The role of school-based health centers in providing long-active reversible contraceptive care to adolescents in New York City.

Long-acting reversible contraceptives (LARCs) are effective contraceptive methods for adolescents. This study describes the initiation and continuation of LARC care to adolescents at school-based health centers (SBHCs) during the COVID-19 pandemic. Participants received contraceptive care in New York City SBHCs from April 2021-June 2022. LARC initiation, LARC discontinuation, and total contraceptive visits were measured monthly. During the study period, the SBHCs provided 1,303 contraceptive visits, including 77 LARC initiations. Among LARC initiations, six-month continuation probability was 79.3 % (95 %CI: 69.0-91.1). SBHCs play an important role in providing adolescents contraceptive services, particularly LARC care, when other health care systems are disrupted.

Needs Assessment of Integrative Health Services at School-Based Health Centers.

Objective: The purpose of this needs assessment was to hear about adolescents' experience with and interest in accessing integrative health services (IHS) at their school-based health centers (SBHCs) so that future education and service offerings could be better informed. Subjects: We surveyed 373 9th to 12th graders, of mostly low-income and minority status, who were enrolled as patients at 6 SBHCs in New York City, New York. Verbal consent was obtained prior to their completing a survey on provided mobile devices. Design: The 35-item anonymous survey asked about adolescents' health goals, familiarity and experience with 14 different integrative health modalities and interest in learning about and accessing these modalities. Results: Among all patients, the most common health goal was improving sleep (65%). Before completing the needs assessment survey, almost all patients (98%) had heard of at least 1 integrative health modality and 69% had ever used any modality. On average, patients were interested in learning more about 7.6 of the modalities and were significantly more interested in learning about each modality from trained professionals than from trained peers or by themselves. Conclusions: Improving sleep was a central health goal for SBHC patients. The majority expressed interest in receiving information on massage, meditation and yoga from trained health professionals, and they wanted access to these modalities at their SBHCs. SBHCs are in a unique position of power in which they can bring desired, cost-effective integrative health modalities to marginalized students. Future efforts should expand provider training to support education on and delivery of these modalities and evaluation of their effectiveness at SBHCs.

PreexposureProphylaxis at School-Based Health Centers: Awareness and Interest in Starting Preexposure Prophylaxis While Attending a School-Based Health Center in New York City.

INTRODUCTION: Youth aged 13-29 years represent 23% of the population but account for 40% of new HIV diagnoses, with risk peaking at ages 22-23 years. We assessed sexual behaviors, PrEP knowledge and attitudes among patients of 6 School-Based-Health-Centers (SBHCs) located in Northern Manhattan and the Bronx. METHOD: 667 patients, aged 13-19 years, completed a survey in the SBHCs waiting rooms between 10/2018 - 4/2019 RESULTS: Of the survey respondents attending SBHCs, 32% reported ever having heard of PrEP and, upon learning of PrEP, 67% stated that would be very likely (35%) or somewhat likely (32%) to take PrEP if it was offered to them free of charge. DISCUSSION: Youth of color are disproportionately infected by HIV throughout the US. Efforts are needed to educate adolescents on the benefits of PrEP, SBHCs are well situated to reduce barriers in providing PrEP directly to those who would benefit from its protection..

Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services.

