SEXUAL HEALTH SERVICES (SHS) REFERRAL TOOLKIT

C. RATIONALE FOR SCHOOL INVOLVEMENTOVER HALF OF CPS TEENS ARE SEXUALLY ACTIVE152%39%11%HIGH SCHOOLSTUDENTSCPS HIGH SCHOOLSTUDENTS27%MIDDLE SCHOOLSTUDENTSCPS MIDDLESCHOOL STUDENTSCPS STUDENTS REPORT HAVING HADSEXUAL INTERCOURSESTUDENTS REPORT NOT USING A CONDOMDURING LAST SEXUAL INTERCOURSEOF SEXUALLY ACTIVE CPS 12TH GRADERSREPORT HAVING HAD 4 OR MORE PARTNERSTEEN STI AND BIRTH RATES ARE HIGH AND THIS AFFECTS SCHOOL SUCCESS90%40%13–242YEAR OLDS#NEW HIVDIAGNOSESCOOK COUNTY HAS THE 2ND HIGHEST NUMBER OFCHLAMYDIA & GONORRHEA INFECTIONS IN THE U.S.OVER 50% OF NEW CASES IN 2015 OCCURRED IN YOUTH228% OF NEW HIV DIAGNOSES INCHICAGO OCCURRED IN 13–24 YEAR OLDS 3BY AGE 22 ONLY 40% OF TEEN MOTHERS GRADUATEFROM HIGH SCHOOL COMPARED TO 90% OF WOMENWHO DID NOT GIVE BIRTH AS A TEEN 4STUDENTS DON’T KNOW THEIR RIGHTS OR HOW TO ACCESS SEXUAL HEALTH SERVICES!?40%40% OF TEENS SURVEYED DID NOTKNOW THAT THEY COULD ACCESSCONTRACEPTION WITHOUT PARENTALINVOLVEMENT OVER THE AGE OF 12 5REFERRALBY HELPING STUDENTS ACCESS HEALTH CARE, SCHOOLS IMPROVEATTENDANCE, BEHAVIOR, ACHIEVEMENT AND GRADUATION SUCCESS. 7CHICAGO YOUTH RISK BEHAVIORSURVEY (YRBS), 2013.2CHICAGO DEPARTMENT OF PUBLICHEALTH. HIV/STI SURVEILLANCEREPORT, 2016. CHICAGO, IL: CITYOF CHICAGO; DECEMBER 2016.3IBID.8 SHS REFERRAL TOOLKITMANY YOUTH HAVE NOT BEEN TESTEDAND, BECAUSE THERE ARE OFTEN NOSYMPTOMS, THEY DON’T KNOW THEYHAVE AN INFECTION.21.5% DID NOT KNOW THAT THEYCOULD BE TESTED FOR STIs WITHOUTPARENTAL INVOLVEMENT 6THIS IS WHERE SCHOOLS COME IN.1BOTH CHLAMYDIAAND GONORRHEAARE EASILY CURABLE.21.5%4NG, A. S., & KAYE, K. (2012). WHYIT MATTERS: TEEN CHILDBEARING,EDUCATION, AND ECONOMICWELLBEING. WASHINGTON, DC: THENATIONAL CAMPAIGN TO PREVENTTEEN AND UNPLANNED PREGNANCY.5UNIVERSITY OF CHICAGO MEDICALCENTER (2011). YOUTH AWARENESSOF A MINOR’S RIGHT TO ACCESSREPRODUCTIVE HEALTH SERVICESINDEPENDENTLY. CHICAGO: FAMILYPLANNING AND CONTRACEPTIONRESEARCH POLICY BRIEF.6IBID.7LEWALLEN TC, HUNT H, POTTS-DATEMA W,ZAZA S, GILES W. THE WHOLE SCHOOL, WHOLECOMMUNITY, WHOLE CHILD MODEL: A NEWAPPROACH FOR IMPROVING EDUCATIONALATTAINMENT AND HEALTHY DEVELOPMENTFOR STUDENTS. J SCH HEALTH. 2015; 85: 729-73.

