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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California Gov. Gavin Newsom said the state is working on emergency legislation that would allow doctors from Arizona to come to California to provide abortions.\u003c/p>\n\u003cp>The announcement comes days after the \u003ca href=\"https://www.npr.org/2024/04/09/1243679136/arizona-abortion-court-decision-ban\">Arizona Supreme Court ruled\u003c/a> that the state should follow a law from the 1860s that outlaws abortions in all cases except when the pregnant person’s life is in danger.\u003c/p>\n\u003cp>Newsom, a Democrat, \u003ca href=\"https://twitter.com/GavinNewsom/status/1782157977069428900\">said Sunday\u003c/a> during an appearance on MSNBC’s \u003cem>Inside with Jen Psaki\u003c/em> that California is in a position to help those who are set to lose the ability to have an abortion in neighboring Arizona.\u003c/p>\n\u003cp>“I think really we need to start focusing on making the kind of progress that’s needed,” Newsom said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On Monday, Newsom spokesperson Brandon Richards told NPR via email that the administration was working closely with the California legislature on the proposal and also coordinating with the offices of Arizona Gov. Katie Hobbs and Arizona Attorney General Kris Mayes, both of whom are Democrats.\u003c/p>\n\u003cp>“Arizona AG Kris Mayes identified a need to expedite the ability for Arizona abortion providers to continue to provide care to Arizonans as a way to support patients in their state seeking abortion care in California,” Richards said. “We are responding to this call and will have more details to share in the coming days.”\u003c/p>\n\u003cp>The Arizona Supreme Court justices stayed enforcement of their April 9 ruling for 14 days and possibly longer, permitting abortions to continue for now.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Since the U.S. Supreme Court \u003ca href=\"https://www.npr.org/2022/06/24/1102305878/supreme-court-abortion-roe-v-wade-decision-overturn\">reversed \u003cem>Roe v. Wade\u003c/em>\u003c/a> in 2022 and eliminated the constitutional right to an abortion, a number of more conservative states have been limiting or banning the procedure, while other states \u003ca href=\"https://www.npr.org/2023/06/23/1183646356/dobbs-roe-abortion-protections-illinois-maryland-michigan-colorado-minnesota\">have taken steps to protect\u003c/a> reproductive rights, including California.\u003c/p>\n\u003cp>Over the weekend, Newsom also \u003ca href=\"https://twitter.com/GavinNewsom/status/1782082600368283715\">debuted a new TV ad\u003c/a> through his Campaign for Democracy PAC that depicts a fictional scene of two women being pulled over by a police officer and asked to take a pregnancy test just before they can drive out of state.\u003c/p>\n\u003cp>\u003ca href=\"https://act.gavinnewsom.com/signup/right_to_travel/\">According to the PAC\u003c/a>, lawmakers in Alabama, Tennessee and Oklahoma have introduced legislation to bar minors from traveling out of state to get an abortion without parental consent.\u003c/p>\n\u003cp>All three states have among the “most restrictive” laws against abortion, \u003ca href=\"https://states.guttmacher.org/policies/\">according to the Guttmacher Institute\u003c/a>, a research group that supports abortion rights and tracks abortion laws across the U.S.\u003c/p>\n\u003cp>“Alabama’s abortion ban has no exceptions for rape or incest. Now, Republicans are trying to criminalize young women’s travel to receive abortion care,” Newsom \u003ca href=\"https://twitter.com/GavinNewsom/status/1782082600368283715\">said in a post on X\u003c/a>. “We cannot let them get away with this.”\u003c/p>\n\u003cp>In November, a federal judge \u003ca href=\"https://apnews.com/article/idaho-abortion-trafficking-travel-ban-270a403d7b4a5e99e566433556614728\">temporarily blocked\u003c/a> an Idaho law that was intended to prevent minors from going out of state to obtain abortions without parental consent.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>As the use of artificial intelligence proliferates in the health care industry, Bay Area unionized nurses call for greater transparency and say in how the technologies are deployed to minimize risks to patients.\u003c/p>\n\u003cp>At a protest on Monday outside of Kaiser Permanente’s San Francisco Medical Center, many in the estimated crowd of about 200 members of the California Nurses Association held red signs that read “Patients are not algorithms” and “Trust nurses, not AI.”\u003c/p>\n\u003cp>“All health care corporations need to make sure that the technology is tested, it’s valid, and it’s not harmful to patients,” said Michelle Gutierrez Vo, a president at CNA, representing 24,000 nurses at Kaiser Permanente. “And before they deploy it, they need to sit down with nurses so that the nurses can review and make sure it’s congruent with patient safety.”\u003c/p>\n\u003cfigure id=\"attachment_11983730\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-scaled.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983730\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-scaled.jpg\" alt=\"A woman wearing sun glasses and a red shirt holds a microphone in front of people while she stands behind a podium with a red sign in the background.\" width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Gutierrez Vo, a registered nurse at Kaiser Permanente Medical Center in Fremont and a California Nurses Association president, speaks during a rally alongside fellow nurses from across California at Kaiser Permanente on Geary Blvd in San Francisco on April 22, 2024, to advocate for patient safety in the face of artificial intelligence technology. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Gutierrez Vo and other nurses worry that without proper oversight and accountability, health care employers will use AI to replace nurses and other medical professionals for profit, to the detriment of patient care. The nurses are calling for health care organizations to hit pause on the rollout of new AI technologies.\u003c/p>\n\u003cp>This comes as state and federal regulators race to catch up with the explosive growth of generative AI tools, which experts say also have great potential to improve health care delivery.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[aside postID=\"news_11976097,news_11980719,news_11982218\" label=\"Related Stories\"]Kaiser Permanente, one of the largest employers in San Francisco, Alameda and other Bay Area counties, has been an early adopter of AI. Company officials \u003ca href=\"https://about.kaiserpermanente.org/news/fostering-responsible-ai-in-health-care\">have said\u003c/a> they rigorously test the tools they use for safety, accuracy and equity.\u003c/p>\n\u003cp>“Our physicians and care teams are always at the center of decision-making with our patients,” a Kaiser Permanente statement said in response to a KQED request for comment. “We believe that AI may be able to help our physicians and employees and enhance our members’ experience. As an organization dedicated to inclusiveness and health equity, we ensure the results from AI tools are correct and unbiased; AI does not replace human assessment.”\u003c/p>\n\u003cp>One program in use at 21 Kaiser hospitals in Northern California is the Advance Alert Monitor, which analyzes electronic health data to notify a nursing team when a patient’s health is at risk of serious decline. The program saves about 500 lives per year, according to the company.\u003c/p>\n\u003cfigure id=\"attachment_11983733\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-scaled.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983733\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-scaled.jpg\" alt='Many people dressed in scrubs hold red signs that say \"Trust Nurses Not AI\" in the street.' width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Nurses from across California rally at Kaiser Permanente on Geary Blvd in San Francisco on April 22, 2024, to advocate for patient safety in the face of artificial intelligence technology. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Gutierrez Vo said nurses have flagged problems with the tool, such as producing inaccurate alarms or failing to detect all patients whose health is quickly deteriorating.\u003c/p>\n\u003cp>“There’s just so much buzz right now that this is the future of health care. These health care corporations are using this as a shortcut, as a way to handle patient load. And we’re saying ‘No. You cannot do that without making sure these systems are safe,’” said Gutierrez Vo, a nurse with 25 years of experience at the company’s Fremont Adult Family Medicine clinic. “Our patients are not lab rats.”\u003c/p>\n\u003cp>The U.S. Food and Drug Administration has authorized some AI-generated services before they go to market, but mostly \u003ca href=\"https://www.politico.com/news/2023/10/28/ai-doctors-healthcare-regulation-00124051\">without the comprehensive data\u003c/a> required for new medicines. Last fall, President Joe Biden issued an \u003ca class=\"c-link\" href=\"https://www.whitehouse.gov/briefing-room/presidential-actions/2023/10/30/executive-order-on-the-safe-secure-and-trustworthy-development-and-use-of-artificial-intelligence/\" target=\"_blank\" rel=\"noopener noreferrer\" data-stringify-link=\"https://www.whitehouse.gov/briefing-room/presidential-actions/2023/10/30/executive-order-on-the-safe-secure-and-trustworthy-development-and-use-of-artificial-intelligence/\" data-sk=\"tooltip_parent\">executive order\u003c/a> on the safe use of AI, which includes a directive to develop policies for AI-enabled technologies in health services that promote “the welfare of patients and workers.”\u003c/p>\n\u003cp>“It’s very good to have open discussions because the technology is moving at such a fast pace, and everyone is at a different level of understanding of what it can do and [what] it is,” said Dr. Ashish Atreja, Chief Information and Digital Health Officer at UC Davis Health. “Many health systems and organizations do have guardrails in place, but perhaps they haven’t been shared that widely. That’s why there’s a knowledge gap.”\u003c/p>\n\u003cfigure id=\"attachment_11983727\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-scaled.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983727\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-scaled.jpg\" alt=\"A woman wearing sun glasses and a red shirt stands in a crowd with red signs in the background.\" width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sandra Larkin listens to speakers alongside fellow nurses from across California during a rally at Kaiser Permanente on Geary Blvd in San Francisco on April 22, 2024, to advocate for patient safety in the face of artificial intelligence technology. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UC Davis Health is part of a \u003ca href=\"https://health.ucdavis.edu/news/headlines/uc-davis-health-and-leading-health-systems-launch-valid-ai/2023/10\">collaboration\u003c/a> with other health systems to implement generative and other types of AI with what Atreja referred to as “intentionality” to support their workforce and improve patient care.\u003c/p>\n\u003cp>“We have this mission that no patient, no clinician, no researcher, no employee gets left behind in getting advantage from the latest technologies,” Atreja said.\u003c/p>\n\u003cp>Dr. Robert Pearl, a lecturer at the Stanford Graduate Business School and a former CEO of The Permanente Medical Group (Kaiser Permanente), told KQED he agreed with the nurses’ concerns about the use of AI at their workplace.\u003c/p>\n\u003cp>“Generative AI is a threatening technology but also a positive one. What is the best for the patient? That has to be the number one concern,” said Pearl, author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine,” which he said he co-wrote with the AI system.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I’m optimistic about what it can do for patients,” he said. “I often tell people that generative AI is like the iPhone. It’s not going away.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As the use of artificial intelligence proliferates in the health care industry, Bay Area unionized nurses call for greater transparency and say in how the technologies are deployed to minimize risks to patients.\u003c/p>\n\u003cp>At a protest on Monday outside of Kaiser Permanente’s San Francisco Medical Center, many in the estimated crowd of about 200 members of the California Nurses Association held red signs that read “Patients are not algorithms” and “Trust nurses, not AI.”\u003c/p>\n\u003cp>“All health care corporations need to make sure that the technology is tested, it’s valid, and it’s not harmful to patients,” said Michelle Gutierrez Vo, a president at CNA, representing 24,000 nurses at Kaiser Permanente. “And before they deploy it, they need to sit down with nurses so that the nurses can review and make sure it’s congruent with patient safety.”\u003c/p>\n\u003cfigure id=\"attachment_11983730\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-scaled.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983730\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-scaled.jpg\" alt=\"A woman wearing sun glasses and a red shirt holds a microphone in front of people while she stands behind a podium with a red sign in the background.\" width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-33-BL-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Michelle Gutierrez Vo, a registered nurse at Kaiser Permanente Medical Center in Fremont and a California Nurses Association president, speaks during a rally alongside fellow nurses from across California at Kaiser Permanente on Geary Blvd in San Francisco on April 22, 2024, to advocate for patient safety in the face of artificial intelligence technology. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Gutierrez Vo and other nurses worry that without proper oversight and accountability, health care employers will use AI to replace nurses and other medical professionals for profit, to the detriment of patient care. The nurses are calling for health care organizations to hit pause on the rollout of new AI technologies.\u003c/p>\n\u003cp>This comes as state and federal regulators race to catch up with the explosive growth of generative AI tools, which experts say also have great potential to improve health care delivery.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Kaiser Permanente, one of the largest employers in San Francisco, Alameda and other Bay Area counties, has been an early adopter of AI. Company officials \u003ca href=\"https://about.kaiserpermanente.org/news/fostering-responsible-ai-in-health-care\">have said\u003c/a> they rigorously test the tools they use for safety, accuracy and equity.\u003c/p>\n\u003cp>“Our physicians and care teams are always at the center of decision-making with our patients,” a Kaiser Permanente statement said in response to a KQED request for comment. “We believe that AI may be able to help our physicians and employees and enhance our members’ experience. As an organization dedicated to inclusiveness and health equity, we ensure the results from AI tools are correct and unbiased; AI does not replace human assessment.”\u003c/p>\n\u003cp>One program in use at 21 Kaiser hospitals in Northern California is the Advance Alert Monitor, which analyzes electronic health data to notify a nursing team when a patient’s health is at risk of serious decline. The program saves about 500 lives per year, according to the company.\u003c/p>\n\u003cfigure id=\"attachment_11983733\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-scaled.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983733\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-scaled.jpg\" alt='Many people dressed in scrubs hold red signs that say \"Trust Nurses Not AI\" in the street.' width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-02-BL-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Nurses from across California rally at Kaiser Permanente on Geary Blvd in San Francisco on April 22, 2024, to advocate for patient safety in the face of artificial intelligence technology. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But Gutierrez Vo said nurses have flagged problems with the tool, such as producing inaccurate alarms or failing to detect all patients whose health is quickly deteriorating.\u003c/p>\n\u003cp>“There’s just so much buzz right now that this is the future of health care. These health care corporations are using this as a shortcut, as a way to handle patient load. And we’re saying ‘No. You cannot do that without making sure these systems are safe,’” said Gutierrez Vo, a nurse with 25 years of experience at the company’s Fremont Adult Family Medicine clinic. “Our patients are not lab rats.”\u003c/p>\n\u003cp>The U.S. Food and Drug Administration has authorized some AI-generated services before they go to market, but mostly \u003ca href=\"https://www.politico.com/news/2023/10/28/ai-doctors-healthcare-regulation-00124051\">without the comprehensive data\u003c/a> required for new medicines. Last fall, President Joe Biden issued an \u003ca class=\"c-link\" href=\"https://www.whitehouse.gov/briefing-room/presidential-actions/2023/10/30/executive-order-on-the-safe-secure-and-trustworthy-development-and-use-of-artificial-intelligence/\" target=\"_blank\" rel=\"noopener noreferrer\" data-stringify-link=\"https://www.whitehouse.gov/briefing-room/presidential-actions/2023/10/30/executive-order-on-the-safe-secure-and-trustworthy-development-and-use-of-artificial-intelligence/\" data-sk=\"tooltip_parent\">executive order\u003c/a> on the safe use of AI, which includes a directive to develop policies for AI-enabled technologies in health services that promote “the welfare of patients and workers.”\u003c/p>\n\u003cp>“It’s very good to have open discussions because the technology is moving at such a fast pace, and everyone is at a different level of understanding of what it can do and [what] it is,” said Dr. Ashish Atreja, Chief Information and Digital Health Officer at UC Davis Health. “Many health systems and organizations do have guardrails in place, but perhaps they haven’t been shared that widely. That’s why there’s a knowledge gap.”\u003c/p>\n\u003cfigure id=\"attachment_11983727\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-scaled.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11983727\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-scaled.jpg\" alt=\"A woman wearing sun glasses and a red shirt stands in a crowd with red signs in the background.\" width=\"2560\" height=\"1707\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-2048x1366.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240422-NursesAI-19-BL-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sandra Larkin listens to speakers alongside fellow nurses from across California during a rally at Kaiser Permanente on Geary Blvd in San Francisco on April 22, 2024, to advocate for patient safety in the face of artificial intelligence technology. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>UC Davis Health is part of a \u003ca href=\"https://health.ucdavis.edu/news/headlines/uc-davis-health-and-leading-health-systems-launch-valid-ai/2023/10\">collaboration\u003c/a> with other health systems to implement generative and other types of AI with what Atreja referred to as “intentionality” to support their workforce and improve patient care.\u003c/p>\n\u003cp>“We have this mission that no patient, no clinician, no researcher, no employee gets left behind in getting advantage from the latest technologies,” Atreja said.\u003c/p>\n\u003cp>Dr. Robert Pearl, a lecturer at the Stanford Graduate Business School and a former CEO of The Permanente Medical Group (Kaiser Permanente), told KQED he agreed with the nurses’ concerns about the use of AI at their workplace.\u003c/p>\n\u003cp>“Generative AI is a threatening technology but also a positive one. What is the best for the patient? That has to be the number one concern,” said Pearl, author of “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine,” which he said he co-wrote with the AI system.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I’m optimistic about what it can do for patients,” he said. “I often tell people that generative AI is like the iPhone. It’s not going away.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Why Nearly 50 California Hospitals Were Forced to End Maternity Ward Services",
