title: Use of health and mental health services by adolescents across multiple delivery sites.
abstract: OBJECTIVE
  To assess the role that school-based health centers (SBHCs) play in facilitating access to care among low-income adolescents and the extent to which SBHCs and a community health center network (CHN) provide similar or complementary care.
  
  
  METHODS
  A retrospective cohort design was used to compare health care service use among adolescents relying on SBHCs compared with adolescents relying on a CHN. The study sample consisted of 451 inner-city high school students who made 3469 visits between 1989 and 1993. Encounter data were abstracted from medical records. Frequency of use and reason for use are examined according to various sociodemographic and health insurance characteristics.
  
  
  RESULTS
  SBHC users averaged 5.3 visits per year. Minority youth who used the SBHC had the highest visit rates (Hispanic, 6.6 visits/year; African-American, 10.6 visits/year). Visits to SBHCs were primarily for medical (66%, p <.001) and mental health services (34%, p <.001). Visits at CHN sites were 97% medical (p <.001). Visits by adolescents were 1.6 times more likely to be initiated for health maintenance reasons (p =.002; confidence interval [CI], 1.17-2.06) and 21 times more likely to be initiated for mental health reasons (p = <.001; CI, 14.76-28.86) at SBHCs than at CHN facilities. Urgent and emergent care use in the CHN system was four times more likely for adolescents who never used a SBHC (p <.001; CI, 3.44-5.47).
  
  
  CONCLUSIONS
  This study supports the view that SBHCs provide complementary services. It also shows their unique role in improving utilization of mental health services by hard-to-reach populations. The extent to which community health centers and other health care providers, including managed care organizations, can build on the unique contributions of SBHCS may positively influence access and quality of care for adolescents in the future.
authors.affiliation: School Health Program, Montefiore Medical Center, 3544 Jerome Avenue, Bronx, New York, 10467 USA. ljuszcza@montefiore.org
authors.forename: Linda
authors.initials: L
authors.lastname: Juszczak
authors.forename: Paul
authors.initials: P
authors.lastname: Melinkovich
authors.forename: David
authors.initials: D
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003151:Community Health Centers / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid; D008605:Mental Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012572:School Health Services / Q000706:statistics & numerical data*; D012923:Social Class; D017664:Uncompensated Care; D014481:United States; D014504:Urban Health