Healthy Meeting’s Tip – Red Wine & Chocolate Bites

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According to The Heart Foundation, February has been designated at Heart Health Month. Heart disease is the leading cause of death for both ment and women in the United States.  The good news?  It is also one of the most preventable.  Making heart-healthy choices, knowing your family health history and the risk factors for heart disease, having regular check-ups and working with your physician to manage your health are all integral aspect of saving lives for this silent killer. Reinforcing healthy behaviors is possible when organizing important business meetings and events.

At the Center for Total Health, we work with groups think about every aspect of their meetings and how to incorporate more positive choices in their planning.  For example, at dinner events, people often expect heavy desserts loaded with fats and sugars. A simple way to satisfy the taste buds is to add a red wine and dark chocolate dessert bar.  For our guests, a sommilier from our caterer can prepare matching red wines with varying degrees of dark cocoa bites.  One ounce tastings of various wines are offered and small bites of chocolate are paired.  Guests leave informed with not only the facts about new wines or chocolates but are reminded that — in moderation – red wine and chocolate is healthy for your heart.  For more information on suggested healthy food menus, check out our healthy meetings page on this website.  For a sample menu, check out this information card provided to guests: KP CTH Red Wine Chocolate Menu

 

What Women Need to Know About Heart Disease

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A stomach ache, jaw pain, fatigue.

Each symptom on its own may not prompt a woman to call her doctor. But combined, they could signal that a woman is having a heart attack.

There’s a myth that heart disease is a “man’s disease,” but the statistics tell a different story. The American Heart Association reports 44 million women in the United States are affected by heart disease, and heart disease and stroke kill approximately one woman every 80 seconds.

Peter Miles, MD, regional chair of the chiefs of cardiology for Kaiser Permanente Northern California, answers questions about what women need to know about heart disease and the steps everyone can take to maintain a healthy heart.

Peter Miles, MD

Peter Miles, MD

How serious is heart disease for women?

Heart disease is the leading cause of death among American women. In fact, heart disease kills more women than men, but 4 out of 5 women don’t know that.

How do heart attack symptoms differ between men and women?

Chest pain is the most common heart attack symptom, but it is not the only one. Women often experience different symptoms than men, and it’s not always the dramatic, crushing chest pain you may see on TV.

Women may feel a burning or numbness that can radiate to the back or shoulders. Because women’s symptoms can differ from men’s, it can be easy for women to think their symptoms aren’t serious. The more symptoms a woman experiences, the more likely it is that she is having a heart attack.

If pain or discomfort lasts more than 5 minutes, isn’t relieved by lying down, and travels through the back, shoulder, neck, or jaw, it’s important to get medical treatment right away. Getting treatment quickly can lower the amount of heart muscle that’s damaged.

Women who are busy with family and work responsibilities may ignore the first signs of a heart attack. They may be preoccupied with taking care of others and may ignore their own health needs. But it’s important to change that trend. We can do that with education and information.

How can women and men reduce their risk of heart attack and heart disease?

To take care of your heart, you need to take care of the whole you. Eat heart-healthy foods like fruits, vegetables, healthy proteins (such as fish, beans, chicken, nuts, and low-fat dairy), and whole grains to help keep your heart and blood vessels in good shape.

If you drink alcohol, drink it in moderation. Women should limit alcohol to no more than one drink a day.

We recommend 150 minutes of moderate exercise a week or at least 30 minutes of exercise on most days. If you can’t do all 30 minutes at once, do 10 minutes at a time. Brisk walking, swimming, or cycling are all good for the heart.

Lowering your weight by just 10 percent can also make a significant difference in reducing your risk for heart disease, and so can lowering your stress. Anger, anxiety, and depression may keep your blood pressure high and increase your risk for heart attack, stroke, and other illnesses. Try meditation, yoga, and breathing exercises to help control the stress in your life.

Finally, if you smoke, it’s time to quit. Talk to your doctor about resources such as medication and classes to help you kick the habit.

Visit www.kp.org/heart for more about the signs and symptoms of heart attacks and heart disease. To learn more about KP’s efforts to eliminate disparities in care, visit the Center for Total Health by scheduling a tour and submit a tour request form.

Consumer Driven Models can Transform Care

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Healthcare IT News interviewed Kaiser Permanente CIO Dick Daniels and he shared his perspective on Kaiser Permanente’s holistic model and the value of the consumer in the care equation.

