Effect of a Comprehensive School-Based Health Center on Academic Growth in K-8th Grade Students

OBJECTIVE

School-based health centers (SBHCs) improve health care access, but associations with educational outcomes are mixed and limited for elementary and middle school students. We investigated whether students enrolled in a comprehensive SBHC demonstrated more growth in standardized math and reading assessments over 4 school years versus nonenrolled students. We also explored changes in absenteeism.

METHODS

Participants were students enrolled in 2 co-located Title I schools from 2015-19 (1 elementary, 1 middle, n = 2480). Analysis of math and reading was limited to students with baseline and postbaseline scores (math n = 1622; reading n = 1607). Longitudinal regression models accounting for within-subject clustering were used to estimate the association of SBHC enrollment with academic scores and daily absenteeism, adjusting for grade, sex, body mass index category, health conditions, baseline outcomes (scores or absenteeism), and outcome pretrends.

RESULTS

More than 70% of SBHC-enrolled students had math (1194 [73.6%]) and reading 1186 [73.8%]) scores. Enrollees were more likely than nonenrollees to have asthma (39.7% vs 19.6%) and overweight/obesity (42.4% vs 33.6%). Adjusted baseline scores were significantly lower in math and reading for enrollees. Mean change from baseline for enrollees exceeded nonenrollees by 3.5 points (95% confidence interval [CI]: 2.2, 4.8) in math and 2.1 points (95% CI: 0.9, 3.3) in reading. The adjusted rate of decrease in daily absenteeism was 10.8% greater for enrollees (incident rate ratio 0.772 [95% CI: 0.623, 0.956]) than nonenrollees (incident rate ratio 0.865 [95% CI: 0.696, 1.076]).

CONCLUSIONS

SBHC enrollees had greater health and educational risk but demonstrated more growth in math and reading and less absenteeism than nonenrollees.

Implementing a School-Based Health Center Virtual Care Program: A Qualitative Exploration of the School Nurse Perspective

BACKGROUND

School-based health centers (SBHCs) have the capability to overcome youth barriers to care. Virtual care programs (VCP) facilitate connection between school nurse and off-site SBHC providers and can increase the reach of SBHCs. This project aimed to examine Denver Public School nurses' perspectives of a pilot VCP.

METHODS

Thirteen semi-structured qualitative interviews were conducted and coded using an inductive approach to identify key themes.

RESULTS

Four major themes emerged: (1) obtaining consent, finding space, and capacity are challenges and nurses have suggestions; (2) nurses enjoy feeling like a valued member of a health care team, and providing additional resources to students; (3) nurses perceive benefits in providing free, efficient, higher level of care; (4) adopting novel technology is a facilitator and challenge; limitations included space and privacy.

CONCLUSIONS

Key findings can be utilized to further inform practice.

Exploratory Qualitative Focus Group Analysis of School-based Health Center Policy Issues: Insights From State Leaders

INTRODUCTION

School-based health centers (SBHCs) provide students with critical, cost-effective access to health care. The pandemic accelerated a shift in SBHC care delivery. From the viewpoint of SBHC state leadership, this study aimed to describe changes since the last national SBHC health policy survey in 2017 through the COVID-19 pandemic.

METHOD

Leaders from state offices funding SBHCs and of School-Based Health Alliance affiliates participated in semistructured virtual focus groups in early 2022. Qualitative researchers triangulated focus group data with open-ended survey questions and performed thematic content analysis.

RESULTS

The results confirmed a priori themes of increased funding, challenges in alignment around the definition, standardization, and metrics of SBHCs, and pandemic-related changes. Emerging themes included: (1) increased mental health services, (2) a shift toward telehealth and increased access delivery models, and (3) workforce challenges.

DISCUSSION

These themes drive further exploration to sustain positive change, overcome challenges, and guide future quantitative SBHC policy analysis.

School-Based Mental Health Service Utilization Through the COVID-19 Pandemic and Beyond

BACKGROUND

We examined trends in mental health service utilization before, during, and in the immediate return to in-person learning throughout the COVID-19 pandemic.

METHODS

Retrospective chart review was assessed for changes in odds of any visit being a mental health encounter from five school-based health centers from the 2018-2019 to the 2021-2022 school years. Data are limited to the in-person school year from mid-August to early June.

