A Review of the HHS Family Planning Program Mission, Management, and Measurement of Results (2009) / Chapter Skim
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3 Title X Goals, Priorities, and Accomplishments
3 Title X Goals, Priorities, and Accomplishments
Pages 71-100
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From page 71... ...
/HIV; and pregnancy diagnosis and counseling. In addition, the Title X program helps clinics respond to patients' needs by supporting training for family planning clinic personnel, information dissemination and community-based education and outreach activities, and data collection and research to improve the delivery of family planning services.
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From page 72... ...
No. 91-1472, 91st Cong., 2d Sess., September 26, 1970; Family Planning Services and Population Research Act of 1970, P.L.
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From page 73... ...
. Indeed, the formal name of the bill was the "Family Planning Services and Population Research Act of 1970." The new legislation was designed to address the population challenge directly by dramatically expanding voluntary family planning services.
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From page 74... ...
; and to the increasing costs of medical services and supplies, especially the more effective methods of family planning, such as IUDs. Taking inflation alone into account, funding for Title X in constant dollars was 62 percent lower in fiscal year (FY)
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From page 75... ...
The guidelines were last updated in 2001. According to the guidelines, each Title X clinic must offer the following: • Client education and counseling, including specialized counseling; • History, physical assessment, and laboratory testing, including breast and cervical cancer screening; • Fertility regulation, including provision of contraceptive methods and/ or prescriptions for contraceptive supplies and other medications; • Basic infertility services; • Pregnancy diagnosis and counseling; • Adolescent services, including abstinence counseling and counseling to minors on how to resist attempts to coerce them into engaging in sexual activities; • Reporting of child abuse, child molestation, sexual abuse, rape, or incest; • Identification of estrogen-exposed offspring; • Gynecological services; • STD and HIV/AIDS prevention education, screening, and referral; • Genetic information and referral; • Health promotion and disease prevention; and • Postpartum care.
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From page 76... ...
• In 2003, applicants were directed to encourage family participa tion in the decisions of minors to seek family planning services by including activities that promote positive family relationships; they were also directed to partner with faith-based organizations. • In 2006, ensuring compliance with state laws requiring notification or reporting of child abuse, child molestation, sexual abuse, rape,
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From page 77... ...
Encouraging participation of families, parents, and/or legal guardians in the decision of minors to seek family planning services; and providing counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities; and 6. Addressing the comprehensive family planning and other health needs of in dividuals, families, and communities through outreach to hard-to-reach and/or vulnerable populations, and partnering with other community-based health and social service providers that provide needed services.
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From page 78... ...
) for use in monitoring performance and improving family planning services; 9.
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From page 79... ...
The committee examined the research portfolio of the Title X program (see Appendix I) , keeping in mind the intent of Congress that the program's research efforts would serve to improve the delivery of family planning services.
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From page 80... ...
Encouraging family participation in the decision of minors to seek family planning services and providing counseling to minors on how to resist attempts to coerce minors into sexual activities, and complying with state laws requiring the notification or reporting of child abuse, child molestation, sexual abuse, rape, or incest; and 3. Integrating HIV prevention activities into Title X services.
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From page 81... ...
Increase the number of unintended pregnancies averted by provid ing Title X Family Planning services, with priority for services to low-income individuals; 2. Reduce infertility among women attending Title X Family Planning clinics by identifying chlamydia infections through screening of females ages 15–24; and 3.
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From page 82... ...
These concerns are compounded by the overall growth in the number of individuals in need of publicly subsidized family planning services and the increasing cost of more effective contraceptives and diagnostics (see the discussion later in this chapter)
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From page 83... ...
The committee also provides an assessment of a fourth measure focused on efficiency -- maintaining the cost per family planning client below the medical care inflation rate. The third subsection examines the contribution of the Title X goals to overall HHS goals.
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From page 84... ...
a birth control method or prescription for a method; (2) a checkup or medical test related to using a birth control method; (3)
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From page 85... ...
SOURCE: Mosher et al., 2004. Extent to Which Title X Is Serving Its Intended Population In accordance with its core mission, Title X has made great strides in providing family planning services to its target population.
