Talita Jordan, MD, MPH

Talita Jordan, MD, MPH

2012-2013

Assistant Clinical Professor of Pediatrics for George Washington University and Children's National Medical Center with the Goldberg Center for Community and Pediatric Health in Washington, DC

Dr. Jordan currently serves as Assistant Clinical Professor of Pediatrics for George Washington University and Children's National Medical Center with the Goldberg Center for Community and Pediatric Health in Washington, DC.  Her passion for the prevention of childhood obesity led her to Disciples Summer Camp where she worked as Director and several non-profit community-based camps and programs holding childhood obesity at their core.  She plans to develop a community- based weight management program centered around prevention strategies involving community organizations, families, clinicians and policy makers.  Her role as child advocate has resulted in the development of a Teen Pregnancy Workshop in addition to involvement in programs around teen abstinence.  Dr. Jordan most recently completed the Mongan Commonwealth Fund Fellowship in Minority Health Policy during which time she obtained her MPH from the Harvard School of Public Health.  She received her medical degree from the University of Maryland School of Medicine in 2008.  While in medical school, she was awarded the National Heart, Lung, Blood Institute Research fellowship for her scholarship and leadership skills.

May 28, 2013 | HSPH News

At age four, Talita Jordan told her mother — a young, single parent — that she wanted to be a doctor. She stuck with the plan, becoming chief resident at Children’s National Medical Center in Washington, D.C. Now, about to graduate from Harvard School of Public Health with an MPH in health policy, Jordan has a new ambitious plan. She is returning to D.C. to pilot a program aimed at tackling childhood obesity through community change that she hopes to eventually take nationwide...

Revolving Loan Fund: A Novel Approach to Increasing Access to Long Acting Reversible Contraception (LARC)

Objectives:

The goal of this project is to evaluate RLF as an effective approach to intervention developed to increase access to and use of LARC thus decreasing unintended pregnancies.

Background:          

One of the most important aspects of reducing disparities in birth outcomes in women is a reduction in unintended pregnancies as births resulting from these pregnancies are at high risk for low birth weight, preterm birth and other adverse outcomes.  Contraception is an important strategy to reduce the rates of unintended pregnancy and LARC is the most effective mode of contraception.  LARC is established as safe and effective by the FDA which in the past were the most important criteria for choice of contraception.  However, the most recent National Survey of Family Growth found the most common forms of contraception in adolescents to be condoms and withdrawal followed by birth control pills.  While there is little data on choice to initiate LARC in this population, two barriers to obtaining LARC have been demonstrated.  First is the reluctance of medical providers to provide LARC to young women despite ACOG recommendations.  The second barrier is out- of- pocket cost with women with higher up- front costs being less likely to choose LARC.

In 2011 the Boston Public Health Commission (BPHC) recognized continued disparities in birth outcomes with black women in Boston being 1.2 times more likely to deliver prematurely and 1.5 times more likely to experience an infant death when compared to white women.  A task force was developed and focused its policy efforts on family planning.  A local Boston organization, Action for Boston Community Development (ABCD) provides LARC to 340B-qualified, city community health centers at a reduced rate. A review of 2012 data from ABCD showed that only 15% of patients seeking contraception at the 52 ABCD sites used LARC.  In addition, LARC was only distributed to 27% of ABCD sites eligible to purchase these methods.  The task force developed the LARC Loan Pilot Project (LLPP) to evaluate whether providing ABCD sites with access to increased funding for LARC provision through a revolving loan fund improves patient access to LARC.

Methods:

Conducted a literature review on existing approaches to interventions addressing access to LARC and the translation of this potential improvement in access into increased use of LARC.

Results:                  

A review of the data showed that successful approaches to interventions thus far have focused on overcoming the barrier of high out- of- pocket cost associated with LARC.  When an intervention to change insurance status or provide funding to decrease or alleviate out of pocket expense was implemented, LARC use increased significantly.  For this reason, current policy has focused on cost-free access to LARC and universal coverage for contraception without cost-sharing. The RLF is truly a novel approach as it addresses access and therefore the health system.  The translation of this improved access to increased use relies on patient identified barriers to use, provider identified barriers to recommending as first line and engaging all stakeholders to determine potential approaches to intervention and recommendations for action.

Future Directions:             

Community- based participatory research (CBPR) involving patients, physicians, community health centers, payers and local agencies to determine barriers and potential interventions to overcome them.  Expansion of RLF and effective process determined in pilot to a city wide intervention increasing access to LARC in Boston.

Preceptors:            

Audra Robertson MD, MPH, Department of Obstetrics and Gynecology Brigham & Women’s Hospital

Deborah Allen ScD, Director, Bureau of Child, Adolescent and Family Health