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"content": "\u003cp>\u003cstrong>Update, 5:30 p.m. Sunday:\u003c/strong> Santa Clara County officials are warning that the upcoming holiday season is expected to coincide with a spike in COVID-19, nearly as severe as the omicron surge last year. The county moved into the high-risk designation over the weekend, prompting the federal Centers for Disease Control and Prevention to recommend people wear high-quality masks in public spaces. Dr. Sara Cody, the county’s health officer, says levels of the virus in San José’s sewer system — which draws from three quarters of the county’s population — are already at about 84% of the omicron peak.\u003c/p>\n\u003cp>“We not only have COVID as we’ve had the last two winters, but we have flu and RSV and other viruses circulating as well,” said Cody. “So it’s like a winter of viral soup. There’s a ton of virus circulating and if you want to be healthy for the holidays, you need to take action and you need to do it now.”\u003c/p>\n\u003cp>RSV refers to respiratory syncytial virus, a respiratory infection common in childhood, that can potentially cause pneumonia and other serious lung ailments. Cody said the flu and RSV seasons also began early this year, though RSV is beginning to plateau.\u003c/p>\n\u003cp>\u003cstrong>Original story, 5:30 p.m. Friday:\u003c/strong> More stringent masking rules have been reinstated for certain high-risk settings in Alameda, Contra Costa and Napa counties to protect against the spread of COVID-19, health officials said Friday.\u003c/p>\n\u003cp>Universal masking is now required for staff and residents in homeless shelters, emergency shelters and cooling and heating centers. It’s also now required in county correctional and detention centers.\u003c/p>\n\u003cp>Per \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx\">state guidance\u003c/a>, masking in these settings becomes required after the level of community spread of COVID-19, as defined by the federal Centers for Disease Control and Prevention, shifts from low to medium. Alameda and Contra Costa county officials said community spread moved from low to medium on Thursday, and that they will require high-risk settings to abide by the state’s guidance. Napa County officials on Friday said they also now are at medium, and will likewise require masking per state guidance.\u003c/p>\n\u003cp>Masking continues to be required in health care and long-term care facilities.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Joanna Locke, COVID guidance lead, Alameda County Public Health Department\"]‘I don’t think we anticipate getting up to the peak of last winter, but I definitely don’t think we’ve peaked.’[/pullquote]\u003c/p>\n\u003cp>“We moved into medium [level] because we reached over 10 new COVID hospital admissions per 100,000 persons,” said Joanna Locke, COVID guidance lead for Alameda County’s public health department, on Friday. As of Thursday, 149 county residents were hospitalized with COVID-19, she said.\u003c/p>\n\u003cp>“Right now we’re averaging a little over 20 cases per day per 100,000,” said Locke. “The peak of our spring-summer wave was around 50, and our winter peak last year was obviously much higher … I don’t think we anticipate getting up to the peak of last winter, but I definitely don’t think we’ve peaked.”\u003c/p>\n\u003cp>Locke said with the high level of winter respiratory viruses circulating in addition to COVID-19, she thinks everyone should consider wearing a mask in indoor public settings.\u003c/p>\n\u003cp>“I definitely am masking up now when I go into the grocery store. I took a little break earlier in the year and now I’m sending my kids back to school in masks. Really, we all have these masks in our house now and I think [we’re] shifting our culture to the way that some other countries have been for a long time where, when there’s high levels of any virus, you put on your mask.”\u003c/p>\n\u003cp>Alameda County Health Officer Dr. Nicholas Moss reaffirmed the importance of masking as numbers continue to rise in Alameda and Contra Costa.\u003c/p>\n\u003cp>“We have observed worsening increases in COVID-19 case reports and hospitalizations since October,” Moss said in a statement. “Taking actions like masking and staying home when sick can prevent spreading illnesses like COVID-19, flu, and RSV and help protect our health care system from strain.”\u003c/p>\n\u003cp>Solano County also is now at the medium level of community spread, according to the CDC, but the county has not indicated whether it’s reinstating masking rules in those high-risk settings where it’s required by state guidelines. A message to the county’s public health administrator was not returned.\u003c/p>\n\u003cp>\u003cem>This story includes reporting from Bay City News.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We moved into medium [level] because we reached over 10 new COVID hospital admissions per 100,000 persons,” said Joanna Locke, COVID guidance lead for Alameda County’s public health department, on Friday. As of Thursday, 149 county residents were hospitalized with COVID-19, she said.\u003c/p>\n\u003cp>“Right now we’re averaging a little over 20 cases per day per 100,000,” said Locke. “The peak of our spring-summer wave was around 50, and our winter peak last year was obviously much higher … I don’t think we anticipate getting up to the peak of last winter, but I definitely don’t think we’ve peaked.”\u003c/p>\n\u003cp>Locke said with the high level of winter respiratory viruses circulating in addition to COVID-19, she thinks everyone should consider wearing a mask in indoor public settings.\u003c/p>\n\u003cp>“I definitely am masking up now when I go into the grocery store. I took a little break earlier in the year and now I’m sending my kids back to school in masks. Really, we all have these masks in our house now and I think [we’re] shifting our culture to the way that some other countries have been for a long time where, when there’s high levels of any virus, you put on your mask.”\u003c/p>\n\u003cp>Alameda County Health Officer Dr. Nicholas Moss reaffirmed the importance of masking as numbers continue to rise in Alameda and Contra Costa.\u003c/p>\n\u003cp>“We have observed worsening increases in COVID-19 case reports and hospitalizations since October,” Moss said in a statement. “Taking actions like masking and staying home when sick can prevent spreading illnesses like COVID-19, flu, and RSV and help protect our health care system from strain.”\u003c/p>\n\u003cp>Solano County also is now at the medium level of community spread, according to the CDC, but the county has not indicated whether it’s reinstating masking rules in those high-risk settings where it’s required by state guidelines. A message to the county’s public health administrator was not returned.\u003c/p>\n\u003cp>\u003cem>This story includes reporting from Bay City News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "'Heartbroken': Visitors, Staff of Shuttered Tenderloin Center Left Reeling Amid SF's Ongoing Overdose Crisis",
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"content": "\u003cp>\u003cb>Update, 2:10 p.m. Monday:\u003c/b> With the recent closing of the Tenderloin Center, local officials have expressed support for opening overdose prevention programs in the city.\u003cb>\u003c/b>\u003c/p>\n\u003cp>“The city attorney has been clear that he would support a nonprofit moving forward with New York’s model of overdose prevention programs, which the U.S. Department of Justice has not taken action on,” said Jen Kwart, spokesperson for San Francisco City Attorney David Chiu. “Under New York’s model, the sites are not operated on city property, with city staff, or with city funding for that use. We continue to await guidance from the U.S. Department of Justice on how local jurisdictions can operate overdose prevention programs consistent with federal law.”\u003c/p>\n\u003cp>According to officials in Mayor London Breed’s office, she is waiting for the Department of Justice to provide legal guidelines on opening an overdose prevention program and defers to the city attorney’s office on legal questions around these sites.\u003c/p>\n\u003cp>“The Tenderloin Emergency Initiative has helped us move forward a lot of positive efforts and outcomes, like deploying Urban Alchemy ambassadors to help stabilize many blocks in the neighborhood, helping hundreds of people into shelter and housing, and preventing overdoses that have saved countless lives,” according to a statement from Breed’s office. “The Tenderloin Center has supported this work, and it has provided a respite from the street for many, helped prevent many overdoses, and connected people to services. We tried something new, knowing there will be successes and lessons learned, and an opportunity to build and grow from there.”\u003c/p>\n\u003cp>Former staffers of the Tenderloin Center shared their concerns about the closure and the impact it could have on people seeking harm-reduction services.\u003cb>\u003c/b>\u003c/p>\n\u003cp>“We refer people to other organizations … that provide similar services. But the main attraction, possibly the most important service, I would say that we provided isn’t happening anywhere, which is safe consumption,” said staffer Bill Buehlman. “We revived people almost every day. I think the most amount of people reversals on one shift that I supervised was six overdose reversals.”\u003c/p>\n\u003cp>Cleo Jenkins, manager of HealthRight 360’s program at the Tenderloin Center, was saddened by the closure.\u003c/p>\n\u003cp>“You don’t feel the impact of the closure until you actually see it come to the end. It’s horrible. It’s despicable,” said Jenkins.\u003c/p>\n\u003cp>\u003cb>Original \u003c/b>\u003cb>story\u003c/b>\u003cb>, 3:09 p.m. Friday: \u003c/b>On Sunday, Dec. 4, the day the Tenderloin Center closed, Vitka Eisen saw people she hadn’t seen in months. Visitors who had come to the site when it first opened in January stopped by to deliver thank-you cards, or give social workers updates on their housing situation.\u003c/p>\n\u003cp>“It was really poignant,” said Eisen, president and CEO of HealthRight 360, one of several nonprofits that provided housing and drug treatment services at the walk-in facility, the city’s only supervised drug-consumption site, located in United Nations Plaza.\u003c/p>\n\u003cp>Eisen noted that many of the regulars she spoke to said they were disappointed but not surprised.[pullquote align=\"right\" size=\"medium\" citation=\"Sarah Shortt, director of public policy and community organizing, HomeRise\"]‘People have come to depend on the kind of care that they have been receiving, and without it … they will become unhealthy [and] they will literally die.’[/pullquote]“People talked about their experiences there. There was also sadness and anger, and a sense of resignation because … the experience of life [for unhoused people] is to be so marginalized and not seen as people,” she said, of those who paid tribute this weekend. “So I think it was kind of like, ‘Yeah, this is happening to us again.'”\u003c/p>\n\u003cp>Opened as part of Mayor London Breed’s \u003ca href=\"https://www.kqed.org/news/11899726/sf-mayor-breed-declares-state-of-emergency-in-tenderloin\">emergency declaration\u003c/a> to tackle the high rate of \u003ca href=\"https://www.kqed.org/news/11896375/the-difference-between-life-and-death-how-some-california-emergency-rooms-are-working-to-stem-the-overdose-crisis\">overdose deaths\u003c/a>, crime and homelessness in the beleaguered Tenderloin neighborhood, the center has provided showers, meals, housing referrals and — most controversially — drug-consumption services to an average of 400 people every day over the last 11 months, according to Dr. Hillary Kunins, director of behavioral health services at the San Francisco Department of Public Health. Workers at the center have used the medication naloxone to reverse more than 300 opioid overdoses this year, she said.\u003c/p>\n\u003cp>The center, Kunins said, was always intended as a temporary site. But it also proved costly to operate — to the tune of about\u003ca href=\"https://sfstandard.com/public-health/city-funded-survey-says-the-tenderloin-center-improved-the-neighborhood-others-arent-convinced/\"> $22 million\u003c/a> — and faced considerable criticism that likely hastened its closure.\u003c/p>\n\u003cp>Despite a city-funded report showing that \u003ca href=\"https://sfstandard.com/public-health/city-funded-survey-says-the-tenderloin-center-improved-the-neighborhood-others-arent-convinced/\">neighborhood conditions around the site had improved since the center opened\u003c/a>, some nearby businesses complained that it resulted in long lines of people on the street waiting for services and intensified drug use and dealing in the immediate vicinity.\u003c/p>\n\u003cp>The center also became the target of critics of safe consumption sites, who said it had failed to get many visitors into\u003ca href=\"https://www.kqed.org/news/11909484/new-tenderloin-site-highlights-challenge-of-connecting-people-to-drug-treatment-and-housing-services\"> longer-term treatment\u003c/a> and, in some cases, had even encouraged more drug use.\u003c/p>\n\u003cp>In moving to close the center, Mayor London Breed largely agreed with the criticism. Last week, she told \u003cem>The San Francisco Chronicle\u003c/em> that it “was designed as place to try and meet people where they are, but get them into some sort of help, some sort of support, and that wasn’t really happening in the way that it should have been happening, and that was part of the problem.”\u003c/p>\n\u003cp>With the site now shuttered, the city plans to increase police presence in the public plaza and limit open hours in an effort to “address harmful behaviors,” \u003ca href=\"https://www.sfexaminer.com/lifestyles/health/un-plaza-to-close-early-after-tenderloin-center-closes/article_ea291aba-767a-11ed-9602-67d3ba350761.html\">\u003ci>The San Francisco Examiner\u003c/i> reported Friday\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11910653\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11910653 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\" alt=\"A sandwich board sign on the street that says 'Tenderloin Linkage Center Entrance'\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">People wait in line to get into the Tenderloin Center in San Francisco on Feb. 8, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But harm-reduction advocates argue that the center provided essential services to a population in desperate need of help, and warn that its closure will have dire consequences. Among the likely impacts, they say, will be a spike in unsupervised drug use on the streets, where the risk of overdose is significantly higher.\u003c/p>\n\u003cp>“People have come to depend on the kind of care that they have been receiving, and without it … they will become unhealthy [and] they will literally die,” said Sarah Shortt, director of public policy and community organizing at HomeRise, a supportive housing nonprofit that helped run the center. She said the city has a responsibility to immediately provide replacement services in the neighborhood.\u003c/p>\n\u003cp>In 2021, \u003ca href=\"https://sf.gov/sites/default/files/2022-08/2021_OCME%20Overdose%20Report_1.pdf\">641 people in San Francisco were known to have died from accidental drug overdoses (PDF)\u003c/a>, a slight decline from the previous year, according to data from the San Francisco Medical Examiner’s Office. Of those deaths, 128 — roughly 20% — occurred in the Tenderloin, more than in any other neighborhood in the city. This year, overdose deaths have largely kept pace, with 501 recorded in the city from January through October, \u003ca href=\"https://sf.gov/sites/default/files/2022-11/2022%2011_OCME%20Overdose%20Report.pdf\">102 of them in the Tenderloin (PDF)\u003c/a>.[aside label=\"Related Stories\" postID=\"news_11909484,news_11915870,news_11904277\"]A transitional team is \u003ca href=\"https://sf.gov/information/tenderloin-center\">scheduled to offer support services outside the closed center through Dec. 11\u003c/a>, according to the city’s closure announcement. In the 48 hours after the center closed, Eisen said the team had already reversed three overdoses in the plaza.\u003c/p>\n\u003cp>Breed has said the city expects to open at least one new center in a different location, but specific details have yet to be announced.\u003c/p>\n\u003cp>“We are seeking sites for future centers,” said Kunins, of SFDPH. “Space can be difficult to identify that is appropriate for such a center. Additionally, we know that we need to work with community members and communities to make sure it is sited in an appropriate way and works to extend and complement already existing services in any given neighborhood. So we are eagerly and aggressively continuing to work on that.”\u003c/p>\n\u003cp>But advocates say that even if the city does open another center in the coming months, the gap in services will be detrimental.\u003c/p>\n\u003cp>“I’m incredibly proud of the work we did at the TLC, and I’m also heartbroken,” said Eisen, adding that until two or three weeks ago, she had maintained hope that the city would open another location before closing this one. She also emphasized that the center was designed as an outdoor pop-up site, which could be easily and quickly replicated at a new location.\u003c/p>\n\u003cp>“I don’t understand why you would close a program that was doing a number of things that were necessary, one of which was preventing overdose deaths, and two, moving people who were using drugs on the street or in public spaces into less public spaces,” Eisen said. “If it was effective, why would you close one without opening another?”\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cb>Update, 2:10 p.m. Monday:\u003c/b> With the recent closing of the Tenderloin Center, local officials have expressed support for opening overdose prevention programs in the city.\u003cb>\u003c/b>\u003c/p>\n\u003cp>“The city attorney has been clear that he would support a nonprofit moving forward with New York’s model of overdose prevention programs, which the U.S. Department of Justice has not taken action on,” said Jen Kwart, spokesperson for San Francisco City Attorney David Chiu. “Under New York’s model, the sites are not operated on city property, with city staff, or with city funding for that use. We continue to await guidance from the U.S. Department of Justice on how local jurisdictions can operate overdose prevention programs consistent with federal law.”\u003c/p>\n\u003cp>According to officials in Mayor London Breed’s office, she is waiting for the Department of Justice to provide legal guidelines on opening an overdose prevention program and defers to the city attorney’s office on legal questions around these sites.\u003c/p>\n\u003cp>“The Tenderloin Emergency Initiative has helped us move forward a lot of positive efforts and outcomes, like deploying Urban Alchemy ambassadors to help stabilize many blocks in the neighborhood, helping hundreds of people into shelter and housing, and preventing overdoses that have saved countless lives,” according to a statement from Breed’s office. “The Tenderloin Center has supported this work, and it has provided a respite from the street for many, helped prevent many overdoses, and connected people to services. We tried something new, knowing there will be successes and lessons learned, and an opportunity to build and grow from there.”\u003c/p>\n\u003cp>Former staffers of the Tenderloin Center shared their concerns about the closure and the impact it could have on people seeking harm-reduction services.\u003cb>\u003c/b>\u003c/p>\n\u003cp>“We refer people to other organizations … that provide similar services. But the main attraction, possibly the most important service, I would say that we provided isn’t happening anywhere, which is safe consumption,” said staffer Bill Buehlman. “We revived people almost every day. I think the most amount of people reversals on one shift that I supervised was six overdose reversals.”\u003c/p>\n\u003cp>Cleo Jenkins, manager of HealthRight 360’s program at the Tenderloin Center, was saddened by the closure.\u003c/p>\n\u003cp>“You don’t feel the impact of the closure until you actually see it come to the end. It’s horrible. It’s despicable,” said Jenkins.\u003c/p>\n\u003cp>\u003cb>Original \u003c/b>\u003cb>story\u003c/b>\u003cb>, 3:09 p.m. Friday: \u003c/b>On Sunday, Dec. 4, the day the Tenderloin Center closed, Vitka Eisen saw people she hadn’t seen in months. Visitors who had come to the site when it first opened in January stopped by to deliver thank-you cards, or give social workers updates on their housing situation.\u003c/p>\n\u003cp>“It was really poignant,” said Eisen, president and CEO of HealthRight 360, one of several nonprofits that provided housing and drug treatment services at the walk-in facility, the city’s only supervised drug-consumption site, located in United Nations Plaza.\u003c/p>\n\u003cp>Eisen noted that many of the regulars she spoke to said they were disappointed but not surprised.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“People talked about their experiences there. There was also sadness and anger, and a sense of resignation because … the experience of life [for unhoused people] is to be so marginalized and not seen as people,” she said, of those who paid tribute this weekend. “So I think it was kind of like, ‘Yeah, this is happening to us again.'”\u003c/p>\n\u003cp>Opened as part of Mayor London Breed’s \u003ca href=\"https://www.kqed.org/news/11899726/sf-mayor-breed-declares-state-of-emergency-in-tenderloin\">emergency declaration\u003c/a> to tackle the high rate of \u003ca href=\"https://www.kqed.org/news/11896375/the-difference-between-life-and-death-how-some-california-emergency-rooms-are-working-to-stem-the-overdose-crisis\">overdose deaths\u003c/a>, crime and homelessness in the beleaguered Tenderloin neighborhood, the center has provided showers, meals, housing referrals and — most controversially — drug-consumption services to an average of 400 people every day over the last 11 months, according to Dr. Hillary Kunins, director of behavioral health services at the San Francisco Department of Public Health. Workers at the center have used the medication naloxone to reverse more than 300 opioid overdoses this year, she said.\u003c/p>\n\u003cp>The center, Kunins said, was always intended as a temporary site. But it also proved costly to operate — to the tune of about\u003ca href=\"https://sfstandard.com/public-health/city-funded-survey-says-the-tenderloin-center-improved-the-neighborhood-others-arent-convinced/\"> $22 million\u003c/a> — and faced considerable criticism that likely hastened its closure.\u003c/p>\n\u003cp>Despite a city-funded report showing that \u003ca href=\"https://sfstandard.com/public-health/city-funded-survey-says-the-tenderloin-center-improved-the-neighborhood-others-arent-convinced/\">neighborhood conditions around the site had improved since the center opened\u003c/a>, some nearby businesses complained that it resulted in long lines of people on the street waiting for services and intensified drug use and dealing in the immediate vicinity.\u003c/p>\n\u003cp>The center also became the target of critics of safe consumption sites, who said it had failed to get many visitors into\u003ca href=\"https://www.kqed.org/news/11909484/new-tenderloin-site-highlights-challenge-of-connecting-people-to-drug-treatment-and-housing-services\"> longer-term treatment\u003c/a> and, in some cases, had even encouraged more drug use.\u003c/p>\n\u003cp>In moving to close the center, Mayor London Breed largely agreed with the criticism. Last week, she told \u003cem>The San Francisco Chronicle\u003c/em> that it “was designed as place to try and meet people where they are, but get them into some sort of help, some sort of support, and that wasn’t really happening in the way that it should have been happening, and that was part of the problem.”\u003c/p>\n\u003cp>With the site now shuttered, the city plans to increase police presence in the public plaza and limit open hours in an effort to “address harmful behaviors,” \u003ca href=\"https://www.sfexaminer.com/lifestyles/health/un-plaza-to-close-early-after-tenderloin-center-closes/article_ea291aba-767a-11ed-9602-67d3ba350761.html\">\u003ci>The San Francisco Examiner\u003c/i> reported Friday\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11910653\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11910653 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg\" alt=\"A sandwich board sign on the street that says 'Tenderloin Linkage Center Entrance'\" width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/04/RS53605_010_SanFrancisco_TLLinkageCenter_02082022-qut-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">People wait in line to get into the Tenderloin Center in San Francisco on Feb. 8, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But harm-reduction advocates argue that the center provided essential services to a population in desperate need of help, and warn that its closure will have dire consequences. Among the likely impacts, they say, will be a spike in unsupervised drug use on the streets, where the risk of overdose is significantly higher.\u003c/p>\n\u003cp>“People have come to depend on the kind of care that they have been receiving, and without it … they will become unhealthy [and] they will literally die,” said Sarah Shortt, director of public policy and community organizing at HomeRise, a supportive housing nonprofit that helped run the center. She said the city has a responsibility to immediately provide replacement services in the neighborhood.\u003c/p>\n\u003cp>In 2021, \u003ca href=\"https://sf.gov/sites/default/files/2022-08/2021_OCME%20Overdose%20Report_1.pdf\">641 people in San Francisco were known to have died from accidental drug overdoses (PDF)\u003c/a>, a slight decline from the previous year, according to data from the San Francisco Medical Examiner’s Office. Of those deaths, 128 — roughly 20% — occurred in the Tenderloin, more than in any other neighborhood in the city. This year, overdose deaths have largely kept pace, with 501 recorded in the city from January through October, \u003ca href=\"https://sf.gov/sites/default/files/2022-11/2022%2011_OCME%20Overdose%20Report.pdf\">102 of them in the Tenderloin (PDF)\u003c/a>.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>A transitional team is \u003ca href=\"https://sf.gov/information/tenderloin-center\">scheduled to offer support services outside the closed center through Dec. 11\u003c/a>, according to the city’s closure announcement. In the 48 hours after the center closed, Eisen said the team had already reversed three overdoses in the plaza.\u003c/p>\n\u003cp>Breed has said the city expects to open at least one new center in a different location, but specific details have yet to be announced.\u003c/p>\n\u003cp>“We are seeking sites for future centers,” said Kunins, of SFDPH. “Space can be difficult to identify that is appropriate for such a center. Additionally, we know that we need to work with community members and communities to make sure it is sited in an appropriate way and works to extend and complement already existing services in any given neighborhood. So we are eagerly and aggressively continuing to work on that.”\u003c/p>\n\u003cp>But advocates say that even if the city does open another center in the coming months, the gap in services will be detrimental.\u003c/p>\n\u003cp>“I’m incredibly proud of the work we did at the TLC, and I’m also heartbroken,” said Eisen, adding that until two or three weeks ago, she had maintained hope that the city would open another location before closing this one. She also emphasized that the center was designed as an outdoor pop-up site, which could be easily and quickly replicated at a new location.\u003c/p>\n\u003cp>“I don’t understand why you would close a program that was doing a number of things that were necessary, one of which was preventing overdose deaths, and two, moving people who were using drugs on the street or in public spaces into less public spaces,” Eisen said. “If it was effective, why would you close one without opening another?”\u003cbr>\n\u003c/p>\u003c/div>",
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"slug": "how-street-medicine-teams-are-tackling-the-unhoused-health-care-crisis",
"title": "How Street Medicine Teams Are Tackling the Unhoused Health Care Crisis",
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"content": "\u003cp>Living on the streets of California is a deadly affair. The\u003ca href=\"https://www.researchgate.net/profile/David-Turbow/publication/336130686_Principal_Component_Analysis_of_Morbidity_and_Mortality_among_the_United_States_Homeless_Population_A_Systematic_Review_and_Meta-Analysis/links/5d913ac9299bf10cff1a0b50/Principal-Component-Analysis-of-Morbidity-and-Mortality-among-the-United-States-Homeless-Population-A-Systematic-Review-and-Meta-Analysis.pdf\"> life expectancy of an unsheltered person is 50\u003c/a>, according to national estimates, nearly 30 years less than that of the average Californian. As \u003ca href=\"https://calmatters.org/housing/2022/10/california-homeless-crisis-latinos/\">homelessness spirals out of control\u003c/a> throughout the state, so too do \u003ca href=\"https://www.nytimes.com/2022/04/18/us/homeless-deaths-los-angeles.html\">deaths on the street\u003c/a>, but it’s those whose lives are the most fragile who are least likely to get medical care.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Brett Feldman, physician assistant\"]‘They have Medi-Cal. They’re eligible for all these benefits, but they can’t access these benefits.’[/pullquote]Now, the state Medi-Cal agency is endeavoring to improve health care access for people experiencing homelessness. Through a series of incentives and regulatory changes, the Health Care Services Department is encouraging Medi-Cal insurers to fund and partner with organizations that bring primary care into encampments.\u003c/p>\n\u003cp>They’re known as street medicine teams. There are at least 25 in California.\u003c/p>\n\u003cp>“Oh, crap. This is where she was, and they just swept that,” said Brett Feldman on a Friday morning in November, looking at a green tent, crumpled and abandoned on Skid Row in Los Angeles. Feldman, a physician assistant, is searching for a female patient in her 40s with severe and unmanaged asthma. She cycles predictably in and out of the hospital, and Feldman knows she’s due for another hospitalization soon.\u003c/p>\n\u003cfigure id=\"attachment_11934632\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934632\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-800x526.png\" alt=\"A man wearing a black t-shirt and gray pants leans over to look at a tent on the street.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-1020x670.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-1536x1009.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM.png 1540w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physician assistant Brett Feldman asks a man in his encampment if he has seen a patient along Skid Row in Los Angeles on Nov. 18, 2022. The patient was likely pushed out of the area as the Los Angeles sanitation department cleared the unhoused to clean the street near Skid Row. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The road is streaked with water from a cleaning truck, and sanitation workers in fluorescent vests sweep up debris. Parking enforcement and police cruisers line the section of road where a homeless encampment once stood. Nearly 5,000 people live in the half-mile block infamous for the hypervisibility it affords the state’s unrelenting homelessness crisis.[aside postID=\"news_11932895,news_11927968\" label=\"Related Posts\"]Burdened by disproportionate rates of \u003ca href=\"https://escholarship.org/uc/item/44c5j3qz\">substance use disorders, mental health disorders and chronic disease\u003c/a>, people experiencing homelessness are some of the state’s neediest patients, but few receive anything more than emergency services. Barriers like lack of transportation and cumbersome insurance rules keep most from getting regular health care. Instead, they drift through the emergency room during a crisis, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">racking up high costs to the system (PDF)\u003c/a> and deteriorating physically in the interim.\u003c/p>\n\u003cp>Delivering health care this way is costly and not particularly effective for the patient or the system. \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">More than half of the state’s $133 billion Medi-Cal budget is spent on the top 5% of high-needs users (PDF)\u003c/a>, according to the California Department of Health Care Services.\u003c/p>\n\u003cp>“Where we have been falling short, especially with this population, is their reality is so different from ours that we haven’t been building reality-based systems for them,” Feldman said. “They have Medi-Cal. They’re eligible for all these benefits, but they can’t access these benefits.”\u003c/p>\n\u003cp>The state’s efforts to bridge the gap between eligibility and access is supported in part through \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">CalAIM\u003c/a>, a multiyear plan to revamp the state’s lower-income health insurance program. Grants to hire staff or invest in billing or data collection software offer some stability to teams that have historically been volunteer- or charity-operated. The department also issued a rule change in November \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-023.pdf\">allowing street medicine teams to tap into and manage unhoused patients’ Medi-Cal benefits (PDF)\u003c/a>, meaning providers can be reimbursed for their work.