Mixed-methods Exploration of Telehealth-supported Long-acting Reversible Contraceptive Services in School-based Health Centers: How Much Added Value?

INTRODUCTION: This study explored adolescent and young adult preferences and experiences with telehealth-supported long-acting reversible contraceptive (LARC) services in New York City school-based health centers (SBHCs) during COVID-19. METHOD: Sequential mixed methods included post-LARC insertion surveys and in-depth interviews. RESULTS: Survey respondents (n = 45) were aged 14-21 years and predominantly Hispanic (53.3%). Only four respondents completed a postinsertion visit via telehealth. Most (82.2%) preferred in-person for future LARC visits; none preferred telehealth. Four themes emerged in interviews (n = 15): LARC self-efficacy and autonomy; SBHC convenience and accessibility; comfort with SBHC providers; and preference for in-person visits despite telehealth benefits. DISCUSSION: Although telehealth theoretically adds value to LARC service delivery, uptake and preference for telehealth in the SBHC context were low. Despite the perceived acceptability of telehealth, adolescents and young adults prefer in-person SBHC visits, suggesting SBHC access may eliminate barriers to care that telehealth seeks to overcome.

Translating Screening into Action: Risk Assessment and Intervention for Bullying in Pediatric Settings.

The prevalence and consequences of childhood bullying demand routine screening and intervention in all pediatric health care settings. Although there are many validated screening tools available, there is little guidance on how to assess children at risk and provide interventions based on risk level. Guided by the Screening, Brief Intervention, and Referral to Treatment model for adolescent substance use, we reviewed the literature to identify factors that raise a child's risk level from bullying. In this article, we discuss the five factors identified and propose interventions for differential risk among children. Beyond screening questions and general guidance, a framework for identifying children most at risk of negative outcomes owing to bullying and practical next steps for care is essential. This article outlines such a framework for use by pediatric nurse practitioners and in pediatric care settings at large.

Patient-Delivered Expedited Partner Therapy for Chlamydia trachomatis Infection Among Female Adolescents Using School-Based Health Centers.

INTRODUCTION: Expedited partner therapy (EPT) may reduce Chlamydia trachomatis reinfection. This pilot study was conducted to determine if female adolescents with C. trachomatis accept and deliver EPT to male sexual partners and whether it is associated with decreased C. trachomatis reinfection rates at 3 and 6 months. METHOD: Forty-six female adolescents, aged 13 to 19years and diagnosed with C. trachomatis at two urban school-based health centers, participated in four visits over 6 months. Participants completed a self-administered self-efficacy scale and a sexual risk behavior and EPT questionnaire and were retested for C. trachomatis 3 and 6 months after treatment. RESULTS: Overall, 65% accepted EPT, and 73% of those who accepted EPT delivered EPT to their partners. Eighty percent completed the 3-month visit, of these, 30% tested positive for C. trachomatis; 57% completed the 6-month visit, and of these, 15% tested positive for C. trachomatis. Acceptance of EPT was associated with reductions in C.trachomatis reinfection at 3 months (p = .04) but not at 6 months (p = .10). Delivery of EPT was not associated with reductions in C. trachomatis reinfection at 3 or 6 months (p = .08 and p = .44, respectively). Self-efficacy scales did not predict acceptance and delivery of EPT. DISCUSSION: Although two-thirds of participants accepted EPT and acceptance of EPT was associated with reductions in C. trachomatis reinfection at 3 months, rates of reinfection were high. Implications of these findings are limited by the small sample size. Larger studies are needed to understand potential barriers to delivery of EPT.