Clinical Partners Needs Assessment

Form Approved
OMB No. 0920-0952
Exp. 12/31/2015

Community and Clinical Partner
Clinical Partner Needs Assessment

Public reporting burden of this collection of information is estimated to average 60 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not conduct
or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports
Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0952).

1

ID: _____

Clinical Partner Needs Assessment (CPNA)
Reducing Teen Pregnancy: Integrating Services, Programs, and Strategies
through Community-wide Initiatives

The purpose of this assessment is to help your organization identify current services, as well as areas of potential
growth, related to the provision of health care services to support adolescent reproductive health. Information
gathered through this assessment will be used to track health center progress in improving youth access to
contraceptive and reproductive health services.
Please complete this ASSESSMENT on the provision of health care services for adolescents at your health center.
Please note that for the purposes of this ASSESSMENT, the term “adolescents” refers to all young women and men
between the ages of 12-19 years.

SECTION I: CLINICAL PROVIDER PROFILE – GENERAL INFORMATION
1. Please provide the following information for your health center.
Health center Name:
Mailing Address:
City:
State:
Zip Code:
Phone:
Fax:
E-mail:
2. Please provide contact information for yourself (Contact 1), as well as other “key contacts” at your
health center who have responsibilities for managing or overseeing health center practices, policies,
and procedures.
Contact 1

Contact 2

Contact 3

Contact 4

First Name:
Last Name:
Title/Position:

Phone:
Fax:
E-mail:

2

3a. Which of the following best describes the clinic partner institution type? Check all that apply.
Private practice

Community college

Hospital-based ambulatory care (teaching)
Hospital-based ambulatory care (nonteaching)

Four-year college

Mobile clinic

School-linked health center

State health department

Job Corps

County health department

Foster care

City health department

Substance abuse treatment center

Federally Qualified Health Center

Correctional facility

Community health center (non-FQHC)

Other (specify:

School-based health center

)

3b. Which of the following best describes the clinic partner practice setting and their Title X funding
status? Check all that apply.
Practice Setting
Title X funding
Yes
Primary Care
Pediatric practice (age range:

No

)

Adolescent clinic (age range:
Obstetrics and gynecology

)

Family planning
Hospital-based ambulatory care (teaching)
Hospital-based ambulatory care (nonteaching)
School-based health center
School-linked health center
Post-partum Unit
Correctional Health
Other (specify:

)

4. Which of the following best describes the service area for the health center? Check all that apply.
Urban
Suburban
Rural
Other (specify:

)

3

5. Please answer the following questions about your health center by checking the appropriate box.
YES

Does the health center…
Provide reproductive/sexual health care services to
adolescent females?
Provide reproductive/sexual health care services to
adolescent males?

NO

SECTION II: REFERRALS AND LINKAGES
6. Please indicate the number of existing formal and informal linkages 1 and new formal linkages
developed during this past year with each of the following types of organizations, providers,
programs, and/or institutions, for the purposes of linking at-risk adolescents to contraceptive and
reproductive health services.
Organization/Provider/ Program
Type
A

Community-Based Organization
(please specify)________________

B
C
D
E
F
G
H
I
J
K
L

High School
Middle School
Community college
Four-year college
After School Program
Foster Care Program
GED Program
Juvenile Detention
Family practice
Pediatric practice
Community health center

Formal Linkages
Total

New

Informal Linkages
Total

New

M Mental health/Counseling Agency
N Other (specify:
)

1

By “formal linkages” we mean written agreements to work with these providers or organizations to
enhance access to contraceptive or reproductive health services that your health center provides; by
“informal linkages” we mean no written agreement exists.

