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"slug": "at-hidden-tahoe-lab-scientists-learn-the-art-of-measuring-snow",
"title": "At Hidden Tahoe Lab, Scientists Learn the Art of Measuring Snow",
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"headTitle": "At Hidden Tahoe Lab, Scientists Learn the Art of Measuring Snow | KQED",
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"content": "\u003cp>[dropcap]A[/dropcap]nyone riding the gondola lift at Sugar Bowl Ski Resort one bright day in January might have seen something unexpected in the glade below them: A series of figures energetically digging pits in the snow by hand — deep enough for them to then jump inside.\u003c/p>\n\u003cp>These pit diggers intently studied the walls of their newly carved chambers before pressing bright yellow sensors into the ice. They were, in fact, student scientists receiving training from the Central Sierra Snow Lab close by.\u003c/p>\n\u003cp>And while most visitors to the Sierra would never have a reason to come across this stocky, unassuming 1940s cabin nestled on a nearby backroad, the Snow Lab has been at the forefront of snow science for almost 80 years, maintaining the data that has huge implications for California’s water supply.\u003c/p>\n\u003cfigure id=\"attachment_1995844\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995844\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"845\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-800x264.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-1020x337.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-160x53.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-768x253.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-1536x507.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-2048x676.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-1920x634.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Measuring implements to gauge the layers and depth of the Sierra snowpack (left) in use at the Snow Science School. Anne Nolin (right), professor of geography at the University of Nevada, Reno and a snow school attendee, marks the edge of where to dig a pit in the snowpack. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now, this event, its first-ever Snow Science School, saw the Snow Lab open its doors to teach a new generation the tools of their trade — almost 7,000 feet above sea level in the mountains of Tahoe National Forest.\u003c/p>\n\u003ch2>Hidden history on Donner Summit\u003c/h2>\n\u003cp>Though now managed by UC Berkeley, the Central Sierra Snow Lab in Soda Springs began life in 1946 as a collaboration between the Army Corps of Engineers and what’s now known as the National Weather Service. But while the Snow Lab’s own snowfall and snow depth measurements date back to its birth, this cabin beneath towering pine trees near Donner Summit also maintains much older records from the area going back to 1878 documenting the Central Pacific Railroad’s own efforts — making these the longest such climatological records in the world when it comes to snow.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And for the scientists working up here in 2025, the job is essentially “to play in the snow and learn more about it,” said Andrew Schwartz, its director.\u003c/p>\n\u003cfigure id=\"attachment_1995851\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995851\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1585\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-800x495.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-1020x632.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-160x99.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-768x476.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-1536x951.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-2048x1268.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-1920x1189.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Schwartz, director of UC Berkeley’s Central Sierra Snow Lab, holds a decades-old printout of snow measurements (left) and a black-and-white photograph (right) in the lab’s archives. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For the three days in January that saw 20 students from across the U.S. arrive at the Snow Science School, Tahoe was in the middle of a sunny, dry spell, with the snowpack at Donner Summit at 94% of the average for this time of year. But at an elevation of over 6,700 feet, the Snow Lab has seen its share of wild winters and momentous snowfall — making it an apt place to study snow science any time.\u003c/p>\n\u003cp>Schwartz, who took over the Snow Lab in 2021 and lived inside the building for his first two years, recalled how, in 2023, the snow was so deep that he and his colleagues could “walk directly into the third-floor windows.” That year, the Snow Lab received a total of 63 feet of snow, its second-biggest winter accumulation on record — precipitation that would eventually become the snowmelt that’s crucial for California’s water supply.\u003c/p>\n\u003cfigure id=\"attachment_1995837\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995837\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Participants listen during a morning lecture at the Clair Tappan Lodge during the Snow Science School organized by UC Berkeley’s Central Sierra Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Schwartz, his “number one” hope for the Snow Lab’s inaugural school is that the students leave “with an appreciation of snow and a better understanding of how it works, really — because it’s so important to the world.”\u003c/p>\n\u003cp>“Roughly two billion people [around the world] use water obtained from snowpack. And we tend to take it for granted,” he said.\u003c/p>\n\u003cp>The school’s student body included a large handful of people from the California Department of Water Resources — one of the Snow Lab’s partners in this work — but also graduate students, researchers, snow modelers and teachers, as well as folks sent by the National Parks Service and the National Forest Service.\u003c/p>\n\u003cfigure id=\"attachment_1995836\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995836\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Participants gather for a morning lecture during Snow Science School. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The breadth of experience and background among the Snow Science School’s students is a testimony to the wide range of applications this work can have — and to the disciplines that snow brings together. “It’s a very close-knit community,” said Preetika Kaur, a Snow Lab student attending from the University of Wyoming. “I love to meet people who are pros.”\u003c/p>\n\u003ch2>All work and no play? Not at the Snow Lab\u003c/h2>\n\u003cp>After climbing up the steep hill to the Snow Lab on their first day, students were shown past the bright red snowcat — the exact same model that’s featured in the movie \u003cem>The Shining\u003c/em>, noted Schwartz approvingly — and into the warren-like building. Above their heads, the top floor holds sleeping quarters for the scientists who board overnight to conduct research or who’ve been trapped inside by an impenetrable Sierra storm.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995838\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1104\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-800x345.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-1020x440.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-160x69.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-768x331.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-1536x662.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-2048x883.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-1920x828.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003c/p>\n\u003cfigure id=\"attachment_1995839\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995839\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">UC Berkeley’s Central Sierra Snow Lab, based in Soda Springs near Donner Summit. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The first floor and basement, where the lab’s scientists work throughout the day, was full not just of computer screens and boxes full of measuring tools but also handwritten logs, archive photography depicting their Snow Lab predecessors out on the job, vintage road signs and instruments saved from the building’s past.\u003c/p>\n\u003cp>There’s even an oscilloscope — an instrument that once measured voltage — with a large “NASA AMES” sticker on it, and even though Schwartz admits they “have no clue” what the Snow Lab scientists of previous years used it for up here, “I’d be lying if I still don’t like to play with the knobs on it,” he said.\u003c/p>\n\u003cfigure id=\"attachment_1995849\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995849\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A Type 555 Dual-beam Oscilloscope, circa 1960s, at the Central Sierra Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_1995848\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995848\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1102\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-800x344.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-1020x439.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-160x69.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-768x330.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-1536x661.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-2048x881.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-1920x826.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Spatulas and rulers (right) are some of the tools used to measure snowfall at the Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Outside, the students tour Snow Lab’s network of remote snow equipment, like the fluid-filled “snow pillow” that detects the weight of the snow falling on it and the sensors submerged in the creek behind the lab that will gauge the height of the icy water as it starts to rise with spring snowmelt. Other remote sensors constantly assess solar radiation — in a region where sunlight can contribute to up to 95% of snowmelt — and soil temperature to get an idea of just how fast the snowpack could melt this year.\u003c/p>\n\u003cp>But as this data collection hums in the background, Schwartz still maintains the lab’s twice-daily manual measurement tradition, which sees him and his colleagues crunch out onto the snow with “our very fancy ruler” — work that on some days, depending on conditions, can feel more like a polar expedition.\u003c/p>\n\u003cfigure id=\"attachment_1995840\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995840\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Gaby May Lagunes, a Ph.D. student in the Environmental Science, Policy, and Management Department at UC Berkeley, puts on her snowshoes to head into the field. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>As \u003ca href=\"https://x.com/UCB_CSSL\">the Snow Lab’s social media presence\u003c/a> has gained in popularity in the last few years, the snow measurements that Schwartz and his team make public are also watched eagerly by a different group of California enthusiasts: skiers and snowboarders desperate to know when to hit the Tahoe slopes.\u003c/p>\n\u003cp>“I love the different uses of our data in our information,” he said.\u003c/p>\n\u003ch2>The impact of the snowpack on water supply\u003c/h2>\n\u003cp>The snowpack can contain clues of the past as well as the future — which is why the snow analysis techniques being taught at the Snow Science School go way beyond just assessing depth.\u003c/p>\n\u003cp>A key concept hydrology students are taught about is “snow water equivalent,” or SWE (usually pronounced “swee” by snow scientists): A measurement that tells scientists just how much water is contained in an area of snow versus the air it also contains alongside its ice crystals.\u003c/p>\n\u003cfigure id=\"attachment_1995841\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995841\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Schwartz, right, director of the Central Sierra Snow Lab, leads instructors and participants of the Snow Science School into the field. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“A lot of the water in California originally falls as snow, and it’s really valuable to humans because there’s a lot of it and because it stores itself for free in places where it’s cold and then melts in the spring, which is when we need it for agriculture,” said Marianne Cowherd, research associate at the Snow Lab and one of the instructors. “Having a good understanding of how much water we have available upstream lets us do things like manage our reservoir levels — so we still have enough water, but we don’t have dangerous operations or overflow.”\u003c/p>\n\u003cp>The next piece of the snow science puzzle is working out when and how the state can expect that snow to melt. At the school, the students learn more about how energy from the sun and from the warm temperatures of the air and from the ground melts the snowpack and how the water flows into California’s soils and streams.\u003c/p>\n\u003cp>“The thing that I’m trying to do is understand the effect of human changes in the landscape, specifically with irrigation on future precipitation patterns and precipitation extremes,” said Gaby May Lagunes, a snow lab student and UC Berkeley graduate researcher. “How the way people change the environment has an impact on the water cycle, not only locally, regionally and globally.”\u003c/p>\n\u003cp>So “if I want to understand water from a data-driven perspective, I need to have an idea of what snow people know,” she said. “We need to work together a lot because we cannot know everything.”\u003c/p>\n\u003cfigure id=\"attachment_1995845\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995845\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Preetika Kaur, left, a Ph.D. student at the University of Wyoming, and Joe Ammatelli, an assistant research scientist with the Desert Research Institute, dig a pit in the snowpack during Snow Science School. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Up close in the snow pits\u003c/h2>\n\u003cp>For students, the real action came when the school decamped closer to Donner Summit for the field measurement portion of their studies. After suiting up in thermal layers, bibs and beanies — plus lab-supplied polarized sunglasses that read “No Biz Like Snow Biz” on the side — the students strap on snowshoes to make the hike along a snow-covered trail to a secluded woods, sandwiched between Sugar Bowl and Donner Ski Ranch. Here, they began to dig out a series of 4-foot-deep snow pits using shovels, low enough to strike soil and complete with steps.\u003c/p>\n\u003cp>The snowpack can be far larger, sometimes as deep as 20 feet, and scientists “have to build literal levels down to measure the whole thing,” Schwartz said — “so you don’t have to Spider-Man your way out every time.”\u003c/p>\n\u003cp>Joe Ammatelli was sent by the Desert Research Institute in Nevada, where he carries out snow modeling, which needs to be validated by field observations. “It’s really valuable as a modeler to get out here and see how it’s done,” he said.\u003c/p>\n\u003cfigure id=\"attachment_1995846\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995846\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"845\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-800x264.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-1020x337.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-160x53.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-768x253.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-1536x507.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-2048x676.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-1920x634.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Snow crystals lay on a measuring device during a field outing with the Snow Science School in January. Chris Northart, right, with the Department of Water Resources Statewide Monitoring Network Unit and a participant of the Snow Science School, uses a magnification lens to measure the size of snow granules. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_1995847\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995847\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A participant of the Snow School weighs a wedge of snow collected from the snowpack in a field outing. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>And for all the technological developments in snow science, it remains deeply tactile for its practitioners. Down in the pits, the students measured the snow’s temperature and observed how it changed the deeper the pit went. Then, using specialized shovels, the students scooped out and leveled off snow before weighing it on a scale — a method of measuring density and snow water equivalent.\u003c/p>\n\u003cp>They examined physical changes in the different layers in the smooth white walls of the snow pits, like studying rings in a tree trunk. These kinds of measurements are an exercise in time travel, explained instructor Cowherd, given the different qualities of snowflakes that fall at different times and how the ever-accumulating snowpack ages.\u003c/p>\n\u003cp>As the air heats and cools, the snow melts and compresses under its own weight — all of which “tells us about the history of what’s happened there,” Cowherd said.