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

Kentucky’s Commitment Kentucky’s Commitment to Changeto Change

““Race, Community and the Race, Community and the Child Welfare System” Child Welfare System”

InitiativeInitiative

Commission for Children withSpecial Health Care Needs2007 Conference

Identified Counties in Most NeedIdentified Counties in Most Need(* = Phase II)(* = Phase II)

CountyCounty% African American % African American Population (Census)Population (Census)

% African American % African American OOHC (foster care)OOHC (foster care)

HardinHardin 11.911.9 18.818.8

WarrenWarren 8.68.6 22.222.2

Jefferson*Jefferson* 18.918.9 53.553.5

MadisonMadison 4.44.4 13.313.3

McCracken*McCracken* 10.910.9 33.333.3

BoyleBoyle 9.79.7 30.730.7

Fayette*Fayette* 13.513.5 45.745.7

DaviessDaviess 4.34.3 19.019.0

Kenton*Kenton* 3.83.8 21.721.7

GravesGraves 4.44.4 32.432.4

Christian*Christian* 23.723.7 48.548.5


Evidence demonstrates that children and families Evidence demonstrates that children and families of color experience the health care system of color experience the health care system differently than do white children in terms of differently than do white children in terms of

access, quality, and outcomes.access, quality, and outcomes.

Health Care Disparities


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

AccessAccess


• 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).

QualityQuality


OutcomesOutcomes

• 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.


Because of these Because of these disparities, it is time disparities, it is time for all institutions to for all institutions to

examine the structural examine the structural and systemic factors and systemic factors that are engrained in that are engrained in

their policies and their policies and practices that practices that

adversely affect the adversely affect the individual health of the individual health of the

clients they serve.clients they serve.


Because of these disparities, it is time for all Because of these disparities, it is time for all institutions to examine the structural and institutions to examine the structural and

systemic factors that are engrained in their systemic factors that are engrained in their policies and practices that adversely affect the policies and practices that adversely affect the

individual health of the clients they serve.individual health of the clients they serve.

We believe that every child that comes into contact We believe that every child that comes into contact with the Cabinet in need of our services should with the Cabinet in need of our services should

have the SAME experience.have the SAME experience.

OUR RESPONSIBILITY AS HEALTH CARE PROVIDERS


At the CCSHCN we beganAt the CCSHCN we beganby examining…by examining…

The reason for referral, time until first The reason for referral, time until first appointment, diagnosis, services provided, age appointment, diagnosis, services provided, age at referral, course of treatment, reason for at referral, course of treatment, reason for discharge, health status at time of discharge and discharge, health status at time of discharge and linkage to post-discharge carelinkage to post-discharge care

The representation of children of color at The representation of children of color at referral, intake, medical assessment, treatment referral, intake, medical assessment, treatment planning and dischargeplanning and discharge

The location of clinics with respect to minority The location of clinics with respect to minority communities, hours of operation of clinics, staff communities, hours of operation of clinics, staff training, and transportationtraining, and transportation

The racial composition of staffThe racial composition of staff The commitment of resources (healthcare The commitment of resources (healthcare

resource allocation by race)resource allocation by race)


ResultsResults

So … what did we do and what did we So … what did we do and what did we find:find:


White/Caucasia

n

Black/African America

nHispa

nic

Some Other

Race/Combination Asian

American

Indian/Alaska Native

Native Hawaiian/Pacific Islander

Total # of

Referrals

Referrals for Outside Services 13501 1322 1751 614 225 14 39 17460

% to Total 77.33% 7.57%10.03

% 3.52% 1.29% 0.08% 0.22%

Less: Pop. Distribution by Race 82.47% 7.74% 5.38% 3.38% 0.81% 0.14% 0.09%

Proportionally Over / Under Served -5.14% -0.17% 4.65% 0.14% 0.48% -0.06% 0.14%


RACIAL DISTRIBUTION OF RACIAL DISTRIBUTION OF

HEALTHCARE SERVICES PROVIDED HEALTHCARE SERVICES PROVIDED BYBY

CCSHCN OVER 4.5 YEAR PERIODCCSHCN OVER 4.5 YEAR PERIOD

We reviewed health services utilization data We reviewed health services utilization data from 1/1/03 to the present. A total from 1/1/03 to the present. A total

population of 19,763 children received population of 19,763 children received services in this timeframe. Data services in this timeframe. Data

delineating client race was available for delineating client race was available for 63.53% of the total client population.63.53% of the total client population.


