F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Putting the QFP into Practice Series: Integrating Reproductive Life Planning (RLP)

into Your Family Planning SessionMarch 19, 2015

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Putting the QFP into Practice Series:

Integrating Reproductive Life Planning into Your Family Planning SessionMarch 19, 2015

Alvina Long Valentin RN, MPH

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

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PROVIDER UNIT: Cardea Services

COMPLETING THIS ACTIVITYSuccessful completion of this continuing nursing education (CNE) activity includes the following: • Attending the entire CNE activity; • Completing the online evaluation; • Submitting an online CNE request.

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F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

The planners and presenters of this CNE activity have disclosed no conflict of interest including no relevant financial relationships with any commercial companies pertaining to this CNE activity.

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Conflict of Interest

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Providing Quality Family Planning (QFP) Services

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

• Overview• Reproductive life plan assessment and delivery of

care• Case studies• Integration of reproductive life planning into your

clinic

Integrating Reproductive Life Planning into Your Family Planning Session

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Learning Objectives • Discuss the purpose of the reproductive life plan in the

family planning visit

• Integrate reproductive life planning into a family planning session in order to guide the provision of care

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Presenter

Alvina Long Valentin, RN, MPH

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Overview—Benefits of Family Planning and the Reproductive Life Plan

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Family Planning Services

Contraceptive servicesPregnancy testing &

counselingAchieving pregnancy

Basic infertility Preconception healthSexually transmitted

diseases

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Health Benefits of Family PlanningBetter Health Outcomes: Plan

and space births, preconception health services prevention of

unintended/teen pregnancies, Infants

Women

Men

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Health Risks of Unintended Pregnancy Women have a greater risk of negative mental health outcomes during and after

pregnancy and experiencing physical abuse while pregnant

Increased chance of having a low birth weight baby

Increased chance of children having poorer mental or physical health, poorer educational and behavioral outcomes

(Logan,C., Manlove, J., Ryan, S., 2007)

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Impact of Family Planning Services

Medical

Social

Financial

(Frost, J., Sonfield, A., Zolna, M., & Finer, L..2014)

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Men and women setting life goals in terms of childbearing

Planning the timing and spacing of healthy pregnancies

Identifying and modifying medical, behavioral, and social factors negatively affecting pregnancy outcomes

Managing pre-existing conditions and behaviors before, between and beyond pregnancies

What Is Reproductive Life Planning?

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Purpose of Reproductive Life Planning

• Guide the care provided to clients• Help ensure planned, healthy pregnancies

and positive birth outcomes• Support the overall health and well-being

of women, men and infants

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Why Reproductive Life Planning Is Important

• Essential step in the delivery of family planning services

• Helps clients assess their own goals; motivates behavior

• Helps staff prioritize which family planning services to provide

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Reproductive Life Plan Assessment and Delivery of Care

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Goal of the Questions

• Assess the client’s RLP, including personal goals about becoming pregnant or fathering a child

• Identify unmet contraceptive and other preconception health care needs

• Get specific information from the client, determine which questions to ask next, and ultimately guide care

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Introducing Reproductive Life Planning

I’d like to ask you some questions, unrelated to the reason of your visit. Some of them may feel personal, however we ask these questions of all our clients to help us provide quality, preventive health care.

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Reproductive Life Planning Questions

1. Do you have any children now?

2. Do you want to have (more) children?

3. How many more children would you like to have and when?

And….how can I help you achieve your goals?

Remember to do RLP with women and men!

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

CDC Reproductive Life Plan Tool Questions1. Do you plan to have any (more) children at any time in your future?

2. How many children would you like to have?

3. How long would you like to wait until you or your partner becomes pregnant?

If pregnancy is not desired4. What family planning method do you plan to use until you or your partner are ready to become pregnant? 5. How sure are you that you will be able to use this method without any problems?

(Centers for Disease Control and Prevention, n.d.)

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

What to Consider in Developing a Reproductive Life Plan

Age Educational goals Career plans Living situation Financial situation Social support Relationship with

partner

Readiness to become a parent

Medical history Current health

status Health behaviors Contraceptive use

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

How the RLP Guides the Delivery of CareClients who seek pregnancy

• Offer counseling to help achieve pregnancy• Offer preconception health services

Clients who are not seeking pregnancy• Offer contraceptive services• Offer preconception health services, especially for clients

who are at high risk for unintended pregnancy

Clients who are not sure• Encourage her/him to develop a reproductive life plan• Provide services including contraceptive and preconception

health services, as indicated

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

When Pregnancy Is Desired

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When Pregnancy Is Not Desired

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Women’s Contraceptive Use and Number of Unintended Pregnancies in the United States

( Guttmacher Institute, 2014)

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

When the Client is Unsure

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Case Studies

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Case Study #1

Jeanine is a 31 year old Caucasian female who has been with her boyfriend for 10 years. She has type-1 diabetes. You learn they are trying to start a family.

• How does this guide future questions and care?

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Case Study #2 Denise is 18 years old, a Hispanic female, BMI 28, current smoker, engages in occasional binge drinking, had 1 child at age 16, has a current boyfriend and is sexually active. They want to have another child once she is done with college in 4 years. She is in for initiation of a family planning method, uses condoms intermittently and has been on the pill before.• How would you begin talking about a birth control method to

best fit their needs?• What type of education can you provide to help them start

thinking about steps to prepare for a healthy pregnancy in the future?

