Barriers to school-based health care programs.

Although school-based health care programs (SBHCPs) provide affordable and accessible health care to children and adolescents and are known to improve school attendance, a variety of barriers affect their development. Focus groups were conducted in three schools in Louisiana to demonstrate how barriers can affect the initiation and development of SBHCPs. Each school-based program was in a different stage of development. Identifying potential barriers and developing strategies to overcome them can enhance already existing SBHCPs and make it easier for new programs to begin. The social worker serves as an important ally in the development of SBHCPs and is a necessary part of the school-based health care team.

Community reactions to reproductive health care at three school-based clinics in Louisiana.

Despite the growing success of school-based health care during the past two decades, the issue of providing reproductive health care at school-based health centers remains controversial. In this article, focus group data from three school-based centers in Louisiana, each in different stages of development, demonstrates how the controversies about reproductive health may frame more general concerns about school-based care. In addition, community readiness to address directly problematic sexual behavior relates not only to the specific needs and priorities of the community but to recognition of the negative effect of the consequences of sexual behavior such as pregnancy, high drop out, and absenteeism rates on a community's educational, rather than social, goals and values.

PIP: Under the direction of the Louisiana Office of Public Health, focus groups at three schools were used to conduct a formal evaluation of the school-based health centers (SBHCs). Specifically, researchers aimed to determine the actual educational and health-related benefits of the SBHCs. One high school was in a politically conservative, small city in southern Louisiana. 60% of the students were African-American. More than 50% of girls became pregnant at least once during their high school years. The high pregnancy rate affected school attendance and drop-out rates. The second SBHC served elementary, junior, and senior high school students who lived in a conservative, close-knit community. Most residents were White. 90% of students enrolled for SBHC services. The third SBHC was located in a high school in the inner city of a medium-sized city. Crime, violence, drug dealing, drug use, single-parent families, and poverty were common. Most students were African Americans. Shared commonalities of the three SBHCs included: little controversy existed about provision of pregnancy and STD (sexually transmitted disease) testing or referral about contraceptive counseling, and everyone was aware of the high pregnancy rates in their communities and that adolescent pregnancy is associated with absenteeism and high drop-out rates. Yet, few people were ready to define adolescent pregnancy as a community concern or as a problem appropriately addressed by the SBHC. The willingness of a community to address reproductive health may reflect their concerns about keeping students in school. These findings suggest that SBHCs must develop and maintain strong support and commitment from students, teachers, parents, and the greater community. Once the SBHC has gained their confidence, it is free to develop services that meet the specific needs of the students. Successful launching of SBHCs depends on keeping the health care goals consistent with the community's educational goals rather than social goals.