\u003c/p>\n\u003cp>“One of our core principles of CalAIM is breaking down the walls of health care and meeting people where they are,” said Jacey Cooper, director of the state’s Medi-Cal program. “We really feel like street medicine helps us do that.”\u003c/p>\n\u003ch2>What is street medicine?\u003c/h2>\n\u003cp>Several months ago, Feldman’s Skid Row patient suffered a brain injury from lack of oxygen during an asthma attack. She’s now confined to a wheelchair and reliant on a friend for basic needs like finding food and using the toilet.\u003c/p>\n\u003cp>Newer asthma medications might be able to help end her hospitalization cycle, but until recently only her assigned primary care doctor, whom she has never seen, was allowed to refer her to a specialist for assessment under Byzantine Medi-Cal rules. Feldman had been trying to get her a primary care appointment for more than a year, to no avail.\u003c/p>\n\u003cp>Under the new rules, however, Feldman could have referred the asthmatic patient directly to the lung specialist she needed or gotten prior authorization for the medication since it was recommended during a hospital stay. Instead, without adequate medical care to address her condition, her life has been irrevocably altered.\u003c/p>\n\u003cp>Statistically, she’ll be lucky to live longer than a few more years.\u003c/p>\n\u003cp>“She used to be a staple down here. She knew everybody,” Feldman said. “Now, she can’t walk, is confined to her tent. She’s lonely because she’s used to being part of the Skid Row community. She had a very full life despite being unhoused.”\u003c/p>\n\u003cp>Feldman, co-founder and director of the street medicine program at the University of Southern California’s Keck School of Medicine, said the goal of street medicine is to give some autonomy back to people who usually have very little power left in their lives.\u003c/p>\n\u003cfigure id=\"attachment_11934633\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934633\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-800x515.png\" alt=\"A man wearing a black t-shirt uses a stethoscope on a woman's arm in a tent.\" width=\"800\" height=\"515\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-800x515.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-1020x657.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-160x103.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-1536x989.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM.png 1538w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physician assistant Brett Feldman checks Carla Bolen’s blood pressure while she sits in her encampment at the Figueroa St. Viaduct above Highway 110 in Elysian Valley Park on Nov. 18, 2022. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Each day he and a team of providers scour the county streets diagnosing chronic and acute conditions, treating mental illness and substance use, delivering medicine, drawing blood for tests and following up with patients who request a visit. Community health workers hand out food and hygiene supplies and help them navigate hurdles as they try to obtain housing and social services.\u003c/p>\n\u003cp>“We know that people who are experiencing homelessness have higher mortality, have higher ER utilization, have higher length of stay when they get admitted,” Cooper said. “We really see this as part of a comprehensive approach to ensuring that we have a true continuum of care for people experiencing homelessness.”\u003c/p>\n\u003cp>The traditional health care system thrives off efficiency: The more patients move through an office, the more the provider gets paid, resulting in brief appointments and little sympathy for circumstances that make patients late. But that setup doesn’t work for unsheltered people who run the risk of getting their belongings stolen if they leave their camp — or who would rather find something to eat than take care of what may seem like a minor malady.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220AB369\">Less than 30% of unhoused people with Medi-Cal have ever seen their primary care provider\u003c/a>, according to a state legislative analysis of a street medicine bill vetoed by Gov. Gavin Newsom in 2021. The measure passed the Legislature with broad support but was opposed by the state Health Care Services Department for potential duplication of services. In the \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2021/10/AB-369-1082021.pdf\">veto (PDF)\u003c/a>, Newsom directed the department to work with street medicine teams to fill any gaps left by CalAIM; one such gap was adjusting billing codes that prevented street medicine reimbursement.\u003c/p>\n\u003cp>“When you’re focused on those very basic needs, like food, safety, shelter, how are you then able to focus on, you know, managing your diabetes or your blood pressure or some of these risk factors that can lead to more serious downstream effects?” said Dr. Kyle Patton, medical director of the street medicine program at Shasta Community Health Center in Redding.\u003c/p>\n\u003cp>On a Monday in September, Patton and Anna Cummings, a case worker, trekked through a wooded area on the north edge of town to meet Amber Schmitt, 47, a patient with an infected leg. The ground is muddy from a storm the night before. Schmitt is paying a friend $700 a month to stay in his apartment, but hidden among the trees and rolling hills is her abandoned encampment, along with dozens of others. Schmitt gets $1,000 a month from Social Security, but it’s not enough to afford a security deposit or rent in the area, she said.\u003c/p>\n\u003cfigure id=\"attachment_11934634\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934634\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-800x531.png\" alt=\"A man wearing a dark shirt, sunglasses and jeans looks down at an object in his hands while a woman wearing a black hooded sweatshirt and pants has her bandaged right leg propped up on the trunk of a car.\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-800x531.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-1020x677.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-160x106.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-1536x1020.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM.png 1542w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Kyle Patton prescribes Amber Schmitt with medication to treat the wound on her leg in the back of his truck on Sept. 19, 2022. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The gash on Schmitt’s right shin is mottled and inflamed. She said she scraped it on a fallen branch. Patton cleaned and dressed it for her previously, but she had no choice but to reuse bandages after running out. Now she can barely walk from the pain.\u003c/p>\n\u003cp>“This is a silver-based dressing, which will kill bacteria in wounds,” Patton tells Schmitt after rinsing the area with a saline wash. “We’ll get you some more dressing, too. And then you’ve got some skin breakdown and maceration between your toes. I don’t like the look of that.”\u003c/p>\n\u003cp>He gives her a fungal cream and a bottle of antibiotics. Schmitt is a leukemia survivor and has had a hip replacement on the same injured leg. Her medical history makes her prone to infections and poor circulation in her extremities, Patton said.\u003c/p>\n\u003cp>“There’s people that would maybe make the argument that … they have health insurance here in California, they should just utilize the system as-is. The reality is because of certain factors within the context of their homelessness, they’re not able to do that,” Patton said.\u003c/p>\n\u003cp>Although they qualify for comprehensive health coverage under Medi-Cal, the program wasn’t necessarily designed with unhoused people in mind. For example, Medi-Cal will pay for transportation to and from a doctor’s appointment, but it requires the patient to provide a fixed address and give several week’s notice to the driver, something most people experiencing homelessness aren’t able to arrange.\u003c/p>\n\u003ch2 id=\"h-link-between-homelessness-and-health\">Link between homelessness and health\u003c/h2>\n\u003cp>Health data on unhoused people is sparse, with no state agency and only a handful of counties tracking the information, but it’s clear that most of their deaths are preventable.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.achch.org/uploads/7/2/5/4/72547769/2018-2020_ac_homeless_mortality_report_final_4.11.2022.pdf\">Alameda (PDF) \u003c/a>and \u003ca href=\"https://nhchc.org/wp-content/uploads/2022/10/Mortality-in-PEH-Marin-Co-10-22.pdf\">Marin (PDF)\u003c/a> counties, half result from acute or chronic health conditions like cardiovascular disease, cancer or respiratory failure. In Orange County, these make up a quarter of deaths among the unhoused. In Los Angeles County, heart disease is the second-leading cause of death among people experiencing homelessness, second only to overdoses.\u003c/p>\n\u003cp>Even overdose deaths are considered preventable — yet in San Francisco, overdoses cause 82% of deaths among the unsheltered.\u003c/p>\n\u003cp>“We commonly see conditions that you would see in a typical population, but they’re just not addressed. So, out-of-control high blood pressure, uncontrolled diabetes … also substance use in terms of opioids, we see a whole lot more than in the general population,” said Dr. Absalon Galat, medical director for LA County’s Department of Health Services’ Housing for Health division.\u003c/p>\n\u003cp>Galat’s team started its foray into street medicine in an effort to dole out COVID-19 vaccines, but team members quickly found they needed to do more. The county used COVID-19 relief funds to purchase mobile clinics, and CalAIM funding has helped them hire 60 staff members.\u003c/p>\n\u003cfigure id=\"attachment_11934635\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934635\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-800x526.png\" alt=\"A man with a black Raiders hat and gray shirt sits down in a medical facility.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-1020x671.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM.png 1058w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Patient Isaac Pierce gets a checkup in the Los Angeles County Department of Health Services’ mobile clinic parked in Whittier Narrows Park on Nov. 17, 2022. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In September, the county’s \u003ca href=\"https://www.latimes.com/california/story/2022-10-13/la-county-mobile-medical-clinic\">fleet of mobile clinics,\u003c/a> complete with fully outfitted exam rooms, began visiting areas where services are sparse. Smaller teams of clinicians and case workers roam encampments to follow up with patients, treat minor issues and bring patients to the mobile clinic. There’s some disagreement among street medicine providers about whether mobile clinics remove enough barriers because they still require patients to travel to a set location, but Galat said his goal is to improve access, whether it’s by wheel or foot.\u003c/p>\n\u003cp>“People are dying every day,” Galat said. “So we have to try with what we know best in the medical field right now to limit people who are dying.”\u003c/p>\n\u003cfigure id=\"attachment_11934636\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934636\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-800x526.png\" alt=\"A light blue medical truck with several photos of people and a medical logo on the side with a ramp and stairs leading inside.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-1020x670.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM.png 1056w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Los Angeles County Department of Health Services’ mobile clinic parked in Whittier Narrows Park to see unhoused patients on Nov. 17, 2022. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The connection between homelessness and health is inextricable, said Dr. Michelle Schneidermann, director of the People-Centered Care team at the California Health Care Foundation, a statewide health policy think tank.\u003c/p>\n\u003cp>“Either one can lead to the other. A catastrophic health incident or a series of conditions can lead to someone not being able to work, leading to poverty,” Schneidermann said. “We see this all the time, health conditions precipitating homelessness, and the other way around.”\u003c/p>\n\u003cp>Take Danny Doran, 56, who visited LA County’s mobile clinic at Whittier Narrows Park on a recent Thursday to pick up insulin. He spent his career as a plumber and owned a home in Bishop. Three years ago he fell into a diabetic coma and was hospitalized for months. A friend Doran trusted to pay his bills while he was hospitalized emptied his bank account and disappeared — Doran has been unhoused ever since. Several weeks ago he was beaten and robbed by another unhoused man, who left him with a fracture in his skull and a tremor in his hands.\u003c/p>\n\u003cp>“I guess I’m a little bit naive,” Doran said. “We’re all humans and we’re prone to mistakes, you know? So I hate for anyone to have their money stolen like mine was and end up like me on the streets.”\u003c/p>\n\u003cp>At the mobile clinic, Doran said the doctor on staff agreed to be his primary care physician. His previous primary care doctor stopped accepting Medi-Cal insurance, and Doran hasn’t had regular access to insulin ever since.\u003c/p>\n\u003cp>“The doc here, she truly has compassion for her patients. I’m glad our paths crossed,” Doran said.\u003c/p>\n\u003cfigure id=\"attachment_11934637\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934637\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-800x523.png\" alt=\"A man wearing black hat, camouflage scarf and black jacket outside near a truck with a medical logo.\" width=\"800\" height=\"523\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-800x523.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-1020x666.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-1536x1003.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM.png 1546w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Unhoused patient Danny Doran sits in the waiting area for the mobile clinic parked in Whittier Narrows Park on Nov. 17, 2022. Doran is being checked after being assaulted near his encampment just a few days before. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Schneidermann, who is overseeing a study on street medicine programs across California, said CalAIM, which also pays for housing services, is an opportunity for the state to address its most pernicious problem.\u003c/p>\n\u003cp>“Until we can end our crisis of homelessness … we have to find a way to deliver care for people on the streets,” Schneidermann said.\u003c/p>\n\u003ch2>New programs popping up\u003c/h2>\n\u003cp>Prior to CalAIM and the Health Care Services Department’s rule changes, street medicine programs operated outside of traditional health care, funded by philanthropies or the rare health organization willing to lose money. Now, the department’s changes offer some hope for stability, Feldman said.\u003c/p>\n\u003cp>Noting that these programs were birthed out of the pandemic, Feldman said they “might not exist in a few years if they’re not supported, but they have all these patients that rely on them.”\u003c/p>\n\u003cp>A year ago only 25 programs existed across the state, primarily concentrated in urban areas, Feldman said. But ever since CalAIM launched at the beginning of 2022, he’s run into more organizations looking to begin services. CalAIM requires Medi-Cal insurers to coordinate patients’ physical, behavioral, dental and developmental care as well as social services — something many street medicine teams already do. The goal is to make the “system hustle behind the scenes rather than making the patient hustle,” California Health Care Foundations’ Schneidermann said.\u003c/p>\n\u003cp>One such program is run by Anthony Menacho in Sacramento. Unlike USC, Shasta Community Health or LA County’s teams that are staffed full-time, Menacho’s street medicine band is composed entirely of volunteers. They visit six camps every other weekend.\u003c/p>\n\u003cp>The work was funded initially by a $100,000 grant from Health Net, the largest Medi-Cal provider in the state, but Menacho, who trained as a physician assistant with Feldman at USC, wants to be able to do the work full-time and hire more clinicians. He’s working to secure money through CalAIM and the Department of Health Care Services.\u003c/p>\n\u003cp>“We don’t have the academic resources or people behind us to be able to put in a department or infrastructure on the drop of the dime,” Menacho said. “We run on grants, but that’s not true sustainability. We can’t do it ourselves. It has to be a coordinated effort and I think that’s what CalAIM is trying to do.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Unhoused people often have sporadic or no access to health care, resulting in costly, chronic conditions. A new statewide effort encourages Medi-Cal insurers to partner with street teams to improve care.",
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"title": "How Street Medicine Teams Are Tackling the Unhoused Health Care Crisis | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Living on the streets of California is a deadly affair. The\u003ca href=\"https://www.researchgate.net/profile/David-Turbow/publication/336130686_Principal_Component_Analysis_of_Morbidity_and_Mortality_among_the_United_States_Homeless_Population_A_Systematic_Review_and_Meta-Analysis/links/5d913ac9299bf10cff1a0b50/Principal-Component-Analysis-of-Morbidity-and-Mortality-among-the-United-States-Homeless-Population-A-Systematic-Review-and-Meta-Analysis.pdf\"> life expectancy of an unsheltered person is 50\u003c/a>, according to national estimates, nearly 30 years less than that of the average Californian. As \u003ca href=\"https://calmatters.org/housing/2022/10/california-homeless-crisis-latinos/\">homelessness spirals out of control\u003c/a> throughout the state, so too do \u003ca href=\"https://www.nytimes.com/2022/04/18/us/homeless-deaths-los-angeles.html\">deaths on the street\u003c/a>, but it’s those whose lives are the most fragile who are least likely to get medical care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘They have Medi-Cal. They’re eligible for all these benefits, but they can’t access these benefits.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Now, the state Medi-Cal agency is endeavoring to improve health care access for people experiencing homelessness. Through a series of incentives and regulatory changes, the Health Care Services Department is encouraging Medi-Cal insurers to fund and partner with organizations that bring primary care into encampments.\u003c/p>\n\u003cp>They’re known as street medicine teams. There are at least 25 in California.\u003c/p>\n\u003cp>“Oh, crap. This is where she was, and they just swept that,” said Brett Feldman on a Friday morning in November, looking at a green tent, crumpled and abandoned on Skid Row in Los Angeles. Feldman, a physician assistant, is searching for a female patient in her 40s with severe and unmanaged asthma. She cycles predictably in and out of the hospital, and Feldman knows she’s due for another hospitalization soon.\u003c/p>\n\u003cfigure id=\"attachment_11934632\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934632\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-800x526.png\" alt=\"A man wearing a black t-shirt and gray pants leans over to look at a tent on the street.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-1020x670.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM-1536x1009.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.25-PM.png 1540w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physician assistant Brett Feldman asks a man in his encampment if he has seen a patient along Skid Row in Los Angeles on Nov. 18, 2022. The patient was likely pushed out of the area as the Los Angeles sanitation department cleared the unhoused to clean the street near Skid Row. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The road is streaked with water from a cleaning truck, and sanitation workers in fluorescent vests sweep up debris. Parking enforcement and police cruisers line the section of road where a homeless encampment once stood. Nearly 5,000 people live in the half-mile block infamous for the hypervisibility it affords the state’s unrelenting homelessness crisis.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Burdened by disproportionate rates of \u003ca href=\"https://escholarship.org/uc/item/44c5j3qz\">substance use disorders, mental health disorders and chronic disease\u003c/a>, people experiencing homelessness are some of the state’s neediest patients, but few receive anything more than emergency services. Barriers like lack of transportation and cumbersome insurance rules keep most from getting regular health care. Instead, they drift through the emergency room during a crisis, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">racking up high costs to the system (PDF)\u003c/a> and deteriorating physically in the interim.\u003c/p>\n\u003cp>Delivering health care this way is costly and not particularly effective for the patient or the system. \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">More than half of the state’s $133 billion Medi-Cal budget is spent on the top 5% of high-needs users (PDF)\u003c/a>, according to the California Department of Health Care Services.\u003c/p>\n\u003cp>“Where we have been falling short, especially with this population, is their reality is so different from ours that we haven’t been building reality-based systems for them,” Feldman said. “They have Medi-Cal. They’re eligible for all these benefits, but they can’t access these benefits.”\u003c/p>\n\u003cp>The state’s efforts to bridge the gap between eligibility and access is supported in part through \u003ca href=\"https://calmatters.org/health/2022/02/california-medi-cal-reform/\">CalAIM\u003c/a>, a multiyear plan to revamp the state’s lower-income health insurance program. Grants to hire staff or invest in billing or data collection software offer some stability to teams that have historically been volunteer- or charity-operated. The department also issued a rule change in November \u003ca href=\"https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-023.pdf\">allowing street medicine teams to tap into and manage unhoused patients’ Medi-Cal benefits (PDF)\u003c/a>, meaning providers can be reimbursed for their work.\u003c/p>\n\u003cp>“One of our core principles of CalAIM is breaking down the walls of health care and meeting people where they are,” said Jacey Cooper, director of the state’s Medi-Cal program. “We really feel like street medicine helps us do that.”\u003c/p>\n\u003ch2>What is street medicine?\u003c/h2>\n\u003cp>Several months ago, Feldman’s Skid Row patient suffered a brain injury from lack of oxygen during an asthma attack. She’s now confined to a wheelchair and reliant on a friend for basic needs like finding food and using the toilet.\u003c/p>\n\u003cp>Newer asthma medications might be able to help end her hospitalization cycle, but until recently only her assigned primary care doctor, whom she has never seen, was allowed to refer her to a specialist for assessment under Byzantine Medi-Cal rules. Feldman had been trying to get her a primary care appointment for more than a year, to no avail.\u003c/p>\n\u003cp>Under the new rules, however, Feldman could have referred the asthmatic patient directly to the lung specialist she needed or gotten prior authorization for the medication since it was recommended during a hospital stay. Instead, without adequate medical care to address her condition, her life has been irrevocably altered.\u003c/p>\n\u003cp>Statistically, she’ll be lucky to live longer than a few more years.\u003c/p>\n\u003cp>“She used to be a staple down here. She knew everybody,” Feldman said. “Now, she can’t walk, is confined to her tent. She’s lonely because she’s used to being part of the Skid Row community. She had a very full life despite being unhoused.”\u003c/p>\n\u003cp>Feldman, co-founder and director of the street medicine program at the University of Southern California’s Keck School of Medicine, said the goal of street medicine is to give some autonomy back to people who usually have very little power left in their lives.\u003c/p>\n\u003cfigure id=\"attachment_11934633\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934633\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-800x515.png\" alt=\"A man wearing a black t-shirt uses a stethoscope on a woman's arm in a tent.\" width=\"800\" height=\"515\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-800x515.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-1020x657.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-160x103.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM-1536x989.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.35-PM.png 1538w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physician assistant Brett Feldman checks Carla Bolen’s blood pressure while she sits in her encampment at the Figueroa St. Viaduct above Highway 110 in Elysian Valley Park on Nov. 18, 2022. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Each day he and a team of providers scour the county streets diagnosing chronic and acute conditions, treating mental illness and substance use, delivering medicine, drawing blood for tests and following up with patients who request a visit. Community health workers hand out food and hygiene supplies and help them navigate hurdles as they try to obtain housing and social services.\u003c/p>\n\u003cp>“We know that people who are experiencing homelessness have higher mortality, have higher ER utilization, have higher length of stay when they get admitted,” Cooper said. “We really see this as part of a comprehensive approach to ensuring that we have a true continuum of care for people experiencing homelessness.”\u003c/p>\n\u003cp>The traditional health care system thrives off efficiency: The more patients move through an office, the more the provider gets paid, resulting in brief appointments and little sympathy for circumstances that make patients late. But that setup doesn’t work for unsheltered people who run the risk of getting their belongings stolen if they leave their camp — or who would rather find something to eat than take care of what may seem like a minor malady.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220AB369\">Less than 30% of unhoused people with Medi-Cal have ever seen their primary care provider\u003c/a>, according to a state legislative analysis of a street medicine bill vetoed by Gov. Gavin Newsom in 2021. The measure passed the Legislature with broad support but was opposed by the state Health Care Services Department for potential duplication of services. In the \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2021/10/AB-369-1082021.pdf\">veto (PDF)\u003c/a>, Newsom directed the department to work with street medicine teams to fill any gaps left by CalAIM; one such gap was adjusting billing codes that prevented street medicine reimbursement.\u003c/p>\n\u003cp>“When you’re focused on those very basic needs, like food, safety, shelter, how are you then able to focus on, you know, managing your diabetes or your blood pressure or some of these risk factors that can lead to more serious downstream effects?” said Dr. Kyle Patton, medical director of the street medicine program at Shasta Community Health Center in Redding.\u003c/p>\n\u003cp>On a Monday in September, Patton and Anna Cummings, a case worker, trekked through a wooded area on the north edge of town to meet Amber Schmitt, 47, a patient with an infected leg. The ground is muddy from a storm the night before. Schmitt is paying a friend $700 a month to stay in his apartment, but hidden among the trees and rolling hills is her abandoned encampment, along with dozens of others. Schmitt gets $1,000 a month from Social Security, but it’s not enough to afford a security deposit or rent in the area, she said.\u003c/p>\n\u003cfigure id=\"attachment_11934634\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934634\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-800x531.png\" alt=\"A man wearing a dark shirt, sunglasses and jeans looks down at an object in his hands while a woman wearing a black hooded sweatshirt and pants has her bandaged right leg propped up on the trunk of a car.\" width=\"800\" height=\"531\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-800x531.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-1020x677.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-160x106.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM-1536x1020.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.44-PM.png 1542w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Kyle Patton prescribes Amber Schmitt with medication to treat the wound on her leg in the back of his truck on Sept. 19, 2022. \u003ccite>(Larry Valenzuela/CalMatters/CatchLight Local)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The gash on Schmitt’s right shin is mottled and inflamed. She said she scraped it on a fallen branch. Patton cleaned and dressed it for her previously, but she had no choice but to reuse bandages after running out. Now she can barely walk from the pain.\u003c/p>\n\u003cp>“This is a silver-based dressing, which will kill bacteria in wounds,” Patton tells Schmitt after rinsing the area with a saline wash. “We’ll get you some more dressing, too. And then you’ve got some skin breakdown and maceration between your toes. I don’t like the look of that.”\u003c/p>\n\u003cp>He gives her a fungal cream and a bottle of antibiotics. Schmitt is a leukemia survivor and has had a hip replacement on the same injured leg. Her medical history makes her prone to infections and poor circulation in her extremities, Patton said.\u003c/p>\n\u003cp>“There’s people that would maybe make the argument that … they have health insurance here in California, they should just utilize the system as-is. The reality is because of certain factors within the context of their homelessness, they’re not able to do that,” Patton said.\u003c/p>\n\u003cp>Although they qualify for comprehensive health coverage under Medi-Cal, the program wasn’t necessarily designed with unhoused people in mind. For example, Medi-Cal will pay for transportation to and from a doctor’s appointment, but it requires the patient to provide a fixed address and give several week’s notice to the driver, something most people experiencing homelessness aren’t able to arrange.\u003c/p>\n\u003ch2 id=\"h-link-between-homelessness-and-health\">Link between homelessness and health\u003c/h2>\n\u003cp>Health data on unhoused people is sparse, with no state agency and only a handful of counties tracking the information, but it’s clear that most of their deaths are preventable.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.achch.org/uploads/7/2/5/4/72547769/2018-2020_ac_homeless_mortality_report_final_4.11.2022.pdf\">Alameda (PDF) \u003c/a>and \u003ca href=\"https://nhchc.org/wp-content/uploads/2022/10/Mortality-in-PEH-Marin-Co-10-22.pdf\">Marin (PDF)\u003c/a> counties, half result from acute or chronic health conditions like cardiovascular disease, cancer or respiratory failure. In Orange County, these make up a quarter of deaths among the unhoused. In Los Angeles County, heart disease is the second-leading cause of death among people experiencing homelessness, second only to overdoses.\u003c/p>\n\u003cp>Even overdose deaths are considered preventable — yet in San Francisco, overdoses cause 82% of deaths among the unsheltered.\u003c/p>\n\u003cp>“We commonly see conditions that you would see in a typical population, but they’re just not addressed. So, out-of-control high blood pressure, uncontrolled diabetes … also substance use in terms of opioids, we see a whole lot more than in the general population,” said Dr. Absalon Galat, medical director for LA County’s Department of Health Services’ Housing for Health division.\u003c/p>\n\u003cp>Galat’s team started its foray into street medicine in an effort to dole out COVID-19 vaccines, but team members quickly found they needed to do more. The county used COVID-19 relief funds to purchase mobile clinics, and CalAIM funding has helped them hire 60 staff members.\u003c/p>\n\u003cfigure id=\"attachment_11934635\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934635\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-800x526.png\" alt=\"A man with a black Raiders hat and gray shirt sits down in a medical facility.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-1020x671.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.54-PM.png 1058w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Patient Isaac Pierce gets a checkup in the Los Angeles County Department of Health Services’ mobile clinic parked in Whittier Narrows Park on Nov. 17, 2022. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In September, the county’s \u003ca href=\"https://www.latimes.com/california/story/2022-10-13/la-county-mobile-medical-clinic\">fleet of mobile clinics,\u003c/a> complete with fully outfitted exam rooms, began visiting areas where services are sparse. Smaller teams of clinicians and case workers roam encampments to follow up with patients, treat minor issues and bring patients to the mobile clinic. There’s some disagreement among street medicine providers about whether mobile clinics remove enough barriers because they still require patients to travel to a set location, but Galat said his goal is to improve access, whether it’s by wheel or foot.\u003c/p>\n\u003cp>“People are dying every day,” Galat said. “So we have to try with what we know best in the medical field right now to limit people who are dying.”