HomeMy WebLinkAboutAgenda - 11-16-1993 - III-B (2) 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
Action Agenda
Item No. 777-*B
ACTION AGENDA ITEM ABSTRACT
Meeting Date: November 16, 1993
SUBJECT: Orange County Teen Clinic Expansion and Renewal,
a Project Grant Application.
DEPARTMENT: HEALTH PUBLIC HEARING: Yes X No
ATTACHMENT(S): INFORMATION CONTACT:
HEALTH DIRECTOR'S OFFICE X2412
1. The Grant Proposal
TELEPHONE NUMBER:
Hillsborough 732-8181
Chapel Hill - 968-4501
Mebane 227-2031
Durham 688-7331
PURPOSE:
To authorize the Orange County Health Department to submit, on behalf of the
Orange County Coalition for Healthy North Carolina Youth, a grant application for
a comprehensive adolescent health care project.
BACKGROUND:
In the most recent Orange County Health Department Community Diagnosis, five of
the eight top health problems relate significantly to adolescent health care
issues. These problems are a high number of unwanted pregnancies, poor pregnancy
outcomes, increasing numbers of communicable diseases, increasing numbers of
injuries due to motor vehicle accidents and increasing use of drugs and alcohol.
The Adolescent-in-Need project began working in Northern orange county in 1981.
The project provides medical and social work services to students in the school
system who are identified as being at risk for dropout, pregnancy, and other
health problems. In 1988 the orange County Health Department and the Adolescent-
in-Need project worked cooperatively to open a Comprehensive Health Care Teen
Clinic in Northern Orange County at the Hillsborough office of the Health
Department.
On February 1, 1993, the Board of Commissioners authorized the Health Department
to submit an application to the Division of Maternal and Child Health within the
Department of Environment, Health and Natural Resources to expand the Teen Clinic
to Southern Orange. The initial application was not successful. However,
indications are that the application would be well received in the second round
of funding.
The overall goal of the project is to:
Enhance the physical, mental and social health of adolescents in Orange County by
increasing access to and utilization of comprehensive health services. A key to
the success of the Northern orange Clinic has been the relationship among the
schools, the Adolescent-in-Need Program, and the Health Department, with the
Health Department School Health Nurses providing continuity.
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The objectives are the following:
1. By June 30 of 1994, provide school-linked comprehensive health care services
in the southern branch of the Orange County Health Department to 75
adolescents.
2. By July 1 of 1995, and each year thereafter, services in Southern orange
County will be expanded to include school-linked adolescent dental, mental
health and social work services.
3. By June of 1994, complete a marketing plan in Southern Orange County with
annual letters thereafter to inform persons/organizations of the program's
progress.
4. By June 30 of 1995, in the Northern Orange branch of the Orange County Health
Department, utilization of existing school-linked adolescent clinic will
increase by 20 percent.
5. By January 28 of 1994, in Northern orange increase the availability, breadth,
and measurable effect of health and behavioral education materials to
students by utilizing the clinic.
6. By February of 1994, provide a record system at both clinic sites to ensure
follow-up.
7. By September, 1994, develop a Teen/Parent Health Advisory Network in both
clinical sites to educate students and parents, collectively and individually
on health topics which can be shared with peers, family and community
members.
8. By June of 1995, develop an organized system to access sources of revenue for
medical services.
The project is needed because adolescence is a time of great need when very
important preventive work can be done. Many adolescents are unable to fulfill
their potential due to physical and mental health problems which go untreated.
Adolescents are the only population in the United States that have not
experienced an improvement in health status over the past 30 years. In fact, a
random survey of adolescent student health cards in the southern part of the
county indicated that 16% had no medical provider and 19% used the emergency room
for primary health care. The model in Northern orange which incorporates the
Health Department clinic, the Adolescents in Need program and the services of the
school nurse has proven to be successful in accessing comprehensive care for
adolescents. The clinic currently serves over 300 adolescents each year in over
400 visits. Based upon the percentages of Southern Orange students with no
regular primary care provider, this model is very much needed to serve this
population. The grant is needed to provide the resources necessary to establish
this service.
The North Carolina General Assembly has appropriated funds for ten new adolescent
programs. Initial funding will be for a period of 17 months from February 1,
1994 through June 30, 1995, with annual renewals available for the subsequent
four years. For the first, seventeen month period, funds are available in the
amount of $91,500. For each subsequent year the maximum allowable is $65,000.
The budget reflects other funds which are the in kind contributions coming from
the schools, the Adolescent-In-Need Program, and the Orange County Health
Department existing budgets.
No matching funds are required.
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. ,
The funding will be used for a clinic manager, school nurse and physician time at
.11 FTE each, medical and office supplies, medical equipment, and other operating
expenses necessary to establish the clinic.
