AwkTalk: Conversations on Sex and Reproductive Health – PediaCast 491
- Meg Kane and Sarah Saxbe visit the studio as we consider AwkTalk: a school-based program focused on sex education and reproductive health. Learn why this program is important and how kids, teens and families across the country can benefit from their work. We hope you can join us!
- Sex Education
- Reproductive Health
- School-Based Health Services at Nationwide Children’s
- AwkTalk Web Site
- AwkTalk – Find a Clinic
- Power to Decide – Teen Talk
- Talking to Children & Teens About Sex – PediaCast 331
- Birth Control for Teenagers – PediaCast CME 17
- SexED Library
- Planned Parenthood
- Society for Adolescent Health and Medicine
- Three Rs
- Our Whole Lives
- Talking to Your Child About Sex
- Adolescent Sexuality: Talk the Talk Before They Walk the Walk
- Helping Teens Resist Sexual Pressure
- Contraception Explained: Options for Teens & Adolescents
- Teaching Health Education in School
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We are in Columbus, Ohio.
It's Episode 491 for May 26th, 2021. We're calling this one "AwkTalk: Conversations on Sex and Reproductive Health". I want to welcome all of you to the program.
So, we have another important topic for you this week, as we explore a school-based program that focuses on sexual and reproductive health and education. And our goal today is going to be threefold.
First, for those of you living in Central Ohio, you may have heard of AwkTalk, especially if your children are enrolled in certain Columbus city schools. If you have not heard of AwkTalk, it's something that maybe appearing in your child's building or school district at some point in the future, as the program builds on its success and expands its many services, which we will cover today in considerable detail.
Second, if AwkTalk is not in your building or district or perhaps you don't live in Central Ohio, which actually describes the vast majority of our audience, your family can still benefit from AwkTalk's efforts because the program provides lots of helpful online resources for families, educators, and clinicians as you embark on the important but often awkward conversations with kids and teens regarding sex and reproductive health.
Speaking of that, I just want to point out really quick. If you do have young kids, we don't get too explicit in our conversation today. But just keep in mind, we are talking about sex and reproductive health. And you know your kids, so keep that in mind as you continue listening.
We will share AwkTalk resources with you today and point you in the direction of other helpful websites aimed at supporting all of us in this important endeavor as we have these conversations.
And then, third, we're going to talk about how this program got started. We'll identify the key partners and talk about how you, if interested, could perhaps coordinate a similar program in your community because sex education and access to reproductive health services is vastly important in every corner of our country and, really, in all countries around the world.
Just as an example of why this is important, here in Ohio, there are over 8,000 teenage births each year. And by teenager, we mean those between 15 and 19 years of age. So 8,000 girls between the ages of 15 and 19 each year here in Ohio give birth to a baby. In Franklin County, Ohio, which is where Columbus is located, teenager mothers make up 4.5% of all pregnancies.
And this is an important consideration because babies born to teenage moms are more likely to be born prematurely with all the health problems that go along with premature births. And these babies are twice as likely to die during the first year of life.
Additionally, in Franklin County, Ohio, youth under the age of 19 make up 37% of all chlamydia cases. And syphilis among teenagers is sharply on the rise.
But there are also some good news. Access to sex education and reproductive health services decreases the incidence of sexually transmitted infections, decreases the incidence of babies born to teenage moms and increases high school graduation rates.
Unfortunately, access to trustworthy sex education and reproductive health services is not equally available to all students. And this is where AwkTalk and other like-minded programs step in, helping parents, educators, and clinicians talk with kids and teens about sex and reproductive health, and to directly provide educational and clinical services in schools and across the community, because we really do need to ramp up these efforts.
To help us with our conversation today, we have two terrific guests joining us. Meg Kane is a pediatric nurse practitioner and Sarah Saxbe is project manager for health education, both with school-based health services at Nationwide Children's Hospital.
Before we get to them, I do want to remind you that you can find PediaCast, really, wherever podcasts are found. We are in the Apple and Google Podcast apps, also iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
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So, let's take a quick break. We'll get our guests connected to the studio. And then we will be back for some AwkTalk. That's coming up right after this.
Dr. Mike Patrick: Meg Kane is pediatric nurse practitioner and clinical quality coordinator for School Health Services at Nationwide Children's Hospital. And Sarah Saxbe is a medical social worker and project manager of Health Education for our hospital's Community Wellness program.
Meg and Sarah provides support to children, teenagers, and families through the Nationwide Children's School-Based Health Program and both have a passion for educating students about sex and reproductive health. Of course, this can be awkward conversations at home and school and even among friends, which is why our guests are here today, to introduce us to the AwkTalk Program and the many services it provides.
So, let's give a warm PediaCast welcome to Meg Kane and Sarah Saxbe, thank you both so much for stopping by.
Sarah Saxbe: Thank you for having us.
Meg Kane: Thank you.
