BUT THEN, MANY INTERNISTS WITH AN ADULT PRACTICE ARE NOT

THAT ANXIOUS TO TAKE ON ADOLESCENTS AS PATIENTS.

SO, AGAIN THEY FALL THROUGH THE CRACKS.

76


SERVICES MUST NOT SIMPLY BE IN THE COMMUNITY --AS

IMPORTANT AS THAT IS-- THEY MUST ALSO BE


COORDINATED

ONE OF THE MAJOR PROBLEMS IN DEALING WITH ADOLESCENT

HEALTH NEEDS IS THE PROBLEM OF FRAGMENTED SERVICES.

77


SO FAR THE RESPONSE OF CONCERNED CITIZENS AND

LEGISLATORS HAS BEEN TO SET UP A NUMBER OF PROGRAMS

OR SERVICES, EACH DESIGNED TO DEAL WITH A SPECIFIC

PROBLEM: AIDS, CHILD ABUSE, TEENAGE PREGNANCY, DRUGS,

AND SO FORTH.

BUT THE LACK OF COLLABORATION BETWEEN THESE PROGRAMS

CAN BLUNT THEIR SUCCESS, OR EVEN DOOM THEM TO FAILURE.

BUREAUCRATIC MYOPIA, RIGID REPORTING PROCEDURES,

OVERLY RESTRICTED FUNDING, AND PLAIN INSENSITIVITY TO THE

LARGER PICTURE OF THE ADOLESCENT'S WORLD CAN DOOM THE

BEST INTENDED PROGRAM.

78


FRAGMENTATION OF SERVICES CAN LEAD TO BITTER

FRUSTRATION.

FOR EXAMPLE, AN ADOLESCENT WHOSE NEEDED MEDICAL CARE


IS PAID FOR BY MEDICAID CAN LOSE ELIGIBILITY FOR MEDICAID


IF HIS MOTHER GOES TO WORK OR REMARRIES.

OR A TEEN ALCOHOL ABUSER MAY FINISH AN ALCOHOL ABUSE

PROGRAM, BUT IN THE MEANTIME HAS TAKEN TO COCAINE,

BECAUSE THE PROGRAM HAS NOT TOUCHED THE BASIC


BEHAVIORAL PROBLEM.

79


A TEENAGE MOTHER MAY BE DENIED ENTRY INTO A PARENTING

PROGRAM BECAUSE SHE HAS NOT DROPPED OUT OF SCHOOL

ADOLESCENTS AND FAMILIES TO PREVENT GAPS IN SERVICE, AND

TO KEEP SERVICES FROM BEING PROVIDED SEPARATELY FROM

EACH OTHER.

STRONG LEADERSHIP AND COMMITMENT ARE NEEDED AS

PEOPLE AND GROUPS WORK TOGETHER TO IMPROVE DELIVERY

OF SERVICES.
    /

80


THE FURTHER THE ADMINISTRATION OF THE PROGRAMS GET

FROM THE LOCAL LEVEL, THE LESS SUCCESSFUL THEY WILL BE.

LOCAL GROUPS SEE THE LOCAL PROBLEMS THE MOST CLEARLY.

/

THEY NEED TO BE GIVEN THE POWER AND THE FUNDS TO DO

WHAT NEEDS TO BE DONE FOR THEIR YOUNG PEOPLE. THEY

KNOW HOW TO LINK SELF-HELP GROUPS WITH HEALTH

PROGRAMS. THEY ARE THE ONES WHO CAN INSURE

COLLABORATION WITHOUT BAFFLING COMPLEXITY.
               /

81


THE PLACE WE NEED THE GREATEST COORDINATION, THE

CLOSEST COLLABORATION, IS BETWEEN THE HEALTHCARE

SERVICES AND THE SCHOOLS;/

THE CLOSE CONNECTION BETWEEN THE PROBLEMS OF

ADOLESCENT HEALTH AND THE PROBLEMS OF ADOLESCENT

EDUCATION HOLD THE PERIL OF COMMON DESTRUCTION..... OR


THE OPPORTUNITY OF JOINT SOLUTION.

