When a child enrolls in a childcare program, it is generally required that he or she have all immunizations up-to-date, and many programs also require a current medical examination. It is equally important that each child receive regular medical care, both routine checkups, and prompt attention in case of illness and injury.

All children have the right to comprehensive, quality care that helps them grow to their optimal potential and ensures that their medical, psychological, social, and developmental needs are met. The American Academy of Pediatrics (AAP) refers to the source of this type of care as the child's "medical home."

Unfortunately, many families do not have a single source of medical care. This can result in missed immunizations, delays in diagnosis and treatment, and unnecessary use of the emergency room. As a childcare provider, you can assist families in recognizing the importance of, and locating a medical home, and help insure that the children in your care are receiving proper medical attention.

A Medical Home Matters

A medical home is a partnership between parents, health care professionals, and caregivers. Children with medical homes have a primary provider who works with the family and caregiver to ensure that all medical, psycho-social, and educational needs are met. Having a medical home ensures that children have access to a full range of medical services and that these services are delivered by compassionate health professionals.

The AAP recommends that health care be delivered by well-trained physicians who facilitate all aspects of pediatric care and who develop relationships of mutual responsibility and trust with families. According to the AAP, a medical home reflects care that is:

• Accessible--easy to schedule, convenient, and affordable.
• Comprehensive--provides health care 24 hours a day, seven days a week.
• Continuous--supports families in times of wellness and illness.
• Family-centered--honors the diversity, strength, and permanency of families.
• Culturally competent--recognizes, values, and respects a family's cultural background.
• Coordinated--promotes communication and collaboration among professionals.
• Compassionate--identifies family concerns and listens to what families and children want and need.

Childcare providers play an important role in promoting a medical home. Because they spend a large amount of time with children each week, they are in touch with the needs of those children. By teaming families with health care providers, childcare providers can ensure that all children receive the best care possible.

Head Start programs across the nation also support the concept of the medical home. The Head Start philosophy is that parents, as the primary educators of their children, must be involved in their child's education. Because the well-being of the child is linked to the well-being of the family, Head Start programs support parents on topics such as child rearing, nutrition, and developmentally appropriate activities parents can do with their children at home. In addition, Head Start requires that each child have proof of current immunizations prior to the first day of class, and have a physical examination by a doctor or nurse practitioner and a dental examination. Head Start helps families who do not have a doctor or lack medical insurance find a primary care provider, thereby promoting partnerships among the family, the caregiver, and the health care professional.

All Children Deserve a Medical Home

According to the National Center of Medical Home Initiatives for Children with Special Needs, 11 million children younger than age 19 are uninsured and lack access to a primary care provider. Others who have primary providers may not have medical homes because of insurance restrictions that prevent the type of care they receive from meeting the above criteria.

Under served children--such as those from migrant or homeless families, those who do not have medical insurance or who have special health care needs--especially are in need of the care that comes from a medical home. However, because of the special obstacles these populations face, such as poverty and language and cultural barriers, it often is difficult for them to access the kind of quality health care and preventive services they need. Promoting the medical home ensures that these children--and all children--receive comprehensive care.

Childcare providers can provide regular assistance to families by answering their questions, helping them solve problems, or helping them identify resources and ways to access care. They can collaborate with health care professionals to promote inclusion of children with special health care needs and can support uninsured children by making referrals to local or state agencies that determine eligibility for Medicaid, State Children's Health Insurance Program (SCHIP) benefits, or privately-funded programs. In addition, childcare providers can facilitate contact with community-based primary care providers or look to their state Healthy Child Care America grantee for information about incorporating the medical home into childcare.

Finding a Medical Home

A medical home is important for preventing illness, keeping immunizations and screenings up-to-date, and promoting health and well-being. Finding a medical home is not as difficult as it may seem, and childcare providers can help families by discussing medical or developmental concerns and providing appropriate referrals to local professionals. Childcare providers also can review the current recommended childhood immunization schedule and share this information with families to ensure that children are age-appropriately immunized.

It is especially important that caregivers and health professionals acknowledge the family's expertise in determining the care of their children throughout this process. Working together, the family, the caregiver, and the primary care provider can determine the best course of treatment for the child.

by Diona L. Reeves
American Academy of Pediatrics
Dept. of Community Health Services

To learn more about a medical home and how to promote the medical home concept through childcare, refer to the following resources:

The National Center of Medical Home Initiatives for Children with Special Health Care Needs This center provides access to educational and advocacy materials that address barriers to medical homes for children with special health care needs. 847-434-4989; www.aap.org/advocacy/medhome/aap.htm

Healthy Child Care America (HCCA) is based on the principle that families, childcare providers, and health professionals can partner to promote the healthy development of young children in childcare. 888-227-5409; www.healthychildcare.org.

Head Start programs offer a nurturing environment that supports the healthy growth and development of each child in the context of family, culture, and community. 866-763-6481; www.acf.dhhs.gov/programs.html#hs

Childhood Immunization Support Program seeks to improve immunization delivery, enable providers to communicate effectively with parents about vaccines, and promote immunization practices within a medical home. 847-434-7106; www.cispimmunize.org