II. TRAINING STAFF FOR NEW SERVICES

It is important to plan for training current staff and onboarding new staff to help ensure consistency. You can prepare for staff training needs in various areas below.

1. Helping alert patients about reproductive services

Patients may not know or assume that their provider offers abortion care. Studies exploring if, when, and how patients wish to be informed of available abortion services at their primary care clinics showed participants were most open to provider-initiated discussion of available abortion services during wellness exams or contraception visits (Dianat 2020, Hatcher 2018). Appropriate communication of abortion services included:

1. using sensitive language,
2. respect for and assessment of patient beliefs, and
3. contextualizing abortion services within reproductive health.

Ensure patient education materials on sexual and reproductive health (SRH) services are easily accessible and visible in exam rooms, waiting areas, and online platforms. Including language such as, “We offer an array of services for early pregnancy options including prenatal care, abortion care, and miscarriage care, should you need them,” can normalize care. Routine inclusion of abortion services in materials and conversations can help educate patients, reduce stigma, and strengthen the patient-provider relationship.

2. Scheduling Appointments

Make every effort to minimize the wait time for an appointment, and the number of calls and visits required to complete the process. In settings where laws mandate waiting periods, expediting care can be more difficult. On-line scheduling can improve patient experience, reduce staff time and decrease scheduling mistakes. If phone scheduling is required, a sample Abortion Scheduling Template (TEACH) is available for use.

To expedite care, consider incorporating telehealth for aspects of screening and counseling. Utilize other members of the care team for elements such as information provision, counseling and follow up, as appropriate.

All staff interact with patients about their reproductive health needs, including front desk personnel, medical assistants, nurses, and providers. Therefore, it is important that all staff are trained in using non-judgemental and gender neutral language while speaking with patients in order to create an inclusive environment.

3. Patient-Centered Counseling and Consent

Centering a person’s preferences, priorities, and needs is essential to delivering  high-quality, equitable health care, including in the context of reproductive health care. In many primary care settings, the provider does most of the counseling, but occasionally a counselor or health educator may take on this role.  Optimize opportunities for patient self-education through on-line scheduling (by offering videos and education before the visit (at on-line scheduling) or/and at the point of care (using QR codes to instructional videos, well-designed instruction cards). Other staff can provide information and explore patient questions and concerns, which can be followed up by the provider, who usually performs formal informed consent. In addition to having staff members review Ch. 2: Counseling, consider having them visit or virtually observe (through live video) a high-volume abortion site to observe counseling styles and get an understanding of workflows. Counseling around EPL can differ substantially from options counseling for an abortion visit (see Chapter 8: EPL Counseling and providecare.org).

4. Ultrasound (US) Training

While US is not required before medication abortion or uterine aspiration, it can be useful when clinical dating is uncertain, to assess pregnancy or placental location, and/or to provide procedural support.

There are many ways to increase provider and staff ultrasound skills. Consider initiating training using online ultrasound training videos (See Ch. 3: Videos). If you work with Planned Parenthood, you may have access to their interactive online curriculum, Ultrasound in Abortion Care (ARMS). If US is available on site, it is also helpful to receive training on US guidance to assist with challenging procedures. After completing online training, consider creating a relationship with a hospital OB radiology department or high-volume abortion care setting to observe and/or train. There are also in-person training courses through Global Ultrasound Institute and Wake Forest University, and others listed in Ch 3. There are an increasing number of options for point-of-care ultrasound machines and smart-phone or tablet connected ultrasound devices (such as Butterfly, VScan Air, Clarius and Lumify) available for purchase. Consider consulting with individual colleagues on reproductive health listservs.

5. Assisting in the Procedure Room

Just as you obtained individual training, your support staff will need training in many of the same techniques and language. Ch 2: Counseling and Consent and Ch 6: Uterine Aspiration of this Curriculum are good resources for them. A Training Checklist for Staff Assisting in the Procedure Room (TEACH) may be a helpful training tool.

6. Working With Interpreters for People with Limited English Proficiency

For your patients who speak or sign other languages, use the resources you already use in your practice for interpretation. Utilizing certified bilingual staff or qualified language or sign language interpreters is essential. This can be done in person, by telephone, or through video remote interpreting (VRI). Interpreters should be qualified to facilitate interpretation in medical settings. These resources should provide comprehensive language skills, neutrality and confidentiality.

• Document interpreter services, interpreter name and ID number as applicable,
• Provide written notes and summaries of the information provided,
• Use plain language (e.g. 6th-grade level) and visual aids to communicate.

