Improving Quality of Services…
Ana*, 19 years old, and her boyfriend knew they weren’t ready to start a family—both were enrolled in school and didn’t want to have a baby at this stage of their lives. Ana was apprehensive, however, because she had heard that birth control could harm her body and ability to have children.
Seeking advice, the couple met with a counselor at a federally qualified health center (FQHC) in Corona, Queens, to discuss options. The counselor addressed Ana’s misinformation and reassured her that, although birth control may cause certain side effects, it would not cause harm to her health or affect her long-term fertility. After discussing several effective methods, Ana decided on a birth control shot, receiving her first injection that day at the clinic. Three months later, Ana and boyfriend returned for her next shot, meeting again with the counselor and telling her they were happy with the method and planned to continue using it.
The health center where Ana received care is one of four FQHCs that improved contraceptive services through the Family Planning Capacity Building Program, an initiative of Public Health Solutions (PHS) funded in part by NYSHealth.
FQHCs provide comprehensive primary and preventive care regardless of a patient’s insurance status or ability to pay. Although FQHCs are required to provide family planning services, many do not receive funding through the U.S. Department of Health and Human Services’ Title X Family Planning Program to do so—leaving them inadequately equipped or improperly trained to provide the same scope of services as their funded counterparts. However, in light of the new guidelines issued by the Centers for Disease Control and Prevention and U.S. Office of Population Affairs on providing quality family planning, FQHCs are expected to find ways to meet patients’ family planning needs.
The family planning program developed by PHS is a quality improvement collaborative pilot project that ultimately aims to prevent unintended pregnancies. The program works to increase the uptake of effective contraceptive methods among women who receive primary care at non-Title X-funded FQHCs and are not seeking to become pregnant. Four New York City FQHCs participated in the collaborative: William F. Ryan Community Health Center, Urban Health Plan, Bedford-Stuyvesant Family Health Center, and Project Renewal.
An initial assessment of the clinics conducted by PHS found that all four sites had limited capacity to provide contraceptive services. Barriers to offering these services included a lack of provider and staff knowledge of best practices, as well as inadequate data reporting systems.
Over the two-year pilot, PHS educated and trained health center staff on integrating evidence-informed best practices in contraceptive care at their clinics. It worked with quality improvement teams at each site to help identify areas for improvement, including contraceptive counseling and prescribing practices, method availability, and data collection and reporting. PHS then provided the teams with the appropriate coaching and technical assistance to test, adapt, and implement practice changes that would lead to improvements.
Incorporating a contraceptive counselor at each of the sites was also essential to the program’s success. After receiving training from PHS, the counselors helped patients determine pregnancy intention and in selecting, initiating, and continuing to use effective contraceptive methods.
The four FQHCs saw major improvements in contraceptive service provision at their sites after implementing the needed changes they identified during the pilot program. Between May 2014 and August 2015, pregnancy intention screening for patients increased from 3% to 84% across all participating sites. Among women seeking to prevent pregnancy, those who left a clinic visit starting or continuing an effective contraceptive method increased from 2% to 61%.
As a culminating product of the initiative, PHS is developing a comprehensive toolkit that provides guidance and tools for practitioners seeking to improve the quality of contraceptive care in primary care settings.
“We know FQHCs that lack Title X funding are eager and motivated to provide quality contraceptive services, despite their prior limited capacity to do,” said Lisa David, PHS President and CEO. “The Family Planning Capacity Building Program gives health centers the tools and training they desire and need to make successful improvements to contraceptive care, ensuring that the women seeking care at these health centers have access to a full range of effective methods.”
And Expanding Access to Care….
Many young people—especially those from low-income families—lack access to health care services, including reliable family planning and reproductive health services such as contraceptive counseling and services; reproductive education; and sexually transmitted infection (STI) screening, counseling, and testing. Young people on Staten Island in particular had faced challenges in accessing reproductive health care because of a dearth of such services in the community. With NYSHealth funding, Planned Parenthood of New York City (PPNYC), in partnership with Community Health Action of Staten Island, established a new health center on Staten Island to provide safe, affordable family planning and reproductive health services for young people, especially those living in low-income neighborhoods of the borough.
PPNYC opened its only existing permanent Staten Island health center in October 2011. The center provides comprehensive family planning services, including contraceptive counseling and provision; gynecological exams; cancer screening; HIV/STI screening, counseling, and testing; and male services, which typically include STI and testicular cancer screenings.
The Staten Island health center also offers on-site health insurance screening and enrollment services, with staff members helping eligible patients enroll in Medicaid and other publicly funded programs, as well as through NY State of Health Marketplace. Health insurance enrollment ensured better access to sexual and reproductive health services and other types of health care as needed from PPNYC and other health care providers. For those without insurance, the health center offers sliding-scale fees so all patients are able to afford services and get the care they need.
NYSHealth’s investment in the Staten Island health center allowed PPNYC to expand its operating hours beginning in spring 2015, improving access for those patients who visit the center after school or work. The health center has had a significant impact on the community, with 3,000 patient visits in 2015. As one Staten Island patient shared, “Planned Parenthood helped me when I had a large ovarian cyst. They caught it before it ruptured and caused damage. But if I hadn’t been able to go to Planned Parenthood, I would have waited it out because I couldn’t afford to go to another doctor.”
*Name changed to protect privacy