Implementation Guide | The Road Map - Key Action Steps

Environmental scan

Identifying areas with high rates of STD morbidity among youth is the first step in implementing Project Connect. In general, this is done in coordination with the state or local health department, as they will have information on rates of reportable infections, such as chlamydia, gonorrhea, and HIV, along with other demographic factors. Geocoded data can be used to pinpoint high morbidity areas, and demographic information can provide insight into the makeup of the target population. Once a geographic area is selected, the next step is to identify partners within the community who have access to these at-risk youth. These partners can provide not only a venue through which to disseminate materials and advertise but also insight into the health care needs of the youth they serve. It may be necessary to ask community partners about the types of youth they serve to make sure that their constituency aligns with the identified target population.

Implementation tip: Project Connect can be implemented through schools or through other agencies within the community. Juvenile justice programs, after-school care programs, or other community based organizations might provide a good venue for reaching at-risk youth.

Health Care Infrastructure Scan and Provider Referral Guide Development

The initial selection of providers to include in the guide constitutes a multi-step process.

Step 1:

If possible, develop an initial pool of potential providers by partnering with the state or local health department to identify all providers within the areas identified during the environmental scan who meet certain, pre-identified criteria. For example, it may be helpful to select the initial pool from providers who have reported a certain number of cases of chlamydia among youth. Further information about these providers should be collected before they are included on the Provider Referral Guide. Providers offering a wide range of sexual and reproductive health services and providers with a youth-friendly practice should be prioritized.

Implementation tip: In Los Angeles, providers in the initial pool reported 10 or more cases of chlamydia among 15-19 year olds in the past year. This cut-off was chosen because it was thought that it would identify a population of providers who were seeing a large number of youth, who had access to an at-risk population, and who were screening youth for chlamydia and reporting results. In order to increase the variability and dispersal of providers included in the pool, some providers were included who reported fewer than 10 cases of chlamydia among 15-19 year old patients. Recommendations for additional providers could be provided by: 1) school nurses who recommended a clinic they felt comfortable with or who had heard about a clinic from students; or 2) additional branches of clinics which met the earlier inclusion guideline of 10 or more cases. Additional providers recommended for inclusion in the guide were cross-referenced with the local health department to ensure that they had reported chlamydia cases among 15-19 year olds in the past year.

Step 2:

Survey health care providers identified through the health care infrastructure scan to learn about their practice. Topics of interest include: a general description of the services offered, whether they are taking new adolescent patients, if they see boys and girls, if they offer emergency contraception, and if they are interested in being included in the Provider Referral Guide. Consider removing providers if they are non-responsive after multiple attempts, do not routinely collect sexual history/sexual activity information from youth, do not screen sexually active youth for chlamydia, do not offer STD treatment on-site (e.g., only screen, not treat), or do not provide free services.

Implementation tip: Completion of this initial survey takes approximately 20-30 minutes. Because of the busy nature of most clinicians, the clinic manager may be your best contact within a clinic. You can contact providers by phone or in-person to collect this information.

Step 3:

Visit all providers who remain eligible after Step 2 to collect information on: ease of access, location information, locally available public transportation routes convenient to the facility, accessibility issues, and the receptiveness of staff to youth patients.

Implementation tip: If a clinic has a pronounced focus on prenatal care, you may want to note this on the Project Connect referral guide so that youth not in need of this service can find a clinic better suited to their needs.

Step 4:

Build a Project Connect Provider Referral Guide. Content may include:

• Clinic information, such as name, address, phone number, and website;
• General information, such as distance from implementation site and available public transportation routes;
• Availability of evening and weekend appointments;
• General services, such as gender of patients seen and youth friendly features offered (e.g., a youth check-in area, youth coordinator, youth-focused materials, and/or a youth waiting room);
• Sexual and reproductive health services, including urine-based chlamydia testing, family planning methods available, availability of male and/or female condoms, hormonal contraception availability, and emergency contraception availability (as needed or in advance);
• Whether services, including free or sliding scale payment options as well as participation in Medicaid or other insurance programs.

Implementation tip: The typical number of providers listed on a Project Connect Provider Referral Guide ranges from 10-20. In the past, the guide has been distributed as 8.5 x 11 inch, double-sided tear-away notepads or pocket guides to be given to youth, or as a poster displayed by the key touchpoints for easy reference. See examples from Los Angeles and Detroit. Online versions are in development and may be the best way to reach youth in certain communities.

Training and Dissemination

Although it is important to train partner organizations on the purpose for and delivery of Project Connect, it is unlikely that this will be an onerous process. In fact, the most difficult thing may be getting the right people together for training.  Consider including others aside from identified key touchpoints in this training, such as administrators, on-staff health care providers, and frontline staff, who will be important to intervention success. In the past, training has taken an hour or less. Because of its simple and straight-forward nature, extensive training on the use of the actual Provider Referral Guide itself will only take a portion of the time. This discussion will likely consist primarily of an explanation of the categories of information available on the guide and the rationale behind their inclusion. The rest of the time can be devoted to other issues that complicate youths’ referral for health care. Key touchpoints may have questions about state laws outlining minors’ ability to consent for health care, the confidentiality of provided health care services, concerns about any personal responsibility associated with referring youth to local health care providers, or other issues.  In some locations (e.g., schools), there may also be training needs around raising awareness of the sexual and reproductive health care needs of the youth served by partner organizations.  This can be an essential step in securing the support of key touchpoints who will be counted on to make referrals.

Implementation tip: After an initial group training, it may only be necessary to hold individual or small group trainings if there is turnover in key staff at partner organizations.  In schools, when referring students off-campus during the school day, attendance staff need to be involved as well as those making the referrals.