Orange County's proposal was developed by a team of professionals representing
the Adolescents-in-Need Program, both school systems and the Health Department
with input from the area Mental Health Center. The development of an orange
County Coalition for Healthy North Carolina Youth is underway with invitations
being extended to other key agencies, the local community health center (OCCHS),
' and private providers.
RECOMMENDATION(S):
The manager recommends authorizing the Health Department to submit the grant
application on behalf of the orange County Coalition for Healthy North Carolina
Youth to the Division of Maternal and Child Health, the Department of
Environment, Health and Natural Resources.
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ORANGE COUNTY TEEN CLINIC
EXPANSION AND RENEWAL
DANIEL B. REIMER, DIRECTOR
ORANGE COUNTY HEALTH DEPARTMENT
JOHN T. HUGHES, JR.
STEERING COMMITTEE CHAIR
Project to Serve Orange County
Chapel Hill
Carrboro
Hillsborough
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ABSTRACT
Our local steering committee for comprehensive adolescent health care is made up of providers
from mental health, public health, social services, two school systems and Adolescents-in-Need
Project staff. Through cooperative efforts we have developed a proposal that will provide
comprehensive health care to teens identified in the needs statement as having little or no access
to medical care.
The Adolescents-in-Need Project (AIN) began in Northern Orange County in 1981. The Project
provides medical and social work services to students in the school system who are identified as
being at risk for pregnancy, drop out, run away, family dysfunction or health problems.
Services are provided in the school and homes of the students by a social worker and nurse
practitioner/pediatrician.
In 1988 the Orange County Health Department (OCHD) and the AIN Project worked
cooperatively to open a comprehensive health care teen clinic in Northern Orange County at the
Hillsborough office of the OCHD. The target population is adolescents who are identified as
having little or no access to care. Accessibility is insured by transportation to the clinic, no fee
for service unless Medicaid or private insurance can be utilized, and confidentiality based on the
current policy of the OCHD.
The clinical services are provided by the AIN Project staff and the nursing staff of the Orange
County Health Department. The teen clinic nurse is also the school nurse who provides services
to middle and high school students. The presence of the same staff, AIN and school nurse, in the
teen clinic and at the schools provides a network of continuity of services. With the Healthy NC
Youth grant we plan to duplicate these efforts in the Southern branch of the Orange County
Health Department.
In addition, mental health services and dental care will be provided at both clinic sites. On site
mental health.clinicians will address emergency needs and function as a referral source to the
local mental health center and private providers. Dental services will be provided during
adolescent clinic hours at both clinic sites in order to facilitate referrals and follow up.
{
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NEEDS STATEMENT
The adolescents of Orange County have significant problems with unintended pregnancy, poor
pregnancy outcomes, sexually transmitted diseases, chronic disease, substance abuse, mental
health problems, school dropout, poverty, poor access to health care, violence including,
homicide and suicide, injury, homelessness and delinquency.
Orange County is an environment of contrasts. The county consists of seven townships with a
total population of 99,674 persons. Three of the townships are urban with over two thirds of
the county's population and the remaining five are rural. Eighty percent of the county residents
are white, sixteen percent black, two and one half percent Hispanic, one percent American
Indian and one half percent other. Throughout the proposal references to the county will be
made as Southern Orange County(SOC) which consists of Chapel Hill and Carrboro and Northern
Orange County(NOC) which consists of Hillsborough, Cheeks, Little River, Cedar Grove,
Bingham and Eno.
Orange County has 13,488 youth between the ages of 10 and 19. Of these, forty seven percent
are males, fifty three percent females and twenty percent live in rural communities. There are
two public school systems within the county, Orange County Schools (NOC) and the Chapel
HilI/Carrboro City Schools (SOC) with a combined enrollment of approximately 9,145 students
in grades six through twelve.
Orange county is home to a state university and major medical center which is the largest
employer in the county. The unemployment rate is slightly over two percent but there are
nearly four thousand cases of public assistance per month and fourteen percent of residents live
below the poverty level. Over sixty percent of mother's in Orange County work outside of the
home.
Despite the seemingly abundant availability of health care, the health needs of the urban and
rural adolescent of Orange County are not being met. In a recent Orange County Health
Department Community Diagnosis, five of the eight top health problems, high number of
unwanted pregnancies, poor pregnancy outcomes, increasing numbers of communicable
diseases, increased number of injuries due to motor vehicle accidents and increasing use of
drugs and alcohol relate significantly to adolescent health care issues.
Access to health care is a major problem for adolescents in both Northern and Southern Orange
County. The primary barriers to services are unavailability of clinical sites and clinical
hours, transportation to services, visibility of services in and outside of the school, quality
confidential care that can be assured to any adolescent despite income or socioeconomic level,
flexibility of services that considers the inherent differences in a culturally and racially
diverse population and coordination of services with a means of intersecting services to enhance
delivery and results rather than fragment.