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"content": "\u003cp>In just the first few months of 2024, four California hospitals have closed or announced plans to close their maternity wards.\u003c/p>\n\u003cp>The closures are part of an accelerating trend unfolding across the state, creating maternity care deserts and decreasing access to prenatal care. In the past three years, 29 hospitals stopped delivering babies, according to a \u003ca href=\"https://calmatters.org/health/2023/11/california-hospitals-close-maternity-wards/\">CalMatters investigation on maternity ward closures\u003c/a>. Nearly 50 obstetrics departments have closed over the past decade.\u003c/p>\n\u003cp>Now, California lawmakers are trying to slow the trend.\u003c/p>\n\u003cp>Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/akilah-weber-165432\">Akilah Weber\u003c/a> and Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/dave-cortese-164699\">Dave Cortese\u003c/a> are pursuing legislation to increase transparency around planned maternity ward closures, potentially giving counties and the state time to intervene.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Weber, a Democrat from La Mesa, wants hospitals to notify the state a year in advance if labor and delivery services are at risk of ending. The measure would also require the state to conduct a community impact report when a hospital indicates that it may lose maternity care.\u003c/p>\n\u003cp>Cortese, a Democrat from Campbell, wants to increase the public notification requirement of an impending closure from 90 days to 120 days and require the hospital to analyze how a closure could increase costs for the county health system, where the next-closest maternity wards are located and who is most likely to be affected.\u003c/p>\n\u003cp>Cortese’s bill would also require increased notification for planned closures of inpatient psychiatric services.\u003c/p>\n\u003cp>“We cannot continue to just discuss these issues and not implement policies to prevent or mitigate the harms and the continued disparities,” Weber said during an Assembly Health Committee hearing on Tuesday.\u003c/p>\n\u003cp>Groups representing doctors and reproductive health advocates support the measure. Nurses and consumer health advocates support Cortese’s bill.\u003c/p>\n\u003ch2>Why are California maternity wards closing?\u003c/h2>\n\u003cp>Ryan Spencer, a lobbyist for the regional chapter of the American College of Obstetricians and Gynecologists who testified in support of Weber’s measure, said there are often situations during birth where “every minute can be the difference between life and death.”\u003c/p>\n\u003cp>“What if you are a patient like this and literally had nowhere to go, who had to drive hours upon hours to get care? We have to find a way to end this crisis,” Spencer said during his testimony.[aside postID=news_11968835 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/12/20231108-Alameda-Black-Maternal-Health-021-JY-qut-1020x680.jpg']Maternity wards are closing for several reasons, according to hospital administrators. They cite labor shortages, increasing costs, low reimbursements and declining birth rates.\u003c/p>\n\u003cp>The California Hospital Association opposes Cortese’s bill and has registered “concerns” about Weber’s. The group argues that neither bill will address the underlying reasons for maternity ward closures and may cause hospitals to terminate services sooner as employees leave and patients look elsewhere for care, said Kirsten Barlow, vice president of policy with the hospital association, during a Senate hearing earlier this month.\u003c/p>\n\u003cp>Current law requires hospitals to notify the public 90 days before a proposed service cut but doesn’t require the state to receive additional notification. Weber said that 90 days is “clearly not sufficient for the state to be able to intervene.”\u003c/p>\n\u003ch2>Maternity care deserts emerge\u003c/h2>\n\u003cp>CalMatters found that 12 counties have no hospital delivering babies, including Madera County, where the sudden closure of the county’s only hospital in 2022 spurred a flurry of emergency legislation supporting \u003ca href=\"https://calmatters.org/health/2023/08/california-hospitals-bailout-loans/\">distressed hospitals\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2024/02/madera-hospital-reopen/\">Madera Community Hospital\u003c/a> is now on track to reopen but without a maternity ward. The company reopening the hospital, American Advanced Management, has indicated that low insurance reimbursement rates factored into its decision to open without labor and delivery.[aside postID=news_11976372 hero='https://cdn.kqed.org/wp-content/uploads/sites/10/2024/02/010423-MaderaCommunityHospital-LV_CM_07-copy-1020x680.jpg']“Reopening maternity would be like reopening two hospitals at the same time,” Matthew Beehler, chief strategy officer at American Advanced Management, previously told CalMatters.\u003c/p>\n\u003cp>Still, the bill authors and advocates are adamant that access to maternity care is a necessity. National studies indicate that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885848/\">rates of preterm birth increase,\u003c/a> and \u003ca href=\"https://corey-white.com/assets/docs/frw_reduced_form_manuscript_AEJ_R1.pdf\">women receive less prenatal care\u003c/a> when labor and delivery units shut down, particularly in rural areas. CalMatters found that maternity closures in California disproportionately impact low-income and Latino communities.\u003c/p>\n\u003cp>“This is really a very simple bill. It doesn’t do much. It creates a public hearing opportunity at the local level to deal with issues that are …absolutely vital to the survival of our constituents,” Cortese said during a Senate Health Committee hearing on his measure.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>In just the first few months of 2024, four California hospitals have closed or announced plans to close their maternity wards.\u003c/p>\n\u003cp>The closures are part of an accelerating trend unfolding across the state, creating maternity care deserts and decreasing access to prenatal care. In the past three years, 29 hospitals stopped delivering babies, according to a \u003ca href=\"https://calmatters.org/health/2023/11/california-hospitals-close-maternity-wards/\">CalMatters investigation on maternity ward closures\u003c/a>. Nearly 50 obstetrics departments have closed over the past decade.\u003c/p>\n\u003cp>Now, California lawmakers are trying to slow the trend.\u003c/p>\n\u003cp>Assemblymember \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/akilah-weber-165432\">Akilah Weber\u003c/a> and Sen. \u003ca href=\"https://digitaldemocracy.calmatters.org/legislators/dave-cortese-164699\">Dave Cortese\u003c/a> are pursuing legislation to increase transparency around planned maternity ward closures, potentially giving counties and the state time to intervene.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Weber, a Democrat from La Mesa, wants hospitals to notify the state a year in advance if labor and delivery services are at risk of ending. The measure would also require the state to conduct a community impact report when a hospital indicates that it may lose maternity care.\u003c/p>\n\u003cp>Cortese, a Democrat from Campbell, wants to increase the public notification requirement of an impending closure from 90 days to 120 days and require the hospital to analyze how a closure could increase costs for the county health system, where the next-closest maternity wards are located and who is most likely to be affected.\u003c/p>\n\u003cp>Cortese’s bill would also require increased notification for planned closures of inpatient psychiatric services.\u003c/p>\n\u003cp>“We cannot continue to just discuss these issues and not implement policies to prevent or mitigate the harms and the continued disparities,” Weber said during an Assembly Health Committee hearing on Tuesday.\u003c/p>\n\u003cp>Groups representing doctors and reproductive health advocates support the measure. Nurses and consumer health advocates support Cortese’s bill.\u003c/p>\n\u003ch2>Why are California maternity wards closing?\u003c/h2>\n\u003cp>Ryan Spencer, a lobbyist for the regional chapter of the American College of Obstetricians and Gynecologists who testified in support of Weber’s measure, said there are often situations during birth where “every minute can be the difference between life and death.”\u003c/p>\n\u003cp>“What if you are a patient like this and literally had nowhere to go, who had to drive hours upon hours to get care? We have to find a way to end this crisis,” Spencer said during his testimony.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Maternity wards are closing for several reasons, according to hospital administrators. They cite labor shortages, increasing costs, low reimbursements and declining birth rates.\u003c/p>\n\u003cp>The California Hospital Association opposes Cortese’s bill and has registered “concerns” about Weber’s. The group argues that neither bill will address the underlying reasons for maternity ward closures and may cause hospitals to terminate services sooner as employees leave and patients look elsewhere for care, said Kirsten Barlow, vice president of policy with the hospital association, during a Senate hearing earlier this month.\u003c/p>\n\u003cp>Current law requires hospitals to notify the public 90 days before a proposed service cut but doesn’t require the state to receive additional notification. Weber said that 90 days is “clearly not sufficient for the state to be able to intervene.”\u003c/p>\n\u003ch2>Maternity care deserts emerge\u003c/h2>\n\u003cp>CalMatters found that 12 counties have no hospital delivering babies, including Madera County, where the sudden closure of the county’s only hospital in 2022 spurred a flurry of emergency legislation supporting \u003ca href=\"https://calmatters.org/health/2023/08/california-hospitals-bailout-loans/\">distressed hospitals\u003c/a>.\u003c/p>\n\u003cp>\u003ca href=\"https://calmatters.org/health/2024/02/madera-hospital-reopen/\">Madera Community Hospital\u003c/a> is now on track to reopen but without a maternity ward. The company reopening the hospital, American Advanced Management, has indicated that low insurance reimbursement rates factored into its decision to open without labor and delivery.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Reopening maternity would be like reopening two hospitals at the same time,” Matthew Beehler, chief strategy officer at American Advanced Management, previously told CalMatters.\u003c/p>\n\u003cp>Still, the bill authors and advocates are adamant that access to maternity care is a necessity. National studies indicate that \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885848/\">rates of preterm birth increase,\u003c/a> and \u003ca href=\"https://corey-white.com/assets/docs/frw_reduced_form_manuscript_AEJ_R1.pdf\">women receive less prenatal care\u003c/a> when labor and delivery units shut down, particularly in rural areas. CalMatters found that maternity closures in California disproportionately impact low-income and Latino communities.\u003c/p>\n\u003cp>“This is really a very simple bill. It doesn’t do much. It creates a public hearing opportunity at the local level to deal with issues that are …absolutely vital to the survival of our constituents,” Cortese said during a Senate Health Committee hearing on his measure.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Opill — the \u003ca href=\"https://opill.com/\">over-the-counter birth control pill\u003c/a> that was \u003ca href=\"https://apnews.com/article/birth-control-pills-without-prescription-fda-b6728e98af5f1625520e0fa5fbc911c3\">approved by the Food and Drug Administration last year\u003c/a> — is \u003ca href=\"https://apnews.com/article/birth-control-pill-pharmacy-contraceptive-add40fec7589dae8ba26eb29bee36b8b\">now available\u003c/a>.\u003c/p>\n\u003cp>This means people now have access to a birth control pill without needing a prescription from a doctor or requiring health insurance — making it accessible “over-the-counter,” like a painkiller like Tylenol.[pullquote size=\"medium\" align=\"right\" citation=\"Sophia Yen, clinical associate professor, Stanford Medical School\"]‘I think it’s really important for people to know that this is the best, most efficacious method available over the counter.’[/pullquote]\u003c/p>\n\u003cp>“I think it’s really important for people to know that this is the best, most efficacious method available over the counter,” said Sophia Yen, a clinical associate professor at Stanford Medical School and \u003ca href=\"https://www.pandiahealth.com/dr-sophia-yen/\">co-founder of Pandia Health\u003c/a>, an organization specializing in reproductive care.\u003c/p>\n\u003cp>Back in 2019, the American College of Obstetrics and Gynecology recommended that all birth control methods — \u003ca href=\"https://www.usatoday.com/story/news/health/2019/09/26/birth-control-should-sold-over-counter-gynecologists-without-prescription-acog/2439101001/\">including the ring, patch, and the pill\u003c/a> — should become available over-the-counter, as Opill now is. And now, this pill is becoming readily \u003ca href=\"https://apnews.com/article/birth-control-pill-pharmacy-contraceptive-add40fec7589dae8ba26eb29bee36b8b\">available at a time\u003c/a> when reproductive rights — like access to abortion — have been under \u003ca href=\"https://www.kqed.org/news/tag/abortion\">legal attacks throughout the country after the Supreme Court overturned Roe v. Wade\u003c/a>.\u003c/p>\n\u003cp>If you are a person who wants to start taking birth control but may not have health insurance or access to a prescriber, keep reading to find out what to know about the over-the-counter birth control pill.\u003c/p>\n\u003ch3>Who can buy Opill, and where is it available?\u003c/h3>\n\u003cp>You can buy Opill in the following ways in California, with no insurance required:\u003c/p>\n\u003cul>\n\u003cli>Over-the-counter at a pharmacy like Walgreens or CVS.\u003c/li>\n\u003cli>In the family planning aisles of a major retail store (for example, Walmart).\u003c/li>\n\u003cli>Online at \u003ca href=\"http://opill.com\">opill.com\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>There is \u003ca href=\"https://apnews.com/article/birth-control-pill-pharmacy-contraceptive-add40fec7589dae8ba26eb29bee36b8b\">no age restriction on sales\u003c/a>, and the packaging is described by the company as “discreet,” for buyer’s privacy.\u003c/p>\n\u003cp>According to the manufacturer, you \u003ca href=\"https://cdn.shopify.com/s/files/1/0719/3211/7296/files/Opill-CIL.pdf?v=1707506323\">should not use Opill\u003c/a>:\u003c/p>\n\u003cul>\n\u003cli>If you have ever had breast cancer.\u003c/li>\n\u003cli>Together with another birth control pill, vaginal ring, patch, implant, injection or an IUD.\u003c/li>\n\u003cli>If you are allergic to ingredients in Opill (for example, some people allergic to aspirin are also allergic to tartrazine, which is the color additive in Opill).\u003c/li>\n\u003c/ul>\n\u003ch3>How much does Opill cost?\u003c/h3>\n\u003cp>According to Opill’s website, a month’s supply retails for $19.99. A three-pack supply of Opill costs \u003ca href=\"https://opill.com/products/opill?variant=47067484487984\">around $50\u003c/a>, and a six-pack costs $90.\u003c/p>\n\u003cp>As of August 2023, California passed \u003ca href=\"https://www.americanprogress.org/article/the-first-over-the-counter-birth-control-pill-marks-a-pivotal-moment-in-birth-control-access/#:~:text=Is%20Opill%20covered%20by%20insurance,prescription%20and%20without%20cost%20sharing.\">a law requiring state-regulated private health insurers\u003c/a> to cover over-the-counter contraception without a prescription and without cost sharing. But as NPR notes, “\u003ca href=\"https://www.npr.org/sections/health-shots/2024/03/04/1235404522/opill-over-counter-birth-control-pill-contraceptive-shop\">not everyone wants their birth control pill to show up on their insurance\u003c/a>, so they may choose to pay out of pocket” rather than having insurance cover those costs.\u003c/p>\n\u003cp>Opill is also eligible for reimbursement through a \u003ca href=\"https://opill.com/pages/faqs?topic=buying-opill\">Flexible Spending Account or Health Savings Account\u003c/a> — meaning the \u003ca href=\"https://hr.nih.gov/about/news/benefits/difference-between-flexible-spending-account-fsa-and-health-savings-account-hsa\">money people set aside in their employee benefits\u003c/a> can potentially be used to purchase Opill.\u003c/p>\n\u003cp>There is also \u003ca href=\"https://opill.com/pages/cost-assistance-program\">a cost assistance program for low-income folks who want to purchase Opill\u003c/a>. In order to be eligible for the cost assistance program, a person must:\u003c/p>\n\u003cul>\n\u003cli>Reside in the United States or its territories, and\u003c/li>\n\u003cli>Not be covered by commercial or public insurance (like Medicaid/Medi-Cal, Medicare, VA health care), and\u003c/li>\n\u003cli>Have a household income at or below \u003ca href=\"https://www.medicaidplanningassistance.org/federal-poverty-guidelines/\">200% of the Federal Poverty Level\u003c/a> (For one person, that is at or below $30,120. For a household of two people, it is $40,880.)\u003c/li>\n\u003c/ul>\n\u003ch3>How does Opill work to prevent pregnancy?\u003c/h3>\n\u003cp>Opill is a daily progestin-only pill, also known as a “mini-pill.”\u003c/p>\n\u003cp>Progestin-only pills work by \u003ca href=\"https://www.thewomens.org.au/health-information/contraception/contraceptive-pills#:~:text=The%20combined%20pill%20contains%20two,through%20to%20fertilise%20the%20egg.\">thickening the mucus at the entrance of the uterus\u003c/a> so sperm cannot pass through to fertilize an egg and result in pregnancy. \u003ca href=\"https://cdn.shopify.com/s/files/1/0719/3211/7296/files/Opill-CIL.pdf?v=1707506323\">Opill takes 48 hours to become effective\u003c/a>, so extra protection — such as condoms — should be used for those first two days.\u003c/p>\n\u003cp>There are a few things to consider about choosing a progestin-only pill like Opill, Yen said. Other prescription birth control pills typically both include estrogen and progestin, and are known as the “combined pill”, because they contain two hormones that \u003ca href=\"https://www.thewomens.org.au/health-information/contraception/contraceptive-pills#:~:text=The%20combined%20pill%20contains%20two,through%20to%20fertilise%20the%20egg.\">prevent the ovaries from releasing an egg each month\u003c/a>. This means they are \u003ca href=\"https://gynraleigh.com/birth-control-progestin-only-pills-vs-combination-pills/#:~:text=One%20of%20the%20main%20advantages,women%20who%20cannot%20take%20estrogen.\">slightly more effective than the progestin-only counterparts\u003c/a> like Opill.\u003c/p>\n\u003cp>Bleeding patterns on the progestin-only pills can also be unpredictable, Yen said. However, some people — like \u003ca href=\"https://gynraleigh.com/birth-control-progestin-only-pills-vs-combination-pills/#:~:text=One%20of%20the%20main%20advantages,women%20who%20cannot%20take%20estrogen.\">individuals over the age of 35, people breastfeeding, or those who are at higher risk of blood clots\u003c/a> — may want to avoid estrogen and, therefore, seek out a progestin-only pill anyway.\u003c/p>\n\u003cp>Research from \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK430882/\">Louisiana State University Health Sciences Center\u003c/a> has found that when either pill is used perfectly — meaning every day, on time — “less than one woman out of 100 will become pregnant in the first year of use.”\u003c/p>\n\u003cp>But “perfect” use isn’t always realistic. This is why research notes that \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK430882/\">the failure rate for “typical use” of combined oral contraceptive pills\u003c/a> — that is, pills not always used consistently — is 9% “due to human error.\u003c/p>\n\u003cp>That means timing is important. A person using birth control pills needs to take one pill at the same time every day for maximum effectiveness at preventing pregnancy — but “any birth control pill has a window of forgiveness,” Yen said.\u003c/p>\n\u003cp>A combination pill, she explained, has “a 24-hour window of forgiveness, generally.”\u003c/p>\n\u003cp>“Usually we say: ‘You miss one pill? Take it as soon as you remember it. If you miss three pills, [the] game’s up, and you need emergency contraception.'”\u003c/p>\n\u003cp>However, a progestin-only pill like Opill has a smaller window of forgiveness because “you don’t have estrogen as the backup” as you do with the combination pill, Yen said, “so the window of forgiveness is three hours, technically.”\u003c/p>\n\u003cp>But “who hasn’t been late taking their birth control by three hours?” Yen said, acknowledging how unexpected schedule changes or straight-up forgetfulness can impact a person’s pill regimen. If you do find you’re taking your progestin-only pill three hours late or more, “you will need to abstain from sex for at least the next 48 hours,” she recommends, “while the hormone level gets [back] up to a level that can protect you.” \u003ca href=\"https://opill.com/pages/faqs?topic=taking-opill\">Opill’s own FAQs also note that you should “use a condom\u003c/a> each time you have sex for the next two days” if you don’t abstain.\u003c/p>\n\u003cp>What if a person is three or more hours late in taking their pill and they’ve had sex in the past three to five days? Since sperm can live for up to five days, in this case, Yen suggests seeking out emergency contraception as soon as possible.\u003c/p>\n\u003cp>Often, confusion over when to take birth control can arise when a person is traveling and arriving in a new time zone. In this case, the next pill needs to be taken 24 hours after you last took a pill, advised Yen.\u003c/p>\n\u003ch3>What should I do if I miss the ‘window of forgiveness’ with my birth control pill?\u003c/h3>\n\u003cp>Emergency contraception \u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/emergency-contraception#:~:text=Emergency%20contraception%20(EC)%20can%20prevent,assault%20if%20without%20contraception%20coverage.\">can prevent 95% of pregnancies within five days\u003c/a> of unprotected sex, like a broken condom or missing the window of forgiveness. Options include \u003ca href=\"https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-plan-b-morning-after-pill\">morning-after pills like Plan B\u003c/a>, \u003ca href=\"https://www.plannedparenthood.org/learn/birth-control/iud/non-hormonal-copper-iud\">the copper IUD\u003c/a> and \u003ca href=\"https://www.plannedparenthood.org/learn/birth-control/iud/hormonal-iuds#:~:text=The%20hormonal%20IUD%20releases%20a,while%20you're%20using%20it.\">the hormonal IUD\u003c/a>. You can find a clinic that offers these services \u003ca href=\"https://www.plannedparenthood.org/get-care\">using Planned Parenthood’s search tool\u003c/a>.[aside tag=\"health\" label=\"More Health Stories\"]\u003c/p>\n\u003cp>Yen said emergency contraception that is prescribed “beats any over-the-counter emergency contraception and efficacy at every single time point,” Yen said. “And thanks to the Affordable Care Act, if you have insurance, it’s available with no co-pay, no deductible, aka free.”\u003c/p>\n\u003cp>However, Yen said a person’s body mass index does factor in whether or not the over-the-counter emergency contraception is effective. For example, if a person’s BMI is greater than 26 — a medication like Plan B may not work as well. If it is greater than 30, Yen said, it “doesn’t work at all.”\u003c/p>\n\u003cp>Yen said Ella — a \u003ca href=\"https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-ella-morning-after-pill\">prescription emergency contraception\u003c/a> (also known as a “morning-after pill”) — is effective with BMIs up to 35. Planned Parenthood has \u003ca href=\"https://www.plannedparenthood.org/online-tools/emergency-contraception\">a quiz for people to see which method of emergency contraception could work for them\u003c/a>.\u003c/p>\n\u003ch3>Can a birth control pill prevent STIs?\u003c/h3>\n\u003cp>No, pills \u003ca href=\"https://cdn.shopify.com/s/files/1/0719/3211/7296/files/Opill-CIL.pdf?v=1707506323\">cannot prevent sexually transmitted infections\u003c/a>.\u003c/p>\n\u003cp>If a person is aged 12 to 19 in California, \u003ca href=\"https://www.teensource.org/condoms/free\">the Condom Access Project has a search tool to find free condoms\u003c/a>.\u003c/p>\n\u003cp>You can \u003ca href=\"https://www.sfcityclinic.org/patient-education-resources/all-about-condoms\">also get condoms\u003c/a> in the \u003ca href=\"https://www.sfcityclinic.org/services/sti-and-hiv-testing\">San Francisco City Clinic\u003c/a>, which provides low-cost STI testing. Free or low-cost condoms are also available at the Public Health Division on Van Ness Avenue.\u003c/p>\n\u003cp>Your county may also provide free condoms as \u003ca href=\"https://publichealth.sccgov.org/services/community-resources#3925188384-263336965\">Santa Clara County does at the Crane Center\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Opill — the \u003ca href=\"https://opill.com/\">over-the-counter birth control pill\u003c/a> that was \u003ca href=\"https://apnews.com/article/birth-control-pills-without-prescription-fda-b6728e98af5f1625520e0fa5fbc911c3\">approved by the Food and Drug Administration last year\u003c/a> — is \u003ca href=\"https://apnews.com/article/birth-control-pill-pharmacy-contraceptive-add40fec7589dae8ba26eb29bee36b8b\">now available\u003c/a>.\u003c/p>\n\u003cp>This means people now have access to a birth control pill without needing a prescription from a doctor or requiring health insurance — making it accessible “over-the-counter,” like a painkiller like Tylenol.\u003c/p>\u003c/div>",
