Like child care, access to health care and health insurance are areas where Black Belt counties usually land at the bottom, especially for its children.

But in one of those counties, Bibb County, the reverse has happened. Thanks to an initiative founded by UA, Bibb is one of the first, and perhaps only, counties in the United States to have achieved one hundred percent health insurance coverage for children.

This achievement was accomplished through the efforts of the Alabama Child Caring Initiative (CCI), a partnership founded by UA's College of Community Health Sciences (CCHS) to increase health insurance coverage for children through community action.

Its mission is to ensure that all children from the involved communities are enrolled in a health insurance program, receive medical care and health information appropriate for their age, and develop expectations about personal health and hygiene that carry over to their families.

Bibb County was the first county to join the CCI. The Bibb County Child Caring Initiative (BCCCI) represents a collaborative effort between CCHS, the Bibb County community, the Rural Alabama Health Alliance, UA's Capstone College of Nursing and Blue Cross Blue Shield of Alabama.

"BCCCI is founded on the idea that the strength of the local community must be engaged to successfully lead interested institutional partners in funding, implementing and evaluating a lasting and effective community endeavor," said Dr. John Wheat, principal investigator of the first CCI project, and co-principal investigator of the Covering Kids and Families projects.

BCCCI collected data (later validated with school-based health examinations) concerning access, utilization and health behaviors/outcomes of children enrolled in the public school system.

"One of the more consistent themes of this data was that only children privately insured or children under age six and covered by Medicaid see a medical practitioner on a regular basis," said Wheat, UA professor of community and rural medicine in CCHS.

Wheat pointed out that the disparity between insured and uninsured children is especially notable in terms of health utilization and health access.

"Uninsured children are far less likely to have a regular doctor. Uninsured children are also more likely to report having gone a longer time between health visits," he said.

School-based health fairs, operated by UA faculty and students, along with community volunteers, assessed these children and provided needed health screening, education and referrals.

Wheat noted that UA's Capstone College of Nursing was especially helpful with the fairs. "[UA nursing professor] Marsha Adams, a Bibb County resident, and UA's nursing students played a key role in implementing these health fairs," he said.

In the first year, over one-half of the children (57.5 percent) received a referral for follow-up care or evaluation. But the most notable outcome of the BCCCI has been the increase in insurance coverage among children. In 1996, 16 percent of children reported having no health coverage. In 2001, all children had coverage.

In response to Alabama's new insurance program for low-income children, Covering Alabama's Kids, the BCCCI took it upon themselves to assist and advocate for their children's health insurance coverage.

Additionally, they served as a local resource for families completing applications and ensured that applications arrived in the hands of eligibility personnel complete and ready to be processed.

"It is the unique collaboration of CCI and the engagement of the community in finding solutions for ensuring child health coverage that has been the impetus for creating one hundred percent coverage among Bibb County children," said Wheat.

"The community-led collaborations also give UA's Rural Medical Scholars and nursing students the chance to work in rural Alabama," he said.

"Several Black Belt counties are targets in the Covering Kids and Families Program, a Robert Wood Johnson Foundation-funded project, which builds on work done in BCCCI and extends the efforts of the Covering Alabama Kids project," he added.

Initial success in Bibb County has led to program replication in Fayette, Pickens and Sumter counties, which are also member counties in the Rural Alabama Health Alliance.

"The primary lesson to be learned from Bibb County is that healthy communities take care of their kids and are capable [of doing so] given the opportunity to reach consensus, build collaborations and find solutions to insuring their children," said Wheat.