- Provide CME/CEU-eligible training to staff and clinicians on evidence-based contraceptive counseling and care that is centered around the patient’s needs and goals. Our training is designed to reduce bias and coercion and is in compliance with the CDC/OPA’s Quality Family Planning Guidelines. We regularly update our curriculum to reflect best practices in patient-centered care and shared decision-making, including content related to the historical context that impacts our work and how bias impacts the patient experience.
- Implement a pregnancy intention screening question for all patients of reproductive age. Asking patients of reproductive age whether they want to get pregnant in the next year is a way to assess in most cases whether they may want contraception. It also centers the conversation around the patient’s needs and desires—whether that be to plan or to prevent a pregnancy.
- Teach clinicians how to place and remove IUDs and the implant, and provide new learners with access to preceptors. We also provide training on immediate postpartum placement.
- Ensure adequate eligibility screening is conducted
- Increase staff knowledge of all contraceptive methods including mechanism of action, efficacy, risks, side effects and benefits
Our partnership includes:
- Provide access to contraceptive protocols, policies and procedures, and consent forms
- Provide customized billing and coding guides for financial and clinical staff
- Integrate pregnancy intention screening questions into care and electronic medical records
- Assist with contraceptive stocking and supplies
- Provide workflow assistance that increases single-visit access to all methods of contraception
- Provide on-site coaching via Implementation Coaches, who work elbow-to-elbow with staff as they implement quality contraceptive care practices
- Provide patient education materials in multiple languages for in-center use
- Increase patient knowledge and awareness of contraceptive options and where contraception can be obtained
- Engage patients to provide regular feedback and input
- Ensure that all patients have access to high-quality contraceptive care. Our training curriculum for clinicians includes content on serving LGBTQI+ patients, with special care given to:
- Supporting clinicians in understanding terms related to gender identity and sexual orientation
- Providing case studies throughout the curriculum that include transgender and non-binary patients
- Educating on best practice patient-centered reproductive healthcare for transgender men and non-binary people whose sex assigned at birth was female. This includes how to provide appropriate pelvic exams.
- Upstream is a reproductive health organization that utilizes a Reproductive Justice framework to inform our approach and our program. We aim to be supportive of, amplify, and be in solidarity with Reproductive Justice organizations.
- Conduct regular monitoring and evaluation with each health care partner, including patient surveys and focus groups
- Ensure partners have the tools and skills they need to continue offering patient-centered contraceptive care to all patients once our partnership has concluded
- Evaluate each statewide partnership so that the impact of our work can be understood both in and outside the state
It was immediate—from that point on, we were able to do same-day IUD and implant placements. We have patients who still choose pills, patch, ring, or Depo because that’s their choice. But if a young woman chooses an implant or an IUD, they should be able to choose that with us as well and we’re glad to be able to offer that as a result of Upstream.”Renee McConey Director of Adolescent Health Services, The Door
Prior to working with us, The Door was not offering a full range of contraceptive methods. This data shows that before our work together, patients had access to some methods, but they could not choose IUDs and implants. After our work, it is clear that patients now have the ability to choose from a range of methods to find one that suits their needs best.
All contraceptive clients for The Door receive condoms at every visit, and condoms are readily available in the waiting room and patient bathrooms. Monitoring the percentage of patients choosing natural family planning coaching (<2%) began in Q1 2019. Other barrier methods available to patients include diaphragms (0%) and cervical caps (0%).
Self-reported data on the percentage of clients aged 13-45 choosing and receiving a method of contraception provided by The Door, a healthcare provider in New York City.
I feel we are more equipped and have more tools to really help people.
This was a great, creative training that I can implement in my daily practice.Providers and Staff Duffy Health Center
Yeah, that same day thing, oh my goodness, being able to have that Mirena, walk out the door with it, not having to schedule another appointment, and come back. The most important thing to me when it came to birth control was having something that worked for me. Birth control should be the way you want it and it should serve you.”Kori Patient
Pre- and post-surveys following Upstream training show increases in clinician and staff knowledge on LARC methods and a range of other indicators.
Table shows large gains from pre- to post-survey in respondents’ average scores on a set of LARC-related knowledge items.
Data represent group-level averages for attendees at over 30 Upstream trainings held in Delaware from mid-2017 to early 2019. Pre-survey data were collected up to 2 weeks before trainings, and post-survey data were collected immediately following trainings.
Upstream USA dramatically changed the way we provide contraceptive counseling and care.”Carolena Cogdill Chief Executive Officer, Haven Health Clinics