ASSOCIATION OF THE CARE OF CHILD HEALTH

WASHINGTON, D.C.

MAY 30,199O

C. EVERETT KOOP, M.d., SC.D.



I AM DELIGHTED TO HAVE BEEN CHOSEN TO SPEAK TO YOU AT

THIS CLOSING PLENARY SESSION OF THE 25TH ANNIVERSARY

MEETING OF THE ASSOCIATION FOR THE CARE OF CHILDREN'S

HEALTH.

THE SIGNIFICANCE OF ACCH IN THE HEALTH CARE SYSTEM LIES

IN ITS MULTI-DISCIPLINARY NATURE WHICH ENCOURAGES A

TEAM APPROACH IN SOLVING THE PROBLEMS CHILDREN FACE IN

A WORLD THAT SEEMS TO ME TO GROW EVER MORE HOSTILE.


IT IS SIGNIFICANT, AND AUGERS WELL FOR THE FUTURE THAT SO

MANY PARENTS ARE PARTICIPANTS IN THIS MEETING.

THE INTERNATIONAL FLAVOR OF THE MEETING HAS PROVIDED AN

OPPORTUNITY FOR THE UNITED STATES AND CANADA TO LEARN

FROM EACH OTHER:


OUR GOALS ARE COMMON; THE MEANS TO THEM ARE

DIFFERENT; BUT WE EACH HAVE STRENGTHS AND WEAKNESSES.


GOOD HEALTH CARE IS OBVIOUSLY NOT NECESSARILY A MATTER


OF WHO HAS MOST DOLLARS, IMPORTANT THOUGH MONEY CAN


BE. OUR CURRENT CHALLENGE IS TO INVEST LIMITED DOLLARS


MOST WISELY, ANOTHER AREA WHERE WE HAVE MUCH TO LEARN


FROM OTHER SYSTEMS.


WHAT IS OUR COMMON CHARGE?

CHILDREN ARE THE FUTURE OF OUR NATIONS -- A VERY SPECIAL

RESOURCE. IN THIS COMPETITIVE WORLD CHILDREN ARE TOO

SMALL, TOO WEAK, TOO POOR - TO LOBBY FOR THEMSELVES.

WE MUST ASSURE THAT ALL CHILDREN HAVE THE FULLEST

OPPORTUNITY TO PARTICIPATE IN ALL ASPECTS OF LIFE.


CHILDREN DESERVE TO GROW UP RECEIVING QUALITY HEALTH

CARE, EDUCATION, AND NECESSARY SOCIAL SUPPORT SERVICES.

THEY DESERVE TO HAVE A HOME WITH A FAMILY AND LIVE IN A

COMMUNIN THAT CAN MEET THEIR NEEDS. INVESTMENT IN

CHILDREN AND FAMILIES IS THE CORNERSTONE OF PUBLIC


HEALTH AND SHOULD BE THE FOUNDATION OF EVERY NATION'S


POLITICAL AGENDA.


WE MUST MOVE TO CONSENSUS AND THEN TO ACTION TO MEET

CHILDREN'S NEEDS AND TO SUPPORT THEIR FAMILIES

APPROPRIATELY.

AS WE MOVE INTO THE LAST DECADE OF THE TWENTIETH

CENTURY, NEITHER THE U.S. NOR CANADA HAS YET ENACTED A

NATIONAL YOUTH AGENDA THAT ADDRESSES THE NEEDS OF

CHILDREN COMPREHENSIVELY. EXISTING SERVICE DELIVERY

SYSTEMS DO NOT FUNCTION IN WAYS THAT CHERISH AND

PROVIDE FOR CHILDREN AND THEIR FAMILIES. CHILDREN SEEM

TO COME LAST, NOT FIRST. IT SHOULD BE THE OTHER WAY

AROUND.


IT IS TIME TO RE-EXAMINE THE WAYS IN WHICH WE LOOK AT

CHILDREN AND FAMILIES -- TO REALLOCATE RESOURCES AND


TO REDESIGN SERVICE DELIVERY SYSTEMS IN WAYS THAT HELP

ALL OF OUR YOUNG PEOPLE AND THEIR FAMILIES, OVERCOME

THE BARRIERS THAT KEEP THEM FROM BECOMING HEALTHY,

WELL-EDUCATED, PRODUCTIVE CITIZENS.

THIS IS OUR TASK! THIS IS OUR CHARGE!


THE COUNTENANCE OF HEALTH CARE HAS CHANGED. IT IS NOW

INEXTRICABLY TIED IN WITH THE SOCIO-ECONOMIC STATUS OF

CHILDREN AND THEIR FAMILIES.

POVERTY, GHETTO LIFE, ILLITERACY, POOR NUTRITION NOT ONLY

CONTRIBUTE TO DISEASE AND DIMINISHED HEALTH; THEY ALSO

IMPEDE ACCESS TO CARE, AND IF THAT IS ACHIEVED, TREATMENT

THEREAFTER.


