The Journal of School Nursing2021, Vol. 37(5) 404–411© The Author(s) 2019Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/1059840519867363journals.sagepub.com/home/jsn
Many factors impact an adolescent’s willingness to appropriately use health-care services and intent to begin the health-care transition process. Published literature continues to show that the way adolescents experience and utilize health-care services is ineffective and has long-term impacts on individuals and systems. Building upon the success of an existing peer-to-peer workshop, a Toolkit was created to provide school-based health professionals the information and resources needed to deliver pertinent information to high school students in one lesson. Of 416 students, over two thirds reported that they plan to be more involved in their health care (69.8%), advocate for themselves in health-care settings (68.0%), talk openly and honestly with health-care providers (71.9%), and learn more about managing their own health care (68.6%). Integrating this information into existing health curricula provided a broader reach with minimal work and promising results that could improve overall health-care transition efforts.
health education, middle/junior/high school, program development/evaluation, health-care transition, patient activation, patient engagement, adolescent health
Adolescence is known as an important transitional period, providing youth an opportunity to develop critical knowledge and skills needed for adulthood. Unlike other physical, social, vocational, and cultural transitions, managing health care and effectively using health services is often not given as much attention (Eaton et al., 2017; Lebrun-Harris et al., 2018). Published literature continues to show that the way adolescents experience and utilize health-care services is ineffective and has long-term impacts on individuals and health-care systems (Fleary, Joseph, & Pappagianopoulos, 2018; Hargreaves, Elliott, Viner, Richmond, & Schuster, 2015; James, 2013; National Research Council and Institute of Medicine, 2009). As a result, health-care transition—the movement from pediatric-based to adult-oriented care—for adolescents with and without special health care needs has become a priority issue nationwide (American Academy of Pediatrics et al., 2018; Betz, 2017). In 2016, only 17% of youth with special health-care needs and 14% of those without met all three components of the transition measure outlined by the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians (Lebrun-Harris et al., 2018).
Many factors have influenced the momentum and progress of health-care transition efforts (Gray, Schaefer, Resmini-Rawlinson, & Wagoner, 2018). While system- and policy-level interventions are clearly needed, there are significant barriers that even influence an adolescent’s willingness to appropriately use health-care services. Many have concerns and fears about confidentiality, stigma, and judgmental attitudes of health-care providers (hereafter referred to as “HCP”) that directly influence their health-care experiences and overall health outcomes (Britto, Tivorsak, & Slap, 2010; Gilbert, Rickert, & Aalsma, 2014; Irwin, Adams, Park, & Newacheck, 2009). Some even choose to forgo services. Additional awareness and education addressing these key issues is warranted to help improve broader health-care transition efforts. Schools provide a great opportunity for collaboration because they reach such a significant portion of the adolescent population and have existing health education mediums in place.
The purpose of this project was to (1) assess the efficacy of a high school educational lesson in changing adolescents’ knowledge, confidence, and intended behaviors related to becoming engaged and responsible managers of their own health care; (2) determine the feasibility of integrating such content into existing school health curricula; and (3) gain overall participant feedback on the project.
Over the 2016–2017 school year, 10 school-based health professionals (six health teachers, three school nurses, and one staff member of a school’s pregnant and parenting youth program) from six school districts across the state of Wisconsin taught the educational lesson, reaching a total of 430 adolescents. Each lesson facilitator received a PATCH for Teens Toolkit (hereafter referred to as “Toolkit”) which included a scripted lesson, peer-to-peer teaching videos, teen playbook (i.e., a supplemental resource covering the lesson’s main topics), additional activity and facilitation materials, sample PATCH-branded swag (i.e., lip balm and pens), access to additional PATCH resources and materials (i.e., brochures), and a series of evaluations theoretically guided by Kirkpatrick and Kirkpatrick’s (2016) four-level evaluation model. Documentation was received from the University of Wisconsin’s Institutional Review Board’s QI/Program Evaluation Self-Certification Tool indicating institutional review board’s review and approval of the project was not required, and thus, the findings are characterized as program evaluation and improvement.
