Toolkit for Improving Family Planning Services in School Settings

Maximizing Outreach and Access

Zabryna Balén, Hannah Lantos, Jenita Parekh, Jennifer Manlove, Katherine Cushing, Donnie Greco, & Andrea Shore

Positive sexual health outcomes depend on students knowing what sexual health services are available to them—both in and out of school—and how to access them. Maximizing Outreach and Access is one of the four foundational approaches to school-based sexual health services highlighted in this toolkit.

This section of the toolkit highlights outreach strategies that take place throughout the school—meaning those that happen within a school, outside of a health care setting—and those that take place within school-based health settings, such as a school-based health centers (SBHCs) or other school health structures.


Using This Tool

Audience

The outreach strategies included below focus on steps that individuals who work in school settings can take, although some strategies are adaptable for health care organizations and providers outside of a school-based setting or those that are looking to work in schools.

Structure

Each outreach strategy listed below includes:

  1. A brief description of the strategy
  2. Case examples of schools, health centers, or organizations that have implemented the strategy
  3. Reflection questions to guide teams and individuals on how to implement a similar strategy

Adapting outreach strategies to your context

Each outreach strategy varies in complexity, funding, and scope, and is adaptable based on context and resources. Programs can utilize staff in many different roles to oversee these outreach strategies. While health educators can take on many roles in a school or clinic, they often take on key roles for outreach. You are the expert of your setting, your health center, and/or your school. As you read, think about using these examples as ideas or prompts for brainstorming with your staff.

Before getting started, we encourage you to reflect on your outreach goals for sexual health services, what outreach strategies are currently working well, and where there are gaps. To aid this reflection, we provide a set of needs assessment questions designed to guide your thinking about existing outreach efforts. After you’ve read the outreach strategies, we provide a series of prompts, included at the end of this tool, to guide your thinking and set intentions about next steps.

Needs Assessment Questions on Current Outreach Strategies at Your Site

Consider your organization’s goals for sexual health services and what is working well within your setting and your affiliated school(s) to engage students in services.
  1. What are your current outreach strategies for sexual health services?
    1. Which of these are successful?
    2. Where is there room to improve?
Think about who is already doing sexual health work in the school(s) (e.g., health educators, health teachers, coaches, etc.) and consider gaps and opportunities you or other staff can fill.
  1. Who in your SBHC or organization is the best person to provide sexual health services and/or health education?
    1. What percentage of their time do they devote to outreach? Should this percentage change?
    2. How many hours, weeks, or months do you want to dedicate to these activities?
    3. What school staff partnerships might help facilitate presentations about services in your SBHC or organization?
Consider groups of students that are missing from those you serve with existing outreach strategies (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.).
  1. What populations of students do you currently reach (if any) with your sexual health services and outreach strategies?
    1. What populations of students are you missing? Why are they missing?
    2. How can your program ensure that students you are missing are aware of the available sexual health services?
    3. What opportunities exist or can you develop to reach missing populations in particular?
Consider what barriers may stand in the way of implementing an outreach strategy in your setting or school.
  1. What are the barriers to effectively reaching students in your school-based health setting and/or affiliated schools?
    1. Who may be resistant to outreach strategies to connect students with sexual health services?
    2. What are available resources (e.g., funding, people, space, time)?

You can view the Needs Assessment questions as a PDF form here.

Outreach Strategies that Take Place Throughout the School

The strategies in this section focus on increasing outreach by working throughout the school community rather than limiting activities to a clinic or school-based health setting. Many of these strategies are applicable to schools with SBHCs and are useful for health care organizations looking to enter schools without a clinic to do outreach, education, or service provision.

Extracurricular Activities

SBHCs, health educators, or other organizations working in schools commonly hold sexual health education sessions with students in sports teams, school clubs, and other extracurricular groups. Staff will often partner with coaches and faculty leads of school clubs and groups to make connections to extracurricular groups. During these sessions, staff might present on services offered or give a short educational presentation on health topics such as contraceptives or STI testing. In schools with SBHCs, health center staff work with clubs to engage students in providing feedback on the health center and spread the word about the center and its services (see an example program here). These connections with students in extracurricular activities are important because they reach a wider variety of students and create a network of students who are knowledgeable about the SBHC or its partnering organization. These newly knowledgeable students often help with outreach by telling their friends about the SBHC or partner organization, and the services they offer. Additionally, working with school staff and coaches helps build trust between school staff and their counterparts at the health center or partner organization. School staff may be more willing to refer students or work with the health center or organization in other ways if they are more acquainted personally.

Engaging with students in extracurricular activities can require staff to work after traditional working hours, or spend time and energy developing presentations. Thinking about ways to cover time is an essential factor in scheduling staff. If staff stay late for these interactions, they can start work later, take a longer lunch break, or leave work earlier another day. Additionally, working as a team to develop presentations and messaging can ensure that all staff members can practice and feel comfortable.

Case Examples

At the Children’s Hospital of Philadelphia (CHOP), Health Resource Center (HRC) coordinators from Title X-funded local clinics come into schools without SBHCs to connect students to more comprehensive health services in clinics outside of the school. These coordinators often reach out to football or basketball coaches to schedule sexual health sessions for students on their sports teams. At these sessions, the HRC coordinators discuss not only the services that the HRCs provide (or can connect the students to), but also specific sexual health topics. Coaches have been very supportive of this type of sexual health engagement and education for their athletes.

For more information about the CHOP approach, see this case study.