“Consumer expectations and needs are a primary consideration for everything we do,” Daniels said. “We believe that individuals need to have access to information and services in ways that are welcoming and convenient to them in order to manage their health effectively. We consider all aspects, including how patients experience the selection of the health plan that best meets their needs, the care they receive when they come to one of our facilities, and the access they have to care from wherever they may be.”

Daniels will present “Transforming Care Through a Consumer-Driven Model” at HIMSS 17, running from February 19-23, 2017.

To read the full story, click here.

Strengthening Medicaid as a Critical Lever in Building a Culture of Health

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The National Academy of Social Insurance (NASI) hosted its annual membership meeting and reception at The Center for Total Health,  prior to its 29th Annual Policy Research Conference on January 26.

Joy Lewis, senior health policy leader of Kaiser Permanente’s Institute for Health Policy served on the panel that looked at Medicaid’s role as an insurer of more than 70 million people and its capacity to address the underlying social determinants of health.

“We approach today’s discussion with the belief that Medicaid will continue to serve a pivotal role as an insurer of low-income populations. More and more, health care leaders, providers, and others in the health care ecosystem are giving recognition to the fact that health is greatly influenced by complex social factors,” said Lewis.

The report, Strengthening Medicaid as a Critical Lever in Building a Culture of Health, is the result of a study panel that included state Medicaid program directors, public health and health policy experts, health researchers, medical and health professionals, and health plans, and was convened by the nonprofit NASI.

“The panel approached this project with several key goals in mind,” said Trish Riley, co-chair of the study panel and Executive Director at the National Academy of State Healthy Policy. “We aimed to discuss strategies that could increase Medicaid’s potential to help move the dial on individual and population health, while improving health care quality and program efficiency.”

To learn more about the report: https://www.nasi.org/sites/default/files/research/Strengthening_Medicaid_as_a_Critical_Lever_Low_Res.pdf

To read the entire press release about the conference and highlights of the repor:https://www.nasi.org/press/releases/2017/01/press-release-nonpartisan-expert-panel-recommends-steps

The National Academy of Social Insurance is a nonprofit, nonpartisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solution challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.

Pictured above keynote speaker: Ai-jen Poo, Director, National Domestic Workers Alliance (NDWA) and Co-director, Caring Across Generations

NBA and Kaiser Permanente to Host Second Annual Total Health Forum

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The National Basketball Association and Kaiser Permanente, will hold the second annual Total Health Forum on Thursday, Jan. 26 in Los Angeles. Participants include NBA Commissioner Adam Silver, Kaiser Permanente Chairman and CEO Bernard J. Tyson, NBA All-Star Chris Paul, Hall of Famer Jerry West, NBA Legends Rick Fox and James Worthy, and two-time WNBA Champion Sue Bird.

Bringing together leaders across health, business, community and sports, the Total Health Forum will explore a variety of health and wellness issues affecting families across the country. Through interactive panel discussions and insightful Q&A’s, this year’s forum will address opportunities and strategies for achieving total health of mind, body and spirit, including strengthening both community and personal resiliency. Panelists also will include Oakland Mayor Libby Schaaf, Baltimore Mayor Catherine Pugh and Playworks founder Jill Vialet.nba-fit-week-250x179

NBA FIT Week presented by Kaiser Permanente will feature programs and events designed to inspire the NBA family to be active, eat healthy and play together, while teaching values of the game like hard work, discipline, leadership and teamwork. NBA FIT Team members will help encourage fans of all ages to participate through fitness events and social media.

Learn more here.

Honoring National Diabetes Month and World Diabetes Day

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In honor of National Diabetes Month and World Diabetes Day, we wanted to highlight important research available at the Center for Total Health.  The study is one of the largest and most ethnically diverse to look at maternal diabetes as a risk factor for autism.  Many have probably heard of other suspected causes, but time and time again guests at the center are surprised to hear that children whose mothers developed gestational diabetes by the 26th week of pregnancy were at increased risk of developing autism later in life, according to a Kaiser Permanente study published in the Journal of the American Medical Association on April 14, 2015.  And that’s just a sample of the power of an electronic health record (EHR).

“Kaiser Permanente is uniquely qualified to conduct large scale studies in a real-word setting with the power of our integrated, comprehensive electronic health record,” said lead author Anny Xiang, of the Kaiser Permanente Southern California Department of Research and Evaluation.  “We can follow many women through the electronic health records and assess potential links between historical information and their own health outcomes, and their children’s health outcomes. The large size is particularly important to study rare diseases such as autism spectrum disorders. Appropriate analysis of these data can reveal important findings which could impact our approach to patient care.” She noted that this was an observational study, therefore the findings reveal associations between gestational diabetes and risk of a child developing autism rather than proving a cause and effect relationship.

