GloucesterTimes.com, Gloucester, MA

July 25, 2008

Board eyes contraceptive options for school health clinic

By Patrick Anderson

Closing in on a vote over whether to provide in-school access to contraceptives, the School Committee is weighing a policy that would allow parents to opt their children out of reproductive health services, while still receiving other aspects of care available at Gloucester High School's health clinic.

In districts across the state and country, school health centers have used "opt-out clauses" in their parental consent forms to allow parents uncomfortable with their children getting birth control confidentially to avoid it, without avoiding the clinic altogether.

In the last year, Gloucester High School has pushed enrollment in its student health center from 77 percent to more than 90 percent, one of the higher participation rates in the state.

But as debate about contraception intensified this spring, many, including Principal Joseph Sullivan, feared that unchecked, confidential birth control or condom distribution would lead to mistrust between parents and the school, jeopardizing the number of students being helped by the clinic.

"It was good to see that it had worked in other communities," School Committee Chairman Greg Verga said of the parental opt-out yesterday. "My concern from the beginning was that you would have people opting out of the whole clinic. I would hate to see people not get the other benefits of the clinic."

Addressing the committee as one of its hand-picked experts at a City Hall forum Wednesday night, Dr. Karen Hacker, medical director of the Institute for Community Health in Cambridge, said schools that choose to offer contraceptives can choose from a "menu" of options — including blanket consent to reproductive health services, an option for parents to opt out of reproductive services, and a mechanism that requires parents to opt-in to the services if they want it for their children. The distribution of contraceptives at the high school has taken center stage in the wake of reports that 18 Gloucester High School students became pregnant this past school year, including a number who may have done so by choice. Wednesday's meeting featured a panel of health officials who recommended choices for a school community response.

Hacker said each community had to decide which model best matched its values and determine which would cause more opposition than assistance.

She said the potential downsides of opt-out options include administrative hassles and confusion for staff treating patients, and the possibility that the few students who need the services the most will be the ones whose parents decide they shouldn't have it.

After the meeting, Hacker said in her experience in several different cities, she had never seen significant de-enrollment from a school-based clinic as a result of the adoption of a contraceptive policy.

Yesterday Dr. Brian Orr, the former medical director of the Gloucester High clinic and a supporter of confidential access to contraception, said he wouldn't have a problem with having an opt-out for parents who didn't want their children receiving confidential access to contraceptives.

"My impression is that it is a win-win for the School Committee and the community," Orr said. "Why not have parental consent for general care and then a separate box for reproductive care? If you don't want that option, then parents can choose to use it or not."

Orr said, as a practical matter, breaking the consent forms down into too many options would make it difficult for clinic staff to efficiently provide for patients, but one opt-out box should not cause a problem.

Another option discussed Wednesday was the possibility of providing access to contraceptives at a location outside the school building, such as the new community health center being opened at Addison Gilbert Hospital.

In response to School Committee questions about that possibility, the panel of experts Wednesday warned that creating an extra step in the process of filling any prescription typically causes failure among some patients to follow through.

"With referral, even if it is just across the street, you lose some kids," Hacker said.

In his summary of interviews with staff from school-based health clinics in three other cities that provided access to contraceptives, city Health Director Jack Vondras said one of the communities studied used an opt-out and was satisfied with it. The health clinic staffs had said they noticed a significant number of students did not follow through on outside referrals.

In her remarks to the School Committee, Dr. Lauren Smith, director of the state Department of Public Health, recommended, in addition to improved access to contraceptives, a comprehensive sex education program and a youth development program designed to raise self-esteem among local students. Both of those programs will likely require some level of funding, either by grant or through the city.

Verga said yesterday that choosing exactly what programs would work best for Gloucester would be large part of the committee's decision process going forward.

With recommendations from experts now in hand, the next public step in the School Committee pregnancy policy-making process is a series of "listening posts" similar to the community forums held by the mayor on the future of the harbor. On Wednesday, however, the committee announced changes to the meetings, including when they will be held and what they will be called.

The meetings, which will now be called "Community Conversations," were originally planned for the summer, so that community opinion could be gathered before the start of school in September. But yesterday, Verga said that because many people vacation in August, the meetings would likely be held in the early fall, after the start of school. There will be two meetings for adults and one for students.

A School Committee public hearing and deliberations on a new policy, initially scheduled before the start of school, will come after the forums, with a vote to codify the policy after that.

Another significant difference between the coming pregnancy "conversation" meetings and the harbor listening posts is that the meetings coming up will be reserved for Gloucester residents, who will be required to register before attending.

"We are elected by Gloucester people, and they should be the ones weigh in on the decision," Verga said.

Patrick Anderson can be reached at panderson@gloucestertimes.com