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The Teen Access and Quality Initiative: Improving Adolescent Reproductive Health Best Practices in Publicly Funded Health Centers

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Abstract

Quality adolescent sexual and reproductive health (ASRH) services play an important role in supporting the overall health and well-being of adolescents. Improving access to this care can help reduce unintended pregnancies, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV) infection and their associated consequences, as well as promote health equity. The Centers for Disease Control and Prevention funded three grantees to implement a clinic-based ASRH quality improvement initiative complimented by activities to strengthen systems to refer and link youth to ASRH services. The purpose of this study is to describe the initiative and baseline assessment results of ASRH best practice implementation in participating health centers. The assessment found common use of the following practices: STD/HIV screening, education on abstinence and the use of dual protection, and activities to increase accessibility (e.g., offering after-school hours and walk-in and same-day appointments). The following practices were used less frequently: provider training for Long-Acting Reversible Contraception (LARC) insertion and removal, LARC availability, same-day provision of all contraceptive methods, and consistent sharing of information about confidentiality and minors’ rights with adolescent clients. This study describes the types of training and technical assistance being implemented at each health center and discusses implications for future programming.

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References

  1. Martin, J., Hamilton, B., & Osterman, M. (2019). Births in the United States, 2018. NCHS Data Brief, No. 346. https://www.cdc.gov/nchs/products/databriefs/db346.htm.

  2. Sedgh, G., Finer, L. B., Bankole, A., Eilers, M. A., & Singh, S. (2015). Adolescent pregnancy, birth, and abortion rates across countries: Levels and recent trends. Journal of Adolescent Health,56(2), 223–230. https://doi.org/10.1016/j.jadohealth.2014.09.007.

    Article  PubMed  Google Scholar 

  3. Penman-Aguilar, A., Carter, M., Snead, M. C., & Kourtis, A. P. (2013). Socioeconomic disadvantage as a social determinant of teen childbearing in the U.S. Public Health Rep,128(1), 5–22.

    Article  Google Scholar 

  4. Boonstra, H. D. (2011). Teen pregnancy among young women in foster care: A primer. Guttmacher Policy Review,14(2), 8–19.

    Google Scholar 

  5. Hoffman, S. (2008). Kids having kids: Economic costs and social consequences of teen pregnancy. Washington, DC: The Urban Institute Press.

    Google Scholar 

  6. Assini-Meytin, L. C., & Green, K. M. (2015). Long-term consequences of adolescent parenthood among African-American urban youth: A propensity score matching approach. Journal of Adolescent Health,56(5), 529–535. https://doi.org/10.1016/j.jadohealth.2015.01.005.

    Article  PubMed  Google Scholar 

  7. Stidham Hall, K., Moreau, C., & Trussell, J. (2011). Discouraging trends in reproductive health service use among adolescent and young adult women in the USA, 2002-2008. Human Reproduction,26(9), 2541–2548. https://doi.org/10.1093/humrep/der184.

    Article  PubMed  Google Scholar 

  8. Anachebe, N. F. (2006). Racial and ethnic disparities in infant and maternal mortality. Ethnicity and Disease, 16(2), S3–71–76.

  9. Brindis, C. D., Morreale, M. C., & English, A. (2003). ). The unique health care needs of adolescents. Future Child,13(1), 117–135. https://doi.org/10.2307/1602643.

    Article  PubMed  Google Scholar 

  10. Galloway, C. T., Duffy, J. L., Dixon, R. P., & Fuller, T. R. (2017). Exploring African-American and Latino teens’ perceptions of contraception and access to reproductive health care services. Journal of Adolescent Health,60(3S), S57–S62. https://doi.org/10.1016/j.jadohealth.2016.12.006.

    Article  PubMed  Google Scholar 

  11. Hall, K. S., Moreau, C., & Trussell, J. (2012). Determinants of and disparities in reproductive health service use among adolescent and young adult women in the United States. American Journal of Public Health,102(2), 359–367. https://doi.org/10.2105/ajph.2011.300380.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Oberg, C., Hogan, M., Bertrand, J., & Juve, C. (2002). Health care access, sexually transmitted diseases, and adolescents: Identifying barriers and creating solutions. Current Problems in Pediatric and Adolescent Health Care,32(9), 320–339. https://doi.org/10.1067/mps.2002.128719.