Dr. Mike Patrick: Yeah, absolutely. Really glad you could be here today. So, Megan, I wanted to start with you. Tell us, what is a school-based health center. I think if you're a family that has one of this in your school, you probably know what it is. But it's certainly not in every school and there are a lot of folks out in the audience who aren’t familiar with this term. So, what is a school-based health center?
Meg Kane: School-based health centers are almost exactly what the name sounds like. They’re a place to receive healthcare located within a school. Sometimes, we call them SBHC, sometimes we call them the health clinic or the health center. But they are a center designed to work with kids and families and schools and community agencies and school districts to meet medical needs of a population with as few barriers to care or access as possible, while also working to remove the non-academic barriers to learning.
And as far as what they do or provide, this came up pretty different from place to place, but generally speaking, they have a strong commitment to primary care. And they're going to provide the full spectrum of pediatric and adolescent primary care, including well checks, sick visits, mental and behavioral health, comprehensive reproductive health care. For us, we do labs onsite. We start medications. We do all childhood immunizations.
We do lot of coordination of care. That's a big thing for us, right? So especially for our institution, that means coordinating with our specialty partners, nephrology, hematology, GI, ID. We do a lot of telepsychiatry. Anything that we can do to ensure that patients do not experience barriers to connection or follow-up, not only for us but for anyone in the hospital.
We do a lot of connection with our other school-based health center friends around the country, and we've seen that the SBHCs had really led the charge in terms of COVID vaccination efforts for kids, as they become available. Which is what we've done here in Franklin County, right, over the past several months?
It's because of that existing relationship that we've had with these schools that we've been able to kind of work within that setting and system and pivot pretty quickly, in terms of offering public health initiatives to keep people safe and work towards maybe a smoother school year in the fall.
And generally speaking, they're funded like in different ways. So, they can be funded by a health department or a school system or a community agency. Or for us, they've been funded and supported very generously by a hospital and health care system.
Dr. Mike Patrick: So, this is really a collaboration of effort among a lot of people who care about kids. And so, it's really a collaboration between the school staff, healthcare experts that are able to provide the sort of expert care. And then, community agencies and it can take on different flavors and needs depending on the community.
But you mentioned primary care services, well checkups, all of that. What if a kid already has a medical home? I mean, you're not trying to replace the doctor necessarily that the family wants the child to see, correct?
Meg Kane: No, not at all. And for our departments specifically, we're called Care Connections. One of our goals is to connect that kid back to their medical home if they have one. But to be perfectly frank, the fact of the matter is, for a lot of these kiddos, they don't have a medical home. We become the medical home.
School health exists to fill gaps in access to care, right? We built this program because a large swath of our population was not making it into a primary care visit or a clinic of any kind. And we're frequent utilizers of ED or urgent care for non-emergent needs, which that doesn't serve anyone very well, like the kid or the family or the hospital.
And you obviously know this better than anyone. These are the families that you see in the ED because they need a prescription for ibuprofen. Or they're having teething concerns. Or they're troubled by their kids' growing pains.
These are legitimate reasons to seek medical care and counsel. But they should not be having to do that in the emergency room. So what we found is that when we can provide kid's access to care at school which is a hub for that community and that family, they're much more able to obtain routine well care and avoid ED visits unless it's an emergency.
And we're more likely to successfully transition to adult providers as they graduate and move on in their life. Not to mention, when kids have access to healthcare at school, we see increased graduation rates, decreased discipline interactions. And the kids who are interacting with the SBHCs may improve their attendance and academic performance as well.
The umbrella under which we're housed in community wellness, like I said, is called Care Connections. And it's really important to us to reconnect whenever possible. But that's another advantage of being in the school setting because we can see what are the barriers that have prevented that from happening, right?
Why had people been lost to follow up? Why had people not been making it back to their medical home? And we want to work with the family to remove that obstacle and get them connected. I call PCPs all the time, and say "Hey, I have one of your patients here. How can we get them reconnected to you? What can I do to help?"
Dr. Mike Patrick: Yeah, you're kind of the eyes and the ears on the ground for primary care doctors when that child is established with someone else. And that is wonderful because, a lot of times, as a primary care doc and I had done that in the past, you don't always know exactly what's happening at the school. And the parents don't necessarily know what's happening at the school. But the school folks do and can really have great insight.
And then the other I think really important part of what you're saying is that many of us take for granted the fact that we can have a primary care doctor that is in our back pocket, that we can call, that we can count on. And there are just so many kids who do not have that luxury. And so, this really does fill a gap and provide equal access to healthcare for kids who otherwise would not have access to that sort of expert care.
And so, it's really an important and wonderful program. So, a part of that school-based program as our episode is titled today is called AwkTalk. So, Sarah, tell us what exactly is AwkTalk.
Sarah Saxbe: Well, AwkTalk is a website that our team, which was a partnership between NCH and a program called CelebrateOne in the community designed to bring reproductive and sexual health information to teens. So, it's part of a larger collaborative in the community. So maybe let me give me a little context to kind of some of the works that's been done around this.