WHILE THERE HAVE ALWAYS BEEN POPULATIONS WITHIN OUR


COUNTRIES THAT DO NOT HAVE EQUAL OPPORTUNITY OR EQUAL


ACCESSTOSERVICES,INRECENTDECADESTHEREHAVEBEEN


MAJOR CHANGES IN THE FABRIC OF THE SOCIETY THAT SIGNAL


THE NEED FOR CHANGES IN OUR SOCIAL INSTITUTIONS AND IN


OUR PROFESSIONAL PRACTICES.


FAMILIES NEED NEW KINDS OF SUPPORT IF THEY ARE TO

SURVIVE AND FLOURISH IN AN ENVIRONMENT THAT IS

CHARACTERIZED BY THE FOLLOWING KINDS OF ISSUES:

*   COMMUNITIES AND NEIGHBORHOODS NO LONGER


   .FUNCTION AS SYSTEMS OF SUPPORT WITHIN WHICH

CHILDREN CAN SAFELY GROW INTO ADULTHOOD AND

BECOME SELF-SUFFICIENT. VIOLENCE AND

SUBSTANCE ABUSE HAVE THREATENED THE STABILITY

OF FAMILIES AT ALL SOCIOECONOMIC LEVELS.

10


*   DESPITE THE FACT THAT OUR COMMUNITIES ARE MORE


  CULTURALLY DIVERSE, SOCIAL INSTITUTIONS HAVE

NOT ADAPTED TO THESE CHANGES. PROFESSIONAL

INSENSITIVITY TO CULTURAL DIFFERENCES AND

LANGUAGE BARRIERS IMPEDE ACCESSIBILITY TO

SERVICES FOR CULTURALLY DIFFERENT FAMILIES AND

CHILDREN.

*   POVERTY IS EVER-PRESENT. 21% OF CHILDREN (12.9M)


  ARE POOR; MOREOVER, IN THE LAST FIVE YEARS, THE

NUMBER OF FAMILIES IN POVERTY HAS GROWN BY

FORTY PERCENT.

11


HALF OF AFRICAN-AMERICAN AND LATIN CHILDREN UNDER 6 LIVE

IN POVERTY. HALF OF POOR CHILDREN ARE IN RURAL OR

SUBURBAN AREAS; IT IS NOT AN URBAN PROBLEM ONLY. ONLY

40% OF ALL POOR CHILDREN ARE FROM HOMES IN WHICH BOTH

PARENTS RESIDE.

*   THERE ARE SIGNIFICANT CHANGES IN TRADITIONAL


  FAMILY STRUCTURES AND ROLES. OUR SERVICE

DELIVERY SYSTEMS ARE NOT ORGANIZED IN WAYS

THAT ARE RESPONSIVE TO THE NEEDS OF SINGLE

PARENT FAMILIES, AGGREGATE FAMILIES AND

FAMILIES WITH TWO WORKING PARENTS.

12


NOR ARE THEY TO ADOPTIVE AND FOSTER PARENTS, NOR

HOUSEHOLDS WHERE THE GENERATIONAL LINES ARE BLURRED

BECAUSE GRANDMOTHER, MOTHER AND GRANDCHILD ALL HAVE

CHILDREN BEING RAISED TOGETHER.

THERE ARE FEW SUPPORTIVE SERVICES AVAILABLE TO FAMILIES

IN THEIR COMMUNITIES, SUCH AS CHILD CARE, THAT ENABLE

FAMILIES TO MEET THEIR RESPONSIBILITIES.

13


*   HOMELESSNESS IS REACHING EPIDEMIC PROPORTIONS


   IN THE U.S. FAMILIES ARE THE FASTEST GROWING

SEGMENT OF THE HOMELESS POPULATION.

MOREOVER, ONE OUT OF EVERY FIVE HOMELESS

CHILDREN IS SCHOOL-AGE.

*   42 MILLION CHILDREN AGED 10 - 19 IN THE UNITED


STATES EXPERIENCE SERIOUS PROBLEMS. SUBSTANCE

ABUSE IS INCREASING AND CREATES SERIOtJS

DISRUPTIONS IN THE LIVES   OF CHILDREN AND FAMILIES

AS WELL AS THREATS TO THEIR   HEALTH AND SAFETY.

14


THE NATIONAL ADOLESCENT STUDENT HEALTH SURVEY

INDICATED THAT 77% OF EIGHTH GRADERS AND 89% OF TENTH

GRADERS HAVE USED ALCOHOL; 15% OF EIGHTH GRADERS AND

35% OF TENTH GRADERS HAVE USED MARIJUANA; AND AMONG

THE CLASS OF 1987,5.6% HAD USED CRACK-COCAINE.

TEENAGE SUICIDES AND VIOLENT DEATHS HAVE BEEN

INCREASING AT AN ALARMING RATE. SUICIDE AND HOMICIDE

ARE STILL THE NUMBER ONE CAUSE OF DEATH FOR THIS AGE

GROUP.

