Kentucky’s Commitment to Change

1. Kentucky’s Commitment to Change “Race, Community and the Child Welfare System” Initiative

2. Identified Counties in Most Need(* = Phase II)

3. Evidence demonstrates that children and families of color experience the health care system differently than do white children in terms of access, quality, and outcomes. Health Care Disparities

4. Access • Location, hours of operation, and staffing patterns of health care service providers tend to follow racial lines in the U.S.

5. Quality • A recent report by the Agency for Healthcare Research and Quality (AHCRO) concludes that “racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities”. Minorities receive less aggressive treatments and are more likely to be treated by providers with worse performance records or who are less well trained (Bach, 2004).

6. Outcomes • We know that persons of high SES command greater access to resources such as health information, quality healthcare, and healthy social environments . . . BUT even after controlling for SES, research is unable to statistically eliminate black/white disparities in outcomes such as pre-maturity and low birth weight.

7. Because of these disparities, it is time for all institutions to examine the structural and systemic factors that are engrained in their policies and practices that adversely affect the individual health of the clients they serve.

8. OUR RESPONSIBILITY AS HEALTH CARE PROVIDERS • Because of these disparities, it is time for all institutions to examine the structural and systemic factors that are engrained in their policies and practices that adversely affect the individual health of the clients they serve. • We believe that every child that comes into contact with the Cabinet in need of our services should have the SAME experience.

9. At the CCSHCN we beganby examining… • The reason for referral, time until first appointment, diagnosis, services provided, age at referral, course of treatment, reason for discharge, health status at time of discharge and linkage to post-discharge care • The representation of children of color at referral, intake, medical assessment, treatment planning and discharge • The location of clinics with respect to minority communities, hours of operation of clinics, staff training, and transportation • The racial composition of staff • The commitment of resources (healthcare resource allocation by race)

10. Results • So … what did we do and what did we find:

12. RACIAL DISTRIBUTION OF • HEALTHCARE SERVICES PROVIDED BY • CCSHCN OVER 4.5 YEAR PERIOD • We reviewed health services utilization data from 1/1/03 to the present. A total population of 19,763 children received services in this timeframe. Data delineating client race was available for 63.53% of the total client population.

13. CCSHCN’S STATEWIDE • DISTRIBUTION • Racial representation of this population is Caucasian – 82.47%; African American – 7.74%; 5.38% Latino, and 4.41% Other.

14. DATA ANALYSIS • We were able to extract good information from our existing database in the following areas: • Length of service by race • Number of services received by race • Referrals to outside services by race • Insurance utilization by race • Racial distribution of clients by county

15. Length of Services Received by Race* • When length of total time receiving services is distributed by race, we find that African Americans have a shorter average length of services than whites (15.01 months vs. 20.24) and Hispanics had the longest average length of services (24.03 months). African Americans received more services than whites over a shorter period of time. • *Time from acceptance until discharge

16. Number of Services Received by Race • When the number of health service providers seen by clients is broken down by race, we find that people of color receive disproportionately more services than whites (Caucasians – 7.78%, African Americans 10.20%, and Hispanics – 10.48% on average) – this is true for both clinic and augmentative services.

17. Successful Referral to Outside Providers by Race* • When successful referral to external service providers is broken out by client race, we find no significant differences (Caucasians – 84%, African Americans – 83%, Hispanics – 88%, and Asians – 89%). * Successful means client received the service for which they were referred.

18. Insurance Utilization Patterns by Race • Uninsured: • The % of African Americans that were uninsured was less than their representation in the client population as was the case with whites. Hispanics had the highest percentage of uninsured and their percentile was about four times their representation in the total client population. • Of those that were uninsured, 67% were white, 6.6% African American, and 22.51% Latino.

19. Insurance Utilization Patterns by Race • Public Insurance: • Health insurance distribution by race shows no racial difference in the numbers of those who have public insurance, fewer African Americans with private insurance than whites and far fewer Hispanics with private insurance than either whites or blacks.

20. Racial Distribution of Clients in DCBS Target Areas • In the ten counties with disproportionate representation of blacks in the Child Welfare System in Kentucky, all but one county CCSHCN served had a higher percentage of African Americans than are represented in the county census. The exception was Christian County where health services are also available on the military base at Ft. Campbell.

21. Racial Representation of Providers • We looked at racial representation of our providers, but the available data were incomplete and our numbers too small to analyze. • We do know, however, …

22. Racial Representation of Providers (cont’d.) • Because of the “Common Lens” we share, provider race does not impact service outcomes. • However, positive role models are critical for our children and, therefore, racial diversity among providers is desirable.

23. What are the explanations for the things we are finding… • Is it a good thing or a bad thing when people get referred for more services, stay in our care longer, or are discharged earlier?

24. This is the process an agency should go through to be responsive to this issue… • We just discussed what the Commission has done… • What will we do next…

25. Next Steps… • Raise awareness (discuss types… referral sources/ community/ providers/ parents…)– Who are the Commission partners- where do our referrals come from? • Provide staff training • Educate referral sources

26. Next Steps (cont’) • Satisfaction survey of our clients- this would be one way to determine an outcome for the “length of service” question presented earlier by Dr. Foster. (More/ better services in less time? Were the services responsive to client needs?- Client perspective) • Develop Parent Advocacy Program

27. Next steps (cont’) • Improve Access (location, hours of service, transportation, outreach) • Provide culturally sensitive care management • Establish Team to strategically address • Address structural racism/ how can the Commission structure its services to ensure equality at every level of care? (Reviews/ analyzes/ develops outreach)

28. Next Steps (cont’) • Empower minority community to shape policy and practices (minority representation on Board, Parent Advisory Council, Youth Advisory Council) • Post secondary education- lesson plans and coursework that focus on minority health and disparities to make providers aware

29. Every child that comes into contact with the Cabinet in need of our services should have the SAME experience.

30. What can I do?

31. What you can do…

32. What does it take??? • Commitment to social justice • Ability to collect and use data to demonstrate racial disparities in health • Willingness to ask questions and listen to answers • Tools for understanding and assessing how racism is manifested

33. What does it take??? • Ability to shift from a focus on individual personal health behaviors to a focus on institutions and systems (requires “training” and “skill building”) • Community leadership/coalitions addressing racism • Desire to work “across issues” • Willingness to shift existing resources to support anti-racism work

34. What can you do? • Commit to equity • Attend community workshops and conference (s) • Become a community sponsor • Provide funding • Staff participation • Collect and analyze data by race • Review policies and procedures • Change practice • Evaluate practice changes

35. Future Workshops 9/25/07 - 9/27/07 Home of the Innocents 1100 E. Market St., Louisville, KY  40203 No workshop will be held in October 11/6/07 - 11/8/07 Seven Counties Services, Inc.Commonwealth Business Center11001 Bluegrass Parkway, Suite 200Louisville, KY 40299 12/4/07 - 12/6/07 YMCA Safe Place Services, Conference Rooms B-D 2400 Crittenden Drive Louisville, KY 40217

36. Recommended Reading and Viewing List • www.jointheconversation.net • Casey Family Programs http://www.casey.org/OurWork/Disproportionality/ • Race Matters Consortium http://www.racemattersconsortium.org/index.htm • People’s Institute (delivers Undoing Racism Workshops) http://www.pisab.org/ • Alliance for Racial Equity in Child Welfare http://www.cssp.org/major_initiatives/racialEquity.html

37. Thank you for attending this presentation. • Please feel free to contact us with questions or ideas. • Have a great day!