82


THOSE ADOLESCENTS WHO HAVE GOOD HEALTH, A STRONG

SELF-IMAGE, WHO ARE PHYSICALLY FIT, WILL BE LESS INCLINED

TO RISK A BRIGHT FUTURE BY ENGAGING IN RISKY BEHAVIOR, IN


DRUG OR ALCOHOL ABUSE.

BUT THE ADOLESCENT DOING POORLY IN SCHOOL, FACING A

DARK FUTURE, MAY READILY SEEK ESCAPE IN DRUGS, ALCOHOL,

GANGS, AND THEN OF COURSE, FALL EVEN FURTHER BEHIND.

83


A MINNESOTA STATE-WIDE STUDY CONFIRMED THAT

ADOLESCENTS WITH LOW GRADES IN SCHOOL WERE TWO TO

FIVE TIMES MORE LIKELY TO SMOKE DAILY, USE ALCOHOL

EXCESSIVELY, BE SEXUALLY PROMISCUOUS, AND ATTEMPT

SUICIDE THAN TEENS WITH ABOVE-AVERAGE GRADES. THIS

FINDING WAS ACROSS THE BOARD, FOR ALL RACIAL AND ETHNIC


GROUPS.

84


IT IS FOOLHARDY FOR AMERICANS TO BE CONCERNED ABOUT


THE AMERICAN SCHOOLS WITHOUT SIMILAR CONCERN FOR THE


HEALTH OF AMERICAN SCHOOL CHILDREN AND ADOLESCENTS.

HEALTH AND EDUCATION CAN NO LONGER BE TREATED AS

SEPARATE SPHERES.

ALL TOO OFTEN, TODAY, THE SCHOOL NURSE, THE NUTRITION

COUNSELOR, THE PHYSICAL EDUCATION PROGRAMS ARE SIMPLY


NOT MEETING THE REAL HEALTH NEEDS OF ADOLESCENT

STUDENTS.

85


FOR EXAMPLE SUCCESSFUL "MAINSTREAMING" SPECIAL NEEDS

STUDENTS REQUIRES INTENSE COLLABORATION BETWEEN


HEALTH AND EDUCATION PERSONNEL.

EDUCATIONAL AND HEALTH SERVICES DEAL WITH MANY OF THE

SAME PROBLEMS, SO THEY SHOULD GET THEIR ACTSTOGETHER.

86


/
BUT F E NEED SCHOOL-HEALTH COORDINATION NOT ONLY

BECAUSE THE PROBLEMS ARE INTERTWINED, BUT ALSO

BECAUSE FOR HEALTH SERVICES ~0 * REACH ADOLESCENTS

THEY MUST BE CONVENIENT TO USE.

AND SINCE SCHOOL IS ONE PLACE THE ADOLESCENT SHOULD BE,

IT IS THE BEST PLACE TO LOCATE A PRIMARY HEALTHCARE

FACILITY. AND MAYBE HAVING THE SCHOOL AND CLINIC

TOGETHER WILL MAKE THE ADOLESCENT MAKE BETTER USE OF


EACH.

87


RIGHT NOW, THINGS DO NOT OPERATE VERY EFFECTIVELY.

AT POLICY AND POLITICAL LEVELS WE HAVE RESPONDED WITH

SINGLE ISSUE OR CATEGORICAL PROGRAMS AS EACH HUMAN

SERVICE CONCERN IS BROUGHT TO NATIONAL ATTENTION. IN

THIS COUNTRY, HEALTH AND EDUCATION SERVICES ARE

PROVIDED BY A COMPLEX MIX OF PUBLIC, PRIVATE AND

VOLUNTARY AGENCIES AND ORGANIZATIONS.

8%


WE MUST DEVELOP NEW ORGANIZATIONAL RELATIONSHIPS

AMONG SCHOOLS, PHYSICIANS, PUBLIC HEALTH AGENCIES AND

SOCIAL SERVICE ORGANIZATIONS. IN ADDITION, FEDERAL AND

STATE SYSTEMS MUST ALLOCATE NECESSARY RESOURCES AND

ESTABLISH CONDITIONS THAT FACILITATE THE DEVELOPMENT OF

THESE NEW ORGANIZATIONAL RELATIONSHIPS IN LOCAL


JURISDICTIONS.

