Development of community-based health services for adolescents at risk for sociomedical problems

Community-based service and training programs have been advocated as important for improving access to medical care for the poor as well as enhancing the ambulatory training setting for residents and medical students. In 1981 the Robert Wood Johnson Foundation provided funds to 20 teaching hospitals to support community-based, comprehensive health services to high-risk young people, that is, young people living in communities with high rates of sociomedical problems, such as adolescent pregnancy, drug abuse, alcohol abuse, accidents, homicide, suicide, and depression. In this article, the authors describe the experiences of these institutions in establishing off-campus clinics, concluding that high-risk adolescents need additional services and that teaching hospitals and communities can collaborate to provide these comprehensive services. They discuss issues of maintaining services after foundation grants end and the impact of recent financial restraints on continued support from teaching hospitals for off-campus activities.