Access to clinical services to support sexual and reproductive health (SRH) is important for all Californians, including adolescents. California's adolescent SRH education programs, the federally-funded California Personal Responsibility Education Program (CA PREP) and the state-funded Information and Education Program (I&E), support local agencies to provide comprehensive sexual health and life skills education, including communication with partners and trusted adults. A key component of this programming is linking participants to clinical services. These programs require local implementing agencies (local health departments or community-based organizations) to establish formal partnerships with Family Planning, Access, Care and Treatment (FPACT) providers, and facilitate referrals to clinical services.

Both CA PREP and I&E provide unbiased, comprehensive SRH education in compliance with the 2016 California Healthy Youth Act and offer information about local resources and youths' rights to access SRH care, while also respecting and addressing young people's identities, backgrounds, abilities and needs.

This brief describes CA PREP and I&E participants' awareness of clinical services, perceived barriers to accessing those services, and their likelihood to access services both before and after program participation. The data presented here are based on program reports (2017), focus groups (2018), and surveys completed by 7,675 CA PREP participants and 1,178 I&E participants (2016–2017).

Participants in the CA PREP and I&E programs reported increases in:

• Knowing of a clinic or doctor that provides SRH information and services in their community. This increased from 60% at program entry to 82% at exit.
• Visiting a clinic or doctor for SRH services, if needed. This rose from 68% at program entry to 82% at exit.¹

"They gave us a number to call for any questions you have, you know, secretly. They won't release who it is. It's confidential."
- CA PREP Participant

"If you really care about your body and you want to make sure you are ok, you will just go [to the clinic]. If you don't care about your body or you think it is embarrassing, then you wouldn't be as healthy."
- CA PREP Participant

"They told us that you don't have to take your parents and that  services are free."
- I&E Participant

Perceived Barriers to Accessing SRH Services

Before participating in the CA PREP and I&E programs, survey respondents reported that the most common perceived barriers to accessing SRH services at program entry were:

• Worry about confidentiality of services (37%),
• Worry about test results (29%), and
• Worry about cost of services (27%).

Upon exiting the program, confidentiality concerns saw the largest decrease, dropping by eight percentage points.

Figure 1: Change in the percentage of participants who perceived barriers to accessing SRH services, from program entry to exit (n=8,853)²

Summary

Strengthening the linkages between SRH education and clinical services can improve adolescent access to high-quality confidential SRH services, a critical strategy for long-term success in reducing unintended adolescent pregnancies, promoting SRH well-being and increasing testing and treatment for sexually transmitted infections. Following participation in CA PREP and I&E, participants reported an increase in their awareness of and likelihood to use SRH services and a decrease in their perceived barriers to SRH services.

Resources

Referrals and Linkages to Youth-Friendly Health Care Services: Guide from the Office of Adolescent Health that defines youth-friendly services and outlines how to develop an effective referral system.

Footnotes: 

1. Change between entry and exit is significant (p < .001). There were 453 missing responses at entry and 183 missing responses at exit. 
   

2. Changes between entry and exit are significant for confidentiality and cost (p < .001). There were 290 to 620 missing responses for each question.