So back in 2015, I believe, there was a group convened called the Infant Mortality Task Force. And that was to address the very high rate of infant mortality in Ohio, especially the Black infant mortality rate in Ohio and specifically in our community.
And so, as a result, many stakeholders in the community including all of the major health organizations and many many others got together to come up with the list of priorities to address this issue. So, one of the many goals of the task force was to create programs in the community that kind of provided healthcare to women, specifically in infants and that included reproductive healthcare.
So, kind of what AwkTalk is, is borne out of the work of bringing reproductive healthcare and education to the community and specifically for young people and teens. We do a lot of things in this work.
So, kind of my program that I project manage is a group that provides reproductive health education in schools. So currently, my program is in 19 middle schools and Columbus City school's seventh grade where we provide an evidence-based curriculum, a sexual health curriculum called Get Real to kids in the classroom.
And the program's wonderful. It doesn't just teach sex ed. It teaches skills such as relationship skills, consent, kind of the social emotional learning that's so important for these kids as they grow up and make decisions about their bodies, about their relationships and about their health. And we teach them these skills and these classes and hope they go on to make good decisions and practice healthy behaviors. And with that comes, obviously, your sex ed that you would expect, so information about your body, pregnancy, birth control, STIs and all of that.
So that is a big part of the work, is to provide that education. And in addition to that, we determined that kids also need access to correct information about sex and those topics, those difficult topics.
So, the partnership between that was convened with the Infant Mortality Task Force which we call CelebrateOne in the community and NCH, we got
together to create AwkTalk. AwkTalk is a website, awktalk.org is the website. And we call it the place to get answers for all life's awkward questions.
So, it is a one-stop shop for information that is accurate. It has been vetted by professionals, one of which is Meg Kane who is our guest here. And she is one of our clinical experts in the development of AwkTalk.
And it gives kind of an overview of all the topics that kids might need to know about, including how pregnancy happens, different types of birth control methods to prevent pregnancy, different types of sexually transmitted infections, how you get them, how you prevent them, where to get treatment, where to go to a clinic if you need care in the community. And we actually have an interactive clinic finder on there.
We also have opportunities for parents to receive lots of information in an interactive way with learning modules. We have a chat feature. We have a Q&A feature. So, there's just a lot of kind of multimedia aspects to AwkTalk to get the kids the information and kind of promote that access to the medically accurate information.
I also wanted to add that we created videos with the Marketing team at NCH. They were brilliant and wonderful. We convene focus groups of teens and parents to try to find out what information do you want to know about these topics. How do you want to learn this? What's the most helpful? What are those topics that are difficult to find elsewhere?
So, if people go to this website, they go to AwkTalk. They can get all of that right there. So, it's really been, we're very proud of it, especially to do this during the pandemic when a lot of programs were just completely paralyzed and not able to do that work that is so important. We were able to kind of create this amazing website among other things to have that for the kids in the community and the parents.
Dr. Mike Patrick: Absolutely. The site again is awktalk.org. And I'll put a link to it in the show notes for this episode, 491, over at pediacast.org so folks can find it easily. So, this information, it really covers all sorts of awkward topics, as you mentioned. Just overall awkward health sort of topics, how your body's changed during puberty.
And then also, relationships, sexual identity, of course, sex, birth control pregnancies, sexually transmitted infections. The things that are difficult sometimes to talk about within families but it's so important to really have an open atmosphere and for kids to feel comfortable being able to ask their parents questions about these things.
A lot of times, parents don't know the answers. And so even though the site is geared toward students, parents can learn a lot and they can certainly be helpful in terms of how to approach these conversations. And maybe these videos, as you mentioned, are something you watch with your kids. Or have them watch it first and if they don't feel comfortable right in the beginning, but really try to provide an open conversation about these things between parents and kids.
So why is this sort of thing so important to have as a resource, Sarah?
Sarah Saxbe: Well, there are a lot of reasons and I'm very passionate about it. Number one, every kid deserves to have access to accurate information about their bodies. So that they can make healthy decisions and take care of themselves as they grow older. So, their lives are only going to get more complicated as they grow older. And they're going to need to navigate a lot of difficult things.
And so, if they have the proper information to empower them to make healthy decisions. They will be so much better set up for success as they grow up.
And I think in the past, I know, when I was looking and talking to kids, they felt that they didn't know where to get that information. Unfortunately, with the Internet and all the wonderful things that we have with the Internet, it also comes with a lot of harmful things, like pornography and social media situations and opportunities for kids to learn the wrong thing. And that can be harmful.
And so, kids were really looking for places to go where they could get the answers that they were looking for.
Parents, also as you mentioned, are always looking for ideas and resources. I'm always getting questions, I'm sure Meg does as well, of parents who are saying, "How do I help my kid through this? How do I talk to my kids about these topics?" Many parents, even the most educated and well-connected parents, with all the resources available to them still feel uncomfortable.
