Claire Brindis

Inspiration

As a child, I wanted to save the world, so perhaps it was not surprising that I was attracted to a career in public health, with a special focus on reproductive, maternal and I child health. The birth control pill was first available in the US while I was an undergraduate (late 1960's). While I was in college, the Federal Title X Legislation passed (1970, signed into law by President Richard Nixon and introduced into Congress by then Congressman George H. Bush, Sr.) which enabled low income women, including adolescents to receive free or low-cost contraceptives. People in that time and place explicitly connected the dots between policy and impacts- and knowing that policies were biased against women’s self-determination was a pretty amazing motivator! I was inspired to move into policy by the strong advocates and mentors I met, they taught me that my impacts were broadened by addressing the policy roots of healthcare structures.

Impetus & Impacts

Equal access to evidenced based sex education in schools

Sex education in California High Schools used to be voluntary, the curriculum guided by local standards. Beginning in 1992, public schools had to teach HIV/AIDS prevention, but sex ed, was not required. In 2003, the State Senate passed the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act (SB 71), to align practices across districts. I had worked with advocates to ensure that California’s voluntary curriculum be evidence-based, inclusive of all of sexual backgrounds, developmentally and culturally appropriate, and include all FDA-approved contraception methods. Based on that work, around 2010, the ACLU requested I conduct a follow-up study to gauge the implementation of SB 71, and whether students were receiving equal access to evidence-based sex education information. Together with Sarah Combellick, we interviewed school district administrators statewide. Our 2011 report Uneven Progress: Sex Education in California Public Schools, was used as evidence by the ACLU and the Academy of Pediatrics to sue the Clovis School District. They had implemented a very restricted, abstinence only curriculum The judge in the case indicated that the distorted information being taught was actually dangerous to the lives of young people. As a result of the report and lawsuit, advocates in 2015 successfully passed -- the California Healthy Youth Act, making comprehensive sex education a required subject in all California Schools.

Redefining coverage for women’s reproductive care under the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) of 2010, while an overall healthcare ‘win’ did not address the unique health needs of women, particularly co-pays for contraceptive care. There were various expenses for methods of contraception—up to $600-800 for a long acting contraceptive. This seemed at odds with the provision that preventive health services would be covered with no out-of-pocket costs. Much of my previous experience had been in the evaluation of the Family PACT program. Thus, when the Institute of Medicine (now the National Academy of Medicine) was charged by the US Department of Health and Human Services (DHHS) to make recommendations for the types of women’s health preventative services that should be covered by ACA, I was invited to serve as one of 15 experts on the Clinical Preventive Services for Women Committee. I co-authored the chapter on birth control coverage, with other contributions throughout the book. Clinical Preventive Services for Women: Closing the Gaps, 2011. The study was written over 18 months, plus extensive quality improvement cycles of review and comment by selected peers.

As part of the Committee’s work, we reviewed the evidence on the cost-effectiveness of providing a larger range of FDA contraceptive methods. We looked at how women eligible for Medicaid and other health insurance programs would benefit, and included avoided costs in the analysis (unintended pregnancy is far more expensive than any FDA approved method of contraception). Our eight recommendations were promptly integrated by DHHS into the ACA. New health plans since 2012 are required to provide a FULL range of preventive services without additional co-payments for women, including annual well-woman visits, screening for gestational diabetes, breastfeeding support, HPV testing, STI counseling and HIV screening, contraception methods and counseling, and screening and counseling for interpersonal and domestic violence. Over the past decade, over 100 million women have benefitted from these special, essential preventive services.

The California Wellness Foundation, was the basis for a 10 year, $100 million dollar, Teenage Pregnancy Prevention Statewide Initiative . I was able to help develop the original initiative and worked with a team of researchers to conduct the evaluation of this multi-pronged state-wide endeavor, which I conducted with a variety of concurrent evaluations of statewide teenage pregnancy prevention initiatives.

Strategies

Advisory/technical assistance role
- Conducted a family planning cost-benefit analyses with IHPS’s Dr. Carol Korenbrot, which was cited by California Governor Pete Wilson to support an additional $10 million to the State Family Planning Budget.
- The Bixby Center for Global Reproductive Health and IHPS’s evaluation of the Family PACT program, the largest outside of the federal government, led to a number of other states emulating the program.
Direct advocacy with legislators (1:1 and community meetings) and other decision makers.
Direct work with policymakers

Asked by the National Academy of Medicine to serve as an expert on the Clinical Preventive Services for Women Committee reviewing ACA guidelines, along with a variety of other prominent reports (adolescent health, young adult health, Title X, Children with Special Needs), all of which included recommendations for policy makers.

