June 26, 2000
Conducting Children's Health Insurance Outreach
in African American Communities
by Jacqueline Patterson
In 1998, 19.7 percent of African American children — approximately one in five — were uninsured. (1) Uninsured children are significantly less likely to get preventive and primary health care than children with insurance.(2) As a result, uninsured children often go without eyeglasses, immunizations, and dental check-ups, among other preventive services. Research has shown that uninsured children were about twice as likely as other children to have received no care from a physician for pharyngitis, acute earache, recurrent ear infections, and asthma.(3) African American children have higher rates of asthma, juvenile diabetes, and Human Immunodeficiency Virus than the general population.(4) When left untreated, these illnesses can have severe health consequences, potentially damaging a child's future growth and development.
A majority of African American children — 68 percent — are living in families with income below 200 percent of the federal poverty line, thereby making them eligible for free or low-cost insurance programs, according to the eligibility criteria of most states.(5) Children may qualify for coverage under Medicaid, or under a separate children's health insurance program financed by the federal child health block grant, known as the Children's Health Insurance Program(CHIP).
Parents with eligible children may not know about health insurance programs like Medicaid and CHIP-funded programs. Some mistakenly believe that because they have a job, their children don't qualify. Many don't know how to apply for benefits, or find the application process too complicated or inconvenient for a working family's schedule. Others are discouraged by the stigma that is often attached to being enrolled in public assistance programs.
Since the enactment of CHIP, many outreach initiatives have been launched in an effort to link eligible children with available coverage. In addition to the outreach activities conducted by mainstream organizations and institutions — such as schools, hospitals, etc. — special efforts that are sensitive to the cultures and dynamics of African American communities are needed. In various communities, a growing number of groups are adapting existing strategies and creating new approaches that are culturally appropriate and responsive to demographic trends.
This paper will describe specific recruitment and enrollment strategies that have been employed by groups and institutions to reach out to families in African American communities. Organizations involved in children's health insurance outreach can replicate these strategies or join existing efforts.
The Office of Minority and Women's Health defines cultural competence as: A set of skills that allow understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires an ability to draw on community-based values, traditions, and customs to work with knowledgeable persons of and from the community in developing targeted interventions, communications, and other supports.(6) Several organizations provide cultural competence training.
Black Administrators in Child Welfare
Child Welfare League of America
National Center on Cultural Competence
The Onyx Group
Contact information for each organization can be found below.
Strategies for Facilitating Recruitment and Enrollment for
Children's Health Insurance in African American Communities
Consider the demographics of the population when planning outreach strategies.
Engage fathers in getting their children enrolled.
Children are increasingly being born to female-headed, single parent families. As a result, responsible fatherhood is becoming a common theme in program development nationwide. Community-based groups are searching for ways to support fathers in their efforts to be partners in rearing their children.
California: In San Diego, the Institute for Responsible Fatherhood provides services to fathers and their families. The goal is to strengthen the connection between fathers and their children, families, and communities. As part of this overall goal, fathers are encouraged to enroll their children into children's health insurance programs if employer-based coverage is not available. Enrollment workers come to the Responsible Fatherhood Center to inform fathers about the availability of coverage. Outreach workers make home visits and provide information as well as application assistance.
Reach out to working families.
Community groups have found that, with the working population, outreach workers must address concerns families express regarding stigma. Sentiments such as, "I can pay my own bills and make my own way," can be a barrier to taking advantage of a benefit if it is perceived as a "handout." In Connecticut, the Bridgeport Children's Advocacy Council's outreach efforts for HUSKY — the CHIP- funded separate children's health insurance program — emphasize that coverage is not a "handout". They stress that families are paying for their health insurance when they pay taxes, since taxes fuel the revenue pool that funds coverage.
Engage trusted community members and groups.
For many reasons, in some African American communities, residents harbor suspicion of various institutions, including health care entities. When residents are offered services, a common response is, "There's got to be a gimmick. You're not giving me anything for free." They may make references to past experiences of African American people involving maltreatment in medical establishments. One way to work through this barrier is to engage trusted community members or community-based organizations in delivering messages and helping to bridge the divide between service delivery systems and the public.
Ohio: In Cuyahoga County, community-based groups found that it was important to have outreach workers who were indigenous to the community because they are more likely to relate to and bond with their neighbors. These workers were trained and certified at the local community college and now conduct outreach to inform fellow residents about free health insurance available through the Healthy Kids Program. They distribute applications, provide application assistance, and follow up with families to be sure that children get enrolled. Outreach workers now report that when residents open their door they feel more comfortable because they see someone who looks like them and is likely to have had similar experiences.
