P0090 - “Having to MacGyver it”: Provider Perceptions of Barriers and Facilitators to Sexual and Reproductive Health Care for Welfare-Involved Youth.

Background: Compared to their peers, welfare-involved youth have significantly higher rates of STIs, pregnancy, and teen-parenthood, and due to their status as foster youth may face additional or unique challenges to accessing sexual and reproductive health care. Los Angeles County (LA) serves the largest number of foster youth in the US. In LA, welfare-involved youth receive mandatory initial health assessments in LA Department of Health Services (DHS) Hub clinics, where they see practitioners who specialize in caring for this population. Some youth also receive ongoing care at these clinics. We sought to identify provider perceptions regarding the barriers and facilitators of reproductive care plan creation and execution to welfare-involved youth in the LA DHS Hub clinics.

Methods: We conducted semi-structured interviews with physicians and nurse practitioners working in the Hub clinics. The interview guide was created with input from an advisory board of former welfare-involved youth and the Los Angeles Reproductive Health Equity Project (LA RHEP), a nonprofit that engages agencies through education, advocacy, and policy work to reduce unintended pregnancies in this population. The guide explored the current care delivery process, perceived barriers to access and delivery of reproductive care, and solicited ideas for improvement. Interviews were recorded and transcribed and thematic analysis was performed based on the stepwise process of Braun and Clarke (2006), which included coding before identifying and refining themes.

Results: Seventeen interviews were completed. Four major themes were identified, which include: the importance of building trust and addressing youth privacy concerns, the pressure to develop and execute a reproductive care plan in a single clinical encounter, the tension between balancing youth agency and reproductive autonomy with a desire to encourage long acting reversible contraceptive (LARC) use, and a tension between the perceived benefit of increased collaboration with child welfare-involved agencies and the youths’ desire to maintain privacy.

Conclusion: A single initial health assessment is often insufficient to provide comprehensive sexual and reproductive health care to welfare involved youth. Care plan discussions were limited by time pressures, privacy concerns, competing visit priorities, and issues of agency and reproductive autonomy that were more salient to welfare-involved youth. Multiple potentially modifiable barriers were identified, which can inform interventions to reduce the burden of sexual health morbidity in this vulnerable population. Though this network of specialty ‘Hub” clinics for welfare-involved youth is unique to Los Angeles, the themes and observations could be applied to other settings that manage sexual and reproductive health care for welfare-involved youth.