\u003c/p>\n\u003ch2>‘Every day in the snow is a good day’\u003c/h2>\n\u003cp>The observations that the instructors taught its snow students in the pits are the kind that stretches back almost a century and a half in the Snow Lab’s own archives — and this volume of information is invaluable for assessing the impact of climate change, Schwartz said.\u003c/p>\n\u003cp>“We see the same amount of precipitation coming in, but it’s shifting from snow terrain in all the months — so we’re seeing warming,” he said. “Our rain-snow line is going up in elevation.”\u003c/p>\n\u003cp>The almost 150 years of data can also aid forecasters in looking for variables that smaller data sets just can’t encompass, he said — like the Sierra’s dry spells that are followed by big years for rain and snowfall, a swing that’s seen in “five year periods.”\u003c/p>\n\u003cfigure id=\"attachment_1995850\" class=\"wp-caption aligncenter\" style=\"max-width: 1333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995850\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872.jpg\" alt=\"\" width=\"1333\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872.jpg 1333w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-800x1200.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-1020x1530.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-160x240.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-768x1152.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-1024x1536.jpg 1024w\" sizes=\"auto, (max-width: 1333px) 100vw, 1333px\">\u003cfigcaption class=\"wp-caption-text\">A sign to alert the public of a snow survey shelter structure from the Department of Water Resources is one of the objects in the archive at the Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The school’s emphasis on continuing the tradition of meticulous data collection is shot through with the deep enthusiasm that marks the people in its orbit. Even in the chill of the field, when digging out feet of snow, the students remain upbeat.\u003c/p>\n\u003cp>“Snow people are really fun people for the most part,” said instructor Micah Johnson, as he demonstrated an invention he’d been working on for a decade — showing the students how to stab his Bluetooth-enabled “penetrometer-reflectometer” stick into the snow and call up data from its sensors. “I have yet to meet an indifferent snow scientist of sorts.”\u003c/p>\n\u003cp>Or, as Ammatelli from the Desert Research Institute said, “Every day in the snow is a good day.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story has been updated to correct the spelling of Joe Ammatelli’s name.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">A\u003c/span>\u003c/p>\u003cp>nyone riding the gondola lift at Sugar Bowl Ski Resort one bright day in January might have seen something unexpected in the glade below them: A series of figures energetically digging pits in the snow by hand — deep enough for them to then jump inside.\u003c/p>\n\u003cp>These pit diggers intently studied the walls of their newly carved chambers before pressing bright yellow sensors into the ice. They were, in fact, student scientists receiving training from the Central Sierra Snow Lab close by.\u003c/p>\n\u003cp>And while most visitors to the Sierra would never have a reason to come across this stocky, unassuming 1940s cabin nestled on a nearby backroad, the Snow Lab has been at the forefront of snow science for almost 80 years, maintaining the data that has huge implications for California’s water supply.\u003c/p>\n\u003cfigure id=\"attachment_1995844\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995844\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"845\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-800x264.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-1020x337.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-160x53.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-768x253.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-1536x507.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-2048x676.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01549_duo-1920x634.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Measuring implements to gauge the layers and depth of the Sierra snowpack (left) in use at the Snow Science School. Anne Nolin (right), professor of geography at the University of Nevada, Reno and a snow school attendee, marks the edge of where to dig a pit in the snowpack. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now, this event, its first-ever Snow Science School, saw the Snow Lab open its doors to teach a new generation the tools of their trade — almost 7,000 feet above sea level in the mountains of Tahoe National Forest.\u003c/p>\n\u003ch2>Hidden history on Donner Summit\u003c/h2>\n\u003cp>Though now managed by UC Berkeley, the Central Sierra Snow Lab in Soda Springs began life in 1946 as a collaboration between the Army Corps of Engineers and what’s now known as the National Weather Service. But while the Snow Lab’s own snowfall and snow depth measurements date back to its birth, this cabin beneath towering pine trees near Donner Summit also maintains much older records from the area going back to 1878 documenting the Central Pacific Railroad’s own efforts — making these the longest such climatological records in the world when it comes to snow.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And for the scientists working up here in 2025, the job is essentially “to play in the snow and learn more about it,” said Andrew Schwartz, its director.\u003c/p>\n\u003cfigure id=\"attachment_1995851\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995851\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1585\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-800x495.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-1020x632.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-160x99.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-768x476.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-1536x951.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-2048x1268.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04876_duo-1920x1189.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Schwartz, director of UC Berkeley’s Central Sierra Snow Lab, holds a decades-old printout of snow measurements (left) and a black-and-white photograph (right) in the lab’s archives. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For the three days in January that saw 20 students from across the U.S. arrive at the Snow Science School, Tahoe was in the middle of a sunny, dry spell, with the snowpack at Donner Summit at 94% of the average for this time of year. But at an elevation of over 6,700 feet, the Snow Lab has seen its share of wild winters and momentous snowfall — making it an apt place to study snow science any time.\u003c/p>\n\u003cp>Schwartz, who took over the Snow Lab in 2021 and lived inside the building for his first two years, recalled how, in 2023, the snow was so deep that he and his colleagues could “walk directly into the third-floor windows.” That year, the Snow Lab received a total of 63 feet of snow, its second-biggest winter accumulation on record — precipitation that would eventually become the snowmelt that’s crucial for California’s water supply.\u003c/p>\n\u003cfigure id=\"attachment_1995837\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995837\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00729-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Participants listen during a morning lecture at the Clair Tappan Lodge during the Snow Science School organized by UC Berkeley’s Central Sierra Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Schwartz, his “number one” hope for the Snow Lab’s inaugural school is that the students leave “with an appreciation of snow and a better understanding of how it works, really — because it’s so important to the world.”\u003c/p>\n\u003cp>“Roughly two billion people [around the world] use water obtained from snowpack. And we tend to take it for granted,” he said.\u003c/p>\n\u003cp>The school’s student body included a large handful of people from the California Department of Water Resources — one of the Snow Lab’s partners in this work — but also graduate students, researchers, snow modelers and teachers, as well as folks sent by the National Parks Service and the National Forest Service.\u003c/p>\n\u003cfigure id=\"attachment_1995836\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995836\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00032-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Participants gather for a morning lecture during Snow Science School. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The breadth of experience and background among the Snow Science School’s students is a testimony to the wide range of applications this work can have — and to the disciplines that snow brings together. “It’s a very close-knit community,” said Preetika Kaur, a Snow Lab student attending from the University of Wyoming. “I love to meet people who are pros.”\u003c/p>\n\u003ch2>All work and no play? Not at the Snow Lab\u003c/h2>\n\u003cp>After climbing up the steep hill to the Snow Lab on their first day, students were shown past the bright red snowcat — the exact same model that’s featured in the movie \u003cem>The Shining\u003c/em>, noted Schwartz approvingly — and into the warren-like building. Above their heads, the top floor holds sleeping quarters for the scientists who board overnight to conduct research or who’ve been trapped inside by an impenetrable Sierra storm.\u003c/p>\n\u003cp>\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995838\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1104\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-800x345.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-1020x440.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-160x69.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-768x331.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-1536x662.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-2048x883.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00955_duo-1920x828.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003c/p>\n\u003cfigure id=\"attachment_1995839\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995839\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_00964-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">UC Berkeley’s Central Sierra Snow Lab, based in Soda Springs near Donner Summit. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The first floor and basement, where the lab’s scientists work throughout the day, was full not just of computer screens and boxes full of measuring tools but also handwritten logs, archive photography depicting their Snow Lab predecessors out on the job, vintage road signs and instruments saved from the building’s past.\u003c/p>\n\u003cp>There’s even an oscilloscope — an instrument that once measured voltage — with a large “NASA AMES” sticker on it, and even though Schwartz admits they “have no clue” what the Snow Lab scientists of previous years used it for up here, “I’d be lying if I still don’t like to play with the knobs on it,” he said.\u003c/p>\n\u003cfigure id=\"attachment_1995849\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995849\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04870-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A Type 555 Dual-beam Oscilloscope, circa 1960s, at the Central Sierra Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_1995848\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995848\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"1102\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-800x344.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-1020x439.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-160x69.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-768x330.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-1536x661.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-2048x881.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04694_duo-1920x826.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Spatulas and rulers (right) are some of the tools used to measure snowfall at the Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Outside, the students tour Snow Lab’s network of remote snow equipment, like the fluid-filled “snow pillow” that detects the weight of the snow falling on it and the sensors submerged in the creek behind the lab that will gauge the height of the icy water as it starts to rise with spring snowmelt. Other remote sensors constantly assess solar radiation — in a region where sunlight can contribute to up to 95% of snowmelt — and soil temperature to get an idea of just how fast the snowpack could melt this year.\u003c/p>\n\u003cp>But as this data collection hums in the background, Schwartz still maintains the lab’s twice-daily manual measurement tradition, which sees him and his colleagues crunch out onto the snow with “our very fancy ruler” — work that on some days, depending on conditions, can feel more like a polar expedition.\u003c/p>\n\u003cfigure id=\"attachment_1995840\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995840\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01055-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Gaby May Lagunes, a Ph.D. student in the Environmental Science, Policy, and Management Department at UC Berkeley, puts on her snowshoes to head into the field. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>As \u003ca href=\"https://x.com/UCB_CSSL\">the Snow Lab’s social media presence\u003c/a> has gained in popularity in the last few years, the snow measurements that Schwartz and his team make public are also watched eagerly by a different group of California enthusiasts: skiers and snowboarders desperate to know when to hit the Tahoe slopes.\u003c/p>\n\u003cp>“I love the different uses of our data in our information,” he said.\u003c/p>\n\u003ch2>The impact of the snowpack on water supply\u003c/h2>\n\u003cp>The snowpack can contain clues of the past as well as the future — which is why the snow analysis techniques being taught at the Snow Science School go way beyond just assessing depth.\u003c/p>\n\u003cp>A key concept hydrology students are taught about is “snow water equivalent,” or SWE (usually pronounced “swee” by snow scientists): A measurement that tells scientists just how much water is contained in an area of snow versus the air it also contains alongside its ice crystals.\u003c/p>\n\u003cfigure id=\"attachment_1995841\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995841\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_01224-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Andrew Schwartz, right, director of the Central Sierra Snow Lab, leads instructors and participants of the Snow Science School into the field. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“A lot of the water in California originally falls as snow, and it’s really valuable to humans because there’s a lot of it and because it stores itself for free in places where it’s cold and then melts in the spring, which is when we need it for agriculture,” said Marianne Cowherd, research associate at the Snow Lab and one of the instructors. “Having a good understanding of how much water we have available upstream lets us do things like manage our reservoir levels — so we still have enough water, but we don’t have dangerous operations or overflow.”\u003c/p>\n\u003cp>The next piece of the snow science puzzle is working out when and how the state can expect that snow to melt. At the school, the students learn more about how energy from the sun and from the warm temperatures of the air and from the ground melts the snowpack and how the water flows into California’s soils and streams.\u003c/p>\n\u003cp>“The thing that I’m trying to do is understand the effect of human changes in the landscape, specifically with irrigation on future precipitation patterns and precipitation extremes,” said Gaby May Lagunes, a snow lab student and UC Berkeley graduate researcher. “How the way people change the environment has an impact on the water cycle, not only locally, regionally and globally.”\u003c/p>\n\u003cp>So “if I want to understand water from a data-driven perspective, I need to have an idea of what snow people know,” she said. “We need to work together a lot because we cannot know everything.”\u003c/p>\n\u003cfigure id=\"attachment_1995845\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995845\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02033-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">Preetika Kaur, left, a Ph.D. student at the University of Wyoming, and Joe Ammatelli, an assistant research scientist with the Desert Research Institute, dig a pit in the snowpack during Snow Science School. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Up close in the snow pits\u003c/h2>\n\u003cp>For students, the real action came when the school decamped closer to Donner Summit for the field measurement portion of their studies. After suiting up in thermal layers, bibs and beanies — plus lab-supplied polarized sunglasses that read “No Biz Like Snow Biz” on the side — the students strap on snowshoes to make the hike along a snow-covered trail to a secluded woods, sandwiched between Sugar Bowl and Donner Ski Ranch. Here, they began to dig out a series of 4-foot-deep snow pits using shovels, low enough to strike soil and complete with steps.