Since school-based health centers and other extended services are a relatively new phenomenon, research on and evaluation of these programs are in the early stages. Many of these initiatives are special demonstration projects in a limited number of schools scattered throughout the country. A more complete discussion of selected findings from these initiatives is found in the background paper in Appendix D.
Much of the research has focused on school-based health centers. Studies over the past decade have shown that SBHCs can be implemented successfully in schools, enrolling substantial percentages of students (Dryfoos, 1994b; Kirby, 1994). SBHC users were reported to have received adequate care in a cost-effective manner and to be very satisfied with both the quality of the services and the caregivers. Research has documented that the services are used by youth who need them the most. Studies have also described the organization and functioning of SBHCs, as well as the barriers encountered and strategies for overcoming them. More challenging has been the conduct of studies on the impacts of SBHCs in terms of reducing risky behavior and improving long-term health and educational outcomes. Also, since many findings pertain to specialized initiatives dealing with targeted groups, it is not clear how generalizable the findings are to other settings and populations. Methodological difficulties in conducting research on school health programs are discussed further in Chapter 6. In spite of these limitations, it is possible to glean some interesting insights from existing studies, as described in the following sections.
A basic measure of program utilization is the number and fraction of students in a school enrolled in the SBHC. Typically, enrollment involves the submission of a form indicating parental consent to use the SBHC. Non-enrolled students can be treated for emergencies but then must go through the enrollment process. A related measure is the percentage of enrollees who actually use the facility.
Advocates for Youth reports that in 1993, about two-thirds of the students in the schools that responded were enrolled in their SBHCs, and 75 percent of them utilized the program over the reporting year (Hauser-McKinney and Peak, 1995). A survey supported by the Robert Wood Johnson Foundation of 19 schools showed identical proportions (Kisker et al., 1994a, 1994b).
Clinics responding to the Advocates for Youth survey reported that about 60 percent of enrolled students were female. One-third of the en-