Grandmothers come to the front line to help Florida’s uninsured children

Grandmothers will be putting their knack for caring to good use through a new University of Florida-led statewide initiative to identify low-income children with special health-care needs and enroll them in Florida’s public health insurance programs.

The Telehealth Connections for Children and Youth program, funded by a four-year, $1 million federal grant, will recruit grandmothers in traditionally underserved communities to provide information and support to families who are uninsured and not accessing health-care services, beginning this spring. Computer-based videoconferencing will enable health-care professionals to evaluate children’s medical conditions “live” from distant locations, a practice known as telemedicine.

“Two barriers to health care, particularly in low-income black, Hispanic and rural communities, are lack of awareness of services available and fear or distrust of an unknown health-care system,” said program director Lise Youngblade, a UF College of Medicine assistant professor of pediatrics affiliated with the Institute for Child Health Policy at UF.

According to U.S. Census Bureau figures released in 2002, the most recent figures available, about 11 percent of Florida’s low-income children were uninsured. Some 1.7 million Florida residents under the age of 19 come from low-income families.

Children who are uninsured and have special health-care needs—chronic conditions requiring ongoing, specialty care—risk having poor health throughout their lives, Youngblade said.

Through the program, grandmothers who already are volunteering at churches and other community organizations will be recruited and trained to inform residents about the importance of regular medical care, health insurance and screening for special health-care needs. They will direct these residents to community health centers, which provide primary medical care to low-income families and are federally funded through the Public Health Service Act.

At the health centers, project-trained outreach workers will assist those applying for Medicaid or Florida KidCare, the state’s public health insurance program for low-income children. In addition, outreach workers will screen children for receipt of health-care services—for example, frequent doctor visits or extensive medication or therapy use—that might indicate long-term health problems.

Children who meet the screening criteria will be referred to Children’s Medical Services, a state health-care program for children with special health-care needs. Nurse coordinators at Children’s Medical Services sites will use telemedicine links to evaluate children seeking care at the community health centers to determine whether they are eligible for health services provided through the agency.

“Medical evaluation using telemedicine eliminates the need for families and nurse coordinators to travel, thereby reducing the number of families who may be ‘lost’ to the system as they wait for an evaluation appointment,” Youngblade said. “We expect this technology-based program to enable children to quickly begin receiving needed services because the lag between application and evaluation is eliminated.”

The telemedicine equipment also could be used as part of a patient’s continuing care, Youngblade said.

“For example, a patient could be linked to a dermatologist or to a neurologist who may be many miles away—a benefit for families above and beyond the project’s main purpose,” Youngblade said.

Three community health centers, located in Miami, Immokalee and Trenton, plan to participate in the program and will be linked to Children’s Medical Services offices in Miami, Naples and Fort Myers, and Gainesville, respectively. Another community health center in Gadsden County in the Panhandle will be added to the program in two years. All are being equipped with Tandberg Health Care System III, which allows for real-time videoconferencing and high-resolution diagnostic imaging.

Youngblade estimated that each year the program will reach about 400 children at each site.

“The goal is to make the process family friendly, efficient and effective,” Youngblade said.

The Maternal and Child Health Bureau of the Health Resources and Services Administration, a branch of the U.S. Department of Health and Human Services, provided the grant. Children’s Medical Services, part of the Florida Department of Health, provided nearly $715,000 in additional funding for the telemedicine equipment and nurse coordinators at each site. Other program partners include the Florida Institute for Family Involvement, a statewide parent advocacy organization; the state’s KidCare program; Miami’s Early Childhood Initiative Foundation, a private philanthropy; and Community Voices Miami, sponsored by the W.K. Kellogg Foundation.

Youngblade’s UF collaborators are Elizabeth Shenkman, Ph.D., an associate professor of pediatrics and associate director of the Institute for Child Health Policy; John Nackashi, M.D., a professor and chief of the division of general pediatrics; and Sanjeev Tuli, M.D., a clinical assistant professor of pediatrics.

If the project is successful, it may be extended to other community health centers and Children’s Medical Services sites in Florida, Youngblade said.