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