\u003c/p>\n\u003cp>The snowpack can be far larger, sometimes as deep as 20 feet, and scientists “have to build literal levels down to measure the whole thing,” Schwartz said — “so you don’t have to Spider-Man your way out every time.”\u003c/p>\n\u003cp>Joe Ammatelli was sent by the Desert Research Institute in Nevada, where he carries out snow modeling, which needs to be validated by field observations. “It’s really valuable as a modeler to get out here and see how it’s done,” he said.\u003c/p>\n\u003cfigure id=\"attachment_1995846\" class=\"wp-caption aligncenter\" style=\"max-width: 2560px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995846\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-scaled.jpg\" alt=\"\" width=\"2560\" height=\"845\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-scaled.jpg 2560w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-800x264.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-1020x337.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-160x53.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-768x253.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-1536x507.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-2048x676.jpg 2048w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_02943_duo-1920x634.jpg 1920w\" sizes=\"auto, (max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Snow crystals lay on a measuring device during a field outing with the Snow Science School in January. Chris Northart, right, with the Department of Water Resources Statewide Monitoring Network Unit and a participant of the Snow Science School, uses a magnification lens to measure the size of snow granules. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_1995847\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995847\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173.jpg\" alt=\"\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_03173-1920x1280.jpg 1920w\" sizes=\"auto, (max-width: 2000px) 100vw, 2000px\">\u003cfigcaption class=\"wp-caption-text\">A participant of the Snow School weighs a wedge of snow collected from the snowpack in a field outing. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>And for all the technological developments in snow science, it remains deeply tactile for its practitioners. Down in the pits, the students measured the snow’s temperature and observed how it changed the deeper the pit went. Then, using specialized shovels, the students scooped out and leveled off snow before weighing it on a scale — a method of measuring density and snow water equivalent.\u003c/p>\n\u003cp>They examined physical changes in the different layers in the smooth white walls of the snow pits, like studying rings in a tree trunk. These kinds of measurements are an exercise in time travel, explained instructor Cowherd, given the different qualities of snowflakes that fall at different times and how the ever-accumulating snowpack ages.\u003c/p>\n\u003cp>As the air heats and cools, the snow melts and compresses under its own weight — all of which “tells us about the history of what’s happened there,” Cowherd said.\u003c/p>\n\u003ch2>‘Every day in the snow is a good day’\u003c/h2>\n\u003cp>The observations that the instructors taught its snow students in the pits are the kind that stretches back almost a century and a half in the Snow Lab’s own archives — and this volume of information is invaluable for assessing the impact of climate change, Schwartz said.\u003c/p>\n\u003cp>“We see the same amount of precipitation coming in, but it’s shifting from snow terrain in all the months — so we’re seeing warming,” he said. “Our rain-snow line is going up in elevation.”\u003c/p>\n\u003cp>The almost 150 years of data can also aid forecasters in looking for variables that smaller data sets just can’t encompass, he said — like the Sierra’s dry spells that are followed by big years for rain and snowfall, a swing that’s seen in “five year periods.”\u003c/p>\n\u003cfigure id=\"attachment_1995850\" class=\"wp-caption aligncenter\" style=\"max-width: 1333px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1995850\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872.jpg\" alt=\"\" width=\"1333\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872.jpg 1333w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-800x1200.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-1020x1530.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-160x240.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-768x1152.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2025/02/20250116_Snow-School_DMB_04872-1024x1536.jpg 1024w\" sizes=\"auto, (max-width: 1333px) 100vw, 1333px\">\u003cfigcaption class=\"wp-caption-text\">A sign to alert the public of a snow survey shelter structure from the Department of Water Resources is one of the objects in the archive at the Snow Lab. \u003ccite>(David M. Barreda/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The school’s emphasis on continuing the tradition of meticulous data collection is shot through with the deep enthusiasm that marks the people in its orbit. Even in the chill of the field, when digging out feet of snow, the students remain upbeat.\u003c/p>\n\u003cp>“Snow people are really fun people for the most part,” said instructor Micah Johnson, as he demonstrated an invention he’d been working on for a decade — showing the students how to stab his Bluetooth-enabled “penetrometer-reflectometer” stick into the snow and call up data from its sensors. “I have yet to meet an indifferent snow scientist of sorts.”\u003c/p>\n\u003cp>Or, as Ammatelli from the Desert Research Institute said, “Every day in the snow is a good day.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story has been updated to correct the spelling of Joe Ammatelli’s name.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals",
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"headTitle": "Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals | KQED",
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"content": "\u003cp>\u003cem>This story was originally published on March 20, 2024.\u003c/em>\u003c/p>\n\u003cp>On a warm September morning in 2020, David Alter was cleaning up his kitchen in Berkeley. He saw his wife, Lisa, move towards him out of the corner of his eye. He turned to dry his hands on a towel, and then he heard a loud noise.\u003c/p>\n\u003cp>“I’ll never forget that sound,” he said. “It was like the sound of a baseball getting hit. She did nothing to brace her fall. Her head smacked directly on the linoleum floor.”\u003c/p>\n\u003cp>His wife lay still as blood pooled around her body, and Alter sprinted to the bathroom to scavenge for bandages. He wrapped Lisa’s head in gauze and then carried her to the car before speeding to the emergency department at Kaiser Permanente’s Richmond Medical Center, where he said a doctor diagnosed Lisa with a brain bleed.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Kristof Stremikis, director of market analysis and insight, California Health Care Foundation\"]‘We definitely know that across California more patients are spending longer times in the hospital.’[/pullquote]Lisa has Huntington’s disease, a genetic disorder that causes nerve cells to break down over time, ravaging the brain and body. The condition is marked by involuntary jerking and writhing movements. It impairs one’s gait, posture and balance. Eventually, Lisa could not walk, talk or think.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Alter had failed for an entire year to find a nursing home for his wife, as she was no longer safe at home.\u003c/p>\n\u003cp>“It got to the point that we were going to the ER weekly,” Alter said. “If the fall was late at night, we wouldn’t go right away because we were too exhausted. I would patch her up. I would use suture strips or even sometimes Krazy Glue to close cuts.”\u003c/p>\n\u003cfigure id=\"attachment_1991935\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1991935 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\" alt=\"A man wearing glasses and a dark shirt sits next to a woman lying down in a bed.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter sits next to his wife, Lisa Alter, in Walnut Creek on Feb. 9, 2024. \u003ccite>(Kathryn Styer Martínez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He had called hundreds of skilled nursing facilities across California. He penned personal letters to facility directors illustrated with color photos of their family, describing his wife as “a vibrant woman, wife, elementary school teacher and mother.”\u003c/p>\n\u003cp>He received denial after denial. There was not a single facility that would accept a complex patient who would likely need many years of specialized, very expensive care. Lisa received her Huntington’s disease diagnosis when she was 45 years old. From the onset of symptoms, people with the condition have a life expectancy of 10 to 25 years. Lisa’s needs will likely increase over time.\u003c/p>\n\u003cp>Alter turned to social workers with the Huntington’s Disease Society for help. They advised him to leave his wife in the hospital the next time she landed in the emergency department. “That’s the last resort if the caregiver isn’t safe to take their loved one home,” said Jessica Marsolek, the society’s associate director of community services.\u003c/p>\n\u003cfigure id=\"attachment_1991923\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991923\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\" alt=\"A hallway of a medical center with people walking through.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals are much more equipped to connect and successfully transfer patients to nursing homes. “I don’t know anybody that’s gotten into a nursing home any other way,” said Maura Gibney, executive director for California Advocates for Nursing Home Reform. She regularly advises families to leave their loved ones in the hospital. “That’s the only way.”\u003c/p>\n\u003cp>Four days after Lisa’s fall, she was ready for discharge from Kaiser’s emergency department in Richmond, but Alter made the decision not to pick her up. She wouldn’t leave the hospital for several months.\u003c/p>\n\u003ch2>Part of a growing trend\u003c/h2>\n\u003cp>Patients spend more and more time in the hospital, even people who — like Lisa Alter — are medically stable and ready for a lower level of care at a facility like a nursing home or a psychiatric treatment center. Increasingly, they languish for weeks, months and even years, which delays their recovery, and that, in turn, delays care for patients who need urgent care.\u003c/p>\n\u003cp>“We can’t accept some patients trying to transfer in from smaller hospitals,” said Dr. Valerie Norton, emergency medicine physician at Scripps Mercy Hospital in San Diego. “Because we don’t have room for them. Or there might be somebody down in the emergency department that’s waiting to be admitted into the hospital. And we have to wait until somebody else gets discharged before we can move them upstairs. If you’re lying in a bed in the emergency department, that’s just a hard gurney with a broken hip, and you’re waiting 16 hours for a bed to open up somewhere, that’s pretty tough.”\u003c/p>\n\u003cfigure id=\"attachment_1991924\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991924\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\" alt='The side of a building that says \"Kaiser Permanente.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2022, the average length of stay inside hospitals across the country \u003ca href=\"https://www.aha.org/issue-brief/2022-12-05-patients-and-providers-faced-increasing-delays-timely-discharges\">increased by 19.2%\u003c/a> compared to the year before, according to an issue brief prepared by the American Hospital Association. In California, 4,500 patients are stranded inside hospitals every day, according to a \u003ca href=\"https://calhospital.org/wp-content/uploads/2024/01/Impact-of-Inadequate-Networks-CHA-Analysis-FINAL.pdf\">report from the California Hospital Association, \u003c/a>which attributes the problem of discharge delays to insurance companies openly disregarding “the clinical guidance of doctors and nurses” and “delaying or denying the care” that patients need.\u003c/p>\n\u003cp>“We definitely know that across California, more patients are spending longer times in the hospital,” said Kristof Stremikis, who directs the California Health Care Foundation’s market analysis and insight team.\u003c/p>\n\u003cp>“It’s both very complicated and incredibly simple,” Stremikis said. “It’s rising demand with problems in the supply. There’s more patients that need to be discharged. They tend to be sicker. They tend to have more complex conditions. And then on the supply side, there’s just fewer and fewer places to send them.”\u003c/p>\n\u003cp>[aside postID=\"science_1991739,news_11976372,news_11968579\" label=\"Related Stories\"]As the country’s demographics trend older, more and more patients require care at nursing homes, but those facilities are plagued by dire staffing shortages, according to the \u003ca href=\"https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Historic-Staffing-Shortages-Continue-To-Force-Nursing-Homes-To-Limit-New-Admissions,-Creating-Bottlenecks-at-Hospitals-and-.aspx\">American Health Care Association\u003c/a>. A lack of workers downstream means patients like Lisa Alter get stuck upstream inside the hospital’s emergency department.\u003c/p>\n\u003cp>“We don’t have anywhere safe to send them,” Norton said. “They would qualify to be at a lower level of care like a skilled nursing facility or an assisted living facility. But because of their multiple medical problems or their psychiatric condition, there’s not a place that’s willing to take them.”\u003c/p>\n\u003cp>The number of days patients are stuck at Scripps has tripled in recent years, she said, and costs the health care system $56 million a year.\u003c/p>\n\u003cp>“It’s just insane how long these patients stay in the hospital,” Norton said. “And we’re not getting paid for that. We’re just eating that cost. And they should be in a nursing home somewhere.”\u003c/p>\n\u003cp>The problem was exacerbated by the pandemic, which accelerated feelings of anguish and other persistent mental health issues in health care workers.\u003c/p>\n\u003cp>Nearly half of health care workers across the U.S. reported often feeling burned out in 2022, according to a \u003ca href=\"https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html\">federal survey from the Centers for Disease Control\u003c/a>. About the same amount said they intended to look for a new job.\u003c/p>\n\u003cp>“We’ve had a long, long, long-term problem,” said Craig Cornett, CEO of the California Association of Health Facilities. “Every other part of the health care sector has recovered its staff to its pre-COVID days. We are the only part of the health care continuum that is still below where we were before COVID.”\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"David Alter, software engineer\"]‘You shouldn’t have to leave someone in the hospital and force them to take care of it.’[/pullquote]California is spending $26 million to \u003ca href=\"https://yourcnastory.org/\">recruit\u003c/a> more health care workers to help fill this gap, with the hope of attracting 5,500 certified nursing assistants by 2027. State lawmakers are considering \u003ca href=\"https://legiscan.com/CA/text/SB895/id/2868455\">SB 895\u003c/a>, a new bill that would allow select community college districts to offer nursing degrees, lowering the bar for entry and making it easier for workers to enter the health care industry.\u003c/p>\n\u003cp>But, Cornett said, the workforce challenge is huge, and it is not going away.\u003c/p>\n\u003ch2>The breaking point\u003c/h2>\n\u003cp>Alter always thought he’d grow old alongside his wife. But he could no longer parent his two children, hold a full-time job as a software engineer, and care for Lisa around the clock.\u003c/p>\n\u003cfigure id=\"attachment_1991920\" class=\"wp-caption aligncenter\" style=\"max-width: 1330px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991920\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\" alt=\"A man, woman, and two children wearing tie die t shirts stands outside a home.\" width=\"1330\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg 1330w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-800x1203.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1020x1534.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-160x241.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-768x1155.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1021x1536.jpg 1021w\" sizes=\"(max-width: 1330px) 100vw, 1330px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A family photo of Lisa (left) and David Alter and their children Zachary and Maya in front of their home in Berkeley in 2010, the year before Lisa was diagnosed with Huntington’s disease. \u003ccite>(Courtesy of David Alter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When he learned that his wife was ready to be discharged from the emergency department at Kaiser Richmond, he steadied himself.\u003c/p>\n\u003cp>“I remember talking to them, and I said: ‘I’m not gonna pick her up. I’m not going to take her home.’”