RESULTS

Data were assessed from 1239 students seen through 2256 visits over the 4 school years (Mage  = 12.93). The odds of any visit being related to a mental health encounter increased each school year, with the 2020 to 2021 and 2021 to 2022 school years having significant increases in odds (both compared to the first and to the antecedent school year). In addition, during the 2019 to 2020 and 2020 to 2021 school years, the odds of a repeated mental health encounter significantly increased from year to year.

CONCLUSIONS

Findings indicate a steadily increasing number of mental health service utilization needs among adolescent students that was significantly exponentiated throughout the COVID-19 pandemic.

Integrating Behavioral Health and Primary Care in an Inner-City High School: Expanded Care in a School-Based Clinic in Mississippi, 2018-2020

Adolescence, a critical and rapid stage of human development, requires innovative approaches in the provision of health care. With considerable mental health issues occurring among adolescents, an urgent need exists to address their mental and behavioral health. School-based health centers can provide an important safety net, particularly for young people who lack access to comprehensive and behavioral health care. We describe the design and implementation of behavioral health assessment, screening, and treatment services in a primary care school-based health center. We reviewed primary care and behavioral health measures as well as the challenges and lessons learned of this process. Five hundred and thirteen adolescents and young adults aged 14-19 years from an inner-city high school in South Mississippi were screened for behavioral health issues from January 2018 through March 2020, and all 133 adolescents deemed at risk for behavioral health issues received comprehensive health care. Lessons learned included the importance of recruiting behavioral health providers to ensure sufficient staff, establishing academic-practice arrangements to ensure funding, increasing student enrollment by improving the return rate of consent for care, and enhancing data collection through process automation. This case study may help inform the design and implementation of integrated primary and behavioral health care in school-based health centers.

School-Based Health Centers: A Concept Analysis

INTRODUCTION

This concept analysis aims to provide a conceptual definition for school-based health centers (SBHCs). Despite growing evidence of SBHC growth and impact, there is a gap in the conceptual clarity of SBHCs.

METHOD

A systematic review using Walker and Avant's 8-step method of concept analysis produced 369 articles, of which 17 were analyzed. PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library were searched with no time limit to capture the history and development of SBHCs. Search terms included "school-based health" and "school-based health center."

RESULTS

Accessible and advanced practitioners, heterogeneity, integrated care and location, and youth-friendly provide defining attributions to SBHCs. Antecedents, consequences, and empirical referents are discussed.

DISCUSSION

This concept analysis highlights evidence supporting the potential impact of SBHCs as a health service model for advancing health equity. Clear criteria contribute to understanding SBHCs and serve as a basis for ongoing research and stakeholder collaboration.

Mental Health Service Provision at School-Based Health Centers During the COVID-19 Pandemic: Qualitative Findings From a National Listening Session

INTRODUCTION

School-based health centers (SBHCs) provide health services to more than six million youth annually. When schools throughout the United States closed in spring 2020, many SBHCs were also forced to close physical operations..

METHOD

This study uses qualitative data collected from SBHC representatives nationwide to examine supports and challenges affecting mental health services provision during the COVID-19 pandemic, changes in the provision of these services, and priorities for assessing and supporting student mental health needs in the 2021-2022 school year.

RESULTS

Partnerships, community and stakeholder buy-in, and student access were key supports to continuous care throughout the pandemic, whereas lack of available staff and lack of in-person access to students were key challenges. Patients demonstrated increased acuity of presenting mental health problems, more immediate and complex mental health challenges, and greater co-morbidities.

DISCUSSION

SBHCs pivoted, even with limited resources, to meet students' increasing needs for mental health care.

A comparison of contraceptive services for adolescents at school-based versus community health centers in Oregon

OBJECTIVE

To compare Oregon school-based health centers (SBHCs) with community health centers (CHCs) as sources of adolescent contraceptive services.

DATA SOURCES

Oregon electronic health record data, 2012-2016.

STUDY DESIGN

We compared clinic-level counseling rates and long-acting reversible contraception (LARC) provision, adolescent populations served, and visit-level LARC provision time trends. We evaluated adjusted associations between LARC provision and Title X participation by clinic type.