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"content": "‘I think it’s really important for people to know that this is the best, most efficacious method available over the counter.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think it’s really important for people to know that this is the best, most efficacious method available over the counter,” said Sophia Yen, a clinical associate professor at Stanford Medical School and \u003ca href=\"https://www.pandiahealth.com/dr-sophia-yen/\">co-founder of Pandia Health\u003c/a>, an organization specializing in reproductive care.\u003c/p>\n\u003cp>Back in 2019, the American College of Obstetrics and Gynecology recommended that all birth control methods — \u003ca href=\"https://www.usatoday.com/story/news/health/2019/09/26/birth-control-should-sold-over-counter-gynecologists-without-prescription-acog/2439101001/\">including the ring, patch, and the pill\u003c/a> — should become available over-the-counter, as Opill now is. And now, this pill is becoming readily \u003ca href=\"https://apnews.com/article/birth-control-pill-pharmacy-contraceptive-add40fec7589dae8ba26eb29bee36b8b\">available at a time\u003c/a> when reproductive rights — like access to abortion — have been under \u003ca href=\"https://www.kqed.org/news/tag/abortion\">legal attacks throughout the country after the Supreme Court overturned Roe v. Wade\u003c/a>.\u003c/p>\n\u003cp>If you are a person who wants to start taking birth control but may not have health insurance or access to a prescriber, keep reading to find out what to know about the over-the-counter birth control pill.\u003c/p>\n\u003ch3>Who can buy Opill, and where is it available?\u003c/h3>\n\u003cp>You can buy Opill in the following ways in California, with no insurance required:\u003c/p>\n\u003cul>\n\u003cli>Over-the-counter at a pharmacy like Walgreens or CVS.\u003c/li>\n\u003cli>In the family planning aisles of a major retail store (for example, Walmart).\u003c/li>\n\u003cli>Online at \u003ca href=\"http://opill.com\">opill.com\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>There is \u003ca href=\"https://apnews.com/article/birth-control-pill-pharmacy-contraceptive-add40fec7589dae8ba26eb29bee36b8b\">no age restriction on sales\u003c/a>, and the packaging is described by the company as “discreet,” for buyer’s privacy.\u003c/p>\n\u003cp>According to the manufacturer, you \u003ca href=\"https://cdn.shopify.com/s/files/1/0719/3211/7296/files/Opill-CIL.pdf?v=1707506323\">should not use Opill\u003c/a>:\u003c/p>\n\u003cul>\n\u003cli>If you have ever had breast cancer.\u003c/li>\n\u003cli>Together with another birth control pill, vaginal ring, patch, implant, injection or an IUD.\u003c/li>\n\u003cli>If you are allergic to ingredients in Opill (for example, some people allergic to aspirin are also allergic to tartrazine, which is the color additive in Opill).\u003c/li>\n\u003c/ul>\n\u003ch3>How much does Opill cost?\u003c/h3>\n\u003cp>According to Opill’s website, a month’s supply retails for $19.99. A three-pack supply of Opill costs \u003ca href=\"https://opill.com/products/opill?variant=47067484487984\">around $50\u003c/a>, and a six-pack costs $90.\u003c/p>\n\u003cp>As of August 2023, California passed \u003ca href=\"https://www.americanprogress.org/article/the-first-over-the-counter-birth-control-pill-marks-a-pivotal-moment-in-birth-control-access/#:~:text=Is%20Opill%20covered%20by%20insurance,prescription%20and%20without%20cost%20sharing.\">a law requiring state-regulated private health insurers\u003c/a> to cover over-the-counter contraception without a prescription and without cost sharing. But as NPR notes, “\u003ca href=\"https://www.npr.org/sections/health-shots/2024/03/04/1235404522/opill-over-counter-birth-control-pill-contraceptive-shop\">not everyone wants their birth control pill to show up on their insurance\u003c/a>, so they may choose to pay out of pocket” rather than having insurance cover those costs.\u003c/p>\n\u003cp>Opill is also eligible for reimbursement through a \u003ca href=\"https://opill.com/pages/faqs?topic=buying-opill\">Flexible Spending Account or Health Savings Account\u003c/a> — meaning the \u003ca href=\"https://hr.nih.gov/about/news/benefits/difference-between-flexible-spending-account-fsa-and-health-savings-account-hsa\">money people set aside in their employee benefits\u003c/a> can potentially be used to purchase Opill.\u003c/p>\n\u003cp>There is also \u003ca href=\"https://opill.com/pages/cost-assistance-program\">a cost assistance program for low-income folks who want to purchase Opill\u003c/a>. In order to be eligible for the cost assistance program, a person must:\u003c/p>\n\u003cul>\n\u003cli>Reside in the United States or its territories, and\u003c/li>\n\u003cli>Not be covered by commercial or public insurance (like Medicaid/Medi-Cal, Medicare, VA health care), and\u003c/li>\n\u003cli>Have a household income at or below \u003ca href=\"https://www.medicaidplanningassistance.org/federal-poverty-guidelines/\">200% of the Federal Poverty Level\u003c/a> (For one person, that is at or below $30,120. For a household of two people, it is $40,880.)\u003c/li>\n\u003c/ul>\n\u003ch3>How does Opill work to prevent pregnancy?\u003c/h3>\n\u003cp>Opill is a daily progestin-only pill, also known as a “mini-pill.”\u003c/p>\n\u003cp>Progestin-only pills work by \u003ca href=\"https://www.thewomens.org.au/health-information/contraception/contraceptive-pills#:~:text=The%20combined%20pill%20contains%20two,through%20to%20fertilise%20the%20egg.\">thickening the mucus at the entrance of the uterus\u003c/a> so sperm cannot pass through to fertilize an egg and result in pregnancy. \u003ca href=\"https://cdn.shopify.com/s/files/1/0719/3211/7296/files/Opill-CIL.pdf?v=1707506323\">Opill takes 48 hours to become effective\u003c/a>, so extra protection — such as condoms — should be used for those first two days.\u003c/p>\n\u003cp>There are a few things to consider about choosing a progestin-only pill like Opill, Yen said. Other prescription birth control pills typically both include estrogen and progestin, and are known as the “combined pill”, because they contain two hormones that \u003ca href=\"https://www.thewomens.org.au/health-information/contraception/contraceptive-pills#:~:text=The%20combined%20pill%20contains%20two,through%20to%20fertilise%20the%20egg.\">prevent the ovaries from releasing an egg each month\u003c/a>. This means they are \u003ca href=\"https://gynraleigh.com/birth-control-progestin-only-pills-vs-combination-pills/#:~:text=One%20of%20the%20main%20advantages,women%20who%20cannot%20take%20estrogen.\">slightly more effective than the progestin-only counterparts\u003c/a> like Opill.\u003c/p>\n\u003cp>Bleeding patterns on the progestin-only pills can also be unpredictable, Yen said. However, some people — like \u003ca href=\"https://gynraleigh.com/birth-control-progestin-only-pills-vs-combination-pills/#:~:text=One%20of%20the%20main%20advantages,women%20who%20cannot%20take%20estrogen.\">individuals over the age of 35, people breastfeeding, or those who are at higher risk of blood clots\u003c/a> — may want to avoid estrogen and, therefore, seek out a progestin-only pill anyway.\u003c/p>\n\u003cp>Research from \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK430882/\">Louisiana State University Health Sciences Center\u003c/a> has found that when either pill is used perfectly — meaning every day, on time — “less than one woman out of 100 will become pregnant in the first year of use.”\u003c/p>\n\u003cp>But “perfect” use isn’t always realistic. This is why research notes that \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK430882/\">the failure rate for “typical use” of combined oral contraceptive pills\u003c/a> — that is, pills not always used consistently — is 9% “due to human error.\u003c/p>\n\u003cp>That means timing is important. A person using birth control pills needs to take one pill at the same time every day for maximum effectiveness at preventing pregnancy — but “any birth control pill has a window of forgiveness,” Yen said.\u003c/p>\n\u003cp>A combination pill, she explained, has “a 24-hour window of forgiveness, generally.”\u003c/p>\n\u003cp>“Usually we say: ‘You miss one pill? Take it as soon as you remember it. If you miss three pills, [the] game’s up, and you need emergency contraception.'”\u003c/p>\n\u003cp>However, a progestin-only pill like Opill has a smaller window of forgiveness because “you don’t have estrogen as the backup” as you do with the combination pill, Yen said, “so the window of forgiveness is three hours, technically.”\u003c/p>\n\u003cp>But “who hasn’t been late taking their birth control by three hours?” Yen said, acknowledging how unexpected schedule changes or straight-up forgetfulness can impact a person’s pill regimen. If you do find you’re taking your progestin-only pill three hours late or more, “you will need to abstain from sex for at least the next 48 hours,” she recommends, “while the hormone level gets [back] up to a level that can protect you.” \u003ca href=\"https://opill.com/pages/faqs?topic=taking-opill\">Opill’s own FAQs also note that you should “use a condom\u003c/a> each time you have sex for the next two days” if you don’t abstain.\u003c/p>\n\u003cp>What if a person is three or more hours late in taking their pill and they’ve had sex in the past three to five days? Since sperm can live for up to five days, in this case, Yen suggests seeking out emergency contraception as soon as possible.\u003c/p>\n\u003cp>Often, confusion over when to take birth control can arise when a person is traveling and arriving in a new time zone. In this case, the next pill needs to be taken 24 hours after you last took a pill, advised Yen.\u003c/p>\n\u003ch3>What should I do if I miss the ‘window of forgiveness’ with my birth control pill?\u003c/h3>\n\u003cp>Emergency contraception \u003ca href=\"https://www.who.int/news-room/fact-sheets/detail/emergency-contraception#:~:text=Emergency%20contraception%20(EC)%20can%20prevent,assault%20if%20without%20contraception%20coverage.\">can prevent 95% of pregnancies within five days\u003c/a> of unprotected sex, like a broken condom or missing the window of forgiveness. Options include \u003ca href=\"https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-plan-b-morning-after-pill\">morning-after pills like Plan B\u003c/a>, \u003ca href=\"https://www.plannedparenthood.org/learn/birth-control/iud/non-hormonal-copper-iud\">the copper IUD\u003c/a> and \u003ca href=\"https://www.plannedparenthood.org/learn/birth-control/iud/hormonal-iuds#:~:text=The%20hormonal%20IUD%20releases%20a,while%20you're%20using%20it.\">the hormonal IUD\u003c/a>. You can find a clinic that offers these services \u003ca href=\"https://www.plannedparenthood.org/get-care\">using Planned Parenthood’s search tool\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Yen said emergency contraception that is prescribed “beats any over-the-counter emergency contraception and efficacy at every single time point,” Yen said. “And thanks to the Affordable Care Act, if you have insurance, it’s available with no co-pay, no deductible, aka free.”\u003c/p>\n\u003cp>However, Yen said a person’s body mass index does factor in whether or not the over-the-counter emergency contraception is effective. For example, if a person’s BMI is greater than 26 — a medication like Plan B may not work as well. If it is greater than 30, Yen said, it “doesn’t work at all.”\u003c/p>\n\u003cp>Yen said Ella — a \u003ca href=\"https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-ella-morning-after-pill\">prescription emergency contraception\u003c/a> (also known as a “morning-after pill”) — is effective with BMIs up to 35. Planned Parenthood has \u003ca href=\"https://www.plannedparenthood.org/online-tools/emergency-contraception\">a quiz for people to see which method of emergency contraception could work for them\u003c/a>.\u003c/p>\n\u003ch3>Can a birth control pill prevent STIs?\u003c/h3>\n\u003cp>No, pills \u003ca href=\"https://cdn.shopify.com/s/files/1/0719/3211/7296/files/Opill-CIL.pdf?v=1707506323\">cannot prevent sexually transmitted infections\u003c/a>.\u003c/p>\n\u003cp>If a person is aged 12 to 19 in California, \u003ca href=\"https://www.teensource.org/condoms/free\">the Condom Access Project has a search tool to find free condoms\u003c/a>.\u003c/p>\n\u003cp>You can \u003ca href=\"https://www.sfcityclinic.org/patient-education-resources/all-about-condoms\">also get condoms\u003c/a> in the \u003ca href=\"https://www.sfcityclinic.org/services/sti-and-hiv-testing\">San Francisco City Clinic\u003c/a>, which provides low-cost STI testing. Free or low-cost condoms are also available at the Public Health Division on Van Ness Avenue.\u003c/p>\n\u003cp>Your county may also provide free condoms as \u003ca href=\"https://publichealth.sccgov.org/services/community-resources#3925188384-263336965\">Santa Clara County does at the Crane Center\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>About 100 librarians and their supporters rallied outside San Francisco’s Main Library on Tuesday to demand the city hire security guards for every branch. Workers decried a lack of security at most of the city’s branches and said they are often forced to de-escalate volatile situations and step into the role of providing security themselves.\u003c/p>\n\u003cp>“I am a librarian, I am a branch manager — I am not a policewoman, I am not a security guard,” said Nicole Germain, manager of the Portola Branch Library and president of the Library Guild of SEIU 1021, the union which represents San Francisco library workers.\u003c/p>\n\u003cp>As public spaces, libraries — and the people who work in them — often directly face the city’s most difficult social challenges, like homelessness and substance use disorder.\u003c/p>\n\u003cp>Currently, eight of the city’s 28 public libraries have at least one security guard.\u003c/p>\n\u003cp>Germain said on one occasion, she had to intervene when a half-naked and “mentally unstable” man began wielding a sharp metal object and yelling at people. She chose to physically put herself between the man and a group of preschoolers.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“This is not what I signed up for when I became a librarian,” Germain said. “However, as a branch manager and children’s librarian, that is the position I find myself in.”\u003c/p>\n\u003cp>Union negotiators have asked for more security for the city’s libraries for years. In 2019, the city agreed to hire three more security guards, including at the Portola branch.\u003c/p>\n\u003cp>Germain said it makes a difference and works as a preventative measure. “People are more apt to behave,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11982522\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11982522 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Nicole Germain speaks at Tuesday’s rally in front of San Francisco’s Main Library. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>San Francisco Supervisor Connie Chan joined Tuesday’s rally to support library workers’ demands.\u003c/p>\n\u003cp>“If San Francisco can advocate for our corporations, for our pharmacies, for our downtown stores to be staffed up with guards and police and deputy sheriffs — why can’t we guard our libraries?” Chan said.\u003c/p>\n\u003cp>Chan is also chair of the city’s Budget and Finance Committee. She said San Francisco’s youth commissioners recently came to a committee meeting to talk about their priorities for the city.\u003c/p>\n\u003cp>“They talk about what they want to see in the budget, as they are our future, and where they want the city to invest our money,” Chan said. “And the one place they mentioned is the library.”\u003c/p>\n\u003cfigure id=\"attachment_11982523\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11982523 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">District 1 Supervisor Connie Chan speaks at Tuesday’s rally in front of San Francisco’s Main Library on Larkin Street. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jessica Choy, who works part-time at the Park Branch Library in the city’s Haight-Ashbury neighborhood, said she’s also fighting for full-time employment.\u003c/p>\n\u003cp>“Our public libraries rely on a huge number of part-time workers like me. Even when we get raises, it’s not enough to get by in one of the most expensive cities in the world,” Choy said. “We’re only guaranteed 20 hours a week. So we’re hustling to get extra hours every day, some of us waking up at midnight checking our apps, trying to pick up a shift.”\u003c/p>\n\u003cp>The rally comes as San Francisco’s contracts across 10 unions, representing more than 25,000 city workers, are set to expire June 30. And for the first time in decades, negotiations over those contracts are happening against a backdrop of potential strikes. In July, the California Public Employment Relations Board \u003ca href=\"https://missionlocal.org/2023/07/strike-san-francisco-perb/\">struck down a 50-year-old city rule prohibiting city workers from striking\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Tuesday’s rally is the latest in a series of union actions, with \u003ca href=\"https://www.kqed.org/news/11980278/sf-social-welfare-workers-protest-proposition-f-saying-it-will-worsen-agencys-staffing-crisis\">workers across city departments\u003c/a> seeking to draw attention to what they say is a pervasive understaffing crisis. At these actions, the unions have also been collecting signatures from city employees pledging to join a strike if one is called.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>About 100 librarians and their supporters rallied outside San Francisco’s Main Library on Tuesday to demand the city hire security guards for every branch. Workers decried a lack of security at most of the city’s branches and said they are often forced to de-escalate volatile situations and step into the role of providing security themselves.\u003c/p>\n\u003cp>“I am a librarian, I am a branch manager — I am not a policewoman, I am not a security guard,” said Nicole Germain, manager of the Portola Branch Library and president of the Library Guild of SEIU 1021, the union which represents San Francisco library workers.\u003c/p>\n\u003cp>As public spaces, libraries — and the people who work in them — often directly face the city’s most difficult social challenges, like homelessness and substance use disorder.\u003c/p>\n\u003cp>Currently, eight of the city’s 28 public libraries have at least one security guard.\u003c/p>\n\u003cp>Germain said on one occasion, she had to intervene when a half-naked and “mentally unstable” man began wielding a sharp metal object and yelling at people. She chose to physically put herself between the man and a group of preschoolers.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This is not what I signed up for when I became a librarian,” Germain said. “However, as a branch manager and children’s librarian, that is the position I find myself in.”\u003c/p>\n\u003cp>Union negotiators have asked for more security for the city’s libraries for years. In 2019, the city agreed to hire three more security guards, including at the Portola branch.\u003c/p>\n\u003cp>Germain said it makes a difference and works as a preventative measure. “People are more apt to behave,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11982522\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11982522 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-14-KQED-4-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Nicole Germain speaks at Tuesday’s rally in front of San Francisco’s Main Library. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>San Francisco Supervisor Connie Chan joined Tuesday’s rally to support library workers’ demands.\u003c/p>\n\u003cp>“If San Francisco can advocate for our corporations, for our pharmacies, for our downtown stores to be staffed up with guards and police and deputy sheriffs — why can’t we guard our libraries?” Chan said.\u003c/p>\n\u003cp>Chan is also chair of the city’s Budget and Finance Committee. She said San Francisco’s youth commissioners recently came to a committee meeting to talk about their priorities for the city.\u003c/p>\n\u003cp>“They talk about what they want to see in the budget, as they are our future, and where they want the city to invest our money,” Chan said. “And the one place they mentioned is the library.”\u003c/p>\n\u003cfigure id=\"attachment_11982523\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11982523 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/04/240409-SF-LIBRARY-RALLY-MD-19-KQED-4-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">District 1 Supervisor Connie Chan speaks at Tuesday’s rally in front of San Francisco’s Main Library on Larkin Street. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Jessica Choy, who works part-time at the Park Branch Library in the city’s Haight-Ashbury neighborhood, said she’s also fighting for full-time employment.\u003c/p>\n\u003cp>“Our public libraries rely on a huge number of part-time workers like me. Even when we get raises, it’s not enough to get by in one of the most expensive cities in the world,” Choy said. “We’re only guaranteed 20 hours a week. So we’re hustling to get extra hours every day, some of us waking up at midnight checking our apps, trying to pick up a shift.”\u003c/p>\n\u003cp>The rally comes as San Francisco’s contracts across 10 unions, representing more than 25,000 city workers, are set to expire June 30. And for the first time in decades, negotiations over those contracts are happening against a backdrop of potential strikes. In July, the California Public Employment Relations Board \u003ca href=\"https://missionlocal.org/2023/07/strike-san-francisco-perb/\">struck down a 50-year-old city rule prohibiting city workers from striking\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Tuesday’s rally is the latest in a series of union actions, with \u003ca href=\"https://www.kqed.org/news/11980278/sf-social-welfare-workers-protest-proposition-f-saying-it-will-worsen-agencys-staffing-crisis\">workers across city departments\u003c/a> seeking to draw attention to what they say is a pervasive understaffing crisis. At these actions, the unions have also been collecting signatures from city employees pledging to join a strike if one is called.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>An agreement local air regulators made with Chevron earlier this year includes the settling of dozens of violations tied to some of the largest accidents at the company’s Richmond refinery over the last five years.\u003c/p>\n\u003cp>The Bay Area Air Quality Management District \u003ca href=\"https://www.kqed.org/news/11975650/bay-air-district-hails-decisive-victory-in-battle-to-cut-refinery-pollution\">announced in February that it had reached deals with Chevron and the Martinez Refining Company\u003c/a>, ending a legal war over a rule intended to reduce a harmful form of pollution emitted by the energy companies’ local refineries.\u003c/p>\n\u003cp>Under the agreement, Chevron is also paying $20 million to settle 678 separate violations related to its Richmond refinery. That marks the highest penalty agreement the energy giant has ever made with the air district, according to Philip Fine, the agency’s executive officer.\u003c/p>\n\u003cp>“This a new era of enforcement and holding facilities accountable,” Fine told the Richmond City Council on Feb. 27. “They need to feel these penalties in order to incentivize them to stay in compliance.”\u003c/p>\n\u003cp>The deal resolves all of the air district’s open enforcement actions with Chevron that took place between 2019 and June 30, 2023.