Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services

Study Objective, Design, and Setting: Adolescents face barriers to accessing youth-friendly family planning services, specifically long-acting reversible contraception (LARC). School-based health centers (SBHCs) can provide youth-friendly care. A quality improvement project was undertaken to assess quality of care before, during, and after LARC services at 3 SBHCs, and to identify specific strategies for improving these LARC services. Participants, Interventions, and Main Outcome Measures: We interviewed 18 female adolescents who received LARC services. Two independent reviewers coded deidentified verbatim transcripts; discrepancies were resolved by consensus with a third reviewer. A guide of themes was structured corresponding to Ambresin's domains of youth-friendly services. From these domains, we identified emerging themes using grounded theory, with a focus on practical suggestions for improving LARC services in SBHCs. Results: Interviewees ranged in age from 15 to 19 (average: 17) years. Most had insertions (12 levonorgestrel intrauterine system (LNGIUS); Mirena (R)), 1 copper intrauterine device (Paragard (R)), 5 contraceptive implant (Nexplanon (R)). Overall, participants were highly satisfied with SBHC LARC services. Within the domain of communication, 2 key themes emerged: balancing need for information with concerns about being overwhelmed by information; and interest in information that directly addresses misconceptions about LARCs. Suggested strategies included providing postprocedure "care packages" with information and supplies, and supporting a peer-based network of adolescent LARC users and previous patients to serve as a resource for new patients. Conclusion: This quality improvement project, conducted in a unique setting, gave adolescents a voice. The identified strategies for improving health education, social support, and outreach might be generalizable to other SBHCs. Future research could explore the effect of implementing these suggested strategies on reproductive health care use and outcomes at SBHCs.