Reproductive Health & Wellness Program RHWP Title X Clinical Services & Protocols 2021 Ohio Department of Health Reviewed by: Cynthia Shellhas MD, MPH March 2021 1 TABLE OF CONTENTS SECTION 1 – Providing Quality Family Planning Services Introduction Introduction……………………………………………………………………………………... 6 Service Plans and Protocols…………………………………………………………………….. 7 Procedural Outline……………………………………………………………………………… 8 Client Encounters……………………………………………………………………………….. 10 Checklist of FP and Related Preventative Health Services for Women………………………... 11 Checklist of FP and Related Preventative Health Services for Men…………………………… 12 Family Planning Services Contraceptive Services…………………………………………………………………………. 13 Broad Range of Contraceptives………………………………………………………………. 13 The Clinic Visit……………………………………………………………………………….. 14 Physical and Laboratory Assessment………………………………………………………… 15 Client Education and Counseling…………………………………………………………….. 16 Contraceptive Counseling to Adolescent Clients…………………………………………….. 17 Counseling Returning Clients………………………………………………………………… 18 Preventative Health Promotion and Referral…………………………………………………. 18 Preconception Health Services Medical History for Female Clients………………………………………………………….. 18 Medical History for Male Clients……………………………………………………………. 19 Physical Examination for all Clients…………………………………………………………. 19 Client Plan and Education……………………………………………………………………. 19 Referral……………………………………………………………………………………….. 20 Achieving Pregnancy Services Client Assessment…………………………………………………………………………….. 20 Client Education and Counseling……………………………………………………………. 21 Education of Maximizing Fertility Awareness……………………………………………….. 22 Referral……………………………………………………………………………………….. 22 Pregnancy Diagnosis and Counseling Pregnancy Diagnosis Services………………………………………………………………... 22 The Positive Test Visit……………………………………………………………………….. 23 Nondirective Pregnancy Counseling and Referrals………………………………………….. 23 Negative Test Visit…………………………………………………………………………… 25 Maintenance of physical and financial separation ……………………………………………… 25 2 Basic Infertility Services The Clinic Visit……………………………………………………………………………….. 26 Basic Infertility Care for Women…………………………………………………………….. 26 Basic Infertility Care for Men………………………………………………………………… 27 Infertility Counseling…………………………………………………………………………. 28 Referral……………………………………………………………………………………….. 28 Sexually Transmitted Disease Services The Clinic Visit (Chlamydia, Gonorrhea, Syphilis, HIV/AIDS, Hepatitis C and B, Zika)…………………. 28 Treatment……………………………………………………………………………………….. 31 Expedited Partner Therapy……………………………………………………………………... 31 Counseling……………………………………………………………………………………… 31 Referral…………………………………………………………………………………………. 32 Mandatory Reporting…………………………………………………………………………… 32 Gynecologic Services……………………………………………………………………………. 32 Related Preventative Health Services……………………………………………………………. 32 Quality Clinical Management Referrals and Follow-up………………………………………………………………………... 33 Pharmaceuticals………………………………………………………………………………… 34 Medical Emergencies…………………………………………………………………………… 36 Medical Records………………………………………………………………………………... 37 Quality Improvement…………………………………………………………………………… 39 SECTION 2 – Program Monitoring Site Reviews …………………………………………………………………………………… 41 Technical Assistance Visits and Monitoring …………………………………………………... 43 Financial Program Audit ………………………………………………………………………. 43 SECTION 3 – ODH and National Title X Training Programs Project Directors Meeting ……………………………………………………………………… 44 Additional ODH Staff and Subrecipient Trainings ……………………………………………. 44 National Meetings, Conference, and National Training Center ………………………………. 44 OPA Program Policy Notice Series ……………………………………………………………. 45 The Ohio Family Planning Advisory Council (FPAC) ………………………………………... 45 SECTION 4 – Clinical Protocol Review by Clinicians 47 3 SECTION 5 – General Clinical Lab Services …………………………………………………………………………... 48 Autoclave Pre-sterilization, Operation, and Maintenance ……………………………………... 55 Cleaning and Disinfection for Healthcare Settings ……………………………………………. 60 Reproductive Life Plan ………………………………………………………………………… 63 Clinic Emergencies …………………………………………………………………………….. 66 Syncope ………………………………………………………………………………………. 66 Anaphylactic Shock ………………………………………………………………………….. 66 Cardio-Pulmonary Arrest (Basic Life Support for Healthcare Providers) …………………... 67 Shock/Hemorrhage …………………………………………………………………………... 69 General Emergency Information …………………………………………………………….. 69 Latex …………………………………………………………………………………………… 70 Medical Records, Personal Health Information, and Confidentiality …………………………. 72 SECTION 6 – Psychosocial Human Trafficking …………………………………………………………………………….. 75 Mandated Reporting Policy……………………………………………………………………. 77 Mandated Reporting Procedure ………………………………………………………………... 78 Mandated Reporting Algorithm ………………………………………………………………. 