89


WE MUST ORGANIZE HEALTH AND EDUCATION SERVICES IN WAYS

THAT ACKNOWLEDGE THE COMPLEXITY OF SOCIAL

ENVIRONMENTS AND ADDRESS SUCH CONCERNS AS THEY


EMERGE.

AS THE NEEDS OF CHILDREN AND FAMILIES EXPAND AND

BECOME MORE COMPLEX, IT IS MORE AND MORE APPARENT

THAT BOUNDARIES OF PROFESSIONAL RESPONSIBILITY AS

REFLECTED IN OUR EXISTING SERVICE DELIVERY SYSTEM ARE

OFTEN DYSFUNCTIONAL.

90


THERE ARE SEVERAL POPULATIONS OF ADOLESCENTS


CURRENTLY BEING SERVED INDEPENDENTLY BY HEALTH AND

EDUCATION PROVIDERS. INSTEAD, WE MUST MAKE CHANGES IN

THE SERVICE SYSTEM THAT ALLOW PROFESSIONALS TO PROVIDE

SERVICES TO ADOLESCENTS AND FAMILIES COLLABORATIVELY


BECAUSE OF THE CHANGING SOCIAL CONTEXT WHERE


ADOLESCENTS COME TO SCHOOL WITH EDUCATIONAL


PROBLEMS WHOSE ORIGINS AND SOLUTIONS LIE AS MUCH IN


THE AREA OF HEALTH AS IN EDUCATION.


HEALTH AND EDUCATION SERVICE PROVIDERS MUST CREATE

CHANGES IN THE EXISTING SERVICE DELIVERY SYSTEM THAT

ENABLE EFFECTIVE COLLABORATION.

91


OUR MANY FRAGMENTED ATTEMPTS TO DEAL WITH THE HEALTH

AND EDUCATIONAL PROBLEMS OF ADOLESCENTS HAVE

PRODUCED AT LEAST ONE GOOD MODEL OF A COORDINATED

PROGRAM.   THE SPECIAL EDUCATION EXPERIENCE OF THE

LAST TWO DECADES IS ONE EARLY EFFORT TO ENCOURAGE

COOPERATION BETWEEN HEALTH AND EDUCATION

PROFESSIONALS.

92


f :'

P.L. 94-142 INSURED THE PROVISION OF FREE, APPROPRIATE

PUBLIC EDUCATION SERVICES TO CHILDREN WITH SPECIFIC

HANDICAPPING CONDITIONS. IT ALSO OUTLINED A PROCESS

WHEREBY THESE CHILDREN WOULD, TO THE EXTENT POSSIBLE,

BE EDUCATED IN THE LEAST RESTRICTIVE ENVIRONMENT.

BECAUSE MANY OF THESE CHILDREN WERE MEDICALLY FRAGILE

OR HAD SPECIAL HEALTH NEEDS, HEALTH PROFESSIONALS
BECAME INVOLVED IN DESlGNlNGkfAND OFTEN IMPLEMENTINGI';

INDIVIDUAL EDUCATION PLANS FOR EACH CHILD.

93


IN EFFECT, THE LEGISLATION MANDATED COOPERATION

BETWEEN HEALTH AND EDUCATION PROFESSIONALS,AND

SYSTEMS WERE PUT INTO PLACE TO STREAMLINE THIS SERVICE


COORDINATION IN WAYS THAT WOULD BEST ADDRESS THE


NEEDS OF THIS CATEGORICAL PROGRAM .

P.L. 94-142 DEMONSTRATED THE NEED FOR A BETTER WAY TO


COORDINATE A BROAD RANGE OF SERVICES FOR CHILDREN WITH


HANDICAPPING CONDITIONS.

