Providing Long-Acting Reversible Contraception Services in Seattle School-Based Health Centers: Key Themes for Facilitating Implementation

• Clear communication about the risks and benefits of long-acting reversible contraception (LARC) facilitated this program.
• Expense and minor confidentiality continue to pose challenges for this program.
• School-based health center (SBHC) clinicians' discomfort with procedures presented barriers to LARC provision.
• Trainings for SBHC clinicians alleviated fears and misconceptions about LARCs.
• Provision of LARC is possible in a school-based health setting.

PurposeThe purpose of this study was to describe the implementation of a program that provides long-acting reversible contraception (LARC) services within school-based health centers (SBHCs) and to identify barriers and facilitators to implementation as reported by SBHC clinicians and administrators, public health officials, and community partners.MethodsWe conducted 14 semistructured interviews with key informants involved in the implementation of LARC services. Key informants included SBHC clinicians and administrators, public health officials, and community partners. We used a content analysis approach to analyze interview transcripts for themes. We explored barriers to and facilitators of LARC service delivery across and within key informant groups.ResultsThe most cited barriers across key informant groups were as follows: perceived lack of provider procedural skills and bias and negative attitudes about LARC methods. The most common facilitators identified across groups were as follows: clear communication strategies, contraceptive counseling practice changes, provider trainings, and stakeholder engagement. Two additional barriers emerged in specific key informant groups. Technical and logistical barriers to LARC service delivery were cited heavily by SBHC administrative staff, community partners, and public health officials. Expense and billing was a major barrier to SBHC administrative staff.ConclusionsLARC counseling and procedural services can be implemented in an SBHC setting to promote access to effective contraceptive options for adolescent women.