The Toolkit was developed with youth as a part of the Providers and Teens Communicating for Health (PATCH) Program. PATCH, previously named the Wisconsin Adolescent Health Care Communication Program, was initially founded in 2010 to address the communication barriers between adolescents and their HCP in discussing sexual and reproductive health issues. Over the years, PATCH recognized the importance of open and honest communication with HCP regardless of health topic and shifted its efforts toward improving overall adolescent patient activation—or one’s knowledge, skills, and confidence to effectively manage their own health and health care—through a multiprong approach that addresses the complex triad relationship between adolescents, their families (i.e., parents, guardians, and/or caregivers), and HCP in health-care settings (Hibbard & Greene, 2013; Tebb, 2011).
The PATCH for Teens component of the program aims to educate and empower youth to become responsible managers of their own health care. Previously, PATCH Teen Educators (i.e., youth who have been hired and trained to deliver programmatic workshops and share their authentic adolescent viewpoints) delivered pertinent information solely through peer education workshops. As demand for the content increased and PATCH began expanding into other communities, it became clear that this educational delivery method was limiting PATCH’s overall reach and feasibility.
In the spring of 2016, the Toolkit was developed based on the initial framework of the program’s successful peer education workshop (Olejniczak et al., 2015). Instead of direct peer-to-peer education, the Toolkit allowed reputable adults to deliver the PATCH content while still capitalizing on the benefits of youth voice through the use of technology. Teen Educators worked with PATCH Program staff—professionals with backgrounds in public health, clinical medicine, and health education, promotion, and communication—to develop short video clips that covered core content from the existing peer-to-peer workshop. The videos starred Teen Educators and were intended to provide youth perspective on the importance of health care and health-care transition.
Based on principles from the Activated Health Education instructional model (Dennison & Golaszewski, 2002), program staff drafted a complete PATCH for Teens lesson centered on the video clips. The lesson included scripted language for facilitators and step-by-step instructions on how to deliver the content and associated learning activities to help students comprehend, debrief, and apply the information in the videos. Activities included self-reflection, group discussions, skits, and other scenario-based learning activities. Table 1 provides an outline of the lesson content and activities. The completed lesson was reviewed by Teen Educators, the program’s academic partner with a postdoctoral degree in nursing, health education teachers, school health curriculum supervisors, HCP, and other program stakeholders.
As a result of the lesson, it was projected that youth would understand the importance of learning to manage their health-care experiences, learn to advocate for their health and well-being in health-care settings, and explore steps they could take to make sure they got the care they needed and deserved.
A convenience sample of school-based health professionals and educators was invited via e-mail by the state’s Department of Public Instruction and Department of Health Services networks to integrate the Toolkit into their existing 9th through 12th Grade health education curricula. Within 48 hours, capacity was filled, demonstrating interest and future feasibility. The first 10 facilitators to respond were chosen for the project. Cumulatively, they taught the PATCH for Teens lesson 21 times, reaching 430 students in Grades 9–12 throughout 6 different Wisconsin counties. Class sizes ranged from 3 to 32 students. Table 2 highlights basic demographic information of the facilitators and students.
Facilitators were mailed the Toolkit and required to complete a brief training via phone or prerecorded video, which reiterated the purpose of the project and facilitator expectations. It was expected that facilitators would implement the PATCH for Teens lesson with fidelity during the 2016-2017 school year, complete all of the project’s evaluations, and share the collected information with the PATCH Program. Covering the core content in the lesson was required, but the amount of time allocated to discussion and associated learning activities was up to the discretion of the facilitator and to be documented on the evaluation forms accordingly.
Program staff developed three evaluation tools with the program’s academic partner to (1) measure changes in adolescent knowledge, confidence, and intended behaviors as a result of the PATCH for Teens lesson; (2) determine implementation feasibility; and (3) gain overall project feedback from participants.
Measure 1: Changes in adolescent knowledge, confidence, and intended behavior.
A postlesson Student Evaluation measured changes in adolescents’ knowledge, confidence, and intended behaviors and gathered feedback on their experience. This evaluation tool was based on the evaluation used in the program’s existing peer-to-peer workshop (i.e., a modified version of a retrospective pretest design). Questions were divided into separate sections based on key indicators (i.e., knowledge, confidence, and intended behavior) with a maximum of four statements in each section. Potential responses to knowledge statements included “yes,” “already knew,” “no,” and “not sure.” Confidence responses included “more,” “same,” “less,” and “not sure.” Intended behavior responses included “yes,” “maybe,” and “no.” Students were also given the opportunity to provide feedback via open-ended questions and rated the lesson using a 5-point scale ranging from (Poor/1 Star) to (Excellent/5 Stars). Three questions were used to gather basic demographic information. Anonymous evaluations were completed via pen and paper and were collected by facilitators after the lesson.