15


*   VALUE SYSTEMS ARE BEING TRANSFORMED AS

CHILDREN SEE MATERIALISTIC REWARDS COMING

FROM DEALING IN DRUGS AND FROM OTHER ILLICIT

ACTIVITIES RATHER THAN FROM THE KINDS OF JOBS

THAT THEY CAN OBTAIN AS A RESULT OF THEIR

SCHOOLING.

*   SCHOOLS AND MEDICAL FACILITIES ARE FACED WITH


   SERVING CHILDREN THEY NEVER HAD TO DEAL WITH

BEFORE. CHILDREN WITH HANDICAPPlhlG CONDITIONS

ARE BEING DE-INSTITUTIONALIZED AND

"MAINSTREAMED" INTO EDUCATIONAL PROGRAMS IN

THE PUBLIC SCHOOLS.

16


AS APPROVING AS I AM OF MAINSTREAMING, I DEPLORE THE

LACK OF COORDINATION BETWEEN THOSE WHO PLAN

EDUCATION AND HEALTH CARE FOR OUR CHILDREN.

AIDS HAS BECOME A SERIOUS THREAT TO OUR CHILDREN. AS OF

1990, THERE HAVE BEEN 2116 CASES OF AIDS FROM BIRTH TO 13

YEARS OF AGE. THERE HAVE BEEN 406 CASES IN TEENAGERS 13

TO 19 YEARS OF AGE. BOTH ARE MISLEADING FIGURES.

17


WITH THE LONG INCUBATION PERIOD FOR HIV INFECTION, LOOK

TO THE PREVALENCE OF AIDS IN THE 20 -  30 YEAR GROUP TO


GET AN IDEA OF HOW MUCH HIV INFECTION TAKES PLACE IN THE

TEEN YEARS.

*   THE NUMBER OF TEENAGE PREGNANCIES IS


  ESCALATING AND THE CONSEQUENCES OF

INAPPROPRIATE CARE ARE BEING FELT"IN THE RISE OF

INFANT MORTALITY AND MORBIDITY RATES.

18


ALL OF THESE ISSUES CONSTITUTE THE SOCIAL CONTEXT WITHIN

WHICH SERVICES WILL NEED TO BE OFFERED. WE LIVE IN A

SOCIETY IN WHICH CHANGE IS A CONSTANT. RECOGNIZING THIS

ONGOING SOCIAL CHANGE AND ITS EFFECTS ON FAMILIES AND

CHILDREN, IS NOT ENOUGH.

19


ABOVE ALL WE MUST BE FLEXIBLEAWE ORGANIZE HEALTH,

EDUCATION, AND SOCIAL SUPPORT SERVICES IN WAYS THAT

ACKNOWLEDGE THE COMPLEXITY OF SOCIAL ENVIRONMENTS

AND ADDRESS CONCERNS AS THEY EMERGE.

20


OBVIOUSLY WE NEED A COMPREHENSIVE POLICY.

NEGATIVE SPIRALLING EFFECTS OF POOR HEALTH IN CHILDHOOD

ARE DEVASTATING BECAUSE THEIR IMPACT LASTS A LIFETIME

AND THERE IS A CONTINUING LINK BETWEEN GENERATIONS.

UNHEALTHY MOTHERS GIVING BIRTH TO UNHEALTHY BABIES

WHO GROW UP UNHEALTHY.. . THE CYCLE BECOMES MORE

POWERFUL WITH EACH GENERATION.

21


FORTUNATELY INDIVIDUAL CITIZENS FROM THROUGHOUT NORTH

AMERICA, CORPORATIONS, AND GOVERNMENTS, NOT JUST OUR

HUMAN SERVICE SYSTEMS, ARE BEGINNING TO RECOGNIZE THAT

WE MUST INVEST IN THE HEALTH OF OUR CHILDREN.. . AN

INVESTMENT IN HEALTH, NOT JUST AN INVESTMENT IN THE

TREATMENT OF DISEASE.

22


THE SOLUTIONS ARE NOT SIMPLE, QUICK FIXES. RATHER,

COMPLEX SYSTEMS CHANGE IS REQUIRED. CLEARLY, AS WE

HAVE JUST SEEN, POVERTY IS THE SINGLE CONDITION THAT IS

HAVING THE MOST DRAMATIC IMPACT ON THE HEALTH STATUS

OF CHILDREN IN THE U.S. AND TO A SLIGHTLY LESSER DEGREE,

ON CANADA'S CHILDREN.

23


THE HEALTH CARE SYSTEM ALONE CAN NOT SOLVE POVERTY,

BUT IT DOES NEED TO ADDRESS ISSUES OF POVERTY.

