The Healthy 

Tomorrows 

Partnership for 

Children Program 

in Review: 

Analysis and 

Findings of a 

Descriptive Survey

Naomi Eisen, M.P.H.

Jerome Evans, Ph.D.

Laura Kavanagh, M.P.P.

Jean Athey, Ph.D., and 

Jennifer Schwab
The Healthy 

Tomorrows 

Partnership for 

Children Program 

in Review: 

Analysis and 

Findings of a 

Descriptive Survey

Naomi Eisen, M.P.H.

Jerome Evans, Ph.D.

Laura Kavanagh, M.P.P.

Jean Athey, Ph.D., and 

Jennifer Schwab

National Center for Education

in Maternal and Child Health

Georgetown University
Cite as

Eisen N, Evans J, Kavanagh L, Athey J, Schwab J. 1999. The Healthy Tomorrows Partnership for

Children Program in Review: Analysis and Findings of a Descriptive Survey. Arlington, VA: National

Center for Education in Maternal and Child Health.

The Healthy Tomorrows Partnership for Children Program in Review: Analysis and Findings of a

Descriptive Survey is not copyrighted. Readers are free to duplicate and use all or part of the

information contained in this publication. In accordance with accepted publishing standards,

NCEMCH requests acknowledgment, in print, of any information reproduced in another 

publication.

The mission of the National Center for Education in Maternal and Child Health is to provide

national leadership to the maternal and child health community in three key areas—program

development, policy analysis and education, and state-of-the-art knowledge—to improve the

health and well-being of the nation’s children and families. The Center’s multidisciplinary staff

work with a broad range of public and private agencies and organizations to develop and

improve programs in response to current needs in maternal and child health, address critical

and emergent public policy issues in maternal and child health, and produce and provide access

to a rich variety of policy and programmatic information. Established in 1982 at Georgetown

University, NCEMCH is part of the Georgetown Public Policy Institute. NCEMCH is funded 

primarily by the U.S. Department of Health and Human Services through the Health Resources

and Services Administration’s Maternal and Child Health Bureau.

Library of Congress Catalog Card Number 99-74496

ISBN 1-57285-059-0

Published by:

National Center for Education in Maternal and Child Health

2000 15th Street, North, Suite 701

Arlington, VA 22201-2617

(703) 524-7802

(703) 524-9335 fax

Internet: info@ncemch.org

World Wide Web: www.ncemch.org

Single copies of this publication are available at no cost from:

National Maternal and Child Health Clearinghouse

2070 Chain Bridge Road, Suite 450

Vienna, VA 22182-2536

(703) 356-1964

(703) 821-2098 fax

This publication has been produced by the National Center for Education in Maternal and Child

Health under its cooperative agreement (MCU-119301) with the Maternal and Child Health

Bureau, Health Resources and Services Administration, U.S. Department of Health and 

Human Services.
iii

Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

History of HTPCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

The HTPCP Grant Program . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Study Goals and Methodology. . . . . . . . . . . . . . . . . . . . . . . . . 16

Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HTPCP Goal Number 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HTPCP Goal Number 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

HTPCP Goal Number 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

HTPCP Goal Number 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Project Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Program Oversight and Technical Assistance. . . . . . . . . . . . . 43

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Questions for Further Study . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Appendixes

Appendix A: Descriptive Charts of HTPCP Projects . . . . . . . 58

Figure 1. Organizational Type of HTPCP Grantees . . . . . . . . 58

Figure 2. HTPCP Sites by Community Type . . . . . . . . . . . . . . 58

Table of

Contents
iv

Figure 3. HTPCP Clients by Age Group. . . . . . . . . . . . . . . . . . 59

Figure 4. HTPCP Clients by Insurance Status . . . . . . . . . . . . . 59

Figure 5. HTPCP Clients by Racial/Ethnic Group . . . . . . . . . 60

Figure 6. HTPCP Project Directors by Discipline . . . . . . . . . . 60

Appendix B: HTPCP Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Appendix C: List of HTPCP Projects by State. . . . . . . . . . . . . 71

Tables

Table 1. Types of Services Initiated Through 

HTPCP Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Table 2. HTPCP Projects’ Strategies to Promote 

Cultural Competence and Reduce 

Family- and System-Level Barriers . . . . . . . . . . . . . . . 23

Table 3. Eight Ways in Which HTPCP Projects 

Improved Their Communities . . . . . . . . . . . . . . . . . . . 25

Table 4. HTPCP Projects’ Representative Experiences 

with Partnerships and Collaborations . . . . . . . . . . . . . 30

Table 5. Types of Organizations Collaborating with 

HTPCP Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Table 6. Composition of HTPCP Project Staff . . . . . . . . . . . . . . 32

Table 7. Sources of Long-Term Funding Secured 

by Fourth Year, Fifth Year, and 

Completed Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Table 8. Types of Evaluation Approaches Used by 

HTPCP Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
1

T his study would not have been possible without the financial support and partnership of

the Maternal and Child Health Bureau (MCHB), Health

Resources and Services Administration, Department of

Health and Human Services. Dr. Woodie Kessel and Dr.

Ann Drum initiated this study, and MCHB staff were

partners in every aspect of the analysis: reviewing the

survey instrument, assisting in gathering program materials, and reviewing drafts of the report. In particular, the

authors wish to thank Latricia Robertson, MCHB project

officer for the Healthy Tomorrows Partnership for

Children Program (HTPCP), for providing invaluable

insights about the program.

We extend a heartfelt thanks to the HTPCP 

project directors and staff for finding time in their 

hectic schedules to complete this HTPCP survey. Their

thorough and well-thought-out responses to the survey

provided the data that made this report possible.

Thank you to the project directors who reviewed

an early draft of the survey and advised us on data availability, including Nancy Bryant Wallis, San Diego; Jeffrey

Brown, Denver; Stephen Glicken, Boston; Marsha

Rappley, East Lansing; Richard Solomon, Pittsburgh; 

and Melinda Mashburn, Denton, TX. 

Thanks also to the staff of the five projects who

participated in the pretest of the HTPCP survey, including Maria Gomez, Elida Vargas, Dolize Reyes Bibbs,

Acknowledgments
2

Carmen Fabian, and Carlos Chavarria of Mary’s Center

in Washington, DC; Martha Gardiner and Dorothy

Riegel of the Spanish Catholic Center in Silver Spring,

MD; Elaine Vowels, E. B. Ibikunle, Doug Smarte, and

Bridget Hay of the DC Department of Health; Catherine

Scott of the YWCA of Pocatello, ID; and Elisa Nicholas of

the Long Beach Children’s Clinic in Long Beach, CA. 

Thanks also to the individuals who reviewed the

survey: Bonnie Strickland, David Maglott, Jerry Hood,

Mary Beth Badura, Phyllis Stubbs-Wynn, and Jane Coury

of MCHB; Jane Bassewitz, Lynn Olson, and Karen

O’Connor of the American Academy of Pediatrics; and

Neal Halfon of the Department of Pediatrics at UCLA. 

This report would not have come together without the untiring help and support of our colleagues at

NCEMCH: Rochelle Mayer, Vince Hutchins, Mary

Carpenter, Mary Froehle, Rosalind Johnson, Cheryl Oros,

Tom Vallin, Leslie Gordon, Tadgh Smith, Faith Sharp,

Carol Adams, Deborah Burke, Oliver Green, and Anne

Mattison. Thank you for providing the leadership, technical expertise, and publications support to bring this

study to fruition. 
3

I

n 1989, the Healthy Tomorrows Partnership for

Children Program (HTPCP) was initiated to

engage communities in working to improve children’s

health through prevention and better access to health

care. The program is funded by the Maternal and Child

Health Bureau (MCHB) of the Health Resources and

Services Administration (HRSA). It is administered by

MCHB in partnership with the American Academy of

Pediatrics (AAP).

HTPCP was designed to provide communities

with seed money to identify and address pressing local

problems. A unique aspect of HTPCP, and one that distinguishes it from other MCHB programs, is the partnership that was developed with the AAP. The concerted

effort to blend public health resources with the knowledge and skills of the pediatric professional community

is the hallmark of HTPCP. To date, 107 projects nationwide have been awarded 5-year grants, of which 54 have

completed the federal funding cycle.

The HTPCP evaluation is part of MCHB’s larger

effort to document the impact of its investment in Title V

Block Grant programs and its discretionary grant programs. In particular, MCHB is interested in measuring

the impact of the Special Projects of Regional and

National Significance (SPRANS), which comprise an

array of demonstration, research, and training grants.

Executive

Summary
4

Findings

HTPCP Goal Number 1: Use innovative and costeffective approaches to promote preventive health care among

vulnerable children and their families, especially those with

limited access to quality health services. The clients of the

HTPCP are women and children, 96 percent of whom

either have no insurance or are Medicaid recipients.

HTPCP grantees represented in this survey initiated a

broad range of activities to meet the health needs of the

children and families they served. New case management

services were the single most common component

added: Fully half of grantees reported that they initiated

case management as part of their HTPCP project. Projects

used a variety of settings to reach their clients: homeless

shelters, clients’ homes, elementary and high schools, and

recreational centers, as well as community clinics and

hospitals; all projects stressed coordination and linkage.

To capture insights about the impact of HTPCP

projects in their communities, the questionnaire solicited

open-ended responses on the perceptions of the project

directors, who reported a wide range of successful 

outcomes.

One noteworthy aspect of the HTPCP projects is

the attention devoted to “cultural competency.” Cultural

competence is especially important to the HTPCP program since the projects serve a racially and ethnically

diverse population. 

HTPCP Goal Number 2: Foster cooperation among

community organizations, individuals, agencies, and families.

HTPCP projects generally attempted to work collaboratively in three venues: (a) developing partnerships with 

a core of direct service partners; (b) establishing a community network; and (c) selecting influential persons to

serve on an advisory committee. Projects involved a

broad array of partners—in fact, half the grantees had

five or more partners with whom they worked toward

local program goals. Many grantees found this aspect 

of program development challenging and at times 
5

frustrating, and yet

most grantees ultimately concluded

that it was extremely important to their

project’s success.

HTPCP Goal

Number 3: Involve

pediatricians and other

pediatric health professionals. The majority

of projects reported

that they had pediatricians on staff;

about half of the

project directors

were individuals

with medical

degrees. Other types

of providers were

also utilized, including nurses, social

workers, psychologists, health educators, and nutritionists. This survey suggests that HTPCP projects are successful in integrating a variety of health professionals

into the program and that leadership positions are held

primarily by pediatric-trained providers.

HTPCP Goal Number 4: Build community and

statewide partnerships among professionals in health, education, social services, government, and business to achieve selfsustaining programs. Goal number 4 stresses partnership

building in the context of project sustainability. In fact,

these projects were quite successful in leveraging funds

during the period of the grant and in achieving a permanent service in the community. During the period FY

1990 to FY 1997, MCHB invested $15.95 million in these

projects, which in turn leveraged a total of $67 million.

Questionnaire data from projects that had either completed their grant or were in the last 2 years of funding
6

found that most had secured long-term funding. Those

projects directed by nurses or Ph.D.s were much more

likely than those directed by M.D.s to use state or other

federal sources of reimbursement to sustain their projects, while the M.D. group tended to solicit contributions from local sources, to contract with managed care

organizations, and to merge with the local system of

care. In sum, HTPCP grantees appear to be successful in

forging partnerships that lead to additional support for

children’s health and the long-term sustainability of services, but their approaches to doing so vary.

Project Evaluations. HTPCP grantees are required

to evaluate their projects. Few grantees attempted an

outcome evaluation, but most did undertake a process

evaluation and monitored their own progress toward

meeting project goals. A few grantees noted that the

evaluation process had a positive, transforming impact

on their agencies, but most found that their evaluation

resources were very limited and that technical assistance

was not easily available in this area. In short, grantees

indicated considerable frustration with this aspect of

their grants.

Program Oversight and Technical Assistance. A single federal staff member is responsible for implementing

and monitoring the HTPCP. The creative MCHB/HRSA/AAP

partnership has served both to enhance the support of

and technical assistance for the HTPCP projects and to

secure additional resources. Grantees gave high ratings

to the technical assistance they received from MCHB and

the AAP.

Conclusions 

The HTPCP appears to be an effective strategy for promoting children’s access to health services at the community

level. The HTPCP has clearly enhanced community-based

service programs by creating new services and adding

components to existing programs.
7

Modest funding provided to community organizations,

with a matching fund requirement, can leverage significant

amounts of money for children’s health care. HTPCP grants

are quite small by federal program standards. Yet, this

amount appears to be adequate both to provide a valu-

able service and to attract additional funding.

The HTPCP includes elements that successfully foster

the long-term sustainability of services. The match require

-

ment forces grantees to begin searching for additional

funds immediately. At the same time, grants are funded

for a long enough period (5 years) to both demonstrate

success and value locally and enable grantees to develop

the relationships with other groups that are needed to

secure the resources that can sustain the program.

Small, community-based projects do not have the

expertise or resources to conduct outcome evaluations. Valid

outcome evaluations are challenging and expensive to

conduct. Expertise in evaluation design is costly and may

be difficult to acquire. 

Meaningful multiagency partnerships and collabora-

tions can greatly improve the delivery of services for children,

but they are challenging to develop and attempts to do so fre-

quently fail. Most HTPCP projects ultimately developed

what they considered to be effective and productive part-

nerships that project directors believed critical to the suc-

cess of their projects. However, many difficulties were

encountered in developing these relationships.

Pediatricians and other pediatric health professionals,

when provided with support through a mechanism such as a

grant, can serve as leaders and advocates in improving children’s

access to services. Advocacy efforts on the part of HTPCP

grantees—primarily pediatric health professionals—led to

improved service components, permanent changes in local

services, and new dollars for children’s health.

The activities of staff at the federal level and at the

AAP provide important guidance and leadership to HTPCP

projects and contribute to the program’s success. Projects

received “care and feeding” from a variety of both public
8

and private sources. The overwhelmingly positive

response of projects to the technical assistance they

received points to the effectiveness of this approach.

Recommendations

Continue the programmatic focus on cultural competence. 

Continue to emphasize different types of partnerships with

multiple groups.

Consider the provision of intensive training in coalition building and partnership development for project staff within the

first 6 months of the grant award.

Continue to require outcome evaluations and provide training

and/or special technical assistance materials within the first 6

months of the grant award.

Consider adding community performance monitoring requirements for some projects to assess the usefulness of this

approach to improving children’s health care.

Continue the partnership with AAP.

Increase the technical assistance capacity.

Increase staff at the federal level.

Consider linking with State Children’s Health Insurance

Programs (CHIP).
9

Changes in certain health indicators for

women and children in the United States

over the past decade document the positive impact of

concerted efforts by health professionals to improve

access to care and to prevent serious health problems.

For example, infant mortality and low birthweight are at

all-time lows (CDC, National Vital Statistics System,

1998). More children are entering school with completed

immunizations (CDC, National Immunization Program,

1998), and fewer teens are having babies (CDC, National

Vital Statistics System, 1998).

However, troubling problems remain. Among

African Americans, the frequency of low birthweight 

and infant mortality is still greater than in any other

racial/ethnic group (CDC, Vital Statistics, 1998). Nearly

one out of every four Hispanic children and one out of

every five African-American children have no health

insurance coverage (Weigers et al., Medical Expenditure

Survey Chartbook, 1998). Large numbers of children are

born every year to women who are substance abusers

Introduction

Naomi Eisen, M.P.H,1 Jerome Evans, Ph.D.,2 Laura Kavanagh,

M.P.P.,3 Jean Athey, Ph.D.,4 and Jennifer Schwab5

1At the time of the survey, Naomi Eisen was a Senior Project Associate in the

Office of Policy Analysis at the National Center for Education in Maternal and

Child Health (NCEMCH), part of Georgetown University.

2 Jerome Evans, an evaluation specialist at the Landon Pediatric Foundation,

worked as a consultant to NCEMCH on this project.

3Laura Kavanagh is the Director of the Office of Policy Analysis at NCEMCH.

4 Jean Athey of Health Policy Resources, Inc., worked as a consultant to

NCEMCH on this project.

5 Jennifer Schwab is a graduate research assistant at NCEMCH.
10

(National Institute on Drug Abuse, 1996). The frequency

of reported child abuse and neglect is unacceptable

(National Center on Child Abuse and Neglect, U.S.

Department of Health and Human Services, 1997).

Violence and suicide claim the lives of thousands of

young people every year (U.S. Department of Justice,

Bureau of Justice Statistics, 1998).

While the recently launched State Children’s

Health Insurance Program (CHIP) may make health 

services more available to many socioeconomically disadvantaged children, nonfinancial barriers exist that

limit children’s access to care (Millman, 1993; Margolis et

al., 1995; Riportella-Muller et al., 1996; Meyer and Bagby,

1998). Uncoordinated services, overcrowded or inconveniently located clinics, and inadequate attention to cultural issues all serve to limit the health care that is

available to impoverished children and families. In addition, improving the health of women and children

requires a focus that is broader than health services.

Prevention, in particular, demands a communitywide

approach. Homelessness, family violence, substance

abuse, and sexually transmitted diseases are examples of

problems that cannot be successfully tackled by the 

medical community alone.

In 1989, the Healthy Tomorrows Partnership for

Children Program (HTPCP) was initiated to engage communities in problem solving to promote access to health

care for mothers and children through community-based

prevention programs. The HTPCP is funded by the

Maternal and Child Health Bureau (MCHB) of the

Health Resources and Services Administration (HRSA). 

It is administered in partnership with the American

Academy of Pediatrics (AAP).

Improving the

health of

women and

children

requires a

broad focus

and a 

communitywide approach

 ̃
11

T he HTPCP grew out of a movement in the

late 1980s to promote access to health care for

low-income children. At the time, Medicaid expansions

had made health care more financially accessible to lowincome families, but nonfinancial barriers were still a

source of great concern. Uncoordinated services, lack of

transportation, difficulties in securing child care for siblings, and other problems made it difficult for many

Medicaid-covered women and children to obtain the care

they needed (U.S. General Accounting Office, 1987; Short

et al., 1992). The HTPCP was designed to provide communities with seed money to identify and address pressing local problems that remained unsolved. 

At about the same time, MCHB also launched

other programs expected to yield improvements in

health outcomes for children. In 1991, millions of federal

dollars were allocated for Healthy Start, a multifaceted,

community-based program aimed at reducing infant

mortality. The following year, the Community Integrated

Service Systems (CISS) program was initiated, designed

to foster more coordinated systems of care.

All three programs had the common goal of

building community-based systems of care that are “family centered” and “culturally competent.” Barriers to care

would be reduced and services enhanced and linked. It

was recognized that this would be a slow process, and

that grantees would have varying degrees of success,

History of

HTPCP

HTPCP

provides 

communities

with seed

money to

address 

pressing local

problems

 ̃
12

depending on the local political environment, the degree

of involvement of local pediatric providers, and the

availability of local resources.

