SBHCs & Sexual Health | Sexual Health Education | Teen Dating Violence | SBHCs & TDV | Resources
Teen Pregnancy & STIs Have Long-Term Consequences
Each year, 750,000 American adolescents, aged 15-19, get pregnant.1 Although recent data show a decrease in teen births — driven by increased contraceptive use and increased use of effective contraception — there is still room for significant improvement.2 In California 32 of every 1,000 adolescent girls aged 15-19 have babies each year.3 Notably, this statistic masks persistent and troubling racial/ethnic disparities: annually, for every 1,000 adolescent girls aged 15-19 living in California, there are 51 births to Latinas, 37 to African Americans, 12 to whites, and 9 to Asians.4
Rates of the most common sexually-transmitted infections (STIs), including chlamydia and gonorrhea, peak in late adolescence. Youth aged 15-24 account for more than half of all STIs, including HIV, diagnosed annually.5
Despite their clear need for reproductive health care, adolescent girls access fewer reproductive health services, including contraception services, than young adult women.6 In fact, only 41% of adolescents have accessed reproductive health services.7 Research consistently shows that adolescents “face numerous barriers to accessing needed [reproductive] healthcare, including lack of familiarity with the healthcare system, limited ability to pay for services, fear of disclosure of confidential information to family and friends, and uncertainty about their ability to access [reproductive healthcare] services without the consent of a parent or guardian.”8
Recent research underscores the connection between adolescent reproductive health outcomes and educational outcomes. Nationally, while almost 90% of girls who do not give birth as teenagers earn a high school diploma by age 22, only slightly more than 50% of all girls who do give birth as teenagers achieve this milestone.9
SBHCs Provide Critical Reproductive & Sexual Health Care
Many school-based health centers (SBHCs) provide confidential, developmentally appropriate reproductive and sexual health services for adolescents. These services may include sexual health education, contraception, pregnancy and STI testing, counseling, and referrals to outside services. Research has shown that SBHCs effectively address reproductive and sexual health needs.
- SBHCs provide STI screening/treatment to adolescents who often have no other source of care.10,11
- SBHCs effectively deliver HPV vaccinations to adolescents, including those who are uninsured.12
- Adolescent girls with SBHC access are more likely to get reproductive preventive care, use hormonal contraception, and to have been screened for an STI, than similar girls without an SBHC.13
- SBHCs can reduce the unplanned pregnancy rate among adolescents.14,15
Sexual Health Education: California Healthy Youth Act
The California Healthy Youth Act (AB 329) went into effect in January 2016 and requires schools to provide all students in grades 7-12 with age-appropriate sexual health education that is comprehensive and medically accurate.
The law mandates that curriculum must be LGBTI inclusive so that no students are left out, regardless of their gender identity or sexual orientation. It also requires schools to provide information on sexually transmitted infections/HIV prevention, pregnancy prevention, consent, and healthy relationships (how to avoid adolescent relationship abuse and sex trafficking).
Teen Dating Violence: Prevalent & Disruptive
According to the CDC, teen dating violence (also known as adolescent relationship abuse, or ARA) is defined as the physical, sexual, or psychological/emotional violence within a dating relationship, as well as stalking.16 It can occur in person or electronically and may occur between a current or former dating partner.