At Every Child Pediatrics, based in Colorado, the SBHC program manager worked with the Future Healthcare Professionals (HOSA) Club at a school to market the health center. The SBHC program manager first obtained buy-in from students in the club by giving them a tour of the health center and speaking with them about the center’s services, including sexual health services. Then, staff worked with students to identify and develop new ideas for advertising those services to the student body at large, using methods that engage youth such as social media, posters, and a video tour of the SBHC to air during students’ planning periods. While this program was an extracurricular activity, SBHC staff could also partner with classroom teachers (i.e., health, science, or communications teachers) to develop an assignment like this for a grade.

Reflection Questions

Consider how you can partner with groups, clubs, and sports teams.
  1. What groups, clubs, or sports teams could you partner with to provide sexual health education?
    1. How can you work with these groups to deliver outreach, provide education, receive SBHC feedback, and develop peer educators based on the needs of each group?
    2. What kind of outreach is helpful and useful for the group you are targeting?
    3. How can health- or medical-related clubs engage more closely with work done in your school-based health setting or organization?
  2. Which of your school-based health or organizational staff is best equipped to partner with extracurricular groups, clubs, or sports teams?
    1. How will this impact staffing and scheduling within your organization?
Identify school staff and student leaders who facilitate groups, clubs, and sports teams.
  1. Who are the school sponsors, coaches, or facilitators of the groups you want to partner with?
    1. How can you work with them to reach students and tailor materials to the specific groups?
  2. What student leaders (e.g., presidents, captains, managers, etc.) exist within these groups?
    1. How can you work with them to get buy-in from their group and tailor materials relevant to that population?
Consider what student populations you can target, as well as those currently not reached.
  1. What student population are you targeting with this approach?
    1. What groups of students are already coming in for services (e.g., athletes coming in for sports physicals)?
    2. What other groups of students are high on your list as target populations?
    3. What students are you likely to miss through this approach?
    4. How can you reach these other student populations (e.g., performing arts groups, cultural clubs, Gay-Straight Alliance [GSA], etc.)?
Consider what material you want to share.
  1. What will your messaging be to the groups you’ve identified, and how will you facilitate them learning about the sexual health services available at your school-based health setting or organization?
    1. How can you work with school staff and student leaders to identify the needs of that group of students?
    2. In what ways can you work with these groups to gather feedback and engage in the promotion of SBHC activities and services?

Lunchtime Activities

SBHC staff or staff from outside organizations (e.g., local Title X clinics, a local hospital system, or a community organization) can implement lunchtime activities for students on sexual health topics. This allows engagement during a time in which students have more flexibility and freedom. Besides providing information on services and health education topics, lunchtime activities can increase the visibility of school-based health services. During lunch, students have more autonomy to choose where they want to go, and with whom. Lunchtime activities could include hosting table presentations or conversations, health education assemblies, and small group conversations.

Getting students to attend or interact with a lunchtime activity can be a challenge. Offering games, incentives, raffles, and other interactive components can get students to engage. By actively choosing to participate, students may be more engaged with sexual health topics than when required in settings like classrooms.

Case examples

At the Children’s Hospital of Philadelphia (CHOP), Health Resource Center (HRC) coordinators from Title X-funded local clinics come into schools without SBHCs to provide health education and linkages to more comprehensive care. At some schools, coordinators take a mobile health resource cart to the cafeteria or just sit down at a lunch table regularly. During this time, they are available to interact with students by holding small group or one-on-one conversations and setting up times to meet in a confidential space if the subject is more personal.

For information about CHOP’s approach to Health Resource Coordinators, see this case study.

At an SBHC in New York City, staff create three lunchtime groups—one each for girls, boys, and LGBTQ+ youth. Although these groups are not mutually exclusive, staff focus on creating space for youth to feel comfortable discussing topics that are relevant to them and learning about sexual health. Topics include contraception, healthy relationships, daily challenges, and family issues, and are discussed in a setting that feels more comfortable than formal classroom health presentations. In these groups, staff bring providers from a partner hospital system to answer medical questions and discuss topics like STI and pregnancy prevention. Similar activities could also be done in partnership with an external clinic if a school does not have an SBHC.

At a high-school SBHC in Chicago, IL, staff run lunchtime education sessions on contraception. A nurse practitioner, who provides contraceptive services and counseling to students at the SBHC, uses pizza and other small incentives or prizes to encourage youth to attend these sessions. The nurse noted that, while some students may not be ready for or need to use contraception, these education sessions help students develop knowledge of future options.

Reflection Questions

Identify what resources and support are required to set up lunchtime activities.
  1. What would you need to do to implement sexual health education tables or activities during lunch periods?
    1. What administrative permissions are needed to host an activity during lunch?
    2. What support is required from custodial and other school staff?
    3. What presentation materials are needed for the activities?
Consider what lunchtime activities work with your staff and school setting.
  1. What lunchtime activities make sense for your school-based health setting?
    1. In what different ways can you engage with youth during their lunch period (e.g., lunch table presentation, group conversations, education sessions in the clinic, clinic tours, etc.)?
    2. How can you tailor these activities to the specific needs of groups of students (e.g., group conversations that are gender-specific, LGBTQ+, age-based, etc.)?
Consider the staffing and operational needs to run lunchtime activities.
  1. Which staff are most equipped to run these activities, and what availability do they have during lunch periods?
    1. For schools with SBHCs, what impact will this have on staffing in the SBHC during periods when students might be more likely to drop into the SBHC?
    2. What staff members enjoy this more free, less structured kind of work?
  2. How frequently can your organization support lunchtime activities?
    1. What duration and timing make sense for your organization?
    2. What time of year may these activities be most impactful?