A unique aspect of HTPCP that distinguishes it

from the other programs is the partnership that was

developed with the AAP, a professional membership

association of pediatricians.

Private practitioners joined

with local, public programs

in a new collaboration—just

as MCHB and the AAP

modeled a public-private

partnership at the national

level. The concerted effort

to blend public health

resources with the knowledge and skills of the pediatric professional

community is the hallmark

of HTPCP. 

HTPCP’s 

hallmark is

blending 

public health

resources with

pediatric 

professionals’

knowledge 

and skills

 ̃
13

To qualify for a grant, an HTPCP project must

consist of either a new community initiative

or the addition of a new component to an established

program. Projects must incorporate the following elements, which correspond to the goals of the HTPCP :

• Innovative and cost-effective approaches for promoting preventive health care among vulnerable children

and their families, especially those with limited

access to quality health services;

• Cooperation among community organizations, individuals, agencies, and families, to improve care and

services;

• Involvement of pediatricians and other health care

professionals; and

• Development of partnerships among professionals in

health, education, social services, government, and

business to achieve self-sustaining programs.

HTPCP grants support a wide range of services

for children and their families. For example, programs

have been funded to address issues such as the following:

• Primary care for uninsured children and children

covered through Medicaid;

• Care coordination for children with special health

care needs;

The HTPCP

Grant Program

An HTPCP project must be

either a new

community 

initiative or 

a new 

component to

an established

program

 ̃
14

• Health promotion through risk reduction in families;

• Adolescent health promotion, including reproductive

health, prenatal care, and education services;

• Expanded perinatal care and parent education services; and

• Services for special child and family populations,

such as children in foster care and homeless children.

The HTPCP is administered by MCHB in 

partnership with the AAP. Both organizations provide

technical assistance to grantees. MCHB, with assistance

from the AAP, organizes an annual project directors’

meeting to facilitate networking among project directors and MCHB and AAP staff, and it provides technical assistance and consultation to support ongoing

project implementation and grant administration. The

AAP organizes technical assistance site visits to each

project, helps link projects with local pediatricians, and

fosters partnerships with an array of private-sector

groups.

HTPCP grant awards are capped at $50,000 annually, with a 5-year funding period. Starting in year 2,

projects must meet a two-thirds matching funds requirement by securing a minimum of $100,000 from nonfederal partners. Programs are also required to form a project

advisory committee (PAC) that includes diverse representation from the community, including parents.

Programs are encouraged to develop partnerships with

community organizations, including foundations, local

government, schools, businesses, and nonprofit organizations. The PAC partners raise community awareness

about child health issues and help resolve problems

related to these issues. They also participate in the planning, implementation, and evaluation of the project and

contribute resources to ensure long-term sustainability of

the programs.

To date, 107 projects nationwide have been

awarded 5-year grants, and 54 have completed the federal

HTPCP grant

awards are

capped at

$50,000 

annually, with

a 5-year funding period

 ̃
15

funding. Grants have been awarded to a wide variety of

organizations, including medical centers and schools,

local foundations and nonprofit agencies, communitybased clinics, community health centers, hospitals, local

and state health departments, and schools. (See Figure 1,

Appendix A.)
16

T he HTPCP evaluation is part of MCHB’s

larger effort to document the impact of its

investment in Title V Block Grant programs and its 

discretionary grant programs. In particular, MCHB is

interested in measuring the impact of the Special

Projects of Regional and National Significance

(SPRANS), which comprise an array of demonstration,

research, and training grants. The National Center for

Education in Maternal and Child Health (NCEMCH) at

Georgetown University was awarded a grant that

included, as one of its objectives, the development of a

model for evaluating SPRANS programs, beginning

with the HTPCP. The following MCHB goals are to be

examined in the HTPCP evaluation and in subsequent

SPRANS evaluations:

• The promotion of the development of comprehensive, integrated systems of care for children;

• The promotion of the development of public-private

partnerships to ensure the delivery of quality maternal and child health (MCH) services; and 

• The promotion of the development of MCH services

that are comprehensive, community based, family

centered, and culturally appropriate.

This study also examines progress toward goals

specific to the HTPCP.

Study Goals and

Methodology
17

During the summer and fall of 1997, survey

questions were compiled to elicit responses germane to

the goals of the HTPCP. Six project directors were consulted in the beginning stages of this process and were

asked to contribute relevant topics. A draft survey was

developed, circulated to MCHB staff and MCH

researchers for comment, and revised accordingly. Five

HTPCP sites field-tested the survey; their feedback

helped produce a final survey covering topics in the 

following areas:

• Types and extent of new services provided;

• Strategies for reducing barriers to care;

• Perceived impact on communities;

• Project evaluation;

• Collaborative activities and community partnerships;

• Involvement of pediatricians and other pediatric

health professionals; and

• Strategies used to promote long-term sustainability of

the project.

The questionnaire was mailed to directors of all

85 HTPCP projects initially funded between 1989 and

1996. Responses to the survey were received from 74

The survey was

field-tested at

five HTPCP

sites and the

questionnaire

was mailed 

to directors of

all 85 HTPCP

projects 

initially funded

between 1989

and 1996

 ̃
18

projects (87 percent). Nonresponding sites were typically

those that had completed the 5 years of federal funding;

in these cases staff turnover and reorganization made it

difficult to locate original HTPCP project staff who could

complete the questionnaire. Data from the surveys were

supplemented by a review of project abstracts and available progress and final reports.6

Both numeric and narrative survey data were

obtained. Quantitative data from survey items were

entered into SPSS. Qualitative data were stored in a

FileMaker Pro database so narrative responses could be

summarized and examined for patterns. These patterns

were categorized, and examples were drawn from the

responses to illustrate each of the categories.

Although this study has yielded important findings, it is important to identify its limitations. First, the

findings in this analysis are based on the self-reports of

project staff, and many items on the survey request an

opinion or a judgment on the part of respondents. It is

possible that others in the community might have had

opinions different from those of the project staff. Second,

although the response rate is high, almost all nonrespondents (10 of the 11 nonrespondents) are from terminated

projects, which introduces a bias, at least with respect to

the issue of sustainability. Despite these limitations, this

study provides important descriptive information about

the HTPCP projects that has not been previously available and identifies areas for more in-depth analysis in a

follow-up study.

6This review excluded material that is not available to the public under the

Freedom of Information Act, such as budget and salary information. 
19

HTPCP Goal Number 1: Use innovativeand cost-effective approaches to 

promote preventive health care among vulnerable

children and their families, especially those with

limited access to quality health services.

This descriptive analysis focuses on four aspects

of HTPCP goal number 1: (1) populations served by the

projects, (2) new service approaches, (3) strategies to

ensure cultural competence, and (4) the perceived impact

of these projects on the targeted communities.

Populations Served

The HTPCP is intended to assist vulnerable 

children and their families; thus, it is not surprising that

fully two-thirds (66 percent) of all projects were located

in urban, primarily inner-city areas. Several projects (16

percent) were rural, and several (10 percent) were multicounty or statewide. The remainder were located in 

suburban areas. (See Figure 2, Appendix A.)

Nearly half (49 percent) of all clients served by

HTPCP projects were children between the ages of 1 and

12 years. Other clients included infants (20 percent), adolescents (16 percent), and mothers (15 percent). (See

Figure 3, Appendix A).

Slightly more than half (54 percent) of the women

and children served by HTPCP projects were Medicaid

Findings

Fully two-thirds

of all projects

are located 

in urban, 

primarily 

inner-city areas

 ̃
20

recipients; 42 percent had no insurance. Only a small

percentage of recipients (4 percent) had private insurance. (See Figure 4, Appendix A.)

The survey findings on client demographics 

suggest that the HTPCP is quite successful in reaching 

its target population of vulnerable children 

and families.

Service Approaches

HTPCP grantees initiated a broad range of activities to meet the health needs of the children and families

they serve. New case management services were the

most common component added: fully half of grantees

reported that they initiated case management as part of

their HTPCP project. Other new services funded through

HTPCP grants were parenting education (45 percent)

and support groups (40 percent). More than one-third of

projects used HTPCP funding to add home visiting to

the array of services provided, and support services,

such as transportation and child care, were new in 31

percent of communities. (See Table 1.)

TABLE 1. Types of Services Initiated Through HTPCP Grants

Case management/care coordination

Parenting education

Support groups

Home visiting

Support services (transportation, child care)

Health education

Nutritional services

Multidisciplinary team approach

50

45

40

32

31

28

22

22

Types of Service Percentage of Projects Reporting the

Service Developed as a Result of 

the New Grant (n = 74)

New case

management

services were

the most 

common 

component

initiated in

HTPCP

projects

 ̃
21

Projects reach their clients through a variety of

settings. To maximize access to children and their parents, the projects reach out to where they live, learn, and

play: services are delivered in homeless shelters, clients’

homes, elementary and high schools, and recreational

centers, as well as in more traditional care settings such

as community clinics and hospitals. An array of

providers located throughout the community participate

in projects, and coordination and linkage are stressed.

For example, a home visit to a family would identify

unmet needs and the family would be linked to other

community services, such as WIC or parenting education. Or, a child identified to be at risk by a school-based

health clinic would receive follow-up services by more

specialized health care providers in the community.

These services are “innovative” in the sense that they

were previously unavailable in these communities.

Strategies to Ensure Cultural

Competence

One noteworthy aspect of service delivery in

HTPCP projects is the attention to “cultural competency.”

For many years, MCHB has emphasized the need for all

its grantees to address cultural competency, a concept

that incorporates knowledge of and sensitivity to racial

and ethnic differences, language, and beliefs that could

affect access to care and treatment. HTPCP projects have

been quite innovative in their work in this area.

Cultural competence is especially important to the

HTPCP since the projects serve a racially and ethnically

mixed population. In this survey, Hispanics were the

most represented group, constituting 37 percent of the

total target population, with African Americans representing 30 percent and whites representing 29 percent. Asians

and Pacific Islanders made up 3 percent of the population

served, and American Indians and Alaskan Natives represented 1 percent. (See Figure 5, Appendix A.) 

Project settings

include 

homeless 

shelters,

homes, schools,

recreation 

centers, and

community

clinics and 

hospitals

 ̃
22

Survey respondents provided a good deal of information on how they addressed cultural competence, and

many were particularly thoughtful in their consideration of

this issue:

We have trained members of the community to be

health promoters. They share culture and socioeconomic status with the families they serve. They

communicate in Spanish and English and tailor

their messages for low-literate audiences when

appropriate.

Service delivery [staff] highly reflect and respect the

ethnicity of those receiving our services. 

Our staff are multicultural and bilingual to ensure

that each patient feels welcomed.

We complete 4 hours of cultural diversity and sensitivity training with each worker. We review all

materials used in the program to ensure cultural

relevancy.

Three types of cultural-sensitivity strategies were

developed by HTPCP projects:

(1) Recruitment and training of staff: This strategy is

designed to ensure that all project staff are knowledgeable

about the client population and able to effectively communicate with them.

(2) Use of culturally appropriate communication:

Typically, programs used written materials and other

methods to communicate with the clients they served, but

these materials were not always in the appropriate language or at the appropriate reading level, or in an accessible format. This approach is designed to rectify such

problems.

(3) Community strategies: Communities have

resources to improve cultural sensitivity that frequently go

untapped. Projects developed innovative approaches to

involve the entire community, or special sectors of the community, in improving cultural relations and understanding.

Table 2 presents some examples in each category.

Cultural 

competence is

especially

important

since HTPCP

serves a

diverse 

population

 ̃
23

TABLE 2. HTPCP Projects’ Strategies to Promote Cultural Competence and

Reduce Family- and System-Level Barriers

Staff Recruiting and

Training Strategies

Recruit and hire staff who grew

up in the same culture and

speak the same language

Train staff in diversity issues

Review literature on new

developments in cultural 

competency

Recruit staff experienced in

caregiving in the patients’

cultures

Assess staff performance in cultural competence

Make materials on cultural

competency available to staff

Use bilingual volunteers

Address cultural competency in

regular staff supervision

Hire staff who live in the community they serve

Train staff members in nontraditional forms of health care

Hire front-desk personnel who

speak Spanish or the predominant patient language

Hire interpreters on staff

Give staff any information

gained from family support

groups

Encourage family story-telling

and cultural traditions, and

build these into services

Communication

Strategies

Provide take-home handouts in

patients’ languages

Display posters (in patients’

languages) that are sensitive to

specific cultural issues

Use signs written at a fourthgrade reading level

Solicit cultural experts’ comments on mailings

Ensure that all intake materials

are in patients’ languages

Distribute outreach materials

(in common patient languages)

to neighborhoods

Market the program throughout

the community

Use bilingual patient education

videos

Community 

Strategies

Participate in cultural events in

the community

Locate clinics in patients’

neighborhoods

Maintain a culturally diverse

advisory board

Consult with racial/ethnic

minority community leaders 

Train community pediatricians

on cultural issues

Offer Spanish-language classes

for community professionals

Consult the advisory board on

ways to make services 

culturally competent

Train affiliated professionals

and service staff in cultural

competence

Exchange cultural education

programs with other agencies

Conduct community focus

groups to learn about cultural

issues

Provide program services in

families’ homes

Conduct outreach programs

through other organizations

such as social service agencies,

schools, etc.

Tap community residents for

advice on cultural issues

Participate in an interagency

cultural-competency committee
24

More than 70 percent of the HTPCP projects

reported that they recruited and selected staff from the

communities they served, and that they hired persons

who spoke the language and were familiar with the

racial and ethnic issues important to families. Special

training and supervision were added to ensure cultural

competence. Projects also used community strategies to

work toward cultural competency: almost one-third of

the HTPCP sites reported that they employed this

approach. Some projects used all three approaches to

address cultural competency, and slightly more than

one-third reported employing at least two of the

approaches.

Interestingly, projects serving primarily AfricanAmerican clients tended to favor staff recruiting/training

strategies, while those serving Hispanics emphasized

communication strategies, and those serving whites were

more likely to utilize community strategies. Overall, the

projects demonstrated an appropriate level of attention

to this important attribute of service delivery.

Perceived Impact of HTPCP Projects

The HTPCP aims to increase the number of new

and innovative services delivered in communities and to

ensure that these services are effective in meeting children’s needs. To capture project experience and insights

about the impact of HTPCP projects on their communities, the questionnaire solicited open-ended responses on

the perceptions of project directors and staff. The technique yielded more than 250 examples of achievements,

which were grouped into eight categories, as shown in

Table 3. The following statements from survey respondents illustrate some of the program’s accomplishments: 

The HTPCP was considered a huge success in our

community because the community recognized

the problems, studied (them), and designed and

implemented solutions.

More than one

project noted

the HTPCP’s

catalytic effect

on the 

community

 ̃
25

The catalytic effect of the HTPCP, being the first

home visiting program in the area, resulted not

only in collaborative efforts with other agencies

and hospitals, but [also] . . . awakened interest in

the concept of home visitation . . . as a prevention

modality against child abuse and neglect.

Table 3. Eight Ways in Which HTPCP Projects 

Improved Their Communities (n = 74) 

Raising Awareness among Community Partners

1. Community Awareness: The project increased community residents’ general awareness

of issues surrounding access to care by low-income families (n = 21).

2. Professional Awareness: Health and social service providers developed a greater 

awareness of factors in the access and use of services by at-risk groups (n = 30).

Developing Innovative Services

3. New or Expanded Services: The project created new services or expanded existing 

services (n = 24).

Reducing Barriers to Care

4. Reducing Family-Specific Barriers: The projects improved clients’ use of needed services by addressing obstacles such as parents’ unfamiliarity with resources, their language

differences, and their lack of understanding of the importance of preventive pediatrics

(n = 18).

5. Reducing System-Level Barriers: Projects successfully promoted new partnerships, 

advocated for system models in service planning, and bridged services across agencies

and fiscal guidelines (n = 35).

6. Reducing Fiscal Barriers: Access to health and social services improved for low-income

families when projects found solutions to economic barriers (n = 7).

Improving Outcomes

7. Short-Term Outcomes: Immediate benefits were observed in targeted families, such as

higher immunization compliance or better school attendance (n = 20).

8. Long-Term Outcomes: Projects predicted specific long-term effects of programs 

(e.g., child readiness for school, parental employment) (n = 9).
26

Children who were previously served only in

hospitals were served in community-based settings. Children who were previously served in

isolation were served in settings that included

non–medically fragile children. The health care

system and the early intervention system were

drawn closer together in direct cooperation than

ever before.

We highlighted some of the challenges for the

population—lack of transportation, access to

phones, confusion about complex medical plans,

and limited financial resources—which affect

compliance.

We started collaborative relationships with key

agencies who had not worked together. They

came together towards a common goal of 

assisting . . . families.

The impact of HTPCP projects as reported by

these respondents represents a wide range of successful

outcomes. Projects were characterized as operating outside the traditional boundaries of existing programs and

moving into new territory in their communities. Most

projects challenged their communities to acknowledge

the unmet needs of low-income children and their 
27

families. Health professionals were educated (1) in the

systems approach to care, which emphasizes integrating

all service systems (e.g., social, education) needed by

families; (2) on the effectiveness of certain interventions

with at-risk populations; and (3) on how new approaches

to primary care (e.g., school-based clinics) could succeed

alongside traditional clinic and hospital services.

This analysis of the HTPCP’s first goal suggests

that the program is in fact targeting the vulnerable families it has identified as its focus, and that the projects

have successfully instituted many services new to their

communities. They have accomplished this with particular attention to race/ethnicity and culture.

HTPCP Goal Number 2: Foster cooperation among 

community organizations, individuals, agencies,

and families.

A decade ago, when the HTPCP was initiated,

MCHB and the AAP recognized the value of partnerships and collaborative working agreements among a

variety of groups. Many public health programs have

encouraged collaborations, but not all attempts to form

them have been successful. Research on the process of

developing community coalitions is currently under way

and will identify factors that contribute to success (IOM,

1997, p. 71). It is already well known, however, that

impediments to successful coalition building and to the

forming of partnerships are formidable.

Organizations typically have budget commitments to specific issues in mandated populations; it may

not be easy to shift these commitments. Often the most

forward-thinking, visionary staff have the heaviest workload. Pressed by demands from many quarters, administrators may question the advisability or the feasibility of

adding tasks associated with interagency agreements

and other linkages. Individual and organizational barriers such as territoriality, the desire to take rather than

share credit, and the desire to control resources can

impede effective partnerships. Good leadership is probably the most important factor in the success of coalitions

Most projects

challenged

their 

communities to 

acknowledge

the unmet

needs of 

low-income

children and

their families

 ̃
28

and partnerships, but it is not always available. In short,

there are many factors that affect the ability of a collaboration to be successful—but the rewards of success can

be great (Melaville and Blank, 1991; White and Wehlage,

1995; Bazzoli et al., 1997).

