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Research article
Emily Leung
CAI
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1742-0303
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Across the United States, sexually transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools, due to their proximity and access to youth, can increase student access to sexual health services (SHS) by creating referral systems (RS) to link students to school- and community-based SHS. From 2013-2018, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools and stakeholders to develop and implement RS to increase student access to SHS. Cicatelli Associates Inc. (CAI) was funded to provide capacity-building to LEA. In 2016-2017, CAI conducted case studies at two LEA, both large and urban sites, but representing different geographical and political contexts, to elucidate factors that influence RS implementation.
Methods Nineteen LEA and community-based healthcare (CBH) staff were interviewed in the Southeastern (n=9) and Western U.S. (n=10). Key constructs (e.g., leadership engagement, resources, state and district policies) across the five domains of the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Qualitative data was analyzed using the Framework Method and contextual factors and themes that led to RS implementation were identified.
Results Interviewees strongly believed that school-based RS can decrease STI, HIV and unintended pregnancy and increase students’ educational attainment. We identified the following contextual key factors that facilitate successful implementation and integration of an RS: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies can have significant impact and influence to impede or promote those policies.
Conclusions Through the use of the CFIR framework, the interviews identified important contextual factors and themes associated with LEAs’ implementation barriers and facilitators. The study’s results present key recommendations that other LEA can consider to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.
Keywords
Consolidated framework for implementation science, School health, Implementation tools, Case study methods , Implementation , Sustainability, School-based referral system
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CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 3
Posted 24 Mar, 2020
No community comments so far
Editorial decision: Accept
On 23 Mar, 2020
Editor assigned
On 19 Mar, 2020
Submission checks complete
On 18 Mar, 2020
Editor invited
On 18 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 17 Mar, 2020
Review #1 received
Received 14 Mar, 2020
Reviewer #1 agreed
On 29 Feb, 2020
Reviewers invited
Invitations sent on 27 Feb, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
Editor invited
On 16 Feb, 2020
No comments provided
Editorial decision: Major revision
On 16 Dec, 2019
Review #2 received
Received 03 Oct, 2019
Reviewer #2 agreed
On 16 Sep, 2019
Review #1 received
Received 13 Jul, 2019
Reviewer #1 agreed
On 12 Jul, 2019
Reviewers invited
Invitations sent on 12 Jul, 2019
Editor assigned
On 28 Jun, 2019
Submission checks complete
On 24 Jun, 2019
Editor invited
On 24 Jun, 2019
First submitted
On 21 Jun, 2019
Metrics
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PDF Downloads: ...
HTML Views: ...
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See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Emily Leung
CAI
Corresponding Author
ORCiD: https://orcid.org/0000-0003-1742-0303
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 3
Posted 24 Mar, 2020
No community comments so far
Editorial decision: Accept
On 23 Mar, 2020
Editor assigned
On 19 Mar, 2020
Submission checks complete
On 18 Mar, 2020
Editor invited
On 18 Mar, 2020
No comments provided
Editorial decision: Minor revision
On 17 Mar, 2020
Review #1 received
Received 14 Mar, 2020
Reviewer #1 agreed
On 29 Feb, 2020
Reviewers invited
Invitations sent on 27 Feb, 2020
Editor assigned
On 17 Feb, 2020
Submission checks complete
On 16 Feb, 2020
Editor invited
On 16 Feb, 2020
No comments provided
Editorial decision: Major revision
On 16 Dec, 2019
Review #2 received
Received 03 Oct, 2019
Reviewer #2 agreed
On 16 Sep, 2019
Review #1 received
Received 13 Jul, 2019
Reviewer #1 agreed
On 12 Jul, 2019
Reviewers invited
Invitations sent on 12 Jul, 2019
Editor assigned
On 28 Jun, 2019
Submission checks complete
On 24 Jun, 2019
Editor invited
On 24 Jun, 2019
First submitted
On 21 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background Across the United States, sexually transmitted infections and unintended pregnancy rates are alarmingly high among youth. Schools, due to their proximity and access to youth, can increase student access to sexual health services (SHS) by creating referral systems (RS) to link students to school- and community-based SHS. From 2013-2018, the Centers for Disease Control and Prevention’s Division of Adolescent and School Health funded 17 Local Education Agencies (LEA) to partner with priority schools and stakeholders to develop and implement RS to increase student access to SHS. Cicatelli Associates Inc. (CAI) was funded to provide capacity-building to LEA. In 2016-2017, CAI conducted case studies at two LEA, both large and urban sites, but representing different geographical and political contexts, to elucidate factors that influence RS implementation.
Methods Nineteen LEA and community-based healthcare (CBH) staff were interviewed in the Southeastern (n=9) and Western U.S. (n=10). Key constructs (e.g., leadership engagement, resources, state and district policies) across the five domains of the Consolidated Framework for Implementation Research (CFIR) framework guided the methodology and analysis. Qualitative data was analyzed using the Framework Method and contextual factors and themes that led to RS implementation were identified.
Results Interviewees strongly believed that school-based RS can decrease STI, HIV and unintended pregnancy and increase students’ educational attainment. We identified the following contextual key factors that facilitate successful implementation and integration of an RS: enforcing state and district policies, strong LEA and CBH collaboration, positive school culture towards adolescent health, knowledgeable and supportive staff, leveraging of existing resources and staffing structures, and influential district and school building-level leadership and champions. Notably, this case study challenged our initial assumptions that RS are easily implemented in states with comprehensive SHS policies. Rather, our conversations revealed how districts and local-level policies can have significant impact and influence to impede or promote those policies.
Conclusions Through the use of the CFIR framework, the interviews identified important contextual factors and themes associated with LEAs’ implementation barriers and facilitators. The study’s results present key recommendations that other LEA can consider to optimize integration of RS-related evidence-based practices, systems, and policies in their districts.
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