\u003c/p>\n\u003cfigure id=\"attachment_11934636\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934636\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-800x526.png\" alt=\"A light blue medical truck with several photos of people and a medical logo on the side with a ramp and stairs leading inside.\" width=\"800\" height=\"526\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-800x526.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-1020x670.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.24.59-PM.png 1056w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Los Angeles County Department of Health Services’ mobile clinic parked in Whittier Narrows Park to see unhoused patients on Nov. 17, 2022. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The connection between homelessness and health is inextricable, said Dr. Michelle Schneidermann, director of the People-Centered Care team at the California Health Care Foundation, a statewide health policy think tank.\u003c/p>\n\u003cp>“Either one can lead to the other. A catastrophic health incident or a series of conditions can lead to someone not being able to work, leading to poverty,” Schneidermann said. “We see this all the time, health conditions precipitating homelessness, and the other way around.”\u003c/p>\n\u003cp>Take Danny Doran, 56, who visited LA County’s mobile clinic at Whittier Narrows Park on a recent Thursday to pick up insulin. He spent his career as a plumber and owned a home in Bishop. Three years ago he fell into a diabetic coma and was hospitalized for months. A friend Doran trusted to pay his bills while he was hospitalized emptied his bank account and disappeared — Doran has been unhoused ever since. Several weeks ago he was beaten and robbed by another unhoused man, who left him with a fracture in his skull and a tremor in his hands.\u003c/p>\n\u003cp>“I guess I’m a little bit naive,” Doran said. “We’re all humans and we’re prone to mistakes, you know? So I hate for anyone to have their money stolen like mine was and end up like me on the streets.”\u003c/p>\n\u003cp>At the mobile clinic, Doran said the doctor on staff agreed to be his primary care physician. His previous primary care doctor stopped accepting Medi-Cal insurance, and Doran hasn’t had regular access to insulin ever since.\u003c/p>\n\u003cp>“The doc here, she truly has compassion for her patients. I’m glad our paths crossed,” Doran said.\u003c/p>\n\u003cfigure id=\"attachment_11934637\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM.png\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11934637\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-800x523.png\" alt=\"A man wearing black hat, camouflage scarf and black jacket outside near a truck with a medical logo.\" width=\"800\" height=\"523\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-800x523.png 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-1020x666.png 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-160x105.png 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM-1536x1003.png 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/12/Screen-Shot-2022-12-08-at-12.25.07-PM.png 1546w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Unhoused patient Danny Doran sits in the waiting area for the mobile clinic parked in Whittier Narrows Park on Nov. 17, 2022. Doran is being checked after being assaulted near his encampment just a few days before. \u003ccite>(Larry Valenzuela/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Schneidermann, who is overseeing a study on street medicine programs across California, said CalAIM, which also pays for housing services, is an opportunity for the state to address its most pernicious problem.\u003c/p>\n\u003cp>“Until we can end our crisis of homelessness … we have to find a way to deliver care for people on the streets,” Schneidermann said.\u003c/p>\n\u003ch2>New programs popping up\u003c/h2>\n\u003cp>Prior to CalAIM and the Health Care Services Department’s rule changes, street medicine programs operated outside of traditional health care, funded by philanthropies or the rare health organization willing to lose money. Now, the department’s changes offer some hope for stability, Feldman said.\u003c/p>\n\u003cp>Noting that these programs were birthed out of the pandemic, Feldman said they “might not exist in a few years if they’re not supported, but they have all these patients that rely on them.”\u003c/p>\n\u003cp>A year ago only 25 programs existed across the state, primarily concentrated in urban areas, Feldman said. But ever since CalAIM launched at the beginning of 2022, he’s run into more organizations looking to begin services. CalAIM requires Medi-Cal insurers to coordinate patients’ physical, behavioral, dental and developmental care as well as social services — something many street medicine teams already do. The goal is to make the “system hustle behind the scenes rather than making the patient hustle,” California Health Care Foundations’ Schneidermann said.\u003c/p>\n\u003cp>One such program is run by Anthony Menacho in Sacramento. Unlike USC, Shasta Community Health or LA County’s teams that are staffed full-time, Menacho’s street medicine band is composed entirely of volunteers. They visit six camps every other weekend.\u003c/p>\n\u003cp>The work was funded initially by a $100,000 grant from Health Net, the largest Medi-Cal provider in the state, but Menacho, who trained as a physician assistant with Feldman at USC, wants to be able to do the work full-time and hire more clinicians. He’s working to secure money through CalAIM and the Department of Health Care Services.\u003c/p>\n\u003cp>“We don’t have the academic resources or people behind us to be able to put in a department or infrastructure on the drop of the dime,” Menacho said. “We run on grants, but that’s not true sustainability. We can’t do it ourselves. It has to be a coordinated effort and I think that’s what CalAIM is trying to do.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "tripledemic-causing-shortage-of-fever-reducing-medicines-for-kids",
"title": "'Tripledemic' Causing Shortage of Fever-Reducing Medicines for Kids",
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"content": "\u003cp>If you stroll the cold and flu medicine aisle these days, you might notice shelves that are bare, or nearly so. Some medicines that can be particularly hard to find are fever reducers for kids, like children’s Tylenol, Motrin or Advil.\u003c/p>\n\u003cp>Drug manufacturers point to a big spike in demand. That’s not surprising, given the surge in three respiratory viruses right now: \u003ca href=\"https://www.npr.org/sections/health-shots/2022/11/22/1137649962/experts-are-concerned-thanksgiving-gatherings-could-accelerate-a-tripledemic\">COVID, RSV and influenza, what has been termed a “tripledemic.”\u003c/a>\u003c/p>\n\u003cp>Johnson & Johnson makes \u003ca href=\"https://www.tylenol.com/products/children-infants\">Children’s Tylenol\u003c/a> and \u003ca href=\"https://www.motrin.com/products/childrens-motrin\">Children’s Motrin\u003c/a>. It says there is no nationwide shortage — just a lot of demand.\u003c/p>\n\u003cp>“Consumer demand for pediatric pain relievers in the U.S. is high, but there are no supply chain issues and we do not have an overall shortage in the U.S.,” company spokesperson Melissa Witt said in an email to NPR. The company says it is “experiencing high consumer demand and are doing everything we can to make sure people have access to the products they need.”\u003c/p>\n\u003cp>Nationally, sales of pediatric internal analgesics — which includes drugs like acetaminophen and ibuprofen — were up more than 26% in October compared with a year earlier. That’s according to data from the Consumer Healthcare Products Association (CHPA), a trade group that represents manufacturers of over-the-counter drugs.[pullquote align=\"right\" size=\"medium\" citation=\"Anita Brikman, spokesperson, CHPA\"]‘If families start to stock up in worry, as opposed to buying what they need, we are concerned that that could amplify the situation.’[/pullquote]\u003c/p>\n\u003cp>While there may not be a countrywide shortage, there is one part of the U.S. where finding these meds is most difficult: areas near the Canadian border. The Buffalo-Rochester area of western New York is seeing the highest demand in the U.S., CHPA says.\u003c/p>\n\u003cp>Sales for such products in the Buffalo-Rochester market surged 53% in October compared to a year earlier. That’s very likely the result of \u003ca href=\"https://www.thestar.com/politics/federal/2022/11/15/health-canada-says-more-childrens-pain-medication-is-on-the-way-but-not-how-much.html\">an ongoing shortage of kids’ pain and fever medications in Canada\u003c/a>, with Buffalo’s close proximity to Toronto making it an ideal place for Canadians to buy such products in the U.S.\u003c/p>\n\u003cp>A spot check on Thursday in Washington, D.C., of four stores — a Giant supermarket, a CVS, a Target, and a Bed Bath & Beyond — found low supplies of children’s fever-reducers, though each had at least a few of such medicines available. Supplies were low of cold and flu products for adults, as well.\u003c/p>\n\u003cp>“The supply chain is strong,” says Anita Brikman, a spokesperson for CHPA. But parents and caregivers may need to check more than one store, buy a store brand instead of a name brand, or order products online, she suggests.\u003c/p>\n\u003ch2>Parents have a range of options for treating fevers\u003c/h2>\n\u003cp>So what to do if you have a fevered child, and are struggling to find Children’s Tylenol or a similar product?\u003c/p>\n\u003cp>There’s a good chance you don’t even need to use medicine, says Dr. Sean O’Leary, a professor of pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado, as well as the chair of the Committee on Infectious Diseases for the American Academy of Pediatrics (AAP).\u003c/p>\n\u003cp>“These medicines are not curative. They don’t alter the duration of the illness or anything like that. They are essentially purely for comfort,” he tells NPR.\u003cstrong> \u003c/strong>“Fevers from common respiratory viruses in and of themselves are not harmful.”\u003c/p>\n\u003cp>He offers a scenario. “If [a child’s] temp is 103, but he’s running around the room having a good time playing, you don’t need to do anything with that. That’s not going to hurt him. Fever is representing our body’s immune response to an infection. On the other hand, if he doesn’t have a fever, but his throat is hurting, something is bothering him, he’s pretty fussy — then that’s where things like ibuprofen or Tylenol, acetaminophen can be helpful.”\u003c/p>\n\u003cp>AAP has guidance on \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Medications-Used-to-Treat-Fever.aspx\">treating a child’s fever\u003c/a>, as well advice on \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Treating-a-Fever-Without-Medicine.aspx\">treating a fever without medicine\u003c/a>.\u003c/p>\n\u003cp>Often when kids do have a fever, they do feel pretty crummy, and so that’s a time to use such medicines — “It’s to treat how the child is feeling,” O’Leary says.\u003c/p>\n\u003cp>Fever is a more serious concern in \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-and-Your-Baby.aspx\">infants\u003c/a> and \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/febrile-seizures.aspx\">children who experience febrile seizures\u003c/a>.\u003c/p>\n\u003cp>“Fever in very young infants, in newborns, is actually a different situation, and that’s something that does need evaluation,” O’Leary says. “Essentially, the younger the child, the more concerned you should be about a fever. For example, a 2-week-old with a fever is something that needs immediate medical attention. A 6-month-old with a fever that’s otherwise doing well does not need immediate medical attention. [Parents] can simply call their child’s pediatrician to get that checked out.”\u003c/p>\n\u003ch2>Be very careful with adapting adult medications\u003c/h2>\n\u003cp>Parents at home might be eyeing their bottle of adult acetaminophen or ibuprofen and wondering if they could give a smaller amount to their sick child. But there’s reason to be very cautious with that — and to consult a doctor or pharmacist first to find out the correct dosage for your particular child.\u003c/p>\n\u003cp>“For both acetaminophen and ibuprofen, there are potential toxicities from taking too much — some of which can be quite severe, particularly for acetaminophen. So you really have to be careful when you do that,” O’Leary says.[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Sean O'Leary, professor of pediatrics, University of Colorado School of Medicine\"]‘These medicines are not curative. They don’t alter the duration of the illness or anything like that. They are essentially purely for comfort. Fevers from common respiratory viruses in and of themselves are not harmful.’[/pullquote]\u003c/p>\n\u003cp>Wendy Mobley-Bukstein, a professor of pharmacy practice at Drake University and the president of the American Pharmacists Association Academy of Pharmacy Practice and Management, agrees.\u003c/p>\n\u003cp>“It’s best to talk to the doctor or pharmacist,” she tells NPR. If a parent or caregiver “can weigh [the child] at home, tell us what they weigh on their scale at home, we can figure out what an appropriate dose would be for them to take,” she says.\u003c/p>\n\u003cp>She explains that repetitively giving a child too large a dose could have liver implications with acetaminophen, and kidney implications with ibuprofen.\u003c/p>\n\u003cp>And Mobley-Bukstein has another piece of advice: Get kids vaccinated for COVID-19 and flu.\u003c/p>\n\u003cp>“Even if you still get the flu or even if you still get COVID, it’s definitely going to lessen the severity of the disease itself. And so just making sure that they’re getting their immunizations is really important,” she says.\u003c/p>\n\u003ch2>PSA: Please don’t hoard the meds\u003c/h2>\n\u003cp>Brikman at the CPHA worries that the notion that there is a shortage will spur parents to buy more than they need.\u003c/p>\n\u003cp>“If families start to stock up in worry, as opposed to buying what they need, we are concerned that that could amplify the situation,” she says.\u003c/p>\n\u003cp>And if you were thinking of stocking up on a bunch of fever meds just in case, Mobley-Bukstein has a practical warning: These products do expire.\u003c/p>\n\u003cp>“So putting a whole bunch of them in your medicine cabinet at home might not serve you if you don’t get sick, or if your kids don’t get sick,” she says. “It’s important for us to remember that they do have expiration dates, that it can be dangerous to give [children] expired medications. And so only buy what you need when you need it, and use up what you have at home before you go and buy new, if it’s still in date.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Drug manufacturers attribute the shortage of children's fever-reducing medicine to a big spike in demand caused by the recent surge in three respiratory viruses: COVID, RSV and influenza.",
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"title": "'Tripledemic' Causing Shortage of Fever-Reducing Medicines for Kids | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you stroll the cold and flu medicine aisle these days, you might notice shelves that are bare, or nearly so. Some medicines that can be particularly hard to find are fever reducers for kids, like children’s Tylenol, Motrin or Advil.\u003c/p>\n\u003cp>Drug manufacturers point to a big spike in demand. That’s not surprising, given the surge in three respiratory viruses right now: \u003ca href=\"https://www.npr.org/sections/health-shots/2022/11/22/1137649962/experts-are-concerned-thanksgiving-gatherings-could-accelerate-a-tripledemic\">COVID, RSV and influenza, what has been termed a “tripledemic.”\u003c/a>\u003c/p>\n\u003cp>Johnson & Johnson makes \u003ca href=\"https://www.tylenol.com/products/children-infants\">Children’s Tylenol\u003c/a> and \u003ca href=\"https://www.motrin.com/products/childrens-motrin\">Children’s Motrin\u003c/a>. It says there is no nationwide shortage — just a lot of demand.\u003c/p>\n\u003cp>“Consumer demand for pediatric pain relievers in the U.S. is high, but there are no supply chain issues and we do not have an overall shortage in the U.S.,” company spokesperson Melissa Witt said in an email to NPR. The company says it is “experiencing high consumer demand and are doing everything we can to make sure people have access to the products they need.”\u003c/p>\n\u003cp>Nationally, sales of pediatric internal analgesics — which includes drugs like acetaminophen and ibuprofen — were up more than 26% in October compared with a year earlier. That’s according to data from the Consumer Healthcare Products Association (CHPA), a trade group that represents manufacturers of over-the-counter drugs.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>While there may not be a countrywide shortage, there is one part of the U.S. where finding these meds is most difficult: areas near the Canadian border. The Buffalo-Rochester area of western New York is seeing the highest demand in the U.S., CHPA says.\u003c/p>\n\u003cp>Sales for such products in the Buffalo-Rochester market surged 53% in October compared to a year earlier. That’s very likely the result of \u003ca href=\"https://www.thestar.com/politics/federal/2022/11/15/health-canada-says-more-childrens-pain-medication-is-on-the-way-but-not-how-much.html\">an ongoing shortage of kids’ pain and fever medications in Canada\u003c/a>, with Buffalo’s close proximity to Toronto making it an ideal place for Canadians to buy such products in the U.S.\u003c/p>\n\u003cp>A spot check on Thursday in Washington, D.C., of four stores — a Giant supermarket, a CVS, a Target, and a Bed Bath & Beyond — found low supplies of children’s fever-reducers, though each had at least a few of such medicines available. Supplies were low of cold and flu products for adults, as well.\u003c/p>\n\u003cp>“The supply chain is strong,” says Anita Brikman, a spokesperson for CHPA. But parents and caregivers may need to check more than one store, buy a store brand instead of a name brand, or order products online, she suggests.\u003c/p>\n\u003ch2>Parents have a range of options for treating fevers\u003c/h2>\n\u003cp>So what to do if you have a fevered child, and are struggling to find Children’s Tylenol or a similar product?\u003c/p>\n\u003cp>There’s a good chance you don’t even need to use medicine, says Dr. Sean O’Leary, a professor of pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado, as well as the chair of the Committee on Infectious Diseases for the American Academy of Pediatrics (AAP).\u003c/p>\n\u003cp>“These medicines are not curative. They don’t alter the duration of the illness or anything like that. They are essentially purely for comfort,” he tells NPR.\u003cstrong> \u003c/strong>“Fevers from common respiratory viruses in and of themselves are not harmful.”\u003c/p>\n\u003cp>He offers a scenario. “If [a child’s] temp is 103, but he’s running around the room having a good time playing, you don’t need to do anything with that. That’s not going to hurt him. Fever is representing our body’s immune response to an infection. On the other hand, if he doesn’t have a fever, but his throat is hurting, something is bothering him, he’s pretty fussy — then that’s where things like ibuprofen or Tylenol, acetaminophen can be helpful.”\u003c/p>\n\u003cp>AAP has guidance on \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Medications-Used-to-Treat-Fever.aspx\">treating a child’s fever\u003c/a>, as well advice on \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Treating-a-Fever-Without-Medicine.aspx\">treating a fever without medicine\u003c/a>.\u003c/p>\n\u003cp>Often when kids do have a fever, they do feel pretty crummy, and so that’s a time to use such medicines — “It’s to treat how the child is feeling,” O’Leary says.\u003c/p>\n\u003cp>Fever is a more serious concern in \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Fever-and-Your-Baby.aspx\">infants\u003c/a> and \u003ca href=\"https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/febrile-seizures.aspx\">children who experience febrile seizures\u003c/a>.\u003c/p>\n\u003cp>“Fever in very young infants, in newborns, is actually a different situation, and that’s something that does need evaluation,” O’Leary says. “Essentially, the younger the child, the more concerned you should be about a fever. For example, a 2-week-old with a fever is something that needs immediate medical attention. A 6-month-old with a fever that’s otherwise doing well does not need immediate medical attention. [Parents] can simply call their child’s pediatrician to get that checked out.”\u003c/p>\n\u003ch2>Be very careful with adapting adult medications\u003c/h2>\n\u003cp>Parents at home might be eyeing their bottle of adult acetaminophen or ibuprofen and wondering if they could give a smaller amount to their sick child. But there’s reason to be very cautious with that — and to consult a doctor or pharmacist first to find out the correct dosage for your particular child.\u003c/p>\n\u003cp>“For both acetaminophen and ibuprofen, there are potential toxicities from taking too much — some of which can be quite severe, particularly for acetaminophen. So you really have to be careful when you do that,” O’Leary says.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Wendy Mobley-Bukstein, a professor of pharmacy practice at Drake University and the president of the American Pharmacists Association Academy of Pharmacy Practice and Management, agrees.\u003c/p>\n\u003cp>“It’s best to talk to the doctor or pharmacist,” she tells NPR. If a parent or caregiver “can weigh [the child] at home, tell us what they weigh on their scale at home, we can figure out what an appropriate dose would be for them to take,” she says.\u003c/p>\n\u003cp>She explains that repetitively giving a child too large a dose could have liver implications with acetaminophen, and kidney implications with ibuprofen.\u003c/p>\n\u003cp>And Mobley-Bukstein has another piece of advice: Get kids vaccinated for COVID-19 and flu.\u003c/p>\n\u003cp>“Even if you still get the flu or even if you still get COVID, it’s definitely going to lessen the severity of the disease itself. And so just making sure that they’re getting their immunizations is really important,” she says.\u003c/p>\n\u003ch2>PSA: Please don’t hoard the meds\u003c/h2>\n\u003cp>Brikman at the CPHA worries that the notion that there is a shortage will spur parents to buy more than they need.\u003c/p>\n\u003cp>“If families start to stock up in worry, as opposed to buying what they need, we are concerned that that could amplify the situation,” she says.\u003c/p>\n\u003cp>And if you were thinking of stocking up on a bunch of fever meds just in case, Mobley-Bukstein has a practical warning: These products do expire.\u003c/p>\n\u003cp>“So putting a whole bunch of them in your medicine cabinet at home might not serve you if you don’t get sick, or if your kids don’t get sick,” she says. “It’s important for us to remember that they do have expiration dates, that it can be dangerous to give [children] expired medications. And so only buy what you need when you need it, and use up what you have at home before you go and buy new, if it’s still in date.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>\u003cem>This story contains clarifications.\u003c/em>\u003c/p>\n\u003cp>In a storage room behind an old dance studio in San Francisco’s Bayview neighborhood, four volunteers busily pack diapers, wipes, fresh produce and other household essentials into cardboard boxes.\u003c/p>\n\u003cp>Asmara Gebre, a nurse-midwife and founder of \u003ca href=\"https://oneloveblackcommunity.org/\">One Love Black Community\u003c/a>, a local group dedicated to improving Black people’s access to reproductive health care, shuffles through notes. She calls a client who gave birth a month earlier to find out what she needs.\u003c/p>\n\u003cp>“Do you already have a hand pump or just an electric pump?” Gebre asks. “Are you exclusively breastfeeding or formula feeding, too?”[pullquote size=\"medium\" align=\"right\" citation=\"Asmara Gebre, nurse-midwife and founder, One Love Black Community\"]‘I have not met one patient that doesn’t care about their pregnancy or want the best for themselves and their baby, though there are so many factors around them that are influencing their ability to engage or not engage in the kind of quality of care that they want.’[/pullquote]Once the boxes are filled and crammed into car trunks and back seats, the volunteers caravan across San Francisco to make deliveries to expectant and new Black parents.\u003c/p>\n\u003cp>The “Sunday Show Ups” began at the start of the pandemic when Gebre noticed that few of the Black patients at her Zuckerberg San Francisco General Hospital clinic were taking advantage of a pantry a doctor had set up for pregnant patients. Concerned about insufficient outreach to a vulnerable population during an uncertain time, Gebre sought donations on social media for her Black patients, and the grassroots effort took off.\u003c/p>\n\u003cp>“There were disparities in access to masks, access to education and factual information around the pandemic,” Gebre says. “Out of this hard period, we created a space where we can engage in conversations and give back to the community in a positive way.”\u003c/p>\n\u003cfigure id=\"attachment_11933205\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933205\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"A woman wearing a face mask looking down and holding a cellphone stands next to a woman wearing a brown hooded sweater outside. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">One Love Black Community organizer Asmara Gebre speaks with expectant mother Tanisha Bell about resources for her newborn in Bayview-Hunters Point, San Francisco, on Nov. 13, 2022, during the organization’s ‘Sunday Show Up.’ \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The focus on Black families is personal and purposeful: Gebre, 34, was living in a home for pregnant people more than 15 years ago. She relates to the multitude of challenges her patients face. As a medical professional, she has seen Black birthing people suffer from higher rates of pregnancy-related complications and preterm births even as the city’s Black population dwindles.\u003c/p>\n\u003cp>In San Francisco, Black birthing people make up \u003ca href=\"https://www.sfdph.org/dph/files/MCHdocs/Epi/2022/5-3%20_Disparities_in_preterm_birth_and_days_of_gestation_lost_2020-2021.pdf\">half of the city’s pregnancy-related deaths, and Black children make up 15% of infant deaths (PDF)\u003c/a> despite representing just 4% of all births. City data also shows nearly 14% of Black infants are born prematurely compared with 7.3% of white infants. It’s a cause for alarm because preterm babies are more likely to experience chronic disease, not to mention learning and behavioral difficulties in school.\u003c/p>\n\u003cp>At first, the donations included masks, hand sanitizer, diapers, children’s books, produce and money. The cash donations allowed Gebre to distribute $200 per household — no strings attached.\u003c/p>\n\u003cp>As her network of volunteers grew, so did her reach.\u003c/p>\n\u003cfigure id=\"attachment_11933208\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933208\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-800x533.jpg\" alt=\"Two women standing outside with the woman on the right wearing all black and the woman on the left wearing a green jacket with a black t-shirt.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cassandra Perkins (left) and Asmara Gebre pose for a portrait on Treasure Island after making all their deliveries during One Love Black Community’s ‘Sunday Show Up’ on Nov. 13, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>With the help of her most dedicated volunteer, Cassandra Perkins — an outreach coordinator for the San Francisco Department of Public Health — they expanded their deliveries to new parents participating in the California Black Infant Health program and to pregnant people who are unhoused. They also aligned with several Bay Area initiatives that are trying to address \u003ca href=\"https://www.medicalnewstoday.com/articles/weathering-what-are-the-health-effects-of-stress-and-discrimination\">racial inequalities to improve Black maternal health\u003c/a>.\u003c/p>\n\u003cp>Perkins has spent the last 23 years working in HIV and family planning clinics in the city’s Black neighborhoods. She has an easy smile and is the kind of person who gives away books, socks and toiletries stashed in her car to people she meets on the street.\u003c/p>\n\u003cp>She calls the Sunday Show-Ups her church.\u003c/p>\n\u003cp>“I look like them, so it’s easier for them to relate to me … just to inform, educate and be of service and always treat people with dignity and respect and you get it back tenfold,” Perkins says.\u003c/p>\n\u003cp>She said after birthing patients leave the hospital and recover at home, many of them miss out on information about services focused on Black people’s health. The home visits are filling a crucial gap in postpartum care and establishes One Love Black Community as a reliable source of information to a community wary of outsiders after experiencing decades of poverty, environmental injustice and racial discrimination.\u003c/p>\n\u003cp>Bayview-Hunters Point became a Black neighborhood in the 1940s as African Americans from the Gulf Coast migrated to the Bay Area to work at the nearby Navy shipyard. After World War II ended, jobs evaporated. Black people, who were limited in where they could live in San Francisco due to racist housing policy, were left languishing in the area, surrounded by pollution left over from the shipyard.\u003c/p>\n\u003cp>“If they show initiative in how much they care to help you, then that’s the most helpful because they make you want to put more initiative into yourself,” says Charise Haley, who met Perkins when she was living on the streets and pregnant with her now 10-month-old son.\u003c/p>\n\u003cp>Haley, who continues to cope with losing her partner to suicide, says she’s close to receiving a subsidized apartment.\u003c/p>\n\u003cp>“Cassandra is one of my favorite people because if it wasn’t for her actually believing in what I can do, I probably wouldn’t be where I am right now,” she says about Perkins.\u003c/p>\n\u003cp>Haley was among seven women who received deliveries on one Sunday last month.\u003c/p>\n\u003cfigure id=\"attachment_11933209\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933209\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"A woman wearing glasses puts a small child into a stroller shaped like a toy car.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charise Haley picks up her son Isaiah from his toy car outside her home in San Francisco on Nov. 13, 2022, during a visit by One Love Black Community volunteers. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I ride with Gebre in her SUV that’s cluttered with baby supplies in the back and her half-eaten breakfast in the front. A tireless multitasker, she also finds time to lead \u003ca href=\"https://blackcentering.ucsf.edu/\">Black Centering\u003c/a>, a program at SF General where she organizes nature walks, CPR classes and other community-building activities for expectant Black parents.\u003c/p>\n\u003cp>Perkins and Katiana Carey-Simms, a midwifery student, follow in two other cars filled with supplies. Meanwhile, Gebre’s son Devin comes along to pack and haul boxes.\u003c/p>\n\u003cp>We go uphill to an apartment complex overlooking the bay and meet Crystal Hill, who is receiving her first delivery from One Love Black Community. Inside her unit, football plays on the TV while Hill’s 2-month-old boy lies in a baby swing.\u003c/p>\n\u003cp>Big pots of stew simmer in the kitchen, and the aroma prompts Gebre to offer to sign Hill up for six weeks of meals delivered by \u003ca href=\"https://www.m2mpostpartum.org/nourish\">Postpartum Justice\u003c/a>, an organization that recruits Bay Area restaurants to cook nourishing meals for Black people healing from childbirth.\u003c/p>\n\u003cp>“I need to start getting healthy because I have high blood pressure and diabetes that stayed with me after [pregnancy],” Hill, 40, tells her.\u003c/p>\n\u003cp>“This would be a beautiful transition, just having some nice meals and sharing with the family and thinking differently,” Gebre replies.\u003c/p>\n\u003cp>A short drive later, we stop at the Bayview home of a pregnant woman Perkins recently met while shopping at Safeway. Perkins urges the woman, who declines to be interviewed, to enroll in the \u003ca href=\"https://www.expectingjustice.org/\">Abundant Birth Project\u003c/a> because she is in her first trimester and thus eligible. The guaranteed income program gives $1,000 per month to a randomly selected group of Black and Pacific Islander pregnant people who face some of the greatest degrees of income inequality in one of the nation’s most expensive cities.\u003c/p>\n\u003cfigure id=\"attachment_11933210\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933210\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"A woman sitting on a couch holding a baby.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sabrina Hall holds her newborn, Harleigh Quin, at her home in Bayview on Nov. 13, 2022, while visiting with volunteers from One Love Black Community. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The experiment is part of a \u003ca href=\"https://www.mayorsforagi.org/\">growing number of guaranteed income programs\u003c/a> responding to racial and economic inequality by giving unconditional cash directly to people in need. Abundant Birth’s goal is to ease financial stress for these people and improve their health outcomes.