HTPCP projects generally attempted to work collaboratively in three venues: (a) developing partnerships

with a core of direct service partners; (b) establishing a

community network (for promoting awareness of common interests and encouraging cooperation from local

service professionals and organizations); and (c) selecting

influential persons to serve on an advisory committee.

Their experiences were mixed: Some collaborations were

quite successful while others did not appear to be 

especially productive.

Respondents commented on their experiences 

collaborating with others in the community:

We were fortunate to have excellent collaborators

and partners. They actually participated in both

direct [health] service [delivery] and program

planning. They continue almost 10 years later to

be actively involved.

Advisory committee members were also committee members on numerous other community

committees/task forces that we participated in.

Often, the focus of these community committees

was on our efforts . . . so the advisory committee

became more a duplication of other more routine

meetings [than] a help.

In the beginning, there were boundary issues; it

was difficult to bring all the partners together to

focus on a common goal. Since then, trust has

been built and it is much easier.

As a physician, I initially felt that there was resistance to my becoming involved in a communitybased initiative that traditionally had been the

territory of other disciplines.

Good 

leadership is

crucial to 

successful

coalitions and

partnerships,

but it is not

always 

available

 ̃
29

The best experiences [are] with representatives

who are themselves direct health service

providers.

Table 4 presents the grantees’ experiences of collaborative partnerships that worked and those that did

not. Respondents mentioned 20 types of problems

encountered in their efforts to develop partnerships and

collaborations. In general, when direct service providers

had a mutual interest in partnering—that is, common

target populations, high-level administrative commitment to collaboration, and personnel to carry out interagency communication—substantial benefits were

realized. However, when any one of the ingredients was

absent, working together became more problematic.

Another important finding was the necessity for partners, representatives, and advisory committee members

to be consistently present at meetings; when meeting

attendance dropped off, joint efforts occurred only minimally, turf issues were not resolved, and roles were

never adequately defined. It was also difficult to define

roles when multiple partners were involved in a collaboration. Lack of high-level organizational support and

failure to appoint liaisons were other frequently cited

problems.

Projects involved a broad array of partners: In

fact, half the grantees had five or more partners with

whom they worked toward local program goals.

Community professionals, human services groups, community-based organizations, hospitals, businesses, and

other groups were all involved in these projects. Table 5

shows the variety of organizations that collaborated with

HTPCP projects.

Surveyed sites were asked to rate, on a five-point

scale, how “helpful” their partners were in achieving

project goals. More than two-thirds (68.9 percent) judged

partners “very helpful,” the highest score. About one

project in 10 was dissatisfied with their partners’ performance, rating them as “neutral” or “not helpful.” Using

the same rating scale, programs indicated that their adviSubstantial

benefits were

achieved when

partnering

providers had

common 

populations,

high-level 

commitment to

collaboration,

and personnel

for interagency

communication

 ̃
30

TABLE 4. HTPCP Projects’ Representative Experiences with 

Partnerships and Collaborations

Successful Experiences

Very useful in bringing the community’s point of view to

the project

Helpful in reviewing program plans

Pediatrician participation was invaluable

Talking with agencies helped build and repair relationships

with them and with their individual staff members

It helped form a larger focus than just HTPCP

Helped us form linkages

Partners were clients’ advocates when they needed them

Excellent support from school district partner

Support in partner group when some agencies faced 

funding reduction

Parents helped to target needs

Partners helped raise funds for the HTPCP

The opportunity to collaborate with partners was critical to

the success of the project

Always able to dialogue with partners

Partners continue to be involved in direct services

Relationships with partners who could contribute funds

were more substantial than with partners who did not 

contribute funds

Partners helped reach other people and organizations in

the community

A lot of support was received from partners, particularly

with evaluation

Partners who had “protected” (paid) time could make a

more substantial contribution

Problematic Experiences

Unable to mobilize a parent community advisory group that

represented the targeted inner-city population

Difficult to bring all the parties together at the same time

Didn’t feel that partners had a strong impact on our program

Initially there was passive resistance on the part of [professional staff], but this was overcome in time

Dealing with the government bureaucracy has been 

a challenge

We need new partners as we transition to sustained efforts

Our success came after 2–3 years of committee meetings with

the involved parties, before we could reach a consensus

The partners set overly ambitious goals for the program 

Partner meetings were initially very helpful, but ran out of

steam, partly because of the demands for partners 

to collaborate

Some members were unhappy when they thought others

were not doing their share

Members at meetings were lost with staff turnover

Advisory group had no defined role

Didn’t have active partnership meetings, as they 

met quarterly

Reorganizing and downsizing hospitals and clinics caused

unstable attendance at meetings

Difficult to get others to recognize the difficult financial 

picture for the project

Some services competed with territory claimed by other community organizations

Attendance was a problem because in a small community

everyone wears several hats; difficult to assemble people

Some came to meetings only to raise their agendas

Partners worked well, but the advisory committee was 

a burden

Partnering with hospitals has been the most challenging
31

sory committees were less important in reaching project

goals. Over one-third (36.1 percent) thought they were

“neutral” or “not helpful.” The mean rating for all projects on partner contribution was 4.6 (of 5), but only 3.8

(of 5) for advisory committees. Analysis showed that

when HTPCP projects included health and human services agencies in their operations (e.g., pediatric clinics,

local health departments, social service agencies), they

were significantly more satisfied with their partnerships.

Programs rated the contributions of partners higher

when the program had a wide variety of partners, rather

than a few. Despite the problems they encountered, staff

repeatedly emphasized that forging collaborative relationships was critical to the success of their projects.

In sum, HTPCP projects appear to have met the

national program goal of forging collaborative or cooperative relationships among a variety of community

groups. Many grantees found this aspect of program

development challenging and at times frustrating, and

yet most ultimately concluded that it was extremely

important.

HTPCP Goal Number 3: Involve pediatricians and

TABLE 5. Types of Organizations Collaborating 

with HTPCP Projects

Community professionals

Health or human services groups

Schools

Community-based organizations

Hospitals

Foundations

Universities

Businesses

81

77

72

69

68

50

43

30

Category of Partner Percentage of Projects Reporting a

Collaboration with This Category

Half the

grantees had

five or more

partners with

whom they

worked

toward local

program goals

 ̃
32

other pediatric health professionals.

The majority (77 percent) of projects reported that

they had pediatricians on staff. Many programs had

nurses (50 percent) or nurse practitioners (40 percent) on

staff, including pediatric nurse practitioners. Although a

handful of projects secured full-time pediatricians, most

pediatricians on staff were part time. On-staff pediatricians averaged 14 hours per week on the project. Most

pediatricians worked on a paid basis, but a small number

served on a volunteer basis. Approximately one-half of

projects were directed by individuals with medical

degrees, the majority of whom were pediatricians. (See

Figure 6, Appendix A.)

Given that HTPCP projects address complex medical and social needs, other types of providers are also

needed and were utilized: social workers were included

in 50 percent of project teams, psychologists in 24 percent,

health educators in 20 percent, and nutritionists in 15 percent. Service coordinators, who play an important role in

ensuring that clients use available services, were included

in 27 percent of projects. (See Table 6.)

M.D.-led projects were more likely to have stable

TABLE 6. Composition of HTPCP Project Staff

Pediatricians

Nurses

Social workers

Nurse practitioners

Service coordinators

Psychologists

Health educators

Nutritionists

77

50

50

40

27

24

20

15

Provider Percentage of Projects Reporting That This

Provider Was Included on Staff (n = 74)

Leadership

positions in

HTPCP

projects 

are held 

primarily by 

pediatrictrained

providers

 ̃
33

staffing (i.e., only one project director during the course

of the grant) than projects led by R.N.s/Ph.D.s (chisquare = 4.90 [n = 58]; p < .05). Such stability is sometimes associated with more successful projects, and at

least in terms of sustainability, that appeared to be the

case with these projects: Projects that had only one project director were somewhat more likely to obtain longterm funding.

Thus, it appears that HTPCP projects are successful in integrating a variety of health professionals into

the program and that leadership positions are held 

primarily by pediatric-trained providers.

HTPCP Goal Number 4: Build community and

statewide partnerships among professionals in

health, education, social services, government, and

business to achieve self-sustaining programs.

To some degree, this fourth goal identified by the

HTPCP program overlaps with the second (which

addresses cooperation and collaboration). However, goal

number 4 stresses partnership building in the context of

projects becoming self-sustaining. Thus, this component

of the study addresses the issue of sustainability.

The HTPCP projects are required to secure additional matching funds by year 2 of their grant. They are

encouraged to seek support from a broad base of partners in both the public and private sectors, and by the

completion of the 5-year funding period to have funding

arrangements in place to ensure the long-term sustainability of the project.

A 1-year “snapshot” approach was taken to

assess the ability of projects to leverage their federal dollars. Budget data for FY 1997 were obtained for the 54

active projects funded during that year. During FY 1997,

MCHB granted a total of $2.7 million, and projects leveraged $10.34 million. On average, each project leveraged

$182,241 during FY 1997, with three-quarters of projects

exceeding the minimum annual matching requirement of

Social workers

were included

in 50 percent

of project

teams, service 

coordinators

in 27 percent, 

psychologists

in 24 percent,

health 

educators 

in 20 percent,

and 

nutritionists 

in 15 percent

 ̃
34

$100,000. Interestingly, even projects that were only in

their first year of funding during FY 1997, and thus had

no matching requirement, reported that they had leveraged funding.

Information was also obtained from MCHB program files on the total amount leveraged by projects 

over the first 9 years of the program. During the period

FY 1990 to FY 1997, MCHB invested $15.95 million in

these projects, which in turn leveraged a total of $67 

million.

While grantees are permitted to count “in-kind”

support (such as contributed space or staff time) as part

of the match, MCHB strongly encourages grantees to

obtain actual monetary contributions and to obtain these

funds from numerous partners so as to enhance the likelihood of sustainability. In fact, close to 60 percent of

grantees indicated that more than half of their match

was in the form of “hard money” from sources such as

foundations (55 percent), state government (46 percent),

local government (33 percent), and corporations 

(19 percent).

Questionnaire data from a subset of projects (n =

40) that had either completed their grant or were in the

last 2 years of funding were analyzed with respect to

sustainability issues. (Note: 53 projects in the study met

these criteria but 13 did not provide useable data in the

questionnaire.) Almost a third of these projects (30 percent), including some completed ones, indicated that

they were still in the process of securing long-term

funding. However, the majority of these 40 projects (68

percent) indicated that they had some type of long-term

funding arrangement in place. It should be noted, however, that several of the projects for which this issue is

most salient—namely, 10 completed projects—are not

included in this study since project staff could not be

located. It is not clear whether these projects were more

or less likely to secure long-term funding than those

who did respond to the survey. Given that information

on sustainability was not available for 13 projects (25

During 

FY 1997,

MCHB granted

a total of $2.7

million and

HTPCP

projects 

leveraged

$10.34 million

 ̃
35

percent) of all projects that were completed or in their

last 2 years of funding (either because staff could not be

located or did not provide information), the true percentage of projects that secured long-term funding is

unknown.

Five distinct funding approaches emerged from

the data. This analysis examined only the primary source

of additional funding for each project, although many

projects indicated that they relied on multiple sources of

funding. The approaches with specific project examples

are displayed in Table 7.

The majority of projects reported that they sustained their HTPCP activities by integrating some or all

of the activities into the operations of the grantee

agency. They used a variety of funding mechanisms to

accomplish this: securing state or federal support (30

percent), maximizing medical reimbursement (22 percent), acquiring local or foundation support (22 percent),

and forging contractual arrangements with managed

care organizations (7 percent). Some grantees (19 percent) reported that project components were adopted by

another organization other than the grantee, usually a

local hospital or provider network. Only two projects

had successfully forged contracts with managed care

organizations at the time of the survey, although many
36

State or Federal

Support

Maximizing

Reimbursement

Local or Foundation

Support

Contracts with

Managed Care

Organizations

Adopted by Another

Local Provider

State Department of Healthsupports programOther state governmentresources support programState-level EarlyIntervention departmentsupports programState grants and IndianHealth Service funds support programProgram supported throughNIH perinatal researchfundingProgram received statefunding to develop training modules for state’s universal home-visiting project for adolescent mothers

Established billing mechanismMaximized medical reimbursementReceived designation as aFederally Qualified HealthCenter so can receive cost-based Medicaid reimbursementMedicaid reimbursementhas kept project solventImproved reimbursementfrom patient careMaximization of fee-for-service reimbursement opportunities

Receive local business andcounty supportReceive contributions fromValley Family Health CareReceive local municipalsupportReceive funding from St. Joseph’s Health SystemReceive support fromGerberReceive United Way funding

Secured revenue contractswith local managed care organizationsSigned formal contractswith several managed careorganizations as well aswith a network of hospitalsand providers

Project picked up by threerural hospitalsProject bought by localchildren’s hospitalProject integrated into managed care programsLocal home care department picked uphome care nursing positionIncorporation of project’scase management protocolinto Head Start 

TABLE 7. Sources of Long-Term Funding Secured by Fourth-Year, Fifth-Year, and Completed Projects
37

more said they were working toward this goal. They

commented on the need to market their activities more

aggressively to managed care organizations and to

exploit this market more fully.

Projects used a variety of means to secure longterm support. Local, project-specific evaluation data

were successfully used by some grantees to demonstrate

project efficacy in their bid to obtain long-term support.

Numerous projects reported that receipt of the HTPCP

grant in and of itself was helpful to them in leveraging

funds; they commented that the federal funding gave

their projects added prestige, credibility, and legitimacy

in the eyes of potential funders.

Sustainability data were further analyzed to

determine if certain project characteristics (e.g., organizational type, location, project year, project director’s discipline) were associated with the use of specific funding

arrangements. Only one characteristic—project director’s

discipline—was found to be related to the type of funding arrangement used. Projects directed by R.N.s or

Ph.D.s were three times

more likely than those

directed by M.D.s to use

state or other federal

sources of reimbursement

to sustain their projects. The

M.D.-led group, on the

other hand, was three times

more likely than the

R.N./Ph.D. group to rely on

local approaches to sustainability, including raising

contributions from local

sources, contracting with

managed care organizations, and merging with the

local system of care (chi-square = 6.24 [n = 28]; p < .02).

This somewhat surprising finding may be related to the

personal connections of these groups: it may be that

The prestige

and credibility

of the HTPCP

grant helped

the projects

leverage funds

 ̃
38

physicians have strong ties with local hospitals and managed care organizations that can facilitate these arrangements. Nurses, particularly those with years of

community health experience, may be more familiar with

and more inclined to turn to state child health programs

or Medicaid for funding. These different approaches

deserve further analysis.

Too few projects in this study had secured longterm funding arrangements that would permit comparative analyses that might have identified patterns

regarding the characteristics of projects that succeeded in

this endeavor versus those that did not.

In summary, a substantial portion of HTPCP

grantees appear to be successful in meeting the program

goal of forging partnerships that can lead to additional

support for children’s health and the long-term sustainability of projects. 
39

Like other MCHB grantees, HTPCP grantees

are required to evaluate their projects. Each

applicant must submit an evaluation component as part

of the initial grant application. The objective review

panel must approve the evaluation design before a project can be funded. Grantees are supposed to “measure

changes in child health outcomes and monitor progress

in meeting the program’s goals and objectives.” Table 8

lists examples of evaluation strategies reported by

grantees in this survey.

The majority of projects did undertake a process

evaluation and monitored their own progress toward

meeting project goals and objectives. Few grantees (six)

reported that they attempted an outcome evaluation.

Some projects formally solicited information from clients,

providers, and others on a variety of topics, such as parent satisfaction with the services that were delivered,

provider and advisory committee member opinions of

the project and ways to strengthen it, and the opinions of

other agency staff of various aspects of the project. Only

one project reported that it had collected client information such as the number of children referred and the

extent to which other service providers accepted these

referrals.

A few grantees noted that the evaluation process

had a positive, transforming effect on their agencies. For

example, one project commented that in their community

Project

Evaluations
40

Tracking

Community

Health Indicators

Measuring Client

Outcomes

Assessing Patient

Satisfaction

Assessing Staff’s

and Others’ Views

Tracking and

Assessing Services Tracking Costs

Followed occurrence of unfavorable events(e.g., reports of childabuse and neglect).

Obtained informationon clients’ utilization ofa defined set of healthservices (e.g., TBscreening, family planning appointment, STDscreening, school attendance).

Information obtained onthe satisfactionexpressed by patients.Grantees learned aboutthe utility of programchanges to increaseaccessibility and patientperception on othertopics.

Project managerswatched program operations over time, thencompared results withtheir experience inother service deliveryvenues, forming impressions on success withimproving health outcomes.

Service utilization, clinic attendance, andcompliance withprovider recommendations were monitored.

Calculated cost of providing services thatwere desired by thecommunity, but thatwere not availablethrough any existingorganizations.

Used information in adatabase on ER andhospitalization use tocompare utilization byclients receiving comprehensive integratedservices with similarpersons.

Pre- and post-programtests of parenting skills,youth risk behavior, orstress-related risk factorswere obtained frompatients and/or parents.

Noted observations ofchanges in the processof service delivery itselfand feedback in staffmeetings to see whethertheir ideas resulted inimproved operationalefficiency (e.g., “Are weworking smarter?” and“What is the effect ofhaving a pediatricianpresent?”).

Collected comprehensive data on system ofcare, including thenumber of communityproviders participatingin the project, the number of children referredto the providers, andthe extent providersaccepted these HTPCPreferrals.

TABLE 8. Types of Evaluation Approaches Used by HTPCP Projects

Table 8 continued on next page
41

Tracking

Community

Health Indicators

Measuring Client

Outcomes

Assessing Patient

Satisfaction

Assessing Staff’s

and Others’ Views

Tracking and

Assessing Services Tracking Costs

TABLE 8. Types of Evaluation Approaches Used by HTPCP Projects (continued)

Used health data collected by the healthdepartment as a baseline against which tocompare the status ofpreviously underservedprogram participants.

Reviewed the medicalrecords of infants, toddlers, and children atthe start and later intheir program participation to determine overall project success witha high-need, chronically ill target group.

Through supervision ofline staff, the projectdirector was able toobtain “key informant”opinions about communitywide progresstoward integratinghealth and family support functions.

Documented work output and the number ofpersons served usingintake and servicerecords. These includednot just health services,but also housing, education, and parenting services. Also asked, “Howmany units of servicewere delivered to newpatients not seen beforein the program?”