4

7. Please indicate the number of formal and informal linkages you have developed with each of the
following types of organizations, providers, and/or programs for the purposes of referring youth to
care and social support for services not provided by your agency.
Organization/Provider/ Program Type
A

Community-Based Organization (please
specify)________________

B
C
D
E
F
G
H
I

Substance Abuse
Mental Health
Intimate Partner Violence
After School Program
Foster Care Program
GED Program
Family Medicine or Pediatric Practice
Other (specify:

Formal Linkages
Total
New

Informal Linkages
Total
New

)

8. Please indicate the types of materials and strategies used to increase awareness of health center
services, and which of these are tailored specifically for adolescents, by checking the appropriate box.
Available
Type of Material/Strategy
YES
A
B
C
D
E
F
G
H
I

NO

Tailored
Specifically for
Adolescents
YES

Number of Youth who
indicate this as source of
referral (if available)

NO

Referral Guide
Website
Hotline or Informational Call
Center
Health Center Brochure
Flyer
Community
Outreach/Education
Social Media (e.g., Twitter,
Facebook, etc.)
Referral network for services
not offered by health center
Other (specify:
)

5

SECTION III: HEALTH INSURANCE BILLING PRACTICES AND REVENUE
The following tables ask about billing practices for adolescent patients between the ages of 12-19
years.
9a. Please indicate both the percentage of revenue the health center receives for adolescent visits by
source and the number of visits per revenue source. If none, then enter “0” for the item. Please note
that by “visits” we mean any clinic visit where an adolescent is seen by a health care team member –
not only visits where contraceptive or reproductive health services are provided.
% of
Number Source of Revenue
Revenue of Visits
Medicaid Fee for Service
Medicaid Family Planning Waiver
Medicaid Managed Care
Commercial Insurance
Sliding Fee Scale (Patient pays for a portion of the charges out-of-pocket)
Full Pay (Patient pays for the full cost of service out-of-pocket)
No pay (services are covered by grants, e.g., Title X, Title V, 330, Private
Foundation, etc.)
Uninsured (health center absorbs costs of services)
Other [Please describe:
]
9b. Please indicate both the percentage of revenue by source the health center receives for
adolescent visits at which contraceptive or reproductive health services are provided, and the number
of visits at which contraceptive or reproductive health services are provided per revenue source. If
none, then enter “0” for the item.
% of Revenue

Number of
Contraceptive/Repro
ductive Health Visits

Source of Revenue
Medicaid Fee for Service
Medicaid Family Planning Waiver
Medicaid Managed Care
Commercial Insurance
Sliding Fee Scale (Patient pays for a portion of the charges
out-of-pocket)
Full Pay (Patient pays for the full cost of service out-of-pocket)
No pay (services are covered by grants, e.g., Title X, Title V,
330, Private Foundation, etc.)
Uninsured (health center absorbs costs of services)
Other [Please describe:
]

6

SECTION IV: STAFF TRAINING

10. Please indicate the number and percentage of ALL health center staff (e.g., all clinical and nonclinical staff that have direct contact with adolescent clients) that have received training in the
following areas in the past two years.

A
B
C
D
E
F
G
H
I

In the past two years, staff received training
on…
Stages of Adolescent Development
State- specific Minors' Rights to Consent and
Confidentiality laws or provisions
State-specific laws related to Immigrant
Minors’ Rights to Confidentiality (as relevant)
State-specific sexual abuse and reporting laws
Cultural Competency
Continuous Quality Improvement
Youth Friendly Services
Strategies for serving non-English speaking
populations (includes interpreter)
Addressing the needs of Lesbian, Gay, Bisexual,
Transgender ,and Queer (LGBTQ) Youth

Number of
Staff

Percentage of
all staff

11. Please indicate the number and percentage of the clinical staff who serve adolescent clients (e.g., MDs,
advance practice clinicians, nurse-extenders) that have been trained in the following areas in the
past two years.
In the past two years, clinical staff received
Percentage of
Number
training on…
clinical staff
A
Contraceptive Services for Adolescents
B
C

Use of the Quick Start method for initiation of
hormonal contraception
Use of Quick Start method for initiation of IUD

D

IUDs for Adolescents

E

Hormonal Implants

F

Emergency Contraception

G

Pap Smear Guidelines

H

Breast Exam Guidelines

I

Conducting a sexual health assessment/history
for an adolescent
STI testing for adolescents
HIV testing for adolescents
Male sexual and reproductive health services
Continuous Quality Improvement
Youth Friendly Services
Adolescent development

