In 2006, Executive Ron Sims' convened a Children's Health Access Task Force of child health experts to advise King County on the creation of an innovative county-based children's health program. In May 2007, the King County Council adopted a motion that laid out policies and a measurement and evaluation plan for a Children's Health Initiative dedicated to improving the access to care and the health of children in King County. The council motion included a vision, mission, and goals to guide CHI's advocacy, outreach, and health innovation pilot projects.

Vision and mission

King County's vision is for every child in King County to achieve optimal health and grow into a healthy adult. Recognizing that regular access to healthcare is necessary to achieving optimal health, the mission of the county's Children's Health Initiative is to create conditions under which children have consistent access to comprehensive, preventive-focused primary healthcare prioritizing those activities which will have the most significant impact on health or reduction in health disparities.

Goals:

1. Advocacy goals:
• Ensure that the state fulfills its adopted goal to extend healthcare insurance coverage to all children by 2010
• Ensure that the state fulfills its goals to connect children to a medical home and assure that high-quality, cost-effective care is provided
2. Outreach goals:
• Improve insurance access by increasing the number of insured children by identifying and enrolling eligible children in public insurance projects
• Improve health knowledge by training parents and staff at community agencies to identify children's health problems and encourage families to seek preventive care
• Improve access to healthcare by connecting children to regular sources of medical and dental care
• Improve health status by ensuring that children receive appropriate evidence-based preventive healthcare services
3. Health innovation pilot projects goals:
• Ensure that children receive appropriately integrated services for the mouth, the mind, and the body by strengthening linkages in the healthcare system
• Reduce barriers children face in accessing healthcare services by developing systems that assure children receive timely coordinated preventive care
• Leverage current opportunities to build evidence for future state-funded efforts by demonstrating innovative approaches and measuring effectiveness with carefully designed and implemented evaluations

The council motion requires semiannual and annual measurement and evaluation reports to summarize progress toward reaching CHI's vision, mission, and goals. To measure overarching outcomes that span program components, the CHI has added measures to help capture the program's impacts as a whole. These additional measures include impacts such as work and school days missed, reductions in preventable hospitalizations, and changes in immunization rates.

Partners 

The CHI is a collaborative initiative of the King County Council, the King County Executive, Public Health--Seattle & King County (PHSKC), the State of Washington, Group Health Cooperative, the Washington Dental Service, and a diverse range of private funders and community-based organizations. The breadth of CHI's financial support and the expertise of its service delivery and advocacy partners are testimony to the importance the community places on ensuring access to timely preventive services and medical, dental, and behavioral healthcare for low-income children and their families.

The initiative's cornerstone funding comes from the King County Council--a $1M per year commitment for 2007, 2008, and 2009. This significant allocation enabled PHSKC staff to leverage additional private sector resources totaling $3,000,300. Group Health Cooperative donated $1M, the Washington Dental Service committed $1M (which it administers directly), and other community partners added $1,000,300. The generosity of these donors brings the total CHI resources to $6,000,300 over the 2007 - 2009 time period.

In addition to this impressive list of funding partners, the CHI works collaboratively with a group of excellent service providers and advocacy allies. These partners include community health centers, private dentists, school districts, health plans, hospitals, children's advocates, mental health agencies, and family support centers throughout King County.

Program overview

The CHI is a multi-faceted effort that helps children and their families overcome barriers to obtaining needed healthcare services through a set of state-of-the-art programs.

• The Advocacy and Alignment Component works collaboratively with state and federal policymakers to ensure achievement of full implementation of the Cover All Kids law, including federal and state healthcare coverage for all low-income children and families, targeted outreach, improvement of health literacy, linkage to medical homes, receipt of preventive services, and incentive payments for provision of quality care. Working with other child and family advocates, CHI staff work for the implementation of policies and systems that improve the health of low-income families.
• The Access and Outreach Component assertively reaches out to identify and enroll children in public health insurance programs for which they are eligible, employs trusted messengers from the community to deliver information about the value of early prevention and insurance, links families and children to a regular source of medical and dental care, and encourages quality integrated service delivery within clinics by utilizing care coordinators.
• The Online Enrollment Pilot Project builds a user-friendly web-based bridge for parents to easily enroll their children in public health insurance and other basic needs programs and helps them identify where to obtain services through use of WithinReach's ParentHelp123 system. The Online Enrollment Pilot Project is also developing a Super-User Site, or Professional Version, that will enable application workers and other outreach staff to use the web-based system to rapidly complete benefit applications for their clients.
• The Maternal and Child Behavioral Health Pilot provides a diverse array of multi-lingual services to provide an integrated set of mental health and medical care services for children and their families. CHI partners HealthPoint (formerly known as Community Health Centers of King County), Country Doctor Community Health Services, International Community Health Services, Puget Sound Neighborhood Health Centers, Sea Mar Community Health Centers, and Valley Cities Counseling and Consultation are working with PHSKC staff to implement the program in coordination with other behavioral health activities in King County.
• The KC Kids Dental Pilot Project served as a demonstration for the expansion of dental coverage, which was to be launched by the state in January 2009. The program worked in collaboration with CHI's Access and Outreach Component to identify children between 250% - 300% FPL, link them with a participating dentist, and provide payment for services delivered. The pilot ended in December 2008.

