Established school-based health centers (SBHCs) in every school offer an entrée for STD screening (Baltimore), however most school districts lack SBHCs in every school (IHS, NO, NYC, Philadelphia). Political champions from the state, city, tribe and/or school district are key to gaining entrée. Demonstrating need and success on a small scale is an important first step followed by engaging health and education stakeholders in the implementation process. Successful cooperation with schools hinges on acknowledging the important work of the schools and the ability of the program to be flexible and work within the framework of individual school communities.