\u003c/p>\n\u003cp>Gebre stopped taking cash gifts for a while due to tax reasons, but has resumed accepting them as donations after receiving fiscal sponsorship from the San Francisco Public Health Foundation.\u003c/p>\n\u003cp>She estimates 300 women have received deliveries from One Love Black Community in just over two years. This Christmas, she hopes to show up for 100 families with the help of volunteers from a Black sorority for registered nurses, Lambda Chi Chi.\u003c/p>\n\u003cp>She recalls the small acts of kindness that made a big difference for her when she was raising Devin in the Santa Cruz area. Gebre volunteered at a horse ranch when Devin was a boy. When someone there saw her struggling, they slipped a surprise in the book Gebre was reading.\u003c/p>\n\u003cp>[aside label='Early Childhood Education and Care' tag='early-childhood-education-and-care']“I remember one day I was running out of gas and was like, ‘I don’t know how I’m going to get through this week of school.’ I opened the book and there was $100 in cash in there,” Gebre says. “There were so many moments where my community showed up for me. Little things here and there, but they add up.”\u003c/p>\n\u003cp>She says she’s driven to give back because of the support she received.\u003c/p>\n\u003cp>When we reach Sabrina Hall at her home in an industrial part of the Bayview, Gebre and Perkins pitch the postpartum meals and \u003ca href=\"https://womenshealth.ucsf.edu/coe/embrace-perinatal-care-black-families\">online support group\u003c/a> for Black moms facilitated by UC San Francisco.\u003c/p>\n\u003cp>Hall, 41, says she developed gestational diabetes during pregnancy and suffered nerve damage and other complications after delivering her daughter, Harleigh Quin, three weeks early. The baby weighed just 5 pounds.\u003c/p>\n\u003cp>The experience was nonetheless an improvement from four previous pregnancies, Hall says. She participated in the guaranteed income study, and says the extra cash helped her buy baby gear and catch up on some bills.\u003c/p>\n\u003cp>“With my other kids, no one told me about doulas. [There was] just a lack of education,” Hall says. “This birth, I had a doula, I had Black Infant Health — you know, just the support. I had no one to speak for me with the medical office or the staff. And this time I had an advocate.”\u003c/p>\n\u003cfigure id=\"attachment_11933204\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933204\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"Boxes filled with diapers, formula and other essentials sitting in a cart.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Boxes filled with diapers, formula and other essentials are loaded into a car to be delivered to mothers throughout San Francisco and Treasure Island as a part of One Love Black Community’s ‘Sunday Show Up’ on Nov. 13, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Back in the car, Gebre says since the guaranteed income pilot launched two years ago, she noticed that patients who receive the money participate more actively in their prenatal care. For example, patients in transitional housing were more likely to find transportation to show up for their appointments.\u003c/p>\n\u003cp>“I have not met one patient that doesn’t care about their pregnancy or want the best for themselves and their baby, though there are so many factors around them that are influencing their ability to engage or not engage in the kind of quality of care that they want,” she says. “When you’re able to provide additional resources to minimize those stress factors — that burden, that toll is no longer present — you can notice the difference in patients and how they engage in care.”\u003c/p>\n\u003cp>She drives across a section of the Bay Bridge and exits onto Treasure Island, passing a housing construction project and new ferry terminal. She parks in front of a cluster of townhouses to check on her former patient Danesha Johnson.\u003c/p>\n\u003cp>“How are you?” Gebre asks while hugging Johnson, who gave birth a month earlier.\u003c/p>\n\u003cp>“The recovery is fine, no complications. I’m fine,” the 21-year-old says.\u003c/p>\n\u003cp>When Johnson’s partner, Darrian Burrows, comes out to carry the supplies inside, Gebre tells Perkins that he assisted her in the delivery room and caught his daughter when Johnson made her final push. Perkins remembers seeing him in the hospital when Johnson was in labor, and she’s overcome with emotions.\u003c/p>\n\u003cp>“That was so beautiful for you to be in the tub with her when she was going through labor to help ease things,” she says as tears fill her eyes.\u003c/p>\n\u003cp>“You’re giving me the chills, because I work in our communities of color and they’re always giving our men a hard time,” Perkins continues. “And some programs, there’s something for the mom and the baby but they don’t want the dad involved. So just to see you all as a couple and loving one another and having a baby brung into this world together … .”\u003c/p>\n\u003cp>Bearing witness to a happy, healthy birth makes her want to keep this thing going, she says.\u003c/p>\n\u003cp>\u003cem>Nov. 30: This story has been updated to reflect that One Love Black Community is inclusive of all Black people accessing reproductive services in San Francisco.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "In San Francisco, Black birthing people make up half of the city's pregnancy-related deaths, and Black children make up 15% of infant deaths despite representing just 4% of all births. One Love Black Community focuses on improving Black people's access to reproductive health care.",
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"title": "Diapers, Food and Cash: San Francisco Group Helps Black Families, One Delivery at a Time | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story contains clarifications.\u003c/em>\u003c/p>\n\u003cp>In a storage room behind an old dance studio in San Francisco’s Bayview neighborhood, four volunteers busily pack diapers, wipes, fresh produce and other household essentials into cardboard boxes.\u003c/p>\n\u003cp>Asmara Gebre, a nurse-midwife and founder of \u003ca href=\"https://oneloveblackcommunity.org/\">One Love Black Community\u003c/a>, a local group dedicated to improving Black people’s access to reproductive health care, shuffles through notes. She calls a client who gave birth a month earlier to find out what she needs.\u003c/p>\n\u003cp>“Do you already have a hand pump or just an electric pump?” Gebre asks. “Are you exclusively breastfeeding or formula feeding, too?”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Once the boxes are filled and crammed into car trunks and back seats, the volunteers caravan across San Francisco to make deliveries to expectant and new Black parents.\u003c/p>\n\u003cp>The “Sunday Show Ups” began at the start of the pandemic when Gebre noticed that few of the Black patients at her Zuckerberg San Francisco General Hospital clinic were taking advantage of a pantry a doctor had set up for pregnant patients. Concerned about insufficient outreach to a vulnerable population during an uncertain time, Gebre sought donations on social media for her Black patients, and the grassroots effort took off.\u003c/p>\n\u003cp>“There were disparities in access to masks, access to education and factual information around the pandemic,” Gebre says. “Out of this hard period, we created a space where we can engage in conversations and give back to the community in a positive way.”\u003c/p>\n\u003cfigure id=\"attachment_11933205\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933205\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"A woman wearing a face mask looking down and holding a cellphone stands next to a woman wearing a brown hooded sweater outside. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/029_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">One Love Black Community organizer Asmara Gebre speaks with expectant mother Tanisha Bell about resources for her newborn in Bayview-Hunters Point, San Francisco, on Nov. 13, 2022, during the organization’s ‘Sunday Show Up.’ \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The focus on Black families is personal and purposeful: Gebre, 34, was living in a home for pregnant people more than 15 years ago. She relates to the multitude of challenges her patients face. As a medical professional, she has seen Black birthing people suffer from higher rates of pregnancy-related complications and preterm births even as the city’s Black population dwindles.\u003c/p>\n\u003cp>In San Francisco, Black birthing people make up \u003ca href=\"https://www.sfdph.org/dph/files/MCHdocs/Epi/2022/5-3%20_Disparities_in_preterm_birth_and_days_of_gestation_lost_2020-2021.pdf\">half of the city’s pregnancy-related deaths, and Black children make up 15% of infant deaths (PDF)\u003c/a> despite representing just 4% of all births. City data also shows nearly 14% of Black infants are born prematurely compared with 7.3% of white infants. It’s a cause for alarm because preterm babies are more likely to experience chronic disease, not to mention learning and behavioral difficulties in school.\u003c/p>\n\u003cp>At first, the donations included masks, hand sanitizer, diapers, children’s books, produce and money. The cash donations allowed Gebre to distribute $200 per household — no strings attached.\u003c/p>\n\u003cp>As her network of volunteers grew, so did her reach.\u003c/p>\n\u003cfigure id=\"attachment_11933208\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933208\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-800x533.jpg\" alt=\"Two women standing outside with the woman on the right wearing all black and the woman on the left wearing a green jacket with a black t-shirt.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/063_KQED_OneLoveBlackCommunity_11132022-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cassandra Perkins (left) and Asmara Gebre pose for a portrait on Treasure Island after making all their deliveries during One Love Black Community’s ‘Sunday Show Up’ on Nov. 13, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>With the help of her most dedicated volunteer, Cassandra Perkins — an outreach coordinator for the San Francisco Department of Public Health — they expanded their deliveries to new parents participating in the California Black Infant Health program and to pregnant people who are unhoused. They also aligned with several Bay Area initiatives that are trying to address \u003ca href=\"https://www.medicalnewstoday.com/articles/weathering-what-are-the-health-effects-of-stress-and-discrimination\">racial inequalities to improve Black maternal health\u003c/a>.\u003c/p>\n\u003cp>Perkins has spent the last 23 years working in HIV and family planning clinics in the city’s Black neighborhoods. She has an easy smile and is the kind of person who gives away books, socks and toiletries stashed in her car to people she meets on the street.\u003c/p>\n\u003cp>She calls the Sunday Show-Ups her church.\u003c/p>\n\u003cp>“I look like them, so it’s easier for them to relate to me … just to inform, educate and be of service and always treat people with dignity and respect and you get it back tenfold,” Perkins says.\u003c/p>\n\u003cp>She said after birthing patients leave the hospital and recover at home, many of them miss out on information about services focused on Black people’s health. The home visits are filling a crucial gap in postpartum care and establishes One Love Black Community as a reliable source of information to a community wary of outsiders after experiencing decades of poverty, environmental injustice and racial discrimination.\u003c/p>\n\u003cp>Bayview-Hunters Point became a Black neighborhood in the 1940s as African Americans from the Gulf Coast migrated to the Bay Area to work at the nearby Navy shipyard. After World War II ended, jobs evaporated. Black people, who were limited in where they could live in San Francisco due to racist housing policy, were left languishing in the area, surrounded by pollution left over from the shipyard.\u003c/p>\n\u003cp>“If they show initiative in how much they care to help you, then that’s the most helpful because they make you want to put more initiative into yourself,” says Charise Haley, who met Perkins when she was living on the streets and pregnant with her now 10-month-old son.\u003c/p>\n\u003cp>Haley, who continues to cope with losing her partner to suicide, says she’s close to receiving a subsidized apartment.\u003c/p>\n\u003cp>“Cassandra is one of my favorite people because if it wasn’t for her actually believing in what I can do, I probably wouldn’t be where I am right now,” she says about Perkins.\u003c/p>\n\u003cp>Haley was among seven women who received deliveries on one Sunday last month.\u003c/p>\n\u003cfigure id=\"attachment_11933209\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933209\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"A woman wearing glasses puts a small child into a stroller shaped like a toy car.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/043_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Charise Haley picks up her son Isaiah from his toy car outside her home in San Francisco on Nov. 13, 2022, during a visit by One Love Black Community volunteers. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>I ride with Gebre in her SUV that’s cluttered with baby supplies in the back and her half-eaten breakfast in the front. A tireless multitasker, she also finds time to lead \u003ca href=\"https://blackcentering.ucsf.edu/\">Black Centering\u003c/a>, a program at SF General where she organizes nature walks, CPR classes and other community-building activities for expectant Black parents.\u003c/p>\n\u003cp>Perkins and Katiana Carey-Simms, a midwifery student, follow in two other cars filled with supplies. Meanwhile, Gebre’s son Devin comes along to pack and haul boxes.\u003c/p>\n\u003cp>We go uphill to an apartment complex overlooking the bay and meet Crystal Hill, who is receiving her first delivery from One Love Black Community. Inside her unit, football plays on the TV while Hill’s 2-month-old boy lies in a baby swing.\u003c/p>\n\u003cp>Big pots of stew simmer in the kitchen, and the aroma prompts Gebre to offer to sign Hill up for six weeks of meals delivered by \u003ca href=\"https://www.m2mpostpartum.org/nourish\">Postpartum Justice\u003c/a>, an organization that recruits Bay Area restaurants to cook nourishing meals for Black people healing from childbirth.\u003c/p>\n\u003cp>“I need to start getting healthy because I have high blood pressure and diabetes that stayed with me after [pregnancy],” Hill, 40, tells her.\u003c/p>\n\u003cp>“This would be a beautiful transition, just having some nice meals and sharing with the family and thinking differently,” Gebre replies.\u003c/p>\n\u003cp>A short drive later, we stop at the Bayview home of a pregnant woman Perkins recently met while shopping at Safeway. Perkins urges the woman, who declines to be interviewed, to enroll in the \u003ca href=\"https://www.expectingjustice.org/\">Abundant Birth Project\u003c/a> because she is in her first trimester and thus eligible. The guaranteed income program gives $1,000 per month to a randomly selected group of Black and Pacific Islander pregnant people who face some of the greatest degrees of income inequality in one of the nation’s most expensive cities.\u003c/p>\n\u003cfigure id=\"attachment_11933210\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933210\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"A woman sitting on a couch holding a baby.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/037_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sabrina Hall holds her newborn, Harleigh Quin, at her home in Bayview on Nov. 13, 2022, while visiting with volunteers from One Love Black Community. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The experiment is part of a \u003ca href=\"https://www.mayorsforagi.org/\">growing number of guaranteed income programs\u003c/a> responding to racial and economic inequality by giving unconditional cash directly to people in need. Abundant Birth’s goal is to ease financial stress for these people and improve their health outcomes.\u003c/p>\n\u003cp>Gebre stopped taking cash gifts for a while due to tax reasons, but has resumed accepting them as donations after receiving fiscal sponsorship from the San Francisco Public Health Foundation.\u003c/p>\n\u003cp>She estimates 300 women have received deliveries from One Love Black Community in just over two years. This Christmas, she hopes to show up for 100 families with the help of volunteers from a Black sorority for registered nurses, Lambda Chi Chi.\u003c/p>\n\u003cp>She recalls the small acts of kindness that made a big difference for her when she was raising Devin in the Santa Cruz area. Gebre volunteered at a horse ranch when Devin was a boy. When someone there saw her struggling, they slipped a surprise in the book Gebre was reading.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“I remember one day I was running out of gas and was like, ‘I don’t know how I’m going to get through this week of school.’ I opened the book and there was $100 in cash in there,” Gebre says. “There were so many moments where my community showed up for me. Little things here and there, but they add up.”\u003c/p>\n\u003cp>She says she’s driven to give back because of the support she received.\u003c/p>\n\u003cp>When we reach Sabrina Hall at her home in an industrial part of the Bayview, Gebre and Perkins pitch the postpartum meals and \u003ca href=\"https://womenshealth.ucsf.edu/coe/embrace-perinatal-care-black-families\">online support group\u003c/a> for Black moms facilitated by UC San Francisco.\u003c/p>\n\u003cp>Hall, 41, says she developed gestational diabetes during pregnancy and suffered nerve damage and other complications after delivering her daughter, Harleigh Quin, three weeks early. The baby weighed just 5 pounds.\u003c/p>\n\u003cp>The experience was nonetheless an improvement from four previous pregnancies, Hall says. She participated in the guaranteed income study, and says the extra cash helped her buy baby gear and catch up on some bills.\u003c/p>\n\u003cp>“With my other kids, no one told me about doulas. [There was] just a lack of education,” Hall says. “This birth, I had a doula, I had Black Infant Health — you know, just the support. I had no one to speak for me with the medical office or the staff. And this time I had an advocate.”\u003c/p>\n\u003cfigure id=\"attachment_11933204\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11933204\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-800x533.jpg\" alt=\"Boxes filled with diapers, formula and other essentials sitting in a cart.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/11/016_KQED_OneLoveBlackCommunity_11132022.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Boxes filled with diapers, formula and other essentials are loaded into a car to be delivered to mothers throughout San Francisco and Treasure Island as a part of One Love Black Community’s ‘Sunday Show Up’ on Nov. 13, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Back in the car, Gebre says since the guaranteed income pilot launched two years ago, she noticed that patients who receive the money participate more actively in their prenatal care. For example, patients in transitional housing were more likely to find transportation to show up for their appointments.\u003c/p>\n\u003cp>“I have not met one patient that doesn’t care about their pregnancy or want the best for themselves and their baby, though there are so many factors around them that are influencing their ability to engage or not engage in the kind of quality of care that they want,” she says. “When you’re able to provide additional resources to minimize those stress factors — that burden, that toll is no longer present — you can notice the difference in patients and how they engage in care.”\u003c/p>\n\u003cp>She drives across a section of the Bay Bridge and exits onto Treasure Island, passing a housing construction project and new ferry terminal. She parks in front of a cluster of townhouses to check on her former patient Danesha Johnson.\u003c/p>\n\u003cp>“How are you?” Gebre asks while hugging Johnson, who gave birth a month earlier.\u003c/p>\n\u003cp>“The recovery is fine, no complications. I’m fine,” the 21-year-old says.\u003c/p>\n\u003cp>When Johnson’s partner, Darrian Burrows, comes out to carry the supplies inside, Gebre tells Perkins that he assisted her in the delivery room and caught his daughter when Johnson made her final push. Perkins remembers seeing him in the hospital when Johnson was in labor, and she’s overcome with emotions.\u003c/p>\n\u003cp>“That was so beautiful for you to be in the tub with her when she was going through labor to help ease things,” she says as tears fill her eyes.\u003c/p>\n\u003cp>“You’re giving me the chills, because I work in our communities of color and they’re always giving our men a hard time,” Perkins continues. “And some programs, there’s something for the mom and the baby but they don’t want the dad involved. So just to see you all as a couple and loving one another and having a baby brung into this world together … .”\u003c/p>\n\u003cp>Bearing witness to a happy, healthy birth makes her want to keep this thing going, she says.\u003c/p>\n\u003cp>\u003cem>Nov. 30: This story has been updated to reflect that One Love Black Community is inclusive of all Black people accessing reproductive services in San Francisco.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "COVID-19, Flu and RSV: Why Families Need a Plan for Thanksgiving and Beyond",
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"content": "\u003cp>As Thanksgiving fast approaches and the holiday season gets underway, California public health leaders are urging folks to bolster protections against a triple threat of respiratory viruses: RSV (respiratory syncytial virus), flu and COVID-19.\u003c/p>\n\u003cp>“In every category that we track — whether it’s test positivity, case rate numbers, wastewater surveillance, hospitalizations — we’re seeing increases for RSV, flu and COVID,” said Dr. Mark Ghaly, secretary of California Health and Human Services, during a news conference last week.\u003c/p>\n\u003cp>According to Ghaly, COVID transmission — both in test positivity and case rates — was up by 25% over the past one to two weeks.\u003c/p>\n\u003cp>This is further compounded by an alarming uptick in cases of flu and RSV, \u003ca href=\"https://www.kqed.org/science/1980524/bay-area-childrens-hospitals-strained-as-rsv-surge-arrives\">a respiratory virus that primarily affects infants and has been straining hospitals across the region\u003c/a>.\u003c/p>\n\u003cp>Another concerning statewide trend? The vaccine uptake for the bivalent booster is low. \u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/#overview\">Only around 16% of eligible Californians have gotten a second booster.\u003c/a>\u003cspan style=\"font-weight: 400;\">[aside postID='news_11924327,news_11914514' label='Resources for staying safe this holiday season']\u003c/span>\u003c/p>\n\u003cp>“I think people are kind of tired of talking about getting boosted, and this is another reason why we need to talk about this,” said Dr. Kavita Trivedi, communicable disease controller for Alameda County’s public health department. “We know that these boosters are still really good at preventing severe disease and hospitalization.”\u003c/p>\n\u003cp>Along with rapid testing and the expansion of treatment options like Paxlovid, boosters can help lower the risk of gathering together, said Dr. Mychi Nguyen, chief medical officer at Asian Health Services, a community health provider with sites across Oakland.\u003c/p>\n\u003cp>“I would tell folks, ‘Have a plan,'” for gathering over the holidays, she said. “It’s very important to make one before, during and after.”\u003c/p>\n\u003cp>Nguyen talked with KQED’s Brian Watt about how to reduce the health risks of gathering this Thanksgiving — for yourself and your loved ones. Keep reading for the highlights of their conversation, which have been edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>BRIAN WATT: Are you concerned hospitals and clinics will be overwhelmed in the coming weeks?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>DR. MYCHI NGUYEN:\u003c/strong> As we’re approaching the holiday season, we do expect respiratory viruses to increase as people gather with their loved ones and celebrate more.\u003c/p>\n\u003cp>We know that both flu and RSV are circulating earlier this year, with right now not a lot of folks getting boosters or their flu shots. And with the workforce shortage, we’re seeing that hospitals are getting overwhelmed with the number of cases.\u003cspan style=\"font-weight: 400;\">[pullquote size='medium' align='right' citation=\"Dr. Mychi Nguyen, chief medical officer, Asian Health Services\"]‘I would say ‘yes’ to celebrating — with some precautions.’[/pullquote]\u003c/span>\u003cstrong>Given all this, is it a good idea for folks to be getting together for Thanksgiving — in the way we’re used to doing that?\u003c/strong>\u003c/p>\n\u003cp>I would say “yes” to celebrating — with some precautions.\u003c/p>\n\u003cp>I would recommend that folks get tested the morning of, if you’re going to have a holiday dinner. And limit your interactions with folks the weeks and days coming up for the holidays. Something that you may consider is limiting your interactions in crowds.\u003c/p>\n\u003cp>We know that in California — in the Bay Area in particular — if you can have good weather, dine outdoors if possible. Or if it is indoors, have really good ventilation.\u003c/p>\n\u003cp>And even despite your best efforts, if someone does get ill or if you have symptoms, then make sure that you \u003ca href=\"https://www.kqed.org/news/11914514/if-you-get-covid-should-you-try-to-get-paxlovid-heres-how-with-or-without-health-insurance\">get tested right away and seek treatment\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Is COVID testing something you should factor into a plan?\u003c/strong>\u003c/p>\n\u003cp>Yes, you don’t want to be the dreaded spreader, especially to a vulnerable loved one. So I would recommend testing the day of or the morning of, if you’re going to gather later that day.\u003c/p>\n\u003cp>It will allow for folks who do test positive to know right away — even if you don’t have symptoms — to know to stay home, and probably join in via Zoom, or other ways. And if you’re \u003cem>having\u003c/em> symptoms, if you’re feeling ill, definitely stay home and don’t gather and find other ways to celebrate.\u003c/p>\n\u003cp>\u003cstrong>If you do get infected with COVID, tell us more about the treatment options.\u003c/strong>\u003c/p>\n\u003cp>As soon as you have symptoms, it is important to test right away, and \u003ca href=\"https://www.kqed.org/news/11914514/if-you-get-covid-should-you-try-to-get-paxlovid-heres-how-with-or-without-health-insurance\">if you are positive, it’s important to seek treatment\u003c/a>. Most adults and some children 12 years and above are eligible. And a lot of folks do not know that they’re eligible for treatment.\u003cspan style=\"font-weight: 400;\">[pullquote size='medium' align='right' citation=\"Dr. Mychi Nguyen, chief medical officer, Asian Health Services\"]‘You don’t want to be the dreaded spreader, especially to a vulnerable loved one. So I would recommend testing the day of or the morning of, if you’re going to gather later that day.’[/pullquote]\u003c/span>Treatment and the medications can prevent risk of hospitalizations and death up to 88%. You must act quickly for the effectiveness to take. It’s usually within the first five to seven days of symptom onset. Treatment is free.\u003c/p>\n\u003cp>\u003cstrong>How useful is it to get boosted right before the holidays? Are we talking about some immediate protection if someone goes and gets boosted right away?\u003c/strong>\u003c/p>\n\u003cp>Full immunity will occur in about two weeks. So really, as we’re approaching the holidays, \u003ca href=\"https://www.kqed.org/news/11924327/where-can-i-find-a-new-omicron-covid-booster-shot-near-me\">getting vaccinated as soon as possible is very important\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>You mentioned not a lot of folks have gotten their booster. Do you get this sense as well that there is vaccine fatigue?\u003c/strong>\u003c/p>\n\u003cp>There is a sense of vaccine fatigue that I’m seeing in the clinic. One of the things that I do [with patients] is exploring \u003cem>why\u003c/em>.\u003c/p>\n\u003cp>Some of the concerns are perhaps side effects. And so I would ask them what happened at their previous vaccination, and we would talk about making a plan if there’s some pain or a fever.\u003c/p>\n\u003cp>Usually those symptoms last for a couple days. We tell folks that getting COVID creates potentially more illness and [they] also [could] develop long COVID. And so the short-term benefits outweigh a lot of getting sick from COVID long-term.\u003c/p>\n\u003cp>\u003cstrong>Is it concerning that you’re still hearing some of this hesitation as we enter the third year of this pandemic?\u003c/strong>\u003c/p>\n\u003cp>It is concerning. One thing that we know is that COVID is still with us. It is something that we are learning to live with, and it is very different from before.\u003c/p>\n\u003cp>We are in a much better place with vaccines, with testing, with treatment and really getting that information out there. Those strategies should continue to be strategies that help to fight against COVID.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>How do you get the word out at this moment about the importance of getting the bivalent booster? What is this outreach looking like on the ground?\u003c/strong>\u003c/p>\n\u003cp>At Asian Health Services, we serve patients in English and 14 Asian languages. And we know that if folks do not have access in language, it is very, very difficult to even get testing, or vaccinations, or treatment or to learn how to prevent or take care of themselves if they do get sick. So we really provide that cultural competency, that language outreach in different ethnic media. We send patient newsletters. We go and do outreach into the community, and make sure that websites are translated into the different languages.\u003c/p>\n\u003cp>One thing we also know is that in addition to the language barrier, there is a digital divide. Anyone who has helped a family member navigate online accounts or get to a website knows that if you are not tech-savvy, you can get left behind in terms of accessing a lot of these resources.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>As Thanksgiving fast approaches and the holiday season gets underway, California public health leaders are urging folks to bolster protections against a triple threat of respiratory viruses: RSV (respiratory syncytial virus), flu and COVID-19.\u003c/p>\n\u003cp>“In every category that we track — whether it’s test positivity, case rate numbers, wastewater surveillance, hospitalizations — we’re seeing increases for RSV, flu and COVID,” said Dr. Mark Ghaly, secretary of California Health and Human Services, during a news conference last week.\u003c/p>\n\u003cp>According to Ghaly, COVID transmission — both in test positivity and case rates — was up by 25% over the past one to two weeks.\u003c/p>\n\u003cp>This is further compounded by an alarming uptick in cases of flu and RSV, \u003ca href=\"https://www.kqed.org/science/1980524/bay-area-childrens-hospitals-strained-as-rsv-surge-arrives\">a respiratory virus that primarily affects infants and has been straining hospitals across the region\u003c/a>.\u003c/p>\n\u003cp>Another concerning statewide trend? The vaccine uptake for the bivalent booster is low. \u003ca href=\"https://covid19.ca.gov/vaccination-progress-data/#overview\">Only around 16% of eligible Californians have gotten a second booster.\u003c/a>\u003cspan style=\"font-weight: 400;\">\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003cp>“I think people are kind of tired of talking about getting boosted, and this is another reason why we need to talk about this,” said Dr. Kavita Trivedi, communicable disease controller for Alameda County’s public health department. “We know that these boosters are still really good at preventing severe disease and hospitalization.”\u003c/p>\n\u003cp>Along with rapid testing and the expansion of treatment options like Paxlovid, boosters can help lower the risk of gathering together, said Dr. Mychi Nguyen, chief medical officer at Asian Health Services, a community health provider with sites across Oakland.\u003c/p>\n\u003cp>“I would tell folks, ‘Have a plan,'” for gathering over the holidays, she said. “It’s very important to make one before, during and after.”\u003c/p>\n\u003cp>Nguyen talked with KQED’s Brian Watt about how to reduce the health risks of gathering this Thanksgiving — for yourself and your loved ones. Keep reading for the highlights of their conversation, which have been edited for length and clarity.\u003c/p>\n\u003cp>\u003cstrong>BRIAN WATT: Are you concerned hospitals and clinics will be overwhelmed in the coming weeks?\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>DR. MYCHI NGUYEN:\u003c/strong> As we’re approaching the holiday season, we do expect respiratory viruses to increase as people gather with their loved ones and celebrate more.\u003c/p>\n\u003cp>We know that both flu and RSV are circulating earlier this year, with right now not a lot of folks getting boosters or their flu shots. And with the workforce shortage, we’re seeing that hospitals are getting overwhelmed with the number of cases.\u003cspan style=\"font-weight: 400;\">\u003c/p>\u003c/div>",
