O2119: Smells Like Teen Spirit- Enhancing the Adolescent Friendliness of School Based Health Centers

Background: The Policy Statement on Achieving Quality Health Services for Adolescents from the American Academy of Pediatrics emphasizes the importance of, and inherent challenges in, high-quality adolescent-friendly healthcare. Adolescents are infrequent utilizers of preventive care with the lowest primary care usage rate of any age group in the US. The policy recommends specific interventions to close this gap such as confidential care, prioritizing patient feedback, and decreasing barriers to access. An adolescent-friendly environment where teens feel safe, comfortable, and valued is key to best outcomes in this population. School based health centers (SBHCs) are well-positioned to address adolescent health concerns due to location, accessibility, and integration; however, a clinic’s teen friendliness likely impacts willingness to seek care there. We describe an assessment and improvement process in partnership with the Adolescent Health Initiative (AHI) aimed at improving 12 key areas of the adolescent-centered experience for two SBHCs.

Methods: AHI developed the Adolescent Centered Experience- Assessment Process in partnership with both youth and professional collaborators. Data was reviewed via electronic medical record (EMR) and anonymous patient feedback surveys collected at initiation and termination. Provider confidence was also assessed at the beginning and end. Process improvements were implemented including self-scheduling via patient portal, clinic environment changes (robust soundproofing, hygiene and comfort stations, and visual displays of affirmation for teens), and increased integration of behavioral health. Training was provided for SBHC staff, including risk assessment, cultural responsiveness, LGBTQ+ care, and best practices in patient confidentiality, among others. EMR was optimized to ensure standardization of interventions.

Results: Participation in this process resulted in improvement in all key areas of adolescent friendliness, especially behavioral health practices, adolescent empowerment, and engagement. Patient feedback showed clinic environment changes increased comfort when discussing sensitive topics. Implementing self-scheduling options lead to more visit initiated by teens as well as increased visits overall. SBHCs saw increased STI and depression screening and follow up appointments, leading to volume growth, more comprehensive care, and risk reduction. Providers reported enhanced confidence in adolescent health topics due to added training and EMR support. Patient experience feedback showed improvement in nearly all categories, with the greatest increases seen in “I will tell my provider all of my concerns, even if they don’t ask,” and “I am completely honest when talking with my provider.” Both clinics were awarded Gold Level Certification in Adolescent Centered Environments from AHI.

Conclusion: As a result of our participation in this process, we were able to further remove barriers to access, increase patient visits, improve adolescent-friendliness, and advance comprehensive care delivery to teens seen in SBHCs. Staff also became more confident navigating complex topics of adolescent health. Additional opportunities include expanding the process to other clinic sites and further developing the patient feedback process.