\u003c/p>\n\u003cp>[aside postID=news_11975650]“We believe this resolution will allow us to turn our full focus on the future safe and reliable operation of our facility,” Chevron said in a statement sent by company spokesperson Caitlin Powell.\u003c/p>\n\u003cp>Air district officials told KQED 105 of the violations Chevron settled are tied to eight major incidents at the refinery over the last five years. They include several cases in which refinery components malfunctioned, leading to flaring.\u003c/p>\n\u003cp>\u003ca href=\"https://www.baaqmd.gov/plans-and-climate/emission-tracking-and-monitoring/flare-minimization-plans\">Flaring operations\u003c/a> take place when refineries send gasses to their flares to reduce pressure inside the facilities during malfunctions as well as start-up and shutdown operations. Oil industry officials have emphasized that the practice is a way to prevent more serious and possibly dangerous accidents.\u003c/p>\n\u003cp>Some of the flaring operations involved in the settlement released significant amounts of toxic gas into the air above the Richmond area. In several of these incidents, nearby residents could see black smoke and fire bursting into the sky, with some calling the air district to complain. Those cases garnered a significant amount of news coverage and social media posts.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Regulators say 71 of the violations are connected to \u003ca href=\"https://www.kqed.org/news/11894150/chevron-refinery-malfunction-during-storm-shut-down-processing-units-causing-fire-and-toxic-flaring\">several days of pollution releases from the Richmond refinery that began Oct. 24, 2021\u003c/a>, when one of the Bay Area’s strongest storms in recent years brought significant rain to the region. The refinery sustained a series of malfunctions that led to three days of flaring and significant concerns by Richmond area residents.\u003c/p>\n\u003cp>Two weeks after the releases started, the City Council asked Chevron executives to explain what happened in a public hearing. \u003ca href=\"https://www.kqed.org/news/11895438/richmond-to-chevron-listen-to-our-residents-concerns-about-your-problems\">Residents who showed up to the virtual meeting left upset\u003c/a>. They complained that company representatives did not have an explanation for what caused the major refinery malfunction. One of them, Randy Joseph, told the council and the company that he learned nothing from the hearing.\u003c/p>\n\u003cp>[aside postID=news_11895438]Reached two and a half years later, on the heels of the deal that essentially closes the book on that accident, Joseph said his dissatisfaction with Chevron has not subsided.\u003c/p>\n\u003cp>“Chevron always has the answers,” Joseph said in an interview. “They just refuse to share with us. They know they’re polluting. They also know they can come and say nothing and get away with it,” he said.\u003c/p>\n\u003cp>A few months after the October 2021 incident, \u003ca href=\"https://www.kqed.org/news/11901875/chevron-richmond-refinery-roof-leak-october-2021-flaring-incident\">KQED reported that problems started when an atmospheric river storm poured rain through a leaky roof into a key part of the refinery\u003c/a>, triggering significant power and steam loss. That, in turn, knocked half a dozen petroleum processing units offline, caused a small fire, and resulted in several days in which the refinery flared off toxic gases.\u003c/p>\n\u003cp>“They never came back to City Council. They never came back and explained. They never came back to apologize,” said Joseph, who is a community organizer with the group Reimagine Richmond and said he only learned of the cause of that accident from KQED’s reporting.\u003c/p>\n\u003cp>[aside label='Related Coverage' tag='chevron']Chevron says it informs the public and the air district about its releases. The company points out that residents can check real-time air quality data through \u003ca href=\"https://richmondairmonitoring.org/\">the refinery’s fenceline monitoring system\u003c/a>. The causes of many flaring events are posted several months later on \u003ca href=\"https://www.baaqmd.gov/about-air-quality/research-and-data/flare-data/flare-causal-reports\">the air district’s website\u003c/a>.\u003c/p>\n\u003cp>“Chevron Richmond also will be implementing various improvements to our flare monitoring and sampling systems and setting up ways to discuss flaring events and other air quality issues directly with our community,” the company said through its representative.\u003c/p>\n\u003cp>The 71 violations for the October 2021 incident involve times in which Chevron broke public nuisance, permit condition, visible emission and flare monitoring regulations, according to Kristine Roselius, an air district spokesperson. But the settlement essentially obscures the fine amount for each penalty.\u003c/p>\n\u003cp>“We accounted for the seriousness of these violations in determining an appropriate overall penalty amount for all the covered violations, but there is no allocation of specific dollar amounts to each individual violation, Roselius said in an email.\u003c/p>\n\u003cp>In the last decade, the oil industry \u003ca href=\"https://www.kqed.org/news/11960699/oil-industry-sets-back-efforts-to-increase-fines-against-polluting-california-refineries-yet-again\">has successfully killed or delayed legislative attempts to increase penalties on refineries\u003c/a> that violate air quality laws in California. The most recent bill, proposed by Assemblymember Buffy Wicks (D-Oakland), would increase the ceiling of many of those penalties to $30,000 per violation. That bill, \u003ca href=\"https://legiscan.com/CA/bill/AB1465/2023\">AB 1465\u003c/a>, is on hold.\u003c/p>\n\u003cp>Air district officials say 13 of Chevron’s violations settled in the recent deal were tied to an \u003ca href=\"https://www.kqed.org/news/11860389/chevron-says-flawed-electrical-diagram-triggered-major-flaring-incident\">incident on Nov. 2, 2020,\u003c/a> when an incorrectly labeled electrical diagram caused a power outage leading to the flaring of more than 100,000 pounds of sulfur dioxide and other chemicals.\u003c/p>\n\u003cp>The agency says 11 other violations were connected to a \u003ca href=\"https://www.cchealth.org/home/showpublisheddocument/28612/638337601986530000\">malfunction at the Richmond refinery on March 9, 2023,\u003c/a> when a hydrogen-producing plant tripped offline thanks to an electrical equipment malfunction. On the same day, a fire broke out thanks to a pump seal leak.\u003c/p>\n\u003cp>For years, Chevron’s Richmond refinery has flared more than the Bay Area’s other refineries.\u003c/p>\n\u003cp>The company argues that its “flaring performance has been steadily improving over the past few years.”\u003c/p>\n\u003cp>“To supplement these efforts, we will be formalizing an operator training program related to flare reduction and conducting a comprehensive assessment of previous flaring events to identify if any additional corrective actions are warranted,” the company said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>An agreement local air regulators made with Chevron earlier this year includes the settling of dozens of violations tied to some of the largest accidents at the company’s Richmond refinery over the last five years.\u003c/p>\n\u003cp>The Bay Area Air Quality Management District \u003ca href=\"https://www.kqed.org/news/11975650/bay-air-district-hails-decisive-victory-in-battle-to-cut-refinery-pollution\">announced in February that it had reached deals with Chevron and the Martinez Refining Company\u003c/a>, ending a legal war over a rule intended to reduce a harmful form of pollution emitted by the energy companies’ local refineries.\u003c/p>\n\u003cp>Under the agreement, Chevron is also paying $20 million to settle 678 separate violations related to its Richmond refinery. That marks the highest penalty agreement the energy giant has ever made with the air district, according to Philip Fine, the agency’s executive officer.\u003c/p>\n\u003cp>“This a new era of enforcement and holding facilities accountable,” Fine told the Richmond City Council on Feb. 27. “They need to feel these penalties in order to incentivize them to stay in compliance.”\u003c/p>\n\u003cp>The deal resolves all of the air district’s open enforcement actions with Chevron that took place between 2019 and June 30, 2023.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“We believe this resolution will allow us to turn our full focus on the future safe and reliable operation of our facility,” Chevron said in a statement sent by company spokesperson Caitlin Powell.\u003c/p>\n\u003cp>Air district officials told KQED 105 of the violations Chevron settled are tied to eight major incidents at the refinery over the last five years. They include several cases in which refinery components malfunctioned, leading to flaring.\u003c/p>\n\u003cp>\u003ca href=\"https://www.baaqmd.gov/plans-and-climate/emission-tracking-and-monitoring/flare-minimization-plans\">Flaring operations\u003c/a> take place when refineries send gasses to their flares to reduce pressure inside the facilities during malfunctions as well as start-up and shutdown operations. Oil industry officials have emphasized that the practice is a way to prevent more serious and possibly dangerous accidents.\u003c/p>\n\u003cp>Some of the flaring operations involved in the settlement released significant amounts of toxic gas into the air above the Richmond area. In several of these incidents, nearby residents could see black smoke and fire bursting into the sky, with some calling the air district to complain. Those cases garnered a significant amount of news coverage and social media posts.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Regulators say 71 of the violations are connected to \u003ca href=\"https://www.kqed.org/news/11894150/chevron-refinery-malfunction-during-storm-shut-down-processing-units-causing-fire-and-toxic-flaring\">several days of pollution releases from the Richmond refinery that began Oct. 24, 2021\u003c/a>, when one of the Bay Area’s strongest storms in recent years brought significant rain to the region. The refinery sustained a series of malfunctions that led to three days of flaring and significant concerns by Richmond area residents.\u003c/p>\n\u003cp>Two weeks after the releases started, the City Council asked Chevron executives to explain what happened in a public hearing. \u003ca href=\"https://www.kqed.org/news/11895438/richmond-to-chevron-listen-to-our-residents-concerns-about-your-problems\">Residents who showed up to the virtual meeting left upset\u003c/a>. They complained that company representatives did not have an explanation for what caused the major refinery malfunction. One of them, Randy Joseph, told the council and the company that he learned nothing from the hearing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Reached two and a half years later, on the heels of the deal that essentially closes the book on that accident, Joseph said his dissatisfaction with Chevron has not subsided.\u003c/p>\n\u003cp>“Chevron always has the answers,” Joseph said in an interview. “They just refuse to share with us. They know they’re polluting. They also know they can come and say nothing and get away with it,” he said.\u003c/p>\n\u003cp>A few months after the October 2021 incident, \u003ca href=\"https://www.kqed.org/news/11901875/chevron-richmond-refinery-roof-leak-october-2021-flaring-incident\">KQED reported that problems started when an atmospheric river storm poured rain through a leaky roof into a key part of the refinery\u003c/a>, triggering significant power and steam loss. That, in turn, knocked half a dozen petroleum processing units offline, caused a small fire, and resulted in several days in which the refinery flared off toxic gases.\u003c/p>\n\u003cp>“They never came back to City Council. They never came back and explained. They never came back to apologize,” said Joseph, who is a community organizer with the group Reimagine Richmond and said he only learned of the cause of that accident from KQED’s reporting.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Chevron says it informs the public and the air district about its releases. The company points out that residents can check real-time air quality data through \u003ca href=\"https://richmondairmonitoring.org/\">the refinery’s fenceline monitoring system\u003c/a>. The causes of many flaring events are posted several months later on \u003ca href=\"https://www.baaqmd.gov/about-air-quality/research-and-data/flare-data/flare-causal-reports\">the air district’s website\u003c/a>.\u003c/p>\n\u003cp>“Chevron Richmond also will be implementing various improvements to our flare monitoring and sampling systems and setting up ways to discuss flaring events and other air quality issues directly with our community,” the company said through its representative.\u003c/p>\n\u003cp>The 71 violations for the October 2021 incident involve times in which Chevron broke public nuisance, permit condition, visible emission and flare monitoring regulations, according to Kristine Roselius, an air district spokesperson. But the settlement essentially obscures the fine amount for each penalty.\u003c/p>\n\u003cp>“We accounted for the seriousness of these violations in determining an appropriate overall penalty amount for all the covered violations, but there is no allocation of specific dollar amounts to each individual violation, Roselius said in an email.\u003c/p>\n\u003cp>In the last decade, the oil industry \u003ca href=\"https://www.kqed.org/news/11960699/oil-industry-sets-back-efforts-to-increase-fines-against-polluting-california-refineries-yet-again\">has successfully killed or delayed legislative attempts to increase penalties on refineries\u003c/a> that violate air quality laws in California. The most recent bill, proposed by Assemblymember Buffy Wicks (D-Oakland), would increase the ceiling of many of those penalties to $30,000 per violation. That bill, \u003ca href=\"https://legiscan.com/CA/bill/AB1465/2023\">AB 1465\u003c/a>, is on hold.\u003c/p>\n\u003cp>Air district officials say 13 of Chevron’s violations settled in the recent deal were tied to an \u003ca href=\"https://www.kqed.org/news/11860389/chevron-says-flawed-electrical-diagram-triggered-major-flaring-incident\">incident on Nov. 2, 2020,\u003c/a> when an incorrectly labeled electrical diagram caused a power outage leading to the flaring of more than 100,000 pounds of sulfur dioxide and other chemicals.\u003c/p>\n\u003cp>The agency says 11 other violations were connected to a \u003ca href=\"https://www.cchealth.org/home/showpublisheddocument/28612/638337601986530000\">malfunction at the Richmond refinery on March 9, 2023,\u003c/a> when a hydrogen-producing plant tripped offline thanks to an electrical equipment malfunction. On the same day, a fire broke out thanks to a pump seal leak.\u003c/p>\n\u003cp>For years, Chevron’s Richmond refinery has flared more than the Bay Area’s other refineries.\u003c/p>\n\u003cp>The company argues that its “flaring performance has been steadily improving over the past few years.”\u003c/p>\n\u003cp>“To supplement these efforts, we will be formalizing an operator training program related to flare reduction and conducting a comprehensive assessment of previous flaring events to identify if any additional corrective actions are warranted,” the company said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp class=\"p1\">\u003ca href=\"#episode-transcript\">\u003ci>View the full episode transcript.\u003c/i>\u003c/a>\u003c/p>\n\u003cp>Every child in California under 3 is entitled to early intervention services like physical, speech, and occupational therapy if they show signs that they need developmental support. Experts say getting these services early and in-person is critical for babies’ development, and that it can actually reduce the need for special education services later in life.\u003c/p>\n\u003cp>But many families aren’t receiving the care they need. KQED’s Daisy Nguyen explains why.\u003c/p>\n\u003cp>\u003cb>Links: \u003c/b>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.kqed.org/news/11980312/a-caregivers-guide-to-navigating-early-intervention-services\">‘Early Start’ 101: Here’s How Families Can Access Early Intervention Services for Younger Kids\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" frameborder=\"0\" height=\"200\" scrolling=\"no\" src=\"https://playlist.megaphone.fm/?e=KQINC5200793499\" width=\"100%\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch2 id=\"episode-transcript\">Episode Transcript\u003c/h2>\n\u003cp>\u003ci>This is a computer-generated transcript. While our team has reviewed it, there may be errors.\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>I’m Ericka Cruz Guevarra and welcome to the Bay. Local news to keep you rooted. Baby brains have lots to absorb early on. They’re learning how to walk and talk, and their brains are most adaptable in the first three years of life. That makes it a crucial period, because if the child shows signs of delays in their development, those first three years are the time to intervene.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Receiving early intervention services could really change the developmental path of a child. It could make a big difference, but it has to be given during this period.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>In California, babies are entitled to help from the state. They show signs of developmental delay, and it happens through a program known as Early Start. But many of the neediest families aren’t getting that help today. I talked with KQED early childhood education reporter Daisy Nguyen about the barriers to getting babies crucial, life altering services on time.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Reyna Balladares, is a foster parent who lives in the tenderloin.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Then she became a foster parent, during the pandemic. She told me that at the time when the, you know, the world was shutting down, she wanted to open up her home to help foster children. She first took care of a baby boy for about six months. And, I think that was a really good experience for her, even though ultimately, you know, that the child was placed in a different home.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And then she met this little girl, this newborn baby in 2021.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She told me that she just remembered the the baby’s smile and just how sweet her face was. How she lit up when she saw her second city.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>You know, it broke her heart that the situation, that in which this girl came to her. But the little glimmer of hope when she saw that the girl was making some progress in her development, really reinforced her desire to want to advocate for this, for this little girl.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>When did Reyna start to notice this little girl struggling a little bit in her development?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She said this child was just slow to begin walking and talking. And I think because Reyna had raised two daughters, she had some personal experience.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She just felt something wasn’t right. And she she said she mentioned this to doctors who initially told her this is normal. That was slightly dismissive. But she was certain that there was something going on. And ultimately, after seeing specialists, it was confirmed to her that this little girl needed a lot of early intervention services, essentially to help her reach her potential. It was recommended that this little girl receives a physical therapy, speech therapy, occupational therapy, and feeding therapy.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>We’re talking about really important services that kids need very early on. And I mean, I have to imagine time is of the essence. Why was it so hard for Rina to get the services that she needed for this baby girl? Why did she have to push so hard?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>When I learned was just that the regional center has been overwhelmed, especially since the pandemic, with just a high caseload of children seeking services and probably some staffing shortages, not only at the regional center, but also with a shortage of early intervention providers. Families have to really push to get the services that they need in a timely manner and in the way that they want it to receive it, meaning if they want it to happen in the natural environment of the child.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Reyna said that what she stumbled upon was just a lot of resistance by the therapist to come to the tenderloin, where she lives. She told me that the regional center coordinators told her that the therapists were just afraid to come to the tenderloin because they felt unsafe.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>What does Reyna say about what it was like to not have therapists willing to meet with her foster daughter in person?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She just felt it was unjust that it was because of where she lives. The therapists weren’t coming there to provide the services that her foster daughter crucially needed.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>What happened instead was that she was given an alternative, but it wasn’t what she wanted. So the Golden Gate Regional Center was telling her that she could take her foster child to the different clinics across San Francisco to make all these different appointments, which kind of stacked up during the week for her. She had to take a lot of time out of her working days.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>But the other alternative was to have these services done through zoom.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>It wasn’t ideal. She said her foster child would not respond to the therapist or just not want to sit in front of a screen.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>I want to step back a little bit, Daisy, and talk a little bit more about what early intervention services are, what kind of services are we talking about? Exactly? And I know these services are also things that families are entitled to. Right.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Children with developmental delays are entitled to receive a host of early intervention services to enhance their ability to sit or walk or talk. The services could include physical therapy, speech therapy, occupational therapy. It could even include equipment that helps young children maintain or improve certain skills, or parents could also receive some counseling and training to support their child’s developmental needs.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Getting the services as early as possible is crucial for children. Experts say that’s because this is a period when children’s brain are rapidly developing, and so they’re more adaptable. So receiving early intervention services could really change the developmental path of a child. It could make a big difference.