7. Ensuring Accessibility for People with Disabilities (PWD)

A. Providing Reasonable Accommodations and Modifications to PWD

Providers are required to take affirmative steps to ensure that programs and services are accessible to and usable by PWD, which may include providing reasonable accommodations. Reasonable accommodations are changes to the usual way of doing things to include PWD and provide equal opportunity for them to benefit from services. Clinic staff should ask patients if they have access needs at the first point of contact, and note the person’s disability and needed accommodation in their medical chart. Accommodation requests should be arranged ahead of time if possible, but clinics should also be prepared to implement common accommodations on the spot. This might require having ASL interpretation and live captioning contracts in place ahead of time. Clinics can only refuse to offer an accommodation if it would change the essential nature of the services offered, or result in a significant cost or difficulty (a high bar to meet because significant cost is considered in light of the entity’s entire budget). Common reasonable accommodations include, but are not limited to:

• • Reserving additional time for an appointment (time spent transferring, engaging with interpreters, checking understanding, taking breaks, etc.)
  • Allowing a support person to be present and aid a PWD in decision-making
  • Moving items that might block the path of travel for a wheelchair user
  • Allowing a service animal into the office and exam room
  • Arranging for an interpreter to be present during an appointment
  • Reserving a room with accessible equipment for a patient with a mobility disability
  • Turning down the brightness of exam room lights
  • Offering telehealth appointment alternatives
  • Offering pelvic exams in alternative positions that are more accessible for a person with a mobility disability (See Ch 3: Pelvic Examination, RHAP 2023)
  • Training staff in using accessible medical equipment and safe transfers

Reasonable accommodations will look different for each person. When serving a person with a disability, providers and staff should be flexible and open to solving problems creatively. Remember that all people should be considered experts in their own bodily experience, including disability, so they know what accommodations and solutions work best for them (Ipas 2021).

B. Ensuring Effective Communication

Providers must take affirmative steps, at no cost to the patient, to ensure communication with PWD is as effective as communication with nondisabled people. Effective communication is also essential to ensuring patients provide informed consent to medical procedures. See Chapter 2 for more information. Providers should ask people at the first point of contact about their access and communication needs (i.e. what best supports understanding) and note preferences. Providers must give priority to the specific supports requested by the patient. Effective communication may require “auxiliary aids and services” such as:

• • Qualified sign language interpreters (in-person or through video remote interpreting [VRI]) for in-person and video appointments
    • Some patients may need a team of interpreters including one hearing interpreter and one Deaf interpreter. Note that VRI may not provide effective communication for some patients and circumstances.
    • For video appointments, integrate interpreters into the video platform
    • Speak directly to the patient, not to the interpreter or the patient’s supporter.
  •  Real-time captioning for in-person and video appointments
    • Captioning must be integrated into the video platform
    • Assistive listening devices (e.g. hearing loop, pocket talker)
  • Written materials in alternative formats (e.g. braille, large text, plain language (6th grade reading level or below)).

Effective communication may require reasonable accommodations like the use of plain language, visual aids, or the teach-back method to help the person understand the communication.

The AAFP provides resources for incorporating medical interpreters into your practice. The National Association of the Deaf also has a Question and Answer Resource for providers about auxiliary aids and services for Deaf people.

C. Having Accessible Facilities and Medical Equipment

Medical facilities must be accessible to and usable by PWD to ensure equal opportunity to access and benefit from medical providers’ services. The physical accessibility requirements that apply to a given facility depend on the type of facility (new or existing), and its date of constitution or alteration (Department of Justice 2025). The Department of Justice has an in-depth resource on the elements of physical accessibility for patients with mobility disabilities (Department of Justice 2025).

Accessible medical equipment is an essential element of equal access to medical services for PWD (Health and Human Services Department 2024, Department of Justice 2025). Accessible medical diagnostic equipment (MDE) includes adjustable height exam tables with adjustable support rails and padded leg rests (not just footrests), as well as accessible weight scales that are flush to the floor to allow a wheelchair user to roll onto the scale in their wheelchair. Accessible MDE can also include mammography equipment that  enables patients to remain in their wheelchair and be examined in a sitting position. Under updated Section 504 regulations, all newly acquired or newly leased MDE must be accessible (45 CFR §§ 84.90 – 84.97). Medical service providers must acquire at least one adjustable height exam table and one weight scale by July 8, 2026. Larger provider systems may be subject to additional requirements. Staff should also be trained in the location of all accessible MDE, how to operate the equipment, and how to help patients with different types of disabilities transfer onto exam equipment if they ask for assistance.

8. Preparing for Medical Emergencies

Medical complications may arise in any clinical setting and preparedness is the key to managing any medical emergency effectively. Simulation and drills build skills and communication, improve stress readiness during a crisis, and decrease risk to patients. Many medical emergency simulation drills (TEACH, Abortion Clinic Toolkit) are available and can be carried out on a quarterly or recurrent basis.

