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Care for trans and gender nonconforming individuals will become a substantial part of Ob/Gyn practice. However, at present, many Ob/Gyn professionals experience insufficient knowledge and skills to accommodate this group. In this chapter, four key principles will be described to improve clinical services for this group. Key to this is a gender-affirmative approach and a sensitive stand by healthcare professionals, as well as a willingness to assess one’s own assumptions and knowledge (gaps). Also, one is encouraged to openly interact with local trans communities to design clinical services with a welcoming environment and low barriers to care, and to engage individuals in shared decision-making.
To identify implementation strategies for collaborative care (CC) that are successful in the context of perinatal care.
Background:
Perinatal depression is one of the most common complications of pregnancy and is associated with adverse maternal, obstetric, and neonatal outcomes. Although treating depressive symptoms reduces risks to mom and baby, barriers to accessing psychiatric treatment remain. CC has demonstrated benefit in primary care, expanding access, yet few studies have examined the implementation of CC in perinatal care which presents unique characteristics and challenges.
Methods:
We conducted qualitative interviews with 20 patients and 10 stakeholders from Collaborative Care Model for Perinatal Depression Support Services (COMPASS), a perinatal collaborative care (pCC) program implemented since 2017. We analyzed interview data by employing the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to organize empirically selected implementation strategies from Expert Recommendations for Implementing Change (ERIC) to create a guide for the development of pCC programs.
Findings:
We identified 14 implementation strategies used in the implementation of COMPASS. Strategies were varied, cutting across ERIC domains (eg, plan, educate, finance) and across EPIS contexts (eg, inner context – characteristics of the pCC program). The majority of strategies were identified by patients and staff as facilitators of pCC implementation. In addition, findings show opportunities for improving the implementation strategies used, such as optimal dissemination of educational materials for obstetric clinicians. The implementation of COMPASS can serve as a model for the process of building a pCC program. The identified strategies can support the implementation of this evidence-based practice for addressing postpartum depression.
Edited by
Uta Landy, University of California, San Francisco,Philip D Darney, University of California, San Francisco,Jody Steinauer, University of California, San Francisco
Abortion has been available in Sweden, since 1975, on request and without regards to reason, for up to 18 weeks’ gestation and in specific circumstances through 21 +6 weeks’ gestation. Abortion care is viewed as core component of obstetric and gynecological and midwifery care. Medical students in Sweden all receive theoretical training and are offered clinical rotation to abortion care. Similarly, all students in midwifery receive theoretical training in abortion and some clinical training. Core competencies for the registered nurse-midwives include the ability to care for women in abortion care including post abortion contraceptive counselling and provision. For residents in obstetrics and gynecology, training in abortion care is mandatory. Not permitting conscientious objection for any professional cadre guarantees prompt access to services for women seeking abortion care in Sweden, consistent with the principle that abortion is a right and a core service to which access should not be delayed.
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