DATA COLLECTION/EXTRACTION METHODS

We used diagnosis and procedure codes to identify contraceptive counseling and provision visits, excluding visits for adolescents not at risk of pregnancy.

PRINCIPAL FINDINGS

CHCs were more likely to provide LARC on-site than SBHCs (67.2% vs. 36.4%, respectively). LARC provision increased more at SBHCs (5.8-fold) than CHCs (2-fold) over time. SBHCs provided more counseling visits per clinic (255 vs. 142) and served more young and non-White adolescents than CHCs. The adjusted probability of LARC provision at Title X SBHCs was higher than non-Title X SBHCs (4.4% [3.9-4.9] vs. 1.7% [1.4-2.0]), but there was no significant association at CHCs.

CONCLUSIONS

In Oregon, CHCs and SBHCs are both important sources of adolescent contraceptive services, and Title X plays a crucial role in SBHCs. Compared with CHCs, SBHCs provided more counseling, showed a larger increase in LARC provision over time, and served more younger and non-White adolescents.

Which Children Use School-Based Health Services as a Primary Source of Care?

BACKGROUND

School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home.

METHODS

Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria.

RESULTS

Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office.

CONCLUSIONS

While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.

Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial

BACKGROUND

Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships.

OBJECTIVE

This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial.

METHODS

About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study-the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis.

RESULTS

This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021.

CONCLUSIONS

About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30499.

Reducing Missed Opportunities for Human Papillomavirus Vaccination in School-Based Health Centers: Impact of an Intervention

OBJECTIVE

Human papillomavirus (HPV) immunization rates among US adolescents are low. Missed opportunities (MOs) for HPV vaccination are common. School-based health centers (SBHCs) have potential to boost HPV vaccination, but their role in addressing MOs has not been examined.

METHODS

We implemented a multicomponent intervention, consisting of 3 immunization process workflow modifications combined with provider performance feedback, in 2 Los Angeles area SBHCs and conducted a pre/post evaluation of MOs. Our primary outcome was SBHC-based MOs for HPV vaccination during all visits, including visits for confidential reproductive health care (ie, confidential visits). Secondary outcomes were MOs for meningococcal (MenACWY) and influenza vaccination during visits for nonconfidential care.

RESULTS

MOs for HPV vaccination decreased during all visit types from the baseline to the intervention period (82.3% to 46.1%; adjusted risk ratio [RR] = 0.558, P < .0001). The rate decrease appeared to be greater during physical examination visits than confidential visits (83.4% to 31.6% vs 98.7% to 70.4%, respectively). MOs for MenACWY (74.5% to 35.0%; adjusted RR = 0.47, P < .0001) and influenza (86.7% to 69.3%; adjusted RR = 0.792, P < .0001) vaccination also decreased during nonconfidential visits. Vaccine refusal was the most frequently documented reason for HPV vaccine MOs during both physical examination and confidential visits.

CONCLUSIONS

A pragmatic, multicomponent SBHC intervention reduced MOs for HPV vaccination during all visit types. MOs for MenACWY and influenza vaccination also decreased during nonconfidential visits. Findings suggest that practice-level improvements in SBHCs can improve delivery of HPV and other adolescent vaccines.

Higher Child Body Mass Index Is Associated with Greater School-Based Health Center Utilization

Background: Children with overweight status and obesity seek care for acute illnesses more often than normal weight peers. School-based health centers (SBHCs) have a role in acute and chronic disease management; however, little is known about SBHC use by children with overweight status and obesity. This study compared SBHC utilization by student body mass index (BMI) category and investigated whether SBHC visit diagnoses varied by BMI category. Methods: We performed a retrospective analysis of students (n = 1161) in grades K-8 enrolled in a large SBHC for 2 years. Negative binomial regression models were used to test the independent association between BMI category as defined by BMI percentile [normal/underweight (BMI percentile <85%) and overweight/obesity (BMI percentile ≥85%), either overweight (85% ≤BMI percentile <95%) or obesity (BMI percentile ≥95%)], and the number of SBHC visits (nurse, clinician, and total visits) for the 2-year interval. Top five diagnoses based on ICD-10 visit codes were compared. Results: Students in the overweight/obesity category (BMI percentile ≥85%) had higher visit rates than normal/underweight peers after adjusting for age and gender, but only total visits were statistically significant [nurse: incident rate ratio (IRR) 1.42 (95% CI 0.94-2.15); clinician: 1.27 (95% CI 0.93-1.75); total: 1.45 (95% CI 1.02-2.07)]. Visit diagnoses were similar by BMI category. Conclusions: Students with higher BMI percentiles, categorized as overweight/obesity, had higher SBHC utilization than normal/underweight peers, but visit diagnoses were similar. This higher utilization may provide an as-yet untapped opportunity to expand school-based obesity prevention and management.