J
K
L
M
N
O

7

P
Q

In the past two years, clinical staff received
training on…
Addressing the needs of Lesbian, Gay, Bisexual,
Transgender ,and Queer (LGBTQ) Youth
Social determinants of health

Number

Percentage of
clinical staff

SECTION V: IMPLEMENTATION OF EVIDENCE-BASED REPRODUCTIVE HEALTH PRACTICES
12. Please answer the following questions about your health center by checking the appropriate box.
A
B
C
D
E
F
G

YES

Are the following services available on-site at your health center?

NO

Pregnancy testing
Chlamydia screening for all adolescent females at least annually, or
based on diagnostic criteria, consistent with USPSTF and CDC
recommendations
Chlamydia screening for adolescent females utilizing a urine or vaginal
swab specimen
Chlamydia screening for adolescent males utilizing a urine specimen
Gonorrhea screening for both adolescent females and males
Expedited patient delivered partner therapy (EPT) as an option for the
treatment of uncomplicated chlamydial infection
HIV rapid testing for adolescent females and males

13. Please answer the following questions about your health center by checking the appropriate box.

A
B
C
D
E
F
G
H
I

Does the health center provide the following forms of
contraception (via prescriptions and/or dispense on-site)
to adolescents?
Emergency contraception for females
Emergency contraception for males
IUDs
Hormonal Implants (Nexplanon)
Hormonal Contraceptive Pills
Hormonal Injection (Depo-provera)
Patch
Ring
Condoms

Prescriptions
YES

NO

Dispense On-site
YES

NO

8

14a. Please answer the following questions about your health center’s availability of IUDs and
Implants.
How does the health center
obtain the following forms of
contraception to adolescents?

Stocked in
advance
Yes

A
B

Not Available

Yes

Yes

No

No

IUDs
Hormonal Implants (Nexplanon)
Does the health center
provide on-site
insertion or referral for
insertion?

C
D

No

Ordered when
requested by
patient

Method
Inserted on
site – typically
available all
days clinic
open

Method
Inserted on
site –available
on certain
days clinic
open or with
certain
providers

Yes

Yes

No

No

Method not
available
onsite—client
counseled and
referred to
other site for
insertion
Yes

No

Method not
available--no
counseling or
referral
provided to
client

Yes

No

IUDs
Hormonal Implants
(Nexplanon)

14b. Please answer the following questions regarding availability of condoms at your health center.
Does the health center provide
condoms on-site?
E

Condoms

Free
Yes

No

For Purchase

Not Available

Yes

Yes

No

No

14c. Please indicate if the health center performs the following activities by checking the appropriate
box.

A
B

Does your health center…
Offer adolescents the availability of hormonal
contraception or IUD at every visit that the adolescent
makes to the clinical provider?
Initiate hormonal contraception using the Quick Start

Most of the
time/all of
the time

Some of
the time

No

9

C
D
E
F
G
H
I
J
K

Does your health center…
method (starting birth control the day of the visit)?
Provide Quick Start initiation of hormonal contraception
after an adolescent client has a negative pregnancy test?
Provide Quick Start initiation of hormonal contraception
when an adolescent client is provided with Emergency
Contraception where the pregnancy test is negative?
Offer adolescents the option of having an IUD inserted
using the Quick Start method (on the visit when first
requested)?
Offer Emergency Contraception (EC) to female
adolescents for future use (advance provision*)?
Offer Emergency Contraception to male adolescents?
Provide adolescents with time alone with a health care
provider at every visit?
Take or update a reproductive/sexual health history or
assessment at every visit?
Follow current guidelines for Pap screening (routine Pap
screening begins at age 21)?
Offer “fast track” or streamlined visits with limited
waiting time that includes access to hormonal
contraception for adolescents?

Most of the
time/all of
the time

Some of
the time

No

*Advance provision is defined as prescribing emergency contraception in advance to ensure that women have it on hand in case
they need it.

