By Perdita Henry
For 51 years, women in the Texas panhandle have turned to Haven Health for quality care. Established in 1968, the Amarillo-based community clinic has consistently made it their mission to provide basic reproductive healthcare and create a safe space for health education.
It’s a legacy and a mission that Chief Executive Officer, Carolena Cogdill, MBA, CMCO, is proud of.
“During the 2018-19 fiscal year, we provided services to more than 8,000 women and men in the Texas Panhandle, which is a 28 percent increase over the previous year,” Cogdill says. “Approximately 90 percent of our clients receive services through some type of assistance. We provide affordable reproductive health services to women and men regardless of their ability to pay. Payments are made through private insurance, Medicaid, Healthy Texas Women (HTW), the Family Planning Program (FPP) and Title X. We’re also a Texas Breast & Cervical Cancer Services (BCCS) provider, which helps fund sites across the state who provide quality, affordable and accessible breast and cervical cancer screenings and diagnostic services for women. We also provide limited primary health care services through a subcontract with The Coalition for Health Services in Amarillo.”
Haven Health works diligently to ensure that anyone who walks into their clinic can access care and information to assist them in making choices that best fit their lives. “We offer a variety of educational programs for all ages,” Cogdill says. “Although we promote abstinence, we understand not everyone chooses to practice it. For this reason, we want to make sure our community is well informed as they make decisions that could affect the rest of their lives.”
I sat down to talk with Cogdill about the Haven Health legacy, the importance of empowering patients through education, and how they are expanding access to Long Acting Reversible Contraception (LARC) in their community.
Haven Health has a long history in the Amarillo community. How does providing a safe space for client education factor into your mission?
Education is a key component of our mission. We firmly believe reproductive education is important in making the best decision regarding one’s life plan. Often, people, young and old, are afraid to ask questions about reproduction and about how their bodies work. Experiences such as puberty, the onset of menses, or the contraction of a sexually transmitted disease (STD) can be upsetting and confusing.
Providing a safe place to ask questions and receive information is vital. During educational programs, staff emphasize confidentiality and inform participants that what’s said in the group stays in the group. Any information given during the education program will not be repeated outside of the group. We emphasize confidentiality not only in education sessions, but for clinic patients as well.
What are the repetitive misconceptions you see patients coming into the clinic with?
We routinely hear the same stories. The most common are that if someone uses contraception they won’t be able to get pregnant in the future, that you can get pregnant if you take pre-natal vitamins, that birth control will cause weight gain, that you can’t get pregnant while breast feeding, that the pill is the only contraceptive available, that oral and anal sex are not sex, and that you can’t get pregnant while on menses. All these things are false.
You offer education on contraception, reproductive health, sexually transmitted infection (STI), childhood / adolescent development, and puberty and hygiene. How do you create a learning environment for both parents and adolescents navigating these situations?
Oftentimes, parents and adolescents are uncomfortable talking about contraception, reproduction, and STIs. Ice breaker activities help open conversations when discussing these topics. Our education staff uses plush models and visual aids to talk about STIs, and models to illustrate the different types of LARC.
Games are incorporated into the lessons not only to make learning fun, but to emphasize the serious nature of the topic. We talk about the reproductive life plan and offer contraceptive counseling to begin the discussion about contraception.
When hosting the childhood/adolescent development, puberty and hygiene, a hands-on approach is used by showing feminine hygiene products or other items when discussing menstrual cycles. The use of creative educational techniques creates a memorable learning experience.
Why was it important to create a LARC program?
The Texas Panhandle had a high rate of teen pregnancy. I wanted to implement a project that had the potential to decrease our teen pregnancy rate. Our LARC uptake was extremely low, but then I read about the success of the CHOICE project in St. Louis.
“Across all age categories, women who choose LARC methods had significantly lower pregnancy rates – 20 times less than those using a pill, ring, or patch. Women who used LARC methods were happier with these methods, and continuation rates are significantly higher compared to non-LARC methods such as the more commonly used birth control pill or injectable. Research from the Contraceptive CHOICE Project proved when these barriers are removed, women interested in avoiding pregnancy overwhelmingly choose Long-Acting Reversible Contraceptive (IUDs and implants) methods.”
I wanted to recreate a similar project in the Texas Panhandle, so we could provide this wonderful form of contraception to women in our community. I called The CHOICE project to see if I could get a copy of their video to use in our waiting room; unfortunately, the video was not available for distribution. However, I spoke with one of the project managers. She told me about a new non-profit called Upstream. They were looking to train practitioners and staff on contraceptive counseling.
I got in touch with Peter Belden, one of the founders of Upstream, and Haven became one of their first training sites. Not only did they train all our staff on contraceptive counseling, they trained all my practitioners on Nexplanon and Mirena/Paragard insertions.
This quote is from their website:
“Upstream launched its first pilot project at a community health center in Amarillo, Texas. The goal was to train all staff members so that the health center could offer the full range of contraceptive methods in a single visit, without barriers. This health center was one of the very few places low-income women could access any form of prescription birth control in the region, and prior to working with Upstream, they offered very few patients access to IUDs and implants. Following Upstream’s work, they were able to provide patients access to all methods and saw a large increase in the number of patients choosing IUDs and the implant.”
After training, the next step was to raise funds to support the purchase of LARCs. They are the most expensive form of birth control and due to financial constraints at the time, keeping even a modest inventory of LARCs was difficult. I wrote several grants to community foundations in the hope of receiving funding for this project. Amarillo is politically conservative, and I was skeptical the grants would be funded. Much to my surprise and delight, every grant I wrote was funded for the amount requested! As you can see from the statistics below, the LARC project was incredibly successful and continues to be successful today.
LARC education was critical. Combined with external funding, it enabled us to provide LARCs to hundreds of women and increase uptake by more than 133.91 percent the first year.
Why is it important for your organization to be a TWHC member?
Being connected to a state-wide organization that promotes access to preventive healthcare for all Texas women is important, because then we can all work together for the benefit of women in our state.