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INSTITUTIONALIZING REPRODUCTIVE LIFE PLANNING SERVICES IN CALIFORNIA’S TITLE X- FAMILY PLANNING AGENCIES
Maryjane Puffer, BSN, MPA
Claudine Offer, MPH,
Kathryn Horsley, DrPH,
California Family Health Council (CFHC)
3rd National Summit on Preconception Health and Health CareJune 13, 2011
2
FROM INNOVATION TO STANDARD PRACTICE In 2006, California Family Health Council
recognized : Importance of preconception and inter-conception
health for women’s health and positive birth outcomes
Began actions to raise awareness and build partnerships/coalitions across California.
3
FROM INNOVATION TO STANDARD PRACTICE —THANKS TO MARCH OF DIMES
Investigated levels of “readiness” Initiated training for health Conducted pilot integration Developed logic model
4
….TO STANDARD PRACTICE
CFHC “institutionalized” reproductive life planning: Required agencies to include preconception and
inter-conception health care services in applications for (re)funding
Developed clinical guidelines Developed operational performance measures Initiated monitoring of client data: primary
contraceptive method, pregnancy and seeking pregnancy
5
INNOVATION STAGE: 2006-2010SUPPORTED BY MARCH OF DIMES
Recognition Awareness
CollaborationTraining &Pilot Test
Readiness Assessment
6
ASSESS READINESSTO INTEGRATE PCC/ICC IN FP Need for systematic information Goal of survey to assess each agency’s level
of:1. senior staff knowledge of preconception health2. current delivery of preconception care3. organizational readiness
Methods 100% response rate
Findings
7
Based on the definition of PCC/ICC provided, how would you rank your own familiarity/knowledge with these concepts:
Not familiar Somewhat familiar Very familiar0%
10%
20%
30%
40%
50%
60%
1%
46%
52%
46%
54%Medical Director (n=50)
Title X Coordinator (n=67)
8
Which of the following visits should include PCC/ICC health services?
Birth
cont
rol
STI s
cree
n
Routin
e m
edica
l
Post
-par
tum
Annua
l
Neg. p
regn
ancy
test EC
Ferti
lity
BCM d
iscon
tin.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100% 94%
88%
76%
90% 92%90%
86% 88%
96%97%
87%81% 82%
90%93%
81%
96%
87%
9
Does your agency have a written PCC/ICC protocol?
Yes No Don't know0%
10%
20%
30%
40%
50%
60%
70%
22%
60%
18%
31%
55%
13%
Medical Director (n=50)
Title X Coordinator (n=67)
10Never Sometimes Always Don't know
0%
20%
40%
60%
80%
100%
2%
94%
4%1%
66%
21%
12%
Medical Director (n=50)
Title X Coordinator (n=67)
At your agency, how often is folic acid information provided to women of reproductive age regardless of intention for pregnancy?
11Never Sometimes Always Don't know
0%
20%
40%
60%
38%
54%
4% 4%
40% 39%
6%
15%
Medical Director (n=50)
Title X Coordinator (n=67)
At your agency, how often are folic acid supplements (alone or in multivitamin) provided to women of reproductive age at low or no cost?
12
Indicate if your agency developed partnerships with any of the following organizations in efforts to enhance PCC/ICC services
WIC BIH Healthy Start
County MCH
Services
Local MH agency
Don't now
Other0%
10%
20%
30%
40%
50%
60%
70%
80%
54%
12%
22%
40%
26%24%
2%
75%
21%
30%
54%
33%
12%
6%
Medical Director (n=50)
Title X Coordinator (n=67)
13
WORKING TOWARD COMMON UNDERSTANDING
Life course approach
Clinic level pre- and inter-
conception care
14
INSTITUTIONAL STAGE: 2010-2011
$$• Title X priority• CFHC funding
requirement
TA • Guidelines• Training, webinars
QI • Performance measures• Site evaluation checklist
15
SHARING THE (GOOD) NEWS
* • Awareness raising
* • Publications
* • Presentations
16
CLINICAL GUIDELINES FOR TX AGENCIES
Screen for pregnancy intention (short & long term) and for pregnancy risk
Ask/discuss reproductive life plan Assist with giving protection
Prevention and treatment Assist with managing conditions
Pre-disease and chronic conditions Assist with avoiding exposure
Substances, medications, environmental toxins
17
STATEMENT OF WORK FOR TX AGENCIES
1. Integrate PCC protocols with existing protocol
2. Incorporate PCC health assessment into the history form
3. Provide client centered comprehensive counseling
4. Provide PCC training for staff
5. Collect client visit record information for submission to centralized data system
18
TRAINING OF PROVIDERS
Over 550 clinicians and health educators received 1-3 hour orientations
On-going training on practical ways to integrate PCC/ICC into most family planning visits
Over-arching goal: FP providers become so comfortable with integrated services, that integration is “second nature” to their work.
Webinar gave easy access to all agencies in California; now available online
19
CLINIC SITE EVALUATIONS
Review charts for documentation: Discussion of client reproductive life plan √ Client statement of pregnancy intent √
Verify use of PCC protocols √
Verify revised history forms √
20
OPERATIONALPERFORMANCE MEASURE
Agencies provide evidence:PCC protocols integrationRevised history formPregnancy intent captured in client
record
21
CFHC’S INSTITUTIONAL CAPACITY FOR MONITORING SYSTEM-WIDE INTEGRATION
Logic Model guides strategies and actions Baseline measure of agency PCC interest
and current practice guides need for TA Contractual agreements in place Technical assistance on-going Systems of accountability and quality
improvement launched Statement of Work Performance Measures Monthly and yearly client record data Site evaluations
22
WHAT WORK IS AHEAD? Reproductive Life Plans piloted and proven,
available in different languages, appropriate for women and men, teens and adults
Educational materials in multiple languages Revisions to centralized data system and
EMRs/EHRs to document client pregnancy intent
Promotion of interconception guidelines and patient handouts
Full implementation-institutionalization in 85 agencies (340 clinic sites)
23
CONTACT
Questions?
Kathryn HorsleyDirector of Monitoring and Evaluation
California Family Health Council510-486-0412 x2318horsleyk@cfhc.org
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