Washington Heights Health Clinic Evaluations
As a university-based program, the Heilbrunn Department of Population and Family Health is committed not only to providing high-quality services but also to evaluating their impact. Rigorous program evaluation makes it possible to communicate to a wider audience and influence other programs with documented examples of successes and failures.
The following six reports describe the Washington Heights community we serve, the programs we support, and the impact those programs have on the health of neighborhood residents. You can view these papers on-line or download formatted versions of the reports. More information about these service programs is on our Center for Community Health and Education web site.
Pregnancy Prevention Among Young, Minority, Urban Adolescents: Results of the In Your Face Pregnancy Prevention Program
Tiezzi L., Lipshutz J., Wrobleski N., Vaughan, R. and McCarthy, J. Family Planning Perspectives, forthcoming
Abstract: The effectiveness of a pregnancy prevention program for urban minority adolescents was assessed. The program was implemented in 4 NYC junior high schools, in a borough where the pregnancy rate had increased by 30% over the previous 4 year interval among 15-17 year olds. The program was unique in several ways: It was implemented in junior high schools (6th-8th grade) rather than in high school; it utilized sound Public Health strategies to identify students at risk; it incorporated a multidisciplinary approach to the prevention program; and provided individual case management, appropriate services, and intensive follow-up to those students identified as at risk. Four years after program implementation, we observed a 34% reduction in the pregnancy rate, as well as increases in referral and completion rates to family planning clinics. The implications for the level of intensity required to elicit behavior change among this population are discussed.
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The Development, Reliability and Validity of a Risk Factor Screening Survey for Urban Minority Junior High School Students
Vaughan R., McCarthy J., Walter H., Resnicow K., Waterman P., Armstrong B. and Tiezzi L.
Journal of Adolescent Health, 19:171-178, 1996
Abstract: Purpose -- To develop and evaluate a risk factor screening survey as a mechanism to identify inner city junior high school students who may benefit from medical or mental health services available in school-based clinics. Methods: A 36-item health risk factor screening survey was developed and administered to 3,787 predominantly Hispanic students from 4 schools in an economically disadvantaged, medically underserved New York City school district. Students who indicated that they were experiencing one of 5 major risk factors (suicidality, sexual activity, parental or guardian substance abuse, personal substance use, or having run away) were scheduled to visit the clinic for services, and to have their survey responses validated by clinic interview. Results: The development of the screening tool resulted in a short, easy to read and understand survey instrument that was feasible to administer within a classroom setting. The reliability of the instrument was excellent, and the results of the validity study indicated that it was successful in identifying students who did not need clinic services. The screening tool produced mixed results in identifying those truly in need through single item identification (i.e. produced a moderate number of "false positives"), although combining items on the screening tool produced much higher positive predictive values. Conclusions: This screening tool can be used to effectively focus limited clinical resources on those in need. Outreach surveys of this type should be considered as a valuable component of a school-based clinic service delivery strategy.
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Carrying and Using a Weapon: A Survey of Minority Junior High School Students in New York City
Vaughan R., McCarthy J., Armstrong B., Walter H., Waterman P. and Tiezzi L.
American Journal of Public Health, v86 n4, April 1996
ABSTRACT: The purpose of this research was to explore weapon carrying characteristics among young, inner-city adolescents. A two-page anonymous survey was administered in the fall of 1993 to 2005, predominantly Hispanic students in three urban junior high schools. The survey revealed that a substantial proportion reported personally carrying a weapon. Forty-two percent indicated that a family member or close friend had ever been shot. Males, and older students, were more likely to report carrying weapons. Some determinants of weapon carrying and use are explored. Results suggest that preventive efforts may need to begin at the primary or middle school level, and be reinforced thereafter.
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Characteristics of Users and Non-Users of Health Clinics in Inner-City Junior High Schools
Walter H., Vaughan R., Armstrong B., Krakoff R., Tiezzi L. and McCarthy J.