Prevalence of asthma at a school-based health clinic in Nicaragua

BACKGROUND

Worldwide, it is estimated that 235-334 million people have been diagnosed with asthma. In Nicaragua, the current asthma rate for children 13-14 years of age was 15.2%.

PURPOSE

The purpose of this study was to determine the prevalence of asthma at this school-based health clinic in Managua, Nicaragua, associated symptoms or diseases, determine asthma classification, medications, and hospitalization rates.

METHODS

A retrospective chart review was performed on all pediatric patient's medical records seen in the clinic during a 5-day period (n = 105).

RESULTS

A total of 23 patients (21.9%) had asthma documented in the medical chart and were included in the analysis. Of the 23 patients, 3 (13%) patients were classified with intermittent asthma while the rest of the patients (87%) were not classified. Albuterol was prescribed for 19 (86%) of the patients with two patients who had both albuterol and QVAR® prescribed. Six (26%) patients had a family history of asthma.

DISCUSSION

This study demonstrated the prevalence of asthma in school-aged children in Nicaragua is significant and higher than previously reported. The lack of a classification of asthma prevents patients from potentially being treated appropriately.

Evaluating a Strategy for Implementation and Sustainability of School-Based Health Centers in 3 Disparate Communities

BACKGROUND

School-based health centers (SBHCs) increase access to health care and improve academic achievement for underserved students. We report on the test of a strategy to take SBHCs to scale by addressing the issues of community need and support and financial sustainability.

METHODS

Using mixed methods, we collected data on student enrollment, utilization, health outcomes, seat time, patient revenues, surveys and key informant interviews from SBHCs located in 3 geographically and demographically different communities over a 2-year period.

RESULTS

The 3 health centers were comparable in their capacity to implement their operations and achieve quality outcomes but varied considerably in their abilities to achieve sustainability after 2 years of operation. All participated in a planning phase and were able to achieve community buy in and support which impacted their implementation. Only one of the SBHCs which had the highest patient utilization was able to generate enough revenue from patient billings to become sustainable after the second year.

CONCLUSION

Expanding SBHCs requires a period of planning to generate community buy in and support which is required for successful implementation. Sustainability requires sustained high clinic utilization and is enhanced by health centers that are able to receive high Medicaid reimbursements.

Sexual Orientation-Based Depression and Suicidality Health Disparities: The Protective Role of School-Based Health Centers

This study's purpose was to examine whether school-based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past-year depressive episode, suicidal ideation, and suicide attempt versus those attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population.

School-Based Health Centers as the Pediatric Expanded Medical Home

BACKGROUND

School-based health centers (SBHCs) provide primary and preventive health services and have been debated as possible medical homes for the pediatric population. The effect of a SBHC as an expanded medical home has yet to be determined.

OBJECTIVE

The purpose of this paper was to review the research evaluating the use of SBHCs as a pediatric patient's expanded medical home.

METHODS

The databases PubMed and CINAHL were searched for research articles pertaining to the value of using a SBHC as a pediatric medical home.

RESULTS

SBHCs provide care that is accessible, coordinated, comprehensive, continuous, family-centered, compassionate, and mildly culturally effective for adolescents.

CONCLUSIONS

Community health systems and primary care providers should partner with SBHCs to establish an expanded medical home and promote greater coordination and continuity of care for adolescents.

A School-Based Intervention to Increase HPV Vaccination Rates

BACKGROUND

The human papillomavirus (HPV) is responsible for over 33,000 cancer diagnoses each year in the United States. HPV vaccination rates remain 25%-30% lower than other preteen immunizations.

OBJECTIVE

The aim of this project was to increase the HPV vaccination rate among adolescents presenting to a school-based health center (SBHC) using provider recommendation and parent education.