Health Fairs and Health Campaigns

Health fairs provide sexual health education to students and increase the visibility of the school-based health offerings or linkages to external care. These events require extensive planning because staff must organize health topics, booths/stations, games, and interactive components, and coordinate staffing for the event. Those assigned to particular stations or booths must be comfortable with the material, topic area, and interactive component or game.

Health fairs are time-intensive to plan and require numerous staff to support the event. However, community volunteers, student volunteers, and staff from neighboring SBHCs or community clinics can partner to relieve some burdens on school-based health staff. Alternatively, if staffing and resources are strained and a health fair doesn’t seem feasible, health campaigns are a great option. Health campaigns raise broad awareness about specific health topics across the school over time, rather than on one specific day like at health fairs. One possible approach to a health campaign is a focus on monthly health themes that health center staff promote throughout the school via posters, announcements, and events. Select topics and themes based on the specific needs of student populations; examples include sexual orientation, gender identity, and HIV/AIDS.

Case examples

At the Minneapolis Health Department, each SBHC runs an annual health fair in their specific school. The health fair usually operates out of the school gym to provide enough space. The SBHC partners with the school administration, health teachers, and physical education teachers to bring students to the fair during identified class periods. SBHC staff engage students using game-like activities at each station (e.g., a Sexual Health Taboo Game) and through a ‘passport book’ that students stamp as they go from booth to booth. Some teachers provide credit or extra credit when students fill up their passport book. Additionally, the SBHCs gather health department volunteers to alleviate the burden on individual health centers and bring in content experts who may not be staffed at the health centers themselves. Minneapolis staff have found that this event works well simply because it’s fun: The event features music and raffles, and students are able to walk around with their friends, ask questions, and learn in an engaging way—a contrast to lectures or sitting in a classroom. Staff developed a How to Plan a Health Fair guide for use during each year’s planning.

For more information about the Minneapolis Health Department approach, see this case study.

At the Children’s Hospital of Philadelphia’s (CHOP’s) five Health Resource Centers, coordinators often develop monthly health topics or themes with support from the school administration or their community partner. Centers post informational posters, include information about the theme in the daily announcements, and host events (e.g., discussions, assemblies, or lunchtime booths) related to the theme. As an example of themed months, December focused on HIV and AIDS awareness because World AIDS Day is in December. The centers also have months that focus on gender, sexual orientation, STI screening, and other topics.

For more information about the CHOP approach, see this case study.

Reflection Questions

Identify what resources and support are required to set up a health fair or health campaign.
  1. What resources and support do you need to set up a health fair or health campaign?
    1. What administrative permissions are needed to host the event or campaign?
    2. What custodial and other school staff support is needed to make the fair or campaign successful?
    3. What staffing is required to host the event or campaign?
    4. What materials are needed, and who can help develop them?
Consider which school staff provide sexual health education and what role they could play.
  1. Who is doing sexual health education in the school (e.g., health educators, health teachers, coaches, etc.)?
    1. How could these people play a role in the health fair or a health campaign (e.g., marketing, spreading the word, running booths/stations at the fair, developing materials for campaigns, etc.)?
    2. Who from your team should be responsible for reaching out to these individuals? How far in advance do they need to reach out?
Identify health topics that could be turned into monthly health campaigns or booths at a fair.
  1. What sexual health topics could you turn into monthly themes for campaigns or booths at a fair?
    1. What existing health-related days exist, like World AIDS Day, and how could you use those days to create monthly themes?
    2. What topics are most important to cover based on your student population (e.g., sexual orientation, gender identity, STD prevention, and contraception)?
Consider how you can partner with classes, school groups or clubs, and external community organizations or clinics.
  1. What classes, groups, or clubs related to health (e.g., health or medical-related clubs, service clubs, health classes, etc.) could you partner with to help run a health fair or health-themed campaigns?
    1. How can students in these classes, groups, or clubs help market, develop materials for, or volunteer at/support a health fair or campaign?
    2. How can you identify groups that you could partner with in this way?
  2. What community organizations or clinics (e.g., local health department, sexual health clinics, etc.) could you partner with to help run a health fair?
    1. What role could these groups play in a health fair (e.g., running booths or stations, coordinating, etc.)?
    2. Who from your team should be responsible for reaching out to these groups? How far in advance do they need to reach out?

School Assemblies

At schoolwide assemblies, school-based health staff or staff from partner organizations can introduce sexual health topics or the organization itself (SBHC, community clinic, school health resource center, etc.). Schoolwide assemblies provide the opportunity to reach the entire student population. At assemblies, staff might highlight the variety of services available, or the resources available for various sexual health topics, or explain how students can access external resources. These presentations can be curated with tailored content for assemblies targeted to a smaller subset of students. For example, staff might introduce the organization and its sexual health services at a ninth-grade assembly or speak about awareness of sexual harassment in college at a senior assembly. Health staff can work with school staff members responsible for preparing assemblies to ensure designated time for presentations. This coordination can also help staff understand what to prioritize or how to tailor presentations. For schools with SBHCS, staff can have a standing slot in assemblies to provide SBHC updates or health news items.

