Networking child health

28 World Health • 48th Yeor, No. 6, November-December 1995 Networking child health Zeil Rosenberg & lrwin Redlener The children deserve nothing less than the best Despite the high quality of health care services and the extraordi-nary medical technologies available to most persons in the United States, millions of children have been marginalized by the exist- ing health care system. Lack of access to comprehensive and contin- uous paediatric services can have a variety of causes, including families' lack of health insurance coupled with the high costs of care, residence in areas (both rural and inner city) which have shortages of physicians, and special barriers to receiving medical care such as homelessness or frequent placement in foster care. The Children's Health Fund is a non- profit-making, private, voluntary organization designed to meet the complex health needs of children who do not have sufficient access to the high quality medical care they need. At first this was done by supporting the New York Children's Health Project, and later by support- ing a national network of paediatric projects modelled on that successful experience. The New York Children's Health Project was initiated in 1987 to bring medical services, using a fully equipped mobile medical unit, di- rectly to homeless children and their families living in shelters supported by the city. The sites often included poorly maintained "welfare hotels," ill-equipped to provide either the environment for proper child devel- opment or the essential health ser- vices needed by the children housed there. The hotels quickly became foci for the epidemic spread of infec- chickenpox, rubella and diarrhoea) disease. Homeless children are known to be at high risk for a variety of other conditions, including de- layed development, vaccine-pre- ventable diseases and behavioural problems. Drug abuse, crime, and violence at shelter sites further compound already difficult family situations. To provide high quality services, the Project, operated by the Division of Community Pediatrics of the Montefiore Medical Center/ Albert Einstein College of Medicine, has adapted the "medical home" model of paediatric primary care promoted by the American Academy of Pediatrics. Used by all projects affiliated with the national network, this strategy has the following six components. • The mobile medical unit Each Project uses mobile medical units to bring health care directly to children who cannot reach a fixed health care facility owing to lack of transport or the distance involved. The mobile units have two examina- tion rooms, a waiting area, video for health education, a computer for patient registration and record- keeping, and a refrigerator for storing clinical specimens, vaccines and medications. • Paediatrician-led health teams The same paediatrician-led teams, including nurse practitioners and other support staff, come weekly to give the children the opportunity to receive medical care from the same provider. They provide primary health care, and each project has a Medical Director responsible for quality of care and for linkage with the affiliated academic medical centre. • The medical home Paediatric services at each of the project sites are delivered in such a way as to provide a "medical home" for all children seen, with accessible, continuous, comprehensive and family-centred care. All projects use mobile medical visits as part of their service delivery strategy, and in addition they use community health centre clinics, free-standing paedi- atric clinics, satellite clinics and a tious diseases, including measles, Mobile medical units provide comprehensive care for city children . World Health • 48th Year, No. 6, November-December 1995 variety of other outreach strategies to bring care into the community. Specialized services for the child's family may include psychosocial services and referral, nutrition coun- selling, and home visits. Children who have not returned for follow-up visits or have not kept referral ap- pointments are contacted and encour- aged to do so. • Academic medical centre linkage Each project is either administered by or has a formal linkage with an academic medical centre's depart- ment of paediatrics. This allows for direct access to all paediatric subspe- cialty and inpatient hospital services. Medical education and research goals regarding the health needs of medically underserved children are met by training medical students and paediatric residents, and analysing community health needs from records and special surveys. • Computerized management-information system A computerized system records essential demographic, public health and clinical medical information which is taken during health visits. The child's medical history, social history, screening and test results , diagnosis, problem lists and follow- up referrals can be accessed from a portable computer by any mobile medical unit or at fixed locations so that chi ldren can be seen on a walk- in basis at any time. • Child health advocacy Each project is involved in advocacy activities to improve access to health care for the children they serve. Activities include conducting local meetings with parents and commu- nity leaders, documenting child health needs and programme impact, and educating local, state and federal policy-makers about health needs and strategies. National network The National Children's Health Project Network consists of mobile projects serving very diverse popula- tions. Besides the project in New York, examples elsewhere in the United States include: - the Mississippi Children's Health Project, serving an agricultural area with severe poverty and a total population of less than 70 000, which provides primary paediatric services to children in isolated agricultural communi- ties; - the Dallas Children's Health Project, operated by the Parkland Hospital in collaboration with the University of Texas Southwestern Medical Center, where mobile medical units bring medical services to ten different This mobile unit serves the needs of children throughout New York City. 29 emergency, transitional and domestic violence shelters, while a day-care centre is devoted to homeless children and commu- nity outreach includes home visits to mothers of low-birth-weight babies and ongoing follow-up care to ensure complete immu- nization coverage; - the South Florida Children's Health Project, based at the University of Miami School of Medicine, which began its work by responding to immediate child health needs following Hurricane Andrew in 1993 and places spe- cial emphasis on the children of recent immigrants; - the Los Angeles Children's Health Project, operated by the Watts Health Foundation in collaboration with the Charles R. Drew University of Medicine and Science, whose services are focused on permanently housed as well as homeless African- American and Latino children in the economically depressed South Central Los Angeles area. Development of a National Children's Health Project Network is proving essential for ensuring that health professionals are not isolated from the larger medical community, and can thus uphold their patients' needs while continuing their profes- sional growth. Senior project staff attend national Children's Health Fund conferences, share ideas, and develop improved ways to meet the health needs of medically marginal- ized children. Moreover, we know that in the most difficult work envi- ronments the best paediatric care can only be delivered when resources and commitment - both professional and institutional- can be marshalled. The children we serve deserve nothing less. • Or Zeil Rosenberg is Medical Director, Notional Program, The Children's Health Fund, 3 I 7 East 64th Street, New York, NY I 00 2 I , USA, and Or lrwin Redlener is President of the Fund.