School-based health care for urban minority junior high school students
H. J. Walter, R. D. Vaughan, B. Armstrong, R. Y. Krakoff, L. Tiezzi and J. F. McCarthy
Center for Population and Family Health, Columbia University School of Public Health, New York, NY, USA.
OBJECTIVE: To describe the use of school-based health clinics by urban
minority junior high school students. DESIGN: Review of demographic and
utilization data collected by service providers during clinic visits.
SETTINGS AND PARTICIPANTS: Health clinics in four junior high schools that
enrolled predominantly Hispanic students who were residing in an
economically disadvantaged, medically underserved New York (NY) school
district. RESULTS: Of 5757 students who were enrolled in the schools, 5296
(92%) obtained parental consent to use the clinics, and 3723 (65%) used the
clinics during the 1991-1992 academic year. Clinic users were 11 to 15
years old, 50% male and 50% female, 81% Hispanic and 14% black, and 29%
sixth graders, 33% seventh graders, and 38% eighth graders. Clinic users
made 16,340 clinic visits during the 1991-1992 academic year. Presenting
complaints were mental health problems (32%), illness (14%), injury (12%),
physical examination (5%), immunization (3%), follow-up (21%), and other
(13%). Referral sources were clinic outreach (48%), self (44%), and school
personnel (8%). Disposition of visits was on-site treatment (92%), referral
to an affiliated hospital (5%), and referral elsewhere (3%). Compared with
a nationwide group of high school-based clinics that served predominantly
black adolescents, these clinics provided more mental health care (31% vs
21%), similar illness/injury care (32% vs 30%), and less preventive (10% vs
24%) and reproductive/contraceptive (7% vs 12%) care. CONCLUSIONS: Junior
high school-based clinics can provide a wide range of primary and
preventive health care services for large numbers of medically underserved
youths. The provision of mental health services may fill a critical need
among inner-city adolescents. Clinic outreach may be necessary to maximize
utilization, especially among high-risk students.
