ROOSEVELT HIGH SCHOOL BASED CLINIC

A School-Community Health Care
Partnership:
How to Make it Teen-Friendly
Roosevelt High School Health Center
Los Angeles Unified School District &
Planned Parenthood Los Angeles
Presented at the
National Assembly on School-Based Health Care Convention
June 28, 2011
Objectives
Through a presentation of a case study, participants will
be able to:
1. Describe elements of a school-community
partnership that improve access to health services
for teens
2. List three ways students can assist in outreach,
education and advocacy for health care for
adolescents
3. Identify methods to use community needs and
resources to drive meaningful partnerships
The School and Community Context
for a Clinical Partnership
Sherry Medrano, MSN, CPNP
Roosevelt High School
School Health Center
Los Angeles Unified School District
• 2nd largest school
district in the nation
• 625,000 K-12 students
• 850 schools
• 35 school-based health
clinics
• Rapidly changing
organizational structure
East Los Angeles (Boyle Heights)
• Densely Populated:
– 16,248 persons per square mile
– vs. Beverly Hills: 2,315
persons/sq mi
• Large population of
undocumented families
• High Poverty
60% at or below Federal
Poverty Level
East LA/Boyle Heights (90033)
• Increased Crime
Activity
• High
Unemployment
rate
Roosevelt High School
• Founded 1922
• One of the largest
schools in the
nation
• 99% Hispanic
• 83% Free Lunch
• High teen birth
rate (5.7% among
15-19 year old
females)
Roosevelt HS:
“Hot Spot”
Boyle Heights Health Resources
LAC-USC
Medical Center
(Public/County)
White Memorial
Medical Center
(Private)
AltaMed Clinics
(FQHC)
Oscar Romero
Clinics (FQHC)
Roybal Health
Center
(Public/County)
s County Medical Center
White Memorial Medical Center (Private)
Bienvenidos
Family
Services
2nd Street ES
SBHC
Roosevelt HS
SBHC
Planned
Parenthood
Roosevelt HS Clinic Development
• Opened SBHC in
1997 partnering
White Memorial
Medical Center
and District
Full Medi-Cal (Medicaid)
program, incl Title XReproductive Health
1995
Declining hours of
operation and fewer
services
• District and
hospital
providers
replaced with a
contracted IPA
group
2000
Medi-Cal / EPSDT
program and Title X
• Reopened
SBHC in 2006
operating
with District
NP only
Limited services,
mostly Medi-Cal/
EPSDT
2005
PPLA Peer Advocate
Program established
•Future
integration
with school
mental
health?
•Expanded
services with
PPLA?
• District
established
partnership
with Planned
Parenthood LA
in Sept 2008
Peer Advocate
programs
increase at
Roosevelt HS
Full teen wellness
center?
Peer Advocates
integrate with
SBHC
2010
Roosevelt HS Clinic Visits after
District-PPLA partnership
5000
4500
4000
Confidential
Services
3500
3000
Episodic
Visits
2500
Immunizations
2000
1500
Physical
Exams
1000
500
0
2007-08
2008-09
2009-10
2010-11*
* Year-to-date for May 2011
Roosevelt HS ClinicConfidential Services Users
600
500
400
300
MALE
VISITS
200
FEMALE
VISITS
100
0
2007-08
2008-09
2009-10
2010-11*
as of 5/31/11
Roosevelt HS ClinicReproductive Health Care Services
400
350
300
250
BIRTH CONTROL
HOPE
200
EC
150
PREG TEST
ONLY
100
50
0
2007-08
2008-09
2009-10
2010-11*
as of 5/31/11
Roosevelt HS ClinicSTI Health Care Services
Chlamydia testing
400
7 (2%)
350
Gonorrhea testing
400
350
7 (2%)
300
300
250
250
4 (2%)
200
150
POS
CT
200
POS
GC
CT
150
GC
100
100
50
50
0
0
2007-08
2008-09
2009-10
2010-11*
as of 5/31/11
400
2007-08
2008-09
2009-10
HIV testing
350
300
250
200
POS
HIV
150
HIV
100
50
0
2007-08
2008-09
2009-10
2010-11*
2010-11*
as of 5/31/11
Roosevelt HS Clinic PartnershipHow do we measure success?
250
200
150
PREG TEST
ONLY
100
POS
PREG
TEST
50
32 (?%)
3 (4.5%)
10 (4.6%)
7 (4.4%)
0
2007-08
2008-09
2009-10
2010-11*
as of 5/31/11
Roosevelt HS Clinic Partnership
Community/school needs
• High poverty, uninsured
• High teen pregnancy
• Limited access to teen health services
Community resources
• Medical centers (public and private)
• Community clinics
• PPLA
School resources
• School-based health center
• Students: patients, advocates, peer leaders
• School staff: school nurse, teachers, counselors
Identify your own community/school needs
and resources to drive meaningful,
“win-win” partnerships
Community/School
needs
•
•
•
Community
resources
•
•
•
School resources
•
•
•
Peer-to-Peer Outreach, Education,
and Advocacy for Teen Health
Services
Aurora Bermeo
Angelica Ortega
Peer Advocates
Roosevelt High School
Examples of Outreach and
Education by the Peer Advocates
Teen-Friendly Clinic Services
Reasons to be a Peer Advocate
• Top 10
List ideas for engaging and involving students
in teen-friendly school-based health services
Outreach
•
•
•
Education
•
•
•
Advocacy
•
•
•
Roosevelt High School
Peer Advocate Program
German Rodriguez
Director of Youth Development Programs
Planned Parenthood Los Angeles
Planned Parenthood Los Angeles
• Largest provider of reproductive health service (Title X) in Los
Angeles County.
