Implementation Guide | Sustainability, Lessons Learned, and Conclusion

Sustainability

The Provider Referral Guide will need to be updated periodically. Included providers can be surveyed yearly to ensure they are still taking youth patients and to determine if there has been any change in clinic hours, location, or other pertinent clinic-related information. It may be necessary to remove providers the Provider Referral Guide if they are no longer accepting youth patients, are non-responsive, no longer provide sexual and reproductive health care on-site, or if the types of payment they receive has altered significantly. Additional providers may also be added during these yearly updates if it is learned that they might be a good source of sexual and reproductive health care for youth.

Implementation tip: Outside of major changes, other changes to the Provider Referral Guide may involve changes in services offered, such as the provision of male and/or female condoms. In the past, few providers have been removed from the Provider Referral Guide. Those which were removed were generally no longer accepting new youth patients or had shifted their focus to adult care.

Lessons Learned

• Identifying the pool of potential providers will require cooperation with the local health department. Data on reports of positive chlamydia tests, including the patient’s age and relevant provider information, must be routinely and systematically collected by the health department and the health department must be willing to share this information should a provider guide be developed by an organization outside of the health department. The cut-off used to determine which providers seem suitable for consideration may depend on local incidence and prevalence of the STD or health concern of interest among the youth population.
• A clinical infrastructure which is substantial enough to be able to support an influx of youth into the local health care community needs to already exist. The idea that youth can be linked to good providers only works if there are good providers available within a reasonable distance and if there is sufficient variability/dispersion among providers to create a web of available health care providers. Without either of these, institutions can still seek to link youth to available health care providers. However, the process used to develop the current Provider Referral Guide may be less applicable.
• Identify possible structural barriers which will need to be addressed, including:
  • Lack of transportation options, including lack of available public transportation serving provider locations if applicable;
  • Local school policies governing the release of students for confidential health care services during the school day without parent notification and awareness of such policies by relevant school personnel if they exist;
  • Availability of health care providers who have after-school and/or weekend hours;
  • Availability of Medicaid or state-based programs designed to cover the costs associated with youth sexual and reproductive health care.
• Someone will have to spearhead efforts to produce a Provider Referral Guide and build linkages between community-based health care providers and the youth-serving organizations. This person(s) may be in a health department, within the school system, or part of an outside agency. After development of the guide, annual update and review will require continued interest and a commitment to the allocation of personnel to the project if it is to be a sustainable effort.
• The main cost involved in the implementation of a provider guide is not money but, instead, staff time and motivation. There is a moderate time investment involved in the creation and culling of the provider pool and in the development of a Provider Referral Guide which contains all of the information needed by youth to take advantage of available health care options. Past this, the systematic updating of the material so that the information contained within is still relevant and timely will involve systematically and regularly revisiting the development process.
• Immediate evidence of success in the form of a significant uptick in the number of youth receiving screening and treatment from providers listed in the guide may not occur; however, over time, increased linkages between youth and sexual and reproductive health care providers and an increase in health care use by youth should occur.
• This approach may also provide opportunities to influence local providers’ practice.  Through ongoing contact with area providers, they can be supplied with updated guidelines, and by creating a referral guide with a set of criteria for inclusion, local providers may be encouraged to alter their practices to meet these criteria (e.g., becoming more teen friendly, providing services targeting younger patients).

Conclusion

Project Connect is a low-cost mechanism for linking youth to sexual and reproductive health care. It takes advantage of already existing systems (e.g., school nurses, community providers) and facilitates collaboration between community-based providers, schools and/or youth-serving organizations, and the local health department. The primary investment of resources occurs in the first year of development and derives primarily from the allocation of staff time to identifying providers, collecting pertinent provider information, compiling information into a guide format, and working with the implementing organizations to integrate the referral of students to health care. By providing youth with the initial link to community based health care providers, Project Connect begins the training and modeling process for youth to link into a broader health care community.