83 Family and Intimate Partner Violence ………………………………………………………… 84 Substance Abuse ……………………………………………………………………………….. 89 SECTION 7 – Contraception Abstinence or Sexual Risk Avoidance ………………………………………………………… 93 Combined Oral Contraceptives ………………………………………………………………… 98 Emergency Contraception ……………………………………………………………………... 110 Depo Medroxyprogesterone Acetate (DMPA) ………………………………………………… 124 Subdermal Implant (Nexplanon) ………………………………………………………………. 135 Diaphragm and Cervical Cap …………………………………………………………………... 145 Intrauterine Device (IUD) ……………………………………………………………………... 154 Progestin-Only Pills (POPs) …………………………………………………………………… 162 Fertility Awareness-Based Methods (FAM) …………………………………………………... 166 SECTION 8 – Cervical Cancer Screening Management of Abnormal Cervical Cytology ………………………………………………… 176 Cytology Screening Guidelines Chart …………………………………………………………. 182 Referral and Follow-up of Abnormal Findings ………………………………………………... 184 4 SECTION 9 – Special Conditions Preconception Health …………………………………………………………………………... 186 Achieving Pregnancy …………………………………………………………………………... 189 Pregnancy Testing and Counseling ……………………………………………………………. 193 Basic Infertility Services ……………………………………………………………………….. 201 Adolescent Services …………………………………………………………………………… 204 Breast Cancer Screening ……………………………………………………………………….. 208 Menopause ……………………………………………………………………………………... 212 SECTION 10 – Vaginal Infections and Sexually Transmitted Infections (STIs) Expedited Partner Therapy (EPT) ……………………………………………………………... 221 Chlamydia ……………………………………………………………………………………… 224 Gonorrhea………………………………………………………………………………………. 229 Pelvic Inflammatory Disease (PID) ……………………………………………………………. 234 Genital Herpes Simplex Virus (HSV) …………………………………………………………. 239 Syphilis ………………………………………………………………………………………… 245 Human Immunodeficiency Virus (HIV) ……………………………………………………….. 250 Human Papillomavirus (HPV) …………………………………………………………………. 254 Bacterial Vaginosis (BV) ………………………………………………………………………. 260 Trichomoniasis ………………………………………………………………………………… 265 Vulvovaginal Candidiasis ……………………………………………………………………… 269 Nongonococcal Urethritis (NGU) ……………………………………………………………… 273 5 SECTION 1 Providing Quality Family Planning Services INTRODUCTION The Ohio Department of Health (ODH) Reproductive Health and Wellness Program (RHWP) RHWP Title X Clinical Services & Protocols were adapted from the document, Providing Quality Family Planning Services (QFP), 2014 that provides recommendations developed collaboratively by CDC and the Office of Population Affairs (OPA) of the U.S. Department of Health and Human Services (HHS). The QFP document describes how to provide quality family planning services to men, women, and adolescents. The Title X Family Planning Program is administered by the Office of Population Affairs (OPA), Office of the Assistant Secretary for Health (OASH), within the U.S. Department of Health and Human Services (HHS). The family planning services grants program is authorized by Title X of the Public Health Service (PHS) Act (42 U.S.C. 300 et seq.). Implementing regulations are at 42 CFR part 59, subpart A. The requirements that apply to the direct recipients of Title X funds also apply to sub-recipients (42 CFR 59.1; HHS Grants Policy Statement, 2007). The information set forth in this document applies to the award of family planning services grants under section 1001 of the PHS Act (42 U.S.C. 300(a)), “to assist in the establishment and operation of voluntary family planning projects.” These projects “consist of the educational, comprehensive medical, and social services necessary to aid individuals to determine freely the number and spacing of their children” (42 CFR 59.1(a)). Family Planning assists individuals in determining the number and spacing of their children through the provision of affordable, voluntary family planning services including the provision of a broad range of contraceptive methods, education and related preventive health services. By assisting the establishment and operation of voluntary family planning projects throughout Ohio, the program positively impacts the health and well-being of women, children and families. Services provided through family planning clinics allow women and men to make well-informed reproductive health choices. ODH funded family planning clinics are designed to address the unmet family planning needs of low-income women and men and provide access to populations with special needs. No one is denied services because of inability to pay. Quality Title X Family Planning includes these attributes: confidentiality, safety, effectiveness, client-centered approach, timeliness, efficiency, accessibility, equity and cost effectiveness. Quality Family Planning Services include the following clinical elements: • Contraceptive services • Pregnancy testing and counseling •