School-Linked Reproductive Health Services (The Self Center)

Laurie Schwab Zabin, Janet B. Hardy, M.D.C.M. & Rosalie Streett, M.S.

FOCUS

SUMMARY

Originally launched as a partnership between junior and senior high schools and a neighborhood clinic, this program combines education, counseling, and reproductive services into a comprehensive intervention for youth. Services are provided by a team of nurses and social workers who divide their time between the schools and clinic. School-based components include: (1) at least one presentation to each homeroom class per semester to introduce the program and begin discussing values clarification, decision making and reproductive health; ( 2) informal discussion groups that arise as students seek advice and information from staff on such themes as pubertal development, drug use, and parenting; and (3) individual counseling sessions, available as needed, with a social worker. At the clinic, reproductive and extended counseling services are provided, and referrals are given for teens requiring medical care. Staff encourage students waiting for appointments to participate in discussion groups and examine educational videos and pamphlets. A three-year field test of the intervention was conducted in a low-income neighborhood in Baltimore, Maryland, where elevated rates of sexual activity and teen pregnancy had been recorded. Compared to their peers attending comparable schools, students in the target schools showed reduced levels of sexual activity and (among the sexually active) more effective use of contraception. These effects were greatest among the younger, sexually active girls and boys whose use of contraception was minimal at the start of the program. A delay in the onset of sexual activity was also recorded among abstinent youth.

SUITABLE FOR USE IN

This program can be implemented either by school-clinic or community-clinic partnerships. The clinic should be located in close proximity to participating schools or community organizations, or easily accessible to teens.

ORIGINAL INTERVENTION SAMPLE

Age, Gender
The program targeted all students enrolled in two urban schools, one junior high and one senior high (1700 students total). Nearly all students regularly attending school were exposed to at least one program component.

Race/Ethnicity
100% African-American.

PROGRAM LENGTH

This is a continuous, year-round program. The program nurse visits each homeroom class at least once during each semester. Program staff are available to students for individual counseling or informal group discussions in the school during lunch/free periods. The clinic portion of the program is available to teens year round-on weekday afternoons and during school vacations.

STAFFING REQUIREMENTS/TRAINING

One social worker and nurse (either nurse practitioner or nurse midwife) are required for each participating school or community organization. (Note: this was the arrangement for the original program implementation; your needs may depend on the size of the school(s) you plan to serve). A program administrator, preferably with an education or health education background, is needed for each clinic site. Other professionals (e.g., physicians) should be on call to provide necessary services and supervision.

   Primary Pregnancy Prevention
   Secondary Pregnancy Prevention
   STD/HIV/AIDS Prevention

ORIGINAL SITE
   School-Based
   Community-Based
   Clinic-Based

APPROACH
   Abstinence
   Behavioral Skills Development
   Community Outreach
   Contraceptive Access
   Contraceptive Education
   Life Option Enhancement
   Self-Efficacy/Self-Esteem
   Sexuality/STD/HIV/AIDS Education

COMPONENTS
   Adult Involvement
   Case Management
   Group Discussion
   Lectures
   Peer Counseling/Instruction
   Public Service Announcements
   Role Play
   Video
   Other
Peer resource team of student assistants & outreach workers: informal education & games
   

PASHA PROGRAM PACKAGE

The PASHA Program Package for this program includes:

  • PASHA User's Guide
  • School-Linked Reproductive Health Services Program Manual
  • A Set of Sample Educational pamphlets
  • A Set of Original Evaluation Instruments
  • Parental Notification Form
  • Evaluation of Pregnancy Prevention Programs in the School Context
  • Prevention Minimum Evaluation Data Set (PMEDS)
  • Local Evaluator Consultant Network Directory

  • Telephone technical support on implementation and evaluation for 1 year