Table 3.

Potential for Contraceptive Care Integration in Existing Health and Social Services.

	Service type
Service components	Syringe exchange programs	Recovery support programs	Substance use and mental health treatment programs	Emergency departments	Federally Qualified Health Centers
Reach target population	Opportunities: Reaches women in active use with high unmet need for contraception; Challenges: Transient population from larger catchment area may present challenges to follow-up for contraceptive care	Opportunities: Serves women with recent SUD with high unmet need for contraception who have already taken an active step in improving their health; Challenges: May not be serving harder-to-reach populations; Clients in recovery may not be at immediate risk for opioid-exposed pregnancy (but the relapse rate is high)		Opportunities: Reaches women who are not well connected to primary care services and may have risk factors for opioid-exposed pregnancy; Challenges: Target population may not want to spend additional time in the department or may not be in a state to consider contraceptives	Opportunities: Reaches population with no other health insurance or primary care; Challenges: Unmet need for contraception may be lower among patients already connected to services
Provide free or affordable contraception	Opportunities: Some may offer free condoms to clients; Challenges: May not have any infrastructure for contraception prescription/insertion procedures		Opportunities: May have prescription capabilities for contraception; Challenges: Contraception not part of typical patient care		Opportunities: Wide range of contraception available; Challenges: Some methods, particularly LARC, can still be cost-prohibitive to clients
Maximize accessibility	Opportunities: May have well-developed outreach services; Challenges: Access barriers due to few established centers, limited to one urban location in our catchment area	Opportunities: Existing in-house health/social services extremely accessible services to residential clients; Challenges: Access requires intake, admission and retention in long-term programs	Opportunities: Large number of sites to access, particularly in urban areas, some with multiple locations; Challenges: Requires in-take, depending on organization, may be time-consuming or costly for patients	Opportunities: May be available in more rural areas; Open anytime Challenges: May have long waiting times	Opportunities: May have well-developed outreach services (such as mobile clinics); Challenges: Accessing existing sexual and reproductive health services may require scheduling and securing transportation
Provide patient-centered care	Opportunities: Well-developed, trusted relationship with hard-to-reach population of active users; Challenges: May require additional space or considerations to ensure privacy for contraceptive services	Opportunities: Specialize in SUD, extended relationships with patients, perceived as less stigmatizing of OUD; Challenges: Some faith-based organizations may have policies or practices around promoting contraception		Challenges Some women with OUD report feeling stigmatized by ED providers; Less privacy for contraceptive counseling and care	Opportunities: Wide range of services and experience with diverse populations; Challenges: Competing patient needs means contraception counseling may not always be prioritized
Employ qualified, willing, available providers	Challenges: Few, if any, qualified clinicians available to prescribe contraception		Opportunities: May already employ health professionals able to potentially able prescribe contraception; Challenges: Limitations in time, skill, willingness and/or space for existing providers to take on these services		Opportunities: Clinicians have basic training in counseling and prescribing contraception; Challenges: Clinicians typically have many other duties/care priorities, may have gaps in contraceptive care skills
Utilize peer educators	Opportunities: Formal and informal peer outreach leaders help connect women with OUD to service; Challenges: Peers may not have adequate knowledge about contraception, may have biases or misconceptions	Opportunities: May employ peer specialists; Informally, peer leaders further along in their recovery provide support to other women; Challenges: Peers may not have adequate knowledge about contraception, may have biases or misconceptions	Opportunities: Some peer education, patient navigation or outreach models targeting SUD reduction have been successfully integrated in these settings; Challenges: Peers may not have adequate knowledge about contraception or may have biases or misconceptions

Abbreviations: ED, emergency department; LARC, long-acting reversible contraception; OUD, opioid use disorder; SUD, substance use disorder.