Integrated Reproductive Healthcare in School-Based Health Centers Improves Adolescents Access to Long-Acting Reversible Contraception

Abstract

Objective: Long-acting reversible contraception (LARC) is the most effective reversible method of contraception, yet there remain many barriers preventing adolescents in the United States from using it. To mitigate these barriers, Heartland Health Center (HHC) changed the workflow in their school based health centers (SBHCs), introducing a novel integrated model of reproductive healthcare. This project aimed to assess changes in contraceptive provision based on the new model of care. Methods: The integrated model of care includes a certified nurse midwife (CNM) staffing the SBHCs intermittently to provide longer counseling sessions and dedicated time for procedures. Electronic medical records were utilized from before and after the implementation of this model to assess change. Chi-square tests were used to test the significance of change and the association between clinical and demographic data. A Poisson regression model was utilized to estimate the incidence rate ratio (IRR) for the likelihood of receiving LARC.Results: LARC prescriptions rose from just 0.6% in 2016 to 3.9% in 2018 (p<0.001). Further, data showed that students were 17.4 times more likely to get LARC prescriptions in 2018 than in 2016 (p<0.001). The percentage of prescriptions for emergency contraception rose from 9.8% to 24.1% and the percentage of prescriptions for injections fell from 43.7% in 2016 to just 27.1% in 2018.Conclusions: The present model of integrated reproductive healthcare not only has the potential to improve access to methods of contraception that are challenging to receive, but it also provides an opportunity for specialized providers to deliver culturally competent, trauma informed sexual health education and medical care. This study also provides the foundation for a future study investigating student experience and outcomes based on the new model.

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