VOLUME 15 | ISSUE 1 | JANUARY 2, 2018
Quarterly News & Updates
A Note From the Executive Director
By any measure 2017 was an extremely difficult year for family planning programs in Iowa. The legislative, congressional and presidential changes have caused numerous challenges for us at both the state and federal level. When looking back at 2017 it is easy to focus on those problems and issues. We can definitely list the attacks, issues and tests that have confronted us. But, we can also focus on the tremendous amount of support that has arisen to fight back these confrontations. It has been so inspiring to see massive numbers of people who showed up for rallies to support family planning (and not just one rally), who wrote letters on behalf of family planning, and who contacted elected officials about family planning. 
When I remember 2017 it will be that support and fierce defense of family planning that will define the year for me. That willingness of so many Iowans (and people across the country) to stand up for sexual health care that represents the promise of 2018 as we move into the new year.
Thank you to everyone for your support over the past year. We hope you had a happy holiday season and may 2018 show the fruits of our commitment.

Executive Director
In Case You Missed It!

Rural Health Information Hub Webinar Series:

Great recording of the December 18, 2017 webinar on racial and ethnic health disparities in rural areas and how to address them. Webinar featured speakers from the CMS Office of Minority Health, the CDC Office of Minority Health and Health Equity, and two FORHP Outreach grantees.

Iowa Network Against Human Trafficking:

The Iowa Network Against Human Trafficking released a revised resource directory of Iowa Non-Profit Survivor Services and Prevention and Education Resources . Listing includes survivor programs and services funded by the Iowa Crime Victim Assistance Division - Office of the Attorney General as well as other private groups dedicated to ending human trafficking in all forms.
Clinical Corner: Title X Required Adolescent Counseling

Adolescent services are an important aspect of Title X Family Planning and adolescents need to feel safe and comfortable when they seek family planning. There are some stipulations about adolescent clients, though, from the Office of Population Affairs. Title X Family Planning requirements consist of two documents:  “The Program Requirements for Title X Funded Family Planning Projects,” and “Providing Quality Family Planning Services: Recommendations of CDC and the US Office of Population Affairs (QFP).”   

Within the Program Requirements are two legislative mandates regarding adolescent counseling: 
“it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities.”
The QFP outlines additional adolescent counseling:

  1. Comprehensive information about how to prevent pregnancy and STDs, with the use of abstinence, condoms and contraceptive methods including long-acting reversible contraception (LARC). LARC methods are safe and effective for nulliparous women (women who have not been pregnant or given birth) including adolescents.
  2. Family planning providers should offer confidential services, with an explanation of its limits.  All relevant state laws about notification and reporting of child abuse, child molestation, sexual abuse, rape, and human trafficking must be observed.

These four components of Adolescent Counseling can be performed by the nurse or assistant who is checking in the client or the clinician assessing the client. An important aspect of this counseling is the documentation within the electronic medical record. Each system is different, but it is very important to make sure that all four of these items being performed are documented. Evaluate your electronic systems to make sure each component is present or make recommendations for change to include these items. If your electronic systems are set up to include them, it can make documentation easier. These items are just a few of the things evaluated in a full program review, can be an interim review topic, or a Quality Improvement assessment. 
Training News

  • April 25, 2018 Webinar: Strategies for Improving Screening: The Chlamydia Learning Collaborative and Missed Opportunities in Family Planning
  • Spring 2018 Webinars: Opioid Misuse and Incorporating Cultural Awareness in the Family Planning Setting
  • Save-the-Date: Iowa Family Planning Update September 12, 2018
CBSS Update: CDC 2016 STD Surveillance Report Released

The annual report on sexually transmitted diseases was released by the Centers for Disease Control and Prevention (CDC) on September 26th. This surveillance report is based on data from the three STDs that clinicians and laboratories are required to report to local and state public health departments; gonorrhea, chlamydia, and syphilis. (Other STDs, like human papilloma virus (HPV), Trichomoniasis, and genital herpes are not reportable.) There were more than 2 million cases of the three infections reported. Most of the cases are chlamydia (1.6 million). The rates of all three diseases increased for the fourth year in a row. Young people 15 -24 years of age and gay/bisexual men are at the highest risk for STDs. These groups experience unique barriers to service including stigma, confidentiality concerns, and limited access, especially in rural areas.
Especially concerning for Iowa is the increase in reported cases of gonorrhea. According to George Walton, IDPH STD Program Manager, by mid-October of 2017 we have already exceeded the 2,600 gonorrhea cases reported in all of 2016. The state has experienced a 16% increase in 2016 from 2015, and a more than 75% increase between 2013 and 2016. Mr. Walton estimates that there will be over 3,400 gonorrhea diagnoses reported by the end of 2017.
There may be multiple reasons for the increases. Increased testing, especially at our CBSS sites, for oropharyngeal and rectal sites, is contributing to more diagnoses because infections are being found that may have been missed before. Infections at these sites are many times asymptomatic. However, the Department does not feel the increases are due to just this testing but also an indication of more transmission, especially in men. Getting all partners in for treatment is essential and all providers are encouraged to follow the CDC STD Treatment Guidelines for gonorrhea; 250 mg. of ceftriaxone plus 1 gram of azithromycin.
The increases come at a time of federal, state, and local budget cuts to STD programs. Congress has provided no funding increases since 2003. Public health becomes increasingly dependent on the private sector of health care practitioners to follow current guidelines for routine screening in the populations most at risk.
  • The full 2016 STD surveillance data can be found here on the CDC website.
  • The full 2016 Iowa STD Surveillance Report can be found here.

For questions related to local data or programs contact Colleen Bornmueller, CBSS Coordinator, at cbornmueller@fpcouncil.com or George Walton, STD Program Manager, Iowa Department of Public Health at George.Walton@idph.iowa.gov .
Sources: 2016 STD Trends Fact Sheet, CDC, Iowa Department of Public Health, Bureau of HIV/STD/Hepatitis, Sept. Oct 2016 Newsletter and the Friday, Dec. 8, 2017 IDPH Epi-Update

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This publication is funded in part by the U.S. Department of Health & Human Services - Office of Population Affairs/Family Planning: The information, comments, and views posted in this correspondence are the sole responsibility of the Family Planning Council of Iowa.
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