Toolkit for Improving Family Planning Services in School Settings
Strategies for Embedding Equity in School-Based Healthcare
Hannah Lantos, Lisa Kim, Jenita Parekh, Jennifer Manlove, Katherine Cushing, Andrea Shore, & Donnie Greco
The Robert Wood Johnson Foundation (RWJF) defines health equity with the following two components: 1. “everyone has a fair and just opportunity to be as healthy as possible”; and 2. obstacles to health must be removed to ensure equal opportunity. Obstacles may include “poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” This two-part definition makes clear that equity has an outcome component (everyone can be healthy) and a process component (removing obstacles). Achieving equity requires paying attention to student outcomes and to how inclusive the processes in your clinic are. Improved clinical processes can impact patient care—and focusing on both is essential for school-based health centers (SBHCs) to impact equity. In this foundational approach on equity, outcomes and processes are highlighted throughout different examples.
Using This Tool
The equity strategies included in this Foundational Approach focus on steps that individuals who work in school settings can take. These strategies can be helpful to clinic coordinators, directors, and individual practitioners, though many strategies will require buy-in from multiple stakeholders. Some strategies are adaptable for health care organizations and providers outside school-based settings including professionals looking to begin work in schools.
Each equity strategy in this Foundational Approach includes:
- A brief description of the strategy
- Case examples of schools, health centers, or organizations that have implemented the strategy
- Reflection questions to guide teams and individuals on how to implement a similar strategy
Each of these strategies was identified during interviews and virtual site visits with existing school-based health centers or school-based health initiatives. They come from practitioners in the field.
Each equity strategy varies in complexity, funding, and scope and is adaptable based on context and resources. You are the expert for your health center or school setting. As you read, think about using these examples as ideas or prompts for brainstorming with your staff.
Before you start, we encourage you to reflect on the following:
- Your equity goals for sexual health services
- What equity strategies are currently working well
- Where there are gaps between your equity practices and your equity goals
Consider groups of students missing from those you serve (e.g., students who are truant, have less flexibility to be involved with extracurriculars, are new to the school, have cultural or language barriers, etc.).
- What populations of students do you currently reach (if any) with your sexual health services, and what populations are missed?
- What populations of students are you missing? Why do you think they are missing?
- How can your program ensure that students you are missing are aware of the available sexual health services?
- What opportunities exist or can you develop to reach missing populations?
- How can you reach the students you are missing and serve them more equitably?
- How can you partner with youth to ensure you are fully answering this question?
Consider your organization’s goals for sexual health services and what is working well to ensure that all students are served equitably.
- What do equitable services look like in your school or clinic?
- How do you define equity?
- Is there a common definition among your staff?
- What is currently being done in your clinic to ensure that all students have equitable access to services?
- What is being done to ensure that structures and systems do not disadvantage certain students?
- What kind of data do you collect directly from youth on their experiences in your clinic and on whether services are equitable?
Think about how those providing sexual health services are prepared to meet students’ needs and provide equitable care.
- Who in your SBHC or organization is providing sexual health services and/or health education?
- Have they received equity training (e.g., implicit bias, history of racism, racism and discrimination, equitable communication, respectful care, or others)? See examples of trainings here, here, and here though this is not a comprehensive list.
- What ongoing support do they receive to help them define equitable service delivery and then to assess how equitable their services are?
- What voices inform changes to your clinic’s operations and policies? Whose voices are not included that you could benefit from? How can you integrate/further integrate, students’ voices to make the environment more equitable or inclusive?
Consider what barriers may stand in the way of implementing an equity strategy in your clinic or school (e.g., opposition to equitable practices, institutional processes that are cumbersome, needed resources for training or system development, etc.).
- What are the barriers to ensuring that all students in your school-based health setting and/or affiliated schools are equitably served or able to access services?
- Are there certain groups who might experience more resistance to strategies to connect students with sexual health services?
- What resources (e.g., funding, people, space, time) are available to reach all groups of students equitably?
You can view the Needs Assessment questions as a PDF form here.
Strategies to Support Equity in School-Based Health Work
The strategies in this Foundational Approach focus on equity strategies related to improving systems and processes, tracking clinic improvements, and tracking or improving patient outcomes. Many will help your staff ensure that as many students as possible feel welcome, respected, and safe in your clinic and that systematic policies or procedures that create obstacles to advancing equity are removed. While these strategies were defined as relevant for schools with SBHCs, they could be useful for health care organizations that serve adolescents broadly or those looking to enter schools without a clinic to do outreach, education, or service provision. These strategies include approaches such as equitable communication, clinic and patient safety, or staff training.
Next Steps
- The Commonwealth Fund Report on Confronting Racism in Health Care: This report details efforts that eight academic medical institutions are making to “reduce health disparities among their patients, create more equitable workplaces for their employees, and invest in communities of color where many of their patients and staff live.”
- Institute for Healthcare Improvement Presentation on Addressing Social Determinants of Health: This presentation focuses on practical solutions organizations can take to address social determinants of health and social needs.
- University of Colorado Denver Self-Guided Learning Tools on DEI: These tools serve as a starting point for individuals interested in furthering their understanding of DEI-related topics, including bystander intervention, DEI 101, gender visibility, intersectionality, and relationship violence.
- RHNTC Podcast Series on Advancing Sexual and Reproductive Health Equity in Family Planning: This podcast series includes four episodes that explore tips, programs, and frameworks to help clinics and programs address inequities in family planning and provide patient-centered care.
- School-Based Health Alliance (SBHA) Article on The Role of SBHCs in Achieving Health and Educational Equity: This article describes the critical role SBHCs in advancing health and educational equity for Black, Indigenous, and people of color (BIPOC) students.
- Paper on Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults: This paper highlights findings from a qualitative study that explores innovative strategies that programs across the U.S. use to address social determinants of health.
- Power To Decide, The Contraceptive Equity Initiative: This webpage provides information on a new effort from Power to Decide to address barriers to birth control access by expanding research efforts, bolstering policy efforts, and convening a learning collaborative of state and regional projects.
- National Coalition of STD Directors Training on Adolescent Health Equity: This training, hosted in May 2021, provides an overview of health equity and strategies for identifying and addressing health equity, racism, and stigma in adolescent SRH.
- DMPA-SC Planning Guide on Creating Equitable Access to High-quality Family Planning Information and Services: This strategic guide is for program managers, planners, and decision makers looking to identify inequities in family planning and implement interventions to address them.
- Paper on Developing and Strengthening New Strategies to Promote Adolescent Sexual Health: This paper describes findings from a literature review of six promising strategies to address challenges to reducing unintended adolescent pregnancies.
- Paper on Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents: This paper describes current research related to SRH needs of transgender and gender-expansive youth and highlights areas for further research.