METHODS

This project examined whether HPV vaccine acceptance improved over 8 weeks following implementation of a clinic policy requiring immunization records to be reviewed at every visit, along with providing parents with written recommendations and education.

RESULTS

Thirty-six students were found to be lacking HPV vaccination. Parents of these children received written recommendations and education on the HPV vaccine. Fifteen parents consented to the HPV vaccine for their child, a 1400% increase in HPV vaccine acceptance when compared to the same time period in 2017.

CONCLUSIONS

This study found that a SBHC practice initiative led to an increase in HPV vaccine acceptance. There was also an increase in the acceptance of other vaccines such as Tdap, MenACWY, and Influenza.

IMPLICATIONS FOR NURSING

Provider recommendation was influential in improving HPV vaccination rates. SBHC are an ideal alternative setting to improve vaccine acceptance among parents.

Completion of the Human Papillomavirus Vaccination Series Among Adolescent Users and Nonusers of School-Based Health Centers

OBJECTIVES

Uptake and completion of the human papillomavirus (HPV) vaccine series among adolescents are suboptimal in the United States. We examined immunization registry data to determine completion of the 3-dose HPV vaccine series among adolescents in Seattle, Washington, born during 1995-2000 who received ≥1 dose of HPV vaccine.

METHODS

Immunization data included the administrating facility, which identified adolescents who used school-based health centers (SBHCs) for any HPV vaccine dose. We calculated completion of the 3-dose series at any time and on time by the 13th birthday. We stratified analyses by sex and assessed differences in on-time and any-time completion between users and nonusers of SBHCs.

RESULTS

Overall, 67.9% (8612 of 12 676) of females and 41.8% (3560 of 8521) of males with ≥1 dose of HPV vaccine completed the 3-dose series. Compared with female SBHC nonusers, female SBHC users had 37% higher odds of completing the series at any time (adjusted odds ratio [aOR] = 1.37; 95% CI, 1.19-1.58) and 33% higher odds of completing the series on time (aOR = 1.33; 95% CI, 1.08-1.64). Compared with male SBHC nonusers, male SBHC users had 45% higher odds of completing the series at any time (aOR = 1.45; 95% CI, 1.23-1.70) and 79% higher odds of completing the series on time (aOR = 1.79; 95% CI, 1.11-2.89).

CONCLUSION

Adolescent SBHC users had higher odds of completing the HPV vaccine series than adolescents who received all doses in traditional health care settings. SBHCs should be leveraged to increase adolescent immunization rates.

Patient-Centered Medical Home Measurement in School-Based Health Centers

School-based health centers (SBHCs) have been suggested as potential medical homes, yet minimal attention has been paid to measuring their patient-centered medical home (PCMH) implementation. The purposes of this article were to (1) develop an index to measure PCMH attributes in SBHCs, (2) use the SBHC PCMH Index to compare PCMH capacity between PCMH certified and non-PCMH SBHCs, and (3) examine differences in index scores between SBHCs based in schools with and without adolescents. A total of six PCMH dimensions in the SBHC PCMH Index were identified through factor analysis. These dimensions were collapsed into two domains: care quality and comprehensive care. SBHCs recognized as PCMHs had higher scores on the index, both domains, and four dimensions. SBHCs based in schools with just young children and those with adolescents scored similarly on the overall index, but analysis of individual index items shows their strengths and weaknesses in PCMH implementation.

Applying a Global Perspective to School-Based Health Centers in New York City

BACKGROUND

Since the 1960s, school-based health centers (SBHC) in the United States have emerged and grown with the mission of providing primary medical, reproductive, and mental health services, as well as comprehensive health education, to all students who are enrolled in the participating school. SBHCs have demonstrated a unique ability to reduce barriers to medical care for underserved populations in New York City, including undocumented immigrants and those who are of lower income status.

