What Works: Sexual Health Services
The Centers for Disease Control and Prevention’s Division of Adolescent and School Health (DASH) has established an evidence-based approach schools can implement to help prevent HIV, STDs, and unintended pregnancy among adolescents. It includes quality health education, systems that connect students to health services, and safer and more supportive school environments. This info brief focuses on increasing access to sexual health services—preventive health care services that schools can connect students to either on site or in the community.
Just 2% of schools across states and 12% of schools across large urban school districts provide condoms for students.
Sexual health services (SHS) cover broad preventive measures, like taking a sexual history or risk assessment; education; and counseling, testing, and treatment for human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs). SHS can significantly improve an adolescent’s immediate and lifelong health by identifying health issues early and providing services. As young people grow and become sexually active, these services provide health information and tools to help them prevent HIV, STDs, and unintended pregnancy. SHS also ensure that health issues are caught early to enable effective treatment. Several national guidelines for preventive care* and treatment recommend providing SHS for adolescents.
However, many students may not seek or have access to SHS. Even among those who do have access, missed opportunities for receiving SHS are common. Schools can play a critical role in raising awareness about the importance of SHS and connecting students to these preventive services.
Examples of SHS include:
- HIV testing and treatment
- STD testing and treatment
- Contraceptive services
- Health guidance and counseling.
Schools can provide students with access to sexual health services on site or in their community.
- Schools can offer on-site SHS through their own healthcare infrastructure, such as school-based health centers (SBHCs) and school nurses. Schools may also bring in community partners to provide services, such as periodic, school-wide STD screening events or mobile clinics.
- Schools that cannot provide ongoing SHS on school grounds may link students to youth-friendly providers in the community through referrals. To create a successful referral system, schools need to build strong relationships with community providers, such as health departments, community-based organizations, and primary care providers. The cornerstone of a referral system is a referral guide—a list of local youth-friendly SHS providers along with their locations, phone numbers or websites, and other information.
In addition to linking students to services, schools can help improve staff, parent, and student knowledge, awareness, and comfort with adolescent needs for sexual health information and services. For example:
- Hosting quarterly or yearly meetings with healthcare providers can give school staff the opportunity to meet providers, learn about the services they offer, and create ways for students to connect with them.
- Professional development to build staff comfort, capacity, and expertise in adolescent sexual health can improve clinical services in a variety of settings, including SBHCs.
- Sharing information with parents and families on SHS-related topics—such as recommendations for routine, preventive care and how to create a trusting relationship with a provider—may help support student use of SHS.
- Marketing campaigns for students can raise their awareness of SHS, encourage positive attitudes about getting services, and improve healthy behaviors.
Provide professional development to staff on how to use a referral guide and how to create a referral. See Developing a Referral System for Sexual Health Services: An Implementation Kit for Education Agenciesexternal icon for tips and tools.
Train a broad selection of school staff—from teachers, counselors, and social workers, to coaches and security guards—to know the basics about SHS. This includes educating staff about laws and policies around patient confidentiality and minors’ rights to consent to care, as well as policies and procedures for parental consent.
Incorporate information about SHS into your school’s sexual health education curriculum. This leverages your healthcare team’s efforts.
Increasing access to and awareness of sexual health services has positive impacts on student health.
- SBHCs are associated with increased contraceptive use and sexual health care visits, and declines in unintended pregnancy.
- A referral program that helps school nurses connect students to youth-friendly, community health providers increases students’ use of contraception services, STD testing, and counseling.
- Other school programs, such as condom availability programs, school-based STD screening events, and sexual health awareness campaigns, can improve students’ beliefs and attitudes about condom use and STD testing, and their use of SHS.
Here’s how schools can improve student access to sexual health services:
- Provide annual training and professional development to school and health service staff to support SHS activities
- Teach students how to access school-based and community SHS as part of their sexual health education curriculum pdf icon[PDF – 70 pages]
- Improve student use and quality of SHS provided by school-based health centers
- Establish or improve use of a referral system to link sexually active students to community healthcare providers
- Raise student awareness of SHS programs by implementing school-wide, student-planned marketing campaigns
- Organize field trips for students and key school staff to visit community-based, provider organizations
- Conduct school-based HIV and STD screening events
- Implement or improve a condom availability program
- Distribute SHS-related materials to parents and families.
- CDC. PS18-1807 Program guidance: Guidance for school-based HIV/STD prevention (component 2) recipients of PS18-1807. Atlanta, GA: U.S. Department of Health and Human Services; 2019.
- Hagan JF, Shaw JS, Duncan PM. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 4th ed. Elk Grove Village (IL): American Academy of Pediatrics; 2007.
- US Preventive Services Task Force. Guide to clinical preventive services. Alexandria (VA): International Medical Publishing; 1996.
- Elster AB, Kuznets NJ. AMA guidelines for adolescent preventive services (GAPS): Recommendations and rationale. Baltimore (MD): Williams & Wilkins; 1994.
- Klein JD, Handwerker L, Sesselberg TS. Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users. J Adolesc Health 2007;41(2):153-60.
- Ethier KA, Dittus PJ, DeRosa CJ. School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. J Adolesc Health 2011;48(6):562-65.
- Amaral G, Geierstanger S, Soleimanpour S. Mental health characteristics and health-seeking behaviors of adolescent school-based health center users and nonusers. J Sch Health 2011;81(3):138-45.
- Soleimanpour S, Geierstanger SP, Kaller S. The role of school health centers in health care access and client outcomes. Am J Pub Health 2010;100(9):1597-603.
- Dittus PJ, De Rosa CJ, Jeffries RA, Afifi AA, Cumberland WG, Chung EQ. The Project Connect health systems intervention: linking sexually experienced youth to sexual and reproductive health care. J Adolesc Health 2014;55(4):528-34.
- Dittus PJ, Harper CR, Becasen JS. Structural intervention with school nurses increases receipt of sexual health care among male high school students. J Adolesc Health 2018;62(1):52-8.
- Loosier PS, Doll S, Lepar D. Effectiveness of an adaptation of the Project Connect health systems intervention: youth and clinic-level findings. J Sch Health 2016;86(8):595-603.
- De Rosa CJ, Jeffries RA, Afifi AA, Cumberland WG, Chung EQ, Kerndt PR. Improving the implementation of a condom availability program in urban high schools. J Adolesc Health 2012;51(6):572-9.
- Dunville R, Peterson A, Liddon N. Sustained reduction in chlamydia infections following a school-based screening: Detroit, 2010–2015. Am J Pub Health 2018;108(2):231-3.
- Rohrbach LA, Berglas NF, Jerman P. A rights-based sexuality education curriculum for adolescents: 1-year outcomes from a cluster-randomized trial. J Adolesc Health 2015;57(4):399-406.
- Liddon N, Carver L, Robin L, Harper C, Murray C, Habel MA. Get Yourself Tested (GYT) goes to high school: adapted STD prevention campaign and associated student use of clinic STD testing services. Sex Transm Dis 2019;46(6):383-8.