The CATCH (Community Access to Child Health) Program, which supports pediatricians who engage with the community to improve child health, increase access to health care, and promote advocacy through small seed grants, was last evaluated in 1998. The objective was to describe the characteristics of CATCH grant recipients and projects and assess the community impact of funded projects. Prospective data was collected from CATCH applications (grantee characteristics, topic area and target population for projects funded from 2006–2012) and post-project 2-year follow-up survey (project outcomes, sustainability, and impact for projects funded from 2008 through 2010). From 2006 through 2012, the CATCH Program awarded 401 projects to grantees working mostly in general pediatrics. Eighty-five percent of projects targeted children covered by Medicaid, 33% targeted uninsured children, and 75% involved a Latino population. Main topic areas addressed were nutrition, access to health care, and medical home. Sixty-nine percent of grantees from 2008 to 2010 responded to the follow-up survey. Ninety percent reported completing their projects, and 86% of those projects continued to exist in some form. Grantees reported the development of community partnerships (77%) and enhanced recognition of child health issues in the community (73%) as the most frequent changes due to the projects. The CATCH Program funds community-based projects led by pediatricians that address the medical home and access to care. A majority of these projects and community partnerships are sustained beyond their original CATCH funding and, in many cases, are leveraged into additional financial or other community support.
- AAP —
- American Academy of Pediatrics
- CATCH —
- Community Access to Child Health
- SCHIP —
- State Children’s Health Insurance Program
The Community Access to Child Health (CATCH) program supports pediatricians who engage with their communities to increase children’s access to medical homes or specific health services not otherwise available, to improve overall child health at the community level, and to advocate for health equity within their communities. The program encourages community-based pediatricians to take on a leadership role on the project and to include broad-based community partnerships as well as plans for achievable sustainability beyond the grant period.
Over its 20-year history, CATCH has provided funding for 644 grants to practicing pediatricians. CATCH grants are small, used as seed money for planning a program or starting a community project to increase children’s access to health services in the community.1 The CATCH program began so that pediatricians could solve local issues using collaboration with community partners. CATCH projects often serve as a leading indicator for emerging issues of concern within child health and provide an opportunity for pediatricians to address children’s health needs through community-based solutions tested on a small scale. The program focuses on children who experience health inequities or who are uninsured or who are insured but cannot always obtain the services they need.
In the late 1960s, Philip J. Porter, MD, had a vision of creating the Healthy Children Program. With funding from the Robert Wood Johnson Foundation, the program was formally established in 1983 to make health care services universally accessible to children who need them and to leverage existing human and fiscal resources in the community. Under the vision of Julius B. Richmond, MD, and with the financial support from the American Academy of Pediatrics (AAP), the Healthy Children program merged with the AAP Access to Care Initiative in the late 1980s. By 1990, the AAP launched the “One Pediatrician Can Make a Difference for America’s Children” message with a greater emphasis on local pediatricians and community leaders joining together to devise comprehensive, community-based solutions to community-defined problems. With continued Robert Wood Johnson Foundation funding in 1991, the program emerged as the CATCH program with F. Edwards Rushton, MD, as its first director. In 1995, under Thomas F. Tonniges, MD, there was greater integration of the medical home component in the CATCH program. For a detailed history of the CATCH Program, please refer to Hutchins et al 1999.2
Today the CATCH Program is administered by the AAP Division of Community-based Initiatives within the Department of Community, Chapter and State Affairs, reflecting the importance that the AAP attributes to the promotion of community engagement by its members. To support pediatricians engaged in CATCH activities, the AAP has established the CATCH Network, a trained group of volunteer AAP chapter and district members, many of whom are current and past CATCH grantees. An important function of the network is to provide training and technical assistance for the key skills necessary to develop and implement a community-based child health initiative. This can include guidance on how to conduct a needs assessment, community asset mapping, developing resources, motivating colleagues, community coalition building, and program evaluation.1 Information about CATCH grants is available to the public via the Community Pediatrics Grants Database.3 The database serves as a resource for prospective grantees for ideas and for funded grantees for peer consultation. There are 2 types of grants available to practicing pediatricians: Planning and Implementation. Planning grants provide funding for the planning phase of a community-based project, and Implementation grants provide funding for the initial pilot phase of a project. Following are examples illustrating each of the types of grants.
