School-Based Reproductive Health Services as Innovation
By Melissa Akers
Program Manager at the National Assembly on School-Based Health Care
Health care professionals treating adolescents are encouraged to look for evidence of sexually transmitted diseases (STDs) and to counsel them on preventive measures. The American Academy of Pediatrics’ Bright Futures: Guidelines for the Health Supervision of Infants, Children, and Adolescents recommends that adolescents receive gynecological exams and testing for STDs. The American Medical Association’s Guidelines for Adolescent Preventive Services recommends that adolescents be counseled about the transmission and prevention of HIV and STDs, the prevention of pregnancy, and responsible sexual behavior.
Schools offer a unique setting for community health organizations, including federally qualified health centers, hospital systems, local health departments, and universities, to form partnerships and provide comprehensive health services and education for adolescents, a population often thought of as difficult to reach. School-based health centers (SBHCs) are considered an effective model for delivering preventive care, including reproductive health care services, to adolescents. Numerous evaluations have shown that SBHCs increased adolescent health care access when compared with adolescent use in other settings. This finding is especially true for important services delivered onsite such as family planning and screening and counseling for STDs.1,2,3,4,5,6
The Innovations Exchange Profile Inner-City School Health Center’s Comprehensive Reproductive Health Services: Enhancing Access to Screening for Sexually Transmitted Diseases, Prenatal Care, and Contraception demonstrates the ability of SBHCs to deliver comprehensive reproductive and sexual health services to underserved populations with measurable successes. Rush University’s College of Nursing delivered health services primarily to African-American students in three Chicago public schools. The key program elements were convenient location and hours; culturally sensitive outreach and care; and comprehensive, routine, and free sexual health education and services for all students. The results showed that a high proportion of students were screened for STDs, the vast majority of teenage mothers at the schools began using long-term contraception, all pregnant teens were linked to prenatal care, and more male students frequented the clinics.
Although reproductive health services, including STD screening and access to contraceptives, are recommended components of clinical preventive services for adolescents, data suggest that considerable barriers exist to delivering that care. According to the National Assembly on School-Based Health Care 2007–2008 Census, there are 1,096 SBHCs across the country, with the majority serving Hispanic/Latino youth (37 percent) and black youth (26 percent)—the very populations at highest risk for poor health outcomes. Although SBHCs have the opportunity to play a key role linking adolescents at risk of pregnancy and STDs/HIV with a network of services that otherwise might be inaccessible, many SBHCs face restrictive district policies or state laws. Sixty-one percent of SBHCs report that dispensing of contraception is explicitly prohibited and only about 50 percent are allowed to offer onsite STD diagnosis or treatment and chlamydia screenings.
When facing barriers to the onsite provision of reproductive health care, SBHCs need to address both community support and resource development. Even when dispensing of contraception is prohibited onsite, many SBHCs provide primary care and other important reproductive health services and most can refer for services not offered onsite. Given these constraints, SBHCs can serve as important points of entry into reproductive health care for adolescents, as well as providing important followup functions—ensuring that referrals were successfully completed and that adolescents use their chosen contraceptive method(s) effectively. Given the population they serve and locations of SBHCs, this system of care should be seen as an important tool in a portfolio of other comprehensive approaches to reduce poor health outcomes for adolescents.
About the Author
Melissa Akers is Program Manager within the Programs and Professional Services team at the National Assembly on School-Based Health Care. She has worked extensively with at-risk youth and most recently served as the Health Programs Project Manager for Wind Youth Services, a Sacramento-based nonprofit providing comprehensive services for homeless youth.
Disclosure Statement: The author disclosed no financial interests or professional or business affiliations that are relevant to the work described in this article.
References
1 Allison MA, Crane LA, Beaty BL, et al. School-based health centers: improving access and quality of care for low-income adolescents. Pediatrics. 2007;120(4):e887-94. [PubMed]
2 Anglin TM, Naylor NE, Kaplan DW. Comprehensive school-based health care: high school students’ use of medical, mental health, and substance abuse services. Pediatrics. 1996;97:318-30. [PubMed]
3 Juszczak L, Melinkovich P, Kaplan D. Use of health and mental health services by adolescent across multiple delivery sites. J Adolesc Health. 2003;32(6):108-18. [PubMed]
4 Kaplan DW, Calonge BN, Guernsey BP, et al. Managed care and school-based health centers: use of health services. Arch Pediatr Adolesc Med. 1998;152:25-33. [PubMed]
5 Klein JD, Handwerker L, Sesselberg TS, et al. Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users. J Adolesc Health. 2007;41(2):153-60. [PubMed]
6 Lancman H, Pastore DR, Steed N, et al. Adolescent hepatitis B vaccination: comparison among two high school-based health centers and an adolescent clinic. Arch Pediatr Adolesc Med. 2000;154:1085-8. [PubMed] |
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Original publication: March 27, 2013.
Original publication indicates the date the profile was first posted to the Innovations Exchange. Last updated: March 27, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange. |
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