SBHCs play an important role in teen pregnancy prevention efforts, as evidenced by the fact that more than 70% of SBHCs in California provide some form of reproductive health services and education. There is a need to move beyond traditional to more innovative approaches through integration of technology in clinical settings and going beyond the clinic walls to advance the health and well-being of adolescents. This interactive workshop will highlight findings from the Health-E You study at 18 Los Angeles Unified School District Wellness Center and SBHC sites, and introduce scenarios of how reproductive health conversations lead to the provision of services.

1. By Rosario Rico, Associate Program Director
& Robert Renteria, Program Manager
Classroom to Clinics: Teen Pregnancy
Prevention Approach Down the Technology
Highway

2. Disclosure
The following personal financial
relationships with commercial interests
relevant to this presentation existed during
the past 12 months:
No relationship to disclose.

3. Workshop Objectives:
1. Describe the Teen Pregnancy Prevention
(TPP) landscape
2. Describe the Health-E You study & findings
3. List strategies for integrating technology as
part of teen pregnancy prevention efforts
4. Identify ways to optimize the delivery of
teen pregnancy prevention education

4. Los Angeles Unified School District
◻ Boundaries spread over 730
sqft miles across LA County
◻ Over 570,000 K-12 students
enrolled
◻ 75% of students qualify for
free and reduced lunch
◻ High School dropout rate at
13%

5. Los Angeles Unified School District
◻ 74% Latino
◻ 11% Black
◻ 9% White
◻ 6% other

6. LA County Teen
Birth Rates across
LAUSD Schools
Why is this
study
important?

9. California School-Based Clinics
❏ 267 SBHCs in California
❏ 68 SBHCs provide reproductive health services
(on-site contraceptives, Rx and/or referrals)
❏ Type of contraceptives vary (LARCs vs non-
LARCs)
❏ Number of high school SBHCs - 36

10. Emergence of Technology in
Healthcare Setting
◻ Mobile technologies are an especially attractive medium
for adolescents and can be a powerful tool to promote
health
◻ While there are some web-based contraceptive decision
support tools, adolescents in our focus groups and pilot
studies found them generally overwhelming and geared to
young adults
◻ This research study addresses an important gap for
adolescents – especially with it’s emphasis on Latinas

11. Health-E You Study Overview
❏ Developed web-based application (for Smartphones and Tablets) with
health providers, adolescent health researchers and youth
❏ Design: Longitudinal, cluster randomized control trial of 18
school-based health in Los Angeles.
❏ App obtains consent & eligibility
(sexually active, Latina, 14-18yo,
non-use of long acting reversible
contraception (LARCs).
❏ Interactive App gather users’ life-style
considerations/preferences, past experience with contraceptives and
possible medical contraindications: factors that are important for
selecting patient-centered contraception.

12. Health-E You Study Overview
❏ App recommends “top choice” based on user’s input.
❏ Regardless of app recommendation, users can learn about any
contraceptive option with simple info and short videos of clinic and
youth talking about each method
❏ When finished, user selects method(s)
most interested in.
❏ App recommendation(s) and user
selections are printed for the
clinician before the face-to-face
visit.

13. Study Aim
Aim 1: Contraceptive
decision making
• Support
adolescents in
making decisions
about using an
effective method
of contraception
Aim 2: Improve
clinical encounter
• Improve the
effectiveness and
efficiency of the
clinical encounter
Aim 3: Reduce
incidence
•Reduce the
incidence of
unprotected
sexual intercourse
over time
Aim 4: Disseminate
intervention
•Disseminate to all
Wellness Centers –
along with
implementation
support strategies

14. Study Timeline

15. Activity
Breakup into groups of 3
Discuss:
❏ What has been your experience with any type
of technology in your healthcare experience?
❏ Do you find the use of this technology
helpful? Why?
❏ What is your perception of teens perspective
in using this technology?

16. App Demonstration
https://app.box.com/file/294486224799
Video Downloaded on file
Will have walk-through script

17. Scenario
3 short scenarios
1. 15 yo adolescent for emergency contraception
2. 13 yo coming in because mom found out she is
having sex looking for contraception
3. 16 yo coming in for sports physical
What do you think these youth are going through?
Can you visualize/empathize with them?
How would introducing technology help?

18. Implementation-Workflow

19. Implementation

20. Study Findings
• Significant increase in sexual health & contraceptive knowledge
from 3.37 to 4.98 mean correct (out of 7 questions)
•Significant increases in self-efficacy:
✔ Can use birth control correctly to keep from getting pregnant
(8.03 vs 8.45).
✔ Talk to a doctor about what birth control methods to use
(7.96 vs 8.37);
Provider Survey Results:
• 83% agreed that the app helps teens engage in the contraceptive
decision making process
• 75% agreed that it helps to provide a more individually-tailored
discussion around contraceptive options

21. Study Findings
App reduces time required to:
✔provide basic contraceptive information
✔screen for potential medical contraindications
✔identify what contraceptive method/s would be the best fit for
their patient
Post-App Youth Survey (N=287):
•93% agreed that they understood the information on the app
•70% agreed that the app improved the quality of their visit,
helped them talk with their healthcare provider, and helped
them choose a birth control method.

22. Study Findings
Post-App Youth Survey (N=287):
● Teens who used the app were siginificantly more likely to discuss
birth control with their provider than controls (89% vs 69%)
Other Findings:
● Contraceptive use was significantly greater for Health-E You App
users than controls.
● 50% of app users received a more
effective contraceptive method
compared to 29% of controls.
● At baseline 70% were either not using
a contraception or using an ineffective
method which decreased to 10.5% among
app users at 3-month follow-up.

23. Sharing with other SBHCs
https://healtheyouinfo.ucsf.edu/

24. Activity:
Other ways technology could be used either in
TPP or in reproductive/adolescent health?
How do we optimize the delivery of teen
pregnancy prevention education

25. Where do we go from here?
Steps involve
1. Letters to leadership
2. Webinar training
3. Who is interested?
4. Is this useful?

26. PCORI Research Team
L.A. Trust Team UCSF Team
Rosario Rico
Associate Program
Director
rosario@thelatrust.org
Robert Renteria
Program Manager
robert@thelatrust.org
Sang Leng Trieu
Program Director
sang@thelatrust.org
Felicia Rodriguez
Research Associate
Felicia.Rodriguez@ucsf.edu
Kathleen Tebb, PhD
Principal Investigator
Associate Professor,
Dept. of Pediatrics
Kathleen.Tebb@ucsf.edu
Maryjane Puffer
Executive Director
maryjane@thelatrust.org

27. Thank you