The purpose of the evaluation on the effectiveness of pediatric day care was to determine program utilization and possible gaps in services. The evaluation also addressed the community's knowledge, awareness, and perceptions of the program. Data was collected through four means: a mailed survey to clients registered with an AIDS Service Organization; a client focus group; key informant interviews; and a review of monthly reports. People With AIDS Coalition was recruited to collaborate because of their extensive client database. A survey and cover letter, in both English and Spanish, was mailed to 2,568 clients. Discounting returned mail, 1,620 individuals received the survey; 261 completed and returned it for a 16% response rate. Six women of mixed ethnicity participated in the focus group, six people acted as key informants and numerous others assisted with responses to questions and, finally, the HIV Services Department of Harris County provided information on contracts and monthly reports.

Clients
Of the 261 respondents to the survey, 42 or 16% indicated having at least one child age 12 years or younger. 85.7% (36) of respondents with children were female and 14.3% (6) were male. African Americans were the largest group (73.8% or 31), followed by Hispanic/Latino (11.9% or 5), White/Caucasian (9.5% or 4), then Native American (4.8% or 2). The majority of parents were not working outside the home (59.5%) and 50% were disabled. 69% of respondents with children had gross monthly incomes of $750 or less. These 42 families accounted for 91 children aged 12 years or younger and averaged two children per household. The average age of the children was 6 .7 years. 52.4% of adults were diagnosed with HIV between 1995 and 1999 and 2.2% (2) of the children were HIV positive.

Friends and family were most frequently mentioned as childcare providers and the need for childcare averaged 2 times per month. Clients reliant on family and friends do not typically make contingency plans for those days when no one is available to help out. The on-site drop-in childcare service is not well designed to accommodate last-minute childcare needs and at three of the four sites where care is provided, a client must call ahead and schedule childcare services.

45.2% of respondents had their own transportation and another 28.6% had access to transportation. Only 9.5% (4) used transportation provided by the day care center. 44.9% had missed medical appointments due to lack of childcare. 21.4% had used drop-in childcare, 7.1% had used the in-home childcare reimbursement program and 14.3% had used the all-day services. Over 70% of survey respondents report that they do not know about the available childcare services, do not know how to get the services, or do not understand how the service works. Although the clients who had used the service became aware of it through pamphlets at the childcare site or through a case manager, the majority of clients who qualify for the service still are unaware that it exists.

The parents who use the on-site drop-in childcare facilities are usually at a medical appointment when the child/ren are in care. The majority is Hispanic, have very low incomes and have indicated that they do not have money to spend on childcare and would have no alternative if it were not provided at the clinic. The parents who use the childcare most are mothers, both single and partnered women.

64.8% of children of respondents were over five years of age and in school. Participants reported a need for after-school care for days when medical or social service appointments extend late into the afternoon. They also voiced a need for respite care to take care of other family responsibilities e.g. laundry, grocery shopping, etc. People need information about services in Spanish and it should include specific information about childcare policies and discipline. Focus group participants cited a need for weekend and evening hours and more locations near other clinics. Key informants reported problems with the application paperwork, concerns of confidentiality, and suspicion regarding the amount of information required to care for an affected child.

Funded by the Ryan White Planning Council