Researchers examined the electronic health records of more than 322,000 ethnically diverse children born between 28 and 44 weeks at Kaiser Permanente Southern California medical centers between January 1995 and December 2009.  They followed the children for an average of 5.5 years and found that those exposed to gestational diabetes by the 26th week of pregnancy had a 63% increased risk of being diagnose with an autism spectrum disorder than children who were not exposed.  After taking into account maternal age, education, race and ethnicity, household income and other factors, the increased risk of autism associated with gestational diabetes was 42 percent.

For more information on the study, click here.

To learn more about this and other innovation at Kaiser Permanente, visit the Center for Total Health.

The dirty truth about receipts

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Guest blogger Joel Sigler is senior manager for Kaiser Permanente National Environmental, Health & Safety

The Center for Total Health has a self- service health assessment machine that provides visitors a printed receipt indicating their weight and body mass index (BMI). Recently, a visitor asked a great question about whether the receipt paper is coated with Bisphenol A (BPA).

BPA is an endocrine disrupter that mimics estrogen in the body. Studies have found that BPA exposure is potentially linked to a number of health concerns including breast cancer, diabetes, heart disease, sexual dysfunction, and obesity (kind of ironic if present in a machine that tells you your BMI). There are many sources of BPA exposure, it is found in many products including food can linings and plastic bottles. Unfortunately, receipt paper is one of the many items that can also potentially contain BPA. Receipt paper is of particular concern because it can easily be absorbed into the body when the receipt is handled. Absorption of BPA is sped up even more if hand sanitizer has been applied before handling a receipt.

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We promptly called the manufacturer of the self-service health assessment machine to find out if they knew if the receipt paper contained BPA. The good news is that the manufacturer was very responsive. Within a day they had contacted their receipt paper supplier and verified that it was “BPA free.” They even provided KP a letter from the receipt paper supplier. Kaiser Permanente is continuing to communicate with them to find out about any BPA alternatives that they may be using. Bisphenol S (BPS) and Bisphenol F (BPF) are chemicals commonly used as substitutes for BPA. They are less studied than BPA and haven’t gotten the same attention. But because BPS and BPF are similar in chemical structure to BPA, experts have concern that they could represent similar health risks.

It is important to recognize that product manufacturers aren’t always this responsive. It often takes a lot of effort to get an answer to whether a product contains chemicals of concern, either because they don’t know, or because they don’t think it is important enough to find out. In this case, the question had gotten to the President of the manufacturing company and apparently he had gotten similar questions from other customers. So just asking the question helps drive action. It is unfortunate though that when it comes to chemicals of concern, the onus is on the customer/consumer (and not on manufacturers) to drive efforts to find out if a product is “safe.” Kaiser Permanente puts significant effort into identifying and eliminating chemicals of concern like BPA in the products that the organization purchases and uses.

The Environmental Working Group provides the following recommendations to reduce exposure to BPA from receipt paper:

-Minimize receipt collection by declining receipts at gas pumps, ATMs and other machines when possible.

-Store receipts separately in an envelope in a wallet or purse.

-Never give a child a receipt to hold or play with.

-After handling a receipt, wash hands before preparing and eating food (a universally recommended practice even for those who have not handled receipts).

-Do not use alcohol-based hand cleaners after handling receipts.

-Take advantage of store services that email or archive paperless purchase records.

-Do not recycle receipts and other thermal paper. BPA residues from receipts will contaminate recycled paper.

More information on all of Kaiser Permanente’s environmental stewardship program can be found at kp.org/green

Physician Leadership in the Movement Toward Accountable Care

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Blog by Elizabeth Keating
Senior Project Manager, Council of Accountable Physician Practices

“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization.”

This statement was made by Robert Pearl, M.D., CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. Dr. Pearl recently moderated a panel at the CAPG Colloquium held in Washington, DC, on September 29, 2016.

The panel, “Physician Leadership in the Movement Toward Accountable Care,” was hosted by the Council of Accountable Physician Practices (CAPP) and featured CAPP leaders discussing best practices in recruiting, training and developing physician leaders.

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“Healthcare systems should view physician leadership as a capital investment for the future with huge ROI,” said Dr. Pearl, who also serves as the chairman of the board of CAPP. “The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”

Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization.

