New Families Center

State: MN Type: Model Practice Year: 2004

The New Families Center is a response to the national call for universal health coverage for children. This program was founded in recognition of the link between learning and health. Student health is a precondition of quality learning. This collaborative effort between the Minneapolis Department of Health and Family Support and the Minneapolis Public Schools (MPS) targets new immigrant arrivals to the school district by integrating health assessment, immunization, insurance, social work, and health care access navigation services into the school Welcome Center for new families. The target population for this program is underserved and under-immunized families enrolling in Minneapolis Public Schools. The target population is difficult to enumerate, yet through this co-location of services, the New Families Center ensures seamless referral transition between school enrollment and health services that helps establish a healthy foundation for families new to the Minneapolis community. Outcomes of these services include screening and enrolling families in health insurance programs, basic health assessment, and identifying a primary care provider for follow-up care. Newly added services assist families in addressing barriers to accessing health care services once they are connected with a health insurance program. The 2004 goals of the New Families Center include screening 1,600 children for eligibility in health coverage programs, enrolling 700 children in health care coverage programs, immunizing over 1,300 children; and serving 900 families in need of health care navigation services to help address individual barriers to getting health care.
The New Families Center is a response to the national call for universal health coverage for children. This program was founded in recognition of the link between learning and health. Student health is a precondition of quality learning. The New Families Center responds to that need through a unique partnership of local public health, public schools, and non-profits to identify and serve new immigrant arrivals to the school district. It has been well established that racial and ethnic disparities exist in many domains of health care delivery. Populations of color have been shown to be less likely to have a regular source of care, fewer physician visits, and lower total healthcare expenditure. In Minneapolis, populations of color are more likely to be uninsured, to have delayed medical care, or to receive appropriate preventive services such as mammograms, cholesterol screenings, and flu shots. Minneapolis data also shows, that while foreign-born persons practice healthy behaviors in many areas, disparities in health insurance coverage and barriers to health care access abound. Barriers to health care access that contribute to disparities in care utilization have been well documented locally. A recent assessment of reasons that populations of color do not receive services highlighted broad categories of issues that affect health care use. Communication problems among recent immigrant populations are exacerbated by limited English proficiency and need for interpretation services. Many families in the Minneapolis Public Schools are at risk of being uninsured. At the New Families Center, families are provided with vaccinations, a health assessment, enrollment in health insurance, education in using their health coverage and health care, support after enrollment, and follow-up. Outreach to new arrival families through schools is an innovative strategy because education is a universal value. Most likely, new arrival families do not have access to commercial health insurance or other forms of health care coverage as an employee benefit. The New Families Center goes beyond just assisting families in applying for public insurance programs; it also helps with choosing a primary care clinic, education about preventive care, and addressing barriers to services through the health care navigator. The model of using staff from more than one organization—public schools, public health and occasionally state and county enrollment workers—allows access to a wider range of information and engages a broader set of stakeholders in addressing system issues.
Agency Community RolesThe Minneapolis Department of Health and Family Support (MDHFS) is a public health and advocacy agency of the City of Minneapolis. The mission of the department is “to strengthen Minneapolis families by partnering with stakeholders to build an accessible and seamless infrastructure that responds to residents’ human development needs.” A department guiding principle is to partner with other community health, community-based, and public organizations to build community capacity to address underlying social conditions and essential needs that affect Minneapolis' residents. Recognizing and responding to Minneapolis’ increasing diversity is a high department priority. Minneapolis Public Schools Health Related Services (MPSHRS) is the key partner organization for the New Families Center. The partnership founded the New Families Center as the schools' Welcome Center in 1997. New arrival families are referred to the New Families Center upon enrollment in Minneapolis Public Schools. MPSHRS provides the space for the New Families Center in the school and provides nursing staff for immunizations and health assessment. MDHFS provides interpreters and insurance social workers to support the center. Supporting organizations include the Healthy Learners Board, Robert Wood Johnson Foundation, Children’s Defense Fund, Bush Foundation, and the Minneapolis Foundation. In order to foster collaboration with stakeholders and to engage health plans and providers in addressing system issues identified by New Families Center staff, MDHFS participates on the Healthy Learner Board and Cover All Kids Coalition Access to Care Committee. The program works closely with Children’s Defense Fund – Minnesota staff to develop an advocacy agenda and work with the state Medicaid agency and legislators to address policy issues. New Families Center staff work with community clinics and other community based agencies as participants in outreach activities.  Costs and ExpendituresTotal cost for staff is approximately $300,000 for two outreach workers, a part-time shot nurse, part-time coordinator/school nurse, two interpreters, and a part-time health care access navigator. Space is covered as an in-kind donation from the schools. Most of the funding is from grants.  ImplementationThe objectives of the New Families Center in 2004 are as follows: Screen over 1,617 children for eligibility in Minnesota and Hennepin County health coverage programs.  Through application assistance and follow-up, enroll over 716 children in State of Minnesota and Hennepin County health care coverage programs. Immunize over 1,300 children.  Identify and serve 900 families in need of health care navigation services to help address individual barriers to getting health care.
