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"content": "\u003cfigure id=\"attachment_17633\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/IMG_1701-e1392148141663.jpg\">\u003cimg class=\"size-large wp-image-17633 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/IMG_1701-640x359.jpg\" alt=\"IMG_1701\" width=\"640\" height=\"359\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Julie \"Jewels\" Gates (from Berry Creek, Calif., left) and Elena Wilson (from Oroville, Calif., right) saw jail as a one of the few options for low-income people in Butte County to stop using drugs. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: For over a year, we've been bringing you first-person stories about health. Now, we're digging deeper. Each month, we'll be exploring a different health issue and asking diverse community members across the state to share their own stories on that theme. It's a project we're calling \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">Vital Signs\u003c/a>.\"\u003c/em>\u003c/p>\n\u003cp>\u003cem>This month we look at the health needs of people who are homeless. Accurate statistics on homeless Californians are hard to get, but by some estimates roughly one in four people who are homeless abuse drugs. And homeless people face unique challenges when trying to quit.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Today we hear from Julie Gates and Elena Wilson. The two met seven years ago in Chico. Both women struggled with addiction and Gates, who goes by the nickname “Jewels,” sold drugs to support her own habit. In largely rural Butte County, it was hard for them to find treatment they could afford and were daunted by months-long waiting lists for help. Now clean and sober, the two women volunteer at the \u003ca href=\"http://orovillehopecenter.org/\">Hope Center\u003c/a> in Oroville, giving back to the homeless community. They talk to one another about their journey.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Julie Gates and Elena Wilson\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>ELENA WILSON:\u003c/strong> Jewels and I, there were periods of time we didn't see each other but either at the lowest of out lows, and now, at the highest of our highs, God has brought our paths back together.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>JULIE GATES\u003c/strong>: Absolutely.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> The last time I had seen her before I got clean, I was acutally kicking heroin in Chico. I was homeless. I was really, really sick. And I didn't have any money and I couldn't find any heroin. She went and bought me a pack of cigarettes and gave me a little bit of some methanphetamine to do with, to trade, or whatever. She said she'd try to find me some pills.\u003c/p>\n\u003cp>\u003cstrong>\u003c!--more-->GATES:\u003c/strong> I know that's sick sounding.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> But at the time, I was like, oh my gosh. I was dying.\u003c/p>\n\u003cp>\u003cstrong>GATES:\u003c/strong> I mean, it breaks my heart now thinking about it.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> Most of the places I went to you had to be clean to get help and I couldn't get clean to get help. That's why I couldn't stay at the shelters.\u003c/p>\n\u003caside class=\"pullquote alignleft\">In 2012, California was among the top five states with the highest rates of homelessness--nearly 131,000 Californians were homeless, according to the National Alliance to End Homelessness.\n\u003cp>In 2007, roughly 9 percent of all homeless people in the U.S. lived in rural areas, according to the National Alliance to End Homelessness. \u003c/p>\u003c/aside>\n\u003cp>\u003cstrong>GATES:\u003c/strong> There's really not that many options for residential treatment in this area. We're lacking. Especially financially. Yeah, if you have $3,500 in your pocket then, no problem.\u003c/p>\n\u003cp>I was trying to quit drugs so badly. And I knew I was on probation so I was like I'm going to get busted anyway because I can't quit drugs.\u003c/p>\n\u003cp>So they finally arrested me. I was in jail and they gave me three months for my violation. And I was like, yay. I put my feet up on the cot. Great, I'm finally going to get clean. This is fantastic. And then eight days later, [they tell me,] 'Gates, roll it up.' And it's midnight and I'm like, 'I don't want to get kicked out of jail'.\u003c/p>\n\u003cp>And I just remember that feeling. It's a nightmare, nightmare feeling, when you just finally want to get clean.\u003c/p>\n\u003cp>There comes a time where you don't want to use drugs, but you're using drugs. And as much as you want to be healthy and you want to stop-- your addiction is your addiction.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> If you don't have the money to get clean, there's not not really anywhere to go except for jail. And then you're not learning any tools in jail to stay clean when you get out of jail.\u003c/p>\n\u003cp>I checked myself into a ministry. I was there for about three months, and I went to a serenity meeting and low and behold, there was Jewels. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17633\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/IMG_1701-e1392148141663.jpg\">\u003cimg class=\"size-large wp-image-17633 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/IMG_1701-640x359.jpg\" alt=\"IMG_1701\" width=\"640\" height=\"359\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Julie \"Jewels\" Gates (from Berry Creek, Calif., left) and Elena Wilson (from Oroville, Calif., right) saw jail as a one of the few options for low-income people in Butte County to stop using drugs. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: For over a year, we've been bringing you first-person stories about health. Now, we're digging deeper. Each month, we'll be exploring a different health issue and asking diverse community members across the state to share their own stories on that theme. It's a project we're calling \"\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">Vital Signs\u003c/a>.\"\u003c/em>\u003c/p>\n\u003cp>\u003cem>This month we look at the health needs of people who are homeless. Accurate statistics on homeless Californians are hard to get, but by some estimates roughly one in four people who are homeless abuse drugs. And homeless people face unique challenges when trying to quit.\u003c/em>\u003c/p>\n\u003cp>\u003cem>Today we hear from Julie Gates and Elena Wilson. The two met seven years ago in Chico. Both women struggled with addiction and Gates, who goes by the nickname “Jewels,” sold drugs to support her own habit. In largely rural Butte County, it was hard for them to find treatment they could afford and were daunted by months-long waiting lists for help. Now clean and sober, the two women volunteer at the \u003ca href=\"http://orovillehopecenter.org/\">Hope Center\u003c/a> in Oroville, giving back to the homeless community. They talk to one another about their journey.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Julie Gates and Elena Wilson\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>ELENA WILSON:\u003c/strong> Jewels and I, there were periods of time we didn't see each other but either at the lowest of out lows, and now, at the highest of our highs, God has brought our paths back together.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>JULIE GATES\u003c/strong>: Absolutely.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> The last time I had seen her before I got clean, I was acutally kicking heroin in Chico. I was homeless. I was really, really sick. And I didn't have any money and I couldn't find any heroin. She went and bought me a pack of cigarettes and gave me a little bit of some methanphetamine to do with, to trade, or whatever. She said she'd try to find me some pills.\u003c/p>\n\u003cp>\u003cstrong>\u003c!--more-->GATES:\u003c/strong> I know that's sick sounding.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> But at the time, I was like, oh my gosh. I was dying.\u003c/p>\n\u003cp>\u003cstrong>GATES:\u003c/strong> I mean, it breaks my heart now thinking about it.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> Most of the places I went to you had to be clean to get help and I couldn't get clean to get help. That's why I couldn't stay at the shelters.\u003c/p>\n\u003caside class=\"pullquote alignleft\">In 2012, California was among the top five states with the highest rates of homelessness--nearly 131,000 Californians were homeless, according to the National Alliance to End Homelessness.\n\u003cp>In 2007, roughly 9 percent of all homeless people in the U.S. lived in rural areas, according to the National Alliance to End Homelessness. \u003c/p>\u003c/aside>\n\u003cp>\u003cstrong>GATES:\u003c/strong> There's really not that many options for residential treatment in this area. We're lacking. Especially financially. Yeah, if you have $3,500 in your pocket then, no problem.\u003c/p>\n\u003cp>I was trying to quit drugs so badly. And I knew I was on probation so I was like I'm going to get busted anyway because I can't quit drugs.\u003c/p>\n\u003cp>So they finally arrested me. I was in jail and they gave me three months for my violation. And I was like, yay. I put my feet up on the cot. Great, I'm finally going to get clean. This is fantastic. And then eight days later, [they tell me,] 'Gates, roll it up.' And it's midnight and I'm like, 'I don't want to get kicked out of jail'.\u003c/p>\n\u003cp>And I just remember that feeling. It's a nightmare, nightmare feeling, when you just finally want to get clean.\u003c/p>\n\u003cp>There comes a time where you don't want to use drugs, but you're using drugs. And as much as you want to be healthy and you want to stop-- your addiction is your addiction.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> If you don't have the money to get clean, there's not not really anywhere to go except for jail. And then you're not learning any tools in jail to stay clean when you get out of jail.\u003c/p>\n\u003cp>I checked myself into a ministry. I was there for about three months, and I went to a serenity meeting and low and behold, there was Jewels. And we were ecstatic.\u003c/p>\n\u003cp>\u003cstrong>GATES:\u003c/strong> We're both taking this class here to become alcohol and drug counselors, Christian-based. To give back.\u003c/p>\n\u003cp>\u003cstrong>WILSON:\u003c/strong> We're a good team. Way better team than we were on the streets.\u003c/p>\n\u003cp>\u003cstrong>GATES:\u003c/strong> Oh, yes.\u003c/p>\n\u003cp>\u003cem>Listen to Wilson and Gates' story here:\u003c/em>\u003c/p>\n\u003cp>https://soundcloud.com/vital-signs-stories/homeless-addicted-and\u003c/p>\n\u003cp>\u003cem>Ryder Diaz was the reporter for this story.\u003c/em>\u003c/p>\n\u003cp>How has homelessness affected the health of your community? \u003ca href=\"http://vitalsignsstories.tumblr.com/\">Share your story with us.\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_17619\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-e1392140738356.jpg\">\u003cimg class=\"size-large wp-image-17619\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-640x427.jpg\" alt=\"Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/February/11/pharmacists-see-clinical-role-expand.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.\u003c/p>\n\u003cp>\"I was freaking out,\" said Freedman, 55. \"You get very emotional when you think you could drop dead at any moment.\"\u003c/p>\n\u003cp>Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on -- her pharmacist.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We are the most overeducated and underutilized healthcare professional in the U.S.\" \u003c/aside>\n\u003cp>\"It was Diana who figured out what the problem was,\" said Freedman, referring to her longtime pharmacist Diana Arouchanova. \"Had she not been on top of what I’m going through, God knows how many more weeks this could have potentially gone on.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Arouchanova, who owns Clinicare Pharmacy in Northridge, reviewed Freedman's medications and realized that her problem stemmed from the dangerous combination of two prescriptions. She got the physician to change the medications and started checking Freedman's blood pressure daily. Soon, it began to drop.\u003c!--more-->\u003c/p>\n\u003cp>Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis.\u003c/p>\n\u003cp>California is among the states to give pharmacists the greatest flexibility, thanks in part to a law that took effect this year. Other states, including New Mexico and North Carolina, have also allowed pharmacists to take on more clinical responsibilities.\u003c/p>\n\u003cp>It's all part of a push by druggists and pharmacies to take a greater role in guiding patients and promoting good health. One prominent example is CVS Caremark's recent announcement that it will stop selling tobacco products to help customers become healthier.\u003c/p>\n\u003cp>At the same time, health officials are looking for ways to ease the strain on overloaded doctors, improve care and contain costs. With millions of people gaining coverage under the nation's health law, experts say pharmacists can fill gaps in primary care and help avoid unnecessary hospital admissions.\u003c/p>\n\u003cp>Pharmacists, who are required to\u003cstrong> \u003c/strong>have a doctorate in pharmacy, say technicians can fill prescriptions and that their training and education can be put to better use.\u003c/p>\n\u003cp>\"We are the most overeducated and underutilized healthcare professional in the U.S.,\" said R. Pete Vanderveen, dean of the USC School of Pharmacy. \"It doesn't take eight years of education and a professional doctorate to fill a bottle with pills.\"\u003c/p>\n\u003cp>The new California law designates pharmacists as health care providers and allows them to give routine vaccinations and provide some travel and birth-control medications. The law also creates a new class of provider known as an \"advanced practice pharmacist.\" With additional training and experience, such as a residency program, advanced practice pharmacists will be able to collaborate with doctors in assessing and referring patients, starting and stopping medications and managing patients' diseases.