"The Right Time" provides education, access to birth control options for Missourians

The Right Timeis a program led by the Missouri Family Health Council and an initiative of Missouri Foundation for Health that provides education, as well as access to low or no cost birth control to Missourians across the state.

The program is currently available at 22 health centers around the state and has been around for about five years. Michelle Trupiano, the executive director of the Missouri Family Health Council, said across their projects, they serve an estimated 40,000 patients per year.

Rebecca Smith: To start off, I'm gonna have you just explain a little bit of: What is the Family Health Council?

Michelle Trupiano: Sure. So Missouri Family Health Council, our mission is to champion access for every individual that culturally sensitive, quality reproductive and sexual health care. We've been around for over 40 years, and we really work in two ways.

One is on the programmatic service delivery side to ensure that health centers have all the tools and resources they need to provide real high quality family planning services to anybody who needs them.

Our bread and butter is that we try to secure funding, specifically for safety net centers. We pass that funding through to them, so that they can ensure people who are underinsured or uninsured have access to services with no cost barriers.

We also work on the advocacy side because we know that there's a lot of systemic barriers, a lot of the rooted in racism that prevents people from accessing care, and so, we know that doesn't matter how good of a service you deliver, if people can't actually get to it or if they don't know about it, it doesn't really matter.

So, we do a lot on the advocacy side, to really look at those connections and break down those barriers.

Smith: So, tell me a little bit about the right time – how it was launched, how it came about, and how it fits into that mission of the Family Health Council of that “service, delivery and advocacy.”

Provided by Michelle Trupiano

Trupiano: The Right Time really came about as the Missouri Foundation for Health was looking at expanding their portfolio, and really looking at how best to make an impact in terms of ensuring that people had access to care.

And so, along their sort of scoping process they really envisioned, you know, a project that would really focus on that access to specifically reproductive health care, and it fits into what we were already doing. But it allowed us to expand even more.

So, we run the Title X federal family planning program, and so this really works very closely with that and allowed us to expand to health centers that were outside of our Title X network. So, to reach even more health centers with that training and support that they may need and reach even more people.

Because our goal is – no matter where somebody accesses care – whether it's one of our health centers or not, we want them to provide to be provided non-judgmental, really high-quality care.

Smith: So, the Right Time has been around now for about five years, and how have you seen that rollout? You know, like you said you've expanded to new clinics throughout Missouri...

Trupiano: The feedback we get, especially from patients is, it was so nice for them to be able to make a decision about their birth control option without worrying about cost.

And that's really the goal – is that we don't have a particular objective in terms of whether or not somebody chooses a method or doesn't choose a method or what method they may choose – but that everybody has accurate information and access to with no barriers, and they can make the decisions that are right for them.

Smith: What does this partnership look like for those clinics? Is this, you know, money going into they can provide those birth control options for clients? You know, what does that look like?

Trupiano: Yeah, so it really looks twofold. It does reimburse health centers for all birth control methods to anybody who is uninsured or underinsured. So again, it 100% removes cost barriers for folks.

And then yeah, there's a lot of training and technical assistance that is provided just to ensure that clinics are doing everything on their end to make sure that they're providing the full range of counseling.

We provide upfront stocking money so that they can have all the methods available in stock on the shelves. So that they can do same day access.

We know that's a really big barrier – if somebody needs to come back twice for the method of their choice. And so, we provide support and ensuring that all clinics have those methods available same day.

And so, that just really supports, again, that access issue for patients. And so, being able to support the health centers and making those changes ultimately has a tremendous positive impact on a patient's experience.

Smith: What does this look like from the patient's side? I mean, they go in, they have options, what does that look like?

Trupiano: Yeah, I mean, basically, they go in – and depending upon what their needs are and if they're seeking a birth control method – all options are presented to them, they're told they can choose whatever option that they want.

You choose whatever method; they don't see any bill.

The great thing, again, [is] it removes that cost barrier. Because before it could be maybe you wanted an IUD, but that was going to cost you $600, and so, you chose pills because that was going to cost you $15 and it's what you could afford.

And so, it's really removing the cost barriers that people can then choose whatever is right for them.

But then the important thing is, is if they don't like it, for whatever reason, they can come back – maybe they want to choose to start a family and so, they can stop it and then they can come back on it at a later time.

Smith: But what are the options for people? I mean, we're talking about LARCs [long-acting reversible contraception, Nexplanon, those sorts of things?

Trupiano: You know, birth control and contraception has really evolved over time. So, there's a lot of options out there for folks from, you know, your normal birth control pills that a lot of people know and have utilized over the course of their lifetime, along with the patch or the ring or the shot – the Depo shot, which you take once every three months – along with an implant or an IUD.

And so, there's obviously also the condoms, the female condom. I mean, there's a whole range and all of them have benefits, all of them have both pros and cons in terms of what method might be right for you.

And so, that's really where the relationship between the provider and doing the counseling and figuring out with the patient of: What is it that they're looking for? What is it that may be best for them?

And really providing them, again, with all those pros and cons for each of the different types [of birth control] so that people can really leave informed and making the decision that they think is going to work best with their own lifestyle.

Smith: What about for folks that are worried about stigma in rural communities or are afraid of approaching the center? What would you say to them?

Trupiano: That's a great question, and we know stigma and fear and shame go hand in hand when it comes to reproductive health. And so, that is why so much of the work that we do externally is to break those patterns and those cycles to normalize conversations around reproductive health and access.

But for folks who may still be worried or afraid, you know, confidentiality is of the utmost importance to our sites, and that's protecting that confidentiality. And so, even in the rural sites, everybody adheres to the strictest, you know, and highest standards when it comes to confidentiality.