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>But it has to be given during this period. This is a federal program that’s administered in California by a network of nonprofit regional centers. So in the Bay area, the Golden Gate Regional Center is responsible for coordinating these services for families in San Francisco, Marin, and San Mateo County.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>What are the bigger systemic problems with the state system for these early intervention services?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>This program has always been plagued by understaffing and underinvestment by the government. The therapist who would provide these services. They are not paid a competitive rate. The rates in which the providers get paid have never been as competitive as what the private market is able to pay for these services, and so they’re just less incentivized to to provide services through this program.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And so they’re in demand, which means that the number of families who who need the service, who requested these services and are eligible for these services have to kind of wait sometimes just to get it. The other issue is that they don’t get paid to travel to a family’s home.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>So as an alternative, what they’re able to offer to families is appointments in their offices or through telehealth, meaning appointments through zoom. And but for these some of these families, this is not what they considered an ideal way for their children to receive these services. They consider it substandard.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Coming up, how underfunding has hurt those who need the most help and how do we fix this? Stay with us.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>I want to talk more Daisy through, I guess, some of the consequences of this inadequate funding, as you were kind of just starting to talk about. What did you find?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Doctor Jennifer Albon is a pediatrician at UCSF.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>Most of my young patients are needing early intervention services.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>So she just is seeing, you know, growing geographic and socioeconomic disparities when it comes to who gets early intervention services in their home.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>I have many families who, like, live in certain neighborhoods of San Francisco, and the regional center has flat out told them and told us that there’s not providers who will go to your neighborhood, even within San Francisco.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>What does Doctor Albon say about the importance of providing this treatment in these children’s homes, but specifically no matter where they live?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She says it’s just more ideal because children learn best when they’re in familiar surroundings.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>You know, they get scared of coming into like, offices and other things like that. So it’s harder for them to participate when it’s not like their natural environments.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>The parents are also receiving some of the training themselves, so that for the rest of that week, when there’s no therapy, they’re able to practice what they’ve been trained to, you know, by the therapists to do.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>The goal for it to be kind of in their natural environment is that they have all of their regular things. And the and the therapists are showing the family what to do with what they have at home or in these natural environments.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And I should add that it is it’s a lot. It’s a law where it says that services should ideally be provided in the natural environment. The growth in online therapies have made it accessible for many people. But I think in the case with young children, it’s it’s created more inequities.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Will these issues that we’re talking about are systemic, as you described earlier, and they’re also not all new, but what can we do to fix this problem?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>I spoke with leaders of the regional centers, and they say that’s really like the you know, they recognize that this is a distressing situation that they’ve been trying to address for a long time, and they can’t compel therapists to see children in person if they’re just not getting, you know, they’re not being paid enough to do it. And so they’re really calling for greater investment by the state and federal government in the program.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>The state has been gradually been increasing the reimbursement rates for early intervention services. But this budget year, Governor Gavin Newsom wants to delay full implementation of the increases, and the regional center leaders are saying like they they really don’t think delay is a good idea, because increasing the rate is encouraging the therapists to do the work to go and see children in the natural environment. And also it’s encouraging them to to hire more people.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Ultra regional center services Sacramento and about 9 or 10 surrounding counties, and they receive some federal pandemic aid money to implement a pilot project, where they offered an incentive to therapists to go to underserved zip codes and also hard to reach areas in their region. And they noticed that these incentives, which is I think it was something like $200 per visit, that they saw an increase in the number of children seen in these underserved areas. So clearly, you know, money talks.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Coming back to Reyna Balladares, what is she going to do next?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Her foster child just turned three, which means she is, quote unquote, aged out of, early intervention services. And Raina believes that she could have made much more progress if she had received consistent services. Her daughter now will need more, special education services through the San Francisco Unified School District.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>That is kind of heartbreaking, because it sounds like she wasn’t able to get the critical services she needed on time. But at the same time, Raina seems like this very active parent who knows a lot and who really pushed to make sure her kid got the services she needed. But I also imagine there’s probably lots of families who struggle to navigate these services, or maybe just don’t even have the time to and I mean, just maybe give up.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>I think that’s what compelled, Reyna to speak with me, because she would she wanted to speak out on behalf of those parents who you can imagine. I think having a child who, if you’re. Especially if you’re a first time parent, just absorbing the news that your child has a developmental delay. These families are often in crisis, and they don’t have the time to make constant calls to the regional center and push for these types of services.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Ultimately, Reyna wants to adopt the the baby girl, right?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She fell in love with this child.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She is much closer to getting the adoption approved bundle.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And when I met with them, I mean, you can just see this clear bond. And, she she just wants to do what’s best for this little girl.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Well, Daisy, thank you so much for breaking this down for us. I really appreciate it.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Yeah. No problem.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>That was Daisy Nguyen, an early childhood education reporter for KQED. This 38 minute conversation with Daisy was cut down and edited by our intern, Ellie Prickett-Morgan and our senior editor, Alan Montecillo. Maria Esquinca is our producer. She scored this episode and added all the tape music courtesy of the Audio Network. Special thanks as well to Carlos Cabrera-Lomelí.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>By the way, did you know that the Bay is listener supported? Meaning our funders are people just like you? So if you appreciate the value that the Bay brings to your life, consider becoming a KQED member. Just go to KQED.org/Donate. The Bay is a production of listener supported KQED in San Francisco. I’m Ericka Cruz Guevarra. Thanks for listening. Talk to you next time.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">\u003ca href=\"#episode-transcript\">\u003ci>View the full episode transcript.\u003c/i>\u003c/a>\u003c/p>\n\u003cp>Every child in California under 3 is entitled to early intervention services like physical, speech, and occupational therapy if they show signs that they need developmental support. Experts say getting these services early and in-person is critical for babies’ development, and that it can actually reduce the need for special education services later in life.\u003c/p>\n\u003cp>But many families aren’t receiving the care they need. KQED’s Daisy Nguyen explains why.\u003c/p>\n\u003cp>\u003cb>Links: \u003c/b>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.kqed.org/news/11980312/a-caregivers-guide-to-navigating-early-intervention-services\">‘Early Start’ 101: Here’s How Families Can Access Early Intervention Services for Younger Kids\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" frameborder=\"0\" height=\"200\" scrolling=\"no\" src=\"https://playlist.megaphone.fm/?e=KQINC5200793499\" width=\"100%\" class=\"iframe-class\">\u003c/iframe>\u003c/div>",
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"content": "\u003cdiv class=\"post-content post-body\">\u003ch2 id=\"episode-transcript\">Episode Transcript\u003c/h2>\n\u003cp>\u003ci>This is a computer-generated transcript. While our team has reviewed it, there may be errors.\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>I’m Ericka Cruz Guevarra and welcome to the Bay. Local news to keep you rooted. Baby brains have lots to absorb early on. They’re learning how to walk and talk, and their brains are most adaptable in the first three years of life. That makes it a crucial period, because if the child shows signs of delays in their development, those first three years are the time to intervene.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Receiving early intervention services could really change the developmental path of a child. It could make a big difference, but it has to be given during this period.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>In California, babies are entitled to help from the state. They show signs of developmental delay, and it happens through a program known as Early Start. But many of the neediest families aren’t getting that help today. I talked with KQED early childhood education reporter Daisy Nguyen about the barriers to getting babies crucial, life altering services on time.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Reyna Balladares, is a foster parent who lives in the tenderloin.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Then she became a foster parent, during the pandemic. She told me that at the time when the, you know, the world was shutting down, she wanted to open up her home to help foster children. She first took care of a baby boy for about six months. And, I think that was a really good experience for her, even though ultimately, you know, that the child was placed in a different home.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And then she met this little girl, this newborn baby in 2021.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She told me that she just remembered the the baby’s smile and just how sweet her face was. How she lit up when she saw her second city.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>You know, it broke her heart that the situation, that in which this girl came to her. But the little glimmer of hope when she saw that the girl was making some progress in her development, really reinforced her desire to want to advocate for this, for this little girl.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>When did Reyna start to notice this little girl struggling a little bit in her development?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She said this child was just slow to begin walking and talking. And I think because Reyna had raised two daughters, she had some personal experience.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She just felt something wasn’t right. And she she said she mentioned this to doctors who initially told her this is normal. That was slightly dismissive. But she was certain that there was something going on. And ultimately, after seeing specialists, it was confirmed to her that this little girl needed a lot of early intervention services, essentially to help her reach her potential. It was recommended that this little girl receives a physical therapy, speech therapy, occupational therapy, and feeding therapy.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>We’re talking about really important services that kids need very early on. And I mean, I have to imagine time is of the essence. Why was it so hard for Rina to get the services that she needed for this baby girl? Why did she have to push so hard?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>When I learned was just that the regional center has been overwhelmed, especially since the pandemic, with just a high caseload of children seeking services and probably some staffing shortages, not only at the regional center, but also with a shortage of early intervention providers. Families have to really push to get the services that they need in a timely manner and in the way that they want it to receive it, meaning if they want it to happen in the natural environment of the child.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Reyna said that what she stumbled upon was just a lot of resistance by the therapist to come to the tenderloin, where she lives. She told me that the regional center coordinators told her that the therapists were just afraid to come to the tenderloin because they felt unsafe.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>What does Reyna say about what it was like to not have therapists willing to meet with her foster daughter in person?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She just felt it was unjust that it was because of where she lives. The therapists weren’t coming there to provide the services that her foster daughter crucially needed.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>What happened instead was that she was given an alternative, but it wasn’t what she wanted. So the Golden Gate Regional Center was telling her that she could take her foster child to the different clinics across San Francisco to make all these different appointments, which kind of stacked up during the week for her. She had to take a lot of time out of her working days.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>But the other alternative was to have these services done through zoom.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>It wasn’t ideal. She said her foster child would not respond to the therapist or just not want to sit in front of a screen.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>I want to step back a little bit, Daisy, and talk a little bit more about what early intervention services are, what kind of services are we talking about? Exactly? And I know these services are also things that families are entitled to. Right.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Children with developmental delays are entitled to receive a host of early intervention services to enhance their ability to sit or walk or talk. The services could include physical therapy, speech therapy, occupational therapy. It could even include equipment that helps young children maintain or improve certain skills, or parents could also receive some counseling and training to support their child’s developmental needs.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Getting the services as early as possible is crucial for children. Experts say that’s because this is a period when children’s brain are rapidly developing, and so they’re more adaptable. So receiving early intervention services could really change the developmental path of a child. It could make a big difference.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>But it has to be given during this period. This is a federal program that’s administered in California by a network of nonprofit regional centers. So in the Bay area, the Golden Gate Regional Center is responsible for coordinating these services for families in San Francisco, Marin, and San Mateo County.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>What are the bigger systemic problems with the state system for these early intervention services?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>This program has always been plagued by understaffing and underinvestment by the government. The therapist who would provide these services. They are not paid a competitive rate. The rates in which the providers get paid have never been as competitive as what the private market is able to pay for these services, and so they’re just less incentivized to to provide services through this program.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And so they’re in demand, which means that the number of families who who need the service, who requested these services and are eligible for these services have to kind of wait sometimes just to get it. The other issue is that they don’t get paid to travel to a family’s home.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>So as an alternative, what they’re able to offer to families is appointments in their offices or through telehealth, meaning appointments through zoom. And but for these some of these families, this is not what they considered an ideal way for their children to receive these services. They consider it substandard.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Coming up, how underfunding has hurt those who need the most help and how do we fix this? Stay with us.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>I want to talk more Daisy through, I guess, some of the consequences of this inadequate funding, as you were kind of just starting to talk about. What did you find?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Doctor Jennifer Albon is a pediatrician at UCSF.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>Most of my young patients are needing early intervention services.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>So she just is seeing, you know, growing geographic and socioeconomic disparities when it comes to who gets early intervention services in their home.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>I have many families who, like, live in certain neighborhoods of San Francisco, and the regional center has flat out told them and told us that there’s not providers who will go to your neighborhood, even within San Francisco.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>What does Doctor Albon say about the importance of providing this treatment in these children’s homes, but specifically no matter where they live?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She says it’s just more ideal because children learn best when they’re in familiar surroundings.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>You know, they get scared of coming into like, offices and other things like that. So it’s harder for them to participate when it’s not like their natural environments.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>The parents are also receiving some of the training themselves, so that for the rest of that week, when there’s no therapy, they’re able to practice what they’ve been trained to, you know, by the therapists to do.\u003c/p>\n\u003cp>\u003cstrong>Dr. Jennifer Albon: \u003c/strong>The goal for it to be kind of in their natural environment is that they have all of their regular things. And the and the therapists are showing the family what to do with what they have at home or in these natural environments.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And I should add that it is it’s a lot. It’s a law where it says that services should ideally be provided in the natural environment. The growth in online therapies have made it accessible for many people. But I think in the case with young children, it’s it’s created more inequities.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Will these issues that we’re talking about are systemic, as you described earlier, and they’re also not all new, but what can we do to fix this problem?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>I spoke with leaders of the regional centers, and they say that’s really like the you know, they recognize that this is a distressing situation that they’ve been trying to address for a long time, and they can’t compel therapists to see children in person if they’re just not getting, you know, they’re not being paid enough to do it. And so they’re really calling for greater investment by the state and federal government in the program.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>The state has been gradually been increasing the reimbursement rates for early intervention services. But this budget year, Governor Gavin Newsom wants to delay full implementation of the increases, and the regional center leaders are saying like they they really don’t think delay is a good idea, because increasing the rate is encouraging the therapists to do the work to go and see children in the natural environment. And also it’s encouraging them to to hire more people.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Ultra regional center services Sacramento and about 9 or 10 surrounding counties, and they receive some federal pandemic aid money to implement a pilot project, where they offered an incentive to therapists to go to underserved zip codes and also hard to reach areas in their region. And they noticed that these incentives, which is I think it was something like $200 per visit, that they saw an increase in the number of children seen in these underserved areas. So clearly, you know, money talks.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Coming back to Reyna Balladares, what is she going to do next?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Her foster child just turned three, which means she is, quote unquote, aged out of, early intervention services. And Raina believes that she could have made much more progress if she had received consistent services. Her daughter now will need more, special education services through the San Francisco Unified School District.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>That is kind of heartbreaking, because it sounds like she wasn’t able to get the critical services she needed on time. But at the same time, Raina seems like this very active parent who knows a lot and who really pushed to make sure her kid got the services she needed. But I also imagine there’s probably lots of families who struggle to navigate these services, or maybe just don’t even have the time to and I mean, just maybe give up.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>I think that’s what compelled, Reyna to speak with me, because she would she wanted to speak out on behalf of those parents who you can imagine. I think having a child who, if you’re. Especially if you’re a first time parent, just absorbing the news that your child has a developmental delay. These families are often in crisis, and they don’t have the time to make constant calls to the regional center and push for these types of services.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Ultimately, Reyna wants to adopt the the baby girl, right?\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She fell in love with this child.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>She is much closer to getting the adoption approved bundle.\u003c/p>\n\u003cp>\u003cstrong>Reyna Balladares: \u003c/strong>\u003cem>[speaking spanish]\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>And when I met with them, I mean, you can just see this clear bond. And, she she just wants to do what’s best for this little girl.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>Well, Daisy, thank you so much for breaking this down for us. I really appreciate it.\u003c/p>\n\u003cp>\u003cstrong>Daisy Nguyen: \u003c/strong>Yeah. No problem.\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>That was Daisy Nguyen, an early childhood education reporter for KQED. This 38 minute conversation with Daisy was cut down and edited by our intern, Ellie Prickett-Morgan and our senior editor, Alan Montecillo. Maria Esquinca is our producer. She scored this episode and added all the tape music courtesy of the Audio Network. Special thanks as well to Carlos Cabrera-Lomelí.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Ericka Cruz Guevarra: \u003c/strong>By the way, did you know that the Bay is listener supported? Meaning our funders are people just like you? So if you appreciate the value that the Bay brings to your life, consider becoming a KQED member. Just go to KQED.org/Donate. The Bay is a production of listener supported KQED in San Francisco. I’m Ericka Cruz Guevarra. Thanks for listening. Talk to you next time.\u003c/p>\n\n\u003c/div>"