So, I think we just always want to make sure that we're supporting and providing those parents with those resources. And that's why we decided to add the Parent page to AwkTalk to be able to make it more of a conversation between the child and the trusted adult. And it doesn't have to be a parent, actually. It could be a trusted adult and we talk a lot about that in all of the resources that we provide.
But the main point is that if these families, or these trusted adults and youth can have these open conversations, not only will the kids get the right information, but they will all feel like they're supported as they grow up. So, we just wanted to be a part of that and provide the expertise that we have as care providers to children to connect that to them. So that's why I think it's important and I hope we continue to provide that in AwkTalk.
Dr. Mike Patrick: Absolutely. I mentioned during to the intro to the program, and I think it bears repeating, that access to this kind of information decreases the incidence of teenage birth, births to teenage moms. It decreases the incidences of sexually transmitted infections. It increases high school graduation rates.
So, it really can have a profound impact on the lives of teenagers and family. So really, really important. I suspect, Meg, that those kinds of stats really encompass some of the goals of AwkTalk. What are some of the other things that the program sets out to accomplish?
Meg Kane: So, what we are trying to accomplish here was kind of twofold. We wanted to really empower young people with information that was accurate. So that when we're making tough decisions or that they're in a tricky situation and they have question about sex or birth control or sexually transmitted infections, that they have information that they could access that was accurate and easy to understand and developmentally appropriate.
And secondly, to Sarah's point, there is a lot of misinformation out there. And it would be really nice if our educational efforts were not so much about course correction and more about being able to start from a place of honesty, openness, and evidence-based information.
So, we wanted to kind of increase the frequency of and elevate the conversation around reproductive health. And in short, we want to normalize asking these questions and getting answers that make sense and that were helpful. And you probably noticed, but Ohio is the only state that does not have health education standards. And by that, I mean Ohio law does not permit the State Board of Education to adapt health education standards, even the minimum of such for its students. So, it's up to each district and each school to decide what students need to learn and how to manage that.
And some places are doing the really awesome job with this. And other places aren't really sure how to manage that, right, or how to roll it out. And further, Health is the only subject that's required for a high school diploma that lacks state guidelines for what student should be taught.
And I think you mentioned this earlier. I see ramifications of that choice in my clinic all the time. I'm sure you've seen it, too. I know Sarah has as well. When kids have little to no knowledge around really weighty topics, like not just sex ed, right? This has kind of like implications around substance abuse and nutrition and all sorts of really significant things that affect our long-term physical and mental wellbeing.
So when we had the opportunity to utilize this tool of health communication, combined with the platform that kids are already so comfortable with and they're so in, like a truly interactive website like this that appeals to multiple different learning styles, it was an ideal method of information distribution.
Dr. Mike Patrick: And that really, there's been more and more talk about equity and healthcare and how it really makes a difference where you grow up, the kind of information that you're exposed to, which can really impact the quality of your life for decades to come. And so, this whole point of being able to provide this information on a platform that's easily available for everyone is very important.
Speak of it more, Meg, about your efforts surrounding equity.
Meg Kane: Sure. School health in general is not new. It's something that's been around since the 90s and one of the reasons that it's been able to have an impact in equity and addressing health disparity is because of that unique juxtaposition and intersection of healthcare and school and education. It's a really important access point, not for everyone but especially for adolescents.
What we have found is that by placing healthcare, and I'm kind of using healthcare as an umbrella term, right? By healthcare I mean not just actual medical care but education, counseling, anticipatory guidance, all the things that we know are so important for helping and empowering our young people to make better decisions and kind of empower them with the things that they need, to kind of protect them throughout the perpetuity for a long period of their lives. But also, kind of those really important things like the screenings, the little catch points throughout what can be a very rocky and risky time of adolescence.
By putting this access point of healthcare in their schools, we're doing a couple of things. We're kind of increasing their familiarity and comfort level with healthcare. So, one of the things that we know is that adolescents access preventive care less frequently than do other populations, which is a little bit of a dangerous paradox because adolescence can be such a risky time.
We really need them to be accessing care, not only because it's a good idea for anyone to be accessing preventive care annually. But also because we want to take advantage of this time to offer anticipatory guidance, do a lot of health screenings and empower them with a kind of a social knowledge and education that they'll need to serve them throughout their young adulthood and adulthood.
One of the things that we also know about school health and adolescence is that when it's offered to communities that has been historically disadvantaged, marginalized, be that due to lack of resources, poverty, other manifestations of systemic oppression, school-based health centers are a tool that is likely to reduce gaps in education and improve health equity.
And that school-based health centers in general, purposefully, have been developed to exist in areas that had been without access to care, right? So, we've heard about food deserts, but there's also medical deserts. And that is where school health centers had been kind of purposefully been given a genesis. Because I think that when we're looking at a maladaptive social ecosystem that has as a result been kind of forced certain populations to go without medical care, at least medical care that wasn't episodic, right?
