Children and youth with special health care needs (CYSHCN) are those at “increased risk for chronic physical, developmental, behavioral, or emotional conditions that require health and related services of a type or amount beyond that required of children generally.”  More than 12 million U.S. children meet this definition. Comprising 15-18% of the childhood population, CYSHCN use 80% of the health care dollars spent annually for all children.

A key strategy to address the needs of CYSHCN is a model of family-centered, community-based care termed “the Medical Home.”  The attributes of a medical home are that such a care environment is  “accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent.”  

The medical home is the organizational setting that integrates preventive services, acute illness management, and chronic condition management.  An effective medical home seeks to identify the broad spectrum of a child and family’s needs at a given point in time (including preventive care and psychosocial items), as well as to anticipate and design care to address future needs.  The medical home coordinates among agencies and services in the child’s community (termed “horizontal coordination”) and within the health care system (“vertical coordination”) to address current health needs. It also provides continuity over time to address future health needs; care in a medical home spans childhood through adolescence and facilitates a smooth transition to adult services. The medical home fosters competence in patients and families as its key strategy to achieve positive results.