The 2009 CDC Youth Risk Behavior Survey revealed that 9.8% of high school students report being hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend in the 12 months prior to the survey.17 The 2010 National Intimate Partner and Sexual Violence Survey, revealed even more alarming statistics: About 1 in 5 women and nearly 1 in 7 men who ever experienced rape, physical violence, and/or stalking by an intimate partner, first experienced some form of partner violence between 11 and 17 years of age.18
Teen dating violence is also referred to as adolescent relationship abuse because adolescence spans a long time (ages 10-24) and reference to abuse includes a range of abusive behaviors and not only physical violence.19
“Teen dating violence [is] far too prevalent and prevents far too many students from being able to focus on their education.” Kevin Jennings, the Assistant Deputy Secretary, U.S. Department of Education
Research has shown a strong connection between teen dating violence and poor health outcomes. For example, teens who are victims of physical dating violence are more likely than their non-abused peers to smoke, use drugs, engage in unhealthy diet behaviors (taking diet pills or laxatives and vomiting to lose weight), engage in risky sexual behaviors, and attempt or consider suicide. Note that some youth also experience reproductive coercion: abusive behaviors by male partners intended to promote pregnancy in females.20 Female public high school students who reported ever experiencing physical or sexual violence from a dating partner in a Massachusetts study were four to six times more likely than their non-abused peers to have been pregnant and eight to nine times more likely to have attempted suicide in the past year.21
SBHCs Prevent & Address Teen Dating Violence
Healthy relationships, particularly in the context of dating or sexual activity, play an important role in increasing the use of contraception and preventing teen pregnancy. Being located in schools, school-based health centers (SBHCs) are in close proximity to teens’ social environment and have a unique ability to assess adolescents for dating violence and reproductive coercion. SBHCs can also provide counseling support or referrals to address these issues, in addition to promoting respectful relationships through both clinical and classroom education. Adolescent relationship abuse is common among adolescent seeking services, with one study reporting a 40% lifetime prevalence of physical/sexual violence victimization among adolescent females who use urban teen clinics.22 In an adolescent relationship abuse (ARA) intervention pilot study with two adolescent health centers (one of which was an SBHC), researchers found that clients welcomed providers discussing healthy relationships with them, and they saw significant increases in youth knowledge of ARA-related resources, and reductions in tech abuse.23
The California School-Based Health Alliance conducted a review of research and interviews with select SBHCs to gain a better understanding of interventions that are currently being utilized in the exam room and at school. Please see our new Addressing Teen Dating Violence at School-Based Health Centers resource highlighting key TDV strategies and interventions employed by SBHCs in California.
Resources for Practice
Reproductive Health Policy Statement
This policy statement outlines the benefits of offering comprehensive reproductive health education and services at SBHCs. The statement provides a rationale for, and offers recommendations on the delivery of, such services and can be a useful advocacy tool.
The statement begins: “We believe adolescents should have access to comprehensive, age-appropriate information and services in order to make informed decisions about their health and well being. School health centers provide a safe, confidential and youth friendly environment that is accessible to all students.”
Attracting & Retaining Adolescent Patients
This toolkit can assist SBHCs that serve the entire community in maintaining an adolescent-friendly practice to ensure the best healthcare experience for a young person. The resource walks through each step of an average appointment—from the front desk, to the waiting room, to the medical visit—and provides strategies for creating an adolescent-friendly practice with visibility throughout the school. In addition, it presents policy advocacy opportunities for those interested in advancing adolescent-friendly health services.
Teen Pregnancy Prevention at School-Based Health Centers: Challenges & Opportunities
School-based health centers (SBHCs) have played a strong role in California’s efforts to prevent teen pregnancy. This paper reviews current trends in teen birth rates, changes in state and federal funding, and innovative “pay-for-success” financing mechanisms that may provide a new funding opportunity. SBHCs are well positioned to partner in these new financing opportunities and suggestions for how SBHCs can best prepare themselves are provided.
Comprehensive Sexual Health Education Materials
In partnership with the California School Boards Association, we hosted a one-day Policymaker Leadership Institute on comprehensive sexual health education.
Office of Population Affairs Teen Pregnancy Prevention Program
The Office of Population Affairs’ (OPA) Teen Pregnancy Prevention (TPP) program has released seven new pregnancy prevention interventions that have experienced positive outcomes when evaluated for effectiveness.
The seven TPP programs serve populations that experience disproportionately high levels of teen pregnancy and sexually transmitted infections (STIs), such as Black and Latinx youth, non-exclusively heterosexual female youth, and youth in rural areas.
See the new interventions here.
It’s Your Sex Life
The Kaiser Family Foundation and MTV have partnered to create the It’s Your Sex Life campaign. The campaign includes youth-friendly, online resources on preventing pregnancy, STDs and testing, and relationships.
Sexual Health: An Adolescent Provider Toolkit
The Adolescent Health Working Group has recently released Sexual Health: An Adolescent Provider Toolkit. It includes screening tools, counseling guidelines, and health education materials for teens and their adult caregivers.
