Effect of limited English proficiency on child welfare caregivers' access to pediatric health care

Primary caregivers (n=237) of children in the child welfare system were administered a modified Pediatric Access Survey (PAS) to identify barriers to accessing pediatric care. The majority of the caregivers were Hispanic (74%) and female, while the children (mean age 6.4 years) were slightly more likely to be male (57%) and similarly Hispanic. All children were insured. The results indicate that the access barrier most often identified by all caregivers was difficulty understanding doctor's explanations and, in order of frequency, the following variables were also identified: 2) wait too long to see a doctor, 3) clinic hours inconvenient and 4) too difficult to make an appointment. English proficiency was related to the access barriers identified. Birth parents were most likely to have low English proficiency (LEP). LEP caregivers were less likely to rate waiting too long to see a doctor and rudeness of staff as obstacles to care, but more likely to rate “medical care too far away” as an access problem than English-speaking caregivers. Caregivers with higher self-rated English proficiency rated immigration problems (p=.00) lower as an access barrier, although they rated waiting too long to see a doctor (p=.01) and rudeness of staff (p=.01) higher as obstacles to access to care. LEP was not related to caregiver's assessment of their child's health status. The 29 % of the caregivers who rated themselves as LEP will likely need more assistance from child welfare caseworkers in finding nearby healthcare services and/or transportation to services and linguistically appropriate medical explanations.