The New Families Center has a proven track record of identifying and helping uninsured children enroll in health care coverage programs. A randomized, retrospective chart review of New Families Center Clients was conducted to evaluate the outreach process of the New Families Center. Efforts were made to collect data that would provide an understanding of the process involved in assisting families apply and enroll in health insurance programs. Outreach workers documented the number of contacts, type of contacts and the length each case is open. In addition, they also provided information on the referral source, barriers, family-level outcomes and services provided. On average, outreach workers worked with a family for eight to nine weeks before a case was considered closed. The minimum number of weeks a case was open was one week and the maximum was 23 weeks. Closing a case was left to the discretion of the outreach worker. For most cases, this occurred when enrollment into a health insurance program was verified or contact with the family could no longer be made. During the time a case was open, outreach workers initiated a mean of 6.5 contacts. Again, the lowest number of contacts was one contact and the highest was 29 contacts. Nearly 51% of the families served by the health care outreach workers were referred from within the New Families Center. Most other referrals came from school-based staff (34%), including school nurses, teachers and other school registration site staff. Of the 290 families identified from the various referral sources, 23 or 8% were lost to follow-up. An additional 20% had already applied or received health care insurance prior to the outreach worker following up after the initial referral. Only 3% of families expressed disinterest in health insurance in general, and less than 2% of families refused assistance once contact by the outreach worker. The top five barriers facing families as identified by the outreach workers were unfamiliarity with public insurance programs, limited access through employer, unaffordable health insurance, new arrival issues and complicated application process. It is often difficult to determine the resolution of insurance applications, as follow-up with these families is difficult due to high mobility. Additionally, the application process can be lengthy, and can take weeks to determine the outcome of an application. Of those with follow-up data available (54% of total), 94 percent obtained insurance. Most individuals applying for insurance through the New Families Center apply for Assured Care (40.3%), followed by Medical Assistance (27%) and General Assistance Medical Care (16%). The percentage that was denied health insurance varied based on the type of insurance sought. Applicants for the Hennepin County Assured Care program were much less likely to be denied compared to applicants for other public insurance programs. Data collection for 2004 has been revised and expanded to track referrals from insurance staff to the health access navigator. The navigator will then track contact with families, barriers the families face, and how these barriers were addressed. Due to the quality of the work at the New Families Center, more agencies in the community are referring people to the center rather than attempting to help families themselves. This has been a strain on the mission, scope of work and staff.
SustainabilityProgram staff are working with current stakeholders to explore ways to maintain the service once grant funding ends. Commitment to the program is a result of collaborative relationships that have allowed several agencies to work together over a number of years. The results of the effort have been well documented and shared in the community. Actual commitment will always be subject to priorities and available resources. Funding from the Robert Wood Johnson Foundation under Covering Kids and Families will continue for two years. The New Families Center has made it clear to the community and to policy makers that there is a long-term need for a health care coverage enrollment resource in Minneapolis. To plan for future sustainability, discussions begun with 1) the Minnesota Department of Human Services on continuing the New Families Center as a resource for Minnesota Care outreach and 2) Hennepin County for MA and Assured Care. Assured Care is a county funded program that provides discounts on health care at specified clinics. MPS is working with Hennepin County on a plan to coordinate north Minneapolis school enrollment with on-site health care coverage enrollment. Should this relationship prove successful, it could serve as a model for a school enrollment/on-site health care coverage enrollment plan in south Minneapolis. Discussions have also begun with the Minneapolis Public Schools on integrating New Families Center activities into three Family Resource Centers that are newly under the direction of the school district. Key Elements ReplicationThe elements of this program that determine its success include: Strong collaboration between the local public health and public schools that capitalize on the opportunity of reaching families new to the district with health services. Interpretation, insurance social work, nursing, and health access navigation staff with diverse skills capable of addressing the needs addressed by the program. Quantitative evaluation that documents relevant results. Continued discussions with stakeholders to ensure sustainability.