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Child Health and Well Being
 
Adolescent Mothers

What are the medical and psychosocial risk factors associated with adolescent mothers?

  • Poor maternal weight gain
  • Anemia
  • Pregnancy-induced hypertension
  • Poverty
  • Lack of education
  • Inadequate family support
  • Inadequate prenatal care/or no prenatal care
  • Increased risk for domestic violence
  • More likely to be single parents
  • Less likely to finish high school
  • Less knowledge about child development and appropriate parenting practices
  • Higher risk of child neglect and abuse

What are the risk factors associated with repeat pregnancies among adolescent mothers?

  • Decreased educational achievement/Not returning to school within six months
  • Increased dependence on governmental support/societal expense
  • Increased infant mortality
  • Low birth weight
  • Repeat pregnancies occur in 35% of adolescent mothers within 2 years of the first birth

What are the medical and psychosocial risk factors associated with infants of adolescent mothers?

Increased incidence of:

  • Low birth weight
  • Prematurity
  • Developmental disabilities
  • Poorer developmental outcomes than the offspring of older mothers
  • Deficits in cognitive and social development which may persists into adolescence
  • Lower levels of vocalization, touch and emotional nurturing
  • Harsh and rejecting discipline due to poor parenting skills which has been linked with child anger, low self-esteem and social withdrawal

What are the outcomes associated with children and young adult offspring of adolescent mothers?

  • The outcome of exposure to risks factors associated with young adolescent mothers during the first 3 to 4 years of life can have a profound influence on the development of the nerve connections and neurotransmitter networks of the child's brain and can lead to impaired brain development.
  • 33% of these children drop out of school
  • 31% suffer from depression
  • 16% are incarcerated
  • 25% are at risk of adolescent parenthood
Recommendations for Pediatricians
  • Pediatricians should provide continuity of care and a "medical home" for adolescent parents, as well as for their children. Adolescent parents need guidance, early childhood education and the teaching of basic care-giving skills. This guidance should include the adolescent mother and the infant's father, when possible.
  • The pediatrician should facilitate coordination of a multi-disciplinary and comprehensive approach to utilizing community resources such as social services, nutrition programs, parenting classes, and medical and developmental services.
  • The pediatrician should promote breastfeeding by the adolescent mother and advocate for this practice in the school setting.
  • The pediatrician should counsel and advocate for contraceptive counseling during the pregnancy of the adolescent with an emphasis on long acting methods coupled with condom use.
  • Pediatricians should encourage adolescent mothers to complete high school.
  • Pediatricians need to educate the adolescent mother on the importance of a healthy lifestyle for herself and infant. Education on effects of substance abuse and nicotine on the healthy growth and development of infants should be provided.
  • Risk of domestic violence should be assessed by the pediatrician during and after pregnancy visits.
  • The pediatrician should encourage and stress the importance of the adolescent parent caring for his or her own child. The adolescent parent then develops a true understanding of the demands of parenting.
  • Pediatricians should adapt their counseling to the developmental level of the adolescent. Intensive instruction on infant care, human growth and development, discipline, and stress associated with parenting can be provided through office, clinic, home visits or school settings.
  • Pediatricians need be aware of the community resources available to the adolescent parent and their infant. These may include home visits, prenatal, and infant classes, quality child care programs and programs for children with developmental disabilities.
  • Pediatricians need to provide positive reinforcement for adolescent parents who complete high school, abstain from the use of drugs, alcohol and nicotine; continue breastfeeding; keep the child's immunizations current, and attend all well-child visits.
  • Encourage the involvement of the father in the child's life.

American Academy of Pediatrics, Available [on-line] at: www.pediatrics.org, Feb. 2001, Vol. 107, No. 2.

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Assessment of psychosocial problems and treatment of uninsured children

What was learned about the mental and behavioral problems of uninsured and insured children receiving primary care?

