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From Grassroots Movement to Health-Care Mainstream

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PITTSBURGH--More than 250 school-clinic directors and health educators gathered here Oct. 2-4 at what turned out to be a celebration of their high-profile status in President Clinton's health-care-reform plan.

"This is a coming-out party for school-based clinics,'' said one participant, still reeling from the news that the President is expected to request as much as $400 million in federal support for school clinics this year.

That feeling of collective excitement pervaded the conference, which was hosted by the Center for Population Options, a family-planning research group based in Washington.

School clinics are finally becoming part of the health-care mainstream, organizers said.

Since the first school-based clinic opened in Dallas in 1970, opponents have objected to the provision of family-planning services on school grounds. But despite continued opposition, "school clinics are accepted and welcomed with enthusiasm by a broad range of national medical organizations,'' said Pamela Haughton-Denniston, a spokeswoman for the C.P.O.

Conference participants suggested that a combination of factors--shifting federal priorities, private-foundation funding, and increases in teenage pregnancy, drug abuse, and AIDS--have propelled school clinics to the forefront of adolescent health care.

Joy Dryfoos, an author of two books on adolescent health, predicted that 16,000 new clinics would open in the next two years if the President's adolescent-health initiatives are adopted by Congress.

But most conference participants expressed concern about how they would adapt to this new health-care system.

School health workers argued that nurses would need to be retrained for new responsibilities. And many called for technical assistance to schools to help them navigate the proposed new health-care bureaucracy.

But school-clinic advocates are not waiting for health-care reform to define their mission.

"Unless we become more than a fly on the wall, we aren't going to get very far,'' said Bernie Rosenthal, a health-program administrator for the Baltimore city health department.

To that end, local health and education officials are producing studies designed to show federal and local policymakers the importance of school-based clinics in increasing students' access to care.

In Dover, Del., researchers interviewed 1,571 students in three local high schools about their access to health care, whether they had health insurance, and what they expected from school clinics.

The researchers also interviewed 448 parents whose children were participants in the survey about their access to health care in general and the level of social services in their community.

The survey found that those students who most needed the services received the care. Twenty-four percent of the students who used the school clinic reported that it was their usual source of care. And approximately 10 percent of the students using the clinic indicated that if there were no such facility, they would go "nowhere'' for medical care.

Over one-third of all parents interviewed said there were insufficient medical resources in the community for teenagers.

Another study presented here tackled the contentious topic of condom availability in schools.

Although three states prohibit distribution of condoms on school property, the number of schools dispensing condoms has grown dramatically, according to the C.P.O., from one clinic in 1989 to 350 schools today.

Researchers evaluated a program in Commerce City, Colo., where faculty advisers serve on a "prophylactic patrol'' that distributes condoms and AIDS-prevention materials to students.

In the study, 152 randomly selected Adams City High School students were surveyed last March.

The study showed that the prevalence of sexual activity in that school was the same as in other Colorado schools that do not distribute condoms, according to Dr. Larry Wolk, the medical director of community health services in Commerce City and the study's author.

The percentage of sexually active 14- to 19-year-olds remained at 60 percent despite the availability of the contraceptive, the study found.

The benefits of the program outweigh the risks 3 to 1, the author contends.

"The program protects sexually active students from H.I.V. and pregnancy, the same way not smoking protects you from lung cancer,'' Dr. Wolk said.

School-clinic officials said they hope this research will help to disprove the contention that condom distribution encourages sexual promiscuity.--J.P.

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