workers and mental health counselors work together to serve students and families. The school stays open weekends and summers, offering the Dominican community many opportunities for cultural enrichment and family participation. This full-service program adds about $1,000 per student to the budget (over and above the average amount of $6,500 spent in New York City). These additional costs are paid by Medicaid reimbursements and grants to the Children's Aid Society from foundations.

RESEARCH FINDINGS ON SCHOOL SERVICES MODELS

Research on the utilization of school-based health and social services has advanced well, and has documented the use of services by needy and high-risk youth. Conducting impact studies has been more problematic because of the difficulties of surveying, tracking, and establishing control groups for school populations (Gomby, 1993; Support Center for School-Based and School-Linked Health Care, 1995). Over the past decade, a few significant studies of school-based clinics have been conducted. Several recent summaries of these studies have confirmed the consistent finding that clinics could be implemented successfully in schools, enrolling substantial percentages of students (Dryfoos et al., in press; Kirby, 1994). Clinic users were reported to have received adequate care that was provided in a cost-effective manner and to be very satisfied with both the quality of the services and the caregivers.

Utilization Studies

This section focuses on studies that have been conducted since 1990. In general, the studies offer further evidence of high utilization rates.

Enrollment

A basic measure of program utilization is how many of the students in a school enroll in the clinic. Typically, enrollment involves the submission of a form indicating parental consent. Non-enrolled students can be treated for emergencies, but they must then go through the enrollment process. Clinics start out with low enrollments and gradually build over the years, with a high proportion of the students eventually signing up. A related measure is the percentage of enrollees who actually use the facility.

Advocates for Youth (AFY) reports that in 1993, about two-thirds of the students in respondent schools were enrolled in their school-based health centers and 75 percent of them utilized the program over the reporting year (Hauser-McKinney and Peak, 1995). A survey of 19 schools



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