Abstract
Background:Across the United States (U.S.), sexually-transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools play a critical role in improving access to sexual health services (SHS) due to their proximity and access to youth. Schools can increase student access to services by creating referral systems (RS) to link students to school- and community-based SHS. From 2013-2018, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools, and other stakeholders, to develop and implement RS to increase student access to SHS. CAI served as the Technical Assistance Center, providing capacity building to the LEA. CAI conducted a case study at two large urban LEA to elucidate factors that influence RS implementation in 2016-2017.
Methods:This mixed-methods case study included interviewing and surveying 19 LEA and community-based healthcare (CBH) staff in the Southeastern (n=9) and Western U.S. (n=10). Key constructs from the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Consensus qualitative research coding methods were applied to the interviews. We also distributed a quantitative survey to collect participants’ perceived difficulty in implementing and sustaining RS; data was analyzed using descriptive statistics.
Results:Interviewees reported strong beliefs that school-based RS can help students achieve better academic outcomes. We identified several contextual key factors across the five CFIR domains that influenced successful implementation and integration of an RS including: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies have significant influence to either impede or promote those policies.
Conclusions:Using an implementation science lens, this study describes key contextual factors and lessons learned to implementing an RS. Other schools may wish to consider these influencing factors to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.
P089 Evaluating online and clinic-based STI screening services: a case study of umbrella sexual health services, UK
