Making Connections: Going above and beyond to increase access to sexual health services for youth in rural communities


This day and age, teens seem more connected and informed than ever. They are constantly texting, Googling information and are inundated with news on social media. They have so much information and resources at their fingertips – but there are some things that technology cannot replace – that’s one-on-one care and guidance from a health-care professional.

We know from research, that access to reliable information gives young people the knowledge and skills to make healthy choices about their sexual health and relationships. Did you know that research also suggests that the more youth learn about sexual health, the more likely they are to postpone sexual activity and/or engage in safer sexual practices?

Our team of public and community health nurses work each and every day to empower people to take care of their own health. Youth in the Trinity-Conception area, like many other rural areas, have limited access to clinical sexual health services. Distance, infrequent public transportation and cost of travel to the nearest service are common reasons cited as potential barriers to these services.

It seemed logical to remove these barriers by bringing the services directly to the students where they are every day – in school! So, we initiated Eastern Health’s high school sexual health clinics.

Partnering for Student Health

As the health promotion consultant responsible for sexual health and well-being with Eastern Health, part of my job is to make the connections necessary to offer these services to students.

Connecting the right people within Eastern Health came first. Partnerships were established between public health nursing, health promotion, communicable disease control and the medical officer of health. It was also important to establish and strengthen relationships between the education and health sectors. We worked closely with high schools in the Trinity-Conception area as well as the Newfoundland and Labrador English School District (NLESD) in order to put a comprehensive plan in place to address student needs.

Once these relationships were established and our plan was ready, we were set to go!

In February of 2015, we were pleased to begin offering sexual health clinics to students in three rural high schools:

Carbonear Collegiate

Carbonear Collegiate

Ascension Collegiate, Bay Roberts

Ascension Collegiate, Bay Roberts

Crescent Collegiate, Blaketown

Crescent Collegiate, Blaketown

Safe and Healthy Spaces

Jill Rees is a community health nurse working in Bay Roberts. She says finding the right space for the clinic within the school was very important. “It was important for me to work with the school to find a private and comfortable space where students could come to speak to me.”

(l-r) Donna Dawe, health promotion consultant, Tammy Butler, parent of high school student, and Jill Rees, community health nurse

(l-r) Donna Dawe, health promotion consultant, Tammy Butler, parent of high school student, and Jill Rees, community health nurse

Clinic space was established in each school and we got to work sharing information with students:

  • pamphlet racks for promotional material were installed;
  • ballot boxes were made available for student feedback cards;
  • condom vending machines were installed; and,
  • iPads were purchased to provide access to the internet within the clinic space.

Not only did we consider the student perspective in deciding on locations for the clinics, we also looked for as many ways as possible to get their feedback and input on other aspects of the clinics, such as naming the space and promoting it to the student body.

The amount of feedback and involvement we received and continue to receive is incredibly encouraging.

Sexual Health and More!

So, what services do these school sexual health clinics offer?

Each school has a public health nurse assigned to the service who visits the school twice a month. The nurse offers:

  • a variety of resources on sexual health, decision making, and healthy relationships;
  • birth control counselling;
  • sexually transmitted infection testing, counselling, treatment and follow-up; and,
  • pregnancy testing and pregnancy options counselling.

The public health nurse may also consult a nurse practitioner, as required, and family doctors are involved where possible and necessary.

“The Healthy Spaces program at our school has been a tremendous success. Many students are availing of this program for various reasons,” says Melissa Taaffe-Smith, a teacher at Carbonear Collegiate. “Students aren’t always comfortable speaking with their own relatives and family doctors. Some issues students are dealing with are very sensitive so having a safe, caring and easy to talk to nurse to give them guidance and provide support is so important for their mental and physical development. It is great to see that extra support put in place for our students!”

Between February 2015 and June 2016, 550 students have benefited from these safe and healthy spaces within their schools. It is uncommon for students to come to these spaces with a simple question. Usually a student will make comment that leads to an in-depth one-on-one conversation regarding complex issues, some examples of types of concerns we hear are:

  • “I want to go on birth control, but I don’t know what would be best.”
  • “I have been with my boyfriend for a while. I think I love him but lately I don’t feel good about our relationship.”
  • “I was with a guy this weekend and his condom broke.”
  • “I don’t know what’s wrong with me…I feel really sad/anxious all of the time.”

As you can see, it’s not just about sexual health. The public health nurses at the schools are available to help students with other health concerns, including physical and mental health. Students are grateful for this level of support.

One student was quoted as saying to a nurse: “I just wanted to say a massive thank you. I have plans to see a counsellor – without talking to you none of this would be happening.”

Caring Culture

One of the additional  benefits of the clinics has been that the schools are creating more open environments and cultures when it comes to discussion of sexual health matters:

  • sexual health has been promoted in classes such as biology and human dynamics;
  • nursing students have conducted sexual health education in classrooms;
  • teachers have referred students to the public health nurse;
  • students and teachers have created an allied culture, with acceptance for same sex couples and friends walking together during this years prom; and,
  • students requested sexually transmitted infections (STI) testing following education sessions facilitated by the nurse.

“Having the nurse provide service to youth in our school adds to the culture and climate of caring. It builds on what we are teaching in the classroom and supports youth to make healthy decisions,” says Neil Kearley, principal at Ascension Collegiate, Bay Roberts.

(l-r) Ramona Shortall and Mark Shortall, teachers at Ascension Collegiate, with Jill Rees, community health nurse

(l-r) Ramona Shortall and Mark Shortall, teachers at Ascension Collegiate,
with Jill Rees, community health nurse

Healthy Students, Healthy Schools

Providing this service has allowed schools and health professionals to work in comprehensive and collaborative ways to address the needs of students and improve access within the community – staying true to Eastern Health’s vision of Healthy People, Healthy Communities (or in this case: Healthy Students, Healthy Schools).

We are so pleased with results of this program to date and hope to be able to expand these services in high schools around the eastern region.

By connecting one-on-one with students in these rural school communities, we as public health nurses are working to normalize these conversations for young people so that ultimately they make more informed and responsible choices about their sexual health and well-being.

Next time they begin to type a sexual health question into an internet search-engine, we say: “come see us instead!” We’re listening and here to help.”

This story was written by two Eastern Health health-care professionals: Donna Dawe, health promotion consultant, responsible for sexual health and wellbeing, and Colleen Kearley, child health coordinator responsible for Promoting Healthy Child Development / Promoting Healthy Schools.

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