\u003c/p>\n\u003cp>Some physicians, however, are wary of pharmacists doing too much on their own. The American Medical Association supports physician-led teams that include pharmacists, but opposes giving pharmacists prescription privileges without a doctor's supervision. The California Medical Association initially opposed the state law but withdrew the opposition after amendments were added, including one that limited the type of medications they could provide.\u003c/p>\n\u003cp>Pharmacist organizations are quick to point out they don't want to take over the physician's job.\u003c/p>\n\u003cp>\"We are not looking to become the primary care provider for all patients,\" said Stacie Maass, a senior vice president at the American Pharmacists Association. \"We want to be part of the team.\"\u003c/p>\n\u003cp>Research has shown that pairing pharmacists and physicians can save money and improve health outcomes. Other studies are under way.\u003c/p>\n\u003cp>Clinical pharmacist Michelle Lee is funded by a federal grant to the USC School of Pharmacy and AltaMed Health Services to determine whether pharmacists can help high-risk patients control chronic diseases take their medications as prescribed and avoid hospitalization.\u003c/p>\n\u003cp>On a recent day at an AltaMed clinic in Boyle Heights, a primarily Latino neighborhood in Los Angeles, Lee stopped the medications of a liver disease patient whose condition might have worsened if he took what a local hospital just prescribed him. Then she ordered another check of his liver.\u003c/p>\n\u003cp>Lee also saw 57-year-old Maria Flores, who has uncontrolled diabetes, noticing that both her blood sugar and her blood pressure were higher than normal.\u003c/p>\n\u003cp>\"Have you been under any stress?\" Lee asked through a Spanish-language translator.\u003c/p>\n\u003cp>The woman started to tear up. She responded that there had been a death in the family and that she hadn't been able to sleep or eat. Lee ordered a shot of insulin and adjusted her blood-pressure medication. She reminded Flores to check her blood sugar every day.\u003c/p>\n\u003cp>\"It's important for us to know if the insulin is at a good dose,\" she said. \"We might need to make adjustments.\"\u003c/p>\n\u003cp>As a student, Lee worked at Walgreens and customers frequently came in with questions. Lee said she wanted to do more for them. Now, Lee said she believes she is doing that.\u003c/p>\n\u003cp>\"It's a little role but I think it's making a big difference,\" she said.\u003c/p>\n\u003cp>Freedman appreciates the difference. She discovered Clinicare Pharmacy about seven years ago. In contrast to the chain drug store she'd been using, which she felt was impersonal, Arouchanova and her staff regularly called to see how she was feeling and to check on any side effects.\u003c/p>\n\u003cp>Now Arouchanova, 36, helps her track the more than a dozen medications she takes for hypertension, Crohn’s disease and ulcerative colitis.\u003c/p>\n\u003cp>Freedman stops by a couple times a week, sometimes just to say hello. She considers her pharmacist a friend and brings her birthday presents. \"I can walk in here any time of the day,\" she said. \"There is somebody who greets me with a smile.\"\u003c/p>\n\u003cp>Arouchanova, an Armenian immigrant with a bob of short blond hair, said she tries to go \"above and beyond the call of duty.\"\u003c/p>\n\u003cp>\"I take care of each of my patients as if they were my only patients,\" she said. That means working up to 12 hours a day and only seeing her young son briefly in the morning and evening.\u003c/p>\n\u003cp>One day a week, a physician, Hanriet Minasian, works out of an office in the pharmacy. She and Minasian have an agreement that allows Arouchanova to order labs and to start, stop and adjust medications. They refer patients to one another and together review their patients' charts.\u003c/p>\n\u003cp>Erika Pappas, 34, who lives in nearby Reseda, sees both Arouchanova and Minasian for her diabetes and hypertension.\u003c/p>\n\u003cp>\"I don't have to worry about my pharmacist or my doctor not being on the same page,\" she said during a recent visit. \"Everything is very clear.\"\u003c/p>\n\u003cp>Minasian said Arouchanova is another set of eyes on complex cases -- patients with multiple chronic diseases who receive numerous prescriptions.\u003c/p>\n\u003cp>\"It's like a checks and balances system,\" Minasian said. \"The more heads you put together, the better care we can provide for our patients.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"z7rb1W1ynPsKeajzYwtkWOoP3QcHE5NL\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17619\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-e1392140738356.jpg\">\u003cimg class=\"size-large wp-image-17619\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/pharmacy-2-640x427.jpg\" alt=\"Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Clinical pharmacist Diana Arouchanova worked with patient Diana Freedman’s physician to switch one of the medications that helped lower her blood pressure (Heidi de Marco/KHN)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Anna Gorman,\u003c/strong> \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2014/February/11/pharmacists-see-clinical-role-expand.aspx\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Jill Freedman felt like her heart was jumping out of her chest. She knew her blood pressure was too high and feared having a heart attack or a stroke.\u003c/p>\n\u003cp>\"I was freaking out,\" said Freedman, 55. \"You get very emotional when you think you could drop dead at any moment.\"\u003c/p>\n\u003cp>Her doctor doubled one of her medications, she said, but that only made her feel worse. So Freedman turned to the one person she knew she could count on -- her pharmacist.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"We are the most overeducated and underutilized healthcare professional in the U.S.\" \u003c/aside>\n\u003cp>\"It was Diana who figured out what the problem was,\" said Freedman, referring to her longtime pharmacist Diana Arouchanova. \"Had she not been on top of what I’m going through, God knows how many more weeks this could have potentially gone on.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Arouchanova, who owns Clinicare Pharmacy in Northridge, reviewed Freedman's medications and realized that her problem stemmed from the dangerous combination of two prescriptions. She got the physician to change the medications and started checking Freedman's blood pressure daily. Soon, it began to drop.\u003c!--more-->\u003c/p>\n\u003cp>Once limited to filling and dispensing drugs, pharmacists are increasingly providing direct care to patients. Across the country, they are working with doctors to give immunizations and help patients safely manage medications. In some places, they can even write prescriptions after a physician's diagnosis.\u003c/p>\n\u003cp>California is among the states to give pharmacists the greatest flexibility, thanks in part to a law that took effect this year. Other states, including New Mexico and North Carolina, have also allowed pharmacists to take on more clinical responsibilities.\u003c/p>\n\u003cp>It's all part of a push by druggists and pharmacies to take a greater role in guiding patients and promoting good health. One prominent example is CVS Caremark's recent announcement that it will stop selling tobacco products to help customers become healthier.\u003c/p>\n\u003cp>At the same time, health officials are looking for ways to ease the strain on overloaded doctors, improve care and contain costs. With millions of people gaining coverage under the nation's health law, experts say pharmacists can fill gaps in primary care and help avoid unnecessary hospital admissions.\u003c/p>\n\u003cp>Pharmacists, who are required to\u003cstrong> \u003c/strong>have a doctorate in pharmacy, say technicians can fill prescriptions and that their training and education can be put to better use.\u003c/p>\n\u003cp>\"We are the most overeducated and underutilized healthcare professional in the U.S.,\" said R. Pete Vanderveen, dean of the USC School of Pharmacy. \"It doesn't take eight years of education and a professional doctorate to fill a bottle with pills.\"\u003c/p>\n\u003cp>The new California law designates pharmacists as health care providers and allows them to give routine vaccinations and provide some travel and birth-control medications. The law also creates a new class of provider known as an \"advanced practice pharmacist.\" With additional training and experience, such as a residency program, advanced practice pharmacists will be able to collaborate with doctors in assessing and referring patients, starting and stopping medications and managing patients' diseases.\u003c/p>\n\u003cp>Some physicians, however, are wary of pharmacists doing too much on their own. The American Medical Association supports physician-led teams that include pharmacists, but opposes giving pharmacists prescription privileges without a doctor's supervision. The California Medical Association initially opposed the state law but withdrew the opposition after amendments were added, including one that limited the type of medications they could provide.\u003c/p>\n\u003cp>Pharmacist organizations are quick to point out they don't want to take over the physician's job.\u003c/p>\n\u003cp>\"We are not looking to become the primary care provider for all patients,\" said Stacie Maass, a senior vice president at the American Pharmacists Association. \"We want to be part of the team.\"\u003c/p>\n\u003cp>Research has shown that pairing pharmacists and physicians can save money and improve health outcomes. Other studies are under way.\u003c/p>\n\u003cp>Clinical pharmacist Michelle Lee is funded by a federal grant to the USC School of Pharmacy and AltaMed Health Services to determine whether pharmacists can help high-risk patients control chronic diseases take their medications as prescribed and avoid hospitalization.\u003c/p>\n\u003cp>On a recent day at an AltaMed clinic in Boyle Heights, a primarily Latino neighborhood in Los Angeles, Lee stopped the medications of a liver disease patient whose condition might have worsened if he took what a local hospital just prescribed him. Then she ordered another check of his liver.\u003c/p>\n\u003cp>Lee also saw 57-year-old Maria Flores, who has uncontrolled diabetes, noticing that both her blood sugar and her blood pressure were higher than normal.\u003c/p>\n\u003cp>\"Have you been under any stress?\" Lee asked through a Spanish-language translator.\u003c/p>\n\u003cp>The woman started to tear up. She responded that there had been a death in the family and that she hadn't been able to sleep or eat. Lee ordered a shot of insulin and adjusted her blood-pressure medication. She reminded Flores to check her blood sugar every day.\u003c/p>\n\u003cp>\"It's important for us to know if the insulin is at a good dose,\" she said. \"We might need to make adjustments.\"\u003c/p>\n\u003cp>As a student, Lee worked at Walgreens and customers frequently came in with questions. Lee said she wanted to do more for them. Now, Lee said she believes she is doing that.\u003c/p>\n\u003cp>\"It's a little role but I think it's making a big difference,\" she said.\u003c/p>\n\u003cp>Freedman appreciates the difference. She discovered Clinicare Pharmacy about seven years ago. In contrast to the chain drug store she'd been using, which she felt was impersonal, Arouchanova and her staff regularly called to see how she was feeling and to check on any side effects.\u003c/p>\n\u003cp>Now Arouchanova, 36, helps her track the more than a dozen medications she takes for hypertension, Crohn’s disease and ulcerative colitis.\u003c/p>\n\u003cp>Freedman stops by a couple times a week, sometimes just to say hello. She considers her pharmacist a friend and brings her birthday presents. \"I can walk in here any time of the day,\" she said. \"There is somebody who greets me with a smile.\"\u003c/p>\n\u003cp>Arouchanova, an Armenian immigrant with a bob of short blond hair, said she tries to go \"above and beyond the call of duty.\"\u003c/p>\n\u003cp>\"I take care of each of my patients as if they were my only patients,\" she said. That means working up to 12 hours a day and only seeing her young son briefly in the morning and evening.\u003c/p>\n\u003cp>One day a week, a physician, Hanriet Minasian, works out of an office in the pharmacy. She and Minasian have an agreement that allows Arouchanova to order labs and to start, stop and adjust medications. They refer patients to one another and together review their patients' charts.\u003c/p>\n\u003cp>Erika Pappas, 34, who lives in nearby Reseda, sees both Arouchanova and Minasian for her diabetes and hypertension.\u003c/p>\n\u003cp>\"I don't have to worry about my pharmacist or my doctor not being on the same page,\" she said during a recent visit. \"Everything is very clear.\"\u003c/p>\n\u003cp>Minasian said Arouchanova is another set of eyes on complex cases -- patients with multiple chronic diseases who receive numerous prescriptions.\u003c/p>\n\u003cp>\"It's like a checks and balances system,\" Minasian said. \"The more heads you put together, the better care we can provide for our patients.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Whooping Cough Vaccine: Does Its Effectiveness Wear Off Faster?",