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"content": "‘I would say ‘yes’ to celebrating — with some precautions.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003cstrong>Given all this, is it a good idea for folks to be getting together for Thanksgiving — in the way we’re used to doing that?\u003c/strong>\u003c/p>\n\u003cp>I would say “yes” to celebrating — with some precautions.\u003c/p>\n\u003cp>I would recommend that folks get tested the morning of, if you’re going to have a holiday dinner. And limit your interactions with folks the weeks and days coming up for the holidays. Something that you may consider is limiting your interactions in crowds.\u003c/p>\n\u003cp>We know that in California — in the Bay Area in particular — if you can have good weather, dine outdoors if possible. Or if it is indoors, have really good ventilation.\u003c/p>\n\u003cp>And even despite your best efforts, if someone does get ill or if you have symptoms, then make sure that you \u003ca href=\"https://www.kqed.org/news/11914514/if-you-get-covid-should-you-try-to-get-paxlovid-heres-how-with-or-without-health-insurance\">get tested right away and seek treatment\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Is COVID testing something you should factor into a plan?\u003c/strong>\u003c/p>\n\u003cp>Yes, you don’t want to be the dreaded spreader, especially to a vulnerable loved one. So I would recommend testing the day of or the morning of, if you’re going to gather later that day.\u003c/p>\n\u003cp>It will allow for folks who do test positive to know right away — even if you don’t have symptoms — to know to stay home, and probably join in via Zoom, or other ways. And if you’re \u003cem>having\u003c/em> symptoms, if you’re feeling ill, definitely stay home and don’t gather and find other ways to celebrate.\u003c/p>\n\u003cp>\u003cstrong>If you do get infected with COVID, tell us more about the treatment options.\u003c/strong>\u003c/p>\n\u003cp>As soon as you have symptoms, it is important to test right away, and \u003ca href=\"https://www.kqed.org/news/11914514/if-you-get-covid-should-you-try-to-get-paxlovid-heres-how-with-or-without-health-insurance\">if you are positive, it’s important to seek treatment\u003c/a>. Most adults and some children 12 years and above are eligible. And a lot of folks do not know that they’re eligible for treatment.\u003cspan style=\"font-weight: 400;\">\u003c/p>\u003c/div>",
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"content": "‘You don’t want to be the dreaded spreader, especially to a vulnerable loved one. So I would recommend testing the day of or the morning of, if you’re going to gather later that day.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/span>Treatment and the medications can prevent risk of hospitalizations and death up to 88%. You must act quickly for the effectiveness to take. It’s usually within the first five to seven days of symptom onset. Treatment is free.\u003c/p>\n\u003cp>\u003cstrong>How useful is it to get boosted right before the holidays? Are we talking about some immediate protection if someone goes and gets boosted right away?\u003c/strong>\u003c/p>\n\u003cp>Full immunity will occur in about two weeks. So really, as we’re approaching the holidays, \u003ca href=\"https://www.kqed.org/news/11924327/where-can-i-find-a-new-omicron-covid-booster-shot-near-me\">getting vaccinated as soon as possible is very important\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>You mentioned not a lot of folks have gotten their booster. Do you get this sense as well that there is vaccine fatigue?\u003c/strong>\u003c/p>\n\u003cp>There is a sense of vaccine fatigue that I’m seeing in the clinic. One of the things that I do [with patients] is exploring \u003cem>why\u003c/em>.\u003c/p>\n\u003cp>Some of the concerns are perhaps side effects. And so I would ask them what happened at their previous vaccination, and we would talk about making a plan if there’s some pain or a fever.\u003c/p>\n\u003cp>Usually those symptoms last for a couple days. We tell folks that getting COVID creates potentially more illness and [they] also [could] develop long COVID. And so the short-term benefits outweigh a lot of getting sick from COVID long-term.\u003c/p>\n\u003cp>\u003cstrong>Is it concerning that you’re still hearing some of this hesitation as we enter the third year of this pandemic?\u003c/strong>\u003c/p>\n\u003cp>It is concerning. One thing that we know is that COVID is still with us. It is something that we are learning to live with, and it is very different from before.\u003c/p>\n\u003cp>We are in a much better place with vaccines, with testing, with treatment and really getting that information out there. Those strategies should continue to be strategies that help to fight against COVID.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>How do you get the word out at this moment about the importance of getting the bivalent booster? What is this outreach looking like on the ground?\u003c/strong>\u003c/p>\n\u003cp>At Asian Health Services, we serve patients in English and 14 Asian languages. And we know that if folks do not have access in language, it is very, very difficult to even get testing, or vaccinations, or treatment or to learn how to prevent or take care of themselves if they do get sick. So we really provide that cultural competency, that language outreach in different ethnic media. We send patient newsletters. We go and do outreach into the community, and make sure that websites are translated into the different languages.\u003c/p>\n\u003cp>One thing we also know is that in addition to the language barrier, there is a digital divide. Anyone who has helped a family member navigate online accounts or get to a website knows that if you are not tech-savvy, you can get left behind in terms of accessing a lot of these resources.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>California’s nursing agency this week approved rules that will allow nurse practitioners to treat patients without physician supervision. It’s a move that aims to expand access to care in the Golden State at a time when workforce shortages plague just about every corner of health care.[pullquote size=\"medium\" align=\"right\" citation=\"Cynthia Jovanov, president, California Association for Nurse Practitioners\"]‘This means that if I want to do a mobile clinic in Skid Row, I don’t have to be held hostage by paperwork to get a partnering physician who may not have the same desire.’[/pullquote]\u003c/p>\n\u003cp>Monday’s vote is one of the last major steps necessary to fully implement a 2020 law that will allow nurse practitioners to practice more freely. Nurse practitioners, who have advanced degrees and training, currently must enter into a written agreement with a physician who oversees their work with patients.\u003c/p>\n\u003cp>Despite some earlier concerns about potential delays, nurse practitioners say they are now confident that applications to start the certification process will go live early in the new year as planned.\u003c/p>\n\u003cp>“Hopefully we don’t crash the website, but we are very excited,” said Cynthia Jovanov, president of the California Association for Nurse Practitioners. “This means that if I want to do a mobile clinic in Skid Row, I don’t have to be held hostage by paperwork to get a partnering physician who may not have the same desire.”\u003c/p>\n\u003cp>Nurse practitioners are a cost-effective way of bringing more primary care providers to communities that need them, particularly in rural areas, said Glenn Melnick, a health economist at the University of Southern California.\u003c/p>\n\u003cp>“And that can benefit the consumer as long as the quality of care is acceptable,” he said.\u003c/p>\n\u003cp>Nurse practitioners in California have been fighting to break free of physician oversight for years. The biggest pushback came from physicians. During legislative debate, the California Medical Association said nurse practitioners have less training than physicians, so allowing them to practice independently could lessen the quality of care and even pose a risk to patients.\u003c/p>\n\u003ch2>Law is not ‘carte blanche’\u003c/h2>\n\u003cp>In 2020, Gov. Gavin Newsom signed into law \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890\">Assembly Bill 890\u003c/a>, which was authored by Assemblymember Jim Wood, a Santa Rosa Democrat. For it to go into full effect, the Board of Registered Nursing had to first iron out details, including how nurse practitioners would transition into their more independent role and what type of additional training or testing, if any, would be needed to obtain certification.\u003c/p>\n\u003cp>The law essentially created two new categories of nurse practitioner. Starting in January, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for the first category. This first step will allow them to work without contractual physician supervision, but only in certain facilities where at least one doctor or surgeon also practices. The idea is that nurse practitioners would still be able to consult a doctor when needed.\u003c/p>\n\u003cp>“So that does not give them (nurse practitioners) the carte blanche that I think some people were fearful of,” said Loretta Melby, executive officer of the state’s Board of Registered Nursing, during Monday’s meeting. “And then, when they are there for three years in that group setting with a physician or surgeon, only then can they advance to [the second category].”\u003c/p>\n\u003cp>This second designation will allow nurse practitioners full practice authority, without any setting restrictions. And in theory, nurse practitioners would be able to open their own medical practice. Given the phased-in approach, eligible nurse practitioners will likely obtain full independence around January of 2026.\u003c/p>\n\u003cp>\u003ca href=\"https://www.chcf.org/wp-content/uploads/2021/11/TransitionPracticeNPsLessonsOtherStates.pdf\">California’s requirements for nurse practitioners to transition into full independence will be among the most robust in the country (PDF)\u003c/a>, according to one analysis by the California Health Care Foundation.\u003c/p>\n\u003cp>Nurse practitioners can perform physical exams, order lab tests, diagnose ailments and prescribe medication, but in California this has had to be under the oversight of a doctor. Of the 31,000 nurse practitioners in California, an estimated 20,000 will be eligible to apply for expanded authority in 2023, according to the California Association of Nurse Practitioners.\u003c/p>\n\u003cp>Kenny Chen, a family nurse practitioner in South Central Los Angeles, exemplifies the type of clinicians researchers say California needs more of: He is interested in primary care; he speaks multiple languages, including Spanish and his native Mandarin; and he enjoys working with underserved populations.\u003c/p>\n\u003cp>Chen said that while he doesn’t expect major changes to his current role at Martin Luther King, Jr. Outpatient Center, the new law would allow his clinic to hire more nurse practitioners without having to meet physician-to-nurse practitioner ratios. “It can be very difficult to recruit physicians to come work in South Central LA,” Chen said.\u003c/p>\n\u003cp>Giving nurse practitioners more authority, he said, can also attract more of them to California. \u003ca href=\"https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/\">All other Western states\u003c/a>, for example, already allow nurse practitioners greater independence. California’s restrictions could be a deterrence, he said.\u003c/p>\n\u003cp>Ahead of Monday’s vote, the \u003ca href=\"https://www.rn.ca.gov/pdfs/meetings/brd/brd_nov22_item6-1-2.pdf\">California Medical Association sent a letter to the Board of Registered Nursing (PDF)\u003c/a> stating that the nursing board’s rules for nurse practitioners to transition into their independent roles lacked clarity and didn’t provide any more meaningful guidance than what was already stated in the text of the law.\u003c/p>\n\u003cp>Melby, the nursing board’s executive officer, said she has also heard concerns that the law would expand the scope of services that nurse practitioners can provide, but clarified that the law doesn’t actually change the type of work nurse practitioners will be doing.\u003c/p>\n\u003cp>“What was updated was the supervision requirement,” Melby said. “And so it’s not like the nurse practitioner is now going to have the freedom to go out and perform surgery. That has never been a nurse practitioner scope of practice.”\u003c/p>\n\u003ch2>New rules may increase health care access\u003c/h2>\n\u003cp>According to workforce researchers, allowing nurse practitioners more flexibility is a small but \u003ca href=\"https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0435\">key piece of the puzzle in alleviating California’s provider shortage\u003c/a>.\u003c/p>\n\u003cp>Even prior to the pandemic, California was experiencing a \u003ca href=\"https://calmatters.org/projects/californias-worsening-physician-shortage-doctors/\">shortage of medical providers\u003c/a>. A 2019 report by a commission of health care experts estimated that by 2030, the state would need an additional \u003ca href=\"https://futurehealthworkforce.org/wp-content/uploads/2019/02/ExecutiveSummaryFinalReportCFHWC.pdf\">4,100 primary care clinicians (PDF)\u003c/a>. About 7 million Californians already live in provider shortage areas with a need for primary, mental and dental care, according to the report.\u003c/p>\n\u003cp>Rural counties tend to have the greatest shortages; in counties like Glenn, Trinity, San Benito and Imperial, \u003ca href=\"https://letsgethealthy.ca.gov/goals/redesigning-the-health-system/increasing-access-to-healthcare-providers/\">more than 80% of people live without sufficient access to care\u003c/a>. And when patients do find care, they often rely on nurse practitioners. Some studies have shown that although physicians still make up the biggest proportion of primary care providers in rural areas, \u003ca href=\"https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1158\">nurse practitioners are choosing to work in rural settings at a faster rate\u003c/a>.\u003c/p>\n\u003cp>Alexa Curtis, a family and psychiatric mental health nurse practitioner at a substance use disorder facility in Nevada County, said the need in rural communities has driven most of her career. Curtis, who is also an associate dean at the School of Nursing and Health Professions at the University of San Francisco, plans to develop a rural street medicine program with a focus on unhoused people with mental health needs and substance use disorders.\u003c/p>\n\u003cp>Once she is granted greater authority, “I will be able to pursue that goal without the barrier and expense of needing to secure a physician supervisor,” she said.\u003c/p>\n\u003cp>But working with other types of providers, including physicians, will always be part of her practice. “It is how we are trained and how we function as nurse practitioners,” she said.\u003c/p>\n\u003cp>Earlier this year, Newsom also signed into law \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1375\">Senate Bill 1375\u003c/a>, which authorizes nurse practitioners to provide reproductive care and first-trimester abortions without doctor supervision.\u003c/p>\n\u003cp>These two wins were huge for nurse practitioners, said Jovanov, the president of the nurse practitioner lobby. “I can tell you that this will lead to many more bills for regulations that need to change,” she said. “We’re on this momentum and that is really exciting.”\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>\u003c/p>\n\u003cp>Monday’s vote is one of the last major steps necessary to fully implement a 2020 law that will allow nurse practitioners to practice more freely. Nurse practitioners, who have advanced degrees and training, currently must enter into a written agreement with a physician who oversees their work with patients.\u003c/p>\n\u003cp>Despite some earlier concerns about potential delays, nurse practitioners say they are now confident that applications to start the certification process will go live early in the new year as planned.\u003c/p>\n\u003cp>“Hopefully we don’t crash the website, but we are very excited,” said Cynthia Jovanov, president of the California Association for Nurse Practitioners. “This means that if I want to do a mobile clinic in Skid Row, I don’t have to be held hostage by paperwork to get a partnering physician who may not have the same desire.”\u003c/p>\n\u003cp>Nurse practitioners are a cost-effective way of bringing more primary care providers to communities that need them, particularly in rural areas, said Glenn Melnick, a health economist at the University of Southern California.\u003c/p>\n\u003cp>“And that can benefit the consumer as long as the quality of care is acceptable,” he said.\u003c/p>\n\u003cp>Nurse practitioners in California have been fighting to break free of physician oversight for years. The biggest pushback came from physicians. During legislative debate, the California Medical Association said nurse practitioners have less training than physicians, so allowing them to practice independently could lessen the quality of care and even pose a risk to patients.\u003c/p>\n\u003ch2>Law is not ‘carte blanche’\u003c/h2>\n\u003cp>In 2020, Gov. Gavin Newsom signed into law \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB890\">Assembly Bill 890\u003c/a>, which was authored by Assemblymember Jim Wood, a Santa Rosa Democrat. For it to go into full effect, the Board of Registered Nursing had to first iron out details, including how nurse practitioners would transition into their more independent role and what type of additional training or testing, if any, would be needed to obtain certification.\u003c/p>\n\u003cp>The law essentially created two new categories of nurse practitioner. Starting in January, nurse practitioners who have completed 4,600 hours or three years of full-time clinical practice in California can apply for the first category. This first step will allow them to work without contractual physician supervision, but only in certain facilities where at least one doctor or surgeon also practices. The idea is that nurse practitioners would still be able to consult a doctor when needed.\u003c/p>\n\u003cp>“So that does not give them (nurse practitioners) the carte blanche that I think some people were fearful of,” said Loretta Melby, executive officer of the state’s Board of Registered Nursing, during Monday’s meeting. “And then, when they are there for three years in that group setting with a physician or surgeon, only then can they advance to [the second category].”\u003c/p>\n\u003cp>This second designation will allow nurse practitioners full practice authority, without any setting restrictions. And in theory, nurse practitioners would be able to open their own medical practice. Given the phased-in approach, eligible nurse practitioners will likely obtain full independence around January of 2026.\u003c/p>\n\u003cp>\u003ca href=\"https://www.chcf.org/wp-content/uploads/2021/11/TransitionPracticeNPsLessonsOtherStates.pdf\">California’s requirements for nurse practitioners to transition into full independence will be among the most robust in the country (PDF)\u003c/a>, according to one analysis by the California Health Care Foundation.\u003c/p>\n\u003cp>Nurse practitioners can perform physical exams, order lab tests, diagnose ailments and prescribe medication, but in California this has had to be under the oversight of a doctor. Of the 31,000 nurse practitioners in California, an estimated 20,000 will be eligible to apply for expanded authority in 2023, according to the California Association of Nurse Practitioners.\u003c/p>\n\u003cp>Kenny Chen, a family nurse practitioner in South Central Los Angeles, exemplifies the type of clinicians researchers say California needs more of: He is interested in primary care; he speaks multiple languages, including Spanish and his native Mandarin; and he enjoys working with underserved populations.\u003c/p>\n\u003cp>Chen said that while he doesn’t expect major changes to his current role at Martin Luther King, Jr. Outpatient Center, the new law would allow his clinic to hire more nurse practitioners without having to meet physician-to-nurse practitioner ratios. “It can be very difficult to recruit physicians to come work in South Central LA,” Chen said.\u003c/p>\n\u003cp>Giving nurse practitioners more authority, he said, can also attract more of them to California. \u003ca href=\"https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/\">All other Western states\u003c/a>, for example, already allow nurse practitioners greater independence. California’s restrictions could be a deterrence, he said.\u003c/p>\n\u003cp>Ahead of Monday’s vote, the \u003ca href=\"https://www.rn.ca.gov/pdfs/meetings/brd/brd_nov22_item6-1-2.pdf\">California Medical Association sent a letter to the Board of Registered Nursing (PDF)\u003c/a> stating that the nursing board’s rules for nurse practitioners to transition into their independent roles lacked clarity and didn’t provide any more meaningful guidance than what was already stated in the text of the law.\u003c/p>\n\u003cp>Melby, the nursing board’s executive officer, said she has also heard concerns that the law would expand the scope of services that nurse practitioners can provide, but clarified that the law doesn’t actually change the type of work nurse practitioners will be doing.\u003c/p>\n\u003cp>“What was updated was the supervision requirement,” Melby said. “And so it’s not like the nurse practitioner is now going to have the freedom to go out and perform surgery. That has never been a nurse practitioner scope of practice.”\u003c/p>\n\u003ch2>New rules may increase health care access\u003c/h2>\n\u003cp>According to workforce researchers, allowing nurse practitioners more flexibility is a small but \u003ca href=\"https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0435\">key piece of the puzzle in alleviating California’s provider shortage\u003c/a>.\u003c/p>\n\u003cp>Even prior to the pandemic, California was experiencing a \u003ca href=\"https://calmatters.org/projects/californias-worsening-physician-shortage-doctors/\">shortage of medical providers\u003c/a>. A 2019 report by a commission of health care experts estimated that by 2030, the state would need an additional \u003ca href=\"https://futurehealthworkforce.org/wp-content/uploads/2019/02/ExecutiveSummaryFinalReportCFHWC.pdf\">4,100 primary care clinicians (PDF)\u003c/a>. About 7 million Californians already live in provider shortage areas with a need for primary, mental and dental care, according to the report.\u003c/p>\n\u003cp>Rural counties tend to have the greatest shortages; in counties like Glenn, Trinity, San Benito and Imperial, \u003ca href=\"https://letsgethealthy.ca.gov/goals/redesigning-the-health-system/increasing-access-to-healthcare-providers/\">more than 80% of people live without sufficient access to care\u003c/a>. And when patients do find care, they often rely on nurse practitioners. Some studies have shown that although physicians still make up the biggest proportion of primary care providers in rural areas, \u003ca href=\"https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.1158\">nurse practitioners are choosing to work in rural settings at a faster rate\u003c/a>.\u003c/p>\n\u003cp>Alexa Curtis, a family and psychiatric mental health nurse practitioner at a substance use disorder facility in Nevada County, said the need in rural communities has driven most of her career. Curtis, who is also an associate dean at the School of Nursing and Health Professions at the University of San Francisco, plans to develop a rural street medicine program with a focus on unhoused people with mental health needs and substance use disorders.\u003c/p>\n\u003cp>Once she is granted greater authority, “I will be able to pursue that goal without the barrier and expense of needing to secure a physician supervisor,” she said.\u003c/p>\n\u003cp>But working with other types of providers, including physicians, will always be part of her practice. “It is how we are trained and how we function as nurse practitioners,” she said.\u003c/p>\n\u003cp>Earlier this year, Newsom also signed into law \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1375\">Senate Bill 1375\u003c/a>, which authorizes nurse practitioners to provide reproductive care and first-trimester abortions without doctor supervision.\u003c/p>\n\u003cp>These two wins were huge for nurse practitioners, said Jovanov, the president of the nurse practitioner lobby. “I can tell you that this will lead to many more bills for regulations that need to change,” she said. “We’re on this momentum and that is really exciting.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>When Dr. H.M. Green opened his new medical office building on East Vine Avenue in 1922, Black Knoxville residents could be seen only in the basement of Knoxville General Hospital. They were barred from the city’s other three medical centers.\u003c/p>\n\u003cp>Green, one of America’s leading Black physicians, spent his life working to end health inequities like this. He installed an X-ray machine, an operating room, and a private infirmary in his building to serve Black patients. On the first floor was a pharmacy.\u003c/p>\n\u003cp>[pullquote size=\"large\" align=\"right\" citation=\"Berneta Haynes, staff attorney, National Consumer Law Center\"]‘This legacy of segregation and structural racism underlies the racial health gap. It impacts health outcomes and access. And it impacts the level of medical debt.’[/pullquote]\u003c/p>\n\u003cp>Today the Green Medical Arts Building has been replaced by a tangle of freeways that were built after the city’s Black business district was bulldozed in a midcentury urban renewal project.\u003c/p>\n\u003cp>But the health gaps Green labored to narrow still divide this community. And if segregation is less apparent in medical offices today, its legacy lives on in crushing medical debt that disproportionately burdens this city’s Black community.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In and around Knoxville, residents of predominantly Black neighborhoods are more than twice as likely as those in largely white neighborhoods to owe money for medical bills, Urban Institute \u003ca href=\"https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=47&county=47093\" target=\"_blank\" rel=\"noopener noreferrer\">credit bureau data\u003c/a> shows — it’s one of the widest racial disparities in the country.\u003c/p>\n\u003cp>That tracks with a disturbing national trend. Health care debt in the U.S. now affects more than 100 million people, \u003ca href=\"https://khn.org/news/tag/diagnosis-debt/\" target=\"_blank\" rel=\"noopener noreferrer\">a KHN-NPR investigation\u003c/a> found. But the toll has been especially high on Black communities: 56% of Black adults owe money for a medical or dental bill, compared with 37% of white adults, according to \u003ca href=\"https://www.kff.org/health-costs/report/kff-health-care-debt-survey/\" target=\"_blank\" rel=\"noopener noreferrer\">a nationwide KFF poll\u003c/a> conducted for this project.\u003c/p>\n\u003cp>The explanation for that startling disparity is deeply rooted. Decades of discrimination in housing, employment, and health care blocked generations of Black families from building wealth — savings and assets that are increasingly critical to accessing America’s high-priced medical system.\u003c/p>\n\u003cp>Against that backdrop, patients suffer. People with debt avoid seeking care and become sicker with treatable chronic conditions like diabetes or multiple sclerosis. Worse still, hospitals and doctors sometimes won’t see patients with medical debt — even those in the middle of treatment.\u003c/p>\n\u003cp>“African Americans don’t seek health care until we are really, really sick, and then it costs more,” said Tabace Burns, a former emergency room nurse in Knoxville. Burns, who is also a leader in her church, said she routinely helps members of her congregation find medical care they should have sought earlier.\u003c/p>\n\u003cp>Nationwide, Black adults who have had health care debt are twice as likely as white adults with such debt to say they’ve been denied care because they owe money, the KFF poll found. Many Black Americans also ration their care out of fear of cost.\u003c/p>\n\u003cp>Burns recalled a friend who came to see her about an oozing growth on her breast. “She didn’t have any insurance, so she just thought it would get better,” Burns said.[aside tag=\"debt\" label=\"More Debt-Related Stories\"]\u003c/p>\n\u003cp>Burns helped the woman find an oncologist to treat what turned out to be cancer. There was a cost to waiting so long, though. Because the cancer was so advanced, the friend had to undergo chemotherapy and have both breasts removed.\u003c/p>\n\u003cp>It could have been worse. “What if she didn’t know me? What if she just continued to let her breast leak and it was necrotic?” Burns said. But, she added, if her friend hadn’t been so worried about going into debt, she would have gone to the doctor sooner.\u003c/p>\n\u003cp>It’s a terrible cycle, said Berneta Haynes, a staff attorney at the National Consumer Law Center. “This legacy of segregation and structural racism underlies the racial health gap,” she said. “It impacts health outcomes and access. And it impacts the level of medical debt.”\u003c/p>\n\u003ch3>In ‘The Bottom’\u003c/h3>\n\u003cp>The story of how Knoxville’s Black residents came to be its primary victims of medical debt is written in the city’s changing landscape.\u003c/p>\n\u003cp>Just outside downtown, below refurbished office buildings and former warehouses, is an area once called The Bottom, long the heart of the Black community.\u003c/p>\n\u003cp>This area persevered through decades of Jim Crow segregation and violence. In one of the worst episodes, mobs of white rioters in 1919 vandalized Black-owned stores and shot residents after a young Black man was accused of killing a white woman.\u003c/p>\n\u003cp>It was here that Black physicians like Green opened medical offices alongside grocers, pool halls, and funeral homes. Knoxville’s first Black millionaire, a former enslaved man who’d made a fortune in horse racing and saloons, built a YMCA. Billie Holiday and Cab Calloway performed at the Gem Theatre.\u003c/p>\n\u003cp>Beginning in the late 1950s, the city systematically wiped out The Bottom and surrounding neighborhoods in an urban renewal and highway-building campaign. Officials razed more than 500 homes, 15 churches, and more than 100 Black-owned businesses, including Green’s medical building.\u003c/p>\n\u003cp>More than 2,500 families were displaced. Many ended up in public housing projects. Others left Knoxville. Businesses never reopened. “It changed the whole landscape,” said the Rev. Reneé Kesler, director of the Beck Cultural Exchange Center, a nonprofit that preserves Knoxville’s Black history. “You’ll have generations that won’t recover from that.”\u003c/p>\n\u003cp>What urban renewal left behind in East Knoxville was a neighborhood that’s the poorest in the city — and has the largest share of Black residents.\u003c/p>\n\u003cp>A tiny fraction of residents are homeowners. Blocks are blighted by boarded-up buildings and overgrown lots. Down the street from Knoxville’s oldest Black cemetery, a Dollar General recently closed — one of the few stores around that sold groceries.\u003c/p>\n\u003cp>The neighborhood’s residents are sicker than those elsewhere in Knoxville, with higher levels of diabetes and other chronic illnesses. They are less likely to have health insurance.\u003c/p>\n\u003cp>They also have much more medical debt.\u003c/p>\n\u003cp>More than 30% of the people have a medical bill on their credit record, according to credit bureau data collected \u003ca href=\"https://www.urban.org/urban-wire/communities-color-disproportionally-suffer-medical-debt\">by the nonprofit Urban Institute\u003c/a>. A few miles west in Knoxville’s overwhelmingly white suburbs, fewer than 10% carry such debt.\u003c/p>\n\u003cp>It’s not difficult to understand the difference, said Eboni Winford, a clinical psychologist at Cherokee Health Systems, a network of clinics that serve low-income patients. “Black people are less likely to have generational wealth to pass on, which means we don’t have the pockets of money that we can just use if medical bills arise.”\u003c/p>\n\u003cp>Nationally, the median white family now has about $184,000 in assets such as homes, savings, and retirement accounts, according to an \u003ca href=\"https://www.stlouisfed.org/on-the-economy/2021/january/wealth-gaps-white-black-hispanic-families-2019\" target=\"_blank\" rel=\"noopener noreferrer\">analysis by the Federal Reserve Bank\u003c/a> of St. Louis. The assets of the median Black family total just $23,000.\u003c/p>\n\u003cp>“What happened is we concentrated Black poverty,” said Gwen McKenzie, a Knoxville City Council member who grew up not far from The Bottom. “From there, that’s where it became generational.”\u003c/p>\n\u003ch3>‘Always a sacrifice’\u003c/h3>\n\u003cp>Monica Reed lives just up the hill from where The Bottom once was.\u003c/p>\n\u003cp>She considers herself luckier than most. Born in Knoxville and raised by a single mother, Reed became the first in her family to own a home, a small house built after the city demolished The Bottom. For the past 15 years, she’s worked for a faith-based nonprofit that assists low-income residents of Knoxville.\u003c/p>\n\u003cp>“It hasn’t always been easy,” said Reed, who just turned 60. She raised her son by herself. And though she’s always worked, her modest salary made saving difficult. “I just tried to live a frugal kind of life,” she said. “And by the grace of God, I didn’t become homeless.”\u003c/p>\n\u003cp>She couldn’t escape medical debt, though. Diagnosed with cancer five years ago, Reed underwent surgery and chemotherapy. Although she had health insurance through work, she was left with close to $10,000 in medical bills she couldn’t pay.