Evaluation of the Community Access to Child Health Program

Objective. Increasing attention is being focused on the need for pediatrici ans to promote child health in their respective communities. The objective of this study was to evaluate, retrospectively, the American Academy of Ped iatrics' Community Access to Child Health (CATCH) Program. Study Design. Case studies of 12 Community Pediatric projects in existence from 1989 to 1995 with varying degrees of involvement in the CATCH Program. In-person interviews were conducted with 17 pediatricians, 3 CATCH leaders who were not pediatricians, 27 project advisory committee members, 42 proj ect staff, 47 community partners, 22 public health representatives, and per sonnel in 13 affiliated institutions. Results. These projects established or enhanced child health services. Alth ough most pediatricians' interest in community child health preceded CATCH, mentoring, training, and peer support contributed to ongoing involvement. Community factors that facilitated project development included historical collaborative efforts and active public health agencies. However, across si tes, significant barriers related to attitude and resource limitations were noted. Attitudinal barriers included both institutional concerns (eg, comp etition among providers or distrust among community agencies and organizati ons) and cultural concerns (eg, general negative perceptions of providers a bout Medicaid beneficiaries or of members of minority population toward med ical or government establishments). Conclusions. In an era of devolution of responsibility to local communities , there are likely to be more opportunities for pediatricians to work with community members to promote child health. Specific strategies should be re fined and expanded to support pediatricians' involvement in community-based activities, particularly because it is recognized that insurance alone wil l not guarantee children's health.