"title": "Whooping Cough Vaccine: Does Its Effectiveness Wear Off Faster?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17600\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-e1392067906728.jpg\">\u003cimg class=\"size-large wp-image-17600\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-640x425.jpg\" alt=\"A vial containing the acellular pertussis vaccine. (Robyn Beck/AFP/Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A vial containing the acellular pertussis vaccine. (Robyn Beck/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A new rise in whooping cough cases in California is raising questions among doctors about whether there are problems with the current vaccine. California \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Pertussis%20report%202-4-2014.pdf\" target=\"_blank\">public health data \u003c/a>show a spike in whooping cough cases in 2013 compared to the year before, and last week officials confirmed the first death from the disease since the major outbreak of 2010: an infant in Riverside.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"The attempt at making vaccines safer has created a potential lapse in protection.\" \u003c/aside>\n\u003cp>Whooping cough, or pertussis as it is referred to in medical circles, is cyclical in nature and tends to peak every three to five years. But doctors are now finding evidence that the new vaccine may start to wear off on a similar timeline, despite medical recommendations that allow for a span of eight years between booster shots.\u003c/p>\n\u003cp>[contextly_sidebar id=\"75e2b90f971831849adca0e1633a4908\"]\u003c/p>\n\u003cp>“The efficacy of the new vaccine is really good, it works. It’s just that it wanes, and it wanes more quickly,” said Dr. Michael Witte, a pediatrician in Pt. Reyes, north of San Francisco.\u003c/p>\n\u003cp>The new acellular whooping cough vaccine was introduced in the 1990s. It has fewer side effects than the earlier whole-cell vaccine that had been in use since the 1940s. By 2001, the old vaccine was completely phased out. So while many adolescent kids have received boosters of the new vaccine, they would have gotten shots when they were babies that included the old vaccine.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Kids who are now between 11 and 15 years old -- the main group that is getting sick -- are the first generation to have received only the new vaccine. That is leading doctors treating them to conclude that immunity from the acellular vaccine starts to wear off after three years.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0518368a6e2e7d73af4dc8bfccc32f06\"]\u003c/p>\n\u003cp>“Pertussis vaccines have never been that strong,” said Paul Katz, a pediatrician at Kaiser Permanente in San Rafael. “But the attempt at making vaccines safer has created a potential lapse in protection in older people.”\u003c/p>\n\u003cp>Dr. Katz’s \u003ca href=\"http://www.marinmedicalsociety.org/magazine/articles/?articleid=608\" target=\"_blank\">recent research\u003c/a> in Marin County shows that kids who have received had only the new vaccine are five times more likely to get whooping cough.\u003c/p>\n\u003cp>The current medical recommendation is for kids to get four whooping cough shots in the first two years of life, then a booster before kindergarten and another in middle school. That’s a span of up to eight years. Now doctors are talking about whether the recommendations need to be updated to account for the three year dip in the vaccine’s effectiveness.\u003c/p>\n\u003cp>“This phenomenon of waning immunity is just coming to the surface,” said Dr. James Watt, the chief of communicable disease control for the California Department of Public Health. He says the review of current recommendations has reached the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>“Folks at the national level are looking at information about the effectiveness of giving additional doses, whether there are issues with any local reactions associated with additional doses, things like that,” he said.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Dr. Katz and Dr. Witte agree that the root of both the 2010 and 2013 whooping cough outbreaks in Marin was a cluster of kids who had never been vaccinated. Marin has the highest rate of the disease of any county in California, according to \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Pertussis%20report%202-4-2014.pdf\" target=\"_blank\">public health data\u003c/a>. Doctors believe those numbers are directly related to the county's comparatively high rate of parents who \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20CA%20Kindergarten%20Immunization%20Assessment.pdf\" target=\"_blank\">declined to vaccinate\u003c/a> their children.\u003c/p>\n\u003cp>“We had a lot of unvaccinated children that acted as the kindling to start an outbreak,” said Dr. Katz. “Those children were able to infect all the other children who were vaccinated but were too early for a booster – they became the rest of the wood to start the fire.”\u003c/p>\n\u003cp>A \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/23/new-requirement-for-vaccine-exemption-passed-by-senate/\" target=\"_blank\">new state law\u003c/a> that went into effect in January now requires families who refuse vaccines to talk to a health care provider about the risks and benefits of vaccines.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/134124755&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\n",
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"excerpt": "A new rise in whooping cough cases in California is raising questions among doctors about whether there are problems with the current vaccine. California public health data show a spike in whooping cough cases in 2013 compared to the year before, and last week officials confirmed the first death from the disease since the major outbreak of 2010: an infant in Riverside.\r\n\r\nWhooping cough, or pertussis as it is referred to in medical circles, is cyclical in nature and tends to peak every three to five years. But doctors are now finding evidence that the new vaccine may start to wear off on a similar timeline, despite medical recommendations that allow for a span of eight years between booster shots.",
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"description": "A new rise in whooping cough cases in California is raising questions among doctors about whether there are problems with the current vaccine. California public health data show a spike in whooping cough cases in 2013 compared to the year before, and last week officials confirmed the first death from the disease since the major outbreak of 2010: an infant in Riverside.\r\n\r\nWhooping cough, or pertussis as it is referred to in medical circles, is cyclical in nature and tends to peak every three to five years. But doctors are now finding evidence that the new vaccine may start to wear off on a similar timeline, despite medical recommendations that allow for a span of eight years between booster shots.",
"title": "Whooping Cough Vaccine: Does Its Effectiveness Wear Off Faster? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17600\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-e1392067906728.jpg\">\u003cimg class=\"size-large wp-image-17600\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-640x425.jpg\" alt=\"A vial containing the acellular pertussis vaccine. (Robyn Beck/AFP/Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A vial containing the acellular pertussis vaccine. (Robyn Beck/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>A new rise in whooping cough cases in California is raising questions among doctors about whether there are problems with the current vaccine. California \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Pertussis%20report%202-4-2014.pdf\" target=\"_blank\">public health data \u003c/a>show a spike in whooping cough cases in 2013 compared to the year before, and last week officials confirmed the first death from the disease since the major outbreak of 2010: an infant in Riverside.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"The attempt at making vaccines safer has created a potential lapse in protection.\" \u003c/aside>\n\u003cp>Whooping cough, or pertussis as it is referred to in medical circles, is cyclical in nature and tends to peak every three to five years. But doctors are now finding evidence that the new vaccine may start to wear off on a similar timeline, despite medical recommendations that allow for a span of eight years between booster shots.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“The efficacy of the new vaccine is really good, it works. It’s just that it wanes, and it wanes more quickly,” said Dr. Michael Witte, a pediatrician in Pt. Reyes, north of San Francisco.\u003c/p>\n\u003cp>The new acellular whooping cough vaccine was introduced in the 1990s. It has fewer side effects than the earlier whole-cell vaccine that had been in use since the 1940s. By 2001, the old vaccine was completely phased out. So while many adolescent kids have received boosters of the new vaccine, they would have gotten shots when they were babies that included the old vaccine.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Kids who are now between 11 and 15 years old -- the main group that is getting sick -- are the first generation to have received only the new vaccine. That is leading doctors treating them to conclude that immunity from the acellular vaccine starts to wear off after three years.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Pertussis vaccines have never been that strong,” said Paul Katz, a pediatrician at Kaiser Permanente in San Rafael. “But the attempt at making vaccines safer has created a potential lapse in protection in older people.”\u003c/p>\n\u003cp>Dr. Katz’s \u003ca href=\"http://www.marinmedicalsociety.org/magazine/articles/?articleid=608\" target=\"_blank\">recent research\u003c/a> in Marin County shows that kids who have received had only the new vaccine are five times more likely to get whooping cough.\u003c/p>\n\u003cp>The current medical recommendation is for kids to get four whooping cough shots in the first two years of life, then a booster before kindergarten and another in middle school. That’s a span of up to eight years. Now doctors are talking about whether the recommendations need to be updated to account for the three year dip in the vaccine’s effectiveness.\u003c/p>\n\u003cp>“This phenomenon of waning immunity is just coming to the surface,” said Dr. James Watt, the chief of communicable disease control for the California Department of Public Health. He says the review of current recommendations has reached the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>“Folks at the national level are looking at information about the effectiveness of giving additional doses, whether there are issues with any local reactions associated with additional doses, things like that,” he said.\u003cstrong> \u003c/strong>\u003c/p>\n\u003cp>Dr. Katz and Dr. Witte agree that the root of both the 2010 and 2013 whooping cough outbreaks in Marin was a cluster of kids who had never been vaccinated. Marin has the highest rate of the disease of any county in California, according to \u003ca href=\"http://www.cdph.ca.gov/HealthInfo/discond/Documents/Pertussis%20report%202-4-2014.pdf\" target=\"_blank\">public health data\u003c/a>. Doctors believe those numbers are directly related to the county's comparatively high rate of parents who \u003ca href=\"http://www.cdph.ca.gov/programs/immunize/Documents/2012-2013%20CA%20Kindergarten%20Immunization%20Assessment.pdf\" target=\"_blank\">declined to vaccinate\u003c/a> their children.\u003c/p>\n\u003cp>“We had a lot of unvaccinated children that acted as the kindling to start an outbreak,” said Dr. Katz. “Those children were able to infect all the other children who were vaccinated but were too early for a booster – they became the rest of the wood to start the fire.”\u003c/p>\n\u003cp>A \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/23/new-requirement-for-vaccine-exemption-passed-by-senate/\" target=\"_blank\">new state law\u003c/a> that went into effect in January now requires families who refuse vaccines to talk to a health care provider about the risks and benefits of vaccines.\u003c/p>\n\u003cp>\u003cstrong>Listen to the story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/134124755&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medi-Cal Expansion Opens Doors to Care for Transgender Patients",
"title": "Medi-Cal Expansion Opens Doors to Care for Transgender Patients",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_17501\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-e1391629566748.jpg\">\u003cimg class=\"size-large wp-image-17501\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-640x426.jpg\" alt=\"Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED) \u003ccite>(Angela Hart/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care -- transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"I've seen so many trans people with mental health problems, they get access to treatment, and it's like you've flipped a light switch on.\" \u003c/aside>\n\u003cp>\"Where I grew up in New Jersey, there were no resources for me,\" Avery said. \"I never had anyone I could relate to until I moved here. I was no longer called a freak.\"\u003c/p>\n\u003cp>Avery lives without a steady source of income. Because \u003ca href=\"http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx\" target=\"_blank\">California is expanding its Medicaid program\u003c/a>, known as Medi-Cal here, Avery now has access to health insurance. More than one million Californians are newly enrolled as of January 1.\u003c/p>\n\u003cp>And for people like Avery, who are seeking transgender care and sex-reassignment surgery, it's a \"big deal\" says Dawn Harbatkin, Avery's primary care physician who is also executive director for Lyon Martin Health Services, an LGBT-focused community health clinic on Market Street near San Francisco's Hayes Valley neighborhood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"At the same time commercial insurers are also going to be doing this, so the fact that all kinds of coverage is going to be available for transition-related surgeries is an equally big deal.\"\u003c/p>\n\u003cp>Harbatkin and other San Francisco-based doctors who specialize in transgender care said the Medi-Cal expansion, funded by the federal Affordable Care Act, is a huge opportunity for thousands of Californians seeking surgery and other primary care services, such as hormone replacement therapy — a routine regimen for transgender patients going through their transitions — to get health care.