Ariella Herman


Professor Ariella Herman Sees Tremendous Room for Growth

In 2002, UCLA Anderson senior lecturer Ariella Herman helped create the UCLA/Johnson & Johnson Health Care Institute (HCI). The program prepares Head Start personnel to teach parents of Head Start children to care for basic childhood illnesses. Parents learn which problems can be cared for at home and which require professional attention.

The Health Care Institute training model is designed to ensure that families, children and organizations achieve long-term, lasting benefits from participation. The program utilizes a medical reference guide called, What to Do When Your Child Gets Sick, which is published by the Institute for Healthcare Advancement. The guide is written at a third grade reading level. In addition to its healthcare component, the program addresses strategic planning, marketing and how to motivate families to ensure successful implementation of the program.

"Many emergency room visits, especially those involving young children, are for non-urgent conditions such as cold symptoms or mild fever," says Herman. "Parents who are informed about the appropriate use of emergency facilities can help decrease unnecessary visits - improving care, bringing down costs and lessening the burden on the emergency medical system."

So far, some 40,000 families have received training thanks to the Health Care Institute. Herman estimates that potential savings to Medicaid could reach $554 per family in direct costs -- over half a billion dollars annually -- if health literacy training were provided for the nearly one million families served by Head Start. The program has resulted in a dramatic drop in the number of days missed at work and school. In recognition for her work with the Healthcare Institute, Professor Herman received the 2009 Health Literacy Award from The Institute for Healthcare Advancement.

Training for parents takes three to four hours. The format of the program is up to the local Head Start agency. Some agencies present the training at a weeknight dinner meeting and others present it on a Saturday. "We tell them to do the training when parents are most available," Herman says. Sometimes, training is presented as part of a health fair, which children can attend with their parents.

During the past year, The Health Care Institute broadened its curriculum to include nutrition and exercise. "We discuss nutrition for the entire family in order to create a link between children and parents," says Herman. Children sometimes ask their parents to buy more fruits and vegetables - and less soda, she says. "We show parents how to stretch their food dollars in order to buy fruit and other healthy foods."

As part of the training, each Head Start agency prepares a Health Improvement Plan (HIP). This enables the agencies to sustain their training programs and repeat them year after year. "This plan addresses marketing, delivery and follow-up," Herman says. "You can not just train families and let them go. You need to reinforce what they have learned." Follow-up is often done through monthly home visits.

Home visits provide the Health Care Institute with information on the effectiveness of the training. "We ask if they are using the tools we gave them," says Herman. "And we ask if they went to the emergency room during the month. We want to diminish the use of the emergency room, but we encourage them to go when necessary."

Herman followed some 400 Head Start families closely over five years and found that they remember lessons learned in their healthcare training. "Once they gain this knowledge," she says, "they use it for subsequent children. And they share it with their community."

Once a Head Start agency learns the methodology of the Health Care Institute, they can apply it to other areas of healthcare. "There is no need to train the trainers," she says. "They can easily begin teaching other topics. That's one of the strengths of our program."

The Health Care Institute recently added pilot training modules on oral health care and the prevention of diabetes and obesity. "Prevention is the most important tool we can give parents because these are things that they can master," says Herman. "This is a way of empowering them."

"As we expanded the program to different regions, we learned how the program needs to be done in different languages and ethnicities," she continues. So far, training has been delivered in English, Spanish and Chinese. Although the language is different - the training is the same. "We are sensitive to cultural issues," she said. "We're not trying to change cultures. That is one reason the program has been so well accepted by families."

The Health Care Institute is expanding across the country with the help of grants from corporations and government agencies. Pfizer provided funding to train all Head Start agencies in the state of New Mexico. This brought health literacy training to 5,000 families. In 2008, the governor of Washington budgeted funds to train some 7,000 families across the state. The Kansas Head Start Agency funded a program in that state.

Working with a Missouri Head Start agency, the Health Care Institute recently received a $1.1 million federal grant to help expand the program nationally. "It is a three year project that starts with training families in Missouri. Then we will make training available on the East Coast," says Herman. "Any Head Start agency can apply." In 2010, the program will be offered to any Head Start agency on the West Coast.

Professor Herman recently consulted with a team of students in UCLA Anderson's Applied Management Research Program who proposed starting a pilot of the Health Care Institute in Mexico. "Johnson & Johnson would be willing to invest there if the Mexican government would provide a percentage of the funding," she says. Earlier this year, Herman described the Health Care Institute to the Parliament of the European Union. She feels the program would be as effective there as it is here. But, mostly, she is focused on the United States.

"I will never be done with this project," says Herman. "I want every parent in the U.S. to have this knowledge. That's the minimum our society needs to do." Herman hopes for an opportunity to describe the Health Care Institute to policy makers at the U.S. Department of Health and Human Services - parent of the Office of Head Start. "It would be amazing if our program could be adopted by every Head Start agency in the country. It would make a tremendous difference in the lives of families," she says.