\u003c/p>\n\u003cp>She’s been pursued by debt collectors and even taken to court. That’s forced Reed to make difficult choices. “There’s always a sacrifice,” she said. “You just do without some things to pay other things.”\u003c/p>\n\u003cp>Reed said she cut back on trips to the grocery store: “I don’t buy a lot of food. Just plain and simple.”\u003c/p>\n\u003cp>She has adjusted, she said. “You just do what you have to do.” What angers Reed, though, is how she’s been treated by the cancer center where she goes for periodic checkups to make sure the cancer remains in remission. When she recently tried to make an appointment, a financial counselor told her she couldn’t schedule it until she made a plan to pay her bills.\u003c/p>\n\u003cp>“I was so upset, I didn’t even find out how much I owed,” Reed said. “I mean, I wasn’t calling about a little toothache. This is something that affects someone’s life.”\u003c/p>\n\u003ch3>Locking in disparities\u003c/h3>\n\u003cp>Health insurance gains made possible by the Affordable Care Act have narrowed some racial health disparities, studies show.\u003c/p>\n\u003cp>The expansion of Medicaid, in particular, has brought new financial security to millions of low-income Americans. In a \u003ca href=\"https://cdn.theatlantic.com/assets/media/files/bgh_draft_2018.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent analysis\u003c/a> of credit bureau and census data, researchers estimated that Medicaid expansion helped enrollees avoid more than $1,200 in medical debt.\u003c/p>\n\u003cp>But many of those gains have remained out of reach in Knoxville. Tennessee is among 12 states that have rejected federal funding to expand the Medicaid safety net through the 2010 health care law.\u003c/p>\n\u003cp>Eight of the 12 are Southern states with large Black populations. The decision not to expand has disproportionately affected communities like East Knoxville that are already contending with deep racial disparities in health and wealth.\u003c/p>\n\u003cp>Of the roughly 2.2 million people locked out of health coverage because these states rejected Medicaid expansion, nearly 60% are people of color, according to \u003ca href=\"https://www.kff.org/policy-watch/taking-a-closer-look-at-characteristics-of-people-in-the-coverage-gap/\" target=\"_blank\" rel=\"noopener noreferrer\">a KFF analysis\u003c/a>. About a quarter are Black.\u003c/p>\n\u003cp>Locked out of health insurance, many just try to hang on until they become eligible for Medicare, said Cynthia Finch, an advocate in Knoxville who has worked to improve health in the city’s Black community. “People pray they don’t get sick before they are 65,” she said.\u003c/p>\n\u003cp>If Black patients go into debt, they face yet another challenge: a medical debt collections industry that\u003ca href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3465203\" target=\"_blank\" rel=\"noopener noreferrer\"> targets Black debtors\u003c/a> more aggressively than their white counterparts, particularly for smaller debts.\u003c/p>\n\u003cp>About 6 in 10 Black adults with medical debts under $2,500 say they or someone in their household has been contacted by a collection agency in the past five years, the KFF poll found. By contrast, only about 4 in 10 white adults with similar debt said the same.\u003c/p>\n\u003cp>At the courthouse in downtown Knoxville, the dockets are filled with debt collection lawsuits filed by some of the region’s largest hospitals: Fort Sanders Regional Medical Center, East Tennessee Children’s Hospital, and Parkwest Medical Center.\u003c/p>\n\u003cp>That discourages many Black patients from seeking care even if they need it, said Cherokee Health’s Derrick Folsom, who helps patients enroll in health insurance. “Somebody knows somebody who’s getting sued for medical bills,” Folsom said. “So they stay away from medical centers.”\u003c/p>\n\u003cp>Reflecting on her experience with medical debt, Reed said she tries to stay upbeat. “I don’t sweat the small stuff,” she said. “What am I going to do against this hospital?”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>But, she said, she has realized one thing about the nation’s health care system: “It’s not designed for poor people.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Black+Americans+are+more+likely+to+be+saddled+with+medical+debt&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today the Green Medical Arts Building has been replaced by a tangle of freeways that were built after the city’s Black business district was bulldozed in a midcentury urban renewal project.\u003c/p>\n\u003cp>But the health gaps Green labored to narrow still divide this community. And if segregation is less apparent in medical offices today, its legacy lives on in crushing medical debt that disproportionately burdens this city’s Black community.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In and around Knoxville, residents of predominantly Black neighborhoods are more than twice as likely as those in largely white neighborhoods to owe money for medical bills, Urban Institute \u003ca href=\"https://apps.urban.org/features/debt-interactive-map/?type=medical&variable=medcoll&state=47&county=47093\" target=\"_blank\" rel=\"noopener noreferrer\">credit bureau data\u003c/a> shows — it’s one of the widest racial disparities in the country.\u003c/p>\n\u003cp>That tracks with a disturbing national trend. Health care debt in the U.S. now affects more than 100 million people, \u003ca href=\"https://khn.org/news/tag/diagnosis-debt/\" target=\"_blank\" rel=\"noopener noreferrer\">a KHN-NPR investigation\u003c/a> found. But the toll has been especially high on Black communities: 56% of Black adults owe money for a medical or dental bill, compared with 37% of white adults, according to \u003ca href=\"https://www.kff.org/health-costs/report/kff-health-care-debt-survey/\" target=\"_blank\" rel=\"noopener noreferrer\">a nationwide KFF poll\u003c/a> conducted for this project.\u003c/p>\n\u003cp>The explanation for that startling disparity is deeply rooted. Decades of discrimination in housing, employment, and health care blocked generations of Black families from building wealth — savings and assets that are increasingly critical to accessing America’s high-priced medical system.\u003c/p>\n\u003cp>Against that backdrop, patients suffer. People with debt avoid seeking care and become sicker with treatable chronic conditions like diabetes or multiple sclerosis. Worse still, hospitals and doctors sometimes won’t see patients with medical debt — even those in the middle of treatment.\u003c/p>\n\u003cp>“African Americans don’t seek health care until we are really, really sick, and then it costs more,” said Tabace Burns, a former emergency room nurse in Knoxville. Burns, who is also a leader in her church, said she routinely helps members of her congregation find medical care they should have sought earlier.\u003c/p>\n\u003cp>Nationwide, Black adults who have had health care debt are twice as likely as white adults with such debt to say they’ve been denied care because they owe money, the KFF poll found. Many Black Americans also ration their care out of fear of cost.\u003c/p>\n\u003cp>Burns recalled a friend who came to see her about an oozing growth on her breast. “She didn’t have any insurance, so she just thought it would get better,” Burns said.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Burns helped the woman find an oncologist to treat what turned out to be cancer. There was a cost to waiting so long, though. Because the cancer was so advanced, the friend had to undergo chemotherapy and have both breasts removed.\u003c/p>\n\u003cp>It could have been worse. “What if she didn’t know me? What if she just continued to let her breast leak and it was necrotic?” Burns said. But, she added, if her friend hadn’t been so worried about going into debt, she would have gone to the doctor sooner.\u003c/p>\n\u003cp>It’s a terrible cycle, said Berneta Haynes, a staff attorney at the National Consumer Law Center. “This legacy of segregation and structural racism underlies the racial health gap,” she said. “It impacts health outcomes and access. And it impacts the level of medical debt.”\u003c/p>\n\u003ch3>In ‘The Bottom’\u003c/h3>\n\u003cp>The story of how Knoxville’s Black residents came to be its primary victims of medical debt is written in the city’s changing landscape.\u003c/p>\n\u003cp>Just outside downtown, below refurbished office buildings and former warehouses, is an area once called The Bottom, long the heart of the Black community.\u003c/p>\n\u003cp>This area persevered through decades of Jim Crow segregation and violence. In one of the worst episodes, mobs of white rioters in 1919 vandalized Black-owned stores and shot residents after a young Black man was accused of killing a white woman.\u003c/p>\n\u003cp>It was here that Black physicians like Green opened medical offices alongside grocers, pool halls, and funeral homes. Knoxville’s first Black millionaire, a former enslaved man who’d made a fortune in horse racing and saloons, built a YMCA. Billie Holiday and Cab Calloway performed at the Gem Theatre.\u003c/p>\n\u003cp>Beginning in the late 1950s, the city systematically wiped out The Bottom and surrounding neighborhoods in an urban renewal and highway-building campaign. Officials razed more than 500 homes, 15 churches, and more than 100 Black-owned businesses, including Green’s medical building.\u003c/p>\n\u003cp>More than 2,500 families were displaced. Many ended up in public housing projects. Others left Knoxville. Businesses never reopened. “It changed the whole landscape,” said the Rev. Reneé Kesler, director of the Beck Cultural Exchange Center, a nonprofit that preserves Knoxville’s Black history. “You’ll have generations that won’t recover from that.”\u003c/p>\n\u003cp>What urban renewal left behind in East Knoxville was a neighborhood that’s the poorest in the city — and has the largest share of Black residents.\u003c/p>\n\u003cp>A tiny fraction of residents are homeowners. Blocks are blighted by boarded-up buildings and overgrown lots. Down the street from Knoxville’s oldest Black cemetery, a Dollar General recently closed — one of the few stores around that sold groceries.\u003c/p>\n\u003cp>The neighborhood’s residents are sicker than those elsewhere in Knoxville, with higher levels of diabetes and other chronic illnesses. They are less likely to have health insurance.\u003c/p>\n\u003cp>They also have much more medical debt.\u003c/p>\n\u003cp>More than 30% of the people have a medical bill on their credit record, according to credit bureau data collected \u003ca href=\"https://www.urban.org/urban-wire/communities-color-disproportionally-suffer-medical-debt\">by the nonprofit Urban Institute\u003c/a>. A few miles west in Knoxville’s overwhelmingly white suburbs, fewer than 10% carry such debt.\u003c/p>\n\u003cp>It’s not difficult to understand the difference, said Eboni Winford, a clinical psychologist at Cherokee Health Systems, a network of clinics that serve low-income patients. “Black people are less likely to have generational wealth to pass on, which means we don’t have the pockets of money that we can just use if medical bills arise.”\u003c/p>\n\u003cp>Nationally, the median white family now has about $184,000 in assets such as homes, savings, and retirement accounts, according to an \u003ca href=\"https://www.stlouisfed.org/on-the-economy/2021/january/wealth-gaps-white-black-hispanic-families-2019\" target=\"_blank\" rel=\"noopener noreferrer\">analysis by the Federal Reserve Bank\u003c/a> of St. Louis. The assets of the median Black family total just $23,000.\u003c/p>\n\u003cp>“What happened is we concentrated Black poverty,” said Gwen McKenzie, a Knoxville City Council member who grew up not far from The Bottom. “From there, that’s where it became generational.”\u003c/p>\n\u003ch3>‘Always a sacrifice’\u003c/h3>\n\u003cp>Monica Reed lives just up the hill from where The Bottom once was.\u003c/p>\n\u003cp>She considers herself luckier than most. Born in Knoxville and raised by a single mother, Reed became the first in her family to own a home, a small house built after the city demolished The Bottom. For the past 15 years, she’s worked for a faith-based nonprofit that assists low-income residents of Knoxville.\u003c/p>\n\u003cp>“It hasn’t always been easy,” said Reed, who just turned 60. She raised her son by herself. And though she’s always worked, her modest salary made saving difficult. “I just tried to live a frugal kind of life,” she said. “And by the grace of God, I didn’t become homeless.”\u003c/p>\n\u003cp>She couldn’t escape medical debt, though. Diagnosed with cancer five years ago, Reed underwent surgery and chemotherapy. Although she had health insurance through work, she was left with close to $10,000 in medical bills she couldn’t pay.\u003c/p>\n\u003cp>She’s been pursued by debt collectors and even taken to court. That’s forced Reed to make difficult choices. “There’s always a sacrifice,” she said. “You just do without some things to pay other things.”\u003c/p>\n\u003cp>Reed said she cut back on trips to the grocery store: “I don’t buy a lot of food. Just plain and simple.”\u003c/p>\n\u003cp>She has adjusted, she said. “You just do what you have to do.” What angers Reed, though, is how she’s been treated by the cancer center where she goes for periodic checkups to make sure the cancer remains in remission. When she recently tried to make an appointment, a financial counselor told her she couldn’t schedule it until she made a plan to pay her bills.\u003c/p>\n\u003cp>“I was so upset, I didn’t even find out how much I owed,” Reed said. “I mean, I wasn’t calling about a little toothache. This is something that affects someone’s life.”\u003c/p>\n\u003ch3>Locking in disparities\u003c/h3>\n\u003cp>Health insurance gains made possible by the Affordable Care Act have narrowed some racial health disparities, studies show.\u003c/p>\n\u003cp>The expansion of Medicaid, in particular, has brought new financial security to millions of low-income Americans. In a \u003ca href=\"https://cdn.theatlantic.com/assets/media/files/bgh_draft_2018.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">recent analysis\u003c/a> of credit bureau and census data, researchers estimated that Medicaid expansion helped enrollees avoid more than $1,200 in medical debt.\u003c/p>\n\u003cp>But many of those gains have remained out of reach in Knoxville. Tennessee is among 12 states that have rejected federal funding to expand the Medicaid safety net through the 2010 health care law.\u003c/p>\n\u003cp>Eight of the 12 are Southern states with large Black populations. The decision not to expand has disproportionately affected communities like East Knoxville that are already contending with deep racial disparities in health and wealth.\u003c/p>\n\u003cp>Of the roughly 2.2 million people locked out of health coverage because these states rejected Medicaid expansion, nearly 60% are people of color, according to \u003ca href=\"https://www.kff.org/policy-watch/taking-a-closer-look-at-characteristics-of-people-in-the-coverage-gap/\" target=\"_blank\" rel=\"noopener noreferrer\">a KFF analysis\u003c/a>. About a quarter are Black.\u003c/p>\n\u003cp>Locked out of health insurance, many just try to hang on until they become eligible for Medicare, said Cynthia Finch, an advocate in Knoxville who has worked to improve health in the city’s Black community. “People pray they don’t get sick before they are 65,” she said.\u003c/p>\n\u003cp>If Black patients go into debt, they face yet another challenge: a medical debt collections industry that\u003ca href=\"https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3465203\" target=\"_blank\" rel=\"noopener noreferrer\"> targets Black debtors\u003c/a> more aggressively than their white counterparts, particularly for smaller debts.\u003c/p>\n\u003cp>About 6 in 10 Black adults with medical debts under $2,500 say they or someone in their household has been contacted by a collection agency in the past five years, the KFF poll found. By contrast, only about 4 in 10 white adults with similar debt said the same.\u003c/p>\n\u003cp>At the courthouse in downtown Knoxville, the dockets are filled with debt collection lawsuits filed by some of the region’s largest hospitals: Fort Sanders Regional Medical Center, East Tennessee Children’s Hospital, and Parkwest Medical Center.\u003c/p>\n\u003cp>That discourages many Black patients from seeking care even if they need it, said Cherokee Health’s Derrick Folsom, who helps patients enroll in health insurance. “Somebody knows somebody who’s getting sued for medical bills,” Folsom said. “So they stay away from medical centers.”\u003c/p>\n\u003cp>Reflecting on her experience with medical debt, Reed said she tries to stay upbeat. “I don’t sweat the small stuff,” she said. “What am I going to do against this hospital?”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But, she said, she has realized one thing about the nation’s health care system: “It’s not designed for poor people.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Why+Black+Americans+are+more+likely+to+be+saddled+with+medical+debt&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Nearly 2,000 registered nurses at Alta Bates Summit Medical Center campuses in Oakland and Berkeley began a five-day strike Monday in response to high turnover rates, staff shortages and workplace safety issues.\u003c/p>\n\u003cp>The nurses, represented by the California Nurses Association and National Nurses United, called on Sutter Health to implement workplace violence prevention plans, increase staffing and provide more robust safety resources, including better access to medical-grade safety equipment.\u003c/p>\n\u003cp>“I am seeing nurses leave the medical center for other nursing positions on a regular basis. We have nurses working overtime, and even double shifts, day after day to keep the hospital running,” said Mike Hill, a nurse in Sutter’s intensive care unit.\u003c/p>\n\u003cp>Hill said that while workplace violence in hospitals — mostly of patients toward staff — has always been a concern, there was an uptick in incidents during the pandemic, when many patients didn’t have the family support they needed.\u003c/p>\n\u003cp>“Sometimes it’s intentional. Other times, it’s from anger, fear or a medical condition that causes them to lash out at staff. Either way, it’s dangerous for us as professionals,” said Hill. “It’s not just physical violence. Sometimes it’s verbal threats.”\u003c/p>\n\u003cp>When workplace violence occurs, hospitals announce “code gray” on the intercom system to alert security, Hill said. But like the nursing team, the security department at Alta Bates is understaffed, and in some cases it takes too long for guards to arrive at the scene, Hill said, forcing other nurses to step in to help their colleagues. Hill said more security guards are needed both inside the hospital and in the parking garage, to prevent vehicle break-ins, thefts and attacks on staff.\u003c/p>\n\u003cp>Those concerns about violence, he added, are compounded by the hospital failing to take the necessary measures to effectively protect nurses from COVID exposure and other diseases.\u003c/p>\n\u003cp>Last year, the California Division of Occupational Safety and Health (Cal/OSHA) fined Sutter Health for violations tied to COVID-related workplace safety issues after an investigation was launched in response to the July 2021 \u003ca href=\"https://www.nationalnursesunited.org/press/calosha-finds-alta-bates-summit-medical-center-guilty-eight-serious-violations\">death of an Alta Bates nurse\u003c/a>, who contracted the disease.\u003c/p>\n\u003cp>“Sutter must create working conditions to enhance patient care while also providing a safe work environment that retains nurses,” said Hill.\u003c/p>\n\u003cp>Ann Gaebler, a registered nurse of over 40 years, said she has never seen Sutter “act this disrespectfully” toward nurses, and it’s causing experienced health care providers to leave.\u003c/p>\n\u003cp>“Without proper mentorship, we see young nurses suffering the moral injury and the moral distress of having to care for patients without the support they need, and so they leave,” Gaebler said in a statement. “This is not how you grow the next generation of nurses or how to take care of a community. We need Sutter to step up to address our concerns about retention, so we can continue to provide excellent care to our patients.”[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Joanne Spetz, director, Philip R. Lee Institute for Health Policy Studies, UCSF\"]‘I think the pandemic revealed and exacerbated a lot of problems that existed already, and some of those problems were brewing around stress and burnout and workloads, as we’re hearing from physicians and nurses and other health care professionals.’[/pullquote]\u003c/p>\n\u003cp>In response to the walkout, Sutter management faulted local leaders in the nurses unions, accusing them of putting “politics above the patients and the nurses they represent” despite Sutter being willing to bargain, a spokesperson said in a statement on Monday.\u003c/p>\n\u003cp>“Our attention remains on providing safe, high-quality care to the patients and communities we’re honored to serve, and we are confident in our ability to manage this disruption,” the statement said. “We are hopeful the union shares our desire to reach an agreement and enable our nurses to turn their focus back to the patients the union has asked them to walk away from.”\u003c/p>\n\u003cfigure id=\"attachment_11930036\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11930036\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-800x533.jpg\" alt=\"People holding yellow and red signs and wearing red nurse outfits walk across the street.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Nurses begin a five-day strike at Alta Bates Summit Medical Center in Oakland on Oct. 24, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Sutter Health’s proposed contract includes a pay increase of more than 20% over four years and a commitment to pursuing initiatives aimed at promoting diversity and advancing equity among its employees, along with continued health coverage for nurses and their families.\u003c/p>\n\u003cp>The Sutter nurses strike is just the latest in a slew of labor actions in recent months among health care workers throughout the Bay Area, mirroring a larger nationwide trend.\u003c/p>\n\u003cp>The walkout comes less than a week after some 2,000 Kaiser Permanente mental health care employees approved \u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/new-4-year-agreement-ratified\">a four-year contract\u003c/a>, ending an unprecedented, grueling 10-week strike over staffing shortages, wages and patient care, and just days after the Valley Physicians Group, a union representing about 450 doctors employed by Santa Clara County, announced its intention to hit the picket line on November 1 over similar issues.[aside postID=\"news_11929713,news_11924980\" label=\"Related Posts\"]Even though \u003ca href=\"https://www.bls.gov/opub/ted/2020/union-membership-rate-8-point-6-percent-in-manufacturing-23-point-4-percent-in-utilities-in-2019.htm#:~:text=Bureau%20of%20Labor%20Statistics,-The%20Economics%20Daily&text=In%202019%2C%20the%20union%20membership,hunting%3B%20and%20finance%20and%20insurance.\">less than 7% of health care workers nationwide were unionized\u003c/a> as of 2020, the health care sector \u003ca href=\"https://www.npr.org/sections/health-shots/2021/01/11/955128562/for-health-care-workers-the-pandemic-is-fueling-renewed-interest-in-unions\">also has seen renewed interest in unionization since the pandemic\u003c/a>.\u003c/p>\n\u003cp>“I think the pandemic revealed and exacerbated a lot of problems that existed already, and some of those problems were brewing around stress and burnout and workloads, as we’re hearing from physicians and nurses and other health care professionals,” Dr. Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at UCSF, told KQED.\u003c/p>\n\u003cp>The pandemic, she added, also laid bare the extent of labor shortages across a wide range of essential jobs within health care settings, including custodial staff, nursing assistants, food-service workers and delivery people.\u003c/p>\n\u003cp>“When those jobs are all in short supply, that puts even more pressure on physicians, nurses and others,” Spetz said.\u003c/p>\n\u003cp>And many health care workers are finding that their most common demands — for reduced workloads, more support services, more time for administrative tasks and, in a growing number of instances, tougher security measures — are often not sufficiently met by employers, who often cite nationwide labor shortages and rising costs of doing business.\u003c/p>\n\u003cp>Unionization is more popular than it’s ever been, even across political lines, with \u003ca href=\"https://news.gallup.com/poll/398303/approval-labor-unions-highest-point-1965.aspx\">a recent Gallup poll showing that 71% of Americans approve of labor unions\u003c/a>, the highest approval rating since 1965.\u003c/p>\n\u003cp>But questions remain over how financially well positioned hospitals are to hire and train more people and meet their employees’ increasingly vocal — and organized — demands.\u003c/p>\n\u003cp>“Health care is competing against a lot of other industries and sectors that also are having difficulty recruiting,” Spetz said.\u003c/p>\n\u003cp>“A skilled trade or retail or a restaurant can change their prices pretty quickly, but for health care, they are in these often multiyear insurance contracts and they cannot immediately drum up more revenue in order to pay those higher wages,” said Spetz. “They’re likely to be going back to the insurance industry in the next few years as their contracts come up for renegotiation and ask for more money. And then the insurance companies eventually are going to need to figure out how to pass that on in the price of higher premiums.”\u003c/p>\n\u003cp>And, Spetz added, the pressure of keeping costs down at a time of rampant inflation in a labor-intensive field like health care is exacerbated by the rising costs of supplies and equipment.\u003c/p>\n\u003cp>“Because it takes a while to have the ability to raise revenue … that just puts more financial pressure,” Spetz said, adding that as the pandemic relief money fades, hospitals will be facing financial shortfalls and worrying about “how the money’s going to play out for them.”\u003c/p>\n\u003cp>“A lot of it comes down to building a workplace where health care workers really feel valued, are able to use all their skills, are respected as professionals, regardless of what level they work within the organization … and have the autonomy to use their knowledge and skills to the highest ability,” Spetz said. “You need to be adequately staffed in general. And so that’s going to be the big challenge for employers, is how to create that healthy, supportive work culture. And you have to do that while you’re dealing with labor shortages and plugging all the holes that need to be plugged.”\u003c/p>\n\u003cp>\u003cem>Additional reporting was contributed by Bay City News and KQED’s Laura Klivans.\u003c/em>\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>Nearly 2,000 registered nurses at Alta Bates Summit Medical Center campuses in Oakland and Berkeley began a five-day strike Monday in response to high turnover rates, staff shortages and workplace safety issues.\u003c/p>\n\u003cp>The nurses, represented by the California Nurses Association and National Nurses United, called on Sutter Health to implement workplace violence prevention plans, increase staffing and provide more robust safety resources, including better access to medical-grade safety equipment.\u003c/p>\n\u003cp>“I am seeing nurses leave the medical center for other nursing positions on a regular basis. We have nurses working overtime, and even double shifts, day after day to keep the hospital running,” said Mike Hill, a nurse in Sutter’s intensive care unit.\u003c/p>\n\u003cp>Hill said that while workplace violence in hospitals — mostly of patients toward staff — has always been a concern, there was an uptick in incidents during the pandemic, when many patients didn’t have the family support they needed.\u003c/p>\n\u003cp>“Sometimes it’s intentional. Other times, it’s from anger, fear or a medical condition that causes them to lash out at staff. Either way, it’s dangerous for us as professionals,” said Hill. “It’s not just physical violence. Sometimes it’s verbal threats.”\u003c/p>\n\u003cp>When workplace violence occurs, hospitals announce “code gray” on the intercom system to alert security, Hill said. But like the nursing team, the security department at Alta Bates is understaffed, and in some cases it takes too long for guards to arrive at the scene, Hill said, forcing other nurses to step in to help their colleagues. Hill said more security guards are needed both inside the hospital and in the parking garage, to prevent vehicle break-ins, thefts and attacks on staff.\u003c/p>\n\u003cp>Those concerns about violence, he added, are compounded by the hospital failing to take the necessary measures to effectively protect nurses from COVID exposure and other diseases.\u003c/p>\n\u003cp>Last year, the California Division of Occupational Safety and Health (Cal/OSHA) fined Sutter Health for violations tied to COVID-related workplace safety issues after an investigation was launched in response to the July 2021 \u003ca href=\"https://www.nationalnursesunited.org/press/calosha-finds-alta-bates-summit-medical-center-guilty-eight-serious-violations\">death of an Alta Bates nurse\u003c/a>, who contracted the disease.\u003c/p>\n\u003cp>“Sutter must create working conditions to enhance patient care while also providing a safe work environment that retains nurses,” said Hill.\u003c/p>\n\u003cp>Ann Gaebler, a registered nurse of over 40 years, said she has never seen Sutter “act this disrespectfully” toward nurses, and it’s causing experienced health care providers to leave.\u003c/p>\n\u003cp>“Without proper mentorship, we see young nurses suffering the moral injury and the moral distress of having to care for patients without the support they need, and so they leave,” Gaebler said in a statement. “This is not how you grow the next generation of nurses or how to take care of a community. We need Sutter to step up to address our concerns about retention, so we can continue to provide excellent care to our patients.”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In response to the walkout, Sutter management faulted local leaders in the nurses unions, accusing them of putting “politics above the patients and the nurses they represent” despite Sutter being willing to bargain, a spokesperson said in a statement on Monday.\u003c/p>\n\u003cp>“Our attention remains on providing safe, high-quality care to the patients and communities we’re honored to serve, and we are confident in our ability to manage this disruption,” the statement said. “We are hopeful the union shares our desire to reach an agreement and enable our nurses to turn their focus back to the patients the union has asked them to walk away from.”\u003c/p>\n\u003cfigure id=\"attachment_11930036\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11930036\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-800x533.jpg\" alt=\"People holding yellow and red signs and wearing red nurse outfits walk across the street.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS59635_001_KQED_SutterRNStrikeOakland_10242022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Nurses begin a five-day strike at Alta Bates Summit Medical Center in Oakland on Oct. 24, 2022. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Sutter Health’s proposed contract includes a pay increase of more than 20% over four years and a commitment to pursuing initiatives aimed at promoting diversity and advancing equity among its employees, along with continued health coverage for nurses and their families.\u003c/p>\n\u003cp>The Sutter nurses strike is just the latest in a slew of labor actions in recent months among health care workers throughout the Bay Area, mirroring a larger nationwide trend.\u003c/p>\n\u003cp>The walkout comes less than a week after some 2,000 Kaiser Permanente mental health care employees approved \u003ca href=\"https://about.kaiserpermanente.org/who-we-are/labor-relations/new-4-year-agreement-ratified\">a four-year contract\u003c/a>, ending an unprecedented, grueling 10-week strike over staffing shortages, wages and patient care, and just days after the Valley Physicians Group, a union representing about 450 doctors employed by Santa Clara County, announced its intention to hit the picket line on November 1 over similar issues.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Even though \u003ca href=\"https://www.bls.gov/opub/ted/2020/union-membership-rate-8-point-6-percent-in-manufacturing-23-point-4-percent-in-utilities-in-2019.htm#:~:text=Bureau%20of%20Labor%20Statistics,-The%20Economics%20Daily&text=In%202019%2C%20the%20union%20membership,hunting%3B%20and%20finance%20and%20insurance.\">less than 7% of health care workers nationwide were unionized\u003c/a> as of 2020, the health care sector \u003ca href=\"https://www.npr.org/sections/health-shots/2021/01/11/955128562/for-health-care-workers-the-pandemic-is-fueling-renewed-interest-in-unions\">also has seen renewed interest in unionization since the pandemic\u003c/a>.\u003c/p>\n\u003cp>“I think the pandemic revealed and exacerbated a lot of problems that existed already, and some of those problems were brewing around stress and burnout and workloads, as we’re hearing from physicians and nurses and other health care professionals,” Dr. Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at UCSF, told KQED.