15. Which of the following services does the health center require an adolescent patient to receive
prior to prescribing or dispensing hormonal contraception?
A
B
C
D
E
F
G

Service is required prior to dispensing hormonal contraception
Pap Smear
Pelvic Exam
Breast Exam
STD Testing
HIV Testing
Blood Pressure
Weight

YES

NO

SECTION VI: ACCESSIBILITY OF SERVICES FOR ADOLESCENTS
16. Please answer the following questions about your health center by checking the appropriate box.
A

Does the health center…

YES

NO

Require adolescent clients to make an appointment to access care?
10

B
C
D
E

Offer same day appointments for adolescent clients?
Offer appointments after school hours?
Offer appointments during the weekend?
Accept adolescent clients who walk-in for service?

17. Please answer the following questions about your health center by checking the appropriate box.

A
B
C

Is the health center…
Easily accessible by public transportation (within 1 mile of a bus stop,
subway stop, etc.)?
Within close proximity (within 1-2 miles) of places where adolescents
spend their free time?

YES

NO

Less than 10 miles from area schools?

18. Please answer the following questions about your health center by checking the appropriate box.

A
B
C
D
E

Does the health center…
Involve adolescents in designing services to provide reproductive
health care to adolescents?
Involve adolescents in evaluating services to provide reproductive
health care to adolescents?
Clearly display its hours and services?
Produce flyers or pamphlets that advertise its services for
adolescents?
Advertise its services within the target community (e.g., through radio,
local print media, etc.)?

F

Use the Internet (including social media) for education, appointment
reminders, and/or communication with clients?

G

Offer low or no cost contraceptive and reproductive health care
services?

H

See adolescents for confidential reproductive health services without
parental/caregiver consent?

I

Use materials that address the needs of lesbian, gay, bisexual,
transgender, and queer (LGBTQ) adolescents?

J

Use materials that address the needs of non-English speaking
adolescents?

YES

NO

11

SECTION VII: HEALTH CENTER ENVIRONMENT
This section collects information that describes the physical health center environment along with the
use and application of evidence-based clinic practices.
19. Please answer the following questions about the health center environment.

A

Does the health center…
Have a separate space/area to provide services for adolescent clients?

B

Have a separate waiting room for adolescent clients?

C

Have a counseling area specifically for adolescent clients that provides
both visual and auditory privacy?
Have an examination room specifically for adolescent clients that
provides visual and auditory privacy?
Have teen-focused magazines or posters on the walls?

D
E
F
G
H
I

YES

NO

Display information (pamphlets, posters, flyers, fact sheets) about an
adolescent’s ability to access confidential contraceptive and reproductive
health care without parental or caregiver consent?
Provide videos or TV programs showing health related information?
(Please specify:
)
Provide brief evidence-based or evidence-informed video Interventions
designed for adolescents (e.g. "What Could You Do?", now called
"Seventeen Days")? (Please specify:
)
Provide other evidence-based interventions designed for adolescents?
(Please specify:
)

12

SECTION VIII: HEALTH CARE CENTER INFRASTRUCTURE
This section collects information about the health center infrastructure in place to support the provision
of adolescent contraceptive and reproductive health services.
20. Please answer the following questions about your health center by checking the appropriate box.
Does the health center…

YES

A

Participate in the federal 340B drug discount purchasing program?

B

Have a pharmacy on-site that dispense hormonal contraception?

C

Have access to the Internet for all staff?
Have systems in place to facilitate billing third party payers for
contraceptive and reproductive health care services provided?

D

NO

21. Which Electronic Medical Records (EMR) system(s) does your health center use? Check all that
apply.
eClinical Works (eCW)
Centricity
Epic
NextGen
Other (specify:
None

)

22. Please answer the following question about your health center by checking the appropriate box.
Does the health center…

YES

NO

Have staff especially trained and dedicated to quality improvement
initiatives?
23. Please answer the following question about your health center by checking the appropriate box.
Where indicated, please list the measures used.
Does the health center…
Have a set of performance measures that are collected on a regular
basis (e.g., quarterly, monthly) for monitoring the utilization of health
care services for adolescents?
Please list measures used:

YES

NO

Have a set of performance measures that are collected on a regular
basis (e.g., quarterly, monthly) for monitoring the delivery of
13

Does the health center…
contraceptive, reproductive, or sexual health services for adolescents?