\u003c/p>\n\u003cp>Nick Gorton, a primary care physician at Lyon Martin, agrees that the availability of insurance to transgender patients is a game-changer. KQED's Mina Kim talks with Dr. Gorton:\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/133471998\"]\u003c/p>\n\u003cp>\"In my experience I've seen so many trans people who have mental health problems, who have depression, anxiety, they're suicidal — from a mental health perspective, their world has just kind of collapsed onto them,\" Gorton said. \"Then they get hormones, they get surgery, they get access to treatment, and it's like you've flipped a light switch on.\"\u003c/p>\n\u003cp>\u003cstrong>Sex-reassignment Surgery Ruled \"Medically Necessaary\" Years Ago\u003c/strong>\u003c/p>\n\u003cp>In 2001, the California Supreme Court \u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2013/APL13-011.pdf\" target=\"_blank\">ruled that Medi-Cal must cover\u003c/a> \"medically-necessary treatment,\" including sex reassignment surgery. But the problem, Harbatkin said, is Medi-Cal reimbursement rates were too low. In San Francisco, she said, there were no surgeons providing sex reassignment surgery who would take Medi-Cal rates.\u003c/p>\n\u003cp>\"We would write to Medi-Cal and say, 'We'd like you to cover this,' and they'd say 'Great, find a surgeon who takes Medi-Cal,'\" Harbatkin said. \"But there were no surgeons who were taking Medi-Cal.\"\u003c/p>\n\u003cp>But in recent years, California \u003ca href=\"http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx\" target=\"_blank\">shifted patients\u003c/a> to county-run Medi-Cal managed care plans. In San Francisco, that meant two health plans, Anthem Blue Cross and the San Francisco Health Plan, would contract with Med-Cal and providers would now cover sex-reassignment surgeries and other transition-related health care procedures.\u003c/p>\n\u003cp>\"The big exciting piece of this is that Medi-Cal will actually cover transgender surgeries now,\" Harbatkin said. \"The plans have contracted with surgeons who can do transition-related surgeries.\"\u003c/p>\n\u003cp>The response, in a word, has been overwhelming, said doctors who specialize in transgender health care.\u003c/p>\n\u003cp>\"When I started doing trans care in 1997, I did not think in my lifetime that we would be able to see people able to have transgender surgery,\" Harbatkin said. \"So as we move into more accessibility, we're also thinking about how to allow people to be more successful … and have the long-term results they want.\"\u003c/p>\n\u003cp>\u003cstrong>San Francisco a Beacon for Trans Care \u003c/strong>\u003c/p>\n\u003cp>Lyon Martin serves about 2,000 patients annually — 31 percent of whom identify as transgender, according to Harbatkin. She said San Francisco is uniquely positioned to offer care that is sparse in other parts of the state and country.\u003c/p>\n\u003cp>The majority of transgender patients at Lyon Martin come from outside San Francisco.\u003c/p>\n\u003cp>\"Alameda County is number one,\" Harbatkin said. \"But we also have patients come to us from San Mateo, Contra Costa, and Marin counties. Some even come from out of state — we have a trans woman who comes to us from Iowa, and someone comes from Alaska.\"\u003c/p>\n\u003cp>Darryl Avery said clinics like Lyon Martin treat him with respect and allow him to feel safer living life.\u003c/p>\n\u003cp>\"Other places I've been to haven’t treated me with respect,\" he said. \"People become suicidal because they're trying to go through this transition, and trying to understand who they are on the inside. I found peace at Lyon Martin. I'm starting to see the real me.\"\u003c/p>\n\u003cp>Harbatkin and other providers said clinics and hospitals throughout California are still figuring out how to navigate new federal and state regulations that are opening up new options for patients seeking transition-related surgeries.\u003c/p>\n\u003cp>\"It hasn't really trickled down yet,\" Harbatkin said. \"So, for example, you have a patient who goes to fill their prescription for testosterone and we'll get a rejection. Then we have to submit a lot of paperwork, but eventually Medi-Cal will cover it.\"\u003c/p>\n\u003cp>Barry Zevin, a doctor at San Francisco General Hospital who also works at Tom Waddell Urban Health Clinic near San Francisco's City Hall, said San Francisco is ahead of any other city in California in providing transgender health care.\u003c/p>\n\u003cp>Zevin was tapped to launch a \u003ca href=\"http://www.sfdph.org/dph/comupg/oprograms/THS/default2.asp\" target=\"_blank\">San Francisco Department of Public Health initiative\u003c/a> called the Transgender Health Project launched last summer. The program aims to streamline transgender health care by informing clinics, hospitals, and providers about new laws underway, specifically related to low-income patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"The wider scope of the program is improving access and quality of care for everything — mental health care, primary care, access to sex reassignment surgery and follow up after sex reassignment surgery,\" Zevin said. That includes a pathway to surgery, he added.\u003c/p>\n\n",
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"excerpt": "Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care -- transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17501\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-e1391629566748.jpg\">\u003cimg class=\"size-large wp-image-17501\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/Avery3-640x426.jpg\" alt=\"Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED) \u003ccite>(Angela Hart/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Angela Hart\u003c/strong>\u003c/p>\n\u003cp>Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care -- transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"I've seen so many trans people with mental health problems, they get access to treatment, and it's like you've flipped a light switch on.\" \u003c/aside>\n\u003cp>\"Where I grew up in New Jersey, there were no resources for me,\" Avery said. \"I never had anyone I could relate to until I moved here. I was no longer called a freak.\"\u003c/p>\n\u003cp>Avery lives without a steady source of income. Because \u003ca href=\"http://www.dhcs.ca.gov/Pages/Medi-CalExpansionInformation.aspx\" target=\"_blank\">California is expanding its Medicaid program\u003c/a>, known as Medi-Cal here, Avery now has access to health insurance. More than one million Californians are newly enrolled as of January 1.\u003c/p>\n\u003cp>And for people like Avery, who are seeking transgender care and sex-reassignment surgery, it's a \"big deal\" says Dawn Harbatkin, Avery's primary care physician who is also executive director for Lyon Martin Health Services, an LGBT-focused community health clinic on Market Street near San Francisco's Hayes Valley neighborhood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\"At the same time commercial insurers are also going to be doing this, so the fact that all kinds of coverage is going to be available for transition-related surgeries is an equally big deal.\"\u003c/p>\n\u003cp>Harbatkin and other San Francisco-based doctors who specialize in transgender care said the Medi-Cal expansion, funded by the federal Affordable Care Act, is a huge opportunity for thousands of Californians seeking surgery and other primary care services, such as hormone replacement therapy — a routine regimen for transgender patients going through their transitions — to get health care.\u003c/p>\n\u003cp>Nick Gorton, a primary care physician at Lyon Martin, agrees that the availability of insurance to transgender patients is a game-changer. KQED's Mina Kim talks with Dr. Gorton:\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='undefined' height='undefined'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=https://api.soundcloud.com/tracks/133471998&visual=true&undefined'\n title='https://api.soundcloud.com/tracks/133471998'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"In my experience I've seen so many trans people who have mental health problems, who have depression, anxiety, they're suicidal — from a mental health perspective, their world has just kind of collapsed onto them,\" Gorton said. \"Then they get hormones, they get surgery, they get access to treatment, and it's like you've flipped a light switch on.\"\u003c/p>\n\u003cp>\u003cstrong>Sex-reassignment Surgery Ruled \"Medically Necessaary\" Years Ago\u003c/strong>\u003c/p>\n\u003cp>In 2001, the California Supreme Court \u003ca href=\"http://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2013/APL13-011.pdf\" target=\"_blank\">ruled that Medi-Cal must cover\u003c/a> \"medically-necessary treatment,\" including sex reassignment surgery. But the problem, Harbatkin said, is Medi-Cal reimbursement rates were too low. In San Francisco, she said, there were no surgeons providing sex reassignment surgery who would take Medi-Cal rates.\u003c/p>\n\u003cp>\"We would write to Medi-Cal and say, 'We'd like you to cover this,' and they'd say 'Great, find a surgeon who takes Medi-Cal,'\" Harbatkin said. \"But there were no surgeons who were taking Medi-Cal.\"\u003c/p>\n\u003cp>But in recent years, California \u003ca href=\"http://www.dhcs.ca.gov/services/Pages/Medi-CalManagedCare.aspx\" target=\"_blank\">shifted patients\u003c/a> to county-run Medi-Cal managed care plans. In San Francisco, that meant two health plans, Anthem Blue Cross and the San Francisco Health Plan, would contract with Med-Cal and providers would now cover sex-reassignment surgeries and other transition-related health care procedures.\u003c/p>\n\u003cp>\"The big exciting piece of this is that Medi-Cal will actually cover transgender surgeries now,\" Harbatkin said. \"The plans have contracted with surgeons who can do transition-related surgeries.\"\u003c/p>\n\u003cp>The response, in a word, has been overwhelming, said doctors who specialize in transgender health care.\u003c/p>\n\u003cp>\"When I started doing trans care in 1997, I did not think in my lifetime that we would be able to see people able to have transgender surgery,\" Harbatkin said. \"So as we move into more accessibility, we're also thinking about how to allow people to be more successful … and have the long-term results they want.\"\u003c/p>\n\u003cp>\u003cstrong>San Francisco a Beacon for Trans Care \u003c/strong>\u003c/p>\n\u003cp>Lyon Martin serves about 2,000 patients annually — 31 percent of whom identify as transgender, according to Harbatkin. She said San Francisco is uniquely positioned to offer care that is sparse in other parts of the state and country.\u003c/p>\n\u003cp>The majority of transgender patients at Lyon Martin come from outside San Francisco.\u003c/p>\n\u003cp>\"Alameda County is number one,\" Harbatkin said. \"But we also have patients come to us from San Mateo, Contra Costa, and Marin counties. Some even come from out of state — we have a trans woman who comes to us from Iowa, and someone comes from Alaska.\"\u003c/p>\n\u003cp>Darryl Avery said clinics like Lyon Martin treat him with respect and allow him to feel safer living life.\u003c/p>\n\u003cp>\"Other places I've been to haven’t treated me with respect,\" he said. \"People become suicidal because they're trying to go through this transition, and trying to understand who they are on the inside. I found peace at Lyon Martin. I'm starting to see the real me.\"\u003c/p>\n\u003cp>Harbatkin and other providers said clinics and hospitals throughout California are still figuring out how to navigate new federal and state regulations that are opening up new options for patients seeking transition-related surgeries.\u003c/p>\n\u003cp>\"It hasn't really trickled down yet,\" Harbatkin said. \"So, for example, you have a patient who goes to fill their prescription for testosterone and we'll get a rejection. Then we have to submit a lot of paperwork, but eventually Medi-Cal will cover it.\"\u003c/p>\n\u003cp>Barry Zevin, a doctor at San Francisco General Hospital who also works at Tom Waddell Urban Health Clinic near San Francisco's City Hall, said San Francisco is ahead of any other city in California in providing transgender health care.\u003c/p>\n\u003cp>Zevin was tapped to launch a \u003ca href=\"http://www.sfdph.org/dph/comupg/oprograms/THS/default2.asp\" target=\"_blank\">San Francisco Department of Public Health initiative\u003c/a> called the Transgender Health Project launched last summer. The program aims to streamline transgender health care by informing clinics, hospitals, and providers about new laws underway, specifically related to low-income patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "What Philip Seymour Hoffman's Tragic Death Teaches Us About Addiction",
