Abstract
Expanding access to long-acting reversible contraception onsite in NYC school-based health centers
Lorraine Tiezzi, MS1, Rebecca Fisher, MPH, MA1, Kelly Celony, PH.D, MPH, LCSW1, Ruben Santiago1, Lisa M. Maldonado, MA, MPH2 and Phoebe Luong, MPH1
(1)New York City Department of Health and Mental Hygiene, Long Island City, NY, (2)Reproductive Health Access Project, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The New York City (NYC) Health Department's School Based Health Center (SBHC) Reproductive Health Project (RHP) works with SBHCs to implement standard best practices in adolescent sexual and reproductive health, including the onsite availability of a full spectrum of FDA-approved hormonal and long-acting reversible contraceptive (LARC) methods (intrauterine devices [IUDs] and the hormonal implant). While all participating SBHCs provide a range of short-acting contraceptive methods, there are more significant barriers to the provision of LARC methods, including provider knowledge, training and credentialing, clinic staffing and flow, institutional support and approval, purchasing, and equipment sterilization processes. The RHP began working with SBHCs in 2008 to address these barriers, and the first site incorporated LARC services in 2010. In this presentation we will outline steps and considerations required to implement onsite LARC insertion in SBHCs. Additionally, we will describe our innovative collaboration with the Reproductive Health Access Project to train SBHC providers in IUD and hormonal implant insertion through a six-week, hands-on training curriculum. From September 2014-February 2016, we have trained 23 SBHC providers from 8 different institutions that operate NYC SBHCs. As of December 2015 there were 25 SBHCs providing LARC methods onsite, including 15 providing IUD insertions. In total, NYC SBHCs have inserted 824 IUDs and 305 hormonal implants since 2010. In the 2014-2015 school year alone, NYC SBHCs inserted 180 IUDs and 163 hormonal implants. By addressing barriers to implementing LARC services, the RHP has supported SBHCs in incorporating these highly effective contraceptive methods into existing services.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Digital Tools for Innovative Simulation Training
Stefanie Boltz, MPP
University of California San Francisco, San Francisco, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Women have difficulty accessing high-quality, evidence-based reproductive healthcare both in the US and globally. Increasing the health workforce trained to do manual uterine aspiration (MUA) and other intrauterine procedures can improve access to high-quality care. However, learners may lack sufficient exposure to important gynecologic procedures during their training. The use of simulation to imitate these scenarios ensures that clinicians are properly trained before practicing on their own. This interactive presentation is designed to showcase digital tools and innovative simulation models to teach full-spectrum intrauterine gynecologic procedures.
We will demonstrate the Papaya Workshop, a fun hands-on workshop using an inexpensive fruit model to teach intrauterine procedures to health students or clinicians. The papaya is an excellent uterine model that can be used to teach anatomy, bimanual examination, IUD placement, uterine aspiration for managing early pregnancy loss or early abortion, as well as relevant clinical points associated with these skills. The workshop is easily adapted to various skill levels and settings. Alternate fruits can also be used. In low-resource settings, this inexpensive teaching tool is ideal, especially for teaching the skill of manual vacuum aspiration, an essential procedure where electricity is limited.
In addition to demonstrating the Papaya Workshop, we will present learners with an array of digital resources available for teaching or self-paced learning using simulation.
Provision of health care to the public
Abstract
Role of Proctoring to Increase LARC Access in Community Health Centers
Aisha Mays, MD1, Shelly Kaller, MPH2 and M. Antonia Biggs, PhD3
(1)UCSF Bixby Center, Advancing New Standards in Reproductive Health, Oakland, CA, (2)University of California, San Francisco, San Francisco, CA, (3)University of California, San Francisco, Oakland, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background:
Community health centers (CHCs) are an essential source of primary and reproductive health care for women. Yet a strained workforce and competing demands often make it difficult for providers to prioritize contraceptive care, with a particular limitation on the capacity to provide IUDs and implants (LARC). Currently, little is known about the type of training needed to increase LARC delivery within primary care clinics. As part of a comprehensive reproductive health education program aimed to increase access to LARC in CHCs, we designed a training curriculum to include onsite proctoring to supplement the more traditional didactic curriculum. We explored the role of proctoring in increasing IUD and implant access within community health centers.
Intervention:
Community health centers participated in a tailored clinic-based proctoring program that included: hands-on LARC training, modification of clinic flow to streamline LARC delivery and promote same day access, and utilization of the entire medical team to optimize LARC access.
