Access To Care For Children Research Articles

Does Parental Health Mediate the Relationship between Parental Uninsurance and Insured Children's Health Outcomes? Evidence from a U.S. National Survey

Although the United States has made great strides in ensuring near universal health care access for children, the health insurance coverage gap between children and their parents remains high. This study analyzed aggregated data from the 2006-2013 National Health Interview Survey to investigate the direct relationships between parental uninsurance and children's health outcomes. Authors explored how parental health mediates the relationship between parents' health and children's health outcomes. Results suggest that insured children of uninsured parents have worse health status and are at higher risk of asthma, attention-deficit/hyperactivity disorder, developmental delays, learning disabilities, and mental disabilities compared with insured children of insured parents. Parental health mediated this relationship. These findings illuminate the pathway between parental uninsurance and child health outcomes and suggest that policies that provide health insurance coverage to both children and their parents may improve both parental health and children's health outcomes. This study fills an important gap in the literature related to how parental uninsurance affects children's health outcomes mediated by the impact of uninsurance on parental health.

Ecomapping as a Research Tool for Informal Child Care

ABSTRACTResearch Findings: Many young children spend crucial developmental years in informal, home-based child care (HBCC) settings, but parents and others share concerns about HBCC quality. We applied the ecomap method in a descriptive study of racially, ethnically, and linguistically diverse informal caregivers and parents to capture their informal caregiving arrangements, social networks, and social supports. For the parents in our study, informal child care was a flexible, affordable, and readily accessible child care option. For caregivers, informal care provided opportunities to help family and friends and to earn extra income. Social networks were characterized largely by relationships with family and friends, and social supports tended to be strong and mutually beneficial. Practice or Policy: We found that ecomapping is an engaging and flexible method of capturing and understanding complex child care arrangements and social networks in HBCC settings. As a research tool, ecomapping can help improve the quality of care in informal settings by identifying and meeting the needs of parents and HBCC providers and informing program development and delivery strategies.

The motherhood sacrifice: maternal experiences of child care in the Canadian context

ABSTRACTIn the majority of Canadian provinces, the child care system is characterized by a lack of regulated, affordable, and accessible child care spaces. Given that mothers continue to be primarily responsible for the care of children, such limited options may prompt them to make self-sacrifices to mitigate child care constraints. This study explores the question: what messages of sacrifice are embedded in Canadian mothers’ stories about their experiences with navigating child care? Thirteen focus groups were conducted in five locations across the Canadian Province of Alberta with 95 mothers. The analysis of these data showed three central themes regarding maternal sacrifice: sacrificing employment, sacrificing personal goals, and sacrificing interpersonal relationships. This research contributes to the literature on sacrifice, work–life integration, and child care by providing insights from the perspectives of mothers. This work has practical and theoretical implications for improving policy and discourse around child care.

Individual- and community-level predictors of victimization frequency in a sample of women exposed to IPV.

OBJECTIVE: The current study examines individual and community factors related to increased frequency of victimization in a sample of women with a history of intimate partner violence (IPV). The identification of unique and interactive associations of community- and individual-level factors and IPV frequency is rarely examined but may assist in developing services that are sensitive to the social-ecological context. METHOD: Women exposed to IPV in the past 2 years were interviewed (n = 120). Information about the communities in which they resided was drawn from the United States and Canadian censuses. Multilevel analyses nested women within their communities and examined the relationship of individual and community factors to frequency of victimization. RESULTS: Individual income, age, and educational attainment were negatively related to IPV frequency, with lowest victimization frequency for women living in communities with high educational attainment and income. CONCLUSIONS: It may be especially useful for organizations to focus on increased service delivery in under-resourced communities. Further, because young and low-income women are more likely to report increased frequency of violence, it may be helpful for clinicians to consider cohort-appropriate intervention methods and instrumental supports that reflect the specific needs of these women, such as employment support, child-care access, and financial management. Language: en

Child Care, Work-Family Policy and Female Entrepreneurship

The reasons for the underrepresentation of women in entrepreneurship are not well understood. More importantly, the question of how work-family policies shape women's entrepreneurship remains unexplored. This paper examines the effect of access to affordable child care on women's entrepreneurship. Using the first universal child care program in China, I find that an institution with a more accessible child care system significantly increases the number of female entrepreneurs without influencing the number of male entrepreneurs. This finding indicates that family-friendly policies may close the gender gap in entrepreneurial activity. Policies that seek to stimulate female entrepreneurship should be coordinated with work-family programs.

