DC F a mily Pla nning Pro je c t I mpro ving Pe rina ta l He a lth in the Distric t Me e ting Oc to b e r 23, 2018
• We mo b ilize o ur c o mmunity to e nsure tha t e c o no mic a lly vulne ra b le wo me n a nd g irls ha ve the re so urc e s the y ne e d to thrive . • E c o no mic se c urity – a sse ts, jo b s, e duc a tio n, he a lth a nd we ll-b e ing , a nd sa fe ty • Re se a rc h, Gra nt-ma king , a nd Advo c a c y • Co nve ning
DCFPP is working to help address the first prong of DC Health’s strategy to improve perinatal health outcomes in DC: “Every teenage girl and woman in DC is in control of her reproductive health.
• Address policy and • Provide training and institutional technical assistance barriers related to for providers, clinic availability and staff, and clinic reimbursement of administrators all birth control Access Quality methods Community Evaluation Engagement • Develop and • Conduct rigorous implement a evaluation to community measure program engagement plan outcomes
Uninte nde d Pr e gnanc y • US uninte nde d pre g na nc y ra te is o ne o f the hig he st in the wo rld • L o w-inc o me wo me n e xpe rie nc e he a lth ine q uitie s re sulting in hig he r ra te s o f uninte nde d pre g na nc y
In DC in 2010: 62% o f a ll • Outc ome s of uninte nde d pre g na nc ie s pre gnanc ie s c an inc lude : we re uninte nde d • Inc re a se d risk o f Uninte nde d • a dve rse he a lth pre g na nc y ra te s o utc o me s fo r wo ma n a nd c hild a re hig he r in Wa rds 5,7, a nd 8 • Sho rt- a nd lo ng -te rm e duc a tio na l a nd e c o no mic c o nse q ue nc e s
Hig h- qua lity fa mily pla nning se rvic e s: He lp e nsure a ll wo me n & • fa milie s ha ve the a b ility to pla n if a nd whe n to ha ve a c hild Ca n he lp impro ve • pe rina ta l o utc o me s Ca n po sitive ly impa c t • e duc a tio n, wo rkfo rc e pa rtic ipa tio n, e c o no mic se c urity, fa mily we ll-b e ing , me nta l he a lth a nd ha ppine ss.
DC F a mily Pla nning Ne e ds Asse ssme nt
• Co nfide ntia l o nline c linic surve y o f fa mily pla nning site s Study • I n-de pth individua l inte rvie ws o f Co mpo ne nts fa mily pla nning pro vide rs • Qua ntita tive surve y o f a do le sc e nts a nd wo me n 15-29 • F o c us g ro ups with a do le sc e nts a nd wo me n 15-29
K e y F inding s fro m Ne e ds Asse ssme nt
Disc o nne c t b e twe e n a va ila b ility a nd utiliza tio n o f • se rvic e s Se xua lly a c tive a d o le sc e nts/ yo ung wo me n no t in c a re • L imite d a va ila b ility o f a d o le sc e nt-frie nd ly se rvic e s • Co nfid e ntia lity c o nc e rns fo r a d o le sc e nts • L a c k o f kno wle d g e a b o ut L ARC me tho d s • Ne g a tive pe rc e ptio ns, suspic io ns, sa fe ty c o nc e rns a b o ut • b irth c o ntro l me tho d s Clinic al time c o nstra ints a re a b a rrie r to c o mpre he nsive • c a re F a mily pla nning -spe c ific visits hig hly c o rre la te d with use • o f L ARC o r o the r ho rmo na l me tho d s
“T e e ns sa id —a nd this re a lly stuc k with me —whe n yo u’ re d o ing so me thing ne w yo u ne e d to ha ve a ll o f yo ur c o ura g e b e c a use yo u d o n’ t kno w wha t’ s g o ing to ha ppe n. And so me time s yo u ha ve yo ur c o ura g e a nd the n a sma ll thing ha ppe ns a nd ruins it—[fo r e xa mple ] a t the c he c k-in d e sk the y a sk to c o nfirm pa re nt’ s a d d re ss a nd pho ne numb e r a nd the n the te e n thinks ‘ o h no , my pa re nts a re g o ing to find o ut’ .” - Re pro duc tive He a lth Pro g ra m Co o rdina to r
“I he a rd tha t De po g ive s “I he a rd tha t yo u yo u c a nc e r.” sho uldn’ t sta rt to o - T e e n partic ipant yo ung b e c a use yo u do n’ t wa nt to b e o n b irth c o ntro l fo r to o lo ng .” “I he a rd tha t e ve n - T e e n partic ipant with the sho t, yo u ha ve to b e a c e rta in a g e … it c a n d o so me thing to yo ur a b ility to ha ve kid s.” - T e e n partic ipant
