Mental Health Care In A High School Based Health Service

Adolescence, Spring, 1998 by Lisa Jepson, Linda Juszczak, Martin Fisher

METHOD

Facility

Since February 1988, the Division of Adolescent Medicine of North Shore University Hospital has been operating a high school based health center in an isolated but urban section of Queens, New York, serving approximately 2,000 students. The center is open from 8 A.M. to 4 P.M., five days a week, including summers. The center is divided into offices, examining rooms, laboratory space, an emergency area, and a waiting room.

Each student using the center must receive the consent of a parent or legal guardian, who is allowed to choose specific services that can or cannot be provided. Students who have a primary care provider may use the center, as well as students who do not have a regular health provider. Students are not charged out-of-pocket fees, but insurance information is sought so that third-party reimbursement can be obtained when appropriate. Clinic charts are maintained separately from school health records; health service personnel have access to both sets of records, while school personnel have access only to the latter.

At the time of data collection, the center was staffed by (1) a social worker; (2) a doctoral student in clinical psychology, who worked two days a week and was supervised by an off-site licensed psychologist; (3) two pediatric nurse practitioners, one of whom served as the center's director; (4) attending physicans and fellows from North Shore University Hospital, who rotated to cover the center 3-5 hours three times a week; and (5) two health aides provided by the school, who were responsible for record keeping, emergency services for both enrolled and nonenrolled students, reception, triage, and basic, on-site screening tests.

Since the inception of the program, the goal has been to integrate mental health and medical services, which has been accomplished on two levels. First, clinic staff interact on an ongoing basis and discuss both policy issues and individual cases. Second, the initial evaluation communicates to each student that staff are interested in both medical and psychosocial issues, and provides for a screening of every registered student in these areas. The center has been successful in treating a large number of students for a wide range of medical and psychosocial problems. The services provided by the center are listed in Table 1.

Data Collection

Students are seen in the center either for scheduled appointments or as walk-ins. Each new student receives a comprehensive health evaluation, which includes a patient and family medical history; a psychosocial history; a complete physical examination, including a gynecologic examination for sexually active females or those with gynecologic complaints; and laboratory screening tests.

Information obtained from all health evaluations is maintained in patient charts and compiled on a regular basis. Additional information is gathered for each visit (including reason for visit, services provided, diagnosis, referrals, and length of contact), and these data are also compiled regularly.