School-Based Clinics: A Response to the Physical and Mental Health Needs of Adolescents

School-based clinics staffed by an interdisciplinary team of health care professionals, including social workers, are among the pioneering efforts that address both the health and education needs of adolescents. Initial research and publications about this concept of health care service delivery have focused on the area of reproductive health; however, it is necessary to broaden the knowledge base by examining the range of problems experienced by students using the clinics. To provide data on this issue, a study was conducted in four school-based health clinics in a large midwestern city. The results of this study document the use of the clinic for multiple issues and provide statistical support for the clinical impressions of the staff that students, despite their stated reason for visiting the clinic, were equally likely to have other physical and mental health problems.Traditionally, health and education needs of adolescents have been seen as separate issues to be dealt with in separate settings. However, in a recent report by the Carnegie Corporation's Task Force on Education of Young Adolescents (1989), the assertion is made that educators must combine these two arenas and begin to pay attention to the physical and mental health dimensions of educating adolescents. Although school systems cannot be responsible for meeting all the needs of their students, the report argues that when a student's need affects his or her ability to learn, the school must respond and become a "health-promoting environment." Social workers have long been aware of this need. School-based clinics (SBCs) staffed by an interdisciplinary team of health care professionals, including social workers, are among the pioneering efforts that address these issues.In the early 1970s, an innovative model of service delivery to adolescents was inaugurated, making health care services for this vulnerable population more accessible and available: Comprehensive health care clinics were established within public high schools. Currently, there are more than 150 SBCs located in urban and rural areas throughout the United States (Donovan & Waszak, 1989).Initial research and publications about this concept of health care service delivery have focused on the crucial yet controversial area of reproductive health. Both opponents and proponents of SBCs have used these data to justify their respective positions about the efficacy of, or harm created by, such clinics. However, reproductive health services constitute only one-third of all services offered in some clinics and significantly less in many others (Donovan & Waszak, 1989). Until recently (Balassone, Bell, & Peterfreund, 1991; Harold & Harold, 1991), the discussion of other adolescent health needs and the contributions of other disciplines, especially social work, have largely been ignored. To understand fully the uniqueness of and need for SBCs and the role of the health professionals who work in them, it is necessary to broaden the knowledge base by examining the range of problems experienced by students using the clinics.To provide data on this issue, a study was conducted in four school-based health clinics in a large midwestern city. The social workers at these clinics were interested in looking systematically at the psychosocial issues of teenagers who visited the clinics and at problems that might place students at risk. The SBCs in this study were among the first to be established in the United States. Originally, they were developed to deal with adolescent contraceptive and prenatal needs, but they have expanded in scope to ensure student access to a variety of physical and mental health services. These particular clinics are staffed by an interdisciplinary team that works with the school system to make health care an integrated part of the school curriculum rather than an adjunct issue. By coming to the adolescents (that is, by locating in the schools), it is easier and more acceptable for students to seek out help or information regarding psychosocial needs and environmental problems that necessitate a whole range of services in addition to the reproductive health services most commonly associated with SBCs, as evidenced by the early literature (Wetherley & Semke, 1991). …