A longitudinal assessment of multi-site school based family planning clinics and the reduction of reproductive risks

This assessment describes the establishment, continuation and long term impact of four comprehensive school- based clinics on rates of pregnancy, sexual transmitted infections and HIV opt out testing among 3,000 students 14-19 years of age who utilized clinical services from 2005 to the present. Each clinic was initiated by the faculty of a medical school subsequent to the invitation of the high school administration and was sequentially rolled out over time at each of the four school campuses.  The medical and social work services addressed primary and reproductive needs of the enrolled students.  The impact of a variety of implementation issues among sites on clinical utilization rates and reproductive health outcomes were assessedand compared over tme by each campus using chart review. These issues included on-campus access to contraception, the introduction of long action reversible contraception(LARC), the adoption of opt-out HIV testing, the evolution of informed consent, and state sexual abuse reporting requirements. These clinical sites often became the catalyst for the adoption of best practices such as HPV innoculation for males and females, male reproductive health services and expanded primary care for uninusred youth populations.  These findings suggest that such clinical services can effectively reduce reproductive risks in vulnerable adolescent populations.  In addition, our comparisons underscore the importance of school leadership as a facilitator or a barrier to health promotion and disease prevention among adolescent students.