Reorganizing health care for adolescents: The experience of The School Based Adolescent Health Care Program

Lear, Julia Graham; Gleicher, Hope; A, Germaine; Porter, P.

doi:10.1016/1054-139x(91)90022-p

Cited by 77 publications

(32 citation statements)

References 17 publications

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“…School-based health centers also serve to increase utilization of ambulatory care and preventive services for at-risk teens, especially those who are uninsured (11). They bring providers to students, which is especially important in rural and inner-city communities where there are fewer health practitioners.…”

Section: Preliminary Findings In the Field Of Sbcsmentioning

confidence: 99%

“…A strong emphasis on mental health services may supplant the existing focus on comprehensive care, and SBCs may find that the services they are contracted to provide must conform to managed care plan expectations and reimbursement incentives. In other words, there are concerns that the financing structure will influence the kind of SBC models that remain viable, and that these models will be more responsive to the funder than to the community in which they are located (11).…”

Section: Challenges In Creating Viable Partnerships Between Managed Cmentioning

confidence: 99%

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School-Based Health Clinics: Remaining Viable in a Changing Health Care Delivery System

Brindis

Sanghvi

1997

Annu. Rev. Public Health

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Adolescents are often vulnerable to particular health risks and face multiple barriers to accessing health care. School-based clinics and school-linked services represent an alternative model of care that has responded to the unique health issues of adolescents by offering preventive, comprehensive services, including mental health and other sensitive services. The current restructuring of the American health care delivery system presents a serious challenge to the continued existence of these services, which must link successfully with managed care organizations and adapt to significant changes in federal and state funding streams to remain viable. The continued success of school-based health services in improving adolescent health will largely depend on how well they can capitalize on their strategic position to reach adolescents, respond to their health needs, and reduce barriers to care, and how effectively they can integrate themselves into a rapidly evolving US health care delivery system.

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Section: Preliminary Findings In the Field Of Sbcsmentioning

confidence: 99%

Section: Challenges In Creating Viable Partnerships Between Managed Cmentioning

confidence: 99%

School-Based Health Clinics: Remaining Viable in a Changing Health Care Delivery System

Brindis

Sanghvi

1997

Annu. Rev. Public Health

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“…6 In a Robert Wood Johnson Foundation report of 23 high school SBHCs, students averaged between 1.7 and 7.0 visits per user in a school year. 3 The total number of visits by 4000 middle school students to SBHCs offering medical and mental health services was 19 907, 17 an average of 5.0 visits per student. In a study of elementary SBHCs in operation during the 1992-1993 school year, elementary SBHC users averaged, 5.3 visits per school year.…”

Section: Visit Ratesmentioning

confidence: 99%

“…5 One report 3 found between 41% and 100% of students in schools with SBHCs registered at a clinic (students were in grades prekindergarten through 12th grade). By comparison, in the DESBHC, Ͼ100% (811/806) of the school's cross-sectional population registered for clinic services.…”

Section: Clinic Registration and Usementioning

confidence: 99%

“…Since that time, the proliferation of SBHCs has been rapid, 1 and widely endorsed by a range of professional health organizations and community agencies. [2][3][4] By the fall of 1996 Ͼ900 SBHCs and schoollinked health centers were in operation. 5 Numerous studies have documented SBHCs' efficacious reduction of health care access barriers in the adolescent population.…”

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confidence: 99%

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Elementary School-based Health Center Use

et al. 1998

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Objective. To analyze physical and mental primary health care utilization in a comprehensive elementary SBHC for an underserved Hispanic population.Design. Retrospective analyses of services used at an elementary SBHC during the 1995-1996 school year. We describe physical and mental health services utilization provided by SBHC staff who offered a range of primary medical and mental health services.Patients. The study population was predominately Hispanic, and comprised of 811 elementary school students (grades preschool through fifth) registered for SBHC use. Analyses were conducted on 591 students who used the SBHC.Results. The 591 SBHC users made 2443 visits, ranging between 1 and 54 visits/individual; mean 4 visits/ student. Two thirds of visits (1638) were medical provider visits, and 33% (798) were mental health provider visits. Most students (75%) saw a medical provider exclusively, 9% saw a mental health provider exclusively, and 16% of students were seen by both. Mean duration of medical provider visits ؎SD was 15 ؎ 13 minutes, mean for mental health provider visits ؎SD, 37 ؎ 16 minutes. Of the 3035 diagnoses, 64% were medical and 36% were mental health diagnoses. These diagnostic frequencies are grouped as follows: acute medical (31%), health maintenance (22%), depression (10%), non-Diagnostic and Statistical Manual of Mental Disorders-IV mental health diagnoses (8%), conflict disorder/emotional disturbance (8%), chronic medical (8%), academic/learning disorder (7%), anxiety disorder (3%), and other (4%).Conclusions. High rates of SBHC utilization by this population and the range of diagnoses recorded suggest health care delivered in a comprehensive, culturally-sensitive SBHC has the potential for impacting the health and well-being of underserved elementary-aged students. Pediatrics 1998;101(6). URL: http://www.pediatrics. org/cgi/content/full/101/6/e12; child, school health services, student health services, child health services, delivery of health care, schools, outcome and process assessment (health care), Hispanic Americans, pediatrics/og (organization and administration), diagnosis.

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Managed Care and School-Based Health Centers

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et al. 1998

Arch Pediatr Adolesc Med

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Objective: To explore the use of physical and mental health services for adolescents who are enrolled in managed care and have access to a school-based health center (SBHC), compared with adolescents enrolled in managed care without access to an SBHC. Design: Retrospective cohort designed with age, sex, and socioeconomic status matching to compare the use of health services for adolescent members of Kaiser Permanente of Colorado (who had access to SBHCs) with those with no access. Participants: The study included 342 adolescents, resulting in 3394 visits that occurred during 3 academic years. During the study, 240 adolescents with access to an SBHC were compared with 116 adolescents without access to an SBHC. Main Outcome Measures: The use of primary and subspecialty medical, mental health, and substance abuse treatment services; the use of after-hours (emergent or urgent) care; and comprehensive preventive health supervision visits and documentation of screening for highrisk health behaviors. Results: Adolescents with access to SBHCs were more than 10 times more likely to make a mental health or substance abuse visit (98% of these visits were made at the SBHC) (PϽ.001). Adolescents with SBHC access had an after-hours (emergent or urgent) care visit rate of 0.33 to 0.52 visits per year less (38%-55% fewer visits) than adolescents without SBHC access, and, overall, made almost 1 additional medical visit per year. A greater percentage, 80.2%, of adolescents with access to SBHCs had at least 1 comprehensive health supervision visit compared with 68.8% of adolescents without access (P=.04). In addition, the adolescents with access were screened for high-risk behaviors at a higher rate. Conclusions: School-based health centers seem to have a synergistic effect for adolescents enrolled in managed care in providing comprehensive health supervision and primary health and mental health care and in reducing after-hours (emergent or urgent) visits. School-based health centers are particularly successful in improving access to and treatment for mental health problems and substance abuse.

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Reorganizing health care for adolescents: The experience of The School Based Adolescent Health Care Program

Cited by 77 publications

References 17 publications

School-Based Health Clinics: Remaining Viable in a Changing Health Care Delivery System

School-Based Health Clinics: Remaining Viable in a Changing Health Care Delivery System

Elementary School-based Health Center Use

Managed Care and School-Based Health Centers

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