METHODS

The Mount Sinai Adolescent Health Center School-Based Health Program (MSAHC SBHP) was established in 1985 in order to increase access to care for New York City teens. After a change of physical location, one particular site of the MSAHC SBHP had a significant decrease in clinic visits and enrollment. Traditional outreach strategies were utilized, but the results of the efforts were disappointing. Applying the Community Health Worker model, as defined by the World Health Organization (WHO), the MSAHC SBHP developed the Student Ambassador Program, a student-organized community-engagement initiative. The program is based on the premise that youth can be effective at outreach and serving as community liaisons to increase awareness and use of the SBHC. The SBH staff provided recruitment, training, and support. The student ambassadors initiated peer-informed outreach projects to appeal to the student body. Upon completion of the Student Ambassador projects, clinic enrollment increased 4.3% and visits increased 32% over the prior year.

CONCLUSIONS

School-based health centers in the United States have helped to provide comprehensive, multidisciplinary care to many children who would otherwise not be able to access care, but community engagement is critical to their success. Applying the WHO Community Health Worker Model to utilize school students for outreach to their school community is an effective way to increase utilization.

Effect of an iPad-Based Intervention to Improve Sexual Health Knowledge and Intentions for Contraceptive Use Among Adolescent Females at School-Based Health Centers

OBJECTIVES

The use of effective contraception can decrease the incidence of unplanned pregnancy among adolescents. This study aims to examine the effectiveness of an iPad-based application (app) on improving adolescent girls' sexual health knowledge and on its ability to influence their intentions to use effective contraception.

STUDY DESIGN

This was a prospective study of girls aged 12 to 18 years recruited from 3 school-based health centers in California.

RESULTS

A total of 120 racially/ethnically diverse participants used the iPad app; 54% were sexually active, with only 26% using effective contraception at baseline. The average score on baseline sexual health knowledge assessment was 58%. After using the app, 68% of the sexually active participants reported intention to use effective contraception in the future, and sexual health knowledge improved significantly to 79% ( P < .001).

CONCLUSIONS

This iPad-based app is a promising intervention to educate adolescents about sexual health and support them in selecting an effective contraception method.

Effect of an iPad-Based Intervention to Improve Sexual Health Knowledge and Intentions for Contraceptive Use Among Adolescent Females at School-Based Health Centers

OBJECTIVES

The use of effective contraception can decrease the incidence of unplanned pregnancy among adolescents. This study aims to examine the effectiveness of an iPad-based application (app) on improving adolescent girls' sexual health knowledge and on its ability to influence their intentions to use effective contraception.

STUDY DESIGN

This was a prospective study of girls aged 12 to 18 years recruited from 3 school-based health centers in California.

RESULTS

A total of 120 racially/ethnically diverse participants used the iPad app; 54% were sexually active, with only 26% using effective contraception at baseline. The average score on baseline sexual health knowledge assessment was 58%. After using the app, 68% of the sexually active participants reported intention to use effective contraception in the future, and sexual health knowledge improved significantly to 79% ( P < .001).

CONCLUSIONS

This iPad-based app is a promising intervention to educate adolescents about sexual health and support them in selecting an effective contraception method.

"Contraceptive Care for Adolescents in School-Based Health Centers Is Essential!": The Lived Experience of Nurse Practitioners

Adolescents often face hurdles that may interfere with accessing contraceptive services. School-based health centers (SBHCs) are available to many teens in the United States; however, only half of SBHCs that serve adolescents are permitted to provide contraception. The aim of this descriptive phenomenological study was to describe the lived experience of nurse practitioners (NPs) providing contraceptive care to teens in SBHCs. Twelve NPs were interviewed and Colaizzi's method of descriptive phenomenological analysis was used to describe the lived experience of NPs providing contraceptive care to adolescents in SBHCs. Three themes emerged: Contraception is an Essential Part of Care for Teens Using SBHCs; Frustration! There are so Many Hurdles to Negotiate; and Walking a Fine Line. Despite the restrictions on SBHC services and the hurdles the NPs encountered, they remained committed to providing contraceptive services and seized available opportunities to provide health education and support for the adolescents accessing the SBHCs.

Identifying patterns of obesity risk behavior to improve pediatric primary care

PURPOSE

To develop profiles of obesity risk behaviors for children and adolescents.

DESIGN AND METHODS

Risk assessments were obtained from patients (n = 971) at a school-based health center. Latent class analysis was used to create subgroups based on seven indicators measuring diet, activity, and screen time.