It can be challenging to ensure that your team or external partners have time set aside during school assemblies. Administrators may have other priorities during school assemblies beyond students’ sexual health. Therefore, health staff should develop relationships with school administrations to increase administrators’ openness to school-based health presentations. Additionally, sharing data on sexual health outcomes (e.g., STI rates, teen pregnancy statistics) can be a persuasive tool in convincing administrators of the importance of having school-based health staff speak at assemblies.

Case example

At one SBHC run by the Minneapolis Health Department, the student government wanted to prioritize a schoolwide conversation about consent in romantic relationships. To do this, student leadership planned an interactive presentation and worked with a health educator to present at a schoolwide assembly. While the students reached out to SBHC staff in this example, SBHC staff can also ask the school administration for the opportunity to speak with students at assemblies.

For more information about the Minneapolis Health Department approach, see this case study.

Reflection Questions

Identify the logistics related to school assemblies.
  1. What school assemblies exist, and what topics do they address?
    1. When are these assemblies held, and who hosts the assemblies (e.g., administrators, student government, etc.)?
    2. Who is the target audience for each assembly (e.g., first-year students, seniors, all students, etc.), and is this the population you want to target with sexual health information outreach?
    3. Of the existing assemblies, which is/are a good option to include presentations on sexual health topics and services?
    4. What would be required to hold a separate assembly linked to sexual health topics?
Consider who in the school might resist addressing sexual health during assemblies and who could advocate.
  1. How can you partner with school staff to present sexual health service information at school assemblies?
  2. Who in the school might oppose addressing sexual health at school assemblies?
    1. What strategies can you develop to mitigate resistance?
    2. How can facts and data be used to explain why serving students’ sexual health needs is important?
    3. What concerns may teachers, school staff, or parents have, and how can you address them?
Identify community partners to help present at school assemblies.
  1. What organizations could you partner with (e.g., local public health departments, local clinics, etc.) to provide sexual health education at an assembly?

Classroom Presentations and Sex Education Implementation

Classroom presentations serve as a critical way to get the word out about school-based sexual health services available within the school (e.g., at an SBHC) or with partner organizations (e.g., community clinics, Title X clinics, etc.). By meeting students where they are, presenters have a captive audience. In many school-based health settings, staff work with teachers to conduct classroom presentations, introduce school-based health services to students, provide education on sexual health and other topics, or introduce a partner’s external sexual health services. While school-based health staff often partner with health and life skills teachers, they can work with teachers of all subjects. Based on the needs of the school population or the subject matter expertise a teacher seeks, health staff can hold regular, ongoing lessons or one-time sessions in the classroom. Presentations by school-based health staff can range from short introductions to their organization (e.g., the SBHC, community clinic, health resource center, etc.) and its services to presentations on specific health topics or the delivery of an established evidence-based curriculum on sexual health. Classroom presentations can also help identify what teachers might be champions of sexual health work and can be a way to partner with some classes for other activities (such as a marketing assignment in a health class).

One way to scale down classroom presentations is by providing one-time short presentations that introduce the organization’s services, rather than taking up multiple class sessions. This is a great way to start getting school-based health staff or partnering organization staff into the classroom, building relationships with school faculty, and connecting with students. These presentations can be less burdensome on staff members who have other health center or organizational obligations. Regardless of the method of engagement, connecting in the classroom is an important and often utilized strategy to reach students.

Case examples

The Greater Lawrence Family Health Center oversees two SBHCs in Massachusetts. Lawrence, MA is a small city and the population served by its schools tends to be Spanish-speaking students or children of immigrants. Nurse practitioners at Greater Lawrence Technical School meet with all 9th and 10th grade health classes via a “Health Center 101” tour to introduce them to SBHC offerings and confidential access to care. These nurse practitioners also deliver an evidence-based sexual health education curriculum to these health classes and include resident physicians as part of their outpatient adolescent health rotation.

Nurse practitioners working in SBHCs through the King County Public Health Department in Seattle engage in classroom presentations at the start of each semester to introduce the SBHC and educate on contraceptives. Students served by these SBHCs tend to include those with limited English proficiency, those at risk of homelessness, immigrants, and/or those eligible for free and reduced-price lunch. Knowing about free available services can be instrumental in helping students utilize the services. The nurse practitioners noted that visiting classes twice a year helped build relationships with teachers. When teachers are familiar with SBHC staff and the services available, they are more likely to refer students to the health center.

Staten Island University Hospital/Northwell Health serves students in the Staten Island, NY community. Their health educators deliver a seven-session evidence-based sexual health curriculum. These educators take the opportunity of being in the classroom to also share information with students about the SBHC, hand out parental consent forms for enrollment into the SBHC, and conduct mini tours of the SBHC.

At Nationwide Children’s Hospital, which sponsors 13 SBHCs and two mobile clinics in Columbus, Ohio, staff have set up a partnership with community organizations to deliver a comprehensive evidence-based sexual health education curriculum in middle schools throughout the city. The curriculum is implemented over nine days to students in both 7th and 8th grades. At the end of every session, health educators review information on where students can access sexual health services locally. One session of the curriculum specifically addresses how to schedule appointments for services as well as what students can expect at these visits.

For more information about the Nationwide Children’s Hospital approach, see this case study.