  • About 14% of children in the United States are uninsured.
  • Uninsured children are less likely to have access to health care or a regular source of health care.
  • Little is known about the mental and behavioral health of uninsured children.
  • This significant study examined the management of child psychosocial problems in primary care practices for 24,183 children seen by 401 clinicians in all 50 states, the Commonwealth of Puerto Rico, and six Canadian provinces.
  • Source of study data. Each clinician provided information on a consecutive sample of 55 children ages 4 through 15. The study was limited to those children who came from practices with three or more uninsured children, resulting in a sample size of 13,401. Ninety-three percent were insured (n = 12,518) while 7% were uninsured (n = 883).
  • Measures used. Measurements included insurance status, reason for visit, clinician identification of a psychosocial problem, amount of time spent with patient, whether counseling or psychotropic medication was provided, whether a referral was made for mental health treatment. Parents filled out the Pediatric Symptom Checklist, a brief symptom checklist for primary care, and the Family Apgar Scale, a family-functioning measure assessing adult satisfaction with family support.

Findings:

  • Uninsured children more likely to be Hispanic
  • Uninsured children more likely to have parents with less education.
  • Uninsured children tend to have poor to fair health, poor to fair grades, and more psychosocial problems reported by their parents.
  • Uninsured children less likely to have well-child visits.
  • There were no significant differences in percent, severity or treatment of patients with psychosocial problems identified by doctors for the insured and uninsured groups, even among those referrals where such a difference was expected.
  • These results suggest that visit rates to primary care providers and mental health professionals may differ between insured and uninsured children because of differences in access, but that once a child has achieved access, treatment outcomes might be similar.
  • However, parents of uninsured children tended to report significantly more behavioral problems in their children than did doctors. Perhaps doctors tend not to recognize some problems in uninsured children; perhaps these children have fewer clinician visits - especially well-child visits -- and therefore a clinician's sense of responsibility for the well-being of these patients is less well developed.

Conclusions:

  1. Among children served in primary care settings, uninsured and insured children have similar clinician-identified psychosocial and mental health problems, and these problems are treated similarly in the practice setting.
  2. Improving access to continuous care to uninsured children, by providing them with insurance, will improve the likelihood of clinician recognition of psychosocial problems.
Source:

McInerny, T.K., Szilagyi, P.G., Childs, G.E., Wasserman, R.C., & Kelleher, K.J. (2000). Uninsured children with psychosocial problems: Primary care management. Pediatrics, 106(4), 930-936.

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Community pediatrics: What is it?

What is community pediatrics?

The American Academy of Pediatrics (AAP) has issued a policy statement for pediatricians addressing the critical importance of the community in children's health care. Rising levels of intentional and unintentional injuries, substance abuse and dependency, behavioral and developmental disorders, maladaptive family behaviors, sexually transmitted diseases, unplanned pregnancies, and high infant mortality rates in certain communities have not been addressed adequately by the traditional medical practice model alone. Children's health must be addressed within a context of biology, family and community. A community pediatric health-based perspective can intervene early in the life cycle to prevent later problems and promote healthy child development.

The AAP defines community pediatrics as:

  • A perspective that enlarges the doctor's focus from one child to all children in the community.
  • A recognition that family, educational, social, cultural, spiritual, economic, environmental and political forces significantly affect children's health and functioning.
  • A synthesis of clinical practice and public health principles directed toward providing health care to a child and promoting the health of all children within the context of family, school and community.
  • A commitment to collaboration with other professionals, agencies and parents to optimize accessibility, appropriateness and quality of services, and to advocate for those in need.
  • An integral part of the professional role and duty of the pediatrician.

What is needed to promote community pediatric health based strategies?

Two fundamental issues must be addressed in developing interventions based on social and behavioral research. These include (1) the need to address generic social and behavioral determinants of health, and (2) the need to intervene at multiple sources of health influence. In addition, following are recommendations to guide pediatricians in addressing the needs of children and families in a community context:

