Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Mentors, Training (Parent/Family), Education on Disease/Condition,

Intervention Description: NAMI Basics is a six-class manualized curriculum offered in English and Spanish. Classes occur weekly and are approximately 2.5 hours long. The curriculum covers the following content: an introduction to mental disorders and how they affect families, information about treatment of mental illness, communication skills, managing difficult child behaviors, crisis management, information about systems of care, and self-care and advocacy. NAMI-trained peer parents describe their own experiences parenting a child with mental health concerns to frame content and foster sharing of personal stories (see online supplement for more details). NAMI Basics peer parents are caregivers of a child who experienced mental health symptoms before age 13. NAMI relies on a referral process for identifying peer parents, and those who are trained to lead the course have typically taken a course previously. Training to become a peer parent takes approximately 15 hours. Training is led by NAMI state trainers, who have undergone this training previously, have experience observing and leading NAMI Basics classes, and have been recommended by their local affiliate. This study included 33 separate NAMI Basics courses across the five study sites. Nine of these courses occurred at affiliate 1, five at affiliate 2, six at affiliate 3, nine at affiliate 4, and four at affiliate 5. NAMI Basics courses were considered part of the study if at least one study participant attended any of the six classes. Classes were led by one or two peer parents; most were female (79%); half were Caucasian (50%), followed by Hispanic/Latinx (34%), and African American (16%). Fidelity was assessed by NAMI Basics–trained individuals who attended one randomly selected class for each study course and completed an adherence checklist indicating presence or absence of prescribed content (see online supplement). Class 3 was excluded from fidelity monitoring, because this session has a focus on sharing personal experiences. Fidelity to the intervention ranged from 79% to 100% (mean±SD=94.27±6.13).

Intervention Results: Compared with caregivers in the waitlist condition, NAMI Basics participants reported significant increases in parent engagement and activation, as well as intentions to engage with mental health services. NAMI Basics participants also reported significant decreases in their child’s intrapersonal and interpersonal distress, compared with those in the waitlist group. No significant differences were noted on measures of parenting stress, attitudes toward mental health services, or stigma.

Conclusion: NAMI Basics is a peer-parent support program that is readily available to support caregivers of children with mental health concerns, particularly those who experience barriers to service engagement. NAMI Basics significantly increased caregiver activation and engagement, as well as intentions to engage in services, and the children of participants showed decreases in some symptoms. Future research should examine the effects of NAMI Basics on outcomes over a longer duration and assess pathways that may result in child-level changes. Given well-documented barriers to mental health services engagement (1–3, 7–9), peer-parent support is an important resource to be leveraged.

Study Design: Randomized controlled trial

Setting: 5 NAMI affiliate locations in a southwestern U.S. state

Population of Focus: Caregivers of children under age 22 with mental health concerns

Sample Size: 111 caregivers

Age Range: Children were ages 3-22

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs.

Conclusion: Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Uninsured children 0-18 years old whose primary caregiver identified them as Latino and uninsured and reported meeting Medicaid/CHIP eligibility criteria for the child

Data Source: Kids’ HELP trial data; questionnaires

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Mentors, Consultation (Parent/Family), Training (Parent/Family),

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. The study team recruited parent mentors from a primary care clinic or a school and via referrals from other mentors. Mentor candidates were screened and interviewed to recruit people characterized by reliability, promptness, organizational skills, persistence, and motivation to help families with uninsured children. The team aimed to match ZIP codes of residence for mentors and participants to promote neighborhood relationships, social support, and economic investment. Mentors were paid $15/hour. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. Kids’ HELP also would seem to be a promising intervention at the federal level, regardless of the outcome of federal debates about Medicaid, CHIP, and future directions and financing of these programs. More covered Latino children, better outcomes, reduced costs, higher care quality, improved parental satisfaction, and job creation would seem to constitute a potent combination of benefits for the nation. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of wellchild and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs. Kids’ HELP could be implemented as part of existing state community health worker models and federal Medicaid and CHIP outreach and enrollment grants.

Conclusion: A rigorous randomized controlled trial documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, and creates jobs. Kids’ HELP could be implemented as part of existing state community health worker models and federal Medicaid and CHIP outreach and enrollment grants.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Parents and Children

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group)

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: This study examined the effects of parent mentors on insuring minority children in the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) program. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-of-pocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Primary caregiver had ≥1 child 0 to 18 years old who lacked health insurance but was Medicaid/CHIP eligible, and the primary caregiver self-identified the child as Latino/Hispanic or African-American

Data Source: Kids’ HELP trial data; questionnaires; national, state, and regional surveys

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Mentors, Policy/Guideline (Hospital), Quality Improvement,

Intervention Description: Six million children are uninsured, despite two-thirds being eligible for Medicaid/CHIP, and minority children are at especially high-risk. The study team conducted a randomized trial of the effects of parent mentors on insuring minority children. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors were recruited from June 2011 to August 2013 at a hospitalbased Resident Continuity Clinic, charter school, and via established parent mentor referrals. Interviews were conducted to identify optimal candidates characterized by reliability, timeliness, persistence, and desire to help families with uninsured children. From 31 candidates interviewed, 15 parent mentors were chosen. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-ofpocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians. Findings suggest that parent mentors and analogous peer mentors for adults might prove to be highly costeffective interventions for reducing or eliminating insurance disparities and insuring all Americans.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Parents and Children

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years