CDC initiative improves adolescent reproductive health

January 15, 2020
Bob Kronemyer

Freelance writer for Contemporary OB/GYN

Provider training boosted screening and education of teens but efforts to boost update of long-acting reversible contraception were less successful.

An initiative to improve adolescent sexual and reproductive health (ASRH) services underwritten by the Centers for Disease Control and Prevention (CDC) has resulted in increased screening for sexually transmitted disease (STD)/ HIV, education on abstinence and use of dual protection, and activities to increase accessibility, such as after-school hours and walk-in appointments. However, less uptake was seen for parts of the program related to long-acting reversible contraception (LARC), according to a study published in the Journal of Community Health.  

Methods
The report assessed outcomes at eight publicly funded health centers in Georgia, Mississippi and North Carolina serving communities with teen birth rates higher than the national average where the initiative was undertaken. LARC-related aspects included provider training for insertion and removal; efforts to increase LARC availability; same-day provision of all contraceptive methods; and consistent sharing of information about confidentiality and minors’ rights with adolescent clients.

In total, the study looked at outcomes in 16 practice settings: seven primary care/family practices, four family planning, three pediatric and two ob/gyn. Overall, 45 providers from seven of the eight health centers responded to a baseline survey.

The CDC investigators concentrated on results from four key best practice categories for adolescent sexual and reproductive health (ASRH): structure; tasks for nonclinical staff; tasks for clinical staff; and supportive youth-friendly best services.

For structure, limited training was defined as less than half of the staff being trained in the topic over the past year. 

Findings
“Ten of the 16 practice settings had limited training on ensuring that adolescent clients had time alone with providers and on adolescent development,” the authors wrote, while eight of these settings had limited training about confidentiality and minors’ rights.

Moreover, eight practice settings had limited clinical staff training on client-centered birth control counseling; 10 had limited clinician training on LARC insertion and removal; and 11 had limited training on managing LARC side effects. Only four of the 16 practice settings said they currently had available one or more hormonal intrauterine devices (IUDs), while four offered the copper IUD and nine the implant.

Reporting on tasks of clinical and nonclinical staff revealed that 12 of the 16 practice settings often/always provide time alone at every visit and 11 often/always conduct sexual health assessments, like evaluation of sexual activity, current and future contraceptive options, sexual partners, condom use and protection from STDS, and past STD history.

In addition, 11 of the practice settings often/always assess adolescent pregnancy/fatherhood intentions or risk by asking about intentions concerning timing of pregnancies or reproductive life plan in the context of the client’s personal values and life goals.

Furthermore, 12 of the 16 practice settings often/always present information for a wide range of contraceptive methods approved by the FDA, whereas 13 often/always notify their clients that IUDs are safe for adolescents. Eight practice settings often/always offer contraception at nonsexual health client visits, such as during a primary care visit. 

To support youth-friendly best practices, 14 practice settings provide walk-in appointments, 15 offer same-day appointments, 14 have after-school hours and five with weekend hours.

Conclusions
“Publicly funded health centers are particularly well-suited to offer ASRH care to adolescents who might otherwise lack access to these types of core preventive services because they are mandated to provide care to low-income and medically underserved populations,” the authors concluded.