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"content": "\u003cfigure id=\"attachment_17429\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS8528_450461661-hpf.jpg\">\u003cimg class=\"size-full wp-image-17429\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS8528_450461661-hpf.jpg\" alt=\"Philip Seymour Hoffman arrives for the Los Angeles premiere of 'The Hunger Games: Catching Fire' in Los Angeles, California, last November. Robyn Beck/AFP/Getty Images)\" width=\"640\" height=\"431\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS8528_450461661-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS8528_450461661-hpf-400x269.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS8528_450461661-hpf-320x216.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Philip Seymour Hoffman arrives for the Los Angeles premiere of 'The Hunger Games: Catching Fire' last November. Robyn Beck/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>As I think pretty much everyone must know by now, the actor \u003ca href=\"http://ww2.kqed.org/news/2014/02/02/philip-seymour-hoffman-art-howe-moneyball-role\" target=\"_blank\">Philip Seymour Hoffman died Sunday\u003c/a>, apparently of a heroin overdose. I was stunned when I found out, then deeply saddened when I read reports that he had told \"\u003ca href=\"http://www.cbsnews.com/news/2006-philip-seymour-hoffman-on-60-minutes/\" target=\"_blank\">60 Minutes\u003c/a>\" in 2006 that he had given up drugs and alcohol when he was 22 -- \"I got panicked for my life,\" he told Steve Kroft. Hoffman \u003ca href=\"http://www.nytimes.com/2014/02/03/movies/philip-seymour-hoffman-actor-dies-at-46.html?hp&_r=0\" target=\"_blank\">relapsed\u003c/a> last year.\u003c/p>\n\u003cp>But my sadness turned to a kind of cold fury when I saw too many comments on social media clucking disapproval for Hoffman's \"selfishness\" and \"poor choices.\" (I'm not linking to them here; you can find them easily enough if you want to.) One friend on Facebook noted that another friend's thread about Hoffman was the only one he'd seen acknowledging \"the tragedy of his drug addiction.\"\u003c/p>\n\u003cp>And, indeed, addiction is a disease. Dr. David Smith has treated thousands of addicts since he founded the Haight Ashbury Free Clinic in 1967. He talked to me about \"battling an uninformed public.\"\u003c!--more-->\u003c/p>\n\u003cp>\"Diabetes is a disease of the pancreas. Addiction is a disease of the brain,\" he said. If you don't think addiction is a disease, Smith said, \"then take a laxative, sit on the toilet and try not to have a bowel movement.\" Yes, a simplistic analogy, he said, \"but effective.\"\u003c/p>\n\u003cp>Smith told me about the \"4 C's of addiction\" -- craving, compulsion, loss of control and continued use in spite of bad consequences. \"Craving is a signal,\" Smith said, then added the worst thing an addict can do when craving is to isolate. Hoffman appears to have died alone, in a Greenwich Village apartment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a moving piece for The Guardian, the comedian and actor Russell Brand talked about the power of support -- or \"fellowships\" -- in battling his own craving for heroin. The \u003ca href=\"http://www.theguardian.com/culture/2013/mar/09/russell-brand-life-without-drugs\" target=\"_blank\">whole piece\u003c/a> is worth a read, but I'll excerpt here:\u003c/p>\n\u003cblockquote>\u003cp>Without these fellowships I would take drugs. Because, even now, the condition persists. Drugs and alcohol are not my problem, reality is my problem, drugs and alcohol are my solution.\u003c/p>\n\u003cp>If this seems odd to you it is because you are not an alcoholic or a drug addict. You are likely one of the 90% of people who can drink and use drugs safely. I have friends who can smoke weed, swill gin, even do crack and then merrily get on with their lives. For me, this is not an option. I will relinquish all else to ride that buzz to oblivion. Even if it began as a timid glass of chardonnay on a ponce's yacht, it would end with me necking the bottle, swimming to shore and sprinting to Bethnal Green in search of a crack house. I look to drugs and booze to fill up a hole in me; unchecked, the call of the wild is too strong. I still survey streets for signs of the subterranean escapes that used to provide my sanctuary. I still eye the shuffling subclass of junkies and dealers, invisibly gliding between doorways through the gutters. I see that dereliction can survive in opulence; the abundantly wealthy with destitution in their stare.\u003c/p>\u003c/blockquote>\n\u003cp>Smith said that Hoffman's death \"shatters the myth that addiction is a lower socioeconomic disease.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003cem>KQED's Forum discusses \u003ca href=\"http://www.kqed.org/a/forum/R201402040900\" target=\"_blank\">Battling Drug Addiction\u003c/a> Tuesday morning, Feb. 4. \u003ca href=\"http://www.kqed.org/radio/listen/\" target=\"_blank\">Listen Live at 9am\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Watch: Suburban Junkies, a look at young prescription drug addicts in California's Orange County who turn to heroin for a cheaper high.\u003c/em>\u003c/p>\n\u003cdiv style=\"overflow: hidden\">\n\u003cdiv class=\"embedly\">\u003ciframe src=\"//cdn.embedly.com/widgets/media.html?src=http%3A%2F%2Fwww.youtube.com%2Fembed%2FuhgdZHPxYds%3Ffeature%3Doembed&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DuhgdZHPxYds&image=http%3A%2F%2Fi1.ytimg.com%2Fvi%2FuhgdZHPxYds%2Fhqdefault.jpg&key=981697b3caaa4776a9e96c1890128d7f&type=text%2Fhtml&schema=youtube\" frameborder=\"0\" scrolling=\"no\" width=\"640\" height=\"360\">\u003c/iframe>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp>\u003cspan class=\"embedly-powered\" style=\"float: right\">\u003ca title=\"Powered by Embedly\" href=\"http://embed.ly/code?url=http%3A%2F%2Fyoutu.be%2FuhgdZHPxYds\" target=\"_blank\">\u003cimg src=\"http://static.embed.ly/images/logos/embedly-powered-small-light.png\" alt=\"Embedly Powered\">\u003c/a>\u003c/span>\u003c/p>\n\u003cdiv class=\"media-attribution\">via \u003ca class=\"media-attribution-link\" href=\"http://www.youtube.com/\" target=\"_blank\">YouTube\u003c/a>\u003c/div>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17429\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS8528_450461661-hpf.jpg\">\u003cimg class=\"size-full wp-image-17429\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/RS8528_450461661-hpf.jpg\" alt=\"Philip Seymour Hoffman arrives for the Los Angeles premiere of 'The Hunger Games: Catching Fire' in Los Angeles, California, last November. Robyn Beck/AFP/Getty Images)\" width=\"640\" height=\"431\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS8528_450461661-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS8528_450461661-hpf-400x269.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/02/RS8528_450461661-hpf-320x216.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Philip Seymour Hoffman arrives for the Los Angeles premiere of 'The Hunger Games: Catching Fire' last November. Robyn Beck/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>As I think pretty much everyone must know by now, the actor \u003ca href=\"http://ww2.kqed.org/news/2014/02/02/philip-seymour-hoffman-art-howe-moneyball-role\" target=\"_blank\">Philip Seymour Hoffman died Sunday\u003c/a>, apparently of a heroin overdose. I was stunned when I found out, then deeply saddened when I read reports that he had told \"\u003ca href=\"http://www.cbsnews.com/news/2006-philip-seymour-hoffman-on-60-minutes/\" target=\"_blank\">60 Minutes\u003c/a>\" in 2006 that he had given up drugs and alcohol when he was 22 -- \"I got panicked for my life,\" he told Steve Kroft. Hoffman \u003ca href=\"http://www.nytimes.com/2014/02/03/movies/philip-seymour-hoffman-actor-dies-at-46.html?hp&_r=0\" target=\"_blank\">relapsed\u003c/a> last year.\u003c/p>\n\u003cp>But my sadness turned to a kind of cold fury when I saw too many comments on social media clucking disapproval for Hoffman's \"selfishness\" and \"poor choices.\" (I'm not linking to them here; you can find them easily enough if you want to.) One friend on Facebook noted that another friend's thread about Hoffman was the only one he'd seen acknowledging \"the tragedy of his drug addiction.\"\u003c/p>\n\u003cp>And, indeed, addiction is a disease. Dr. David Smith has treated thousands of addicts since he founded the Haight Ashbury Free Clinic in 1967. He talked to me about \"battling an uninformed public.\"\u003c!--more-->\u003c/p>\n\u003cp>\"Diabetes is a disease of the pancreas. Addiction is a disease of the brain,\" he said. If you don't think addiction is a disease, Smith said, \"then take a laxative, sit on the toilet and try not to have a bowel movement.\" Yes, a simplistic analogy, he said, \"but effective.\"\u003c/p>\n\u003cp>Smith told me about the \"4 C's of addiction\" -- craving, compulsion, loss of control and continued use in spite of bad consequences. \"Craving is a signal,\" Smith said, then added the worst thing an addict can do when craving is to isolate. Hoffman appears to have died alone, in a Greenwich Village apartment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a moving piece for The Guardian, the comedian and actor Russell Brand talked about the power of support -- or \"fellowships\" -- in battling his own craving for heroin. The \u003ca href=\"http://www.theguardian.com/culture/2013/mar/09/russell-brand-life-without-drugs\" target=\"_blank\">whole piece\u003c/a> is worth a read, but I'll excerpt here:\u003c/p>\n\u003cblockquote>\u003cp>Without these fellowships I would take drugs. Because, even now, the condition persists. Drugs and alcohol are not my problem, reality is my problem, drugs and alcohol are my solution.\u003c/p>\n\u003cp>If this seems odd to you it is because you are not an alcoholic or a drug addict. You are likely one of the 90% of people who can drink and use drugs safely. I have friends who can smoke weed, swill gin, even do crack and then merrily get on with their lives. For me, this is not an option. I will relinquish all else to ride that buzz to oblivion. Even if it began as a timid glass of chardonnay on a ponce's yacht, it would end with me necking the bottle, swimming to shore and sprinting to Bethnal Green in search of a crack house. I look to drugs and booze to fill up a hole in me; unchecked, the call of the wild is too strong. I still survey streets for signs of the subterranean escapes that used to provide my sanctuary. I still eye the shuffling subclass of junkies and dealers, invisibly gliding between doorways through the gutters. I see that dereliction can survive in opulence; the abundantly wealthy with destitution in their stare.\u003c/p>\u003c/blockquote>\n\u003cp>Smith said that Hoffman's death \"shatters the myth that addiction is a lower socioeconomic disease.\"\u003c/p>\n\u003cp>\u003cstrong>Learn more:\u003c/strong>\u003c/p>\n\u003cp>\u003cem>KQED's Forum discusses \u003ca href=\"http://www.kqed.org/a/forum/R201402040900\" target=\"_blank\">Battling Drug Addiction\u003c/a> Tuesday morning, Feb. 4. \u003ca href=\"http://www.kqed.org/radio/listen/\" target=\"_blank\">Listen Live at 9am\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Watch: Suburban Junkies, a look at young prescription drug addicts in California's Orange County who turn to heroin for a cheaper high.\u003c/em>\u003c/p>\n\u003cdiv style=\"overflow: hidden\">\n\u003cdiv class=\"embedly\">\u003ciframe src=\"//cdn.embedly.com/widgets/media.html?src=http%3A%2F%2Fwww.youtube.com%2Fembed%2FuhgdZHPxYds%3Ffeature%3Doembed&url=http%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DuhgdZHPxYds&image=http%3A%2F%2Fi1.ytimg.com%2Fvi%2FuhgdZHPxYds%2Fhqdefault.jpg&key=981697b3caaa4776a9e96c1890128d7f&type=text%2Fhtml&schema=youtube\" frameborder=\"0\" scrolling=\"no\" width=\"640\" height=\"360\">\u003c/iframe>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003cp>\u003cspan class=\"embedly-powered\" style=\"float: right\">\u003ca title=\"Powered by Embedly\" href=\"http://embed.ly/code?url=http%3A%2F%2Fyoutu.be%2FuhgdZHPxYds\" target=\"_blank\">\u003cimg src=\"http://static.embed.ly/images/logos/embedly-powered-small-light.png\" alt=\"Embedly Powered\">\u003c/a>\u003c/span>\u003c/p>\n\u003cdiv class=\"media-attribution\">via \u003ca class=\"media-attribution-link\" href=\"http://www.youtube.com/\" target=\"_blank\">YouTube\u003c/a>\u003c/div>\n\u003cdiv class=\"embedly-clear\">\u003c/div>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Native American Woman Changes Young Lives Through Traditional Dancing",
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"content": "\u003cfigure id=\"attachment_17219\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/Juliet-Small-21.jpg\">\u003cimg class=\"size-large wp-image-17219\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/Juliet-Small-21-640x577.jpg\" alt=\"Juliet Small, 19, teaches Native American dance to girls at the Intertribal Friendship House in Oakland. (Zaidee Stavely/KQED)\" width=\"640\" height=\"577\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Juliet Small, 19, teaches Native American dance to girls at the Intertribal Friendship House in Oakland. (Zaidee Stavely/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor’s Note: Many Native Americans are reconnecting with the traditions of their ancestors—to eat healthier foods and get more exercise with traditional dance and drumming. At the Intertribal Friendship House in Oakland, there’s a weekly dinner with traditional recipes, followed by a community dance. Before dinner, 19-year-old Juliet Small teaches Native American dancing to young girls. As part of our ongoing series of first-person health profiles called “\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">What’s Your Story?\u003c/a>” we hear from Small who is Apache, Navajo, Cherokee, and Azteca. She has been dancing since she was three-years-old. Small discusses how dancing has brought healing to her family and community. \u003c/em>Reporter: Zaidee Stavely\u003c/p>\n\u003cp>\u003cstrong>By Juliet Small\u003c/strong>\u003c/p>\n\u003cp>Growing up in the Oakland area, it sometimes seems there’s not a lot of outlets for people to get away from the negative aspects of life. There are always so many things you can get caught up with. You know, hanging out with the wrong people, doing the wrong things with those people. But because I’ve always had dancing, that’s always kept me on the right path, to where I want to dance for myself, to keep up with my culture, and to share my culture with everybody else. And when I dance, I’m extremely happy. No negative thoughts. I feel light. I feel relieved of stress.\u003c!--more-->\u003c/p>\n\u003cp>The most inspiring thing about dancing and teaching this class is that you have two-year-olds and three-year-olds coming to dance class who are ready to dance and who tell their parents every day, “I want to go to dance class! I want to go to dance class!” And their parents can be tired and they’ll tell me, “My daughter just had to come today. She just had to be here.” It makes me really happy to see that kids want to keep going with their traditions — they want to keep their culture alive.\u003c/p>\n\u003cp>With [me] teaching them these stories and teaching our tradition and our culture, I'm bringing them healing and health because they can share it with other people. They can share it with their sisters, brothers, aunties, uncles, people who carry bad medicine within them, and explain to them why it’s healing for them. And within their own person, they will be able to heal themselves based on the stories and the teachings.