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Health care providers and insurers make high-quality, comprehensive health care (including preventive, acute, emergency, and chronic care) available, accessible, and affordable to all infants and young children. Child health care meets the standards of care set by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Pediatric Nurse Practitioners.
Child health services are delivered primarily within the context of a "medical home," where care is provided and supervised by qualified child health specialists, and continuity of care and personalized relationships between health professionals and families are maintained over time. The child's medical home is incorporated into emergency care, acute care, and follow-up.
In addition to competent medical care, health services for children and their families include:
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| The Codman Square Health Center in Boston is a community-based, ambulatory care center that provides primary and urgent care onsite. The center employs a broad range of medical professionals including family practice physicians, OB/GYNs, pediatricians, dentists, nurse midwives, optometrists, social workers, and psychologists. Staff are multi-lingual and multi-cultural to meet the needs of a diverse community of clients. www.codman.org
Unity Health Care in Washington, D.C. provides an array of high-quality medical services to medically underserved, uninsured, and homeless persons, regardless of ability to pay, through a network of clinics operating in homeless shelters and community agencies throughout the D.C. area. www.unityhealthcare.org | |
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- Nutrition counseling, with referrals to supplementary nutrition as needed (through WIC, food stamps, food pantries, and meal programs)
- Links to (or provision of) health education, parent education, and family support
- Assistance to families trying to obtain health insurance
- Time for providers to talk with patients about their concerns and to develop warm, mutually respectful relationships
- Information and support for the demands of parenting, including the essentials of infant development
- Pleasant settings and convenient times and locations for child care
Providers of pediatric care pay attention to the living conditions of the children they see, including homelessness, domestic violence, and dangers posed by the home or neighborhood environment. Providers take responsibility for connecting families with people and agencies who can help them deal with such problems.
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| The Boston Medical Center's Department of Pediatrics (www.bmc.org/pediatrics/special/), recognizing “that medical care doesn't mean just caring for illnesses or injuries, but treating the whole child and family,” provides onsite assistance to families with health-related needs. The Family Advocacy Program provides legal assistance to families with problems relating to housing, public benefits, domestic violence, nutrition, health care, employment, education and immigration; educates health care professionals to identify poverty-based barriers to health; and addresses systemic problems and gaps in services through multidisciplinary policy advocacy. Project HEALTH (www.projecthealth.org/) seeks to interrupt the link between poverty and poor health by leveraging community resources to address needs that range from swim programs for asthmatic children to exercise and nutrition programs for obese children and housing for families trapped in unsafe living conditions. Reach Out and Read (www.reachoutandread.org) promotes early literacy by disseminating new books and advice about the importance of reading aloud through pediatric exam rooms. | |
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Providers of routine pediatric care make health screenings and developmental assessments easily accessible to all families. They provide or link families promptly to follow-up, diagnostic, and treatment services by appropriate specialists (including hearing, speech, vision, and physical therapy professionals) and community resources.
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| Healthy Steps for Young Children emphasizes a close relationship between health care professionals and mothers and fathers in addressing the physical, emotional, and intellectual development of children from birth to age three. The program’s Healthy Steps Specialists, who have special training in child development, participate on health care teams. The program uses enhanced well-child visits, home visits, materials for parents, periodic child development screening and family health assessment, a child development telephone information line, parent groups, links to community resources, and training institutes to enhance the knowledge and skills of pediatric clinicians. Healthy Steps was launched in 1994 by the Commonwealth Fund and has formed partnerships with nearly 70 funding sources and 24 pediatric and family practice sites across the country. | |
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Systems outside the health care field (such as child care and income assistance programs) help raise immunization rates without using immunization status as a barrier to receiving other benefits. Dental professionals make high-quality, regular dental assessments and dental care available to all children. They make sure that child health providers, children, parents, and other caregivers are informed about the importance of dental health and oral health habits.
Community entities monitor programs and outcomes for an entire population, neighborhood, or community to ensure that a sufficient level of child health care is accessible, culturally appropriate, and affordable. The entities scan what is available and what is missing to support healthy child development and take steps to fill in the gaps.
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| The Harlem Children’s Zone (HCZ), working with Harlem Hospital, Columbia University, Harlem Health Promotion Center, Touchpoints, and the New York City Department of Health, found that 26% of Harlem children (ages 0 to 12) have asthma—over four times the national average. HCZ now screens all children within the HCZ, offers home visits to conduct individual assessments, and provides information, services, and medical support to families dealing with asthma. It is also getting out the message that when asthma is properly managed, children can enjoy normal lives that include participation in sports and other outdoor activities. | |
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Community agencies work together to connect families with people and agencies who can help them deal with the non-medical aspects of children's health problems.
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| Rhode Island Legal Services, the Roger Williams University School of Law, and several health care providers have developed the Rhode Island Family Advocacy Program (RIFAP), which provides legal assistance in areas such as housing and public benefits to families with health needs. Attorneys meet their clients when and where they access health care. www.rifap.org | |
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Local coalitions strengthen community connections to child health services by publishing annual report cards, creating widely representative citizen advisory boards, and distributing health-related materials in multiple languages. They make formal and informal sources of information, assistance, and support widely accessible and culturally responsive.
Local coalitions reach out to families to help them obtain public and private health insurance for their children.
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| The Healthy Start/Medicaid component of the Cuyahoga County Early Childhood Initiative enrolls children in state and federally funded health insurance programs and connects low-income children with health providers for well-child services.
The Children’s Partnership has established an Express Lane Eligibility Website to provide advocates, community leaders, and policymakers with tools for extending health insurance (through Medicaid and the Children’s Health Insurance Program) to more than 4 million uninsured children enrolled in such public programs as Food Stamps, WIC and School Lunch. This Web resource is a central clearinghouse for information about Express Lane Eligibility strategies in more than a dozen states and cities. http://www.expresslaneinfo.org/AM/Template.cfm?Section=Home2
Covering Kids and Families—Rhode Island, a network of advocacy organizations, community based organizations, neighborhood health centers, and state agencies, works to ensure that all eligible Rhode Island Families are covered by the state health insurance program, RIte Care. Covering Kids, part of a national program funded by the Robert Wood Johnson Foundation, places trained workers at family-friendly sites around the state to enroll every eligible family. It has given Rhode Island the lowest rate of uninsured children in the country. www.rikidscount.org | |
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Community entities monitor the existence of connections between child health care and other necessary services to minimize stress and provide treatment for substance abuse and other problems likely to interfere with healthy parenting.
Community groups work with public health agencies to ensure a healthy environment, including:
- Adequate sanitation and utility services
- Buildings maintained to code
- Access to safe, affordable, high-quality food supplies, including neighborhood markets
Policymakers and funders create payment structures and other policies that promote effective child health care by:
- Supporting training for health care professionals that encourages them to develop strong relationships with high-risk families
- Recognizing the need for, and funding, non-medical support services such as home visits, social services, and housing assistance
Policymakers work (often under pressure from a coalition of advocates) to ensure that all infants and young children have access to comprehensive, continuing, appropriate, and acceptable health care (through public or private health insurance coverage or the provision of direct services).
They seek to:
Expand eligibility for and enrollment in health benefits through Medicaid, State Children's Health Insurance Program (CHIP), and other, broader programs
- Minimize barriers to public and private health care coverage through outreach, simplified rules, and other improvements
- Put safety-net policies in place for uninsured individuals and families and the providers serving them
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