What Family Planning Providers Can Do to Meet Client Needs During COVID-19
Welcome to the Toolkit
“I understand it is an emergency if someone is out of family planning supplies, needs them, and is concerned about getting pregnant...The Office of Population Affairs (OPA) fully supports Title X Grantees to consider creative solutions that will work in [their] communities to ensure that clients continue to receive family planning services.” - Dr. Diane Foley, Deputy Assistant Secretary for Population Affairs (DASPA)
Listed below are suggestions to help family planning providers continue to meet clients’ needs while keeping themselves and clients safe during this nationwide COVID-19 public health emergency.
“As long as the state of emergency exists, any services that [Title X agencies are] able to provide under normal circumstances that you can provide through telehealth will be considered Title X services for which you can use Title X funds and report to FPAR.” – Dr. Diane Foley, DASPA (OPA)
- Develop policies to prioritize which visits will be done remotely.
- Establish systems for telehealth services. CMS has broadened access to telehealth. During the state of emergency, OCR has waived restrictions.
- Plan for implementation with:
- HHS developed a telehealth toolkit for providers.
- NFPRHA’s toolkit, Initiating Telehealth in Response to COVID-19.
- AAFP’s guide to using telehealth.
- Essential Access’ Telehealth Essentials for Sexual + Reproductive Health Care.
- AMA’s quick guide to telemedicine in practice.
- Select or transition to a vendor that offers a platform that is compliant with the Health Insurance Portability and Accountability Act (HIPAA).
- Many electronic medical records have an integrated telehealth platform.
- If that is not an option, OCR lists vendors that offer HIPAA-compliant products that will enter into HIPAA business associate agreements.
- NFPRHA’s toolkit, Initiating Telehealth in Response to COVID-19, provides a table (page 6) analyzing telehealth platforms with HIPAA-compliant video connection.
- AAFP offers details about telehealth platforms along with questions to ask potential telehealth vendors.
- Update staff workflows according to these best practices from UCSF.
- Use this Telehealth Visit Etiquette Checklist, developed by the American Medical Association, to ensure that the professional standards of in-person care is maintained in a virtual environment.
- Obtain client consent virtually. See sample telehealth consent form and guidance for how to obtain consent from AHRQ.
- Develop systems for billing for telehealth. See NFPRHA’s Coding and Billing for Telehealth Services, Medicare’s list of payable telehealth services, and AAFP’s quick reference guide to differentiate and code virtual visits.
- Stay current on the evolving telehealth landscape. Download the Telehealth and COVID-19 toolkit developed by the Telehealth Resource Centers. Review current telehealth coverage policies, state laws, and state actions.
- Develop policies to decide which client visits will be done in-person or remotely, and which can be postponed until after the public health emergency with the FPNTC’s Prioritization of In-Person and Virtual Visits During COVID-19.
- Consider whether curbside pickup or mail delivery of medications and supplies are options that will work in the community.**
- Explore state-level availability of online platforms for contraception and STI testing, as well as the potential opportunities and limitations of these platforms.
- See COVID-19 and Family Planning Services FAQ for responses to questions about how family planning providers are using alternative service delivery approaches.
- Quick Start all methods in accordance with U.S. SPR (see Quick Start Algorithm).
- Identify clients using DMPA that may be candidates for self-administered DMPA (Depo SubQ). See NFPRHA’s Self-Administration of Injectable Contraception.
- When counseling clients with an expiring IUD or implant, consider including the evidence that methods are effective longer than their FDA-approved duration.**
- Provide a 12-month supply of methods (e.g. condoms, oral contraceptive pills (OCPs), patch, ring, etc.) to reduce the need for follow-up visits and supply pick-ups (see the list of states with related policies).**
- Offer information about fertility awareness-based methods as an option for clients looking for methods that do not require leaving home.**
- Preemptively give prescriptions for or supplies of emergency contraception (EC) in case of method failure. Offer the Copper IUD as EC. See ASEC’s EC in the COVID-19 Era.
- Screen for and treat STDs. See guidance from the California Prevention Training Center about treating symptomatic clients when in-person exams are limited. Provide and expand the use of expedited partner therapy (allowable in all but one state.)
- See COVID-19 and Family Planning Services FAQ for responses to questions about how family planning providers are meeting clients’ contraceptive needs and providing STD services.
- Continue to assess family planning needs by asking, “Can I help you with any reproductive health services today such as birth control or planning a healthy pregnancy?”**
- Use social media to communicate with clients about how they can access family planning services and supplies.
