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Objectives: This study compares the prevalence of emotional, academic, and cognitive impairment in children and mothers living in the community with those living in shelters for the homeless., Method: In New York City, 82 homeless mothers and their 102 children, aged 6 to 11, recruited from family shelters were compared to 115 nonhomeless mothers with 176 children recruited from classmates of the homeless children. Assessments included standardized tests and interviews., Results: Mothers in shelters for the homeless showed higher rates of depression and anxiety than did nonhomeless mothers. Boys in homeless shelters showed higher rates of serious emotional and behavioral problems. Both boys and girls in homeless shelters showed more academic problems than did nonhomeless children., Conclusion: Study findings suggest a need among homeless children for special attention to academic problems that are not attributable to intellectual deficits in either children or their mothers. Although high rates of emotional and behavioral problems characterized poor children living in both settings, boys in shelters for the homeless may be particularly in need of professional attention.

We performed a randomized controlled clinical trial in a health center serving a poor population to attempt to find the differences, if any, between the effectiveness of primary care provided to children by two patterns of comprehensive medical care practiced by a pediatrician-internist-allied health team--one pattern offering care exclusively to children and the other offering care to both children and their parents. The study demonstrated few measurable differences between the two groups of children in either utilization or outcome. Where there were differences, most tended to favor slightly the family pattern of care: older children maintained their use of the center, immunization was somewhat more timely and children over time appeared to make fewer visits to sources of ambulatory care other than the health center. The absence of more or greater measurable differences may be due to the relatively short period of study, to the extremely disadvantaged population served, to the special model of family care used or to the comprehensive, team-based care provided to both groups of children.

Ambulatory care services have been reorganized in a New York City hospital. A newly developed Neighborhood Family Care Center (NFCC) replaced the outpatient clinics. The NFCC and both inpatient and emergency services are totally integrated so as to overcome many of the deficiencies that previously existed in ambulatory care, such as inferior quality of care, minimal academic involvement, fragmentation of services, overspecialization, and unresponsiveness to patients' needs. A review of all patients admitted to the Adult Medical Service has shown a statistically significant decrease in admission rates for diabetic coma-acidosis, severe hypertension, congestive heart failure, cerebrovascular accidents, and severe asthma during the 18 months following the reorganization of ambulatory care. Analysis of cost effectiveness of these changes on the utilization of hospital beds indicates the potential for reduced expenditures of limited health care dollars.

A health screening program was established in an inner-city New York public high school using the services of trained members of the student body as screeners. These students were trained to do a variety of health-related examinations and tests. Supervision and training were provided by a school health educator and members of a medical team from a nearby municipal hospital medical center. The primary goal was to reach, through peer involvement, those students who would be unlikely to interact with the routine health-care system. Of the 480 students receiving screening examinations, 291 were found to have abnormalities. In addition, a greater awareness of medical issues and available health-care facilities was seen among the student body. Through their training, the student screeners were exposed to various health-care fields, thus increasing their awareness of medical career potentials.