  1. Focus. Focus on social and behavioral determinants of disease, injury and disability at the national and local levels to be informed of the health and social risks for children, and identifying ways to enhance or modify services and programs so community-based strategies are developed.
    • Interventions that tackle multiple levels of influence and multiple risk factors must make the best use of resources at each level.
  2. Multiple Approaches. Use multiple approaches to promote health such as education, social support, laws, incentives, behavior change programs; identifying and coordinating existing services to ensure children get a strong start by providing, for example, appropriate early education, immunization, injury prevention, nutrition and opportunities for physical activity.
    • Multiple approaches address multiple levels of influence simultaneously - individuals, families, communities and organizations.
    • A social ecological model provides a structure for intervention at multiple levels of influence - individual, interpersonal, institutional, community and policy levels.
    • Health behavior changes need to be supported not only at the individual level, but both at the school based and community-based level for sustained change. Change is influenced by interacting factors.
  3. Partnerships. A partnership with community members offers the best chance to collaborate with others interested in the health and well being of the community's children.
    • Strive to provide a medical home for every child in the community. The pediatric primary care clinic or office may be an opportune setting in which to link child health services to other community-based programs.
    • There is a role for child health supervisors in settings such as child care centers and schools.
    • Bring community and school resources to bear on children's problems.
    • Involve those sectors of society that have not traditionally been associated with health promotion efforts, including law, business, education, social services and the media.
    • Build relationships with communities, and develop interventions that derive from the communities' assessment of their needs and priorities.
  4. The long view. Opportunities for community pediatric health-based services do not end at childhood; evidence indicates that intervention efforts with adolescents and adults can be successful if these efforts address major developmental tasks at each stage and address major sources of health risk at multiple levels.
    • Many risk factors observed in adults can be detected in childhood.
    • Risk behaviors are closely linked to social and economic conditions such as economic inequality, social norms and other forces and interventions needed to address and reduce risks across large population segments.
    • There is compelling evidence that the physical, cognitive and emotional health of infants can be improved with comprehensive, community-based, high quality services that address basic needs of children and families.
    • Adolescents can enjoy healthier life styles if greater attention is paid to the social and environmental context (family, school, work settings) in which youth live and learn. Poor health habits can be avoided and developmental risk averted.
    • Behavioral and social interventions can directly impact physiological functioning.
  5. Educate and mentor. Act as an educator and role model to residents and medical students in community settings, using resources from the AAP on community-based practice.
    • AAP chapters and members should provide leadership for furthering the understanding of community pediatrics, and participation in community-based practice models.
    • AAP chapters should provide leadership, support and recognition for pediatricians involved in advocacy efforts at local, state and national levels to ensure access to care by all children, and to foster integration of community activities as an integral part of the professional role and duty of the pediatrician.

Best Practices for community pediatric health promotion?

  1. Best practices for a comprehensive community-based pediatric health strategy must not just emphasize services but stress a more comprehensive policy and program package, one that includes economic and financial support as well as services aimed at preventing problems. Efforts to improve the health of communities can benefit from public policies that promote healthful environments.
  2. A consistent theme across health promotion research calls for interventions and research conducted in partnerships with communities -- that is, research efforts are conducted by communities rather than on communities, and interventions not strictly message-driven but guided by the voice of the community.
  3. Community partnerships influence community priorities toward healthy outcomes.
  4. Community participation and buy-in enhance the sustainability of interventions.
Sources:
American Academy of Pediatrics Committee on Community Health Services (1999). The pediatrician's role in community practice. Pediatrics, 103(6), 1304-1306.
Promoting health: Intervention strategies from social and behavioral research (2000). Institute of Medicine, Washington, D.C.: National Academy Press.
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Environmental threats to children's health

What is the importance of understanding environmental risk for children's health?

  • Despite improvements in sanitation, vaccination, nutrition, surveillance and monitoring of disease as well as and the development of antibiotics, there continue to be increases in diseases and disorders that affect children, e.g., asthma, cancer, low birth weight, vehicular and other homicides, developmental disabilities, smoking and obesity.
  • Accumulating evidence that environmental factors, e.g., the use of fossil fuels, lead-based paints, solvents, pesticides and polychlorinated biphenyls (PCBs), and over-dependence on television to provide entertainment, contribute to these increases.
  • Little attention is paid to environmental health in medical schools, and few doctors are trained to recognize and respond to environmental issues.
  • Typically, environmental health problems are cumulative and subtle, appearing long after initial exposure to the offending substance, and requiring training to recognize.
  • Furthermore, the training of new medical professionals in the office setting gives them little opportunity to observe seasoned professionals in the role of community advocate.
  • The current structure of the health care delivery system, which views primary care as beginning when the patient first seeks medical care, pays inadequate attention to the environment into which the child is born.