SECTION 2Youth Rights and Protections Regarding SHSA. MINOR CONSENT AND CONFIDENTIALITY LAWS (INCLUDING UNACCOMPANIED MINORS)ACTION ITEMKnow the laws and policies related to students accessing sexual health services (SHS):Illinois has several laws that ensure that minors, aged 12 and up, can access SHS, mostwithout permission or notification of a parent/guardian.CONSENT AND CONFIDENTIALITYDEFINITIONS FOR HEALTH SERVICESConsent is permission to access services. Most medical care foryouth requires parental consent or permission. However, thereare legal exceptions for SHS. (See Appendix B-2015 IllinoisConsent Card)Confidentiality is the legal protection of privacy-that theinformation disclosed or discussed with a health care providermay not be shared with anyone else without the patient’spermission. Most sexual health care is confidential-the health careprovider must keep private the medical information about thepatient. However, there are some legal exceptions. (See AppendixB: 2015-Illinois-Consent Card).THE LAWIn Illinois, youth under 18 seeking general medical care needpermission from a parent or guardian. However, youth 12 yearsof age and older can access most SHS without parental consentor permission. Additionally, Medicaid cannot send home a bill/explanation of benefits for these SHS services.SHS Services Generally Not Needing Parental Consent:»» HIV and Sexually Transmitted Infections (STIs)testing and treatment»» HPV vaccinations»» Contraception (condoms and other birth controlincluding emergency contraception (EC))»» Pregnancy testing»» Medical care when pregnant»» Abortion (notification of an “adult family member” is requiredbut consent is not)»» Also emergency medical treatment (including substance abuseand mental health counseling)There are some exceptions and variations for each. More detailedinformation is provided in Appendix B: 2015-Illinois-Consent Cardor at rd.pdf.Note: Unaccompanied minors may consent for all health care.Unaccompanied minors are students aged 14-18 who are notin the physical custody of a parent or guardian, nor underprotective custody of the Department of Children and FamilyServices (DCFS). (See Unaccompanied Minor’s Access to HealthCare Instructions on the Office of College and Career Success’sStudent Support and Engagement page on the KnowledgeCenter for more information.)9 SHS REFERRAL TOOLKIT

