Developing a School-Based Health Educator Program to Connect Students to School-Based Sexual Health Services

Zabryna Balén, Jenita Parekh, Andrea Vazzano, Hannah Lantos, & Jennifer Manlove

To increase students’ awareness and utilization of school-based health services, including sexual health services, the Minneapolis Health Department’s School Based Clinic Program operates a Health Educator Program. By embedding a health educator within each of the program’s seven centers, the program allows health educators to provide the school community with a variety of tailored services while fostering critical relationships with students and school staff.

In this case study, we describe key recommendations from the development and implementation of the Health Educator Program based on interviews with health educators, school staff, and school-based clinic staff.

See a webinar presentation by the Minneapolis Health Department describing this innovative approach here. (Begins at 22:50)

We also describe the program’s background and context, what program implementation looks like in practice, and the ways in which implementation draws on four foundational approaches that are integral in providing high-quality family planning and sexual health services to youth. At the end of the case study, we provide resources for other organizations interested in implementing a similar program at their site.

The Minneapolis School Based Clinic Program (Minneapolis SBC Program) started in 1979 and now operates school-based health centers (SBHCs) in seven high schools throughout Minneapolis, Minnesota. Each school serves from 100 to 2,000 youth. In five of the seven schools, there is a majority BIPOC (Black, Indigenous, people of color) population with predominantly Black, Hispanic, and/or Hmong students. In these five schools, more than half of the students are eligible for free and reduced lunch. At the remaining two schools, over one in three students are part of the BIPOC population and over one third are eligible for free and reduced lunch.

Over the years, the Minneapolis SBC Program has become a well-established go-to health resource within Minneapolis. Staff at each SBHC have built strong relationships across their communities, including with city and county government, school staff, students, and parents. The Minneapolis community itself has provided longstanding support for the SBC Program, and for efforts to reduce unintended teen pregnancy across the city. For example, in 2006, Hennepin County, the county in which Minneapolis is located, launched the Better Together Hennepin initiative to address the county’s high rate of teen births.

In 2010, Hennepin County approached the Minneapolis SBC Program to participate in a five-year Teen Pregnancy Prevention (TPP) grant from the federal Office of Adolescent Health (OAH), now the Office of Population Affairs (OPA). This grant allowed the Minneapolis SBC Program to implement a clinic-based sexual health education curriculum (called the Safer-Sex Initiative), which was the first step in creating a robust Health Educator (HE) Program. Today, the HE Program is one of three branches of services offered within the Minneapolis SBC Program, along with medical services and mental health. Each Minneapolis SBHC is staffed with personnel who have expertise across all three branches, including a medical provider (either a nurse practitioner or physician assistant), a medical assistant, a health educator, and one or more mental health therapists. A dietitian also provides nutrition services across clinics. This three-pronged model ensures that staff work together to provide holistic care for students.

As its name suggests, the Health Educator Program provides health education—and particularly sexual health education—to students at each of the seven schools with SBHCs. The HE Program is composed of a health education manager and six health educators. Each health educator works full-time with one SBHC based in one school community. The health education manager provides oversight and serves as an additional health educator as needed.

At each school, health educators serve as a link between the school faculty and the SBHC. The primary role of the health educators is to connect students to the SBHC and make them aware of services offered—especially sexual health services. They also build relationships and establish trust with school students, school staff, and clinic staff. Health educators meet regularly with their school’s SBHC team, which includes a medical provider, a medical assistant, and one or more mental health therapists. Through both formal and informal meetings, the SBHC team coordinates overall SBHC operations and refers students to various needs, including medical and mental health, nutrition support, and health education services.

Across SBHCs, health educators meet weekly to discuss challenges and solutions at their respective schools. The health education manager provides supervision and checks in with health educators individually to ensure they feel supported (for more information on the health educator role, see this resource: Health Educator Role Description). The health education manager also provides direction and evaluates further training needs to deliver sexual health education.

The Health Educator Program provides structure for health educators to feel supported. It allows flexibility so that health educators can adapt and tailor specific health education strategies to their schools. Below, we list several key activities that health educators facilitate in each school.

The Health Educator Program’s work relates to a set of four foundational approaches that our team has identified as integral to effective provision of family planning and sexual health services to youth in school-based settings: 1) embedding equity, 2) prioritizing adolescent-friendly care, 3) maximizing outreach and access, and 4) leveraging partnerships. For a detailed description of the four foundational approaches, please visit the Foundational Approaches section of the toolkit.

The Health Educator Program embeds equity in three ways: promoting equity-focused professional development and learning among health educators, ensuring that underserved or historically excluded populations receive health education resources, and using inclusive language in interactions with youth.

The Minneapolis HE Program prioritizes creating adolescent-friendly services across settings and in all interactions with young people, from the way program staff prioritize individualized services to the way in which they intentionally gather meaningful input from youth on service delivery.