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From page 86... ...
. In 2001, Title X clinics "met 28% of the national need for publicly funded family planning services, an 11% increase from 1994" (Frost et al., 2004, p. 213)
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From page 87... ...
The Title X program plays a major role in provid ing family planning services and closely related preventive health services, particularly to younger women who live at or near the federal poverty level. As discussed in Chapter 2, the intended population for Title X services (adults at or below 100 percent of the federal poverty level and adolescents)
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From page 88... ...
. for Needy Families, and some private insurance, not all the need is unmet; however, a portion certainly is (see the discussion in Chapter 4 on other sources of public funding for family planning services)
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From page 89... ...
SOURCE: OMB, 2009. Reducing Unintended Pregnancies One of Title X's key goals is reducing the number of unintended pregnancies by ensuring access to a broad range of family planning services and methods.
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From page 90... ...
Reducing the Rate of Invasive Cervical Cancer by Providing Pap Tests While OFP has no historical data available on this measure, and national standards for prevention of and screening for invasive cervical cancer are
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From page 91... ...
As discussed earlier, the committee considers this performance measure to be less central to the program's mission than the previous two. Maintaining the Actual Cost per Family Planning Client Below the Medical Care Inflation Rate In accordance with the PART process, OFP established an efficiency measure -- to keep the cost per client below the medical care inflation rate.
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From page 92... ...
As discussed above, the target population for Title X services continues to grow, while funding for the program in constant dollars has continued to decline. TABLE 3-4 Measure of Efficiency: Target Versus Actual Cost per Title X Client in Relation to Medical Care Inflation, Actual and Projected, Fiscal Years 2004–2013 Year Target Actual 2004 Baseline: $193.92 2005 $214.61 $200.81 2006 $223.97 $215.56 2007 $233.73 $229.32 2008 $243.92 Fall 2009 2009 $245.55 Spring 2010 2010 $265.62 Spring 2011 2011 $277.18 Spring 2012 2012 $289.25 Spring 2013 2013 $301.85 Spring 2014 SOURCE: OMB, 2009.
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From page 93... ...
Contribution of Title X Goals to HHS Goals As discussed in Chapter 2, public health leaders in the federal government continue to recognize the contribution of family planning services to the public's health and well-being, as well as to the fulfillment of national health objectives as reflected in a number of HHS goals. HHS's goals are embodied in its current Strategic Plan -- FY 2007–2012 and the goals of various agencies within the Department, and in the broader context of Healthy People 2010, a set of national health objectives for 2000–2010 focused on improving the public's health (www.healthypeople.gov)
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From page 94... ...
Economic and Social Well-Being. Family planning services under Title X were developed to decrease the adverse health and financial effects on children, women, and their families of inadequately spaced and unplanned childbearing.
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From page 95... ...
. Two of these indicators -- responsible sexual behavior and access to health care -- are particularly furthered by Title X family planning services.
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From page 96... ...
Although data do not currently exist to permit a comprehensive evaluation of the program, it has clearly delivered care to millions of people despite very limited resources. More funds will be needed, however, to serve the growing number of individuals of reproduc tive age who lack the means to obtain family planning care and to keep pace with changes and improvements in technologies.
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From page 97... ...
, and their leadership, as well as Title X grantees, should be clearly dedicated to this mission and the goals of the Title X program, supportive of family planning as a critical public health intervention, committed to evidence-based practice, and knowledgeable about the field of family planning and reproductive health. The Title X program materials and the program's implementation are focused strongly on preventing pregnancy, often to the exclusion of the broader vision of family planning, which includes planning for families as well.
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From page 98... ...
Where practical and useful, core services and functions should be distinguished from those that are less central to fulfilling the program's mission of providing comprehensive family planning services, especially to low-income individuals. The plan should s pecifically address what services the program can realistically require grantees to provide given limited funding and the presence
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From page 99... ...
. • Specify a process by which emerging issues, problems, and oppor tunities in the field of family planning will be identified in the future and how the program can make needed adjustments in an orderly fashion based on broad consultation and relevant evidence.
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