Social media post from Holyoke Health Center
Adolescent Sexual and Reproductive Health (ASRH) Services Get a Fresh New Look
When health center staff like Glorimar Irizarry, the Women’s Health Program Lead at Holyoke Health Center in Massachusetts, spent time listening to teen patients about ASRH care, it brought her attention to changes she needed to make in her clinic. Glorimar explains, “It’s important for us to understand that our teens have their own rights, their own opinions, and they can advocate for themselves to have their needs understood.” She learned that something as simple as the clinic environment makes a big difference in how open and comfortable her teen patients feel there.
Since the 1960s, Community Health Center staff have understood how we live, work, worship and play affects our health. Today, 300,000+ health center staff provide whole-person care to over 31.5 million patients –yet we may not fully understand or address the needs of our adolescent patients (over 5.2 million aged 11-21 in 2022).
The National Association of Community Health Centers (NACHC) recognizes that adolescents and young adults, especially black or African American adolescents, have disproportionately high rates of syphilis, chlamydia, and gonorrhea (as seen in CDC data from 2022). NACHC is also aware of the American Academy of Pediatrics’ reporting that preventive STI testing with sexually active adolescent females and young men who have sex with men is lower than it should be (Annual STI Testing Among Sexually Active Adolescents, April 2022). At the same time, voluntary family planning and screening for sexually transmitted infections (STIs) are required at health centers and within the scope of primary care.
How Can We Improve ASRH Services? – Q4T (Quality 4 Teens) Shows You
In response to these trends and with support from the CDC Division of Reproductive Health, NACHC worked with Cicatelli Associates Inc. (CAI) and a diverse group of health centers and national experts over the past three years to learn what can be done to improve care for adolescent patients. The result is Q4T (Quality for Teens): A Quality Improvement Package for Adolescent Sexual and Reproductive Health.
Q4T is a transformative new tool that helps health center staff look at quality ASRH services in a new light, with tangible strategies for improvement.
The Q4T (Quality 4 Teens) improvement package, recently released, is filledwith easy-to-adopt strategies for five essential clinical service goals and three youth-friendly practice goals:
- ASRH Clinical Service Goals
- Recommended screening for sexual activity and sexual risk assessment
- Behavioral counseling related to sexual health
- Recommended chlamydia and gonorrhea screening and follow-up
- Patient-centered contraceptive counseling
- Same-day access to the full range of contraceptive methods
- Youth-Friendly Practice Goals
- Welcoming and accessible environment established
- Confidentiality protected
- Trauma-informed approach integrated into care
Q4T resources are customizable, allowing users to tailor thoughtful strategies for the specific needs of each patient group and clinic.
What Do Teens and their Pediatricians Think?
As a contributor to the development of Q4T over the past three years, Ms. Irizarry organized conversations with teen patients to learn how to establish a welcoming and accessible clinical environment (one of the Q4T Youth-Friendly Practice Goals). She and her team used these insights to make enhancements, as Dr. Despina Lekakis explains below. Even simple changes like creating a dedicated clinic space for teens led to an increase in patient satisfaction and better care.
Dr. Lekakis, Pediatrician at Holyoke says, “Our health center had a great experience using the Q4T change package. The youth opened our eyes. We learned we needed to add behavioral health information and intimate partner violence information in clinic spaces used for teen health. They wanted STI testing information and access to free condoms and female hygiene products in our bathrooms since they’re happier to just take what they need rather than ask. Plus, we learned to include LGBTQIA+ signage and posters.” She then shared, “The kids now say they feel more comfortable here and they know we support them. Since those conversations, I’ve had kids kind of nod to say “nice poster”, and I know we did something right.”
Since one-third of Holyoke’s 14,000 patients are under 24 years old and from multiple Latino cultures, Glorimar and Dr. Lekakis are eager to connect with their patients and provide care in more meaningful ways.
Howard Smith, PA-C, DMSc, Chief of Pediatrics at Southwest Community Health Center in Connecticut is direct when he explains, “I think we now have a blueprint with Q4T that allows us to improve care for adolescent patients – specifically around reproductive health and STI measures. I would most definitely recommend the Q4T resource to other health center providers.”
Q4T Can Be Used to Improve ASRH in Any Clinic Setting
Although Q4T was designed for ASRH quality improvement in health centers, it can be transformative for any clinical setting. We invite you to try it at: https://www.quality4teenshealth.org.
If you have questions or would like to learn more, contact Caryn Bernstein, MPH, Deputy Director, Clinical Care and Quality, NACHC, cbernstein@nachc.com.