Evidence of strong impact

Upstream USA has a strong commitment to evaluation. We are focused on continuous improvement, learning what works and communicating the impact of our work. We are working towards a day when all women have access to the full range of contraceptive methods and can choose any method she prefers.

Ensuring patient choice

Over 99% of patients indicated that they either made their own choices about contraception or shared decision-making with their providers in a survey following Upstream USA’s training with the Family Planning Association of Northeast Ohio.

This strongly affirms that Upstream USA-trained providers are empowering patients to make their own decisions about their contraception.


of patients made their own choices about birth control or shared decision-making with their providers.

Enabling women to choose any method

In June 2015, Upstream USA launched a project with The Door, a nationally recognized organization in New York City that serves adolescents and young adults with educational services, counseling, job training and reproductive health services. Before our training, The Door did not provide patients with IUDs or implants – also known as Long-Acting Reversible Contraceptives (LARCs). Upstream USA trained its providers to place and remove IUDs and implants; helped with workflow, billing and coding; and addressed other systems barriers. Perhaps most importantly, we gave the health center the training and tools it needed for support staff members to provide contraceptive counseling. For the first time, women at The Door can access the full range of contraceptive methods. The increase in the use of IUDs and implants has been dramatic.

The Door’s contraceptive patients choosing and receiving IUDs/Implants rose from 0% to 25% after Upstream’s training


We needed help developing protocols, improving our billing and coding and our clinicians needed hands-on training. Once Upstream USA helped us with on-site training and operational support, we were able to offer all methods immediately.”

RENEE MCCONEY, Director of Adolescent Health Services, The Door

Empowering support staff

Haven Health in Amarillo, Texas serves 26 counties and is the only health center within a four-hour radius to prescribe contraception for patients under 21. Before our training, only a few of the clinicians at Haven Health had been trained to place IUDs or implants, and support staff members were not providing counseling.

Post-training, the number of women choosing IUDs or implants has increased dramatically. Central to the improvement was the embrace of our model, which empowers support staff members to provide contraceptive counseling. Word of mouth about the center’s ability to provide all methods of contraception has driven a noticeable increase in both the number of patients as well as the proportion choosing the implant.

After Upstream training, 10x as many Haven Health contraceptive patients chose and received IUDs or Implants

“Upstream USA delivered a fantastic training that dramatically changed the way we do contraceptive counseling and care. I wholeheartedly recommend this training to any health center interested in best practice.”


Engaging the whole health center

In Northeast Ohio, Upstream USA trained seven sites where few contraceptive patients were receiving IUDs or implants, even though nearly all of the clinicians had previously been trained to place them.

Following Upstream USA’s training, which includes a significant focus on support staff, the percentage of all women of reproductive age choosing and receiving IUDs and the implant doubled, while the rate at comparison sites remained flat.

(In contrast to the data from Haven Health and The Door, the available data for the Ohio project measures IUD and implant use among all women of reproductive age rather than among contraceptive users.)

Upstream-trained clinics: Double the rate of reproductive-age women choosing and receiving IUDs/Implants vs. other sites


Join us

Upstream USA’s innovative and holistic approach to training and technical assistance is improving patient care for individual health centers across the nation and statewide in Delaware. Not only do we engage the whole health care team, but we also help health centers tackle the full range of systems barriers by providing training, knowledge, patient education materials, proctoring and advice on billing and financial issues, patient assistance funds and more.

We are currently engaging in statewide and regional initiatives at this time. If your state or region is exploring contraceptive access initiatives, please contact us.

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