Implementing the New Family Planning Recommendations: Lessons from Florida

The release of two MMWRs - Providing Quality Family Planning (QFP) Recommendations, from the US Office of Population Affairs and the CDC, and the Core State Preconception Health Indicators -- PRAMS and BRFSS, 2009 - on the same day this past spring offered public health professionals and clinicians the opportunity to assess the current state of preconception health, then utilize a new tool to address the issues raised. The Core State Preconception Health Indicators reports on the nationally recognized set of preconception health indicators established in 2010, underscoring opportunities for improving the preconception health of US women. The QFP provides evidence-informed recommendations for the delivery of family planning services (including preconception care), defines what services to offer in a family planning visit, and includes information on services both to prevent and to achieve pregnancy.  

Florida's Maternal, Infant and Early Childhood Home Visiting (MIECHV) Initiative has been working to incorporate the new QFP recommendations. Below, Carol Brady, MIECHV Project Director, shares Florida's experience with integrating preconception care and reproductive health services into home visiting programs. The lessons are applicable to Federal Healthy Start and other community initiatives.

Why did MIECHV incorporate family planning and preconception care into its program?

Family planning and preconception health are key areas addressed by the federal MIECHV benchmarks, which are intended to measure program impact. Our initial challenge was to get home visiting programs to understand why the mother's health and her access to quality primary care, preconception care and birth spacing impacts the health and development of the baby. People need to understand the link between planned pregnancy and preventive health services for the mother and the whole family's wellbeing. This will impact the children more than anything else we do. That's what I love about the recommendations. They are so clear about how all this relates.

How important was staff development and training to implementation?

Professional development has been key to helping home visitors implement the broader focus on the parents' health, reproductive life planning and birth spacing. Home visitors need to understand the Recommendations. They need to be able to ask more than "Are you taking folate once a day?" We need to make sure that they can do supportive counseling around reproductive life planning, as well as link women to family planning and preventive services in the community. Home visitors need to be knowledgeable about all contraceptive options including LARCs (long-acting reversible contraception-IUDs and contraceptive implants) and convey that information to clients. LARCs are an important tool in helping women with planning their pregnancies. Home visitors also need to be knowledgeable about community resources so they know they are referring to providers who offer quality family planning, primary care and other services.

So they need to be advocates for the women they serve?

Yes, an important role for home visitors is to advocate for the women and for quality services at the community level. We need to be advocates ourselves at the community, state and federal levels.

Florida didn't expand Medicaid [when the Affordable Care Act was implemented]. Title X [clinics] and Federally Qualified Health Centers are basically all the health care there is for low-income, uninsured women in the state. We need to make sure these programs implement QFP because they are the only source of health care for many women. QFP really sets the standard of care for family planning and reproductive health for all health providers and we need to support and promote its adoption.

What else has been critical to incorporating preconception care and family planning?

In Florida, we are using the benchmarks to frame everything we do with the initiative. The benchmarks are critical for our accountability and effectiveness. They set expectations and standards for care. We are actively tracking performance around them, building accountability at all levels. They help us make sure we are all focusing on factors that make a difference in outcomes.

What's the next step for MIECHV and Florida?

We are now working on building core competencies for home visitors around the benchmarks. This ensures we are comprehensive and don't leave out the "M" in MIECHV. One of the values of QFP is that it provides an opportunity to fully integrate our efforts. We are fortunate to have a strong partnership at the state level with our Title X program which help us be successful!

Carol Brady is the Project Director of the Florida Maternal, Infant and Early Childhood Home Visiting Initiative of the Florida Association of Healthy Start Coalitions, Inc. MIECHV is funded by the Health Services and Resources Administration's Maternal, Child and Infant Home Visiting program. The program provides evidence-based home visiting programs aimed at improving outcomes for children age 0-5. Thank you to Sima Michaels Dembo, MPH, with the Office of Population Affairs for proposing and conducting this interview.