CCSHCN’S STATEWIDECCSHCN’S STATEWIDE

DISTRIBUTIONDISTRIBUTION

Racial representation of this population is Racial representation of this population is Caucasian – 82.47%; African American – Caucasian – 82.47%; African American – 7.74%; 5.38% Latino, and 4.41% Other.7.74%; 5.38% Latino, and 4.41% Other.


DATA ANALYSISDATA ANALYSIS

We were able to extract good information We were able to extract good information from our existing database in the from our existing database in the

following areas:following areas:

1)1) Length of service by raceLength of service by race

2)2) Number of services received by raceNumber of services received by race

3)3) Referrals to outside services by raceReferrals to outside services by race

4)4) Insurance utilization by raceInsurance utilization by race

5)5) Racial distribution of clients by countyRacial distribution of clients by county


Length of Services Received by Length of Services Received by Race*Race*

When length of total time receiving services is When length of total time receiving services is distributed by race, we find that African distributed by race, we find that African Americans have a shorter average length of Americans have a shorter average length of services than whites (15.01 months vs. 20.24) services than whites (15.01 months vs. 20.24) and Hispanics had the longest average length of and Hispanics had the longest average length of services (24.03 months). African Americans services (24.03 months). African Americans received more services than whites over a received more services than whites over a shorter period of time.shorter period of time.

*Time from acceptance until discharge*Time from acceptance until discharge


Number of Services Received by Number of Services Received by RaceRace

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


Successful Referral to Outside Successful Referral to Outside Providers by Race*Providers by Race*

When successful referral to external service providers When successful referral to external service providers is broken out by client race, we find no significant is broken out by client race, we find no significant differences (Caucasians – 84%, African Americans – differences (Caucasians – 84%, African Americans – 83%, Hispanics – 88%, and Asians – 89%).83%, Hispanics – 88%, and Asians – 89%).

* Successful means client received the service for which they were referred.


Insurance Utilization Patterns by RaceInsurance Utilization Patterns by Race

Uninsured:Uninsured:

The % of African Americans that were uninsured was less than their The % of African Americans that were uninsured was less than their representation in the client population as was the case with whites. representation in the client population as was the case with whites. Hispanics had the highest percentage of uninsured and their Hispanics had the highest percentage of uninsured and their percentile was about four times their representation in the total client percentile was about four times their representation in the total client population.population.

Of those that were uninsured, 67% were white, 6.6% African Of those that were uninsured, 67% were white, 6.6% African American, and 22.51% Latino.American, and 22.51% Latino.


Insurance Utilization Patterns by RaceInsurance Utilization Patterns by Race

Public Insurance:Public Insurance:

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


Racial Distribution of Clients in DCBS Racial Distribution of Clients in DCBS Target AreasTarget Areas

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


Racial Representation of ProvidersRacial Representation of Providers

We looked at racial representation of our providers, but We looked at racial representation of our providers, but the available data were incomplete and our numbers the available data were incomplete and our numbers too small to analyze.too small to analyze.

We do know, however, …We do know, however, …


Racial Representation of Providers Racial Representation of Providers (cont’d.)(cont’d.)

Because of the “Common Lens” we share, provider race does Because of the “Common Lens” we share, provider race does not impact service outcomes.not impact service outcomes.

However, positive role models are critical for our children and, However, positive role models are critical for our children and, therefore, racial diversity among providers is desirable.therefore, racial diversity among providers is desirable.