What can health providers do to reduce environmental risks to children?

  • Get out of the office and into the neighborhoods in which the children live to witness the environmental conditions and health risks.
  • Strengthen advocacy efforts even in the face of political realities that bring resistance to change in influential segments of the community. For example, advocacy for child health could threaten the profits and jobs of those manufacturing pesticides, solvents and PCBs, causing uncomfortable pressure on local and national politicians.
  • Begin advocacy early, which is when science has shown that a substance, product or activity is more likely to cause problems, rather than waiting until such has been proven beyond doubt.
  • Develop a mechanism to study and formulate responses to legislation favoring industries producing substances, products and activities that threaten children's health.
  • Expand the time spent in medical schools on environmental health issues. Develop opportunities for medical students and house staff to get out into the community.
  • Have medical students and house staffs undertake environmental scans and assessments of pesticide use in areas where their patients live. Use the data to communicate with residents and policymakers and organize exposure studies in school districts, housing projects, apartment buildings and other places where children routinely spend time.
  • Encourage medical school pediatrics departments to link with such community groups, as educators, social workers, residents and other community organizers to provide research expertise and data on various environmental exposures.
  • Collaborate with colleagues in other disciplines to increase understanding of threats to children's health from environmental degradation.
  • Make participation in an advocacy experience among the requirements of residency.

Source:
Crain, E.F. (2000). Environmental threats to children's health: A challenge for pediatrics: 2000 Ambulatory Pediatric Association (APA) presidential address. Pediatrics, 106(4), 871-875.

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Health behaviors of American parents

Many parents need to set a better example of healthy behavior for their children and to remain physically and mentally healthy for the crucial task of child-rearing. Parents with health or unhealthy behavior can affect their ability to care for their children and earn a living. The health of parents has economic consequences for their employers and for the taxpaying public as a whole.

A new study of parents' health, medical care, and health-related behavior finds that large numbers of parents at all income levels take part in risky behaviors that are harmful to their own health and are likely to harm the health of their children. These behaviors include smoking, heavy drinking, and being overweight and sedentary. Risky behaviors are most common among parents who are high school dropouts, separated or divorced parents, and those who receive welfare, and are comparatively infrequent among parents who are recently immigrated to the United States.

What are the risky behaviors among parents?

  • One of eight parents is in fair to poor health or has a health limitation of activities.
  • Ill health is equally common among mothers and fathers, but twice as many mothers (23 percent) as fathers (11 percent) have six or more doctors visits per year.
  • Working mothers and fathers tend to be in better health than those who are not employed outside the home.
  • Parent have more stress than physical problems.
  • One in eight (13 percent) and one in 16 fathers (6 percent) sought professional help for emotional problems in the last year.
  • Mothers receiving welfare are five times more likely to experience negative feelings than non-poor mothers, while poor mothers not receiving welfare are three times more likely to report such feelings.
  • Less than half of the mothers (46 percent) or fathers (45 percent) engaged in three of these five preventive habits: Always using seat belts while riding in a car, getting regular exercise, getting 7-8 hours of sleep per night, eating breakfast daily, and avoiding between-meal snacks.

What kind of health care do parents get?

  • Four in ten mothers and six in ten fathers do not have a regular source of care and have not seen a doctor in the past two years or a dentist in the past year.
  • One parent in seven lacks health insurance coverage.
  • Parents without medical insurance and those covered by Medicaid are in worse health than parents with private insurance.
  • A majority of parents, regardless of income level, report that during their last checkup, their doctors did not talk to them about important health topics such as diet, drinking, exercise and drug use.
  • For parents who engage in risky health behaviors, encouragement from a doctor or other medical professionals can motivate positive behavioral change.

What are the medical practices should be implemented to help parents?

