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Practice Type: Model
Program Name: Integration of Family Planning Services into an STD Clinic Setting
Organization: Denver Public Health
Web site: www.denverhealth.org
Overview: Strategies are needed which address the integration of pregnancy and STD prevention activities in order to improve clinical efficiency, reduce redundancy in services and avoid missed opportunities. Currently, over 50% of pregnancies are unintended, with rates higher in certain high-risk populations (e.g., adolescents, never-married women, low-income women, those not using contraception, women attending STD clinics). Additionally, a high number of people are infected with or affected by the consequences of STD. While family planning clinics provide both STD and family planning services, most of these clients are low-risk women, with few men ever seeking services in these clinics. Thus, different types of clinical venues are needed to reach clients who are at high-risk for STDs and unintended pregnancy. STD clinics offer an ideal opportunity to provide both services since many of the clients being seen do not use contraception or condoms and thus are at risk for STDs and unintended pregnancy. The goal of this program is to offer initial family planning services to all eligible males/females presenting for STD services at least once a year. The objective of the program is to provide integrated family planning services in an STD clinic setting which compliments STD clinical services. The program intends to ensure that all eligible individuals presenting for clinical care at the Denver Metro Health Clinic (DMHC)(the Denver STD clinic) are offered family planning counseling and services at least once annually. Currently, all STD clinicians have been trained in STD prevention/treatment and family planning services and provides both services to women and men who are eligible for care. Since the program’s inception, approximately 12,500 individual women and 13,000 individual men have received initial family planning services with their STD evaluation. In 2009, almost 80% of heterosexual/bisexual clients seen in the STD clinic received family planning services. Services provided include preconception counseling, pregnancy testing with options, contraceptive counseling, and provision of birth control methods. Contraceptive methods available include oral contraceptives, depot medroxyprogesterone acetate injections (DMPA), combined hormonal patch, combined hormonal ring, emergency contraception, condoms, intrauterine devices, progesterone implant, and spermicide. Each woman seen is provided a three month supply of contraception free of charge, with the majority of women referred to primary care for ongoing services. Teens and high-risk women are offered continuity services. To ensure that all eligible clients are offered family planning at least once annually, we developed programming in our electronic medical record to query the STD database nightly updating the medical information of the client to be able to provide a display on the client’s electronic medical record indicating date of last enrollment for family planning services, ineligibility to receive services, or need to “check eligibility”. Additionally, changes were made to the computerized electronic medical record to combine all required family planning documentation data into the STD clinic chart and to ensure that all required documentation for both STD and family planning reporting are completed, avoiding redundancy in the completion of the clinical chart.
Year Submitted: 2010
Responsiveness and Innovation: Strategies are needed which address the integration of pregnancy and STD prevention activities in order to improve clinical efficiency, reduce redundancy in services and avoid missed opportunities. It is estimated that almost 50% of pregnancies in the United States are unintended, and that approximately half of these result in therapeutic abortions. Almost all women are at risk for unintended pregnancy throughout their reproductive years. However, rates of unintended pregnancies are higher in certain populations such as adolescents, never-married women, women with low-incomes, those not using contraception, and women attending STD clinics. Identifying and removing obstacles to effective contraceptive use will enable women to control the timing of their child-bearing, resulting in positive consequences for the parent, child, and society as a whole. The number of people infected with or affected by the consequences of STD is a major public health problem in modern society. It is estimated that approximately 19 million people are newly infected with an STD annually in the United States, almost half of them being young people ages 15 to 24. Likewise, in the United States, while the pregnancy rate among young women under age 20 has been declining (until 2006), it is still considerably higher than other developed countries. Despite similar rates of sexual activity, one in 14 women aged 15 to 19 becomes pregnant each year in the US. It is estimated that three million pregnancies per year are unintended, including both mistimed and unwanted births, and nearly 1.22 million abortions are reported each year, figures that are most likely understated. Conditions leading to STD and unintended pregnancy resemble each other in a variety of ways. Both require sexual contact, usually intercourse, and it is women who suffer the biological consequences of both of these conditions. For STD, these are more easily transmissible in women, yet more difficult to diagnose because they are more frequently asymptomatic in women than in men, thus potentially delaying treatment and leading to serious sequale. Furthermore, the entire burden of unintended pregnancy often falls entirely on women. Moreover, the characteristics of women most affected by STD and unintended pregnancy are similar: poor, minority women younger than 25 years have the highest rates of both STD and unintended pregnancies. While the responsibility for pregnancy prevention has been mainly the woman’s responsibility, focusing on the role