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J Adolesc Health. 1998 Jul;23(1):29-38.

The school-linked health center: a promising model of community-based care for adolescents.

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Support Center for School-Based, Advocates for Youth, Washington, DC 20005, USA.



To examine the nature of the linkages between school-linked health centers (SLHCs) and schools; the centers' services, staffing, financing, and other operational details; and the advantages of this model of care.


Twenty-one SLHCs completed a written survey on a range of operational issues, including types of services provided, staffing patterns, budgets, and populations served in 1995. The researchers conducted on-site interviews with six centers and telephone interviews with 14 centers to obtain more detailed information.


Although each SLHC has a unique program design, the study identified characteristics common to all sites. In general, SLHCs provide comprehensive medical, reproductive health, mental health, and health education services designed for adolescents. Staffed with a minimum of an administrator, a primary care provider, a nurse, and an administrative assistant, SLHCs serve students from more than one school as well as out-of-school youth. SLHCs develop formal and/or informal linkages with schools to improve outreach and follow-up services.


The report describes a community-based model of care that is designed to provide affordable, age-appropriate, confidential, convenient care to adolescents, a population that traditionally has been very hard to reach. The SLHCs ability to provide reproductive health care makes it an attractive option for communities trying to prevent pregnancy and sexually transmitted diseases among adolescents. To firmly conclude that the SLHC is an effective model for improving adolescent access to services, more research is needed on adolescents' use and nonuse of SLHCs and other models of care; the cost of SLHCs compared to other models of care; and how SLHCs can sustain themselves financially, particularly in a managed care environment.


This study describes the operations of school-linked health centers (SLHCs). Interviews were conducted on-site at 6 SLHCs and by telephone with 14 others. 21 SLHCs returned a written questionnaire for 1995. The 1995 instrument was a modification of a 1994 Advocates for Youth survey of school-based health centers (SBHCs). There are over 900 SBHCs and only 41 SLHCs. SLHCs are health care facilities for adolescents that are located beyond school property and that have formal or informal relationships to one or more schools in the community. Findings indicate that 33% of SLHCs also provided services to young adults and the children of adolescents. 68% of clients in the sample were female. 45% were White, 29% were Black, 11% were Hispanic, and 8% were other. Few SLHCs collected data on socioeconomic status. An average of 15% of clients were out-of-school youth. 81% of SLHCs provided services to homeless youth and university students. Half of SLHCs provided services to pregnant teenagers. 20-30% of SLHCs were linked with clients in foster care, shelters, treatment facilities, or detention centers. SLHCs provide general medical care, social services, reproductive health care, and counseling. Centers are open full-time, half-time, and part-time throughout the year. The 21 SLHCs served 27,300 clients, who made 66,100 visits in 1995. Budgets ranged from $30,000 to $1.5 million. About 71% were privately funded. 57% were partly funded through patient fees. 20 SLHCs required parental consent. SLHCs offer freedom from school control and outreach to hard-to-serve youth.

[Indexed for MEDLINE]

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