When 17-year-old Lasondra wanted to find out about birth control, she wasn't sure whom to ask.
The idea of a big, impersonal hospital was scary. And since her mother was between health insurance plans, Lasondra was concerned about costs.
Then she accompanied a cousin on a visit to the Young People's Health Connection -- an innovative adolescent health clinic in Mondawmin Mall. And the doctors there were OK by her. "If they treat [my cousin] like that," she thought, "they'll treat me like that."
Soon after, she came in for herself, and she's been coming ever since.
She's not alone: Since it opened in March 1990, the Health Connection has seen about 2,000 area adolescents. "Every aspect of your health -- ear, nose, sex, drugs, etc. -- are found within these walls," said Dr. Arista Garnes, the city official who oversees the program.
With today's teens facing a bewildering array of health threats in an increasingly dangerous world, the Health Connection is a part of a new wave in adolescent health care.
Nine Baltimore high schools have similar clinics, using the one-stop-shopping approach that attempts to address adolescent problems ranging from sex and drugs, to flu and ear infections, to broken homes and suicide.
Such clinics are trying to redefine adolescent health programs to include primary health care, family planning and counseling, while infusing it all with the loving attention they believe is necessary to reverse a history of neglect.
The health needs of this age group have long been overlooked, partially because adult nostalgia remembers adolescence as a time of health and vigor.
To compound that problem, many teen-agers' ills don't look like medical problems in the traditional disease model of health care. They can't be cleared up with just a vaccination or a dose of penicillin.
More than 4.5 million adolescents nationally have no health insurance, and even among those who are insured or covered by a government program, many fail to navigate the highly specialized medical industry that is geared primarily to adults, an April report from the Congressional Office of Technology Assessment says.
An average of 54 teen-agers die each day in the United States, the American Medical Association reports, and three out of four of them are dying from largely preventable causes -- car accidents, homicide and suicide, government statistics show.
In addition, 1 million teens get pregnant each year, and 2.5 million contract sexually transmitted diseases, according to the Center for Population Options in Washington.
"We are talking about a generation of youths who are at an increasing risk for not surviving into a healthy adulthood," said Dr. Alain Joffe, director of adolescent medicine at Johns Hopkins. "No one's paid attention to adolescents."
The one-stop shopping approach to adolescent health began to gain momentum in the mid-'80s with the growth of comprehensive, school-based health clinics across the country. The Center for Population Options identified 61 clinics in 1984, 153 in 1988 and 327 last month.
Although they vary widely in funding and services, most clinics offer primary health care, diagnostic procedures, counseling services -- or referral to area counselors -- and general health education.
The clinics, which collect little or nothing in fees from the adolescents they serve, often distribute contraceptives and teach sex education as well, though the clinics' directors often are reluctant to discuss those services for fear of stirring controversy.
The politics of teen sexuality and abortion has haunted the adolescent health movement from the beginning as the clinics have frequently faced both local opposition and lukewarm support from the Reagan and Bush administrations. Still, a recent city health department survey found that 94 percent of parents favored offering family planning services. And Baltimore, which opened clinics in seven schools in 1985, now has nine, serving 5,000 students a year.
A nice place
The Health Connection -- which is affiliated with six area schools -- shares the same premise as the school-based health clinics: You must go where the kids are. In this case, it's a mall rather
than a school, though it has the additional advantage of being able to serve adolescents who are no longer students.
As the fall sports season approached last month, high school athletes of all shapes and sizes crammed into the Health Connection's waiting room to get physicals.
But many just drop by to talk with the staff or chat in the "rap room," which thumps with music.
"It's a nice place to hang out. It's better than the streets," said Kia Hardy, a 15-year-old bookworm who has to zigzag her way to the library to avoid the corners where drug dealers congregate. "You hardly find a nice place to go."
That's a common refrain from the 10- to 24-year-olds who come here, which should be music to the ears of Dr. Garnes and the rest of the staff. Dr. Garnes' conversations are peppered with the pithy slogans that have helped define the clinic: "Adolescents don't do hospitals," she says. On another occasion: "Adolescents don't do birth control clinics."
So the staff has worked to create a health clinic that kids will do. From the style and attitude down to the name, they have asked kids what they want and need. And from all indications, they have responded.
"I like coming here to hang out. Sometimes I get checked out," said Anthony Robinson, a 14-year-old. "It's not really like a hospital."