2008 CATCH Planning Grant
Children’s Outreach: Targeted Community Needs Assessment Turner Courts Service AreaLeann Kridelbaugh MD, FAAP, Dallas, TexasAward: $7350
This project partnered the lead pediatrician with community leaders and residents in a medically underserved area to develop and administer a community pediatric health questionnaire. This survey, translated into Spanish, was composed of 42 items to measure a variety of issues relevant to pediatric health and given to >100 parents, which helped identify barriers to care and pressing health issues in the community. It indicated a high rate of asthma (37%) in the community’s pediatric population and a high rate of low-acuity emergency department utilization. This culminated in an asthma outreach and education effort, raised neighborhood residents’ awareness of children’s health issues, and enhanced the recognition of the community’s health care and social service resources through the provision of a comprehensive pediatric community resources list. This list was also made available to community organizations and facilitated improved children’s access to needed services. Since the grant has ended, there has been a renewed focus on asthma in the community, and a community stakeholders group has been formed to continue to address children’s health issues.
2009 CATCH Implementation Grant
AmeriCorps Workers as Medicaid/State Children’s Health Insurance Program Case ManagersCarole Stipelman MD, MPH, FAAP, Salt Lake City, UtahAward: $11 450
At the Community Health Center clinics in Salt Lake County, >95% of the pediatric patients are Latino, 25% of whom are uninsured. Of the uninsured children, 80% are eligible for Medicaid or State Children’s Health Insurance Program (SCHIP) but have not successfully completed the application process. Through a CATCH Implementation grant, a pilot program was developed to train AmeriCorps members at a community health center to work with families to obtain Medicaid/SCHIP coverage. In a 4-month period, 74% of children from the clinic where case management was provided were enrolled, compared with 26% from the clinic where no case management was provided.
The pilot also found that children who gained coverage were more likely to use preventive care in the following 6 months despite availability of sliding-scale fees for uninsured. As a result of the grant, communication was improved among the Department of Health, the Department of Workforce Services, other community-based agencies, and the clinic. Findings from the CATCH grant were used to apply and led to the receipt of a Children’s Health Insurance Reauthorization Act (CHIPRA) grant to expand the concept to 8 Community Health Center clinics in Utah, and full-time clinic employees were used to perform case management. Since that project, a coalition of the Association for Utah Community Health, United Way 2-1-1, and Utah Health Policy Project has continued to develop the work initiated by the CATCH grant using 25 AmeriCorps members and training many other nonvolunteer staff in the pilot model.
In 1996, the Women’s and Children’s Health Policy Center at Johns Hopkins School of Public Health conducted an independent evaluation of the first 7 years of the CATCH program. Through case studies, oral history, surveys, and key informant interviews, the evaluation showed the potential of the CATCH program to affect the health of children and communities through creative collaborations.4 In the ensuing years, the CATCH program has grown in size and sophistication and has diversified its funding, leading to topic and population-specific funding for projects that have focused on oral health, immunizations, obesity/overweight prevention, reducing the impact of secondhand smoke, and American Indian/Alaska Native children. In 2006, the CATCH program instituted a systematic effort to collect information regarding the grantees, their projects and the impact of funding and technical support on the project, the project’s target population and career trajectory of the grantee. This report summarizes the results of that effort.
To describe the characteristics of the recipients of CATCH grant funds awarded from 2006 to 2012 and assess the community impact for a subset of grants awarded from 2008 to 2010.
CATCH proposals are solicited twice each year from pediatricians practicing in the United States. The proposals are reviewed by at least 3 members of the CATCH network at the state and regional levels and scored on selected criteria to establish funding priority. Grants are awarded on the basis of ranking and the availability of funds. CATCH funds are budgeted to be spent within 6 months of award, although up to two 6-month extensions may be granted at the request of the grantee. CATCH routinely collects information about the pediatrician applicant and the project, including community demographics and goals. Two years after grant completion, information is collected about the project, the pediatrician’s involvement in the project, and sustainability.
