Abstract: CONTEXT: In California, emergency contraception is available without a prescription to females younger than 18 through pharmacy access. Timely access to the method is critical to reduce the rate of unintended pregnancy among adolescents, particularly Latinas. METHODS: In 2005-2006, researchers posing as English- and Spanish-speaking females-who said they either were 15 and had had unprotected intercourse last night or were 18 and had had unprotected sex four days ago-called 115 pharmacy-access pharmacies in California. Each pharmacy received one call using each scenario; a call was considered successful if the caller was told she could come in to obtain the method. Chi-square tests were used to assess differences between subgroups. In-depth interviews with 22 providers and pharmacists were also conducted, and emergent themes were identified. RESULTS: Thirty-six percent of all calls were successful. Spanish speakers were less successful than English speakers (24% vs. 48%), and callers to rural pharmacies were less successful than callers to urban ones (27% vs. 44%). Although rural pharmacies were more likely to offer Spanish-language services, Spanish-speaking callers to these pharmacies were the least successful of all callers (17%). Spanish speakers were also less successful than English speakers when calling urban pharmacies (30% vs. 57%). Interviews suggested that little cooperation existed between pharmacists and clinicians and that dispensing the method at clinics was a favorable option for adolescents. CONCLUSIONS: Adolescents face significant barriers to obtaining emergency contraception, but the expansion of Spanish-language services at pharmacies and greater collaboration between providers and pharmacists could improve access.
Abstract: CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies-which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to adolescents-were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSION: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method.
Abstract: The first section of this webinar is presented by Regina Zerne on “Using Your Provider Profile for Quality Improvement and Utilization Management”. (About 30 minutes.) In the last section, Sandy Navarro introduces eight new metrics to the Provider Profiles, “The Client Demographic Supplement”. (About 15 minutes.)
"Ask the Experts" webcasts are offered to Family PACT providers and staff to provide updated information and an opportunity to ask questions on a variety of topics related to the Family PACT program. Webcasts are interactive internet-based teleconferences utilizing your computer and phone.
Detail about the Family PACT Provider Profile Reports is available at http://familypact.org/en/Providers/provider-profiles.aspx
Abstract: Researchers from UCSF and MCAH will help you learn how to “speak GIS” and talk about “spatial data” in the context
of Public Health and Access to Services. This presentation will cover some key GIS concepts using Family PACT and
WIC data including “spatial data”, “geocoding”, “MSSA polygons”, “spatial selection” and “spatial statistics” such as
“Hot Spot Analysis”.
Abstract: Family PACT, California’s Family Planning Program: Pregnancies and Costs Averted, FY 1998/99 to FY 2005/06
CHALLENGE: Quantifying pregnancies and costs averted by geographic units when full address information for enrolled clients is not accessible from administrative datasets.
SOLUTION: Since clients are enrolled and certified as Family PACT eligible for a full year onsite at a single clinician provider location, clients can be allocated to the district of this initial access point. A Geographic Information System (GIS) was utilized to geocode, and spatially joined each provider with its district. Clients are then joined to a district based on the provider that certified them as eligible for the year. From there, the cost and pregnancies averted methodologies, are applied to calculate the program’s effectiveness.<1,2>
RESULTS: The Program is cost-effective. In fiscal year (FY) 2006/07, the program averted $1.3 billion in public costs through the prevention of unintended pregnancies. The following tables includes data by district on the Family PACT program for two time periods – pre-federal funding (FY 1998/1999) and after eight years of federal funding (FY 2005/2006).
<1>. Pregnancies averted by the program are estimated based on the number of women receiving contraception and the number of months of contraceptive protection dispensed. For more information about pregnancies averted by the program see methodology in Foster, DG. et al. Estimates of Pregnancies Averted Through California’s Family Planning Waiver Program in 2002. Perspectives on Sexual and Reproductive Health, 2006, 38(3):126–131.