of men in family planning is important. In addition, more men than women seek clinical services in STD clinics but their role in family planning is often ignored. Men have reported that they want to know more about reproductive health and want to support their partner more actively. Furthermore, family planning directed at men has been shown to increase condom use and reliance on vasectomy. Programs are needed for men that integrate pregnancy prevention with STD prevention.Unintended pregnancy is an important and complex problem that has significant public health consequences. While family planning clinics have combined the treatment model to include STD screening and treatment services with contraceptive services, STD clinics, which serve a different population, often less socially organized and less interested in preventive health care have less frequently combined these services. At the DMHC, all women seen for services are interviewed regarding their reproductive and contraceptive, as well as their STD history. In the mid 1990s, prior to the initiation of the described program, women in need of contraceptive care who were <19 years of age were referred to our teen clinic, while those women >19 years were provided with condoms and offered a referral for family planning services through an outside community health clinic. During this time period, we suspected that given the generally poor preventive health care behaviors of STD clinic patients, it was likely that a substantial proportion so referred delayed or avoided contraceptive care leaving them vulnerable to unplanned pregnancy. In an attempt to further determine contraceptive outcomes of women not using contraception at the time of an STD clinic visit, a prospective chart review of women seen in the DMHC in 1992 was performed. Among the 953 women reporting no contraceptive use at their visit in 1992, 299 (31%) had at least one return visit to the clinic for a new STD problem over the subsequent 24 months, indicating a high rate of ongoing use of clinic services. Among these 299 women, 145 (48%) continued to report no contraceptive use at their latest visit, a median of 12 months later. Finally, in order to gather current information about the need for and interest in family planning services among women attending the DMHC, a pilot survey was conducted in March 1994. Of the 212 consecutive women attending the clinic who were surveyed, 29% were currently using no contraceptive method, 37% were using only condoms, and, of those using some method of birth control, 21% indicated a desire to use a different method. Reasons given for not using a method or not changing to a desired method included limited access to family planning services (7%), affordability (19%), lack of information (15%), use of birth control by partner (18%), transportation problems (6%), a desire to become pregnant (12%), inability to get pregnant (12%), and not sexually active (14%). With respect to access to primary care, 55% reported having a PCP. Of the 45% who did not have a current PCP, the majority responded that they were unable to afford one (53%) and/or that they had no insurance (62%). Based on these findings, we felt that while our clinic encouraged the use of barrier methods of contraception to prevent the transmission of STD, but generally provide limited attention to non-STD related contraceptive care needs. From this work, we determined that there was a need to develop services which integrated contraceptive and STD services together, but found no studies which had evaluated such an approach of initiating contraceptive care in an STD clinic followed by facilitated transition to existing primary health care facilities for ongoing reproductive health care. We felt that such a strategy would be intuitively attractive in that it could address an identified problem of women seen through an STD clinic as well as enhance access to a care setting in which a variety of ongoing reproductive health and general medical care needs could be addressed. Based on research conducted at the DMHC that demonstrated that women presenting to clinic are at high risk for a pregnancy and that offering contraceptive services in the clinic contributed to consistent, ongoing contraceptive care, the DMHC now offers initial family planning services to eligible men and women who present for STD clinical services, with subsequent referral of clients to primary care for ongoing services (Shlay JC, et al. Initiating contraception in an STD clinic setting: A randomized trial. Am J Obstet Gynecol 2003;189:473-81). These services are made available through a contract with the Women’s Health Section of the Colorado Department of Public Health and Environment’s (CDPHE) Title X family planning program. The expectation is that all heterosexual/bisexual men and women seen for STD services would receive counseling on family planning at least once a year. In 2009 family planning services were provided to 6,402 users (39% women, 61% men), representing 79% of heterosexual/bisexual clients (N=8085) seen in the DMHC.The combination treatment model has been extensively implemented in family planning clinics where STD screening and treatment services are also offered, but much less so in STD clinics, which serve a different population, often less socially organized and less interested in preventive healthcare. Integration of contraceptive care and STD services for men who have sex with women and for women at high risk for both unplanned pregnancy and STD could provide reproductive health care effectively, efficiently and without duplication of effort. Since some methods of contraception may also reduce the risk of STD infections and complications, men and women could receive overlapping benefits from combined services. Although programs combining family planning with STD services in an STD clinic have been described, few studies have evaluated the direct and indirect consequences of integrating pregnancy prevention services with STD prevention services and identified clinical barriers and facilitators. Integration is intuitively attractive because it addresses both