There is no doubt that those who are concerned with the delivery of child health care face serious difficulties in finding the resources and mechanisms to insure that all children in need of preventive, maintenance, and curative services receive them. No matter how the pediatric health care pie, as it presently exists, is sliced, all of the appetites will not be satisfied. This is true for those who seek these services and more so for the greater numbers who are in need, yet do not recognize that need or have the resources to seek the appropriate care. This symposium will address these issues in examining the changing roles and relationships in the delivery of child health care. It will look at the ways and means available now, and in the future, of bridging what has become a serious gap in the provision of health care for children. It will move from the challenge of change presented to the individual pediatri¬ cian and to organized pediatrics through the development of team care, the ways in which nurses and pediatricians will alter their practice patterns and organizational arrange¬ ments, and end with how the focus of the educational process for health workers will need to be altered to ac¬ commodate those changes.

A plan to train and employ family health workers was put into operation as part of a neighborhood health center program. This report shows how a local resident given requisite training as a multipurpose worker can perform in the areas of home nursing and social advocacy. Consequences for simplification of health and social services are emphasized.

This paper describes the present position of family health workers who were trained and worked at a neighborhood health center during the past five years. Problems initially anticipated for such workers did not materialize but others have emerged: lack of self-esteem, lack of upward and lateral mobility, inadequate evaluation of the validity of their training and role, and to some extent paternalism.These are discussed.

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