This report examines how communities and groups can shape the content of health services to bring more comprehensive health services to poor children and families. The report is based on a study of 11 comprehensive primary care programs and systems some of which offer school-based services: 4 freestanding community-based programs, 4 local systems or networks, and 3 state maternal and child health programs. Suggested actions include promoting attributes of quality in primary health care programs by improving accessibility, comprehensiveness, coordination with other services and agencies, accountability, and community orientation. The report also advocates restructuring health programs to meet the needs of children by organizing health care systems to respond to changing needs, incorporating case management or care coordination, and involving hospitals in local systems. In addition, the report argues for creating new comprehensive primary care systems that respond to community needs through national health care reform, state policies and programs, and expansion of promising local efforts. The challenge is to create many partnerships that can assess possibilities for local systems development, identify needs and services, and implement the needed changes. Appendixes contain a list of project participants and the case summaries. A glossary is included. (Contains 46 references.) (JB)