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"content": "\u003cp>Hundreds of workers at AHMC Seton Medical Center in Daly City walked off the job on Monday as part of a two-day strike to demand the hospital reverse changes it recently made to their health care plans.\u003c/p>\n\u003cp>“We’re striking for better medical benefits, something that actually covers our families, that pays the bills,” said Christina Caridis, an X-ray technician, who was among the throng of hospital staff on the picket line hoisting signs that said “Health Care for Health Care Workers.”\u003c/p>\n\u003cp>“We all have outstanding bills; we’ve gone to collections, and these are bills that they (the hospital) were supposed to pay,” she said.\u003c/p>\n\u003cp>The union representing the workers said the hospital’s administration dramatically changed health care options at the beginning of the year after workers’ previous contract expired, forcing them to pay up to $6,000 a year to maintain their coverage or accept a new plan with limited access to local doctors and hospitals.\u003c/p>\n\u003cp>“I’m worried about my family, my kids not having basic insurance that works,” said Juliya Vinogradsky, a respiratory therapist at Seton, noting that the new, more affordable plan has very few options for local care. “The closest doctors are about 45 minutes to an hour’s drive.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The two-day strike, expected to continue through Tuesday, follows \u003ca href=\"https://www.smdailyjournal.com/news/local/seton-nurses-call-for-better-working-conditions/article_66cb8e32-1eaf-11ed-8290-cfd8dd2926c1.html\">a number of previous labor disputes at the facility\u003c/a> since 2020 when \u003ca href=\"https://www.mercurynews.com/2020/08/14/ahmc-healthcare-finalizes-purchase-of-seton-medical-center/\">AHMC Healthcare purchased the hospital\u003c/a> out of bankruptcy. Since then, the Los Angeles-based company has “gutted patient care services and initiated several rounds of layoffs, cutting non-nurse staffing by nearly 25%,” according to the National Union of Healthcare Workers, which represents more than 400 Seton workers, including nursing assistants, licensed vocational nurses, respiratory therapists, housekeepers and medical technicians.[aside label=\"more health coverage\" tag=\"health\"]The union is still negotiating a new contract with the company and said that while it’s “near agreement” on wages, it won’t consider any deal that doesn’t fully restore workers’ health benefits.\u003c/p>\n\u003cp>“I am mainly here for better health care. This health insurance affects my 6-month-old daughter,” said Rachelle Ortua, a material management technician at Seton, who joined the picket line on Monday. “I’m not even worried about myself. I’m only worried about my daughter.”\u003c/p>\n\u003cp>Ortua said she and her daughter now have to drive at least 45 minutes to see a pediatrician who is covered by her new insurance plan. And the closest hospital with emergency pediatric care, she said, is even further away.\u003c/p>\n\u003cp>“I have chronic asthma, and I’m afraid my daughter has it,” Ortua said. “If she has it and she needs to get admitted, you’re telling me that [with] this health care, I have to travel an hour and a half away for her to be admitted into the hospital? I’m not OK with that.”\u003c/p>\n\u003cp>The union also said it fears that AHMC plans to further drain resources and eventually shutter the safety-net hospital that has primarily served lower-income immigrant communities in northern San Mateo County and San Francisco for generations. When it purchased the hospital in August 2020, the company, in an agreement with the state, committed to keeping it open for at least five and a half years — roughly midway through 2026.\u003c/p>\n\u003cp>But Seton’s administrator said concerns about its commitment to the well-being of its workers and patients are unfounded, calling the strike “unnecessary.” It accused the union of prioritizing “a contract negotiating tactic over patient and community care.”\u003c/p>\n\u003cp>The hospital has offered workers “outstanding wages and extraordinary medical benefits,” including 16% pay increases over three years, the option of free medical benefits for employees and their families, and a generous paid time off package, Seton said in a statement on Monday.\u003c/p>\n\u003cp>Since purchasing Seton in August 2020, when the facility “teetered on the edge of closure,” AMHC has pledged to keep the hospital open and make it financially viable by investing $100 million in repairs and upgrades and undertaking a $75 million seismic retrofit, the statement said.\u003c/p>\n\u003cp>“We have been working diligently to ensure Northern San Mateo County has a community hospital for years to come,” Sarkis Vartanian, the hospital’s head administrator, said in the statement. “My focus has been to provide high-quality, affordable care that meets the needs of our community.”\u003c/p>\n\u003cp>But many workers and local officials said the current state of the hospital suggests otherwise.\u003c/p>\n\u003cp>“They’re supposed to get new equipment and they didn’t get new equipment,” said Daly City Councilmember Pamela DiGiovanni, who joined workers on the picket line on Monday. “One of the doctors told me the bulbs are out in some of the operating rooms. It’s just terrible.”\u003c/p>\n\u003cp>DiGiovanni said she’s been calling Vartanian about these issues “three times a day, and he has not called me back.”\u003c/p>\n\u003cp>The hospital operators have failed to “fix and repair equipment that we need and provide the resources that we need to treat our patients,” Caridis, the X-ray technician, added. “In my personal specialty, I have no equipment to do the procedures that I need to do on a safe basis. We cancel a lot of patients.”\u003c/p>\n\u003cp>Workers like Ortua, the material management technician, acknowledged that the hospital is a business with financial constraints but said penalizing its workers and patients is both unethical and foolhardy.\u003c/p>\n\u003cp>“I understand trying to save money but treating your employees this way, you’ll never save money that way,” she said. “You’re going to lose people and end up losing the hospital. The least you can do is provide us with proper health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Sydney Johnson and Matthew Green contributed reporting to this story.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Hundreds of workers at AHMC Seton Medical Center in Daly City walked off the job on Monday as part of a two-day strike to demand the hospital reverse changes it recently made to their health care plans.\u003c/p>\n\u003cp>“We’re striking for better medical benefits, something that actually covers our families, that pays the bills,” said Christina Caridis, an X-ray technician, who was among the throng of hospital staff on the picket line hoisting signs that said “Health Care for Health Care Workers.”\u003c/p>\n\u003cp>“We all have outstanding bills; we’ve gone to collections, and these are bills that they (the hospital) were supposed to pay,” she said.\u003c/p>\n\u003cp>The union representing the workers said the hospital’s administration dramatically changed health care options at the beginning of the year after workers’ previous contract expired, forcing them to pay up to $6,000 a year to maintain their coverage or accept a new plan with limited access to local doctors and hospitals.\u003c/p>\n\u003cp>“I’m worried about my family, my kids not having basic insurance that works,” said Juliya Vinogradsky, a respiratory therapist at Seton, noting that the new, more affordable plan has very few options for local care. “The closest doctors are about 45 minutes to an hour’s drive.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The two-day strike, expected to continue through Tuesday, follows \u003ca href=\"https://www.smdailyjournal.com/news/local/seton-nurses-call-for-better-working-conditions/article_66cb8e32-1eaf-11ed-8290-cfd8dd2926c1.html\">a number of previous labor disputes at the facility\u003c/a> since 2020 when \u003ca href=\"https://www.mercurynews.com/2020/08/14/ahmc-healthcare-finalizes-purchase-of-seton-medical-center/\">AHMC Healthcare purchased the hospital\u003c/a> out of bankruptcy. Since then, the Los Angeles-based company has “gutted patient care services and initiated several rounds of layoffs, cutting non-nurse staffing by nearly 25%,” according to the National Union of Healthcare Workers, which represents more than 400 Seton workers, including nursing assistants, licensed vocational nurses, respiratory therapists, housekeepers and medical technicians.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The union is still negotiating a new contract with the company and said that while it’s “near agreement” on wages, it won’t consider any deal that doesn’t fully restore workers’ health benefits.\u003c/p>\n\u003cp>“I am mainly here for better health care. This health insurance affects my 6-month-old daughter,” said Rachelle Ortua, a material management technician at Seton, who joined the picket line on Monday. “I’m not even worried about myself. I’m only worried about my daughter.”\u003c/p>\n\u003cp>Ortua said she and her daughter now have to drive at least 45 minutes to see a pediatrician who is covered by her new insurance plan. And the closest hospital with emergency pediatric care, she said, is even further away.\u003c/p>\n\u003cp>“I have chronic asthma, and I’m afraid my daughter has it,” Ortua said. “If she has it and she needs to get admitted, you’re telling me that [with] this health care, I have to travel an hour and a half away for her to be admitted into the hospital? I’m not OK with that.”\u003c/p>\n\u003cp>The union also said it fears that AHMC plans to further drain resources and eventually shutter the safety-net hospital that has primarily served lower-income immigrant communities in northern San Mateo County and San Francisco for generations. When it purchased the hospital in August 2020, the company, in an agreement with the state, committed to keeping it open for at least five and a half years — roughly midway through 2026.\u003c/p>\n\u003cp>But Seton’s administrator said concerns about its commitment to the well-being of its workers and patients are unfounded, calling the strike “unnecessary.” It accused the union of prioritizing “a contract negotiating tactic over patient and community care.”\u003c/p>\n\u003cp>The hospital has offered workers “outstanding wages and extraordinary medical benefits,” including 16% pay increases over three years, the option of free medical benefits for employees and their families, and a generous paid time off package, Seton said in a statement on Monday.\u003c/p>\n\u003cp>Since purchasing Seton in August 2020, when the facility “teetered on the edge of closure,” AMHC has pledged to keep the hospital open and make it financially viable by investing $100 million in repairs and upgrades and undertaking a $75 million seismic retrofit, the statement said.\u003c/p>\n\u003cp>“We have been working diligently to ensure Northern San Mateo County has a community hospital for years to come,” Sarkis Vartanian, the hospital’s head administrator, said in the statement. “My focus has been to provide high-quality, affordable care that meets the needs of our community.”\u003c/p>\n\u003cp>But many workers and local officials said the current state of the hospital suggests otherwise.\u003c/p>\n\u003cp>“They’re supposed to get new equipment and they didn’t get new equipment,” said Daly City Councilmember Pamela DiGiovanni, who joined workers on the picket line on Monday. “One of the doctors told me the bulbs are out in some of the operating rooms. It’s just terrible.”\u003c/p>\n\u003cp>DiGiovanni said she’s been calling Vartanian about these issues “three times a day, and he has not called me back.”\u003c/p>\n\u003cp>The hospital operators have failed to “fix and repair equipment that we need and provide the resources that we need to treat our patients,” Caridis, the X-ray technician, added. “In my personal specialty, I have no equipment to do the procedures that I need to do on a safe basis. We cancel a lot of patients.”\u003c/p>\n\u003cp>Workers like Ortua, the material management technician, acknowledged that the hospital is a business with financial constraints but said penalizing its workers and patients is both unethical and foolhardy.\u003c/p>\n\u003cp>“I understand trying to save money but treating your employees this way, you’ll never save money that way,” she said. “You’re going to lose people and end up losing the hospital. The least you can do is provide us with proper health care.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KQED’s Sydney Johnson and Matthew Green contributed reporting to this story.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>A new program to test wastewater for substances like fentanyl, methamphetamine and cocaine is giving San Francisco’s health officials a new window into the city’s pressing overdose crisis.\u003c/p>\n\u003cp>The effort comes as San Francisco recently experienced the \u003ca href=\"https://www.kqed.org/news/11972898/2023-was-san-franciscos-deadliest-year-for-drug-overdoses-new-data-confirms\">worst year for overdose deaths\u003c/a> on record in 2023, when 806 people died of accidental overdose.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jeffrey Hom, director of population behavioral health, San Francisco Department of Public Health\"]‘For the first time, we have data that can shed light on the amounts of drugs that are being used in the city here. This is something that we haven’t had before.’[/pullquote]“For the first time, we have data that can shed light on the amounts of drugs that are being used in the city here,” said Jeffrey Hom, director of population behavioral health for the San Francisco Department of Public Health. “This is something that we haven’t had before. So much of the data that we look at within the health department is based on individuals who are receiving a certain service or who have experienced a certain outcome, like a nonfatal overdose.”\u003c/p>\n\u003cp>San Francisco health officials started tracking drug use and supply trends in November 2023 to monitor the presence of different drugs and to also check for changes in the illicit drug supply.\u003c/p>\n\u003cp>Wastewater samples are collected every two weeks from two different locations, one on the city’s west side and another on the east side. Currently, the city is checking for fentanyl, cocaine and methamphetamine, as well as all three substances in their metabolized form. The samples are then sent to a lab where they are analyzed, and the results are shared back with the city.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Early results from the first four months of testing show there were often higher concentrations of drugs, including fentanyl, cocaine and methamphetamine on the east side of the city compared with the west. That largely tracks with geographic data from the Office of the Chief Medical Examiner, which releases monthly reports on overdoses in the city.\u003c/p>\n\u003cp>Fentanyl, a potent opioid about 50 times stronger than heroin, has contributed to the majority of recent overdose deaths in San Francisco.\u003c/p>\n\u003cp>However, the wastewater data showed much higher concentrations of stimulants across the city. For example, there were 1552 milligrams of methamphetamine per 1000 people per day found in samples collected on the east side of the city on March 7, 2024, compared to 34 milligrams of fentanyl.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11969903,news_11975973,news_11979144\"]That doesn’t necessarily mean there are more people using stimulants, however. The body metabolizes each substance differently, making it hard to compare the prevalence of individual substances. Instead, Hom said, the city is using the findings to monitor changes in the drug supply and use trends over time.\u003c/p>\n\u003cp>“We’re not able to directly compare those and make an assumption that many more people or that much more stimulants are being used because of the way these drugs are metabolized in the body. So trying to make the comparison between drugs is difficult,” Hom said.\u003c/p>\n\u003cp>Public health officials say they hope to use the data to advise the public on overdose risk and drug supply trends.\u003c/p>\n\u003cp>The effort is part of a study funded by the National Institute on Drug Abuse, which ends in August, that San Francisco and other local municipalities are participating in. But the city’s health officials say they hope to expand and continue the program after the study wraps up.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Jeffrey Hom, director of population behavioral health, San Francisco Department of Public Health\"]‘Much of the potential for this kind of surveillance revolves around the opportunity to identify new drugs or something that’s just starting to make its way into the drug supply here.’[/pullquote]San Francisco previously used wastewater testing during the COVID-19 pandemic to track the rise and fall of the virus on a population level. However, the city is not alone in its endeavor to use the technology for the overdose crisis as well. \u003ca href=\"https://www.kqed.org/science/1982720/marin-health-officials-track-illicit-drug-use-by-testing-wastewater\">Marin County\u003c/a> started using the approach in July 2023. Public health officials there issued a health advisory about an increase in fentanyl overdoses that aligned with the wastewater testing, which showed higher rates and amounts of fentanyl in the same period.\u003c/p>\n\u003cp>“Much of the potential for this kind of surveillance revolves around the opportunity to identify new drugs or something that’s just starting to make its way into the drug supply here,” Hom said. “I am hopeful as we look to the next iteration of this that we not only increase the frequency of testing, but increase the number of drugs and especially novel drugs so our response can be timely and focused.”\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A new program to test wastewater for substances like fentanyl, methamphetamine and cocaine is giving San Francisco’s health officials a new window into the city’s pressing overdose crisis.\u003c/p>\n\u003cp>The effort comes as San Francisco recently experienced the \u003ca href=\"https://www.kqed.org/news/11972898/2023-was-san-franciscos-deadliest-year-for-drug-overdoses-new-data-confirms\">worst year for overdose deaths\u003c/a> on record in 2023, when 806 people died of accidental overdose.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“For the first time, we have data that can shed light on the amounts of drugs that are being used in the city here,” said Jeffrey Hom, director of population behavioral health for the San Francisco Department of Public Health. “This is something that we haven’t had before. So much of the data that we look at within the health department is based on individuals who are receiving a certain service or who have experienced a certain outcome, like a nonfatal overdose.”\u003c/p>\n\u003cp>San Francisco health officials started tracking drug use and supply trends in November 2023 to monitor the presence of different drugs and to also check for changes in the illicit drug supply.\u003c/p>\n\u003cp>Wastewater samples are collected every two weeks from two different locations, one on the city’s west side and another on the east side. Currently, the city is checking for fentanyl, cocaine and methamphetamine, as well as all three substances in their metabolized form. The samples are then sent to a lab where they are analyzed, and the results are shared back with the city.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Early results from the first four months of testing show there were often higher concentrations of drugs, including fentanyl, cocaine and methamphetamine on the east side of the city compared with the west. That largely tracks with geographic data from the Office of the Chief Medical Examiner, which releases monthly reports on overdoses in the city.\u003c/p>\n\u003cp>Fentanyl, a potent opioid about 50 times stronger than heroin, has contributed to the majority of recent overdose deaths in San Francisco.\u003c/p>\n\u003cp>However, the wastewater data showed much higher concentrations of stimulants across the city. For example, there were 1552 milligrams of methamphetamine per 1000 people per day found in samples collected on the east side of the city on March 7, 2024, compared to 34 milligrams of fentanyl.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>That doesn’t necessarily mean there are more people using stimulants, however. The body metabolizes each substance differently, making it hard to compare the prevalence of individual substances. Instead, Hom said, the city is using the findings to monitor changes in the drug supply and use trends over time.\u003c/p>\n\u003cp>“We’re not able to directly compare those and make an assumption that many more people or that much more stimulants are being used because of the way these drugs are metabolized in the body. So trying to make the comparison between drugs is difficult,” Hom said.\u003c/p>\n\u003cp>Public health officials say they hope to use the data to advise the public on overdose risk and drug supply trends.\u003c/p>\n\u003cp>The effort is part of a study funded by the National Institute on Drug Abuse, which ends in August, that San Francisco and other local municipalities are participating in. But the city’s health officials say they hope to expand and continue the program after the study wraps up.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>San Francisco previously used wastewater testing during the COVID-19 pandemic to track the rise and fall of the virus on a population level. However, the city is not alone in its endeavor to use the technology for the overdose crisis as well. \u003ca href=\"https://www.kqed.org/science/1982720/marin-health-officials-track-illicit-drug-use-by-testing-wastewater\">Marin County\u003c/a> started using the approach in July 2023. Public health officials there issued a health advisory about an increase in fentanyl overdoses that aligned with the wastewater testing, which showed higher rates and amounts of fentanyl in the same period.\u003c/p>\n\u003cp>“Much of the potential for this kind of surveillance revolves around the opportunity to identify new drugs or something that’s just starting to make its way into the drug supply here,” Hom said. “I am hopeful as we look to the next iteration of this that we not only increase the frequency of testing, but increase the number of drugs and especially novel drugs so our response can be timely and focused.”\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "californias-low-income-families-face-barriers-to-in-home-therapy-for-infants-with-developmental-delays",