Pre-program and followup knowledge surveyswere administered forhealth education program.

Obtained feedback fromfield staff on their observations about the mosteffective outreach service delivery tactics.Also, determined fromsupervisors the types oftraining and supervisionrequired for outreachstaff.

The number of familieswithout health fundingwho received medicalcare for their childrenwas tracked.

Conducted a focusgroup among advisorycommittee members,obtaining informationon perceived strengthsand limitations of services provided.

The number of professionals who receivededucational informationabout the program’sfocus was counted, andfollow-up telephonecalls obtained suggestions for future topics.
42

clinic, staff not involved in the HTPCP project observed

HTPCP staff members’ efforts to evaluate the funded

activities and, as a result, began to design and implement

evaluations of their own programs as well. Soon evaluation became a standard part of many programs in their

clinic.

However, some respondents commented that

their evaluation resources were very limited and that

technical assistance was not easily available in this area.

One grantee responded to this challenge by obtaining a

foundation grant specifically for the purpose of hiring an

evaluation consultant to measure the impact of the

HTPCP project. Another formed a partnership with a

local university, and together they applied for and

received a grant to implement a full-scale evaluation of

the project. A few grantees scaled back their initial evaluation plans because they discovered that these plans

were too ambitious given the resources and the time

frame they had to work within.

In short, grantees expressed considerable frustration with this aspect of their projects: They believed that

there were neither sufficient funds nor adequate technical assistance to conduct a meaningful evaluation—certainly, in almost all cases, the resources were too limited

to conduct an outcome evaluation.

Grantees

expressed 

frustration in

conducting

outcome 

evaluations for

their projects

 ̃
43

MCHB provides a range of support to its

grantees. The MCHB program director provides telephone consultation on an ongoing basis and

covers a multitude of topics, ranging from administrative

issues (e.g., budget changes) to modification of project

objectives and methodology to issues of sustainability.

One project director might call to request help in linking

the program with the state’s Title V program; the next

project director might request assistance on developing a

plan for securing matching funds; and a third might

request information on resources available on a particular substantive programmatic issue. The MCHB program

director establishes the HTPCP policy and develops all

guidance materials for dissemination; reviews all written

materials from the projects, including budgetary information, requests, and annual continuation applications;

and provides oral and written feedback as well as 

recommendations and conditions on grant awards as

appropriate.

The MCHB program director, with assistance

from the AAP staff, plans, coordinates, implements, and

evaluates an annual meeting of all active grantees to

facilitate networking among project directors and with

MCHB and AAP staff. Technical assistance workshops

are provided at this meeting on a diverse array of topics—from fundraising to media promotion to enhancing

cultural competence. The MCHB program director also

provides technical assistance and consultation to support

Program Oversight and

Technical Assistance
44

their ongoing project implementation, evaluation, and

grant administration.

The HTPCP was initiated in an era of federal 

government downsizing. The availability of federal staff

to implement and monitor the program has been

extremely limited. In fact, only one federal position has

ever been allocated for stewardship of this program. The

creative partnership with the AAP has served to enhance

technical assistance by securing, for example, additional

resources through its array of connections and its thousands of members who are privately practicing pediatricians. It was also hoped and anticipated that AAP

involvement would enhance the attention of the organization to public health community-based approaches to

care and would encourage local pediatricians to become

effective advocates for children.

The AAP Committee on Community Health

Services (COCHS) participates as a partner with

MCHB/HRSA in setting the direction of the HTPCP. 

The MCHB/HRSA partnership with the AAP is supported via a cooperative agreement, which is a special type

of grant that establishes responsibilities for both the

grantee and the funding agency. AAP was tasked with

providing technical assistance through both site visits
45

and telephone consultation. Under its cooperative agreement, which was initially supported in 1991, each project

is visited twice, in year 1 and year 4 of the grant. The

technical assistance site visit team, which is led by an

AAP pediatrician and includes the AAP project manager

for the HTPCP, participates in problem solving and provides suggestions and advice during the visit and

through a subsequent written report. Due to restrictions

in travel funds, the MCHB project director is only occasionally able to participate in these site visits. Other site

visit team members include a HRSA field office MCH

program consultant, a state Title V representative, and

the state AAP chapter president. In addition to organizing site visits, the national office of the AAP (represented

by the AAP project manager for the HTPCP) contacts all

new grantees, assists them in identifying appropriate

AAP resources, and responds to telephone requests for

technical assistance.

The grantee questionnaire found that 74 percent

of grantees obtained technical assistance from MCHB

and 68 percent from the AAP project manager for the

HTPCP. Grantees also relied on regional MCH program

consultants (35 percent), the state Title V office (30 percent), local AAP chapters (30 percent), and state AAP

chapters (23 percent) for assistance. HTPCP staff also

showed resourcefulness in seeking out other sources of

technical assistance, including schools of public health,

colleges of nursing, and foundations. Assistance was

most frequently sought in the areas of evaluation (78 percent), substantive program issues (67 percent), long-term

sustainability (57 percent), and securing matching funds

(44 percent).

Grantees gave high ratings to their technical

assistance providers. Those receiving assistance from

MCHB and the national AAP office reported that technical assistance was timely, relevant, and helpful. Grantees

who received technical assistance from local AAP fellows, however, gave more mixed reactions to the assistance. Several grantees pointed out that MCHB and AAP

One grantee

noted, “The

connections 

I made at the

annual project

director’s

meeting have

been wonderful

and supportive.

I think this is a

unique benefit

of this grant.”

 ̃
46

staffs have been accessible, knowledgeable, and supportive. Numerous grantees also offered positive comments

about the annual project director’s meeting:

The connections I made at the annual project

director’s meeting have been wonderful and 

supportive. I think that this is a unique benefit 

of this grant.

The annual director’s meeting has been very

helpful—a great opportunity to meet like-minded

people and to share ideas.

The experience of working with other project

directors was wonderful. The idea of community,

private, federal, and AAP partnerships was

inspiring.

The money was minimal but the contact with

other project directors was outstanding. I learned

how many other people are as crazy as I am

about kids in need.

While reactions were generally favorable to the

technical assistance and support provided by MCHB and

the AAP, a few grantees pointed out that the amount of

reporting and documentation required by the agency is

excessive for a grant of this size. These grantees suggested that reporting requirements be reduced. 
47

The HTPCP appears to be an effective strategy for

promoting children’s access to health services at

the community level.

The HTPCP has clearly initiated new and

enhanced existing community-based service programs.

The goals of these grantees tend to be modest, attainable,

and consonant with the small size of the grant: namely,

to implement proven strategies, such as case management, home visiting, and transportation, that have been

demonstrated as effective elsewhere. This is a worthy

and laudable achievement.

Modest funding provided to community organizations,

with a matching funds requirement, can leverage significant

amounts of money for children’s health care.

HTPCP grants are quite small by federal program

standards. Yet, this amount appears to be adequate both

to provide a valuable service and to attract additional

funding. The match requirement forced grantees to solicit additional funding from the outset, and in fact, the

amount leveraged is quite remarkable, representing

almost a fourfold increase in available dollars for children’s health.

The HTPCP includes elements that successfully foster

long-term sustainability of services.

Several elements of this program may help to

secure permanence for the services it funds: The match

Conclusions

The goals 

of these

grantees tend

to be modest,

attainable, and

consonant

with the small

size of the

grant

 ̃
48

requirement forces grantees to begin searching for additional funds immediately. At the same time, grants are

funded for a long enough period (5 years) both to

demonstrate success and value locally and to enable

grantees to develop the relationships with other groups

that are needed to secure the resources that can sustain

the program.

Small, community-based projects often do not have the

expertise or resources to conduct outcome evaluations.

Valid outcome evaluations are challenging and

often expensive to conduct. Expertise in evaluation

design is required; such expertise is typically costly and

may be difficult to acquire. Thus, it is not surprising that

few HTPCP projects even attempted an outcome evaluation. Even a process evaluation in a services program

may be considered an innovation—and in fact, the

process evaluations and client and staff satisfaction surveys undertaken by these grantees were viewed locally

as innovative and valuable.

Meaningful multiagency partnerships and collaborations can greatly improve the delivery of services for children,

but they are challenging to develop and attempts to do so frequently fail.

Most HTPCP projects ultimately developed what

they considered to be effective and productive partnerships, and project directors believed that these were critical to the success of their projects. However, many

difficulties were encountered in developing these relationships. This finding suggests a need for specialized

training and ongoing support for community-based projects in the development of partnerships and collaborations. Moreover, it might help to clarify different types of

partnerships and collaborations, and what can be realistically expected from each. For example, partnerships with

other health care providers can help ensure a “seamless”

and comprehensive system of care; cooperative arrangements with other service providers (schools, social service agencies, etc.) can broaden the focus of health and
49

enhance the community’s ability to

prevent problems; coalitions with

community groups (PTA, the faith

community, etc.) can provide

avenues for advocacy for children

and children’s services. It is not

clear from this survey whether

grantees distinguished between

these types of partnerships in their

responses.

Pediatricians and other pediatric health professionals, when provided with support through a

mechanism such as a grant, can serve as leaders and advocates

in improving children’s access to services.

Advocacy efforts on the part of HTPCP

grantees—primarily pediatric health professionals—led

to improved service components, permanent changes in

local services, and new dollars for children’s health.

Thus, while the survey data do not directly address

questions of advocacy and leadership by pediatricians,

these can be inferred as program achievements.

The activities of staff at the federal level and at the

AAP provide important guidance and leadership to HTPCP

projects and contribute to the program’s success.

Projects received support from a variety of both

public and private sources. Critical feedback from technical assistance site visits, ongoing telephone consultation,

a written critique of continuation applications, and an

annual grantee meeting helped keep projects on course

and identified areas in need of additional attention. The

overwhelmingly positive response of projects to the technical assistance they received, especially from MCHB

and the AAP HTPCP staff, points to the effectiveness of

this approach.
50

(1) Program attributes:

• Continue the programmatic focus on cultural competence. The ongoing struggle by projects with this

issue demonstrate its profound importance for ensuring children’s access to care. The rapidly changing

demographics of the United States also argue for a

strong, continued emphasis on cultural issues in

health care.

(2) Collaboration:

• Continue to emphasize different types of partnerships with multiple groups. This requirement of the

program appears to be important and successful.

• Consider providing intensive training in coalition

building and partnership development for project

staff within the first 6 months of the grant award.

Projects appear to be repeating mistakes made by

others in their attempts to create new collaborative

arrangements. Intensive training—such as a 2-day

workshop—on this topic might be one way to assist

grantees at an early stage in their grant to be more

successful. Such training could also help clarify for

grantees what might reasonably be expected from a

variety of community groups. Grantees appear to

need special help in developing effective advisory

groups.

Recommendations
51

(3) Evaluation:

• Continue to require outcome evaluation, and provide

training and/or special technical assistance materials

within the first 6 months of the grant award. Projects

reported that even though they had difficulty conducting outcome evaluations, these evaluations were critical for ensuring that programs were indeed effective

in meeting their objectives and in securing funds for

sustaining the program. However, grantees indicated

that they had particular difficulty in obtaining technical assistance on this topic. While the sophistication

and resources needed for outcome evaluation are often

not available to such modestly funded, communitybased grantees as those in the HTPCP, another entity

could be supported solely for providing ongoing technical assistance in program evaluation.

• Consider modifying the HTPCP grant guidance to

include specific outcome measures and other

process/performance measures appropriate for the

program. MCHB might even specify a greater

emphasis on collecting data for a small number of

outcomes (1–3) rather than devoting significant

resources to collecting process data.

• Consider adding community performance monitoring

requirements for some projects to assess the usefulness

of this approach to improving children’s health care.

In recent years, the field of public health has come to

recognize the value of performance monitoring, with

specified accountability, as a model for achieving community-based improvements to health. The HTPCP

would appear to be an excellent vehicle for demonstrating the potential worth of this approach.

(4) HTPCP Management:

• Continue the MCHB/HRSA/AAP partnership: This

public-private partnership provides prestige, visibility, and resources to local programs. It also helps

extend the capability of MCHB to manage this 
52

extensive program with limited staff.

• Increase the HTPCP staff at the federal level: It is

remarkable that only one person is managing such a

large and complex program. Attending to the myriad

administrative details of such a program obviously

limits the time available for program planning,

implementation, and evaluation; participation on the

AAP technical assistance site visit team; and other

important aspects of program management. An

increased level of staffing could enhance MCHB’s

ability to administer this program.

• Increase technical assistance and consultation capacity:

While MCHB and the AAP both provide phone consultation to grantees and the AAP provides technical

assistance site visits, such efforts are still not of sufficient capacity to meet the technical assistance needs of

grantees. MCHB should consider adding staff in order

to provide more intensive, tailored technical assistance

and consultation to projects. Assistance in a variety of

areas—evaluation in particular—with greater sustained attention to each project could benefit these

projects and improve their effectiveness. The goals of

these grantees tend to be modest, attainable, and consonant with the small size of the grant: namely, to

implement proven strategies, such as case management, home visiting, and transportation, that have

been demonstrated as effective elsewhere. 

(5) Sustainability

• Consider linking with CHIP programs. Lessons

learned through the HTPCP experience, such as how

to link uninsured children to needed health services,

should inform the development of state CHIP plans

and local outreach efforts. The extensive experience

of HTPCP projects in working with culturally and

linguistically diverse populations should be shared

with state and local policymakers and program planners who are currently shaping the development of

CHIP programs. 
53

Questions for

Further Study

T his analysis has demonstrated many valuable

and worthy features of the HTPCP and has

provided insights that can inform a future study of the

program. Additional information would help the national program further tailor its technical assistance and program requirements. Questions that could be explored in

future evaluations include

• What strategies are being used to make services 

family centered?

• What are the barriers to achieving integration with

managed care organizations, and what strategies

have projects used that have succeeded in securing

such support?

• What is the impact of project staff turnover on the

accomplishments of the program?

• What are the specific roles that pediatricians play in

HTPCP projects? What are the types of relationships

that pediatricians and pediatric health providers

form in their communities to support the development and sustainability of HTPCP?

Finally, it is important to the nation to understand

how projects such as those funded under the HTPCP can

continue to improve children’s health. The United States’

health care system is currently in the midst of two revolutions that, in theory, could dramatically improve chil-
54

dren’s access to coordinated, preventive health services:

(1) the growth of managed care programs, which are

designed to improve the coordination of preventive and

primary health services for children and families; and 

(2) the implementation of CHIP, which will address the

financial barriers currently facing uninsured children

from working-poor families. It is the movement from theory to practice that will determine whether children’s

health improves as a result of these two revolutions.

When the Medicaid program was expanded to increase

access to health services for pregnant women and children, the public health and medical communities learned

that providing financial access to health services did not

necessarily improve access to care. Nonfinancial barriers

persisted, including transportation problems, uncoordinated services, inadequate attention to language and cultural issues, and the needs beyond health care that affect

a child’s health. MCHB/HRSA and the AAP sought to

address these barriers by developing and implementing

the HTPCP.

The challenge now

is to infuse the lessons

learned from the HTPCP

into managed care systems

that serve children and into

each state’s CHIP program.

This evaluation of HTPCP

projects can serve as one

means of communicating

these lessons. Many more

conduits are needed.

Community-based prevention programs like the

HTPCP that focus on nonfinancial barriers to care and that coordinate health and

other systems of care for children and families can go a

long way toward transforming these promising theories

into practice and improving children’s access to health

care and, ultimately, their health. ■
55

References

Bazzoli GJ, Stein R, Alexander JQ, Conrad DA, Sofaer S,

Shortell SM. 1997. Public-private partnerships in health

and human service delivery: Evidence from community

partnerships. Milbank Quarterly 75(4):533–562.

Centers for Disease Control and Prevention, National

Center for Health Statistics. 1998. National Vital Statistics

System. In National Center for Health Statistics [Web

site]. Available at http://www.cdc.gov/nchswww/

about/major/nvss/nvss.htm.

Centers for Disease Control and Prevention, National

Center for Health Statistics. 1998. National Immunization

Survey. In National Center for Health Statistics [Web

site]. Available at http://www.cdc.gov/nchswww/

about/major/slichs/slichs.htm.

Margolis PA, Carey T, Lannon CM, Earp JL, Leininger L.

1995. The rest of the access to care puzzle: Addressing

structural and personal barriers to health care for socially

disadvantaged children. Archives of Pediatrics and

Adolescent Medicine 149(5):541–545.

Melaville A, Blank MJ. 1991. What It Takes, Structuring

Interagency Partnerships to Connect Children and Families

with Comprehensive Services. Washington, DC: Education

and Human Services Consortium. 
56

Meyer JA, Bagby NS. 1998. Beyond Enrollment: Are SCHIP

Plans Linking Children to Quality Health Care? Washington

DC: New Directions for Policy.

Millman M, ed. 1993. Access to Health Care in America.

Washington DC: National Academy Press.

National Institute on Drug Abuse. 1996. National

Pregnancy and Health Survey: Drug Use Among Women

Delivering Live Births: 1992 (NIH Publication No. 96-

3819). Washington, DC: U.S. Government Printing Office.

Riportella-Muller R, et al. 1996. Barriers to the use of preventive health care services for children. Public Health

Reports 111(1):71–77.

Short PF, Lefkowitz DC. 1992. Encouraging preventive

services for low-income children: The effect of expanding

Medicaid. Medical Care 30(9).

U.S. Department of Health and Human Services,

National Center on Child Abuse and Neglect. 1997. Child

Maltreatment 1996: Reports from the States to the National

Child Abuse and Neglect Data System. Washington, DC:

U.S. Government Printing Office.

U.S. Department of Justice, Bureau of Justice Statistics.

1998. National Crime Victimization Survey. In Bureau of

Justice Statistics [Web site]. Available at

http://www.ajp.usdoj.gov/bjs/ or

http://www.icpsr.umich.edu/NACJD/home.html.

U.S. General Accounting Office. 1987. Prenatal Care:

Medicaid Recipients and Uninsured Women Receive

Insufficient Care (GAO-HRD-87-134). Washington DC:

U.S. General Accounting Office.

Weigers ME, Weinick, RM, Cohen JW. 1998. Children’s

Health, 1996 (Medical Expenditure Chartbook No. 1, 
57

AHCPR Pub. No. 98-0008). Rockville, MD: Agency for

Health Care Policy and Research.