STUDY OBJECTIVE, DESIGN, AND SETTING: Adolescents face barriers to accessing youth-friendly family planning services, specifically long-acting reversible contraception (LARC). School-based health centers (SBHCs) can provide youth-friendly care. A quality improvement project was undertaken to assess quality of care before, during, and after LARC services at 3 SBHCs, and to identify specific strategies for improving these LARC services. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We interviewed 18 female adolescents who received LARC services. Two independent reviewers coded deidentified verbatim transcripts; discrepancies were resolved by consensus with a third reviewer. A guide of themes was structured corresponding to Ambresin's domains of youth-friendly services. From these domains, we identified emerging themes using grounded theory, with a focus on practical suggestions for improving LARC services in SBHCs. RESULTS: Interviewees ranged in age from 15 to 19 (average: 17) years. Most had insertions (12 levonorgestrel intrauterine system (LNG-IUS); Mirena®), 1 copper intrauterine device (Paragard®), 5 contraceptive implant (Nexplanon®). Overall, participants were highly satisfied with SBHC LARC services. Within the domain of communication, 2 key themes emerged: balancing need for information with concerns about being overwhelmed by information; and interest in information that directly addresses misconceptions about LARCs. Suggested strategies included providing postprocedure "care packages" with information and supplies, and supporting a peer-based network of adolescent LARC users and previous patients to serve as a resource for new patients. CONCLUSION: This quality improvement project, conducted in a unique setting, gave adolescents a voice. The identified strategies for improving health education, social support, and outreach might be generalizable to other SBHCs. Future research could explore the effect of implementing these suggested strategies on reproductive health care use and outcomes at SBHCs.

Enhancing referral of sexually active adolescent females from the emergency department to family planning.

BACKGROUND: Female adolescents at high pregnancy risk frequently visit the emergency department (ED) and lack primary providers. It is unclear if current methods of ED referral are successful. The objective of this pilot study was to assess the potential effect and feasibility of a standardized, enhanced method of referral of sexually active females from an ED for family planning (FP). METHODS: We conducted an ED-based intervention study using an enhanced referral process, which included a wallet card advertising a walk-in, adolescent-friendly FP clinic and a standardized ED physician monologue. ED physicians were instructed to disseminate the enhanced process to sexually active females ages 12-19 years (intervention group). Patients receiving the intervention were prospectively enrolled. The control group consisted of patients who, on retrospective review, came to the ED during the enrollment period and were eligible but were not enrolled. We used the electronic medical record (EMR) to identify and randomly select missed eligible patients (control group) and accumulated one control for each case. The primary outcome was FP follow-up within 2 months, measured by EMR review. RESULTS: The intervention (n=101) and control groups (n=101) were similar in age, prior ED visits (54% versus 56%), and previous FP visits (28% versus 28%). The absolute difference in follow-up to a FP clinic between the enhanced referral group (7%; 7/101) compared with the nonenhanced referral group (5%; 5/101) was only 2% (95% confidence interval -5% to 9%). Feasibility of the intervention was modest, with a best-case scenario of 59/160 (37%) of eligible patients captured. CONCLUSIONS: An enhanced referral initiative relying on physician participation did not substantially increase follow-up rates to a FP clinic and showed modest feasibility. More research is required to identify effective means of ED-based referral for preventive reproductive care.

Implementation of expedited partner therapy among women with chlamydia infection at an urban family planning clinic.

BACKGROUND: Reinfection with chlamydia is common and expedited partner therapy (EPT) decreases reinfection in clinical trials. Many clinical practices have adopted EPT as the principal treatment strategy for male partners. Little is known about its application and effectiveness in a community setting. METHODS: We conducted a retrospective cohort study of all female patients with chlamydia between 2004 and 2005 at a university-based family planning clinic. We abstracted demographic and clinical information from charts, including partner treatment strategy. We collected data on reinfection at 3 months and 1 year using a computerized database of laboratory results within the medical system. RESULTS: During 2004 to 2005, 499 women tested positive for chlamydia. Of the 466 women treated, EPT was given to 323 women (69.3%). No baseline characteristics were associated with EPT provision. Only 40% of women returned for a retest within 3 months. Reinfection at 3 months was 4.8%. Patients who received EPT were as likely to be reinfected than those who did not receive EPT (odds ratio, 1.6; 95% confidence interval, 0.2-13.7). CONCLUSIONS: Although EPT was not associated with decreased reinfection, it remains an option for partner treatment. This study highlights the ongoing need to address compliance with retesting within 3 months.