文章基本信息

标题：The Role of School Health Centers in Health Care Access and Client Outcomes
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作者：Samira Soleimanpour ; Sara P. Geierstanger ; Shelly Kaller 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：9
页码：1597-1603
DOI：10.2105/AJPH.2009.186833
语种：English
出版社：American Public Health Association
摘要：Objectives. We describe the impact of school health centers in Alameda County, California, on adolescents' access to care and their mental and physical health outcomes. Methods. We used a multimethod evaluation of 12 school health centers to track data on clients (n = 7410), services, and provider-reported outcomes; client pre–post surveys (n = 286); and student focus groups (n = 105 participants). Results. School health centers were the most commonly reported source of medical (30%), family planning (63%), and counseling (31%) services for clients. Mental health providers reported significant improvements ( P < .05) from baseline to follow-up in clients' presenting concerns and resiliency factors. Medical providers and clients also reported general improvements in reproductive health, particularly in the use of birth control other than condoms. Student focus group participants noted that school health centers helped improve access to services students might not seek out otherwise, particularly counseling and family planning services. Furthermore, students noted that they liked school health centers because of their confidentiality, free services, convenience, and youth-friendly staff. Conclusions. School health centers increase access to care and improve mental health, resiliency, and contraceptive use. School-based and school-linked health centers (hereafter “school health centers”) represent a model of care that responds to the unique physical and mental health issues of adolescents by offering care in an accessible, youth-friendly environment. Studies have found that access to school health centers increases use of primary care, reduces use of emergency rooms, and results in fewer hospitalizations.^{1 – 3} School health centers also expand access to and quality of care for underserved adolescents; one study found that school health center users were more likely than were traditional outpatient clients to have received primary and preventive care services despite the fact that they were less likely to be insured.⁴ Furthermore, adolescents with alternate forms of health care report high degrees of comfort-seeking care at school health centers.⁵ Adolescent mental health outcomes have also improved because of school health centers. Studies have shown a significant decline in depression among students who received school health center mental health services⁶ and a reduced likelihood of suicide ideation among students attending schools with school health centers.⁷ Studies have also documented the positive impact of school health centers on reproductive health outcomes,⁸ including improved contraceptive use.⁹ Although research has demonstrated how the school health center model of care can affect health access and outcomes, many studies have been limited by relatively small sample sizes. Collecting uniform outcome data from larger coalitions of school health centers is challenging, given the obstacles of different school districts, community health providers, service structures, and data confidentiality regulations. Our aim was to demonstrate the impact of 12 school health centers on clients' access to care, satisfaction, and reproductive and mental health outcomes. We incorporated data collection from both client and provider perspectives through a standardized evaluation process that documents services provided, as well as provider assessments of 2 outcome measures that school health centers have been known to affect: reproductive health and mental health.