• PPLA consists of 3 main departments:
– Client services
– Education
– Community Services and External Affairs.
• 17 health centers throughout Los Angeles County; 2 additional
health centers will be opening by the end of 2011.
• Services include:
–
–
–
–
–
–
Pregnancy testing and counseling
STI screening and treatment
Contraception
Abortion services
Adoption referrals
Cancer screenings
PPLA’s Relationship with Roosevelt HS and the
Boyle Heights Community
The peer advocate program is just one of many
strategies in the community and school.
• High School Program, which provides education for
9th grade health classes.
• The Promotoras program works with parents.
• The Middle School Program provides education to
the local middle schools that feed into Roosevelt HS.
• The Youth Development programs provides
presentations to local CBO’s as well as after-school
programs.
Peer Advocate Program Overview
• In 2005, the PPLA Circulo de Salud program, based at the
Bixby Boyle Heights Teen Center began an innovative new
approach to addressing the high rates of STIs and teen
pregnancy in the Boyle Heights Community and at
Roosevelt HS.
• 12 energetic, intelligent and
dynamic young women were
recruited and trained to
outreach to other teens on STIs,
teen pregnancy, health service
and more.
All were certified as Family
Planning Health Workers
through the California Family
Health Council (CFHC).
Peer Advocate Program Overview
Why Peer Advocates?
• New approach to addressing the high rates of STIs
and pregnancy among teens at Roosevelt HS.
• Teens have the potential to make a big impact on
other teens. They know who needs the services.
• The peer advocate program encompasses each
aspect of PPLA: education, client services and
advocacy and have strategies related to each.
Training Peer Advocates
•
•
•
•
•
•
Initial application process
One-on-one interviews
Monthly stipends
Minimum of 1 year commitment
3 months of training
Regular convening with other
local youth organizations
• On going leadership
development
Peer Advocate Outreach Strategies
• Education:
–
–
–
–
–
Informational tables at lunch on health topics
Announcements and articles regarding various youth issues
Educational posters
One-to-one outreach to students
Classroom presentations to students on local youth
resources
– Using social media and directing
other youth to online resources
such as Get Yourself Tested website,
and The Beacon Network
Peer Advocate Outreach Strategies
• Advocacy:
– Outreach and education sessions on voting and legislation.
– Events that encourage students and families to get
involved in protecting reproductive rights.
– Meet with local and state level elected officials to continue
their support for School-Based Health Centers.
Peer Advocate Outreach Strategies
• Client Services
– Informing students on the location and services offered
through the school based clinic.
– Hosting open house events and other activities for teens
at the school-based clinic.
– Outreaching to students on
school-based condom
distribution program.
Evaluation of Peer Advocate
Program
How do we know we are successful?
• All Peer Advocates complete the California Family Health Council
written and oral exams.
• Peer Advocates were given a pre-test to measure their knowledge and
attitudes and are evaluated throughout the year.
• Peer Advocates remain pregnancy-free during their participation in the
program
• Students participate in a health assessment as well as surveys related
to STIs, pregnancy prevention
• Increase in number of students utilizing services through the schoolbased health clinic.
5000
4000
Confidential
Services
3000
Episodic
Visits
2000
Immunizations
1000
Physical
Exams
0
2007-08
2008-09
2009-10
2010-11*
A School-Community Teen-Friendly
Health Care Partnership:
Lessons Learned
Kimberly Uyeda, MD, MPH
Los Angeles Unified School District
Lessons Learned
Challenges to overcome
• Lack of teen-friendly
services in school
– school districts do not
have the capacity to
provide reproductive
health care
Strategies that work
• Look for partners that
have a reproductive
health focus
– Title X providers (i.e.,
PPLA)
– Community Clinics
Lessons Learned
Challenges to overcome
• Administration or staff
disagree with reproductive
health care on campus
Strategies that work
• Provide data on the need
– Teen birth and STI rates
available from state and
county public health
– School nurse or counselors
may collect anecdotal
information
– Consider linkages to
community resources
• Engage leaders and
champions (on and off
campus)
Lessons Learned
Challenges to overcome
• There is no room for a
SBHC on campus
Strategies that work
• Teen services may be
delivered without a
clinic
– “Clinic without walls”
– Mobile van services
– Consider linkages to
community resources
– Screenings at health fairs
or through classes
Lessons Learned
Challenges to overcome
• Teens don’t know about
the SBHC or schoollinked clinic
Strategies that work
• Engage teens in
outreach
– Formal peer advocate
program (e.g., PPLA)
– Leadership club at
school
– Project of health class or
health academy
Lessons Learned
Challenges to overcome
• There is no funding to
support peer health
advocates
Strategies that work
• Recognize that Peer
Advocate programs help
both partners
– Clinic provider benefits from
peer-to-peer outreach (and
increased visits)
– School benefits through
better student outcomes
• Engaged youth
• Leadership development
• Potential career pathways
• Build into a school club or
project of a health class or
health academy
List ideas for overcoming barriers and
challenges to the delivery of teen-friendly
school-based health services
Challenge 1:
• Solutions:
•
Challenge 2:
•
•
Challenge 3:
•
•
Sherry Medrano,
Nurse Practitioner Roosevelt High School Clinic, LAUSD
[email protected]
German Rodriguez,
Director Youth Development Programs, PPLA
[email protected]
Kimberly Uyeda,
Director Student Medical Services, LAUSD
[email protected]
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