Examining the Equitable Implementation of a Contraceptive Care Intervention for Adolescents Hospitalized with Psychiatric Conditions

Background and Purpose: Asking adolescents about their sexual health needs during preventative care visits is recommended by the American Academy of Pediatrics. However, previous studies demonstrate that health care providers infrequently assess adolescent patients’ sexual health care needs, and that patient characteristics like race, ethnicity, age, and history of sexual activity may affect receipt of sexual health services. Further, there is tension between increasing access for racially minoritized groups who experience barriers in accessing sexual health services and perceived or actual reproductive coercion. As a result, interventions designed to enhance contraceptive access have the potential to create or reduce inequities in care. Therefore, examining implementation patterns based on patient characteristics is critical to increasing equitable access to sexual health services. This analysis is part of an ongoing study examining the implementation of an intervention to connect adolescents receiving inpatient psychiatry care to contraceptive counseling at a large, urban pediatric hospital. Intervention components include assessing interest in contraception care, placing orders for contraception consultation, completing consultation, and ensuring follow-up. This study assesses the implementation of the intervention considering patient characteristics like race, ethnicity, and age.

Methods: Patients assigned female at birth (n=1087), ages 14 to 18 years, with hospital encounters between 12/1/2021 and 2/9/2023 (n=1461) were eligible for the intervention and are included in the study. Patients were considered in the intervention group if they had a documented contraceptive interest assessment or had a documented contraception consultation. All other patients were considered non-recipients. Electronic health record information for study participants was extracted and de-identified. We used descriptive statistics to characterize intervention recipients compared to non-recipients. Then, we used logistic regression to investigate whether race, ethnicity, age, and length of stay affected the likelihood of receiving the intervention.

Results: Thirty percent of patient visits had the intervention documented (n=431) from all eligible visits (n=1461) across all units. Of those that received the intervention, the average age was 15.9 years (SD=1.12 years). Approximately 64% (n=262) of patients identified as white, 22.4% (n=92) as Black or African American, 12.4% (n=51) as Multiple Races, and 4.3% (n=18) as Hispanic or Latino/a. Logistic regression showed no significant differences in age (OR = 1.022, p = .683), length of stay (OR = 0.986, p = 0.118), racial (Ref = Black/African American, OR = .927, p = .603 white, OR = 1.035, p = .870 Mixed Race/Other), and ethnic (OR = 1.401, p = .377) characteristics among those who received the intervention and those who did not.

Conclusions and Implications: This analysis suggests no significant disparities in the implementation of a sexual health intervention for adolescents receiving inpatient psychiatric care. The findings demonstrate the feasibility of introducing a contraceptive care access intervention for a diverse patient population. Considering political efforts to constrain access to comprehensive sexual and reproductive health services, increasing equitable access to contraception for adolescents is a timely issue.