NYC Center for Economic Opportunity

Six School Based Health Centers (SBHCs) have been placed in NYC high schools located in high poverty neighborhoods. The clinics provide comprehensive health services.

Problem Statement
Adolescents are the least likely of any age group to have health insurance or to seek health care at a provider's office, even when insured. SBHCs were originally developed to address the low health care utilization rates of school-aged children. Thousands of school age children in New York State have limited access to comprehensive health services because of financial, geographical, and other barriers to care.

Research & Evidence
SBHCs can improve access to primary care for underserved youth by bringing comprehensive primary care services directly to the place where youth are during the day and by addressing critical health problems that make it difficult for students to learn. In addition, increased school absenteeism has been documented in adolescents with chronic diseases including diabetes and asthma, subsequently leading to decreases in school performance.

In 2005, 40% of girls and 24% of boys reported feeling persistently sad for at least 2 weeks, and 10% of adolescents reported attempting suicide. Mental health services provided by SBHCs address behavioral and emotional difficulties that threaten to interfere with a child's ability to perform academically. Youths' mental health problems, if not treated, may interfere with their readiness and motivation to learn, create long-term problems, and affect emotional, intellectual, or physical development. By providing mental health services, school performance and personal relationships can be improved.

Teen pregnancy continues to be a serious health and poverty issue in New York City. In 2004, there were 8,415 births and 13,859 teen abortions to 15-19 year old females citywide. Teen mothers are also less likely to complete high school and earn an adequate living. As a result, young mothers are more likely to require public assistance to support themselves and their children. Studies have shown an increase in the use of contraception and a decrease in the rate of teen pregnancy when school-based or school-linked clinics include reproductive health services. These services include one-on-one counseling, the provision of contraceptives and condoms, and the dissemination of educational materials. One evaluation of a school-based reproductive health services program used pre and post-test data to compare program schools and comparison schools that had no pregnancy prevention program. The results showed that after 28 months, program schools experienced a 30.1% decline in pregnancy rates, whereas comparison schools showed a 57.6% increase in pregnancy rates. It is also worth noting that research has established that the provision of contraception at SBHCs does not increase or hasten the onset of sexual activity of students.

Program Description
SBHCs are established in six selected "high-need" high school sites. Because SBHCs provide comprehensive primary care services, they also offer a non-stigmatized environment for reproductive and mental health services. The onsite reproductive health services are confidential, and include dispensing of contraceptives, testing for pregnancy and sexually transmitted infections, education, counseling, referrals for additional services, and the reinforcement of activities aimed at reducing teen pregnancy and sexually transmitted infections.

The Department of Health and Mental Hygiene contracts with major health providers, such as New York Presbyterian Hospital or the Health and Hospitals Corporation, to provide comprehensive primary care, mental health, and reproductive health services.

Target Population
New York City high school students in neighborhoods with high rates of poverty and teen pregnancy. All students enrolled in a high school at a campus with a SBHC are eligible for services, regardless of health insurance or immigration status.

Expected Outcomes

Short-Term:

• Enroll 40% or more of HS students in the HS in the SBHC in first year of operation; 70% or more thereafter
  
• Provide counseling and education on pregnancy prevention, STI prevention, and general health

Long-Term:

• Increase utilization of health care services (visits to provider) by enrollees
  Improve management of chronic illnesses such as asthma and diabetes
  Reduce number of teen births and prevalence of STIs
  
• Increase utilization of mental and reproductive health care services