Going back to what we talked about earlier, people who have to rely on urgent cares and EDs for primary care needs, we are given a better handle on understanding how and why school-based health centers function. Like addressing the social determinants of how that affect outcomes while also delivering healthcare through a very efficient and accessible model.
Education has not suffered in the same way. And schools have become this hub for kids and communities. And that has been consistent. And they do an excellent job at it. They build trust, they build rapport. Generations of families go through at the same school. I see that in the communities where I work now.
By partnering with these schools, we are able to see that if we can kind of establish ourselves within that same community. And again, I want to be super clear. It's not the same as taking a primary care practice and flopping it down in the school. It's a slightly different model of healthcare delivery while still relying on the same standards that we have for topnotch medical care anywhere else.
By kind of establishing relationship with the school in this community, you're able to kind of reduce barriers to care, such as for the patient, ways for access, missed work for parents and guardians, transportation barriers. We are helping our adolescents kind of feel more empowered to access in care, that we have increased rates of preventive visits and immunizations, improved chronic disease management, better outcomes for asthma, mental health care, decreased healthcare across not just for our kids who have chronic diseases but all the kids who are interacting with the school-based health center.
There's a reason that they're recommended by multiple expert bodies and supported with multiple position papers, including healthypeople.gov, Community Preventive Task Force, et cetera.
So, I completely agree with you that yeah, not everyone has access to them but it's not like saying not everyone has access to glasses, right? Not everyone necessarily needs glasses. There are communities that benefit more from this type of tool than others.
We find that there's a mutually beneficial relationship between the education, the social, and the healthcare community when we have this kind of symbiotic support system, all of which as you said earlier, all of which is serving the aim of improving the health of the community and the kind of the educational aims of the community. So that these kids have everything they need to go where they wanted to go, do what they want to do with as few barriers in their way as possible.
Dr. Mike Patrick: yeah, very very important. So, we talked about the website that we have, awktalk.org. And then we have School-Based Health Services. How did this come together? What sort of services does School-Based/AwkTalk provides? If someone comes to a School-Based clinic looking for help, what sort of clinical services are available to them through this program.
Meg Kane: Yeah, I think I mentioned earlier that we can do almost anything that any other primary care setting can do. Certainly, the full spectrum of primary care but also bags, medication, treatments for acute illnesses, behavioral healthcare especially in partnership with our School-Based Behavioral Health Team which is also on site.
We’re pretty proud of our School-Based Asthma Therapy Program where we're able to further partner with school nurses to provide distribution and onsite supervision of asthma medications for kids with high-risk asthma, so they can receive their medication at school.
We have this roving vaccine clinics that we do which is where we will help district and schools access recommended childhood vaccines by basically showing up to do a vaccine clinic where we're needed. Kind of keeping kids on track with their childhood vaccines, but at the same time making sure that we're preventing kids from being excluded because they are missing their childhood vaccines, which is a kind of a weird thing to happen but it does.
We have this wheelchair seating clinics. We're in partnership with an area school that's committed to caring for kids with medical complexities. The Department of PMR at Children's will bring in a team of professionals to the school twice a year to offer specialized services for kids who have mobility challenges.
We have a couple of new programs that I'll be really remiss in not mentioning, including a school-based Diabetes Management Program, which I'm very excited about, a school-based dentistry program and a new School Nursing Program.
We have been pretty fortunate in the amount of success in our implementation that we've had and then subsequently had just had success with school health in our state in general. And as such, we've just been able to just broaden and develop this consultative model. So that's allowed us to collaboratively strengthen the presence of school health here and in other areas.
And then, we've recently just, I do want to put in a plug for this, had developed a school-health learning collaborative, which is where we partner primary care providers who are interested in expanding access to comprehensive health and wellness services by establishing integrated systems of school-based care through construction of whole child teams. And if anyone listening is interested in that, applications are on the NCH website.
Dr. Mike Patrick: Great. And NCH, Nationwide Children's Hospital, and we will put links to all the things that we're talking about here in the show notes.
Also, the AwkTalk website has, and I think Sarah, maybe you'd mentioned this earlier, a Find A Clinic function within the website. And so, if your school does not have an AwkTalk program or a School-Based program and you're still interested in receiving services or learning more information, some of these resources are available outside of actual schools.
And so, we do have clinics at Nationwide Children's Hospital that see preteens and teenagers. There's also clinics at the Ohio State University Wexner Medical Center, Ohio Health, and Parenthood, Lower Lights Health Center, Columbus Public Health.
There are lots of different resources and places where you could get clinical services if they're not immediately available to you and there's not a School-Based Health Center at your school. There are still other resources. And again, if you go to awktalk.org and do the Find the Clinic research feature, you'll be able to find something there.
And then, you guys do educational outreach as well too, like parents' sessions and presentations, probably more so before the pandemic, I would imagine. How have your services kind of pivoted during COVID? Have you continued, Sarah, to offer AwkTalk services even when school was online?
