2025 Children's of Alabmama Community Health Needs Assessment

It should be noted that specialized pediatric providers and services must be concentrated in an urban area, given the sheer volume needed to support pediatric specialists. Specialty dispersion is not realistic or viable. Alabama should consider how telehealth can be utilized to address specialty care, particularly when transportation is an issue. While specialty care must be concentrated, pediatric primary care can and should be widely available throughout the state. The fact that there are care deserts is due to myriad of factors, including medical residents choosing other specialties over pediatrics, disproportionate investment in adult graduate medical education, lower compensation compared to other medical specialties, and under-investment in pediatric infrastructure by state and federal policy makers. The Jefferson County Department of Health’s Community Health Improvement Plan (CHIP) recognizes this gap as well—one of its goals was to increase the availability of mental health services for children and adults by 10% by 2024. 26 Alabama’s child poverty rate is 21.9% statewide. Rates range from 7.4% in Shelby County to 58.4% in Perry County. Worth noting, the county seats of Shelby and Perry Counties are separated by only 64 miles. Twenty-two of Alabama’s 67 counties have childhood poverty rates of 30% or higher. More than 45% of births in Alabama are paid for by Medicaid. 27 These families may struggle with indirect costs of care (transportation, unpaid time off work, etc.). Survey findings that “ability to pay” is a top concern align with these economics—poverty and healthcare affordability go hand in hand. The survey highlighted transportation difficulties. Transportation is a significant barrier statewide. The state’s population distribution, density, infrastructure, and culture make transportation a very difficult challenge to solve. Various responses have been developed with varying levels of success. Among these are Kid One Transport—a nonprofit designed to provide children with transportation to medical appointments 28 —charitable foundation pilot projects, 29 and even medical practices contracting with Uber and Lyft. 30 These organizations and initiatives are heavily dependent on third-party funding, which can be cyclical and often insufficient for meeting the demand of Alabamians across the state. The Jefferson County CHIP (2020–2024) made public transportation access a strategic priority, aiming to improve transit options countywide by 2025. 31 This was driven by the recognition that many families, particularly in rural or low-income urban neighborhoods, cannot reliably get to medical appointments. Limited bus routes, lack of vehicles, or long distances to pediatric specialists create tangible barriers. The congruence between the CHNA survey and the county’s strategic plan on this point is striking: Both identify that improving transportation is key to better child health access. Respondents noted that some parents and guardians lack information or education about available resources (“parent education” as a barrier). In many Alabama communities, there is a need for increased outreach, navigation assistance, and culturally appropriate health education so that parents know how to utilize preventive services (such as well-child visits, immunizations, and nutrition programs). Even with insurance, families often face out-of-pocket costs, co-pays, or a lack of coverage for certain services.

______________________________________ 26 The Community Health Improvement Plan, 2020–2024. Jefferson County https://www.jcdh.org/SitePages/Misc/PdfViewer?AdminUploadId=2587#:~ :text=match%20at%20L1650%20Strategic%20Issue,Term%20Target 27 2024 Alabama Kids Count Data Book. Voices for Alabama’s Children. https://alavoices.org/2024-alabama-kids-count/ 28 https://www.kidone.org/ 29 “Getting Around Birmingham Is Now Affordable and Easy” Bham Now. https://bhamnow.com/2025/06/18/what-is-the-birmingham-microtransit-how-do you-use-it-heres-what-you-need-to-know/ 30 “Non-Emergency Medical Transportation in Birmingham, Alabama.” https://www.uberhealth.com/us/en/d/nemt/birmingham-al-us/ 31 The Community Health Improvement Plan, 2020–2024. Jefferson County https://www.jcdh.org/SitePages/Misc/PdfViewer?AdminUploadId=2587#:~ :text=match%20at%20L1650%20Strategic%20Issue,Term%20Target

Children’s of Alabama, 2025 CHNA

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