\u003c/p>\n\u003cp>The pandemic, she added, also laid bare the extent of labor shortages across a wide range of essential jobs within health care settings, including custodial staff, nursing assistants, food-service workers and delivery people.\u003c/p>\n\u003cp>“When those jobs are all in short supply, that puts even more pressure on physicians, nurses and others,” Spetz said.\u003c/p>\n\u003cp>And many health care workers are finding that their most common demands — for reduced workloads, more support services, more time for administrative tasks and, in a growing number of instances, tougher security measures — are often not sufficiently met by employers, who often cite nationwide labor shortages and rising costs of doing business.\u003c/p>\n\u003cp>Unionization is more popular than it’s ever been, even across political lines, with \u003ca href=\"https://news.gallup.com/poll/398303/approval-labor-unions-highest-point-1965.aspx\">a recent Gallup poll showing that 71% of Americans approve of labor unions\u003c/a>, the highest approval rating since 1965.\u003c/p>\n\u003cp>But questions remain over how financially well positioned hospitals are to hire and train more people and meet their employees’ increasingly vocal — and organized — demands.\u003c/p>\n\u003cp>“Health care is competing against a lot of other industries and sectors that also are having difficulty recruiting,” Spetz said.\u003c/p>\n\u003cp>“A skilled trade or retail or a restaurant can change their prices pretty quickly, but for health care, they are in these often multiyear insurance contracts and they cannot immediately drum up more revenue in order to pay those higher wages,” said Spetz. “They’re likely to be going back to the insurance industry in the next few years as their contracts come up for renegotiation and ask for more money. And then the insurance companies eventually are going to need to figure out how to pass that on in the price of higher premiums.”\u003c/p>\n\u003cp>And, Spetz added, the pressure of keeping costs down at a time of rampant inflation in a labor-intensive field like health care is exacerbated by the rising costs of supplies and equipment.\u003c/p>\n\u003cp>“Because it takes a while to have the ability to raise revenue … that just puts more financial pressure,” Spetz said, adding that as the pandemic relief money fades, hospitals will be facing financial shortfalls and worrying about “how the money’s going to play out for them.”\u003c/p>\n\u003cp>“A lot of it comes down to building a workplace where health care workers really feel valued, are able to use all their skills, are respected as professionals, regardless of what level they work within the organization … and have the autonomy to use their knowledge and skills to the highest ability,” Spetz said. “You need to be adequately staffed in general. And so that’s going to be the big challenge for employers, is how to create that healthy, supportive work culture. And you have to do that while you’re dealing with labor shortages and plugging all the holes that need to be plugged.”\u003c/p>\n\u003cp>\u003cem>Additional reporting was contributed by Bay City News and KQED’s Laura Klivans.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>An unseasonably early spike in \u003ca href=\"https://www.npr.org/2021/08/14/1027663917/rsv-covid-children\">respiratory syncytial virus\u003c/a> cases among young children is pushing some hospitals to capacity.\u003c/p>\n\u003cp>RSV, as it’s called, is a respiratory virus that mostly manifests as a mild illness with cold-like symptoms in adults but can cause pneumonia and bronchiolitis in very young children. It can be life-threatening in infants and young adults.\u003c/p>\n\u003cp>Most years, infections typically occur in the late fall and winter, often overlapping with flu season. But at least since last year, physicians have begun seeing surges starting during \u003ca href=\"https://www.npr.org/2021/06/24/1009992795/pediatricians-see-off-season-spike-in-rsv-cases-among-kids\">summer months\u003c/a>.[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Laura Romano, Cook Children's Medical Center\"]‘This year, parents are sending their children to daycare and school for the first time following two years of the pandemic. … Children who haven’t been previously exposed to respiratory viruses are getting sick.’[/pullquote]\u003c/p>\n\u003cp>Children’s hospitals in the Washington, D.C. area, including Children’s National Hospital, Inova Fairfax and Johns Hopkins in Baltimore, are at or near capacity, \u003ca href=\"https://dcist.com/story/22/10/20/multiple-childrens-hospitals-are-at-or-near-capacity-across-d-c-maryland-and-virginia/\">DCist reported\u003c/a>.\u003c/p>\n\u003cp>Connecticut Children’s Hospital in Hartford has had its pediatric in-patient beds full for the last few weeks, \u003ca href=\"https://kfor.com/news/health/childrens-hospitals-overflowing-with-respiratory-patients-consider-calling-national-guard/?utm_campaign=socialflow&utm_medium=referral&utm_source=Twitter\">WTNH reported\u003c/a>. With no indication of the spread slowing down, officials there are seeking the help of the National Guard and FEMA to set up tents in order to expand capacity.\u003c/p>\n\u003cp>In Texas, doctors at Cook Children’s hospital in Fort Worth \u003ca href=\"https://www.youtube.com/watch?v=hl38AyRm0e8&t=140s\">told\u003c/a> ABC News they are treating some 300 RSV patients a day.\u003c/p>\n\u003cp>“Last year, more people were wearing face masks and children were more likely to stay home while sick,” Dr. Laura Romano \u003ca href=\"https://www.checkupnewsroom.com/rsv-cases-spiking-higher-and-earlier-so-far-this-year-at-cook-childrens/?utm_source=Twitter&utm_medium=OrganicSocial&utm_campaign=RSVCasesSpiking&utm_term=2022_October&utm_content=RSVCasesSpiking\">said \u003c/a>in Cook Children’s in-house publication.\u003c/p>\n\u003cp>“This year, parents are sending their children to daycare and school for the first time following two years of the pandemic. … Children who haven’t been previously exposed to respiratory viruses are getting sick,” Romano said.\u003c/p>\n\u003cp>Health officials in King County, Wash., are also alarmed as they brace for more cases once winter hits. Dr. Russell Migita with Seattle Children’s Hospital \u003ca href=\"https://www.king5.com/article/news/health/rsv-cases-king-county-rise/281-39dc6773-3935-46e2-acd2-e5da8e7b31c0\">told\u003c/a> King 5 News they are seeing about 20 to 30 positive cases every day, adding that those are “unprecedented” figures.\u003c/p>\n\u003ch3>How RSV shows up\u003c/h3>\n\u003cp>RSV symptoms are similar to a cold and can be harmless in adults, but the CDC says children under the age of 5 are the most affected group. According to the agency’s \u003ca href=\"https://www.cdc.gov/rsv/research/us-surveillance.html\">data\u003c/a>, each year approximately 58,000 children in that age range are hospitalized for RSV. The next most vulnerable group are adults over 65, in whom the infection causes 14,000 deaths a year.\u003c/p>\n\u003cp>RSV can lead to bronchiolitis, an infection that causes airways to become inflamed and clogged with mucus, making it difficult to breathe. If the infection travels to the lung sacs, it can result in pneumonia.\u003c/p>\n\u003cp>Dr. Sara Goza, physician and former president of the American Academy of Pediatrics, \u003ca href=\"https://www.npr.org/2021/06/24/1009992795/pediatricians-see-off-season-spike-in-rsv-cases-among-kids\">talked to NPR last year\u003c/a> about how the infection presents in infants.\u003c/p>\n\u003cp>“A lot of the babies under a year of age will have trouble breathing. They stop eating because they can’t breathe and eat at the same time. And they’re wheezing, so they’re in respiratory distress,” Goza said.\u003c/p>\n\u003cp>Other symptoms include coughing, excessive sleeping and lethargy.\u003c/p>\n\u003cp>There is no vaccine to prevent RSV, but doctors are urging patients to get the flu shot. It doesn’t prevent the infection but it could spare people from more aggressive symptoms and keep them from seeking medical attention at already strained hospitals.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Children%27s+hospitals+grapple+with+a+nationwide+surge+in+RSV+infections&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Children’s hospitals in the Washington, D.C. area, including Children’s National Hospital, Inova Fairfax and Johns Hopkins in Baltimore, are at or near capacity, \u003ca href=\"https://dcist.com/story/22/10/20/multiple-childrens-hospitals-are-at-or-near-capacity-across-d-c-maryland-and-virginia/\">DCist reported\u003c/a>.\u003c/p>\n\u003cp>Connecticut Children’s Hospital in Hartford has had its pediatric in-patient beds full for the last few weeks, \u003ca href=\"https://kfor.com/news/health/childrens-hospitals-overflowing-with-respiratory-patients-consider-calling-national-guard/?utm_campaign=socialflow&utm_medium=referral&utm_source=Twitter\">WTNH reported\u003c/a>. With no indication of the spread slowing down, officials there are seeking the help of the National Guard and FEMA to set up tents in order to expand capacity.\u003c/p>\n\u003cp>In Texas, doctors at Cook Children’s hospital in Fort Worth \u003ca href=\"https://www.youtube.com/watch?v=hl38AyRm0e8&t=140s\">told\u003c/a> ABC News they are treating some 300 RSV patients a day.\u003c/p>\n\u003cp>“Last year, more people were wearing face masks and children were more likely to stay home while sick,” Dr. Laura Romano \u003ca href=\"https://www.checkupnewsroom.com/rsv-cases-spiking-higher-and-earlier-so-far-this-year-at-cook-childrens/?utm_source=Twitter&utm_medium=OrganicSocial&utm_campaign=RSVCasesSpiking&utm_term=2022_October&utm_content=RSVCasesSpiking\">said \u003c/a>in Cook Children’s in-house publication.\u003c/p>\n\u003cp>“This year, parents are sending their children to daycare and school for the first time following two years of the pandemic. … Children who haven’t been previously exposed to respiratory viruses are getting sick,” Romano said.\u003c/p>\n\u003cp>Health officials in King County, Wash., are also alarmed as they brace for more cases once winter hits. Dr. Russell Migita with Seattle Children’s Hospital \u003ca href=\"https://www.king5.com/article/news/health/rsv-cases-king-county-rise/281-39dc6773-3935-46e2-acd2-e5da8e7b31c0\">told\u003c/a> King 5 News they are seeing about 20 to 30 positive cases every day, adding that those are “unprecedented” figures.\u003c/p>\n\u003ch3>How RSV shows up\u003c/h3>\n\u003cp>RSV symptoms are similar to a cold and can be harmless in adults, but the CDC says children under the age of 5 are the most affected group. According to the agency’s \u003ca href=\"https://www.cdc.gov/rsv/research/us-surveillance.html\">data\u003c/a>, each year approximately 58,000 children in that age range are hospitalized for RSV. The next most vulnerable group are adults over 65, in whom the infection causes 14,000 deaths a year.\u003c/p>\n\u003cp>RSV can lead to bronchiolitis, an infection that causes airways to become inflamed and clogged with mucus, making it difficult to breathe. If the infection travels to the lung sacs, it can result in pneumonia.\u003c/p>\n\u003cp>Dr. Sara Goza, physician and former president of the American Academy of Pediatrics, \u003ca href=\"https://www.npr.org/2021/06/24/1009992795/pediatricians-see-off-season-spike-in-rsv-cases-among-kids\">talked to NPR last year\u003c/a> about how the infection presents in infants.\u003c/p>\n\u003cp>“A lot of the babies under a year of age will have trouble breathing. They stop eating because they can’t breathe and eat at the same time. And they’re wheezing, so they’re in respiratory distress,” Goza said.\u003c/p>\n\u003cp>Other symptoms include coughing, excessive sleeping and lethargy.\u003c/p>\n\u003cp>There is no vaccine to prevent RSV, but doctors are urging patients to get the flu shot. It doesn’t prevent the infection but it could spare people from more aggressive symptoms and keep them from seeking medical attention at already strained hospitals.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2022 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Children%27s+hospitals+grapple+with+a+nationwide+surge+in+RSV+infections&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "california-needs-more-latinx-therapists-but-the-mental-health-field-is-still-full-of-barriers-to-entry",
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"content": "\u003cp>Growing up in Daly City, Eric Valladares remembers hearing how his parents and extended family fled El Salvador during the country’s 12-year civil war that ended in 1992.\u003c/p>\n\u003cp>After settling in California, some members struggled financially, finding it hard to adjust to a country where they didn’t speak the language and felt like outsiders.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11929333,news_11926978,news_11912753\"]His family never discussed how they coped with those traumas or mentioned mental health. He remembers adults masking emotions with alcohol, something he later imitated. He didn’t realize he had a problem until he was in graduate school, learning how to help others with \u003ci>their\u003c/i> problems.\u003c/p>\n\u003cp>Valladares decided to become a therapist while an undergraduate student at San Francisco State University. He made the career choice believing he just wanted to help the Latinx community, but his decision was deeper than that.\u003c/p>\n\u003cp>“There was pain and there were experiences from my life and my family’s life that in subtle ways put me on this path,” he said. “I wanted to help others heal and help myself heal, but it didn’t occur to me until later. I thought of it as, ‘Isn’t it nice that I want to help people?’ But no, it was really, ‘I have unresolved issues and I want to work them out.’”\u003c/p>\n\u003cp>Valladares, now 37, spent years providing therapy to mostly immigrant, Spanish-speaking people. He’s now the executive director of Family Connections, a Palo Alto nonprofit that provides educational and mental health services to families with young children.\u003c/p>\n\u003cfigure id=\"attachment_11929791\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929791\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"a Latino man in a blue and white checked shirt poses for a portrait in front of a colorful tree decoration in an office\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Executive Director Eric Valladares at the Redwood City location of his mental health nonprofit, Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In many ways, Valladares exemplifies what experts and policymakers say California needs more of: He’s a multilingual Latino who brings cultural competency to mental health services. But his journey into the profession demonstrates the difficulties mental health care providers face, such as addressing their own traumas and figuring out how to navigate the professional mental health field — from earning enough money to dealing with insurance companies resistant to paying for patient care.\u003c/p>\n\u003ch2>‘Folks need to be served by people who look like them’\u003c/h2>\n\u003cp>Despite growing demand for mental health services for children struggling with depression, anxiety and suicidal ideation, the mental health field has failed at recruiting enough professionals — of any background. California has less than a quarter of the therapists it needs to care for the state’s population, and the majority specialize in treating adults, according to the Kaiser Family Foundation.\u003c/p>\n\u003cp>And the existing mental health workforce doesn’t mirror the state’s demographics. About 40% of Californians identify as Hispanic or Latino, according to research provided to KQED by the Healthforce Center at UCSF. But only 9% of clinical psychologists, 21% of marriage and family therapists and 27% of mental health counselors identified as Hispanic or Latino from 2015 to 2019, the research shows.\u003c/p>\n\u003cp>“Part of what makes any kind of therapeutic intervention work is the relationship between the provider and the person getting the service,” said Chris Stoner-Mertz, CEO of the California Alliance of Child and Family Services, a coalition of about 150 nonprofits and organizations that serve the state’s children and families. “Folks need to be served by people who look like them and who maybe had some of their life experiences.”\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Chris Stoner-Mertz, CEO, California Alliance of Child and Family Services\"]‘Part of what makes any kind of therapeutic intervention work is the relationship between the provider and the person getting the service. Folks need to be served by people who … maybe had some of their life experiences.’[/pullquote]The two biggest barriers to accessing mental health care are the cost and lack of providers. Insurers make it difficult for therapists to get paid by requiring a lot of paperwork, limiting mental health services they will cover and covering only patients with specific diagnoses or those who meet “medical necessity.”\u003c/p>\n\u003cp>Mental health professionals tend to fall into two camps: those who work in the public or nonprofit side and those in private practice. To avoid the hassle of dealing with insurance companies, many therapists go into private practice and accept only cash payments, which inherently means they end up serving patients who can afford to pay $100 to $250 per session.\u003c/p>\n\u003cp>The public or nonprofit side is typically supported by tax or philanthropic funding, and serves people with lower incomes or who aren’t covered by insurance. The government covers the biggest share of mental health care spending in the U.S. In 2019, \u003ca href=\"https://openminds.com/press/u-s-mental-health-spending-reached-225-1-billion-in-2019-open-minds-releases-new-analysis-on-market-spending/\">taxpayers covered 63% of all mental health care costs\u003c/a> — about $150 billion — including therapy and prescriptions, according to Open Minds, a health care market research firm.\u003c/p>\n\u003cp>When Valladares began his career 12 years ago, he wanted to treat underserved Latinx clients who had lower incomes or were immigrants, so he focused on working for nonprofit organizations. At his first job after completing a master’s degree in 2010, he earned $22 per hour or about $46,000 per year.\u003c/p>\n\u003cp>“I lived at home with my parents,” he said, to make it work financially.\u003c/p>\n\u003cp>Valladares estimates that a therapist entering a nonprofit or publicly funded agency now can expect to earn $55,000 to $70,000 per year.\u003c/p>\n\u003cp>“We’re losing a lot of therapists to private practice, and that’s OK,” Valladares said. “I don’t fault them. They don’t want yachts. They just want to be able to live.”\u003c/p>\n\u003cp>Haggling insurance companies to get paid for their services “creates a disillusionment with our mental health system,” Valladares said. “Providers like to say, ‘I don’t want to be a part of a system that just perpetuates this cycle of putting Band-Aids on much deeper issues,’ and then it pushes people into private practice. But again, if you go into private practice, who’s not getting served?”\u003c/p>\n\u003cfigure id=\"attachment_11929795\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929795\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"a Latino man in a blue checked shirt with a mask shows an orange wall of musical instruments\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Executive Director Eric Valladares displays musical instruments in the play area at the Redwood City location of Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Valladares’ focus on the Latinx community is tied to his upbringing. He recalled how some of the relatives who fled El Salvador were later hospitalized or placed on psychiatric holds because of mental health crises. One of his uncles had an alcohol addiction.\u003c/p>\n\u003cp>“I saw in my own family how they were impacted by immigration, trauma, the war that they had witnessed in their country and losing a piece of their identity through that,” he said.\u003c/p>\n\u003cp>The way he saw his relatives cope was by not talking about their issues and drinking in excess, habits he also picked up — which later led to his own alcohol addiction.\u003c/p>\n\u003cp>“In college, it’s normal to have a drink when you’re stressed out,” he said. “You don’t really look at it as a pattern or something you inherited from your family.”\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Eric Valladares, executive director, Family Connections\"]‘I don’t think that there’s enough of us out there. But I do have a lot of faith that there are people out there who still want to help.’[/pullquote]No one questioned Valladares about his drinking until he entered a psychology master’s program at SF State when he was 23. The program encouraged students to see a therapist. When his therapist asked him why he drank frequently, he became defensive and ignored her concerns.\u003c/p>\n\u003cp>He went from only drinking with friends on weekends to frequently drinking at home on weeknights. Then he started canceling plans because he was too hungover. As he was nearing 30, he realized he needed to change.\u003c/p>\n\u003cp>“I was able to dismiss (my alcohol addiction) for years,” he said. “I started getting older and I realized that my patterns hadn’t only changed, they had gotten worse. The biggest part was meeting my wife. She was not OK with my lifestyle.”\u003c/p>\n\u003cp>When he decided to seek help, his insurance company denied him coverage for therapy and suggested he try a support group. He paid out of pocket for a therapist for about two years and has been in recovery for seven years.\u003c/p>\n\u003cp>His graduate program opened his eyes to the undiagnosed mental health conditions he had observed in his family, and how they lacked the understanding and vocabulary to talk about their issues. His mother never described herself as having anxiety, but would often say, “I just worry a lot.”\u003c/p>\n\u003cp>“My mom was an anxious person and I was an anxious child and we bonded over that,” he recalled. “Years later, alcohol helped me calm down.”\u003c/p>\n\u003cfigure id=\"attachment_11929800\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929800\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"two people in masks speak in a children's therapy office\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Valladares speaks with Carolina Calderón Balladares at the Redwood City location of Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>His experience overcoming substance use disorder taught him that even for someone working in mental health, getting access to care is still a challenge. It also illustrated how valuable therapy can be.\u003c/p>\n\u003cp>“If I had not gotten into the mental health field, I would have just assumed and assimilated that that’s part of who I am,” he said. “It does make me a believer in what we do. I don’t think that there’s enough of us out there. But I do have a lot of faith that there are people out there who still want to help.”\u003c/p>\n\u003ch2>A lack of parity\u003c/h2>\n\u003cp>Elected officials in California also recognize that the state needs to expand its mental health workforce. One strategy is to hire more counselors and behavioral coaches — roles that require less education than psychiatrists and psychologists.\u003c/p>\n\u003cp>On August 18, Gov. Gavin Newsom announced a plan to add 40,000 mental health care professionals across the state. At least half of those positions will mostly be housed in schools. Newsom said the missing component to helping kids is “people willing to do this work.” Others say the system isn’t working as it should.\u003c/p>\n\u003cp>The federal Mental Health Parity Act, passed in 1996, ruled that insurers’ dollar limits on mental health benefits couldn’t be lower than their equivalents for physical health. But “that has not been in effect for most insurance companies across the country,” said Naomi Allen, CEO and co-founder of Brightline, a Palo Alto-based behavioral health start-up that provides virtual therapy to kids.\u003c/p>\n\u003cp>She was so frustrated by the experience of trying to find therapists for her three children using commercial insurance that she co-founded Brightline in 2019.\u003c/p>\n\u003cp>“What we have is a situation where year over year, more and more therapists are not available through insurance. They’re going out of network. They’re in private practice,” Allen said. “And so we have this scenario that existed pre-COVID, where care was essentially unaffordable to the vast majority of families.”\u003c/p>\n\u003cfigure id=\"attachment_11929797\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929797\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"kids' art on a bulletin board in a therapist's office\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Art hangs in the therapy room at the Redwood City location of Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patricia Alvarado is one of those practitioners. She founded her online-only practice, Alvarado Therapy, about five years ago, and now employs a team of mostly bilingual therapists serving Latinx clients.\u003c/p>\n\u003cp>“We’re a private pay organization,” she said. “Sometimes it can be really hard to obtain payment (from insurance companies). It could take many months. There’s a lot of restrictions … like you could only work with a client for X amount of sessions and that’s it, and the client may need more.”\u003c/p>\n\u003cp>Some patients who have insurance end up paying out of pocket just to speed up the process of getting care.\u003c/p>\n\u003cp>“A lot of time passes by, and that can take away the motivation of wanting to seek services,” Alvarado said. “It shouldn’t be as hard as it is. ”\u003c/p>\n\u003cp>Valladares provided therapy until he burned out. Then he made the switch to running programs for nonprofits like Family Connections, which works with families who don’t qualify for lower-income programs and can’t afford to pay out of pocket.\u003c/p>\n\u003cp>“As long as the families expressed an interest in mental health services, we’re able to provide them with those services, which has been really great,” he said.\u003c/p>\n\u003cp>The shift to administrative work helped Valladares stay in the field, make more money and have time to spend with his wife and two kids, ages 5 and 1.\u003c/p>\n\u003cp>“I still want to be in a position where I can affect change and support families in a different way,” he said. “I make it a point to go out there and make a connection with the people my organization is serving and definitely not lose sight of why I do what I do.”\u003c/p>\n\u003cp>\u003cem>Blanca Torres reported this story while participating in the \u003ca href=\"https://centerforhealthjournalism.org/about-us\">USC Annenberg Center for Health Journalism’s 2022 California Fellowship\u003c/a>.\u003c/em> \u003cem>Subscribe to her monthly newsletter focused on the Bay Area’s Latinx community, K Onda KQED. \u003ca href=\"https://www.kqed.org/newsletters/k-onda\">Click here to subscribe\u003c/a>.\u003c/em>\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>Growing up in Daly City, Eric Valladares remembers hearing how his parents and extended family fled El Salvador during the country’s 12-year civil war that ended in 1992.\u003c/p>\n\u003cp>After settling in California, some members struggled financially, finding it hard to adjust to a country where they didn’t speak the language and felt like outsiders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>His family never discussed how they coped with those traumas or mentioned mental health. He remembers adults masking emotions with alcohol, something he later imitated. He didn’t realize he had a problem until he was in graduate school, learning how to help others with \u003ci>their\u003c/i> problems.\u003c/p>\n\u003cp>Valladares decided to become a therapist while an undergraduate student at San Francisco State University. He made the career choice believing he just wanted to help the Latinx community, but his decision was deeper than that.\u003c/p>\n\u003cp>“There was pain and there were experiences from my life and my family’s life that in subtle ways put me on this path,” he said. “I wanted to help others heal and help myself heal, but it didn’t occur to me until later. I thought of it as, ‘Isn’t it nice that I want to help people?’ But no, it was really, ‘I have unresolved issues and I want to work them out.’”\u003c/p>\n\u003cp>Valladares, now 37, spent years providing therapy to mostly immigrant, Spanish-speaking people. He’s now the executive director of Family Connections, a Palo Alto nonprofit that provides educational and mental health services to families with young children.\u003c/p>\n\u003cfigure id=\"attachment_11929791\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929791\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"a Latino man in a blue and white checked shirt poses for a portrait in front of a colorful tree decoration in an office\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58551_010_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Executive Director Eric Valladares at the Redwood City location of his mental health nonprofit, Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In many ways, Valladares exemplifies what experts and policymakers say California needs more of: He’s a multilingual Latino who brings cultural competency to mental health services. But his journey into the profession demonstrates the difficulties mental health care providers face, such as addressing their own traumas and figuring out how to navigate the professional mental health field — from earning enough money to dealing with insurance companies resistant to paying for patient care.\u003c/p>\n\u003ch2>‘Folks need to be served by people who look like them’\u003c/h2>\n\u003cp>Despite growing demand for mental health services for children struggling with depression, anxiety and suicidal ideation, the mental health field has failed at recruiting enough professionals — of any background. California has less than a quarter of the therapists it needs to care for the state’s population, and the majority specialize in treating adults, according to the Kaiser Family Foundation.\u003c/p>\n\u003cp>And the existing mental health workforce doesn’t mirror the state’s demographics. About 40% of Californians identify as Hispanic or Latino, according to research provided to KQED by the Healthforce Center at UCSF. But only 9% of clinical psychologists, 21% of marriage and family therapists and 27% of mental health counselors identified as Hispanic or Latino from 2015 to 2019, the research shows.\u003c/p>\n\u003cp>“Part of what makes any kind of therapeutic intervention work is the relationship between the provider and the person getting the service,” said Chris Stoner-Mertz, CEO of the California Alliance of Child and Family Services, a coalition of about 150 nonprofits and organizations that serve the state’s children and families. “Folks need to be served by people who look like them and who maybe had some of their life experiences.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The two biggest barriers to accessing mental health care are the cost and lack of providers. Insurers make it difficult for therapists to get paid by requiring a lot of paperwork, limiting mental health services they will cover and covering only patients with specific diagnoses or those who meet “medical necessity.”\u003c/p>\n\u003cp>Mental health professionals tend to fall into two camps: those who work in the public or nonprofit side and those in private practice. To avoid the hassle of dealing with insurance companies, many therapists go into private practice and accept only cash payments, which inherently means they end up serving patients who can afford to pay $100 to $250 per session.\u003c/p>\n\u003cp>The public or nonprofit side is typically supported by tax or philanthropic funding, and serves people with lower incomes or who aren’t covered by insurance. The government covers the biggest share of mental health care spending in the U.S. In 2019, \u003ca href=\"https://openminds.com/press/u-s-mental-health-spending-reached-225-1-billion-in-2019-open-minds-releases-new-analysis-on-market-spending/\">taxpayers covered 63% of all mental health care costs\u003c/a> — about $150 billion — including therapy and prescriptions, according to Open Minds, a health care market research firm.\u003c/p>\n\u003cp>When Valladares began his career 12 years ago, he wanted to treat underserved Latinx clients who had lower incomes or were immigrants, so he focused on working for nonprofit organizations. At his first job after completing a master’s degree in 2010, he earned $22 per hour or about $46,000 per year.\u003c/p>\n\u003cp>“I lived at home with my parents,” he said, to make it work financially.\u003c/p>\n\u003cp>Valladares estimates that a therapist entering a nonprofit or publicly funded agency now can expect to earn $55,000 to $70,000 per year.\u003c/p>\n\u003cp>“We’re losing a lot of therapists to private practice, and that’s OK,” Valladares said. “I don’t fault them. They don’t want yachts. They just want to be able to live.”\u003c/p>\n\u003cp>Haggling insurance companies to get paid for their services “creates a disillusionment with our mental health system,” Valladares said. “Providers like to say, ‘I don’t want to be a part of a system that just perpetuates this cycle of putting Band-Aids on much deeper issues,’ and then it pushes people into private practice. But again, if you go into private practice, who’s not getting served?”