Reflection Questions

Identify who is providing sexual health education in the school and what role they could play.
  1. Who is doing sexual health education in the school (e.g., health educators, health teachers, coaches, etc.)?
    1. How could you partner with them to present the sexual health services available at your organization?
    2. How can you integrate your presentations with the existing sexual health curriculum?
    3. Who from your team should be responsible for reaching out to these individuals?
Identify community partners to help provide sexual health education in classrooms.
  1. What organizations could you partner with (e.g., local public health departments, local clinics, etc.) to provide sexual health education in classrooms?
    1. How can these organizations provide resources for planning and executing presentations or a curriculum on sexual health?
Consider what is required to do classroom presentations and how you can scale up or down your approach.
  1. What resources are required to develop and present in classrooms, and how does this differ from implementing a sexual health curriculum?
    1. How can your presentations be scaled up or down?
    2. If just starting, how can you provide shorter introductions to your organization and its services?
    3. If you are unable to reach every classroom, what classrooms may not have been targeted with outreach in the past? Which classes might be frequently missed by outreach services? (Examples might include ninth-grade classrooms, in which students are new to the school; classes of a specific subject, such as health or biology; and classes outside of the general education program, such as vocational programs or special education classes, in which students may be less integrated into the school or school programming?)

STI Testing Days

STI Testing Days are events organized to test as many students as possible for STIs. They can reduce the spread of STIs, destigmatize STI testing itself, and increase awareness of the many services offered within the school-based health setting or partnering organization, including sexual health services. Students have reported more comfort being tested at these events because they don’t have to schedule an appointment or explain why they want to come in, and they can come with friends. STI Testing Days tend to be coordinated by school-based health staff, occasionally in partnership with community organizations. Aside from promoting the event, it is important that enough supplies are ordered and that staff schedules are cleared so they are available to help with the event and day-of testing. During these events, it is important that staff communicate to students that testing is completely voluntary and confidential.

These events are time- and resource-intensive, so it is important for each clinic or organization to think about how an STI testing event might be scaled up or scaled down based on staffing and other resources. One way to scale down a testing day is to have students come in for testing by homeroom class. This limits the volume of students coming in to be tested at a given time. Follow-up visits to receive test results can then be scheduled for a later time. Another consideration is whether the organization hosting (e.g., the SBHC) can bill for testing or could partner with another organization or health department to cover lab costs. To scale up, the event could be hosted in a gym and all students from across the school could come throughout the day. To achieve this, school-based health groups like SBHCs could partner with community clinics, the health department, or other SBHCs to ensure sufficient staff to meet with each student. Regardless of the approach, it is essential that tests are well-tracked and consent is documented.

Case examples

At the Minneapolis Health Department, which sponsors seven SBHCs, staff use a scaled-down approach for their STI Testing Days. They host the event within their SBHCs and students come throughout the day for testing rather than holding a single, large event with every student. This method requires that students to be willing to come in on their own and that extra staff be brought in from other SBHCs to manage the larger volume of patients. To get students to come for testing, staff focus extensively on promotion and put flyers in teacher’s mailboxes, update bulletin boards, place posters around the school, include information about the event in daily school announcements, and advertise in unique and fun ways. For example, one health educator walks around the hallways wearing a sandwich sign and a crown made of taped-together condom packages to advertise the event. This grabs students’ attention and interest. The day of the event, staff hold testing within their SBHCs and follow up at a later point with each student once their results are returned. As with all medical care providers, SBHC staff maintain student confidentiality when students come in for testing. In some schools, voluntarily going into the clinic during a day advertised for STI testing might be a deterrent, but clinic staff noted that this was not a barrier in Minneapolis. Staff developed a Fast STI Testing Day Toolkit to refer to each year in their planning.

For more information about the Minneapolis Health Department approach, see this case study.

At Heartland Health Centers in Chicago, the sponsor of seven SBHCs, staff recently conducted a scaled-up STI Testing Day in partnership with the City Health Department. In this scaled-up approach, staff aimed to have all students come to the gym for STI Testing Day. For this event, all students were provided consent forms about the testing process. They were given a labeled urine cup in a bag and asked to go to the bathroom. Each student chose whether to be tested and produce a sample. This process was designed to maintain confidentiality, such that fellow students were unaware of who had consented to being tested. Those who chose to get tested and those who did not were unidentifiable because everyone had a bag and everyone went to the bathroom. Staff developed a Traffic Flow visual to map out this process. They partnered with local community organizations and brought nurse practitioners from all SBHCs to one school to staff the event and work with students. All students then met with a provider to discuss why they chose to be tested or not and to allow providers to connect them with additional services, including family planning services, if wanted. Heartland developed an Exit Counseling Session guideline for providers. Staff followed up individually with students who had positive tests just as if they came into the clinic for an STI test.

Reflection Questions

Identify what resources and support are required to host an STI Testing Day.
  1. What resources and support do you need to host an STI Testing Day?
    1. What permissions are needed to host the event?
    2. What custodial and other school staff support is needed to make the event successful?
    3. What staffing is required to host the event?
  2. If staffing is limited, what community organizations can you partner with to provide volunteers to meet staffing needs the day of the event?
    1. Who on your team can work to make those connections?
    2. How far in advance do they need to reach out?
  3. What resources does your organization have if a large number of students opt to test?
    1. How much time is needed for your organization or a lab to process the tests? How can you ensure this is done in a timely manner?
    2. What staffing is required to respond to test results and provide care for positive results?
Consider how to maintain the privacy and confidentiality of students choosing to get tested.
  1. What processes can ensure that students know testing is voluntary?
    1. What processes will ensure that testing remains confidential (e.g., screens, one-stall bathrooms, asking everyone to enter the bathroom regardless of whether they are getting tested, etc.)?
    2. What language can staff use to ensure that students don’t feel pressured to get tested?
    3. How can marketing materials include confidentiality practices?
Consider which school staff provide sexual health education and what role they could play.
  1. Who is doing sexual health education in the school (e.g., health educators, health teachers, coaches, etc.)? How could these people play a role in a schoolwide testing event?
    1. What roles could these individuals take? What ways could they help with marketing and spreading the word about the event?
    2. Who from your team should be responsible for reaching out to these individuals? How far in advance do they need to reach out?

