July 19, 2004

Ariella Herman: Making A Difference In Children’s Health Care

Research Shows Medicaid Costs Can Be Significantly Reduced By Training Parents

ariella hermanThere are few things with the potential to panic a parent like the illness of their child, but childhood ailments are not uncommon. What symptoms are safe to handle at home, and when should a parent make the time-consuming and expensive trip to an emergency room or clinic? How many parents are equipped with the knowledge to confidently make these decisions?

As shown by a first of its kind study from the UCLA/Johnson & Johnson Health Care Institute, the impact of the answers to these questions extends beyond the personal problems involved. In fact, it reverberates out into one of society’s most intractable dilemmas: the high cost of health care. Under Ariella Herman, senior lecturer of operations and decision sciences at UCLA Anderson School of Management and lead investigator, studies show that Medicaid costs can shrink significantly when parents are trained in the treatment of minor childhood sicknesses.

Ensuring Positive Health Outcomes in Head Start Children and Families, the research headed by Herman, was inspired by Head Start directors who had graduated from UCLA Anderson’s Head Start-Johnson & Johnson Management Fellows Program. Founded in 1991, it is the only executive management program of its kind.

Specializing in research related to social issues, Herman is an expert in childcare and health care management. She is well versed in the concerns of Head Start parents and families, having taught in the fellows program for more than a decade. She received its first Outstanding Head Start Faculty Award in 2000.

“Head Start parents, like all good parents, want only the best for their children,” Herman says. “Our studies showed that by raising the health literacy of Head Start parents, they could immediately apply that knowledge to become the first line of defense in taking care of their children’s health. The findings could have far-reaching implications in bringing down Medicaid costs.”

ariella herman in classroomThe studies began in 2000 with a survey of Head Start-Johnson & Johnson fellows nationwide. Initial research revealed a shared concern: Parents simply lacked time and tools to acquire the basic health care knowledge needed to effectively manage a youngster’s illness. The fellows believed that if parents could become better informed about fundamental health issues, it could lead directly to healthier outcomes for their children.

Started as a pilot project in 2001, the UCLA/Johnson & Johnson Health Care Institute entered its third year in April 2004. By the end of 2005, the institute estimates it will have trained 79 agencies, 790 staff and 11,600 parents nationwide. Achieving this goal could mean savings to Medicaid of nearly $2.4 million annually from direct costs associated with unnecessary health care facility visits. Using $200 as the average cost at a hospital’s emergency room and $30 for a clinic, it was found that Medicaid costs could be reduced annually by at least $198 per family when Head Start parents are provided with easy-to-understand health care guidance.

Researchers estimate that the savings could reach many millions per year if funds were available to provide health literacy training for the nearly one million families served by Head Start. Most Head Start parents depend on Medicaid for their health care needs. The UCLA/Johnson & Johnson Health Care Institute’s 10-year goal is to serve 400,000 Head Start families, reaching approximately half the Head Start agencies in the United States.

In the pilot and follow-up studies, involving 1,600 parents at 14 Head Start agencies, Johnson & Johnson gave parents a medical reference guide, What To Do When Your Child Gets Sick, by Gloria Mayer, R.N., and Ann Kuklierus, R.N. Designed for readers with low health literacy, the guide offers basic information on more than 50 common childhood medical issues, from fevers and minor scrapes to chicken pox and head lice.

Head Start parents were surveyed about their family’s health care habits three months prior to the training and six months afterward. At the outset, 80 percent said that they did not have a single childcare book at home to reference for help when a child fell ill. However, parents said they were “very confident” about taking care of their sick children. Yet the study found that 49 percent said they would take their child to a clinic for a runny nose and cough rather than provide care at home. Over 50 percent of parents did not know what to do with a child who had a temperature of 99.5 degrees Fahrenheit.

Parents surveyed post-training were, in practice, more confident, with 90 percent reporting that they used the book, some as often as four times in six months. By becoming better informed, participating parents reduced unnecessary trips for routine illnesses by 48 percent to emergency rooms and by 37.5 percent to clinics. This also translated to a dramatic drop in the number of “lost days,” by 43 percent from work and by 41 percent from school. Further, the studies documented a profound improvement in parents’ confidence in trusting their own good judgment. Parents reported universally that, for the first time in their lives, they had the know-how to take charge of their own children’s health care needs.

From the start, an objective of the UCLA/Johnson & Johnson Health Care Institute training was 100 percent parent participation. Historically, Herman says, Head Start parents have faced significant barriers – from working multiple jobs to lacking childcare or transportation – to take advantage of training offered by Head Start agencies. Head Start agencies participating in this study were allocated funds to facilitate parental involvement, offering transportation, on-site childcare and meals, and copies of the book.

According to Mernell King, former director of the Head Start program in Hannibal, Mo., which participated in the pilot and follow-up study, “personal empowerment” has been the greatest impact for the families. “The program is a miracle for Head Start families, saving lives and money in our community and giving parents the knowledge to act as primary teachers and nurturers of their children,” King says.

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