youth programs aimed at reducing violence, a significant reduction in gang activity was reported at the six-month follow-up (from 7 to 2 percent) (Wagner et al., 1994).

The Student Assistance Program, a school-based substance abuse program, was evaluated by an outside contractor in the early years of the program (Moberg, 1988). The summary report stated that the program was very effective in preventing nonuser students from taking up alcohol and marijuana use and in reducing or stopping the prevalence among users. Alcohol users improved their attendance at school. There was some evidence that the larger the number of individual counseling sessions, the greater the success. No effect was shown for users of hard drugs. This evaluation did not include data from control schools.

Mental Health

The evaluation of California's Healthy Start clients included examining families as well as students. Six months after the initiation of the program, the proportion of core clients who reported some level of depression dropped from 28 to 22 percent, and when depression did occur, it was significantly less likely to be reported as a major problem at follow-up (32 versus 23 percent of those who were depressed) (Wagner et al., 1994).

Health System Related

Students attending the nine school-based clinics in Baltimore were compared with students in four matched schools in regard to their access to medical and social services and their hospitalizations and use of emergency rooms (Santelli et al., in press). Students in schools with health clinics were more likely to report seeing a social worker (11 percent) than were students in schools without clinics (8 percent). Those in schools with clinics were more likely to have received specific health services (physicals, acute health care, family planning, counseling) and reported significantly lower rates of hospitalization. In regard to use of emergency rooms, rates were reduced only for those students who had been enrolled in the schools with clinics for more than a year.

Decreases in the use of emergency rooms by students in schools with clinics were reported in San Francisco (from 12 to 4 percent over two years) and San Jose (from 9 to 4 percent). At the same time, significant increases were shown in the percentage of students who said that they were able to access health services when needed, presumably through the school-based clinics (Center for Reproductive Health and Policy Research, 1993). The school-based clinic in San Fernando, California, specifically



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