Outreach Strategies that Take Place Within School-Based Health Settings

The strategies in this section focus on increasing outreach by working within the SBHC or other school-based health setting. While these strategies may be harder to implement in the absence of school-based health services, some could be adapted to clinical settings outside of a school.

Sport Physicals

Addressing sexual health needs during sports physicals is a way to take advantage of a common type of health visit to address another common, but often less addressed, need. Providers can take advantage of sports physical visits to speak with students about their sexual health needs and provide students with materials and resources (e.g, pamphlets on preventing STDs, guides on good sexual health practices, information on getting contraception, or STD information sheets). Informing students about the sexual health services offered within their school-based health setting opens the door for them to engage with those services when they choose.

If sports physicals are uncommon in your school-based health setting, staff can also discuss students’ sexual health needs when they come for routine physicals or other health visits, such as those for chronic disease management (e.g., asthma or diabetes) or for prescriptions. This strategy can be applied by organizations without a school-based health setting that see youth for sports physicals or other health visits.

Case Examples

At one SBHC, which serves a large immigrant student population in seven predominantly rural schools in Delaware, staff use sports physicals to ask students about their other health care needs—particularly sexual health. Conducting a sports physical at school is often easier for both the parent and the student than scheduling an appointment with a pediatrician elsewhere. These physicals provide a great opportunity to ensure that students know about other services available at each clinic, including sexual health services. One nurse practitioner there saw over 300 students for sports physicals in one year, each of which created the opportunity for students to learn about how other services could address their additional health needs, including sexual health needs, throughout the school year.

In schools served by a group of SBHCs in New Mexico, the staff pediatrician noted that sports physicals are an excellent time to follow up with students about reproductive health. They added that their adolescent patients often “seem to be waiting to be asked” about their sexual health so that they can ask their own questions. Using any opportunity that a student is in the clinic—like a sports physical—to check in about sexual health opens the door for questions to be asked and needs to be met.

Reflection Questions

Consider how to use sports physicals for outreach about sexual health services. 
  1. How can you educate student athletes about sexual health services available during sports physicals?
    1. What parental consent, if any, is needed for these conversations? If no parental consent is required, how may these conversations be perceived as sneaky in some way and how can you mitigate this?
    2. When issues that are not related to sexual health or to the sports physical come up in these visits, how do you ensure you have time and resources to address them? How can you use this same approach to incorporating sexual health discussions during sports physicals?
  2. What materials or resources (e.g., pamphlets, discussion guides, information videos, etc.) would facilitate information sharing about sexual health services during sports physicals?
Consider the extra strain increased outreach could place on your operations and how you will adapt.
  1.  How will your organization adapt if there is increased interest in sexual health services following periods when you provide sports physicals?
Consider what students are and are not reached during sports physicals.
  1. What, if any, student populations are you targeting for sexual health outreach because you currently reach them less frequently (e.g., all student athletes, students who are new to the school, ESOL/ELL students, etc.)?
    1. What students are you likely to miss through a sports physical-focused approach?
    2. How can you do sports physical outreach but also reach these other student populations?

Adolescent Screening

Screening aims to identify students’ sexual health needs in a systematic way so that students are connected to needed health care. Screening can take different forms depending on the staffing and resources available within a school-based heath setting. One model is to set up adolescent screening visits (ASVs) to meet with as many students as possible at the beginning of the year. This allows SBHCs and other school-based health settings to determine each student’s health needs early. While these visits do not focus exclusively on sexual health, staff can identify students’ sexual health needs during these visits.

If targeting the entire school is not possible, school-based health settings can scale down this approach. One way to do so is by targeting specific populations (e.g., ninth graders, new students, students in English learning classes, immigrant students, or other subpopulations identified through clinic data as not getting their needs met). Another way to scale down is to use a questionnaire instead of a full appointment. If the questionnaire is given to all students (either schoolwide or when students visit the health center), providers can gather data to more effectively target services. Additionally, they can identify patterns in the student population.

Case examples

At La Clinica de la Raza in southern California—a sponsor of eight school-based health clinics serving students from a variety of racial/ethnic backgrounds—providers and health educators begin scheduling ASVs at the beginning of each school year and continue throughout the year with the goal of identifying students’ needs and connecting them to services. Depending on staff capacity, ASVs are conducted in both middle and high schools. In middle schools, staff typically target either 6th graders just entering the school or 8th graders as they are getting ready for high school. At high schools, ASVs are targeted toward ninth graders and “newcomer students,” who are characterized as individuals who have recently immigrated to the United States. Through this practice, students are introduced to the center and learn about its services, which in turn increases utilization of SBHC services as needs arise, including needs related to sexual and reproductive health. Staff have developed an ASV Script and Referral Guideline for providers to use during these visits.