OUR SYSTEMS OF EDUCATION AND CHILD WELFARE OR SOCIAL

SERVICES ARE ALSO VITALLY IMPORTANT PARTNERS IN

ADDRESSING ISSUES OF POVERTY AND BUILDING A

COMPREHENSIVE, COORDINATED SYSTEMS OF HEALTH,

EDUCATION, AND SOCIAL SUPPORT FOR CHILDREN AND THEIR

FAMILIES.

24


WE MUST PUT THESE SERVICES PERMANENTLY IN PLACE AT THE

FAMILY AND COMMUNITY LEVEL. SURELY, OUR NATIONS WITH

THEIR POWER, DOLLARS, AND "KNOW-HOW," CAN ACCOMPLISH

THIS TASK.

CHILDREN SHOULD HAVE THE RIGHT TO QUALITY HEALTH CARE

AND EDUCATION. IT IS TIME THAT OUR COUNTRIES DEVELOPED

NATIONAL COMPREHENSIVE POLICIES FOR CHILDREN AND

FAMILIES.

25


WHAT WOULD THE IDEAL COMPREHENSIVE HEALTH-CARE

SYSTEM BE LIKE?

IT WILL BE:

1.  FAMILY-CENTERED, AND IT WILL BE


2.  COMMUNITY-BASED; AND IT WILL BE


3.  ACCESSIBLE TO ALL; AND IT WILL BE


4.   COORDINATED - NOT A "PIECEMEAL APPROACH - o"7

  FAMILY NEEDS ADDRESSED HOLISflCALLY.

26


IT WILL ALSO BE BASED ON THE ACKNOWLEDGEMENT OF:

THE CENTRAL AND CONSTANT ROLE OF THE FAMILY (DEFINED IN

ITS BROADEST SENSE) IN THE CHILD'S LIFE ("UNITED BY CHOICE

NOT BIRTH"), BUT BASED ALSO ON THE RECOGNITION OF THE

IMPORTANCE OF THE CULTURAL SENSITIVITY, THE NEED TO

SUPPORT, NOT SUPPLANT THE FAMILY'S ROLE, AND THE NEED TO

FOSTER INDEPENDENCE; NOT DEPENDENCE.

27


WE DO HAVE THE EXPERIENCE WITH A FAMILY-CENTERED

PROGRAM FOR CHILDREN WITH SPECIAL NEEDS, IN 1987, - THAT

SHOWED HOW THE APPROACH COULD AND SHOULD WORK; IT

DID NOT HAVE AS A GOAL THE SYSTEMIC CHANGE THAT IS

NEEDED.

NOW WE HAVE TITLE V LEGISLATION.

28


EFFORTS TO ACHIEVE BROADER SYSTEMIC CHANGE IN THE

NATURE OF SERVICE DELIVERY SYSTEMS HAVE EMERGED IN THE

MOST RECENT TITLE V LEGISLATION, THE MATERNAL AND CHILD

HEALTH SERVICES BLOCK GRANT PROGRAM AND IN THE

INITIATIVES SPONSORED BY THE SURGEON GENERAL'S OFFICE

DURING MY TERM OF OFFICE.

29


THE PURPOSt$OF TITLE V INCLUDE THE IMPROVEMENT OF THE

HEALTH OF ALL MOTHERS AND CHILDREN AND FACILITATING THE

DEVELOPMENT OF COMMUNITY-BASED SYSTEMS OF SERVICES

FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND THEIR

FAMILIES.

IT WAS RECOGNIZED THAT THESE EFFORTS NEED TO BE

ACCOMPLISHED BY THE DEVELOPMENT OF FAMILY CENTERED,

COORDINATED SYSTEMS OF CARE WITH THE INVOLVEMENT OF

ALL RELEVANT SECTORS OF THE SERVICE COMMUNITY.

30


THE MCH PROGRAM FOR CHILDREN WITH SPECIAL HEALTH CARE

NEEDS IS AN INNOVATIVE EFFORT TO CHANGE THE WAY THAT

HEALTH SERVICES ARE ORGANIZED FOR THESE CHILDREN AND

THEIR FAMILIES.

THE FOCUS FOR THIS INITIATIVE WAS DEFINED AFTER EXTENSIVE

INVOLVEMENT WITH PROFESSIONALS OF ALL DISCIPLINES AND

WITH PARENTS AND FAMILIES IN NEED OF THESE SERVICES.

31


THESE SERVICE RECIPIENTS HAD HIGH PRAISE FOR

TECHNOLOGICAL ADVANCES AND THE TECHNICAL ASPECTS OF

CARE. HOWEVER, THEY EXPERIENCED SOME OF THE FOLLOWING

DIFFICULTIES WITH THE SERVICE SYSTEM:

*   PROFESSIONALS IN HOSPITALS AND IN COMMUNITY


   PROGRAMS DID NOT VIEW PARENTS AS PRIMARY CARE

PROVIDERS FOR THEIR CHILDREN. AS A RESULT,

FAMILIES WERE NOT RECEIVING ADEQUATE

INFORMATION AND SUPPORT. THEREFORE, SERVICES

SHOULD BE RE-FOCUSED TO BE FAMILY-CENTERED.