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For example, the jingle dress is a healing dress. It’s not exactly like a medicine that you take, but it’s a medicine with prayer. With the jingles, your prayers are taken up to Creator who is there to heal you. For me, I started doing jingle because my cousin was in the hospital. She wasn’t supposed to survive because she’d had multiple seizures.\u003c/p>\n\u003cp>I didn’t have a jingle dress of my own, but I started doing the style. Every day I would go around and I’d dance four times around the circle. I’d pray while I was dancing. My cousin wasn’t supposed to make it more than a month. And two months later, after I’d danced every day, she was out of the hospital.\u003c/p>\n\u003cp>\u003cstrong>Listen to Juliet Small's story here:\u003c/strong>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/129743517&color=ff6600&auto_play=false&show_artwork=true\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17219\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/Juliet-Small-21.jpg\">\u003cimg class=\"size-large wp-image-17219\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/Juliet-Small-21-640x577.jpg\" alt=\"Juliet Small, 19, teaches Native American dance to girls at the Intertribal Friendship House in Oakland. (Zaidee Stavely/KQED)\" width=\"640\" height=\"577\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Juliet Small, 19, teaches Native American dance to girls at the Intertribal Friendship House in Oakland. (Zaidee Stavely/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor’s Note: Many Native Americans are reconnecting with the traditions of their ancestors—to eat healthier foods and get more exercise with traditional dance and drumming. At the Intertribal Friendship House in Oakland, there’s a weekly dinner with traditional recipes, followed by a community dance. Before dinner, 19-year-old Juliet Small teaches Native American dancing to young girls. As part of our ongoing series of first-person health profiles called “\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">What’s Your Story?\u003c/a>” we hear from Small who is Apache, Navajo, Cherokee, and Azteca. She has been dancing since she was three-years-old. Small discusses how dancing has brought healing to her family and community. \u003c/em>Reporter: Zaidee Stavely\u003c/p>\n\u003cp>\u003cstrong>By Juliet Small\u003c/strong>\u003c/p>\n\u003cp>Growing up in the Oakland area, it sometimes seems there’s not a lot of outlets for people to get away from the negative aspects of life. There are always so many things you can get caught up with. You know, hanging out with the wrong people, doing the wrong things with those people. But because I’ve always had dancing, that’s always kept me on the right path, to where I want to dance for myself, to keep up with my culture, and to share my culture with everybody else. And when I dance, I’m extremely happy. No negative thoughts. I feel light. I feel relieved of stress.\u003c!--more-->\u003c/p>\n\u003cp>The most inspiring thing about dancing and teaching this class is that you have two-year-olds and three-year-olds coming to dance class who are ready to dance and who tell their parents every day, “I want to go to dance class! I want to go to dance class!” And their parents can be tired and they’ll tell me, “My daughter just had to come today. She just had to be here.” It makes me really happy to see that kids want to keep going with their traditions — they want to keep their culture alive.\u003c/p>\n\u003cp>With [me] teaching them these stories and teaching our tradition and our culture, I'm bringing them healing and health because they can share it with other people. They can share it with their sisters, brothers, aunties, uncles, people who carry bad medicine within them, and explain to them why it’s healing for them. And within their own person, they will be able to heal themselves based on the stories and the teachings.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For example, the jingle dress is a healing dress. It’s not exactly like a medicine that you take, but it’s a medicine with prayer. With the jingles, your prayers are taken up to Creator who is there to heal you. For me, I started doing jingle because my cousin was in the hospital. She wasn’t supposed to survive because she’d had multiple seizures.\u003c/p>\n\u003cp>I didn’t have a jingle dress of my own, but I started doing the style. Every day I would go around and I’d dance four times around the circle. I’d pray while I was dancing. My cousin wasn’t supposed to make it more than a month. And two months later, after I’d danced every day, she was out of the hospital.\u003c/p>\n\u003cp>\u003cstrong>Listen to Juliet Small's story here:\u003c/strong>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/129743517&color=ff6600&auto_play=false&show_artwork=true\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_17070\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/karen_od/3873637691/sizes/l/\">\u003cimg class=\"size-large wp-image-17070\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/3873637691_10b1718f79_b-640x426.jpg\" alt=\"(Karen_O'D/Flickr)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Karen_O'D/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Daniela Hernandez,\u003c/strong>\u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2014/01/survey-finds-wealthier-patients-in-california-more-satisfied-with-their-health-care/\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Money may not buy happiness, but patients with more money to spend tend to be happier with their health care providers, a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BCSF_leveling_the_playing_field.pdf\" target=\"_blank\">statewide survey\u003c/a> sponsored by the Blue Shield of California Foundation found.\u003c/p>\n\u003cp>Based on responses from 1,500 California residents, researchers found that among those whose household incomes fell below 200 percent of the federal poverty line, only about half said the quality of their care was excellent or very good, compared to almost 70 percent of those with household incomes above 200 percent of the poverty line.\u003c/p>\n\u003cp>The underlying reasons for this disparity, according to the researchers, were not the patients’ income per se but the quality of their relationships with caregivers. Low-income people — who often get their care from resource-strapped community clinics and emergency rooms — tended to see different providers each time they sought care, felt less involved in their own health care decision-making and felt less connected to the facilities where they were treated.\u003c!--more-->\u003c/p>\n\u003cp>By focusing on improving satisfaction and communicating better with patients, health systems serving low-income populations might deliver better care and ultimately better outcomes — without necessarily spending more money, the researchers said. This survey is one in a series. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/24/low-income-californians-want-to-be-engaged-patients-too-shared-decision-making/\" target=\"_blank\">A previous report\u003c/a> showed that low-income Californians want to be more engaged with their care.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“It comes down to customer service,” said Peter Long, the president and CEO of the foundation. “Instead of worrying about problems that could take years to fix, let’s start working today on communication, information and trust.”\u003c/p>\n\u003cp>This \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/November/21/iowa-accountable-care-organization-aco.aspx\" target=\"_blank\">patient-centered, team-based approach\u003c/a> is cheaper — and possibly more effective long-term — than recruiting extra doctors or investing in high-tech gadgets, Long said.\u003c/p>\n\u003cp>When health care providers take the time to get to know their patients, earn their trust and use technology to stay in contact, patients feel more engaged in their health, the researchers said. That’s especially important with low-income populations, which tend to have higher rates of budget-busting chronic conditions like diabetes, obesity and heart disease. Making these patients active participants in their care could ultimately help with prevention and costs, Long said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>This philosophy is the cornerstone of the so-called patient-centered medical home, a model of primary care focused on prevention and treating patients with teams of doctors, nurses and other support staff.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17070\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://www.flickr.com/photos/karen_od/3873637691/sizes/l/\">\u003cimg class=\"size-large wp-image-17070\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/3873637691_10b1718f79_b-640x426.jpg\" alt=\"(Karen_O'D/Flickr)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Karen_O'D/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Daniela Hernandez,\u003c/strong>\u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2014/01/survey-finds-wealthier-patients-in-california-more-satisfied-with-their-health-care/\" target=\"_blank\"> Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Money may not buy happiness, but patients with more money to spend tend to be happier with their health care providers, a \u003ca href=\"http://www.blueshieldcafoundation.org/sites/default/files/publications/downloadable/BCSF_leveling_the_playing_field.pdf\" target=\"_blank\">statewide survey\u003c/a> sponsored by the Blue Shield of California Foundation found.\u003c/p>\n\u003cp>Based on responses from 1,500 California residents, researchers found that among those whose household incomes fell below 200 percent of the federal poverty line, only about half said the quality of their care was excellent or very good, compared to almost 70 percent of those with household incomes above 200 percent of the poverty line.\u003c/p>\n\u003cp>The underlying reasons for this disparity, according to the researchers, were not the patients’ income per se but the quality of their relationships with caregivers. Low-income people — who often get their care from resource-strapped community clinics and emergency rooms — tended to see different providers each time they sought care, felt less involved in their own health care decision-making and felt less connected to the facilities where they were treated.\u003c!--more-->\u003c/p>\n\u003cp>By focusing on improving satisfaction and communicating better with patients, health systems serving low-income populations might deliver better care and ultimately better outcomes — without necessarily spending more money, the researchers said. This survey is one in a series. \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/10/24/low-income-californians-want-to-be-engaged-patients-too-shared-decision-making/\" target=\"_blank\">A previous report\u003c/a> showed that low-income Californians want to be more engaged with their care.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It comes down to customer service,” said Peter Long, the president and CEO of the foundation. “Instead of worrying about problems that could take years to fix, let’s start working today on communication, information and trust.”\u003c/p>\n\u003cp>This \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2013/November/21/iowa-accountable-care-organization-aco.aspx\" target=\"_blank\">patient-centered, team-based approach\u003c/a> is cheaper — and possibly more effective long-term — than recruiting extra doctors or investing in high-tech gadgets, Long said.\u003c/p>\n\u003cp>When health care providers take the time to get to know their patients, earn their trust and use technology to stay in contact, patients feel more engaged in their health, the researchers said. That’s especially important with low-income populations, which tend to have higher rates of budget-busting chronic conditions like diabetes, obesity and heart disease. Making these patients active participants in their care could ultimately help with prevention and costs, Long said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>This philosophy is the cornerstone of the so-called patient-centered medical home, a model of primary care focused on prevention and treating patients with teams of doctors, nurses and other support staff.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_16645\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/IMG_0355-e1386806769336.jpg\">\u003cimg class=\"size-large wp-image-16645\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/IMG_0355-640x480.jpg\" alt=\"IMG_0355\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jon Wheeler, 35, struggled with his own abusive behaviors before finding Men Evolving Non-Violently (M.E.N.). The organization has helped the Occidental resident change his behavior and now he leads support groups for other men.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor’s Note: Jon Wheeler used to have a difficult time controlling his anger in romantic relationships. As part of our occasional series, \"What's Your Story?\" Wheeler shares how a group in Santa Rosa called \u003ca href=\"http://www.sonomacountymen.org\">Men Evolving Non-Violently\u003c/a>, or M.E.N., helped him change his abusive behaviors. Now, he leads those same groups, helping other men who struggle with violent behavior.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Jon Wheeler\u003c/strong>\u003c/p>\n\u003cp>I’d be in a relationship with a woman and whatever was going on in the relationship, I would respond to it with anger. Like, I might even tell you in my words that I’m supporting you, but my tone of voice would say, ‘You’re an idiot and I don’t respect you.' And I've been physically violent with a woman a few times in my life. It has come to that.\u003c/p>\n\u003cp>I felt guilty for my behavior, and I could see the way that I was acting was driving away a person that I was trying to hold close.\u003c!--more-->\u003c/p>\n\u003cp>I’m the sixth of seven children, and there was a ton of fighting between siblings as a kid. And then my own parents hit me when I was a kid, and (there was) a lot of yelling. Those were the tools that were taught to me for how to deal with things that you don’t like that come up in life.