School-based health center viability: application of the COPC model

Providing effective primary and preventive health care to adolescents is challenging. Traditional medical and nursing models have had little success in guiding health care for the individual adolescent. A community-based model would aim programs and intervention at high-risk adolescents identified as needing treatment. Community-Oriented Primary Care (COPC) bridges the gap between primary care and public health to evaluate and improve the delivery of health care to identified populations. The COPC model was used to develop and implement an adolescent school-based health center in a southwestern border community. The four process steps based on the COPC model include: identifying the community of interest, identifying the health problem, developing and implementing intervention(s), and conducting ongoing evaluation. Key stakeholders from the medical, educational, and consumer groups were invited to participate in the first and second steps. Representatives of various school adolescent subcultures formed a group of promotores (health promoters) to monitor, advise, and contribute to the process. The Dartmouth COOP survey was selected to identify health concerns and risks of the targeted high school. The promotores prepared and administered the survey to 1,116 students. Results were used to design the initial health center program components using an interdisciplinary team to implement interventions aimed at the major health concerns and risks identified by the COOP. A short feedback loop contributed to program refinements, and ongoing evaluation continues to shape the practice of health care providers in the school-based health care center.