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Challenges and Strategies

Summary

Family planning is a critical component of programs designed to help welfare clients become self-sufficient and potential clients maintain self-sufficiency. Washington's Community Services Offices (CSOs) determine financial eligibility for entitlement programs and provide social services including case management. In the early 1990s, Washington started a pilot program to bring family planning services into a few CSOs. In 1994, family planning services were introduced to the remaining CSOs. Washington mandates family planning assistance and information for all Temporary Assistance to Needy Families (TANF) clients and potential clients (RCW 74.12.400 and 410).

This qualitative study presents the observations of 62 persons actively involved in CSO-based family planning services from five Washington CSOs (Ballard, Friday Harbor, Kelso, Port Townsend, and Spokane North). During in-person, semi-structured interviews, informants spoke of the challenges they faced and the strategies they used to integrate family planning into CSO activities and clients' lives, and of their vision for the future of this program. The report describes program models and strategies that may be useful for other CSOs facing similar challenges.

Key Findings
Despite the unique characteristics and program focus of the five CSOs studied, striking commonalities emerged. Overall, it is challenging to engage CSO staff members, CSO clients, and communities in dialogue about family planning. Integrating family planning services and staff into the activities of the CSOs and their communities requires that these challenges be overcome.

Critical Factors for Integrating Family Planning into CSOs
Based on the data collected in this study, the following elements are essential for integrating family planning services into CSO activities and the community:

• Leadership from CSO administrators and supervisory staff

• The skills, personality, and presence of the family planning worker and contracted family planning nurse

• Teamwork and communication between CSO family planning staff and contracted family planning nurse and between family planning workers and CSO staff and administration

• Respect for clients as individuals and for their decisions and concerns

• Flexibility in program structure and activities

Future Directions for CSO-Based Family Planning
While respondents from the five sites felt that family planning is becoming integrated into their CSOs and their communities, they also suggested ways to improve the program:

• State and CSO administrators should increase the priority of family planning services with greater support and more leadership.

• Dedicated family planning staff in the CSO should be maintained, with clinical services provided by contracted family planning nurses available at all CSOs.

• Measurable objectives should be developed to help motivate CSO personnel in promoting family planning and integrating these services into CSO activities.

• Client outreach should be expanded to reach CSO clients or potential clients before an unintended pregnancy occurs.

CSO-based family planning depends on the people who implement the program and the way they serve clients. Individuals responsible for the family planning programs at their CSOs exhibit extraordinary dedication to the goals of increasing client access to family planning and integrating family planning into the CSO. Clients are encouraged to make their own decisions and are given respect, whatever their circumstances. Family planning programs flourish where administrators at the CSO level, and at state and regional levels, are willing to take a stand and move forward with a family planning agenda. 

Creating a supportive environment requires education and outreach programs targeting CSO staff, CSO clients, and the community. Those who are familiar with the concerns, opinions and attitudes of each community – the CSO-based family planning staff, contracted family planning nurse, CSO managers, and cooperating agency managers that work within each community – must determine which strategies are appropriate for their community. Program flexibility allows for this, as well as encouraging creative energy for new ideas and approaches.

The importance of CSO-based family planning should be more widely recognized and program efforts enlarged. Societal acceptance of family planning remains a challenge. Broader support at all levels will empower family planning personnel to increase their successful activities, such as training and teambuilding with CSO staff, community education and networking, and family planning outreach to vulnerable populations.

Conclusions
Well-integrated CSO-based family planning services are vital to assist clients in becoming self-sufficient and potential clients in maintaining self-sufficiency. While CSOs have made great strides in achieving this goal, future success depends on continuing leadership from managers and administrators and the dedicated and insightful work of family planning staff.

Modified: Thursday November 17 2005

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