Some students may need a little more support than their peers before they feel comfortable coming to an SBHC for services. For this reason, conducting outreach activities can both inform students about available resources and sustain the work of the SBHC and health educators. In the HE Program, outreach strategies include STI testing days and health fairs—both larger, more labor-intensive events—as well as one-on-one educational visits, classroom presentations, or presentations by health educators at lunch tables or school assemblies. At health fairs, health educators develop informational stations with games and demonstrations on sexual health topics (e.g., demonstration of different forms of birth control) and other health topics (e.g., nutritionists discussing the importance of healthy foods). Each health educator tailors content and activities to engage their student population and ensure that students know which issues they can bring to the clinic. In smaller interactions, health educators work to build rapport with students, develop trusting relationships, and be seen as a friendly, reliable, and trustworthy resource. As health educators build this rapport, students learn more about the services available and, in many cases, even refer their friends (which can be one of the best outreach strategies).

Partnerships with key stakeholders are essential to the HE Program at the clinic, school, and community levels. In SBHCs, health educators work closely with clinic staff to ensure that referrals are handled efficiently and to solidify messaging about the importance of sexual health education to students. Health educators also partner with school staff, including teachers and administrators, to increase awareness and utilization of SBHC and health education services. For example, health educators build on strong relationships with teachers to gain access to classrooms for presentations on sexual health topics. They also leverage relationships with school administrators to ensure STI testing days, health fairs, and the SBHC as a whole has a strong presence in the school. Lastly, the HE Program could not have been possible without the Minneapolis SBC Program’s strong relationship with Hennepin County, which has been a key funding partner and supporter since the HE Program’s inception.

The HE Program has built on longstanding relationships and support from city and county officials, within a political environment that has long valued sexual health education in schools. Health program managers described this buy-in as critical to helping the HE Program flourish:

For programs operating in areas without existing political support, stakeholders from the Minneapolis SBC Program recommend using data and statistics to garner interest and support for programs. For example, when speaking with government partners about funding, programs can highlight how health education has saved money for schools by reducing rates of unwanted teen pregnancy and STIs.

While the original TPP grant that formed the HE program has remained a significant funding source for the HE Program, leadership has drawn on additional funding sources to support program growth. This includes tapping into local public health dollars from the state and county, patient revenue, and other local grants. This hybrid funding model has resulted in sustained programming and reduced the risk of funding gaps when a single source of funding ends:

Other programs should recognize that there is no one ideal funding stream and should take advantage of varied funding opportunities to create and sustain a health educator program. Drawing on multiple funding sources will also allow for more creativity and freedom in the types of activities a health educator program can support.

The HE Program is one of three branches of services in the Minneapolis SBC Program, which also includes medical and mental health services. Staff from each branch work together to provide holistic health and education services to youth. Interviewees saw each part of this three-pronged model as critical:

Similar health educator programs should have health educators work within clinics, alongside other health professionals—a key reason why the Minneapolis HE Program’s collaboration has been effective. Occupying offices next to other clinic staff allows easy collaboration and referrals. In addition, all staff should be given clear roles and responsibilities, which can lead each to value the others’ contributions to the relationship. One health educator described:

Health educators in Minneapolis noted that establishing relationships with school staff was critical for effective health education and outreach. Health educators in other programs can cultivate these relationships by proactively engaging other school staff. For example, they can attend schoolwide staff meetings, use school newsletters to promote events and services, and reach out individually to teachers to find opportunities to enter the classroom.

In addition, the HE Program designated one health educator to each school, which allowed health educators to familiarize themselves with the school climate and student populations. Other programs can replicate this model to ensure that their health educators build meaningful relationships and trust with students and school staff, especially when navigating the sometimes-controversial topic of sexual health education in schools.

Although health educators in the HE Program initially conducted one activity (delivering a clinic-based curriculum), they now lead a wide range of activities designed to reach and connect with students. These include classroom presentations, one-on-one educational visits, and events like STI testing days and health fairs. Health educators in similar programs can reach more students (and more diverse groups of students) by varying their interactions.

HE Program staffing has evolved with program needs and funding. Health education at the seven SBHCs was initially provided by trained RNs, then by a roving health educator, and now by a group of health educators located within the SBHCs. In recent years, the program has also partnered with programs such as AmeriCorps Vista and the Centers for Disease Control and Prevention’s Public Health Fellowship Program (PHAP). These short-term positions, funded through federal programs, have allowed the HE Program to grow in size and capacity.

Programs should consider current needs and resources when designing a staffing plan because onboarding and training can require considerable time and effort. In addition, a program’s staff and structure may need to be revisited depending on changing circumstances. Regardless of the background of health educators employed, programs should look for creative people with good communication skills who can become a sought-out resource in the school: