Adolescent health services in North Carolina's local health departments.

The purpose of this study was to assess availability of clinical health services and special adolescent health programs for those aged 10-19 years administered by local health departments in North Carolina, and to evaluate factors that were associated with the existence of specialized adolescent programs, comprehensive services, and school services. We used self-report surveys mailed to 100 county health directors. All counties responded. One in five (21%) North Carolina youth received one or more health department service in 1990. Thirty-four health departments have programs or services specifically designed for adolescents; 7 health departments provide comprehensive services. The majority of health departments (85%) provide services in public schools, most often health education or counseling. Counties with more adolescents and with higher per capita income were more likely to have adolescent programs and more likely to provide comprehensive clinics. Health departments with school services served proportionally twice as many of their county's adolescents as those without school services. We concluded that few local health departments in North Carolina provide comprehensive health services to their youth. Community-wide participation and state support are needed to improve public sector access to comprehensive health care for adolescents in North Carolina and in other states with decentralized, county-controlled public health systems.

Management issues in the organization and delivery of family planning services.

Statewide family planning programs have been developed primarily in the Southeast and in a few other States of the nation. They are managed by State public health agencies with a few exceptions. This paper presents issues which are of importance to persons and agencies interested in developing a statewide family planning program; namely State support, allocation of funds, setting goals based on impact rather than efficiency of services, secondary sources of funding, and patient data systems. Arguments for a statewide program include the maximum use of available resources (for example, title V maternal and child health funds), the opportunity to distribute resources equitably throughout the State, the development of a statewide third-party reimbursement system, the opportunity to develop evaluation mechanisms, support for starting a system of fee collection, and the use of a statewide patient data system. Arguments against a State program include some loss of local control of a project, possible organizational battles within State agencies, State political domination of program policy, and a possible shift of funding away from existing strong projects. In the early 1970s, development of statewide systems was coupled with a rapid increase of funding when broad coverage of services and accessibility were key factors. At the present, categorical funding is no longer increasing, and efficiency and maximization of resources are becoming more important.