“I wo uld sa y mo re g e ne ra lly… b ut just in g e ne ra l the b ig g e st b a rrie r to e ffe c tive fa mily pla nning in the b ro a d e r c o nte xt o f he a lth c a re is tha t we d o n’ t ha ve e no ug h time to c o unse l pa tie nts. Pro vid e rs a re o n this tre a d mill to g e t the m in, g e t the m o ut, g e t the m in, g e t the m o ut, e spe c ia lly a s re imb urse me nts ha ve fa lle n. So we d o n’ t ha ve 20 minute s to re a lly ta lk a b o ut b e ne fits a nd risks a nd re a lly und e rsta nd wha t the ir re pro d uc tive prio ritie s a re , a nd wha t kind o f a d ve rse e ffe c ts pro file is g o ing to b e so me thing tha t the y c a n live with, a nd g o thro ug h the e ntire c o nse nt fo rm a nd ma ke sure the y g e t e ve ry pie c e o f it.” - Ho spita l-a ffilia te d a nd SBHC CNM/ NP
Pr ovide r / Clinic ian Re c omme ndations Inno va tive c linic / pro vid e r • o utre a c h to the c o mmunity Ne w re pro d uc tive he a lth • c o unse ling stra te g ie s Mo re a d o le sc e nt-frie nd ly & • a d o le sc e nt-spe c ific pro g ra ms Co nfid e ntia lity a nd a d o le sc e nt • re pro d uc tive he a lth b e st pra c tic e s Pro vid e r me nto rship pro g ra ms •
Community- Re late d Re c omme ndations I nno va tive • e duc a tio n a nd o utre a c h c a mpa ig ns Co mmunity • c o a litio n o n ra c ism, implic it b ia s, mistrust
Polic y/ Advoc ac y Re c omme ndations E xpa nd a c c e ss/ utiliza tio n o f sc ho o l- • b a se d he a lth c e nte rs E xpa nd c o mpre he nsive se xua l he a lth • e duc a tio n in sc ho o ls E xpa nd Me dic a id re imb urse me nt • le ve ls I n-de pth re pro duc tive he a lth tra ining • fo r me dic a l pro fe ssio na ls in re side nc y pro g ra ms
Re se ar c h & E valuation Re c omme ndations Re se a rc h o n yo ung wo me n’ s re pro duc tive g o a ls a nd • b e ha vio rs Rig o ro us e va lua tio n o f o utc o me s o f inte rve ntio ns •
Rac ial E quity/ Re pr oduc tive Justic e F r ame wor k pro je c t d rive n b y ne e d s a nd • wa nts o f o ur c o mmunity pa tie nt-c e nte re d stra te g ie s a nd • inte rve ntio ns “Re pro d uc tive Justic e is the huma n rig ht to ma inta in pe rso na l b o d ily a uto no my, ha ve c hild re n, no t ha ve c hild re n, a nd pa re nt the c hildre n we ha ve in sa fe a nd susta ina b le c o mmunitie s.” -Siste rSo ng
DC F a mily Pla nning Pro je c t Go a ls & Prio rity Stra te g ie s
Goa l 1: T o re duc e ba rrie rs tha t a ffe c t a c c e ss to re produc tive he a lth c a re a nd to improve the qua lity of DC re side nts’ se xua l he a lth c a re e xpe rie nc e a nd outc ome s Stra te g ie s: Ne w mo de l(s) fo r pa tie nt-c e nte re d, c ultura lly-se nsitive c o unse ling • No n-c linic ia n c o unse ling b y ra c ia lly/ e thnic a lly dive rse pa ra pro fe ssio na ls a nd/ o r • pe e r c o unse lo rs Inno va tive c linic / pro vide r o utre a c h pro g ra ms – inc luding a t SBHCs • Implic it Bia s/ Ra c ia l E q uity T ra ining a nd T e c hnic a l Assista nc e Pro g ra m (inc luding • Re spe c tful Ca re T o o lkit)
Goa l 2: T o improve the se xua l he a lth lite ra c y of DC re side nts, a nd inc re a se the ir a wa re ne ss, knowle dg e a nd unde rsta nding of birth c ontrol me thods a nd whe re / how to a c c e ss the m. Stra te g ie s: Cultura lly-se nsitive , ta b le t-b a se d e duc a tio na l a nd de c isio n-ma king suppo rt to o l • a va ila b le in c linic a l a nd no n-c linic a l se tting s (e .g . ha ir a nd na il sa lo ns) Inc e ntivize d he a lth e duc a tio n/ suppo rt pro g ra ms fo r te e ns in no n-c linic a l se tting s • Me dia / a dve rtising c a mpa ig n (inc luding so c ia l me dia ) •
Goa l 3: T o c e nte r a ffe c te d c ommunitie s a nd build c ommunity trust in the me dic a l syste m by e nsuring tha t DCF PP inte rve ntions a re g uide d a nd informe d by the insig ht a nd input of those who e xpe rie nc e re produc tive he a lth ine quitie s. Stra te g ie s: De sig n a nd te st a c o mmunity-b a se d, trust b uilding initia tive to e xplo re , • a c kno wle dg e a nd a ddre ss the ro le o f ra c ism, re pro duc tive rig hts a b use s, implic it b ia s, myths, mispe rc e ptio ns, a nd mistrust o f the me dic a l c o mmunity o n re pro duc tive he a lth de c isio n ma king E xpa nd upo n c urre nt re se a rc h (thro ug h fo c us g ro ups, da ta wa lks, pa tie nt surve ys, • e tc .) to b e tte r unde rsta nd DC a do le sc e nts’ / yo ung wo me n’ s a ttitude s, c o nc e rns, pe rc e ptio ns, wa nts a nd ne e ds re g a rding se xua l a nd re pro duc tive he a lth a nd c o ntra c e ptio n
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