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Transportation for Health or Family Support Access

Category

Family Support, Child & Family Health

Child's Age

Prenatal, 0-1 years, 1-2 years, 2-3 years, 3-4 years, 4-5 years

Participant

Children, Parents/Guardian

Languages

English

Brief Description

Transportation not covered by Medicaid to support positive health and family well-being outcomes.

Expected Impact

  • Increased access to health care or family support services by children and families

Core Components for Model Fidelity

  • Transportation: To and from necessary and preventative medical and health care appointments (non-emergencies). May be provided via a variety of means but must be in alignment with Smart Start Cost Principles.

Languages Materials are Available in

English

Delivery Mode

In-person.

Dosage

As needed.

Infrastructure for Implementation

Other: Means of transportation may include coordination with local public transportation, shuttle services, ride share programs, and other means as aligned with Smart Start Cost Principles. Please note that Smart Start funds can only be used to provide transportation services not covered by Medicaid. As a network, Smart Start does not duplicate existing services.

Staffing Requirements

Transportation services can be provided via a multitude of staffing or contracting arrangements, so long as NC safe driving laws are followed.

NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Prevent Child Abuse North Carolina | PCANC (preventchildabusenc.org) or National Family Support Network for more information, training and certification.

Contact Information

LPs will need to coordinate with local transportation services and are encouraged to convene all relevant providers in their community.

Cost Estimates

Cost estimates vary based on local market rates.

Purpose Service Code (PSC)

5415 - Health Care Access and Support

Program Identifier (PID)

Transportation for Health or Family Support Access

Minimal Outputs for NCPC Reporting

FY 24-25:

  • Number of children participating
  • Number of parents/guardians participating†

†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.

Minimal Outcomes for NCPC Reporting

FY 24-25:

  • Increase in parental use of services

Minimal Measures for NCPC Reporting

FY 24-25:

  • No Measure Currently Required

NCPC Evidence Categorization

  Evidence Informed- Industry Standard

Research Summary

Four of the most relevant publications on transportation for child care, health care, or family support services include a report evaluating transportation for health care access in Durham, NC1, a guidebook to help communities improve transportation to health care services2, a webpage from DCDEE with resources regarding safe transportation,3 and a case study on transportation in five rural NC counties (Graham, Warren, Wilson, Chatham, and Beaufort).4 Transportation is considered a social determinant of health, one of several factors that influences health outcomes and well-being and stems from social and economic disadvantages that impact populations such as older adults, people with disabilities, people with lower incomes, and individuals living in inner-city or rural areas. Transportation issues are typically related to a lack of access to public transit or a reliable vehicle, distance or time-related challenges, geographical barriers, transportation eligibility requirements, scheduling difficulties, extensive time and financial costs, disabilities, and infrastructure and driver's license issues, among other concerns. Results of interviews and focus groups indicated that common solutions to transportation disadvantages included walking/cycling, carpooling or receiving assistance from friends, family, or neighbors, paratransit, and using church vans or employer-sponsored transportation. Research indicates that improved access to health care results in reduced missed appointments, greater patient encounters, increased compliance with health care visits, and increases the cost effectiveness of health care services. To address transportation needs, communities should identify geographical barriers based on local knowledge, locate informal transport networks, use census data to build foundational maps of areas with transportation disadvantages, and connect with community members to further identify needs. Use of a standard screening tool to identify health-related social needs, such as transportation, can also highlight needs in the community. Additionally, the state requires that all child care centers implement safe transportation policies and procedures, such as ensuring all children have exited the vehicle at drop off. Child care operators and staff should be aware that transporting children is a high-risk activity requiring careful planning to reduce liability for child care operators and ensure the safety of children and staff. Child care centers are encouraged to provide safety bulletins with clear tips and procedures to help families and staff implement safe transportation practices. North Carolina has several statutes and rules regarding child care transportation that all child care centers must abide by.