White JA, Wehlage G. 1995. Community collaboration: If

it is such a good idea, why is it so hard to do? Educational

Evaluation and Policy Analysis 17(1):23–38.
58

Appendix A: Descriptive Charts of

HTPCP Projects

FIGURE 2. HTPCP Sites by Community Type

FIGURE 1. Organizational Type of HTPCP Grantees (n = 74)
59

FIGURE 3. HTPCP Clients by Age Group

FIGURE 4. HTPCP Clients by Insurance Status
60

FIGURE 5. HTPCP Clients by Racial/Ethnic Group

FIGURE 6. HTPCP Project Directors by Discipline

M.D. 40

R.N. 7

Ph.D. 6

M.A. / M.S. / M.P.H. 10

M.S.W. / L.C.S.W. / L.M.S.W. / A.C.S.W. 4

B.S.N. 2

Dr.P.H. 2

Other 7

None reported 7

Academic Degree Number of Project Directors (n = 85)
61

Appendix B: HTPCP Survey

1. In what year was your Healthy

Tomorrows (HT) project initially

funded?

Year ____________

2. In which year of federal HT funding

are you currently operating? (Circle one.)

Year 1 2 3 4 5 Completed

3. Which best describes the community

in which your HT project operates?

❏ Urban, inner city

❏ Urban, not inner city

❏ Suburban

❏ Rural

❏ Statewide

❏ Other (Specify.)________________________

4. How many Project Directors (PDs)

have you had and how long has

each served? 

No. PDs _____________

Length of service for

PD #1 _______________

PD #2 _______________

PD #3 _______________

PD #4 _______________

5. Is the current Project Director

responsible for daily management

of the project?

❏ Yes ❏ No

If “no,” who is responsible?

Name _________________________________

Title _________________________________

6. What populations were served by

your HT project? What were the

numbers served within each population? (Please include all participants

enrolled in the program, regardless of length

of time enrolled. Please provide an unduplicated count—i.e., do not include a participant in more than one population category.)

(Check all that apply.) (Write no. for each one checked.)

❏ Infants (< 1 year) ____________

❏ Children (1–12 years) ____________

❏ Adolescents (13–21 years) ____________

❏ Pregnant women ____________

❏ Other ____________

7. What proportion of the people ever

served by your HT project fell into

these insurance categories? 

(Check all that apply.) (Write % for each one checked.)

❏ Uninsured ____________

❏ Medicaid recipients ____________

❏ Other (Specify.)

_______________________ ____________

TOTAL=100%

8. What proportion of the children

ever served would you estimate to

be in the following racial or ethnic

groups? (Write a %, including any 0%.)

❏ Black, non-Hispanic ____________

❏ White, non-Hispanic ____________

❏ Hispanic ____________

❏ American Indian/

Alaskan Native ____________

❏ Asian or Pacific Islander ____________

❏ Other (Specify.)

_______________________ ____________

TOTAL=100%
62

9. What implementation strategies have

you included in your HT project to

ensure cultural competence?

_____________________________________ 

_____________________________________ 

_____________________________________ 

_____________________________________ 

_____________________________________ 

_____________________________________

_____________________________________ 

MEETING COMMUNITY NEEDS

Maternal and Child Health Issues 

10. On which child health issues did

your HT project focus? (Check all that

apply.)

❏ Access to medical services (financial barriers)

❏ Access to medical services (nonfinancial

barriers)

❏ Child abuse/family violence

❏ Children with special needs

❍ Broad population of children with 

special needs

❍ Asthma

❍ Hearing impairment

❍ Developmental & learning disorders

❍ Other (Specify.)

________________________________ 

❏ Dental care

❏ Health education

❏ Homelessness

❏ Immunizations/preventive care

❏ Injury prevention

❏ Mental health 

❏ Nutrition

❏ Parenting education/support

❏ Poor pregnancy outcomes/infant mortality

❏ Sexually transmitted disease/HIV

❏ Substance abuse

❏ Teen pregnancy and parenting

❏ Other (Specify.)

___________________________

Services

11a. What services were provided to

address the issues checked above?

(Check all that apply.)

❏ Primary health care services (a)

❏ Enhancement of access to 

medical care (b)

❏ Health education (c)

❏ Counseling (d)

❏ Peer counseling (e)

❏ Support groups (f)

❏ Home visiting (g)

❏ Case management/care coordination (h)

❏ Dental services (i)

❏ Nutritional services (j)

❏ Mental health services (k)

❏ Literacy education (l)

❏ Family empowerment (m)

❏ Parenting skills education (n)

❏ Multidisciplinary team for pediatric

visit/family advisor (o)

❏ Community mentors (p)

❏ Health screening (q)

❏ Support services (e.g., transportation, 

child care, translation) (r)

❏ Services for special populations (s)

❏ Incentive gifts for preventive care (t)

❏ Other (Specify.) 

________________________________ (u)

11b. Please go back to Question 11a

and circle those services that are

new (i.e., those services you initiated under the HT grant).

12a. Of the child health issues you

checked in Question 10, which do

you feel was the most critical?

Issue

__________________________________
12b. Please list up to four services that

you provide to address this particular issue. (Refer to list provided in

Question 11a and write the letter corresponding to the appropriate service in the

boxes provided below.)

Services provided to address this issue (Write in letters.)

12c. Please describe which aspects of

these services are new.

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

BUILDING PROGRAM CAPACITY

Program Operation

13. Briefly describe the new/enhanced

system(s) of care created under your

HT grant. Please highlight any linkages formed between your HT project and other initiatives in the

community. 

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

14. What function does the system of

care serve? (Check all that apply.)

❏ Moving toward a full continuum of care

❏ Providing comprehensive primary care 

❏ Building linkages to services

❏ Coordinating care

❏ Focusing on gaps in services 

❏ Other (Specify.)

_____________________________________

15a. In the table below, please indicate

the type of arrangements you

have in your coordination of

efforts with the other MCH programs indicated. (Check all that

apply.)

____________________________________

____________________________________ 

Local health

department

Social

services

Education

Child care

State Title V

(MCH)

Medicaid

WIC

Title X (family

planning)

Head Start

Healthy Start

AAP state 

chapter

Other 

(Specify below.)

No substantive collaboration

Memorandums of agreementContractual arrangements

Common protocols

Joint staff training

Joint data collection effortsReferral systems

63
15b. Please elaborate on any other

coordination arrangements with

the MCH programs indicated or

any other MCH programs.

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

16. How has your HT project worked

with managed care organizations in

your community? For example, have

you worked with managed care organizations to develop EPSDT standards for managed care contracts?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

Partnerships

17. With whom has your HT project

formed partnerships? (Check all 

that apply.)

❏ Professionals

❏ Families

❏ Businesses 

❏ Foundations

❏ Schools 

❏ Universities

❏ Hospitals

❏ Health or human service agencies 

(Specify.) ___________________________

❏ Community-based organizations

(Specify.) ___________________________

❏ Other (Specify.)

______________________________

18. When were new partnerships

formed? (Check all that apply.)

❏ When planning and writing the grant 

proposal 

❏ After the grant was awarded

19. Were there formal agreements

regarding these partnerships?

(Check one.)

❏ No

❏ Yes (Specify.)

_____________________________________

20. Did partners contribute funds to the

project? (Check one.)

❏ No

❏ Yes 

If “yes,” specify the name of the partner

and the total dollar amount they contributed during the course 

of the project.

Name __________________________________ 

Amt. $__________

Name __________________________________ 

Amt. $__________

Name __________________________________ 

Amt. $__________

21. Did partners assist in fundraising

efforts? (Check one.)

❏ No

❏ Yes

22. How helpful were these partnerships

in meeting the goals of your HT 

project? (Circle one number.)

Not Somewhat Very

Hindrance helpful Neutral helpful Helpful

1 2 3 4 5

64
65

23a. In your estimation, to what extent

are health, education, and social

services integrated in your 

project? (Circle one number.)

Not at all Not very Partially Somewhat Very

Integrated Integrated Integrated Integrated Integrated

1 2 3 4 5

23b. How are health, education, and

social services integrated into

your HT project? 

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

Advisory Committee

24. Was your HT advisory committee

created from (Check one.)

❏ A preexisting advisory committee for

other projects

❏ A community planning group that now

assumes an advisory role

❏ A new group of individuals

❏ Other (Specify.)

______________________________

25. How has your HT advisory committee evolved over time? 

(Check one.)

❏ Remained part of another advisory committee

❏ Grew to be a major committee in the community

❏ Became a stand-alone committee for HT only

❏ Ceased to function as an advisory committee

for HT

❏ Other (Specify.) 

_________________________________________

26. How often does/did your HT advisory

committee meet? (Check one.)

❏ Weekly

❏ Twice a month

❏ Monthly

❏ Quarterly

❏ Other (Specify.)_______________________

27. On average, how many hours did

HT advisory committee members

volunteer per year?

____________ hours

28. Were committee member hours

used toward the funding match by

assigning a money value to the

time? (Check one.)

❏ No

❏ Yes

29. What links were created in the community as a result of the HT advisory committee? 

(Check all that apply.)

❏ With health care organizations/agencies

(Specify.)

_____________________________________

❏ With health care providers

❏ With policymakers

❏ With families

❏ With social services

❏ With support services

❏ With businesses

❏ With schools or universities

❏ With foundations

❏ Other (Specify.)

_____________________________________
66

30. Who is on your HT advisory committee? (Check all that apply.)

❏ Pediatricians 

❏ Other physicians

❏ Public health professionals

❏ Psychologists

❏ Psychiatrists

❏ Dentists

❏ Nutritionists

❏ Nurses

❏ Other health care providers

❏ Educators

❏ Social service agencies

❏ Title V

❏ Medicaid

❏ Parents/consumers

❏ Churches

❏ Local media

❏ Businesses

❏ Representatives from minority organizations

❏ Other (Specify.)

_____________________________________

31. In which HT activities does the advisory committee participate? (Check all

that apply.)

❏ Planning

❏ Networking

❏ Overseeing the HT program

❏ Community organizing and recruiting

❏ Influencing policymakers

❏ Fundraising

❏ Program implementation

❏ Program evaluation

❏ Other (Specify.)

_____________________________________

32. How important was the advisory

committee in helping you meet the

goals of your HT project? (Circle one

number.)

Not Somewhat Very

Hindrance helpful Neutral helpful Helpful

1 2 3 4 5

33. Please comment on your experiences,

both positive and negative, in collaborating with your partners and advisory committee members. 

____________________________________

____________________________________

____________________________________

____________________________________ 

____________________________________ 

STAFF BACKGROUND AND 

LEVEL OF INVOLVEMENT

34. Please provide the following information in the table below.

a. What type of professionals are currently on the staff of your HT project, on either a paid or a volunteer

basis? (Check all that apply.)

b. At what level of involvement? 

(On the appropriate line, please indicate the

average number of hours worked per week

by paid and volunteer staff.)

c. Please circle your Project Director’s

discipline. Paid Volunteer

Hrs/wk Hrs/wk

❏ Pediatrician _______ _______

❏ Obstetrician/gynecologist _______ _______

❏ Psychologist _______ _______

❏ Psychiatrist _______ _______

❏ Nurse practitioner _______ _______

❏ Home visiting nurse _______ _______

❏ Nurse midwife _______ _______

❏ Nurse _______ _______

❏ Dentist _______ _______

❏ Nutritionist _______ _______

❏ Health educator _______ _______

❏ Social worker _______ _______

❏ Service coordinator _______ _______

❏ Public health professional _______ _______

❏ Physical therapist _______ _______

❏ Educator _______ _______

❏ Other (Specify.)

_____________________ _______ _______
67

TECHNICAL ASSISTANCE

35. What technical assistance (TA) have

you received? (Check all that apply.)

❏ Assistance with your grant application

If so, who assisted you?

❏ Attending HT project directors meetings 

❏ Site visits

❏ Other (Specify.) 

36. From whom did you receive TA?

(Please address the full range of TA 

providers involved in your project, including

those providing phone consultation, site 

visits, etc.)

❏ Maternal and Child Health Bureau

❏ Regional MCH Program consultants

❏ State Title V office (MCH Program)

❏ American Academy of Pediatrics (AAP) 

(Elk Grove Village) 

❏ State AAP chapter office

❏ Local fellows representing the AAP

❏ National Center for Education in

Maternal and Child Health

❏ Schools of public health

❏ Other MCHB programs

❏ Other links in the community

❏ Other (Specify.)________________________

37. On what topics did you receive TA? 

(Check all that apply.)

❏ Programmatic issues

❏ Project scope of work

❏ Sustainability

❏ Evaluation

❏ Public relations

❏ Obtaining matching funds

❏ Networking

❏ Identifying resources for TA

❏ Grant administration

❏ Program advisory committee

❏ Other (Specify.)________________________

38a. Please think of the most relevant TA

that you received. Go back to

Question 36 and circle the name of

the one organization that provided

this TA, and then, in Question 37, 

circle the topic of this TA. 

38b.Rate this particular TA on the following dimensions:

Not Somewhat Very Extremely

Timely 1 2 3 4

Relevant 1 2 3 4

Helpful 1 2 3 4

BARRIERS AND CHALLENGES

39.What challenges did you encounter?

(Check all that apply.)

I. Initially, when you were writing

the grant proposal and first

implementing the HT project

(a) In the community

❏ Obtaining resources to apply for HT

❏ Enlisting pediatric involvement

❏ Enlisting support from state Title V

❏ Enlisting business support

❏ Enlisting support of local community

organizations

❏ Enlisting support of local government

❏ Other (Specify.)_____________________

(b) In the program

❏ Recruiting staff

❏ Obtaining space

❏ Other (Specify.)_____________________

II. Later, during full HT program

operation

(a) In the community

❏ Obtaining matching funds

❏ Recruiting participants

❏ Using community workers

❏ Obtaining cooperation in integrating

efforts with other agencies

❏ Implementing policy changes at 

various levels

❏ Maintaining family involvement

❏ Other (Specify.)____________________
(b) In the program

❏ Staff turnover

❏ “Red tape,” paperwork

❏ Setting overly ambitious goals

❏ Operationalizing management information systems 

❏ Recruiting and retaining members for

the advisory committee

❏ Convening the advisory committee 

❏ Other (Specify.)

____________________________________

40. What was your most significant barrier and what steps did you take to

try to overcome it?

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

FINANCES/SUSTAINABILITY

41. What was your total HT project budget for the last fiscal year, including

the federal HT grant? (For projects that

are already completed, please provide the

budget from project year 5.)

Total budget $ __________________

42. What percentage of your two-thirds

match in years 2 through 5 was

obtained in

Hard money? _________%

In-kind contributions? _________%

43. From whom was the hard money

match obtained in years 2 through 5?

(Check all that apply.)

❏ Corporations

❏ Foundations

❏ State government

❏ Local government

❏ Other (Specify.)_______________________

44. Which of the following community

resources have helped you implement/maintain your program with

in-kind contributions? (Check all that

apply.)

❏ Other health care providers

❏ Local health departments

❏ Local or state government

❏ Foundations/philanthropic groups 

or individuals

❏ Local community boosters 

(e.g., Kiwanis, Lions)

❏ Local churches

❏ Community schools

❏ Local managed care/health 

maintenance organizations

❏ Individuals

❏ Other (Specify.)________________________

45. Which of the following in-kind

contributions have helped support

your program?

(Check if applied 

(Check all that apply.) to 2/3 match.)

❏ Free rent ❍

❏ Free utilities ❍

❏ Donated physician services ❍

❏ Donated services from other 

health professionals ❍

❏ Other nonmedical volunteer labor ❍

❏ Donated medical supplies ❍

❏ Donated nonmedical materials, 

such as furniture or food ❍

❏ Other (Specify.) 

________________________ ❍

68
46. Did the HT grant help you secure

funding from other sources? 

(Check one.)

❏ No

❏ Yes (Explain how.)

____________________________________

____________________________________ 

47. What steps have you taken to

ensure the sustainability of your

HT project efforts at the end of your

federal funding year?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

EVALUATION

48. What kind of an evaluation have

you done?

❏ Quasi-experimental design (comparison

groups)

❏ Before-and-after comparison 

❏ Process evaluation (description of program activities)

❏ Satisfaction survey

❏ Other (Specify.)

__________________________

49. Please elaborate on your evaluation

design and explain how you use it

to measure progress toward project

goals and objectives.

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

50. What do you see as your project’s

main accomplishments?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

51. How did your HT project make a

difference in your community?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

69
70

CONSUMER IMPRESSIONS

52. How have you measured consumer

reaction to your HT project services

and what did you find?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

LESSONS LEARNED

53.Given your experiences, what

lessons have you learned about how

to establish and run a successful HT

project? What key advice would you

give to those trying to start a program?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

OTHER COMMENTS

54.Do you have any other comments

you would like to make about your

HT program?

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________ 

CONTACT INFORMATION

On the first line below, please provide your

name, highest degree, and job title. Below it,

please fill in the name(s), degree(s), and job

title(s) of the individual(s) who assisted you in

completing this survey.

Name Degree

____________________________________

Job Title

____________________________________ 

Name Degree

____________________________________

Job Title

____________________________________ 

Name Degree

____________________________________

Job Title

____________________________________ 

Your phone number:

____________________________________ 
71

Projects are listed alphabetically by state and

include all HTPCP grants funded from FY 1989

through FY 1996. For a longer description of projects, please visit the National Center for

Education in Maternal and Child Health

(NCEMCH) Web site at www.ncemch.org.

ALABAMA

TEEN (Teens Empowered through

Education and Nurturing)

Shirley Worthington, L.C.S.W., P.I.P.

Family Oriented Primary Health Care Clinic

Mobile County Health Department

251 North Bayou Street

P.O. Box 2867

Mobile, AL 36652

Project Number 018632

The project aims to (1) reduce repeat adolescent pregnancy for the Family-Oriented

Primary Health Care Clinic (FOPHCC)

Women’s Center primagravida adolescents

through expanding community collaboration; and (2) reduce the incidence of child

abuse and neglect among this high-risk,

socioeconomically disadvantaged population

of first-time adolescent mothers and infants.

We will use prenatal and postnatal intensive

case management, home visits, preventive

health care, and community-based family

strengthening programs, including parentchild interactive skill building and knowledge-based group programs.

ALASKA

Rural TOTS

Paula McMeen, B.S.

REACH, Inc.

Infant Learning Program

P.O. Box 34197

3272 Hospital Drive

Juneau, AK 99803-4197

Project Number 028675

Reducing the severity of chronic health and

developmental disability for children and

families in rural southeast Alaska is the aim

of the project. The project will focus on providing families with local access to early

intervention and medical services. Family

service coordination and developmental

assessments will be provided in the community. This program will shift the model from

the medical model to the family-centered

model.

New Beginnings

Keirsten Smart

Southcentral Foundation

64501 Diplomacy Drive

Anchorage, AK 99508

Project Number 028030

This program seeks to reduce child abuse

and neglect in Alaska Native and American

Indian families in the Anchorage area. The

objective for the 5-year period is to reach

approximately 200 families, resulting in a 50-

percent reduction of child abuse and neglect.

