Tackling chlamydia through data, screening, and education

Data from The L.A. Trust Data xChange showing St. John’s chlamydia screening rates from 2018 – 2023.

Chlamydia is the most reported sexually transmitted infection (STI) in the United States and California, particularly among females ages 15-24. According to the California Department of Public Health's STI Surveillance report, there were 190,806 reported cases of chlamydia in 2021, highlighting the pressing need for effective screening and education. The Los Angeles Trust for Children’s Health (The L.A. Trust) recognizes this is an urgent public health issue and advocates for sexual and reproductive health by promoting chlamydia screenings at school Wellness Centers.

Recent data reveals that many individuals infected with chlamydia are asymptomatic, which can lead to serious health complications if the infection is left untreated. The L.A. Trust is committed to changing this narrative through education and proactive measures. By receiving screenings, treatment, and vital information, students gain access to the resources they need to maintain their health and well-being.

A Data-Driven Approach to Screening and Intervention

In partnership with school Wellness Centers and School-Based Health Centers, The L.A. Trust facilitates the collection of critical student health data through its innovative Data Xchange platform. This tool enables centers to track screening rates, identify trends, and monitor outcomes, ensuring that interventions are timely and effective. By using data-driven insights, The L.A. Trust and its partners can more precisely target outreach and screening efforts, making sure that students who are most at risk receive the care they need.

Leadership in Chlamydia Screening: St. John's Community Health

St. John’s Community Health has emerged as a leader in addressing the challenge of chlamydia screening among adolescents. Under the guidance of Dr. Sushant Bandarpalle and Linh Phan, St. John's implemented a strategic STI Screening Improvement Project that has significantly increased chlamydia screening rates within Wellness Centers and School-Based Health Centers. As highlighted in this recent Best Practices to Improve Chlamydia Screening Brief, their approach focuses on enhancing clinical protocols, continuous training, and ongoing monitoring, which are essential for ensuring that young people receive appropriate care. As Dr. Bandarpalle explains, "Successful diagnosis and treatment are really a testament to the provider-patient relationship and the provider's comfort level in educating our patients. Our approach to driving these measures focused on enhancing our EMR systems and creating a well-supported space for providers to enhance their delivery of the patient's sexual health."

Student Advisory Board members at Mendez High School.

Empowering Students through Education and Peer Advocacy

Beyond clinical initiatives, The L.A. Trust believes in empowering students through education. Maryjane Puffer, Executive Director of The L.A. Trust, emphasizes the importance of these initiatives: “Empowering students with access to education, screenings, and treatment is crucial for their success and well-being. We believe that by promoting sexual and reproductive health, we’re not just improving individual lives but also enhancing the overall health of our communities.”

The L.A. Trust’s Student Advisory Board (SAB) members play a vital role in educating their peers and advocating for essential services like chlamydia screenings and HPV vaccinations. Our SAB members actively engage with their peers to educate them on the importance of STI prevention and screenings. Through outreach initiatives, these young advocates help demystify health services and promote healthy decision-making within their communities.


Best Practices to Improve Chlamydia Screening Brief

The crucial role School-Based Health Centers play in underserved communities

School-based health care gives children an invaluable resource for their physical and emotional well-being.

February is National School-Based Health Center Awareness Month, making it an ideal time to recognize the crucial role that school-based health centers (SBHCs) play. For many children and adolescents, SBHCs are a critical resource. These centers provide comprehensive health services to underserved communities, thus eliminating barriers to healthcare and helping ensure that students receive the care they need to stay healthy.

Convenience is one of the biggest advantages of having an SBHC on school grounds. Transportation can be a significant barrier to accessing healthcare for some students, particularly those whose parents cannot take them to appointments or who do not have access to transportation. With an SBHC located within their school, these students can easily access healthcare when needed.

In addition, SBHCs offer a wide range of services that can help address various health issues. These include physical exams and immunizations as well as mental health counseling, reproductive health services, and nutrition counseling. By providing these services onsite at schools, clinics give students access to the care they need without them having to leave campus or find ways to get to a doctor’s office or clinic.