9. Preparing for Security Emergencies

Security is an issue for any medical setting, and something your clinic already does a lot about. Security drills help prepare staff to handle critical situations. They also help staff understand their role in keeping their workplace safe, express concerns, and know their fears are taken seriously. When working with staff, it may be helpful to put security into a larger framework (e.g. all clinics need to be prepared to handle fires or disruptive patient behavior, not just those that offer abortion services). In fact, integrating these services into primary care settings makes security issues less likely, as these patients blend with others. We have linked to five different security drills that may be useful to practice. It is also important to train staff and providers on practices to protect patients and their information to minimize the criminalization and surveillance of care. See Chapter 2 for more information.

National Abortion Federation can provide personal security assessments, staff preparedness training, law enforcement assistance, referrals for security, and security alerts for members, as well as incident reporting mechanisms for members and non-members.

New providers should consider personal and online security precautions before providing  services. See Ch 9: Personal Security Section.

10. Sterilization and Disinfection

We have included easy-to-follow training posters on the following techniques:

• Wrapping Instruments and Trays for Sterilization (TEACH)
• Unwrapping Sterile Packages, Using Aseptic Technique (TEACH)
• Decontaminating, Cleaning & Disinfecting the IPAS Syringe (Ipas)
• Reprocessing Vaginal Ultrasound Probe (TEACH)

11. Fetal Tissue Questions and Disposal

Patients often have questions about fetal development and want to see or know what happens to the tissue. There are books available for Patient Centered Pregnancy Tissue Viewing that can help train staff on how to have these discussions with patients (available through ACN). See Ch. 2: Challenging Questions for how to discuss these questions. All removed tissue is considered biohazard and should be handled, stored, and disposed of to minimize exposure risk (NAF 2022). A protocol for tissue handling, storage, and disposal must be in place (Stanford EHS 2017). Some patients may request to take tissue home for  various reasons, although this is regulated in several states and settings due to public health concerns. Contact your local Department of Health to determine current regulations.

12. Medications, supplies, and storage

Ordering necessary medications and supplies may take some time and up-front costs. A comprehensive list of medications, supplies, and vendors necessary to provide medication and aspiration management of EPL and/or abortion can be found here and a sample budget here.

If your site already performs IUD placements, adding a set of dilators and manual vacuum aspirators to an IUD setup may be easy for aspiration procedures. Supplies for checking pregnancy tissue are generally inexpensive and available through online retailers.

If offering aspiration procedures, additional medications that should be stocked include medications for pain and for complication management. For pain management, sites should have ibuprofen and lidocaine available. For complication management, it is important to have misoprostol and/or methergine readily available in case of hemorrhage. Additionally, sites should consider having an emergency kit or cart available, including diphenhydramine and epinephrine for unlikely allergic reactions and a foley catheter with a large balloon for intrauterine tamponade.

13. After Hours Calls

For patients undertaking EPL management or abortion care, provide a 24-hour contact number to triage any concerns that arise. Counseling patients thoroughly on what to expect will help decrease the number of calls, but a phone call can often save patients an ED visit. Print the after-hours number on your written aftercare instructions. (See Ch 6 Abortion Aftercare for sample aftercare instructions)

• All members of the call pool should be familiar with triage algorithms and informed that these additional services are being provided.
• Leadership buy-in is critical so that all providers in the call pool understand they are expected to appropriately triage patients, regardless of whether they provide abortion services.
• The U.S. clinician-facing Reproductive Health Hotline is a free, in-the moment, evidence-based hotline for provider questions about medical standards for early abortion, miscarriage, contraception, or other SRH-related care, via (1-844-REPROHH/1-844-737-7644) weekdays from 6AM -5PM Pacific Time. \
• Patients may also speak with a volunteer medical provider at the Miscarrage & Abortion Hotline if outside of care, or unable to contact a provider.

14. Understanding and Defining Telehealth

Telehealth refers to the use of telecommunications technology to provide healthcare services at a distance. This includes a two-way, real-time interactive communication between a patient and a physician or practitioner, often utilizing audio and video equipment, but sometimes audio-only (CMS 2025, Medicaid 2025). While telemedicine refers more narrowly to the remote delivery of clinical care or visits, it has at times excluded care of nurses and midwives, who are licensed under their boards to practice nursing and/or midwifery rather than medicine, respectively (CCHP). We therefore utilize the broader term, while clarifying that broader functions (including facilitation of education, care management, and self-management of a patient’s health care, often by non-licensed staff) are not implicated by restrictions or bans.

While the literature may use these terms interchangeably, some states are moving to solely use the term telehealth (MBC 2025, DHCS 2025). The following site reviews state regulations for licensing requirements for telemedicine/telehealth/telecommunications, with nuanced comparisons (for example, the language used by California and Alaska is inclusive of many providers, vs. that of Alabama is physician only; CCHP 2025).

For further information, please see the following resources:

• Telehealth Systems (Mechanic 2022)
• Telehealth Policy and the Advanced Practice Nurse (Garber 2023)