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  • Title: School-based clinics: a national conference.
    Author: Kenney AM.
    Journal: Fam Plann Perspect; 1986; 18(1):44-6. PubMed ID: 3803548.
    Abstract:
    On October 9-12, 1985, 250 health personnel, educators, and social service workers attended the 2nd national conference on school based clinics in the US. The conference, held in Chicago, was sponsored jointly by the Center for Population Options (CPO), a Washington based organization which provides technical assistance to groups interested in establishing school clinics, and the Ounce of Prevention Fund, a group of funding agencies in Illinois which works in cooperation with the state government to provide funds for school clinics in Illinois. The growth and accomplishments of the school based clinic movement in the US was reviewed in opening remarks made by the chairperson of the CPO. In 1984, at the time of the 1st national conference, there were clinics in only about 12 communities throughout the nation. Currently, there are clinics in about 50 communities located in 26 states. The clinics provide primary health care, including physical exams, immunizations, treatment for minor illnesses, counseling, nutrition assistance, gynecological exams, and family planning counseling. Some of the clinics dispense contraceptives. Most of the clinics do not provide abortion referrals. The clinics are generally operated by groups outside the educational system, e.g., hospitals, health departments, and nonprofit organizations. The schools furnish space for the clinics. Clinics are usually staffed by a nurse practitioner and a social worker with a backup physician. Topics discussed by the conference participants included strategies for establishing clinics and for gaining community and student acceptance, clinic evaluation, and funding issues. Controversy frequently accompanies the establishment of new clinics. Participants tended to agree that an essential element in launching a successful program is the establishment of a community advisory committee. A concerted effort must be made to address all community concerns about the clinic. Participants noted that it was best to obtain the support of school board members, administrators, and superintendents before approaching the staff at individual schools. Efforts must be made to gain the student's confidence in the ability of the clinics to serve their needs in a confidential manner. This goal can be more effectively met if the clinic is staffed by full-time rather than part-time workers. Some clinics successfully avoided initial controversy by deferring the provision of contraceptive services until their 2nd year of operation. Available but limited evaluation data suggest that clinic utilization is relatively high and that the clinics have had a negative impact on teenage pregnancy and a positive impact on contraceptive use among adolescents. For example, in St. Paul, Minnesota, a school clinic program was introduced in the 1970s, and between 1976-77 and 1984-85, the teenage birth rate declined from 59/1000 to 37/1000. The proportion of female students who used family planning increased from 7%-35% between 1976-77 and 1983-84. During the conference, the CPO announced plans to conduct a much needed large-scale evaluation of school clinics. The 3-year study will cover 7 geographical areas. The cost of operating the clinics is estimated to be US$100-US$125/student. Funding for the clinics comes primarily from the federal government sources including Maternal and Child Health and Social Services block grants, Medicaid, Title X of the Public Health Service Act, and the Adolescent Family Life Act. State governments and private donor organizations also support the clinics. A few clinics offset their expenses by charging minimal student fees. The participants tended to agree that in the long run, public funds should be used to support the programs. There was some disagreement among participants as to whether the primary task of the clinics was to improve the health status of adolescents or reduce the teenage pregnancy rate.
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