32


*   SERVICES WERE SOMETIMES INADEQUATE WHEN


   CHILDREN LEFT HOSPITALS AND RETURNED TO THEIR

HOME COMMUNITIES; SO, THE SERVICE DELIVERY

SYSTEM SHOULD BE RESHAPED TO BE COMMUNITY-

BASED.

*   FAMILIES OFTEN HAD TO APPROACH MULTIPLE


  AGENCIES AND PROFESSIONALS (OFTEN AS MANY AS

20 - 30) IN ORDER TO GET ALL NEEDED SERVICES;

THUS, SERVICE SYSTEMS SHOULD BE COORDINATED

TO FACILITATE ACCESS TO SERVICES.

33


IN ORDER TO RESPOND APPROPRIATELY TO CONCERNS OF

CHILDREN WITH SPECIAL NEEDS AND THEIR FAMILIES, SERVICE

PROFESSIONALS NEEDED TO RECONCEPTUALIZE THE SERVICE

DELIVERY SYSTEM THEREBY CALLING FOR BROAD SYSTEMIC

CHANGE. THESE ISSUES REPRESENT THE CURRENT FOCUS OF

THE TITLE V LEGISLATION.

34


THREE KEY ISSUES IN A COMPREHENSIVE SYSTEM OF CHILD

HEALTH CARE

FIRST, CARE MUST BE ACCESSIBLE. WHAT DOES THIS ENTAIL?

ADEQUATE FINANCING, FOR ONE THING. BUT THAT IS NOT ALL.

OUR CANADIAN COLLEAGUES HAVE DEALT WITH THIS ISSUE

MORE SUCCESSFULLY THAN WE HAVE IN THE U.S. FOR EXAMPLE,

THERE IS UNIVERSAL ACCESS TO PRENATAL CARE IN CANADA,

WHICH CONTRIBUTES TO CANADIAN RATES OF INFANT

MORTALITY AND LOW BIRTH WEIGHT BABIES BEING LOWER THAN

THE U.S.

35


BUT CANADA DOES NOT HAVE THE NUMBERS WE DO, NOR THE

ETHNIC, RACIAL AND ILLITERACY BARRIERS THAT ARE OURS.

WE HAVE THE PARADOX OF WOMEN WANTING PRENATAL CARE

AND NOT GETTING IT WHILE AT THE SAME TIME WE HAVE FAILING

CAMPAIGNS TO GET UNWILLING WOMEN TO AVAILABLE CARE.

36


*   ALL CHILDREN AND THEIR FAMILIES SHOULD HAVE


  ACCESS TO ADEQUATE HEALTH CARE INSURANCE.

IT MUST COVER CHRONIC CARE AND CARE IN THE

COMMUNITY.

IT MUST RECOGNIZE THE COMPREHENSIVE NEEDS OF

CHILDREN AND THEIR FAMILIES. IT MUST ASSURE EQUAL

ACCESS TO CARE FOR ALL CHILDREN ACROSS GEOGRAPHIC

BOUNDARIES.

37


MANY OPTIONS ARE BEING CONSIDERED TO IMPROVE PUBLIC

AND PRIVATE INSURANCE. AS SYSTEMS AND SERVICES ARE

DEVELOPED, PUBLIC, PRIVATE AND VOLUNTARY RESOURCES

MUST BE REDIRECTED IN WAYS THAT SUPPORT FAMILIES.

THIS WILL VARY BY STATE AND LOCALITY AND YOU MUST BE

FLEXIBLE AS WELL AS INNOVATIVE IN BRINGING THIS ABOUT IN

YOUR OWN COMMUNITIES.

38


SECOND, CARE MUST BE GEOGRAPHICALLY ACCESSIBLE, THAT

IS, -- COMMUNITY-BASED.

*   THE UNITED STATES IS RECOGNIZED


   INTERNATIONALLY FOR SOPHISTICATED TERTIARY

CARE AND TECHNOLOGICAL ADVANCES; YET WE

LACK ACCESS AND EQUITY FOR BASIC SERVICES

AT THE FAMILY AND COMMUNITY LEVEL.

39


WE ARE THE ONLY DEVELOPED NATION THAT DOES NOT

GUARANTEE HEALTH CARE i0 EVERY CITIZEN. SERVICES NEED

TO BE PROVIDED IN OR NEAR THE HOME COMMUNITIES OR

NEIGHBORHOODS OF CHILDREN AND THEIR FAMILIES.

FAMILIES SHOULD NOT HAVE TO TRAVEL LONG DISTANCES FOR

SERVICES. WHENEVER POSSIBLE, CHILDREN SHOULD BE CARED

FOR AT HOME RATHER THAN IN A HOSPITAL.

