View Research by Author - Sarah Benatar

Sarah Benatar, PhD, is a Research Associate in the Health Policy Center of the Urban Institute. Her research interests include maternal and child health policy and reproductive health, as well as health coverage, quality and access for vulnerable populations. Since joining the Urban Institute in 2008, Dr. Benatar has worked on several program evaluations including a multiyear evaluation of Best Start Los Angeles, a home visiting and community-based investment aimed at improving health and developmental outcomes for low-income children in a Los Angeles neighborhood. She is also a key member of the team evaluating ongoing efforts to redesign the county clinic system in San Mateo County, California and improve care and health coverage for adult patients with chronic conditions. Dr. Benatar directed an evaluation of the feasibility of implementing a universal vaccine purchase program for children in New York State and is leading an evaluation of a physician incentive program implemented by a publicly accountable health plan in California serving primarily Medicaid and CHIP members. Her recent work includes a retrospective birth certificate analysis comparing maternal and infant outcomes for women cared for at a free standing birth center in Washington, D.C. with women in the district who received conventional care.

Publications

The Family Health and Birth Center in Washington, D.C. provides accessible, culturally appropriate prenatal care and delivery services to low income women. This study of the outcomes of care at that center improves on previous research by controlling for risk selection into birth center care. We find that women who receive at least two prenatal visits from birth center midwives regardless of whether they deliver at the center or in a hospital—are less likely to have a C-section and less likely to have an induced delivery. They have fewer preterm babies and their babies have higher birth weights.

This report summarizes the results of a literature review of recent family planning service delivery research (2003-2011) and presents areas for further research recommended by leading experts in the field. Identified research priorities include studies focused on various family planning models, best practices for contraceptive counseling, interactions between contraceptive counseling/care and chronic diseases, and research focused on the family planning needs of specific age groups. Continued consideration of the research landscape, increased collaborative efforts across funding agencies, and the replication of agenda-setting exercises will be critical to ensuring the growth and relevance of the field.

Focus groups held with parents, home visitors, and community stakeholders revealed that Best Start LA, a place-based community investment in Los Angeles County designed to improve the well-being, development, and care experienced in children ages five and under, continued to receive strong support during its third year of implementation. Mothers receiving Welcome Baby! home visiting expressed great appreciation of the support the program provides. Home visitors described positive changes to the Welcome Baby! model that increased their ability to serve and retain mothers. Stakeholders similarly reported positive developments in community mobilization efforts, but continue to look for ways to become more efficient and effective.

Best Start LA-a place-based investment designed to improve the well-being, development and care experienced by children ages five and under-has gained momentum in its third year and become more firmly established in the downtown Los Angeles pilot community, according to the third case study of a longitudinal evaluation of the initiative. Home visiting through Welcome Baby! has emerged as the strongest intervention being implemented through Best Start LA in the "pilot community" and could serve as a model throughout Los Angeles County. Community-level investments have also become more productive, as evidenced by the funding of two rounds of "collaborative partner" grants supporting a range of strategies to enhance community services and supports. Systems-level work has been deemphasized in the past year to allow for more focus on promising Welcome Baby! and community strategies.

In 2008 San Mateo County, California launched its Adult Coverage Expansion and Systems Redesign Initiative. The initiative expanded coverage for all uninsured adults below 200 percent of the poverty level and redesigned care in county safety net clinics. The program substantially improved access to care for uninsured adults, as well as improved continuity and quality of care for those served by county safety net clinics. However, access remains a problem for new enrollees, due to restrained provider supply and the economic recession. The report provides lessons for other counties as they expand coverage under national health reform.

This second case study of the implementation of Best Start LA finds that the place-based investment—designed to improve the well-being, development and care experienced by children ages five and under—has made good progress during its second year, gaining momentum as it has become more firmly established in the downtown Metro LA pilot community. Welcome Baby! home visiting appears to be a high-quality service that could serve as a model throughout Los Angeles County. Community strategies have been funded through a series of "first step" contracts with various local agencies. And systems-level efforts appear to be laying the groundwork for important changes that could make Los Angeles communities more family-friendly for parents with young children.

A case study of the initial implementation of Best Start LA-a place-based community investment in Los Angeles County designed to improve the well-being, development, and care experienced by children ages five and under-finds mostly positive results, thus far. At the family level, home visiting for pregnant and parenting mothers is off to a strong start, rendering services to nearly 750 families by the end of 2010. Community-level efforts to mobilize community members and develop family-support strategies have been slower to develop. Systems-level investments to develop family-friendly policies and services across the county are proceeding on schedule.

An evaluation of San Mateo County's comprehensive health system redesign initiative finds notable improvements in access to high quality patient care for formerly uninsured adults. For example, the percent of such individuals having a usual source of care rose from 42.5 to 91.2 percent with the initiative. The initiative met with success despite mounting fiscal challenges associated with the economic recession and state budget crisis – threatening the county's ability to support these innovations. The county's efforts offer lessons for local and national policymakers, program administrators, and providers about how progress is possible despite severe financial obstacles.

This report assesses the administrative, fiscal, and political feasibility of implementing a universal childhood vaccine purchasing program in New York State. Program benefits, stakeholder impacts, and implementation challenges were considered through interviews with key stakeholders, program managers in states with universal vaccine purchasing programs, and independent experts. Costs were estimated from population data, immunization schedules, and a range of possible purchase prices. Findings illustrate that a universal vaccine purchasing program is feasible in New York and could result in benefits for children and primary care providers, but ought to build upon existing infrastructure and incorporate lessons from other states' experiences.

The Covering Kids and Families program was a national initiative of the Robert Wood Johnson Foundation to reduce the number of eligible but uninsured children and adults through enrollment in Medicaid and SCHIP. This report presents trends in media use and in-person outreach conducted by state grantees and local projects funded through the initiative. While grantees faced funding and staffing limitations, demand for their services remained high due to decreases in state-funded outreach. Grantees stretched their resources by partnering with other organizations, relying heavily on media outreach to reach large numbers of families, and performing outreach at already-established events.

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