Addressing Autism – Understanding a Complex Condition


Autism spectrum disorder (ASD) is a developmental disorder that the CDC estimates affects one in 68 children.

The symptoms are different for each child, but may include difficulties with social interaction or communication or repetitive behaviors. As with the disorder, the causes are also complex, and it is generally accepted that both genetic and environmental factors play a role.

Researchers at Kaiser Permanente are studying autism with the belief that their findings could lead to development of better prevention and treatment strategies.

See more of this story: Kaiser Permanente’s Institute for Health Policy

This Week in Total Health: Maintenance Rules

Last week, the Center was closed to the public to allow for upgrades to our conference room audio visual equipment, so we don’t have the usual number of pictures to share. We are, however, very excited for the changes!

We were lucky to host a special tour for two colleagues visiting from California: Annette Guido, MD, and Carolyn Ofiara, RN. Dr. Guido is the Medical Director, Health Information and Payment Policy, for the Permanente Federation.

Annette Guido and Carolyn Ofiara

Ted Eytan, MD, with Annette Guido, MD, and Carolyn Ofiara, RN

This Week in Total Health: Innovation and Transportation Rule the Week

After being closed to the public for a few weeks for maintenance work, the Center for Total Health was delighted to host several tours this week.

The Transportation Research Board’s Annual Meeting brought tens of thousands of transportation experts to Washington. We got to spend time with two experts who are innovating public spaces and transportation in very exciting ways – Sam Piper (Boston-based Senior Planner at Alta Planning + Design, @altaplanning) and Leah Shahum (San Francisco-based Director of the Vision Zero Network, @visionzeronet).

CTH Team with Sam Piper, Alta Planning & Design

CTH Team with Sam Piper, Alta Planning & Design


CTH Team with Leah Shahum, Vision Zero Network, and Celeste James, Kaiser Permanente Community Benefit

CTH Team with Leah Shahum, Vision Zero Network, and Celeste James, Kaiser Permanente Community Benefit

We also had the opportunity to spend time with the Veterans Administration’s Innovation Specialists (@VAInnovation), who were in town from all over the US for a series of meetings and site visits. Of course, they chose to take their photograph with Dominique, the CTH’s resident veteran.

VA Innovation Specialists

VA Innovation Specialists with Dominique

To see photographs from all the great visitors we had this week, check out this album.

Health Care as Part of the Climate Problem and Part of the Climate Solution

Hospitals and health systems, particularly in the most industrialized settings, make a significant impact on the climate. In the United States alone, health care contributes 8 percent of the country’s greenhouse gas emissions.

Globally, communities are already suffering health impacts of climate change as a result of extreme weather, disruption of food and water supplies, wildfires, air pollution, mass migration and changes in prevalence of diseases — such as those borne by insects — all resulting in health consequences including asthma, cardiovascular disease and mental health problems, among many others.

Read more of this article here


Growing Numbers of Clinics Ask about Physical Activity along with Taking Your Pulse


Everyone knows walking is good for you.

It’s plain common sense, backed by a wealth of recent medical research. In fact, a major new study found that lack of physical activity is twice as deadly for us as obesity.

Health data shows that as little as 30 minutes of walking a day cuts the incidence of Alzheimer’s Disease in half, lowers the likelihood of diabetes by 60 percent, limits colon cancer by 31 percent for women and reduces risk of dementia, heart disease, depression, osteoporosis, glaucoma and catching a cold.

This kind of evidence prompted US Surgeon General Vivek Murthy to issue a call for Americans to walk more . “Physical activity – such as brisk walking – can significantly reduce the risk of heart disease and diabetes,” Murthy explains. “Even a small first effort can make a big difference in improving the personal health of an individual and the public health of the nation.

In 2009, physical activity was designated as a vital sign for Kaiser Permanente facilities in Southern California and the idea was quickly adopted throughout the rest of the non-profit organization—the nation’s largest integrated care health system.

See more of this article here:


Celebrate today!


A positive outlook on life can make a big difference to your overall well being. For a happier, healthier you, try a little gratitude.

Take a break from your day, especially during this busy time of year, to practice gratitude and to connect yourself and others.

Laugh! Laughing boosts the immune system, so catch up on a favorite TV show, watch that new stand up special, or connect with your funniest friend or colleague.

Brain Boost! Try something new to keep your mind stimulated – pick up a new instrument, whip up a new recipe, or discover a new route home from work.

Power Down! Don’t take your tech to bed; pick up an old fashioned book instead. You’ll sleep better and give your imagination some exercise, too.

Check out this infographic for more gratitude ideas and information, and find more suggestions here.

This Week In Total Health

Another exciting week at the Center for Total Health has come to an end. We had a great week, capped off by a full house today that highlighted how diverse the facets of total health can be. Today’s meetings were hosted by the International Federation of Health Plans, Kaiser Permanante’s Institute for Health Policy, and Kaiser Permanente’s local Human Resources. We were thrilled to host all of this week’s guests, and even more excited that they got to meet one another.

Check out all of the photos from this week here.

