most of these youth received group education about preventive health and accessing care
• 496 American Indian and Latino adolescents received a preventive health or dental exam directly from grantees
• 40 clinicians received specific training and feedback from adolescent actors as part of the University of Minnesota Division of Pediatrics and Adolescent Health project, the only grantee to focus on addressing intrinsic barriers that may reduce the effectiveness of practicing clinicians
• Grantees report that more than 1,700 families made progress toward getting health insurance due to help from the project
• In all, about 17,500 individuals received outreach, training or referrals through Growing Up Healthy
• In a follow-up survey, 100 percent of immigrant parents who received health or dental information said they found the information helpful
• Seven out of 10 parents surveyed reported that the project helped them overcome barriers to receiving care — most commonly, the cost of care, lack of insurance and lack of transportation
  

The projects increased access to preventive services for families of color through three primary methods:

• Bringing the services to the child by providing preventive care at schools and preschools
• Reaching out through bilingual/bicultural community health workers who advocate, translate and bridge cultures for families from immigrant and tribal communities
• Engaging community leaders to change cultural norms and traditional health beliefs regarding preventive care

Other key results of Growing Up Healthy

Partnerships were forged among communities of color and/or recent immigrant groups, health providers and other organizations. Fifty different agencies collaborated with Growing Up Healthy grantees. Health and dental care providers strengthened their cultural competence through training and through the integration of bicultural or bilingual community health workers.

In addition, projects repeatedly found that many families needed help with basic needs and crisis issues such as acute health problems, loss of housing, lack of financial resources and legal problems — priorities that needed to be addressed first, before families could receive and accept preventive health messages.

Blue Cross Foundation staff observed that working with the nine grantees through Growing Up Healthy has helped them think about their new strategic direction. With a focus on addressing socio-economic and environmental barriers to preventive care, Growing Up Healthy provides valuable learning and services as a bridge to the foundation’s new grantmaking priorities.