    Article  PubMed  Google Scholar 

  13. Brittain, A. W., Loyola Briceno, A. C., Pazol, K., et al. (2018). Youth-friendly family planning services for young people: A systematic review update. American Journal of Preventive Medicine,55(5), 725–735. https://doi.org/10.1016/j.amepre.2018.06.010.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tyler, C. P., Warner, L., Gavin, L., & Barfield, W. (2014). Receipt of reproductive health services among sexually experienced persons aged 15-19 years–National Survey of Family Growth, United States, 2006-2010. MMWR Supplements,63(2), 89–98.

    PubMed  Google Scholar 

  15. Donaldson, A. A., Lindberg, L. D., Ellen, J. M., & Marcell, A. V. (2013). Receipt of sexual health information from parents, teachers, and healthcare providers by sexually experienced U.S. adolescents. Journal of Adolescent Health,53(2), 235–240.

    Article  Google Scholar 

  16. Ackard, D. M., & Neumark-Sztainer, D. (2001). Health care information sources for adolescents: Age and gender differences on use, concerns, and needs. Journal of Adolescent Health,29(3), 170–176.

    Article  CAS  Google Scholar 

  17. Secura, G. M., Madden, T., McNicholas, C., et al. (2014). Provision of no-cost, long-acting contraception and teenage pregnancy. New England Journal of Medicine,371(14), 1316–1323. https://doi.org/10.1056/NEJMoa1400506.

    Article  CAS  PubMed  Google Scholar 

  18. Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., et al. (2016). U.S. Medical eligibility criteria for contraceptive use, 2016. Morbidity and Mortality Weekly Report (MMWR),65(3), 1–103. https://doi.org/10.15585/mmwr.rr6503a1.

    Article  Google Scholar 

  19. Trussell, J. (2011). Contraceptive failure in the United States. Contraception,83(5), 397–404. https://doi.org/10.1016/j.contraception.2011.01.021.

    Article  PubMed  PubMed Central  Google Scholar 

  20. ACOG Committee Opinion No. (2018). 735: Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstetrics and Gynecology,131(5), e130–e139. https://doi.org/10.1097/aog.0000000000002632.

    Article  Google Scholar 

  21. Beeson, T., Wood, S., Bruen, B., Goldberg, D. G., Mead, H., & Rosenbaum, S. (2014). Accessibility of long-acting reversible contraceptives (LARCs) in Federally Qualified Health Centers (FQHCs). Contraception,89(2), 91–96. https://doi.org/10.1016/j.contraception.2013.09.014.

    Article  PubMed  Google Scholar 

  22. Goldberg, D. G., Wood, S. F., Johnson, K., et al. (2015). The organization and delivery of family planning services in community health centers. Womens Health Issues,25(3), 202–208. https://doi.org/10.1016/j.whi.2015.02.007.

    Article  PubMed  Google Scholar 

  23. Ford, C. A., English, A., & Sigman, G. (2004). Confidential health care for adolescents: Position paper of the Society for Adolescent Medicine. Journal of Adolescent Health,35(2), 160–167. https://doi.org/10.1016/j.jadohealth.2004.03.002.

    Article  PubMed  Google Scholar 

  24. Klein, J. (2008). Achieving quality health services for adolescents: Policy statement of the Committee on Adolescence. Pediatrics,121(6), 1263–1270.

    Article  Google Scholar 

  25. Burke, P. J., Coles, M. S., Di Meglio, G., et al. (2014). Sexual and reproductive health care: A position paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health,54(4), 491–496. https://doi.org/10.1016/j.jadohealth.2014.01.010.

    Article  PubMed  Google Scholar 

  26. Whiteman, M. K., Tepper, N. K., Kottke, M., et al. (2014). Using a checklist to assess pregnancy in teenagers and young women. Obstetrics and Gynecology,123(4), 777–784. https://doi.org/10.1097/AOG.0000000000000179.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Curtis, K. M., Jatlaoui, T. C., Tepper, N. K., et al. (2016). U.S. selected practice recommendations for contraceptive use, 2016. Morbidity and Mortality Weekly Report: Recommendations and Reports,65(4), 1–66.

    Google Scholar 

  28. Aiken, A. R., Borrero, S., Callegari, L. S., & Dehlendorf, C. (2016). Rethinking the pregnancy planning paradigm: Unintended conceptions or unrepresentative concepts? Perspectives on Sexual and Reproductive Health,48(3), 147–151. https://doi.org/10.1363/48e10316.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Borrero, S., Nikolajski, C., Steinberg, J. R., et al. (2015). “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception,91(2), 150–156. https://doi.org/10.1016/j.contraception.2014.09.014.

    Article  PubMed  Google Scholar 

  30. Gavin, L., Moskosky, S., Carter, M., et al. (2014). Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs. Morbidity and Mortality Weekly Report: Recommendations and Reports,63(Rr-04), 1–54.