"title": "Why These California Families Aren't Receiving Vital Early Development Services",
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"content": "\u003cp>When the world shut down during the pandemic, Reyna Balladares decided to open her apartment in San Francisco’s Tenderloin neighborhood to a foster child.\u003c/p>\n\u003cp>A single mother of two grown daughters, Balladares heard from a social-worker friend about the challenges of finding a home for foster children and wanted to help.\u003c/p>\n\u003cp>Balladares took care of a baby boy for six months, and then in 2021, she got paired up with a newborn girl. As months went by, Balladares noticed she was slow to begin walking and talking.[pullquote size=\"medium\" align=\"right\" citation=\"Reyna Balladares, foster parent and San Francisco resident\"]‘They’re afraid to come to this community.’[/pullquote]A pediatrician recommended that the girl get physical, speech, occupational and feeding therapy to support her development. Balladares was referred to \u003ca href=\"https://www.dds.ca.gov/services/early-start/\">Early Start\u003c/a>, California’s early intervention program for infants and toddlers with developmental delays, which approved the treatments.\u003c/p>\n\u003cp>However, getting connected to certain therapists took months.\u003c/p>\n\u003cp>When Balladares asked a program coordinator about the long wait, she learned few therapists were willing to make house calls to her neighborhood, which has been at the center of the city’s homelessness and \u003ca href=\"https://www.kqed.org/news/11972898/2023-was-san-franciscos-deadliest-year-for-drug-overdoses-new-data-confirms\">drug crisis\u003c/a>.\u003c/p>\n\u003cp>“They’re afraid to come to this community,” she said.\u003c/p>\n\u003cp>And that kept the girl from getting the services she was entitled to receive.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California established Early Start in 1986 in response to a federal law guaranteeing early intervention services for children under 3, regardless of their families’ income levels. A network of nonprofit regional centers is responsible for determining a child’s eligibility for developmental support and arranging those services.\u003c/p>\n\u003cp>Getting services early on is crucial, \u003ca href=\"https://www.cdc.gov/ncbddd/actearly/whyActEarly.html\">experts say,\u003c/a> because babies’ brains are more adaptable during the first three years of life, and the intervention can head off the need for special education services later on.\u003c/p>\n\u003cp>The law also requires that children receive the services in their home, daycare or other “natural environments” as much as possible because young children learn best \u003ca href=\"https://www.pacer.org/ec/early-intervention/natural-environments.asp\">when they’re in familiar surroundings\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11977975\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11977975 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED.jpg\" alt=\"A collection of kids' toys sits on a beige and blue table beside a white wall.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A small table and chair with children’s toys in Reyna Balladares’ home in San Francisco on Feb. 26, 2024. \u003ccite>(Kathryn Styer-Martínez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Advocates tell KQED they see a growing divide between who gets quality services and who doesn’t.\u003c/p>\n\u003cp>“There’s vast inequities,” said Jennifer Albon, a pediatrician who treats children with high health care needs at UCSF Medical Center at Mount Zion.\u003c/p>\n\u003cp>She said several patients who live in the Tenderloin and other low-income districts like the Bayview did not receive at-home therapies because the Golden Gate Regional Center, which coordinates early intervention services in San Francisco, San Mateo and Marin counties, couldn’t find providers willing to see children there.[pullquote size=\"medium\" align=\"right\" citation=\"Jennifer Albon, pediatrician, UCSF Medical Center at Mount Zion\"]‘Families who are well-resourced and live in nicer areas, those are the only families who are getting that care in their natural environment, even though [they don’t have] the most need.’[/pullquote]“The regional center has flat-out told them and told us that there’s no providers who will go to your neighborhood,” she said. “Families who are well-resourced and live in nicer areas, those are the only families who are getting that care in their natural environment, even though [they don’t have] the most need.”\u003c/p>\n\u003cp>Child care centers in the Tenderloin are also impacted.\u003c/p>\n\u003cp>Heidi Lamar, director of Compass Children’s Center, said when she noticed a therapist had stopped showing up to work with a child, she reached out to a case manager at Golden Gate Regional Center or GGRC.\u003c/p>\n\u003cp>The case manager replied in an email message to Lamar: “The provider is not coming anymore because she was shoved onto the sidewalk by someone on the street while walking to Compass. She had previously been yelled at, cursed at, and followed by a man on a bicycle while walking to Compass on another occasion.”\u003c/p>\n\u003cp>The case manager acknowledged increased difficulty finding providers willing to go to the Tenderloin.[aside postID=news_11958841 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/08/230822-HOME-HEALTHCARE-WORKER-LM-KQED-1020x680.jpg']“We can’t compel therapists to provide services in situations where they don’t feel safe,” the case manager wrote. “We just keep our fingers crossed that the providers don’t drop the families entirely.”\u003c/p>\n\u003cp>The Tenderloin has long been plagued by drug dealing, homelessness and mental illness — conditions that residents and business owners say \u003ca href=\"https://www.sfchronicle.com/sf/article/tenderloin-little-saigon-homeless-18601130.php\">have worsened since the pandemic\u003c/a>, despite city efforts to increase safety in the area.\u003c/p>\n\u003cp>It’s also a refuge for thousands of lower-income and immigrant families who come seeking affordable housing and social support from organizations like Compass. Another child care center — Wu Yee Children’s Services — hires a “street usher” to escort kids to playgrounds in the neighborhood.\u003c/p>\n\u003cp>“I’m sure you’ve seen in the news our neighborhood is struggling. There were two daytime shootings outside our school building in the last few months,” Lamar said. “But this is where we work every day; this is where our children and our families live. We have to serve them. We have to find a way.”\u003c/p>\n\u003cp>Frustrated by the delay in services, Lamar hired a speech and language pathologist to work on-site with children who have difficulty communicating.\u003c/p>\n\u003cp>Another parent, Ashley Chac, said she waited nine months to get a GGRC coordinator to respond to her request for occupational and physical therapy for her 1 1/2-year-old daughter.[pullquote size=\"medium\" align=\"right\" citation=\"Heidi Lamar, director, Compass Children’s Center\"]‘ … This is where we work every day, this is where our children and our families live. We have to serve them. We have to find a way.’[/pullquote]Chac said she’s upset about missing early intervention during a stage when it can make the greatest impact on her daughter’s development.\u003c/p>\n\u003cp>“Time is of the essence for her,” Chac said. “I’m mad that we fell through the cracks.”\u003c/p>\n\u003cp>Eric Zigman, executive director of the GGRC, said he’s keenly aware of providers’ reluctance to serve certain neighborhoods and calls it a distressing situation. He said his hands are tied as long as the state pays providers less than the market rate for their services.\u003c/p>\n\u003cp>“Until those rates are changed, we can’t control every action of every provider,” Zigman said.\u003c/p>\n\u003cp>Inadequate funding and a shortage of providers have limited regional centers’ ability to improve access and delivery of Early Start services, according to \u003ca href=\"https://calbudgetcenter.org/resources/california-can-better-support-infants-toddlers-with-disabilities-or-developmental-delays/\">a 2022 analysis of the program by the California Budget & Policy Center\u003c/a>.\u003c/p>\n\u003cp>Early Start’s problems have raised enough of a concern that the federal Office of Special Education Programs deemed California “\u003ca href=\"https://sites.ed.gov/idea/idea-files/2023-spp-apr-and-state-determination-letters-part-c-california/\">needs assistance\u003c/a>” to improve outcomes for children who receive early intervention services.\u003c/p>\n\u003ch2>Pushing back against Zoom therapy\u003c/h2>\n\u003cp>Advocates say that a growing reliance on telehealth is also leading to substandard care.\u003c/p>\n\u003cp>California allowed remote delivery of early intervention services at the beginning of the pandemic to ensure children continued to receive care. But as the threat of COVID-19 subsided, advocates said the practice continued.\u003c/p>\n\u003cp>Intervening early and in the child’s home should be the “gold standard,” said Amy Westling, executive director of the Association of Regional Center Agencies. However, the regional centers have a hard time finding providers and paying them a competitive rate, she said.\u003c/p>\n\u003cp>“If the service can’t be provided in the natural environment or we can’t identify a provider to do so, we don’t want to say then, ‘We’re not going to offer some alternative,’” Westling said.\u003c/p>\n\u003cp>Left without choices, Balladares tried virtual therapy, but she couldn’t get her foster daughter to focus or respond to the therapist. She said children need to form relationships in person in order to learn.\u003c/p>\n\u003cp>“Nothing replaces a person-to-person relationship, especially for a child,” she said.[pullquote size=\"medium\" align=\"right\" citation=\"Amy Westling, executive director, Association of Regional Center Agencies\"]‘If the service can’t be provided in the natural environment or we can’t identify a provider to do so, we don’t want to say then, ‘We’re not going to offer some alternative.”[/pullquote]In the end, Balladares had to cut back her work hours to take the girl to multiple appointments at different clinics each week.\u003c/p>\n\u003cp>“Running with [her] from one place to another, sometimes trying to make two different appointments in one day … then rushing home to prepare our meals,” she said. “She was exhausted, and so was I.”\u003c/p>\n\u003cp>After two years of therapies, Balladares said, the toddler hasn’t made as much progress as she hoped. After turning 3 last month, she is no longer eligible to receive services under Early Start and will require more therapies through the San Francisco Unified School District.\u003c/p>\n\u003cp>Critics say some therapists or their agencies are exploiting a loophole in the law that allows telehealth services if the child’s parents or guardians agree to the arrangement.\u003c/p>\n\u003cp>“How people took advantage of that was they said to the parent, ‘We can see your child next week virtually, but if we see them in person, it will take several months,’” said Elaine Westlake, a physical therapist who has been demanding a clearer policy on the use of telehealth for Early Start services. “So, of course, the parent says, ‘Well, I guess virtual.’”\u003c/p>\n\u003cp>Westlake said she saw a growing problem when parents in the Tenderloin wondered why she was the only therapist making home visits while others offered their services remotely. She thinks providers are leaning on telehealth because it saves on travel time. What’s more, Medi-Cal pays the same amount whether services are delivered remotely or in person.[aside postID=news_11961256 hero='https://ww2.kqed.org/app/uploads/sites/10/2023/09/023_KQED_LaBombaPreschool_04202023-1020x680.jpg']“It’s plain economics because you can see one child after the other [via telehealth],” Westlake said.\u003c/p>\n\u003cp>Westlake said she is not compensated for the time she spends driving to a child’s home or daycare for each physical therapy appointment. She’s seen the positive impact of that effort. Two recent patients were born prematurely and spent months in neonatal intensive-care units.\u003c/p>\n\u003cp>“When they came home from the hospital, the parents were afraid to even move them,” Westlake said. Now, she said, both children are walking, running and climbing.\u003c/p>\n\u003cp>“That never would have happened if I had not seen them in person,” Westlake said.\u003c/p>\n\u003cp>New York’s health department recently \u003ca href=\"https://www.health.ny.gov/community/infants_children/early_intervention/docs/eip_telehealth_guidance_document.pdf\">issued guidance on using telehealth\u003c/a> after the state’s comptroller \u003ca href=\"https://www.health.ny.gov/community/infants_children/early_intervention/docs/eip_telehealth_guidance_document.pdf\">issued an audit\u003c/a> that found many eligible children didn’t receive early intervention services or faced delays. The guidance lays out scenarios where telehealth is allowed and requires that early intervention providers document how they delivered the services.\u003c/p>\n\u003cp>Lawmakers there are also considering a 5% increase in payments for in-person services and an extra 4% for serving hard-to-reach or underserved areas.\u003c/p>\n\u003cp>In Northern California, a pilot project funded by the American Rescue Plan aimed at boosting in-person therapies showed promising results, according to Lori Banales, executive director of Alta California Regional Center, which serves Sacramento and nine surrounding counties.\u003c/p>\n\u003cfigure id=\"attachment_11978893\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11978893 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Reyna Balladares and her 3-year-old foster child in San Francisco on March 9, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The project offered $200 incentives for therapies done in underserved areas, in languages other than English or during hours that would accommodate parents’ work schedules, Banales said. Furthermore, $10,000 internship grants also helped early intervention providers to hire more bilingual therapists.\u003c/p>\n\u003cp>“We know that this works. Money does talk,” she said.\u003c/p>\n\u003cp>While California has been gradually raising reimbursement rates for providers, Gov. Gavin Newsom wants to delay fully funding the increases to save $1 billion in the next budget year as he moves to close a $38 billion shortfall. That would hinder ongoing efforts to grow the workforce and could lead to longer waits for services, according to\u003ca href=\"https://lao.ca.gov/reports/2024/4837/DDS-Budget-021324.pdf\"> a report by the state Legislative Analyst’s Office\u003c/a>.[pullquote size=\"medium\" align=\"right\" citation=\"Lori Banales, executive director, Alta California Regional Center\"]‘The very rapid growth puts a lot of pressure on a system where there’s just not enough clinicians. So I think there’s a lot of work to be done to close some of those gaps at this point.’[/pullquote]Some recent policy changes included hiring more regional center coordinators to lower caseloads and expanding eligibility for Early Start services, which is expected to add 10% more children into a program currently serving 56,000 infants and toddlers.\u003c/p>\n\u003cp>Westling said that’s a lot of change all at once.\u003c/p>\n\u003cp>“The very rapid growth puts a lot of pressure on a system where there’s just not enough clinicians,” she said. “So, I think there’s a lot of work to be done to close some of those gaps at this point.”\u003c/p>\n\u003cp>Until reform takes hold, Westlake urges her fellow therapists to uphold their code of ethics and care for kids in their natural environments — just as they did before telehealth came along.\u003c/p>\n\u003cp>“We did it before, and we can certainly do it again,” she said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "In California, infants and toddlers with developmental delays qualify for in-home therapy through the Early Start program. Yet families in low-income neighborhoods, like the Tenderloin and the Bayview, face barriers as therapists refuse to provide services there, forcing parents to choose between inconvenient travel or remote therapy.",
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"title": "Why These California Families Aren't Receiving Vital Early Development Services | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When the world shut down during the pandemic, Reyna Balladares decided to open her apartment in San Francisco’s Tenderloin neighborhood to a foster child.\u003c/p>\n\u003cp>A single mother of two grown daughters, Balladares heard from a social-worker friend about the challenges of finding a home for foster children and wanted to help.\u003c/p>\n\u003cp>Balladares took care of a baby boy for six months, and then in 2021, she got paired up with a newborn girl. As months went by, Balladares noticed she was slow to begin walking and talking.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>A pediatrician recommended that the girl get physical, speech, occupational and feeding therapy to support her development. Balladares was referred to \u003ca href=\"https://www.dds.ca.gov/services/early-start/\">Early Start\u003c/a>, California’s early intervention program for infants and toddlers with developmental delays, which approved the treatments.\u003c/p>\n\u003cp>However, getting connected to certain therapists took months.\u003c/p>\n\u003cp>When Balladares asked a program coordinator about the long wait, she learned few therapists were willing to make house calls to her neighborhood, which has been at the center of the city’s homelessness and \u003ca href=\"https://www.kqed.org/news/11972898/2023-was-san-franciscos-deadliest-year-for-drug-overdoses-new-data-confirms\">drug crisis\u003c/a>.\u003c/p>\n\u003cp>“They’re afraid to come to this community,” she said.\u003c/p>\n\u003cp>And that kept the girl from getting the services she was entitled to receive.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California established Early Start in 1986 in response to a federal law guaranteeing early intervention services for children under 3, regardless of their families’ income levels. A network of nonprofit regional centers is responsible for determining a child’s eligibility for developmental support and arranging those services.\u003c/p>\n\u003cp>Getting services early on is crucial, \u003ca href=\"https://www.cdc.gov/ncbddd/actearly/whyActEarly.html\">experts say,\u003c/a> because babies’ brains are more adaptable during the first three years of life, and the intervention can head off the need for special education services later on.\u003c/p>\n\u003cp>The law also requires that children receive the services in their home, daycare or other “natural environments” as much as possible because young children learn best \u003ca href=\"https://www.pacer.org/ec/early-intervention/natural-environments.asp\">when they’re in familiar surroundings\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11977975\" class=\"wp-caption alignnone\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11977975 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED.jpg\" alt=\"A collection of kids' toys sits on a beige and blue table beside a white wall.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240301-EARLY-START-DEVELOPMENTAL-DELAYS-KSM-08-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A small table and chair with children’s toys in Reyna Balladares’ home in San Francisco on Feb. 26, 2024. \u003ccite>(Kathryn Styer-Martínez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Advocates tell KQED they see a growing divide between who gets quality services and who doesn’t.\u003c/p>\n\u003cp>“There’s vast inequities,” said Jennifer Albon, a pediatrician who treats children with high health care needs at UCSF Medical Center at Mount Zion.\u003c/p>\n\u003cp>She said several patients who live in the Tenderloin and other low-income districts like the Bayview did not receive at-home therapies because the Golden Gate Regional Center, which coordinates early intervention services in San Francisco, San Mateo and Marin counties, couldn’t find providers willing to see children there.\u003c/p>\u003c/div>",