<2>. Public costs averted represent the amount of money that would have been spent on publicly-funded services for mother and baby in the first two years of life. For information about public costs averted see methodology in Amaral, G, et al. Public Savings from the Prevention of Unintended Pregnancy: A Cost Analysis of Family Planning Services in California. Health Services Research, 2007, 42(5):1960-80.
Abstract: Geographic Information System (GIS) is utilized in public health for topics such as disease surveillance and air quality assessment, but its utility in family planning program monitoring and evaluation may not be immediately apparent. Family PACT is California's fee-for-service family planning program serving over 1.6 million residents annually. The UCSF program monitoring and evaluation team employs various techniques to monitor contraceptive provision, recommend targeted interventions, and assess outcomes. One technique includes the integration of GIS with administrative data. Nearly all of the program's administrative data has a 'spatial' component such as point locations for provider addresses and geographic boundaries of client zip codes. We will present several examples how GIS can be used with spatial data to create maps for presentation as well as spatial query and analysis for reporting. For example, in the case of Intrauterine Contraceptives (IUC), geographic patterns in low utilization may indicate a lack of trained providers willing to recommend or perform IUC insertions. Further, with the help of GIS we found that providers located in rural areas are more likely to offer IUCs to their clients than in urban areas (71% v. 58%; p≤0.001). Other topics that have been informed by GIS include Emergency Contraception provision, referrals for vasectomy services in isolated areas, and unmet need for publicly funded family planning services. As the technology has improved, the utility and value of cartography, spatial query/analysis is clearer, though there are still challenges and limitations to consider.
Learning Objectives:
List how administrative data from a large family planning program can be “spatial”. Describe how GIS can be a tool to inform policies and intervention strategies. List the geographic differences in the provision of Family PACT funded contraception throughout California. Describe challenges and limitations associated with integrating GIS with paid medical claims data from a fee-for-service family planning program.
Abstract: UCSF's Bixby Center for Reproductive Health Research & Policy Family PACT, California s statewide family planning program, provides comprehensive reproductive health services at no cost to eligible low-income residents. In FY 2003/2004, the program served over 1.5 million men and women. Utilizing GIS has proven to be a valuable program support tool and an importantm component to the overall program evaluation strategy. This non-technical presentation includes Family PACT descriptive maps which may have parallel uses in other public health programs.
Abstract: Historically, family planning programs have focused on the reproductive health needs of females. In recent years, increased attention has been devoted to the male partner's role in contraceptive decision making and use. As such, the need to identify how males utilize family planning/reproductive health (FPRH) services and how providers can adapt their services to meet the needs of male clients has emerged. California and its state family planning program, Family PACT, which served 200,000 male clients in FY 03/04, provides a unique opportunity to learn about male clients' experiences accessing family planning services and providers' experiences in serving males. In FY 03/04, males represented 11% of Family PACT clients. Male clients were primarily Latino (64%), Spanish-speaking (51%), and had incomes that were at 0 to 50% of the federal poverty level (41%). Compared with female clients, males were more likely to be older and report smaller family sizes. Further, males utilized private sector providers (55% v. 35%) and displayed much lower retention rates than females (15% v. 46%). Surveys of Family PACT providers reveal that a variety of methods are used to promote male utilization of services, including having male staff (19.1%), offering services specifically for males (14.3%), and conducting active marketing and outreach to males (13.2%). The Family PACT Program has made a tremendous contribution to improving access to FPRH services for males in California. Several key program features could be applied to other programs across the nation in order to further increase males' use of FPRH services.
Abstract: The Maternal, Child and Adolescent Health program, the Office of Family Planning, and the University of California at San Francisco are pleased to announce the release of Teen Births in California: A Resource for Planning and Policy. The resource shows California teen birth rates, differences by race and ethnicity, and comparisons at the Medical Service Study Area (MSSA) level. MSSAs, are subcounty areas comprised of contiguous census tracts that do not cross county boundaries.
