How do we Successfully Implement SUD Screening and Referrals in Title X Family Planning Settings? Integration of Services Is Key

Lena Marceno, MSc
Denise Raybon, MPH

Can we talk of integration until there is integration of hearts and minds? Unless you have this, you only have a physical presence and the walls between us are as high as the mountain range. — Chief Dan George

How do we break down walls? How do we integrate health care services to holistically meet the needs of our community? Research has shown that integrating care can lead to improved patient experience and health outcomes. In particular, the integration of family planning (FP) services and services for those with a substance use disorder (SUD) is critical to ensuring the reproductive health needs of those with SUD are met.

People with SUD report an unmet need for family planning services, with only half reporting using contraception. Those who do use contraception rely mostly on “moderately effective” methods. These challenges are compounded by the fact that when people with SUD seek care from providers, they often experience stigma, judgment, and shame creating further barriers to their care. Yet the heightened stress, loneliness, and anxiety brought on by the COVID-19 pandemic has only exacerbated the unmet need for behavioral health care services in our communities.

Administered by the Office of Population Affairs (OPA), Title X family planning programs provide services to assist in achieving or preventing pregnancy, STI prevention, and a host of related prevention services. Family planning clinics are well positioned to screen for substance use, as they are often the primary entry point to the health care system for women. OPA strongly encourages its grantees to screen for substance use disorders and provide referrals, when appropriate. However, in a recent survey, only half of family planning clinics reported making external referrals for patients who screened positive for substance use disorder. Reaching a growing number of people with both family planning needs and substance disorders requires an interdisciplinary approach.

To learn more about the impact of this work, watch this short video featuring the voices of the community Altarum serves.

With funding from OPA, Altarum is breaking down walls by conducting a multi-faceted research study using an innovative cross-training model. The cross training brings together family planning and SUD providers from the same geographic region and is designed to equip providers with the skills and self-efficacy to effectively screen and refer their clients. As part of the training, participants engage, learn from, and network with one another and create concrete action plans to increase and sustain linkages.

The study also includes financial and economic analyses focusing on the benefits for individual clinics and providers, including expected increases in patient volumes, patient retention, and overall quality of care, as well as broader societal benefits.

The program is available to any Title X funded family planning provider and any behavioral health provider that provides services or treatment for substance use disorder nationwide. If you are interested in learning more, please visit the website, or reach out to Lena Marceno, Project Manager, at

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