O2029: Innovations Driving a More Comprehensive Well Visit at a School Based Health Center

Background: School-based health centers (SBHCs) provide comprehensive health care delivery particularly for marginalized and vulnerable populations that may otherwise struggle with access to health care. While adolescents are frequent utilizers of SBHCs, they still experience barriers to ongoing care and referrals. Given those challenges, it is particularly important for well care in SBHCs to be as comprehensive as possible to maximize available “face time” with the patient. Here we will describe a trio of innovations to the SBHC adolescent well visit through the incorporation of social determinants of health via a lens of adolescent friendliness.

Methods: The first intervention is an expanded approach to screening for sexually transmitted infections (STI) not predicated on disclosure of sexual history. A second intervention involves standardizing healthcare transition education through electronic medical record alerts, routine use of a transition screening instrument, and tracking a transition readiness self-assessment score annually to guide a “warm hand-off” to local adult medical providers. A third intervention consists of screening all adolescent patients for adolescent relationship abuse inclusive of digital dating violence, monitoring behaviors, and physical abuse among other harmful relationship patterns.

Results: This expanded screening criteria for STIs resulted in twice the number of tests performed as compared to a baseline period in an unchanged population, but yielded over three times as many positive tests, suggesting that previous testing criteria was insufficient in detecting chlamydia effectively in our population. The intervention also led to subsequent increased encounters for STI treatment, re-screening, clinical guidance, education, and annual health supervision visits. Clinics also noted an increase in peer referrals and self-referrals to the SBHC for reproductive health care concerns.

Quality improvement initiatives around healthcare transition readiness, including Plan Do Study Act (PDSA) cycles, have thus far resulted in 80% of well care visits including transition assessment, transition counseling, and transition readiness scoring which is tracked longitudinally. Transition guidance is provided on an individual basis at least annually according to areas of need for each adolescent.

Partner violence focused quality improvement infrastructure, including PDSA cycles, have resulted in greater than 55% of health supervision visits including screening and guidance about adolescent relationship abuse. Regardless of screening outcome, education is provided about healthy relationships and support systems. This destigmatizes conversations around intimate partner violence and results in a wraparound educational approach in the SBHC allowing young people to feel safe disclosing harmful relationships and ask for support navigating complex social connection.

Conclusion: These interventions have become a routine part of the annual health supervision visit for adolescent patients in the SBHC and offer an efficient, comprehensive, and adolescent-friendly experience. In addition to providing more robust care for at-risk youth, these innovations also encourage continuity and increased utilization of the SBHC through empowerment of the adolescent population.