The primary sources of medical care for adolescents in Orange County are private physicians,
Orange County Health Department (OCHD), University of North Carolina Hospital (UNCH) and
UNCH-Emergency Room (UNCH-ER) and Orange-Chatham Health Services (OCCHS). At the
present time there is no single numerical indicator as to who provides the bulk of medical care
for Orange County adolescents. The OCHD is the only source of free medical care for adolescents
in the county and in 1992 it provided unduplicated services to 887 adolescents ranging from the
age of 12 to 21 with over 400 follow up visits. A crude estimate of how many adolescents do not
have a known medical provider was found in a random survey of two middle schools' health
information forms in SOC. Sixteen percent of health forms indicated that students did not have a
known medical provider and nineteen percent indicated the use of the emergency room for
primary medical care. Similar findings were found among middle school students in NOC with
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eighteen percent of health forms reporting no physician. In other words, there appear to be
many adolescents that do not have an identifiable source of primary care.
According to school nurse records, NOC has twelve percent of sixth graders, fifteen percent of
middle school students and thirteen percent of high school students that have significant health
problems. In SOC, ten percent of teens have health problems requiring an emergency medical
plan at school. When mental health problems are included the percentage almost doubles. In
other words, it appears that there are a large number of adolescents with primary medical and
psychological problems causing some degree of morbidity, such as absenteeism, poor self image
and poor school performance.
Pregnancy:
In the U.S., over one million teens aged 10 to 19 become pregnant each year with a national rate
of 109 pregnancies per 1,000 females and 44 abortions per 1,000 females between the ages of
15 and 19. Although, Orange County's total pregnancy rate (71.7 per 1,000) and pregnancy
rate in the fifteen to nineteen year age group (62.6 per 1,000) continue to be lower than
national and state rates, there is a significant number of unplanned pregnancies as indicated by a
high number of abortions and the number of pregnancies in adolescents aged ten to seventeen.
Orange County has the highest total abortion rate in the state (34.0 per 1,000) and ranks in the
top ten counties for abortion rates in the fifteen to nineteen year old age group (46.1 per
1,000). In the past year there have been forty three known pregnancies in adolescent females
within the two school systems, with eighty six percent of the pregnancies in high school
students (ages 15-17) and the remainder in middle school students (ages 13 - 14).
There is a striking discrepancy between total pregnancy rates (county rates, w 59.3, nw
121.4) and total abortion rates (county rates, w 24.6, nw 69.9) for the white and nonwhite
populations in the state and county. A similar finding is seen in the fifteen to nineteen year old
age group ( county pregnancy rates, w 47.5, nw 113.7, county abortion rates, w 36.6, nw
76.1). This same discrepancy between whites and nonwhites is found with total rates of
inadequate prenatal care, LBW births, fetal deaths, neonatal deaths and infants deaths.
Examination of the ten to nineteen year old age groups reveals that nonwhites have significantly
higher rates of inadequate prenatal care, LBW birth and fetal deaths in contrast to whites having
higher rates of neonatal deaths and infant deaths in the county and statewide. In other words,
there are many unplanned pregnancies in adolescent females along with significant racial
differences which appear to impact on the final pregnancy outcome.
Sexually Transmitted Diseases:
In 1992, over 385 adolescents were seen at the OCHD-Sexually Transmitted Disease (STD)
clinic for diagnosis and treatment of an STD with the majority (98%) between the ages of
fifteen and twenty one. In North Carolina, for the year of 1991-1992, there were 29
adolescents between the ages of twelve and nineteen that tested positive for HIV and twenty one
known cases of AIDS in the thirteen to nineteen age group. Orange County ranks in the top ten
counties for the rate of AIDS cases. Sexually transmitted diseases, especially AIDS, are of
increasing concern for our adolescent population.
Nutrition:
The nutritional needs of adolescents are of significant concern as gross evidence indicates that
children are more sedentary, fatter, and less fit with immediate and long-term health
consequences. A recent OCHD survey of adolescent clinic attendees indicates that approximately
one third of adolescents in Orange County are obese. Additionally, more adolescents are
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developing eating disorders such as anorexia nervosa and bulimia resulting in adolescent clinic
referrals.
Mental health:
Nationally, there is a higher reported lifetime prevalence of emotional and behavioral problems
among 12 to 17 year olds living in urban areas (19.1%) in contrast to rural youth (16.5%).
