Children with special needs should be given greater attention and help than insurance coverage alone can provide. This group includes a wide variety of children: those with chronic illnesses and disabilities and other special health needs, those living in poverty, those at risk for a variety of social problems, and adolescents at particular risk of unintended pregnancy. For these children, even more than for children in general, integration of health care with education and other community services is vital. Most European nations provide direct financial support in the form of hard currency, not coupons or other similar substitutes, to such children and their families. 2. Community-based preventive care—including identification of children, adolescents, and families with special needs; their integration into the community; and the coordination of health, education, and social services within a community—should be available to all children in the United States. 3. Such preventive care should be mediated by an empowering agent, a professional who assists families in finding their own skills and in taking care of their own needs, rather than one whose efforts take responsibility away from families. The British health visitor seems to more clearly represent such an agent than do the case managers, care coordinators, and other individuals who perform similar services in the United States. 4. Improved generic systems, possibly mediated through expanded Public Law 99-457 activities, should track all children in the United States, without means testing or other exceptions. 5. A communications network should link existing services, both within and among communities, many of which have substantial capacity.
A 1990 study studied this question.