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School-based health clinics with reproductive health services

Health Factors: Sexual Activity
Decision Makers: Educators Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Some Evidence
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

School-based health clinics provide a variety of health care services to attending students. Many middle and high school-based clinics offer reproductive services, which generally include abstinence and contraception counseling, pregnancy and STI testing, and may also distribute contraceptives. Such clinics also sometimes offer prenatal care (Strunk 2008). Clinics are most frequently located in urban and rural neighborhoods with residents of lower socio-economic status (NBER-Lovenheim 2016, CG-SBHC); in 2013-14, about 70% of students attending schools with clinics were racial or ethnic minorities (SBHA-SBHC).

Expected Beneficial Outcomes

Reduced low birthweight births
Reduced teen births
Increased use of contraception
Increased reproductive health care
Reduced teen pregnancy
Increased preventive care
Improved student attendance
Increased high school graduation

Evidence of Effectiveness

There is some evidence that school-based health clinics (SBHCs) that provide reproductive health services reduce birth rates (NBER-Lovenheim 2016, Owen 2010, Ricketts 2006), especially among African American and Hispanic teens (NBER-Lovenheim 2016), and reduce the likelihood of low birthweight births (CG-SBHC, Strunk 2008). However, additional evidence is needed to confirm effects.

SBHCs that offer contraception may increase receipt of reproductive health care (Ethier 2011) and prenatal care (CG-SBHC) among teen girls. Overall, evidence indicates that SBHCs do not increase contraceptive use, though several recent studies suggest that in some circumstances they may increase use among teen girls (CG-SBHC, Keeton 2012, Ethier 2011). Clinics that offer contraception appear to increase contraception receipt among sexually active students more than clinics that offer health assessments or counseling only (Blank 2010).

School-based clinics with reproductive health services  may reduce absenteeism and dropout rates among pregnant and parenting teens (Strunk 2008) but do not appear to have a significant effect on dropout rates overall (NBER-Lovenheim 2016).

Some school-based clinics may offer patients screening and advice about substance abuse, nutrition, physical or sexual abuse, mental health, and preventing repeat pregnancies more frequently than community clinics (Strunk 2008). Ease of access (Mason-Jones 2012) and confidential services are often cited as incentives for teens to use these clinic services (Keeton 2012). 

Implementation

United States

Many school-based health clinics (SBHCs) offer reproductive health services; examples include clinics in Baltimore, Maryland; Multnomah County, Oregon; and St. Paul, Minnesota (AFY-SBHC).

Services provided vary, most often including pregnancy testing (80.2%), STI diagnosis and treatment (69.5%), and pap tests (45.3%). As of a 2013-2014 census of SBHCs, just over half of all SBHCs are restricted from dispensing contraceptives, most often by district policy. The portion of SBHCs that dispense contraceptives has been increasing for the past decade. As of 2013-2014, 96.8% of SBHCs that dispense contraceptives dispense barrier methods, 82.9% hormonal methods, 73.3% emergency contraception, and 39.8% provide implantable devices (SBHA-SBHC).

Implementation Resources

CA SBHA - California School-Based Health Alliance (CA SBHA). Putting health where kids are. Accessed on March 30, 2017
NYC DOE-SBHC - New York City Department of Education (NYC DOE). School-Based Health Centers (SBHC). Accessed on March 30, 2017
SBHA - School-Based Health Alliance (SBHA). Redefining health for kids and teens. Accessed on March 30, 2017

Citations - Description

CG-SBHC - The Guide to Community Preventive Services (The Community Guide). Health Equity: School-Based Health Centers (SBHC). 2015. Accessed on January 4, 2017
NBER-Lovenheim 2016 - Lovenheim M, Reback R, Wedenoja L. How does access to health care affect teen fertility and high school dropout rates? Evidence from school-based health centers. National Bureau of Economic Research (NBER). 2016: Working Paper 22030. Accessed on October 18, 2016
SBHA-SBHC - School-Based Health Alliance (SBHA). 2013-2014 Digital Census Report: School-based health centers (SBHC). Accessed on April 6, 2017
Strunk 2008* - Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: An integrated literature review. The Journal of School Nursing. 2008;24(1):13-20. Accessed on March 28, 2017

Citations - Evidence

Blank 2010* - Blank L, Baxter SK, Payne N, Guillaume LR, Pilgrim H. Systematic review and narrative synthesis of the effectiveness of contraceptive service interventions for young people, delivered in educational settings. Journal of Pediatric and Adolescent Gynecology. 2010;23(6):341–51. Accessed on April 19, 2017
CG-SBHC - The Guide to Community Preventive Services (The Community Guide). Health Equity: School-Based Health Centers (SBHC). 2015. Accessed on January 4, 2017
Ethier 2011* - Ethier KA, Dittus PJ, DeRosa CJ, et al. School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. Journal of Adolescent Health. 2011;48(6):562-5. Accessed on March 28, 2017
Keeton 2012* - Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: Building on history. Current Problems in Pediatric and Adolescent Health Care. 2012;42(6):132–156. Accessed on March 28, 2017
Mason-Jones 2012 - Mason-Jones AJ, Crisp C, Momberg M, et al. A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health. Systematic Reviews. 2012;1:49. Accessed on October 18, 2016
NBER-Lovenheim 2016 - Lovenheim M, Reback R, Wedenoja L. How does access to health care affect teen fertility and high school dropout rates? Evidence from school-based health centers. National Bureau of Economic Research (NBER). 2016: Working Paper 22030. Accessed on October 18, 2016
Owen 2010 - Owen J, Carroll C, Cooke J, et al. School-linked sexual health services for young people (SSHYP): A survey and systematic review concerning current models, effectiveness, cost-effectiveness and research opportunities. Health Technology Assessment. 2010;14(30). Accessed on April 18, 2017
Ricketts 2006 - Ricketts SA, Guernsey BP. School-based health centers and the decline in black teen fertility during the 1990s in Denver, Colorado. American Journal of Public Health. 2006;96(9):1588-92. Accessed on March 28, 2017
Strunk 2008* - Strunk JA. The effect of school-based health clinics on teenage pregnancy and parenting outcomes: An integrated literature review. The Journal of School Nursing. 2008;24(1):13-20. Accessed on March 28, 2017

Citations - Implementation

AFY-SBHC - Contraceptive access at school-based health centers (SBHC): Three case studies. Advocates for Youth (AFY). Accessed on March 30, 2017
SBHA-SBHC - School-Based Health Alliance (SBHA). 2013-2014 Digital Census Report: School-based health centers (SBHC). Accessed on April 6, 2017

Page Last Updated

April 18, 2017

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