\u003c/p>\n\u003cfigure id=\"attachment_11929795\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929795\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"a Latino man in a blue checked shirt with a mask shows an orange wall of musical instruments\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58566_024_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Executive Director Eric Valladares displays musical instruments in the play area at the Redwood City location of Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Valladares’ focus on the Latinx community is tied to his upbringing. He recalled how some of the relatives who fled El Salvador were later hospitalized or placed on psychiatric holds because of mental health crises. One of his uncles had an alcohol addiction.\u003c/p>\n\u003cp>“I saw in my own family how they were impacted by immigration, trauma, the war that they had witnessed in their country and losing a piece of their identity through that,” he said.\u003c/p>\n\u003cp>The way he saw his relatives cope was by not talking about their issues and drinking in excess, habits he also picked up — which later led to his own alcohol addiction.\u003c/p>\n\u003cp>“In college, it’s normal to have a drink when you’re stressed out,” he said. “You don’t really look at it as a pattern or something you inherited from your family.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>No one questioned Valladares about his drinking until he entered a psychology master’s program at SF State when he was 23. The program encouraged students to see a therapist. When his therapist asked him why he drank frequently, he became defensive and ignored her concerns.\u003c/p>\n\u003cp>He went from only drinking with friends on weekends to frequently drinking at home on weeknights. Then he started canceling plans because he was too hungover. As he was nearing 30, he realized he needed to change.\u003c/p>\n\u003cp>“I was able to dismiss (my alcohol addiction) for years,” he said. “I started getting older and I realized that my patterns hadn’t only changed, they had gotten worse. The biggest part was meeting my wife. She was not OK with my lifestyle.”\u003c/p>\n\u003cp>When he decided to seek help, his insurance company denied him coverage for therapy and suggested he try a support group. He paid out of pocket for a therapist for about two years and has been in recovery for seven years.\u003c/p>\n\u003cp>His graduate program opened his eyes to the undiagnosed mental health conditions he had observed in his family, and how they lacked the understanding and vocabulary to talk about their issues. His mother never described herself as having anxiety, but would often say, “I just worry a lot.”\u003c/p>\n\u003cp>“My mom was an anxious person and I was an anxious child and we bonded over that,” he recalled. “Years later, alcohol helped me calm down.”\u003c/p>\n\u003cfigure id=\"attachment_11929800\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929800\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"two people in masks speak in a children's therapy office\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58556_016_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Eric Valladares speaks with Carolina Calderón Balladares at the Redwood City location of Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>His experience overcoming substance use disorder taught him that even for someone working in mental health, getting access to care is still a challenge. It also illustrated how valuable therapy can be.\u003c/p>\n\u003cp>“If I had not gotten into the mental health field, I would have just assumed and assimilated that that’s part of who I am,” he said. “It does make me a believer in what we do. I don’t think that there’s enough of us out there. But I do have a lot of faith that there are people out there who still want to help.”\u003c/p>\n\u003ch2>A lack of parity\u003c/h2>\n\u003cp>Elected officials in California also recognize that the state needs to expand its mental health workforce. One strategy is to hire more counselors and behavioral coaches — roles that require less education than psychiatrists and psychologists.\u003c/p>\n\u003cp>On August 18, Gov. Gavin Newsom announced a plan to add 40,000 mental health care professionals across the state. At least half of those positions will mostly be housed in schools. Newsom said the missing component to helping kids is “people willing to do this work.” Others say the system isn’t working as it should.\u003c/p>\n\u003cp>The federal Mental Health Parity Act, passed in 1996, ruled that insurers’ dollar limits on mental health benefits couldn’t be lower than their equivalents for physical health. But “that has not been in effect for most insurance companies across the country,” said Naomi Allen, CEO and co-founder of Brightline, a Palo Alto-based behavioral health start-up that provides virtual therapy to kids.\u003c/p>\n\u003cp>She was so frustrated by the experience of trying to find therapists for her three children using commercial insurance that she co-founded Brightline in 2019.\u003c/p>\n\u003cp>“What we have is a situation where year over year, more and more therapists are not available through insurance. They’re going out of network. They’re in private practice,” Allen said. “And so we have this scenario that existed pre-COVID, where care was essentially unaffordable to the vast majority of families.”\u003c/p>\n\u003cfigure id=\"attachment_11929797\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929797\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg\" alt=\"kids' art on a bulletin board in a therapist's office\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58544_001_KQED_EricValladaresFamilyConnections_09062022-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Art hangs in the therapy room at the Redwood City location of Family Connections. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patricia Alvarado is one of those practitioners. She founded her online-only practice, Alvarado Therapy, about five years ago, and now employs a team of mostly bilingual therapists serving Latinx clients.\u003c/p>\n\u003cp>“We’re a private pay organization,” she said. “Sometimes it can be really hard to obtain payment (from insurance companies). It could take many months. There’s a lot of restrictions … like you could only work with a client for X amount of sessions and that’s it, and the client may need more.”\u003c/p>\n\u003cp>Some patients who have insurance end up paying out of pocket just to speed up the process of getting care.\u003c/p>\n\u003cp>“A lot of time passes by, and that can take away the motivation of wanting to seek services,” Alvarado said. “It shouldn’t be as hard as it is. ”\u003c/p>\n\u003cp>Valladares provided therapy until he burned out. Then he made the switch to running programs for nonprofits like Family Connections, which works with families who don’t qualify for lower-income programs and can’t afford to pay out of pocket.\u003c/p>\n\u003cp>“As long as the families expressed an interest in mental health services, we’re able to provide them with those services, which has been really great,” he said.\u003c/p>\n\u003cp>The shift to administrative work helped Valladares stay in the field, make more money and have time to spend with his wife and two kids, ages 5 and 1.\u003c/p>\n\u003cp>“I still want to be in a position where I can affect change and support families in a different way,” he said. “I make it a point to go out there and make a connection with the people my organization is serving and definitely not lose sight of why I do what I do.”\u003c/p>\n\u003cp>\u003cem>Blanca Torres reported this story while participating in the \u003ca href=\"https://centerforhealthjournalism.org/about-us\">USC Annenberg Center for Health Journalism’s 2022 California Fellowship\u003c/a>.\u003c/em> \u003cem>Subscribe to her monthly newsletter focused on the Bay Area’s Latinx community, K Onda KQED. \u003ca href=\"https://www.kqed.org/newsletters/k-onda\">Click here to subscribe\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>When Mariana Pimentel thinks about her childhood in a small town in Mexico, she remembers being surrounded by anger and desperation.\u003c/p>\n\u003cp>Her parents worked long hours to support Pimentel and her brothers and sisters, so they were often absent. When they \u003cem>were\u003c/em> home, her parents communicated by yelling.\u003c/p>\n\u003cp>“I want my kids to grow up in a different environment from how I grew up and not repeat the same mistakes,” said Pimentel, a 41-year-old mother of three.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=\"news_11926978,news_11924343,news_11924980\"]Shifting away from the parenting style she grew up with took time and lots of work. Nine years ago, Pimentel, who lives in Salinas, began attending free classes on topics such as positive parenting and discipline at GoKids Inc., a nonprofit that provides early childhood education to lower-income families.\u003c/p>\n\u003cp>“I’ve noticed that if I am stressed or anxious, I will end up transmitting that to my kids. There is a connection,” Pimentel said. “The more I attend classes, the more I learn, the better I can help my children and the better off they will be.”\u003c/p>\n\u003cp>In addition to taking classes, Pimentel, her husband and two of her children received individual therapy through GoKids to deal with depression and anxiety. The family’s experience demonstrates the importance of addressing mental health not just for one person, but the family as a whole.\u003c/p>\n\u003ch2>Pandemic ‘forced us to look at the shadows’\u003c/h2>\n\u003cp>During the first year of the pandemic, \u003ca href=\"https://www.cdc.gov/mmwr/volumes/70/wr/mm7024a3.htm#:~:text=Among%202%2C391%20parents%2Dcaregivers%2C%20approximately,past%2Dmonth%20serious%20suicidal%20ideation.\">nearly two-thirds of caregivers, including parents, reported adverse mental or behavioral health symptoms\u003c/a>, according to a Centers for Disease Control and Prevention survey. The survey also found that 27% of parents of children under 18 reported that their mental health worsened during the pandemic.\u003c/p>\n\u003cp>The need to come to terms with how parental mental health influences the mental health of children has come into sharper focus as the United States grapples with a crisis of children experiencing higher rates of anxiety, depression and thoughts of suicide.\u003c/p>\n\u003cp>In 2020, California saw a 70% increase in kids being diagnosed with anxiety or depression. That’s 1 in 8, up from 1 in 14 in 2016, \u003ca href=\"https://assets.aecf.org/m/resourcedoc/aecf-2022kidscountdatabook-2022.pdf\">according to The Annie E. Casey Foundation (PDF)\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11929357\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929357\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-800x640.jpg\" alt=\"a young Latinx couple, a man and a woman, in white shirts, smiling in front of a blue sky\" width=\"800\" height=\"640\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-800x640.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-1020x816.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-160x128.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-1536x1229.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Angel Morales and Mariana Pimentel learned to manage their own stress and anxiety with therapy, and are working to pass the tools they’ve learned on to their children. \u003ccite>(Courtesy of Mariana Pimentel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Children of color suffer the most, say experts, because services remain inaccessible to them for a variety of reasons.\u003c/p>\n\u003cp>“One thing the pandemic did is that it forced us to look at the shadows, the darker things, both within ourselves and within our communities that need attention,” said Tlazoltiani Jessica Zamarripa, who co-founded the Institute of Chicana/o/x Psychology with her husband, Manuel X. Zamarripa.\u003c/p>\n\u003cp>Based in Austin, Texas, the organization provides training for mental health providers and individuals with an emphasis on ancestral knowledge and practices from Indigenous cultures of Mexico. The Zamarripas founded the Institute of Chicana/o/x Psychology as a way to combat what they call the “mental health industrial complex” that has largely left kids from nonwhite communities underserved.\u003c/p>\n\u003cp>“Our children have never been immune to the stresses, the anxieties, the intergenerational ancestral, familial, interpersonal and racial traumas, and the harms and violence we have experienced and experience now,” Zamarripa said.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Tlazoltiani Jessica Zamarripa, co-founder, Institute of Chicana/o/x Psychology\"]‘Our children have never been immune to the stresses, the anxieties, the intergenerational ancestral, familial, interpersonal and racial traumas, and the harms and violence we have experienced.’[/pullquote]Often, when a child is struggling, the focus is solely on what they are doing wrong and correcting those behaviors, while not taking into account the stressors in their environment, including some caused by stressed parents. Parents need to recognize when their children need help, but also need to understand their own behavior, mental health and patterns of generational trauma, Zamarripa said.\u003c/p>\n\u003cp>In 2019, close to 1 in 5 white children received some form of mental health treatment. For \u003ca href=\"https://www.cdc.gov/nchs/products/databriefs/db381.htm\">Latino and Black children the rate was about 1 in 11\u003c/a>, according to the CDC.\u003c/p>\n\u003cp>“It’s a deep pain to know that our children are struggling and suffering,” Zamarripa said. “We just want to believe that they’re happy and playful.”\u003c/p>\n\u003cp>But children don’t have the same coping mechanisms and understanding that adults have. When a child is acting out, Zamarripa’s advice is to avoid reacting, punishing or judging the behavior.\u003c/p>\n\u003cp>“Kids act out in all kinds of ways, and for generations and generations and generations that has been misinterpreted as bad behavior when, in fact, all behavior is communication,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11929393\" class=\"wp-caption aligncenter\" style=\"max-width: 709px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11929393\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM.jpg\" alt=\"a man and a woman in traditional Chicana/o/x dress talk in a room\" width=\"709\" height=\"399\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM.jpg 709w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM-160x90.jpg 160w\" sizes=\"(max-width: 709px) 100vw, 709px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Manuel X. Zamarippa (left) and Tlazoltiani Jessica Zamarripa, co-founders of the Institute of Chicana/o/x Psychology. \u003ccite>(Courtesy of the Institute of Chicana/o/x Psychology)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some parents, particularly the parents of children of color, often don’t know how to manage the stigma attached to seeking therapy for themselves or their children.\u003c/p>\n\u003cp>“Sometimes the difficulty with gaining access [to mental health care] is even getting buy-in” from parents, said Patricia Alvarado of Alvarado Therapy, a Los Angeles-based practice made up of Latinx and Spanish-speaking therapists. “If we’re talking about a young person, like a kid or a teenager, it can be quite difficult to say, ‘Yes, I need help.’ And also for the parent, depending on their socioeconomic status, their background, their education, they may not even know what that means.”\u003c/p>\n\u003cp>Not treating mental illness in kids can cause long-term harm. CDC researchers estimate that \u003ca href=\"https://www.cdc.gov/childrensmentalhealth/features/kf-childrens-mental-health-report.html\">13% to 20% of children are affected by an emotional or mental health disorder before the age of 17\u003c/a>.\u003c/p>\n\u003cp>“We still don’t know the long-term impact of the pandemic on children,” said Dr. Sandra Pisano, director of behavioral health for AltaMed, a community health provider in Southern California that serves lower-income people and mostly Latinx patients. “By normalizing wellness and self-care, this is where there’s a great opportunity for us to provide services to develop a healthy future generation after the pandemic.”\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Dr. Sandra Pisano, director of behavioral health, AltaMed\"]‘By normalizing wellness and self-care, this is where there’s a great opportunity for us to provide services to develop a healthy future generation after the pandemic.’[/pullquote]According to Pisano, many parents don’t know how to talk to their children about self-care, which can be as simple as good sleep, eating well, taking deep breaths and doing something that brings joy or relaxation.\u003c/p>\n\u003cp>“It’s important for them as they grow older … that they still have the practice of self-care, because this is creating a healthy child who will eventually be a healthy adult,” Pisano said.\u003c/p>\n\u003ch2>The transformative power of therapy\u003c/h2>\n\u003cp>When she was 24 years old, Pimentel left her home in Hidalgo, a state in central Mexico, to join her brother and sister in Salinas. There she met her husband, Jose Angel Morales, and started a family. Their three children are ages 9, 6 and 7 months.\u003c/p>\n\u003cp>“I looked for parenting resources when my eldest daughter was born, and connected with GoKids,” she said. “We started with classes and workshops and then wellness visits for my daughter and then, eventually, I found out they offered therapy.”\u003c/p>\n\u003cp>In 2020, Pimentel sank into depression after going through a miscarriage and went to therapy for the first time to deal with her grief.\u003c/p>\n\u003cp>In early 2021, she noticed her son biting his nails, a habit that went from occasional to excessive. His personality shifted from mostly happy and outgoing to somber and anxious, she said. He came home from school with bruises because classmates were bullying him.\u003c/p>\n\u003cfigure id=\"attachment_11929362\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929362\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-800x600.jpg\" alt=\"a Latinx family posing in a park, with a dad, mom and three young kids\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-1536x1153.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut.jpg 1599w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Angel Morales, Mariana Pimentel and their children. \u003ccite>(Courtesy of Mariana Pimentel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the same time, Pimentel’s 9-year-old was also showing signs of anxiety. When she had to take a test or do something new, she would freeze with fear and struggle to complete her work. The stress of going from remote to in-person school also put a strain on her. Her children attended therapy sessions for about a year, until December of 2021.\u003c/p>\n\u003cp>Pimentel’s husband went to therapy last year to cope with stress from the pandemic — like losing his job at a car wash and family members contracting the virus, including Pimentel.\u003c/p>\n\u003cp>According to Pimentel, her husband’s therapist helped him realize that he had put too much emphasis on working extra hours or taking on additional tasks, all because he was afraid of being fired. He eventually found a new job at a different car wash and is far less stressed about work.\u003c/p>\n\u003cp>For families like Pimentel’s, having timely access to affordable mental health services was transformative, along with creating a culture of mental wellness at home.\u003c/p>\n\u003cp>Her son is more relaxed and joyful, she said, and many of his anxious behaviors, such as the nail biting, have decreased. He’s also developed the tools and confidence to stand up to bullies.\u003c/p>\n\u003cp>Her daughter has learned to calm her anxiety with techniques such as taking deep breaths, a sip of water or a short walk. She is bringing home higher grades.\u003c/p>\n\u003cp>“I didn’t know that I had depression or that I had a lot of anxiety,” Pimentel said, referring to the time before she entered therapy. “I have discovered many things, how to understand these issues and how I can work on them. And also how to help my children.”\u003c/p>\n\u003cp>\u003cem>Blanca Torres reported this story while participating in the \u003ca href=\"https://centerforhealthjournalism.org/about-us\">USC Annenberg Center for Health Journalism’s 2022 California Fellowship\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "In 2020, California saw a 70% increase in kids being diagnosed with anxiety or depression, which experts say can't be separated from parents and caregivers' struggles — and children of color are suffering the most. Here's how one family used therapy and other tools to address stress and grief.",
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"title": "Breaking the Cycle: How Parental Mental Health Affects Kids — and What to Do About It | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Mariana Pimentel thinks about her childhood in a small town in Mexico, she remembers being surrounded by anger and desperation.\u003c/p>\n\u003cp>Her parents worked long hours to support Pimentel and her brothers and sisters, so they were often absent. When they \u003cem>were\u003c/em> home, her parents communicated by yelling.\u003c/p>\n\u003cp>“I want my kids to grow up in a different environment from how I grew up and not repeat the same mistakes,” said Pimentel, a 41-year-old mother of three.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Shifting away from the parenting style she grew up with took time and lots of work. Nine years ago, Pimentel, who lives in Salinas, began attending free classes on topics such as positive parenting and discipline at GoKids Inc., a nonprofit that provides early childhood education to lower-income families.\u003c/p>\n\u003cp>“I’ve noticed that if I am stressed or anxious, I will end up transmitting that to my kids. There is a connection,” Pimentel said. “The more I attend classes, the more I learn, the better I can help my children and the better off they will be.”\u003c/p>\n\u003cp>In addition to taking classes, Pimentel, her husband and two of her children received individual therapy through GoKids to deal with depression and anxiety. The family’s experience demonstrates the importance of addressing mental health not just for one person, but the family as a whole.\u003c/p>\n\u003ch2>Pandemic ‘forced us to look at the shadows’\u003c/h2>\n\u003cp>During the first year of the pandemic, \u003ca href=\"https://www.cdc.gov/mmwr/volumes/70/wr/mm7024a3.htm#:~:text=Among%202%2C391%20parents%2Dcaregivers%2C%20approximately,past%2Dmonth%20serious%20suicidal%20ideation.\">nearly two-thirds of caregivers, including parents, reported adverse mental or behavioral health symptoms\u003c/a>, according to a Centers for Disease Control and Prevention survey. The survey also found that 27% of parents of children under 18 reported that their mental health worsened during the pandemic.\u003c/p>\n\u003cp>The need to come to terms with how parental mental health influences the mental health of children has come into sharper focus as the United States grapples with a crisis of children experiencing higher rates of anxiety, depression and thoughts of suicide.\u003c/p>\n\u003cp>In 2020, California saw a 70% increase in kids being diagnosed with anxiety or depression. That’s 1 in 8, up from 1 in 14 in 2016, \u003ca href=\"https://assets.aecf.org/m/resourcedoc/aecf-2022kidscountdatabook-2022.pdf\">according to The Annie E. Casey Foundation (PDF)\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11929357\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929357\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-800x640.jpg\" alt=\"a young Latinx couple, a man and a woman, in white shirts, smiling in front of a blue sky\" width=\"800\" height=\"640\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-800x640.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-1020x816.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-160x128.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut-1536x1229.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58811_image000000-1-2-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Angel Morales and Mariana Pimentel learned to manage their own stress and anxiety with therapy, and are working to pass the tools they’ve learned on to their children. \u003ccite>(Courtesy of Mariana Pimentel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Children of color suffer the most, say experts, because services remain inaccessible to them for a variety of reasons.\u003c/p>\n\u003cp>“One thing the pandemic did is that it forced us to look at the shadows, the darker things, both within ourselves and within our communities that need attention,” said Tlazoltiani Jessica Zamarripa, who co-founded the Institute of Chicana/o/x Psychology with her husband, Manuel X. Zamarripa.\u003c/p>\n\u003cp>Based in Austin, Texas, the organization provides training for mental health providers and individuals with an emphasis on ancestral knowledge and practices from Indigenous cultures of Mexico. The Zamarripas founded the Institute of Chicana/o/x Psychology as a way to combat what they call the “mental health industrial complex” that has largely left kids from nonwhite communities underserved.\u003c/p>\n\u003cp>“Our children have never been immune to the stresses, the anxieties, the intergenerational ancestral, familial, interpersonal and racial traumas, and the harms and violence we have experienced and experience now,” Zamarripa said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘Our children have never been immune to the stresses, the anxieties, the intergenerational ancestral, familial, interpersonal and racial traumas, and the harms and violence we have experienced.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Often, when a child is struggling, the focus is solely on what they are doing wrong and correcting those behaviors, while not taking into account the stressors in their environment, including some caused by stressed parents. Parents need to recognize when their children need help, but also need to understand their own behavior, mental health and patterns of generational trauma, Zamarripa said.\u003c/p>\n\u003cp>In 2019, close to 1 in 5 white children received some form of mental health treatment. For \u003ca href=\"https://www.cdc.gov/nchs/products/databriefs/db381.htm\">Latino and Black children the rate was about 1 in 11\u003c/a>, according to the CDC.\u003c/p>\n\u003cp>“It’s a deep pain to know that our children are struggling and suffering,” Zamarripa said. “We just want to believe that they’re happy and playful.”\u003c/p>\n\u003cp>But children don’t have the same coping mechanisms and understanding that adults have. When a child is acting out, Zamarripa’s advice is to avoid reacting, punishing or judging the behavior.\u003c/p>\n\u003cp>“Kids act out in all kinds of ways, and for generations and generations and generations that has been misinterpreted as bad behavior when, in fact, all behavior is communication,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11929393\" class=\"wp-caption aligncenter\" style=\"max-width: 709px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-11929393\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM.jpg\" alt=\"a man and a woman in traditional Chicana/o/x dress talk in a room\" width=\"709\" height=\"399\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM.jpg 709w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58816_2_5_2022-12_52_44-AM-160x90.jpg 160w\" sizes=\"(max-width: 709px) 100vw, 709px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Manuel X. Zamarippa (left) and Tlazoltiani Jessica Zamarripa, co-founders of the Institute of Chicana/o/x Psychology. \u003ccite>(Courtesy of the Institute of Chicana/o/x Psychology)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Some parents, particularly the parents of children of color, often don’t know how to manage the stigma attached to seeking therapy for themselves or their children.\u003c/p>\n\u003cp>“Sometimes the difficulty with gaining access [to mental health care] is even getting buy-in” from parents, said Patricia Alvarado of Alvarado Therapy, a Los Angeles-based practice made up of Latinx and Spanish-speaking therapists. “If we’re talking about a young person, like a kid or a teenager, it can be quite difficult to say, ‘Yes, I need help.’ And also for the parent, depending on their socioeconomic status, their background, their education, they may not even know what that means.”\u003c/p>\n\u003cp>Not treating mental illness in kids can cause long-term harm. CDC researchers estimate that \u003ca href=\"https://www.cdc.gov/childrensmentalhealth/features/kf-childrens-mental-health-report.html\">13% to 20% of children are affected by an emotional or mental health disorder before the age of 17\u003c/a>.\u003c/p>\n\u003cp>“We still don’t know the long-term impact of the pandemic on children,” said Dr. Sandra Pisano, director of behavioral health for AltaMed, a community health provider in Southern California that serves lower-income people and mostly Latinx patients. “By normalizing wellness and self-care, this is where there’s a great opportunity for us to provide services to develop a healthy future generation after the pandemic.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>According to Pisano, many parents don’t know how to talk to their children about self-care, which can be as simple as good sleep, eating well, taking deep breaths and doing something that brings joy or relaxation.\u003c/p>\n\u003cp>“It’s important for them as they grow older … that they still have the practice of self-care, because this is creating a healthy child who will eventually be a healthy adult,” Pisano said.\u003c/p>\n\u003ch2>The transformative power of therapy\u003c/h2>\n\u003cp>When she was 24 years old, Pimentel left her home in Hidalgo, a state in central Mexico, to join her brother and sister in Salinas. There she met her husband, Jose Angel Morales, and started a family. Their three children are ages 9, 6 and 7 months.\u003c/p>\n\u003cp>“I looked for parenting resources when my eldest daughter was born, and connected with GoKids,” she said. “We started with classes and workshops and then wellness visits for my daughter and then, eventually, I found out they offered therapy.”\u003c/p>\n\u003cp>In 2020, Pimentel sank into depression after going through a miscarriage and went to therapy for the first time to deal with her grief.\u003c/p>\n\u003cp>In early 2021, she noticed her son biting his nails, a habit that went from occasional to excessive. His personality shifted from mostly happy and outgoing to somber and anxious, she said. He came home from school with bruises because classmates were bullying him.\u003c/p>\n\u003cfigure id=\"attachment_11929362\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11929362\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-800x600.jpg\" alt=\"a Latinx family posing in a park, with a dad, mom and three young kids\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut-1536x1153.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2022/10/RS58810_IMG-20220915-WA0009-qut.jpg 1599w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jose Angel Morales, Mariana Pimentel and their children. \u003ccite>(Courtesy of Mariana Pimentel)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>At the same time, Pimentel’s 9-year-old was also showing signs of anxiety. When she had to take a test or do something new, she would freeze with fear and struggle to complete her work. The stress of going from remote to in-person school also put a strain on her. Her children attended therapy sessions for about a year, until December of 2021.\u003c/p>\n\u003cp>Pimentel’s husband went to therapy last year to cope with stress from the pandemic — like losing his job at a car wash and family members contracting the virus, including Pimentel.\u003c/p>\n\u003cp>According to Pimentel, her husband’s therapist helped him realize that he had put too much emphasis on working extra hours or taking on additional tasks, all because he was afraid of being fired. He eventually found a new job at a different car wash and is far less stressed about work.\u003c/p>\n\u003cp>For families like Pimentel’s, having timely access to affordable mental health services was transformative, along with creating a culture of mental wellness at home.\u003c/p>\n\u003cp>Her son is more relaxed and joyful, she said, and many of his anxious behaviors, such as the nail biting, have decreased. He’s also developed the tools and confidence to stand up to bullies.\u003c/p>\n\u003cp>Her daughter has learned to calm her anxiety with techniques such as taking deep breaths, a sip of water or a short walk. She is bringing home higher grades.\u003c/p>\n\u003cp>“I didn’t know that I had depression or that I had a lot of anxiety,” Pimentel said, referring to the time before she entered therapy. “I have discovered many things, how to understand these issues and how I can work on them. And also how to help my children.”\u003c/p>\n\u003cp>\u003cem>Blanca Torres reported this story while participating in the \u003ca href=\"https://centerforhealthjournalism.org/about-us\">USC Annenberg Center for Health Journalism’s 2022 California Fellowship\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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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": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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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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"title": "Possible",
"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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"tagline": "Real stories with killer beats",
"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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