Sarah Saxbe: Yep, we never stopped. Well, we were briefly interrupted in the Spring of 2020 or the Winter of 2020, I guess, as everyone else was because we were in schools in person, and then obviously, that ended. But thanks to our partnership and some support that we received, we were able to convert the in-person curriculum into a virtual fully online, very interactive curriculum. So, we still were able to do Get Real in the schools as the kids were learning from home.
And we have continued to do that and we're still doing it. We are ending next week as school lets out at Columbus City schools. Even though the kids are back in session in a hybrid model, we are still providing for the most part our instruction online with our virtual curriculum. So, we hired an e-learning developer and a designer who did a wonderful job of helping us create that online.
We had to do it quickly, talk about pivoting and that's got to be the word of the pandemic. Because I think everyone, in order to survive, had to figure out a way. But with AwkTalk, like I said, we took the opportunity to create that, because we knew more kids were going to be learning from home and were going to be online getting information, as well as parents.
So that was really the time that we're able to do that. But the one thing, and Meg mentioned all the great services that the School-Based Health Clinics provide, it was concerning when kids are learning from home and they weren't at the schools in person. And they weren't able to get the care that they're used to getting.
And so, I think, this was an issue with healthcare everywhere, especially at pediatrics. It's that kids, because they weren't able to be at their school where they were able to get that access, we were concerned about vaccinations and just well checks and sickness and all those things that those kids need.
And the same one for education. So, we really try to do as much as we can to bring the education to those kids. And so, it actually was pretty successful and we're pretty proud of ourselves for that.
Dr. Mike Patrick: The two of you are, obviously, extremely passionate about this topic. And AwkTalk has already accomplished so much in a short amount of time. But I suspect that you have more up your sleeve. So, what's next for AwkTalk?
Sarah Saxbe: So, I can speak to the kind of the website and the education piece. And then I'll have Meg speak a little bit to the clinical piece. But for the website, we do want to create more content to put on there. We want to specifically add content about healthy online behavior, more about relationships and consent.
And we want it to contain more information about LGBTQ. And we want it to be more inclusive for LGBTQ kids and allies and come and find lots of resources and information so that all kids are supported.
We also want to make sure it's fresh. We know that things get stale, especially when adults are creating things for kids. So, we want to make sure we are always making sure that AwkTalk is youth informed. So, we'll continue to convene groups of youth to provide feedback and to give us ideas for new content.
So, I personally did a focus group in a community last year with kids all socially distanced and the information that I learned was amazing. And I used that to inform the content for AwkTalk. So, we're going to keep doing that.
And we are also, for the education, in the schools, we will continue to provide sex ed in Columbus City schools with the support of our community partnership and also from a federal grant that we received last year. And so, that is allowing us to do education with eighth graders this Fall. So, we'll be kind of continuing education that the seventh graders have already received into eighth grade. And we'll be continuing that as long as we can and even expanding it to more grade levels, more school districts, and even providing some consultation and support outside of our community to others.
Because like Meg said, we are sharing this information in our networks and we are receiving attention and request for support. So, we'll provide that as well.
Dr. Mike Patrick: Meg, are you guys have plans for expanding School-Based Services to more buildings and perhaps even more school districts?
Meg Kane: We are currently engaging in some construction. We are expanding a little bit. We look a lot at how, constantly, our focus is how can we expand our programming, how can we improve our services.
We look internally a lot and make sure that we are working with our staff and our providers who constantly look at how can we make sure our education is comprehensive, how can we make sure that we're working towards engaging in reproductive justice, how can we do person-first contraceptive counseling with all of our providers. Are we engaging in social justice education? We have an active racial justice working group.
So, a lot of our work is internal as well. So, I think the shortest answer to your question is yes, but then it's also kind of 'a rolling stone gathers no moss' situation. I did want to address maybe, if I could go back to the question you asked, Sarah, and talked a little bit about when we're looking at AwkTalk, I think when I've work with parents and families about during sex ed or even contraceptive counseling, reproductive education, I don't want the parents to feel left out of this, right? Because it is very much a family conversation.
So, I think there has been this sense of, I think you mentioned it earlier, maybe the parents don't necessarily know what to do or know how to manage this conversation. I did want to speak to that part of AwkTalk because there is a parent section on AwkTalk. But they don't have to get all of their content from there, they don't have to get all of their information from there.
One of the things I say to parents a lot regarding sex ed or reproductive health counseling is that this is something that is okay to outsource. We as parents outsource a lot of things. I do not cut my kids' hair. I do not homeschool them, even during the pandemic. I was like homeschool-like, right, you know what I mean?
I don't make my kids' clothes. Some people might do those things. I'm not those people. We make different choices based on our background and our comfort level and our knowledge about what we want to handle internally and what we want to hand to over to someone who has a greater comfort level, a greater knowledge level, a different level of expertise.
