Blum (1987) documented the growing problem of adolescent mortality and morbidity related to life style and risk-taking behavior. The death toll for teenagers from motor vehicle accidents, suicide, drug overdose, and AIDS has been rising. In our high school of approximately 700 students, they were periodically checked for typical health maintenance problems throughout their school years, but no consistent assessment and guidance in the areas of social, emotional, nutritional, attitudinal, spiritual life style, and familial risk factors was provided. In order to develop and implement a system that might address these areas, the Maine School Administrative District #22 developed a model health center which opened its doors in February of 1986. Until that time the students were underserved; only one nurse was on site for 30 minutes daily, and there was no designated health center work space. The plan called for the health center to be located in a high-traffic area of the school.
To accomplish the goal of providing broad-based health assessment, a computer-assisted inventory using software developed by the Problem Knowledge Coupler [R] (PKC) Corporation was chosen. The goal for the first year was to have 50% of the freshman class complete the PKC Wellness Coupler [R] (on a voluntary basis). This self-evaluation is done in a manner that is as nonjudgmental, nonprejudicial, and nonthreatening as possible. This approach assures that all questions are asked and presented in a consistent format.
Skinner et al. (1985) provided an additional basis for the use of self-administered lifestyle questions. They found that a ten-minute questionnaire assessment of lifestyle patterns resulted in a two- to three-fold increase in the patient's intention to discuss lifestyle problems with their physician. This finding was demonstrated in the PRO-MIS [R] Clinic experience in 1970 when self-administered, patient health guidance system questionnaires as described in Cross (1972) was started.
The health center staff consists of a nurse with expertise in adolescent health and a paraprofessional school health aide. Additional resources include the school district physician, the school district nurse, and the Rural Pediatrics physicians and staff as needed. (Rural Pediatrics is a department of the Eastern Maine Medical Center, and was the intermediary funding agency for this project.) A community-based advisory committee provided assistance in implementation and evaluation. This committee consisted of physicians, parents, clergy, teachers, students, and school administrators.
Contraceptives and Unplanned Pregnancy
Early in the health center planning stage, several issues were addressed: The advisory committee and the State of Maine Director of the Department of Human Services were in agreement that the center would not dispense contraceptives. This decision kept the school from becoming involved in political and social controversy which so commonly plagues efforts to establish school-based health clinics. It was also decided that the center would provide a minimum of direct medical services. Students with unplanned pregnancies were provided choices of referral.
The PKC [R] Wellness Coupler, a computer-driven questionnaire, was chosen because of the breadth of areas covered and the ease of modifying and adapting it to our student population. It was also selected because of Weed's (1991) documentation of the value of a coupler as a management tool, and specifically because each person elicits a unique set of options; the direct connection between reliability of (an individual's) input, and the reliability of output is apparent to the user; immediate printout/feedback is received by the user who is in command of the details; and ambiguities inherent in verbal, "off-the-cuff" discussions about findings and recommendations are minimized.
Each of the standard questionnaire statements was reviewed, then modified and/or deleted. …