clinical issues at the same time, enhances the clinical services being provided, and improves clinical efficiency for the clients being cared for. Furthermore, integrating family planning services with STD prevention follows the strategy being promoted by Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) which is working with its partners to advance its’ strategic priority of enhanced service integration known as Program Collaboration and Service Integration (PCSI) in order to increase efficiency, reduce redundancy and avoid missed opportunities for clients being seen for prevention services.In 2005 DPH implemented a comprehensive, paperless, Web-based, electronic medical record information system in our STD clinic called HealthDoc. The system electronically documents all demographic, clinical, diagnostic, treatment, and laboratory test information on STD clinic clients. It provides quick access to all DMHC medical histories dating back to 1987, transmits electronic morbidity reports to CDPHE, receives electronic laboratory results from CDPHE, and utilizes decision support and rules programming to provide real-time feedback to clinicians on data quality and required chart information. The HealthDoc clinical information system received a Model Practice award by the National Association of County and City Health Officials in 2006. The electronic medical record used by the DMHC has been programmed to assist in the determination of a person’s family planning eligibility. To do this, the following two modifications were done to our system: First, we developed programming which queries the STD database nightly updating the medical information of the client to be able to provide a display on the client’s electronic medical record indicating date of last enrollment for family planning services, ineligibility to receive services, or need to “check eligibility.” This family planning eligibility status is based on prior documentation of enrollment into the family planning program, sexual orientation (client reporting within the past year as being a man who has sex with men would be ineligible), or permanently sterilized (e.g., vasectomy, bilateral tubal ligation, hysterectomy). Second, changes were made to the HealthDoc computerized electronic medical record to combine the family planning clinical record with the STD clinical record which has integrated all data collected related to the visit to be entered in an efficient manner by the clinician on the day of the visit. New rules were developed and programed into the rules engine for HealthDoc to review the family planning questions on the clinic encounter to ensure completion of the questions and consistency. Clinicians, using the eligibility status and integrated charting for STD and family planning documentation, are able to rapidly determine whether to enroll the client into family planning and efficiently document the services provided to the client. Since these changes were implemented in January 2010, we have documented an increased number of eligible clients receiving both family planning and STD services at the time of their clinic visit. Using our position as a local public health department, we developed a consumer-focused preconception program which is offered in communities at risk for adverse birth outcomes. This program provides education on how to plan for a healthy family including the need to use contraception to avoid unplanned pregnancies. As part of this program we have developed processes to faciliate access for these clients to obtain needed STD/family planning services. Clients seen through the preconception program are offered a brochure on family planning services offered in the Denver Metro Health Clinic. Women are able to call and schedule an appointment to obtain initial family plannings services at no charge. In addition, we have established a process through the STD clinic to have clients screened for government-sponsored insurance or discount programs facilitating their ability to obtain ongoing primary care services through our community-health partners. We are also working with various community-based organizations on linking a currently conducted school-located pregnancy prevention program with a community-based intervention that will encourage parent-child communication on pregnancy/STD prevention. As part of this program, access to family planning and STD clinical services will be offered to the teens and others in the community.
Agency and Community Roles: Denver Public Health (DPH) is the local public health department for the City and County of Denver. It has a long and effective track record of meeting City, State and Federal contracts to improve the health of the residents of Denver. DPH provides contracted public health services for the City and County of Denver which includes recommendations for addressing disease control, provision of direct disease control services (e.g., tuberculosis, HIV, STD clinics and immunizations), administration of vital records/vital statistics (such as births and deaths), tobacco control, STD/HIV training programs, and health promotion/wellness programs. The Denver Metro Health Clinic (DMHC) is the largest STD clinic and HIV testing facility in the Rocky Mountain region with nearly 16,000 visits annually. DMHC offers free confidential testing, counseling, and treatment for a comprehensive array of STDs for residents in the Denver metro region. Since 2001, the clinic has offered initial family planning services with subsequent referral of clients to primary care for ongoing services. Initially services were only provided for women, but were expanded in 2003 to provide family planning services for both men and women. To increase access to family planning services, we have partnered with a number of outside organizations to increase exposure of the services available and allow them to refer primarily women to our clinic. These groups represent community-based organizations, schools, peer educators, and teen groups throughout the Denver Metro area. Additionally, staff has provided training to groups seen through these community-based organizations.
