School-based health center: position paper of the Society for Adolescent Medicine

Barriers and Facilitators to School-Based Health Centers: pilot Data From 3 Sites in Georgia

BACKGROUND

School-based health centers (SBHCs) provide opportunities for offering quality service to underserved populations. The objectives of this study were to: (1) document the SBHC process at different locations and evaluate their similarities and differences; (2) explore SBHC clinic staff satisfaction; and (3) identify facilitators and barriers to utilizing SBHCs.

METHODS

Three Georgia SBHCs located in either predominantly Caucasian, African American, or Hispanic elementary schools were included in this study. Mixed methods data collection efforts included: (1) observational assessment of each SBHC; (2) interviews with 7 clinic administrators and staff; and (3) focus group discussions (N = 5) with parents of children that do and do not utilize SBHCs.

RESULTS

Observational assessments indicated some clinics have more resources available than others. In-depth interviews found that centers are functioning at capacity, with potential for expansion and greater workload. Focus groups revealed that parents are satisfied with services provided, the price of the care, and the convenience of the centers. However, barriers have made utilization difficult for lower income families.

CONCLUSIONS

Although most SBHC goals are being met, staff realize that further development and funding must be obtained to meet the needs of their communities.

Cyber dating abuse among teens using school-based health centers

OBJECTIVE

To estimate the prevalence of cyber dating abuse among youth aged 14 to 19 years seeking care at school-based health centers and associations with other forms of adolescent relationship abuse (ARA), sexual violence, and reproductive and sexual health indicators.

METHODS

A cross-sectional survey was conducted during the 2012-2013 school year (participant n = 1008). Associations between cyber dating abuse and study outcomes were assessed via logistic regression models for clustered survey data.

RESULTS

Past 3-month cyber dating abuse was reported by 41.4% of this clinic-based sample. More female than male participants reported cyber dating abuse victimization (44.6% vs 31.0%). Compared with no exposure, low- ("a few times") and high-frequency ("once or twice a month" or more) cyber dating abuse were significantly associated with physical or sexual ARA (low: adjusted odds ratio [aOR] 2.8, 95% confidence interval [CI] 1.8-4.4; high: aOR 5.4, 95% CI 4.0-7.5) and nonpartner sexual assault (low: aOR 2.7, 95% CI 1.3-5.5; high: aOR 4.1, 95% CI 2.8-5.9). Analysis with female participants found an association between cyber dating abuse exposure and contraceptive nonuse (low: aOR 1.8, 95% CI 1.2-2.7; high: aOR 4.1, 95% CI 2.0-8.4) and reproductive coercion (low: aOR 3.0, 95% CI 1.4-6.2; high: aOR 5.7, 95% CI 2.8-11.6).

CONCLUSIONS

Cyber dating abuse is common and associated with ARA and sexual assault in an adolescent clinic-based sample. The associations of cyber dating abuse with sexual behavior and pregnancy risk behaviors suggest a need to integrate ARA education and harm reduction counseling into sexual health assessments in clinical settings.

Adolescent immunization delivery in school-based health centers: a national survey

PURPOSE

Vaccinating adolescents in a variety of settings may be needed to achieve high vaccination coverage. School-based health centers (SBHCs) provide a wide range of health services, but little is known about immunization delivery in SBHCs. The objective of this investigation was to assess, in a national random sample of SBHCs, adolescent immunization practices and perceived barriers to vaccination.

METHODS

One thousand SBHCs were randomly selected from a national database. Surveys were conducted between November 2007 and March 2008 by Internet and standard mail.

RESULTS

Of 815 survey-eligible SBHCs, 521 (64%) responded. Of the SBHCs, 84% reported vaccinating adolescents, with most offering tetanus-diphtheria-acellular pertussis, meningococcal conjugate, and human papillomavirus vaccines. Among SBHCs that vaccinated adolescents, 96% vaccinated Medicaid-insured and 98% vaccinated uninsured students. Although 93% of vaccinating SBHCs participated in the Vaccines for Children program, only 39% billed private insurance for vaccines given. A total of 69% used an electronic database or registry to track vaccines given, and 83% sent reminders to adolescents and/or their parents if immunizations were needed. For SBHCs that did not offer vaccines, difficulty billing private insurance was the most frequently cited barrier to vaccination.

CONCLUSIONS

Most SBHCs appear to be fully involved in immunization delivery to adolescents, offering newly recommended vaccines and performing interventions such as reminder/recall to improve immunization rates. Although the number of SBHCs is relatively small, with roughly 2000 nationally, SBHCs appear to be an important vaccination resource, particularly for low income and uninsured adolescents who may have more limited access to vaccination elsewhere.

Adolescent health, school health activities, community contexts, and health surveys in Sweden

School health activities have been very important in improving adolescent health in Sweden for almost 200 years. In the 1800s, emphasis was on medical services. Vaccination programs and medical examinations became the key issues. Deterioration of adolescent health in the 1960s changed the objectives of both school education and health services to health promotion. Important members of the community followed suit and involvement of the local community has remained a hallmark, even though the extent and direction varies. The subsequent period was characterized by substantial improvement in adolescent health behavior. The latter years of the 1980s and the 1990s saw deterioration of adolescent health behavior. Less emphasis on health promotion, decentralization of school health responsibility from physicians to administrators, and heavy savings directed toward schools were important mediators. Adolescents were also more engaged in international youth cultures with liberal practices, such as drug use. Community surveys of adolescent health behaviors have proven to be important in mobilizing broad local involvement in adolescent health promotion. The lesson learned is that health promotion has to involve as many community members as possible. Coordinating resources and having unified objectives is cost efficient