Barriers to School-Based Health Care Programs

Although school-based health care programs (SBHCPs) provide affordable and accessible health care to children and adolescents and are known to improve school attendance, a variety of barriers affect their development. Focus groups were conducted in three schools in Louisiana to demonstrate how barriers can affect the initiation and development of SBHCPs. Each school-based program was in a different stage of development. Identifying potential barriers and developing strategies to overcome them can enhance already existing SBHCPs and make it easier for new programs to begin. The social worker serves as an important ally in the development of SBHCPs and is a necessary part of the school-based health care team. Key words barriers focus groups health care school-based programs A growing awareness that many school-age children and adolescents had limited regular access to comprehensive health services resulted in a proliferation of school-based health care programs (SBHCPs) throughout the 1980s. In 1986 the Robert Wood Johnson Foundation provided funding to underwrite SBHCPs by creating the School-Based Adolescent Health Care Program. With this funding, 24 sites across the nation were established to meet the health care needs of adolescents through the delivery of primary health care services in high schools (Terwilliger, 1994). Although each SBHCP was to a degree unique, all had an underlying goal to improve the overall physical and emotional health of adolescents by providing affordable, accessible health care (Elders, 1993). Communities that have established SBHCPs have realized secondary benefits including improved school attendance, enhanced levels of contraceptive use, and fewer births to teenage mothers (Dryfoos, 1985). The success and benefits of SBHCPs have been illustrated extensively in the literature (Dryfoos, 1993; Feroli, Hobson, Miola, Scott, & Waterfield, 1992; Goldsmith, 1991; Society for Adolescent Medicine, 1988). However, little attention has been directed to identifying and understanding the range of barriers that affect the initiation and development of SBHCPs. Using the experiences of several SBHCPs developed in Louisiana, this article examines sources of potential barriers and potential strategies to addressing these barriers. For the purpose of this article, a barrier is defined as a constellation of attitudes, values, and beliefs of a group of individuals, community members, parents, and students that impede or oppose one or many aspects of a SBHCP. Despite the potential benefits of SBHCPs, support and acceptance for programs varies across communities. Many communities show tremendous support for SBHCPs and thus face few if any barriers from program initiation and development (Davis & DeVaney, 1986). In other communities, SBHCPs face opposition from a variety of sources, most of whom see no logical link between the delivery of health care and a school environment (Lavin, 1993). Usually problems of SBHCP development can be traced to the public's lack of knowledge about the health problems of adolescents and the health benefits of early medical screening. In addition, some community constituencies think that SBHCPs are developed solely for the provision of contraception and abortions, a misconception that must be worked through if the SBHCP is to be successful. In some instances, barriers to the initiation and development of SBHCPs may be transitory and dissipate on their own as familiarity with the program grows. In addition, some barriers may be transitory in one community but not in another community. SOURCES OF BARRIERS Barriers can arise at any stage in the development of a SBHCP, from its inception through its years of operation. Furthermore, barriers can be raised by a variety of sources, including professionals in the health care community, students and parents at the target school, parents of students outside of the school, unaffected students and their parents, media, community political groups, religious organizations, school boards, and factions within the educational system (Dryfoos, 1993; Dryfoos & Santelli, 1992; Edwards, Ball, Reif, & Zimmerman, 1993). …