Seeking pathways to a coordinated system of health and human services for 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 erosion of its manufacturing base and a flight of employment opportunities and population from the city to the suburbs. While commonly misperceived as an affluent, white-collar community, in reality there are many families, particularly within the city of Rochester, that are afflicted by some of the most devastating health and social problems facing the United States today. It was against this backdrop that, in 1991, an ongoing effort was begun to develop a system of coordinated health and human services to more effectively address the needs of Rochester's children and families. As a first step, a study was conducted to obtain a detailed picture of the current service system in Rochester; lay out a series of recommendations to improve collaboration and communication; and foster coordinated and integrated services for high-risk youth and families in the community. Key indicators of child and family health were collected, collated, and analyzed, and extensive interviews were conducted with human-service and medical providers, government officials, education professionals, and parents. This paper describes the process that was used in the study and the recommendations that were included in the final report, which is intended to create a framework for the creation of a comprehensive, needs-based health care system for impoverished and at-risk children and families, including the effective integration of health services into the human service network.