Costs and Expenditures: This program was initially started in 2001. Based on a study conducted at the the Denver Metro Health Clinic (DMHC) which determined the effectiveness of initiation of contraception in an STD clinic setting, stable funding was procured for the provision of initial family planning services for women through Title X. (Please see the previous 2004 Model Practice award on this program for more explicit details on the initial start-up). Initially, funding covered an RN posiition who provided family planning services to clients identified as needing assistance by the STD clinicians as well as contraceptive supplies. In-kind services were provided by the STD program and included attending back-up, laboratory services, an examination room within the STD clinic to provide counseling and treatment, and all ancillary services needed to register and discharge the family planning clients. However, the original staffing model used (single RN providing family planning services) was inefficient since patients had to wait for another clinician to receive family planning services. To address this issue, gradually all staff were trained to provide integrated family planning/STD prevention services. Additional funding was provided by Title X in order to address the need for more integrated services and to provide counseling to men on their role in family planning as part of their STD clinical assessment. This program receives funds from the Colorado Department of Public Health and Environment’s (CDPHE) Women’s Health Section. Funding is provided through Title X and other state health department grants. The infrastructure of the STD clinical program also supports this program. Currently, family planning funding provides apprximately 25% of the total funding for our STD clinical program.
Implementation: Strategies are needed which address the integration of pregnancy and STD prevention activities in order to improve clinical efficiency, reduce redundancy in services and avoid missed opportunities. It is estimated that almost 50% of pregnancies in the United States are unintended, and that approximately half of these result in therapeutic abortions. Almost all women are at risk for unintended pregnancy throughout their reproductive years. However, rates of unintended pregnancies are higher in certain populations such as adolescents, never-married women, women with low-incomes, those not using contraception, and women attending STD clinics. Identifying and removing obstacles to effective contraceptive use will enable women to control the timing of their child-bearing, resulting in positive consequences for the parent, child, and society as a whole. The number of people infected with or affected by the consequences of STD is a major public health problem in modern society. It is estimated that approximately 19 million people are newly infected with an STD annually in the United States, almost half of them being young people ages 15 to 24. Likewise, in the United States, while the pregnancy rate among young women under age 20 has been declining (until 2006), it is still considerably higher than other developed countries. Despite similar rates of sexual activity, one in 14 women aged 15 to 19 becomes pregnant each year in the US. It is estimated that three million pregnancies per year are unintended, including both mistimed and unwanted births, and nearly 1.22 million abortions are reported each year, figures that are most likely understated. Conditions leading to STD and unintended pregnancy resemble each other in a variety of ways. Both require sexual contact, usually intercourse, and it is women who suffer the biological consequences of both of these conditions. For STD, these are more easily transmissible in women, yet more difficult to diagnose because they are more frequently asymptomatic in women than in men, thus potentially delaying treatment and leading to serious sequale. Furthermore, the entire burden of unintended pregnancy often falls entirely on women. Moreover, the characteristics of women most affected by STD and unintended pregnancy are similar: poor, minority women younger than 25 years have the highest rates of both STD and unintended pregnancies. While the responsibility for pregnancy prevention has been mainly the woman’s responsibility, focusing on the role of men in family planning is important. In addition, more men than women seek clinical services in STD clinics but their role in family planning is often ignored. Men have reported that they want to know more about reproductive health and want to support their partner more actively. Furthermore, family planning directed at men has been shown to increase condom use and reliance on vasectomy. Programs are needed for men that integrate pregnancy prevention with STD prevention.Unintended pregnancy is an important and complex problem that has significant public health consequences. While family planning clinics have combined the treatment model to include STD screening and treatment services with contraceptive services, STD clinics, which serve a different population, often less socially organized and less interested in preventive health care have less frequently combined these services. At the DMHC, all women seen for services are interviewed regarding their reproductive and contraceptive, as well as their STD history. In the mid 1990s, prior to the initiation of the described program, women in need of contraceptive care who were <19 years of age were referred to our teen clinic, while those women >19 years were provided with condoms and offered a referral for family planning services through an outside community health clinic. During this time period, we suspected that given the generally poor preventive health care behaviors of STD clinic patients, it was likely that a substantial proportion so referred