At some SBHCs in South Florida, staff do not schedule specific screening visits, but do conduct an Adolescent Risk-Taking Behavior Screening, which is administered to each student every time they are seen at their health center. These clinics serve a large population of immigrants or children of immigrants, as well as families with Medicaid. Screening before the visit can help providers identify urgent issues while also addressing long-term needs. In this model, students are given an iPad to answer the questionnaire privately and confidentially. Subsequently, providers review the results and connect students to appropriate sexual health services when needed.

Reflection Questions

Consider the administrative processes needed to support screening.
  1. If you want to incorporate adolescent screening questionnaires, what equipment and materials do you need in place to effectively operate a screening questionnaire?
    1. What questions are most useful in determining sexual health-related needs, and how long will the questionnaire take?
    2. Where will the questionnaire be administered (e.g., in the waiting room or once the student is sent to the patient room)?
    3. In what ways could the screening questionnaire be administered (e.g., on paper or electronic)? If electronic, what technology needs to be provided to the students, or will they need their own device?
    4. How will providers see responses, and how will the responses connect to existing medical files?
  2. If you want to begin Adolescent Screening Visits, what staffing and coordination are needed? What schoolwide administrative processes do you need to think about?
    1. How much staff time is required to conduct ASVs? What staff are available to conduct these visits?
    2. Who can give approvals to allow students to leave class?
    3. Who needs to help with parental/guardian consent?
  3. If you already have ASVs, what impact will addressing sexual health during each ASV have on operations and timing?
    1. How many ASVs happen each month?
    2. On average, how much longer do you expect each adolescent screening visit to take?
    3. Which staff members will be impacted by this change? How?
    4. How will (or can) you adjust schedules to accommodate longer visits?
If starting ASVs schoolwide is not feasible, think about targeting specific student populations.
  1. How might you start small and grow if there are staffing and operational constraints?
  2. With what population can you start in your school (e.g., first-years, seniors, new students, etc.)?
    1. What data are available to help you identify populations within your school that have higher unmet needs?
    2. What resources do you have that could support targeting those populations?
    3. Who might be missed by choosing this target population?
  3.  How can ASVs increase demand for services, and how do you need to plan to accommodate or use that increased demand strategically?
Consider who in the school might resist addressing sexual health during ASVs.
  1. Who in the school might oppose addressing sexual health during these visits?
    1. What strategies can you develop to mitigate resistance?
    2. What might help you message the importance of including sexual health in screening visits?
    3. How might you address teachers who oppose letting students out of class? Are there classes that might have more built-in flexibility (e.g., homeroom or health class)?
    4. How can you use facts and data from your school-based health setting to explain why serving students’ sexual health needs is important?

One-on-One Education Visits

Engaging with students one-on-one allows for personalized sexual health education opportunities. One-on-one education visits are an opportunity to learn more about individuals, use motivational interviewing techniques, and have goal-setting conversations while providing a safe space for private conversations. Staff can use this time to let students ask questions about their sexual health and provide contraceptive counseling. One-on-one education visits operate similarly to traditional medical appointments: Students themselves can sign up for an educational visit or be referred by other medical staff. Health educators, medical assistants, or nurses can all conduct these educational visits.

One of the main challenges to these visits is funding them. SBHCs and other school-based health settings often cannot bill for these health education visits without medical service provision. When funding—especially through grants—is available, staff can proactively reach students and help create a space to let students guide what they want to learn.

Case examples

The Minneapolis Health Department uses grant funding to support health educators in their seven SBHCs to meet with students one-on-one. Students can set up appointments for these one-on-one sessions as if they were meeting with a provider. In these sessions, the health educators have conversations with students to address a broad range of health needs, including sexual health. The staff conducting the visits are trained in motivational interviewing so that they are able to encourage students to steer the conversation toward what the students themselves need and want to hear.

For more information about the Minneapolis Health Department approach, see this case study.

At one SBHC in Ohio that relies on grant funding from the local health department, health educators meet with students one-on-one to discuss how to avoid unwanted pregnancy, set goals, and access prenatal and postpartum care if the students are pregnant. Health educators seek to meet with every student in the school. These conversations are guided by a wellness questionnaire, which includes a component on goal setting. Health educators receive motivational interviewing training. In these sessions, the health educators are also able to provide contraceptive counseling if appropriate for the student based on their goals and sexual activity.

Reflection Questions

Consider staffing and coverage needs to implement one-on-one education visits.
  1. What impact will adding one-on-one sexual health education have on operations and timing?
    1. How many one-on-one sexual health education visits do you aim to add per month? What time is required to implement these visits?
    2. What existing staff members could hold these visits? What staff may need to be brought in to hold these visits?
    3. Which other staff members will be impacted by this change? How?
    4. How could you adjust scheduling for certain staff to support these one-on-one interactions?
    5. What local grants or volunteer programs could fill this staffing need?
Consider who in the school might resist addressing sexual health during one-on-one visits.
  1. Who in the school might oppose addressing sexual health with one-on-one visits?
    1. What strategies can you develop to mitigate resistance? How can facts and data be used to explain why serving students’ sexual health needs is important?
    2. What might help you message the importance of meeting with students one-on-one about their sexual health needs?
    3. What concerns may teachers or school staff have (e.g., students missing class), and how can you address them (e.g., bringing in students during more available classes like homeroom, life skills, etc.)?