YES

NO

Please list measures used:

24. Please indicate your health center’s experience using the following performance improvement or
continuous quality improvement methods to plan, monitor, and evaluate health care delivery
systems. Check all that apply.
Continuous Quality Improvement (CQI) Method
A
B
C
D
E
F
G

IHI Model for Improvement including Plan Do Study Act (PDSA)
Run Collaboratives
Clinical Quality Improvement Initiatives (specify/describe initiatives:
Performance Measures
Using Data for Program Planning, Monitoring, and Evaluation (Data Dashboard)
Other (specify:
None that I am aware of

)

)

14

SECTION IX: USE OF HEALTH CARE SERVICES BY ADOLESCENTS
NOTE: The following data may be collected via billing records, EMRs, and other methods. We are open
to suggestions for other data collection methods based on your familiarity with your health center
partners and your ability to collect data from your partners. It is recommended that you collect these
data for each month.
Please note that by “visits” we mean any visit where an adolescent is seen by a health care team
member – not only visits designated as reproductive/sexual health visits.
Please note that by “adolescent visits where contraceptive, reproductive, or sexual health services are
provided” we mean any health center visit where contraceptive, reproductive, or sexual health services
are provided to the adolescent patient, regardless of the primary reason for the visit.
25a. Please specify the data source used to complete Tables 1-4.
Data source used to complete Tables 1-4 below.
(Potential data sources: Billing, pharmacy management, electronic medical records (EMR), or other
administrative and/or reporting databases.)

25b. Please indicate which of the following contraceptive, reproductive or sexual health services
provided were included in the data reported (i.e. what services were queried from your EMR or billing
data to produce the numbers reported in Q25 Tables 1and 2)? Please check all that apply.
Contraceptive, Reproductive, or Sexual Health Services
A
B
C
D
E
F
G

Sexual health assessment
Contraceptive and/or sexual health counseling
Pap smear
Insertion of or prescription for hormonal contraception or IUD
STD screening and/or treatment
HIV testing
Other: Please describe as fully as possible

15

25. Please complete the following tables. Complete Table 1 for FEMALE adolescents and Table 2 for
MALE adolescents.
Table 1. FEMALE Adolescent Clients (Unduplicated) and Visits by Race/Ethnicity and Age Group.
# Adolescent Clients
(Unduplicated)

FEMALES

# Adolescent Visits

2

# Adolescent Visits at which
Contraceptive, Reproductive, or
Sexual Health Services are
3
Provided

4

Hispanic/Latina – All Races
12-14 years
15-17 years
18-19 years
Total
Black or African American (Non-Hispanic)
12-14 years
15-17 years
18-19 years
Total
White (Non-Hispanic)
12-14 years
15-17 years
18-19 years
Total
Other (Non-Hispanic)
12-14 years
15-17 years
18-19 years
Total
Unknown Race and Ethnicity

2

Any visit where an adolescent is seen by a healthcare team member – not only visits designated as reproductive/sexual health visits.
Includes any health center visit where contraceptive , reproductive, or sexual health services are provided to the adolescent patient,
regardless of the primary reason for the visit.
4
Count data for all clients that indicated Hispanic/Latino(a) ethnicity, regardless of race
3

16

FEMALES

# Adolescent Clients
(Unduplicated)

# Adolescent Visits

2

# Adolescent Visits at which
Contraceptive, Reproductive, or
Sexual Health Services are
3
Provided

12-14 years
15-17 years
18-19 years
Total
All Races and Ethnicities
12-14 years
15-17 years
18-19 years
Total

17

Table 2. MALE Adolescent Clients (Unduplicated) and Visits by Race/Ethnicity, Age Group.