Measure 2: Implementation fidelity and feasibility.
A Facilitator Process Form documented the extent to which the lesson was implemented, time allocated to each section, and any other factors unique to a particular session (e.g., noting time constraints and population characteristics like pregnant and parenting youth). This form also collected fidelity measures including utilization of the scripted lesson, delivery of the peer-to-peer education videos, and facilitation of supplemental lesson activities.
Measure 3: Participant Feedback.
As indicated above, students were given the opportunity to provide feedback on the Student Evaluations. Furthermore, a Facilitator Reflection Form was sent electronically to facilitators at the very end of the project to gain anonymous feedback and suggestions on the Toolkit and their overall experience. Five-point Likert-type scales were used to evaluate the Toolkit, lesson, and facilitation materials. Ratings ranged from (very poor) to (excellent), and included (no opinion) and (not applicable) for a total of seven different response options. Additional open-ended questions elicited how the lesson was integrated into existing curricula, as well as the successes, challenges, and insights from facilitators.
All paper-based evaluations (i.e., Student Evaluations and Facilitator Process Forms) submitted to program staff were transferred verbatim into a corresponding online Google Form. Each Google Form was linked to a Google Sheet where all descriptive data were analyzed using pivot tables. Student responses were analyzed in Stata SE Version 14.2 using logistic regression models and included differences by race, gender, and age. Demographic variables were controlled in all significant comparisons reported. Free response answers were organized and coded for themes using qualitative thematic analysis. Partially completed evaluations were included if more than half of the form was completed.
Four hundred sixteen (416; 96.7%) of the 430 students who participated in the lesson completed a Student Evaluation. As a result of the lesson, over two thirds of students reported that they plan to be more involved in their health care (69.8%), advocate for themselves (68.0%), talk openly and honestly with HCP (71.9%), and learn more about how to manage their own health care (68.6%). When asked to write a short paragraph about how they will use the information from the lesson, half of respondents (49.6%) mentioned their intent of becoming more responsible for their health care. Other students stated that they would be more honest with their provider and discussed improving their overall communication in health-care settings. The following quotes represent the statements made by students: “I will take more control of my health care. I will ask more questions, and make sure I understand what is going on in a health care situation” (15 year-old, white male); “… I can be an advocate for myself. If I don’t feel comfortable or they aren’t listening I can help stand up for myself and say what is right” (15-year-old, biracial female).
Students who reported being 14 years old and younger were more likely than their older peers to have found the lesson interesting (OR 2.82; 95% CI [1.59, 4.98]; p = .000) and report learning something new (OR 1.83; 95% CI [1.04, 3.23]; p = .036). They also were more confident in their ability to be open and honest with their HCP (OR 2.04; 95% CI [1.16, 3.60]; p = .013) and knew that they had a personal responsibility to take charge of their health care (OR 1.88; 95% CI [1.07,3.32]; p = .029).
Students who self-identified as Black or African American were 3.66 times more likely than their White peers to report a newfound understanding of the importance of the relationship with a HCP (OR 3.66; 95% CI [1.20, 11.19]; p = .023). They were also more likely to report an increased confidence in their ability to be an active participant in their health care (OR 3.67; 95% CI [1.37,9.79]; p = .009), advocate for themselves in health-care settings (OR 2.67; 95% CI [1.03, 6.91]; p = .043), and take responsibility for their health care (OR 2.92; 95% CI [1.07, 7.96]; p = .036). Those who self-identified as Hispanic or Latinx were more likely than their White peers to report that they learned a lot as a result of the lesson (OR 3.70; 95% CI [1.29, 10.60]; p = .015). Yet, they were less likely to report an increased intention to participate in their health care (OR 0.25; 95% CI [0.08,0.76]; p = .015).
Furthermore, students who self-identified as female were more likely than their self-identified male peers to report their intentions of becoming more involved in their health care (OR 1.79; 95% CI [1.12, 2.84]; p = .014), advocating for themselves in health-care settings (OR 1.95; 95% CI [123, 3.07]; p = .004), and talking openly and honestly with HCP (OR 1.79; 95% CI [1.12, 2.87]; p = .015). A comprehensive list of measures on teen outcomes are reported in Table 3.