- Consider proactively reviewing charts to identify clients who will soon run out of contraceptive supplies or are due for DMPA to invite them for a scheduled appointment at a safe time, to come in for curbside pick-up, or to receive supplies by mail or at the pharmacy.**
- See COVID-19 and Family Planning Services FAQ for responses to questions about how family planning providers are meeting clients’ contraceptive needs.
- Screen staff and clients for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering the health care facility. Separate clients with respiratory symptoms so they are not waiting among other clients seeking care. Refer sick clients for acute care services as appropriate. Employees who are sick (or exposed) should stay home. (CDC, UCSF)
- Educate clients about how to stay safe during in-person visits. Post visual alerts at entrances and in strategic places with instruction on hand hygiene, respiratory hygiene, and cough etiquette (see CDC’s Print Resources and Multilingual Resources from the International Rescue Committee). Provide clients simple answers to questions about COVID-19. (CDC)
- Help clients and staff minimize contact to reduce risk of exposure. Complete registration, billing, counseling, and consents remotely. Ask clients to wait in their car, for instance, while completing intake so when they enter the facility they can immediately enter an exam room. Make supplies available (tissues, waste receptacles, alcohol-based hand sanitizer, face masks). Minimize the number of staff in rooms. (CDC, UCSF)
- Ensure proper use of personal protection equipment (PPE). Health care personnel who come in contact with clients should wear the appropriate PPE. Explore strategies to optimize PPE supplies. (CDC)
- See COVID-19 and Family Planning Services FAQ for responses to questions about how family planning providers are ensuring the safety of staff and clients.
Interim CDC Guidance on Handling Non-COVID-19 Public Health Activities that Require Face-to-Face Interaction with Clients in the Clinic and Field in the Current COVID-19 Pandemic (CDC)
Minimizing Exposure Risk During In-Person Visits (UCSF)
- Stay informed about OPA guidance for financial and Title X grants management issues. The slides from OPA’s March 19, 2020 COVID-19 call with grantees and an updated FAQ document were added to each grantee’s file in GrantSolutions.
- Include assigned OPA Project Officers and Grants Management Specialists on all communication about grants. (OPA)
- Consider providing guidelines and a remote work policy.* (See sample policies and agreements from Cornell University, New York University, and Vermont Department of Human Resources.)
- Have a back-up staffing plan. Prepare for office staff illness, absences, and/or quarantine. Cross-train staff for all essential office and medical functions. Plan for cross-coverage with other health care professionals. (AAFP)
- Consider obtaining a 30-day waiver from OPA for non-directive options counseling to be provided by other trained staff if advanced practice providers are not available. (OPA)
- Take actions to reduce staff burnout and secondary traumatic stress. Use these tips for family planning providers. The Headspace app provides free meditation, sleep, and movement exercises.
- Subscribe to CDC email alerts, stay up-to-date on Information for Healthcare Professionals, and sign up for State Health Alert Network (HAN) alerts.
- Visit the following resources for more information about providing family planning and related health services during the COVID-19 public health emergency:
- AAFP: Checklist to Prepare Physician Offices for COVID-19
- ACOG: General COVID-19 and FAQs for Obstetrician–Gynecologists
- Futures Without Violence: Resources to support survivors of intimate partner violence
- NFPRHA: COVID-19 Resource Hub
- Reproductive Health Access Project: Contraception in the Time of COVID-19
- Society of Family Planning: Updated interim recommendations for contraceptive provision
- UCSF: Contraceptive Care During COVID-19
- Upstream USA: Ensuring Contraceptive Access During the COVID-19 Pandemic
Last updated July 16, 2020.
**Promising practices shared by Title X agency staff. FPNTC acknowledges the following Title X Grantees for providing input into this resource: Carson City Health and Human Services, Nevada Primary Care Association, New Jersey Family Planning League, New Mexico Department of Health, U.S. Virgin Islands Department of Health, and the Women’s Health and Family Planning Association of Texas.
Note: This toolkit contains links to outside sources which may refer to services outside the scope of Title X (including care for pregnant individuals). The views expressed do not necessarily reflect the views of FPNTC or HHS/OASH/OPA, nor should inclusion be construed as an endorsement by FPNTC or HHS/OASH/OPA.
Abbreviations: AAFP = American Academy of Family Physicians; ACOG = American College of Obstetricians and Gynecologists; AHRQ = Agency for Healthcare Research and Quality; AMA = American Medical Association; ASEC = American Society for Emergency Contraception; CDC = Centers for Disease Control and Prevention; CMS = Centers for Medicare & Medicaid Services; DMPA = depot medroxyprogesterone acetate; HHS = Department of Health and Human Services; NFPRHA = National Family Planning and Reproductive Health Association; OCR = Office for Civil Rights; SPR = Selected Practice Recommendations for Contraceptive Use; UCSF = University of California San Francisco.
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