Improving Child Health Services: Removing Categorical Barriers to Care

An RWJF National Program

Dates of Program: December 1989 through August 1999

Field of Work: Integrating health services for children.

Problem Synopsis: Most public funding for child health services flows from distinct programs that are separately funded and/or regulated by federal and/or state agencies. In many cases, the vital health services funded through this system have given rise to agencies and programs that provide only a single service or narrow set of closely related services. This has led to entirely separate programs for preventive health services, maternal and child health services, and family planning services. This precise targeting, however, has contributed to the fragmentation of services for children and has created burdensome logistical problems for their parents.

Synopsis of the Work: Improving Child Health Services: Removing Categorical Barriers to Care tested the feasibility of improving the efficiency and effectiveness of child health services by removing restrictions on the use of categorical program funds so that those funds could be used to finance services based on children's needs rather than on program requirements. The aim was to allow greater flexibility and coordination of those services required by children with multiple health care needs.

Key Results

  • Ten communities were funded under the program to pursue improvements in child health services by reducing categorical barriers to care. According to the National Program Office report on the program:

    • Only the Monroe County Child Health Initiative in Rochester, N.Y., came close to achieving true decategorization.
    • Most of the projects attained new resources through creative approaches to project financing.
    • Each of the projects raised public awareness of their community's most pressing child health needs through the development of countywide child health status reports.
    • The projects developed care coordination or case management programs that integrated the provision of health and social services to children with multiple health care needs.