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BARRIERS TO CARE
| Information on ease of
access and on barriers to care provides
a context within which to understand the
challenges faced by Healthy Start grantees
in addressing their clients’ needs,
and ultimately, reducing or eliminating
disparities in outcomes. Grantees rated
the ease of obtaining access to 17 types
of services for Healthy Start clients
when they needed these services. Grantees
indicated that routine interconceptional
care, such as a 6-week postpartum visit
and family planning, were relatively easy
to obtain, while specialty care during
the interconceptional period was viewed
as difficult to obtain by the majority
of grantees. Substance abuse treatment
and dental care were the most difficult
services to obtain for Healthy Start clients
when they needed them.
Certain specialty services were perceived
to be more difficult to access by grantees
in rural areas. For example, 65 percent
of rural grantees indicated that specialty
interconceptional care was somewhat or
very difficult to obtain, compared to
33 percent of urban grantees and 42 percent
of those in urban/rural areas. In addition,
45 percent of rural grantees felt that
HIV treatment was somewhat or very difficult
to obtain, compared to 11 percent of urban
grantees, and eight percent of urban/rural
grantees. Finally, rural grantees (30
percent) were less likely to report that
family planning services were very easy
to obtain for their Healthy Start clients,
compared to urban grantees (52 percent)
and urban/rural grantees (42 percent).
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| Services can be
difficult to obtain for a variety of reasons,
some of which may be systems-related,while
others may relate to clients’ social
or financial circumstances. The most common
barriers reflected a mix of social and financial
issues, including unstable housing, lack
of insurance coverage, lack of transportation,
mobility of clients, clients’ belief
that they had more pressing needs, and lack
of child care. These six issues were reported
by at least 50 percent of grantees. These
issues reflect the multifaceted dimensions
that Healthy Start case managers and service
providers may need to address in order to
reduce disparities among this highly vulnerable
target population. Systems issues - such
as lengthy appointment waiting times, lack
of convenient or culturally sensitive providers,
and language barriers - were much less frequently
reported as significant challenges, perhaps
because Healthy Start has made inroads in
increasing the availability and cultural
competence of services for this target population.
Thus, the most significant challenges represent
large social issues that Healthy Start case
managers and other service providers may
have limited resources to resolve. These
findings highlight the importance of broad
collaboration within Healthy Start communities
to reduce barriers to care. |
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next page: Consortia
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