\u003c/p>\n\u003cp>Alter said the hospital’s discharge team struggled to find a nursing home for Lisa, too. His wife Lisa would spend over four months at Kaiser, a time period that Alter described as “excruciating” for him. He was so worried that the hospital would force him to take his wife home that he held off from visiting her in the hospital initially.\u003c/p>\n\u003cp>“It’s incredibly emotional to walk away,” Alter said. “And Kaiser’s calling you. And they’re like, ‘Why aren’t you picking her up?’ It’s really, really stressful. And it gets worse every day she’s there.”\u003c/p>\n\u003cp>Kaiser Permanente declined an interview for this story. In an emailed statement, the organization said it strives to find the right care for patients as quickly as possible. “While the vast majority of placements occur in a timely fashion, there are some circumstances, including the need for highly specialized care and patient or family preferences, that can present challenges,” the statement said.\u003c/p>\n\u003cp>\u003cb>Patient discrimination\u003c/b>\u003c/p>\n\u003cp>On top of staffing issues, facilities have a financial incentive to choose patients who can pay the highest price. “It’s unfortunate, but it is true,” Stremikis said. “Medi-Cal rates are way lower than private payers. It’s just another example of the inequalities within our system.”\u003c/p>\n\u003cp>Medi-Cal is the state’s insurance program, which covers Alter’s wife. It’s supposed to pay for her to receive specialized care at a round-the-clock facility, but that has not been his experience. “There’s nowhere I can place her,” Alter said.\u003c/p>\n\u003cfigure id=\"attachment_1991922\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991922\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\" alt=\"A person holds an image of a man, woman and young child.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter holds a photo of himself, his wife Lisa, and their son Zachary at his home in Berkeley on March 18, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Eventually, after more than four months, Kaiser Permanente did find housing for Lisa in Walnut Creek. The home provides food and supervision but not specialized nurses or regular doctor visits. Alter said she’s not at the right facility, but he doesn’t know what to do. He hired consultants and lawyers and wrote his legislators, all to no avail.\u003c/p>\n\u003cp>Three years after Alter left his wife in the hospital as a hail mary play to get her the care she needs, that’s still not happening. “You’re just defeated,” he said.\u003c/p>\n\u003cp>Meanwhile, his wife declines. “She’s 70 or 80 pounds,” Alter said. “She’s so tiny. She’s skin and bones.”\u003c/p>\n\u003cp>He also worries she could injure herself again, land back in the hospital, and then get stuck in the cycle all over again.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“You shouldn’t have to leave someone in the hospital and force them to take care of it,” Alter said. “That’s not the right solution. As a society, we’re not set up in a way to care for people properly.”\u003c/p>\n\n",
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"excerpt": "One woman with Huntington's disease was left in limbo at Kaiser’s emergency department in Richmond for more than 4 months as she waited for space in a nursing home. ",
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"title": "Systemic Neglect: How Staffing Shortages In Nursing Homes Leave Patients Trapped in Hospitals | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This story was originally published on March 20, 2024.\u003c/em>\u003c/p>\n\u003cp>On a warm September morning in 2020, David Alter was cleaning up his kitchen in Berkeley. He saw his wife, Lisa, move towards him out of the corner of his eye. He turned to dry his hands on a towel, and then he heard a loud noise.\u003c/p>\n\u003cp>“I’ll never forget that sound,” he said. “It was like the sound of a baseball getting hit. She did nothing to brace her fall. Her head smacked directly on the linoleum floor.”\u003c/p>\n\u003cp>His wife lay still as blood pooled around her body, and Alter sprinted to the bathroom to scavenge for bandages. He wrapped Lisa’s head in gauze and then carried her to the car before speeding to the emergency department at Kaiser Permanente’s Richmond Medical Center, where he said a doctor diagnosed Lisa with a brain bleed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Lisa has Huntington’s disease, a genetic disorder that causes nerve cells to break down over time, ravaging the brain and body. The condition is marked by involuntary jerking and writhing movements. It impairs one’s gait, posture and balance. Eventually, Lisa could not walk, talk or think.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Alter had failed for an entire year to find a nursing home for his wife, as she was no longer safe at home.\u003c/p>\n\u003cp>“It got to the point that we were going to the ER weekly,” Alter said. “If the fall was late at night, we wouldn’t go right away because we were too exhausted. I would patch her up. I would use suture strips or even sometimes Krazy Glue to close cuts.”\u003c/p>\n\u003cfigure id=\"attachment_1991935\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1991935 size-full\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg\" alt=\"A man wearing glasses and a dark shirt sits next to a woman lying down in a bed.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240209-AVOIDABLEBEDDAYS-KSM-1-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter sits next to his wife, Lisa Alter, in Walnut Creek on Feb. 9, 2024. \u003ccite>(Kathryn Styer Martínez/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>He had called hundreds of skilled nursing facilities across California. He penned personal letters to facility directors illustrated with color photos of their family, describing his wife as “a vibrant woman, wife, elementary school teacher and mother.”\u003c/p>\n\u003cp>He received denial after denial. There was not a single facility that would accept a complex patient who would likely need many years of specialized, very expensive care. Lisa received her Huntington’s disease diagnosis when she was 45 years old. From the onset of symptoms, people with the condition have a life expectancy of 10 to 25 years. Lisa’s needs will likely increase over time.\u003c/p>\n\u003cp>Alter turned to social workers with the Huntington’s Disease Society for help. They advised him to leave his wife in the hospital the next time she landed in the emergency department. “That’s the last resort if the caregiver isn’t safe to take their loved one home,” said Jessica Marsolek, the society’s associate director of community services.\u003c/p>\n\u003cfigure id=\"attachment_1991923\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991923\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg\" alt=\"A hallway of a medical center with people walking through.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-09-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hospitals are much more equipped to connect and successfully transfer patients to nursing homes. “I don’t know anybody that’s gotten into a nursing home any other way,” said Maura Gibney, executive director for California Advocates for Nursing Home Reform. She regularly advises families to leave their loved ones in the hospital. “That’s the only way.”\u003c/p>\n\u003cp>Four days after Lisa’s fall, she was ready for discharge from Kaiser’s emergency department in Richmond, but Alter made the decision not to pick her up. She wouldn’t leave the hospital for several months.\u003c/p>\n\u003ch2>Part of a growing trend\u003c/h2>\n\u003cp>Patients spend more and more time in the hospital, even people who — like Lisa Alter — are medically stable and ready for a lower level of care at a facility like a nursing home or a psychiatric treatment center. Increasingly, they languish for weeks, months and even years, which delays their recovery, and that, in turn, delays care for patients who need urgent care.\u003c/p>\n\u003cp>“We can’t accept some patients trying to transfer in from smaller hospitals,” said Dr. Valerie Norton, emergency medicine physician at Scripps Mercy Hospital in San Diego. “Because we don’t have room for them. Or there might be somebody down in the emergency department that’s waiting to be admitted into the hospital. And we have to wait until somebody else gets discharged before we can move them upstairs. If you’re lying in a bed in the emergency department, that’s just a hard gurney with a broken hip, and you’re waiting 16 hours for a bed to open up somewhere, that’s pretty tough.”\u003c/p>\n\u003cfigure id=\"attachment_1991924\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991924\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg\" alt='The side of a building that says \"Kaiser Permanente.\"' width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-10-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The Kaiser Permanente Richmond Medical Center on March 19, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In 2022, the average length of stay inside hospitals across the country \u003ca href=\"https://www.aha.org/issue-brief/2022-12-05-patients-and-providers-faced-increasing-delays-timely-discharges\">increased by 19.2%\u003c/a> compared to the year before, according to an issue brief prepared by the American Hospital Association. In California, 4,500 patients are stranded inside hospitals every day, according to a \u003ca href=\"https://calhospital.org/wp-content/uploads/2024/01/Impact-of-Inadequate-Networks-CHA-Analysis-FINAL.pdf\">report from the California Hospital Association, \u003c/a>which attributes the problem of discharge delays to insurance companies openly disregarding “the clinical guidance of doctors and nurses” and “delaying or denying the care” that patients need.\u003c/p>\n\u003cp>“We definitely know that across California, more patients are spending longer times in the hospital,” said Kristof Stremikis, who directs the California Health Care Foundation’s market analysis and insight team.\u003c/p>\n\u003cp>“It’s both very complicated and incredibly simple,” Stremikis said. “It’s rising demand with problems in the supply. There’s more patients that need to be discharged. They tend to be sicker. They tend to have more complex conditions. And then on the supply side, there’s just fewer and fewer places to send them.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>As the country’s demographics trend older, more and more patients require care at nursing homes, but those facilities are plagued by dire staffing shortages, according to the \u003ca href=\"https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Historic-Staffing-Shortages-Continue-To-Force-Nursing-Homes-To-Limit-New-Admissions,-Creating-Bottlenecks-at-Hospitals-and-.aspx\">American Health Care Association\u003c/a>. A lack of workers downstream means patients like Lisa Alter get stuck upstream inside the hospital’s emergency department.\u003c/p>\n\u003cp>“We don’t have anywhere safe to send them,” Norton said. “They would qualify to be at a lower level of care like a skilled nursing facility or an assisted living facility. But because of their multiple medical problems or their psychiatric condition, there’s not a place that’s willing to take them.”\u003c/p>\n\u003cp>The number of days patients are stuck at Scripps has tripled in recent years, she said, and costs the health care system $56 million a year.\u003c/p>\n\u003cp>“It’s just insane how long these patients stay in the hospital,” Norton said. “And we’re not getting paid for that. We’re just eating that cost. And they should be in a nursing home somewhere.”\u003c/p>\n\u003cp>The problem was exacerbated by the pandemic, which accelerated feelings of anguish and other persistent mental health issues in health care workers.\u003c/p>\n\u003cp>Nearly half of health care workers across the U.S. reported often feeling burned out in 2022, according to a \u003ca href=\"https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html\">federal survey from the Centers for Disease Control\u003c/a>. About the same amount said they intended to look for a new job.\u003c/p>\n\u003cp>“We’ve had a long, long, long-term problem,” said Craig Cornett, CEO of the California Association of Health Facilities. “Every other part of the health care sector has recovered its staff to its pre-COVID days. We are the only part of the health care continuum that is still below where we were before COVID.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘You shouldn’t have to leave someone in the hospital and force them to take care of it.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>California is spending $26 million to \u003ca href=\"https://yourcnastory.org/\">recruit\u003c/a> more health care workers to help fill this gap, with the hope of attracting 5,500 certified nursing assistants by 2027. State lawmakers are considering \u003ca href=\"https://legiscan.com/CA/text/SB895/id/2868455\">SB 895\u003c/a>, a new bill that would allow select community college districts to offer nursing degrees, lowering the bar for entry and making it easier for workers to enter the health care industry.\u003c/p>\n\u003cp>But, Cornett said, the workforce challenge is huge, and it is not going away.\u003c/p>\n\u003ch2>The breaking point\u003c/h2>\n\u003cp>Alter always thought he’d grow old alongside his wife. But he could no longer parent his two children, hold a full-time job as a software engineer, and care for Lisa around the clock.\u003c/p>\n\u003cfigure id=\"attachment_1991920\" class=\"wp-caption aligncenter\" style=\"max-width: 1330px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991920\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg\" alt=\"A man, woman, and two children wearing tie die t shirts stands outside a home.\" width=\"1330\" height=\"2000\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED.jpg 1330w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-800x1203.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1020x1534.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-160x241.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-768x1155.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-12-KQED-1021x1536.jpg 1021w\" sizes=\"(max-width: 1330px) 100vw, 1330px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A family photo of Lisa (left) and David Alter and their children Zachary and Maya in front of their home in Berkeley in 2010, the year before Lisa was diagnosed with Huntington’s disease. \u003ccite>(Courtesy of David Alter)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>When he learned that his wife was ready to be discharged from the emergency department at Kaiser Richmond, he steadied himself.\u003c/p>\n\u003cp>“I remember talking to them, and I said: ‘I’m not gonna pick her up. I’m not going to take her home.’”\u003c/p>\n\u003cp>Alter said the hospital’s discharge team struggled to find a nursing home for Lisa, too. His wife Lisa would spend over four months at Kaiser, a time period that Alter described as “excruciating” for him. He was so worried that the hospital would force him to take his wife home that he held off from visiting her in the hospital initially.\u003c/p>\n\u003cp>“It’s incredibly emotional to walk away,” Alter said. “And Kaiser’s calling you. And they’re like, ‘Why aren’t you picking her up?’ It’s really, really stressful. And it gets worse every day she’s there.”\u003c/p>\n\u003cp>Kaiser Permanente declined an interview for this story. In an emailed statement, the organization said it strives to find the right care for patients as quickly as possible. “While the vast majority of placements occur in a timely fashion, there are some circumstances, including the need for highly specialized care and patient or family preferences, that can present challenges,” the statement said.\u003c/p>\n\u003cp>\u003cb>Patient discrimination\u003c/b>\u003c/p>\n\u003cp>On top of staffing issues, facilities have a financial incentive to choose patients who can pay the highest price. “It’s unfortunate, but it is true,” Stremikis said. “Medi-Cal rates are way lower than private payers. It’s just another example of the inequalities within our system.”\u003c/p>\n\u003cp>Medi-Cal is the state’s insurance program, which covers Alter’s wife. It’s supposed to pay for her to receive specialized care at a round-the-clock facility, but that has not been his experience. “There’s nowhere I can place her,” Alter said.\u003c/p>\n\u003cfigure id=\"attachment_1991922\" class=\"wp-caption aligncenter\" style=\"max-width: 2000px\">\u003ca href=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-1991922\" src=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg\" alt=\"A person holds an image of a man, woman and young child.\" width=\"2000\" height=\"1333\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED.jpg 2000w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2024/03/240318-AVOIDABLE-BED-DAYS-MD-06-KQED-1920x1280.jpg 1920w\" sizes=\"(max-width: 2000px) 100vw, 2000px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">David Alter holds a photo of himself, his wife Lisa, and their son Zachary at his home in Berkeley on March 18, 2024. \u003ccite>(Martin do Nascimento/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Eventually, after more than four months, Kaiser Permanente did find housing for Lisa in Walnut Creek. The home provides food and supervision but not specialized nurses or regular doctor visits. Alter said she’s not at the right facility, but he doesn’t know what to do. He hired consultants and lawyers and wrote his legislators, all to no avail.\u003c/p>\n\u003cp>Three years after Alter left his wife in the hospital as a hail mary play to get her the care she needs, that’s still not happening. “You’re just defeated,” he said.\u003c/p>\n\u003cp>Meanwhile, his wife declines. “She’s 70 or 80 pounds,” Alter said. “She’s so tiny. She’s skin and bones.”\u003c/p>\n\u003cp>He also worries she could injure herself again, land back in the hospital, and then get stuck in the cycle all over again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“You shouldn’t have to leave someone in the hospital and force them to take care of it,” Alter said. “That’s not the right solution. As a society, we’re not set up in a way to care for people properly.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won't Insurance Companies Cover Them?",