RESULTS

Four classes emerged, with 44% classified as the "Healthiest," 8% as the "Least Healthy," 37% as "Mixed Diet/Low Activity/Low Screen Time," and 11% as "Mixed Diet/High Activity/High Screen Time." Several demographic predictors distinguished the classes.

PRACTICE IMPLICATIONS

Obesity risk factor profiles may help providers identify strengths and risks, tailor counseling, and plan interventions with families.

Using the Program Logic Model to Evaluate ¡Cuídate!: A Sexual Health Program for Latino Adolescents in a School-Based Health Center

BACKGROUND

Addressing the disparities in pregnancy and sexually transmitted infection (STI) rates for Latino youth in the United States requires an evidence-based approach. Although randomized controlled trials for sexual risk reduction interventions have shown promise in improving short-term outcomes, program sustainability has not been extensively examined in school settings where teens spend time. Latina teen pregnancy rates are nearly twice the national average. Adolescents comprise only 17% of the U.S. population, yet they account for 50% of STIs. ¡Cuídate! is a high-impact sexual health group program endorsed by the Centers for Disease Control and Prevention that has not been replicated in a real-world setting.

AIMS

The program logic model (PLM) was used as the systematic approach to plan, implement, and evaluate a sustainable model of sexual health group programing (¡Cuídate!) in a U.S. high school with a large Latino student population.

METHODS

The PLM provided the framework for the evaluation of outputs, outcome, and impact. A multivariate repeated measures analysis of variance was used as the means to evaluate the participant outcomes immediately postprogram and at 8-12 weeks.

RESULTS

¡Cuídate! was executed within an existing school structure and time constraints, below cost projections, and with high participant retention (95.8%). Three cohorts (N = 24) of female teens demonstrated significant increases in STI or HIV knowledge, self-efficacy, and intention to use condoms (p < .01). Condom use increased postprogram. No participants initiated sexual behavior, nor were there any reported pregnancies or STIs.

CONCLUSIONS

An evidence-based intervention previously tested in randomized controlled trials can be sustained in a school-based health center with similar results of efficacy.

LINKING EVIDENCE TO ACTION

Our success served as a platform for a sustainable program. We continue to extend the impact of the program by delivering ¡Cuídate! in the school setting using a community health worker.

Clinician adherence to childhood overweight and obesity recommendations by race/ethnicity of the child

PURPOSE

This study describes school-based health center (SBHC) providers' adherence to obesity guidelines.

DESIGN AND METHODS

Providers (n = 28) were from SBHCs in six states serving children 5-12 years of age. A random sample of well-child charts (n = 850) were audited for body mass index percentage, blood pressure percentage, overweight/obesity diagnosis, and laboratory assessment.

RESULTS

Body mass index percentage was documented on 73% of charts and blood pressure percentage on 30.5%. Providers accurately diagnosed 40% overweight and 49.3% obese children. Laboratory guidelines were followed in 80.4% of cases. Assessments differed by child's race/ethnicity (p < .05), with most criteria having higher adherence in minority youth.

PRACTICE IMPLICATIONS

There is a need for increased accuracy in how SBHC providers screen overweight/obese children.

Development and clinical use of Rapid Assessment for Adolescent Preventive Services (RAAPS) questionnaire in school-based health centers

INTRODUCTION

The purpose of this study is to describe the development and clinical use of Rapid Assessment for Adolescent Preventive Services (RAAPS), a time-efficient screening tool to assess for multiple adolescent risk behaviors.

METHOD

A retrospective chart audit was conducted to obtain descriptive data of middle school (N = 106) and alternative high school (N = 39) adolescents who completed the 17- to 18-item RAAPS questionnaire. Surveys assessed providers' evaluations of the RAAPS.

RESULTS

Descriptive statistics and qualitative analysis indicated that providers using the RAAPS were able to identify risk behaviors/factors, provide counseling for these behaviors, and refer 26% of 9- to 15-year-olds and 43% of 16- to 20-year-olds for further assessment or ongoing risk counseling. In one brief clinic visit, the providers were able to address and document most risk behaviors/factors reported by the adolescents.

DISCUSSION

Although psychometric analysis is needed, the RAAPS is a time efficient and comprehensive risk assessment tool. Early risk identification can assist providers in tailoring specific preventative education counseling and intervention programs that are geared to meet the specific needs of the adolescent population.