Birth Control Implants
Essential Access Health has a website and resources on LARCs, which are long-acting reversible contraception. You can learn more by visiting their website here.
In April 2009, Essential Access Health (formerly the California Family Health Council), the California Department of Public Health, STD Control Branch, and Internet Sexuality Information Services, Inc., ( ISIS ) launched the Hookup, a statewide text messaging service. The service aims to provide youth with relevant and accurate sexual and reproductive health information and a convenient, confidential resource for accessing local clinics that offer free or low-cost sexual and reproductive health services. The online home for the Hookup service is Teensource, Essential Access Health’s website for youth.
Bedsider has a website for youth which explains the various birth control methods, where to get them, reminders to take birth control, and frequently asked questions. They also have a website for providers which offers various resources.
UCSF Bixby Center for Global Reproductive Health
The Bixby Center has done research on best practices for adolescent sexual health programs as well as has some resources.
Rutgers University started Sex, etc. is a website created by teens, for teens. It has various sexual health resources.
I Wanna Know
The American Sexual Health Association created I Wanna Know, a website on sexual health for teens and young adults. Topics covered include: sexual health, STIs, relationships, and LGBTQ.
What Works: Curriculum-Based Programs that Prevent Teen Pregnancy
This brief, from the National Campaign to Prevent Teen and Unplanned Pregnancy, provides an overview of what is known about evaluated interventions that help delay sex, improve contraceptive use, and/or prevent teen pregnancy. It includes a list of 30 effective programs and information on how to obtain them.
Teen Pregnancy and the Achievement Gap Among Urban Minority Youth
This article, Healthier Learners Are Better Learners by Charles E. Basch, describes how disproportionate rates of teen pregnancy among urban minority youth contribute to the achievement gap. It highlights the prevalence of teen pregnancy and outlines ways schools can help to prevent it, while also supporting students who are pregnant and parenting.
California Teen Legal Guide to Sex, Pregnancy, and Parenting
On this website, lawyers from The National Center for Youth Law answer questions that teens might have about teen’s legal rights and responsibilities related to sex, pregnancy, and being a young parent in California.
Building Emergency Contraception Awareness Among Adolescents
This Toolkit for Schools and Community-Based Organizations provides suggestions for increasing emergency contraception (EC) awareness among adolescents and adults in schools and communities. Developed by the Academy for Educational Development, it provides basic information about emergency contraceptive pills, makes the case that adolescents should know about EC, prepares adults to increase access and awareness among adolescents (as well as among their own peers), identifies resources for keeping current on the issues, and suggests evaluation strategies. The report discusses EC issues specific to schools, SBHCs, and community-based organizations, and includes sample letters, articles, forms, protocols, and instruments.
California Healthy Youth Act
The following resources can help educators and school-based health practitioners learn about this new requirement for California schools.
- California Family Health Council’s On-Demand Webinar on the CA Healthy Youth Act
This free webinar clarifies all sections of the CA Education Code (51930-51939) that were updated with the passage of the Healthy Youth Act. It also provides specific examples of how the purpose of the act, required criteria, and required instruction can all be implemented to provide comprehensive sexual health education in grades 7-12 in compliance with the HYA.
- The American Civil Liberties Union of Northern California’s Know Your Rights: Sex Education
The ACLU of Northern California works with parents and community members to ensure that the sex education provided in local schools is medically accurate and in compliance with California law. This page has materials they have developed to help you understand the law and advocate for better sex education in your schools.
National Sexuality Education Standards
The first-ever national standards for sexuality education in schools provide clear, consistent, and straightforward guidance on the essential minimum, core content for sexuality education that is developmentally appropriate for students in grades K through 12. The standards are the result of a cooperative effort by the American Association for Health Education, the American School Health Association, the National Education Association Health Information Network, and the Society of State Leaders of Health and Physical Education, in coordination with the Future of Sex Education (FoSE) Initiative.
