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

blaughery@upstream.org

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?