Toolkit for Improving Family Planning Services in School Settings

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.

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.

Background and Context

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.

Understanding the Health Educator Program

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.

Key activities of health educators

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.

One-on-one educational visits: Students can schedule or be referred for educational visits with a health educator to ask sexual health-related questions, share concerns, and/or discuss family planning options (e.g., the decision to begin using contraception).

Classroom presentations: Health educators partner with teachers to increase awareness of reproductive services offered in the clinic. These presentations range from short, five-minute introductions to the clinic to longer, topic-focused sessions or multiple sessions.

STI testing days: Each school has one or two days a year focused specifically on testing for STIs (see this resource developed by the Minneapolis SBC Program: Fast STI Testing Day Toolkit). The schools advertise widely and encourage students to come into the clinic to be tested.

Health fairs: Each health educator hosts one health fair per year in their school (to plan a health fair, see this resource: How to Plan a Health Fair). The fairs are composed of stations with games (see an example of a sexual health game: Taboo – Mental & Sexual Health Game), demonstrations, and education related to adolescent health, with a particular focus on sexual health. To staff the event, health educators rely on students and volunteers from local health departments (for a sample permission slip for students, see: Health Fair Student Volunteer Permission Slip).

Teen Health Empowerment Council (THE Council): Health educators manage and facilitate a youth advisory council, called THE Council, on which at least one student from each school participates. THE Council allows student representatives to learn about being a peer health educator and provide feedback on the SBHC.

 

The Health Educator Program Draws on Four Foundational Approaches

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.

Embedding equity

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.

Professional development: The health education manager connects new and existing staff to trainings on topics like LGBTQ+ health, inclusiveness, and racial equity (for related trainings, see this resource: Online Training Webinars). Health educators also share resources and create space during staff meetings to reflect on and learn from their experiences. For example, in a meeting, one health educator described a Latinx student who wanted to prevent pregnancy but had moral concerns about birth control related to their familial and cultural beliefs. The health educator described how she navigated that conversation using empathy and open-ended conversation.

Reaching underserved or historically excluded populations: Each health educator tailors activities to their particular school’s population. For example, in one school with a Somali population, the health educator partnered with the English Language Learner (ELL) teacher to present on sexual consent to ELL classes. Using an interpreter to address the language barrier, the presentation included a discussion around students’ culture and family life to help them apply lessons to their cultural context. The health educator also provided space for students to ask more personal questions, including questions about whether the information presented was useful to them given their cultural norms around adolescent sexual behavior.

Using inclusive language: Health educators use intentional and inclusive language, particularly around gender, diversity, and reproductive health. They make sure to use gender pronouns in introductions and educate using anatomical non-gendered language like “people with vaginas” or “people with penises.” When speaking with students, health educators will start by “explain[ing] that it doesn’t matter your race, ethnicity, sexual orientation, gender, or immigration status,” or whether a student is insured or not—the clinic is “open to everyone.”

Prioritizing adolescent-friendly care

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.

Providing tailored one-on-one services: Health educators’ one-on-one educational visits are designed to provide an open space for students to hold conversations about their health. The visits are tailored to each youth’s needs and allow for time to discuss goals, concerns, or plans. In addition, health educators work together with clinical providers to ensure that students receive cross-referrals as needed. In some cases, a provider or health educator may walk a student to the other’s office to ensure the connection is successful.

Creating a Youth Advisory Council: As part of the HE Program, health educators developed and facilitate a youth advisory council called THE Council. THE Council consists of at least one student from each of the seven schools served by health educators and aims to help students become sexual health peer educators and provide another way for youth to receive sexual health information. During meetings, facilitators (i.e., health educators) lead presentations and discussions on a variety of health topics such as safer sex, condoms, birth control, STI testing, mental health, gender identity, and sexual orientation. In addition, council members serve as advisors to the SBHC, providing feedback on services and ways in which the clinics can be more appealing to adolescents. For example, students partake in “secret shopping”—an activity in which members and their friends go into the SBHC to test services and identify opportunities for the clinic to improve. This council member feedback has led to tangible changes in clinic and programs, such as establishing an internship position for a council member to create and lead social media presence for the Minneapolis SBC Program.

Maximizing outreach and access

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).

Leveraging partnerships

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.

Key Recommendations for Other Programs

01

Secure program buy-in from funders, policymakers, and other community partners.

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:

“I think Hennepin County public health were big supporters and champions of this model and really helped us expand, saw the value of our work, saw the impact it was having in Minneapolis … [they] see our work is really integral to their work in the county as a whole.”

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.

02

Seek diverse funding streams for program flexibility and sustainability.

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:

“I think honestly, it kind of needs to remain a hybrid. I think having all of it wrapped into one specific grant would be challenging because grants don’t always get refunded or priorities shift and change, or administrations shift and change. And then the kind of health education or sex education they want to fund may shift and change.”

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.

03

Promote collaboration between health educators and SBHC providers.

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:

“If you take any piece away from that model, it’s just not going to function in the same way, and we won’t be as effective and successful.”

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:

“Understanding your relationship and what your roles are in the clinic is so important and I think just understanding that role as a health educator and being that supportive role [to providers is key].”  

04

Support health educators in building authentic relationships with students and school staff.

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.

“Connecting to administration and making sure that they know and trust you was huge … If there’s a staff meeting, go to it… Teachers don’t have the capacity to seek you out, you need to be available to them.”

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.

“Having that one person at each school building really helps because they really do get to know the student community [and] they really do get to know the stakeholders in that building. And they honor individual differences among the student communities.”

05

Offer a variety of opportunities for connection to maximize reach.

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.

“There’s benefits of all the different things that I do. There’s tons of benefits to going into the classroom, there’s benefits to hosting [an] STI event, there’s benefits to one-on-ones, there’s benefits to working closely with the nurse practitioner so that if they have questions, she can bring them over and they can talk to me.”

06

Recruit engaged and proactive staff but allow flexibility.

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:

“I think communication [skills are important for health educators]. We look for people that have had experience if possible, but if not, there’s other traits like really having a passion for adolescents… people that are comfortable doing that one-to-one. And creativity … because a lot of things we are doing [require] creativ[ity].”

Resources

Several resources used and/or created by the Minneapolis SBC Program appear below; these documents and guidelines may be used as references when developing a similar health educator program. However, the resources should be modified to a program’s specific context before use.

Note on Methods

The innovative program described in this case study was selected through a rigorous site selection process that considered factors such as geographic location, populations served, and the success and replicability of the innovation. This case study was informed by 10 interviews with program leaders, health educators, and clinic and school staff. Interviewees were given the opportunity to provide feedback on case study content before publication to ensure accuracy. For more information about how the sites included in this project were selected, read here.


Suggested Citation

Balén, Z., Parekh, J., Vazzano, A., Lantos, H., & Manlove, J. (2022). Developing a school-based health educator program to connect students to school-based sexual health services. Child Trends. https://doi.org/10.56417/8872l8116p

This publication is supported by the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,036,999 with 100 percent funded by OPA/OASH/HHS. The contents reflect the views of the author(s) and do not necessarily represent the official views of, nor an endorsement by, OPA/OASH/HHS, or the U.S. Government. For more information, visit https://opa.hhs.gov/.

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