Implementing a Sexual Health

Services Referral System in

Your Priority Schools

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• Live questions

• Typed questions/chat

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Meet the SHS

Capacity Building Assistance Team

Sandra Leonard, CDC DASH Project Officer

Amanda Brown, CAI Project Director

Anna Williams, CAI Project Evaluator

Dawn Middleton, CAI Principal Investigator

Polling Question #1

Where do you work?

6

Materials Needed

• CDC DASH 1308 Program

Guidance Document

• Referral System Framework

• BPS Referral Tracking Form

Learning Environment

Learning Environment

Goal

Introduce the core components

of a school-based referral system for SHS

and to inform LEA activities associated with

establishing or adapting referral systems in

your own districts.

Objectives

• Identify the core components of a school-based referral system for sexual health services (SHS)

• Describe key considerations and activities for addressing each of the core components of an SHS referral system

• Examine LEA experiences to date in establishing an SHS referral system consistent with the core components

Background

Referral

A process of assisting students in obtaining

preventive health services through a variety

of activities, including but not limited to,

connecting students to adolescent friendly

providers on the basis of an identified need.

Referral System

A set of resources and processes that

when combined produce an outcome.

Referral System Framework

7 Key Sexual Health Services

• HIV testing

• STI testing and

treatment

• Pregnancy

testing

• Condoms

• Contraceptive

methods other

than condoms

• Condom

compatible

lubricants

• HPV Vaccine

LEA SHS Process Measures

Funded LEA has assessed its SHS-related policies

Funded LEA has monitored the implementation of SHS-related policies in priority schools

% of priority schools that received assistance on SHS

1

2

3

LEA SHS Performance Measures

Funded LEA has a system to refer students to youth-friendly off-site providers for key SHS

% of priority schools that provide students with on-site services or referrals to healthcare providers for key SHS

# of referrals made by school staff to youth-friendly off-site providers or SBHCs for ANY of the 7 key sexual health services

1

2

3

Referral System Implementation Kit

Semi-Structured LEA Interviews

During September - November, 2014

CAI conducted semi-structured

interviews with 17 LEAs.

Core Components

Referral Staff

What Staff Make SHS Referrals?

29%

41%

59%

65%

88%

88%

0% 20% 40% 60% 80% 100%

Health Resource Center Staff

Youth

Other Staff

Teachers (e.g. Health, PE)

Counselors/Social Workers

School Nurses

Percent by LEA (N = 17)

Training for Referral Staff

What? Who? How?

• Epidemiology • State, district,

and school policy

• Referral guide • List of providers • Basic

information about SHS

• Based on the particular job function and role of referral staff member

• Periodic in-person PD

• Web-based learning

• Follow-up support

Referral Staff

•Nurses, SBHC & health resource center

staff, social workers and counselors

•Health & PE teachers, other teachers,

coaches

•Students

Popular Referral Staff Training Topics

29%

47%

82%

88%

88%

88%

0% 20% 40% 60% 80% 100%

Other

Evidence-Based SHS

Referral Guide

Epidemiology

Minor Access Laws

Written Procedures

Percent by LEA (N = 17)

Polling Question #2

How helpful would access to a

set of web-based modules be

in supporting your efforts to

train school staff to make

referrals?

Written Procedures

Referral Procedures

Existing referral

procedures can be

adapted for SHS, 53%

Referral procedures developed,

for SHS 41%

Percent by LEA (N = 16)

16 of the 17

LEAs have

some type of

Referral

Procedures in

place

Chat-In

What do you see as the

greatest CHALLENGE to

implementing district-wide

procedures for SHS referrals

in your priority schools?

Referral Guide

Philadelphia Referral Guide

http://imatterphilly.org/

NYC Referral Guide

http://www.nyc.gov/html/doh/teen/html/sexual-health-pregnancy/clinics.shtml

Referral Guide

Using or updating an

already existing referral guide, 71%

Created a new referral

guide for SHS, 29%

All 17 LEAs

have an

existing

Referral Guide

Percent by LEA (N = 17)

7 Step Guide Development

Decide what information to include in the guide for each provider: service provided, target population served, access information

Gather a list of potential SHS health care providers

Identify services provided by SHS providers

Finalize SHS provider list

Design, produce, and disseminate guide either electronically and/or hard copy

Update and Maintain Referral Guide at minimum every 12-16 months to ensure the guide is relevant and current

Train and Disseminate

Step 1

Step 2

Step 3

Step 4

Step 5

Step 6

Step 7

7 Step Guide Development

SHS Providers

Adolescent Friendly Assessment

• Self

• Facilitated

• Youth-led

How would you rate your level

of partnership with your city or

county health department

partners?

Networking and

Communication

Cooperation

Coordination

Coalition

Collaboration

National Network for Collaboration’s Levels of Partnership http://www.uvm.edu/extension/community/nnco/collab/framework.html#framework

Polling Question #3

Share information

Working together

Sharing Resources

Long-term commitment

One system

Marketing & Communications

Marketing for Students

•Poster and Flyers

•Classrooms

•Social Media

•School Events

Marketing for School Faculty

• Website Promotion

• Staff meetings

• In-person and virtual PD

• Email Blasts

Chat-In

How has your district engaged

youth in the design and

distribution of the referral

guide?

Monitoring & Evaluation

Monitoring and Evaluation Basic Moderate High

School referral staff count # of referrals made.

Community-based SHS providers count # of priority school students served.

Schools and community-based SHS providers count # of referrals completed.

• Types of referral tracking systems:

– Logs (paper-based and electronic)

– Databases

– Individual (student-level) referral sheets

– Survey Monkey

Referral Tracking

Referral Tracking:

Lessons from the Field

• Collaboration between the Health & Wellness

and Health Services Departments

• Feedback from SHS nurse liaisons

• Next Steps

– Training for referral staff (nurses)

– Engaging community SHS providers

Patricia Dao-Tran, Boston Public Schools

Policy

Policy

• Access to school-based health care

• Leave school premises to receive community-based medical services during school hours

• FERPA/HIPAA

• State laws on minors right to consent for SHS

Policy: Lessons from the Field

•School Nurses

•School Counselors

•Principals

•Health Teachers

•Students

•Community Partners

Rachel Miller, San Diego Unified School District

Management & Oversight

Management & Oversight

• Key staff, partners or school groups

• Minimum, 1 school champion or a

sub-committee of a larger school

health team or council

Management and Oversight

• Persons responsible for overseeing all

the referral system work include:

– Key 1308 Project Staff

– Health Services Staff

– Health Department

– Community-based health care providers

– SHAC

Key Tasks

• Update protocols

• Designate and train

referral staff

• Maintain

partnerships with

SHS providers

• Update &

disseminate referral

guide

• Implement marketing

plan

• Measure, monitor,

report and improve

• Share successes

Polling Question #4

How interested are you in

participating in occasional topic-

focused webinars?

Polling Question #5

How interested are you in

joining an ongoing virtual

learning group?

Polling Question #6

How interested are you in

receiving on-site technical

assistance?

Next Steps

• On-site and remote individualized

follow-up TA on request

• Virtual learning opportunities

– One-time

– On-going

• Dissemination of the Referral System

Implementation Kit

Questions

abrown@caiglobal.org 212.594.7741 ext. 294

This webinar was supported by Cooperative Agreement Number, 5U87PS004164-02, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. Human Services.