Senior Check-Out Visits

Connecting students to care as they age out of SBHCs or other school-based health settings is an essential role for clinicians. Senior check-out visits are one way that staff can link graduating seniors to ongoing care, including sexual health services. The focus of these visits is to help students know where they can receive care after leaving high school and provide them with resources (e.g, Bedsider, a website that can connect youth with sexual health services and contraception; or a guide on good sexual health habits). With these visits, staff try to reach every graduating student and identify where students can continue to receive services, whether at college or in the community. These visits ensure that students can meet any final health care needs that the SBHC or school-based health setting can address before they graduate.

It’s important to think carefully about some challenges with senior check-out visits. Specifically, having enough staff to handle the volume of students, scheduling visits toward the end of the year, and getting administrative approval to bring in all seniors (some of whom may miss class) are factors to consider. Establishing collaborations with school staff can address some of these challenges. If reaching all seniors may not be possible, think about ways to reach sub-populations, like those attending local community colleges or trade schools where on-campus health care may be less available.

Case examples

At Legacy Community Health, an organization with more than 30 SBHCs embedded in charter school networks and an independent school district in greater Houston, TX, staff help prepare high school seniors to become self-reliant when it comes to managing their health and wellness by hosting senior check-out visits and providing primary care, sick care, and behavioral health services. These visits are marketed to students graduating during the academic year. Senior check-outs include a physical exam, required/recommended vaccinations, and health education and information relevant to each student. Following their visit, Legacy provides each student with a packet of information and a QR code to access Legacy’s health resources for young adults, which include Legacy’s patient portal and the student’s own health record.

At the University of Rochester School of Nursing’s SBHCs in Upstate New York, staff meet with seniors in the winter and spring to plan for students’ sexual health and family planning goals upon graduation. Staff walk students through the logistics of picking up a prescription or calling a medical office to schedule an appointment. Besides providing a letter that includes health centers and mental health resources in the areas where students are moving after graduation, SBHC staff also discuss backup plans with students for accessing health care if their initial post-graduation plans change. This letter to graduating seniors is an example of a letter staff send to their seniors reminding them to make an appointment and providing several local medical and mental health care centers.

Reflection Questions

Consider what staffing and resources are needed to implement senior check-out visits.
  1. What resources, staff, and space would be required to hold these visits?
    1. What materials or resources (e.g., pamphlets, discussion guides, information videos, etc.) would facilitate information sharing about sexual health services during senior check-out visits?
    2. How can senior check-out visits be scaled down to meet staffing and resource availability?
    3. What groups of seniors could you target to begin senior check-out visits (e.g., those not going to college, going to community college/trade schools, at risk of not graduating, etc.)
Identify what timing considerations are required to address sexual health services during senior check-out visits.
  1. What impact will addressing sexual health during every senior check-out visit have on operations and timing?
    1. How many senior check-out visits happen each month?
    2. On average, how much longer do you expect each senior check-out visit to take?
    3. Which staff members will be impacted by this change? How?
    4. What adjustments need to be made in scheduling to accommodate longer visits?
    5. How can visits be spread out over several months instead of at the very end of the year to ensure sufficient staffing?
Consider who in the school might resist addressing sexual health during senior check-out visits.
  1. Who in the school might oppose addressing sexual health with senior check-out visits?
    1. What strategies can you develop to mitigate resistance?
    2. How can facts and data explain why serving students’ sexual health needs is important?
    3. What might help you message the importance of meeting with senior students about their sexual health needs?
  2. What concerns may teachers or school staff have (e.g., students missing class), and how can you address them?
    1. How can these visits be scheduled around the end-of-year testing and obligations?
    2. What classes might be more amenable schedule-wise to these visits (e.g., homeroom, life skills, etc.)?
Consider what students are and are not reached during senior check-out visits.
  1. What student populations are you targeting for sexual health outreach?
    1. What students are you likely to miss through this approach?
    2. How can you reach these other student populations?

Next Steps

Now think about potential next steps to increase outreach related to sexual health services and set some intentions. The following statements can serve as prompts to help you identify next steps.

Reflections on Goal Setting

1. Identify at least one new sexual health outreach strategy to implement within your school-based health setting or organization over the next three months.

Think about new opportunities for sexual health outreach and engagement in your SBHC. Ensure that your conversation identifies ways to reach all student populations.

2. Identify at least one existing sexual health outreach strategy within your school-based health setting or organization to improve over the next three months.

Think about what is already happening within your SBHC with sexual health services outreach and engagement. Consider what could be done more efficiently or more effectively and what efforts are not having the desired outcomes. Think about smaller changes that you can test and include in SBHC protocols. Ensure that your conversation identifies ways to reach all student populations. Then consider an additional small change.

3. Identify at least one new sexual health outreach strategy to implement within the school(s) at which you are located over the next three months.

Think about new opportunities for schoolwide outreach and engagement related to sexual health services. Ensure that your conversation identifies ways to reach all student populations.

4. Identify at least one existing sexual health outreach strategy within the school(s) at which you are located to improve over the next three months.

Think about what your SBHC is already doing in the school around outreach and engagement related to sexual health that could be done more efficiently or could be more effective. Think about smaller changes that you can test and include in SBHC protocols. Ensure that your conversation identifies ways to reach all student populations. Then consider an additional small change.

You can view the Next Steps questions as a PDF form here.


Suggested citation

Balén, Z., Lantos, H., Parekh, J., Manlove, J., Cushing, K., Greco, D., & Shore, A. (2022). Maximizing outreach and access. Child Trends. https://doi.org/10.56417/3934l7655c

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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