Starting in 2006, applicants applied through a Web-based application that facilitated the collection of data regarding the applicant, the applicants’ practice site, the community and population to be targeted, and the nature of the proposed intervention.
Deidentified application data for successful applicants were used to create descriptive statistics for the successful applicants from 2006 to 2012.
From 2006 to 2008, the CATCH leadership and staff developed a Grantee Follow-Up Survey in consultation with research and evaluation experts within the AAP (see Supplemental Information). The survey inquires about the project’s outcome, the pediatrician’s ongoing role in both this project and the field of community pediatrics, and the impact of the project on child health in the community. Follow-up questions were derived from 2 primary sources. Most demographic and pediatrician-specific questions were drawn from the Periodic Survey of the AAP. Most questions specific to the goals of the CATCH program were adapted from the 2004 evaluation plan developed by Cynthia Minkovitz and Holly Grason of Johns Hopkins University Bloomberg School of Public Health.5
To supplement forced choice semiquantitative items, respondents were afforded the opportunity to provide feedback or explanation through qualitative responses to summative questions. All grantees receiving awards from 2008 on were invited to complete the Grantee Follow-Up Survey 2 years after the completion of their projects. Because of the time lag between the grant award and follow-up survey, postgrant assessment data were only available for grants funded from 2008 to 2010 at the time of this analysis (Fig 1). Follow-up data are not available for grants funded before 2008 (approximately one-third of those in the 2006–2012 time frame), but will be collected for the 2011 and 2012 cohorts (∼22% of grants in the time frame) and additional cohorts going forward at the appropriate 2-year interval.
SPSS18.0 (2009, PASW Statistics for Windows, Version 18.0. Chicago, IL: SPSS Inc) was used to create descriptive statistics of applicant characteristics and postgrant assessments. Information on primary focus and topics of grants was collapsed into categories using qualitative analytic techniques. Responses were coded and grouped into themes independently by 2 investigators (NSS and WLH), and discrepancies were resolved via investigator consensus. Thematic categories were used to characterize the types of grants awarded and topics important to pediatricians who applied to CATCH.
The study was exempted from formal informed consent by the Institutional Review Board of the AAP.
Over a 7-year period (2006–2012), the CATCH Program funded 401 projects of 731 applications (55%) with an average award amount of $10 213. Grants were awarded throughout the United States. Figure 2 illustrates the distribution of grants awarded across all AAP chapters.
Description of CATCH Grantees and Projects
Eighty-seven percent of grantees reported obtaining technical assistance for their projects from the CATCH network, mostly from chapter facilitators (62%) and CATCH staff (36%). The nature of technical assistance obtained was varied, with proposal preparation/grant writing (63%) and information/materials (44%) most frequently reported. Most grantees (80%) worked full-time in a variety of clinical settings, with 76% spending more than half of their time in general pediatrics (Table 1).
The projects were conducted in a broad range of communities and settings, with 47% in urban, inner-city communities and 41% in rural communities. More than a quarter (26%) of projects were conducted in health clinic settings, 21% in community-based organizations and 15% in schools. Collectively, the projects looked to address community and/or system issues across the entire age and developmental spectrum of childhood and adolescence. A majority of the projects (85%) focused on children covered by Medicaid and one-third (33%) on uninsured children. Most projects targeted multiple ethnic groups, with the highest proportion (75%) reporting a Latino population as a primary target population (Table 2).
Forty-five project topic foci were reported by grantees. These foci were grouped into 8 thematic categories (Table 3). Although themes varied slightly year to year, nutrition, medical home, and access to care were the most frequently reported areas of focus over the 7 years included in this review.
