Strategies for Providing School-based Family Planning during COVID-19
Widespread school closures and additional safety concerns related to COVID-19 have restricted students’ ability to access reproductive health care, especially through school-based health centers (SBHCs). Young adults (ages 15 to 24) have the highest rates of unintended pregnancy and sexually transmitted infections (STIs) of any age group, which means that their access to sexual and reproductive health care through SBHCs is especially important. Despite school closures, though, SBHCs can use innovative strategies to reach students remotely and maintain their access to reproductive care.
About school-based health centers
SBHCs are critical sources of primary health care for students at over 10,000 schools in the United States, especially for adolescents from low-income, rural, and racial or ethnic minority populations. Many SBHCs are located on school grounds and may typically rely on in-person communication with students to provide various family planning services. As a result, SBHCs that operate at schools that are closed or have adopted a hybrid model (some online and some in-person classes) for the upcoming academic year will need to use innovative strategies to maintain students’ access to their primary source of family planning services.
SBHCs can use the following six innovative strategies to reach students and administer family planning services remotely.
Use social media and phone calls to connect with students virtually.
One of the biggest challenges to providing remote school-based family planning services is to ensure that students, especially new students, know that family planning services and providers are available to them. SBHCs may commonly rely on foot traffic and casual interactions to connect with students and advertise their services. With school closures eliminating personal interactions in hallways and classes, clinics can feature their services prominently on school webpages or online portals. Clinics can also provide contact information for clinical staff on their social media accounts and post about remote and in-person services.
Students in rural areas and low-income families may have limited access to high-speed internet or data plans that enable them to learn about or access these resources via social media outreach; however.
Providers can also make phone calls to inform students about family planning services. Clinics can schedule phone outreach during evenings, when adolescents are more likely to be alone in their rooms and can talk more freely about family planning services. Additionally, adolescents are more likely to stay up late at night and sleep longer in the morning, so the timing of calls should be an important consideration for clinics. One clinic found that youth were less likely to answer calls during the day than in the evening. Clinics can also use phone calls to check in with students to ask how they are doing and build rapport.
Set up a phone line to allow students to reach the clinic at any time and inquire about sexual and reproductive health services.
Adolescents are often curious about contraceptive options but may not always be comfortable having clinics reach out to them. In particular, many adolescents are unlikely to be comfortable talking to clinic staff when they are with their parents or when their parents can hear them. Further, because parent-child communication about sexual health is often shaped by families’ racial and ethnic backgrounds, adolescents from some racial or ethnic groups may have less open communication with their parents about sexual and reproductive health. Therefore, during school closures, some adolescents might have concerns about clinics calling them while they are with their parents, and may be uncomfortable talking about sexual and reproductive health in a non-clinic setting.
Instead, clinics can set up hotlines using a shared phone line (like Google Voice) to allow students to reach clinic staff at their convenience. Unlike a traditional phone number, the hotline allows multiple clinic staff to be on call on a rotational basis. Providing a hot-line phone line can encourage students to call, in real time, to discuss any non-emergency health concerns and receive the information they need.
Upload videos to social media outlets to educate students virtually on sexual and reproductive health.
Clinics can create or share videos about reproductive health topics and upload them to social media platforms to provide ongoing health education to students. Patient education videos may be especially effective and relatable if they involve the target audience in the content creation process. One way to accomplish this is through the use of a human-centered design approach to create videos, bearing in mind the characteristics and needs of the local student community. Certain adolescent populations, like Asian American teens, are less likely to talk to providers about sexual and reproductive health, and have been traditionally underrepresented in sexual and reproductive health education materials. Representation in videos might make these groups feel more comfortable with clinical staff. In addition to posting on social media, clinics can also email or text video links to their students.
Use proxy servers and HIPAA-compliant videoconferencing platforms to ensure confidentiality in telehealth services.
During the COVID-19 pandemic, the U.S. Department of Health and Human Services has encouraged health care providers to adopt and use telehealth as a safe way to provide care. Adolescent telehealth users may have concerns about audio-visual privacy and the risk of their personal health information being shared without their consent. Patients in rural areas may be especially concerned about exchanging personal information virtually, and may mistrust the health care system or providers. HIPAA-compliant videoconferencing platforms that offer end-to-end encryption, like doxy.me and RingCentral for Healthcare, represent confidential options to provide counseling. Clinics can implement a proxy server to protect their online medical records. Under the proxy server, only select individuals—in addition to the student and their provider—will have access to students’ personal medical records. Additionally, parents and guardians will only have limited access to clinical notes once the student reaches age 12. These practices help ensure confidentiality for sensitive services, such as STI testing or contraceptive counseling, and could increase students’ trust in clinic staff.