Despite the lack of baseline data to support advocating for the mental heath needs of adolescents
in Orange County there is substantial anecdotal evidence to warrant the need for more mental
health services. In the four years of service through the Adolescent Clinic at the OCHD it has
become apparent that a substantial proportion of adolescents seeking care for medical problems
suffer from psychological problems serious enough to warrant mental health treatment. It is
the most prevalent issue not adequately addressed by the present health care system. In the
school based Adolescents in Need project, the majority of adolescents followed on a regular basis
have mental health problems causing significant morbidity. Problems range from post-
traumatic stress syndrome secondary to the aftermath of physical or sexual abuse, loneliness,
depression, suicidal ideations, loss of a parent through divorce or death, family dysfunction
secondary to alcoholism, depression, schizophrenia and school truancy. In a review of forty
four ongoing cases by school psychologist in Northern Orange County,forty three percent of
clients were being followed for depression and suicidal ideations. During the present school
year, in Northern Orange County, there have been two hospitalizations of adolescents for
suicidal ideations and depression and one completed suicide in a child with known mental health
problems. In Southern Orange County, three children, from three different schools were
admitted for inpatient treatment of a mental health problem within the same week. Finally,
over 900 contacts were made to a students involved in a Peer Helper Program (PHP) during an
eight month period in Northern Orange County. Referrals were diverse with many centering
around sexuality, loss/grief, depression, stress, academic pressure and relationships.
Anecdotal evidence indicates that the mental health needs of adolescents in Orange County are
diverse and unmet with the present system of care.
Substance Abuse:
Tobacco and alcohol are the primary drugs abused by North Carolina youth. One out of every
four North Carolina adolescents uses cigarettes or smokeless tobacco on a regular basis
compared to one out of ten who use marijuana, cocaine or other drugs besides alcohol. According
to a 1987 survey, drug use among North Carolina youth was found to be equal to or exceed the
national average and almost 13 percent of students reported coming to school drunk or high at
least once in the previous year. For eleventh and twelfth graders, the figure was almost one in
five. It is estimated that twenty percent of all students in the school system are projected to
have or develop a problem with chemical dependency, serious enough to warrant intervention.
This past year 227 students were referred to Student Assistance Program in SOC with twice as
many white females being referred than the previous year and five students at one of the middle
schools were referred for in-patient care. Substance abuse is a common problem in adolescents
in Orange County and warrants further organized efforts at prevention and recovery.
Mortality:
In North Carolina the five leading causes of death among adolescents ages 15 to 19 are accidents,
homicide, suicide, cancer and cardiovascular problems. Nationally more than forty percent of
the deaths of sixteen to nineteen year olds are caused by motor vehicle accidents and ten percent
by suicide. In Orange County, between 1988 and 1990, the rates of death among people under the
age of 20 by accidents, both motor vehicle (9.90/100,000 ) and other (1.41/100,000), are
32% and 85% lower than the state, respectively. However, the suicide rate for Orange County
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adolescents (5.66/100,000) is 22% higher than that of the state and homicide accounts for
four percent of deaths under the age of twenty.
Social:
In Orange County almost thirteen percent of children aged 0-17 live at or below the poverty
level.. Approximately, 2,050 (21%) of Orange County Public school students receive free or
reduced rate for meals. During 1987, 98 cases of child abuse or neglect were substantiated in
children and adolescents aged 0-17 in Orange County. According to the North Carolina Advocacy
Institute, Orange County ranked 90th in the state for reported cases.
Nationally it is estimated that there as many as 1 million homeless and runaway adolescents
each year. In Orange County nobody really knows how many children and adolescents are
homeless, either living in homeless families or on their own, but in a recent survey done by
social service agencies in Northern Orange County it was found that sixteen females aged 16 to
19 were found eligible for a group home setting secondary to homelessness as defined by
presently living outside of their nuclear family and lack of a consistent place to live.
Delinquency is a major problem in Northern and Southern Orange County. Presently, there are
thirty five Northern Orange County youth involved in active probation cases and forty five
Southern Orange County youth. The crimes are significant in that, if committed by adults, they
would be punishable by the law. There are twenty adolescents who have been referred to the
juvenile court as high risk for committing crime and are connected to a court counselor for
appropriate referral and intervention.
Academic indicators:
School absenteeism secondary to medical and psychosocial problems is a significant issue for
adolescents in Orange County. During the 1991 school year, there were 492 out of school
suspensions and six long-term suspensions (remainder of year) for students in fourth through
twelfth grade in Northern Orange County. The 1991 state dropout rate was 3.4 percent
compared to Orange County's unduplicated dropout rate of 1.78 percent. The major reasons
cited for dropping out were poor school attendance, health problems, child care issues and
chronic discipline problems.
