Document 0633
 DOCN  M95A0633
 TI    Coordination, comprehensiveness and access to reproductive health
       services in school-based clinics. American Pediatric Society 104th
       annual meeting and Society for Pediatric Research 63rd annual meeting;
       1994 May 2-5; Seattle.
 DT    9510
 AU    Klein JD; Zukoski AP; Division of Adolescent Medicine, University of
       Rochester, NY,; USA.
 SO    Pediatr AIDS HIV Infect. 1994 Oct;5(5):316 (unnumbered abstract). Unique
       Identifier : AIDSLINE AIDS/95330411
 AB    OBJECTIVE: Access to comprehensive, coordinated health services is
       believed to improve adolescents' health. However, many school-based
       health clinics have difficulty providing a full range of reproductive
       health services. We studied school-based health clinics' coordination
       with other provider organizations in relationship to their service
       comprehensiveness. METHODS: We selected a sample of 100 school-based
       health programs from a 1990 national census of 435 comprehensive
       adolescent health programs. We surveyed program directors using a
       structured telephone interview. One of three interviewers qualitatively
       rated care coordination as good, fair, and poor, by the interviewer and
       overread by another interviewer based on responses to 5 questions about
       patient follow-up, case management, and outreach systems.
       Comprehensiveness was defined by the services provided on-site. RESULTS:
       Of 91 programs interviewed (91%), 88% provided health services and 73%
       provided mental health services on site. Of the 86 providing health
       services, 52% reported providing reproductive health care, 69% provide
       pregnancy testing, 37% provide HIV testing, 31% provide contraceptive
       prescriptions, 33% provide condoms, and 22% provide other contraceptives
       on site. Coordination was rated as good in 32% of programs, fair in 53%,
       and poor in 15%. Interviewers agreed on coordination ratings in 96% of
       cases. Programs that did not provide various reproductive services or
       mental health services on site were no more likely to have better
       coordinated services than those that provided these services (Chi square
       p's range = 0.13-0.69 and p = 0.22, respectively). Directors reported
       that clients have many problems with access, including: mental health
       (31% of programs), specialty referrals (20%), dental care (16%), primary
       care (12%), reproductive health care (12%), abortions (7%),
       pharmaceuticals (6%), and shelter (4%). CONCLUSION: School-based clinics
       that provide less comprehensive on-site services are not ensuring access
       to care through greater attention to service coordination. Even when
       school-based health care is available, many adolescents still may have
       unmet reproductive health care, mental, or dental health care needs.
 DE    Adolescence  *AIDS Serodiagnosis  *Contraception  Health Services
       Accessibility  Human  *Pregnancy Tests  *School Health Services  MEETING
       ABSTRACT  JOURNAL ARTICLE

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