Sample School District Policies on Sexual Health Education
- CSBA Board Policy Sample on Comprehensive Sexual Health Education
- Fremont Unified School District Health and Sex Education Advisory Committee Case Study
- Fresno Unified School District Case Study
- San Diego Unified School District Case Study
- San Francisco Unified School District Case Study
- Selma Unified School District Case Study
Sexual Health Education Websites and Resources
- ACLU of Northern California: California Healthy Youth Act Toolkit
- California Department of Education
- Overarching California Health Education Content Standards and Rationales
- California Healthy Kids Resource Center: Sexual Health Curriculum Review Form
- National Institute of Reproductive Health: Urban Initiative Website
- Rutgers University: Answer Sex Ed, Honestly
- National Campaign’s What Works in Teen Pregnancy Prevention
- Asian Communities for Reproductive Justice: Parent Communication Toolkit
- California Latinas for Reproductive Justice: Focus Group Findings Report
- California Parents’ Preferences and Beliefs Regarding School-Based Sex Education Policy. N.A. Constantine, P Jerman, A.X. Huang. Perspectives on Sexual and Reproductive Health, 2007, 39(3) :167-175
Understanding Confidentiality and Minor Consent in California
The Adolescent Health Working Group has an adolescent provider toolkit on Understanding Confidentiality and Minor Consent in California.
For many other resources, see our Consent and Confidentiality section.
Sample Protocols & Tools
- Wallet cards providing education and resources to adolescent students
- Sample flow chart on SBHC ARA (Alameda High SBHC)
- LAUSD resolution on ARA
- Attracting and Retaining Adolescent Patients
- Student Health Services Dating Abuse Screening and Response Protocol (Austin School District)
Domestic Violence Organizations
Futures Without Violence, formerly, the Family Violence Prevention Fund, works to prevent and end violence against women and children around the world. Futures Without Violence works to advance the health, stability, education, and security of women and girls, men and boys worldwide through education, train professionals such as healthcare providers, coaches, and judges on improving responses to violence and abuse, and also work with policymakers and advocates to end violence against women and children. There is also a large focus on violence prevention with tweens and teens.
The California Partnership to End Domestic Violence (CPEDV) is a statewide membership coalition comprised of 150 member organizations and individuals across the state to foster unity within the domestic violence movement in California. CPEDV works on public policy issues, increase community awareness, strengthen members’ capacity, and provides a plethora of trainings and resources to the field.
Peace Over Violence is a sexual and domestic violence, stalking, child abuse and youth violence prevention center based in Los Angeles and dedicated to building healthy relationships, families and communities free from sexual, domestic and interpersonal violence. Peace Over Violence works with many schools throughout Los Angeles with their In Touch with Teens program and is also a site of the Robert Wood Johnson Foundation’s Start Strong program, a national initiative targeting 11-14 year-olds to prevent teen dating violence and abuse.
The National Domestic Violence Hotline hosts the loveisrespect website. Loveisrespect’s purpose is to engage, educate, and empower young people to prevent and end abusive relationships. Their website is for young people and has a chat and text line.
Domestic Violence Program Models & Resources
Start Relating Before They Start Dating is an online guide of the Start Strong initiative for parents to find information and tools to talk with their kids about healthy relationships. The guide also includes information on how parents can communicate with their teens who are part of the digitally savvy generation.
Break the Cycle is a leading, national nonprofit organization addressing teen dating violence by providing honest, practical help and information for teens and young adults. The organization focuses on prevention education, legal services, public awareness campaigns, youth leadership and activism, and training and support for adults who work with teens.
Dating Matters is a evidence-based teen dating violence prevention model developed by the Centers for Disease Control to stop teen dating violence before it starts. It focuses on teaching 11-14 year olds healthy relationship skills before they start dating and reducing behaviors that increase the risk for dating violence, like substance abuse and sexual risk-taking.
Literature & Reports on TDV
Prevention in Middle School Matters: A Summary of Findings on Teen Dating Violence Behaviors and Associated Risk Factors Among 7th-Grade Students – Robert Wood Johnson Foundation report
Understanding teen dating violence: practical screening and interview strategies for pediatric and adolescent healthcare providers. Cutter-Wilson, E. & Richmond, T. (2011), Current Opinion in Pediatrics, 23, 379-383.