B. PRIVACYSchool’s Role in Maintaining Confidentiality:»» Counting or tracking referrals and informal follow-upwith students can and should occur. However, identifyinginformation like name or ID should be kept private.»» To maintain confidentiality, referrals should not be documentedin the Student Educational Records as parents/guardians mayaccess them, in accordance with FERPA.»» Schools should maintain student privacy. FERPA contains noaffirmative obligation that requires schools to inform parent/guardians about minor consent health care services the studentmay have received. Families can be encouraged to discusshealth care decisions together.»» CPS Law Department has developed a comprehensive guide:“Guidance for School Counselors, School SocialWorkers and School Psychologists on Disclosing InformationStudents Tell You in Confidence” which can be found at thislink: https://goo.gl/qQN0yS.C. MANDATED REPORTING AND SEXUAL VIOLENCE DISCLOSURESSchool personnel should advise students that conversations andreferrals are private and confidential unless: there is suspected abuse, in which case the DCFS Hotlinemust be called (1-800-25-ABUSE) if a student may cause harm to self or others»» If you learn or suspect that sexual violence has occurred, seeAppendix C: Recommended Sexual Violence Response Tree fornext steps to support the student as well as if and to whom youneed to report the information.»» CPS Law Department has developed a very comprehensiveguide: “Guidance for School Counselors, School Social Workersand School Psychologists on Disclosing Information StudentsTell You in Confidence” which can be found at this link:https://goo.gl/qQN0yS.D. C PS POLICY: SCHOOL ATTENDANCE AND EXCUSED ABSENCES FORMEDICAL APPOINTMENTSExcused absence for Medical Appointments:»» The CPS Policy on Absenteeism and Truancy states that an“Excused Absence” shall mean: an absence for which there isa valid cause either: (i) known to the principal or principal’sdesignee or (ii) attested by a letter (or note) signed by theparent or legal guardian. Illness is one of the “valid causes” forstudent absence.»» Visiting On-Site Health Providers During the School Day: S tudents may visit an on-site school based health clinic(SBHC) or a mobile health provider for SHS during theschool day without parental permission. (Note: Parents10 SHS REFERRAL TOOLKITmust consent students for other medical services.) Schoolsand providers should communicate about best times forstudents to visit the clinic to maximize instructional time.»» Visiting Off-Site Health Providers During the School Day: S tudents aged 17 and under need parental or principalpermission to leave school for a medical appointment.Unaccompanied minors present an exception: they maycomplete all consent forms that would normally be filled outby a parent. Students aged 18 and over may sign themselves out ofschool for a medical appointment.E. PROTECTIONS FOR LGBTQ, PREGNANT AND PARENTING STUDENTS:TITLE IX AND CPS NON-DISCRIMINATION POLICYTitle IX of the Education Amendments of 1972 is a comprehensivefederal Civil Rights law that prohibits discrimination on the basisof gender identity and sexual orientation in any federally fundededucation program or activity. Pregnant and parenting studentsas well as lesbian, gay, bisexual, transgender, and questioning(LGBTQ) students have a great need for health care. Title IXprotects them and ensures that schools can help to meet theirneeds.CPS Policy “Comprehensive Non-Discrimination Title IX andSexual Harassment” outlines CPS’s procedures for reporting andinvestigating claims.Rights of LGBTQ Students under Title IXGender identity and sexual orientation are protected under TitleIX. Thus, lesbian, gay, bisexual, transgender and questioning(LGBTQ) students have the right to attend medical appointmentsand receive referrals for sexual health services. They are alsoprotected against bullying and harassment.For more detailed guidance on ensuring rights of transgenderstudents, CPS has developed the CPS Guidelines for Transgenderand Gender Non-Conforming Individuals, available on theKnowledge Center.To learn more about supporting LGBTQ students at school,complete "Creating Safe Schools for LGBTQ and All Youth," a3 hour online training available on the CPS Learning Hub (coursecode: 31062; search words: “Sexual Health”).

Rights of Pregnant and Parenting Students under Title IX"With better comprehensive sexual health education and preventionprograms, we can help many young people prevent unintendedpregnancy. Still, some young people will become pregnant andchoose to have the baby. When that happens, we should make surethey have the support, respect, and access to education and healthprograms that can help them be successful."- “THE PUBLIC’S VIEWS ON SUPPORTING YOUNG PARENTS”ADVOCATES FOR YOUTH, OCTOBER 2015F. CPS SEXUAL HEALTH EDUCATION POLICYWhile connecting students to SHS is important, providingstudents with medically accurate sexual health education iscritical for improving student understanding of their healthrisks and rights to services. The CPS sexual health educationcurriculum includes lessons on sexual health services. (SeeSection 4-C: Sexual Health Education).As a reminder, the CPS Sexual Health Education Policy requiresschools to teach sexual health education annually at every gradelevel. See Appendix D for full CPS Sexual Health Education Policy.»» The minute requirements for Kindergarten to 4th grade are 300minutes and for 5th to 12th grade are 675 minutes.Pregnancy discrimination is considered a form of sexdiscrimination.According to Title IX, pregnant and parenting studentshave the right to:»» Stay at their school and remain up-to-date on their coursework.»» Be treated fairly»» Use excused absences»» Participate in school activities»» Make up missed work»» Receive support from school and school district»» Receive homebound services if deemed necessary»» Teen fathers also have the right to receive excused absences toattend medical appointments with their pregnant partner. For help with homebound options, contact Chicago PublicSchools Office of Diverse Learner Supports and Services(ODLSS) Home and Hospital Instruction Program coordinator,at homeandhospital@cps.edu or Tora Evans at 773-553-3409or tevans@cps.edu.11 SHS REFERRAL TOOLKIT»» Each school must have at least two trained instructors whoprovide instruction. For instructor training, search “SexualHealth” on the CPS Learning Hub.»» Parent notification: Parents, as their children’s primaryeducators of sexual health, are to receive at least threenotifications about the instruction including the time that itwill occur. Parents have the right to opt their child out of all ofthe instruction or specific lessons. Parent notification lettersin English and Spanish can be found within the sexual healthcurriculum folder which is available to all who have completedsexual health education instructor training.