Grantee Follow-Up Survey Data
From 2008 to 2010, 187 grants were funded. After exclusion of those who declined their grants, those who had reported that their grants were not completed as of the 2012 survey date, and those for whom no current contact information was available, 157 grantees were electronically sent the Grantee Follow-Up Survey, ∼2 years after their grants were awarded. Sixty-nine percent of grantees (n = 109) responded to the follow-up surveys. Ninety percent (98) reported that they had completed their projects, and of those, 66% (62) reported that they remained involved with the project. Of those who had completed their projects, 86% (83) indicated that the project continued to exist, in the original form, partial form, expansion into a larger project, or by being absorbed into a larger organization or intervention. Post-CATCH funding of projects came from a variety of sources (Table 4). Twenty-nine percent of grantees reported leveraging additional funding for their projects. Partnerships with diverse community organizations were developed during the projects, and 97% (91) of respondents reported that at least some of those partnerships were sustained. Sixty-four percent (59) of grantees reported forming new partnerships since CATCH funding had ended. At the time of the follow-up, a majority (51.5%) of respondents reported active partnerships with local public health service agencies. Other frequently reported active partnerships were with schools/education groups (46.4%), parents/families (44.3%), grassroots organizations (43.3%), and hospitals (42.3%). Although we know the types of organizations partnered with, we do not have information on the nature of the partnerships.
Grantees were asked to indicate changes that had occurred in their communities as a result of their CATCH projects. Respondents reported a wide range of community changes, most frequently including the development of community partnerships (77%), enhanced recognition of child health issues in the community (73%), and expanded pediatrician involvement in community-based programs (72%) (Table 4). Additionally, respondents reported that their CATCH-funded projects helped to enhance the visibility of pediatricians in their communities (64%).
Three grantees reported that they would be unable to complete their projects. One reported lack of community interest in the project, and another reported being limited by time constraints and “extensive reporting requirements.” The third grantee who did not expect to complete the project had left her position and was unable to identify another provider to take it over.
Pediatricians in the 21st century have been called on to improve the health of all children in a world of changing demographics, inequitable distribution of health care resources and an increasing number of children growing up in poverty.6 For the past 20 years, AAP CATCH grants have helped pediatricians engage with communities to improve child health. The grantees funded from 2006 to 2012 proposed projects that addressed the needs of infants, children, and adolescents throughout the country, focusing on families whose children were part of Medicaid programs and those who were not able to access insurance. Grantees were engaged in the practice of community pediatrics,7 working with other professionals, community agencies, and parents to achieve optimal access to appropriate, high-value of services for all children.8 Only 26% of applicants were in academic practice, indicating that the program has successfully supported practicing pediatricians, outside of academic health centers, in community engagement. The grantees described their work as supportive of the medical home model9 in which pediatricians deliver family-centered comprehensive care to all children and youth, addressing the “millennial morbidities”10 of children’s health.
Over the past decade, pediatricians have become less likely to engage in the kind of community activities supported by the CATCH program. According to a survey of practicing fellows of the AAP, pediatrician involvement in community child health activities dropped from 45.1% in 2004 to 39.9% in 2010. Over that same period, the percentage of pediatricians receiving payment for community child health activities fell from 20.5% to 14.2%.11 CATCH attempts to encourage pediatricians, through relatively small starter grants of ≤$12 000, to engage in a greater role in community health. CATCH or other community engagement programs may not be sufficient, however, to overcome the economic reality of the way in which pediatricians are compensated for their professional efforts. More research is needed to understand the reasons for the change in pediatricians’ involvement in community child health and the factors that facilitate or hinder that participation.
The CATCH program was designed to help pediatricians create sustainable partnerships that have an impact on the communities they serve. More than half of respondents reported partnering with public health agencies and more than a third with government health agencies, suggesting the possibility of an effect on policy, population health, and children’s health and health care.
Because of the small size and diverse foci of CATCH projects, child health outcome measures with statistical rigor are seldom available for study. However, reported community effects and sustainability of these projects are encouraging. Eight-six percent of completed projects continued to exist after the end of funding, and partnerships were sustained and expanded, similar to the sustainability seen in the Maternal and Child Health Bureau’s Healthy Tomorrows program.12 Pediatricians, often using in-kind support, were able to collaborate with partnering organizations to continue these projects. Sustained community engagement allows pediatricians to address important child health issues such as poverty, early childhood brain development, epigenetics, quality and access, highlighted by the AAP in the Agenda for Children13 and the Vision of Pediatrics 2020.14 Priority areas such as care of Children with Special Healthcare Needs and child nutrition continue to be among those most consistently receiving CATCH funding. Over time, these projects have the potential to influence the health of the communities they serve.