California: The Birthing Project is an initiative designed to assist women through the birthing experience. The Birthing Project has been touted as the "Underground Railroad for New Life." Throughout the country there are many Birthing Project Sister Circles. Pregnant women are linked with volunteer "sister friends" who guide them through the prenatal and postnatal period. One of the roles of a sister friend is to connect her sister to resources, such as children's health insurance. Depending on the state application procedures, sister friends may refer sisters to resources for applying for health insurance, bring an application to a visit, or help the sister through the application process. In some states the Birthing Project operates its own health care facilities. The Sacramento Birthing Project clinic has a Medi-Cal enrollment worker assigned to the facility who recruits and enrolls families on-site.Michigan: Operation Get Down has adopted an approach based on philosophical ideals that are intrinsic to many African cultures. In 1966, Maulena Karenga created Kwanzaa, an African American holiday which is rooted in the following principles: Umoja (unity), Kujichagulia (self-determination), Ujima (collective work and responsibility), Ujamaa (cooperative economics), Nia (purpose), Kuumba (creativity), and Imani (faith). (The names are in Kiswahili, a common East African language.) From this, a new cultural framework has developed within some African American communities. Adherence to these principles, by many African Americans, has given rise to a plethora of organizations whose practices are guided by these ideals. In accordance with the principle of Ujima, Operation Get Down developed its Medicaid Application and Eligibility Assistance Program. This program provides outreach to the community informing families of free and low-cost health insurance offered by Michigan's MI Child and Healthy Kids(Medicaid) Insurance Programs. Application assistance is provided through home visits and at the Operation Get Down Center.
Join efforts with African American institutions.
Long-standing organizations have a history of service to their communities that provides visibility and credibility. When African American institutions work together they have the advantage of a fundamental, common cause which unites them—the advancement of African American people. From this foundation they can combine resources to focus on a task that contributes to the mutual goal, such as facilitating health insurance coverage for African American children in families with low income.
Fraternities and Sororities
A commitment to community service is central to the core values of African American fraternities and sororities. For example, chapters participate in big brother/sister programs, offer scholarships, sponsor or volunteer at local events, and assist with economic development projects. Click here for a listing of African American sororities and fraternities and contact information.
Nationwide: The Alpha Kappa Alpha sorority has joined with the National Consortium for African American Children, the U.S. Department of Housing and Urban Development (HUD) Neighborhood Network Centers, and Hope for Kids to champion children's health insurance outreach. This initiative was launched at the Edgewood Neighborhood Network Center in Washington, DC. Applications and information on how community members can apply for coverage under the DC Healthy Kids program were distributed. The collaborative plans to work together to conduct outreach through the Neighborhood Network Centers throughout the country.
Over the years a number of African American professional organizations have been developed to address concerns affecting African American professionals and their constituents. These organizations deal with diverse issues including economic development, health, racial justice, child welfare, and criminal justice. The spectrum of sectors covered by these entities results in a web of potential contact points for reaching families.
Nationwide: The Summit Health Coalition (SHC) is a collaborative body of professional organizations, and other entities, that have an interest in health. SHC has distributed children's health insurance outreach materials to each of its member-organizations and has encouraged members to conduct outreach activities. The National Association of Black Social Workers, a member of SHC, has distributed outreach materials to members and has conducted children's health insurance outreach training workshops at its annual conference. As a result of the training, one DC-based member, who works as a school social worker, now distributes applications for DC Healthy Kids and conducts application assistance.
African American Businesses and Business Groups
Businesses can inform their customers about the availability of free and low-cost health insurance by posting information and by making flyers and applications available in their establishments. Businesses can also keep their employees informed and facilitate the application process. Business groups have formed to provide support for entrepreneurship in African American communities. Approaching a business group is one method of connecting with the commercial establishments of a community. This relationship adds credibility to the outreach effort as well as provides an opportunity to reach a number of businesses through one contact. For example, North Carolina promotes NC Health Choice and Health Check by working through the NC Black Chamber of Commerce to reach African American business owners, their employees and their customers.
Ohio: Visits to beauty shops occur often and may last for hours. Therefore establishments that provide hair and nail care are ideal places to conduct outreach. In Cuyahoga County outreach workers have arranged with beauty parlor owners to distribute materials to customers. They visit on certain days and answer patrons' questions regarding applying for children's health insurance.
African American churches are the backbone of many communities. In addition to offering spiritual enrichment, churches provide a venue where social connections are made and networking occurs. For many neighborhoods, the foundation for community development is rooted in the church. As such, churches have often been natural partners for outside groups that want to conduct outreach to neighborhood residents. In addition, churches have initiated activities in their communities.
Virginia: The Agape Community Development Corporation is a consortium of churches in the Hampton Roads area of Virginia. The Corporation has pledged that each church will reach out to the Tidewater communities to conduct programs to identify and help enroll children into Medicaid and the state's CHIP-funded separate program. The churches distribute applications and provide application assistance to congregants and community residents.
Over the past few decades the number of African American people who practice Islam has increased significantly. In many Muslim groups there is an emphasis on self-advancement spiritually, economically, and socially. Therefore, some families may not be easily accessible through traditional routes of contact.
