How we work

In each state, we provide patient-centered training and technical assistance to hospital systems, state and local health departments, Federally Qualified Health Centers (FQHCs), Planned Parenthoods, community agencies and more. 

Our partnership includes:

  • 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
  • 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 low or no-cost contraception can be obtained through consumer marketing campaigns
  • Engage patients to provide regular feedback and input
  • 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

Sustainable results

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.   

Knowledge increases

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.  

Our partnership values

We meet every organization where they are, working together to improve contraceptive care. We tailor aspects of our model to our partners’ needs, making sure that our training and technical assistance is seamlessly integrated into their organizational processes and culture.

We prioritize the patient experience

We meet every partner where they are

We work on site and in person

We give our partners the resources they need

Our interventions are timely and efficient

We create sustainable results

Partner with us

Upstream is currently recruiting healthcare partners across Washington, Massachusetts and North Carolina. Contact our state teams to learn more.

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