  • Doctors and clinics should advocate necessary behavior changes when adults become parents. The medical staff should outline the full range of positive health behaviors and encourage those engaged in risky behavior to change.
  • Public health officials' ability to identify and foster effective ways for behavioral changes are impeded by the large number of adults without insurance coverage.
  • Public health officials should recognize and address the frequently unmet need for psychological care among vulnerable parents who lack health coverage.
  • Public information campaigns should be developed to encourage parents to be healthy role models for their children.

Child Trends - Research Brief (1999). The Healthy Behaviors of American Parents: Implications for Children.

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Health care needs of children in the foster care system

What is the health of children who enter the foster care system?

  • Children who enter the foster care system are frequently in very poor health, not only due to the abuse or neglect that triggered their placement away from home, but also because of exposure to poverty, poor prenatal care, prenatal infection, prenatal parental substance abuse, lack of access to health care, parental mental illness, and direct and indirect exposure to family and/or neighborhood violence.
  • Children in foster care have consistently high rates of both physical and mental health and developmental problems, and exhibit more psychological and behavioral problems than children with similar backgrounds who have remained out of the foster care system.
  • Children placed in relative or kinship care are also at risk for ongoing health problems. Kinship caregivers tend to be older, less educated, less financially stable and in poorer health than nonrelative foster parents. When this placement is undertaken informally (e.g., no court involvement and no legal transfer of custody), the health, social and financial supports and oversight that the family receives are most likely inadequate.
  • Psychological and emotional problems can worsen during foster or relative care for some children.

What are the barriers to receiving health and mental health care for children in foster care?

  • Many agencies lack policies regarding health care in foster placements.
  • Foster care workers rely on foster parents to tend to the child's health care needs, even when they have not been authorized to give legal consent for treatment.
  • Frequent moves among foster homes contribute to a lack of continuity and/or absence of health care.
  • Many health care providers, child protection workers, foster care workers and mental health professionals have little or no training on the health care issues of foster children.
  • The complexity of the individual child's situation requires extra time and attention by health care providers who receive little reimbursement for their efforts.
  • Health care providers frequently have difficulty communicating with the rigid child welfare system and the Medicaid funding system.

What is needed to support the health care needs of children in foster care?

  • Integration of needs. Physical and social services must be viewed as one component of the larger cluster of economic and primary supports provided to families and in particular to foster care providers.
  • Integrate health care plans into child welfare plans.
  • Home visit models. Home health visiting services and the "well-baby" services provided by health practitioners or the family's primary care physician are necessary to address health concerns and developmental problems in out-of-home placement.
  • Home health visiting services can be linked to a clinic, physician or social service agency and can monitor health problems, detect social problems, and link parents and foster parents with local health clinics.
  • Home health visits to foster care placements - both relative and nonrelatives - can improve children's health.
  • Medical home. Identify a medical home for each child in the foster care system, thus providing care and reducing fragmentation of care.
  • Mandatory health and well-being assessment. Children new to the foster care system should have a comprehensive health, mental health and developmental assessment within 30 to 60 days of placement, including screenings for diseases and conditions related to poverty and abuse and using standardized measures.
  • Centralize foster child health records.
  • Develop and maintain a system of "health passports" containing essential health information for each child. The British model of child development and health record is excellent. The plan should be updated after each health encounter, or periodic review, and communicated to the child, the child's parents, the caregiver and others needing the information.
  • Research models of the impact of foster care health education programs and the impact of specific health interventions on the well-being of children in foster care.

Sources:
British Profiles of Child Assessment and Care Records. England.
Shonkoff, J. P. & Meisels, S. (Eds.) (2000). Handbook of early childhood intervention. (Second edition). New York: Cambridge University Press.
Simms, M.D., Dubowitz, H., & Szilagyi, M.A. (2000). Health care needs of children in the foster care system. Pediatrics, 106(4), 909-918.

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Preventive health services for children

What accounts for missed opportunities for immunization services for children?

