A community-based system of services is an infrastructure that operates across service sectors. It facilitates the integration of services in several dimensions—including organization, delivery, and financing. The development of community-based systems of services is a response to the complexity and fragmentation of services for children with special health care needs and their families. Multiple service programs—each with its own funding streams, eligibility requirements, policies, procedures, and service sites—serve CSHCN. It is clear that communities and their resources affect the way families of children with special health needs find and use services. Therefore, the health of communities themselves can have a positive effect on the growth and development of CSHCN. There now exist a number of initiatives to develop community-based systems of services and a number of related community development initiatives in communities throughout the Nation. The public sector has furnished much of the impetus for such initiatives, but the private sector, especially through the efforts of several national foundations, has increasingly become active in instituting such initiatives.
This outcome was assessed using a single question asking parents whether they had had difficulties trying to use the range of services their children had needed over the past year. This outcome was achieved by 89.1 percent of CSHCN.
Three-quarters of children whose conditions affected their daily activities usually, always, or a great deal achieved this objective, compared to nearly all (96 percent) children whose activities were never affected. In addition, 92 percent of children in the highest income bracket achieved the objective, compared to 86 percent of children in poverty.