Change Strategies by Focus Area
Overview
Change strategies are provided throughout this site for each of Q4T’s quality improvement goals. They are shown here by focus area for health centers that want to organize their Quality Improvement (QI) efforts this way.
Change Strategies
Key Foundations
- Establish a policy to screen every adolescent patient for sexual activity and conduct sexual risk assessment at least annually
- Establish a policy to provide behavioral counseling for all sexually active adolescents to prevent sexually transmitted infections (STIs)
- Establish a policy to include recommended chlamydia and gonorrhea screening as part of preventive care
- Establish a policy to provide adolescents with patient-centered contraceptive counseling
- Establish policies that support access to the full range of contraceptive services
- Establish policies that support adolescent access to services
- Create youth-friendly spaces
- Establish policies that support adolescent access to confidential services
- Assess organizational needs related to integrating a trauma-informed approach
Equipping Teams
- Train the care team on conducting sexual histories and sexual risk assessments
- Train the care team to provide behavioral counseling about risk and protective behaviors
- Train the care team on recommended chlamydia and gonorrhea screening for sexually active adolescents and tracking, following up, and treating those who have positive screens
- Train the care team in shared-decision making and communication skills to deliver patient-centered contraceptive counseling
- Ensure care team members are comfortable and trained in provision and management of all methods of contraception
- Train and mentor care team members in LARC insertion, management, and removal
- Ensure common understanding of adolescent development
- Train staff to provide respectful, inclusive, youth-friendly care
- Train staff on confidentiality policies and practices, including provision of time alone
- Train staff to be aware of trauma and adverse childhood experiences and in using a trauma-informed approach
Service Delivery
- Implement a clinic workflow to conduct a risk assessment using a tool that includes sexual risk
- Use electronic health records (EHRs) to support sexual history taking and risk assessment
- Implement a clinic workflow to provide counseling about risk and protective behaviors for sexual health
- Implement a clinic workflow to conduct recommended chlamydia and gonorrhea screening
- Standardize coding and billing practices for chlamydia and gonorrhea screening and treatment
- Implement a patient-centered contraceptive counseling framework
- Implement a clinic workflow to ensure same-day contraceptive access is available every day of clinical services
- Optimize reimbursement for contraceptive services, including LARC devices
- Document sexual orientation and gender identity for all patients
- Implement a clinic workflow to provide time alone at every patient visit
- Ensure confidentiality of the patient’s medical record
- Ensure coding and billing practices protect confidentiality
Engaging Adolescent Patients and Families
- Educate parents about the importance of sexual risk assessment
- Equip parents to have conversations with their adolescents that reinforce behavioral counseling messages
- Inform patients and parents of clinical recommendations and health center protocols regarding chlamydia and gonorrhea screening
- Equip parents with information about contraceptive methods
- Engage youth to both assess and help create youth-friendly spaces
- Communicate the health center’s time alone and confidentiality practices and minors’ rights