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"content": "‘Families who are well-resourced and live in nicer areas, those are the only families who are getting that care in their natural environment, even though [they don’t have] the most need.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“The regional center has flat-out told them and told us that there’s no providers who will go to your neighborhood,” she said. “Families who are well-resourced and live in nicer areas, those are the only families who are getting that care in their natural environment, even though [they don’t have] the most need.”\u003c/p>\n\u003cp>Child care centers in the Tenderloin are also impacted.\u003c/p>\n\u003cp>Heidi Lamar, director of Compass Children’s Center, said when she noticed a therapist had stopped showing up to work with a child, she reached out to a case manager at Golden Gate Regional Center or GGRC.\u003c/p>\n\u003cp>The case manager replied in an email message to Lamar: “The provider is not coming anymore because she was shoved onto the sidewalk by someone on the street while walking to Compass. She had previously been yelled at, cursed at, and followed by a man on a bicycle while walking to Compass on another occasion.”\u003c/p>\n\u003cp>The case manager acknowledged increased difficulty finding providers willing to go to the Tenderloin.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“We can’t compel therapists to provide services in situations where they don’t feel safe,” the case manager wrote. “We just keep our fingers crossed that the providers don’t drop the families entirely.”\u003c/p>\n\u003cp>The Tenderloin has long been plagued by drug dealing, homelessness and mental illness — conditions that residents and business owners say \u003ca href=\"https://www.sfchronicle.com/sf/article/tenderloin-little-saigon-homeless-18601130.php\">have worsened since the pandemic\u003c/a>, despite city efforts to increase safety in the area.\u003c/p>\n\u003cp>It’s also a refuge for thousands of lower-income and immigrant families who come seeking affordable housing and social support from organizations like Compass. Another child care center — Wu Yee Children’s Services — hires a “street usher” to escort kids to playgrounds in the neighborhood.\u003c/p>\n\u003cp>“I’m sure you’ve seen in the news our neighborhood is struggling. There were two daytime shootings outside our school building in the last few months,” Lamar said. “But this is where we work every day; this is where our children and our families live. We have to serve them. We have to find a way.”\u003c/p>\n\u003cp>Frustrated by the delay in services, Lamar hired a speech and language pathologist to work on-site with children who have difficulty communicating.\u003c/p>\n\u003cp>Another parent, Ashley Chac, said she waited nine months to get a GGRC coordinator to respond to her request for occupational and physical therapy for her 1 1/2-year-old daughter.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Chac said she’s upset about missing early intervention during a stage when it can make the greatest impact on her daughter’s development.\u003c/p>\n\u003cp>“Time is of the essence for her,” Chac said. “I’m mad that we fell through the cracks.”\u003c/p>\n\u003cp>Eric Zigman, executive director of the GGRC, said he’s keenly aware of providers’ reluctance to serve certain neighborhoods and calls it a distressing situation. He said his hands are tied as long as the state pays providers less than the market rate for their services.\u003c/p>\n\u003cp>“Until those rates are changed, we can’t control every action of every provider,” Zigman said.\u003c/p>\n\u003cp>Inadequate funding and a shortage of providers have limited regional centers’ ability to improve access and delivery of Early Start services, according to \u003ca href=\"https://calbudgetcenter.org/resources/california-can-better-support-infants-toddlers-with-disabilities-or-developmental-delays/\">a 2022 analysis of the program by the California Budget & Policy Center\u003c/a>.\u003c/p>\n\u003cp>Early Start’s problems have raised enough of a concern that the federal Office of Special Education Programs deemed California “\u003ca href=\"https://sites.ed.gov/idea/idea-files/2023-spp-apr-and-state-determination-letters-part-c-california/\">needs assistance\u003c/a>” to improve outcomes for children who receive early intervention services.\u003c/p>\n\u003ch2>Pushing back against Zoom therapy\u003c/h2>\n\u003cp>Advocates say that a growing reliance on telehealth is also leading to substandard care.\u003c/p>\n\u003cp>California allowed remote delivery of early intervention services at the beginning of the pandemic to ensure children continued to receive care. But as the threat of COVID-19 subsided, advocates said the practice continued.\u003c/p>\n\u003cp>Intervening early and in the child’s home should be the “gold standard,” said Amy Westling, executive director of the Association of Regional Center Agencies. However, the regional centers have a hard time finding providers and paying them a competitive rate, she said.\u003c/p>\n\u003cp>“If the service can’t be provided in the natural environment or we can’t identify a provider to do so, we don’t want to say then, ‘We’re not going to offer some alternative,’” Westling said.\u003c/p>\n\u003cp>Left without choices, Balladares tried virtual therapy, but she couldn’t get her foster daughter to focus or respond to the therapist. She said children need to form relationships in person in order to learn.\u003c/p>\n\u003cp>“Nothing replaces a person-to-person relationship, especially for a child,” she said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In the end, Balladares had to cut back her work hours to take the girl to multiple appointments at different clinics each week.\u003c/p>\n\u003cp>“Running with [her] from one place to another, sometimes trying to make two different appointments in one day … then rushing home to prepare our meals,” she said. “She was exhausted, and so was I.”\u003c/p>\n\u003cp>After two years of therapies, Balladares said, the toddler hasn’t made as much progress as she hoped. After turning 3 last month, she is no longer eligible to receive services under Early Start and will require more therapies through the San Francisco Unified School District.\u003c/p>\n\u003cp>Critics say some therapists or their agencies are exploiting a loophole in the law that allows telehealth services if the child’s parents or guardians agree to the arrangement.\u003c/p>\n\u003cp>“How people took advantage of that was they said to the parent, ‘We can see your child next week virtually, but if we see them in person, it will take several months,’” said Elaine Westlake, a physical therapist who has been demanding a clearer policy on the use of telehealth for Early Start services. “So, of course, the parent says, ‘Well, I guess virtual.’”\u003c/p>\n\u003cp>Westlake said she saw a growing problem when parents in the Tenderloin wondered why she was the only therapist making home visits while others offered their services remotely. She thinks providers are leaning on telehealth because it saves on travel time. What’s more, Medi-Cal pays the same amount whether services are delivered remotely or in person.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“It’s plain economics because you can see one child after the other [via telehealth],” Westlake said.\u003c/p>\n\u003cp>Westlake said she is not compensated for the time she spends driving to a child’s home or daycare for each physical therapy appointment. She’s seen the positive impact of that effort. Two recent patients were born prematurely and spent months in neonatal intensive-care units.\u003c/p>\n\u003cp>“When they came home from the hospital, the parents were afraid to even move them,” Westlake said. Now, she said, both children are walking, running and climbing.\u003c/p>\n\u003cp>“That never would have happened if I had not seen them in person,” Westlake said.\u003c/p>\n\u003cp>New York’s health department recently \u003ca href=\"https://www.health.ny.gov/community/infants_children/early_intervention/docs/eip_telehealth_guidance_document.pdf\">issued guidance on using telehealth\u003c/a> after the state’s comptroller \u003ca href=\"https://www.health.ny.gov/community/infants_children/early_intervention/docs/eip_telehealth_guidance_document.pdf\">issued an audit\u003c/a> that found many eligible children didn’t receive early intervention services or faced delays. The guidance lays out scenarios where telehealth is allowed and requires that early intervention providers document how they delivered the services.\u003c/p>\n\u003cp>Lawmakers there are also considering a 5% increase in payments for in-person services and an extra 4% for serving hard-to-reach or underserved areas.\u003c/p>\n\u003cp>In Northern California, a pilot project funded by the American Rescue Plan aimed at boosting in-person therapies showed promising results, according to Lori Banales, executive director of Alta California Regional Center, which serves Sacramento and nine surrounding counties.\u003c/p>\n\u003cfigure id=\"attachment_11978893\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11978893 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2024/03/240309-EARLY-START-DEVELOPMENTAL-DELAYS-MD-01-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Reyna Balladares and her 3-year-old foster child in San Francisco on March 9, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The project offered $200 incentives for therapies done in underserved areas, in languages other than English or during hours that would accommodate parents’ work schedules, Banales said. Furthermore, $10,000 internship grants also helped early intervention providers to hire more bilingual therapists.\u003c/p>\n\u003cp>“We know that this works. Money does talk,” she said.\u003c/p>\n\u003cp>While California has been gradually raising reimbursement rates for providers, Gov. Gavin Newsom wants to delay fully funding the increases to save $1 billion in the next budget year as he moves to close a $38 billion shortfall. That would hinder ongoing efforts to grow the workforce and could lead to longer waits for services, according to\u003ca href=\"https://lao.ca.gov/reports/2024/4837/DDS-Budget-021324.pdf\"> a report by the state Legislative Analyst’s Office\u003c/a>.\u003c/p>\u003c/div>",
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"content": "‘The very rapid growth puts a lot of pressure on a system where there’s just not enough clinicians. So I think there’s a lot of work to be done to close some of those gaps at this point.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Some recent policy changes included hiring more regional center coordinators to lower caseloads and expanding eligibility for Early Start services, which is expected to add 10% more children into a program currently serving 56,000 infants and toddlers.\u003c/p>\n\u003cp>Westling said that’s a lot of change all at once.\u003c/p>\n\u003cp>“The very rapid growth puts a lot of pressure on a system where there’s just not enough clinicians,” she said. “So, I think there’s a lot of work to be done to close some of those gaps at this point.”\u003c/p>\n\u003cp>Until reform takes hold, Westlake urges her fellow therapists to uphold their code of ethics and care for kids in their natural environments — just as they did before telehealth came along.\u003c/p>\n\u003cp>“We did it before, and we can certainly do it again,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The rate of overdose deaths in San Francisco remained steady in the first two months of 2024, according to data released Monday from the Office of the Chief Medical Examiner.\u003c/p>\n\u003cp>The new data shows there were 131 overdose deaths in San Francisco between January and February of this year. That’s compared to 136 overdose deaths over the same period a year ago. There were 811 overdose deaths in San Francisco in all of 2023.\u003c/p>\n\u003cp>Most of these overdoses involved fentanyl, an opioid about 50 times stronger than heroin. But many people who die from an overdose in the city are combining substances with fentanyl, like methamphetamine or cocaine.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Hillary Kunins, director, Behavioral Health and Mental Health SF\"]‘We want everyone to know, even though addiction is a chronic illness, recovery is possible.’[/pullquote]In response, city health officials say they are expanding opportunities for contingency management, a positive-reinforcement-based model that’s primarily used for adjusting methamphetamine and cocaine use.\u003c/p>\n\u003cp>“Recovering from stimulants improves an individual’s health and reduces their overall risk of overdose,” Christy Soran, deputy medical director of substance use services for the Department of Public Health, told reporters on Tuesday.\u003c/p>\n\u003cp>Unlike opioid addiction or alcoholism, there are no government-approved medications for stimulant-use disorder. Contingency management offers another option. People participating typically attend weekly or regular meetings with a group and counselor, and they take a drug test for the substance they are targeting. If the test is negative, a small stipend, such as a gift card, is offered.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Percent of overdoses in Jan. – Feb. 2024 involving at least this drug\n\" aria-label=\"Bar Chart\" id=\"datawrapper-chart-df81A\" src=\"https://datawrapper.dwcdn.net/df81A/3/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"600\" height=\"321\" data-external=\"1\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768930/\">Veterans Affairs\u003c/a> has used contingency management for decades. A \u003ca href=\"https://www.sciencedirect.com/science/article/abs/pii/S0376871618300784\">2018 study\u003c/a> found that, on average, VA patients attended more than half of their counseling sessions, and 91% of participants tested negative for the targeted substance.\u003c/p>\n\u003cp>[aside postID=\"news_11965813,news_11972898,news_11967618\" label=\"Related Stories\"]San Francisco’s embrace of contingency management is not new. But its expansion comes alongside statewide efforts to grow access to the model.\u003c/p>\n\u003cp>In 2021, California became the first state to cover contingency management through Medi-Cal.\u003c/p>\n\u003cp>The state has also allocated $58.5 million to pilot contingency management programs in \u003ca href=\"https://www.dhcs.ca.gov/Pages/DMC-ODS-Contingency-Management.aspx\">nearly two dozen other California counties\u003c/a>. In those programs, each patient receives a maximum of $599 over six months, after which they are referred for follow-up recovery programs and services.\u003c/p>\n\u003cp>Locally, the San Francisco Department of Public Health provides contingency management at the \u003ca href=\"https://citywide.ucsf.edu/stimulant-treatment-outpatient-program-stop\">Citywide Clinic’s Stimulant Treatment Outpatient Program\u003c/a>, the \u003ca href=\"https://psych.ucsf.edu/news/office-based-buprenorphine-induction-clinics-work-highlighted-national-magazine\">Office-Based Buprenorphine Induction Clinic\u003c/a> and \u003ca href=\"https://sf.gov/reports/october-2022/overdose-prevention-plan-2022\">Project HOUDINI LINK\u003c/a>. The San Francisco AIDS Foundation and others also provide similar programs.\u003c/p>\n\u003cp>Meanwhile, San Francisco has been working to increase opioid addiction treatments like buprenorphine or methadone medications as overdose deaths have remained at epidemic levels.\u003c/p>\n\u003cp>“These medications, specifically buprenorphine and methadone, each reduce a person’s risk of dying by approximately 50%,” Hillary Kunins, director of Behavioral Health and Mental Health SF for the San Francisco Department of Public Health, said on Tuesday to reporters. “I really cannot understate the effectiveness of these medications. They save lives, and they are within every person’s reach.”\u003c/p>\n\u003cp>Buprenorphine is available across the San Francisco Health Network, including in primary care and hospital settings.\u003c/p>\n\u003cp>“We want everyone to know, even though addiction is a chronic illness, recovery is possible,” Kunins said. “There is a way out of addiction and into a healthier life.”\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>In response, city health officials say they are expanding opportunities for contingency management, a positive-reinforcement-based model that’s primarily used for adjusting methamphetamine and cocaine use.\u003c/p>\n\u003cp>“Recovering from stimulants improves an individual’s health and reduces their overall risk of overdose,” Christy Soran, deputy medical director of substance use services for the Department of Public Health, told reporters on Tuesday.\u003c/p>\n\u003cp>Unlike opioid addiction or alcoholism, there are no government-approved medications for stimulant-use disorder. Contingency management offers another option. People participating typically attend weekly or regular meetings with a group and counselor, and they take a drug test for the substance they are targeting. If the test is negative, a small stipend, such as a gift card, is offered.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Percent of overdoses in Jan. – Feb. 2024 involving at least this drug\n\" aria-label=\"Bar Chart\" id=\"datawrapper-chart-df81A\" src=\"https://datawrapper.dwcdn.net/df81A/3/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"600\" height=\"321\" data-external=\"1\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768930/\">Veterans Affairs\u003c/a> has used contingency management for decades. A \u003ca href=\"https://www.sciencedirect.com/science/article/abs/pii/S0376871618300784\">2018 study\u003c/a> found that, on average, VA patients attended more than half of their counseling sessions, and 91% of participants tested negative for the targeted substance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>San Francisco’s embrace of contingency management is not new. But its expansion comes alongside statewide efforts to grow access to the model.\u003c/p>\n\u003cp>In 2021, California became the first state to cover contingency management through Medi-Cal.\u003c/p>\n\u003cp>The state has also allocated $58.5 million to pilot contingency management programs in \u003ca href=\"https://www.dhcs.ca.gov/Pages/DMC-ODS-Contingency-Management.aspx\">nearly two dozen other California counties\u003c/a>. In those programs, each patient receives a maximum of $599 over six months, after which they are referred for follow-up recovery programs and services.\u003c/p>\n\u003cp>Locally, the San Francisco Department of Public Health provides contingency management at the \u003ca href=\"https://citywide.ucsf.edu/stimulant-treatment-outpatient-program-stop\">Citywide Clinic’s Stimulant Treatment Outpatient Program\u003c/a>, the \u003ca href=\"https://psych.ucsf.edu/news/office-based-buprenorphine-induction-clinics-work-highlighted-national-magazine\">Office-Based Buprenorphine Induction Clinic\u003c/a> and \u003ca href=\"https://sf.gov/reports/october-2022/overdose-prevention-plan-2022\">Project HOUDINI LINK\u003c/a>. The San Francisco AIDS Foundation and others also provide similar programs.\u003c/p>\n\u003cp>Meanwhile, San Francisco has been working to increase opioid addiction treatments like buprenorphine or methadone medications as overdose deaths have remained at epidemic levels.\u003c/p>\n\u003cp>“These medications, specifically buprenorphine and methadone, each reduce a person’s risk of dying by approximately 50%,” Hillary Kunins, director of Behavioral Health and Mental Health SF for the San Francisco Department of Public Health, said on Tuesday to reporters. “I really cannot understate the effectiveness of these medications. They save lives, and they are within every person’s reach.”\u003c/p>\n\u003cp>Buprenorphine is available across the San Francisco Health Network, including in primary care and hospital settings.\u003c/p>\n\u003cp>“We want everyone to know, even though addiction is a chronic illness, recovery is possible,” Kunins said. “There is a way out of addiction and into a healthier life.”\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>\u003ca href=\"https://www.kqed.org/liveblog/election-2024\">\u003cstrong>Primary Election 2024 Live Updates: Follow KQED reporters as we cover election results from across California and the Bay Area.\u003c/strong>\u003c/a>\u003c/em>\u003c/p>\n\u003cp>California voters on Tuesday appear to be supportive of Proposition 1, a landmark reform to the state’s mental health funding and a top priority for Gov. Gavin Newsom.\u003c/p>\n\u003cp>At last count, 53% of voters supported the measure, which will fund new treatment facilities and earmark existing mental health funding for housing. That’s with about 38% of votes tallied. It passes with a majority vote.\u003c/p>\n\u003cp>Newsom crafted Proposition 1 to focus on a specific subset of Californians experiencing homelessness: those with severe mental health or substance abuse challenges. The governor called it the last piece of his reforms to programs at the intersection of homelessness and behavioral health — following the creation of a civil court system that allows judges to order people into treatment and housing for residents with severe mental illness, and a subsequent expansion of the state’s conservatorship law.\u003c/p>\n\u003cp>Proposition 1 included a $6.38 billion bond to fund the construction of residential care facilities and supportive housing — including apartments with wrap-around services dedicated for veterans. It also would changed the Mental Health Services Act, approved by voters in 2004, by shifting money from California counties and mental health service providers toward the construction of housing and care facilities. It also would expanded the class of people who are eligible under the act to include Californians with substance abuse issues who don’t have a mental health diagnosis.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Supporters said the measure will finally provide the stable shelter for unhoused Californians with mental illness that disappeared when the state closed its controversial mental health hospitals in the 1960s and 1970s. A \u003ca href=\"https://www.kqed.org/forum/2010101893673/what-ucsfs-statewide-homelessness-study-found-out-about-the-causes-of-californias-crisis\">statewide survey of Californians experiencing homelessness\u003c/a> published last year by UCSF found 27% of participants had been hospitalized for a mental health condition.\u003c/p>\n\u003cp>But the measure faced opposition from fiscal conservatives over the size of the bond. Meanwhile, mental health service providers feared the new emphasis on housing would lead to less funding for less visible programs, such as peer support groups or drop-in counseling. And civil liberties advocates worried that too many of the new treatment facilities would be restrictive, locked beds.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Big donors across the state poured $21.6 million into the Yes on Prop 1 campaign, including Uber, the Federated Indians of Graton Rancheria, Kaiser Permanente and influential groups representing correctional officers and hospitals. Their shared interest? A desire to build facilities for Californians who often end up in emergency rooms and correctional facilities — and just as likely, a chance to contribute to a political victory for the governor.\u003c/p>\n\n",
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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"possible": {
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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},
"rightnowish": {
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"title": "Rightnowish",
"tagline": "Art is where you find it",
"info": "Rightnowish digs into life in the Bay Area right now… ish. Journalist Pendarvis Harshaw takes us to galleries painted on the sides of liquor stores in West Oakland. We'll dance in warehouses in the Bayview, make smoothies with kids in South Berkeley, and listen to classical music in a 1984 Cutlass Supreme in Richmond. Every week, Pen talks to movers and shakers about how the Bay Area shapes what they create, and how they shape the place we call home.",
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"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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