delayed or avoided contraceptive care leaving them vulnerable to unplanned pregnancy. In an attempt to further determine contraceptive outcomes of women not using contraception at the time of an STD clinic visit, a prospective chart review of women seen in the DMHC in 1992 was performed. Among the 953 women reporting no contraceptive use at their visit in 1992, 299 (31%) had at least one return visit to the clinic for a new STD problem over the subsequent 24 months, indicating a high rate of ongoing use of clinic services. Among these 299 women, 145 (48%) continued to report no contraceptive use at their latest visit, a median of 12 months later. Finally, in order to gather current information about the need for and interest in family planning services among women attending the DMHC, a pilot survey was conducted in March 1994. Of the 212 consecutive women attending the clinic who were surveyed, 29% were currently using no contraceptive method, 37% were using only condoms, and, of those using some method of birth control, 21% indicated a desire to use a different method. Reasons given for not using a method or not changing to a desired method included limited access to family planning services (7%), affordability (19%), lack of information (15%), use of birth control by partner (18%), transportation problems (6%), a desire to become pregnant (12%), inability to get pregnant (12%), and not sexually active (14%). With respect to access to primary care, 55% reported having a PCP. Of the 45% who did not have a current PCP, the majority responded that they were unable to afford one (53%) and/or that they had no insurance (62%). Based on these findings, we felt that while our clinic encouraged the use of barrier methods of contraception to prevent the transmission of STD, but generally provide limited attention to non-STD related contraceptive care needs. From this work, we determined that there was a need to develop services which integrated contraceptive and STD services together, but found no studies which had evaluated such an approach of initiating contraceptive care in an STD clinic followed by facilitated transition to existing primary health care facilities for ongoing reproductive health care. We felt that such a strategy would be intuitively attractive in that it could address an identified problem of women seen through an STD clinic as well as enhance access to a care setting in which a variety of ongoing reproductive health and general medical care needs could be addressed. Based on research conducted at the DMHC that demonstrated that women presenting to clinic are at high risk for a pregnancy and that offering contraceptive services in the clinic contributed to consistent, ongoing contraceptive care, the DMHC now offers initial family planning services to eligible men and women who present for STD clinical services, with subsequent referral of clients to primary care for ongoing services (Shlay JC, et al. Initiating contraception in an STD clinic setting: A randomized trial. Am J Obstet Gynecol 2003;189:473-81). These services are made available through a contract with the Women’s Health Section of the Colorado Department of Public Health and Environment’s (CDPHE) Title X family planning program. The expectation is that all heterosexual/bisexual men and women seen for STD services would receive counseling on family planning at least once a year. In 2009 family planning services were provided to 6,402 users (39% women, 61% men), representing 79% of heterosexual/bisexual clients (N=8085) seen in the DMHC.The combination treatment model has been extensively implemented in family planning clinics where STD screening and treatment services are also offered, but much less so in STD clinics, which serve a different population, often less socially organized and less interested in preventive healthcare. Integration of contraceptive care and STD services for men who have sex with women and for women at high risk for both unplanned pregnancy and STD could provide reproductive health care effectively, efficiently and without duplication of effort. Since some methods of contraception may also reduce the risk of STD infections and complications, men and women could receive overlapping benefits from combined services. Although programs combining family planning with STD services in an STD clinic have been described, few studies have evaluated the direct and indirect consequences of integrating pregnancy prevention services with STD prevention services and identified clinical barriers and facilitators. Integration is intuitively attractive because it addresses both clinical issues at the same time, enhances the clinical services being provided, and improves clinical efficiency for the clients being cared for. Furthermore, integrating family planning services with STD prevention follows the strategy being promoted by Centers for Disease Control and Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) which is working with its partners to advance its’ strategic priority of enhanced service integration known as Program Collaboration and Service Integration (PCSI) in order to increase efficiency, reduce redundancy and avoid missed opportunities for clients being seen for prevention services.In 2005 DPH implemented a comprehensive, paperless, Web-based, electronic medical record information system in our STD clinic called HealthDoc. The system electronically documents all demographic, clinical, diagnostic, treatment, and laboratory test information on STD clinic clients. It provides quick access to all DMHC medical histories dating back to 1987, transmits electronic morbidity reports to CDPHE, receives electronic laboratory results from CDPHE, and utilizes decision support and rules programming to provide real-time feedback to clinicians on data quality and required chart information. The