Oral Health Care Access for Children in North Carolina: Profile of General and Pediatric Dentists

General practicing dentists (GPs) and pediatric dentists are recognized as primary dental care providers for children. The purpose of this study was to assess the changes from 1990 to 2010 in demographics and practice distribution of these two groups in North Carolina (NC). Dental practitioner and practice data were obtained from the North Carolina Health Professions Data System and county population data from the North Carolina State Data Center. Provider location/patient ratios were higher in 2010 than 1990 and were consistently higher in metropolitan counties than rural counties. The mean age of GPs increased each decade and in 2010 was higher in rural counties than metropolitan counties (P<0.001). From 1990 to 2010, an increase in the gender and racial diversity of GPs and pediatric dentists occurred in NC (P< 0.002). These changes were almost exclusively in metropolitan counties. This trend was most pronounced in pediatric dentistry. Although the number of primary care providers and their location to population ratios increased from 1990 to 2010 in NC, the disparity between rural and metropolitan counties appears to be increasing. The aging dental workforce, especially in rural counties, is a major concern and could exacerbate future workforce balance. The dental health of residents, particularly children, in NC, and possibly other states experiencing similar trends, may be negatively impacted by the disparity in provider ratios. This issue could be exacerbated if the incidence of dental caries increases in children.

The Federal Social Security Program: Taking Gender into Account - Submission to the Standing Committee on Human Resources Development and to the Federal Department of Human Resources Development

This report by the National Association of Women and the Law (NAWL) sets out a list of recommendation to the Standing Committee on Human Resources Development on the reform of the federal social security system. NAWL takes the view that Canadian women must be full and equal participants in creating social welfare policy and that the federal reform process should consider a fundamental objective to be the promotion of women's substantive equality. NAWL has made 26 recommendations for social security reform. Among these: Canadian women must be recognized as equal participants in social welfare policy decision-making. Social spending should not be targeted as a deficit reduction measure without a reassessment of all federal tax and spending policies. Social security reform must recognize women's market and non-market roles as mothers and as household labourers. Federal training programs must be accessible and accountable to women facing diverse needs. Literacy and language training should be considered a basic right. Part-time work should be fully insured under Unemployment Insurance, and treated equally under other federal employment programs and statutes. The federal minimum wage should be increased. Federal transfers for post-secondary education should not be replaced by an expanded income-contingent loan but instead, should be tied to education equity goals. The Canada Assistance Plan (CAP) should not be replaced with an unconditional block funding formula, or a funding formula tied only to increasing employability or reducing child poverty. Existing national conditions under CAP should be fully enforced, except to meet the distinct concerns of Quebec and Canada's First Nations. The CAP condition related to adequacy should be strengthened, and a non-discrimination condition be added. Willingness to participate in training or other employment programs should never be a pre-condition for receiving social assistance. Child poverty should be remedied by addressing the poverty of mothers. Universality in child benefit programs should be retained, but the greatest support should be provided to families with the greatest needs. Accessible child care should be a national priority, as it is a systemic barrier to women's equal access to education, training and employment. Issues around health, housing, immigration and settlement should be part of the social security review process, with special attention to the impact of any reform on women. Changes to the social security system should be made overtly, after full Parliamentary debate.

Summary of: The development of a designated dental pathway for looked after children

To explore the impact of a community-based dental care pathway on the dental care of children entering residential or foster care. The study used qualitative data collected during interviews with children who used the service, their carers and key professionals involved in the pathway, and routine quantitative data concerned with care entry and the dental service use. The dental pathway facilitated dental care access for children entering statutory care, met the dental needs of service users even when dental care provision proved challenging, and offered a consistent dental service regardless of care moves. Improved interagency integration and support was reported by key professionals as was better dissemination and documentation of dental assessments and outcomes. The dental care pathway had a beneficial impact on the dental access and experiences of children who used it, promoted better interagency working and facilitated record keeping. These findings call for extension of the service to a wider population to allow further evaluation of its impact and efficacy in different regional areas and contexts.