To me, teaching your kids sex ed based on your comfort level is no different than teaching your kid to drive, which by the way, I did not do. I also outsourced that. I always tell parents like, "Your role is the role of the values communicator." I communicated my values to my kid regarding learning to drive. I said like, "In this house, we do not drink and drive. We do not speed. We obey traffic lights. We are considerate drivers."
But then as far as the mechanics and what actually had to happen, I turn the rubber to a driving school. I was like "This person will tell you all the other stuff you need to know."
I think sex ed is similar. Parents communicate their value in sex and relationships and all of that, but then how those things might intersect. But it's really okay to go to a health educator or a medical provider or someone else to kind of get the information that scientific and accurate information of how to keep ourselves safe and healthy in our relationships.
With that in mind, AwkTalk has a ton of information, but that's not where you want to go or you looked at that, you want something else, you can go to Planned Parenthood, like you mentioned. The Society for Adolescent Health and Medicine has a ton of information as well. AMAZE.org and 3Rs both of which are put out by Advocates for Youth have family-centered evidence-based curriculum and resources for everyone.
Our Whole Lives has an education and curriculum that encompasses faith tradition and its evidence-based and developmentally appropriate and inclusive, with a focus on social justice. And it really again affirms the parent as the primary educator and communicator.
These are just a few of the resources. I can give you more. But I just wanted to make sure that parents felt like that we, on this side of things, very much see them as a team member and someone that is involved in this kind of like trifecta of keeping your kids super safe and informed at this particular juncture of their life.
Dr. Mike Patrick: Really, really important points. And the AwkTalk website does have a lot of information, but of course, there are other places as Meg mentioned, where you can find wonderful information. Some of the stuff on the AwkTalk website includes, especially for teenagers, in-depth articles on your body, puberty, sex and pregnancy, sexually transmitted infections, birth control.
There's also resources on relationships, what's a healthy relationship, what is a consent, why is it important to talk to a trusted adult? And all of these things are available there on the website.
And then for parents, there's a lot of information at AwkTalk as well. And in-depth articles, just some example, Seven Ways for Parents to Support Their Child in Their First Relationship, Sexually Transmitted Infections in Teenagers: Parents Hold the Key to Prevention, 10 Things They Don't Tell Your Teens in Sex Ed, Talking with Your Children About Getting Pregnant.
So, lots of difficult topics and really a terrific resource for both the teens and parents. Some other sites and resources that I have found helpful, one of them is Power to Decide Teen Talk. And then the SexEd Library is a huge comprehensive resource that we've talked about in this program before that parents can tap into.
And then, we've had a couple of other PediaCast episodes, if you're interested in learning more about all of this. PediaCast Episode 331 was Talking to Children and Teens About Sex. And PediaCast CME, Episode 17, which is for healthcare providers was all about the different options for birth control in teenagers.
And then, the American Academy of Pediatrics has lots of resources as well, Talking to Your Child About Sex, Adolescent Sexuality: Talking the Talk Before Walking the Walk, Helping Teens Resist Sexual Pressure, Contraception Explained, Teaching Health Education in School. So, lots of resources and we're going to put all of these in the show notes for this episode, 491, over at pediacast.org.
So, this is just an entry point, this episode. But do some further digging and check out the show notes. We'll have lots of resources for you.
Sarah, how did AwkTalk get started? Where was the genesis for this idea?
Sarah Saxbe: So, I think what I mentioned, back in 2014 and '15 when Infant Mortality Task Force was convened. And then, the community-facing agency, CelebrateOne, was created. There was really this focus on reproductive health for teens. So how can we promote this more. And so, at NCH, we have the BC4Teens Clinic, which is kind of new because some people think, well, teenagers can just go to their regular doctor. Or they can go to Planned Parenthood or they can go somewhere else.
But we wanted there to be a place where teens felt like they were really given special care and treatment. So, Dr. Elise Berlan created and helped create BC4Teens and that was kind of a starting point. Even though there have been work being done for years and years and lots of people were prescribing birth control for teens, it was kind of a good kickoff to really spreading this more in the community.
So other agencies were also providing more access to teens for birth control, including our School-Based Clinic. And when our School-Based Clinic started, our director really felt passionate. And NCH also felt the value of providing this health education in the schools and that access in the clinic. And clinicians like Meg and some of our other staff members also kind of shared in that passion.
And so, everyone was collaborative in this kind of energy to work on this and to really focus on this. And so, I've been doing this for a long time here. I've been in NCH for 20 years and I've been working in this field for almost eight years. And so, just to see that energy and that support come together really kind of is the genesis for AwkTalk.
Even though it seems like it's just a website, it's really not just the website, it's really the work of so many different passionate people both in NCH and in the community, CelebrateOne, and all of our partners to really focus on the importance of this access for teens and their families, for information and for care for reproductive health.