The main purpose of this resource is to identify locations in California with higher or lower teen birth rates based on births in 2004/2005 as well as comparing changes in teen birth rates from 2000/2001 to 2004/2005. Included are maps by county and MSSA displaying overall teen birth rates and rates by race and ethnicity. Also included are tables organized alphabetically by county and MSSA community/place name and number. Presenting the data geographically by race and ethnicity, and in table form, will assist the targeting of teen pregnancy-related and teen birth-related programs. Major funding for this effort was provided by Title V Maternal and Child Health Block Grant. The teen birth rate resource can be found here: http://www.cdph.ca.gov/programs/mcah/Documents/MO-TeenBirthsinCalifornia.pdf
Notes: Sandy Navarro's role was a GIS consultant and writer/editor (2006-2008).
Abstract: In this report, we present an estimate of the number of reproductive age women in need of publicly funded family planning services and the proportion who accessed these services through the two public programs in California – Family PACT and Medi-Cal – during the five-year period from Fiscal Year (FY) 1999-00 to FY 2003-04
Abstract: Overview of the Study
Increasing access to the Family PACT Program is an essential goal of the Centers for Medicare and Medicaid Services (CMS) waiver demonstration project being implemented in California. Among its efforts to achieve this goal, California’s Office of Family Planning (OFP) seeks to coordinate with community-based organizations (CBOs) throughout the state to facilitate referrals of low-income women, men and adolescents to Family PACT services. Reaching out to CBOs is likely to be an effective strategy for increasing access for Family PACT-eligible populations. These organizations are, as the name implies, centered within the community and, therefore, attuned to the particular issues and needs of that community. They have established track records of addressing the needs of low-income residents, and often serve as a critical gateway between their clients and needed health and social services.
The 2008 Family PACT Survey of Community-Based Organizations was developed to assess the extent to which California CBOs – particularly those based in counties where access to family planning services is poor – are positioned to refer their clients to Family PACT providers. The study examined the extent to which CBOs are knowledgeable about the Family PACT Program and its services, refer their clients to Family PACT providers, and are involved in collaborative partnerships with providers. Surveys were collected from 209 Executive Directors of CBOs that serve clients likely to be eligible for Family PACT services and have in their mission an aim to connect clients to needed health services.
Key Findings
Most CBOs serve populations who are in need of family planning services and are likely eligible for the Family PACT Program; however, very few had heard of the Family PACT Program prior to the survey.
Among CBOs that had heard of Family PACT, most had a general understanding of the program’s eligibility criteria and available services.
CBOs have experience with referrals and collaboration, and are well-positioned to provide clients with referrals to Family PACT.
While most CBOs have not referred clients to or collaborated with Family PACT providers, those that do are satisfied with the process.
Conclusions
Improving access to family planning services for eligible populations will continue to be an essential goal of the Family PACT Program. Encouraging partnerships and referrals between Family PACT providers and community-based organizations is likely to be a fruitful effort, as both aim to improve the health and well-being of common target populations. Future Family PACT evaluation studies can help OFP plan for such efforts by looking at multiple perspectives, including those of the providers, CBO staff, and state-level directors of programs that serve eligible populations.
Abstract: The goal of this document is to provide an overview of key program metrics in the tenth full fiscal year of the Family PACT program. This year’s program report shows the five-year period between fiscal year (FY) 02/03 and FY 06/07 as well as a ten-year period since program inception for key indicators. The report describes provider and client populations, the types of services utilized, fiscal issues, and county profiles.
Notes: S. Navarro is author of Chapter 2: Profile of Clinician Providers and Maps on p.4 and p.46
Notes: Lead coordinator for this UCSF subcontracted study to Public Health Institute (Nov 2005), findings were later adapted by UCSF for Reaching out for Success: Family PACT Provider Guide to Effective Outreach co-author, Oct 2006.
Notes: S. Navaro is primary author of Section 2.1 Profile of Clients and Co-author of Section 5.4: Fertility and Birth Trends, as well as p. 5 & 15 maps.
