Teens Linked to Care (TLC)

A teacher talking with students

Teens Linked to Care (TLC) is a three-year pilot project to assess the feasibility of implementing integrated prevention strategies to address both substance use and sexual risk among youth in high-risk rural communities.

Adolescence is a critical high-risk period for the initiation of substance use and progression to addiction. Teens with substance use disorders experience higher rates of physical and mental illnesses, and diminished overall health and well-being.

Research shows that behaviors and experiences related to sexual behavior, high-risk substance use, violence victimization, and mental health contribute to substantial morbidity in youth, including risk for HIV, STDs, and teen pregnancy. Data indicate that these four risk behaviors co-occur, and some young people may experience more than one risk behavior. Primary prevention of high-risk substance use among youth presents an important opportunity to prevent infectious diseases and protect the mental and physical health of adolescents.

The project is a collaboration between the Centers for Disease Control and Prevention (CDC), the CDC Foundation, the Conrad N. Hilton Foundation, and three pilot sites: Scott County School District 1 (Austin, Indiana), The Brighton Center (Campbell County, Kentucky), and Portsmouth City Health Department (Portsmouth, Ohio).

The goal of the pilot is to develop a framework for schools to address HIV, STD, teen pregnancy, and high-risk substance use (i.e., use of prescription, illicit, or injection drugs) among youth through education, primary prevention, and early detection screening.


Of the students screened for risky substance use behavior through TLC:


received brief intervention by a health care provider


were referred to substance use treatment


$1.5 million in funding has been awarded for the 3-year pilot initiative (2016 – 2018).


The CDC Foundation and CDC staff routinely conduct on-going needs assessments, monitor progress, assess processes, and evaluate outcomes.

TLC Accomplishments

The TLC pilot sites implement program activities through their Youth Advisory Boards (YAB) and Community Advisory Boards (CAB). The three pilot sites have successfully:

  • Implemented new health education curricula reaching all students in their respective high schools that address prevention of HIV, STD, teen pregnancy, risky sexual behavior, and substance use;
  • Developed and distributed products, such as directories and fliers, that promote youth-friendly health service providers in their communities in order to increase access to HIV, STD, and substance use screening and testing, as well as other health services;
  • Collaborated with local health departments to offer health screenings to identify those most at risk for HIV, STDs, teen pregnancy, and high risk substance use;
  • Collected data about student opinions and experiences with bullying at school, resulting in a review of school bullying policies due to the association between bullying and substance use;
  • Produced anti-bullying and anti-opioid campaign videos to promote positive school climates where students feel safe from bullying and the risk of substance use; and
  • Partnered with their community’s drug-free coalition to leverage resources and increase youth and adult knowledge in substance use and prevention.

Next Steps

Future activities include developing a framework that integrates school-based strategies for the prevention of high-risk substance use and HIV, STDs, and teen pregnancy. The framework will be based on lessons learned during the pilot and will allow the three sites to move from implementation to outcomes (i.e., behavior change evaluation). This framework will also help inform a second phase of TLC where it could be expanded to additional rural schools and modified for large urban areas with communities that have youth that are at high risk for substance use.