"headTitle": "Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won’t Insurance Companies Cover Them? | KQED",
"content": "\u003ch2>\u003cem>What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?\u003c/em>\u003c/h2>\n\u003cp>[dropcap]W[/dropcap]hen Yvonne was walking across campus and heard someone calling her name, she stopped and looked around, but the other students flowed around her, oblivious. She continued on, then heard it again.\u003c/p>\n\u003cp>\u003cem>Yvonne?\u003c/em> Stop. Look. Nothing.\u003c/p>\n\u003cp>She was confused, but like anyone else would, Yvonne brushed it off.\u003c/p>\n\u003cp>She sat down in her anatomy class, in the middle of a big lecture hall, and when the professor began his lesson on the renal system, Yvonne started to feel funny, like he was talking about \u003cem>her\u003c/em> body.\u003c/p>\n\u003cp>“I was like, ‘Why is he talking about \u003cem>my\u003c/em> kidneys? How dare he,’” she remembered. “I got really scared and I ran out of class.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She shook this off, too. As she crunched through the rust-colored leaves of an East Coast autumn, she started to hear chattering, like a radio was on in the background of her life. She ignored it as long as she could — until the voices started speaking to her in full sentences, telling her what to do: “You should jump off a bridge. Take that knife and cut yourself,” they said. “You’re worthless.”[pullquote citation='Yvonne, who has schizoaffective disorder']‘My life wasn’t my own. It was up to these voices because they told me what to do. They wouldn’t go away.’[/pullquote]Her doctor prescribed some medications, but Yvonne, 22 at the time, continued to lose perspective. Maybe the voices weren’t just her mind playing tricks on her? Maybe they were real? That’s when the aliens arrived. She heard the loud, screeching sound of their ship hovering outside her window at night.\u003c/p>\n\u003cp>“We need to remove you from this planet,” the aliens told Yvonne. Then they spoke to each other in their own gargled alien language that she couldn’t understand.\u003c/p>\n\u003cp>Yvonne had no doubt this was real. And when God started talking to her a few weeks later, that was real, too. He told her she was going to be the next Jesus and he was going to give her instructions on how to save the world. At first, this made Yvonne feel great. God had chosen her. But then she got scared, overwhelmed by the responsibility. What if she couldn’t fulfill what God wanted for her?\u003c/p>\n\u003cp>“He’s going to send me to hell and I’m a terrible person,” Yvonne said.\u003c/p>\n\u003cp>Yvonne’s mom convinced her to check herself into the hospital. But it was almost six months after she left the hospital that she got an accurate diagnosis: schizoaffective disorder — roughly, schizophrenia with bouts of mania or depression. And for another six months after that, she sat on her parents’ couch, unable to read, unable to go to school, waiting for a spot to open up in a treatment program.\u003c/p>\n\u003cp>“My life wasn’t my own,” said Yvonne, who asked that we use a family name to protect her mental health history. “It was up to these voices because they told me what to do. They wouldn’t go away and I couldn’t do anything with them. So they ruled my life.”\u003c/p>\n\u003cp>Yvonne is one of \u003ca href=\"https://portal.ct.gov/DMHAS/Initiatives/Evidence-Based/First-Episode-Psychosis#:~:text=Psychosis%20impacts%20approximately%20100%2C000%20youth,others%20may%20have%20ongoing%20symptoms.\">100,000 young adults or adolescents\u003c/a> who have a psychotic episode every year in the U.S. For most of them, it takes \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201400124\">a year and a half to get into meaningful treatment\u003c/a>, if they ever do at all. Treatment programs\u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\"> recommended by the National Institute of Mental Health \u003c/a>as the gold standard of care for early psychosis rarely have enough slots available for the people who need them, and health insurance companies typically refuse to cover the full cost of these programs, even when they are available.\u003c/p>\n\u003cfigure id=\"attachment_1981638\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981638 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg\" alt=\"A woman with light skin, dark brown hair, glasses, and a purple knit hat holds a sign that says "Depressed? Suicidal? I'll see in you 6 weeks." She faces the camera and stands amid a crowd of people marching on a sidewalk, many of whom are, like the woman, wearing red T-shirts, and holding signs on wooden dowels that say "Kaiser Don't Deny."\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1020x765.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-160x120.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-768x576.jpeg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1536x1152.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician.jpeg 1832w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Mental health clinicians at Kaiser Permanente went on strike in December 2018 and 2019 over long patient wait times. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Instead, many young people like Yvonne inch through the country’s fragmented mental health care system, struggling to find a clinician with adequate training in psychosis. Yvonne waited \u003ca href=\"https://www.kqed.org/news/11791527/kaiser-therapists-strike-again-over-long-wait-times\">up to six weeks between therapy appointments\u003c/a> at Kaiser Permanente, and said she made little progress with a clinician who always seemed to change the subject when Yvonne wanted to talk about her voices. “She would skip over it and talk about my anxiety instead,” Yvonne said.\u003c/p>\n\u003cp>Eventually, Kaiser agreed to pay for Yvonne to go to the \u003ca href=\"https://pathprogram.ucsf.edu/\">UCSF Path Program for Early Psychosis\u003c/a>, a two-year outpatient treatment program designed specifically for young people in the earliest stages of psychotic illness. The clinic is one of about 50 in California and 340 across the country that began operating in the mid-2000s. Right away, Yvonne knew this would be different. In her first session, Yvonne’s therapist had her set goals for what she wanted to achieve.\u003c/p>\n\u003cp>“No one had ever asked me what my goals for treatment were,” Yvonne said.\u003c/p>\n\u003ch2>A revolutionary idea for treating schizophrenia\u003c/h2>\n\u003cp>Back in the ’80s and ’90s, doctors didn’t really know what to do with schizophrenia, and they \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8990328/#:~:text=The%20NIMH%20RAISE%20initiative%20aimed,costs%20associated%20with%20psychotic%20disorders.\">didn’t have many options\u003c/a>. They prescribed high doses of antipsychotic medications that sedated people into zombie-like depths. They advised patients to give up on any career ambitions and sign up for disability payments instead. Even today, some doctors still see schizophrenia as a lost cause.\u003c/p>\n\u003cp>“There’s a real failure to appreciate how much potential there is to manage the illness and symptoms,” said \u003ca href=\"https://www.ucsfhealth.org/providers/dr-daniel-mathalon\">Dr. Daniel Mathalon\u003c/a>, a psychiatrist at UCSF’s early psychosis program.\u003c/p>\n\u003cp>Around the turn of the century, a new generation of doctors started thinking, What if we ask patients what they want and actually work with them toward full recovery? “It’s not just about stabilizing you clinically. It’s about making sure we don’t lose track of your future,” said \u003ca href=\"https://health.ucdavis.edu/psychiatry/team/1290/tara-niendam---pediatric-and-transition-age-youth-mental-health-sacramento/\">Tara Niendam\u003c/a>, a child psychologist who runs \u003ca href=\"https://health.ucdavis.edu/psychiatry/specialties/edapt/\">the early psychosis clinic at UC Davis\u003c/a>. “You \u003cem>should\u003c/em> be in college. You \u003cem>should\u003c/em> be living on your own.”\u003c/p>\n\u003cp>With other conditions like diabetes or cancer, the sooner people get into care, the better they do. \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">The same is true of psychotic illness.\u003c/a> Upwards of 80 studies from early psychosis clinics show that patients see \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/26481174/\">a greater reduction of symptoms\u003c/a>, like voices or delusions, and a greater improvement in functioning at school, at work and in their social lives, compared to people who get treatment as usual.\u003c/p>\n\u003cp>There are a few reasons why earlier treatment is more effective, Niendam said. People respond more quickly to medication and at a lower dose, so they have fewer side effects that make them want to stop taking them. Families are more involved and more supportive, and patients themselves are more curious about their psychotic experiences. “They come out of it and they’re like, ‘Whoa! What was that?’” Niendam said. “Folks are still in that questioning phase.”\u003c/p>\n\u003cp>When someone is deep in psychosis, their beliefs are rigid, intractable. They might not see themselves as being sick. But if they get help earlier, Niendam said, they’re more likely to engage in treatment.\u003c/p>\n\u003cfigure id=\"attachment_1981632\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981632 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg\" alt=\"A woman with gray black, short cropped hair and a purple lanier around her neck speaks to a person with blond hair. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Clinical psychologist Tara Niendam speaks with a colleague at the UC Davis Behavioral Health Center in Sacramento on Feb. 7, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Yvonne, even though she believed the alien ship outside her window was real, her doctors at UCSF started her on a new medication that shook that belief loose. Her new therapist then used targeted cognitive behavioral techniques that helped Yvonne challenge those beliefs further.\u003c/p>\n\u003cp>“So for example, I’d have a thought: ‘Aliens are going to abduct me,’” she said. “So then we do ‘evidence for’ that thought and ‘evidence against’ that thought.”\u003c/p>\n\u003cp>First, she made a list of all the evidence she had that the alien abduction plan was real: I hear the aliens. They’re talking to me. I hear their ship.\u003c/p>\n\u003cp>Then she had to list the evidence that they weren’t real. For this, the therapist had Yvonne set up a jar in her bedroom. Every morning that she woke up and had not been abducted, she would put a blue marble in the jar. If she had been abducted, she was supposed to put a white marble in the jar.\u003c/p>\n\u003cp>“And I had all blue marbles,” Yvonne said. “So that’s evidence against ‘they’re going to get me,’ cause they haven’t yet.”\u003c/p>\n\u003cp>To get control over the voices in her head, Yvonne learned to talk back to them. She would sit in the therapist’s office, in the chair on the right side of the room, and pretend to be her voices, telling her to go back to bed or not to go outside. “It’s dangerous,” she’d say.\u003c/p>\n\u003cp>Then Yvonne would go sit in the chair on the left side of the room and practice her response.\u003c/p>\n\u003cp>“Thank you, voices, for wanting to protect me and watch out for me,” she’d say back. “But I’m going to get up and be brave and go out into the world today.”\u003c/p>\n\u003cp>It took a while to get the hang of it, maybe a year, but when she did, Yvonne was able to go back to school. When the voices would start yelling at her while she was in class, calling her dumb, she was ready.\u003c/p>\n\u003cfigure id=\"attachment_1981731\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-1981731\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg\" alt=\"A drawing of a clear jar filling with round, blue marbles.\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">(Illustration by Anna Vignet/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>“I’d be like, ‘You know what? I really don’t appreciate the way you talk to me. Let’s talk after class, let’s talk at 2 p.m.,’” she told them.\u003c/p>\n\u003cp>The voices wouldn’t go away completely, but they would fade into the background, enough where Yvonne could finish class or read a book or do her homework. “I just started to feel more in control,” said Yvonne, now 27.\u003c/p>\n\u003cp>She graduated college last spring, summa cum laude, and she’s now working a full-time job. She’s about to move into her own place. She keeps up with her broad circle of friends, going to shows in the city or having bonfires on the beach. If she thinks she hears a voice or an alien, she does a literal reality check. “Oh, did you hear that?” she’ll ask a friend or her mom. And if they don’t, she tells herself, “Okay, that’s just a voice.”\u003c/p>\n\u003cp>But mostly, Yvonne doesn’t like talking about her illness with her friends. She’d rather talk about the Kardashians instead.\u003c/p>\n\u003cp>“I just like to be normal when I’m with them,” she said.\u003c/p>\n\u003ch2>Independent, career-oriented people\u003c/h2>\n\u003cp>Even though the skills Yvonne learned from therapy at UCSF were a revelation, there was actually a whole other dimension of care that she never got. That’s because UCSF’s program only accepts private insurance, and private health insurers only cover about half of the services of early psychosis treatment.\u003c/p>\n\u003cp>People who get care under government health coverage, like Medi-Cal, can enroll in programs like the \u003ca href=\"https://felton.org/\">Felton Institute\u003c/a>‘s, which offer not just specialized therapy, like Yvonne got, but a full array of social support, as well. At Felton’s five clinic locations, they believe it takes a full team of specialists who all talk to each other, who are all looking out for every aspect of a young person’s life.\u003c/p>\n\u003cp>That includes specialists like Monet Burpee, an education and employment coach. On a typical workday, she’ll drive her clients to the local mall or downtown shopping district, charting their path according to the “Help Wanted” signs. Together, they’ll chat with store managers about open positions, then sit down and fill out the applications.\u003c/p>\n\u003cp>Burpee says helping her clients who have psychosis find work is about more than landing a job; it’s about helping them see themselves differently, as independent, career-oriented people, rather than permanent patients receiving government wage assistance.\u003c/p>\n\u003cp>“If you work, you’re going to notice a huge improvement in your self-esteem,” she tells them. “It has better long-term, positive results versus you just sitting around on SSI.”\u003c/p>\n\u003cfigure id=\"attachment_1981636\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981636 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg\" alt=\"A Black woman with a green cutoff t-shirt and beige hat speaks through a black mask to a man in a blue surgical mask inside a bright space with tables and colorful art on the wall. \" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monet Burpee (right) talks to the manager of a restaurant in Redwood City on one of her job-scouting expeditions in July 2022. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This is what she said to one of her clients, Sandy, after she had her first psychotic episode. Sandy was taking new medications that made her really sleepy, and she was struggling to get motivated.\u003c/p>\n\u003cp>“Since I didn’t really have anything to do, I would just take superlong naps during the day,” said Sandy, now 20, who asked that we call her by a family name so her health history doesn’t disrupt her career path.\u003c/p>\n\u003cp>For her, psychosis hit when she was working her first job after high school, at a fast-food restaurant making burgers. Her co-workers were chatting over the fryer one day when Sandy got this weird feeling, that somehow they knew what she was thinking. It was like her co-workers could read her mind and were discussing her thoughts with each other.\u003c/p>\n\u003cp>“I was like, are they talking about burgers or are they talking about me?” Sandy said.