  • Although health professionals and communities have indicated widespread support for immunization and other preventive services for children, only 60% to 70% of children have completed such services by the age of 2.
  • Children may not be receiving the services either because they have not come into a primary care clinic or office, or because they have not received the needed service when they appeared.
  • Charts do not document whether a child has been assessed for prevention services, and critical information is lost.
  • A research study identified the six key steps that lead office staff, doctors and patients through a process that results in providing preventive service:
    1. Assessment of need for preventive care.
    2. The health care provider is made aware of the need.
    3. The needed service is performed.
    4. The service is documented in the patient's chart.
    5. The patient is educated about the need and timing of future preventive services.
    6. Follow-up is conducted to ensure future service. Although these steps are conceptually simple, the process is complex in practice. At numerous points various people in the chain may or may not do what is necessary to ensure that opportunities for providing preventive services are not missed.
  • Summary of research approach. The steps in the process were measured using three data collection methods: (1) chart audits to measure prevention service status before and after an office visit, (2) exit interviews of parents to assess preventive service delivery not included in the patient's chart, and (3) a staff checklist to assess the role of nursing and other staff. The feasibility of using this combination of measures to identify problems within the steps was evaluated in three representative primary care settings: (1) an urban private pediatric practice, (2) an urban private family medicine practice, and (3) a rural private pediatric practice.

Findings. The practices with the lowest proportion of children whose charts were screened for preventive services needs had the lowest performance of preventive services.

What is needed to improve preventive health services to children?

    · Screening the chart for preventive services. · All staff must be adequately trained in screening procedures. · All staff must engage in the screening process consistently. · The process must be monitored on an on-going basis.

Source
Gest, K.L., Margolis, P., Bordley, W.C., & Stuart, J. (2000). Measuring the process of Preventive service delivery in primary care practices for children. Pediatrics, 106(4), 879-885.

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The medical home concept in child health care

What is a medical home?

According to the American Academy of Pediatrics and its Healthy Child Care America campaign, children's health care should be provided in a medical home setting. Summarized below are elements that have been incorporated into 46 programs in health services for people who have not been served well in the past or who are especially vulnerable. None of these programs uses all the elements presented here, although some use a majority. None of these programs could be transferred whole into a new community and with expectations of success. We present these elements so those who interested in establishing a network of medical homes in their community can choose those appropriate to their situation.

The ideal elements of a medical home have these characteristics:

  • A place easy to get to where parents can take their children for health care concerns and needs.
  • High-quality health and related service at a reasonable cost.
  • Family-centered. Recognizes and uses family strengths.
  • Compassionate, understanding and culturally sensitive staff.
  • Staffs that willingly share complete and unbiased information with families.
  • A doctor trained in children's medicine either permanently on staff, or at least supervising and directing the health care practitioners on staff.
  • A doctor who routinely advocates for the child's health care needs and takes responsibility for the care provided.
  • A doctor and health care staff who understand the relationship of the child's community and the child's physical and mental health.
  • Comprehensive services.
  • Emergency, outpatient and in-patient care that are always open.
  • Ongoing monitoring of the child's physical and mental health.
  • Preventive care services such as immunizations, growth and development assessments and screenings, counseling about physical and mental health issues.
  • Centralized medical records that are confidential but can provide all information about the child's medical history when needed.
  • Makes referrals linking to and consulting with specialized medical or mental health experts when needed for more complex or life-threatening problems.
  • Monitoring or follow-up to specialist recommendations, including explaining of specialist recommendation to families.
  • Linking to and coordinating services in schools and community agencies.

What core services are provided in a medical home?

  • Medical.
  • Dental.
  • Mental health.
  • Case management.
  • Nutrition.
  • Behavior management.
  • Referrals to special services or resources.

What are the core principles of service of a medical home?

  • Provide total coordination of care.
  • Continuity of care.
  • Be accessible.
  • Programs and personnel who are sensitive to the wants and needs of different cultures.

What special services can be provided in a medical home?