94


WHILE IT DID NOT FORMALLY ENCOURAGE COLLABORATION

BETWEEN THOSE WHO PROVIDE HEALTH AND EDUCATION

SERVICE, IMPLEMENTORS IDENTIFIED SEVERAL ISSUES RELATED

TO SERVICE COORDINATION THAT NEEDED TO BE ADDRESSED IN

ORDER TO BETTER SERVE THE TARGETED POPULATION.

FOR THE FIRST TIME IN THE FEDERAL EDUCATION LEGISLATIVE

PROCESS, STATES WERE CHALLENGED TO MAKE CHANGES IN

EXISTING SERVICE SYSTEMS THROUGH A COORDINATED,

MANAGED EARLY INTERVENTION PROCESS.

95


SOME OF THE MOST CREATIVE EXAMPLES OF COLLABORATION

BETWEEN EDUCATION AND HEALTH PROFESSIONALS CAN BE

FOUND IN THE EXTENSIVE INTERAGENCY PLANNING PROCESS

THAT IS NOW OCCURRING AS STATES CREATE SERVICE DELIVERY

SYSTEMS IN LOCAL JURISDICTIONS FOR INFANTS AND TODDLERS

WITH HANDICAPS AND THEIR FAMILIES.

IN SUCH A SYSTEM, PUBLIC AND PRIVATE HEALTH, EDUCATION

AND SOCIAL SERVICE PROFESSIONALS COORDINATE THEIR

SERVICES IN THE INTERESTS OF CHILDREN AND FAMILIES

RATHER THAN IN THE INTERESTS OF THE SERVICE SYSTEMS. IN

THIS WAY, ADEQUATE RESOURCES ARE GARNERED AND

PROVIDERS ARE APPROPRIATELY SUPPORTED AND REIMBURSED.

96


COORDINATING THE SCHOOLS AND HEALTHCARE SERVICES WILL

MEAN SHELVING SOME OLD SUSPICIONS.

ONCE I TRIED TO GET SOME SCHOOL-BASED CLINICS GOING IN _
fi'LW*uR'b , BUT IMMEDIATELY RAN INTO OPPOSITION BECAUSE

MOST PEOPLE ASSOCIATED SCHOOL-BASED CLINICS

EXCLUSIVELY WITH CONTRACEPTION AND PREGNANCY ISSUES.

ACTUALLY, GOOD SCHOOL-BASED CLINICS FIND THAT

CONTRACEPTION OR PREGNANCY ISSUES AMOUNT TO ONLY 6

PERCENT OF THEIR WORK.

97


ANOTHER GOOD REASON TO PLACE CLINICS AND SCHOOLS

TOGETHER IS THAT IT WILL ENABLE HEALTH CONSULTATIONS TO


OCCUR WITH GREATER


CONFIDENTIALITY.

CONFIDENTIALITY IS ESSENTIAL.

THERE IS A PERVASIVE DISTRUST IN THE ADOLESCENT

COMMUNITY.

98


WHEN I WAS FILMING FOR THE TV SPECIAL ON ADOLESCENT

HEALTH, I ARRANGED FOR SOME CANDID TALK WITH KIDS IN

MINNEAPOLIS. MEETING WITH THEM INVOLVED GOING THROUGH

STEPS LIKE THOSE WE SEE IN MOVIES ABOUT THE MAFIA:
         d-                4&P&J  ~~/F$wl4 bfk"' Rwc
         RESTAURANT&             E





                             , AND SUSPICION SO THICK YOU COULD

CUT IT WITH A KNIFE.

99


MY INITIAL GREETING BY ONE OF THESE YOUNGSTERS WAS, "I


DON'T TRUST YOU. I DON'T LIKE YOU. YOU WORKED FOR THE

GOVERNMENT, SO YOU MUST BE A LIAR."

/

OBVIOUSLY, DISTRUST OF PUBLIC OFFICIALS MUST BE


OVERCOME IF WE EXPECT THE PUBLIC SECTOR TO HAVE A

POSITIVE IMPACT UPON ADOLESCENTS AND THEIR HEALTH.

ASSURING CONFIDENTIALITY IS ESSENTIAL.
             /

100