National Clinical Training Center for Family Planning



Podcast TranscriptTitle: Family Planning and COVID-19: Interviews from the Field, Part ThreeSpeaker: Raissa Ameh, MSN, WHNP-BCDuration: 00:15:01NCTCFP (00:04):Hello, and welcome to The Family Planning Files, a podcast from the National Clinical Training Center for Family Planning. The National Clinical Training Center for Family Planning is one of the training centers funded through the Office of Population Affairs to provide programming, enhance the knowledge of family planning staff. I'm your host, Katherine Atcheson.NCTCFP (00:23):In response to the recent global pandemic of COVID-19 or novel coronavirus, this episode will be part of a series of interviews from the field with frontline family planning staff, in order to learn how they and their organizations are adapting in these challenging times, and to provide ideas and direction for listeners who are facing similar situations in their own clinical practices.NCTCFP (00:45):Our guest today is Raissa Ameh, the board-certified women's health nurse practitioner with over a decade of experience in both clinical and academic settings. She's the clinical manager for the Missouri Family Health Council, a Title X grantee, and oversees the family planning services at 66 service sites throughout the state. Prior to her position at MFHC, Raissa worked as a family planning clinician in Texas and a clinical instructor in nursing programs at Tyler Junior College and Iowa Western Community College. Welcome to the podcast, Raissa. We're so excited to speak with you today.Raissa Ameh (01:20):Thank you, Katherine. So happy to be here.NCTCFP (01:23):So let's just dive right in. What have you seen as particular concerns around COVID-19 for your family planning health centers in Missouri?Raissa Ameh (01:32):So the coronavirus pandemic has profoundly impacted family planning service delivery here in Missouri. The governor directed the state's Department of Health and Senior Services to require distancing restrictions to protect the public's health, effective on March 23rd. So here at MFHC, we knew that we needed to gather as much information as possible, in order to support our subrecipients with service delivery during these unprecedented times.Raissa Ameh (02:00):So Michelle, our executive director and I, work together to deliver information to our subrecipients via webinar on March 23rd. During this webinar, we were able to address some initial concerns, such as PPE, particularly on when to have a mask on and when not to have a mask on, scenarios of when to have a client come in to the clinic, versus providing care via telephonic or telehealth visits.Raissa Ameh (02:26):After this webinar, some other concerns surfaced regarding confirmation that family planning services are essential. And we were able to confirm this through the grantee call provided by OPA. Other concerns were about meeting their unduplicated count goals amid this public health crisis. But we provided our subrecipients with reassurance and have been tracking their service interruptions, as a result of this pandemic.NCTCFP (02:54):You've given us a good overview of what you've done so far. Can you give us a more in-depth look at the policy and procedure or even physical changes that have been made in your service sites to reduce transmission risk for COVID-19?Raissa Ameh (03:09):Sure. So we provided guidance to our clinics about making sure to provide staff education about COVID-19 infection control, and also informed them to update policies as required. We encourage them to develop a process for screening and triage of phone calls and email requests for care, in order to limit office visits to those that require in-person provider evaluation. We also recommended to establish an additional screening process, such as a supplemental screening intake to be completed via phone, or handed to the client at the front desk.Raissa Ameh (03:45):We encourage our clinics to develop a process to limit non-essential routine visits, which can flex with demands of the COVID-19 pandemic. We also encourage displaying signage at the front entrance for clients to reschedule appointments if they are exhibiting signs and symptoms of COVID-19. And we provided our subrecipients with sample signage for their utilization.Raissa Ameh (04:09):We also recommended to create an area to spatially separate any clients with respiratory symptoms, at least six feet away in waiting areas. We also recommended if staff travel to multiple sites, to consolidate the clinic to one main site and consider mailing contraceptives when appropriate.NCTCFP (04:29):You also touched upon triaging for telehealth services. So how many of your health centers have instituted telehealth services? And what steps were needed for you all to start these services via telehealth?Raissa Ameh (04:43):So many of our health centers have implemented telehealth. We were fortunate to be able to allocate funding for subrecipients interested in purchasing telehealth platforms. And our program manager, Ashley Kuykendall, was able to create a comparison document of Zoom and Doxy.me for our subs to aid in their decision making process. But of course, they could use any telehealth platform that they preferred. So here in Missouri, MO HealthNet, which is our Medicaid, loosened the requirements regarding telehealth, and Medicaid waived the requirement that physicians must have an established relationship with a patient before providing telehealth services.Raissa Ameh (05:24):So in addition to telehealth services, may be provided to a Medicaid participant while at home, using their telephone.NCTCFP (05:32):And since you are using telehealth platforms, how do your service sites and clinicians deal with privacy issues? What have you done to document consent and confidentiality for your patients?Raissa Ameh (05:45):So we informed our subrecipients that effective March 17, the Office of Civil Rights. So OCR and the U.S. Department of Health and Human Services, HHS, waived potential penalties for HIPAA violations against healthcare providers that serve patients during this public health emergency with everyday communication technologies.Raissa Ameh (06:07):So we let them know that they can use Zoom, Skype, Google Hangouts, FaceTime, but they cannot utilize any public facing video communications, such as Facebook Live, TikTok, Instagram Live or Twitch. So what we have heard from the field, is that clients are encouraged to go to a private space in their home. For our adolescent clients, we have device and sample script language, so they are aware of what a telehealth visit entails when they call to schedule their appointment. And also a discussion that there will be the same expectation of allowing privacy for that teen during the telehealth visit, as there would be for an in-person visit, such as having the parents step out each visit, to ensure that one on one time with that teen.NCTCFP (06:51):And our whole conversation here has been around the technical assistance you've provided to your subrecipients in setting up these new policies and procedures. What challenges have you and your clinicians encountered, in terms of rolling out these new policies and doing so, so quickly?Raissa Ameh (07:11):So I have reviewed some sample telehealth