THE PREVENTIVE 'AT-RISK' PROGRAM OF THE HILLCREST MEDICAL CENTER IN TULSA, OKLA., PROVIDES SPECIFICALLY STRUCTURED GUIDANCE IN WHICH PHYSICAL, SOCIAL, EMOTIONAL, AND DEVELOPMENTAL HEALTH PROBLEMS ARE ALL CONSIDERED IN AN EFFORT TO ELIMINATE POOR PARENT-CHILD RELATIONSHIPS AND TO HELP FAMILIES OVERCOME CRISES WHICH RESULT IN CHILD ABUSE. THE FAMILY-CENTERED MODEL, WHICH EMPHASIZES THE FAMILY UNIT AND SEES AS PRIORITY THE COORDINATION OF CONTINUITY OF CARE, WAS USED IN THE CONCEPTUALIZATION AND INITIATION OF THIS PROGRAM. THERE ARE THREE SEGMENTS: INPATIENT SCREENING OF INFANTS AND CHILDREN, INPATIENT PROTOCOL AND TEACHING PROGRAMS IN CHILD AND FAMILY HEALTH, AND A PEDIATRIC 'AT-RISK' OUTPATIENT CLINIC. EACH OF THESE SEGMENTS IS DISCUSSED IN TERMS OF PROGRAM CRITERIA, AIMS AND METHODOLOGY. THERE ARE FIVE PRIMARY OBJECTIVES OF THE PROGRAM: COORDINATED AND CONTINOUS MEDICAL CARE, INCREASED KNOWLEDGE OF POSITIVE HEALTH MAINTENANCE AND A SENSE OF PERSONAL WORTH TO THE FAMILY, IDENTIFICATION OF AREAS OF FAMILY STRESS, FACILITATION OF REFERRAL, AND IDENTIFICATION OF SAFETY LIMITS OF PARENT-CHILD RELATIONSHIPS. THESE OBJECTIVES ARE BRIEFLY REVIEWED REGARDING PROGRAM METHODOLOGY. OF THE REFERRALS TO THE PROGRAM, 33 PERCENT WERE NEWBORNS SUFFERING FROM AT LEAST TWO OF THE FOLLOWING PROBLEMS: LOW BIRTHWEIGHT, MOTHERS UNDER 17 YEARS OF AGE, RETARDED MOTHERS, OR DRUG DEPENDENT MOTHERS. PROBLEMS OBSERVED IN THE CHILDREN INCLUDED MULTIPLE CONGENITAL DEFECTS, SMALL OR LARGE HEAD CIRCUMFERENCES, AND DIAGNOSIS OF SEPSIS AT BIRTH. OF ALL CHILDREN SEEN, 40 PERCENT WERE BETWEEN THE AGES OF 1 MONTH AND 2 YEARS; THESE WERE MOST OFTEN REFERRED WITH A DIAGNOSIS OF ENVIRONMENTAL FAILURE-TO-THRIVE. MAJOR PROBLEMS SEEN IN THE 2-YEAR TO 6-YEAR AGE GROUP INCLUDE MALNUTRITION, CONGENITAL PROBLEMS, AND EMOTIONAL CONFLICTS. CHILDREN BETWEEN THE AGES OF 7 AND 16 MOST COMMONLY SUFFER FROM CHRONIC ILLNESS -- SPECIFICALLY ASTHMA, SEIZURE DISORDER, CYSTIC FIBROSIS, EMOTIONAL PROBLEMS, MINIMAL BRAIN DYSFUNCTION, AND LEARNING DISABILITIES. THE HOSPITAL AND CLINIC SETTINGS ARE USED AS A RESOURCE THROUGH WHICH THE FAMILY CAN BE EVALUATED AND SUPPORTED, AND THEY OFTEN PROVIDE THE ONLY CONTACT WITH A PROFESSIONAL UNTIL ABUSE HAS OCCURRED. NO REFERENCES CITED. (KBL)