“Every physician is a leader. We start with that assumption,” said Marc Klau, MD, Assistant Medical Director of SCPMG. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.

Dr. Klau described how SCPMG’s expansive geography allows for unique leadership development opportunities because programs begin at the medical center level. He explained that each medical center allows emerging physician leaders to build programs that work toward the Triple Aim goal. He stressed that this display of clinical excellence is critical to growing as a physician leader, because it builds trust among peers.
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Dr. Klau also discussed how SCPMG’s leadership programs are geared toward training leaders in Permanente culture, not just administrative practices.

“It’s not about learning to log in to our electronic health record,” he said. “It’s about anchoring people in our history, quality expectations and developing communication skills.”

The panelists overwhelmingly agreed that physician leaders must possess emotional intelligence to be effective.

“The best leaders are going to be visionary but anchored in reality,” said Dr. Klau. “People who have a passion for doing something are the people who will move and change the world.”

The panelists agreed that physicians who are aspiring to lead their health systems or who think they might want to take on a more comprehensive role should start small. Emerging physician leaders could join clinical improvement committees or the first stage of a leadership program to determine if the track is right for them.

Can you see me now? Video Visits at Kaiser Permanente

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Dennis Truong, MD, is an emergency medicine specialist and the telemedicine director for the Mid-Atlantic Permanente Medical Group.

Smart phones and tablets are everywhere. Adoption of these devices now largely spans age, income, race and ethnicity. Americans, of all stripes, are emailing, tweeting, posting, banking, gaming, navigating, checking weather and so much more almost nonstop. Yet when it comes to using those nearly ubiquitous devices, only 2 percent report having access to video visits with their doctor.

In stark contrast, almost 9 in 10 family physicians believe telehealth – the suite of technologies and tactics to deliver virtual medical, health, and education services – is a way to increase access to care. Putting two and two together, that means far more than 2 percent of people should have access to video visits – a core component of telehealth.

Dr. Truong conducts a simulated video visit with a member.

Dr. Truong conducts a simulated video visit.

Why this disconnect? Telehealth regulatory policy for one. From the patchwork of state by state rules to privacy protections to reimbursement rules. Doctors (and some patients) also worry that telehealth has limited diagnostic and treatment value relative to face-to-face care and will adversely impact the day-to-day practice of an office. Not only does it interfere with the routine of quickly moving from one prepped patient to the next, it changes how you chart, plan for space in your office, bill and collect, and so much more.

The regulatory and payment framework must evolve, and technological advances in remote capabilities can help validate telehealth as a reliable solution. But it is easy to overlook the fact that none of it matters if doctors don’t want to change their norms. And, that adoption will fail if the consumer satisfaction barometer is not met as a result of a fragmented experience. At the Mid-Atlantic Permanente Medical Group (MAPMG), and all the Permanente groups of Kaiser Permanente, video visits have become a key part of our clinical offering. Making it work has been a case study in careful planning rather than chasing a “sexy” concept without judiciously working out all the details.

Since launching video visits three years ago, we carefully worked through the legal and regulatory steps. We put in the necessary equipment, trained every provider, collaboratively chose the specified set of clinical chief complaints that should be eligible for video, and slowly built video visit appointments into the schedule that gave physicians dedicated time for the care. The “competition” isn’t other providers. It is the doctor’s frame of reference. Is this as easy as when the patient is sitting in the exam room ready and waiting with forms completed, vitals collected, and nursing tasks done?

As the industry saw more platforms and pure-play video offerings emerge, we worked to stay true to a principle that says video care shouldn’t be fragmented from the normal care patients receive. Patients do not want to repeat themselves, pay for redundant tests, or fail to get a diagnosis because the doctor doesn’t have enough information to definitively make one. Nor do they want to have their “regular” doctor fail to provide care in consideration of what is known from any previous video encounters.

We purposefully integrated our solution into the same integrated electronic medical record we use for every face-to-face visit, telephone, or email visit. All the information is there to make the right clinical call. The ordering and referring process is identical (and can be done for the patient by the provider). The activity is visible to the patient’s regular provider(s).

When practiced right, it becomes as clear as the face on that smart phone screen that video visits are a powerful tool to improve access and patient satisfaction. The medical community needs to invest in making it not simply available to more patients, but making it available in a way that allows them to integrate that care with their overall primary and specialty care.

National HIV Testing Day

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For National HIV Testing Day, 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. 

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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.”

Authors:

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