Family planning offered in local welfare offices
By expanding access to family planning services through community welfare offices, Washington state government officials see a way to decrease unintended pregnancies and help families on assistance achieve self-sufficiency.
This innovative program relies on a close partnership among welfare family planning workers, health care providers, and administrators to see that services such as contraceptive methods and counseling, pregnancy testing, and sexually transmitted diseases counseling are offered in a setting that is respectful of the clients served. By working together as a team, those involved in the program not only reach those in welfare offices, they also contact clients in other community locations to offer family planning education.
The program offers benefits for all involved, as clients have "one-stop shopping" access to a variety of government assistance programs from jobs training to medical coupons. For the state, the program is one facet of addressing the cost of unintended pregnancy, says Claudia Lewis, family planning program manager with the Medical Assistance Administration of the Department of Social and Health Services in Olympia.
The program pays for itself in terms of the costs of unintended pregnancy, Lewis says. In 1996, an estimated 60% of the 19,307 births paid for by the Washington Medical Assistance Administration office were unintended. Prenatal care labor and delivery costs, plus first-year medical care for the infant, averages $7,700, she says. Even if state funds are matched 50/50 with federal dollars, each unintended pregnancy costs nearly $4,000 in state monies. In comparison, oral contraceptives, the most commonly used method, average about $400 a year. Matched at 90%, the state portion is $40. Spending $40 to save almost $4,000 is good business, Lewis points out.
With welfare reform now a federal mandate, many states are looking at ways to increase self-sufficiency among assistance clients. Washington state is ahead of the curve with the family planning program, created in 1992. The program began by educating staff members in community services offices (CSOs) on family planning issues in an effort to extend information to those on assistance. In 1994, the program received funding to place registered nurses or nurse practitioners at the CSOs to offer family planning services.
"Since the program's inception, we have family planning contracted nurses placed in most of the CSOs, and we have eight full exam clinics collocated," Lewis says.
CSO family planning workers and the contracted nurses work together in a partnership in getting information to clients, she says. Brain-storming has led to a number of creative solutions, says Joan Helmich, training director for The Center for Health Training in Seattle. The center provided staff training and collaborated with state and local family planning personnel to develop a resource handbook for CSO workers and family planning nurses.
Each CSO typically assigns at least one staff member to the family planning program, Helmich explains. The nurse works under contract and usually is scheduled on a part-time basis. The closer the interaction between CSO workers and nurses, the more inventive the strategies used to reach the clients and community, she says.
One collaboration has led to a number of community outreach projects between Jean Carson Fletcher, ARNP, a Forks, WA, nurse practitioner, and Andy Pascua, administrator of the Forks CSO. This team not only works together in the CSO setting but goes to schools and other community organizations to talk about family planning. Pascua, a Native American who is well-received by young Native American males, is particularly successful in that endeavor, Fletcher says.
When Fletcher is in the CSO office, she offers contraceptive counseling, pregnancy tests, and STD prevention education, and she prescribes and dispenses contraceptives on a delayed exam protocol. She works with patients in setting up exam appointments with local private providers or at health department clinics. Fletcher, who has been a community nurse for several years, has good rapport with both providers and patients and serves as a link between the two.
"Patients know they can access me," she says. "They can call me with questions even after they have seen the provider."
Expanding access is key
The Washington family planning project continues to grow, with strong collaborations forming with providers such as Mount Baker Planned Parenthood in Bellingham, WA. Mount Baker contracts with the Medical Assistance Administration to provide clinicians for CSOs in the organization's three-county service area.
Under contact with Washington state, Mount Baker has just opened a full-service clinic at the Mount Vernon CSO and operates a second clinic in the San Juan Islands. Women on assistance are able to meet with the CSO family planning worker, receive counseling on birth control methods, and be seen the same day in the adjacent clinic for a full gynecological exam.
"In one stop, women are educated, receive medical services, and begin a contraceptive method at a site that is accessible, familiar, and comfortable," says Susan Edgar, Mount Baker's executive director.
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