care for all pregnant women and a “medical home” to provide primary health care services for all children. To this end, efforts to expand Medicaid eligibility for prenatal care for low-income women and the current federal-state program to provide health insurance for low-income children (State Children's Health Insurance Program under Title XXI of the Social Security Act) are vital public initiatives. Beyond the matter of insurance coverage, the content of pediatric primary care is also receiving attention through new initiatives that underscore the time-intensive need for relationship building among health care providers, parents, children, and a range of professionals who provide developmental and social services through non-medical programs.
Central to an effective strategy to protect and promote the healthy development of young children is the need to both understand the important role of the personal health care system and recognize its significant limitations. This is particularly salient with respect to two critical challenges. First, many of the well-documented risk factors that can impair early brain development are embedded in the experiences of poverty, malnutrition, illiteracy, violence, toxic exposures, and substance abuse and other risk-taking behaviors. These threats to child health and development call for a strengthened prevention agenda that extends beyond the capacity of individually oriented medical care and requires a more vigorous and creative public health approach. Second, much of the expertise needed to address the needs of children with significant developmental and behavioral impairments is located in separate programs that are provided under the administrative and financial auspices of a variety of agencies (e.g., education, social or human services, child welfare). When communication and coordination among multiple systems is good, the needs of children and families are served. When it is poor, resources are not used efficiently and important needs are not met adequately. Developmentally vulnerable children who live in highly stressed environments, particularly where there are concerns about possible abuse and neglect, warrant special concern.
The growing racial, ethnic, linguistic, and cultural diversity of the early childhood population requires that all early childhood programs and medical services periodically reassess their appropriateness and effectiveness for the wide variety of families they are mandated to serve. Poor “take-up” and high rates of program attrition that are common to many early intervention programs, while not at all restricted to specific racial, ethnic, or linguistic groups, nonetheless raise serious questions about whether those who design, implement, and staff early childhood programs fully understand the meaning of cultural competence in the delivery of health and human services.