Journal of Adolescent Health, 18:344-348, 1996
ABSTRACT: Purpose: To compare the demographic, behavioral, psychosocial, and academic characteristics of users vs. non-users of inner city middle school-based health clinics. Methods: Students who used (n=1,344) and did not use (n=2,394) the health clinics based in four middle schools in an economically disadvantaged, medically underserved New York City school district were compared on their responses to a health risk survey administered at the end of the 1991/92 academic year. Results: Compared to students who did not use the clinics, students who used the clinics were more likely to have had unprotected sexual intercourse, to have had suicide intentions or attempts, to be suspended from school for fighting, to be exposed to violence and the illicit drug culture, to hold beliefs favoring involvement in sexual intercourse and suicidality, and to have failed subjects in school. Conclusions: Users of these middle school-based health clinics are engaging in behaviors and hold beliefs that place them at risk for serious adverse health outcomes. School-based clinics have the potential to provide essential primary and preventive health care services for these high risk adolescents. Clinic outreach may be necessary to encourage clinic utilization, especially among high-risk students.
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School-Based Health Care for Urban Minority Junior High School Students
Walter H., Vaughan R., Armstrong B., Krakoff R., Tiezzi L. and McCarthy J.
Archives of Pediatrics and Adolescent Medicine, v149, November 1995
ABSTRACT: Objective: To describe the utilization of school-based health care services by urban minority middle school students. Design: Review of demographic and utilization data collected by service providers during clinic visits. Setting and Participants: Health care clinics in four middle schools enrolling predominantly Hispanic students residing in an economically disadvantaged, medically underserved New York City school district. Results: Of 5,757 students enrolled in the schools, 5,296 (92%) obtained parental consent to use and 3,723 (65%) used the clinics during the 1991/92 academic year. Clinic users were 11 to 15 years old; 50% male and 50% female, 81% Hispanic and 14% black; 29% 6th graders, 33% 7th graders, and 38% 8th graders. Clinic users made 16,340 clinic visits during the 1991/92 academic year. Presenting complaints were mental health problems (32%), illness (14%), injury (12%), physical examination (5%), immunization (3%), follow-up (21%), and other (13%). Referral sources were clinic outreach (48%), self (44%), and school personnel (8%). Disposition of visits was on-site treatment (92%), referral to affiliated hospital (5%), and referral elsewhere (3%). Compared to a nationwide group of high school-based clinics serving predominantly black adolescents, these clinics provided more mental health care (31% vs. 21%), similar illness/injury care (32% vs. 30%), and less preventive (10% vs. 24%) and reproductive/contraceptive (7% vs. 12%) care. Conclusions: Middle school-based clinics can provide a wide range of primary and preventive health care services for large numbers of medically underserved youths. The provision of mental health services may fill a critical need among inner city adolescents. Clinic outreach may be necessary to maximize utilization, especially among high-risk students.
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Sexual, Assaultive, and Suicidal Behaviors Among Urban Minority Junior High School Students
Walter H., Vaughan R., Armstrong B., Krakoff R.,Maldonado L., Tiezzi L. and McCarthy J.
J. Am. Academy of Child Adolescent Psychiatry, 34:1, January 1995
ABSTRACT: Objective: A greater understanding of minority adolescents' involvement in sex and violence is an essential precursor to the development of effective prevention programs targeted at inner-city youths. Method: To estimate the prevalence of involvement in sexual, assaultive, and suicidal behaviors and to quantify the relative importance of demographic, psychosocial, and behavioral risk factors for those behaviors, a survey was administered in the spring of 1992 to a sample of 3,738 predominantly Hispanic and African-American students attending four junior high schools in an economically disadvantaged, medically underserved New York City school district. The mean age of participants was 13.5 years; 73.7% were Dominican, 6.9% were other Hispanic, and 10.4% were black. Results: Thirty-one percent of males and 7% of females reported involvement in sexual intercourse, 27% of males and 8% of females reported involvement in assaultive behavior, and 10% of males and 19% of females reported suicide intentions/attempts. The primary risk factor for sexual intercourse was a belief that involvement in intercourse was common and acceptable among peers. The primary risk factor for assaultive behavior was adverse social circumstances. The primary risk factor for suicide intentions/ attempts was symptoms of depression. The risk for involvement in each of the three investigated risk behaviors was substantially increased by involvement in the other two behaviors. Conclusions: These findings underscore the urgent need for comprehensive sex and violence prevention programs targeted at urban minority junior high school students and suggest factors that may identify students at highest risk.
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