Connecting Youth to High-Quality Reproductive Healthcare Services in the Community: Adaptation of Project Connect in Detroit

Background: Detroit has the highest rates of chlamydia, gonorrhea, and pregnancy among females ages 15-19 in Michigan. In response, Michigan Public Health Institute adapted the Project Connect Health Systems Intervention (Connect), which was found to increase rates of STD, HIV, and pregnancy testing and receipt of contraceptives among sexually-active high school students. Connect links community providers already providing quality sexual and reproductive healthcare (SRHC) services with at-risk youth.

Objectives: Adapt Connect for use in Detroit.

Methods: Zip-code level STD rates identified high-risk schools. Three high schools were approached as intervention sites. Local health infrastructure data were collected via interviews with community providers from over 60 clinics. Criteria for inclusion on the provider referral guide included: accessible location/hours, high clinic volume of adolescent patients, routine SRHC services. Teen focus groups were conducted on referral guide terms, information for the guide, and approachable school staff.  School touchpoints and identified staff were trained to use the guide directing adolescents to selected providers.

Results: Adaptation of Connect faced multiple challenges. Significant healthcare and school system infrastructure limitations resulted in an attenuated provider base and instability among school-based linkages to care; recruitment criteria had to be modified to fit the local environment.

Conclusions: High STD, pregnancy rates, fragmentation within the Detroit school environment and limited community health resources created an even greater need to provide a connection for youth to quality reproductive health care options. Connect utilized a systematic approach to identifying and linking at-risk youth to quality SRHC services to fill a much needed gap.

Implications for Programs, Policy, and Research: Connect can be effective when adapted for use in other settings. Engagement with key community stakeholders is critical to the success of the program; local readiness for intervention must be addressed both in schools and through evaluation of the healthcare infrastructure.