Upstream’s 2022 in Review

The transition from fall to winter and the spirit of the new year has me looking back at what Upstream accomplished in 2022, and where we are headed in 2023. The past year was filled with important learning opportunities and many exciting milestones for Upstream and our partners. Here’s just a few highlights from this year.

1. Our Virtual Training Program Works

As data we released earlier this year shows, our virtual training is equally as effective as our in-person training and Upstream is now better positioned to navigate training challenges, like the pandemic. After so many COVID-related delays in 2021, our training and technical assistance activity picked up at several of our health centers. Upstream’s training team completed 80 virtual training sessions, including training 109 coaches in a virtual setting. We know there are many competing priorities in health centers, and this work is a testament to our partners’ commitment to expanding equitable access to contraceptive care!

2. Expanding Access to Contraceptive Care

The reproductive health landscape experienced dramatic change in 2022, underscoring the importance of delivering on our mission to expand access to best-in-class contraceptive care wherever patients decide to get their healthcare. Access to the full range of birth control options should never be limited to patients visiting specialists – contraceptive care is primary care – and patients should be able to access these services from their primary care provider.

One way Upstream works to expand access to contraceptive care in a primary care setting is by training our healthcare partners to adopt and use the Pregnancy Intention Screening Question (PISQ). This simple exercise provides patients an intentional opportunity to voice their reproductive health goals during visits with their primary care provider. From September 2021 through September 2022, the PISQ was used 377,892 times by Upstream-trained healthcare centers across the country. This work is a cornerstone of Upstream’s program and builds on the research and development work of organizations like Power to Decide and their One Key Question® tool.

3. Removing Barriers to Immediate Postpartum Contraception

We value the vantage points we gain by spending time with our health center partners and learning about the various barriers that stand in their way of offering their patients the full range of contraceptive methods, including immediate postpartum contraception (IPPC). Not only is IPPC an option for patients to control if and when they become pregnant, it is also critical to maternal and newborn health. When Upstream was working with a Tacoma, Washington provider to strengthen its contraceptive care program, we discovered a health insurance barrier impeding them from offering IPPC. This discovery motivated us to ask state Representative My-Linh Thai to file legislation that would help rectify this disparity in coverage. Specifically, the legislative measure aimed to make it easier for providers to offer IPPC by holding commercial insurance plans to the same standard as state Medicaid plans and requiring them to cover the cost of IPPC provided in hospital and birth center settings as a separate payment from the standard labor and delivery payment. Governor Inslee signed this measure into law on March 24, 2022. As our 2023 work takes Upstream inside new health centers, we will continue to take our on-the-ground experiences and observations to inform necessary policy change.

4. Improving Virtual Data Collection

Patient surveys are administered at Upstream-trained health centers and their results help us understand whether patients are leaving their appointments feeling heard and with their chosen birth control method – including the decision to not use birth control. This survey tool ensures patient experience is a driver in each partners’ practice transformation journey and helps us better understand how patient experiences may have changed since partnering with Upstream. With the onset of the pandemic, we transitioned to an entire virtual survey experience, allowing us to survey far more patients and in more languages than ever before. In 2022, we collected over 11,518 patient survey responses across 31 health agency partners.

Another important evaluation tool is Upstream’s pre and post training surveys. This data collection helps us track whether trainees have an increased understanding of bias and coercion, confidence in providing patient-centered contraceptive care, and knowledge of birth control methods and management. This year, we transitioned our training evaluation by collecting survey data using our learning management system and we have increased response rates, collecting over 1,000 surveys so far.

5. Investing in our People Culture

Our work has made a significant impact in the lives of people of reproductive age and at the center of carrying out this mission is the people who work at Upstream. During our OneUpstream retreat last fall, we took the opportunity to recognize four individuals who embody our organization’s four values: Mission, EDI, Trust, and Joy. I was pleased to present them with our first ever OneUpstream Philosophy Awards.

OneUpstream Award Winners

  • Sade Rodgers – OneUpstream Philosophy Award for Mission.
  • Priscilla Castillo – OneUpstream Philosophy Award for EDI (Equity, Diversity, and Inclusion).
  • Elizabeth G. Henry, MHS, DrPH – OneUpstream Philosophy Award for Trust.
  • Felicia Hernández – OneUpstream Philosophy Award for Joy.

To realize our organization’s fullest potential, we must continue to invest in our team’s culture. At the core of this work is our commitment to Equity, Diversity and Inclusion (EDI). Upstream is just beginning this journey, taking an inward look at ourselves, how we treat each other and how we run the organization. I am excited to continue this journey in 2023 with the implementation of our EDI strategy and framework. My hope is this work will transform Upstream’s culture and inevitably prepare us to better serve our healthcare partners and the communities we serve across the country.

When we started our work more than eight years ago at a clinic in Amarillo, TX, I never could have imagined how much we would learn and grow on our path to nationwide impact. We began 2022 working in just five states, and are ending it with partnerships in over five more. In 2023, we expect to celebrate reaching one million women of reproductive age, expanding our program into new states, partnering with a diverse range of providers and welcoming new team members in support of our mission.

For Upstream, 2022 was a year of challenges, changes and great achievements. We pressed-on in advancing our mission while adapting and growing along the way. For 2023, I know there will be moments where we must once again adapt and be flexible, and I am eager to see how we will rise to the moment with our partners and further our mission to reduce unintended pregnancy across the U.S.

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