Toolkit for Improving Family Planning Services in School Settings
Strategies for Embedding Equity in School-Based Healthcare
Hannah Lantos, Lisa Kim, Jenita Parekh, Jennifer Manlove, Katherine Cushing, Andrea Shore, & Donnie Greco
The Robert Wood Johnson Foundation (RWJF) defines health equity with the following two components: 1. “everyone has a fair and just opportunity to be as healthy as possible”; and 2. obstacles to health must be removed to ensure equal opportunity. Obstacles may include “poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” This two-part definition makes clear that equity has an outcome component (everyone can be healthy) and a process component (removing obstacles). Achieving equity requires paying attention to student outcomes and to how inclusive the processes in your clinic are. Improved clinical processes can impact patient care—and focusing on both is essential for school-based health centers (SBHCs) to impact equity. In this foundational approach on equity, outcomes and processes are highlighted throughout different examples.
Using This Tool
Audience
Structure
Adapting equity strategies to your context
Needs Assessment Questions on Current Equity Strategies at Your Site
Strategies to Support Equity in School-Based Health Work
The strategies in this Foundational Approach focus on equity strategies related to improving systems and processes, tracking clinic improvements, and tracking or improving patient outcomes. Many will help your staff ensure that as many students as possible feel welcome, respected, and safe in your clinic and that systematic policies or procedures that create obstacles to advancing equity are removed. While these strategies were defined as relevant for schools with SBHCs, they could be useful for health care organizations that serve adolescents broadly or those looking to enter schools without a clinic to do outreach, education, or service provision. These strategies include approaches such as equitable communication, clinic and patient safety, or staff training.
Prioritize hiring staff who understand the communities you serve and their lived experiences
Prioritize hiring staff who understand the communities you serve and their lived experiences
Create a culture of transparency and openness
Create a culture of transparency and openness
Train on the history of racism and the social determinants of health
Train on the history of racism and the social determinants of health
Train on implicit bias
Train on implicit bias
Gather patient feedback systematically
Gather patient feedback systematically
Validate patient experiences and focus on patient-centered care
Validate patient experiences and focus on patient-centered care
Use inclusive, accessible, and plain language
Use inclusive, accessible, and plain language
Recognize patient autonomy and support their healthy literacy
Recognize patient autonomy and support their healthy literacy
Prioritize hiring staff who understand the communities you serve and their lived experiences
Create a culture of transparency and openness
Train on implicit bias
Gather patient feedback systematically
Validate patient experiences and focus on patient-centered care
Use inclusive, accessible, and plain language
Recognize patient autonomy and support their healthy literacy
Next Steps
Now think about potential next steps to embed equity into sexual health services and set some intentional goals. The following statements can serve as prompts to help you identify next steps.
Reflections on Goal Setting
1. Identify at least one new sexual health equity strategy to implement in your school-based health setting or organization over the next three months.
Think about what you discussed in response to the needs assessment questions and then identify new opportunities for sexual health equity in your SBHC. Ensure that your conversation identifies ways to reach all student populations or that if you narrow to focus on one population, it is intentional. Consider what data can help you identify the strategies on which you should focus.
2. Identify at least one existing sexual health equity strategy in your school-based health setting or organization to improve over the next three months.
Think about what is already happening in your SBHC regarding equity in your sexual health services. Consider what could be done more efficiently or more effectively and what efforts are not having the desired outcomes. Think about smaller changes that you can test and include in SBHC protocols. Ensure that your conversation identifies ways to reach all student populations. Then consider an additional small change. Consider what data can help you identify the strategies on which you should focus.
3. Identify at least one new sexual health equity strategy to implement in the school(s) where you are located over the next three months.
Think about new opportunities for schoolwide equity work related to sexual health services. Ensure that your conversation identifies ways to reach all student populations.
4. Identify at least one existing sexual health equity strategy in the school(s) where you are located to improve over the next three months.
Think about what your SBHC is already doing in the school regarding equity and sexual health that could be done more efficiently or effectively. Think about smaller changes that you can test and include in SBHC protocols. Ensure that your conversation identifies ways to reach all student populations. Then consider an additional small change.
General Resources and Further Reading
- The Commonwealth Fund Report on Confronting Racism in Health Care: This report details efforts that eight academic medical institutions are making to “reduce health disparities among their patients, create more equitable workplaces for their employees, and invest in communities of color where many of their patients and staff live.”
- Institute for Healthcare Improvement Presentation on Addressing Social Determinants of Health: This presentation focuses on practical solutions organizations can take to address social determinants of health and social needs.
- University of Colorado Denver Self-Guided Learning Tools on DEI: These tools serve as a starting point for individuals interested in furthering their understanding of DEI-related topics, including bystander intervention, DEI 101, gender visibility, intersectionality, and relationship violence.
- RHNTC Podcast Series on Advancing Sexual and Reproductive Health Equity in Family Planning: This podcast series includes four episodes that explore tips, programs, and frameworks to help clinics and programs address inequities in family planning and provide patient-centered care.
- School-Based Health Alliance (SBHA) Article on The Role of SBHCs in Achieving Health and Educational Equity: This article describes the critical role SBHCs in advancing health and educational equity for Black, Indigenous, and people of color (BIPOC) students.
- Paper on Innovative Approaches to Address Social Determinants of Health Among Adolescents and Young Adults: This paper highlights findings from a qualitative study that explores innovative strategies that programs across the U.S. use to address social determinants of health.
- Power To Decide, The Contraceptive Equity Initiative: This webpage provides information on a new effort from Power to Decide to address barriers to birth control access by expanding research efforts, bolstering policy efforts, and convening a learning collaborative of state and regional projects.
- National Coalition of STD Directors Training on Adolescent Health Equity: This training, hosted in May 2021, provides an overview of health equity and strategies for identifying and addressing health equity, racism, and stigma in adolescent SRH.
- DMPA-SC Planning Guide on Creating Equitable Access to High-quality Family Planning Information and Services: This strategic guide is for program managers, planners, and decision makers looking to identify inequities in family planning and implement interventions to address them.
- Paper on Developing and Strengthening New Strategies to Promote Adolescent Sexual Health: This paper describes findings from a literature review of six promising strategies to address challenges to reducing unintended adolescent pregnancies.
- Paper on Sexual and Reproductive Health Considerations for Transgender and Gender Expansive Adolescents: This paper describes current research related to SRH needs of transgender and gender-expansive youth and highlights areas for further research.
Suggested Citation
Lantos, H., Kim, L., Parekh, J., Manlove, J, Cushing, K., Shore, A., & Greco, D. (2022). Embedding Equity Approaches into Clinic Processes and Patient Interactions. Child Trends. https://doi.org/10.56417/3031i7003s
This publication is supported by the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2,036,999 with 100 percent funded by OPA/OASH/HHS. The contents reflect the views of the authors and do not necessarily represent the official views of, nor an endorsement by, OPA/OASH/HHS, or the U.S. Government. For more information, please visit https://opa.hhs.gov/.
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