The development of a designated dental pathway for looked after children

To explore the impact of a community-based dental care pathway on the dental care of children entering residential or foster care. The study used qualitative data collected during interviews with children who used the service, their carers and key professionals involved in the pathway, and routine quantitative data concerned with care entry and the dental service use. The dental pathway facilitated dental care access for children entering statutory care, met the dental needs of service users even when dental care provision proved challenging, and offered a consistent dental service regardless of care moves. Improved interagency integration and support was reported by key professionals as was better dissemination and documentation of dental assessments and outcomes. The dental care pathway had a beneficial impact on the dental access and experiences of children who used it, promoted better interagency working and facilitated record keeping. These findings call for extension of the service to a wider population to allow further evaluation of its impact and efficacy in different regional areas and contexts.

CHILDCARE ACCESS AND EMPLOYMENT: THE CASE OF WOMEN WITH PRESCHOOL‐AGED CHILDREN IN TOKYO

This article presents an empirical study on childcare accessibility and the importance of access to childcare in attaining preferred employment among women with preschool‐aged children in Tokyo. The age‐wise childcare accessibility of this study takes into account spatial variations in the supply and demand of childcare, as well as “spatial competition,” based on spatially micro areas — blocks. The accessibility reveals a considerable geographic mismatch between childcare center supply and demand, particularly for children aged up to two years. Empirical results show that access to childcare is closely associated with a higher probability of attaining preferred employment among women with preschool‐aged children. The association is remarkably strong when a woman has a very young child aged up to two years and when the childcare center is one that is desired. Adequate childcare provision, particularly for children under the age of three, helps to augment active female participation in the labor market.

Labor Market Penalties for Mothers in Italy

We use a large Italian employer-employee matched dataset to study how motherhood affects women’s working career in terms of labor force participation and wages. We confirm that the probability of exiting employment significantly increases for mothers of pre-school children; however, this is mitigated by higher job quality, human capital endowment and childcare accessibility. Most importantly, the availability of part-time jobs reduces their probability of moving out of the labor force. Women not leaving employment after becoming mothers experience lower wages than women with no pre-school child, and there are no signs of this gap closing 5 years after childbirth. Contrary to previous literature, the wage gap penalty emerges only among women working full-time, thanks to the high protection accorded to part-time jobs in Italy.

Choosing Work and Care: Four Australian Women Negotiating Return to Paid Work in the First Year of Motherhood

Australian women make decisions about returning to paid work and care for their child within a policy environment that presents mixed messages about maternal employment and childcare standards. Against this background, an investigation of first-time mothers' decision-making about workforce participation and childcare was undertaken. Four women were studied from pregnancy through the first postnatal year using interview and diary methods. Inductive analyses identified three themes, all focused on dimensions of family security: financial security relating to family income, emotional security relating to childcare quality, and pragmatic security relating to childcare access. The current policy changes that establish improved childcare quality standards in Australia present a positive step toward alleviating family insecurities, but are insufficient to alleviate the evidently high levels of tension between workforce participation and family life experienced by these four women transitioning back into the workforce in Australia.

“He only takes those type of patients on certain days”: Specialty care access for children with special health care needs

Background Expansions to public and private coverage opportunities under the Affordable Care Act and the Children’s Health Insurance Program are meant to provide greater access to medical services, particularly for the 10 million US children with special health care needs (CSHCN). Objective/Hypothesis We used qualitative methods to explore the nuanced processes of obtaining access to specialty care for publicly and privately insured CSHCN. Methods From May 2009 to February 2010, 30 in-depth qualitative interviews (60-90 minutes in length) were conducted with English-speaking family caregivers of CSHCN covered by public insurance ( n = 15), private insurance ( n = 6), or both ( n = 9) in Cook County, IL. We used purposive quota sampling techniques to recruit parents from a group of 102 respondents from a related telephone survey who agreed to follow-up contact. All audio transcriptions and field notes were entered into Atlas-Ti software and analyzed by the authors through a thematic coding scheme. Results Respondents varied in their success in obtaining requested specialty care. Several themes emerged that shape access to specialty care for CSHCN in this study: marked differences based upon insurance type, the acuity of a child’s health condition, and the presence of language and cultural barriers in scheduling and attending appointments. Conclusions Qualitative interviews with families illuminated current perceptions of inequities in access to outpatient specialty care for CSHCN. Such findings generate questions and concerns about parity across public and private coverage systems for vulnerable children and suggest areas for future research and policy consideration for ensuring access to both primary and specialty care.

Is Universal Child Care Leveling the Playing Field?