Summary:
Orange county enjoys a low unemployment rate, a low school dropout rate, a low pregnancy rate,
and a multitude of medical services. The real picture, however, is of a county with a high
number of its citizens living below the poverty level, too many students out of school before
completion of their education and a large number of adolescents who do not, for various reasons,
have a regular source of medical care. Psychological services are limited. The quality of life
depicted by the unemployment rate and average income figures does not give us a picture of the
group of adolescents who live daily with chronic medical and psychological issues that can be
best addressed by a comprehensive approach to medical care that is unencumbered by roadblocks
such as confidentiality, transportation and finances.
OUTREACH PLAN
A historical picture of the current Adolescents-in-Need, teen clinic, school network will best
describe our outreach plan.
In 1981 the UNC Department of Pediatrics developed a service project in Northern Orange
County called Adolescents-in-Need. Links were established with the Orange County School
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System, the Orange County Health Department, Department of Social Services, Juvenile Court,
Mental Health Center and church community. The program utilizes a nurse practitioner/social
worker team based in the school system who meet with adolescents considered at high risk,
including pregnant teens, parenting teens, teens at risk of becoming pregnant, depressed teens,
teens not attending school regularly, and teens in need of mental health counseling. Counseling,
guidance, referral and family home visits are provided to reduce these risks. As a result of
this networking, the needs of adolescents in terms of service delivery became a goal of the
entire county and adolescents completed their education, pregnancy rates dropped, adolescent
fathers were involved in their child's birth, and resources such as scholarships for day care and
actual day care services were developed. Major conclusions of the program were that a broader
range of health care services for adolescents was needed to address the medical, social and
behavioral needs of adolescents in Orange County with an emphasis on prevention, behavioral
counseling and extension of services to the early adolescent age group. Further
recommendation was that adolescents should be able to go to one location for evaluation and
subsequent referral, as needed.
in 1988 a program of comprehensive health care services for teens was begun in Northern
Orange County through the joint efforts of the Orange Counth Health Department and the
Adolescents-in-Need Project. The clinic staff consists of a medical provider from the
Adolescents-in-Need Project, a school nurse, clinic manager, lab technician, and health aide,
employed by the Health Department. This creates a loop from school to clinic to home if
necessary, and back to school. The Teen Clinic/Adolescents-in-Need concept currently reaches
youth with information about services through the school nurse employed by the local health
department, the school nurse employed by the school system, guidance counselors from the
middle schools and the high school, coaches at these three schools,juvenile court counselors,
mental health providers, health department staff, and peer helpers at the high school. Thus
students can receive information about the health and counseling services from multiple entry
points.
To facilitate expansion of the above project to Southern Orange a steering committee consisting
of representatives from the major agencies such as Department of Social Services, Mental
Health, Public Health, Housing, local medical providers, schools, and court counselors will be
organized to advocate for use of the clinic and make referrals to the clinic on a regular basis
through their agencies. Through the Chapel Hill/Carrboro School System, organizations such
as The School Health Advisory Board, made up of parents, professionals and students, the School
Governance Committee, and Putting Children First will provide an opportunity to promote the
clinic. Student groups such as The Peer Counseling program, Proconian(school newspaper),
Student Government, and Teen Awareness will be informed about the clinic services. A Teen
advisory Board will be formed in each school system as a major format for information sharing
of students' needs with service providers.
School nurses, counselors, Adolescents-in-Need staff, and coaches, as well as other clinics
within the OCHD are referral sources for the Northern Orange Clinic. The school nurse is the
most frequent referral and follow up source in the existing project and is predicted to be in the
Chapel Hill/Carrboro extension plan. Nurses from the middle and high schools have been
involved in the planning process thus far and will continue to be a major referral source.
School guidance counselors are the second most frequent source of referral to the clinic.
Counselors in Southern Orange County will be educated about the availability of services and
how to access the system for their students. Coaching staff have been and will continue to be an
invaluable asset in reaching males and females through use of the Adolescent Clinic for sports
physicals at which time preventive education and counseling about developmentally appropriate
topics can take place. Other clinics within the OCHD will be informed about the clinic's services
and will be encouraged to make referrals for continued continuity of care. All of the above
individuals and agencies will be thoroughly informed about the services available at both clinics
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and the manner in which to utilize and access these services. As the social work outreach plan
begins in the Southern Orange Clinic, students in need of health services will also be identified
through contacts at school.
This networking will be facilitated by the Program Coordinator (the medical staff person in the
Adolescents-in-Need Project) who will be available during the first cycle of the grant to set up
the clinic and the supporting network. This person will spend time meeting with the above
groups as she sets up the physical aspects of the clinic and meeting periodically with key
individual providers from each agency.
DESCRIPTION OF SERVICES
The target community has a wealth of medical services available to its population. A major
teaching hospital, a community health clinic and private physicians reach many people. The
proposed clinic/outreach program will complement these services by providing free care to
students who do not have access to comprehensive health care.