Kaiser Permanente Mid-Atlantic Human Resources with the International Federation of Health Plans


Kaiser Permanente Mid-Atlantic Healthworks Team


Juice Tasting Party

Minority Women with HIV or AIDS May Suffer From Violence at the Hands of Intimate Partners, Delaying Necessary Treatmen

Today concludes the 2015 National HIV Prevention Conference – a national conference to share advances, strategies and accomplishments in HIV prevention and care. You can follow along with a number of interesting talks and presentations on social media #NHPC2015. Similarly, Kaiser Permanente’s Institute for Health Policy recently published findings regarding women who are a growing risk group that suffer from the illness and face barriers in seeking and receiving care.

Minority Women with HIV or AIDS May Suffer From Violence at the Hands of Intimate Partners, Delaying Necessary Treatment

Brigid McCaw, MD, MPH, MS, Medical Director for Kaiser Permanente’s Family Violence Prevention Program

An interview with Brigid McCaw, MD, MPH, MS, Medical Director for Kaiser Permanente’s Family Violence Prevention Program.

Although the U.S. has made progress in identifying and treating HIV and the late symptoms of the infection, AIDS, women are a growing risk group that suffer from the illness and face barriers in seeking and receiving care.  Recent studies have shown that violence against women – specifically violence at the hands of an intimate partner – may be an important cause of this gender-based disparity in care for people with HIV/AIDS.

In 2013, out of more than 47,000 newly HIV-positive individuals in the U.S., nearly 20 percent were women, with 86.6 percent of their infections coming from heterosexual contact. Those from minority backgrounds were disproportionately affected, with close to 6,000 new diagnoses in African American women and 1,400 in Hispanic/Latinas. And while the number of women with HIV/AIDS is growing, only 45 percent of women living with HIV are engaged in care, and even fewer, 32 percent, have the virus under control.

– Read the full article here.

Community-Based Organizations Remain Integral to Reduce HIV/AIDS Disparities


For World AIDS Day (Dec. 1, 2015), we offer this following post written by community practitioners, advocates, activists and researchers with the Kaiser Permanente Community-Based HIV Test and Treat Initiative. Through the initiative they have found that community-based organizations play a critical role in serving people living with HIV when they are able to link their medical care with social, economic and behavioral support services – the total health of an individual. 


In July 2015, the White House updated its National HIV/AIDS Strategy for the United States, with a vision to ensure that new infections are rare and all people living with HIV (PLWH) have equal and unfettered access to HIV clinical care. Central to achieving this vision for the country’s 1.2 million PLWH are recommendations for widespread linkage to and retention in comprehensive HIV care, support for HIV medical adherence, and achievement of viral suppression. Unfortunately, racial/ethnic disparities persist in linkage to care, retention in care, and viral suppression. Community-based organizations (CBOs), and particularly AIDS Service Organizations, may be better able to provide more tailored approaches to reach and support socially vulnerable and minority PLWH, but there is little guidance in the national strategy regarding how CBOs can support these goals.

For World AIDS Day 2015, we offer our recommendations for CBOs to achieve these National Strategy goals, as a collective of community practitioners, advocates, activists and researchers with the Kaiser Permanente (KP) Community Based HIV Test and Treat Initiative. The Kaiser Permanente HIV initiative began in 2013 and involves implementation and evaluation of innovative community-based and CBO-led interventions to increase linkage to and retention in HIV care among Black and Hispanic men who have sex with men (MSM) in Los Angeles, CA; African American women and transgender women in Oakland, CA; African Americans in the rural and suburban southeast; and people who use drugs and those recently released from prison in the New York metropolitan area. While outcome evaluation findings are not yet available, our collective experience over the past three years demonstrates the following findings to support more effective CBO interventions:


  1. Community-based organizations (CBOs) can play an instrumental role in reaching PLWH, but require strong relationships with clinics to support linkage to and retention in care.

CBOs connected to racial/ethnic minority or socially vulnerable groups (e.g., prison releases, MSM of color, transgender women) and holistic AIDS services may have better reach to PLWH within these communities, than may non-community-based HIV clinics. Through partnership with CBOs, clinics may extend their reach for linkage and retention in care. CBOs with in-house clinical services and those effectively partnered with clinics appear to be most successful in recruiting and retaining patients who have fallen out of care. Culturally and linguistically tailored services were uniformly identified as central to meeting the needs of these clients.


  1. CBOs can support more effective HIV care by helping clients understand and recall medications and information on clinical indicators, such as CD4 and viral load.

While clinical care and initiation of and adherence to antiretroviral therapy (ART) can improve quality and longevity of life, meaningful engagement in HIV care and treatment requires understanding and recall of medication regimens and clinical indicators of health. Many participants reached through this initiative reported recent receipt of CD4 counts and viral load but could not recall the numbers, impeding their use of this information as a means of tracking their health. Low health literacy was also a concern, with participants reporting difficulties reading their medication bottle labels or understanding when to take their medications. CBOs can support patients’ health literacy related to medications and reinforce strategies for recall and interpretation of health indicators following clinical care appointments.

  1. CBOs’ promotion of effective engagement in HIV care for socially vulnerable populations requires support for clients’ linkage to care for key comorbidities, as well.

