Adolescent Sexual Health Successes in Denver

Since 2004, Denver has seen a 59% decline in teen births. Many factors contributed to this decline, with two playing a major role: access to effective contraceptives and sexual health education.

Currently in Colorado, sexual health education is not mandated in schools, and therefore the role of Denver Health School-Based Health Centers (SBHC), Community Health Centers (CHC), Denver Public Health, and sexual health educators at these sites is vital to the health of Denver youth. SBHCs, CHCs, and Denver Public Health offer access to free, confidential sexually transmitted disease (STD) testing and treatment, contraception, and individualized sexual health education for adolescents. The health education program (HEP) was designed to prevent unintended teen pregnancies in Denver, and was integrated into SBHCs in 2006 as the result of a small grant from the Colorado Department of Public Health and Environment (CDPHE).

When the grant was awarded, a survey was developed and disseminated to determine which of the program’s topic areas to focus on: suicide, drugs and alcohol, or teen pregnancy. Feedback from school administrators, educators, students and parents overwhelmingly indicated teen pregnancy prevention as the most critical priority. At the time, the teen birth rate in Denver was almost 80 per 1,000 females, so this was no surprise. The program was built on research and science with technical assistance provided from a local nonprofit, Colorado Youth Matter. HEP started in six Denver Health SBHCs in communities with “at-risk” youth of middle and high school age, providing inclusive sexual health to all young people regardless of race, ethnicity, gender expression, sexual orientation, socio-economic background, religion, body shape, size, and ability.

As part of HEP, health educators hold one-on-one individualized visits with students to provide sexual health education. The overall goal of HEP is to decrease unintended pregnancies and STDs among young people by delaying the onset of sexual activity in non-sexually active teens, and increasing correct and consistent use of condoms and contraception among sexually active teens. Utilizing a positive youth development framework and motivational interviewing techniques, the health educators tailor sessions to individual students’ needs, wants, or developmental levels. Education covers topics such as abstinence, refusal skills, partner and parent communication, puberty, menstruation, conception, STD risk and transmission, barrier methods, contraception, and healthy relationships. In addition, health educators conduct classroom presentations about sexual health topics. These health educators work closely with the SBHC team – which includes nurse practitioners, mental health therapists and medical assistants – as well as with the school psychologist, social worker, counselors, and administration to provide the best health and educational outcomes for students. In the last decade, the program has made great strides in promoting youth sexual health.

From 2008-2016, the HEP has served more than 15,500 students in 34,000 visits. In 2010, SBHC piloted an initiative to dispense contraception and condoms at one site, and due to overwhelming support from school administration and utilization by students, access to contraception and condoms has expanded to all 17 SBHCs. During the 2015-16 school year, 902 females reported using a form of contraceptive at last visit, with 53% of those students reporting use of a long acting reversible contraceptive. Additionally, of the students HEP saw in 2015-2016, 32% were male and 12% identified as LGBTQIA+. But numbers only tell part of the story: this school year, a male student came in to see the health educator stating he had multiple partners and only used condoms 40-50% of the time. After talking about STIs and condoms he decided to get an STI test, which came back positive for chlamydia. Upon returning for treatment, the student shared he had not had sex since getting tested and doesn’t think he could ever have sex without a condom again because “you just never know what can happen.”

The successes of the HEP program and dispensing affordable and effective contraceptive methods would not have been possible without partnerships with schools, Denver Health, and organizations and individuals passionate about advancing youth sexual health resources in Denver. Building relationships between schools and organizations working in youth sexual health created less duplication of services in communities, and increased access and utilization of resources, including CHCs and SBHCs. As part of the work plan with Denver Health, Denver Public Schools and Denver Public Health established a Youth Sexual Health workgroup and the Denver Health Services Council to increase the partnership of health organizations that serve young people. These long-standing collaborations of Denver Public Schools, CDPHE, Denver Public Health, Colorado Youth Matter and local foundations remain strong and have facilitated sustained stakeholder involvement in the HEP since its inception. The partnership between local public health and local education in Denver creates a more comprehensive, cohesive, and collective approach to sexual health, and ultimately student health to keep students engaged in their education and development through adolescence.