Variations in family and child level factors associated with emergency room visits among infants and toddlers in an Early Head Start-eligible cohort

Early Head Start (EHS) is a comprehensive, early childhood development program serving low-income pregnant women, infants, and toddlers. EHS has an explicit focus on mitigating the effects of poverty through targeted family and community partnerships. A unique component of this program is the provision of health services. Over 3,000 families participated in the Early Head Start Research and Evaluation Study conducted by Mathematica Policy Research from 1996 to 1998. This dissertation research was a randomized retrospective cohort study of a subset of these data. The purpose of the study was to determine the use of the emergency room for non-trauma care (ERNT) in a high-need, well-defined population. This study focused on family, child and access to care (as defined by insurance coverage and usual source of care) factors and their relationships to ERNT. Although the study and reference groups did not differ in ERNT, homelessness (P = 0.019), receiving energy assistance (P = 0.012), having concerns about the child's growth and development ( P = 0.042) and low birth weight of the focus child (P = 0.039) were all associated with ERNT in the reference group. The maximum likelihood estimates derived through logistic regression techniques indicated that energy assistance (2.375) and low birth weight (1.163) were strongly and positively predictive of ERNT, whereas homelessness (-0.565) was inversely associated with ERNT. These finding indicate the need for EHS programs to work closely with eligible, unenrolled families on how to access emergent care. Additionally, these findings suggest that there is a relationship between "efficient" social service use and ERNT.