A Model for Training Community-Based Providers for Children with Special Health Care Needs

Title V of the Social Security Act of 1935 established the nation's first categorical health care program for children: the Crippled Children's Service. In 1985, federal legislation changed the name of the Crippled Children's Service to the Program for Children With Special Health Care Needs. Four years later, new amendments to Title V dramatically altered the Program's mission. States are now required to spend 30% of the funds from the Maternal and Child Health Services block grant on children with special health care needs and to take specific steps toward improving the service system for these children and their families. The new mandate is the only current foundation of a national health policy for children with special health care needs. The 1989 law substantially broadens the mission of the state programs and explicitly recognizes that all children with a special health care need should have access to an appropriate, community-based system of care monitored by state Children with Special Health Care Needs agencies. In addition, states are now required to conduct needs assessments pertaining to these children, to foster local systems of care, and to ensure a high quality of community-based services. Understanding the implications of the new amendments is essential because pediatricians and other child health care professionals have key roles to play in implementing these new policies.

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General Comments

PEDIATRICS ◽

10.1542/peds.91.5.1023 ◽

1993 ◽

Vol 91 (5) ◽

pp. 1023-1024

Author(s):

Merle McPherson

Keyword(s):

Health Care ◽

Special Health Care Needs ◽

Leadership Role ◽

Block Grant ◽

Health Care Needs ◽

Care Needs ◽

National Goal ◽

Community Based ◽

Special Health Care ◽

Special Health

As the year 2000 approaches, we as a nation face unique challenges in facilitating the development of systems of services for children and their families which support and nurture our next generation in healthy, productive lives. Title V of the Social Security Act has a proud history of leadership in response to needs of children and families and has worked to improve the health of underserved women, infants, children, and youth, including children with special health care needs. In 1989, amendments were enacted to the Title V Maternal and Child Health Grant (MCH block grant). These amendments redefine the mission of the state Children With Special Health Care Needs programs (CSHCN programs). The MCH block grant mandates the state CSHCN programs to assume a leadership role in developing community-based systems of services for children with special health care needs and their families. The mandate in the MCH block grant to the CSHCN programs to assume a leadership role with respect to systems development reflects the national goal of building systems of services for children with special health care needs and their families that are family-centered, community-based, and coordinated. This goal was first enunciated in 1987 by the US Surgeon General's office and the federal Bureau of Maternal and Child Health. In accordance with this national goal, the recently issued Year 2000 National Health Promotion and Disease Prevention Objectives includes objective 17.20, which specifically calls for the building of family-centered, community-based, coordinated systems of services for this population. The national initiative to develop systems of services for children with special health care needs and their families can and should be seen as part of a larger national movement to develop community-based systems of services.

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