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Seeing my own violent behavior and knowing that I wanted to change it and didn’t know how to do that, I felt terrified that that’s who I am. That I’m a violent man and there’s nothing I can do about it.\u003c/p>\n\u003cp>My first night with M.E.N., I felt a little bit scared that I was going to try to something and fail at it. Because that was my experience: I wanted to connect with women and I had an experience of failing at that over and over and over again.\u003c/p>\n\u003cp>I felt ashamed that I needed help. I was scared to be known among batterers. But I really believed in what I was doing and I believed deep down that those who knew what I was doing would respect it and would appreciate my effort to try to be better.\u003c/p>\n\u003cp>One of the most powerful parts of M.E.N. is that you get to be going through a process that’s shared. That all these guys who were like burly men could sit down and be gentle and be tender with one another and be like totally emotionally vulnerable.\u003c/p>\n\u003cp>I think the most important part of my journey was when I figured out that I have low self-esteem. Underneath it all is a fear of not being good enough. So, if I’m not good enough and you find someone else better, then I get left alone.\u003c/p>\n\u003cp>My participation in M.E.N. is an act of liberating myself from everything that held me captive for a couple decades. And now I can be free of that, and I can live with a heart full of love.\u003c/p>\n\u003cp>\u003cstrong>Listen to Wheeler's Story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201401060850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201401060850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16645\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/IMG_0355-e1386806769336.jpg\">\u003cimg class=\"size-large wp-image-16645\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/IMG_0355-640x480.jpg\" alt=\"IMG_0355\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jon Wheeler, 35, struggled with his own abusive behaviors before finding Men Evolving Non-Violently (M.E.N.). The organization has helped the Occidental resident change his behavior and now he leads support groups for other men.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor’s Note: Jon Wheeler used to have a difficult time controlling his anger in romantic relationships. As part of our occasional series, \"What's Your Story?\" Wheeler shares how a group in Santa Rosa called \u003ca href=\"http://www.sonomacountymen.org\">Men Evolving Non-Violently\u003c/a>, or M.E.N., helped him change his abusive behaviors. Now, he leads those same groups, helping other men who struggle with violent behavior.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Jon Wheeler\u003c/strong>\u003c/p>\n\u003cp>I’d be in a relationship with a woman and whatever was going on in the relationship, I would respond to it with anger. Like, I might even tell you in my words that I’m supporting you, but my tone of voice would say, ‘You’re an idiot and I don’t respect you.' And I've been physically violent with a woman a few times in my life. It has come to that.\u003c/p>\n\u003cp>I felt guilty for my behavior, and I could see the way that I was acting was driving away a person that I was trying to hold close.\u003c!--more-->\u003c/p>\n\u003cp>I’m the sixth of seven children, and there was a ton of fighting between siblings as a kid. And then my own parents hit me when I was a kid, and (there was) a lot of yelling. Those were the tools that were taught to me for how to deal with things that you don’t like that come up in life.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Seeing my own violent behavior and knowing that I wanted to change it and didn’t know how to do that, I felt terrified that that’s who I am. That I’m a violent man and there’s nothing I can do about it.\u003c/p>\n\u003cp>My first night with M.E.N., I felt a little bit scared that I was going to try to something and fail at it. Because that was my experience: I wanted to connect with women and I had an experience of failing at that over and over and over again.\u003c/p>\n\u003cp>I felt ashamed that I needed help. I was scared to be known among batterers. But I really believed in what I was doing and I believed deep down that those who knew what I was doing would respect it and would appreciate my effort to try to be better.\u003c/p>\n\u003cp>One of the most powerful parts of M.E.N. is that you get to be going through a process that’s shared. That all these guys who were like burly men could sit down and be gentle and be tender with one another and be like totally emotionally vulnerable.\u003c/p>\n\u003cp>I think the most important part of my journey was when I figured out that I have low self-esteem. Underneath it all is a fear of not being good enough. So, if I’m not good enough and you find someone else better, then I get left alone.\u003c/p>\n\u003cp>My participation in M.E.N. is an act of liberating myself from everything that held me captive for a couple decades. And now I can be free of that, and I can live with a heart full of love.\u003c/p>\n\u003cp>\u003cstrong>Listen to Wheeler's Story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\" classid=\"d27cdb6e-ae6d-11cf-96b8-444553540000\" codebase=\"http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201401060850c.xml\">\u003cparam name=\"src\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cembed width=\"335\" height=\"85\" type=\"application/x-shockwave-flash\" src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" flashvars=\"file=http://www.kqed.org/radio/archives/R201401060850c.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003cem>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Phyllis.jpg\">\u003cimg class=\"alignnone size-large wp-image-16964\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Phyllis-640x425.jpg\" alt=\"Phyllis\" width=\"640\" height=\"425\">\u003c/a>Editor’s Note: Eighty-three-year-old Phyllis Donner Wolf figured she would live on her own until the end of her life and die peacefully in her sleep. But last spring, she fell and broke her neck, leaving her paralyzed from the chest down. She went from living independently in her apartment in Palo Alto to a nursing facility in San Francisco called the Jewish Home. As part of our ongoing series of first-person health profiles called \"What's Your Story?\" we talk to Wolf about what it takes to live a life of grace in a nursing home.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Phyllis Donner Wolf\u003c/strong>\u003c/p>\n\u003cp>I was very active. I did yoga. I did yoga for 40 years. I was in an exercise class that met every morning at quarter to 8. I drove the car for friends to go to the symphony in the city. I was the one who took someone’s walker and put it in the trunk. So when I fell it was unbelievable. I didn’t dream I would wind up in a wheelchair.\u003c/p>\n\u003cp>I stood up in the middle of the night, which I often would just walk to the bathroom, and this time when I stood up I found myself on the floor. I think I heard a crack, which meant that my neck and spine, the bones just were brittle and broke. And I knew I had done great damage because I could not move the lower part of me.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Institutional living means you put your body and yourself into someone else’s control. I was expected to have a shower at a certain time, and I was expected to go to bed at a certain time, I was expected to get up and get dressed at a certain time. And that’s still difficult. Especially when you’ve been so independent.\u003c/p>\n\u003cp>What I see here are people who are well taken care of; people who are very limited physically and mentally. My first shock at seeing the dining room with people who could not feed themselves or whose heads are down in their lap, was like, \"How am I going to eat in here every night?\"\u003c/p>\n\u003cp>You can choose to go in your bedroom, lock the door, never see people, mope, complain. Or you can just face life. I mean this is what's happened to you, deal with it.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>I just feel that it’s more fun to laugh and smile than to really weep over what’s taken place for me or for the other people. I’m going to make my fun. I’m going to make my laugh, my smile, I’m not going to let it get me down.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Phyllis.jpg\">\u003cimg class=\"alignnone size-large wp-image-16964\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/Phyllis-640x425.jpg\" alt=\"Phyllis\" width=\"640\" height=\"425\">\u003c/a>Editor’s Note: Eighty-three-year-old Phyllis Donner Wolf figured she would live on her own until the end of her life and die peacefully in her sleep. But last spring, she fell and broke her neck, leaving her paralyzed from the chest down. She went from living independently in her apartment in Palo Alto to a nursing facility in San Francisco called the Jewish Home. As part of our ongoing series of first-person health profiles called \"What's Your Story?\" we talk to Wolf about what it takes to live a life of grace in a nursing home.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Phyllis Donner Wolf\u003c/strong>\u003c/p>\n\u003cp>I was very active. I did yoga. I did yoga for 40 years. I was in an exercise class that met every morning at quarter to 8. I drove the car for friends to go to the symphony in the city. I was the one who took someone’s walker and put it in the trunk. So when I fell it was unbelievable. I didn’t dream I would wind up in a wheelchair.\u003c/p>\n\u003cp>I stood up in the middle of the night, which I often would just walk to the bathroom, and this time when I stood up I found myself on the floor. I think I heard a crack, which meant that my neck and spine, the bones just were brittle and broke. And I knew I had done great damage because I could not move the lower part of me.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "San Francisco's Chinese Community Health Plan Diversifies, Sort Of, Under Obamacare",
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"content": "\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_16890\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8056_L1006917-lpr.jpg\">\u003cimg class=\"size-large wp-image-16890\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8056_L1006917-lpr-640x427.jpg\" alt=\"CCHP enrollment counselor Kristen Chow explains Covered California and federal subsidies to a Chinese-language caller. Currently, more than 90 percent of the HMO's members are ethnically Chinese. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">CCHP enrollment counselor Kristen Chow explains Covered California and federal subsidies to a Chinese-language caller. Currently, more than 90 percent of the HMO's members are ethnically Chinese. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Valerie Hamilton\u003c/strong>\u003c/p>\n\u003cp>\u003cspan>The kitchen at San Francisco's Chinese Hospital is a little different from other hospital cafeterias in the city. The commercial steel kitchen range where you might expect big vats of orange hospital Jell-O to be stewing is here topped with industrial-sized woks. Cooks hired from local Chinatown restaurants are frying Chinese broccoli, onions and noodles.\u003c/span>\u003c/p>\n\u003cp>\u003cspan>Larry Loo was born in Chinese Hospital. Now he's the director of business development for Chinese Community Health Plan (CCHP), the HMO affiliated with the hospital and 15 clinics around San Francisco. CCHP has 15,000 members. More than 90 percent of them are Chinese Americans. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_16889\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8055_L1007003-lpr.jpg\">\u003cimg class=\"size-medium wp-image-16889\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8055_L1007003-lpr-300x200.jpg\" alt=\"The walk-in service center for CCHP members in San Francisco's Chinatown. "We want to make sure the existing community is taken care of," says director of business development Larry Loo. "To the extent that it broadens out, that's great." (Marcus Teply/KQED)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The walk-in service center for CCHP members in San Francisco's Chinatown. \"We want to make sure the existing community is taken care of,\" says director of business development Larry Loo. \"To the extent that it broadens out, that's great.\" (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>But that may soon change. CCHP is one of 11 insurers statewide -- along with big names like Kaiser and Anthem Blue Cross -- vying for new customers on Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The hospital and the health plan have made their name providing what's called \"culturally competent\" care to patients from the city's Chinese community. That goes beyond stir-fried hospital food. Here, people speak Mandarin and Cantonese, the plan covers Eastern medicine, and staff understand Chinese patients' attitudes about health and medical care.\u003c/p>\n\u003cp>\"The reason we're even here is because the Chinese community always had a tough time getting access to care, getting access to doctors that speak their language and understand their needs,\" Loo explains.\u003c/p>\n\u003cp>The health plan's roots go back more than 100 years, to a time when widespread racial discrimination meant San Francisco's Chinese were excluded from mainstream health care. The community founded its own medical dispensary in Chinatown to meet the need. That grew into the Chinese Hospital and later, in the 80s, into the Chinese Community Health Plan.\u003c!--more-->\u003c/p>\n\u003cp>Through it all, they've kept a strongly Chinese identity. When they decided to join Covered California, to make sure their existing members could take advantage of federal subsidies, it was a big step into the multicultural unknown.\u003c/p>\n\u003cp>Dr. Gustin Ho is a primary care physician in CCHP's network. He says it's time for CCHP to become more diverse.\u003c/p>\n\u003cp>\"Diversity is the way to go, because that's how the society is,\" Ho says. \"I'm not saying it's good or it's bad, but you have to adapt to it. … Are we ready for this change? I think so. The time has come.