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Biomedical subjects

J G Lear

Publications and source records attributed to J G Lear.

14 recordsLinked to original sources
PubMed1999

The growth of school-based health centers and the role of state policies: results of a national survey.

OBJECTIVES: To document recent growth among school-based health centers across the United States and identify state policies that may be facilitating that growth, using a nationwide survey. This was the fourth in a series of surveys undertaken by the Making the Grade office, Washington, DC. DESIGN: During the period from July to September 1998, a written survey instrument was sent to 50 state governments plus the District of Columbia requesting data on numbers of school-based health centers as well as their basic characteristics and a description of state funding and other policies as they relate to the centers. Follow-up telephone calls and additional mailings secured a 100% completion rate. MAIN OUTCOME MEASURES: The numbers of centers by state and region, basic health center characteristics, levels of state financial support, and numbers of states implementing specific policies to sustain and replicate the centers. RESULTS: School-based health centers increased from 900 during school year 1995-1996 to 1157 in 1997-1998, a 29% gain. Mid-Atlantic and New England states continue to lead the regions with 37% of the total. The fastest growth occurred in the Midwest and the Southwestern/Rocky Mountain states. State grant funding of centers decreased slightly during this period. Other policies, including support from Medicaid and the State Child Health Insurance Program, are increasing third-party revenues. CONCLUSIONS: The spread of school-based health centers into the Southwest and Rocky Mountain states is increasing the importance of the centers to rural communities. Because these areas are generally more conservative than either coast, these developments suggest a continued migration of school-based health centers from the political margins into the mainstream. The growth of the centers during a period of stagnation in state grant funding may also suggest that other sources of support, including third-party payments and support from private institutions, are becoming more significant.

Adolescent↗
PubMed1998

The new child health insurance expansions: how will school-based health centers fit in?

In June 1998, the Making the Grade National Program Office and the National Assembly on School-Based Health Care sponsored a workshop on the relationship between the State Child Health Insurance Program (SCHIP) and school-based health centers. Workshop participants used the health centers' experience with Medicaid managed care as a window for understanding their prospects for negotiating contracts with health plans under SCHIP. Speakers representing the federal perspective, state agencies, health plans, and local school-based health centers offered their views on the challenges of developing contracts, incentives, and disincentives that health plans have to contract with school-based health centers, and what has accounted for success where relationships are moving forward. Experiences in Colorado and Connecticut were presented as case studies on these evolving issues.

Child↗
PubMed1996

Key issues affecting school-based health centers and Medicaid.

Public support for establishing school-based health centers has outstripped understanding of how to pay for them in the long term. As a result, a large number of school-based health centers have been started without a clear notion of how they will be sustained. Since 1990, the number of school-based health centers has grown from an estimated 200 to almost 700. A substantial portion of these centers face staffing and service cuts if stable funding mechanisms to support school-based health centers are not put into place. This article addresses issues raised as state governments and the centers consider the possibility of patient care revenue as a component of a long-term funding strategy.

Financing, Government↗
PubMed1995

Back to school: training opportunities in school-based health centers.

School-based health centers are a rapidly growing model for provision of comprehensive, primary health care to elementary, middle, and senior high school students. They offer an exciting new training opportunity that is nontraditional, multidisciplinary, and relevant to future practice. The programs funded by the Robert Wood Johnson Foundation found that trainees made a significant contribution to their projects. The value of school-based health centers as training sites extends to trainees, schools, and the future growth of school-based health centers. Integration of medical and mental health services and delivery of services by a multidisciplinary team are essential components of school-based health centers. These characteristics make school sites well suited to the training needs and practice opportunities sought by a number of disciplines, including developmental and behavioral pediatrics. A school-based health center rotation may be particularly important in developmental and behavioral pediatrics because many trainees may be called on to consult with schools in their future careers, and this rotation may provide their only school-related experience.

Education↗
PubMed1989

The High-Risk Young People's Program. A summing up.

For over five years, 21 teaching hospitals and 54 community cosponsors provided health services to young people at risk for sociomedical problems, i.e., to young people living in communities characterized by high rates of teen pregnancy, sexually transmitted disease, drug abuse, alcohol abuse, accidents, homicide, suicide, and mental illness. With support from The Robert Wood Johnson Foundation, the 20 grantees of the High-Risk Young People's Program developed projects whose collective goal was to expand services to high-risk youth and improve their health. This goal was to be achieved by a direct provision of medical services, training health providers in the care of high-risk youth, consolidating categorical youth services into single, comprehensive care sites, and securing long-term support for these new services and training activities. During the grant period, 114 fellows, 974 residents, 453 medical students, and 126 graduate nurses trained at project sites. Patient visits, which totaled 47,203 the first year, reached 84,754 the second year, and were reported at 89,024 in the fourth year. Sixteen of the 20 projects secured 117 grants worth nearly $7 million. We conclude that the projects were successful in training health care providers and in securing additional support for Program purposes, but were less successful in expanding services beyond the initial pilot for clinical care.

Adolescent↗
PubMed1985

Development of community-based health services for adolescents at risk for sociomedical problems.

Community-based service and training programs have been advocated as important for improving access to medical care for the poor as well as enhancing the ambulatory training setting for residents and medical students. In 1981 the Robert Wood Johnson Foundation provided funds to 20 teaching hospitals to support community-based, comprehensive health services to high-risk young people, that is, young people living in communities with high rates of sociomedical problems, such as adolescent pregnancy, drug abuse, alcohol abuse, accidents, homicide, suicide, and depression. In this article, the authors describe the experiences of these institutions in establishing off-campus clinics, concluding that high-risk adolescents need additional services and that teaching hospitals and communities can collaborate to provide these comprehensive services. They discuss issues of maintaining services after foundation grants end and the impact of recent financial restraints on continued support from teaching hospitals for off-campus activities.

Adolescent↗