Should (Sexual) Healthcare Go to School? Conflict and Collaboration in a School-Linked Community Health Center

• In Event: What Students and Teachers Know About Health: Implications for School and Community Partnerships

Abstract

Panelist 3 will draw upon data that point to the potential of school-based health centers (SBHCs) for promoting access to health care, reducing students’ risky health behaviors, and building community ties (Geierstanger & Amaral, 2005). These health centers are one innovative solution to making quality healthcare accessible to some of America’s most vulnerable children. However, their potential is achieved only if the school in which the health center is located embraces the idea of providing comprehensive health care to the entire school community, including appropriately adolescent students’ risky sexual health practices. Topics such as sex education, contraception, STI treatment and prevention, and/or prenatal care and parenting skills are often uncomfortable and, some suggest, outside the work of schools.

This case study of one community health center situated on the campus of an urban public high school explores the many challenges that educational, healthcare, community, and youth stakeholders face when defining what health care for adolescents could – and should - mean in a public school setting. It draws on empirical data from (1) our nearly 30 year history of U.S. school-based health clinics (Dryfoos, 1994; Gustafson, 2005); (2) literature on the importance of “relational trust” in supporting inter-disciplinary partnerships in school reform (Bryk & Schneider, 2003); and (3) evidence of broad benefits for youth when sexual health education is included in health programming for high school students (Strunk, 2008).

Data were collected over the course of four months through (1) interviews with school officials, parent volunteers, and health care specialists in a health center adjoined to the school; (2) observations of school and health center practices; (3) field notes; (4) focus groups with 9th and 10th-grade students; and (5) survey data that examine students’ general health knowledge and their feelings regarding the presence of a community health center inside their struggling inner-city high school.

Findings from the field study suggest both complexity and possibility for SBHCs. They point to the potential for continuity and the realities of discontinuity when a service is created for the community in a school site versus integrated into the mission of the school For example, some of the educators and the school administrator in this study feel that classroom instruction and student test scores are the top priority, while clinicians believe that health and wellness are essential and necessary before classroom learning can occur. Patterns in the data also reveal (1) limited communication between school administration and health center staff, leading to mistrust and conflict; (2) no communication at all between the high school nurse and the health center staff; (3) extremely limited general health and sexual health knowledge among the students; and (4) nearly 10% of all female students at the high school already pregnant or parenting, with many in need of information and services but none currently accessing care at the health center.

Author

• Laura Carolyn Murray, University of Pennsylvania