Below are three different screening models ranging from the least time and resource intensive to the most.
Screening in the classroom is the least time and resource intensive.
The SBHC can give a class presentation about the clinic, services available, and purpose of screening. They can also provide some health education (i.e., meaning of minor consent, confidentiality, psychoeducation/mindfulness).
Then students can complete the confidential screen as a large group or in small groups of 5-8 (hard copy or electronic).
Pros
Less time and resource intensive
Reach a larger audience more quickly – time efficient
Easier for administrators to agree to one-time interruption
Cons
Students do not visit or enroll at the health center
Missing the experience of getting to know and build relationship with health center staff/providers
Students can visit the SBHC in small groups or as a whole class.
Hands-on/participatory stations can be set up for students to get familiar with the health center. One station should be dedicated to helping the youth complete the screen.
SBHCs could make this a ‘career exploration’ – an opportunity to/talk to career professionals at each station.
Pros
Students become familiar with the health center and health center staff – leads to future visits
Hands on/participatory
Provides opportunity for career exploration
Cons
Can be more time and resource intensive
Students do not register as patients
Not doing an individual, person to person screen with a provider
Students complete the paperwork to enroll as a clinic patient (can happen prior to visit).
Students can visit the SBHC in small groups or as a whole class. Stations can be set up for students to get familiar with the health center.
Students receive a brief one-on-one provider visit. This visit is billable (MediCal or Family PACT).
Pros
Students become familiar with the health center and health center staff
Students enrolled as patients – leads to future visits
Increase percentage of students served – identifying students who may not come through other means or who may have unmet needs
A billable service
Cons
More time and resource intensive
Can have push back from schools for enrolling students for FPACT
Location of Screening SBHC Space
If you need private areas for confidential discussions or exams, consider how other space in your clinic might be re-purposed in addition to the exam rooms (such as offices, conference rooms, or lab areas) in order to increase your capacity for seeing multiple patients at once.
Don’t forget to consider spatial logistics and potentials for bottlenecks in your flow, such as only having one bathroom in your clinic if your goal is to collect urine samples for STI screening on multiple students in a short period of time.
If other clinic services will be suspended during the event, develop a secondary plan for how urgent or acute drop-in visits will be handled. If you anticipate generating a large number of follow-up visits from your program, consider how you might adjust future clinic schedules and/or recruit additional staff or providers to accommodate.
Be creative in maximizing space for your screening needs. If your program includes interventions that are non-invasive and/or can be conducted in semi-private areas, consider talking to the school about using large areas such as the gym, cafeteria, or auditorium and developing temporary privacy screens or partitions to divide up the space.
If you use a venue outside the clinic for screening, but patient recruitment and/or exposure to your clinic is one of your goals, see if there is a way to incorporate a visit to the clinic as part of the screening program.
Timing of Screening Program Duration
Once you have determined the group and approximate numbers of students you intend to screen, create a detailed and realistic schedule for your screening event, including checking in students, onsite health education, measurements, surveys, additional testing you will include, and any face-to-face time with a provider.
This should result in an estimate of the staffing you will need and the number of students you can feasibly screen in one class period. Then estimate the number of class periods it will take to complete screening for your population of choice.
As soon as possible, contact the school administration to review the overall school calendar and identify a time that will avoid major schedule conflicts, such as school vacations, standardized testing weeks, and/or other school-wide celebrations (graduation, etc.) and allow adequate time for follow-up.
If the school desires the screening program to coincide with a particular course (i.e., science, health, etc.), be sure to consult with teachers as to when it might fit best in the curricular plan.
If you are planning to incorporate the use of health profession trainees to expand your personnel capabilities, consult with program faculty to determine if trainee availability will coincide with your timeline.
The above information will help you narrow down the days and times when your screening program can take place. Even if overall coordination is done with the school administration, it is wise to connect with individual teachers directly to ensure that you are not conflicting with any scheduled classroom initiatives, tests, or field trips.
This information is adapted from the Population-Wide Screenings in Schools Guide: A publication of UCSF and Family Health Together. We are grateful to our partners at ETR for funding and the UCSF School of Nursing for creating this content: Naomi Schapiro, RN, PhD, CPNP; Emily Green, RN, PhD; Victoria F. Keeton, PhD, RN, CPNP-PC; and Ivette Gutierrez, M.A.
We would also like to acknowledge Alameda County Center for Healthy Schools and Communities, Oakland Unified School District, La Clínica de la Raza, Native American Health Center, Lifelong Medical, Karen Gersten-Rothenberg, and Joanna Bauer for their contributions to this toolkit.