Cyber Dating Abuse Among Teens Using School-Based Health Centers. Dick, R., McCauley, H., Jones, K., Tancredi, D., Goldstein, S., Blackburn, S., … Miller, E. (2014). Pediatrics, 134 (6). Retrieved from https://pediatrics.aappublications.org/content/pediatrics/early/2014/11/12/peds.2014-0537.full.pdf
(1) Ralph, L.J & Brindis, C.D. (2010). Access to Reproductive Healthcare for Adolescents: Establishing Healthy Behaviors at a Critical Juncture in the Lifecourse. Current Opinion in Obstetrics and Gynecology. 22:369-374.
(2) Guttmacher Institute. (2012). New Government Data Finds Sharp Decline in Teen Births: Increased Contraceptive Use and Shifts to More Effective Contraceptive Methods Behind This Encouraging Trend. http://www.guttmacher.org/media/inthenews/2011/12/01/index.html
(3) California Adolescent Sexual Health Work Group. (2010). 2008 California Data for Adolescent Births, AIDS, STDs. http://www.californiateenhealth.org/uncategorized/now-updated-with-2008-data-ashwg-data-tables-and-charts-for-adolescent-births-aids-and-std.
(4) Ralph et al.
(5) Ralph et al.
(6) Hall, K.S., Moreau, C., Trussell, J. (2011). Discouraging Trends in Reproductive Health Service Use Among Adolescent and Young Adult Women in the USA, 2002-2008. Human Reproduction. 0(0): 1-8.
(7) Hall et al.
(8) Ralph et al.
(9) Child Trends. Fact Sheet: Diploma Attainment Among Teen Mothers. http://www.childtrends.org/Files/Child_Trends-2010_01_22_FS_DiplomaAttainment.pdf. Accessed October 2011.
(10) Braun, R.A. & Provost, J.M. (2010). Bridging the Gap: Using School-Based Health Services to Improve Chlamydia Screening Among Young Women. American Journal of Public Health. 100(9): 1624-1629.
(11) Crosby, R.A. & St. Lawrence, J. (2000). Adolescents’ Use of School-Based Health Clinics for Reproductive Health Services: Data from the National Longitudinal Study of Adolescent Health. Journal of School Health. 70(1): 22-27.
(12) Gold, R., Naleway, A.L, Jenkins, L.L., Riedlinger, K.K., et al. (2011). Completion and Timing of the Three-Dose Human Papillomavirus Vaccine Series Among Adolescents Attending School-Based Health Centers in Oregon. Preventive Medicine. 52: 456-458.
(13) Ethier, K.A., Dittus, P.J., DeRosa, C.J., Chung, E.Q., et al. (2011). School-Based Health Center Access, Reproductive Health Care, and Condom Use Among Sexually Experienced High School Students. Journal of Adolescent Health. 48: 562-565.
(14) Ricketts, S.A. & Guernsey, B.P. (2006). School-Based Health Centers and the Decline in Black Adolescent Fertility During the 1990s in Denver, Colorado. American Journal of Public Health. 96(9): 1590-1592.
(15) Koo, H.P., Dunteman, G.H., George, C., Green, Y., et al. (1994). Reducing Adolescent Pregnancy through a School- and Community-Based Intervention: Denmark, South Carolina, Revisited. Family Planning Perspectives. 26(5): 206-211.
(16) Centers for Disease Control, Injury Center: Violence Prevention site.
(17) Centers for Disease Control, Youth Risk Behavior Survey, 2009
(18) National Intimate Partner and Sexual Violence Survey, 2010
(19) National Institute of Justice, Office of Justice Programs, 2011
(20) Centers for Disease Control, Injury Center: Violence Prevention site.
(21) Silverman, J, Raj A, et al. 2001. Dating Violence Against Adolescent Girls and Associated Substance Use, Unhealthy Weight Control, Sexual Risk Behavior, Pregnancy, and Suicidality. JAMA. 286:572-579.
(22) Roberts TA, Auinger P, & Klein JD. (2005): Intimate Partner Abuse and the Reproductive Health of Sexually Active Female Adolescents. Journal of Adolescent Health 36: 380-385.
(23) Miller E, Decker MR, Raj A, Reed E, Marable D, & Silverman JG. (2009): Intimate Partner Violence and Health Care-Seeking Patterns among Female Users of Urban Adolescent Clinics. Matern Child Health J.