A Review of the HHS Family Planning Program Mission, Management, and Measurement of Results (2009) / Chapter Skim
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Appendix D: Program Guidelines for Project Grants for Family Planning Services
Appendix D: Program Guidelines for Project Grants for Family Planning Services
Pages 215-250
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Appendix D Program Guidelines for Project Grants for Family Planning Services 215
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216 A REVIEW OF THE HHS FAMILY PLANNING PROGRAM Program Guidelines For Project Grants For Family Planning Services United States Department of Health and Human Services Office of Public Health and Science Office of Population Affairs Office of Family Planning 4350 East West Highway, Suite 200 Bethesda, Maryland 20814 January 2001
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. 6 5.5 Human Subjects Clearance (Research)
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. 18 8.3 History, Physical Assessment, And Laboratory Testing .
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The Law: Title X Population Research and Voluntary Family Planning Programs B Regulations: Grants for Family Planning Services under Title X of the Public Health Service Act C
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The "project" consists of those activities described in the grant application and supported under the approved budget. "Delegate/contract agencies" are those entities that provide family planning services with Title X funds under a negotiated, written agreement with a grantee.
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is eligible to apply for a Title X family planning services project grant [59.2, 59.3]
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Competitive grant applications must include a full and updated needs assessment. 3.3 THE APPLICATION The Department of Health and Human Services' Office of Population Affairs administers the Title X Family Planning Program through the DHHS Regional Offices.
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3.4 PROJECT REQUIREMENTS Projects must adhere to: • Section 59.5 and all other applicable provisions of the regulations, which list the requirements to be met by each project supported by Title X • The applicable requirements of these Program Guidelines for Project Grants for Family Planning Services.
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4.0 Grant Administration All grantees must comply with the applicable legislative, regulatory and administrative requirements described in the Public Health Service Grants Policy Statement. A copy of the Public Health Service Grants Policy Statement may be obtained from the Office of Grants Management for Family Planning Services.
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6.0 Project Management 6.1 STRUCTURE OF THE GRANTEE Family planning services under Title X grant authority may be offered by grantees directly and/or by delegate/contract agencies operating under the umbrella of the grantee. However, the grantee is responsible for the quality, cost, accessibility, acceptability, reporting, and performance of the grantfunded activities provided by delegate/contract agencies.
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A schedule of discounts is required for individuals with family incomes between 101% and 250% of the Federal poverty level. Fees must be waived for individuals with family incomes above this amount who, as determined by the service site project director, are unable, for good cause, to pay for family planning services.
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Title X projects offering services that are not required by the statute, regulations or these Guidelines should whenever possible seek other sources of funding for such services before applying Title X funds to those activities.
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. Grantees must also ensure that: • Projects are administered by a qualified project director; • The clinical care component of the project operates under the responsibility of a medical director who is a licensed and qualified physician with special training or experience in family planning; • Protocols exist that provide all project personnel with guidelines for client care; -9
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Training through regional training centers is available to all projects under the Title X program. In addition to training, grantees may receive technical assistance for specific project activities.
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. 6.9 COMMUNITY PARTICIPATION, EDUCATION, AND PROJECT PROMOTION Boards and advisory committees for family planning services should be broadly representative of the population served.
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Grantees should ensure that publications developed under Title X do not contain information which is contrary to program requirements or to accepted clinical practice. Federal grant support must be acknowledged in any publication.
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Part II of this document has been developed to assist grantees in determining those services which will be provided to fulfill the mission of Title X • Projects must provide services stipulated in the law or regulations, or which are required by these Guidelines for the provision of high quality family planning services.
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APPENDIX D 233 Education • Presentation of relevant information and educational materials, based upon client needs and knowledge; Counseling • Interactive process in which a client is assisted in making an informed choice; Informed Consent • Explanation of all procedures and obtaining a general consent covering examination and treatment and, where applicable, a method specific informed consent form; History • Obtaining of a personal and family medical and social history; Examination • Performance of a physical examination and any necessary clinical procedures, as indicated; Laboratory Testing • Performance of routine and other indicated laboratory tests; Follow-up & Referrals • Planned mechanism for client follow-up; • Performance of any necessary clinical procedures; • Provision of medications and/or supplies as needed; and • Provision of referrals as needed.