Although Facilitator Process Forms were gathered on all 21 of the classroom sessions, only 19 (90%) were included in the following analysis due to the extent to which the form was completed. The class sessions ranged in duration from 45 to 120 min with a majority lasting between 45 and 55 min. All facilitators reported completing core content activities as designed, while some indicated adaptations to the associated learning activities based on how much time was allocated to the lesson (i.e., more time allocated to the lesson meant more time for activities and discussion, and vice versa). Facilitators mentioned the benefit of having more time to cover, process, and discuss the lesson’s content based on the fact that students had a lot of questions about the topic, generating rich classroom discussions. Main discussion points and questions brought up by students were related to their ability to trust HCP and the laws pertaining to their confidentiality (i.e., having alone time with a provider, mandated reporting, and confidentiality breeches as a result of insurance). Facilitators that indicated time constraints suggested increasing the total lesson duration to approximately 90 min or two full class periods. The following quotes illustrate comments that were shared by facilitators: “Too much content to fit into one class period. My students are accustomed to lots of discussion and processing of information as a group”; “The lesson took me 2 hours by choice. I think there are many great components that I could expand upon.”
Table 4 shows student and facilitator feedback related to the classroom lesson. The majority of students reported that they learned a lot (yes or kind of) from the lesson (51.1% and 36.5%) and thought it was useful (65.5% and 28.5%) and easy to understand (73.3% and 22.2%). The following are a few comments from students regarding their experience: “I liked that you had teenagers do it [teach the content through videos] because it was easier to relate”; “This is a good program and it makes me feel more comfortable and confident for my next appointment cause now I know it’s okay to be shy but speak up!”
The majority of the facilitators that completed a Facilitator Reflection Form (8 of 10) also indicated that the lesson was excellent or above average in terms of relevance to students (25% and 50%), student engagement (50% and 25%), organization (37.5% and 37.5%), being educational (50% and 25%), being age-, language-, culturally-, and developmentally appropriate (25% and 62.5%), being student-centered (25% and 75%), and empowering students (50% and 25%). The following quotes exemplify the feedback from facilitators: “It was a topic kids never learned about”; “This lesson has a ton of potential to discuss numerous [National School Health Education] standards since it is constructed in the part/whole method.”
Both students and facilitators also had various suggestions for improvement. Key themes from both groups included the need for the following: higher quality and easy-to-use video clips since the project originals were created by an undergraduate university intern, more use with the emoji booklets (i.e., a spiral-bound booklet containing different emojis that were used to gauge students’ responses, feelings, and reactions during the lesson in a fun and interactive way), and a method for integrating the teen playbook into the lesson instead of being solely a resource. The following quotes are examples of suggestions: “Make it more fun and not so informational” (Student); “Some parts of the videos were cheesy and some parts I thought were excellent” (Facilitator); “My students loved the use of emojis. They wanted more emojis to choose from” (Facilitator); “Have the playbook be more integrated into the lesson, and have more actual information about what they [HCP] can and cannot do” (Student).
Evaluation of this project determined that the development of a Toolkit provided PATCH the ability to widely disseminate its PATCH for Teens peer-to-peer content while still incorporating youth voice through technology. Adolescent students self-reported changes in knowledge, confidence, and intended behaviors of becoming engaged and responsible managers of their own health care as a result of the lesson. However, increased confidence was lower than the other two domains which may be a result of (1) time constraints and the need to adapt or bypass the skill-based learning activities to ensure core content was covered and/or (2) students learning new content, leading to overwhelming feelings and uncertainty on how to act upon it.
Variances among age, racial, and gender groups were documented. Younger students reported more significant changes in knowledge-based measures, which may be linked to health literacy levels and first exposure to the information. Students who self-identified non-White were also more likely to report newfound knowledge but ranged on their intended behaviors. It is assumed that cultural norms and previous health-care experiences may have attributed to their responses. Furthermore, students who self-identified as female indicated higher intentions of responsibility and self-advocacy over their self-identified male counterparts which could be associated with their level of utilization and comfort in health-care settings.
