School-Based Clinics: The Politics of Change
Pacheco, Mario, Powell, Wayne, Cole, Catherine, Kalishman, Norton, Benon, Robert, Kaufman, Arthur, Journal of School Health
Literature on school-based clinics (SBCs) has focused on documenting success in addressing the needs of adolescents. (1-6) Few articles, however, have discussed the public controversy that often surrounds the concept, creation, and maintenance of SBCs. Yet, such clinics are frequent targets of intense criticism at the local and national level by political and religious groups.
Albuquerque, N.M., is a city of about 350,000, with one of the largest numbers of SBCs per capita in the U.S. It has nine such clinics, six in high schools, two in middle schools, and one in an elementary school. In 1987, the role and value of these clinics underwent intense scrutiny by the city's Public School Board in response to well-organized and highly vocal community groups who opposed the clinics. A case study of how the SBCs were able to successfully defend their role in the community and how they were able to promote their eventual acceptance and expansion is presented.
ESTABLISHMENT OF SBCs IN ALBUQUERQUE
During the past decade, SBCs in Albuquerque developed as separate partnerships between three publicly funded health provider organizations and their inner city, neighborhood schools. One, the Family Medicine Division, University of New Mexico School of Medicine, established affiliations with an inner city high school, two of its feeder schools (a middle school and an elementary school), a local high school for incarcerated adolescents, and a high school for pregnant teen-agers. Health care services are donated by medical personnel, ranging from medical and nursing students to faculty. In exchange, the community provides training sites for students and residents at the SBCs. A second, the Albuquerque Family Health Centers, a federally funded network of primary care clinics located in federally designated underserved communities, established clinics in a high school and in its feeder middle school, and in an alternative high school. And third, the New Mexico Health and Environment Dept. established a clinic in a high school near one of its district offices, donating its services with the expectation that the clinic would help diminish high-risk behavior among adolescents.
The three organizations had no affiliation with each other, nor was there any coordination between their school-based efforts when the clinics began. The character of SBC services, therefore, varied from site to site, reflecting the unique needs perceived by the local school communities and their health care providers.
In the early years, the clinics ran relatively smoothly with little publicity or controversy. The clinics cared for a variety of student health needs such as sports physical examinations, respiratory infections, injuries, depression, and issues regarding sexuality. At the request of the principals, the clinics neither dispensed nor prescribed contraceptives. The community was predominantly Catholic, and it was felt that such services would be unacceptable to a large segment of the population. Providers could, however, counsel on contraception, perform pregnancy testing, and refer students to outside physicians, both public and private. They could discuss available services with a range of orientations, from Birth Right to Planned Parenthood, depending on the teen-agers' preference.
Early in summer 1987, Albuquerque's SBCs came under broad attack following a wire service article, printed in a local newspaper, concerning the controversy surround the dispensing of contraceptives at SBCs in New York City. SBCs were targeted at the national level by a coalition of fundamentalist religious organizations, anti-abortion activists, and conservative political groups, as part of their national political agenda. One participant group, the National Association of Christian Educators and Citizens for Excellence in Education, distributed nationally a newsletter offering strategies for organizing local political action groups opposing SBCs. …