    Google Scholar 

  31. Institute of Medicine Committee on Quality of Health Care in America. In Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US) Copyright 2001 by the National Academy of Sciences. All rights reserved.

  32. Riley, M., Patterson, V., Lane, J. C., Won, K. M., & Ranalli, L. (2018). The adolescent champion model: Primary care becomes adolescent-centered via targeted quality improvement. Journal of Pediatrics,193(229–236), e221. https://doi.org/10.1016/j.jpeds.2017.09.084.

    Article  Google Scholar 

  33. Gray, S. H., Pasternak, R. H., Gooding, H. C., et al. (2014). Recommendations for electronic health record use for delivery of adolescent health care. Journal of Adolescent Health,54(4), 487–490. https://doi.org/10.1016/j.jadohealth.2014.01.011.

    Article  PubMed  Google Scholar 

  34. Society for Adolescent Health Medicine, & American Academy of Pediatrics. (2016). Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process. Journal of Adolescent Health,58(3), 374–377. https://doi.org/10.1016/j.jadohealth.2015.12.009.

    Article  Google Scholar 

  35. Reddy, D. M., Fleming, R., & Swain, C. (2002). Effect of parental notification on adolescent girls’ use of sexual health care services. JAMA,288(6), 710–714.

    Article  Google Scholar 

  36. Chandra-Mouli, V., Camacho, A. V., & Michaud, P. A. (2013). WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. Journal of Adolescent Health,52(5), 517–522. https://doi.org/10.1016/j.jadohealth.2013.03.002.

    Article  PubMed  Google Scholar 

  37. Winter, L., & Breckenmaker, L. C. (1991). Tailoring family planning services to the special needs of adolescents. Family Planning Perspectives,23(1), 24–30. https://doi.org/10.2307/2135397.

    Article  CAS  PubMed  Google Scholar 

  38. Brindis, C. D., Geierstanger, S. P., Wilcox, N., McCarter, V., & Hubbard, A. (2005). Evaluation of a peer provider reproductive health service model for adolescents. Perspectives on Sexual and Reproductive Health,37(2), 85–91. https://doi.org/10.1363/3708505.

    Article  PubMed  Google Scholar 

  39. Herz, E. J., Olson, L. M., & Reis, J. S. (1988). Family planning for teens: Strategies for improving outreach and service delivery in public health settings. Public Health Reports,103(4), 422–430.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Kavanaugh, M. L., Jerman, J., & Finer, L. B. (2015). Changes in use of long-acting reversible contraceptive methods among U.S. women, 2009-2012. Obstetrics and Gynecology,126(5), 917–927. https://doi.org/10.1097/aog.0000000000001094.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Ethier, K. A., Dittus, P. J., DeRosa, C. J., Chung, E. Q., Martinez, E., & Kerndt, P. R. (2011). School-based health center access, reproductive health care, and contraceptive use among sexually experienced high school students. Journal of Adolescent Health,48(6), 562–565. https://doi.org/10.1016/j.jadohealth.2011.01.018.

    Article  PubMed  Google Scholar 

  42. Gupta, S., Hogan, R., & Kirkman, R. J. (2001). Experience of the first pelvic examination. The European Journal of Contraception & Reproductive Health Care,6(1), 34–38. https://doi.org/10.1080/ejc.6.1.34.38.

    Article  CAS  Google Scholar 

  43. Morrison, A., Mackie, C. M., Elliott, L., Elliott, L. M., Gruer, L., & Bigrigg, A. (1997). The Sexual Health Help Centre: A service for young people. Journal of Public Health Medicine,19(4), 457–463. https://doi.org/10.1093/oxfordjournals.pubmed.a024677.

    Article  CAS  PubMed  Google Scholar 

  44. Colorado Department of Health and Environment. (2017). Taking the unintended our of pregnancy: Colorado’s success with long-acting reversible contraception, January 2017. Retrieved from https://www.colorado.gov/pacific/sites/default/files/PSD_TitleX3_CFPI-Report.pdf.

  45. Mueller, T., Tevendale, H. D., Fuller, T. R., et al. (2017). Teen pregnancy prevention: Implementation of a multicomponent, community-wide approach. Journal of Adolescent Health,60(3s), S9–S17. https://doi.org/10.1016/j.jadohealth.2016.11.002.

    Article  PubMed  Google Scholar 

  46. Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and Mortality Weekly Report. Recommendations and Reports,64(Rr-03), 1–137.