consents and devised a sample telehealth consent for our subrecipients. We have also provided resources for development of these policies and procedures. Just recently, I have started to review some of these telehealth policies and procedures. Some of the challenges that I have faced include making sure that these policies and procedures are robust and not duplicative of the in-person policies and procedures already in place.Raissa Ameh (07:43):Also, the issue of consent did surface. So we provided guidance on how to obtain verbal consent, if needed, and document this in the medical record, and to obtain written consent, when and if the client returns to the clinic. We also discussed that they could share a digital copy with the client if they also have this access.NCTCFP (08:04):And at the beginning of the podcast, we talked a little bit about how you and your service sites and clinicians have started to evaluate who needs to come in for an in-person visit, who can be evaluated via telehealth. How do your clinicians make these determinations at this time? And what factors go into your triage, if you will, methods?Raissa Ameh (08:26):So during our initial webinar, we recommended doing contraceptive services. So a method initiation for pills, patch, ring and emergency contraception, also doing sexually transmitted disease services for prep testing and treatment. They could do uncomplicated gynecological conditions, such as yeast, urinary tract infections for established clients. And then basically, we encourage them to assess the clients based on a case by case basis, and making sure that they use their best clinical judgment in these certain situations.NCTCFP (09:03):And have your clinicians had any difficulties with referring patients to outside services, such as HIV treatment or domestic violence services? And how have you addressed any issues?Raissa Ameh (09:16):We have not been informed that this has been an issue, but many community service agencies in the state are temporarily closed, in light of COVID-19. So they may have had some influx of patients that have traditionally received their family planning services elsewhere.NCTCFP (09:35):And have you seen any problems with clinic supplies or stocking medications along in the supply chain? And have you had to address this at all in any way?Raissa Ameh (09:46):Fortunately, we haven't had any issues regarding this to our knowledge, but a few of our subrecipients have reached out about moving their 340 B stock from other locations to their primary service delivery location. And we have provided them with guidance to contact Afaxys, and Afaxys was able to provide them with the support that they needed.NCTCFP (10:07):As you mentioned earlier, there's also the need to assess staff readiness to provide services. Can you go into a little more detail, how your service sites are assessing staff health during this challenging time, and if you've had to deal with any gaps in staffing due to coronavirus?Raissa Ameh (10:24):Sure. So some of our subrecipients have implemented temperature checks for their staff. So they're letting folks work from home if they have any coexisting conditions that put them at higher risk, if feasible, and they have been prioritizing PPE. Fortunately for our state, they have implemented a PPE supply solution website, where providers can gain access to the PPE that they need.Raissa Ameh (10:50):A few of our health centers have dealt with their staff being furloughed. And so they have had to transition responsibilities to the staff that continue to work during the pandemic. So what we've been doing here at MFHC, is we have been sensitive to our subrecipients' needs. We've accommodated any extensions they've needed and offered extensions if needed, for any reports or work plan calls during this pandemic.NCTCFP (11:16):And what has been done to reassure your staff and clinicians, and just keep up morale during this time?Raissa Ameh (11:23):So what we have heard from the field, is that their institutions have made them feel cared for. They have been relieved, because they are able to convey any concerns that they may have, and they've also had a voice at the table during these decision making processes. So we've had a lot of positive feedback during this crisis.NCTCFP (11:45):We've been dealing with COVID-19 for several months now, and some states, including Missouri, have begun to loosen restrictions. Has anything changed for how your health centers are operating, versus how they started operating back in March?Raissa Ameh (12:00):Yes. So a good amount of health centers that were closed are now starting to open up and do in-person visits. So they're integrating those nonessentials to the well person visits into their workflow again. They have elongated their appointment times to limit them on clients in the health center at one time. And this also allows for social distancing and for them to clean after seeing clients.NCTCFP (12:26):And as MFHC is a Title X grantee and you oversee Title X sub-grantees. Have there been any special considerations that you've had to factor in around providing services during COVID-19?Raissa Ameh (12:41):So here at MFHC, we have had to figure out how to best offer support and technical assistance, and how to be flexible as everyone's needs are different. You know, our health centers range from federally qualified health centers, to public health department, to community action agencies, to stand alone family planning clinics. So everyone's needs are going to be different and have been different, as well as the populations that they serve.NCTCFP (13:10):Well, our time is almost up today, Raissa. But before we go, are there any final takeaways you'd like our listeners to know or think about going forward?Raissa Ameh (13:19):I’d like to say thank you to all family planning providers. Family planning services are so vital for our communities to have positive health outcomes. So I appreciate all that you all are doing to address the needs of your communities during these challenging times. Thank you.NCTCFP (13:35):And thank you so much for joining us today, Raissa and for sharing your time and expertise. For more content, search for The Family Planning Files Podcast, or subscribe to our show on iTunes, Google Podcasts, Spotify, Stitcher, or wherever you listen to podcasts. For transcript of this podcast, as well as other online learning activities and continuing education opportunities, please visit our website at .NCTCFP (14:04):This podcast is supported by award number five, FPTPA 006029-02-00, from the U.S. Department of Health and Human Services or HHS, Office of the Assistant Secretary of Health or OASH, Office of Population Affairs or OPA. Its contents are solely the responsibility of the presenters, and do not necessarily represent the official views of HHS, OASH, or OPA.NCTCFP (14:34):Theme music written by Dan Jones and performed by Dan Jones and The Squids. Other production support provided by the Collaborative to Advance Health Services at the University of Missouri, Kansas City School of Nursing and Health Studies. And thank you to our listeners for tuning in today. We hope that you'll join us next time for another episode of The Family Planning Files. ................
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