Upstream Washington State Plan Overview May 2018
Who We Are Upstream is a nonprofit organization that helps health centers across the country eliminate barriers that prevent women from obtaining the full range of contraceptive methods so that all women are empowered to become pregnant only when they want to.
Unplanned Pregnancy in Washington 35 % And, up to 48% of all pregnancies are estimated of all births in to be unplanned.** Washington are unplanned* *Source: Washington State Department of Health, PRAMS ( 2014) **Source: Guttmacher Institute , based on latest available data (2010)
Unplanned Pregnancy’s Role Nearly half of these pregnancies occur to women using contraception. 41 % Unplanned pregnancy can cause women to drop out of school, disrupt their careers, and lead to poorer birth outcomes for children, all of which limit economic and educational opportunity. https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
Goals for better Contraceptive Access Every Woman Any Method A Single Visit
Our Results: Delaware Title X Sites Upstream 15.4% intervention start (late 2014) End Method Rates, 11.5% 2012-2016 6.2% 5.4% 4.6% 2012 2013 2014 2015 2016 6 Source: Title X data: % of all women aged 15-44, excluding those pregnant or seeking pregnancy
Our Results: Delaware Patient Survey Who chose your birth control method today? 99% of patients made their own choices about birth control or used shared-decision making with their providers 1% Mostly clinic staff chose
Our Results: Unintended Pregnancy Rates Simulated unintended pregnancy rates among Title X family planning clients ages 20-29 in Delaware and the United States After the first two years of Upstream's partnership with the state of Delaware, there was an estimated 15% decrease in unplanned pregnancies among Title X patients . Pregnancies per 1,000 family planning clients Source: ChildTrends
Our Approach Sustainable solutions to the five biggest barriers to contraceptive access: Screening for Issues billing, Consumer Lack of trained Clinic workflow pregnancy coding and awareness providers intention stocking LARCs = + + Specialized Training Technical Interventions Consumer Marketing
Training for Providers • Barriers • LARC Background & Education • CDC Family Planning Guidelines • Patient Education & Counseling • IUD Placement & Practicum • Complications & Management
Training for Support Staff • Barriers • Patient-Centered Counseling Skills • Contraceptive Information • Addressing Contraception Myths & Facts • Putting new skills to practice: Contraceptive Counseling • Implementation Coaches
Pediatric Work Basics o PISQ o Focus on creating space to discuss reproductive health o Confidentiality o Insurance o Take Charge program o Contraception options o Rumor mill o Training has focus on contraceptive myths o Patient education information
Referral Network Basics o Upstream trains site referral networks o Updated Counseling and contraceptive education materials o Based on site’s existing referral partners o Ex: family planning agency and in-home care o Updated counseling & patient education materials o Translated into many languages
Be Your Own Baby o Targeted marketing campaign to drive business back into clinics o Youtube Video https://www.youtube.com/watch?v=uLtUWLXhx4M o Website: www.beyourownbaby.org o Information on contraceptive options o List of agencies who completed Upstream engagement & offer all methods o Instagram o Facebook o Transportation: Uber & public transit
Quality Improvement Timeline INITIAL CONTACT ADMINISTRATIVE PHASE Site signs up for Initial site Site signs Dates set for Needs assessment Azara platform recruitment Memorandum training & Quality with Quality and Upstream meeting with of Understanding Improvement Improvement collects baseline Upstream & Equipment kick-off (QI) team data for pre/post representative + Use Agreement comparisons site leadership IMPLEMENTATION PHASE APPLY LAUNCH MAINTAIN MEET GAIN LEARN SUPPORT Clinician Ongoing QI, QI work begins, On-site training Upstream QIO Financial Practice precepting and TA and including regular technical for all staff sessions with pelvic continues to provide mentoring is implementation meetings between assistance occurs QI + TA; simulator during supported and support provided site-assigned Implementation Consulting occurs on-site training or on completed Upstream Quality before or after on- Coach provides different Improvement on-site support site training; day; clinician Officer (QIO) & QI continues precepting begins focused on model site champion adoption
Washington: Our Planned Scope Years of training and technical assistance 5 delivery, starting in 2019 Participating agencies; including FQHCs, In Washington we are Tribal and IHS providers, rural health 40 seeking and preparing centers, and private providers serving a high partners focused on percentage of Medicaid patients meeting goals and achieving impact . Public and private health sites receive 300 training and technical assistance Women of reproductive age (WRA) reached 540K by heath centers served when project is complete
Questions? Breanne Laughery Director of Partnerships, Upstream Washington (206) 915-1257 blaughery@upstream.org
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