UTILIZATION OF WELL-CHILD CARE SERVICES FOR AFRICAN-AMERICAN INFANTS IN A LOW-INCOME COMMUNITY - RESULTS OF A RANDOMIZED, CONTROLLED CASE-MANAGEMENT HOME VISITATION INTERVENTION

Objective. To evaluate a case management/home visitation intervention to improve access to and utilization of well-child care (WCC) visits. Study Design. Randomized, controlled trial with baseline and follow-up interview surveys. Mothers and infants in the intervention group were assigned to a case manager who made at least four home visits during the infant's first year of life. In addition, the case managers contac ted clients by telephone and mail to see if they had kept their WCC ap pointments and to follow up on other issues. Sample and Data Collectio n. A population-based random sample of African-American mothers of new borns from South Central Los Angeles: 185 mothers in the intervention group and 180 in the control group completed both interview surveys. T he principal outcome variable was number of WCC visits. Additional out come variables included the child's type of insurance, the number of m onths with insurance coverage during the first year of life, age when first enrolled in Medi-Cal, age at the first WCC visit, usual source o f WCC, travel time to the usual source of care, whether the child had a regular provider, and whether the child ever needed care but did not get it. Results. There was little change in the overall distribution of number of WCC visits during the first year of life. Comparisons of the cumulative numbers of visits for each possible cutoff showed that children in the intervention group were more likely than children in t he control group to have at least four visits (81% vs 70%). Because th is split was identified empirically rather than through an antecedent hypothesis, we conducted a Smirnov test to account for multiple compar isons. This test showed a reduced level of significance. Other outcome variables did not show significant differences for the control and in tervention groups. Conclusions. In light of the high expense of this i ntervention, our evaluation shows that our moderate-intensity case man agement and home visitation program is not an effective way to increas e the number of WCC visits.