These various models reflect many of the characteristics of the Youth Clinics implemented in Sweden in 1972. There are 187 such clinics in existence in Sweden-a country with a population under nine million. These clinics provide comprehensive services to adolescents and are credited with a major positive impact on prevention of STDs and unintended pregnancy.

Collaborating with Community-Based Health Programs

Community-based health providers such as community health centers, family planning programs, and school-based health clinics are potentially important sources of STD-related services because they serve a patient population with a high prevalence of STDs. Although many community-based health programs currently provide STD-related clinical services, most have not made STD prevention a priority, despite its high prevalence in their patient population, and some do not have expertise in providing such services. There are, however, some notable exceptions to this observation.

Programs that provide family planning services, for example, have long recognized the importance of integrating STD clinical and educational services into family planning services, although not all programs provide STD-related services. In Chicago, Planned Parenthood provides STD- and HIV-related services in the context of comprehensive primary care for women and adolescents, while focusing on reproductive health. Using a population-based public health approach, the Chicago Planned Parenthood program provides outreach and education services directly to several high schools and through its clinics. The West End Community Health Center in Atlanta has developed a substantial STD program and provides STD-related services along with extensive primary care services. In this comprehensive model, clients receive STD screening, diagnosis, and treatment through their primary care provider of choice. Outreach, follow-up, and special counseling and education are available through clinic-based staff in collaboration with the local health department STD program staff. Most important, services are centered on the patient, coordinated by a primary care provider, documented in a single medical record, and monitored by relevant public health agencies.

In addition, local health departments in several cities (e.g., Baltimore, Boston, Denver, Minneapolis, and Portland) have developed collaborative pilot programs linking school-based health centers sponsored by the health department with local managed care organizations (Schlitt et al., 1995; Zimmerman and Reif, 1995). These programs provide comprehensive primary care, easily accessed at school, and multidisciplinary health education, health promotion, and mental health and social services. All routine STD- and reproductive-health-related care is provided through these centers. Agreements with the participating managed care organizations have enabled the providers in the school-based health center to

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