Vulnerable PLWH commonly present with multiple comorbidities, including substance use and mental health issues, as well as chronic diseases increasingly faced by the nation’s aging HIV-positive population. Linking clients to clinical care broadly, not just HIV care, is critical and may better support more cost-effective funding streams to help sustain CBOs working with PLWH by extending these health support services to vulnerable populations regardless of HIV status.

  1. Life-stabilizing wraparound services and trauma-informed care are needed to support HIV care utilization and medical adherence given the social vulnerabilities faced by PLWH.

HIV care utilization can only be prioritized when their clients’ diverse range of non-medical social needs are simultaneously supported through wrap-around services, including transportation assistance, housing, food security, and group support. A disproportionate burden of abuse histories across the lifespan is also reported among populations served through this initiative, and trauma-informed care and social services have been identified as requirements to support broader HIV and other health care utilization.

  1. Social support as part of palliative care remains an important CBO service for PLWH.

Life-enhancing benefits of ART are not reflected in the health status of our most socially and medically vulnerable PLWH, some of whom learn of their HIV status when they are already at Stage 3 disease progression, rendering a need for complementary palliative care support well into the 3rd decade of the epidemic. Too often social support networks are inadequate for PLWH, and end of life social support from CBO representatives may offer the only non-clinical social support available to these clients. Training and support for CBO staff providing these services is vitally important to help sustain CBO continuity of care.

We offer these recommendations for CBOs to support their capacities to extend the reach of clinical care and link and retain racial/ethnic minority and socially vulnerable PLWH in care, as we believe that elimination of health disparities in care utilization, medical adherence and HIV-related life expectancy requires a community-centered approach best achieved via CBOs. We believe that engagement of CBOs in partnership with HIV clinical care can accelerate the progress of the National HIV Strategy and achieve the Strategy’s vision with regard to “unfettered access to high quality, life-extending care, free from stigma and discrimination.”


Kaiser Permanente, National Community Benefit, Oakland CA

Alexandra Caraballo, National Manager, Philanthropy

John Edmiston, National Manager, Community Engagement

Pamela Schwartz, MPH, Director Program Evaluation

Melissa Ramos, Evaluation Consultant


UC San Diego Center on Gender Equity and Health- UCSD GEH, San Diego CA

Anita Raj, PhD, Professor of Medicine and Global Public Health

Lianne Urada, PhD, Assistant Professor of Medicine and Global Public Health

Laramie Smith, PhD, Assistant Professor of Medicine and Global Public Health

Sankari Ayyaluru, Research Coordinator


John Wesley Community Health (JWCH) Institute, Los Angeles CA

Sergio Avina, Division Director

Christopher Hucks-Ortiz, MPH, Evaluation Specialist


Institute for Public Health Innovation (IPHI), Prince Georges County MD

Bradley Boekeloo, PhD, Evaluator, University of Maryland

Abby Charles, MPH, Senior Program Manager


Public Health Institute (PHI), Oakland CA

Tooru Nemoto, PhD, Research Program Director

Mariko Iwamoto, Project Director


The Fortune Society, Long Island City NY

Nilda Ricard, Director Drop in Center-Health Services, Fortune Society

Brendan O’Connell, MSW, Senior Program Analyst

Jahad Robinson, Transitional Specialist


North Jersey Community Research Initiative (NJCRI), Newark NJ

Corey Rosmarin-DeStefano, Director of Clinical Services

Sharif Hall, Data Coordinator

Liliane Windsor, PhD, MSW, Assistant Professor, The University of Illinois at Urbana-Champaign


ASK4Care/Duke University, North Carolina

Beth Stringfield, Project Coordinator

Sara LeGrand, PhD, Assistant Research Professor of Global Health


Women Organized to Respond to Life Threatening Diseases (WORLD), Oakland CA

Cynthia Carey-Grant, Executive Director

Stephanie Cornwell, MA, Program Services Director

Samantha Feld, MPH, Evaluation Data Manager, Cardea Services, Oakland CA




Joanne Schottinger, MD, at Cancer Care Delivery in a Rapidly Changing Healthcare System

ESRI 2015 00172

Left to Right: Carolyn Clancy, MD (U.S Department of Veterans Affairs) Ann Geiger, PhD (National Cancer Institute), Joanne Schottinger, MD (Kaiser Permanente) (View on

Washington, D.C was host to ECRI Institute’s Cancer Care Delivery in a Rapidly Changing Healthcare System, which featured Joanne Schottinger, MD, representing Kaiser Permanente in “How do integrated delivery systems provide cancer care?”

And the answer is…comprehensively, as the data shows, for example: Kaiser Permanente Share | Reducing Disparities in Colon Cancer Through Integrated Care which is part of the larger Complete Care Program: Kaiser Permanente Share | ‘Complete Care’ Improves Patient Outcomes

Schottinger noted that Kaiser Permanente delivers 250,000 chemotherapy treatments per year, 4,000 of which are part of clinical trials. This along with our electronic health record system allows greater insight into caring for patients in real world situations that supplements the latest research-based evidence used to guide care.