Implementation Science to Expand Contraception Access for Adolescents Hospitalized with Mental Health IssuesImplementation Science to Expand Contraception Access for Adolescents Hospitalized with Mental Health Issues https://pediatricsnationwide.org/wp-content/uploads/2018/06/TeenGirl.gif 1024 575 Pam Georgiana Pam Georgiana https://pediatricsnationwide.org/wp-content/uploads/2023/07/May-2023.jpg
- August 01, 2023
- Pam Georgiana
Research has documented that adolescents with mental health concerns have a higher need for contraceptive counseling and care because they are at a higher risk for unintended pregnancy.[i] [ii] Unintended pregnancies can make mental health symptoms worse, especially depressive symptoms. [iii]
Counseling and use of contraceptives are simple evidence-based strategies to reduce unplanned pregnancies. However, young people experience many barriers to accessing this care, even in a hospital setting.
It was clear to Elise D. Berlan, MD, MPH, faculty physician in the Division of Adolescent Medicine, Ryan S. Bode, MD, MBOE, in his role as Chief of Hospital Pediatrics, and Anna J. Kerlek, MD, physician in the Division of Psychiatry at Nationwide Children’s Hospital, that more needed to be done to avoid unplanned pregnancies in adolescents who receive care at the Big Lots Behavioral Health Pavilion.
“Traditionally in health care, there is a disconnect between caring for our mental and physical health. We saw this need for contraceptive care as an opportunity to address the entire person. We also wanted to better serve the specific needs of young people hospitalized with psychiatric disorders by providing this essential health care to them,” Dr. Kerlek explains.
The leaders of this project believed that novel solutions were needed to improve training for clinicians, routinize patient screening and standardize contraceptive care. Drs. Berlan and Kerlek brought together a highly collaborative interdisciplinary team to develop, refine, and utilize a formal implementation blueprint for scaling-up contraceptive care at the Behavioral Health Pavilion. This team included:
- Samuel W. Dudley III, MD – Division of Hospital Medicine, Nationwide Children’s Hospital
- Charles Hardy, MHA, CPHQ – Center for Clinical Excellence, Nationwide Children’s Hospital
- Samantha A. Herrmann, PA – Division of Hospital Medicine, Nationwide Children’s Hospital
- Kathryn A. Hyzak, College of Social Work, The Ohio State University
- Alicia C. Bunger, College of Social Work, The Ohio State University
- Stephanie Lauden, Division of Pediatric Hospital Medicine, Children’s Hospital Colorado
- Abigail Underwood, College of Social Work, The Ohio State University
Implementation blueprints are comprehensive plans that describe strategies, goals, timelines and key personnel necessary for launching new interventions. The blueprint for this project was recently published in Global Implementation Research and Applications. [iv]
In Stage 1 of this project, the team assembled a Research Advisory Board (RAB) and conducted a formative evaluation to identify potential barriers to implementing contraceptive care. Barriers included patient safety and privacy, the short length of stay and patient availability.
In Stage 2, a comprehensive plan was rolled out in phases to four units over 18 months. The components included:
- Assessing interest in contraceptive care
- Scheduling a consultation for contraceptive care
- Delivering contraception counseling
- Providing contraceptives to interested patients
RAB members used activity logs to track implementation activities, which were then mapped to formal strategies for the blueprint. The result of each phase was a core bundle of services, customized for the patient and setting.
In Stage 3, the final blueprint was refined, with 16 goals linked to ten pre-implementation strategies and six implementation strategies. One of the goals was to complete 75% of the consultations while patients were at the Pavilion. The team has completed 90% regularly since implementation.
Between December 2021 and March 2023, 289 patients completed a consultation, and 162 were prescribed a new contraceptive. There were no differences in age, length of stay, ethnicity or race of consultation recipients versus nonrecipients.
The clinicians reported that most patients and families welcomed the intervention.
“There were very few problems. We weren’t sure what to expect because this was something new. We were very pleased,” Dr. Berlan says.
Because the team had strong leadership support, this intervention was a successful collaborative effort between psychiatry, nursing, adolescent medicine, pharmacy, quality improvement and others.
“We were able to have hard conversations and make huge changes because we didn’t have to battle for support,” Dr. Berlan says.
This intervention demonstrates that integrating high-quality adolescent contraceptive counseling and care into psychiatric hospitalization is possible and provides value to patients.
[i] Hall KS, Moreau C, Trussell J, Barber J. Role of young women’s depression and stress symptoms in their weekly use and nonuse of contraceptive methods. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine.2013;53(2);241–248. https://doi.org/10.1016/j.jadohealth.2013.02.009
[ii] Hall KS, Steinberg JR, Cwiak CA, Allen RH, Marcus SM. Contraception and mental health: A commentary on the evidence and principles for practice. American Journal of Obstetrics and Gynecology. 2015;212(6):740–746. https://doi.org/10.1016/j.ajog.2014.12.010
[iii] Bahk J, Yun S-C, Kim Y, Khang Y-H. Impact of unintended pregnancy on maternal mental health: A causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy and Childbirth. 2015;15(1):85. https://doi.org/10.1186/s12884-015-0505-4
[iv] Hyzak KA, Bunger AC, Herrmann SA, Kerlek A, Lauden S, Dudley, Underwood A, Berlan ED. Development of an Implementation Blueprint to Scale-Up Contraception Care for Adolescents with Psychiatric Conditions in a Pediatric Hospital. Global Implementation Research and Application. 12 May 2023;3:147-161. https://doi.org/10.1007/s43477-023-00082-7
Image credit: Nationwide Children’s
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