SBHCs play a critical role in keeping students healthy and in class, which can help reduce absenteeism due to illness or injury and support academic success. Research has shown that students with chronic illnesses are often absent from school due to their conditions, but with the right care and support from an SBHC, they can stay in school more consistently and keep up with their studies. Furthermore, studies have found that visiting an SBHC is associated with an increase in school attendance. Preliminary analysis of the Data xChange attendance and student health data for 14,030 users reveal that students’ attendance increased by 5.4 school days per year following any type of visit to a school-based health center, and it increased by 7 school days per year after a school-based health center visit for a mental health diagnosis. This is especially beneficial for disadvantaged communities where health disparities can lead to decreased educational opportunities for some children and adolescents.

Maryjane Puffer, Executive Director of The L.A. Trust said, “By investing in school-based health centers, we are investing in the health and well-being of our future generations. We cannot afford to ignore the needs of our most vulnerable communities, and SBHCs are a critical component in addressing health disparities and promoting health equity.”

As a final point, school-based health centers are crucial resources for underserved communities, providing access to healthcare services that might not otherwise be available to students. SBHCs address the unique needs of children and adolescents by offering convenient, comprehensive, and age-appropriate healthcare services on school grounds. By reducing barriers to healthcare, promoting healthy attendance, and addressing health disparities, SBHCs help ensure that all students have the opportunity to thrive and succeed in school and beyond. As such, school-based health centers play an essential role in creating healthy and equitable communities for all.

Care Beyond the Clinic Walls focuses on equity and health care

Irma Rosa Viera spoke at the statewide conference, Care Beyond the Clinic Walls hosted by The California School-Based Health Alliance.

School based-health providers, educators, and advocates from across California met for the 2022 statewide school health conference, Care Beyond the Clinic Walls, on Friday, April 29. The California School-Based Health Alliance hosted the statewide conference, their first in-person event since 2019, at the University of Redlands’ Orton Center.

The two-day conference was an opportunity for student healthcare professionals from across the state to learn strategies on how to improve the performance of practicing professionals working to impact the health, safety and well-being of children and their communities. The conference offered a wide range of workshops including Peer Mentoring, Screening for Psychosocial Risks & Trauma, and Starting a School Based Health Center.

It was inspirational to see a lively group of almost 300 health care professionals come together and express their commitment to strengthening our California communities by providing equitable access to quality health care for students and their families.

Keynote speaker Dr. Dana L. Cunningham, a longtime school psychologist, researcher, and practitioner in the development of application of evidence-based practices for youth of color gave a powerful presentation on “Social Justice: Catalysts and Barriers to Progress.”  She spoke on the systematic (In)visible barriers that are impacting students of color and preventing them from thriving. Today, far too many students of color are faced with higher suspension and expulsion rates, offered fewer opportunities to enter gifted courses, and attend schools that must fight for scraps of funding and resources.

Dr. Cunningham emphasized the need for a paradigm shift in how we confront these issues. Communication and collaboration is key, and we must engage in difficult dialogues about race to move past our fears. Lean into the discomfort, identify systems of oppression, acknowledge what we don’t know, and speak about injustices when we see them.

To close out the conference, Children & Youth Behavioral Health Initiative (CYBHI) led a delightful brainstorming session and an insightful group activity on self-reflection.

Care Beyond the Clinic Walls offered something for everyone who cares about providing quality health care services to communities regardless of income. As we continue to live through COVID, it was a great experience to get out and see some old friends and meet new ones.  We are already looking forward to the 2023 conference and we hope to see you there!

California school-based health convention builds bridges

Dr. Janine Jones discussed the “silent struggle” experienced by many students of color at the California School Health Conference November 3. 

Equity was topic one as more than 350 healthcare providers, educators and policymakers met online November 2-4, 2021, at the California School Health Conference hosted by the California School-Based Health Alliance, co-hosted by REL West and sponsored by The L.A. Trust and others.  

Keynotes and workshops focused on the theme “Building Bridges to Healthy and Resilient Communities.” Esther Yepez, program manager for The L.A. Trust, appeared on the “Bite Back” panel, examining oral health challenges and solutions. 

CSHA Board President Sergio Morales opened the virtual event, saying the past months “have tested our resilience” and contributed to a mental health crisis among students. He cited reports showing a 58% decrease in pediatrician visits, a 25% increase in suicidal ideation and the loss of five months of learning by students. 

Morales said school-based healthcare can play a crucial role in building bridges to community, and he thanked healthcare providers and educators for helping children and youth by facilitating vaccinations, mental and oral healthcare, hot meals and PPE during the pandemic. 

