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Building Medical Homes for Children With Special Health Care Needs

Nickel, Robert E. MD; Cooley, W Carl MD; McAllister, Jeanne W. RN, MS, MHA; Samson-Fang, Lisa MD


The medical home is an approach to providing high quality health care services to children in partnership with families and community professionals. The current focus on the medical home at national and state levels affords an opportunity for early intervention and early childhood special education providers to improve their collaboration with primary health care professionals and thus improve the system of care for children and families in their local communities.

IN 1978, the Hawaii Medical Association and the Hawaii Chapter of the American Academy of Pediatrics (AAP) adopted a comprehensive Child Health Plan that stressed the importance of providing child health care through a “medical home” that would provide comprehensive services and focus on the whole child in the context of the family and the community (Sia & Breakey, 1985). The essentials of the medical home included (1) geographic and financial accessibility; (2) continuity of care from the prenatal period through adolescence; (3) coordination of care; and (4) community orientation with awareness of child health problems and resources within the community. In 1985, the Hawaii legislature provided funds for a demonstration project linking infants at high psychosocial risk with medical homes. This program subsequently was expanded by a 3-year grant from the United States Maternal and Child Health Bureau (MCHB), the Physicians Involvement Project conducted by Dr Calvin Sia and colleagues (Sia & Peter, 1988).

In the 2 decades since Hawaii's Child Health plan, the medical home has come of age. It has grown from a demonstration project in Hawaii onto center stage of the national agenda of the AAP and the MCHB. Current resources include the National Center for Medical Home Initiatives for Children with Special Needs and the National Medical Home Mentorship Network; MCHB-funded grants to support statewide implementation of medical homes; AAP-funded CATCH (Community Access to Child Health program) grants that focus on medical home activities in local communities; community pediatric residency programs; and the collaborative training program, “Every Child Deserves a Medical Home,” developed by the AAP, MCHB, Family Voices, Shriners Hospitals for Children, and the National Association of Children's Hospitals and Related Institutions (NACHRI).

In this article we will describe the components of the medical home approach and discuss the changes needed in primary health care services in order to address current child, family, and community needs. We will review the supports and resources that are available to health professionals to make these changes; discuss special issues such as lack of reimbursement for care coordination in the primary care office; and finally, identify ways that early intervention (EI) and other community providers can support health care professionals to improve the overall system of care for children and families in their local communities.

From the Oregon Health & Science University, Portland, Ore, and the Regional Services Center, Child Development and Rehabilitation Center, Eugene, Ore (Nickel)

The Center for Medical Home Improvement, Hood Center for Children & Families, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Cooley, Jeanne)

The Crotched Mountain Rehabilitation Center, Greenfield, NH (Cooley)

The Department of Pediatrics, University of Utah, Salt Lake City, Utah. (Samson-Fang)

Corresponding author: Robert E. Nickel, MD, Clinical Services Building, 901 E 18th St, Eugene, OR 97405 (e-mail:

©2003Lippincott Williams & Wilkins, Inc.