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Reproductive Life Planning for Men

• Ask RLP questions from a male perspective:

• Have you or your partner used a family planning method (now or ever?)

• What were some of the challenges and successes with using that method?

• Discuss behaviors that contribute to male fertility and overall health

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Case Study #3Jim is a 25 year old Caucasian male, has a current girlfriend and is sexually active. He comes in for evaluation of a possible STD. He has no children, but wants to have children in about 10 years.

• How would this discussion guide the care he receives?

(Centers for Disease Control and Prevention, 2011)

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Case Study #4It is an extremely busy afternoon, 4 clients have been added to your schedule, and you need to leave on time today. Monica, a 37 year old African American female, is your next client. She is in for a Pap. She is sexually active, but not taking her pills on a consistent basis. She doesn’t have children and strongly feels that she doesn’t want children in the future, but sometimes she feels unsure about that. She does not think she is at risk for becoming pregnant. • On a busy clinic day, what are some ways to discuss RLP and

guide care?

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Integrating Reproductive Life Planning at Your Clinic

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Integrating RLP into Your Clinic• Ask all clients about their reproductive life plans

• Revise forms to add questions about RLP including client self-assessment and clinical history forms

• Incorporate RLP into the electronic health records

• Select RLP tools for clients to complete in the waiting room

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Integrating RLP into Your Clinic

Bring staff on board through discussions and training

Determine which provider will counsel about RLP and at what point during the visit (MA, nurse, mid-level provider, health educator)

Have tailored information available for people who are contemplating pregnancy and for people who are not

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Contemplators vs Non-Contemplators

Contemplators - women who are planning a pregnancy, more open to messages about behavior change, contemplating some serious life choices, prepared to make appropriate adjustments in behavior and beliefs.

Non-contemplators - women who are not currently thinking about or planning a pregnancy, more resistant to pregnancy-related messages and harder to inform.

( Centers for Disease Control and Prevention, 2004)

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Summary Reproductive life planning guides the tailored

care you provide to clients, and assists clients with achieving a healthy pregnancy or preventing pregnancy.

There are different strategies for integrating reproductive life planning into clinical services including revising clinic forms, providing client tools and engaging a team approach.

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Summary cont.

RLP includes counseling about risk behaviors, environmental exposures, positive health behaviors, providing protection, and assistance with managing conditions – regardless of pregnancy intention.

Ask all clients about their reproductive life plan

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Thank You For Your Participation!

Alvina Long Valentin RN MPHalvinalong@hotmail.com

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Q & A

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

ReferencesLogan, C., Holcombe, E., Manlove, J., & Ryan, S. (2007). The consequences of unintended childbearing: A white paper. Washington, DC: Child Trends, and the National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved March 17, 2015, from The National Campaign to Prevent Teen and Unplanned Pregnancy website: https://thenationalcampaign.org/sites/default/files/resource-primary-download/consequences.pdf Frost, J., Sonfield, A., Zolna, M., & Finer, L. (2014). Return on investment: A fuller assessment of the benefits and cos of saving of the US publicly , funded family planning programs. The Milbank Quarterly, Vol. 92, No. 4, 2014. (pp. 703-704). Retrieved on March 17, 2015, from the Guttmacher Institute website: http://www.guttmacher.org/pubs/journals/MQ-Frost_1468-0009.12080.pdf

Centers for Disease Control and Prevention. (n.d.). Preconception Health. Retrieved on March 17, 2015, fromhttp://www.cdc.gov/preconception/documents/rlphealthproviders.pdf Guttmacher Institute: Contraceptive Use in the United States (2014). Retrieved on March 17, 2015, from http://www.guttmacher.org/pubs/fb_contr_use.html

Centers for Disease Control and Prevention. (2011, April). 10 ways STDs impact women differently from men. Retrieved March 17, 2015, from http://www.cdc.gov/nchhstp/newsroom/docs/STDs-Women-042011.pdf Centers for Disease Control and Prevention. (2002, April). Media Campaign Implementation Kit. ( 3-5). Retrieved March 17, 2015, from http://www.cdc.gov/ncbddd/folicacid/documents/MediaCampaignKit.pdf

F a m i l y P l a n n i n g N a ti o n a l T r a i n i n g C e n t e r s · S u p p o r t e d b y O ffi c e o f P o p u l a ti o n A ff a i r s

Reproductive Life Planning: Resource Page

• Life Planning Tool – Someday starts nowwww.somedaystartsnow.com/wp-content/uploads/fileDownloads/HTB-Lifeplan.pdf

• Are You Ready? Sex and Your Future (Reproductive life planning booklet) whb.ncpublichealth.com/Manuals/AreYouReadySexAndYourFutureRevised-9-10-10.pdf

• Que Haras en Tu Futuro? (Spanish adaptation) whb.ncpublichealth.com/Manuals/QueHarasEnTuFuturo-9-10-10-WebLayout.pdf

• Clinical Self-history Formwhb.ncpublichealth.com/Forms/4060F_WEB_20120530.pdf

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