Public Health Magazine: Spring 1996, Vol.4, No.1
School-Based Clinics: Making the Grade
Growing a Good Idea

Things don't happen just because someone has a good idea," says Judith Jones, founding director of CSPH's National Center for Children in Poverty and now a clinical professor of public health at the School. Nevertheless, CSPH's clinics began as Jones' good idea-one that she considered a natural progression from Presbyterian Hospital's Adolescent Pregnancy Prevention Program which she launched with the full support of the dean and Presbyterian Hospital.

Alarmed by a rising number of first-time pregnancies among very young clients, Jones began re-thinking the goals of prevention and outreach. Conversant with the significant body of literature indicating that students who are not doing well in school are more likely to get pregnant or drop out or both, she envisioned a comprehensive approach to the problem.

Judith Jones

In 1986, Jones visited two junior high school principals in Washington Heights, an area plagued by the difficulties of dislocation common to immigrant populations. She proposed setting up comprehensive school-based clinics as the answer to the Washington Heights School Health Council's concerns that teens were at risk of severe health and social problems.

Created through a partnership between CSPH's Center for Population and Family Health and Presbyterian Hospital, the clinics now serve some 8,000 students-about 90 percent of the combined student bodies of the five schools involved. (Only 199 of New York City's 1,200 public schools have school-based clinics.)

Along the way, Jones had overcome a number of barriers to service, among them obtaining special state waivers to permit the clinics to function in school settings and securing more than $1 million in start-up funds from private foundations.

"We also had a strong relationship with the community, a long-time partnership with Presbyterian Hospital and Columbia University and a very good staff," says Jones, who also serves as senior advisor for the Carnegie Corporation of New York and director of the Robert Wood Johnson Foundation's National Initiative for Head Start.

After the first two clinics opened, the project was turned over to its present director, Lorraine Tiezzi, who, according to Jones, has "done a marvelous job" building on the program's earlier achievements.

Lorraine Tiezzi

"No Time To Waste"

Confronting needs at every turn, Tiezzi has rolled up her sleeves more than she cares to think about. When she became the director of community health and education, she brought with her a sense of urgency. "There was no time to waste. Kids were facing problems that we never faced as adolescents-problems compounded by their economic and immigrant status." Schools here in Washington Heights serve a largely poor, Dominican community, and the conditions parallel what Jonathan Kozol describes in Amazing Grace, an inside view of children's lives in the South Bronx.

"The clinic log notes a growing number of students who prefer to come in- rather than sleep in- when they aren't feeling great. We know attendance has improved since the clinics opened. And when we document our clinics' effect on school attendance as earlier clinics have done, we can demonstrate their effect on academic achievement," says Tiezzi.

A Positive Impact

"We continue to reach out and develop community partnerships. Because of a partnership with Columbia's School of Dental and Oral Surgery, we offer dental care at the site. We brought the Helen Keller Institute into some of our clinics so that, in an hour on the premises, a student's eyes can be tested and fit with prescription glasses. When you add these capabilities to what we can handle in the areas of mental and physical health, you begin to realize that we are health care for these kids."

James McCarthy

In addition, James McCarthy, Ph.D., head of CSPH's Population and Family Health Center and professor of public health, has been engrossed in research aimed at documenting the clinics' impact. He sums up his findings in one sentence: "You can provide these services, you can get kids to come and you can get parents to accept the clinics." As evidence, more than 90 percent of parents have signed the consent forms to permit their children to be treated. Furthermore, the clinic services are cost-effective, McCarthy maintains:

"It costs us a couple of hundred dollars a year per kid; that's equivalent to one visit to the emergency room."

The center's current research focuses on an intensive program for sexually active students, aged 10 to 13, in the four junior high schools. The program links students with the CSPH and Presbyterian Hospital-sponsored family-planning clinics because, while the junior high schools may conduct pregnancy exams and offer sex education, they may neither prescribe nor distribute birth control devices.

Four years after it began, the program has managed to reduce the number of pregnancies from 35 to about half that number, which is good news and bad news, according to McCarthy.

"The good news is that we're reaching about half the kids. The bad news is there's still the other half." Still, every victory is worth celebrating. As McCarthy sees it: "What's the benefit of reaching only one kid? It's considerable."

-MJF

School-Based Clinic

Medical/Health Services