SECTION 3School-Level PlanningA. DETERMINE SCHOOL-LEVEL PLANNING NEEDSACTION ITEMComplete a school self-assessment using the Sexual Health Services (SHS) Referral ImplementationChecklist to determine next steps (See Section: How to Use this Toolkit or Appendix A). Theremaining sub-sections of School-Level Planning will help you complete any outstanding items on thechecklist.B. LETTER TO THE PRINCIPALACTION ITEMGarner administrative support, asneeded, using the Letter to thePrincipal provided in Appendix E.Also share the Rationale for SHS(p8) or The Sexual Health Services(Shs) Referral Toolkit 1-Pager inAppendix I.Dear Principal,In Chicago Public Schools (CPS), approximately 52% of high school students and 11% of middle schoolstudents report having had sexual intercourse, and condom use rates remain low (CDC, 2013). Further,Cook County, which includes Chicago, has the 2nd highest number of chlamydia and gonorrhea infectionsin the nation. 63% and 55% of new cases in 2015, respectively, occurred in youth.Many Chicago students are at high risk for teen pregnancy and sexually transmitted infections (STIs)which can affect their attendance, academic achievement, behavior and graduation success (J Sch Health.2015; 85: 729-73).Students need sexual health services (SHS) and education that can keep them healthy and on a path tograduation and schools can help.As an administrator, your support for mobilizing staff and supporting student access to SHS is critical. Asyour students may already ask school personnel for information about SHS, the CPS Office of StudentHealth and Wellness (OSHW) has provided a toolkit to help staff provide medically and legally accurateinformation and link students to appropriate and supportive medical care.You can support your staff by:»» Understanding the laws, policies & rationale related to SHS for students»» Selecting a referral point person or team, if necessary»» Making any school-wide decisions about referral procedures in a timely manner»» Allowing time during staff meetings for training and awareness of the laws and policies around access toSHS, student need and the school’s procedures for referral making»» If applicable, communicating with your school-based health center or mobile health provider to createprotocols that are mutually beneficial to school and providerYou can support your students by:»» Strategically planning for sexual health education to be implemented at all grade levels by teachers whohave completed the CPS Sexual Health Education Instructor Training. (See CPS Sexual Health EducationPolicy for more information.)»» Allowing students to participate in awareness marketing campaigns»» Allowing posters and wallet cards with referral information to be disseminatedMost information needed is located in the Sexual Health Services (SHS) Referral Toolkit: Guidelines andResources for Connecting Students to Sexual Health Services and Making Referrals. If any additionalinformation or support is needed, please contact the Office of Student Health and Wellness atsexualhealthed@cps.edu. Thank you for your support.LOCATED IN APPENDIX E12 SHS REFERRAL TOOLKIT

C. STAFF WHO CAN MAKE REFERRALS AND COORDINATE SCHOOL’S SHS REFERRAL EFFORTSWHO CAN MAKE SHS REFERRALS?ACTION ITEMAn SHS referral point person orteam coordinates the school's SHSreferral efforts and determineswho at the school will bedesignated and trained to makeSHS referrals.Designated staff who have received necessary training»» Who can be designated? Options for schools to consider:1.ALL STAFF2. AN IDENTIFIED GROUP OF PEOPLE (I.E. COUNSELORS, CARE TEAM, SCHOOL SUPPORT STAFF)3. ONE INDIVIDUAL POINT PERSONThe following individuals should beconsidered:SUCCESS STORYReferral Team RecruitmentIn one CPS high school the assistantprincipal presented the Sexual HealthServices (SHS) Referral Toolkit 1-Pager(Appendix I) during an all staff meeting.She spent 10 minutes going over theinformation as well as the proceduresand marketing efforts specific to thatschool. Following the presentation, 2more staff members volunteered to beon the Referral Team.»» Those who are comfortableaddressing sexual health topics»» Those who are available for trainingopportunities»» Those who are already makingSHS referralsPossible candidates include:»» School counselors»» Social workers»» Gay Straight Alliance (GSA) advisors»» Health teachers»» Sexual health education instructors»» School nursesReferral teams already in place—such as CARE and MTSS teams—may be comfortableaccepting these responsibilities.Referral Team or Point Person:»» In addition to making referrals, these individuals will:1. HELP ESTABLISH THE SCHOOL’S APPROACH FOR MAKING SHS REFERRALS.2. ENSURE SCHOOL-WIDE KNOWLEDGE ABOUT MAKING REFERRALS.3. COUNT REFERRALS MONTHLY.13 SHS REFERRAL TOOLKIT

