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Objective To determine the influence of maternal health literacy and child’s age on participation in social welfare programs benefiting children. Methods In a longitudinal prospective cohort study of 560 Medicaid-eligible mother-infant dyads recruited in Philadelphia, maternal health literacy was assessed using the Test of Functional Health Literacy in Adults (short version). Participation in social welfare programs (Temporary Assistance to Needy Families [TANF], Supplemental Nutrition Assistance Program [SNAP], Special Supplemental Nutrition Program for Women, Infants, and Children [WIC], child care subsidy, and public housing) was self-reported at child’s birth, and at the 6, 12, 18, 24 month follow-up interviews. Generalized estimating equations quantified the strength of maternal health literacy as an estimator of program participation. Results The mothers were primarily African-Americans (83%), single (87%), with multiple children (62%). Nearly 24% of the mothers had inadequate or marginal health literacy. Children whose mothers had inadequate health literacy were less likely to receive child care subsidy (adjusted OR= 0.54, 95% CI: 0.34–0.85) than children whose mothers had adequate health literacy. Health literacy was not a significant predictor for TANF, SNAP, WIC or housing assistance. The predicted probability for participation in all programs decreased from birth to 24 months. Most notably, predicted WIC participation declined rapidly after age one. Conclusions During the first 24 months, mothers with inadequate health literacy could benefit from simplified or facilitated child care subsidy application processes. Targeted outreach and enrollment efforts conducted by social welfare programs need to take into account the changing needs of families as children age.

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The objective of this study is to develop new methods to better identify psychosocial risk such that children with the greatest risk of poor future outcomes receive more intensive preventive health services. Based on structured literature review and secondary data analysis, a 52-item psychosocial risk questionnaire was administered to 2,083 families of children (<36 months). To quantify the questionnaire's construct validity, developmental concern was assessed with the Ages and Stages Questionnaire version II (ASQ) [n = 1,163]. An iterative model selection process was used to produce the most parsimonious predictive model. Model fit was examined using c-statistics, the Hosmer-Lemeshow test, and a heuristic measure of model overfit based on the fitted log-likelihood values and associated number of degrees of freedom. We found 13 items easily obtained from parental report produced a regression model with a c-statistic of 0.70. Using an integer scoring system derived from the regression model, we calculated stratum specific likelihood ratios to revise a given prior probability of ASQ failure. The posterior probability of ASQ failure was 44.9 % for a child in the highest risk group (score >25) on the questionnaire, more than double our observed average failure rate of 19.5 %, while it was less than 7 % for a child with the lowest possible score on the questionnaire. Thirteen parent-reported items can be compiled into a summary psychosocial risk questionnaire that predicts failure on developmental screening among preschool children. With further validation, this questionnaire could conceivably be used by clinicians to tailor pediatric preventive care to children at varying levels of risk.