title: Integrating Long-Acting Reversible Contraception Services into New York City School-Based Health Centers: Quality Improvement to Ensure Provision of Youth-Friendly Services.
abstract: 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.
  
  
  METHODS
  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 (LNG-IUS); Mirena®), 1 copper intrauterine device (Paragard®), 5 contraceptive implant (Nexplanon®). 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York. Electronic address: sangraulamanaswi@gmail.com.
authors.forename: Manaswi
authors.initials: M
authors.lastname: Sangraula
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Garbers
authors.affiliation: Center for Community Health and Education, Family Planning and School-Based Health Center Programs, New York-Presbyterian Hospital, New York, New York.
authors.forename: Janet
authors.initials: J
authors.lastname: Garth
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Emily Birchfield
authors.initials: EB
authors.lastname: Shakibnia
authors.affiliation: Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York.
authors.forename: Sarah
authors.initials: S
authors.lastname: Timmons
authors.affiliation: Department of Pediatrics, Columbia University Medical Center and Population and Family Health, Mailman School of Public Health, School Based Health Centers, New York-Presbyterian Hospital, Center for Community Health and Education, New York, New York.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Gold
mesh_terms: D000293:Adolescent; D003267:Contraception / Q000379:methods; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006801:Humans; D009519:New York City; D058996:Quality Improvement; D012572:School Health Services; D012574:Schools; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: Adolescent; Contraception; Contraceptive implants; Intrauterine device; Long-acting reversible contraception (LARC); Pregnancy prevention; Qualitative; Quality improvement; School-based health centers (SBHC); Youth services