D. TRAINING FOR STAFF WHO WILL MAKE REFERRALSACTION ITEMDesignated staff should review this toolkit withspecial focus on the topics listed below to ensurethey are equipped with the knowledge, skills, andresources necessary to promote, make and countappropriate referrals in accordance with schoolprocedures.REFERRAL STAFF TRAINING CHECKLISTRECOMMENDED ADDITIONAL TRAININGStaff should understand: Complete the CPS Sexual Health Education Rationale for schools’ making SHS referrals, toinclude the data on youth risk behavior and healthstatistics Definitions of key sexual health services Laws and policies around minor consent andconfidentiality, attendance and mandated reporting How to effectively make an SHS referral for students How to select a youth friendly health care providerand how to connect with providers Referral countingInstructor Training. It includes medically accurate,up-to-date information and access to the CPSSexual Health Education Curriculum and Resources.Trainings are available online or in-person. Search“Sexual Health” in the CPS Learning Hub. Complete the "Creating Safe Schools for LGBTQ andall Youth," a 3 hour online PD available on the CPSLearning Hub (search "Sexual Health"). A dditional PD topics include: adolescentdevelopment, addressing the sexual andreproductive health needs of LGBTQ adolescents,male sexual health, contraceptive options, traumainformed care, managing controversy, and STI/HIVCPS Office of Student Health and Wellness(OSHW) is available for support. Emailsexualhealthed@cps.eduoverview. (While not in this toolkit, many of thesetopics are included in the Sexual Health EducationCurriculum and Resources, which is available to allwho have completed the Sexual Health EducationInstructor Training).14 SHS REFERRAL TOOLKIT

E. CHOOSING AND/OR CONNECTING WITH YOUTH FRIENDLY HEALTH CARE PROVIDERSACTION ITEMSelect and connect with anearby no-or low-cost youthfriendly health providerfor referralsStudents are looking for convenient, low cost health care options forSHS. Schools may choose to identify 1 or more youth friendly providers forreferrals and/or they may choose to refer students to a resource directory.Keeping in mind that different students have different needs but withoutmaking assumptions, a student who requests it might be referred to aclinic that specializes in working with specific populations, such as LGBTQyouth, or one that is staffed with speakers of various languages. Otherconsiderations include the provider’s location, accessibility via publictransportation, cost and hours.THIS SECTION INCLUDES INFORMATION ON THEFOLLOWING:THIS SECTION IS TO GUIDE SCHOOLS EITHER IN:»» Choosing a youth friendly health care provider for referrals ifthey do not already have a relationship with onea. Characteristics of a youth friendly health provider»» Connecting with a youth friendly health care provider that theirstudents already utilize»» Partnering with a provider to increase student access to sexualhealth services and sexual health education»» Connecting their students to Medicaid, if neededb. Types of free or low cost SHS providersc. H ow to find a health provider using resource directorieswebsites with lists of clinicsd. P artnering

6 SHS REFERRAL TOOLKIT ITEMS TO BE COMPLETED DONE SCHOOL-LEVEL PLANNING NOTES/IDEAS/RESOURCES Ensure Training for Referral Team Review entire SHS Referral toolkit sections: Rationale for SHS Related Laws and Policies School’s Referral Procedures Provider Information – SHS Provider Info