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Upstream WashingtonState Plan Overview
May 2018
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.
Who We Are
And, up to 48% of all pregnancies are estimated to be unplanned.**
35%of all births in Washington are unplanned*
*Source: Washington State Department of Health, PRAMS (2014)
**Source: Guttmacher Institute, based on latest available data (2010)
Unplanned Pregnancy in Washington
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.
41%
Nearly half of these pregnancies occur to womenusing contraception.
Unplanned Pregnancy’s Role
https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
Goals for better Contraceptive Access
Every WomanAny Method
A Single Visit
4.6%5.4% 6.2%
11.5%
15.4%
2012 2013 2014 2015 2016
Source: Title X data: % of all women aged 15-44, excluding those pregnant or seeking pregnancy
Our Results: Delaware Title X Sites
6
Upstream intervention start (late 2014)End Method Rates,
2012-2016
1%Mostly clinic staff chose
99% of patients made their own choices about birth control or used shared-decision making with their providers
Our Results: Delaware Patient Survey
Who chose your birth control method today?
Our Results: Unintended Pregnancy Rates
Simulated unintended pregnancy rates among Title X family planning clients ages 20-29 in Delaware and the United States
Source: ChildTrends
Pregnancies per 1,000 family planning clients
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.
+Specialized Training Technical Interventions
Sustainable solutions to the five biggest barriers to contraceptive access:
Lack of trained providers
Screening for pregnancy intention
Issues billing, coding and
stocking LARCs
Clinic workflow Consumer awareness
=
Consumer Marketing
+
Our Approach
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 PISQo Focus on creating space to discuss reproductive health
o Confidentialityo Insuranceo Take Charge programo Contraception options
o Rumor millo Training has focus on contraceptive mythso 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 partnerso Ex: family planning agency and in-home care
o Updated counseling & patient education materialso Translated into many languages
Be Your Own Baby
o Targeted marketing campaign to drive business back into clinics
o Youtube Videohttps://www.youtube.com/watch?v=uLtUWLXhx4M
o Website: www.beyourownbaby.orgo Information on contraceptive optionso List of agencies who completed Upstream
engagement & offer all methodso Instagramo Facebooko Transportation: Uber & public transit
Quality Improvement Timeline
IMPLEMENTATION PHASE
INITIAL CONTACT ADMINISTRATIVE PHASE
QI work begins, including regular
meetings between site-assigned
Upstream QualityImprovement
Officer (QIO) & site champion
Financialtechnical
assistanceConsulting occurs before or after on-
site training;QI continues
On-site trainingfor all staff
occurs
Practicesessions with pelvic
simulator during on-site training or on
different day; clinician
precepting begins
Upstream QIOcontinues to provide
QI + TA; Implementation Coach provides on-site support
focused on model adoption
Clinicianprecepting and mentoring issupported and
completed
Ongoing QI,TA and
implementation support provided
MEET SUPPORTGAIN LEARN APPLY LAUNCH MAINTAIN
Site signs Memorandum of Understanding & Equipment Use Agreement
Needs assessment with Quality Improvement(QI) team
Site signs up for Azara platform and Upstream collects baseline data for pre/post comparisons
Dates set for training & Quality Improvement kick-off
Initial site recruitment meeting with Upstream representative + site leadership
In Washington we are seeking and preparing partners focused on meeting goals and achieving impact.
540K Women of reproductive age (WRA) reached by heath centers served when project is complete
Public and private health sites receive training and technical assistance300
Years of training and technical assistance delivery, starting in 2019 5Participating agencies; including FQHCs, Tribal and IHS providers, rural health centers, and private providers serving a high percentage of Medicaid patients
40
Washington: Our Planned Scope
