LARC Method Appropriateness in Substance Use Treatment: A Quality Improvement Project for Integrated Care

Problem: Individuals with substance use disorder (SUD) have disproportionately higher rates of unintended pregnancy when compared to the general population, estimated to be 85% (Heil et al., 2011). Not only are poor maternal and fetal outcomes associated with unplanned pregnancies, but pregnancies in women with SUD are further complicated by additional risks and adverse outcomes (Black & Day, 2016). Context: Addiction treatment centers and programs are primed with opportunity to offer family planning services, when contact with medical providers is increased for substance use treatment. In response to the opioid crisis and unprecedented rates of unintended pregnancy, this project was designed to identify, develop, and implement an evidence-based approach to integrate birth control education and services, emphasizing long-acting reversible contraception (LARC) in substance use treatment. Interventions: A two-part interdisciplinary training was designed to include best practice recommendations regarding LARC utilization and comprehensive contraceptive counseling, hands-on skills training with vaginal simulators, and subdermal implant training and certification. Measures: A pre/post training assessment was utilized to assess change in provider confidence and readiness in offering contraceptive counseling, as well as, performing LARC procedures in preparation for service integration on site. Results: Through data analysis, results indicated a 33.33% increase in provider comfort in providing contraceptive counseling and confidence in identifying LARC eligible candidates. The greatest changes were seen in provider self-assessed preparedness in providing counseling regarding LARC safety and efficacy, with a 44.44% increase, and a 57.89% increase in provider comfortability with the Nexplanon insertion and removal procedures compared with pre- training assessments. Conclusions: Didactic and hands-on training are effective approaches to prepare providers for service expansion to include contraceptive services at addiction treatment centers