Evidence-Based Practice in Foster Parent Training and Support ...

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EBP in Foster Parent Training and Supportburden and financial problems among the uninsured. Evidence was mixed for theeffects of insurance type and insurance characteristics on outcomes. None of thestudies attempted to assess the impact of health insurance on health outcomes.Implications: The review of the literature found plentiful evidence demonstratingthe positive and substantial impact of insurance on access and utilization. There isalso clear evidence that insurance protects families against financially burdensomeexpenses.Krauss, M. W., Gulley, S., Sciegaj, M., &Wells, N. (2003). Access to specialtymedical care for children with mentalretardation, autism, and other special healthcare needs. Mental Retardation, 41, 329-339.Population: Children with special healthcare needs (could include foster childrenbut not exclusive)Limitations: Many of the studies rely on cross-sectional, correlational designswhich lack random assignment.Method: This article examined access to specialty medical care among childrenwith mental retardation, autism, or other types of special health care needs from anational survey. In 1998-1999, 2,220 families of children with special health careneeds in 20 states responded to a survey conducted by Brandeis University andFamily Voices, a national organization of family and friends of children with specialhealth care needs. The sample was drawn from two sources, 1) 42.6% of thesample was form state-based mailing lists of Family Voices, and 57.4% of thesample were families whose children received service from the participating stat’sTitle V program. Of the 2,220 children on whom survey data were collected,virtually all (97%) were covered by a health plan. Almost half (46%) were coveredby health plans purchased privately and over a third (39%) had their primary planpaid for by Medicaid. A total of 1,799 children (81% of total sample) were includedin the analyses. Three groups were compared: those with mental retardation (n =434), those with autism (n = 152), and children with special health care needs withother conditions (n = 1,213).Findings: Over a third of the children with autism, over a fifth with mentalretardation, and over a fifth with other types of special health care needs hadproblems obtaining needed care from specialty doctors in the preceding year. Themost common problems included getting referrals and finding providers withappropriate training. Children with unstable health conditions, autism, or thosewhose parent were in poor health were at greater risk for problems. PrimaryMedicaid coverage and public secondary health coverage were associated withfewer access problems.Center for Advanced Studies in Child Welfare (CASCW)University of Minnesota School of Social WorkContact: Kristine N. Piescher, Ph.D. kpiesche@umn.edu 121
EBP in Foster Parent Training and SupportNewacheck, P. W., Hung, Y., Marchi, K. S.,Huges, D. C., Pitter, C., & Stoddard, J. J.(2001). The impact of managed care onchildren’s access, satisfaction, use andquality of care. Health Services Review, 36,315-334.Population: Non-institutionalized childrenLimitations: This study did not include a control group; all medical conditions (i.e.asthma) would be considered in the third category. This study was dependent onself-reported data by the primary care giver.Method: This descriptive study explored the effects of managed care on access,satisfaction, utilization, and quality of pediatric health services. Study used datafrom the 1996 Medical Expenditure Panel Survey (MEPS). The MEPS collects dataat both the person and household levels and, when weighted, provides nationallyrepresentative estimates of health care access, satisfaction, utilization, quality,expenditures, sources of payment, and insurance coverage for the U.S. civilian,non-institutionalized population. Interviews were conducted in person with one adultmember of each participating household using a computer assisted personalinterview methodology. A total of 5,995 children ages 0-17 were represented in allthree rounds and are used in the analyses that follows.Findings: Among the 18 outcome indicators examined, the bivariate analysisrevealed only three statistically significant differences between children enrolled inmanaged care and children in traditional health plans: children enrolled in managedcare were more likely to receive physician services, more likely to have access tooffice-based care during evening or weekend hours, and less likely to report beingvery satisfied with overall quality of care. However after controlling for confoundingfactors, none of these differences remained statistically significant.Okumura, M. J., McPheeters, M. L., &Davis, M. M. (2007). State and Nationalestimates of insurance coverage and healthcare utilization for adolescents with chronicconditions from the national survey ofchildren’s health, 2003. Journal ofAdolescent Health, 41, 343-349.Limitations: This study used self-reported data; the researchers were not able toverify the type of insurance and plan. The level and quality of care were subjectiveto parents’ report.Method: This descriptive study examined health and insurance characteristics ofadolescents (aged 14-17) with special health care needs at both state and federallevels. Data came from the National Survey of Children’s Health 2003, a nationallyrepresentative sample of children in the U.S. Estimates are based on 102,353interviews completed from January 2003 through July 2004.Findings: Approximately 22% of adolescents 14-17 years old have a special healthcare need. On average, adolescents with special health needs have one moreannual office visit per year than adolescents without these needs. Additionally,adolescents with special health needs reported three times the rate of unmetmedical needs, despite higher rates of insurance coverage. Overall 26.9% of theseCenter for Advanced Studies in Child Welfare (CASCW)University of Minnesota School of Social WorkContact: Kristine N. Piescher, Ph.D. kpiesche@umn.edu 122
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