Through county funding, an Adolescent Clinic was developed in the Northern branch of the OCHD
and is staffed by a physician, nurse, clinic manager, lab technician and nutritionist. The clinic
is held on one afternoon per week and provides care for 8-10 students per clinic day.
Transportation is offered from school to clinic and all services are free. The adolescent clinic
provides services to teens aged 12 to 21 and recommends annual visits for physical
examinations and health guidance. Follow up visits or referrals to other providers are
scheduled as warranted by clinical signs or symptoms.
Adolescents present with complaints ranging for acne to orthopedic problems to sexuality
issues. On arrival to the clinic, adolescents fill out an intake form that helps them define how
they are feeling physically and emotionally. This information is then used by providers to
discuss issues relevant to the individual adolescents health and behavior. All adolescents under
the age of eighteen are required to have permission from their guardian to be seen at the clinic.
Confidentiality is guaranteed for family planning, diagnosis and treatment of STDs and mental
health counseling. Acute or chronic medical problems needing referral, require permission
from guardian for services to be rendered.
Health guidance is part of each clinic encounter in order to promote a better understanding of
physical growth, psychosocial and psychosexual development and to encourage the adolescent to
become actively involved in decisions regarding their health care. Topics covered in health
guidance are injury prevention, fitness and nutrition, sexual behaviors including abstinence,
tobacco use, alcohol use and other substances including anabolic steroids.
Screening services are available through the adolescent clinic for hypertension,
hyperlipidemia, scoliosis, tobacco, alcohol and other substances, sexual behaviors, sexually
transmitted diseases, depression or suicide, emotional, physical or sexual abuse, learning or
school problems and TB skin test. If screening is positive, appropriate referrals are made to
providers at local tertiary care centers, mental health and social service agencies. Follow up is
coordinated through the referring physician, clinic manager, school nurse and receiving
physician at the time of the referral.
Medical care is provided for common problems seen in the adolescent clinic not requiring
referral such as acne and other skin problems, asthma, musculoskeletal problems including
minor sports injuries, headaches, sexually transmitted diseases, allergies, sinusitis, urinary
tract infections, anemia, upper and lower respiratory tract infections, immunizations, stress,
peer pressure, chronic abdominal pain and obesity.
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Labs provided by the health department for the adolescent, are hematocrit, urinalysis, urine
culture, throat culture, chlamydia culture, gonorrhea culture, wet prep, serum cholesterol,
serum glucose, RPR serology, thyroid panel, HIV anonymous and confidential screening, AFP,
Rubella and B Strep cervical culture.
Reproductive health services available to adolescents are provided at both branches of the OCHD
through the family planning and sexually transmitted disease clinic. Services provided are
physical examinations, HIV testing and counseling, nutrition counseling, health education on
contraception, dispensing of birth control and diagnosis and treatment of sexually transmitted
diseases.
Services specific to the expectant teen mother in the Northern Orange County branch are
prenatal care which includes a series of prenatal education classes, nutrition counseling, WIC
services, maternity care coordination by social workers, presumptive eligibility for Medicaid,
prenatal medical care, home visitation to each mother after delivery and transportation.
For the child of the teen mother, services free of charge include physical exams,
immunizations, developmental screening, lead testing, vision and hearing screening, parent
education and counseling, home visitation, child service coordinator for children with special
needs and sickle cell screening and counseling. These services will continue to be offered to the
children of the adolescent mothers when needed.
Dental services are provided at both branches of the OCHD which include routine cleanings,
extractions and restorations. A free screening examination is provided with the remainder of
services on a fee for service sliding scale basis. Dental services are to be increased through the
development of an adolescent dental clinic which will provide services at the same time as the
adolescent clinic and by direct referrals from the adolescent clinic. This will allow students to
access the same transportation source to and from school.
Nutrition services are provided through the adolescent clinic in the form of annual physical
examinations with measurement of specific growth parameters. Counseling and education is
coordinated the by OCHD nutritionist who sees students at school and the home setting if
necessary. The school nurse follows students at school with weekly weights and further
nutritional education.
A service unique to Northern Orange County is the Adolescents-in-Need (AIN) Project of the
UNC Division of Community Pediatrics which serves at risk students in the Orange County
School system. This project serves as a portal of entry for students when no service exists or
service is fragmented. A medical/social work team provides counseling and guidance to students
in their homes and at school. The medical person on the team is also the medical provider at the
adolescent clinic described above. The medical/social work model integrates with existing
county and school services to insure success in school, development of communication in
families, health care access, and strong personal relationships among friends and significant
others. Services are delivered at school and in the homes of teens, giving the service systems a
complete picture of the environmental issues affecting the students' lives. The social work
component blends with the medical component to provide linkages to services and resources that
enhance the physical well being of adolescents. Linkages to school and service providers
produces a model that is designed to insure comprehensive health and social services to students.