  1. ^ See Cooper et al. (2012). This report evaluates transportation access to health care services for Durham residents. The study found that Durham-based non-profit organizations and public health clinics primarily serve people who are uninsured, underinsured, low-income, on fixed incomes, unemployed, or belonging to racial/ethnic minority groups. These residents are more likely to be dependent upon public transit than the average Durham resident. The most frequent destinations for residents using Durham's public transit system to health care providers and agencies included hospitals, mental health facilities, specialists, clinics, and local referral centers. They sought medical examinations, immunizations, TB testing, and referrals to local services such as dental care, family planning, food and clothing pantries, housing benefits, and more. Residents also identified employment centers and public housing locations as destinations or origins for transit. Assessments of transit quality in Durham indicated that Central Durham had the greatest accessibility as a significant number of transit centers, low-income areas, and health care facilities were located within walking distance or close proximity to bus services. South, West, and East Durham had the poorest coverage compared to other regions of Durham as no downtown destinations were located within a 30-minute bus ride of the health care providers in South, West, or East Durham. Characteristics of cities with high quality, affordable public transportation to health care services include low-income bus pass programs, discount fares available through individual purchase, virtual databases for monitoring, and a partnership between public and private agencies, organizations, and funding sources. To improve transit access to healthcare, it is recommended that public agencies and private health care providers provide clients with appropriate information about transportation services, advocate and plan for improved transit services connecting peripheral destinations, and continue to improve monitoring and evaluation of health care access and public transit.
  2. ^ See American Speech-Language-Hearing Association (n.d.). This webpage from the American Speech-Language-Hearing Association (ASHA) describes the signs of speech, language, and hearing disorders. Signs of language problems vary by age and may include not babbling, not using gestures, not putting two words together, and difficulty with early reading and writing. Children with voice disorders may have hoarse, scratchy voices or sound nasal while a child with hearing loss may have difficulty paying attention to sounds, responding when their name is called, or following directions. Signs of speech sound disorders include difficulty pronouncing sounds like "p," "w," and "t" or stuttering (including repeating the first sounds of words, stretching sounds out, or pausing often while talking). ASHA recommends that parents and caregivers concerned about their child's speech or language development seek help early by contacting a speech-language pathologist who have earned the Certificate of Clinical Competence (CCC) from ASHA. These professionals may provide diagnosis and treatment through services like speech-language therapy.
  3. ^ See North Carolina Division of Child Development and Early Education (n.d.). As described by NCDCDEE, the state requires that all child care centers implement safe transportation policies and procedures, such as ensuring all children have exited the vehicle at drop off. Child care operators and staff should be aware that transporting children is a high-risk activity requiring careful planning to reduce liability for child care operators and ensure the safety of children and staff. Child care centers are encouraged to provide safety bulletins with clear tips and procedures to help families and staff implement safe transportation practices. North Carolina has several statutes and rules regarding child care transportation that all child care centers must abide by.
  4. ^ See Combs et al. (2016). This case study sampled five rural counties in North Carolina (Graham, Warren, Wilson, Chatham, and Beaufort counties). Researchers conducted interviews with key informants and focus groups with community members, including citizens of the Eastern Band of the Cherokee Nation, senior citizens, migrant farm workers, social service workers, and other populations. Results of interviews and focus groups indicated that common solutions to transportation disadvantages included walking/cycling, carpooling or receiving assistance from friends, family, or neighbors, paratransit, and using church vans or employer-sponsored transportation. Community members’ ongoing concerns with transportation included limited access to health care destinations, complications posed by local geography (such as a river requiring transport by ferry), transportation eligibility limitations (including lack of funding, income requirements, and health status), limited destinations, scheduling difficulties, long distances, and extensive time commitments. To address transportation needs, communities should identify geographical barriers based on local knowledge, locate informal transport networks, use census data to build foundational maps of areas with transportation disadvantages, and connect with community members to further identify needs.

Combs, T. S., Shay, E. Salvesen, D., Kolosna, C., & Madeley M. (2016). Understanding the multiple dimensions of transportation disadvantage: the case of rural North Carolina. Case Studies on Transport Policy, 4(2) 68-77. https://www.doi.org/10.1016/j.cstp.2016.02.004 

Cooper, H., Curtis, T., Dennerlein, T., Mansfield, A., Turner, C., Wang, L. & McDonald, N. (2012). Transportation Access to Healthcare in Durham: Research and Strategies for Durham's Nonprofit and Public Healthcare Agencies. https://healthydurham.org/cms/wp-content/uploads/2016/03/AccesstoCareTransportReport.pdf

KFH Group, Incorporated. (2021). Chapter 2: Why Should Communities Improve Transportation to Health Care? In Guidebook and Research Plan to Help Communities Improve Transportation to Health-Care Services (pp. 9-22). Transit Cooperative Research Program. National Academies of Sciences, Engineering, and Medicine. https://nap.nationalacademies.org/read/25980/chapter/1 

North Carolina Division of Child Development and Early Education. (n.d.). Be on the Safe Side: Transportation Safety. North Carolina Department of Health and Human Services. https://ncchildcare.ncdhhs.gov/Whats-New/be-on-the-safe-side-transportation-safety



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Transportation for Health or Family Support Access. Local Partnership contact information can be found here.