The prevention of child abuse and neglect

will be facilitated by a family service worker.

Home visit family support services will

include crisis intervention, emotional supAppendix C: Healthy Tomorrows

Partnership for Children

Program (HTPCP) Projects 
72

port to parents, informal counseling, role

modeling of family relationships, communication skills, life coping skills, and linkages

to other services.

CALIFORNIA

East County Healthy Tomorrows

Bronwen Anders, M.D.

East County Community Clinic

10039 Vine Street, Suite 2

Lakeside, CA 92040

Project Number 068903

This project provides coordinated perinatal

and comprehensive pediatric care to an

underserved Hispanic population. A bilingual health educator makes contact with

women at the time of delivery and schedules

a prompt return to the clinic. The groups are

run by a health educator, a pediatrician, and

a research assistant. Health outcomes monitored include improved breastfeeding rates,

more complete and timely immunizations,

and reduced use of emergency rooms for

minor pediatric problems.

The San Diego Homeless Adolescent

Health Care Project

Nancy Bryant Wallis, Dr.P.H.

Logan Heights Family Health Center

1643 Logan Avenue

San Diego, CA 92113

Project Number 068918

This 5-year project has established the following goals: (1) Create a system of comprehensive, case-managed health care for the

thousands of throwaway, runaway, and

near-homeless adolescents in San Diego by

bringing available services onsite to places

where young persons and their families live

and congregate; (2) create a coalition of community agencies and pediatric professionals

to provide services to homeless adolescents;

(3) collect and disseminate project data,

including demographics, chronic and acute

medical conditions diagnosed, and contagious diseases (such as sexually transmitted

diseases, HIV infection, and tuberculosis);

and (4) obtain a detailed risk assessment to

monitor clients’ knowledge, attitudes,

beliefs, and behaviors. 

San Diego Dental Health Initiative

Amethyst C. Cureg, M.D.

County of San Diego, Department of 

Health Services

3851 Rosecrans Street

P.O. Box 85222, Mailstop: P511F

San Diego, CA 92186-5222

Project Number 068005

The overall project goal is to improve the

oral health of children in San Diego County.

Health systems improvement goals are to 

(1) provide quality oral health care at no cost

to culturally diverse, underserved incomeeligible children with urgent dental needs,

and (2) provide community-based culturalspecific approaches to oral health education

for families. The health status improvement

goal is to increase the number of children

receiving oral care for urgent conditions of

dental disease or injury. A public-private

partnership will be created to provide family

preventive oral-health education and appropriate and timely no-cost treatment for uninsured children of low-income families. 

Healthy Tomorrows Partnership for

Children

Lucinda Hundley, M.A.

Santa Ana Unified School District

1601 East Chestnut

Santa Ana, CA 92701

Project Number 068908

This collaborative project targets five elementary schools (4,000 students) in an ethnically diverse school district where 85 percent

of the population is Hispanic and immigrants constitute 40 percent of the population. The project goals are to (1) provide

accessible preventive health care for elementary school students in the school district, 

(2) provide school-linked social services, and

(3) empower parents as primary caregivers

through comprehensive health education.

Objectives are being met through a mobile

medical van staffed by a full-time bilingual

pediatrician and a full-time bilingual regis-
73

tered nurse, who provide appropriate preventive and followup medical care; a bilingual health insurance counselor (who also

functions as secretary and driver); five fulltime, school-linked social workers; and a

comprehensive parent education program

(currently being developed).

Project for Attention Related Disorders

Phillip Nader, M.D.

San Diego Unified School District

2716 Marcy Avenue

San Diego, CA 92113

Project Number 068906

A school-community network will provide

diagnostic and intervention services for lowincome children and youth who exhibit

symptoms of attention-deficit disorder. The

network will include pediatricians, school

nurses, teachers, school administrative and

support personnel, after-school care

providers, community mental health and

medical clinic staff, and representatives from

parent advocacy groups. Professional education will include didactic sessions, written

guidelines and resource materials, and site

consultation for multicase review and problem solving. Interdisciplinary collaboration

will be stressed with the use of a common

data base and cross-discipline training.

Parental instruction will provide knowledge

of the causes and implications of attentionrelated disorders and will build those skills

needed to modify behavior and to facilitate

academic performance and social interaction.

Protocols for curriculum and classroom

modifications will be developed for local

and state distribution.

Brighter Tomorrows

Elisa Nicholas, M.D., M.S.P.H.

Long Beach’s Children’s Clinic

2801 Atlantic Avenue

P.O. Box 1428

Long Beach, CA 90801

Project Number 068904

International Elementary School, a multicultural public school serving low-income children, has developed a Family Center to meet

the needs of the school’s children and families. This project addresses the Center’s

health components and aims to (1) improve

immunization rates and lifestyle behaviors,

and (2) reduce illness from delayed diagnosis and care of treatable diseases. Services

include monthly immunization sessions; an

onsite clinic for screening, diagnosis, and

treatment services; and access to specialty

services at The Children’s Clinic and to a

nonprofit mental health clinic for evaluations

and referrals. 

Advocates for Children Project

Paul Russell, M.D.

Pediatric Diagnostic Center Associates

3400 Loma Vista Road

Ventura, CA 93003

Project Number 068913

The Advocates for Children Project provides

the first early intervention program to prevent child abuse in Ventura County. The 5-

year project will prevent child abuse and

neglect by (1) developing and implementing

an assessment protocol at the Ventura

County hospital via the creation of a fulltime Early Identification Worker position; 

(2) developing and implementing a community-based, home-visitation family support

system for-high risk families; and (3) promoting the involvement and coordinated participation of multiple public and private agencies

in focusing resources on families at risk.

Humboldt Healthy Families Collaborative

Project

Rebecca A. Stauffer, M.D.

Humboldt County Public Health

Department

712 Fourth Street

Eureka, CA 95501

Project Number 068606

This project intends to reduce child abuse

and neglect and the postneonatal death rate

to approach the Healthy People 2000 goals.

The project will (1) assess 90 percent of families giving birth each year through a uniform

risk summary tool and postpartum nurse

home visit, (2) identify risk factors for child
74

abuse and neglect, and (3) refer families to

appropriate home visiting services. It will

promote a standard for home visitation practice, including family-centered strengthsbased interventions and professional support

for home visitors. Systematic data collection

will identify gaps and needs in existing

home-based early intervention services.

COLORADO

Healthy Tomorrows for Denver

Jeffrey Brown, M.D., M.P.H.

Denver Health and Hospital Authority

660 Bannock, Third Floor

Denver, CO 80204

Project Number 088807

The goals of the Healthy Tomorrows for

Denver project are to (1) increase the number

of infants and children referred by the

Denver Department of Health and Hospitals

to Child Find, (2) increase the proportion of

families following through on recommended

treatment options, (3) increase utilization by

low-income and minority parents, and 

(4) create an automated tracking/management system. A case management system

will be implemented, and the project will

serve 850 families during its 5-year duration.

Healthy Start/Children’s Clinic

Barbara Hinson

Children’s Clinic

400 Remington

Fort Collins, CO 80524

Project Number 088801

The Children’s Clinic is dedicated to serving

the children of Larimer County who cannot

afford basic acute and preventive medical

services. The clinic seeks the support and

involvement of the community at large. It

will provide both direct medical care and

increased access to a broad referral base of

health and social services, always respecting

the right of every patient to quality health

care and human dignity.

CONNECTICUT

Healthy Tomorrows for New Haven

William Quinn, M.P.H.

New Haven Health Department

Gateway Center

54 Meadow Street, Ninth Floor

New Haven, CT 06519

Project Number 098112

This project aims to strengthen the existing

health resources at the elementary school–

and middle school–based clinic that is located in an economically depressed and geographically isolated area of New Haven. Its

purpose is to provide comprehensive health

care for at-risk children, including primary

pediatric services and mental health and

child development consultation. These services are offered to all children, including

newborns and preschoolers.

Prenatal-to-Pediatric Transition Project

Laurel Shader, M.D.

Fair Haven Community Health Clinic

374 Grand Avenue

New Haven, CT 06513

Project Number 098125

The Prenatal-to-Pediatric Transition Project

will (1) increase coordination among existing

health care resources in the community in

order to improve access to culturally sensitive prenatal and pediatric care and reduce

inappropriate use of emergency services,

and (2) provide enhanced bilingual and

bicultural health education, highlighting parenting skills, normal infant development,

proper nutrition, and preventive pediatric

care, including immunizations and anticipatory guidance.
75

DISTRICT OF COLUMBIA

Healthy Tomorrows Partnership for

Children

Yvette Clinton-Reid, M.D.

D.C. Commission of Public Health

D.C. General Hospital

Building #9, AG12—West Wing Fourth Floor

1900 Massachusetts Avenue, S.E.

Washington, DC 20003

Project Number 118339

This project promotes the concept of the primary health care home, wherein every child

has one provider who ensures continuity of

health care services. This can be accomplished through collaboration with hospitals

and private practices and through individual

empowerment relative to primary health

care and community-based services. These

community outreach goals include in-depth

and culturally sensitive health education

activities and appropriate assistance in

enabling parents to access the medical and

social service systems. Specific measurable

objectives include (1) continuous Medicaid

coverage for 90 percent of project participants for the duration of the project; (2)

immunization rates of 90 percent for children younger than 2 years old; and (3) lead

screening rates of 90 percent for children

who are at environmental risk.

Making Dreams Possible for Hispanic

Teens

Elida Vargas, M.A.

Mary’s Center for Maternal and Child 

Care, Inc.

2333 Ontario Road, N.W.

Washington, DC 20036

Project Number 118337

The goals of this project are to (1) develop a

system that links Hispanic adolescents in the

community to essential bilingual, community-based services that prevent pregnancies,

sexually transmitted diseases, and other

adverse health outcomes for adolescents,

and (2) provide bilingual, comprehensive

supportive services to 200 hard-to-reach

Hispanic pregnant adolescents and their

infants enrolled at Mary’s Center, with a

focus on the prevention of repeated pregnancies and adverse child health outcomes.

Mary’s Center will collaborate with The

Latin American Youth Center to provide

bilingual, culturally competent, communitybased, family-centered comprehensive services to Hispanic adolescents. Pregnant

adolescents and their infants will also

receive nutrition education, a six-part

“Strengthening the Family” series, home visits, developmental screenings and referrals,

and parenting training.

GEORGIA

Grady First Steps to Healthy Families

Sandra Browner

The Fulton-Dekalb Hospital Authority

Mail Box 26158

80 Butler Street

Atlanta, GA 30335-3801

Project Number 138412

The Grady First Steps to Healthy Families

project aims to decrease the risk of child

abuse and neglect in Atlanta’s inner-city

population by providing intensive, homebased services, including parenting education, emotional and social support, linkage

to community resources, and accessible

health care. The program will result in

healthier parenting practices and parentchild interaction, as well as a reduction in

the demand for hospital and community services relating to tertiary child abuse and

neglect interventions.

Improving Health Care Access for Hispanic

Families

Noemi A. Carcar, M.D.

Mercy Mobile Health Care

60 Eleventh Street

Atlanta, GA 30309

Project Number 138425

Hispanic children with special health care

needs and pregnant women in the Hispanic

community of metropolitan Atlanta lack

access to a coordinated system of pediatric

and prenatal care. Barriers to care are especially limiting for Hispanics who are recent

immigrants and have a limited English lan-
76

guage capability with which to learn about

available health care services. Each year this

project will (1) identify 50 Hispanic children

with special health care needs who require

assessment, treatment, and followup services; (2) improve awareness/usage of coordinated health care services by 50 Hispanic

families with children with special needs; 

(3) help 100 pregnant Hispanic women to

receive early prenatal care; and (4) improve

the cultural awareness and sensitivity of

health care providers regarding health issues

affecting Hispanic families.

The Cobb Healthy Futures Alliance

Virginia Galvin, M.D., M.P.H.

Cobb County Board of Health

1650 County Services Parkway, S.W.

Marietta, GA 30060

Project Number 138420

The Cobb Healthy Futures Alliance is a comprehensive, coordinated system of primary

health care for the medically indigent and

Medicaid-eligible children of Cobb County.

Developed as a result of a local planning initiative (Access to Health Care Task Force),

the project began to enroll children in

January 1993 and aims to enroll a minimum

of 3,000 children within 2 years. Partners in

this system include the Cobb County Board

of Health, the Kennestone Regional Health

Care System, the Department of Family and

Children Services, Cobb Hospital and

Medical Center, private sector physicians,

and parents of children who are eligible for

services within the framework of the project. 

HAWAII

Enhanced Community Health Options

Loretta Fuddy, A.C.S.W., M.P.H.

Maternal and Child Health Branch 

State of Hawaii Department of Health

741 A Sunset Avenue

Honolulu, HI 96816

Project Number 15938

The Ko’olauloa Healthy Tomorrows project

seeks to address system problems that currently exist and to improve access to child

health services for families residing in the

area. This goal will be realized through

increased and coordinated outreach services,

promotion of an integrated system of comprehensive health care, improved continuity

of care through home visiting, increased

paternal participation in accessing health

care, and provision of developmental/psychological assessments of at-risk children.

The project will work with the existing

health care system and the community to

provide a community-based, family-centered, comprehensive, and culturally relevant system of care.

Parent-Pediatric Partnerships

Jean Johnson, Dr.P.H.

Hawaii Department of Health

1600 Kapiolani Boulevard 

Suite 1401

Honolulu, HI 96814

Project Number 158902

This project is a partnership between families and their medical home to develop a

demonstration model for care coordination

for environmentally at-risk infants and toddlers in low-income, culturally diverse urban

and rural settings. The families are being

served as part of the eligible population

under Public Law 99–457, with an individualized family support plan being developed

for each family. The target population

includes many families of various ethnic 

origins.

IDAHO

Healthy Tomorrows Partnership Project

Heather Kemp, B.S.

YWCA of Pocatello

454 North Garfield

Pocatello, ID 83204

Project Number 168010

In Pocatello, unofficial reports by Intake and

Treatment Services indicate that 75 to 80 percent of reported cases of child abuse/neglect

involve some form of substance use. Project

goals are to (1) identify for services 30 clients

in year 1, 30 clients in year 2, and 30 clients

in year 3 from the at-risk target population;

and (2) provide home visitor services to
77

address the needs of substance-abusing parents. The program will emphasize early

identification and intervention, which will be

followed by intensive and prolonged visits

coupled with referrals to other local

resources. Home visits with each client/family will occur at a minimum of once a week.

Malheur Maternity Project

Hugh Phillips

Valley Family Health Care

1441 N.E. 10th Avenue

Payette, ID 83661

Project Number 168029

The Malheur Maternity Project will increase

access to comprehensive maternal and child

health care, provide individualized and continuous case management to pregnant and

postpartum women and their newborns, and

implement planned and systematic educational programs to stress the importance of

early and adequate prenatal and child care.

ILLINOIS

REACH Futures

Cynthia Barnes-Boyd, Ph.D., M.S.N., R.N.

University of Illinois at Chicago

Mile Square Neighborhood Health Center

Office of the Vice Chancellor for Health

Services

1737 West Polk, M/C 973

Chicago, IL 60612

Project Number 178507

REACH Futures is a 5-year innovative service project designed to prevent infant morbidity and mortality in a low-income

inner-city community. Trained community

residents, who are supervised by a maternal

and child nurse, will make home visits to

pregnant women and mothers with infants

to promote and maintain health. During the

project, the health-trained residents will

encourage community activities and the

development of peer support groups.

Evaluation will include comparisons of the

health outcomes with those of infants served

by previous projects.

Luz del Corazon

Donald J. Camp

Children’s Memorial Hospital

2300 Children’s Plaza

Chicago, IL 60614

Project Number 178502

The project will increase the accessibility and

use of bereavement services for Hispanic

families in the metropolitan Chicago area by

developing a program that is culturally sensitive and that can be easily replicated in the

Hispanic community. The goals of this project are to (1) develop culturally sensitive

modifications to a successful bereavement

program through formal and informal collaboration with Hispanic community representatives; (2) create evaluation tools that

document changes in the health status of

bereaved children and adults and thereby

assess program effectiveness; (3) implement

the program by refining program content,

training volunteers, and involving families

during the second year; and (4) secure longterm funding.

Pediatric Care for Infants of Parenting

Teens

Carol Rolland, Ph.D.

Pediatric Ambulatory Care Center

Illinois Masonic Medical Center

3048 North Wilton

Chicago, IL 60657

Project Number 178606

Child health and development will be

enhanced by providing needed information

and support to parenting adolescents. In a

well-child care group setting, infants will

receive pediatric care and young mothers

will participate in activities to facilitate

responsive mother-child relationships.

Central to the program is a plan for intensive

individual case management as well as linkage of the adolescent parents to communitybased comprehensive services. Evaluation

will focus on decreasing rates of emergency

room visits, hospitalization, and injury as

well as enhancing parents’ skill and 

competence.
78

Infant and Family Follow-Up Program

Karen Walsh, M.D.

University of Chicago

Woodlawn MCH Center 

950 East 61st Street

Chicago, IL 60637

Project Number 178531

The Infant and Family Follow-Up Program is

an early comprehensive health and social

intervention program for families to improve

the outcome for very premature, very-lowbirthweight babies and to encourage the

maximal function of these children later in

their lives. Parenting resources for these families through education and peer support

groups are known to be necessary components for effective care coordination. Care

coordination, therefore, is coupled with a

sturdy family support group that supports

and enhances parenting abilities to appropriately utilize social and health resources.

KANSAS

Healthy Children Project

Sechin Cho, M.D.

Wichita Primary Care Center

1125 North Topeka

Wichita, KS 67214-3199

Project Number 208006

Approximately 58 percent of the families

with children in target schools have an

annual income of $25,000 or less.

Approximately 33 percent of the children are

minorities—the largest group of which is

African American. The ultimate goal is to

increase the high school graduation rate.

Project goals are to (1) provide onsite comprehensive primary care services to improve

the physical, mental, and dental health status

of children attending middle and elementary

schools in the target area and, in the long

term, increase the graduation rate at West

High School; (2) motivate children and

extended families to adopt healthy lifestyles;

(3) teach children and families how to use

health care resources appropriately and

effectively; and (4) teach pediatric residents,

medical students, nurse practitioner students, and school nurses about school health,

community pediatrics, and multidisciplinary

team functioning.

KENTUCKY

Family Care Center Health Project

Doane Fischer, M.D.

Lexington-Fayette Urban County

Government

1135 Red Mile Place

Lexington, KY 40506

Project Number 218402

The Family Care Center offers comprehensive services to low-income families through

the integration of three onsite programs: 

(1) Developmental child care, (2) children’s

health services, and (3) parent education.