Healing communities 

“We are sitting between trauma and transformation,” said opening keynote speaker Dr. Shawn Ginwright, professor of education at San Francisco State. He challenged the concept of PTSD as it is often applied, saying that people of color are experiencing “a persistent traumatic environment”; he said calling it a disorder places the onus on the person rather than the system.  

“People can’t be well if the community is not.” He called for “healing-centered engagement, a nonclinical, strength-based approach that advances a holistic view of healing and recenters culture and identity as a central feature in well-being.” 

Dr. Janine Jones, Wednesday’s keynote speaker, said “culture is key” to understanding Adverse Childhood Experiences (ACEs). Jones, who is professor and associate dean for academic affairs in the College of Education at the University of Washington, said that in addition to the previously recognized Adverse Childhood Experiences, educators and healthcare providers must also be aware of Adverse Community Experiences driven by implicit bias, cultural blind spots and microaggressions. 

She said microaggressions are often subtle and unintentional but “they are like tiny cuts” that make the subject feel powerless. Jones said microaggressions are fueled by stereotypes. “It’s a silent struggle” and students may respond with isolation, avoidance, apathy or anxiety. When they do, they are sending out an SOS that adults should respond by listening to the student and examining unconscious, implicit bias in the environment and the system. 

Community trauma  

Closing keynote speaker Dr. Howard Pinderhughes, professor and chair of the Department of Social and Behavioral Sciences at the University of California San Francisco, recounted his personal experience growing up in the Roxbury section of Boston. 

“Roxbury was a mixed-raced, mixed income neighborhood until the early ’60s,” Pinderhughes said. Real-estate “blockbusting” and racial uprisings in 1967 and 1968 accelerated the exit of white and middle-income residents and “the community became almost entirely poor.” He experienced the trauma of seeing a neighbor’s body in a black plastic bag lying in the street. Later, a young Black girl killed in a nearby park. “It became clear the neighborhood was not safe.” By the early ’90s, Roxbury had become the youth murder capital of the world. 

Similar trauma — defunded infrastructure, capital flight, concentrated poverty and violence — were experienced in neighborhoods across the country. When Pinderhughes moved to the Bay Area, he witnessed community trauma in East and West Oakland, Richmond and the Western Addition of San Francisco. 

The killing of 23-month old Baby Hiram in West Oakland caused the community to be “wracked with despair, worry and trauma,” Pinderhughes said. “I remember thinking about the impact – not just on the family but on the community.” 

He said Black and Hispanic youth have developed rituals to deal with the violent death around them. “As soon as there is a shooting death the altars and the (memorial) T-shirts come out.” Kids wear their prom suits to funerals “because they aren’t sure they’ll live to go to prom.” 

“How did we get here?” 

Pinderhughes listed root causes (poverty, inequality, racism, sexism, oppression and heteronormativity), structural factors (economic, political, social and institutional) and environmental factors (neighborhood, family and peer group).  

Pinderhughes advocated a two-track approach to address and prevent community trauma. He said root causes must be faced, but communities must strengthen resilience at the same time. 

“Let’s change the conditions but let’s be real,” he said. “Let’s develop safer public spaces, reclaim our communities and develop bridge housing during replacement of public housing.” He called for strategies including restorative justice, healing circles, workforce development and strategies that resist the forces of gentrifications, which he called a “form of structural violence.” 

He also said communities should change the narrative about themselves and the place they live: First by organizing regular positive activities and second by giving voice and power to community members in changing structural and environmental factors. He cited one example where a school district enrolled students to help in redesigning and restructuring schools. Another example was building a skate park on Lakota land that not only became a gathering place for youth but a sacred space for the community. The most successful programs were intergenerational and some were multicultural, like a group that brought Black and Hispanic men together. 

State of the Alliance 

Tracy Mendez, executive director of the CSHA, wrapped up the event by thanking the hundreds of attendees from across California and beyond and reviewing key conference takeaways. 

Mendez wore a “Black Lives Matter” tee and said those words could just be a slogan but served to remind her and others that she is accountable. “We need as many reminders as possible.” 

“School-based health centers are a great model of care,” Mendez said. “We should have one in every school” and CSHA is pushing for 500 SBHCs in California by the end of the decade. 

Mendez announced the Student Health Index, California’s first comprehensive statewide analysis to identify the counties, districts and schools where new SBHCs will have the greatest impact on student health and healthcare equity. She also cited the California Student Mental Health Implementation Guide, which CSHA helped develop.