A study published in the Journal of Substance Abuse in March 2011 found that of nearly 1,000 pregnant, opioid-abusing women, almost nine of every 10 pregnancies were unintended. In light of these findings and understanding the importance of reducing barriers to reproductive health services for all who want them, Behavioral Health Services Baltimore (BHSB) and the Baltimore City Health Department (BCHD) undertook a qualitative research project in 2015 to evaluate the reproductive health needs of substance abuse treatment clients. The research found: 1) substance abuse treatment centers on the whole do not ask clients about family planning services; 2) clients who are interested in receiving these services face multiple barriers to receiving them; and 3) clients would prefer that contraceptive services be offered onsite at the treatment facility.
In response to these findings, BHSB is conducting a pilot program to integrate reproductive health services into several substance abuse treatment centers in Baltimore City. In addition to screening and education on contraceptive choices and reproductive health, the pilot sites are the first treatment facilities in the city and state to offer the following onsite: oral contraception, injectable contraception, long-acting reversible contraception (LARCs) such as IUDs and implants, and referrals for sterilization. Staff counsels clients on family planning methods, emphasizing LARCs as the most effective option. The three substance abuse treatment centers selected for the pilot are the Institute for Behavior Resources (IBR), Gaudenzia, and Recovery Network.
Training has been provided to all treatment staff on family planning options and how to engage and talk to clients about family planning and reproductive health. This training is modeled on the Contraceptive Choice Project, an evidence-based approach that helps patients choose a family planning method with an emphasis on more effective methods such as LARCs. BHSB has also engaged the Johns Hopkins School of Nursing, which will provide nursing students to assist with family planning counseling and help with procedures.
This pilot is one of the first in the nation to attempt to fully integrate reproductive health into behavioral health. The total budget for the pilot is $117,362 with Abell Foundation funds supporting startup costs at all three sites, including a part-time project coordinator, cost of services at each facility, training, and implementation of billing procedures. Once the billing protocols are in place, the cost of services will be reimbursable and the pilot sites should be fully sustainable through federal funding. If this pilot is successful, BHSB intends to expand these services to treatment programs throughout the City.