\u003c/p>\n\u003cp>There was one co-worker in particular, a guy she had a crush on, that she was pretty sure was watching her — even following her around. If she was walking down the street, or hanging out in the park, she saw him. Her mom remembers Sandy wanted to sleep with the lights on, repeatedly asking her, “Mom, is someone here?”[pullquote size='medium' citation='Sandy, who has schizophrenia']‘I was like, are they talking about burgers or are they talking about me?’[/pullquote]One day, her mom said Sandy got so scared, she locked herself in the bathroom and just screamed and screamed and screamed.\u003c/p>\n\u003cp>Her mom wanted to call for help. But she didn’t have a job at the time. This was about a year into the pandemic, and the hotel where Sandy’s mom worked had been closed since the first government lockdown. When she lost her job, her union helped her hold on to her health benefits for a while, but that extension was about to run out. “My husband was like, ‘What is that going to cost?’” her mom remembers.\u003c/p>\n\u003cp>Sandy’s mom called 911 anyway. In the hospital, Sandy was diagnosed with schizophrenia. From there, she was enrolled in the Felton Institute’s outpatient early psychosis treatment program. At this point, she and her family were covered by Medi-Cal, the state’s public insurance. They wouldn’t have to pay a dime.\u003c/p>\n\u003cp>Right away, Sandy was introduced to a team of providers who would be by her side for the next two years: a physician, a psychotherapist, an occupational therapist, an education and employment specialist, a peer specialist and a family support specialist for her mom.\u003c/p>\n\u003cp>Sandy’s mom found she needed almost as much support as her daughter did after the diagnosis. She blamed herself. She started meeting once a week with Mike Krechevsky, Felton’s family specialist. He walked her through what schizophrenia was, explained that it was no one’s fault, and helped her manage her own feelings about it so that she didn’t pass them on to Sandy. “When you express anxiety to your child, they don’t feel as though they have any capability of going out in the world, stumbling, falling, picking themselves up, learning from their mistakes and moving forward. You infantilize them,” Krechevsky said. “If you continue to do that, they’re never going to recover.”\u003c/p>\n\u003cp>When Sandy was ready to look for work, she and Burpee went to the mall on a job-scouting expedition. They filled out the applications together. “Next thing I know, I was being interviewed and I got hired,” Sandy said.\u003c/p>\n\u003cp>She started out as a cashier at a new fast-food restaurant and within three months she got promoted to a manager role. Now Burpee is coaching her on how to ask for a raise. “She has a brand-new car,” Burpee said, beaming with pride. “She’s meeting new friends.”\u003c/p>\n\u003cp>For Sandy, it was just one step in her long-term recovery plan.\u003c/p>\n\u003cp>“I want to focus on getting a degree, to get a better career,” she said.\u003c/p>\n\u003ch2>A reverse disparity\u003c/h2>\n\u003cp>In an unusual twist of the U.S.’ separate and unequal health system favoring the wealthy, the reason Sandy was able to get the best care after her psychotic episode was primarily because her mom had lost her job and her insurance.\u003c/p>\n\u003cp>[pullquote citation='Tara Niendam, UC Davis clinical psychologist']‘I can give the Rolls-Royce of care if you walk in and you have Medi-Cal. But 60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.’[/pullquote]This is because the state and federal government are the main funders of these early psychosis clinics, investing tens of millions of dollars into them every year. Officials believe it will save money in the long run, because \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">without sufficient treatment, people with schizophrenia can deteriorate so much\u003c/a>, they end up on wage assistance, in a group home, on the street or in jail — all things the government pays for.\u003c/p>\n\u003cp>But commercial insurance companies, like Anthem or Blue Shield, don’t face those risks. They don’t have the incentive to cover full-scope psychosis treatment. For that reason, and others, they don’t.\u003c/p>\n\u003cp>This means lower-income families with public insurance like Medi-Cal can get the gold standard of care, while middle-class families with commercial plans cannot.\u003c/p>\n\u003cp>“It is a reverse disparity,” said UC Davis’ Niendam, testifying at a state Senate Committee on Health hearing last year, about the impact of this disparity at the early psychosis clinic she runs in Sacramento.\u003c/p>\n\u003cp>“I can give the Rolls-Royce of care if you walk in and you have Medi-Cal,” she said. But “60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.”\u003c/p>\n\u003cp>At the Felton Institute in the Bay Area, early psychosis director \u003ca href=\"https://felton.org/about-us/who-we-are/leadership/adriana-furuzawa/\">Adriana Furuzawa\u003c/a> said the same. For every one person who has Medi-Cal and is eligible for care at her Alameda clinic, there are another two with commercial insurance who are turned away. Last year, they turned about 100 people away.\u003c/p>\n\u003cp>“It was very difficult to think that behind each number, there is a young person, there is a family, that we’re saying no to, when we have the resources right here,” Furuzawa said.\u003c/p>\n\u003cfigure id=\"attachment_1981634\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981634 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg\" alt='A woman with dark red hair and glass sits in a black office chair in a room with \"positive\" painted on the wall above a white lamp and alongside a brown door. ' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adriana Furuzawa, division director for early psychosis services at the Felton Institute, sits in her office in Alameda on Feb. 13, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So what happens to these kids? Generally, they’re on their own to find a psychiatrist and therapist who accepts their insurance. Health plans will pay for these medical services. But they won’t cover anything else: the job and education support, the peer specialist, the family coach.\u003c/p>\n\u003cp>This is discrimination, health advocates argue. If someone has cancer, insurers would never just pay for surgery and radiation, but not chemotherapy.\u003c/p>\n\u003cp>“It’s a package of services,” said David Lloyd, chief of policy at the \u003ca href=\"https://www.thekennedyforum.org/\">Kennedy Forum\u003c/a>. “So the idea that you can split apart the package of services and only reimburse for little components of it really destroys the whole evidence base of what the service is.”\u003c/p>\n\u003cp>This almost happened to Sandy. A few months into her treatment, her mom got her job back at the hotel, and the family was back on her commercial insurance plan. In most counties, this would have meant Sandy got kicked out of the program. Her mom said there would have been no way she could afford to pay for a job coach, a family coach and a peer specialist on her own.\u003c/p>\n\u003cp>“I couldn’t do it. I would definitely stop all the help,” she said, even though it was keeping Sandy alive. Maybe she would have turned to Craigslist to find other parents to talk to, she said, or looked up mental health advice on YouTube to pass on to Sandy. “I just hope and pray for the best,” she said.\u003c/p>\n\u003cp>Last year, state lawmakers wanted to help families like Sandy’s, by forcing insurance companies to cover the full spectrum of early psychosis treatment. One state has done this already — \u003ca href=\"https://www.ilga.gov/legislation/publicacts/101/101-0461.htm\">Illinois\u003c/a> — while Massachusetts and Virginia are working on a similar effort. But the proposal in California, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB1337\">Senate Bill 1337\u003c/a>, died under pressure from the insurance lobby.\u003c/p>\n\u003cp>Historically, insurers have not covered the costs of services provided by non-licensed staff, like job or family coaches. More importantly, they do not like being cornered into covering specific treatments, according to Nick Louizos, a lobbyist with the \u003ca href=\"https://www.calhealthplans.org/\">California Association of Health Plans\u003c/a>, a trade group that represents companies like Anthem, Blue Shield and Kaiser.\u003c/p>\n\u003cp>“Science evolves. Research evolves. There could be evidence-based techniques that are better in the future,” he testified at the Senate health committee hearing last year.\u003c/p>\n\u003cp>While scores of studies show \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202120220SB1337\">the treatment works in the short term\u003c/a> — people are more likely to stay in school, in jobs, in treatment and out of the hospital — the treatment hasn’t been around long enough for researchers to know how long the positive effects last.\u003c/p>\n\u003cp>“There is a lack of evidence of this model’s long-term effectiveness,” Louizos said.\u003c/p>\n\u003cp>Kaiser Permanente is currently running a pilot project, sending 30 of its patients to a full-scope early psychosis clinic based in Solano County. Louizos claims insurers want to see the results from that study — although they are short-term results — before the industry considers investing in the treatment as a whole.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Early Psychosis Treatment By County\" aria-label=\"Map\" id=\"datawrapper-chart-GXdZu\" src=\"https://datawrapper.dwcdn.net/GXdZu/2/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"845\" data-external=\"1\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch2>Perverse incentives\u003c/h2>\n\u003cp>The insurance restrictions create a perverse incentive for middle-income families who need help now. Some parents are so desperate to give their kids the best care, they actually drop them from their health plans and enroll them in Medi-Cal so they can access county-funded clinics like Felton.\u003c/p>\n\u003cp>Some counties, including Sacramento and San Mateo, have taken an even bolder step. Health officials there said denying young people the full suite of care is unethical, enough so that they decided to use taxpayer dollars from the county’s coffers to pay for the services that private insurers refuse to cover. In the end, this is what allowed Sandy to stay in the Felton program.\u003c/p>\n\u003cp>But all of these workarounds are problematic, said the Kennedy Forum’s Lloyd. For-profit insurance companies are essentially making more profits by allowing the public to pay their bills.\u003c/p>\n\u003cp>“That’s not an appropriate role for taxpayers, to be picking up that burden,” he said, adding that insurers’ lack of investment is stifling the growth that’s needed in these programs to provide care for all the young people who need it.\u003c/p>\n\u003cp>Formal consumer protections may ultimately come from a novel 2021 California law designed to expand the kinds of mental health care insurers are required to cover. Under \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">SB 855\u003c/a>, health plans must make mental health coverage decisions based on expert-recognized guidelines for treatment, rather than their own internal criteria, which are often \u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">arbitrary or cost-driven\u003c/a>.\u003c/p>\n\u003cp>Multiple agencies, including the \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">National Institute of Mental Health\u003c/a>, the \u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\">Centers for Medicare and Medicaid Services\u003c/a> and the \u003ca href=\"https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901\">American Psychiatric Association\u003c/a>, all recommend full-scope early psychosis care for treatment of a first psychotic episode. State regulators are considering inscribing this guidance explicitly into the official rules they will use to enforce SB 855, with regulatory agencies planning to finalize draft rules this year.\u003c/p>\n\u003cp>Until that happens, psychosis patients with commercial insurance are stuck navigating the status quo of in-network providers. Finding one who understands psychosis, or \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614988/\">who can accurately identify it\u003c/a>, can be a serious challenge.\u003c/p>\n\u003cp>[pullquote citation='Marie, who has bipolar disorder with psychotic features']‘When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on.’[/pullquote]“When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on,” said Marie, 27, who asked us to refer to her by her middle name because of the stigma she’s experienced around her illness, bipolar disorder with psychotic features.\u003c/p>\n\u003cp>When Marie was in high school, her bedroom walls started talking to her. She read a book about Buddhism and it took over her thoughts completely. For three months, she skipped school and went to the beach to meditate instead. “Because I thought I was chosen and I needed to go meditate to attain nirvana,” she said. The entire time, she was seeing a therapist.\u003c/p>\n\u003cp>“Not even close to enough training to be able to say, ‘Oh, I think you’re having psychosis. Let’s go to the hospital,’” Marie remembers. “No. Instead it took months for me to end up in the hospital.”\u003c/p>\n\u003cp>But the hospital was also horrible. There was no empathy, no respect. Marie later researched this and found that mental health providers hold the same level of \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/21954319/\">stigmatizing beliefs about mental illness\u003c/a> as the general population.\u003c/p>\n\u003cp>“I think that has a lot to do with why people hate the hospital,” she said. “It’s because the people in the hospital hate them.”\u003c/p>\n\u003cp>Marie made her own way through college, and when she got a job at a residential treatment program for people with mental illness, she was horrified to discover this thinking was baked into the way staff got trained: Marie’s supervisors warned her to watch out for clients who lied, and constantly referred to the clients as “manipulative.”\u003c/p>\n\u003cp>Marie quit, and found a different approach at the early psychosis program at UC Davis. She got hired to be their peer specialist, drawing on her own experience to counsel young people after their first psychotic episode, when they’re the most scared and confused.\u003c/p>\n\u003cp>“The people around them don’t understand it at all,” Marie said. “But I totally get it. I think that’s the point of my existence — I get it.”\u003c/p>\n\u003cp>She talks to her clients about symptoms, about how to come out to their friends. She becomes a role model to them, a living example of someone who was able to manage her symptoms and get better. Marie is now in nursing school.\u003c/p>\n\u003cp>But for her, recovery was a long and very lonely road. She said she can hardly imagine what it would have meant to her, to her self-esteem, if her insurance had covered the kind of peer support that she provides to others.\u003c/p>\n\u003cp>“I believed I wouldn’t get better,” she said. “It would have been life changing to see someone who got better say that I could.”\u003c/p>\n\u003cp>For Sandy and her family, the full-scope early psychosis care has been life changing. Sandy has struggled with some of her symptoms recently at her fast-food job. The difference is, now she knows what’s happening. She has skills to quiet the voices. She knows her mom will understand. She knows there are half a dozen providers who will pick up if she calls for help.\u003c/p>\n\u003cp>When her mom thinks about the generosity, she thinks about her own father. He was a doctor in the Philippines, and none of his patients had insurance. If they didn’t have money, he treated them anyway. “I remember people paying him with chicken and rice,” she said.\u003c/p>\n\u003cp>She thinks, maybe all the help Sandy got was because of him. The luck of landing in a county that paid for all her care — maybe it was her dad’s karma paying off. \u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">KQED is part of the \u003c/span>\u003ca href=\"https://publicintegrity.org/health/health-parity/mental-health-parity-collaborative/\">\u003cspan style=\"font-weight: 400\">Mental Health Parity Collaborative\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a group of newsrooms that are covering the challenges and solutions to accessing mental health care in the U.S. in partnership with The Center for Public Integrity and The Carter Center.\u003c/span>\u003c/em>\u003c/p>\n\n",
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"excerpt": "What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?",
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"description": "What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?",
"title": "Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won't Insurance Companies Cover Them? | KQED",
