SEEKING PATHWAYS TO A COORDINATED SYSTEM OF HEALTH-AND-HUMAN-SERVICESFOR HIGH-RISK URBAN CHILDREN AND FAMILIES - THE ROCHESTER, NEW-YORK EXPERIENCE

The Rochester, New York community has undergone major changes over the past 20 years. Like many other industrial areas, it has seen an erosi on of its manufacturing base and a flight of employment opportunities and population from the city to the suburbs. While commonly misperceiv ed as an affluent, white-collar community, in reality there ae many fa milies, particularly within the city of Rochester, that are affiliated by some of the most devastating health and social problems facing the United states today.(1) It was against this backdrop that, in 1991, a n ongoing effort was begun to develop a system of coordinated health a nd human services to more effectively address the needs of Rochester's children and families. As a first step, a study was conducted to obta in a detailed picture of the current service system in Rochester; lay out a series of recommendations to improve collaboration and communica tion; and foster coordinated and integrated services for high-risk you th and families in the community. Key indicators of child and family h ealth were collected, collated, and analysed, and extensive interviews were conducted with human-service and medical providers, government o fficials, education professionals, and parents. This paper describes t he process that was used in the study and the recommendations that wer e included in the final report, which is intended to create a framewor k for the creation of a comprehensive, and needs-based health care sys tem for impoverished and at-risk children and families, including the effective integration of health services into the human service networ k.