Title X Programs Could Expand into Primary Care Settings
April 1, 2023
Family planning services could reach more low-income and underserved communities if Title X services integrated family planning into primary care settings, according to recent research.1
It is critical to expand access to family planning, says Anna Newton-Levinson, PhD, MPH, a postdoctoral fellow in the department of health policy and management and a GEMMA scholar in the Hubert Department of Global Health at Emory University in Atlanta.
“Expanding into health centers is a nice way to integrate these services into communities that serve low-income populations,” Newton-Levinson says. “Integrating family planning into primary care is a great way to expand access.”
Newton-Levinson and colleagues examined a network of family health centers in Georgia that integrated Title X into their services. The Title X grantee consisted entirely of community health centers, mostly Federally Qualified Health Centers (FQHCs). “This network really wanted to have a true integration in all health centers,” Newton-Levinson says.
As members of the Title X network, they receive Title X funding and must comply with applicable regulations. Their services include comprehensive family planning services, adolescent services, and other Title X services.
“This was the first time the full grant went to this network of mostly Federally Qualified Health Centers,” Newton-Levinson explains. “It was a unique situation where it wasn’t a conglomeration of health departments and Planned Parenthood, but fully a community health center grantee.”
Their network included 28 sub-recipient agencies, comprised of multiple health centers. The 28 sub-recipients represented 160 health service center sites in 156 counties in Georgia. “The health centers thought this was an exciting service to offer,” Newton-Levinson notes. “Access is not one size fits all, and people have different preferences.”
For instance, some prefer a specialized family planning center. But public and reproductive health leaders have learned that no one service can meet all a person’s needs. The integration of Title X family planning with primary care can address more health issues.
“We’ve known from Texas and other places that had massive shifts in family planning that no one network can support the needs of everyone who needs the services,” Newton-Levinson says. “This [model] is an option.”
Researchers did not interview patients at these primary care Title X sites because they were focused on the experience of health centers that integrated family planning services and what helped them during the process.
“One challenge with integrating family planning into primary care is there is a lot to do in one [patient] visit,” Newton-Levinson says. “It’s this critical window for providers to ask about patients’ reproductive health desires and goals.”
They can address their needs in a first visit and not require patients to return for a second appointment. “They recognize the benefit of providing holistic care at one point in time,” Newton-Levinson notes. “The model they were implementing was everyone gets asked about their reproductive health goals and desires.”
Providers asked whether the patient considered pregnancy in the next year. They followed up, asking, “Is there anything we can do to support you today?” Newton-Levinson says.
“This was integrated into each visit with someone of reproductive age,” she adds. “It was a good way to make sure everybody had that conversation.”
Newton-Levinson and colleagues did not address the overall funding challenges faced by Title X programs. They only studied the experiences of primary care health centers with a five-year Title X grant. The grant, which was in place from 2014 to 2019, has been renewed.
“We knew many health centers struggle even when receiving Title X funds,” Newton-Levinson says. “They’ve been seeking small grants to get funding for long-acting reversible contraception [LARC]. A lot of legwork, beyond providing care, goes into helping people access affordable services.”
One component of the Title X services was providing same-day LARC. “The grantee navigated some of the challenges that smaller health centers faced in trying to stock all methods of LARC or in training providers to [insert] LARC,” Newton-Levinson says. “They really emphasized trying to provide the method of choice on the same day.”
If providers could not give all patients their choice of contraception because of various challenges, then they would link patients to another health center. “One of the overall hurdles to navigate was getting new providers, especially those working in rural areas, trained on providing different LARC methods,” she adds.
Newton-Levinson and colleagues focused on the implementation experience of the health centers. “It’s to inform FQHCs or primary care providers about what this process was like and what could influence successful integration in similar settings in the future,” she explains. “We found there were initial challenges when setting up these in FQHCs because they needed to train staff and providers on sexual and reproductive healthcare, and they may not be [skilled] in having those conversations. They received training and technical assistance that helped to increase comfort and increase access to family planning and reproductive care.”
Some training solutions included assigning a provider to shadow another provider at a different clinic or finding existing resources within the network to leverage a small site’s resources.
“With some creative solutions, that grantee stepped up and helped to navigate those agencies to getting those resources,” Newton-Levinson says.
REFERENCE
- Newton-Levinson A, Regina R, Dys G, et al. Implementation of Title X family planning services in primary care: A qualitative study of a primary care network in Georgia. Womens Health Issues 2022;S1049-3867(22)00116-5.
Family planning services could reach more low-income and underserved communities if Title X services integrated family planning into primary care settings, according to recent research.
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