    PubMed  Google Scholar 

  47. Romero, L. M., Olaiya, O., Hallum-Montes, R., et al. (2017). Efforts to increase implementation of evidence-based clinical practices to improve adolescent-friendly reproductive health services. Journal of Adolescent Health,60(3s), S30–S37. https://doi.org/10.1016/j.jadohealth.2016.07.017.

    Article  PubMed  Google Scholar 

  48. Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health,38(1), 4–23. https://doi.org/10.1007/s10488-010-0327-7.

    Article  PubMed  Google Scholar 

  49. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. J. I. S. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science,4(1), 50. https://doi.org/10.1186/1748-5908-4-50.

    Article  PubMed  Google Scholar 

  50. Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine,43(3), 337–350. https://doi.org/10.1016/j.amepre.2012.05.024.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Fixsen, D., Blase, K., Naoom, S., & Duda, M. (2013). Implementation drivers: Assessing best practices. Retrieved October 17, 2019, from https://nirn.fpg.unc.edu/ai-hub

  52. Stefancyk, A., Hancock, B., & Meadows, M. T. (2013). The nurse manager: Change agent, change coach? Nursing Administration Quarterly,37(1), 13–17. https://doi.org/10.1097/NAQ.0b013e31827514f4.

    Article  PubMed  Google Scholar 

  53. Schneider, H., English, R., Tabana, H., Padayachee, T., & Orgill, M. (2014). Whole-system change: Case study of factors facilitating early implementation of a primary health care reform in a South African province. BMC Health Services Research,14, 609. https://doi.org/10.1186/s12913-014-0609-y.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Westover, J. (2010). Managing organizational change: Change agent strategies and techniques to successfully managing the dynamics of stability and change in organizations. Westover: Jonathan H.

    Google Scholar 

  55. Due, T. D., Thorsen, T., Waldorff, F. B., & Kousgaard, M. B. (2017). Role enactment of facilitation in primary care—A qualitative study. BMC Health Services Research,17(1), 593. https://doi.org/10.1186/s12913-017-2537-0.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kotecha, J., Han, H., Green, M., Russell, G., Martin, M. I., & Birtwhistle, R. (2015). The role of the practice facilitators in Ontario primary healthcare quality improvement. BMC Family Practice,16(1), 93. https://doi.org/10.1186/s12875-015-0298-6.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Harvey, G., & Lynch, E. (2017). Enabling continuous quality improvement in practice: The role and contribution of facilitation. Frontiers in Public Health,5, 27. https://doi.org/10.3389/fpubh.2017.00027.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Carter, M. W., Gavin, L., Zapata, L. B., Bornstein, M., Mautone-Smith, N., & Moskosky, S. B. (2016). Four aspects of the scope and quality of family planning services in US publicly funded health centers: Results from a survey of health center administrators. Contraception,94(4), 340–347. https://doi.org/10.1016/j.contraception.2016.04.009.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Morgan, I. A., Zapata, L. B., Curtis, K. M., & Whiteman, M. K. (2019). Health care provider attitudes about the safety of ‘quick start’ initiation of long-acting reversible contraception for adolescents. Journal of Pediatric and Adolescent Gynecology. https://doi.org/10.1016/j.jpag.2019.01.007.

    Article  PubMed  Google Scholar 

  60. Janiak, E., Clark, J., Bartz, D., Langer, A., & Gottlieb, B. (2018). Barriers and pathways to providing long-acting reversible contraceptives in Massachusetts Community Health Centers: A qualitative exploration. Perspectives on Sexual and Reproductive Health,50(3), 111–118. https://doi.org/10.1363/psrh.12071.

    Article  PubMed  Google Scholar 

  61. Practice Bulletin No. (2017). 186: Long-acting reversible contraception: Implants and intrauterine devices. Obstetrics and Gynecology,130(5), e251–e269. https://doi.org/10.1097/aog.0000000000002400.

    Article  Google Scholar 

  62. HRSA. (2018). What is a Health Center? Retrieved September 17, 2019, from https://bphc.hrsa.gov/about/what-is-a-health-center/index.html.

  63. HRSA. (2018). 2018 National Health Center Data. Retrieved September 17, 2019, from https://bphc.hrsa.gov/uds/datacenter.aspx.

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Funding

This study was funded by National Center for Chronic Disease Prevention and Health Promotion (Grant No. CDC-RFA-DP15-1508).

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Correspondence to Anna W. Brittain.

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Brittain, A.W., Tevendale, H.D., Mueller, T. et al. The Teen Access and Quality Initiative: Improving Adolescent Reproductive Health Best Practices in Publicly Funded Health Centers. J Community Health 45, 615–625 (2020). https://doi.org/10.1007/s10900-019-00781-z

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