Because this is a descriptive study, relying on self-report for the initial assessment and the follow-up survey, the result must be interpreted with caution. There is no control or comparison group, so changes in both the degree of pediatric engagement and in community outcome cannot be solely attributed to the CATCH program. There is a risk of response bias and recall bias in grantee survey data, and there was no mechanism to corroborate grantee reporting with actual outcomes in communities. These data should be seen as a summary of the current state of the program, and future directions may include a closer study of a subset of grantees in any given year or a large-scale survey of all members of the CATCH Network. Inclusion of final reports from grantees after completion of their projects in analyses may yield qualitative data revealing additional themes of interest, but those data were not available at the time of this study. CATCH is a philosophy, a process, and a program and is an evolving set of concepts based on program goals that have been additive and evolving.15 The program continues to explore ways to refine the evaluative component of the program, and future studies may reflect these methodologies.
CATCH was originally conceived as 1 of the 3 prongs of the AAP’s Access to Care Initiative related to establishing community-based programs and the belief that pediatricians are not too busy to become involved in community work because they benefit directly from such activity and they are particularly well suited to initiate leadership in the community.2 As the US health care system evolves towardperformance-based management and patient-centered care, as envisioned in the Affordable Care Act,16 this concept has increasing relevance because primary care practitioners will be held accountable for population outcomes. Those receiving CATCH grants report being able to practice population health at the community level and assume leadership roles in overcoming barriers to implementing system changes in communities to improve child health. The core of CATCH is the family-centered medical home, which is considered the foundation of a primary-care-driven integrated delivery system that will anchor an Accountable Care Organization.17 CATCH may be able to serve as an incubator for the practitioner of the future as health care moves toward this accountable care model.
The CATCH Program funds community-based projects led by community pediatricians that address the medical home and access to care. A substantial majority of these projects and the community partnerships CATCH seeks to foster are sustained beyond their original CATCH funding and, in many cases, are leveraged into additional financial or other community support.
We thank the CATCH staff and District CATCH facilitators for their guidance, as well as Dr Marsha Raulerson and Dr Paul Chung for input on the content of this article. The CATCH program is a national program of the AAP supported by Pfizer, Inc., the Walmart Foundation, and individual donations through the AAP Friends of Children Fund.
- Accepted October 25, 2013.
- Address correspondence to Neelkamal S. Soares, MD, 120 Hamm Dr, Suite 2, Lewisburg, PA 17837. E-mail:
Dr Soares conceptualized and designed the study and drafted the initial manuscript; Dr Hobson designed the study and reviewed and revised the manuscript; Dr Ruch-Ross was involved in the initial design and implementation of the evaluation plan and data system, conducted the data analysis, and revised the manuscript; Ms Finneran provided data on the CATCH Program and reviewed and revised the manuscript; Dr Varrasso was involved in the initial design and implementation of the evaluation plan and reviewed the manuscript; Dr Keller was involved in the initial design and implementation of the evaluation plan, and reviewed and revised the manuscript; and all authors accepted the final manuscript as submitted and revised and approved the final manuscript as submitted.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- ↵American Academy of Pediatrics Community Access to Child Health (CATCH). Available at: http://www2.aap.org/catch. Accessed on June 21, 2012
- ↵American Academy of Pediatrics Community Pediatrics Grants Database. Available at: http://www2.aap.org/commpeds/default.cfm. Accessed on May 3, 2013
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- ↵American Academy of Pediatrics Agenda for Children. Available at: http://www.aap.org/en-us/about-the-aap/aap-facts/AAP-Agenda-for-Children-Strategic-Plan/Pages/AAP-Agenda-for-Children-Strategic-Plan.aspx. Accessed July 18, 2013
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- ↵Patient protection and Affordable Care Act. Available at: http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm. Accessed February 2, 2013
- Accountable Care Organization Workgroup. Accountable care organizations (ACOs) and pediatricians
- Copyright © 2014 by the American Academy of Pediatrics