40


THIRD, THERE IS THE PART OF ACCESSIBILITY THAT INVOLVES

SERVICE COORDINATION, THE -- ELIMINATION OF GAPS AND

OVERLAPS.

SERVICES MUST BE COORDINATED TO BE RESPONSIVE TO

CHILDREN AND FAMILIES, TO PREVENT GAPS IN SERVICE, AND TO

KEEP SERVICES FROM BEING PROVIDED SEPARATELY FROM

EACH OTHER. STRONG LEADERSHIP AND COMMITMENT ARE

NEEDED AS PEOPLE AND GROUPS WORK TOGETHER TO IMPROVE

DELIVERY OF SERVICES.

41


INCREASED FORMAL COLLABORATION BETWEEN HEALTH,

EDUCATION, AND SOCIAL SERVICE PROFESSIONALS IS AN

IMPORTANT BUILDING BLOCK IN THE DEVELOPMENT OF THESE

NEW SYSTEMS OF CARE.

AS THE NEEDS OF CHILDREN AND FAMILIES EXPAND AND

BECOME MORE COMPLEX, IT IS MORE AND MORE APPARENT

THAT BOUNDARIES OF PROFESSIONAL RESPONSIBILITY, AS

REFLECTED IN OUR EXISTING SERVICE DELIVERY SYSTEM, ARE

OFTEN DYSFUNCTIONAL.

42


THERE ARE SEVERAL POPULATIONS OF CHILDREN CURRENTLY

BEING SERVED INDEPENDENTLY BY HEALTH, MENTAL HEALTH,

EDUCATION, AND SOCIAL SERVICE CARE GIVERS.

INSTEAD, WE MUST MAKE CHANGES IN THE SERVICE SYSTEM

THAT ALLOW, INDEED FORCE, PROFESSlCjNALS TO PROVIDE

SERVICES TO CHILDREN AND FAMILIES COLLABORATIVELY.

43


FOURTH, THERE MUST BE ACCESS TO INFORMATION.

KNOWLEDGE IS POWER; FAMILIES MUST BE GIVEN ACCESS TO

CULTURALLY APPROPRIATE RESOURCES -- THERE IS A MAJOR

NEED FOR COMPREHENSIVE AND UNDERSTANDABLE HEALTH

EDUCATION.

FINALLY, ACCESS INVOLVES TIME AND SCHEDULES - ADJUSTING

OUR PROFESSIONAL HOURS TO FIT THOSE OF WORKING

FAMILIES.

44


AS HEALTH CARE COSTS SOAR, WE ARE BEGINNING TO REALIZE

THERE IS A BETTER WAY THAN REPARATIVE AND REHABILITATIVE

MEDICINE.

CARE MUST FOCUS ON PREVENTION.

PREVENTION MUST BE THE NORM -- IT NOT ONLY SAVES LIVES

BUT IS ULTIMATELY COST-EFFECTIVE.

45


WE KNOW WHAT WE CAN DO WITH SMOKING, FOR EXAMPLE.

DURING MY EIGHT YEARS AS SURGEON GENERAL, SMOKING AS A

PERCENTAGE OF THE POPULATION, FELL FROM 33 TO 24%

AND WE NEED MORE SOPHISTICATED APPLICATION OF

TECHNIQUES OF BEHAVIOR MODIFICATION FOR DRUG ABUSE,

TEEN AGE PREGNANCY, STD, ACCIDENT PREVENTION, CONTROL

OF INTERPERSONAL VIOLENCE.

46


IT IS IMPERATIVE THAT THERE BE A CHANGE IN PRIORITIES BOTH

FOR INDIVIDUALS, THOSE WHO PROVIDE HEALTH CARE, POLICY

MAKERS, AND IN THE U.S., THE PAYORS.

PREVENTION AND HEALTH PROMOTION ACTIVITIES MUST

BECOME A SIGNIFICANT PRIORITY. WE MUST BE WILLING TO

ALLOCATE RESOURCES TO PREVENTION, NOT JUST TO THE

TREATMENT OF DISEASE.

47


LACK OF RESOURCES FOR IMMUNIZATIONS, AT THE RIGHT TIME

LEADS TO COSTLY TREATMENT OF PREVENTABLE DISEASES.

LACK OF EDUCATION FOR HEALTHY BEHAVIORS AND LIFESTYLES

AGAIN LEADS TO EXPENSIVE TREATMENT OF PREVENTABLE

DISEASES.

THE TERRIBLE PLIGHT OF BABIES BORN TO COCAINE,

PARTICULARLY CRACK, ADDICTED MOTHERS IS STRAINING

HOSPITAL PEDIATRIC SERVICES.

48


TO BACK THIS UP, WE HAVE A STRONG PUBLIC HEALTH SYSTEM.

MORE PUBLIC HEALTH ACTIVITIES MUST TAKE PLACE IN

COMMUNITIES, HOMES AND ESPECIALLY SCHOOLS WHICH ARE A

VASTLY UNDERUSED RESOURCE.