Maryland: Baltimore Health Care Access recognized the need to bring their outreach campaign within the walls of local mosques. Outreach workers speak with members and distribute materials at area mosques during services.
Historically Black Colleges and Universities (HBCU)
Because of their history of community involvement, HBCUs have earned a strong reputation as respected pillars in the African American community. They can approach recruitment and enrollment on two levels. First, many students have to fulfill a community service requirement as part of their degree program. For some, conducting children's health insurance outreach could be the ideal community service placement. Students have energy and enthusiasm, which are assets for outreach. Their youth can also be a benefit for recruitment efforts with teens. Local groups would be happy to have an HBCU student join their outreach team. Second, a significant number of students enrolled in universities have children who may qualify for free and low-cost health insurance. The university can help those students apply for coverage for their children.
Texas: Students at Texas Southern University conducted a fair for the surrounding community. One of the activities was recruiting families who are eligible for the Medicaid program. Students distributed Medicaid applications and answered questions throughout the day. During the course of the event, it became apparent that students on the campus and their children appeared to be eligible for coverage. The fair succeeded in connecting parents from the greater community, as well as students of the university, to information on obtaining health insurance for their children.
Convey messages through popular media.
African American newspapers, magazines, radio stations, and television networks proliferate throughout the nation. Popular media can play a key role in communicating information about the availability of free and low-cost health insurance and how to obtain coverage.
Illinois: The African American Family Commission invited WGCI, a Chicago-based African American radio station, to attend a health fair and bring the popular WGCI van. In Chicago, wherever the WGCI van goes, a multitude of people are sure to follow, so this proved to be a successful strategy for publicizing the event. During the course of the day flyers and applications were distributed. Applications were completed on-site. Announcements about the availability of KidCare, the state's child health coverage program, were broadcasted throughout the city.
Maryland: The Baltimore Times is a popular free newspaper which publishes information of particular interest to African American residents of Baltimore City. The newspaper also hosts several events in the city during the year. Baltimore City Health Care Access took advantage of the opportunity to have a booth at one of those events, as well as to run an advertisement in the newspaper publicizing the availability of the Maryland Children's Health Insurance Program.
Reach out to the community through special events.
In most cities, African American sponsors host an array of cultural events which attract thousands of people. Across the country outreach campaigns have taken advantage of such venues for recruitment and enrollment.
North Carolina: One outreach effort to promote Health Check and Health Choice for Children — North Carolina's children's health insurance programs — took place at an annual African American festival. For this event the health department solicited a local business to donate T-shirts and sweatshirts. Participants who filled out applications on-site received a T-shirt or sweatshirt.Ohio: Outreach was conducted at the Black Family Reunion, which attracted over 200,000 people. Outreach workers gave out information, asked interested families to share contact information, and later followed up to ensure that the application process was going smoothly.
It is important to remember that children's health insurance outreach activities not only present opportunities to share resources, but it is also an opportunity to learn more about the barriers facing families. Through contact with the uninsured population, organizations can acquire information needed for furthering and enhancing strategies.
Contact information for organizations that provide training in cultural competence Black Administrators in Child Welfare
440 First Street, NW, Third Floor
Washington, DC 20001-2085
National Center on Cultural Competence
Child Development Center
3307 M Street NW Suite 401
Washington DC 20007-3435
E-mail: [email protected]
Child Welfare League of America
440 First Street, NW, Third Floor
Washington, DC 20001-2085
The Onyx Group
P.O. Box 60
Bala Cynwyd, PA 19004
E-mail: [email protected]
African American Fraternities and Sororities:
Alpha Kappa Alpha Sorority
Alpha Phi Alpha Fraternity
Delta Sigma Theta Sorority
Iota Phi Theta Fraternity
Kappa Alpha Psi Fraternity
Omega Psi Phi Fraternity
Phi Beta Sigma Fraternity
Sigma Gamma Rho Sorority
Zeta Phi Beta Sorority
The Pan-Hellenic Council can provide contact information for each organization:
Memorial Hall W108
Bloomington, IN 47405
For more information on outreach activities,
please contact Jacqueline Patterson at 202-408-1080.
1. Center on Budget and Policy Priorities calculation based on March1998 Current Population Survey data from the U.S. Census Bureau.
2. A. Monheit and P. Cunningham, "Children Without Health Insurance," The Future of Children 2 (1992), p. 154-170.
3. U.S. General Accounting Office, "Health Insurance: Coverage Leads to Increased Health Care Access for Children," (Washington, DC: Government Printing Office, November 1997), p.3.
4. Centers for Disease Control, http://www.cdc.gov/ .
5. Center on Budget and Policy Priorities calculation based on 1996-1998 Current Population Survey data from the U.S. Census Bureau.
6. Office of Minority and Women's Health, www.bphc.hrsa.dhhs.gov/omwh/omwh_7.htm