Primary health care services include acute

and preventive care, dental care, psychological services and speech, and physical and

occupational therapy. Transportation and

outreach programs of the clinic facilitate

access to health care as well as outside services for participating families. The outcome

of the project will be determined by examining the effects of services provided on access

to care, health status, and parenting behaviors. Through the coordinated efforts of all of

the programs, the Family Care Center strives

to help families overcome the barriers to

optimal health, overall well-being, and economic independence.

LOUISIANA

First Steps Primary Prevention Program

Jacinta Setton

Louisiana Council on Child Abuse

343 Third Street

Suite 510

Baton Rouge, LA 70801

Project Number 228613

This initiative has established a hospitalbased program that seeks to reduce the

stress experienced in the early weeks and

months following childbirth for first-time

and adolescent parents, with the goal of

replicating the program statewide.

Emotional support and education during the

postpartum stay are offered by trained vol-
79

unteers; information on early childhood

development and stress prevention is disseminated; and followup continues for 3

months after childbirth. In addition, this program has provided training and networking

opportunities for public health nurses and

has sponsored a statewide education conference for service providers.

MAINE

Homeless and At-Risk Youth Health

Services

Nathan Nickerson, N.P.

City of Portland

Public Health Division

389 Congress Street, Room 305

Portland, ME 04101

Project Number 238639

Project goals are to (1) address personal

issues that impair individual homeless and

at-risk youth from functioning within their

families or independently in the community,

(2) change environmental conditions that

provide barriers to their health and wellbeing, and (3) identify systemic problems

that impede a youth’s ability to achieve optimal wellness. The project will (1) expand its

homeless Youth Clinic, (2) hire a nurse coordinator, (3) establish a partnership with a

local hospital to provide free ancillary services, (4) recruit volunteer resident interns

and attending pediatric physicians to

increase clinic hours, and (5) provide salient

inservice education to homeless and at-risk

youth service workers.

Pediatric Partnership to Protect Children in

Rural Maine

Lawrence Ricci, M.D.

The Spurwink Clinic Child Abuse Program

17 Bishop Street

Portland, ME 04103

Project Number 238623

The project goal is to reduce (1) the prevalence of abuse reports in Knox and Kennebec

Counties by 10 percent over 5 years, and (2)

the substantiation rate of recurring abuse

among all families served by the project by

50 percent. Objectives are to (1) provide

diagnostic and treatment services to 300 children from 200 families per year, (2) decrease

domestic violence in the households of

referred children, (3) increase the positive

interactions between children and their parents, and (4) increase the skills and knowledge of ancillary health professionals in the

rural communities.

MARYLAND

Healthy Tomorrows Program for Children 

Martha Gardiner, B.S.N., R.N.

Spanish Catholic Center, Inc.

1015 University Boulevard

Silver Spring, MD 20903

Project Number 248618

The major goals and principal objectives of

the project include improving the health status of Hispanic children in the community

by (1) expanding services at the Spanish

Catholic Center (SCC) clinic and promoting

access to primary care, (2) screening and

referring 50 children with development

delays, and (3) increasing the access to care

for working families through Saturday clinics. Within the first year of the initiation of

this program, one full-time pediatrician and

one full-time registered nurse will be added

to the SCC staff.

Families in Transition

Wayne Holden, Ph.D.

Western Health Center

700 West Lombard Street, Second Floor

Baltimore, MD 21201

Project Number 248327

Health care for homeless children in

Baltimore suffers from a paucity of resources

targeted specifically to their needs. That such

resources are necessary is evidenced by literature suggesting that these children have

(1) an increased prevalence and severity of

health problems; (2) substantially decreased

opportunities for preventive health care; and

(3) competing parental and family needs that

make preventive care a low priority. The

Comprehensive Health Care for Homeless

Children in Baltimore program will employ

a focused but wide-ranging interdisciplinary
80

approach that allows for identification and

treatment of the medical, psychosocial, and

environmental needs of the child and family.

Healthy Tomorrow’s Parenting Program at

CAP

Lauren M. Jansson, M.D.

Center for Addiction and Pregnancy

Johns Hopkins Bayview Medical Center

4940 Eastern Avenue, D3C

Baltimore, MD 21224

Project Number 248326

This project aims to (1) improve parenting

skills among a population of substance-abusing women, (2) facilitate mother-infant communication, (3) enhance maternal

appreciation of normal child development,

thereby negating unrealistic expectations,

and (4) improve the cognitive, emotional,

and social development of drug-exposed

children.

MASSACHUSETTS

The Deaf Family Clinic

Stephan R. Glicken, M.D.

New England Medical Center

750 Washington Street

NEMC Box 471

Boston, MA 02111

Project Number 258116

In eastern Massachusetts, children who are

deaf or hard of hearing, or whose parents

are deaf or hard of hearing, lack access to

linguistically and technologically appropriate sources of pediatric care. This 5-year

Deaf Family Clinic project will (1) improve

the access of target families to all aspects of

the health care system; (2) improve the

health status of children who are deaf or

hard of hearing, or whose parents are deaf

or hard of hearing; (3) improve the level of

patient and parent satisfaction with the pediatric care delivery system; (4) enhance families’ understanding of their children’s

medical problems and improve their management abilities; and (5) improve access to

and satisfaction with adjunctive treatments

such as mental health services.

Mothers’ Mentors

Margaret Henderson, M.A.

Networking for Life/Project Mattapan

The Medical Foundation

95 Berkely Street

Boston, MA 02116

Project Number 258124

The Mothers’ Mentors project will address

the rates of infant mortality and low birthweight in the three predominantly lowincome, inner-city Boston neighborhoods

with the highest risk of poor pregnancy outcomes. It will do so by ensuring that pregnant and parenting women have access to

needed services. Specifically, the project will

ensure that (1) at least 98 percent of project

participants identify and secure needed preventive health services and benefits (including prenatal, perinatal, pediatric, and family

support); (2) 100 percent of all infants

enrolled in the project obtain developmental

screenings; and (3) 100 percent of project

participants enhance their parenting and

nurturing skills.

Project Healthy Asian Teens (PHAT)

Esther H. P. Lee, R.N.

Family Life Center, South Cove Community

Health Center

145 South Street

Boston, MA 02111

Project Number 258672

This project seeks to serve Chinese,

Cambodian, and Vietnamese immigrant and

refugee youth by (1) decreasing the barriers

they face in accessing primary health care

services, (2) promoting awareness of the

need for primary health care and healthy

lifestyles, and (3) increasing access to primary health care services through screenings

and followup. Objectives include (1) the use

of focus groups to determine the youths’

health needs, barriers to care, and motivation to seek health care, and (2) a 50-percent

increase, over the course of 5 years, in the

number of youth using primary health care.
81

Injury Prevention for Pregnant and

Parenting Teens

Rebecca O’Brien, M.D.

Division of General Pediatrics and

Adolescent Medicine

750 Washington Street

Boston, MA 02111

Project Number 258123

A home visiting model to reduce the risk of

injuries in a high-risk population of children

of adolescent parents will be implemented

and evaluated. The introduction of a home

visitor into a comprehensive program for

pregnant and parenting adolescents is

expected to improve outcomes and compliance with medical visits, including prenatal

care, routine child health care, health status,

and safety of the children. Duplication of the

model and expansion of services to pregnant

and parenting adolescents at 10 community

health centers in high-risk neighborhoods of

Boston will occur during the project.

Project SEED

Joan Pernice, M.S.

Dimock Community Health Center

55 Dimock Street

Roxbury, MA 02119

Project Number 258002

Informal reports from the Boston Public

School system state that 25 to 30 percent of

children entering school are not ready. The

project goal is to ensure that young children

are developmentally and educationally prepared to enter school. To reduce the risk of

affective, behavioral, and cognitive delays, a

family-centered, multidisciplinary, culturally

competent developmental practice will be

integrated into a pediatric health care system. The integration of a family advisor into

the pediatric, primary care multidisciplinary

team will provide the essential link between

the family, the community, and health care

providers. During a 5-year period, school

readiness skills will increase from 70 to 85

percent.

Preschool Asthma Education Project

Suzanne F. Steinbach, M.D.

Boston Medical Center 

Department of Pediatrics

818 Harrison Avenue

Boston, MA 02118

Project Number 258134

The goal of the Preschool Asthma Education

Project is to reduce the excessive morbidity

experienced by young inner-city children

with asthma who are enrolled in a Head

Start program. Objectives include (1) increasing asthma care knowledge among participating parents and teachers, (2) increasing

asthma preventive-care visits to primary care

providers by the enrolled asthmatic children,

and (3) reducing excess health care use

(emergency room treatment and hospitalization) among enrolled asthmatic children. The

project physician will provide comprehensive training to the team of Head Start nurses regarding pediatric asthma and project

implementation.

Pediatric Family Violence Awareness

Project

Bonnie Tavares

The Commonwealth of Massachusetts

Department of Public Health

250 Washington Street

Boston, MA 02108-4619

Project Number 258101

The Pediatric Family Violence Awareness

Project will (1) improve pediatric identification of child and maternal victims of family

violence through educational interventions;

and (2) increase access to an innovative pediatric service, the Boston Floating Hospital for

Infants and Children Family Advocacy

Clinic, which conducts comprehensive

health and psychosocial evaluations of children and provides safety planning and

advocacy services to their mothers.
82

MICHIGAN

Center for Healthy Beginnings

Molly Kaser, R.N., M.P.H.

Center for Family Health, Inc.

817 West High Street

Jackson, MI 49203

Project Number 268515

The goal of the center is to reduce the infant

mortality rate in Jackson County by providing prenatal care access to a population that

is approximately 90-percent Medicaidinsured. Services available at the center

include the Special Supplemental Nutrition

Program for Women, Infants and Children

(WIC), perinatal substance abuse treatment,

and dietitian services. The center has a

strong partnership with its local hospital and

other providers of health and human services.

Madres y Ninos Colonia Health Program

Rosamaria Murillo, L.M.S.W. 

Midwest Migrant Health Information 

Office, Inc.

502 West Elm Avenue

Monroe, MI 48161

Project Number 268007

The women and children in the Hispanic

colonias are incapable of accessing health

care services because of language difficulties,

poverty, physical isolation, lack of transportation, fear of professional health

providers, and misconceptions about routine

health exams and procedures. Project goals

are to increase (1) the residents’ knowledge

of health issues and available health

resources, and (2) the mothers’ and children’s access to needed health services.

Health workers will be used to facilitate project goals. Evaluation methods include questionnaires and health assessment forms.

Collaborative Developmental Clinic

Marsha D. Rappley, M.D.

Michigan State University, College of

Human Medicine

Department of Pediatrics and Human

Development

B-240 Life Sciences Building

East Lansing, MI 48824-1317

With the goal of affecting school-related

behavior and learning problems, the clinic

will bring together a pediatrician, a child

psychologist, and a school consultant to provide comprehensive evaluation and treatment. The focus will be family oriented, and

interventions will be designed to address

children’s educational, psychological, and

medical needs. Factors contributing to the

poor representation of lower socioeconomic

families will be examined. Another goal will

be enabling the model of collaboration

between community medical and educational institutions to become economically viable

over the funding period.

Consultation Services for Children with

Severe Chronic Illness

Jane Turner, M.D.

Michigan State University, College of

Human Medicine

Department of Pediatrics and Human

Development

B-240 Life Sciences Building

East Lansing, MI 48824-1317

Project Number 268509

In Michigan, children with severe chronic illness, representing 35,000–50,000 children in

the state, are frequently unable to obtain

access to effective primary health care services. This project will increase access to care

and improve the health status of these

severely ill children by providing annual

comprehensive assessments that include

family involvement in the development of

Individual Health Plans and identification of

appropriate support services for implementation by the child’s primary care physician.

Evaluation of process and outcomes for the

physician, child, and family will be carried

out with a variety of objective measures.
83

MINNESOTA 

Partnership Project

Donna Zimmerman, M.P.H.

Health Start, Inc.

640 Jackson Street

St. Paul, MN 55101

Project Number 278516

The goals of this project are to (1) facilitate

the development of secure mother/infant

attachments, and (2) minimize closely spaced

pregnancies within the client population.

This population is composed of mothers

who are at risk for having multiple problems

in parenting and who demonstrate a need

for and an ability to benefit from the project’s services. These services include case

management, home visits, pediatric health

care, support groups, and nutrition and family planning services. Intervention efforts

will begin in the last 4 months of each

woman’s pregnancy and will continue for

2.5 years.

North Star Elementary School-Based

Community Health Center

M. Kathleen Amble, M.A., R.N.

Minneapolis Department of Health and

Family Support

Public Health Center

250 Fourth Street South 

Minneapolis, MN 55415-1372

Project Number 278538

This elementary school–based primary care

clinic serves students, their families, and

community residents in the near-north community of Minneapolis with the goal of

improving the health and educational status

of the community’s families and children.

Through multidisciplinary and multiagency

approaches, the clinic provides comprehensive health and social services, which have

been scarce in this diverse, underserved

community.

Air Care

David Aughey, M.D.

Minneapolis Children’s Health Care

Teen Age Medical Service

2525 Chicago Avenue South

Minneapolis, MN 55404

Project Number 278510

The project’s overall objective is to improve

the health status of inner-city children (especially minority children) who have severe

asthma. Specially designed interview and

assessment tools will be piloted with a group

of six children. The protocols and curriculum

prescribe at least 1 year of intensive and frequent home visits by the asthma home care

nurse. A computerized data base will assist

in tracking the progress of each child and the

eventual cohort of 25 children toward selected outcome objectives.

Establishment of Habitat Health Services

Barbara Elliott, Ph.D.

Duluth School of Medicine

Department of Family Medicine

10 University Drive

Duluth, MN 55812

Project Number 278009

Habitat, a Duluth Public Schools’ alternative

high school track, provides a parenting class

for adolescent mothers and in-school child

care for their infants and toddlers. Unity

High School, an alternative program for students with behavior or emotional problems,

has some students who are single mothers

with young children. Project goals are to 

(1) improve the overall health of Unity and

Habitat adolescent mothers and their children; (2) improve their access to, continuity

of, and completeness of medical care; 

(3) reduce the number of infant and toddler

emergency department visits in this population; and (4) provide a realistic one-on-one

adolescent and small-child care teaching 

setting for medical and nurse practitioner

students.
84

MISSISSIPPI

Cary Christian Health Center

Patricia Thomas

The Luke Society, Inc.

P.O. Box 57

Cary, MS 39054

Project Number 288404

The Sharkey-Issaquena Health Alliance is a

5-year program designed to lower infant

mortality in the poverty areas of rural

Mississippi. The project uses an alliance of

volunteers, providers, and civic institutions

to provide a five-pronged solution.

Community volunteers are trained to provide home visits and promote greater health

awareness. Transportation is provided to

health facilities and perinatal education is

made available to parents. Education of

young people is provided to combat adolescent pregnancy. Child abuse prevention and

recognition education are provided.

MISSOURI

Family Friends

Edward Hoffman, M.D.

The Children’s Mercy Hospital

2401 Gillham Road

Kansas City, MO 64108

Project Number 298719

This project will implement a comprehensive, family-centered program to decrease

the prevalence of disabilities and infant mortality. Objectives include (1) developing linkages between the community and health care

agencies to strengthen their ability to

enhance health outcomes for children where

substance abuse is a problem, (2) assisting 20

families per year through weekly visits by a

trained visitor who is a community member,

(3) ensuring regular visits and immunizations for each child or adolescent, (4) decreasing by 50 percent the repeat pregnancies among participating women within 18

months of delivery and increasing the birthweight of infants born to women who

become pregnant during the project period,

and (5) decreasing the incidence of child

abuse in the population through a 70-percent

decrease in the abuse risk factors of participating families and a 20-percent increase in

their level of parenting skills.

NEBRASKA

Rural Partnership for Children

Frederick A. McCurdy, M.D.

University of Nebraska Medical Center

Department of Pediatrics

600 South 42nd Street

Omaha, NE 68198-2165

Project Number 318717

Complementing the health care provided by

local family physicians, this project seeks to

improve access to community-based pediatric consultative care for children with special health needs in four rural counties in

northwest Nebraska. Monthly, rotating,

pediatric consultation clinics, which move

among four sites to enhance geographic

access, allow a team of pediatricians, behavioral psychologists, and a nutritionist to see

children with chronic or recurrent illnesses

who are referred by local providers. This

team confirms diagnoses, recommends treatment, and develops, with the family, a coordinated, comprehensive health plan for the

children served. In addition, an advocacy

coordinator works with the providers, the

families, and the team on issues of outreach

and followup.

NEW HAMPSHIRE

Seacoast HealthNet

Gwendolyn Gladstone, M.D.

212 North Haverhill Road

Exeter, NH 03833

Project Number 3380048

Project goals are to (1) improve access to

health care services by addressing the financial and nonfinancial barriers that exist for

the target population; (2) increase the

involvement of parents in their own education and awareness of child health needs; 

(3) increase the awareness and use of preventive wellness services and activities currently available to low-income families in

their communities; (4) reduce the number of
85

injury admissions and admissions treatable

through ambulatory care, and educate physicians in optimal patient management of

medical conditions that result in frequent

hospitalizations; and (5) develop communitywide coordination and integration around

health education initiatives.

NEW JERSEY

Trenton Loves Children (TLC) Home

Visiting Project

Sunday Parker, R.N., M.P.H.

City of Trenton 

Department of Health and Human Services

222 East State Street

Trenton, NJ 08608

Project Number 348623

This project seeks to (1) improve the health

and well-being of families with infants and

young children by tracking health measures

and providing in-home assessment, education, and support for appropriate use of primary health care and essential social support

services; and (2) reevaluate the role of the

local public health agency in response to the

impending changes in health care and the

move to managed care in New Jersey by

working with the state agencies for Health

and Human Services. Health outcome measures (prenatal visits, gestational age, birthweight, immunization status by age 2, lead

screening, developmental assessments,

vision and hearing testing) will be improved

for infants, children, and families participating in the project.

NEW MEXICO

The Puentes Program

Naomi Hannah

Presbyterian Medical Services

P.O. Box 30

1219C Gusdorf Road 

Taos, NM 87571

Project Number 358626

The Puentes Program seeks to (1) provide

the means for adolescent parents to develop

improved health and safety practices for

themselves and their babies, (2) support adolescent parents in developing positive childrearing practices, and (3) increase possibilities of long-term self-sufficiency for

adolescent parents. The program will identify first-time pregnant adolescents through

referrals from various entities in the community. Intergenerational support and community involvement will be encouraged

through documentation and communication

of traditional Hispanic and Native American

health and parenting practices.

Healthy Families Santa Fe

Robin Lackey, M.S.W., L.I.S.W.