Mental health services for adolescents are provided by the Orange Person Chatham Mental
Health Center (individual and family counseling with sliding scale fee for services), school
psychologists (educational testing and counseling), school social workers (counseling and
networking), private mental health facilities (admission for life threatening emergencies or
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long term care) and local tertiary care center emergency rooms (acute crisis). When follow up
or more diagnostic expertise and testing is required there is a lack of funding and networking to
insure the services are being accessed and provided. Plans to increase access and services to
adolescents seen in the clinic will be done through increasing referrals to the existing providers
and by providing an on-site skilled mental health provider in the adolescent clinic. This mental
health provider will offer mental health services and facilitate referrals.as well establish links
with school, family and community when necessary.
Substance abuse services are provided by Orange Person Chatham Mental Health Center
(individual, group and family counseling with sliding scale fee for services), private providers
and state and private institutions for life threatening and long term care of substance abuse
problems. School based student assistant programs staffed by teachers and administrative
school staff target students for whom chemical dependency is a potential obstacle for personal or
academic success. With the addition of a mental health provider at both teen clinic sites, direct
referrals to already existing programs will be increased and on-site substance abuse services
will be provided through individual and group counseling.
In the Orange County School System (NOC) students are involved in providing services through a
Peer Helper Program which trains students in listening and information gathering skills. These
skills allow them to help facilitate referrals of peers in need of help in dealing with issues such
as sexuality, loss, depression, medical problems, stress, academic pressure, family and
relationship problems. AIN Project staff and the school nurse will continue to be involved in
the training of the peer helpers which will provide a means of marketing and referrals to the
clinic.
In both school systems, school counselors provide counseling for a broad range of issues from
school performance to future education plans. Social workers are employed by each school to
provide dropout prevention services for the middle and high school students. Health educators
work together with the school nurse and other school personnel to plan and implement
educational activities such as lectures on stress management, substance abuse, nutrition and
weight management, self protection, relationships and personal fitness. Through the continued
participation of the AIN project sttaff and school nurse in teaching activities and consultation a
referral base to the clinic will continue to be established.
Other county agencies providing services to Orange County adolescents are Planned Parenthood.
of Orange and Durham County, Department of Social Services, Dispute Settlement Center,
Orange County Women's Commission, Rape Crisis, Orange County Parks and Recreation and the
Juvenile Court System. A network for interagency communication and referral will be
developed by identifying an individual at each agency who is involved serving adolescents. This
group will serve as the steering committee of the Orange County Coalition for Healthy Youth.
In summary, if funding is granted to Orange County it will provide monies to develop new
services in Southern Orange County consisting of a school linked Adolescent Clinic in the
Southern branch of the OCHD and a school based Adolescents-in-Need Project as described above. E`
Funding would also allow the expansion of services for adolescents in Northern Orange county
with a specific emphasis on increasing referrals to the adolescent and dental clinics and
providing on-site mental health services. With this model of coordination between the school
nurse, AIN project and school-linked adolescent clinic staff, a method of insuring service access
and delivery will be established and maintained.
14
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1
20
APPLICANT QUALIFICATIONS
The Orange County Steering Committee for Healthy N.C. Youth is made up of representatives of
agencies that developed the original Adolescents-in-Need Project and the teen clinic in Northern
Orange County(DSS, Mental Health, Orange County Schools, Health Department, Juvenile Court)
as well as representation from the schools in the target area in Chapel Hill/Carrboro.
Two members of the Adolescents-in-Need Project serve on the Steering Committee. The
Adolescents-in-Need Project and staff have been recognized at the state and national level. A
recent publication on how to develop a program such as theirs, along with staff consultation, has
facilitated the replication of 10 similar sites across N.C. The pediatrician in the Adolescents-
in-Need Project is the medical provider for the current clinic. She is board eligible for
adolescent medicine and board certified in pediatrics.
Current Health Department staff and Adolescents-in-Need staff on the Steering Committee were
involved with the development of the model teen clinic in 1988. The Health Department has
administrative and nursing representation and will continue its leadership in adolescent clinic
development.
Members of the Steering Committee have been successful in developing day care for teen parents
in Orange County, lowering the teen pregnancy rate and the school dropout rate in the county and
developing a spirit in the county that places the needs of adolescents as a high priority. County
government continues its financial support of the existing teen clinic and the Adolescents-in-
Need Project.
In delivery of comprehensive health care, mental health needs continue to rise as a concern. To
address this rise in mental health needs the Steering Committee has a local mental health
provider and an administrator who will offer expertise in the establishment of the mental
health component at each clinic site.
