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. 2023 Jul;73(1):155-163.
doi: 10.1016/j.jadohealth.2023.02.024. Epub 2023 Apr 18.

Expanding Contraceptive Access for Teens-Leveraging the Pediatric Emergency Department

Cynthia Mollen  1 , Tara Ketterer  2 , Jungwon Min  2 , Romina L Barral  3 , Aletha Akers  4 , Amber Adams  5 , Elizabeth Miller  6 , Melissa K Miller  5
Affiliations

Expanding Contraceptive Access for Teens-Leveraging the Pediatric Emergency Department

Cynthia Mollen et al. J Adolesc Health. 2023 Jul.

Abstract

Purpose: Adolescents have limited access to sexual healthcare services, and the emergency department (ED) may be the only place some will seek care. We implemented an ED-based contraception counseling intervention to assess intervention feasibility, and adolescent intention to initiate contraception, contraception initiation, and follow-up visit completion.

Methods: This prospective cohort study trained advanced practice providers in the EDs of two pediatric urban academic medical centers to deliver brief contraception counseling. A convenience sample of patients enrolled from 2019 to 2021 included females aged 15-18 not pregnant/desiring pregnancy and/or using hormonal contraception/an intrauterine device. Participants completed surveys to assess demographics and intention to initiate contraception (yes/no). Sessions were audiotaped and reviewed for fidelity. We ascertained contraception initiation and follow-up visit completion via medical record review and participant survey at 8 weeks.

Results: Twenty-seven advanced practice providers were trained, and 96 adolescents were counseled/responded to surveys (mean age 16.7 years; 19% non-Hispanic White, 56% non-Hispanic Black; 18% Hispanic). Mean counseling duration was 12 minutes and >90% of reviewed sessions maintained fidelity to content/style. Most participants (61%) reported intention to initiate contraception, and these participants were older and more likely to report prior contraceptive use, compared to those without intention. One-third (33%) initiated contraception in the ED or after the follow-up visit.

Discussion: Contraceptive counseling was feasible to integrate in the ED visit. Intention to initiate contraception was common and many adolescents initiated contraception. Future work should increase the pool of trained providers and supports for same-day contraception initiation for those desiring in this novel setting.

Keywords: Contraception; Counseling; Emergency department.

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Conflict of interest statement

Dr. Melissa K. Miller received funds from Organon to support some of her research. No other authors have any other conflicts of interest or financial disclosures to report.

We would like to thank the participating APPs for their time and hard work dedicated to this study. Additionally, we would like to thank Dr. Laurel Gabler for her significant contribution to developing the training curriculum for providers. Dr. Cynthia Mollen attests that all persons that have contributed substantively to this manuscript have been acknowledged.

Figures

Figure 1.
Figure 1.
Screening Consort Flow Diagram
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