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"headline": "Proven Schizophrenia Treatments Keep People in School, at Work and off the Street. Why Won't Insurance Companies Cover Them?",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ch2>\u003cem>What if, instead of telling patients with schizophrenia to prepare for a lifetime of disability, we asked them what they want and worked with them toward full recovery?\u003c/em>\u003c/h2>\n\u003cp>\u003c/p>\u003cp>\u003cspan class=\"utils-parseShortcode-shortcodes-__dropcapShortcode__dropcap\">W\u003c/span>\u003c/p>\u003cp>hen Yvonne was walking across campus and heard someone calling her name, she stopped and looked around, but the other students flowed around her, oblivious. She continued on, then heard it again.\u003c/p>\n\u003cp>\u003cem>Yvonne?\u003c/em> Stop. Look. Nothing.\u003c/p>\n\u003cp>She was confused, but like anyone else would, Yvonne brushed it off.\u003c/p>\n\u003cp>She sat down in her anatomy class, in the middle of a big lecture hall, and when the professor began his lesson on the renal system, Yvonne started to feel funny, like he was talking about \u003cem>her\u003c/em> body.\u003c/p>\n\u003cp>“I was like, ‘Why is he talking about \u003cem>my\u003c/em> kidneys? How dare he,’” she remembered. “I got really scared and I ran out of class.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She shook this off, too. As she crunched through the rust-colored leaves of an East Coast autumn, she started to hear chattering, like a radio was on in the background of her life. She ignored it as long as she could — until the voices started speaking to her in full sentences, telling her what to do: “You should jump off a bridge. Take that knife and cut yourself,” they said. “You’re worthless.”\u003c/p>\u003c/div>",
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"content": "‘My life wasn’t my own. It was up to these voices because they told me what to do. They wouldn’t go away.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Her doctor prescribed some medications, but Yvonne, 22 at the time, continued to lose perspective. Maybe the voices weren’t just her mind playing tricks on her? Maybe they were real? That’s when the aliens arrived. She heard the loud, screeching sound of their ship hovering outside her window at night.\u003c/p>\n\u003cp>“We need to remove you from this planet,” the aliens told Yvonne. Then they spoke to each other in their own gargled alien language that she couldn’t understand.\u003c/p>\n\u003cp>Yvonne had no doubt this was real. And when God started talking to her a few weeks later, that was real, too. He told her she was going to be the next Jesus and he was going to give her instructions on how to save the world. At first, this made Yvonne feel great. God had chosen her. But then she got scared, overwhelmed by the responsibility. What if she couldn’t fulfill what God wanted for her?\u003c/p>\n\u003cp>“He’s going to send me to hell and I’m a terrible person,” Yvonne said.\u003c/p>\n\u003cp>Yvonne’s mom convinced her to check herself into the hospital. But it was almost six months after she left the hospital that she got an accurate diagnosis: schizoaffective disorder — roughly, schizophrenia with bouts of mania or depression. And for another six months after that, she sat on her parents’ couch, unable to read, unable to go to school, waiting for a spot to open up in a treatment program.\u003c/p>\n\u003cp>“My life wasn’t my own,” said Yvonne, who asked that we use a family name to protect her mental health history. “It was up to these voices because they told me what to do. They wouldn’t go away and I couldn’t do anything with them. So they ruled my life.”\u003c/p>\n\u003cp>Yvonne is one of \u003ca href=\"https://portal.ct.gov/DMHAS/Initiatives/Evidence-Based/First-Episode-Psychosis#:~:text=Psychosis%20impacts%20approximately%20100%2C000%20youth,others%20may%20have%20ongoing%20symptoms.\">100,000 young adults or adolescents\u003c/a> who have a psychotic episode every year in the U.S. For most of them, it takes \u003ca href=\"https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201400124\">a year and a half to get into meaningful treatment\u003c/a>, if they ever do at all. Treatment programs\u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\"> recommended by the National Institute of Mental Health \u003c/a>as the gold standard of care for early psychosis rarely have enough slots available for the people who need them, and health insurance companies typically refuse to cover the full cost of these programs, even when they are available.\u003c/p>\n\u003cfigure id=\"attachment_1981638\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981638 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg\" alt=\"A woman with light skin, dark brown hair, glasses, and a purple knit hat holds a sign that says "Depressed? Suicidal? I'll see in you 6 weeks." She faces the camera and stands amid a crowd of people marching on a sidewalk, many of whom are, like the woman, wearing red T-shirts, and holding signs on wooden dowels that say "Kaiser Don't Deny."\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-800x600.jpeg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1020x765.jpeg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-160x120.jpeg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-768x576.jpeg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician-1536x1152.jpeg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Kaiser-clinician.jpeg 1832w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Mental health clinicians at Kaiser Permanente went on strike in December 2018 and 2019 over long patient wait times. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Instead, many young people like Yvonne inch through the country’s fragmented mental health care system, struggling to find a clinician with adequate training in psychosis. Yvonne waited \u003ca href=\"https://www.kqed.org/news/11791527/kaiser-therapists-strike-again-over-long-wait-times\">up to six weeks between therapy appointments\u003c/a> at Kaiser Permanente, and said she made little progress with a clinician who always seemed to change the subject when Yvonne wanted to talk about her voices. “She would skip over it and talk about my anxiety instead,” Yvonne said.\u003c/p>\n\u003cp>Eventually, Kaiser agreed to pay for Yvonne to go to the \u003ca href=\"https://pathprogram.ucsf.edu/\">UCSF Path Program for Early Psychosis\u003c/a>, a two-year outpatient treatment program designed specifically for young people in the earliest stages of psychotic illness. The clinic is one of about 50 in California and 340 across the country that began operating in the mid-2000s. Right away, Yvonne knew this would be different. In her first session, Yvonne’s therapist had her set goals for what she wanted to achieve.\u003c/p>\n\u003cp>“No one had ever asked me what my goals for treatment were,” Yvonne said.\u003c/p>\n\u003ch2>A revolutionary idea for treating schizophrenia\u003c/h2>\n\u003cp>Back in the ’80s and ’90s, doctors didn’t really know what to do with schizophrenia, and they \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8990328/#:~:text=The%20NIMH%20RAISE%20initiative%20aimed,costs%20associated%20with%20psychotic%20disorders.\">didn’t have many options\u003c/a>. They prescribed high doses of antipsychotic medications that sedated people into zombie-like depths. They advised patients to give up on any career ambitions and sign up for disability payments instead. Even today, some doctors still see schizophrenia as a lost cause.\u003c/p>\n\u003cp>“There’s a real failure to appreciate how much potential there is to manage the illness and symptoms,” said \u003ca href=\"https://www.ucsfhealth.org/providers/dr-daniel-mathalon\">Dr. Daniel Mathalon\u003c/a>, a psychiatrist at UCSF’s early psychosis program.\u003c/p>\n\u003cp>Around the turn of the century, a new generation of doctors started thinking, What if we ask patients what they want and actually work with them toward full recovery? “It’s not just about stabilizing you clinically. It’s about making sure we don’t lose track of your future,” said \u003ca href=\"https://health.ucdavis.edu/psychiatry/team/1290/tara-niendam---pediatric-and-transition-age-youth-mental-health-sacramento/\">Tara Niendam\u003c/a>, a child psychologist who runs \u003ca href=\"https://health.ucdavis.edu/psychiatry/specialties/edapt/\">the early psychosis clinic at UC Davis\u003c/a>. “You \u003cem>should\u003c/em> be in college. You \u003cem>should\u003c/em> be living on your own.”\u003c/p>\n\u003cp>With other conditions like diabetes or cancer, the sooner people get into care, the better they do. \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">The same is true of psychotic illness.\u003c/a> Upwards of 80 studies from early psychosis clinics show that patients see \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/26481174/\">a greater reduction of symptoms\u003c/a>, like voices or delusions, and a greater improvement in functioning at school, at work and in their social lives, compared to people who get treatment as usual.\u003c/p>\n\u003cp>There are a few reasons why earlier treatment is more effective, Niendam said. People respond more quickly to medication and at a lower dose, so they have fewer side effects that make them want to stop taking them. Families are more involved and more supportive, and patients themselves are more curious about their psychotic experiences. “They come out of it and they’re like, ‘Whoa! What was that?’” Niendam said. “Folks are still in that questioning phase.”\u003c/p>\n\u003cp>When someone is deep in psychosis, their beliefs are rigid, intractable. They might not see themselves as being sick. But if they get help earlier, Niendam said, they’re more likely to engage in treatment.\u003c/p>\n\u003cfigure id=\"attachment_1981632\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981632 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg\" alt=\"A woman with gray black, short cropped hair and a purple lanier around her neck speaks to a person with blond hair. \" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/DrTaraNeindamSacramento_02072023-qut_action.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Clinical psychologist Tara Niendam speaks with a colleague at the UC Davis Behavioral Health Center in Sacramento on Feb. 7, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>For Yvonne, even though she believed the alien ship outside her window was real, her doctors at UCSF started her on a new medication that shook that belief loose. Her new therapist then used targeted cognitive behavioral techniques that helped Yvonne challenge those beliefs further.\u003c/p>\n\u003cp>“So for example, I’d have a thought: ‘Aliens are going to abduct me,’” she said. “So then we do ‘evidence for’ that thought and ‘evidence against’ that thought.”\u003c/p>\n\u003cp>First, she made a list of all the evidence she had that the alien abduction plan was real: I hear the aliens. They’re talking to me. I hear their ship.\u003c/p>\n\u003cp>Then she had to list the evidence that they weren’t real. For this, the therapist had Yvonne set up a jar in her bedroom. Every morning that she woke up and had not been abducted, she would put a blue marble in the jar. If she had been abducted, she was supposed to put a white marble in the jar.\u003c/p>\n\u003cp>“And I had all blue marbles,” Yvonne said. “So that’s evidence against ‘they’re going to get me,’ cause they haven’t yet.”\u003c/p>\n\u003cp>To get control over the voices in her head, Yvonne learned to talk back to them. She would sit in the therapist’s office, in the chair on the right side of the room, and pretend to be her voices, telling her to go back to bed or not to go outside. “It’s dangerous,” she’d say.\u003c/p>\n\u003cp>Then Yvonne would go sit in the chair on the left side of the room and practice her response.\u003c/p>\n\u003cp>“Thank you, voices, for wanting to protect me and watch out for me,” she’d say back. “But I’m going to get up and be brave and go out into the world today.”\u003c/p>\n\u003cp>It took a while to get the hang of it, maybe a year, but when she did, Yvonne was able to go back to school. When the voices would start yelling at her while she was in class, calling her dumb, she was ready.\u003c/p>\n\u003cfigure id=\"attachment_1981731\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-1981731\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg\" alt=\"A drawing of a clear jar filling with round, blue marbles.\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/03/IMG_0142-e1677283844671.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">(Illustration by Anna Vignet/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>“I’d be like, ‘You know what? I really don’t appreciate the way you talk to me. Let’s talk after class, let’s talk at 2 p.m.,’” she told them.\u003c/p>\n\u003cp>The voices wouldn’t go away completely, but they would fade into the background, enough where Yvonne could finish class or read a book or do her homework. “I just started to feel more in control,” said Yvonne, now 27.\u003c/p>\n\u003cp>She graduated college last spring, summa cum laude, and she’s now working a full-time job. She’s about to move into her own place. She keeps up with her broad circle of friends, going to shows in the city or having bonfires on the beach. If she thinks she hears a voice or an alien, she does a literal reality check. “Oh, did you hear that?” she’ll ask a friend or her mom. And if they don’t, she tells herself, “Okay, that’s just a voice.”\u003c/p>\n\u003cp>But mostly, Yvonne doesn’t like talking about her illness with her friends. She’d rather talk about the Kardashians instead.\u003c/p>\n\u003cp>“I just like to be normal when I’m with them,” she said.\u003c/p>\n\u003ch2>Independent, career-oriented people\u003c/h2>\n\u003cp>Even though the skills Yvonne learned from therapy at UCSF were a revelation, there was actually a whole other dimension of care that she never got. That’s because UCSF’s program only accepts private insurance, and private health insurers only cover about half of the services of early psychosis treatment.\u003c/p>\n\u003cp>People who get care under government health coverage, like Medi-Cal, can enroll in programs like the \u003ca href=\"https://felton.org/\">Felton Institute\u003c/a>‘s, which offer not just specialized therapy, like Yvonne got, but a full array of social support, as well. At Felton’s five clinic locations, they believe it takes a full team of specialists who all talk to each other, who are all looking out for every aspect of a young person’s life.\u003c/p>\n\u003cp>That includes specialists like Monet Burpee, an education and employment coach. On a typical workday, she’ll drive her clients to the local mall or downtown shopping district, charting their path according to the “Help Wanted” signs. Together, they’ll chat with store managers about open positions, then sit down and fill out the applications.\u003c/p>\n\u003cp>Burpee says helping her clients who have psychosis find work is about more than landing a job; it’s about helping them see themselves differently, as independent, career-oriented people, rather than permanent patients receiving government wage assistance.\u003c/p>\n\u003cp>“If you work, you’re going to notice a huge improvement in your self-esteem,” she tells them. “It has better long-term, positive results versus you just sitting around on SSI.”\u003c/p>\n\u003cfigure id=\"attachment_1981636\" class=\"wp-caption alignleft\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981636 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg\" alt=\"A Black woman with a green cutoff t-shirt and beige hat speaks through a black mask to a man in a blue surgical mask inside a bright space with tables and colorful art on the wall. \" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-768x576.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited-1536x1152.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/Monet-Burpee-2_edited.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Monet Burpee (right) talks to the manager of a restaurant in Redwood City on one of her job-scouting expeditions in July 2022. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>This is what she said to one of her clients, Sandy, after she had her first psychotic episode. Sandy was taking new medications that made her really sleepy, and she was struggling to get motivated.\u003c/p>\n\u003cp>“Since I didn’t really have anything to do, I would just take superlong naps during the day,” said Sandy, now 20, who asked that we call her by a family name so her health history doesn’t disrupt her career path.\u003c/p>\n\u003cp>For her, psychosis hit when she was working her first job after high school, at a fast-food restaurant making burgers. Her co-workers were chatting over the fryer one day when Sandy got this weird feeling, that somehow they knew what she was thinking. It was like her co-workers could read her mind and were discussing her thoughts with each other.\u003c/p>\n\u003cp>“I was like, are they talking about burgers or are they talking about me?” Sandy said.\u003c/p>\n\u003cp>There was one co-worker in particular, a guy she had a crush on, that she was pretty sure was watching her — even following her around. If she was walking down the street, or hanging out in the park, she saw him. Her mom remembers Sandy wanted to sleep with the lights on, repeatedly asking her, “Mom, is someone here?”\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>One day, her mom said Sandy got so scared, she locked herself in the bathroom and just screamed and screamed and screamed.\u003c/p>\n\u003cp>Her mom wanted to call for help. But she didn’t have a job at the time. This was about a year into the pandemic, and the hotel where Sandy’s mom worked had been closed since the first government lockdown. When she lost her job, her union helped her hold on to her health benefits for a while, but that extension was about to run out. “My husband was like, ‘What is that going to cost?’” her mom remembers.