Many developed countries currently consider a move towards a universal child care program. The challenge in assessing the case for universal child care programs is that the evidence base is scarce. We analyze the staged expansion of subsidized, universally accessible child care in Norway. Our approach differs from existing literature which estimate mean impacts of universal child care programs; in contrast, we use non-linear difference-in-differences methods to estimate quantile treatment effects, showing how the child care expansion affected the earnings distribution of exposed children as adults. We complement these estimates with local linear regressions of the child care effects by family income. Our findings suggest that the effects of child care vary systematically across the earnings distribution, that the mean impact misses a lot, and that children of low income parents seem to be the primary beneficiaries of subsidized child care. These findings are important when considering the case for universal child care programs, since the benefits of providing subsidized child care to middle and upper-class children are unlikely to exceed the costs. To help understand the differential effects on earnings, we examine how the child care expansion affected the educational trajectories and cognitive test scores of the exposed children.

Does universally accessible child care protect children from late talking? Results from a Norwegian population-based prospective study

This study examines the association between type of child care arrangement at age 1, 1.5 and 3 years and late talking (LT). The data were from 19,919 children in the population-based prospective Norwegian Mother and Child Cohort Study (MoBa) and included information about child care arrangement, LT and a variety of covariates. Attendance at universally accessible child care at 1.5 and 3 years of age was related to a reduced risk for LT, even after controlling for covariates, including early social communication skills before entering child care. However, type of child care at one year of age did not predict LT. Children attending centre care full-time at age three years showed less LT than children attending centre care part-time, whereas no such relationship was found for children at age 1.5 years or for children attending family day care. The results indicate that high-quality universal child care protects children from LT.

No Child Left Behind: Subsidized Child Care and Children's Long-Run Outcomes

Many developed countries are currently considering a move toward subsidized, widely accessible child care or preschool. However, studies on how large-scale provision of child care affects child development are scarce, and focused on short-run outcomes. We analyze a large-scale expansion of subsidized child care in Norway, addressing the impact on children's long-run outcomes. Our precise and robust difference-in-differences estimates show that subsidized child care had strong positive effects on children's educational attainment and labor market participation, and also reduced welfare dependency. Subsample analyses indicate that girls and children with low-educated mothers benefit the most from child care. (JEL J13, J16)

The Young and the Restless: Pre‐Tenure Women Speak Out

The Young and the Restless: Pre‐Tenure Women Speak Out

Exploring the Impacts of Public Childcare on Mothers and Children in Italy: Does Rationing Play a Role?

This paper investigates the effects of public childcare availability in Italy on mothers’ working status and children’s scholastic achievements. We use a newly available dataset containing individual standardized test scores of pupils attending second grade of primary school in 2008-09 in conjunction with data on public childcare availability. Public childcare coverage in Italy is scarce (12.7 percent versus the OECD average of 30 percent) and the service is rationed: each municipality allocates the available slots according to eligibility criteria. We contribute to the existing literature taking into account rationing in public childcare access and the functioning of childcare market. Our estimates indicate that childcare availability has positive and significant eff ects on both mothers’ working status and children’s language test scores. The effects are stronger when the degree of rationing is high and for low educated mothers and children living in lower income areas of the country. JEL Classification: J13, D1, H75

Social paediatrics: creating organisational processes and practices to foster health care access for children ‘at risk’

In recent years understanding and addressing child health inequities has become a priority for research and practice. In this paper we share research insights on an approach that shows promise for engaging across the spectrum of health services to foster access to services and supports for child development to reduce child health inequities. As pathways of influence on children’s health and development extend beyond the biomedical domain new approaches to practice are needed to foster health care access and to mobilise needed supports. The Social Paediatrics Initiative has been introduced in one of Canada’s poorest inner city neighbourhoods where a disproportionate number of children experience adverse childhood events and enter school developmentally delayed. The research was undertaken in partnership with practitioners, community based organisations and the formal health services sector. The study gathered data from parents, community members and clinicians to understand the range of conditions that interfere with access to health care and to illustrate the ways the Social Paediatrics Initiative sought to foster access and provide care that was responsive to the health and developmental needs of children at risk because of their social and material circumstances. In particular we illustrate ways in which intersectoral and interdisciplinary partnerships enabled clinicians to provide needed supports to address the social determinants of health.

Review: Social paediatrics: creating organisational processes and practices for health care access for children ‘at risk’

Review: Social paediatrics: creating organisational processes and practices for health care access for children ‘at risk’