Assessing perspectives on an intervention connecting adolescents in outpatient psychiatry care to contraceptive counseling in the United States.

BACKGROUND: Adolescents with psychiatric disorders have high rates of unintended pregnancy and experience barriers to accessing sexual and reproductive health (SRH) care. Outpatient psychiatry visits are potential opportunities to connect adolescents to SRH care. This study informs the development of the Link2BC intervention which links adolescents in outpatient psychiatry care to SRH care. METHODS: We conducted group interviews with adolescents (3 groups, 7 total participants) and caregivers (3 groups, 9 total participants) and individual interviews with 8 psychiatry providers who received or provided outpatient psychiatric treatment in clinics in a pediatric hospital in a city in the Midwestern United States. We asked questions about the acceptability of Link2BC, potential implementation needs, and implementation determinants. Using consensus-building techniques, two coders analyzed transcriptions using a codebook informed by the Consolidated Framework for Implementation Research 2.0. RESULTS: Participants agreed on the need for interventions that expand access to SRH care. Adolescents emphasized that services should be confidential and accessible and were open to their psychiatrists introducing SRH topics during appointments. Providers expressed preference for training and clear workflows. Participants agreed that psychiatry providers could serve as liaisons between adolescents and their caregivers to facilitate conversations about contraception. Participants had concerns about time constraints during visits but mentioned few other barriers to the intervention. CONCLUSION: This study demonstrates the acceptability of connecting adolescents in outpatient psychiatry care to contraceptive counseling and informs the refinement and implementation of Link2BC. Integrating contraception counseling in outpatient psychiatry settings is an innovative approach to prevent unintended pregnancy among adolescents by increasing access to SRH care services.

Development of an Implementation Blueprint to Scale-Up Contraception Care for Adolescents with Psychiatric Conditions in a Pediatric Hospital.

Implementation blueprints are comprehensive plans that describe implementation strategies, goals, timelines, and key personnel necessary for launching new interventions. Although blueprints are a foundational step in driving intervention rollout, little is known about how blueprints are developed, refined, and used in practice. The objective of this study was to describe a systematic, collaborative approach to developing, refining, and utilizing a formal implementation blueprint for scaling up the Contraception Care at Behavioral Health Pavilion (CC@BHP) intervention for adolescents hospitalized in psychiatric units within a pediatric hospital in the United States. In Stage 1 (Planning/Preparation), we assembled a Research Advisory Board (RAB) of 41 multidisciplinary members and conducted a formative evaluation to identify potential barriers to CC@BHP implementation. Barriers were mapped to implementation strategies using the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) tool and used to create an initial blueprint. In Stage 2 (Development/Implementation), RAB members used activity logs to track implementation activities over the 18-month study period, which were then mapped to formal implementation strategies used to further develop the blueprint. About 30% of strategies were situated in the 'Train and Educate Stakeholders' ERIC category, 20% in 'Use Evaluative and Iterative Strategies,' and 16% in 'Develop Stakeholder Interrelationships' category. In Stage 3 (Synthesis/Refinement), the final blueprint was refined, consisting of 16 goals linked to 10 strategies for pre-implementation and 6 strategies for implementation. Feedback on the blueprint emphasized the role of the project champion in translating the blueprint into smaller, actionable steps for implementers.

Community-based Systems Dynamics for Reproductive Health: An Example from Urban Ohio.

BACKGROUND: Health outcomes, risk factors, and policies are complexly related to the reproductive health system. Systems-level frameworks for understanding and acting within communities through community-engaged research are needed to mitigate adverse reproductive health outcomes more effectively within the community. OBJECTIVES: To describe and share lessons learned from an ongoing application of a participatory modeling approach (community-based system dynamics) that aims to eliminate racial inequities in Black-White reproductive health outcomes. METHODS: The community-based system dynamics approach involves conducting complementary activities, workshops, modeling, and dissemination. We organized workshops, co-developed a causal loop diagram of the reproductive health system with participants from the community, and created materials to disseminate workshop findings and preliminary models. LESSONS LEARNED: Many opportunities exist for cross-fertilization of best practices between community-based system dynamics and community-based participatory research. Shared learning environments offer benefits for modelers and domain experts alike. Additionally, identifying local champions from the community helps manage group dynamics. CONCLUSIONS: Community-based system dynamics is well-suited for understanding complexity in the reproductive health system. It allows participants from diverse perspectives to identify strategies to eliminate racial inequities in reproductive health outcomes.