have not been interested in providing STD-related services and prefer to refer patients to the health department. Public health officials from Columbus are currently conducting outreach to physicians in private practice to involve them more fully in the diagnosis and reporting of STDs.

The West Central Health District programs collect fees from the Medicaid program for services. The staff is very concerned about changes that will occur with the implementation of Medicaid managed care and is looking for a niche in a managed care environment. The staff also expressed concern about the impact of block grants for HIV, STD, and TB and agreed that STDs are not a high priority in rural area. They are in the process of working with private providers to arrange a public/private partnership and have begun discussions with a local hospital. The director of the program has personally approached all the private sector providers in the area to arrange a public/private partnership.

The Emory/Grady Teen Services Program Atlanta, GA

The Emory/Grady Teen Services Program, a collaboration between Emory University and Grady Memorial Hospital, is a nationally acclaimed program that seeks to provide continuity of care for adolescents at risk for unintended pregnancy. The program has a school-based education component and a clinical component. The Teen Services Program has a formal agreement with the Atlanta Public Schools to provide 10 classroom periods of reproductive health education to all eighth-grade students, most of whom are from low-income families. The program educates 4,500 students each year through this agreement. "Postponing Sexual Involvement" is a component of the 10-hour outreach program in the Atlanta schools designed to help teens avoid early sexual involvement. Five sessions of the "Postponing Sexual Involvement" educational series are taught by Grade 11 and 12 students under the supervision of the hospital staff. The teen-led sessions are designed to help younger teens develop skills and resist social and peer pressures to begin sexual intercourse before they are able to take full responsibility for the consequences of their actions. The older youth also serve as role models, showing that they can be successful teenagers without being sexually involved. One session of the educational series is devoted exclusively to HIV infection and other STDs. The program emphasizes prevention of high-risk behaviors and STDs rather than providing detailed information on each STD.

Two special after-school family planning clinics (supported by Title X funds) are held at Grady Hospital each week. Nearly 1,200 sexually active female adolescents age 16 and younger are seen in these clinics annually. Once enrolled, adolescents continue to receive their care in these clinics until age 18 or graduation from high school. At Grady Hospital, each counselor sees patients from assigned schools who come for family planning services at least three or four times a year. Teen Services' nurses and counselors are assigned responsibility for



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