Although time was a significant barrier, facilitators were able to easily adapt the lesson to ensure all the core content was covered to meet their student’s learning needs. Both facilitators and students believed the topic was important and beneficial to address, especially since transition of health-care responsibility is not often clearly taught to youth. As a result, the Toolkit has since been revised based on the findings and feedback from this project and is being adopted by a growing network of professionals into existing initiatives and programming. Examples of changes include a more formalized facilitator guide and lesson plan, a simplified student activity sheet (formally known as the “teen playbook”), professionally created videography, and streamlined knowledge sharing to allow for increased discussion, interaction, and skill building. Program staff remains dedicated to ongoing evaluation and quality improvement efforts of the project.
First, this was a one-time intervention. Reinforcement and integration of health-care transition into other school efforts would increase the strength and potential impact of the project. Second, all data collected were self-reported measures creating an opportunity for participants to be biased in their response by social desirability. The potential lack of confidentiality (e.g., recognition of handwriting by facilitator) may have also impacted student responses. Third, changes in student knowledge, confidence, and intended behavior were measured immediately postlesson with a modified version of a retrospective pretest, not a traditional pretest–posttest design. A delayed postassessment would be beneficial to understand longer term effects of the lesson on students. Fourth, although differences were documented across age, gender, and racial groups, generalizations can only be made about the population sampled that had limited diversity and disproportionately favored certain demographics. Finally, it is difficult to know exact lesson fidelity due to the variations in facilitator types, backgrounds, experiences, and reporting methods. In-person fidelity monitoring would enhance future analysis of the project including an additional assessment of feasibility.
Health care and educational systems have long seen the importance of working together to improve the seamless provision of comprehensive health services to children and youth. However, many unique factors hinder the adolescent population from accessing and receiving the care they ultimately need.
The PATCH for Teens Toolkit served as a baseline intervention to help educate adolescents about health-care transition and has since been revised to better meet its intended objectives. To enhance the project’s efforts, school nurses can advocate for an enhanced health curriculum that continually provides adolescents with essential knowledge and skills to be responsible health care consumers at critical points in their development. Furthermore, since the school health system serves as a direct link to health-care services (onsite or via referral system), school nurses have the ability to follow up with students and address potential barriers that are impacting a student’s ability to utilize and/or transition effectively.
The PATCH Program enthusiastically welcomes the opportunity to collaborate with individuals and organizations seeking to improve adolescent health-care transition, offering additional resources and programs to supplement and enhance existing efforts.
Addressing the primary concerns and fears of adolescents in health-care settings and preparing adolescents for their responsibility of health-care transition can be one way to alleviate some common stressors and misunderstandings of adolescents that impact overall health-care access, utilization, and outcomes. Integrating this information into existing health curricula at local high schools might be the best way to reach the majority of adolescents and improve the overall health care transition efforts of this nation.
This article was presented, in part, at the American School Health Association Conference in 2016 and as part of a round-table discussion at the American Academy of Pediatrics National Conference in November 2018.
Our work would not be possible without the support from many individuals and organizations who have rallied around the vision of Providers and Teens Communicating for Health; a vision of empowerment and advocacy that is vital to the health and wellbeing of adolescents. We are especially thankful for Heather Royer PhD, Katie Brow, and Sara Finger-Warmuth for their guidance and support in preparing this article for publication.