PROMOTING OPTIMAL PHYSICAL DEVELOPMENT AND MENTAL

HEALTH ARE CRITICALLY IMPORTANT ASPECTS OF PREVENTION.

49


IT SHOULD GO WITHOUT SAYING THAT CARE MUST BE PROVIDED

BY PROFESSIONALS AND PARAPROFESSIONALS WHO RESPECT

AND VALUE THE FAMILY, WHICH MEANS WE MUST RECRUIT AND

ADEQUATELY PREPARE PROFESSIONALS AND

PARAPROFESSIONALS IN SUFFICIENT NUMBERS TO DO THE JOB.

*   FAMILIES SHOULD PARTICIPATE IN THE


   DEVELOPMENT OF CURRICULA AND PREPARATION

OF THESE PROVIDERS AT THE PRE-SERVICE AND

IN-SERVICE LEVELS.

50


*   PROFESSIONAL ORGANIZATION MEETINGS AND

TRAINING PROGRAMS SHOULD BE MODELS OF

PARENT/PROFESSIONAL COLLABORATION.

*   AN INTERDISCIPLINARY APPROACH TO HEALTH


   CARE SHOULD BE EMPLOYED WITH A BALANCE OF

PROFESSIONALS AND PARAPROFESSIONALS.

51


*   MORE EMPHASIS SHOULD BE PLACED ON THE


   TEAM APPROACH TO HEALTH CARE DELIVERY IN

ALL SETTINGS.

*   EDUCATION OF THOSE WHO GIVE CARE SHOULD


   INVOLVE MORE COURSE WORK AND PRACTICAL

EXPERIENCE IN THE DEVELOPMENTAL NEEDS OF

CHILDREN. TRAINING PROGRAMS SHOULD

EMPHASIZE THE INFLUENCES OF FAMILY,

PSYCHOSOCIAL, AND ENVIRONMENTAL FACTORS

ON HEALTH STATUS.

52


*   HEALTH PERSONNEL TRAINING SHOULD INCLUDE


   PROGRAMS THAT PROVIDE CONTACT OVER TIME

WITH CHILDREN WITH SPECIAL HEALTH CARE

NEEDS AND THEIR FAMILIES, PARTICULARLY IN

HOME AND COMMUNITY SETTINGS.

*   INCENTIVES TO SERVE UNDERSERVED

  POPULATIONS, MUST BE DEVISED,PARTICULARLY * f?

THOSE IN REMOTE RURAL AREAS AND IN OUR

INNER CITIES.

53


I KNOW THAT MANY OF YOU ARE HOSPITAL-BASED PERSONNEL.

AS WE WORK TOGETHER TO DEVELOP COMPREHENSIVE

SYSTEMS OF CARE, HOSPITALS HAVE A KEY ROLE. MAJOR

CHANGES ARE NEEDED IN OUR HOSPITALS, AS WELL. THESE

INCLUDE:

54


-MORE MUST SHOW BETTER LEADERSHIP IN HEALTH

PROMOTION.

-BETTER INTERFACE, MORE EFFECTIVELY WITH COMMUNITY

CARE GIVERS.

-ENHANCEMENT OF SYSTEMS OF COORDINATION - THE EVER

INCREASING SPECIALIZATION CREATES HAVOC FOR FAMILIES.

-GREATER RESPONSIVENESS TO CHILDREN AND THEIR FAMILIES.

A REEXAMINATION OF METHODS OF TRAINING HEALTH

PROFESSIONALS.

55


THE NEXT FEW YEARS PROVIDE A SPLENDID OPPORTUNITY TO

BUILD A STRONGER HEALTH AND EDUCATION FOUNDATION FOR

CHILDREN. WE HAVE SUFFICIENT RESEARCH THAT TELLS US

WHAT WORKS. NOW IS THE TIME TO APPLY THAT KNOWLEDGE

TO ALL CHILDREN AND THEIR FAMILIES.

56


I THINK IT IS POSSIBLE IN SPITE OF FISCAL CONSTRAINTS.  THE


CHALLENGE IS TO WORK TOGETHER COLLABORATIVELY TO PUT

PERMANENT SYSTEMS OF SERVICES IN PLACE IN OUR

COMMUNITIES.

I THINK THAT WE HAVE IDENTIFIED THE KEY ELEMENTS OF

EFFECTIVE SERVICE DELIVERY. WE KNOW THAT SUCCESSFUL

PROGRAMS ARE COMPREHENSIVE, FLEXIBLE, AND ACCESSIBLE.

WE KNOW THAT SKILLED, DEDICATED PROFESSIONALS FOCUS ON

THE NEEDS OF THE FAMILY, NOT THE AGENCY.

57


WE KNOW THAT MOVING FROM CATEGORICAL TO GENERIC

SERVICE APPROACHES AND MOVING FAMILY-CENTERED

SERVICES ARE CHALLENGING AND TIME-CONSUMING TASKS

THAT REQUIRE STRONG COMMITMENT, SKILLS, AND TALENT.

