Six-month continuation rate was nearly 80%
By Melinda Young
School-based health centers can offer long-acting reversible contraceptive (LARC) care to adolescents and have positive results regarding LARC initiation and six-month continuation, new research shows.1
The study found that from April 2021 to June 2022, school-based health centers in New York City provided 1,303 contraceptive visits, including 77 LARC initiations. The six-month continuation probability was 79.3%.1
Investigators concluded that school-based health centers play an important role in providing contraceptive services to adolescents, even during a time — the pandemic — when other healthcare systems experience care disruptions.1
“There are 2,600 school-based health centers across the country, and they are equally dispersed in urban areas, rural areas, and suburban areas,” says Samantha Garbers, PhD, a teaching professor and undergraduate program director at Northeastern University Bouvé College of Health Sciences in Boston, MA.
“They are required to provide primary care and operated by a clinical entity in collaboration with schools and — often — community partners,” she adds. “They are a model of delivering care for children and adolescents.”
Some of these health centers are located in mobile vans; some provide mental health services, and some provide contraceptive services. They often serve students in summers, as well as during the school year.
They are different from a school nurse’s office because they are operated by an entity that is separate from the school district.
“It’s in collaboration with the school,” Garbers explains. “About 63% are operated by independent health centers like federally qualified health centers, and about 20% are operated by hospitals and medical centers; local health departments are 5%, and mobile units are 3%.”
Having a school-based health center also appears to lead to better health among all students in a school, Garbers notes.
“The research has shown that students who have access to a school-based health center, whether they use it or not, have better outcomes than those who don’t have access to a school-based health center,” she says. “We’ve done a lot of work looking at school connectiveness, and this is a multidimensional construct, the feeling that adults are invested in your wellbeing, feeling that you belong.”
The better outcomes among students who have access to these centers is explained, in part, by school connectedness.
Another positive factor is that students who have access to a school-based health center have higher rates of immunization, lower rates of teen pregnancy, lower rates of substance use, and lower rates of depression, Garbers adds.
Garbers and co-investigators closely examined outcomes for students who initiated a LARC method during a 14-month study period.
“We looked at initiation and the extent to which young people stayed with the method, which is a measure of satisfaction in the method,” she says. “And the evidence on continuation of LARC is high.”
These centers will bill insurers — including Medicaid — for the care students receive. Or, if a student did not want the insurance company billed because of privacy concerns, there typically is a sliding scale fee for the services.
The school-based health centers that provide contraceptive services often have emergency contraception that is available to students, as well as a full range of contraception, Garbers says.
“Seventy-seven percent of the centers provide at least some reproductive health services, including contraception, counseling, pregnancy testing, testing for sexually transmitted infections (STIs), and condoms,” she adds.
About 37% offer dental care and 83% have behavioral healthcare, she says.
During the COVID-19 pandemic period of 2020 to 2023, school-based health centers served as a dependable place for students to receive health services — even as many health centers and doctors’ offices became more challenging to access.
“When access to care is disrupted, such as through a pandemic, we see worsening outcomes for adolescents, lower access to care,” Garbers explains. “School-based health centers bridge the gap because adolescents have access to convenient and youth-friendly care.”
Being perceived as youth-friendly is very important to improving healthcare access for adolescents, she adds.
“Access to primary care, behavioral health, and reproductive health has been shown to improve adolescent health outcomes,” Garbers says. “When adolescents don’t have access to reproductive health services, they have worse outcomes.”
Cost and perceived friendliness are each important to ensure access for adolescents.
“It’s not just being accessible during the school day, it’s also this notion of youth-friendly and how important it is to provide appropriate care to adolescents and how it’s perceived by adolescents to be accessible and have independence,” she says.
“When this study started, a school-based health center was offering telehealth services so students could come in and do telehealth counseling,” Garbers says. “What we found was the youth wanted to be there in person.”
The students wanted a good patient-provider relationship, and they recognized the school-based health center providers as being experts on their care and also knowing what their needs are, she adds.
“We were surprised by the telehealth findings,” Garbers says. “There are a lot of folks who talk about telehealth as expanding accessibility, but not necessarily using it to fill in the gaps.”
In theory, telehealth is a great idea, especially if it provides healthcare services for people at times that are more convenient for them, such as evenings and weekends.
“But during the school day, students want to go into the health center and value that connection,” she says.
Providers working with youth can enhance their connection with patients through following youth-friendly practices, such as the teach-back method, and delivering information directly and without a lecturing tone of voice, Garbers says.
“Use active listening, which means when the other person is talking, you’re not thinking about what you’re going to say next, and you are listening without judgment,” she says.
REFERENCE
- Groth R, Gold MA, Maier MC, et al. The role of school-based health centers in providing long-active reversible contraceptive care to adolescents in New York City. Sex Reprod Healthc 2024;100972. [Online ahead of print].
