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Aug 3 -- The Office of Population Affairs (OPA), U.S. Department of Health and Human Services (HHS), invites comments to OMB for a new collection. The Title X Implementation Study. Comments are due by September 9, 2022 (30 days after submission to OMB on Aug 10).

The Title X Service Grants Program, the only federal program solely dedicated to family planning and reproductive health, has a mandate to provide a broad range of acceptable and effective family planning methods and services. Supported services include individualized counseling, pregnancy testing, and helping couples achieve their desired family size. Administered by the Office of Population Affairs (OPA) in the U.S. Department of Health and Human Services (HHS), Title X prioritizes services for people with low incomes who might otherwise lack access to family planning care. In 2019, Title X clinics provided services to more than 3.9 million clients through a national network of 3,954 service providers. About two-thirds of these clients had family incomes below the federal poverty level, and one in four lacked health insurance.

With this new Information Collection Request (ICR), OPA seeks Office of Management and Budget (OMB) approval over three years for data collection activities necessary to conduct an implementation study of Title X grantees. The study will document (1) how grantees ensure access to equitable, affordable, client-centered, high quality family planning services; (2) the steps Title X grantees take to give clients from diverse communities equitable access to affordable, high quality, client-centered health services; (3) any pivots and/or accommodations they made in recent years to keep providing care, including during the COVID-19 pandemic; and (4) how they assess their impact.

The Title X Service Grants Program was created in 1970 and is authorized under the Public Health Service Act (42 United States Code [USC] 300). Section 1001 of Title X (“Project Grants and Contracts for Family Planning Services”) enables OPA to award grants to assist in the establishment and operation of voluntary family planning projects that provide a broad range of acceptable and effective family planning methods and related preventive health services. Services include natural family planning methods, infertility treatment, and services for adolescents; effective contraceptive methods; breast and cervical cancer screening and prevention services that correspond with nationally recognized standards of care; education, counseling, testing and referral on preventing STIs and HIV; abstinence counseling for adolescents; and other preventive health services. In addition, Section 1004 of Title X (“Research”) enables OPA to award grants and contracts for research in the biomedical, contraceptive development, behavioral, and program implementation fields that is related to family planning and population. Projects under this Section conduct data analysis and related research and evaluation on issues of interest to the family planning field, as well as research into specific topic areas related to improving service delivery. The proposed Title X Implementation Study meets these requirements by supporting research in the program implementation field and specific topic areas related to improving service delivery.

The Title X Implementation Study has four main objectives. The first is to describe how Title X grantees ensure access to equitable, affordable, client-centered quality family planning services. The study team will document and describe the service delivery strategies that have been put in place to ensure grantees’ services are in alignment with the program’s pillars of access, quality, and equity. This will include documenting (1) the structure of clinical encounters in different settings and (2) how the types of Title X services vary by sub-recipient and service delivery site.

The second study objective is to describe the steps Title X grantees take to provide clients from diverse communities with equitable access to affordable, high quality, client-centered health services. For the Title X program to achieve its desired outcomes, grantees must be able to provide diverse populations with access to high quality family planning services. To understand the program’s effectiveness in achieving this goal, the study team will explore the various strategies grantees, sub-recipients and service sites have used to ensure they reach and serve a range of populations, including adolescents, LGBTQ+, Indigenous communities, persons with limited English proficiency, and those living in rural and remote settings.

The third study objective is to describe pivots and accommodations made by Title X grantees and sub-recipients to provide care in recent years, including during the COVID-19 pandemic. The study team will summarize the pandemic’s impact on grantees, sub-recipients, and service delivery sites. The study will focus on understanding which pivots, accommodations, and innovations in service delivery introduced during the pandemic can inform future efforts to expand equitable access to quality family planning care by placing the client at the center.

The fourth study objective is to describe grantees’ self-assessments of impact. The study team will document grantees’ processes for monitoring and evaluating their effectiveness in meeting each client’s desired family planning goals. This will include gaining a better understanding of how grantees use performance measures data, findings from site visits and any correction action plans, and other assessments to evaluate the effectiveness of their work and their capacity to monitor and ensure federal quality standards.

To carry out these objectives, the study team will rely on the following five proposed data sources: (1) a web-based survey of the 2022 cohort of Title X grantees (Instrument 1); (2) grantee telephone interviews (Instrument 2); (3) in-person or virtual listening visits with clinic administrators (Instrument 3), service providers (Instrument 4), and community outreach or partner staff (Instrument 5) at a subset of Title X sub-recipients and service delivery sites; (4) an intercept survey of up to 30 clients at up to 10 of the sites selected for listening visits (Instrument 6); and (5) telephone interviews with subject matter experts (Instrument 7).

OPA consulted with staff from Mathematica (contractor for the Title X Implementation Study), JSI Research & Training Institute (contractor for OPA’s Reproductive Health National Training Center), three Title X service grantees (Missouri Family Health Council, Inc., Louisiana Department of Health, and Virginia Department of Health), Power to Decide, and Planned Parenthood Federation of America in developing the data collection instruments.

Title X Service Grants Program: https://opa.hhs.gov/grant-programs/title-x-service-grants
Submission to OMB: https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202207-0990-006 Click on IC List for collection instruments, View Supporting Statement for technical documentation. Submit comments through this site.
FR notice inviting public comment: https://www.federalregister.gov/d/2022-16597
For AEA members wishing to submit comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at https://www.aeaweb.org/content/file?id=5806

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