title: Providing long-acting reversible contraception services in Seattle school-based health centers: key themes for facilitating implementation.
abstract: OBJECTIVE
  The purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners.
  
  
  METHODS
  We conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups.
  
  
  RESULTS
  The most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff.
  
  
  CONCLUSIONS
  LARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women.
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington. Electronic address: kellyg18@uw.edu.
authors.forename: Kelly
authors.initials: K
authors.lastname: Gilmore
authors.affiliation: Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Hoopes
authors.affiliation: Neighborcare Health, Seattle, Washington.
authors.forename: Janet
authors.initials: J
authors.lastname: Cady
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Amies Oelschlager
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
authors.forename: Sarah
authors.initials: S
authors.lastname: Prager
authors.affiliation: Department of Psychiatry and Behavioral Sciences and Department of Epidemiology, University or Washington, Seattle, Washington.
authors.forename: Ann
authors.initials: A
authors.lastname: Vander Stoep
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D007434:Intrauterine Devices; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D012572:School Health Services; D014861:Washington
chemical_list: D003271:Contraceptive Agents, Female
keywords: Adolescent pregnancy prevention; Adolescent reproductive health; LARC; Long-acting reversible contraception; Program implementation; School-based health; School-based health care providers