SHS Possibilities with Telehealth

With in-person visits unavailable or limited during the pandemic, telehealth has proven to be a valid and reasonable form of care.  In some instances, providers have been able to remain connected with patients and continue providing SHS by deploying innovative telehealth strategies.

Telehealth appointments offer increased access to sexual and reproductive health services for adolescents through shorter visits, elimination of the need for transportation, and access to contraception and some treatments and testing by mail. These appointments are convenient, taking place anywhere the teen chooses as long as there is an internet connection and adequate device.  This convenience also allows telehealth appointments to offer greater privacy, as virtual appointments can take place in a private space where the adolescent can be alone.  Some adolescents may find greater comfort in speaking with a provider and sharing sensitive information if they are in a space that is familiar and comfortable to them.

Due to the nature of sexual health appointments, providers should consider what services they can offer entirely through telehealth and what services require a hybrid model with in-person visits such as at SBHC or through referrals to a community clinic or other provider.

Telehealth-only SHS

Education, counseling, and prescription of oral medications are common reasons for telehealth-only SHS visits. Patients can provide a health history, discuss symptoms, complete screeners or questionnaires, and ask questions through consultation by video or phone. Based on the findings, providers can ensure that adolescents receive combined hormonal contraception and STI testing and treatment options without a preliminary office visit.

• Combined hormonal contraception can use telehealth for the entire process, with adolescents picking up prescriptions at a pharmacy or having them mailed to a trusted and convenient location.
• At-home testing kits for STIs can be shipped to the adolescent or picked up and sent to the lab after the test is self-administered. Treatments requiring an injection, including expedited partner therapy, can be replaced with oral medications when possible.
• Counseling and visits for HIV care services can take place virtually, as can the prescription of PrEP. If the clinic or lab is not open due to COVID-19 or otherwise, the CDC recommends home testing and prescribing PrEP if test results are negative. Providers may require in-office follow-up based on appointments initiated as telehealth-only.

Hybrid SHS

While providers can examine and diagnose some conditions through telehealth visits, they must take special considerations for these appointments. Many of them will require an in-person visit. Hybrid telehealth models are needed to meet the need for in-person encounters for LARCs, pap smears, and acute pelvic complaints among other services. Hybrid models may also be necessary when symptoms persist after treatment, requiring an in-person examination for follow-up.

Linking Telemental Health and SHS

It is also worth noting the benefit of telehealth on adolescents’ access to mental health services, as research has shown an association between poor mental health and adverse sexual health outcomes in adolescents. CDC researchers have identified that routine changes due to COVID-19 negatively impact adolescents’ mental health. Zoom fatigue, disruptions in learning methods, restricted access to healthcare, loss of important milestones such as prom and graduation, and the security typically provided in school have led to an increase in mental health needs for adolescents.

Before the pandemic, the Youth Risk Behavior Surveillance System (YRBSS) 2019 data showed that 36.7% of all youth reported feeling sad or hopeless almost every day for two or more weeks in a row and stopped participating in usual activities during the 12 months before the survey. For many adolescents, school closures, social isolation, loss of family members, and lack of access to health care contributed to poor mental health during the pandemic.  In the first ever Adolescent Behaviors and Experiences Survey (ABES) recently released by the CDC,  findings highlighted the fact that 37.1% of adolescents experienced poor mental health during the pandemic, while 44.2% experienced persistent feelings of sadness or hopelessness in the 12 months before the survey.

Adolescents in abusive or unsupportive homes no longer had school hours and activities to get out of the house and were more limited in their contact with other trusted individuals. Traumatic or abusive experiences, low self-esteem, and lack of a supportive environment are all factors that can influence the relationship between mental health and sexual health.  Telehealth offers an easy way to remain connected with a provider they already feel comfortable with and trust and can talk to about what they are experiencing.  These conversations can be included during a virtual visit for other SHS and can mimic a conversation the provider might have with them in the exam room.