  • Health education.
  • Mental health/substance abuse.
  • Community outreach.
  • Environmental health.
  • Dental screenings and care.
  • Maternal health care.
  • Pharmaceutical services.
  • Assistance with entitlement programs.
  • HIV testing and counseling.
  • Laboratory/radiology services.
  • Immunizations.
  • Urgent care.
  • Assistance with transportation.
  • Housing.
  • Lead testing, anemia, sickle cell screens.
  • Hearing exams.
  • Developmental assessments.
  • Pre-school and school physicals.
  • Vision screenings.
  • Newborn exams.
  • Violence prevention and screening.
  • Diabetes education and screening.
  • Grandparenting groups.
  • Young mother support groups.
  • STD outreach and screening.
  • Asthma education.
  • Job training/employment.
  • Family planning.

What clinical elements are provided in a medical home?

  • Nurse-managed program.
  • Physician assistants.
  • Advanced practice nurses.
  • Community health workers.
  • Addiction services.
  • Mental health providers.
  • Clinical quality improvement.
  • Recruitment retention.
  • Cultural diversity sensitivity.
  • Follow-up and tracking.

What are the significant partners for a medical home?

  • Hospital or health system.
  • Managed care organization.
  • University health and allied health professions.
  • Schools (elementary/middle/high).
  • State/local government health agencies.
  • State/local government non-health agencies.
  • Community-based organizations.
  • Religious organizations.

What special populations are served by a medical home?

  • Homeless.
  • HIV- infected.
  • Farm workers.
  • Adolescents.
  • Children.
  • Elderly.
  • Public housing residents.
  • Inner city residents.
  • Rural residents.

Where is the location of care for a medical home?

  • Outpatient clinic.
  • Community health center.
  • Health department.
  • Home.
  • School.
  • Church.
  • Mobile unit.
  • Work.
  • Housing project.

What are the personnel requirements for a medical home?

  • Nurses.
  • Doctors.
  • Dentists.
  • Psychologists.
  • Social workers.
  • Outreach workers.
  • Physician assistants.
  • Trained volunteers.
  • Community health workers.
  • Student trainees/interns.
  • Educators.
  • Government workers.

What are the major financing mechanisms for a medical home?

Private managed care Medicaid managed care
Bureau of Primary Health Care Grant Maternal and Child Health Policy Grant
National Health Services Corp. Ryan White Grant
Medicaid Medicare
AHEC co-op agreement Robert Wood Johnson Foundation grant
Kellogg Foundation grant

Sources:
American Academy of Pediatrics (1992). The medical home. Pediatrics, 90(5).
American Academy of Pediatrics (1993). Pediatric Primary Health Care (Addendum to the medical home statement). AAP News, 11/93.
U.S. Department of Health and Human Services, Health Resources and Services Administration (1999). Models That Work: Innovative Health Improvement Programs for Underserved and Vulnerable Populations: Compendium 1998. Washington, D.C.: Author.
U.S. Department of Health and Human Services, Health Resources and Services Administration (1999). Successful Approaches in Public Housing: Primary Care Programs 1998. Washington, D.C.: Author.

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What is the Healthy Child Care America Project?

The American Academy of Pediatrics and the U.S. Department of Health and Human Services have joined in a campaign called Healthy Child Care America, intended to bring together families and child care providers in an effort to make it easier for parents to find and use health services, and to make childcare settings safer and healthier.

What can communities do to promote safe and healthy child care?

Healthy Child Care America suggests these 10 steps to quality child care:

  1. Promote safe, healthy, and developmentally appropriate environments for all children in child care.
  2. Increase immunization rates and preventive services for children in child care.
  3. Help families access key public and private health and social service programs.
  4. Promote and increase comprehensive access to health screenings.
  5. Conduct health and safety education and promotion programs for children, families and child care providers.
  6. Strengthen and improve nutrition services in child care.
  7. Provide training and ongoing consultation in social and emotional health to child care providers and families.
  8. Expand and provide ongoing support to child care providers and families caring for children with special needs.
  9. Use child care health consultants to help develop and maintain healthy child care.
  10. Assess and promote the health, training and work environment of child care providers.

For further information and how you can influence change within your community, contact:
Child Care Bureau, Administration on Children, Youth and Families
200 Independence Ave./ Room 320-F
Washington, D.C. 20201
Phone: (202) 690-5641 Fax: (202) 690-5600

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