# Adolescent Clients
(Unduplicated)

MALES

Hispanic/Latino – All Races

# Adolescent Visits

5

# Adolescent Visits at which
Contraceptive, Reproductive or
Sexual Health Services are
6
Provided

7

12-14 years
15-17 years
18-19 years
Total
Black or African American (Non-Hispanic)
12-14 years
15-17 years
18-19 years
Total
White (Non-Hispanic)
12-14 years
15-17 years
18-19 years
Total
Other (Non-Hispanic)
12-14 years
15-17 years
18-19 years
Total
Unknown Race and Ethnicity
12-14 years
15-17 years
18-19 years
Total
All Races and Ethnicities
12-14 years
15-17 years
18-19 years
Total

5

Any visit where an adolescent is seen by a healthcare team member – not only visits designated as reproductive/sexual health visits.
Includes any health center visit where contraceptive, reproductive, or sexual health services are provided to the adolescent patient, regardless
of the primary reason for the visit.
7
Count data for all clients that indicated Hispanic/Latino(a) ethnicity, regardless of race
6

18

SECTION X: USE OF HORMONAL CONTRACEPTION AND IUD BY ADOLESCENTS
26. Please complete the following tables (or use the attached Microsoft Excel worksheets).
Table 3. FEMALE Adolescent Clients (Unduplicated) and Number Provided Hormonal Contraception or
IUD, by Age Group
FEMALES
All Unduplicated Clients (Total)
12-14 years
15-17 years
18-19 years
Total
Provided the Pill
12-14 years
15-17 years
18-19 years
Total
Provided the Patch
12-14 years
15-17 years
18-19 years
Total
Provided the Ring
12-14 years
15-17 years
18-19 years
Total
Provided Injectable Contraception (e.g., Depo Provera)
12-14 years
15-17 years
18-19 years
Total
Provided IUD
12-14 years
15-17 years
18-19 years
Total
Provided Contraceptive Implants (e.g., Nexplanon)
12-14 years
15-17 years
18-19 years
Total

# Adolescent Clients (Unduplicated)

19

Provided Emergency Contraception (EC)
12-14 years
15-17 years
18-19 years
Total
9
% Contraceptive Coverage
12-14 years
15-17 years
18-19 years
Total
10
% LARC Coverage
12-14 years
15-17 years
18-19 years
Total

8

Table 4. FEMALE Adolescent Clients (Unduplicated) and Number Provided Hormonal Contraception or
IUD, by Race/Ethnicity
FEMALES
All Unduplicated Clients (Total)
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
Provided the Pill
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
Provided the Patch
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanc)
Other (non-Hispanic)
Unknown/unreported
Total

# Adolescent Clients (Unduplicated)

8

Including the provision of EC as a backup method along with another contraceptive method
Calculated as the proportion of all unduplicated adolescent female clients provided hormonal contraception, contraceptive implants, or IUD.
10
Calculated as the proportion of all unduplicated adolescent female clients provided contraceptive implants, or IUD.
9

20

Provided the Ring
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
Provided Injectable Contraception (e.g., Depo Provera)
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
Provided IUD
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
Provided Contraceptive Implants (e.g., Nexplanon)
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
11
Provided Emergency Contraception (EC)
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
12
% Contraceptive Coverage
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total
11
12

Including the provision of EC as a backup method along with another contraceptive method
Calculated as the proportion of all unduplicated adolescent female clients provided hormonal contraception, contraceptive implants, or IUD.

21

13

% LARC Coverage
Hispanic/Latina (all races)
Black or African American (non-Hispanic)
White (non-Hispanic)
Other (non-Hispanic)
Unknown/unreported
Total

Save File as

Submit Form

13

Calculated as the proportion of all unduplicated adolescent female clients provided contraceptive implants, or IUD. The unduplicated clients
reported in Table 1 should be used as the denominator and reported at the top of Tables 3 & 4 (e.g., for calculating the number of Black/African
American who received the pill, use total Black/African American clients unduplicated as denominator which includes clients who did not
receive any form of contraceptive).

22