Because, like I've said before, if these kids learn the facts about their body and they learn skills to make healthy decisions, just how to say no to a situation that doesn't feel comfortable to them.
And it's not just saying the word no necessarily. It's a lot more. It's learning about non-verbal and verbal communication; it's learning what words to say. It's learning how to have a plan and who to call and identifying people that can help you.
Learning those skills, those are skills that you have to learn. And we're trying to teach those to the kids. Teaching them that if you don't feel right, if you are in pain or if you think something is wrong, go to the clinic. The clinic is there for you. You walk in the door and Meg is sitting there and happy to see you and excited to see you.
Teaching the kids these things. These are life skills. They are going to be so much better equipped to go off into adulthood. And so, it's not just getting them access to birth control or condoms. It's teaching them how to care for their bodies and to care for themselves and teach themselves determination. And I can get sappy and talk about it all day, but I've been just so proud on a team that values this.
Dr. Mike Patrick: Absolutely. I'm sure there are a lot of listeners out there right now who feel just as passionate as you do about these topics. And they're perhaps not in Central Ohio and they're thinking how do we start something like this in our community? What advice do you have for folks that may be thinking about starting something like AwkTalk someplace else?
Meg Kane: Yeah, I think that first of all, great, do it. I'm happy to hear that. But I think we mentioned earlier, it is a process that is a little bit different than just taking a successful primary care practice and installing it into a school, right? Because there are so many partnerships to consider.
Reach out to someone who has done it successfully. That can be on the education side, because like we said before, there are many places where this is supported as an educational endeavor. Or on the healthcare side, there are some places like us where this is done through the healthcare system.
So, find someone who's done successfully and say where do we need to start. You can always contact us. We're happy to help. But I think find a model and then work with that model and just say what is it going to look like in my community? Find your community partners. See what their goals are.
Because I think actually one of the most beautiful things about school health is that while the overarching goal is the same every single place you go, every single SBHC is different because it is representative of its community. It's representative of the partners involved. It's representative of the people of the people who are there.
And I think that's wonderful. So, I think you have to talk to who your stakeholders are and figure what this is going to look like here. And then find someone who has a practice that is what you want for your place and start from there.
Dr. Mike Patrick: Absolutely. And your local children's hospital may be a good place to start in terms of getting the various stakeholders together. And there may be already interest within that children's hospital to start this kind of thing in community schools.
So, it can be done. It's just that there's a lot of hard work but the payoff is tremendous and can really make a difference in kids and families' lives for decades and decades to come.
Meg, you had mentioned some of the other school-based health services that we have here at Nationwide Children's Hospital. And I'm going to put a link in the show notes to School-Based Health Services here at Nationwide Children's Hospital so folks can look you up and find out all the different things that you do. But it really is pretty incredible that the breadth of clinical services that we're able to provide right there in schools.
The Asthma Therapy Program that you mentioned, we've talked about that on the show in the past. But as you said, folks can get well checkups, immunizations, sports physicals, and even psychological services. Can they get those within School-Based Health, too? Tell us about that.
Meg Kane: Yeah, absolutely. So, we are pretty fortunate to have a large number of behavior health clinicians under the School-Based umbrella as well. So, every school that has a School-Based Health Center also has a school-based behavior health clinician. And we work in partnership.
So, in addition to kind of collaborating in that sense, we can talk about mutual patients and kind of make a better plan, more comprehensive plan with those patients.
We also are fortunate to have a Telepsychiatry Program. So, if there's something that is kind of beyond the scope of primary care because I can do primary care mental health needs, address those within my clinic. I do that all the time.
But if there's something, a kiddo that maybe has needs that are outside of my scope, I have a telepsychiatry opportunity to kind of escalate that kid's need, do that in a very timely way. And do that with as few barriers as possible for that family.
So, we really are trying to think outside the box and make use of all of our resources to get kids what they need so they're able to stay in school, miss as little class time as possible. Family is able to kind of work toward healing. We're just doing everything we can to work to partner with that family partner with all these wonderful services who've been so great at kind of thinking on their feet and kind of moving along with us.
Everyone is just committed to doing the best thing for kids at all times. And it's awesome to see.
Dr. Mike Patrick: Yeah, absolutely. Once again, this is one of those episodes we're going to have a treasure trove of resources for you in the show notes over at pediacast.org for Episode 491. So definitely, if you've made it this far in the program, you are interested in this topic. And if you are that interested in this topic, be sure to visit the show notes because we will have lots and lots of links and resources for you there.
So once again, Meg Kane, pediatric nurse practitioner and Sarah Saxbe, project manager for Health Education, both with School-Based Health Services at Nationwide Children's Hospital, thank you much for stopping by today.
Meg Kane: Thank you for having us.
Sarah Saxbe: Thank you so much.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Thanks to our guests this week, Meg Kane, pediatric nurse practitioner and Sarah Saxbe, project manager for Health Education, both with School-Based Health Services at Nationwide Children's Hospital.
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