October 1997

Grant Results

National Program

Improving Child Health Services: Removing Categorical Barriers to Care


When the Rochester community focused on the health of low-income children, it devised a strategy that featured a local time-honored tradition: home visits. Starting in the first year of a child's life, the Monroe County Child Health Initiative provides weekly or biweekly visits by trained paraprofessionals who coordinate the health care of the mother and child, provide parenting education, assure that preventive measures are being followed, and arrange for services if problems arise. These paraprofessional home visitors function as part of a recently improved early intervention, the home visiting service program operated by the Monroe County Department of Health.

This strategy has proved so successful that it is being incorporated as a permanent part of the care at Rochester General Hospital and is beginning to receive reimbursements from managed care plans.

Who is served?
The initiative serves high-risk mothers, infants, and children up to age two who live in the northeast quadrant of Rochester, one of the poorest areas of the city, and who are patients of Rochester General Hospital's outpatient centers. The focus is on families with children who are at high-risk of developmental difficulties because of social and economic factors, but who do not have a documented disability or chronic condition.

How does the project work?
The initiative invites families to participate during pregnancy. Paraprofessional home visitors drawn from the local community serve as peer counselors and care coordinators. A community health nurse supervises the home visitors. The home visitors also stay in touch with the Rochester General Hospital pediatric care teams who provide health care for the families. Referrals to local family resource centers are planned after the children served reach the age of two.

How is the project financed?
The initiative has received approval from the State of New York for consolidation of eight federal and state maternal and child health grants. Final federal approval is anticipated in the very near future. The more flexible funds received through the consolidated grant would be used in conjunction with other federal block granted funds and state funds for services to young, at-risk children. As a result of negotiations with the area's major Medicaid managed care provider, the initiative has an agreement to provide limited home visiting and care coordination services to enrolled clients. The project also received Medicaid administrative reimbursements and United Way funding.

Quotes About the Project
"The Child Health Initiative enables us to create the Child and Family Health grant from eight separate categorical programs. This will substantially improve the way maternal and child health services are delivered to families, and streamline health department administrative procedures. The end result will be better both for families and for the county."
Andrew S. Doniger, M.D., M.P.H., Director, Monroe County Health Department

"Families, especially those who are isolated or non-English speaking, enjoy having someone come into their home on a regular basis. Families feel more in control in their own homes, where the worker is a guest."
Sally Farrell Partner, Operational Coordinator, Monroe County Child Health Initiative

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Monroe County, New York, Child Health Initiative: Removing Categorical Barriers to Care


Monroe County Department of Health (Rochester,  NY)

  • A Home Visitation Community-Based Program in Monroe County, Rochester, N.Y.
    Amount: $ 498,601
    Dates: July 1993 to October 1997
    ID#:  021889


Andrew S. Doniger, Project Director
(716) 274-6068

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Report prepared by: William D. Hobson
Reviewed by: Teri Larson
Reviewed by: Crystal Tetrick
Program Officer: Michael P. Beachler

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