OPA Program Instruction Series, OPA 09-01
Department of Health and Human Services
Office of the Secretary
Assistant Secretary for Health
Office of Assistant Secretary for Health
Office of Population Affairs
Washington, DC 20201
Date: April 28, 2009
To: Regional Health Administrators, Regions I-X
From: Acting Director, Office of Population Affairs
Subject: OPA Program Instruction Series, OPA 09-01: Clinical Services in Title X Family Planning Clinics – Consistency with Current Practice Recommendations
The purpose of this Program Instruction is to provide guidance to Title X family planning services providers regarding the delivery of clinical services that are consistent with nationally recognized standards of care. A copy of this memorandum should be provided to all Title X grantees in your region.
The "Program Guidelines for Project Grants for Family Planning Services" (Title X Program Guidelines) were last revised and distributed to all Title X family planning services providers in grantees in understanding the family planning services grant program authorized by Title X of the Public Health Service Act (42 U.S.C. 300, et seq.), and to clarify the requirements of the program, as set out in the Title X family planning services regulations (42 CFR part 59, subpart A).
Since the issuance of the Title X Program Guidelines in 2001, based upon current, science-based evidence, there have been a number of changes or modifications to the recommendations or standards of practice for quality clinical services. Many of these changes impact clinical practice the recommendations set out in the Title X Program Guidelines. This Program Instruction is being issued to provide clarification and eliminate grantee confusion regarding any inconsistencies that may exist between current practice recommendations and the Title X Program Guidelines – there are inconsistencies, Title X providers should provide care that is consistent with current nationally recognized standards.
Therefore, in order for Title X grantees to continue to provide services that are of high quality and in compliance with Title X requirements, Title X providers, in consultation with agency medical directors, should develop written clinical protocols that are consistent with the most current nationally recognized standards of care. These protocols should be reviewed on a regular basis, and modified as needed. Agency protocols should include a reference to the specific nationally recognized standard(s) of care, recommendations(s), and/or practice standards, as well as the date of protocol review and modification. Clinical protocols should continue to incorporate considerations of individual client characteristics, including the use of specific contraceptive methods, in addition to current standards for care.
Agency policies and procedures should indicate the frequency of protocol review. In addition, agencies should ensure that training be provided to clinical staff on nationally recognized practice standards and any changes to protocols along with quality improvement/quality assurance procedures. Clinical practice should adhere to written protocols based on identified national practice standards.
Clinical protocols should reflect the current recommendations for practice or standards of care established by health agencies or professional organizations, such as the following:
- American Cancer Society
- Agency for Health Care Policy and Research, U.S. Preventive Services Task Force
- Centers for Disease Control and Prevention
- American College of Obstetricians and Gynecologists
- North American Society of Pediatric and Adolescent Gynecology
- American Society for Colposcopy and Cervical Pathology
- Agency for Healthcare Research and Quality
- Partners in Information Access for Public Health Resources (Department of Health and Human Services)
- AIDSinfo (Department of Health and Human Services)
- National Heart Lung and Blood Institute (Department of Health and Human Services)
Title X grantees are responsible for ensuring that all sub-recipient agencies maintain and use written clinical protocols that are consistent with nationally recognized practice standards. Regional offices should continue to review and monitor clinical protocols of Title X grantees, delegate agencies, and clinics, particularly during site visits and comprehensive program reviews.
If you have questions, please contact Susan Moskosky, Director, Office of Family Planning on (240) 453-2888.
Evelyn M. Kappeler
Acting Director, Office of Population Affairs
cc: Regional Program Consultants for Family Planning