Evaluation of a peer provider reproductive health service model for adolescents.

CONTEXT: The use of peer providers in family planning clinics has been proposed as a strategy that could better serve sexually active adolescent populations. METHODS: Baseline and follow-up survey data from 1,424 female and 166 male adolescent clients of five California community health clinics were analyzed to assess the effectiveness of a peer provider model between 1996 and 1999. Multivariable analyses examined differences in outcomes between clients' first and last clinic visits, and by whether clients received only clinical services or other components of the model (outreach and telephone follow-up) as well. RESULTS: Female clients were significantly more likely at their last visit than at their first visit to report consistent birth control use (odds ratio, 1.9), use at last intercourse (1.8) and use of effective methods (3.5), and were significantly less likely to report consistent condom use (0.7). There were no significant differences in male birth control or condom use between first and last visits. Females who received all components of the model were more likely than those who received only clinical services to return for an annual exam (2.2) and to make three or more visits during the study period (1.7). The full model was particularly effective for females who were Hispanic, had been born to adolescent mothers or had had more than one sexual partner in the six months before their first clinic visit. CONCLUSIONS: The peer provider model appears to be a promising addition to the mix of service delivery models, particularly for certain subgroups of clients. The findings underscore the importance of tailoring programs on the basis of clients' risk profiles.

School-based health centers and academic performance: research, challenges, and recommendations.

School-based health centers (SBHCs) provide physical and mental health services on school campuses to improve student health status, and thereby potentially facilitate student academic success. With a growing emphasis on school accountability and the simultaneous dwindling of resources at the federal, state, and local levels, SBHCs face increasing pressures from school administrators and funders to document their impact on student academic achievement. This article reviews the methods, findings, and limitations of studies that have examined the relationship between SBHCs and academic performance. It also describes methodological challenges of conducting and interpreting such research, and discusses factors and intermediate variables that influence student academic performance. Recommendations are offered for SBHC researchers, evaluators, and service providers in response to the pressure they are facing to document the effect of SBHC services on academic outcomes.