Seeking Pathways to a Coordinated System of Health and Human Services for High-risk Urban Chwildren and Families: The Rochester, New York Experienc

Children and families who live in poverty or are otherwise at high risk face many obstacles in the current health care system. One of the most difficult obstacles is the manner in which child health has historically been viewed. The traditional view is exclusively centered on medical interventions, but the health of children living in poverty is inextricably intertwined with their socioeconomic circumstances and requires organized interventions extending far beyond the parameters of traditional medicine. Although there has been substantial progress in preventing or ameliorating the effects of many physical health problems of children, little progress has been made in addressing problems that stem from the child's life circumstances. Families facing the many issues that accompany poverty need to have ready access to an array of preventive and supportive health and human services. A growing literature reflects the number of individuals and communities recognizing the shortcomings of the current categorical organization of services and the need for more integrated and coordinated health and human services for children and families.2-8 Children growing up in poverty are likely to experience some of the most severe social problems facing our nation today. This fact is true in Rochester, as it is in other parts of the country. To cite just a few examples: * In 1989, a Children's Defense Fund study ranked Rochester 13th in the nation for the percentage of its children living in poverty.1 Whereas 14% of the city's children lived in poverty in 1969, growing to 27% by 1979, in 1989 a full 38% lived below the poverty line, more than in New York City and the same as in Newark, New Jersey. Twenty-five percent of white children, 47% of black children, and 55% of Hispanic children in Rochester are living in poverty. * Between 1970 and 1993, the proportion of elementary-school students in the Rochester City School District who are poor, defined as those who qualify for free or reduced-price lunches, increased by 615%. In 1992, 76% of the district's elementary P,xm;. 268 VOIUMNIF 71, NUMNBER 2 COORDINATED HEALTH AND HUMAN SERVICES students, or 18,000 children, were classified as poor, a 7% increase in just the past 2 years alone (Gannett Rochester Newspapers, Nov. 7, 1993). * In 1990, 46% of Rochester's families with children h