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O.T.A. Report Advocates School Clinics To Provide Services To Needy Teenagers

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Washington--The creation of school-linked or community-based health centers may be the best way to provide health services to medically needy adolescents, a new government report concludes.

The report, compiled by the Office of Technology Assessment at the request of 29 members of the Congress, paints a bleak picture of the availability and suitability of health services for teenagers.

According to the report, the health-care system is not geared toward meeting the needs of adolescents. Although teenagers are probably the healthiest segment of the population in the sense that comparatively few of them die each year, many suffer from emotional and physical problems--such as mild depression, drug abuse, and family and school problems--that are not easily treated.

As a result, the report notes, "in the case of adolescents in particular, the line between prevention and treatment is not always clear."

The report found that many adolescents have either very limited or no access to health care. One out of seven teenagers does not have health insurance, including the one in three poor adolescents who is not covered by a state Medicaid program, it said. Even if these youths are covered, health-care policies often exclude certain services, such as mental-health care, that adolescents particularly need,4the report said.

Adolescents also often lack transportation to health facilities, and may not receive the consent they need from their parents for certain services or procedures, the report said.

One reason teenagers do not get the services they need, the report said, is that "the Federal Government does not have a coordinated approach to adolescent health."

Several dozen federal agencies, along with numerous Congressional committees, create policies and programs without consulting one another, according to the study. Federally funded research into adolescent health is also shortchanged, it noted. For example, the National Institute on Child Health and Human Development, the lead agency for basic research in this area, devoted only 6.6 percent of its total expenditures in 1988 on adolescent issues, the report said.

To remedy this situation, the Congress can consider three major options, the report said: improve the access of adolescents to health services; restructure and reinvigorate federal efforts to bolster the health of teenagers; and support efforts to improve teenagers' family and community life.

The guiding principle behind these efforts, the ota said, should be ''providing a prolonged protective and appropriately supportive envi8ronment for adolescents."

One way that the Congress can improve adolescents' access to health care is to encourage the creation or maintenance of school-linked and community-based health centers, the ota said.

The Congress could provide seed money for the development of such centers, continue funding for the centers, or reduce barriers that prevent the delivery of services in these facilities. These barriers include state, Medicaid, and insurance prohibitions against reimubursement for services provided by nonphysicians, the report said.

The Congress could also consider mandating the expansion of Medicaid to include poor adolescents, and requiring employers to provide health insurance for their workers and the employees' dependents, the report said.

Other options the ota said the Congress could consider include:

Creating a new federal agency at the Cabinet or sub-Cabinet level that would aim to improve adolescent health.

Improving federal efforts to collect data about adolescent health.

Allocating more money for research into adolescent conditions.

Limiting the access of teenagers to firearms.

Expanding supervised recreational activities, and monitoring the effects on adolescents of the National and Community Service Act of 1990.

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