Medicaid costs for a child's trip to an emergency room or clinic can be reduced annually by at least $198

Medicaid costs for a child's trip to an emergency room or clinic can be reduced annually by at least $198 per family when Head Start parents are provided with easy-to-understand health-care guidance, according to a first-of-its kind study by the UCLA/Johnson & Johnson Health Care Institute. 

The institute's goal is to train approximately 12,000 Head Start families nationwide by 2005, which could mean a significant savings to Medicaid of nearly $2.4 million annually in direct costs associated with unnecessary emergency room and clinic visits. Using $200 as the average cost for a visit to a hospital's emergency room and $30 for a clinic visit, researchers at UCLA estimate that the savings could reach many millions per year if funds were available to provide health-literacy training for the nearly 1 million families served by Head Start. Most Head Start parents depend on Medicaid for their health-care needs.

Parents who participated in the UCLA/Johnson & Johnson Health Care Institute's pilot and follow-up training sessions became better informed about their children's health, reducing by 48 percent the number of unnecessary trips to an emergency room and by 37.5 percent to a clinic for routine illnesses, such as a cold, cough or mild fever. This also translated to a dramatic drop in the number of lost days at work (43 percent) and at school (41 percent).

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 children's health-care needs.

"Head Start parents, like all good parents, want only the best for their children. 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," said Ariella Herman, senior lecturer of Operations and Decision Sciences at the UCLA Anderson School of Management and lead investigator of the studies. "The findings could have far-reaching implications in bringing down Medicaid costs."

Inspired by Head Start directors

Entitled "Ensuring Positive Health Outcomes in Head Start Children and Families," the research by Dr. Herman was inspired by Head Start directors who were graduates of the Head Start/Johnson & Johnson management fellows program held at the UCLA Anderson School of Management. Founded in 1991, it is the only executive management program of its kind.

In 2000 a survey of Head Start/Johnson & Johnson fellows from around the United States revealed a shared concern: Parents simply lacked the time and basic health-care knowledge to become better informed about their children's health. The fellows, all Head Start directors themselves, 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 will enter its third year in April 2004 at the annual meeting of the National Head Start Association in Anaheim, Calif.  By the end of 2005, the Health Care Institute estimates it will have trained 79 agencies, 790 staff and 11,600 parents.

"We are extremely proud of our programs for Head Start directors and the impact that they have had on the lives of thousands of mothers, fathers and young children," said Alfred T. Mays, worldwide vice president of corporate contributions and community relations for Johnson & Johnson.  "With the right training and tools, we are all empowered to achieve personal and business goals and to make healthier decisions. That's what we've seen in the over 900 directors who have become Johnson & Johnson fellows."

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.

Findings of the pilot study, which involved 400 parents, are available in the June 2004 issue of the Journal of Community Health. (The pilot study found that by training 10,000 Head Start families nationwide, Medicaid potentially could save nearly $2 million in unnecessary E.R. and clinic visits annually.)

What to do at 99.5°

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 registered nurses Gloria Mayer and Ann Kuklierus. Designed for readers with low health literacy, the guide offers easy-to-understand 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.

Prior to the training, 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. More than 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. In addition, 84 percent of parents said they were now more at ease in taking care of their child's health-care needs.

Proper training, better quality of care

From the start, an objective of the UCLA/Johnson & Johnson Health Care Institute training was 100 percent parent participation. Historically, Herman said, Head Start parents faced significant barriers in taking advantage of any type of training offered by Head Start agencies, such as not having childcare or transportation, or working two jobs.

Participating Head Start agencies were allocated funds to ensure 100 percent parental involvement. Agencies turned the training sessions into easily accessible events, offering transportation, on-site childcare and meals, plus 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 said.

Johnson & Johnson is the world's most comprehensive and broadly based manufacturer of health-care products, as well as provider of related services for the consumer, pharmaceutical and medical devices, and diagnostics markets. The company is headquartered in New Brunswick, NJ. For more information, visit

In 1991 Johnson & Johnson and UCLA joined to strengthen the entrepreneurial management skills of Head Start directors through training at the Anderson School of Management's top-ranked Harold Price Center for Entrepreneurial Studies. The UCLA/Johnson & Johnson Health Care Institute was formally established in 2003 to determine strategies for assisting Head Start families in gaining health-care knowledge and to study the impact of health literacy in assuring children are receiving the best health treatment possible. For more information, visit

Johnson & Johnson Fellows of note include Helen Taylor, who later became the Head Start Associate Commissioner in Washington, D.C.; Ron Herndon, current chairman of the National Head Start Association; Manda Lopez, executive director of the National Migrant and Seasonal Head Start Association; Amanda Bryans, director of operations for the Head Start Bureau; and Lawrence Pucciarelli, director for the Head Start State Collaboration for Rhode Island. For more information, visit the Health Care Institute Web site at


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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