Chelsea J. Aeschbach contributed to conception or design, acquisition, analysis, or interpretation; drafted the article; critically revised the article; and agreed to be accountable for all aspects of work ensuring integrity and accuracy. William B. Burrough contributed to acquisition, analysis, or interpretation; critically revised the article; gave final approval; and agreed to be accountable for all aspects of work ensuring integrity and accuracy. Amy B. Olejniczak contributed to conception or design, critically revised the article, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy. Erica R. Koepsel contributed to conception or design, critically revised the article, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Chelsea J. Aeschbach, MPH, CHES, https://orcid.org/0000-0002-2447-5276
American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, Transitions Clinical Report Authoring Group, White, P. H., & Cooley, W. C. (2018). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics, 142. doi:10.1542/peds.2018-2587
Betz, C. L. (2017). SPN position statement: Transition of pediatric patients into adult care. Journal of Pediatric Nursing, 35, 160. doi:10.1016/j.pedn.2017.05.003
Britto, M. T., Tivorsak, T. L., & Slap, G. B. (2010). Adolescents’ needs for health care privacy. Pediatrics, 126, e1469. doi:10. 1542/peds.2010-0389
Dennison, D., & Golaszewski, T. (2002). The activated health education model: Refinement and implications for school health education. Journal of School Health, 72, 23–26. doi:10.1111/j.1746-1561.2002.tb06507.x
Eaton, C. K., Davis, M. F., Gutierrez-Colina, A. M., LaMotte, J., Blount, R. L., & Suveg, C. (2017). Different demands, same goal: Promoting transition readiness in adolescents and young adults with and without medical conditions. Journal of Adolescent Health, 60, 727–733. doi:10.1016/j.jadohealth.2017.01.002
Fleary, S. A., Joseph, P., & Pappagianopoulos, J. E. (2018). Adolescent health literacy and health behaviors: A systematic review. Journal of Adolescence, 62, 116–127. doi:10.1016/j.adolescence.2017.11.010
Gilbert, A. L., Rickert, V. I., & Aalsma, M. C. (2014). Clinical conversations about health: The impact of confidentiality in preventive adolescent care. Journal of Adolescent Health, 55, 672–677. doi:10.1016/j.jadohealth.2014.05.016
Gray, W. N., Schaefer, M. R., Resmini-Rawlinson, A., & Wagoner, S. T. (2018). Barriers to transition from pediatric to adult care: A systematic review. Journal of Pediatric Psychology, 43, 488–502. doi:10.1093/jpepsy/jsx142
Hargreaves, D. S., Elliott, M. N., Viner, R. M., Richmond, T. K., & Schuster, M. A. (2015). Unmet health care need in US adolescents and adult health outcomes. Pediatrics, 136. doi:10.1542/peds.2015–0237
Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32, 207–214. doi:10.1377/hlthaff.2012.1061
Irwin, C. E., Adams, S. H., Park, M. J., & Newacheck, P. W. (2009). Preventive care for adolescents: Few get visits and fewer get services. Pediatrics, 123, e565–e572. doi:10.1542/peds.2008-2601
James, J. (2013). Health policy brief: Patient engagement. Health Affairs. doi:10.1377/hpb20130214.898775
Kirkpatrick, J. D., & Kirkpatrick, W. K. (2016). Kirkpatrick’s four levels of training evaluation. Alexandria, VA: ATD Press.
Lebrun-Harris, L. A., McManus, M. A., Ilango, S. M., Cyr, M., McLellan, S. B., Mann, M. Y., & White, P. H. (2018). Transition planning among US youth with and without special health care needs. Pediatrics, 142. doi:10.1542/peds.2018-0194
National Research Council and Institute of Medicine. (2009). Adolescent health services: Missing opportunities. Committee on adolescent health care services and models of care for treatment, prevention, and healthy development. In R. S. Lawrence, J. Appleton Gootman, & L. J. Sim, (Eds.), Board on children, youth, and families. Division of behavioral and social sciences and education. Washington, DC: The National Academics Press.
Olejniczak, A., Otalora-Fadner, H., Hannah, C., Hudson, E., Tess, J., & Royer, H. (2015). Evaluation of a curriculum to improve clinician communication with adolescents. Wisconsin Medical Journal, 144, 213–216.
Tebb, K. (2011). Forging partnerships with parents while delivering adolescent confidential health services: A clinical paradox. Journal of Adolescent Health, 49, 335–336. doi:10.1016/j.jadohealth.2011.08.005
Chelsea J. Aeschbach, MPH, CHES®, is a PATCH development manager at Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women’s Health, Madison, WI, USA.
William B. Burrough, MD, MPH, is a pediatric resident at the Benioff Children’s Hospital, University of California San Francisco, Oakland, CA, USA and an Alumnus in the School of Medicine and Public Health, University of Wisconsin, Madison, WI.
Amy B. Olejniczak, MS, MPH, is a PATCH director at the Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women’s Health, Madison, WI, USA.
Erica R. Koepsel, MA, is a PATCH implementation manager at the Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women’s Health, Madison, WI, USA.
1 Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women’s Health, Madison, WI, USA
2 Benioff Children’s Hospital, University of California San Francisco, Oakland, CA, USA
3 School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
Corresponding Author:Chelsea J. Aeschbach, MPH, CHES®, Providers and Teens Communicating for Health (PATCH) Program, Wisconsin Alliance for Women’s Health, PO Box 1726, Madison, WI 53701, USA.Email: chelsea@patchprogram.org