Results:
To date, preliminary findings of clinic staff beliefs post proctoring (n=14) include:
Most participating providers and staff felt that provider receptivity to IUDs (11/14) and implants (9/14) increased “very much”; most felt that same-day IUD (12/14) and implant (13/14) placements increased “very much” or “somewhat”; and most reported that that the provision of the copper IUD as emergency contraception increased “very much” or “somewhat” (9/14).
Conclusion:
Tailored clinic-based proctoring appears important to increasing medical providers' proficiency with LARC placement and to implementing the multifactorial changes that are recommended in didactic LARC training programs.
Administration, management, leadership Advocacy for health and health education Clinical medicine applied in public health Provision of health care to the public Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
Implementation Science Research: Bringing a Provider IUD and Implant Training to Scale
Cynthia Harper, PhD1, Rosalyn Schroeder, MPH, MSc1, Maya Blum, MPH2, Connie Folse, MPH1 and Suzan Goodman, MD, MPH3
(1)University of California, San Francisco School of Medicine, San Francisco, CA, (2)University of California, San Francisco, San Francisco, CA, (3)UCSF, San Francisco, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The U.S. has persistently high unintended pregnancy, with few effective interventions from randomized trials to address this public health challenge. We developed and tested a provider training intervention in a national cluster randomized trial. Results showed patient-centered counseling that improved contraceptive knowledge and significantly reduced pregnancy in family planning clinics, a first for clinic-based interventions. Post-trial, we launched an implementation science phase (2012-2016), and brought our intervention to over 500 diverse community clinics (family planning, primary care, teen clinics) and hospitals, delivering our scientifically-tested curriculum. 2,400 clinic staff serving 750,000 annual contraceptive clients participated in our trainings. We collected data from pre and post-intervention surveys to measure provider changes and data from clinic service statistics to measure changes in contraceptive use. In the CME/CE-evaluation, the overall training quality was rated 4.6 (scale 1-5). There were significant changes in the proportion who felt experienced enough to counsel on the implant (40% increase) and the IUD (24%), as well as in those who would consider an IUD for a patient with a history of PID (61%), post-abortion (33%) and adolescents (21%). Clinic service statistics also showed significant changes in IUDs and implants inserted during 6-months pre and post-training. Full analyses of changes by practice type will be presented. The intervention was well-received outside of the clinical trial framework, and succeeded in increasing provider competency and knowledge as well as client use of high-efficacy contraceptives. Dissemination efforts will continue across the U.S. until access to the full range of contraceptives becomes routine practice.
Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Expanding LARC Access: Hands-on model for training community health workforce
Lisa M. Maldonado, MA, MPH1, Kelita Fox, MD1, Gabrielle deFiebre, MPH1, Linda Prine, MD1 and Seema Shah, MD, MPH2
(1)Reproductive Health Access Project, New York, NY, (2)Institute for Family Health/Reproductive Health Access Project, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Despite the compelling evidence about the safety and efficacy of the IUD and the contraceptive implant, there are many barriers to increasing access to long-acting reversible contraception (LARC) including the perpetuation of commonly held myths about safety, up-front costs of purchasing the methods, and a shortage of primary care providers competently trained to insert and remove LARC.
LARC insertion and removal skills are relatively simple procedures to learn, but, unfortunately, hands-on post-graduate training options are nearly non-existent. Developing cost-effective, replicable models for post-graduate training to competency in LARC insertion and removal would address a critical barrier to LARC access.
Methods: In collaboration with a large community health center in NY, we piloted a model for providing LARC procedure training to competency. The model includes a process for addressing the liability and credentialing of trainees; a six-session training curriculum that contains didactic, simulation, and hands-on teaching modalities; clinical evaluation tools; and tools to assess site-readiness and a start-up resource guide.
Results: Between 09/2014 – 01/2016 we trained 24 community-based clinicians in LARC insertion and removal.
Preliminary findings (n= 24) include:
• Prior to training 45.5% of trainees had no experience inserting IUDs, 61.5% had no experience inserting contraceptive implants, and 63.6% of trainees had some or no experience performing speculum Insertions.
• 95% of the trainees completing the program were trained to competency.
Conclusions: Intensive, short-term post-graduate clinical training can provide community clinicians, even those with very limited reproductive health care experience, with the skills to provide LARC.
Planning of health education strategies, interventions, and programs Program planning Public health or related education