2. Project HOME
3-year $1.2M grant funded by the Office of Head Start, Administration for Children and Families
Project Team
Lise Youngblade, PhD, & Karen Caplovitz Barrett, PhD, co-Principal Investigators
Collaborators:
Francisco Palermo, PhD, Department of HDFS
Jonna Pearson, PhD, Department of Journalism and Technical Communication
Ann Bruce, PhD, CSU Extension
Kimberly Miller, PhD, Tri-Ethnic Center and Department of Psychology
Jennifer Anderson, PhD, & Laura Bellows, PhD, Department of Food Science & Human Nutrition
Graduate Students (Laura Hahn, Jamie Wensink, Liz Zimmerman, Melanie Kelsea, April Thomas, Lydia Linke, Marie LeHaye, Hayley Jackson)
Partners
Head Start State Collaboration Office
CO Department of Public Health & Environment, CO Medical Home Initiative
CO Department of Health Policy & Financing
Head Start programs in 3 Colorado areas

3. Goal
To refine, implement, evaluate, and sustain a family-empowering, culturally sensitive, replicable train-the-trainers curriculum for improving Head Start families’ healthcare literacy skills

4. Background
Children eligible for Head Start are at risk for non-optimal use of the healthcare system. Risk factors include:
Low SES (income, education, resources, challenging life situations)
Cultural factors
System barriers
These risk factors, in concert with non-optimal use of healthcare, set children on potential pathway to increasingly poor health outcomes and concomitant expensive service utilization.
Has an accelerated effect because effects of poor health early in life are difficult to reverse, become more complex with added comorbidities, and become extremely expensive to the system.
None of the risks are completely presumptive, so great opportunity for early intervention.

5. Background
An important impediment to low-SES families’ optimal use of the healthcare system is their need for further knowledge and skills related to:
Recognizing health warning signs and knowing how to respond
Understanding common childhood illnesses
Distinguishing symptoms that require a visit to a healthcare provider from those that one can care for at home
An intervention study showed that such healthcare training with Head Start families can reduce emergency department and clinic visits (Herman & Mayer, 2004; Herman, 2007).
Parent report of Medicaid utilization suggested reduced Medicaid costs
Project HOME will adopt a more stringent approach of accessing actual Medicaid program usage data.

6. Background
Health policy has grappled with these issues and coalesced around a model of pediatric access known as “Medical Home”
Medical Home is not a place, but rather a set of guiding standards for ensuring that healthcare is accessible, community based, family-centered, continuous, comprehensive, coordinated, compassionate, and delivered in a culturally competent environment
Medical Home promotes an empowering partnership between family and provider, and creates a coordinating center for both medical and non-medical needs
When implemented, research demonstrates improvement in access to care, pediatric health outcomes, improved system efficiencies, and control of healthcare spending

7. Expected Outcomes
Goal: Improve Healthcare Literacy Skills for Head Start Families.
Improved parent knowledge about health, use of healthcare and available resources
Increased understanding about Medical Home
Improved parent behavior with increased use of preventive care, identification of medical home and decreased inappropriate ER and clinic use.
Increased preventive health behavior (eating and physical activity)

8. Intervention Components
Three areas
What to do when their child is sick
Understand the healthcare system, what a Medical Home is & why it is important
Promote health through nutrition and physical activity
We train Head Start family workers and other interested staff to provide this curriculum
Head Start staff provide parent training

9. Training Materials Used
What to do when your child gets sick
English & Spanish
Medical Home Brochure
Medical Home Resource List
Food and Activity Cards

14. Measures Pre/post knowledge tests at each parent meeting
Medical Home (4 multiple-choice questions)
What to do when your child is sick (11 multiple-choice questions)
Each question has 1 right answer
Parent surveys (baseline, 1 month, 3 months, 6 months)
Demographics
Healthcare utilization (self report of source & amount of use)
Medical home assessment of usual source of care (qualities, barriers)
Healthy Eating and Physical Activity

15. First Year
Consents and at least some Surveys from 132 families (72 Spanish, 60 English); 83% Hispanic/Latino; 6% Native; 2% each Black, Asian; 52% of children were girls
79 have pre/post training data
39 have pre/post/follow-up for medical utilization reports, medical home, and nutrition/activity outcomes

16. First Year Initial Results: Knowledge
Compared test average from pre-to-post:
Parents improved from 63% correct to 68% correct on Medical Home test (trend level significance, p < .08).
Parents improved from 76% correct to 87% correct on What to Do When Your Child is Sick test (statistically significant at p < .001)
Compared by primary language, English-speaking and Spanish-speaking parents showed the same pattern of results, although overall English-speaking parents had greater percentages of correct answers.

17. First Year Initial Results: Healthcare Utilization
Pretest--Posttest—Followup Contrasts F(1,37):
Times Visit doctor when sick : significant linear decline from to times in past 3 months, F(1,37)= p = .003
Times see specialist: no change (1.26 to 1.21).
Times go to ER when sick: significant decline pre to post, from to 1.08, F(1,37) = 4.83 p=.034
Times go to ER when hurt: no change from 1.03 to 1.00
Days child absent from preschool: significant linear decline from to 1.13, F(1,37) = p <.001
Days parent misses work due to child illness: significant linear decline from 1.36 to 1.08, F(1,37)= p =.003.
No interaction with language, but Spanish speakers report slightly lower overall absence from preschool

18. Change from Pretest to Follow-up

19. Change from Pretest to Follow-up

20. Change from Pretest to Follow-up

21. First Year Initial Results: Identification of medical home
Pretest—Posttest—Follow-up Contrasts:
Pre-post increase in families’ identification of medical homes for their children (F[2,34]=8.579, p<.0001).
Qualified by ethnicity (Latino or non-Latino; F(2,34)=3.816, p<.05)

22. Change from Pretest to Follow-up
Percentage of Families Identifying Medical Home

23. Change from Pretest to Follow-up
Percentage of Families Identifying Medical Home: by Latino Ethnicity

24. First Year Initial Results: Nutrition and Activity
Pretest—Posttest—Follow-up Contrasts:
Child Behavior:
Child ate fruit/vegetables in last week: no change
Child spent 15 minutes in physical activity with parent: no change
Child watched TV: significant linear decrease
Parent beliefs:
Importance of child eating fruit/vegetables: significant increase
Importance of child being physically active: significant increase

25. Change from Pretest to Follow-up
Child watched TV

26. Change from Pretest to Follow-up
Important for child to eat fruits/vegetables

27. Change from Pretest to Follow-up
Important for child to be physically active

28. Limitations and Future Directions
Restricted sample size, missing data
Use of parent report
Lack of control group
Future directions
Evaluate impact on behavior through analysis of Medicaid claims
Additional sites with diverse families
Modifications in training
Inclusion of control group