Baltimore's consumer ombudsman and assistance program: an emerging public health service in Medicaid Managed Care.

OBJECTIVES: To present Baltimore City Health Department's (BCHD) experience in developing and operating an ombudsprogram for Maryland's Medicaid Managed Care HealthChoice Program as an innovative public health response to its MCH Title V assurance functions. METHODS: This paper presents a case study that 1) describes Baltimore City's Consumer Ombudsman and Assistance Program (COAP) in terms of development, function, structure, and resources; 2) provides a summary of its first 30 months' experiences, both quantitatively and qualitatively; and 3) describes COAP's successes, value, and limitations with respect to its three essential roles--a) conflict resolution for individuals, b) education for consumers, providers and advocates, and c) catalyst for quality improvement. OUTCOMES: Over 1300 cases (involving enrollment, access, billing, and treatment issues) were referred to COAP by the State's Complaint Resolution Section during the first 2 1/2 years of HealthChoice. Ombudsman interventions resulted in conflict resolution for enrollees using a continuum of education, mediation and advocacy, and in generating systematic data for systems change through collaboration with state and community public health, managed care organization, provider, consumer, and advocacy officials and groups. CONCLUSIONS: Public health ombudsprograms can effectively assist and educate enrollees; and provide concurrent, or real-time, information for consumer, provider, health plan, and advocacy groups, as well as public policymakers and legislators to better inform systems improvement and innovation. The community-based ombudsman role is an effective mechanism to ensure appropriate care for MCH populations and others with special needs. Such efforts can be funded by federal/state Medicaid administrative funds and are a sound investment in assuring access to comprehensive care for vulnerable populations.

Lead exposure and child behavior.

OBJECTIVES: Unlike cognitive impairments associated with lead exposure, lead-associated child behavior problems have been difficult to specify, particularly in young children. METHODS: The Child Behavior Checklist (CBCL) and the Center for Epidemiologic Studies Depression Scale were used as the outcome and confounding variables, respectively, of major interest. These measures were examined with respect to blood lead levels of 201 African-American children aged 2 through 5 years. RESULTS: In comparison with the low exposed group, the high exposed group (two consecutive blood lead levels greater than or equal to 15 micrograms/dL) had a significantly higher mean CBCL Total Behavior Problem Score (TBPS) and Internalizing and Externalizing scores; when other factors, including maternal depressive symptomatology, were controlled for, regression procedures indicated a .18-point TBPS increase for each unit increase in lead and a 5.1-point higher TBPS in the high exposed group; children in this group were 2.7 times more likely to have a TBPS in the clinical range. CONCLUSIONS: Through its use of a standardized parent-report measure of behavior and its consideration of maternal morale in multiple linear and logistic regression procedures, this study provides further evidence of lead's detrimental effect on child behavior at levels typical of present-day exposure.

Effectiveness of the Denver Developmental Screening Test with biologically vulnerable infants.

The Denver Developmental Screening Test (DDST) was initially developed specifically to identify children with mental retardation. However, its use in screening low birth weight and other biologically at-risk infants for motor problems is widespread. In view of the absence of biologically vulnerable children in the DDST standardization sample, and the limited validational support available for its use with children under 30 months of age, the purpose of this study was to investigate the effectiveness of the DDST in screening 62 Neonatal Intensive Care Unit graduates during infancy. Categorical results (Normal, Questionable, Abnormal), obtained in the home setting by DDST, were compared with results of Neonatal Intensive Care Unit Follow-up Clinic evaluations. There was a marked underselection of the DDST's categorical results in identifying those infants with suspect or abnormal findings on the more detailed clinic evaluations. However, the effectiveness of the screeners' clinical impression ratings (based on observations made during administration of the DDST) in identifying infants with positive criterion results was encouraging. These findings suggest that, although the DDST's categorical results may be of limited value in screening biologically vulnerable infants, administration of the DDST may provide a useful framework for more systematically observing and documenting significant qualitative aspects of an infant's developmental status, particularly for the screener who is less experienced in neuromotor assessment. These observations need to be defined further, and validated.