Engagement with community advocacy groups (local, regional, or national)

In my role as Director of the Philip R. Lee Institute for Health Policy Studies, I regularly work to convene advocacy groups related to health policy, particularly in women’s health.

Media engagement

As a founding Director of UCSF’s Bixby Center for Global Reproductive Health, I have been a very public advocate, interviewed regularly for evidence-based opinion on issues relating to adolescent and women’s reproductive health.

Participate in a policy-related academic center

Director of the Philip R. Lee Institute for Health Policy Studies

Participation in professional associations and advisory bodies

2011 Elected a member of Institute of Medicine of the National Academy of Medicine (IOM-NAM), a well-respected national organization, established by Abraham Lincoln to provide Congress and others with rigorous, evidence-based reviews/synthesis.

Provided public testimony to legislators and regulator

I have worked at the state level since my college years to ensure equitable access to high quality reproductive services.

2006 Joint Informational Hearing of the Senate Health Committee and the Assembly Health Committee Proposition 85: Waiting Period and Parental Notification Before Termination of Minor’s Pregnancy

1999 GET ORGANIZED: A GUIDE TO PREVENTING TEEN PREGNANCY.

Public advisory bodies – served on a number of advisory groups, for example for CDC, the Department of Health and Human Services, Bureau of Maternal and Child Health Federal Office of Adolescent Health
Public policy research

I have long history of conducting reputable, rigorous research of a program that is serving nearly 2 million Californians over many years.

Published in professional literature

As a lifelong academic, I have extensive peer reviewed publications, the record of my expertise development. In addition, I co-authored Advocacy and Policy Change Evaluation: Theory and Practice, a book addressing how to best evaluate health policy strategies

Received training in a policy-related field
Serve as an expert witness

Though I have personal “biases” about the elimination of financial and other barriers to family planning care, I remain and am perceived by policymakers as being able to be ‘evidence-driven’ and objective as a university-based researcher.

Work with groups that advocate for policy change
Write editorials/blogs promoting research-informed policy change

Timeline

After graduating with a Master’s Degree in Public Health from UCLA, I had an unusual opportunity to serve as the staff for a Blue-Ribbon Commission on Preventing Teenage Pregnancy in Atlanta, Georgia—a 9 month assignment. At the conclusion of the study in 1974, we put on a city-wide conference with 330 participants and 44 community co-sponsors. I was hired to implement the recommendations that emerged from that convening. I worked to establish a city-wide sex education clearinghouse that served as a broker between school teachers wanting a guest speaker to teach sex education and a number of community-based organization offering that service. That clearinghouse enabling better distribution of resources and avoided of duplication. I was also responsible for helping to implement two family planning clinics at Grady Memorial Hospital that offered confidential services to teenagers.

I became increasingly passionate about the power of providing women and men with the tools to make decisions regarding childbearing-whether or not to bear a child, timing, and number of desired children. I originally envisioned a career managing a family planning clinic, but circumstances opened other doors, allowing me to work with giants in the field of reproductive health---Irv Kushner, Robert Hatcher, and eventually, Philip Darney. In 1983, after finishing a doctorate in social sciences and public health at UC Berkeley, I conducted a three-month review of teenage pregnancy prevention efforts for the Philip R. Lee institute for Health Policy Studies (PRL-IHPS). The group I worked with was part of an early reproductive health policy initiative established at IHPS in 1982. We evaluated the expansion of California's family planning program under the federal 1115 Medicaid Waiver Family PACT Program. For nearly 20 years, I worked with Dr. Phil Darney and an amazing team of researchers, to assess the state-wide program, demonstrating the effectiveness of providing culturally responsive, women-centered, high quality and cost-effective services to a diverse group of women, adolescents, and men. The expertise and exposure of this work opened opportunities to serve on national advisory groups to the federal government (Federal Office of Population Affairs, CDC, Bureau of Maternal and Child Health, and the Federal Office of Adolescent Health), as well as private foundations looking for evidence of 'what worked' to make funding decisions. This experience led to being asked to sit on the Committee addressing preventative services in women’s health under the ACA. The implementation of the ACA provided a policy window to advance additional coverage of preventive health visits.

The role of knowledge generator, synthesizer of available knowledge (not just our own!), and translator/ interpreter of data “fit” me and my desire to bring more evidence-based knowledge to bear upon policy making is a major motivator. Navigating the maze of a career is not a scripted activity. Opportunities to give a talk, serve on committees, or work on problems arise, and I remain open to them. Sometimes they don’t work out! I’ve had lots of meetings that went no-where, I’ve worked with groups that weren’t productive, but some percentage of them are, and being open to trying, being willing to make that meeting, or discuss that paper, means opportunities emerge. It also means being proactive when one identifies a policy window and a need to bring evidence to bear on a policy-relevant topic.