\u003c/p>\n\u003cp>Sandy’s mom called 911 anyway. In the hospital, Sandy was diagnosed with schizophrenia. From there, she was enrolled in the Felton Institute’s outpatient early psychosis treatment program. At this point, she and her family were covered by Medi-Cal, the state’s public insurance. They wouldn’t have to pay a dime.\u003c/p>\n\u003cp>Right away, Sandy was introduced to a team of providers who would be by her side for the next two years: a physician, a psychotherapist, an occupational therapist, an education and employment specialist, a peer specialist and a family support specialist for her mom.\u003c/p>\n\u003cp>Sandy’s mom found she needed almost as much support as her daughter did after the diagnosis. She blamed herself. She started meeting once a week with Mike Krechevsky, Felton’s family specialist. He walked her through what schizophrenia was, explained that it was no one’s fault, and helped her manage her own feelings about it so that she didn’t pass them on to Sandy. “When you express anxiety to your child, they don’t feel as though they have any capability of going out in the world, stumbling, falling, picking themselves up, learning from their mistakes and moving forward. You infantilize them,” Krechevsky said. “If you continue to do that, they’re never going to recover.”\u003c/p>\n\u003cp>When Sandy was ready to look for work, she and Burpee went to the mall on a job-scouting expedition. They filled out the applications together. “Next thing I know, I was being interviewed and I got hired,” Sandy said.\u003c/p>\n\u003cp>She started out as a cashier at a new fast-food restaurant and within three months she got promoted to a manager role. Now Burpee is coaching her on how to ask for a raise. “She has a brand-new car,” Burpee said, beaming with pride. “She’s meeting new friends.”\u003c/p>\n\u003cp>For Sandy, it was just one step in her long-term recovery plan.\u003c/p>\n\u003cp>“I want to focus on getting a degree, to get a better career,” she said.\u003c/p>\n\u003ch2>A reverse disparity\u003c/h2>\n\u003cp>In an unusual twist of the U.S.’ separate and unequal health system favoring the wealthy, the reason Sandy was able to get the best care after her psychotic episode was primarily because her mom had lost her job and her insurance.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘I can give the Rolls-Royce of care if you walk in and you have Medi-Cal. But 60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>This is because the state and federal government are the main funders of these early psychosis clinics, investing tens of millions of dollars into them every year. Officials believe it will save money in the long run, because \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">without sufficient treatment, people with schizophrenia can deteriorate so much\u003c/a>, they end up on wage assistance, in a group home, on the street or in jail — all things the government pays for.\u003c/p>\n\u003cp>But commercial insurance companies, like Anthem or Blue Shield, don’t face those risks. They don’t have the incentive to cover full-scope psychosis treatment. For that reason, and others, they don’t.\u003c/p>\n\u003cp>This means lower-income families with public insurance like Medi-Cal can get the gold standard of care, while middle-class families with commercial plans cannot.\u003c/p>\n\u003cp>“It is a reverse disparity,” said UC Davis’ Niendam, testifying at a state Senate Committee on Health hearing last year, about the impact of this disparity at the early psychosis clinic she runs in Sacramento.\u003c/p>\n\u003cp>“I can give the Rolls-Royce of care if you walk in and you have Medi-Cal,” she said. But “60% of Californians have commercial insurance. That’s 60% of kids who can’t get care, 60% of kids whose parents call me crying when I tell them they can’t access my clinic.”\u003c/p>\n\u003cp>At the Felton Institute in the Bay Area, early psychosis director \u003ca href=\"https://felton.org/about-us/who-we-are/leadership/adriana-furuzawa/\">Adriana Furuzawa\u003c/a> said the same. For every one person who has Medi-Cal and is eligible for care at her Alameda clinic, there are another two with commercial insurance who are turned away. Last year, they turned about 100 people away.\u003c/p>\n\u003cp>“It was very difficult to think that behind each number, there is a young person, there is a family, that we’re saying no to, when we have the resources right here,” Furuzawa said.\u003c/p>\n\u003cfigure id=\"attachment_1981634\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1981634 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg\" alt='A woman with dark red hair and glass sits in a black office chair in a room with \"positive\" painted on the wall above a white lamp and alongside a brown door. ' width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/35/2023/02/RS63024_005_KQED_AdrianaFuruzawaFeltonInst_02132023-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Adriana Furuzawa, division director for early psychosis services at the Felton Institute, sits in her office in Alameda on Feb. 13, 2023. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>So what happens to these kids? Generally, they’re on their own to find a psychiatrist and therapist who accepts their insurance. Health plans will pay for these medical services. But they won’t cover anything else: the job and education support, the peer specialist, the family coach.\u003c/p>\n\u003cp>This is discrimination, health advocates argue. If someone has cancer, insurers would never just pay for surgery and radiation, but not chemotherapy.\u003c/p>\n\u003cp>“It’s a package of services,” said David Lloyd, chief of policy at the \u003ca href=\"https://www.thekennedyforum.org/\">Kennedy Forum\u003c/a>. “So the idea that you can split apart the package of services and only reimburse for little components of it really destroys the whole evidence base of what the service is.”\u003c/p>\n\u003cp>This almost happened to Sandy. A few months into her treatment, her mom got her job back at the hotel, and the family was back on her commercial insurance plan. In most counties, this would have meant Sandy got kicked out of the program. Her mom said there would have been no way she could afford to pay for a job coach, a family coach and a peer specialist on her own.\u003c/p>\n\u003cp>“I couldn’t do it. I would definitely stop all the help,” she said, even though it was keeping Sandy alive. Maybe she would have turned to Craigslist to find other parents to talk to, she said, or looked up mental health advice on YouTube to pass on to Sandy. “I just hope and pray for the best,” she said.\u003c/p>\n\u003cp>Last year, state lawmakers wanted to help families like Sandy’s, by forcing insurance companies to cover the full spectrum of early psychosis treatment. One state has done this already — \u003ca href=\"https://www.ilga.gov/legislation/publicacts/101/101-0461.htm\">Illinois\u003c/a> — while Massachusetts and Virginia are working on a similar effort. But the proposal in California, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB1337\">Senate Bill 1337\u003c/a>, died under pressure from the insurance lobby.\u003c/p>\n\u003cp>Historically, insurers have not covered the costs of services provided by non-licensed staff, like job or family coaches. More importantly, they do not like being cornered into covering specific treatments, according to Nick Louizos, a lobbyist with the \u003ca href=\"https://www.calhealthplans.org/\">California Association of Health Plans\u003c/a>, a trade group that represents companies like Anthem, Blue Shield and Kaiser.\u003c/p>\n\u003cp>“Science evolves. Research evolves. There could be evidence-based techniques that are better in the future,” he testified at the Senate health committee hearing last year.\u003c/p>\n\u003cp>While scores of studies show \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billAnalysisClient.xhtml?bill_id=202120220SB1337\">the treatment works in the short term\u003c/a> — people are more likely to stay in school, in jobs, in treatment and out of the hospital — the treatment hasn’t been around long enough for researchers to know how long the positive effects last.\u003c/p>\n\u003cp>“There is a lack of evidence of this model’s long-term effectiveness,” Louizos said.\u003c/p>\n\u003cp>Kaiser Permanente is currently running a pilot project, sending 30 of its patients to a full-scope early psychosis clinic based in Solano County. Louizos claims insurers want to see the results from that study — although they are short-term results — before the industry considers investing in the treatment as a whole.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Early Psychosis Treatment By County\" aria-label=\"Map\" id=\"datawrapper-chart-GXdZu\" src=\"https://datawrapper.dwcdn.net/GXdZu/2/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"845\" data-external=\"1\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003ch2>Perverse incentives\u003c/h2>\n\u003cp>The insurance restrictions create a perverse incentive for middle-income families who need help now. Some parents are so desperate to give their kids the best care, they actually drop them from their health plans and enroll them in Medi-Cal so they can access county-funded clinics like Felton.\u003c/p>\n\u003cp>Some counties, including Sacramento and San Mateo, have taken an even bolder step. Health officials there said denying young people the full suite of care is unethical, enough so that they decided to use taxpayer dollars from the county’s coffers to pay for the services that private insurers refuse to cover. In the end, this is what allowed Sandy to stay in the Felton program.\u003c/p>\n\u003cp>But all of these workarounds are problematic, said the Kennedy Forum’s Lloyd. For-profit insurance companies are essentially making more profits by allowing the public to pay their bills.\u003c/p>\n\u003cp>“That’s not an appropriate role for taxpayers, to be picking up that burden,” he said, adding that insurers’ lack of investment is stifling the growth that’s needed in these programs to provide care for all the young people who need it.\u003c/p>\n\u003cp>Formal consumer protections may ultimately come from a novel 2021 California law designed to expand the kinds of mental health care insurers are required to cover. Under \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855\">SB 855\u003c/a>, health plans must make mental health coverage decisions based on expert-recognized guidelines for treatment, rather than their own internal criteria, which are often \u003ca href=\"https://www.kqed.org/stateofhealth/series/state-of-mind\">arbitrary or cost-driven\u003c/a>.\u003c/p>\n\u003cp>Multiple agencies, including the \u003ca href=\"https://www.nimh.nih.gov/research/research-funded-by-nimh/research-initiatives/recovery-after-an-initial-schizophrenia-episode-raise\">National Institute of Mental Health\u003c/a>, the \u003ca href=\"https://www.hhs.gov/guidance/document/coverage-early-intervention-services-first-episode-psychosis\">Centers for Medicare and Medicaid Services\u003c/a> and the \u003ca href=\"https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901\">American Psychiatric Association\u003c/a>, all recommend full-scope early psychosis care for treatment of a first psychotic episode. State regulators are considering inscribing this guidance explicitly into the official rules they will use to enforce SB 855, with regulatory agencies planning to finalize draft rules this year.\u003c/p>\n\u003cp>Until that happens, psychosis patients with commercial insurance are stuck navigating the status quo of in-network providers. Finding one who understands psychosis, or \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614988/\">who can accurately identify it\u003c/a>, can be a serious challenge.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“When I had my first episode of psychosis, my therapist thought I was on drugs. She had absolutely no clue what was going on,” said Marie, 27, who asked us to refer to her by her middle name because of the stigma she’s experienced around her illness, bipolar disorder with psychotic features.\u003c/p>\n\u003cp>When Marie was in high school, her bedroom walls started talking to her. She read a book about Buddhism and it took over her thoughts completely. For three months, she skipped school and went to the beach to meditate instead. “Because I thought I was chosen and I needed to go meditate to attain nirvana,” she said. The entire time, she was seeing a therapist.\u003c/p>\n\u003cp>“Not even close to enough training to be able to say, ‘Oh, I think you’re having psychosis. Let’s go to the hospital,’” Marie remembers. “No. Instead it took months for me to end up in the hospital.”\u003c/p>\n\u003cp>But the hospital was also horrible. There was no empathy, no respect. Marie later researched this and found that mental health providers hold the same level of \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/21954319/\">stigmatizing beliefs about mental illness\u003c/a> as the general population.\u003c/p>\n\u003cp>“I think that has a lot to do with why people hate the hospital,” she said. “It’s because the people in the hospital hate them.”\u003c/p>\n\u003cp>Marie made her own way through college, and when she got a job at a residential treatment program for people with mental illness, she was horrified to discover this thinking was baked into the way staff got trained: Marie’s supervisors warned her to watch out for clients who lied, and constantly referred to the clients as “manipulative.”\u003c/p>\n\u003cp>Marie quit, and found a different approach at the early psychosis program at UC Davis. She got hired to be their peer specialist, drawing on her own experience to counsel young people after their first psychotic episode, when they’re the most scared and confused.\u003c/p>\n\u003cp>“The people around them don’t understand it at all,” Marie said. “But I totally get it. I think that’s the point of my existence — I get it.”\u003c/p>\n\u003cp>She talks to her clients about symptoms, about how to come out to their friends. She becomes a role model to them, a living example of someone who was able to manage her symptoms and get better. Marie is now in nursing school.\u003c/p>\n\u003cp>But for her, recovery was a long and very lonely road. She said she can hardly imagine what it would have meant to her, to her self-esteem, if her insurance had covered the kind of peer support that she provides to others.\u003c/p>\n\u003cp>“I believed I wouldn’t get better,” she said. “It would have been life changing to see someone who got better say that I could.”\u003c/p>\n\u003cp>For Sandy and her family, the full-scope early psychosis care has been life changing. Sandy has struggled with some of her symptoms recently at her fast-food job. The difference is, now she knows what’s happening. She has skills to quiet the voices. She knows her mom will understand. She knows there are half a dozen providers who will pick up if she calls for help.\u003c/p>\n\u003cp>When her mom thinks about the generosity, she thinks about her own father. He was a doctor in the Philippines, and none of his patients had insurance. If they didn’t have money, he treated them anyway. “I remember people paying him with chicken and rice,” she said.\u003c/p>\n\u003cp>She thinks, maybe all the help Sandy got was because of him. The luck of landing in a county that paid for all her care — maybe it was her dad’s karma paying off. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan style=\"font-weight: 400\">KQED is part of the \u003c/span>\u003ca href=\"https://publicintegrity.org/health/health-parity/mental-health-parity-collaborative/\">\u003cspan style=\"font-weight: 400\">Mental Health Parity Collaborative\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a group of newsrooms that are covering the challenges and solutions to accessing mental health care in the U.S. in partnership with The Center for Public Integrity and The Carter Center.\u003c/span>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.",
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
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"radiolab": {
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"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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"reveal": {
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"info": "Created by The Center for Investigative Reporting and PRX, Reveal is public radios first one-hour weekly radio show and podcast dedicated to investigative reporting. Credible, fact based and without a partisan agenda, Reveal combines the power and artistry of driveway moment storytelling with data-rich reporting on critically important issues. The result is stories that inform and inspire, arming our listeners with information to right injustices, hold the powerful accountable and improve lives.Reveal is hosted by Al Letson and showcases the award-winning work of CIR and newsrooms large and small across the nation. In a radio and podcast market crowded with choices, Reveal focuses on important and often surprising stories that illuminate the world for our listeners.",
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},
"science-friday": {
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