COMPREHENSIVE SCHOOL-BASED HEALTH-CARE - HIGH-SCHOOL-STUDENTS USE OF MEDICAL, MENTAL-HEALTH, AND SUBSTANCE-ABUSE SERVICES

Objectives. To explore adolescent students' use of school-based health and medical care and mental health and substance abuse counseling ser vices and to compare adolescents' patterns of use of medical, mental h ealth, and substance abuse services located in school-based and tradit ional settings. Design. Retrospective analysis of computer-stored, sta ndardized data for all student visits during a 4-year period. Setting. Three high school-based student health centers. Subjects. A total of 3818 adolescent students who used services provided by the school-base d health centers (SBHCs). Outcome Measures. Frequencies of student vis its to medical providers and mental health and substance abuse counsel ors and frequencies of diagnostic assignments. Results. During a 38-mo nth period, 3818 students attending senior high school made a total of 27 886 visits to three SBHCs. They represented 63% of students enroll ed in the SBHCs and approximately 42% of the total school population. There were no significant demographic differences between students att ending the SBHCs and the overall student body. However, compared with students who were enrolled in the SBHCs but did not use them, users we re more likely to be female and Hispanic. Ninety-four percent of stude nts using the services had visits with medical providers; 25% had visi ts with mental health counselors; and 8% of students had visits with s ubstance abuse counselors. The fetal annual mean number of student vis its was 4.7, and the annual mean numbers of visits for students who us ed the following services were: medical, 3.3; mental health, 5.8; and substance abuse, 6.8, An average of 1.4 diagnoses were made per visit. The most common major diagnostic categories were emotional problems ( 29% of all diagnoses), health supervision (13%), respiratory problems (11%), reproductive health problems (11%), and substance abuse problem s (8%). Almost one fourth of the students had contact with more than o ne of the three categories of service provider. Visit frequency increa sed significantly for students who used two categories of provider (13 to 15 mean total visits compared with 4 to 5 mean total. visits for s tudents who used just one category of provider) and escalated to a mea n of 32 total visits if all three categories of service were used. Con clusions. Adolescents attending SBHCs had higher rates of visits for h ealth and medical fare than adolescents using traditional sources of m edical fare. The proportions of student users of SBHC mental health an d substance abuse counseling services were commensurate with the estim ated prevalences of these problems in this country's adolescent popula tion. In addition, the mean numbers of visits to mental health counsel ors in SBHCs compared favorably with adolescent visit rates for mental health services in other settings. Too little information is availabl e about adolescent use of substance abuse services in non-school-based settings to make similar comparisons. In summary, adolescent users of SBHCs seemed to have higher use of medical, mental health, and probab ly substance abuse counseling services than did adolescents in the gen eral population. These findings are consistent with the interpretation that SBHCs do enhance adolescents' access to care for medical, mental health, and substance abuse problems.