Upstream Washington
State 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 women
using contraception.
Unplanned Pregnancy’s Role
https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
Goals for better Contraceptive Access
Every Woman
Any 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
Quality Improvement Timeline
IMPLEMENTATION PHASE
INITIAL CONTACT ADMINISTRATIVE PHASE
QI work begins,
including regular
meetings between
site-assigned
Upstream Quality
Improvement
Officer (QIO) &
site champion
Financial
technical
assistance
Consulting occurs
before or after on-
site training;
QI continues
On-site training
for all staff
occurs
Practice
sessions with pelvic
simulator during
on-site training or on
different
day; clinician
precepting begins
Upstream QIO
continues 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.
540KWomen 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 5
Participating 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
Questions?
Breanne LaugheryDirector of Partnerships,
Upstream Washington
(206) 915-1257
Table Discussion
Questions:
o What improvements could you make in your practice to make it
easier for women to access all methods of contraception, same
day?
o What types of assistance do patients or clients need in order to
access all methods of contraception?
o How can the Technical Assistance from Upstream USA help
CPAA meet their goals? Is this an opportunity for CPAA to pursue?