• 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.

References:
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.

This page will be updated as new information becomes available. Please check back here for updates. If you have a suggestion or resource that is not here, please contact us at info@fpntc.org.