Reproductive Care & Telehealth: A Vital Tool in the Prevention & Education of Teens & Young People
The 2020 COVID pandemic forced School-Based Health Centers (SBHCs) to quickly pivot to telehealth in order to deliver services among school closures and ever changing COVID-19 guidelines and regulations. While some SBHCs had already begun utilizing telehealth, for others the transition was more abrupt and the NY School-Based Health Foundation (the Foundation) knew that SBHC staff had developed creative solutions to address barriers students faced in receiving care.
This is the story of BMS Family Health Centers’s SBHCs and how they continued to deliver reproductive health services through the pandemic, as told by former Health Program Coordinator, Rosemary Polanco.
BMS Family Health Center (BMSFHC) aims to promote healthy social and physical environments in the Brownsville and East New York communities in Brooklyn, while increasing community access to health care. As a federally qualified health center (FQHC), BMSFHC offers a sliding fee scale, providing comprehensive services to an underserved area including those who utilize their school-based health center (SBHC) at Jefferson high school.
Within their SBHC, BMSFHC provides medical care, counseling, health education, and access to other health services across their practices – at no cost to the students or the parents. In total, their SBHC serves a combined 1,200+ students within the five individual academies that are housed on the Jefferson Campus.
On March 16th, 2020, at the start of the COVID-19 pandemic, former Mayor Bill de Blasio ordered that all schools be closed down. This included closing existing SBHCs until schools were able to either reopen or begin operating by telehealth.
Like other health centers, the closures forced BMSFHC to adapt, offering telehealth appointments across all their clinical and non-clinical services. Typically, these include physical examinations, reproductive health, preventative immunizations, vision and hearing screenings, administration of emergency medications, nutrition and self-care health education, as well as behavioral health services and many more. However, with the limitations of telehealth, the majority of their SBHC offerings had to be adapted and some took to telehealth better than others, such as mental health, counseling and education services.
While challenging, the team continued offering the majority of their services via telehealth, and learned some valuable lessons along the way. Using these lessons, the SBHC team at BMSFHC discovered new ways to deliver vital reproductive services to students whose main point of access was their SBHC.
Access to high-quality and comprehensive family planning services helps promote adolescent sexual and reproductive health (1). However, youth—especially those who are historically excluded or who live in resource-limited areas (2)— often face challenges in accessing services, including lack of awareness about available services (3), fears about confidentiality (4), or lack of culturally sensitive practices in clinics (5).
By providing sexual and reproductive health services in school-based settings, clinicians are able to tackle some of these barriers faced by youth and deliver preventative services and treatment to those who need it. For BMSFHC, reproductive services include birth control and emergency contraception, STI/HIV testing, pregnancy testing, and sexual health education.
Given the number of students who rely on these services, it is important that staff continue to deliver reproductive care through school and clinic shutdowns in order to prevent pregnancy and/or transmission of any STIs among sexually active students.
Ms. Polanco describes a situation involving a student who came into the clinic for STI testing prior to a school break. Knowing how anxious the student was to receive her results, staff was able to contact the patient via telehealth, schedule a video visit, read her results, provide her with counseling, and guide her on the symptoms to look out for and what to do in the event of an emergency.
The patient was then able to come to the school the next day and receive treatment. The student later returned to the Nurse Practitioner at the SBHC who mentioned how happy the student was that she was able to receive her results and guidance even though she wasn’t in school.
For the SBHC team, this instance represented a huge success for telehealth as they were able to potentially avoid transmission of the STI by advising the student to delay sexual activity as well as provide the patient with peace of mind knowing her status. They were also able to provide information to help her understand her symptoms and what to look out for as urgent, especially during a prolonged school break when her symptoms could worsen.
Given the sensitive nature of these conversations, the BMSFHC team ensures their students receiving telehealth services are aware of their confidentiality policy around reproductive services. During the height of COVID-19, the team received training around maintaining confidentiality with students virtually. They typically begin sessions by asking, “Are you in a safe space? Are you able to speak freely? Are you alone right now or is there someone there with you?”
Now with students back to in-person learning, the majority of reproductive services are once more delivered face-to-face. However, telehealth is still utilized for certain purposes as the BMSFHC team recognizes its value to inform students on SBHC services via virtual clinic tours, and deliver health education and counseling services for students.
Applied to reproductive services in particular, telehealth is utilized to inform students on birth control methods, sexual consent education, birth control counseling, and STI education.
Beyond these education and counseling offerings, Ms. Polanco notes how telehealth has allowed SBHC staff to be prepared for anything, “For reproductive health, I think the only thing moving forward is to continue to do counseling, continue to do access and health education. But at least we’re comfortable enough in knowing that if we ever find ourselves in a situation where we’re having to work virtually, and not able to see the patients in person–that we know we can provide those services via telehealth and that we have safe ways of providing those services to ensure the students get the same service, quality, confidentiality, that they would receive if they were in person.”
Now, no school closures or student absences can prevent clinicians from delivering vital reproductive care to students in need. For providers serving young adults and teens, telehealth allows the delivery of much needed services and education, and is an important tool for removing barriers to care and ensuring that these conversations continue despite whatever outside circumstances that may prevent access.