What are the explanations for the What are the explanations for the things we are finding…things we are finding…

Is it a good thing or a bad thing Is it a good thing or a bad thing when people get referred for when people get referred for

more services, stay in our more services, stay in our care longer, or are discharged care longer, or are discharged

earlier?earlier?


This is the process an This is the process an agency should go agency should go

through to be through to be responsive to this responsive to this

issue…issue…

We just discussed We just discussed what the Commission what the Commission

has done…has done…

What will we do What will we do next…next…


Next Steps…Next Steps…

Raise awareness (discuss Raise awareness (discuss types… referral sources/ types… referral sources/ community/ providers/ community/ providers/ parents…)– Who are the parents…)– Who are the Commission partners- where do Commission partners- where do our referrals come from?our referrals come from?

Provide staff trainingProvide staff training Educate referral sourcesEducate referral sources


Next Steps (cont’)Next Steps (cont’)

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

Develop Parent Advocacy ProgramDevelop Parent Advocacy Program


Next steps (cont’)Next steps (cont’) Improve Access (location, hours of service, Improve Access (location, hours of service,

transportation, outreach)transportation, outreach)

Provide culturally sensitive care managementProvide culturally sensitive care management

Establish Team to strategically address Establish Team to strategically address

Address structural racism/ how can the Address structural racism/ how can the Commission structure its services to ensure Commission structure its services to ensure equality at every level of care? (Reviews/ equality at every level of care? (Reviews/ analyzes/ develops outreach)analyzes/ develops outreach)


Next Steps (cont’)Next Steps (cont’)

Empower minority community to shape Empower minority community to shape policy and practices (minority policy and practices (minority representation on Board, Parent representation on Board, Parent Advisory Council, Youth Advisory Advisory Council, Youth Advisory Council)Council)

Post secondary education- lesson plans Post secondary education- lesson plans and coursework that focus on minority and coursework that focus on minority health and disparities to make providers health and disparities to make providers awareaware


Every child that Every child that comes into comes into

contact with the contact with the Cabinet in need Cabinet in need of our services of our services

should have the should have the SAME SAME

experience.experience.


What can I do?What can I do?


What you can do…What you can do…


What does it take???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


What does it take???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


What can you do?What can you do?Commit to equityCommit to equity

Attend community workshops Attend community workshops and conference (s)and conference (s)

Become a community sponsorBecome a community sponsor Provide funding Provide funding Staff participationStaff participation

Collect and analyze data by Collect and analyze data by race race

Review policies and Review policies and proceduresprocedures

Change practiceChange practice

Evaluate practice changesEvaluate practice changes


Future WorkshopsFuture Workshops

9/25/07 - 9/27/07Home of the Innocents

1100 E. Market St., Louisville, KY 40203

No workshop will be held in October

11/6/07 - 11/8/07Seven Counties Services, Inc.

Commonwealth Business Center11001 Bluegrass Parkway, Suite 200

Louisville, KY 40299

12/4/07 - 12/6/07YMCA Safe Place Services, Conference Rooms B-D

2400 Crittenden DriveLouisville, KY 40217


Recommended Reading and Recommended Reading and Viewing ListViewing List

www.jointheconversation.netwww.jointheconversation.net

Casey Family ProgramsCasey Family Programshttp://www.casey.org/OurWork/Disproportionality/http://www.casey.org/OurWork/Disproportionality/

Race Matters ConsortiumRace Matters Consortiumhttp://www.racemattersconsortium.org/index.htmhttp://www.racemattersconsortium.org/index.htm

People’s InstitutePeople’s Institute (delivers Undoing Racism Workshops) (delivers Undoing Racism Workshops)http://www.pisab.org/http://www.pisab.org/

Alliance for Racial Equity in Child WelfareAlliance for Racial Equity in Child Welfarehttp://www.cssp.org/major_initiatives/racialEquity.htmlhttp://www.cssp.org/major_initiatives/racialEquity.html


Thank you for attending Thank you for attending this presentation.this presentation.

Please feel free to contact Please feel free to contact us with questions or us with questions or

ideas.ideas.

Have a great day!Have a great day!

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

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