community health infrastructure on which many parents rely (Fawcett, Pain, Francisco, and Vliet, 1993). The community service system includes a range of child development, behavioral, and mental health services and centers; programs to address the needs of children with learning disabilities and behavioral problems; health education programs provided through public health departments; educational services; nutritional services; and other programs provided by public health systems and communities (Halfon, Inkelas, Wood, and Schuster, 2001). At present, there is no systematic measurement of the effectiveness and efficiency of these community service systems or their capacity to meet the service needs of their communities and provide services acceptable to parents.

There are also major gaps in understanding the delivery of health services and the potential effect of these services on special populations. For example, although the number of children in foster care has increased dramatically over the past two decades and the high prevalence of mental health conditions in this population is solidly documented, there has been little focus on the accessibility and appropriateness of health services provided to children in foster care. It is not known whether health care providers and local health care systems are capable of providing mental health and developmental services to this high-risk group of children, the degree of continuity in the services provided, or whether the services are actually effective in addressing each child’s particular needs (Rubin et al., 2004; Simms, Dubowitz, and Szilagyi, 2000; Horwitz, Simms, and Farrington, 1994; Takayama, Bergman, and Connell, 1994; Halfon, Berkowitz, and Klee, 1992; Halfon and Klee, 1987). Such measures would not only be helpful in specifying the burden of illness in this high-risk group of children, but in better understanding whether local and state authorities responsible for ensuring the well-being of children in foster care are actually meeting their legal and morel responsibilities.

A similar case can be made for a number of other special populations. For example, while the Report of the Surgeon General’s Conference on Children’s Mental Health (U.S. Public Health Service, 2000) documented the increase in mental health needs and the widening gaps in unmet needs for services, there is very little information at the federal, state, or local level on the affect of preventive, treatment, or rehabilitation services on children with mental health problems or on monitoring of the extent to which gaps are being closed.

It is also important to consider how services may be arranged and delivered based on population health needs. In keeping with the concept of health that was adopted for this report, we consider the services not only to prevent and treat diseases, conditions, and impairments, but also to prevent the effect of adverse influences and promote optimal health. The latter factors are especially important for children with serious ongoing health conditions. While only a minority of children have such conditions, they use a disproportionate amount of personal health care services and their medical expenses account for a substantial portion of health care expenditures (Ireys and Perry, 1999).



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