605 Letrado Street

Santa Fe, NM 87505

Project Number 358626

There is a high incidence of child abuse and

neglect in Santa Fe County that is due to a

lack of parenting skills; inadequate knowledge of early childhood development; isolation; and a lack of knowledge of and access

to community resources. Santa Fe First Steps

will reduce child abuse and neglect in Santa

Fe County by (1) disseminating early childhood development information and community resource information to all mothers

giving birth; (2) providing early identification of parents who are at risk for maltreating their children; (3) making periodic home

visits to parents at risk for maltreating their

children; and (4) sharing aggregate data

regarding numbers of at-risk parents with

public and private agencies, as well as state,

city, and county officials and the general

community, to improve allocations of funds

for child abuse and neglect prevention 

programs.

Helping Indian Children of Albuquerque

Katherine Mariano, M.S.

All Indian Pueblo Council, Inc.

3939 San Pedro, N.E., Suite D

P.O. Box 3256

Albuquerque, NM 87190

Project Number 358633

The first goal of this project is to improve

access to and use of health care and related

resources by urban Indian children and their
86

families. The second goal is to improve the

health status, functional ability, and developmental capability of urban Indian children

with limiting conditions and special needs.

This long-term health status goal, relevant to

Healthy People 2000 objectives, relates

directly to problems inherent in the current

health system (e.g., inadequate access to and

utilization of services).

NEW YORK

Preventive Primary Services for Substance

Abusing Families

Karen Blount, R.N.

Children’s Hospital at Buffalo

219 Bryant Street

Buffalo, NY 14222

Project Number 368209

This 5-year project provides comprehensive

services to drug-exposed children and their

families. The ultimate purpose of this project

is to decrease morbidity/mortality in both

the children and their families by keeping

families together and optimizing outcomes

for the children. The project increases the

likelihood that these families will access services through its use of trained, culturally

sensitive, nondrug-using women to provide

home-based intervention, advocacy, and role

modeling, and through a center-based “onestop shopping” model for primary pediatric

health care. Linkages to multiple social service agencies in the community (Child

Protection Services, foster care, early intervention programs, day care, drug treatment)

have been established with the PACT

Program to streamline service delivery to

target families.

Fostering Improved Health Status for

Foster Care Children

Michael Henrichs, Ph.D.

Kids Adjusting Through Support, Inc.

600 East Avenue

Rochester, NY 14607

Project Number 368218

This project develops (1) support groups for

foster care children and their families, and 

(2) programs for families in which a family

member has a life-threatening illness or has

died. Children’s groups are led by mental

health counselors and are organized by age

groups. Foster parent groups meet simultaneously to assist parents in dealing with

such issues as child behavior, limit setting,

value systems, and forming attachments

with their foster children. These support

groups are led by volunteers and meet weekly for 10 weeks. Project staff conduct preparticipation and postparticipation evaluations

to track the project.

Pediatric Comprehensive Asthma

Management Program

David J. Valacer, M.D.

The New York Hospital–Cornell Medical

Center

Division of Allergy, Immunology, and

Pulmonology

525 East 68th Street, J-116

New York, NY 10021

Project Number 368214

The Pediatric Comprehensive Asthma

Management Program at the Women and

Children’s Health Center of Western Queens

has been established to provide specialty

evaluation and long-term followup care to

children with moderate to severe chronic

asthma. The major goal of this program is to

reduce asthma emergency room and hospitalization rates to a level commensurate with

those of higher income communities in metropolitan New York City, by providing lowincome patients with equal access to

specialty medical care and 24-hour advice 

as well as respiratory health education 

programs.

NORTH CAROLINA

Mental Health Treatment for Sexually

Abused Children

Thomas Frothingham, M.D.

Duke University Medical Center

Center for Child and Family Health

4020 North Roxboro Road

Durham, NC 27704

Project Number 378405

Sexually abused children often have poor
87

mental health. In north central North

Carolina, access to appropriate mental health

services fails for more than half of the children identified as sexually abused. This 5-

year project will improve access to

appropriate mental health services as well as

the mental health and behavioral status of

these children and their caretakers.

OHIO

Toledo Healthy Tomorrows

Bernard J. Cullen, M.D.

Toledo Hospital

2142 North Cove Boulevard

Toledo, OH 43606

Project Number 398536

This project seeks to reduce the incidence of

child abuse and neglect among children of

adolescent families participating in the program. The outcome objective is to reduce the

need for children participating in the project

to be referred to children’s services for possible abuse or neglect, so that close to 0 percent of participants require referral during

the project period. The project’s impact

objectives for program participants are 

(1) improvement in parent-child interaction

skills shown by 80 percent of families, (2) at

least nine well-baby visits by 70 percent of

children by age 24 months, and (3) completion of age-appropriate immunization schedules by 75 percent of children by age 2.

Healthy Tomorrows/CFHS Pediatric

Tracking Program

Edward F. Donovan, M.D.

University of Cincinnati College of Medicine

Department of Pediatrics

Medical Sciences Building, Room 6253

231 Bethesda Avenue

Cincinnnati, OH 45229

Project Number 398511

The goals of the Cincinnati Healthy

Tomorrows program are to improve (1) child

health outcomes in three contiguous, innercity neighborhoods for infants born to

women with poor prenatal care, and (2) the

outcome of subsequent pregnancies. Specific

aims are to (1) significantly increase utilization of well-child care, (2) significantly

reduce infant mortality, (3) reduce emergency room and postneonatal hospitalization, (4) decrease the low-birthweight rate

for subsequent pregnancies, and (5) reduce

the cost of care for children and their mothers by implementing specific preventive

health care strategies.

Collaborations for Healthier Children

Debbie Wilson, R.N.

Good Samaritan Medical Center

800 Forest Avenue

Zanesville, OH 43701

Project Number 398528

Children from indigent families living in

rural southeastern Ohio often lack available

and consistent access to primary health care.

These underserved children often have inadequate well-child checkups, developmental

screenings, immunizations, and followup

treatment. This 5-year project will (1) establish an advisory board composed of representatives from the health departments of

the six counties served by the Pediatric WellChild Clinic; (2) improve access to health

care for all indigent children ages newborn

to 5 years in the project’s six-county service

area; (3) improve the coordination, quality,

and continuity of care in the delivery of

medical, nursing, social, and educational services provided to the target population; and

(4) increase the availability of support services to adolescent parents.

OREGON

Latino Medical Access Coalition Well Child

Care Project

Jeannette M. Brooke, M.S.

PeaceHealth Medical Group

1162 Williamette Street

Eugene, OR 97401

Project Number 418622

This project will initiate a nurse-based wellchild care program to help meet the immediate clinical preventive service needs of

Latino children ages newborn to 6. As a

long-term solution, the coalition plans to

help build the physician community’s capac-
88

ity to offer culturally competent pediatric

practices and to capitalize on the prenatal

clinic’s trusted position in the Latino community by providing onsite education to its

Latino clients about the proper use of the

health care system and the importance of

establishing a medical home for their infants.

Kids’ Clinic

Barbara Arnold, B.S.N.

Eugene School District Clinics

200 North Monroe

Eugene, OR 97402

Project Number 418017

Many students (grades K–8) in the Eugene

School District are without health insurance

or Medicaid coverage and use the hospital

emergency room for care when medical

attention is necessary. This project will give

these students access to the school-based

health clinics already established in two area

high schools. School nurses will refer students and their families to the clinic; volunteers and district staff will provide

transportation; and a nurse practitioner will

see eligible students. Students needing further care will be referred to an established

network of physicians, hospitals, or other

providers who have agreed to provide free

care. The growing number of Hispanic families will receive culturally sensitive care from

bilingual clinic staff and will also receive

printed materials in Spanish.

PENNSYLVANIA 

Ken-Crest Centers

Mary Ellen Caffrey, Ph.D.

Philadelphia Children’s Services

3132 Midvale Avenue

Plymouth Meeting, PA 19129

Project Number 428305

This 5-year project is designed to treat medically fragile, technology-dependent children

(birth to 5 years) in the community near their

home. The project aims to (1) sustain or

improve the medical conditions of these children; (2) provide for their developmental

needs; and (3) teach the parents to foster

their child’s health, growth, and development. Children have an individually tailored

health plan and receive developmental and

educational treatment in a community-based

center. Collaboration with parents is ongoing, and children are mainstreamed when

possible.

Health Care for Children in Foster Care

Mary Carrasco, M.D.

Children’s Hospital of Pittsburgh

3705 Fifth Avenue at DeSoto Street

Pittsburgh, PA 15213-2583

Project Number 428319

This project is dedicated to coordinating primary health care delivery and monitoring

500 children who are ages 6 years or

younger and live in homeless shelters or are

in foster care. Staff provide case management services through the hospital and

develop individualized health care plans for

each child. Assistance is also provided to

link children with permanent medical

homes.

Project Caring

Charles P. LaValle

Western Pennsylvania Caring Foundation

500 Wood Street, Suite 600

Pittsburgh, PA 15222

Project Number 428308

Project Caring is designed to promote family-centered, community-based care for

chronically ill children of the working poor.

A registered nurse provides care coordination services for 80 chronically ill children

and their families. These services and a continuing medical education program are

intended to facilitate an increased role for

the primary care provider in managing care

for special needs children. This project will

assist the Pennsylvania Department of

Health in identifying the prevalence of

chronic conditions and the obstacles to

obtaining care and in developing a statewide

program of care coordination.
89

Family Growth Center Pilot Project

Richard Solomon, M.D.

Allegheny-Singer Research Institute

320 East North Avenue

Pittsburgh, PA 15212

Project Number 428321

The goal of this project is to use an integrated primary prevention approach to promote

the health and development of at-risk adolescent and young parents and their children. To achieve this goal, the project

increases the parents’ social supports and

enhances their parenting abilities through

hospital-based perinatal coaching and by

linking selected families with a Family

Growth Center. These centers feature a dropin/drop-off child care program and familyoriented social recreation programs; they

also provide additional support services,

such as a parent support group, parenting

skills workshops, and a home-based involvement program for newborns and mothers.

PUERTO RICO

Cofani Medical Home of Coamo

Luisa I. Alvarado, M.D.

49 Florencio Santiago Street

Coamo, PR 00769

Project Number 728004

In Coamo, Puerto Rico, children with special

needs lack primary preventive health services by qualified pediatricians; have poor

access to diagnosis, consultation, and treatment services by specialists; and lack the

coordination and followup needed to manage their complicated medical and developmental problems. Project goals are to (1)

develop a family-centered medical home to

provide quality pediatric primary care services, referrals, followups, and continuity of

care to children with special needs; (2) provide developmental and behavioral consultation services onsite; (3) collaborate with

other concerned agencies and organizations;

and (4) educate other professionals in the

field to improve the quality and timing of

their services.

Centro Pediatrico De La Lactancia y

Crianza, Inc.

Desiree Pagan, M.D.

Ashford Presbyterian Community Hospital

1357 Ashford Avenue, #304

San Juan, PR 00907-1403

Project Number 728001

Although current rates have not been studied, in 1982, the number of children totally

breastfed at the age of 1 month was less than

4.5 percent for children born in both public

and private hospitals in Puerto Rico. Project

goals are to (1) increase the breastfeeding

rates in the low-income families of the San

Juan Health District by at least 100 percent

over the measured baseline, and (2) improve

the health status, functional ability, and

developmental capability of these medically

indigent infants. The baseline will be established by contacting a representative sampling of women who have delivered in one

public or one private hospital and asking

them questions related to their infant-feeding choice and the support they received.

RHODE ISLAND

Foster Children’s Assessment, Referral and

Care Coordination Project

Monica Schaberg, M.D., M.P.H.

Emma Pendleton Bradley Hospital

1011 Veterans Memorial Parkway

E. Providence, RI 02915

Project Number 448132

The goal of this project is to plan and develop a permanent system of foster children’s

assessment, referral, and medically indicated

care coordination that will ensure all foster

children of a medical home that delivers (1)

preventive, diagnostic, and therapeutic care;

(2) appropriate referral (and followup) for

special medical, developmental, mental

health, and inpatient services; and (3) referral to a qualified provider of comprehensive

care coordination for medically indicated

social services.
90

SOUTH CAROLINA

The Second Chance Club

Janice D. Key, M.D.

Medical University of South Carolina

171 Ashley Avenue

Charleston, SC 29425

Project Number 458422

Parenting adolescents and their infants are at

increased medical, developmental, and social

risk. A second pregnancy during adolescence further increases that risk. The Second

Chance Club will provide family-centered,

multigenerational peer education intervention for parenting adolescents and their families, coordinated with medical care in a

school-based clinic. Trained peer educator

interventions will take place both in participants’ homes and in the school. The project

will decrease the repeat adolescent pregnancy rate by (1) increasing effective contraception use, and (2) increasing and improving

family discussion and knowledge of sexuality and family planning.

TEXAS

COPC Family-Focused Strategy

Laurie Dekat, M.D.

Dallas County Hospital District

6263 Harry Hines Boulevard, Suite 402

Dallas, TX 75235

Project Number 488611

The purpose of this project is to develop and

demonstrate effective intervention strategies

for the 10- to 15-year-old age group that can

be carried out within a school-based comprehensive health care system to reduce the

occurrence of premature and unprotected

sexual intercourse in adolescents. More than

300 10-year-old children and their parents

have been enrolled to receive annual health

maintenance evaluations and a series of

activities to enhance parent-child communication, parental knowledge of adolescent

social and sexual development, and problem-solving and decision-making skills.

Pediatric Clinic for Denton County

Melinda Mashburn, R.N., M.S.N., P.N.P.

Cook Children’s Community Clinics

505 South Locust Street

Denton, TX 76201

Project Number 488630

The Pediatric Clinic for Denton County provides well-child and sick-child care to lowincome Medicaid-eligible children. The

project uses pediatric nurse practitioners to

demonstrate a replicable method of delivering comprehensive, family-oriented pediatric

services with the goal of decreasing unnecessary emergency room visits, providing casemanaged pediatric care, improving

immunization rates, and proving the costeffectiveness of the system.

Health Education and Literacy Partnership

Alice Pita, M.D.

City of Dallas 

Department of Health and Human Services

1500 Marilla Street

Dallas, TX 75201

Project Number 488606

The Health Education and Literacy

Partnership is a coalition of professionals in

the fields of health (Dallas Department of

Health and Human Services), education

(Dallas Independent School District, Dallas

County Community College District), and

literacy (Dallas Public Library, Dallas

County Adult Literacy Council). Concerned

about the effect of illiteracy on health care

choices, this project will (1) increase access to

health and social support services for highrisk mothers and their children, (2) identify

barriers to access for high-risk families, 

(3) increase the literacy rate among high-risk

mothers and the emergent literacy of their

children, and (4) increase awareness among

pediatricians and community members of

the importance of emergent literacy and parents’ role in the early educational process.
91

School Based Health Center Project

Carmen Rocco, M.D.

Brownsville Community Health Center

2137 East 22nd Street

Brownsville, TX 78521

Project Number 488615

This project offers comprehensive health care,

including medical care, health education, case

management, and counseling, tailored to the

unique needs of adolescents. The service area

of the Teen Clinic in Brownsville is primarily

Hispanic, and nearly half the population lives

in poverty. Clinic providers strive to have an

impact on the risk-taking behaviors of the

adolescents they see—specifically, activities

that result in unintended pregnancies and

failure to graduate from high school. Each

adolescent receives an in-depth risk assessment, with appropriate referrals and counseling as the primary intervention.

PediPlace

Cassandra Rochon-Bailey, R.N., M.S.,

C.P.N.P.

PediPlace, Inc.

502 South Old Orchard, Suite 126

Lewisville, TX 75067

Project Number 488627

Children of low-income and Medicaid families and insured families who cannot meet

out-of-pocket expenses lack access to all but

emergency care in southern Denton County.

PediPlace will serve this population through

pediatric nurse practitioners as primary caregivers, with local volunteer pediatricians

providing call support and consulting service. The goal is to provide a medical home

to 1,200 children while demonstrating that a

project of this type can be cost effective and

eventually self-supporting.

Project First Step

Susan Spalding, M.D.

Parkland Memorial Hospital, COPC

6263 Harry Hines Boulevard, Suite 405 

Dallas, TX 75235

Project Number 488621

This project aims to reduce infant mortality

and morbidity in targeted areas of Dallas

County by improving the health status of

medically indigent, low-birthweight infants.

Four geographically targeted low-birthweight clinics provide services one to three

times a month, and staff work to ensure that

all eligible infants have access to this quality

health care. Public health nurses serve as

case managers, and home visits are conducted by the staff as appropriate.

VERMONT

Peoples’ Co-op Doulas: A

Prenatal/Parenting Peer Support Program

Calvin Robinson

Minority Business Association

64 North Street

Burlington, VT 05401

Project Number 508651

This community-based project (1) provides

health education and support for expectant

and new parents in the Old North End who

are not being reached by the existing professional outreach system, (2) improves birth

outcomes and infant health for this population, and (3) coordinates more consistent

pediatrician involvement with the target

population so that the pediatricians are better able to provide culturally relevant pediatric care. An MCH nurse directs this project.

VIRGINIA

Comprehensive Health Investment Project

of Abingdon

Robert G. Goldsmith, M.A.

People Incorporated of Southwest Virginia

1173 West Main Street

Abingdon, VA 24210

Project Number 518008

The program goals are to (1) provide an

additional 60 children, ages newborn to 6

years, and 20 pregnant women in

Washington County and Bristol, VA, with

access to a comprehensive, coordinated community-based network of health and family

support services; (2) improve the health status of these low-income pregnant women

and children by providing health and social

case management services, resulting in a
92

comprehensive health care and family assistance plan; (3) promote parental involvement

as an integral part of each child’s health and

welfare, development, and education; and

(4) assist families in moving toward self-sufficiency and empowerment.

WISCONSIN

Teen Pregnancy Service: Adolescent

Primary Care

Steven C. Matson, M.D.

Medical College of Wisconsin

Department of Pediatrics

8701 Watertown Plank Road

P.O. Box 26509

Milwaukee, WI 53226-0509

Project Number 558521

The Adolescent Primary Care model will

combine care coordination/case management with the availability and accessibility

of comprehensive primary health care in a

community and familiar environment. The

overall goal is to provide effective, comprehensive primary care to adolescents in a

cost-effective and culturally relevant manner. Comprehensive health care in this project builds on the prenatal services presently

provided and on an acute awareness of the

special needs of this population to include

not only medical but also social and psychological interventions. The project design will

emphasize the goal of increasing community

involvement and cultural sensitivity because

of the critical effect of the composition of this

primarily African-American, low-income

community and the problems affecting this

population.
ISBN 1-57285-059-0