HealthDoc clinical information system received a Model Practice award by the National Association of County and City Health Officials in 2006. The electronic medical record used by the DMHC has been programmed to assist in the determination of a person’s family planning eligibility. To do this, the following two modifications were done to our system: First, we developed programming which queries the STD database nightly updating the medical information of the client to be able to provide a display on the client’s electronic medical record indicating date of last enrollment for family planning services, ineligibility to receive services, or need to “check eligibility.” This family planning eligibility status is based on prior documentation of enrollment into the family planning program, sexual orientation (client reporting within the past year as being a man who has sex with men would be ineligible), or permanently sterilized (e.g., vasectomy, bilateral tubal ligation, hysterectomy). Second, changes were made to the HealthDoc computerized electronic medical record to combine the family planning clinical record with the STD clinical record which has integrated all data collected related to the visit to be entered in an efficient manner by the clinician on the day of the visit. New rules were developed and programed into the rules engine for HealthDoc to review the family planning questions on the clinic encounter to ensure completion of the questions and consistency. Clinicians, using the eligibility status and integrated charting for STD and family planning documentation, are able to rapidly determine whether to enroll the client into family planning and efficiently document the services provided to the client. Since these changes were implemented in January 2010, we have documented an increased number of eligible clients receiving both family planning and STD services at the time of their clinic visit. Using our position as a local public health department, we developed a consumer-focused preconception program which is offered in communities at risk for adverse birth outcomes. This program provides education on how to plan for a healthy family including the need to use contraception to avoid unplanned pregnancies. As part of this program we have developed processes to faciliate access for these clients to obtain needed STD/family planning services. Clients seen through the preconception program are offered a brochure on family planning services offered in the Denver Metro Health Clinic. Women are able to call and schedule an appointment to obtain initial family plannings services at no charge. In addition, we have established a process through the STD clinic to have clients screened for government-sponsored insurance or discount programs facilitating their ability to obtain ongoing primary care services through our community-health partners. We are also working with various community-based organizations on linking a currently conducted school-located pregnancy prevention program with a community-based intervention that will encourage parent-child communication on pregnancy/STD prevention. As part of this program, access to family planning and STD clinical services will be offered to the teens and others in the community.
Sustainability: Over the years DPH has seen the value in providing integrated family planning and STD prevention services together. The family planning brings in necessary resources that augment STD clinical services funding allowing our health department to provide these two complementary services in a seamless fashion. Over the past year, the STD clinic developed the processes needed to safely offer intrauterine devices and progesterone-only implants to clients seen in the clinic. While clients seen in these clinics are at higher risk for having STDs, careful screening and utilization of standardized protocols has allowed our clinic to be able to offer long-acting contraceptives to women at high-risk for unintended pregnancy. Furthermore, in 2008 we obtained a three year grant from the Office of Population Affairs to evaluate feasibility, acceptability, replicability, and cost effectiveness of these integrated services. As part of this grant we are in the process of conducting an extensive evaluation of our program. To date, a baseline assessment of the processes being utilized in the clinic has been done. Staff and clients have been interviewed to access the strengths and challenges of the current program. From these baseline assessments, clinical processes have been revised included integrating all charting for family planning and STD services into one electronic clinical record. Additionally, an electronic reminder system has been developed to prompt staff that a client is eligible for family planning services. Clients have indicated that they value the program. Our final evaluation after the development of an integrated charting system and an electronic reminder system will be conducted in 2011. Findings from this grant will be used to determine if integrating family planning and STD services in an STD clinic are beneficial. All of the systems developed and the processes being utilized have been established to provide these integrated services over the long-haul. We will continue to be a Title X clinical site which offers financial resources to our program to provide the family planning services. The main challenge for our program is leveraging the grant support that we have to be able to continue to offer the services we currently have. In the future, we plan to explore the possibility of billing Medicaid for family planning services provided as part of Medicaid waiver program being developed in Colorado. The feasibility of billing for services will need to be examined carefully.
Lessons Learned:

 

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