WE MUST TAKE ACTION THAT RESPONDS TO OUR COMMON

CONCERNS AND RESULTS IN COLLABORATIVE PROVISION OF

SERVICES TO CHILDREN AND FAMILIES IN THEIR COMMUNITIES.

58


EACH OF YOU MUST FIND WAYS TO COLLABORATE IN THE

DEVELOPMENT OF COMPREHENSIVE SERVICE DELIVERY SYSTEMS

AT THE COMMUNITY LEVEL.

TO ACCOMPLISH THIS, WE MUST SHARE INFORMATION ABOUT

INNOVATIVE EFFORTS TO MODIFY SERVICE DELIVERY IN ALL

PROFESSIONS AND IDENTIFY AREAS WHERE WE CAN WORK

TOGETHER AND ASSUME MUTUAL RESPONSIBILITY.

59


MANY OF YOU     WORK ON THE FRONT LINE WITH CHILDREN


AND FAMILIES. YOU SHOULD VIEW EVERY HEALTH ENCOUNTER

AS AN OPPORTUNITY TO ENHANCE THE CONFIDENCE AND

COMPETENCE OF THE CHILD AND FAMILY.. . AN OPPORTUNITY

TO PROMOTE HEALTH

YOU SHOULD THINK BIGGER THAN JUST A HOSPITAL STAY.. . TO

THE DAY-TO-DAY EXPERIENCE, OVER TIME, OF THE CHILD AND

FAMILY.

60


NO MATTER WHAT YOUR HEALTH DISCIPLINE, CONSIDER

LISTENING, TEACHING AND THE EFFECTIVE PROVISION OF

INFORMATION TO FAMILIES AND TO OTHER PROFESSIONALS AS

MAJOR ROLES FOR YOU.

BECOME INVOLVED IN SHAPING HEALTH CARE SYSTEMS IN YOUR

COMMUNITY. VOLUNTEER TO SERVE ON LOCAL COMMITTEES IN

THE HEALTH COMMUNITY OR THE BUSINESS COMMUNITY THAT IS

BECOMING CONCERNED ABOUT HEALTH.

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CALL YOUR HEALTH DEPARTMENT. WRITE YOUR LOCAL AND

NATIONAL LEGISLATORS AND THEIR HEALTH STAFF. WORK WITH

PARENT ORGANIZATIONS AND VICE VERSA.

YOU CAN LEARN FROM EACH OTHER. THERE IS POWER IN

NUMBERS AND IN BRINGING MULTIPLE PERSPECTIVES

TOGETHER.

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MANY OF YOU ARE INVOLVED IN TEACHING FUTURE HEALTH

PROFESSIONALS GIVE GREATER PRIORITY TO BUILDING

KNOWLEDGE AND SKILLS IN HEALTH PROMOTION AND IN

RESPECTING AND ENABLING FAMILIES.

BE MORE CREATIVE IN HELPING INDIVIDUAL CARE GIVERS

UNDERSTAND AND RELATE TO COMMUNITY ORGANIZATIONS AND

AGENCIES.

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MANY OF YOU ARE FAMILIES CARING FOR CHILDREN WITH,

SPECIAL NEEDS. WE NEED YOUR VOICES, YOUR IDEAS, YOUR

PARTNERSHIP TO REDESIGN THE SYSTEMS OF CARE TO BE MORE

RESPONSIVE TO YOUR NEEDS AND STRENGTHS.

THE TASK BEFORE US IS DIFFICULT. I BELIEVE, HOWEVER, THAT

WE CAN TAKE IMPORTANT STEPS TO ENHANCE COLLABORATION

BETWEEN HEALTH, EDUCATION, AND SOCIAL SERVICE

PROFESSIONALS WHICH WILL MOVE BEYOND SINGLE ISSUES TO

A DEVELOPING STRUCTURE WITHIN WHICH ONGOING

COLLABORATION IS SUPPORTED AND SUSTAINED.

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THEREFORE, LET US WORK TOGETHER TO ENABLE ALL CHILDREN

TO RECEIVE THE KIND OF SERVICES THEY NEED AND DESERVE.

WE HAVE MANY STRENGTHS TO BUILD UPON. USING OUR

KNOWLEDGE AND SKILLS, AND BY COLLABORATING, I KNOW THAT
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WE CAN MAKE IT HAPPEN -- COORDINATED, FAMILY-CENTERED

SERVICES FOR CHILDREN IN THEIR COMMUNITIES.

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THESE ARE EXCITING TIMES. I DO NOT SHARE THE GLOOM AND

DOOM MENTALITY. IF I WERE YOUNG ENOUGH TO MAKE A

CAREER DECISION, I WOULD DO THE SAME THING ALL OVER -

ONLY TRY HARDER. THERE IS NO GREATER SATISFACTION THAN

HELPING A CHILD.

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