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  • Title: A school-linked health service for adolescents in Jerusalem.
    Author: Halevy A, Hardoff D, Knishkowy B, Palti H.
    Journal: J Sch Health; 1995 Dec; 65(10):416-9. PubMed ID: 8789706.
    Abstract:
    This paper describes the Adolescent Health Service (AHS) and its multidisciplinary, school-linked, community-based adolescent health clinic located in a western neighborhood of Jerusalem. Files of the first 134 adolescents who completed or discontinued treatment in the clinic during the first two years of operation were reviewed for demographic data, referral source, number of visits, health concerns and clinical impressions. The clinic population included Jewish Jerusalem residents, ages 12-18, 75% of whom were female. Most referrals came from schools. The average number of visits per patient was five (range 1-20). The most frequent presenting concerns as well as the most frequent clinical impressions were in the psychosocial and nutritional domains. Concordance between presenting concern and clinical impression was 61% (k = 0.47). Health problems of Israeli high school students attending the clinic mainly were psychosocial and nutritional. The school-linked health service applied a comprehensive approach to the biopsychosocial needs of adolescents, not addressed at other health services. In Jerusalem, Israel, a community-based comprehensive adolescent health center was established in 1989 to promote health among the students of 11 secondary and high schools; to provide multidisciplinary health care within a community-based, school-linked clinic; to serve as a professional training facility; and to establish a research database. The service is accessible during after-school hours, confidential, and free to adolescent residents of Jerusalem. To evaluate the service, data from the first 134 adolescents treated during the first 2 years of service were analyzed to determine demographic parameters, referral sources, presenting symptoms (nutritional, psychosocial, sexuality, somatic, or health maintenance), diagnoses, number of patient visits, management approach, duration of follow-up, and termination of contact. It was found that 75% of the patients were girls, and 75% were 14-17 years old. Referrals came from school professionals (60%), parents (11%), primary care physicians (4%), and the adolescents themselves (25%). The patients averaged 5 visits, with 35% being seen only once and 15% more than 10 times. The most frequent presenting complaints were psychosocial and nutritional problems (sexuality was named by only 4.5% of the patients), and concordance between presenting concern and clinical impression was only 61% (with most discordance among those who presented for health maintenance). Most of the youth who attended were from middle- and upper-class families despite the clinic location in a low-to-middle class neighborhood. It was concluded that the clinic had not yet had a major impact on access to health services for most of the teenagers in the city but that it provided a unique service with a multidisciplinary approach that has served as a model for adolescent "non-acute" health care in Israel. The clinic's high drop-out rate was attributed to ambivalent care-seeking behavior and accessibility of primary health care (which, however, fails to address many of the problems addressed by the adolescent clinic).
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