Mental Health Care In A High School Based Health Service

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

Group for Children of Substance Abusers

Because 34% of the students using the mental health services reported problematic substance use among family members, a group for children of substance abusers was developed for the following academic year. Due to limited space, the group was restricted to nine participants (all female, between ages 14 and 19). Three were African American and six were Hispanic. Of the nine members, four reported personal use of alcohol or marijuana in addition to that of family members. Although this group focused on issues related to substance abuse, this problem represents only one of the many complex psychosocial issues confronting these youth (see Table 6). The multiple psychosocial stressors shown in Table 6 are not only typical of those situations encountered in inner-city school-based health centers, but clearly indicate that high-risk youth are using clinic services.

DISCUSSION

The data indicate that adolescents need and use a broad range of psychosocial services available to them in a school-based health center. Over a five-year period, the number of mental health visits quadrupled, while the percentage of visits devoted to mental health issues nearly doubled. As school-based health centers become established, the experience has been that increasing numbers of students present with mental health needs and that an increasing amount of staff time must be devoted to these issues.

There are distinct advantages to providing a broad range of mental health services in school-based health centers. The integration of mental health and medical services reduces the need to make referrals to outside facilities, which, in our experience, increases the likelihood that students will receive needed care. Our experience is consistent with that of Harold and Harold (1993), who argue that adolescents are less likely to seek services in unfamiliar settings, and with that of Hoberman (1992), who argues that adolescents require convenient, comprehensive services that do not involve complex or extensive planning for access. That nearly 95% of children and youth are in elementary and secondary schools underscores the convenience and accessibility of school-based health centers (Iverson & Kolbe, 1983). With high-quality care freely available in schools, parents are neither obligated to take time off from work to accompany their children on health care visits nor confronted with having to choose between th eir children's health and economic hardship. These issues become most crucial where professional care must be provided on a regular basis, which is generally the case with mental health services. The regular attendance at group meetings by the children of substance abusers supports our belief that school-based health centers represent an optimal solution to the multiple barriers involved in providing health care to adolescents.

As shown in Table 4, high-risk behaviors, particularly those related to sexuality, are among the leading reasons adolescents seek mental health services in school-based health centers. Taken together, 26.5% of the students using the mental health services were seeking assistance with issues related to either sexuality or pregnancy. Although 19% of this total represents pregnant teens, the other 7.5% represents students seeking information that may be used to postpone sexual activity, to engage in safe sexual activities, or to prevent unwanted pregnancies. It should be noted, however, that at the time of data collection, the social worker was responsible for follow-up visits with pregnant teens, a responsibility that has since been delegated to the nurse practitioner. At present, therefore, the number of visits related to pregnancy would be significantly smaller than that found in this study. Given the shifts in clinic priorities and staff interests, data are likely to vary both among practices and staff memb ers.