Thus we have an experienced Steering Committee complimented with people in the Southern
Orange service system who are eager to expand the concept to their school system as well as the
political and cultural background to help lay the groundwork for a clinic.
A
21
PROJECT BUDGET FOR 2/1/94 -6/30/94
,
A. EXPENDITURES A I B C
1
1. Salaries CAI-ICP FUNDS 1 OTHER FUNDS TOTAL
_ ___
Contract physician 1 _ 1 7100 7100
Contract FNP 1 35001 1 .
3500
Contract Mental Health 30001 —1 3000
Lab Tech 11601 1160 2320
Comm. Health Aide 8601 860 1720
Clinic Manager 1750 1750 3500
1
School Nurse 13441 I 1344_ 2688
1
Contract Dental Services 3000 3000
2. Office Supplies 1 ,
Duplication 500 500
!-----
Routine supplies 1
and charts 4751 475
1
!
3. Telephone 1200 1200
1 i
4. Postage 250 1 250
i
5. Travel
Client Transport 175 175
Staff Mileage 250 250
1 ,
6. Malpractice insurance
Physician 1500 1500
Other Clinic Staff 500 500
7. Advertising 300 300
8. Continuing Education
for Staff 500 500
9. Office Equipment
2 File Cabinets 400 400,
.
Display Shelves 3001 300
Video/VCR 1500 1500
Computer 2000 2000
Printer 1 500 500
. 1 1
Page 1
i
22
PROJECT BUDGET FOR 2/1/94 -6/30/94
,
I
i
EXPENDITURES A B C
10. Medical Equipment
Audiometer 800 800 1600
Titmus Vision Tester
1 1000 1000 ' 2000
Oto-opthalmascope 400 400 800
Blood Pressure Cuffs 200 200 400
.
Stethoscope 50 50 100
Exam Lamp _ 160 160 320
Peak Flow Meter 100 100 200
11. Medical Office
Supplies 1500 1500
Lab supplies, tests,
send out labs,
exam supplies
12. Rent 4800 4800
13. Educational Material
Medical Text 400 400
Posters 200 200
Adol. Specific Brochures 500 500
Anatomical Flip Charts 325 325
Teaching Videos 400 400
Other Adolescent 200 200
Resource Books
TOTAL 26499 24424 50923
B. REVENUES
1. State DMCI-Funds 26499 _
2. Local Government Funds
Health Department Funds 15424
Adolescents-in-Need Funds 9000
TOTAL 26499 24424 50923
Page 2
it
23
PROJECT BUDGET FOR 7/1/94-6/30/95
A. EXPENDITURES 'A 'B 'C
1
1. Salaries j CAHCP FUNDS _ OTHER FUNDS TOTAL
Contract FNP
I 8300 8300
Contract FNP i 8300 8300
Contract Mental Health _ 7300 7300
Lab Tech 2908 2908 5816
Comm. Health Aide 2157 2157, ( 4314
Clinic Manager 4404 4404 8808
School Nurse 6774 6774
Contract Dental Services 12800 12800
Contract Social Worker 18329 18329
Medical Supervision 1500 , 1500
2. Office Supplies
Duplication 500 1 500
Routine supplies
and charts 600 600
3. Telephone 1680 1680
4. Postage 300 300
5. Travel
Client Transport 500 500
Staff Mileage 400 400
6. Malpractice insurance
Physician/FNP I 1500 1500
Other Clinic Staff 500 500
7. Advertising 200
200
8. Continuing Education
for Staff I 500
500
9. Office Equipment
VCR 1500 1500 i''.
Computer/printer 2000 I 2000
1
■
Page 1
24
PROJECT BUDGET FOR 7/1/94-6/30/95
EXPENDITURES A B --T -C_.--
1
10. Medical Equipment ) —
Audiometer, 1600 1 1600
Titmus Vision Tester i 2000 I 2000
Oto-opthalmascope 800 I 800
Blood Pressure Cuffs 4001 400
Stethoscope 100' 100
Exam Lamp 320 320
Peak Flow Meter 200 200
11. Medical Office
Supplies 1500 1500
Lab supplies, tests, ,
send out labs,
exam supplies
12. Rent 11520 11520
13. Educational Material
Dental education materials 1500 1500
Adol. Specific Brochures 500 500
Anatomical Flip Charts 300 340
Teaching Videos 300 300
Other Adolescent 200 200
Resource Books
TOTAL I 64998 48663 113661
B. REVENUES
1. State DMCI7 Funds 64998
2. Local Government Funds
Health Department Funds 37053
Adolescents-in-Need Funds 11610
TOTAL 64998' 48663 113661
Page 2