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County health officer wants school clinics expanded

February 22, 1999|By BRUCE HAMILTON

School health services should be expanded to combat substance abuse, pregnancy and mental health problems among teenagers, according to Washington County Health Officer Robert Parker.

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Dr. Parker wants to develop school-based health centers to better serve students who aren't getting the care they need. He made a preliminary proposal to the Washington County Board of Education Tuesday, stressing the need for broad support.

"We need the backing of the community," he said. Without it, "there's no question something like this won't fly."

With combined start-up and operating costs estimated at more than $400,000, funding is a major hurdle. The plan is potentially controversial because it involves a prickly political issue- the reproductive health of minors.

"Are you considering distributing contraception?" asked School Board member B. Marie Byers. "This is a decision that has to be made with the community," Dr. Parker replied.

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In a Thursday interview, he emphasized other ways of addressing teen pregnancy, such as counseling. The centers could also offer pregnancy testing, diagnosis and treatment of sexually transmitted diseases, prenatal and post-natal care as well as family planning.

But the centers should go forward whether or not they treat students for reproductive health, Dr. Parker said.

In 1997, the Washington County Health Department conducted an "adolescent health needs assessment." Student surveys show they need more accessible health care, according to Dr. Parker.

Washington County high school students reported using marijuana, alcohol and tobacco more frequently than state averages, he said.

The county's teen pregnancy rate has been higher than the state's since 1991, according to Dr. Parker. He said there is also a need among students for mental health services, primary health and dental care.

"The reasons teens don't access health services is they are uncomfortable showing up at their pediatrician's office," he said. A clinic on campus would be closer and easier to use.

In 1993, the state mandated that every Maryland school system offer health services. The counties reacted to the requirement differently and some already have health clinics, according to Dr. Parker.

Washington County began implementing a school health system in 1994. Currently, every school has a full-time health assistant, Dr. Parker said. A group of registered nurses divide their time between an average of three schools each, he said.

Dr. Parker envisions health care facilities on the combined campuses of middle and high schools throughout the county. They would be set up in portable classrooms similar to the unit behind the health department.

Although a mobile unit is also a possibility, Dr. Parker said a permanent building is preferable. The school health centers would be staffed by nurse practitioners. Each center would have examining, counseling and consulting rooms.

Dr. Parker said he would begin with a pilot center on one campus. Based on similar models like Washington County Hospital's mobile unit, he estimates the initial building cost between $200,000 and $300,000.

Dr. Parker believes federal and state grants, along with the County Commissioners, could help cover that cost. He hopes a combination of fund-raising campaigns, corporate and community contributions would help pay annual operating costs of about $200,000.

Medicaid and private insurers could also reimburse the county, Dr. Parker said.

School Board members welcomed the plan, but they were wary of cost and possible controversy. Board member Mary Wilfong said, "I like the idea of going to where the need is." There are people "you can't reach any other way." But Wilfong there are several questions that must be answered before she'll make a judgment.

"I think it's very much needed," said board member Herbert Hardin. "It warrants serious and long consideration."

The price tag is important, he said, and the plan could be controversial "politically and socially. Hopefully we can come up with the wisest decision."

School Board President Edwin Hayes put off taking action. "We need to have a lot of dialogue on the board and in the community before we go forward," he said.

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