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7.3 EMERGENCIES Emergency situations involving clients and/or staff may occur at any time. All projects must therefore have written plans for the management of on-site medical emergencies.
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8.0 Required Services The services contained in this section must be provided by all projects funded under Title X The client's written informed voluntary consent to receive services must be obtained prior to the client receiving any clinical services.
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To provide informed consent for contraception, the client must receive information on the benefits and risks, effectiveness, potential side effects, complications, discontinuation issues and danger signs of the contraceptive method chosen. Specific education and consent forms for the contraceptive method provided must be part of -17
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Persons who provide counseling should be knowledgeable, objective, nonjudgmental, sensitive to the rights and differences of clients as individuals, culturally aware and able to create an environment in which the client feels comfortable discussing personal information. The counselor must be sufficiently knowledgeable to provide accurate information regarding the benefits and risk, safety, effectiveness, potential side effects, complications, discontinuation issues and danger signs of the various contraceptive methods.
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8.3 HISTORY, PHYSICAL ASSESSMENT, AND LABORATORY TESTING ! History At the initial comprehensive clinical visit, a complete medical history must be obtained on all female and male clients.
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. Histories of reproductive function in male clients must include at least the following: • Sexual history; • Sexually transmitted diseases (including HBV)
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For many clients, family planning programs are their only continuing source of health information and clinical care. Therefore, an initial complete physical examination, including height and weight, examination of the thyroid, heart, lungs, extremities, breasts, abdomen, pelvis, and rectum, should be performed.
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Family planning clinics also may be an important source of reproductive health care for male clients. Physical examination should be made available to male clients, including height and weight, examination of the thyroid, heart, lungs, breasts, abdomen, extremities, genitals and rectum.
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, IUDs, fertility awareness methods, natural family planning, and hormonal methods (injectables, implants, orals)
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Level II infertility services may be offered in projects with clinicians who have special training in infertility. Level III services are considered to be beyond the scope of Title X program.
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Title X projects may not require written consent of parents or guardians for the provision of services to minors. Nor can the project notify parents or guardians before or after a minor has requested and received Title X family planning services.
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9.2 SEXUALLY TRANSMITTED DISEASES (STD) AND HIV/AIDS The increasing incidence and prevalence of STDs, particularly among adolescents, requires that family planning projects increase their efforts to provide education and information about the more common STDs and HIV/AIDS.
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Extensive genetic counseling and evaluation is beyond the scope of the Title X program. Referral systems should be in place for those who require further genetic counseling and evaluation 9.5 HEALTH PROMOTION/DISEASE PREVENTION Family planning programs should, whenever possible, provide or coordinate access to services intended to promote health and prevent disease.
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It is essential that each facility maintain an adequate supply and variety of drugs and devices to effectively manage the contraceptive needs of its clients. Projects should also ensure access to other drugs or devices that are necessary for the provision of other medical services included within the scope of the Title X project.
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The written consent of the client is required for the release of personally identifiable information, except as may be necessary to provide services to the client or as required by law, with appropriate safeguards for confidentiality [59.11]
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APPENDIX D 249 10.4 QUALITY ASSURANCE AND AUDIT A quality assurance system must be in place that provides for ongoing evaluation of project personnel and services. The quality assurance system should include: • An established set of clinical, administrative and programmatic standards by which conformity would be maintained; • A tracking system to identify clients in need of follow-up and/or continuing care; • Ongoing medical audits to determine conformity with agency protocols; • Peer review procedures to evaluate individual clinician performance, to provide feedback to providers, and to initiate corrective action when deficiencies are noted; • Periodic review of medical protocols to insure maintenance of current standards of care; • A process to elicit consumer feedback; and • Ongoing and systematic documentation of quality assurance activities.
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