The Children's Health Initiative (CHI) is a public/private partnership to improve low-income families' ability to enroll in federal and state health insurance programs for which they are eligible and to ensure that their children obtain appropriate preventive-focused primary medical, dental, and behavioral healthcare. The CHI supports outreach to families and services to help link them to an ongoing source of health care. Three pilot projects explore new ways to increase access to care, including dental and mental health care. The CHI's advocacy work is intended to sustain the effort into the future.

The CHI made good progress on a number of fronts in 2008, its second year. As data begins to become available on the initiative's outcomes and performance goals, early results are promising. Specifically, the Access and Outreach team surpassed all of its enrollment and education goals for the year, advocacy and alignment efforts garnered the attention of state leadership and national organizations, and the pilot projects improved capacity for electronic submittal of applications, screened children for mental health issues in coordination with primary care visits, and provided children between 250% - 300% of the federal poverty level (FPL) with dental care.

The value of CHI's outreach and linkage strategies is highly important for King County for many reasons, as the preventive care made available not only improves children's health and lowers costs from avoidable emergency room visits and hospitalizations, but can also reduce the number of school and work days that families miss due to a child's illness.

Findings

Big picture measures in 2008

With the intent of demonstrating the combined impact of CHI's initiatives, a set of "big picture" measures were selected to show the value of and the return on investment of enrolling children in healthcare coverage and linking them to needed services. While data on many of these measures is not yet available a key source of information about the percentages of uninsured children in King County did become available in 2008. Information from the 2008 Washington State Population Survey shows that the percentages of uninsured children in King County are remaining relatively stable, despite significant increases in uninsured adults and despite the economic recession.

Advocacy and alignment

The focus of CHI's advocacy work is to ensure that the state's implementation strategies, policies, and budget priorities support access to care for all children as the state implements the Cover All Kids law.

Advocacy efforts this past year have culminated in several notable achievements, including:

• Participation in Health Coalition for Children and Youth meetings to help develop and inform the 2009 State Legislative agenda
• National exposure, through participation in a Kaiser Commission and other national panels, requests for consultation on strategies from national and academic groups, and attention in a recent press conference held by Group Health Cooperative's CEO

Access and outreach

The Access and Outreach component of the CHI disseminates messages and provides education about the value of early prevention and insurance coverage. It proactively reaches out to identify eligible low-income families, enrolling them in publicly-funded health insurance programs. CHI's outreach efforts target difficult to reach populations with significant language, cultural, racial, and socioeconomic barriers to address existing disparities in healthcare access. After enrollment, the CHI works to link children to medical and dental homes, integrated preventive care, and needed wrap-around services.

Key results include:

• Achievements surpassed goals for each outcome area measuring enrollment, training, and health education
• From January 2007 through December 2008, 4,463 children were successfully enrolled in public insurance programs (Medicaid, SCHIP, BHP, and Children's Health Program)
• During the spring of 2007, 89% of the children enrolled completed at least 1 medical visit and 60% completed at least 1 dental visit

Health innovation pilot projects

The pilot projects' aim is to improve the effectiveness of health services for low-income children in King County and across the state. The three pilot projects, launched in 2007, focus on streamlining access to healthcare through web-based approaches, integrating behavioral health services into primary care settings where low-income families obtain services, and increasing low-income families' access to preventive and primary dental care.

Online enrollment pilot project

WithinReach, CHI's community partner for implementation of a client-friendly online enrollment system for families, worked hard throughout 2008 to improve electronic access for families.

Results to-date include:

• The initiation of e-faxing of applications in November 2008
• More than 2,000 applications submitted electronically

Maternal and child behavioral health pilot

The Maternal and Child Behavioral Health Pilot is developing family-centered mental health treatment strategies appropriate for safety net primary care settings. This four-year pilot is also supported by funds from the King County Veterans and Human Services Levy to address maternal depression via integrated mental health services in maternity support programs.

Among the Maternal and Child Behavioral Health Pilot's accomplishments in 2008 are:

• More than 1,600 children age 0 - 12 screened for mental health issues in coordination with well-child care or other primary care visits
• The launch of peer support groups and an adaptation of UW's Mental Health Integrated Tracking System (MHITS), a web-based mental health registry, allowing for tracking of clinic services, referral activities, and consultation and screening outcomes for both adult and pediatric clients

King County Kids (KC Kids) Dental Pilot Project

Funded and administered directly by CHI partner Washington Dental Service, the year-long KC Kids Dental Pilot Project moved forward quickly to identify, enroll, and make connections to dental homes for many children between 250% - 300% FPL in advance of the state's anticipated expansion of coverage in 2009.

Highlights of the pilot project's efforts include:

• 808 children enrolled and 671 children accessed services
• Highly positive survey results from providers and clients about their experience with the program

Measurement and evaluation

CHI's measurement and evaluation process promises to provide important information regarding the effectiveness of the initiative. This data will guide CHI program managers and King County leadership, and inform the state as a whole regarding the most effective strategies for increasing children's access to insurance and preventive and primary medical, dental, and behavioral healthcare.