\"\u003c/p>\n\u003cfigure id=\"attachment_16888\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8054_L1006992-lpr.jpg\">\u003cimg class=\"size-medium wp-image-16888 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8054_L1006992-lpr-300x200.jpg\" alt='Cooks in the Chinese Hospital kitchen stir-fry Chinese broccoli. The hospital and its CCHP health plan focus on \"culturally competent\" care for Chinese-American patients; that includes Mandarin- and Cantonese-speaking doctors, coverage for some Eastern medicine, and Chinese hospital food. (Marcus Teply/KQED)' width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cooks in the Chinese Hospital kitchen stir-fry Chinese broccoli. The hospital and its CCHP health plan focus on \"culturally competent\" care for Chinese-American patients; that includes Mandarin- and Cantonese-speaking doctors, coverage for some Eastern medicine, and Chinese hospital food. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Across the city from the Chinatown neighborhood, Mari Duarte is juggling walk-ins and calls at a CCHP enrollment center in San Francisco's ethnically diverse Mission district. CCHP opened the center this fall, to try reach out to people who might not know the plan is open to all people.\u003c/p>\n\u003cp>\"Our focus is more here to the Latinos,\" Duarte says. \"because they're not aware that anyone can come here and sign up, not just the Chinese community.\"\u003c/p>\n\u003cp>But in practice, most of CCHP's own marketing efforts have been directed at the Chinese community. The Spanish-language section of its website is mostly in English, and the people in the website photos are still Asian. The health plan has just two Spanish-speaking enrollers. And for customer service in languages other than English, Mandarin and Cantonese, they rely on phone interpreters.\u003c/p>\n\u003cp>Brenda Yee is the CEO of both the health plan and the hospital. She says she'd like the HMO to remain majority Asian, and that caring for a more diverse population through Covered California won't change who they are.\u003c/p>\n\u003cp>\"Our primary goal is to serve the Asian community,\" Yee says. \"We know where … everything started. So we won't lose our identity. You know people question, 'Why don't we change our name?' and I said, 'Why? No, we are the Chinese Community Health Plan.' It's just that we're serving a lot more other people other than the Chinese now.\"\u003c/p>\n\u003cp>Not as many, though, as they might, in a diverse region like the San Francisco Bay Area.\u003c/p>\n\u003cp>As of mid-December, Chinese Community Health Plan had enrolled more than 2600 new members through Covered California. Of those, almost three-quarters identified themselves as ethnically Chinese.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_16887\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8053_L1006982-lpr.jpg\">\u003cimg class=\"size-large wp-image-16887\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8053_L1006982-lpr-640x427.jpg\" alt=\"Chinese Community Health Plan CEO Brenda Yee shows visitors a model of the new Chinese Hospital building. "We know where our culture, we know where our foundation, where everything started," she says. "We won't lose our identity." (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chinese Community Health Plan CEO Brenda Yee shows visitors a model of the new Chinese Hospital building. \"We know where our culture, we know where our foundation, where everything started,\" she says. \"We won't lose our identity.\" (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16886\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8052_L1006938-lpr.jpg\">\u003cimg class=\"size-large wp-image-16886\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8052_L1006938-lpr-640x427.jpg\" alt=\"A woman waits to see Dr. Gustin Ho at his office in San Francisco's Chinatown. Ho says 99 percent of his current patients are ethnically Chinese, but that for CCHP, "diversity is the way to go." (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A woman waits to see Dr. Gustin Ho at his office in San Francisco's Chinatown. Ho says 99 percent of his current patients are ethnically Chinese, but that for CCHP, \"diversity is the way to go.\" (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16885\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8051_L1006929-lpr.jpg\">\u003cimg class=\"size-large wp-image-16885\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8051_L1006929-lpr-640x427.jpg\" alt=\"CCHP's motto, "caring for generations," in action at the entrance to Dr. Gustin Ho's medical practice in Chinatown. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">CCHP's motto, \"caring for generations,\" in action at the entrance to Dr. Gustin Ho's medical practice in Chinatown. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16884\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8050_L1006926-lpr.jpg\">\u003cimg class=\"size-large wp-image-16884\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8050_L1006926-lpr-640x427.jpg\" alt=\"A man reads a Chinese-language newspaper in San Francisco's Chinatown. In the 19th century, the Chinese community was often excluded from mainstream healthcare, and in response, it founded its own Tung Wah medical dispensary. That grew into Chinese Hospital, and later, into CCHP. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A man reads a Chinese-language newspaper in San Francisco's Chinatown. In the 19th century, the Chinese community was often excluded from mainstream healthcare, and in response, it founded its own Tung Wah medical dispensary. That grew into Chinese Hospital, and later, into CCHP. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16883\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8049_L1006890-lpr.jpg\">\u003cimg class=\"size-large wp-image-16883\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8049_L1006890-lpr-640x427.jpg\" alt=\"Chinese Community Health Plan's main office, in San Francisco's Chinatown. The historically Chinese-American HMO joined Covered California this year. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chinese Community Health Plan's main office, in San Francisco's Chinatown. The historically Chinese-American HMO joined Covered California this year. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_16890\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8056_L1006917-lpr.jpg\">\u003cimg class=\"size-large wp-image-16890\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8056_L1006917-lpr-640x427.jpg\" alt=\"CCHP enrollment counselor Kristen Chow explains Covered California and federal subsidies to a Chinese-language caller. Currently, more than 90 percent of the HMO's members are ethnically Chinese. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">CCHP enrollment counselor Kristen Chow explains Covered California and federal subsidies to a Chinese-language caller. Currently, more than 90 percent of the HMO's members are ethnically Chinese. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Valerie Hamilton\u003c/strong>\u003c/p>\n\u003cp>\u003cspan>The kitchen at San Francisco's Chinese Hospital is a little different from other hospital cafeterias in the city. The commercial steel kitchen range where you might expect big vats of orange hospital Jell-O to be stewing is here topped with industrial-sized woks. Cooks hired from local Chinatown restaurants are frying Chinese broccoli, onions and noodles.\u003c/span>\u003c/p>\n\u003cp>\u003cspan>Larry Loo was born in Chinese Hospital. Now he's the director of business development for Chinese Community Health Plan (CCHP), the HMO affiliated with the hospital and 15 clinics around San Francisco. CCHP has 15,000 members. More than 90 percent of them are Chinese Americans. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_16889\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8055_L1007003-lpr.jpg\">\u003cimg class=\"size-medium wp-image-16889\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8055_L1007003-lpr-300x200.jpg\" alt=\"The walk-in service center for CCHP members in San Francisco's Chinatown. "We want to make sure the existing community is taken care of," says director of business development Larry Loo. "To the extent that it broadens out, that's great." (Marcus Teply/KQED)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The walk-in service center for CCHP members in San Francisco's Chinatown. \"We want to make sure the existing community is taken care of,\" says director of business development Larry Loo. \"To the extent that it broadens out, that's great.\" (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>But that may soon change. CCHP is one of 11 insurers statewide -- along with big names like Kaiser and Anthem Blue Cross -- vying for new customers on Covered California, the state's health insurance marketplace.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The hospital and the health plan have made their name providing what's called \"culturally competent\" care to patients from the city's Chinese community. That goes beyond stir-fried hospital food. Here, people speak Mandarin and Cantonese, the plan covers Eastern medicine, and staff understand Chinese patients' attitudes about health and medical care.\u003c/p>\n\u003cp>\"The reason we're even here is because the Chinese community always had a tough time getting access to care, getting access to doctors that speak their language and understand their needs,\" Loo explains.\u003c/p>\n\u003cp>The health plan's roots go back more than 100 years, to a time when widespread racial discrimination meant San Francisco's Chinese were excluded from mainstream health care. The community founded its own medical dispensary in Chinatown to meet the need. That grew into the Chinese Hospital and later, in the 80s, into the Chinese Community Health Plan.\u003c!--more-->\u003c/p>\n\u003cp>Through it all, they've kept a strongly Chinese identity. When they decided to join Covered California, to make sure their existing members could take advantage of federal subsidies, it was a big step into the multicultural unknown.\u003c/p>\n\u003cp>Dr. Gustin Ho is a primary care physician in CCHP's network. He says it's time for CCHP to become more diverse.\u003c/p>\n\u003cp>\"Diversity is the way to go, because that's how the society is,\" Ho says. \"I'm not saying it's good or it's bad, but you have to adapt to it. … Are we ready for this change? I think so. The time has come.\"\u003c/p>\n\u003cfigure id=\"attachment_16888\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8054_L1006992-lpr.jpg\">\u003cimg class=\"size-medium wp-image-16888 \" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8054_L1006992-lpr-300x200.jpg\" alt='Cooks in the Chinese Hospital kitchen stir-fry Chinese broccoli. The hospital and its CCHP health plan focus on \"culturally competent\" care for Chinese-American patients; that includes Mandarin- and Cantonese-speaking doctors, coverage for some Eastern medicine, and Chinese hospital food. (Marcus Teply/KQED)' width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cooks in the Chinese Hospital kitchen stir-fry Chinese broccoli. The hospital and its CCHP health plan focus on \"culturally competent\" care for Chinese-American patients; that includes Mandarin- and Cantonese-speaking doctors, coverage for some Eastern medicine, and Chinese hospital food. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Across the city from the Chinatown neighborhood, Mari Duarte is juggling walk-ins and calls at a CCHP enrollment center in San Francisco's ethnically diverse Mission district. CCHP opened the center this fall, to try reach out to people who might not know the plan is open to all people.\u003c/p>\n\u003cp>\"Our focus is more here to the Latinos,\" Duarte says. \"because they're not aware that anyone can come here and sign up, not just the Chinese community.\"\u003c/p>\n\u003cp>But in practice, most of CCHP's own marketing efforts have been directed at the Chinese community. The Spanish-language section of its website is mostly in English, and the people in the website photos are still Asian. The health plan has just two Spanish-speaking enrollers. And for customer service in languages other than English, Mandarin and Cantonese, they rely on phone interpreters.\u003c/p>\n\u003cp>Brenda Yee is the CEO of both the health plan and the hospital. She says she'd like the HMO to remain majority Asian, and that caring for a more diverse population through Covered California won't change who they are.\u003c/p>\n\u003cp>\"Our primary goal is to serve the Asian community,\" Yee says. \"We know where … everything started. So we won't lose our identity. You know people question, 'Why don't we change our name?' and I said, 'Why? No, we are the Chinese Community Health Plan.' It's just that we're serving a lot more other people other than the Chinese now.\"\u003c/p>\n\u003cp>Not as many, though, as they might, in a diverse region like the San Francisco Bay Area.\u003c/p>\n\u003cp>As of mid-December, Chinese Community Health Plan had enrolled more than 2600 new members through Covered California. Of those, almost three-quarters identified themselves as ethnically Chinese.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\u003cfigure id=\"attachment_16887\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8053_L1006982-lpr.jpg\">\u003cimg class=\"size-large wp-image-16887\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8053_L1006982-lpr-640x427.jpg\" alt=\"Chinese Community Health Plan CEO Brenda Yee shows visitors a model of the new Chinese Hospital building. "We know where our culture, we know where our foundation, where everything started," she says. "We won't lose our identity." (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chinese Community Health Plan CEO Brenda Yee shows visitors a model of the new Chinese Hospital building. \"We know where our culture, we know where our foundation, where everything started,\" she says. \"We won't lose our identity.\" (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16886\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8052_L1006938-lpr.jpg\">\u003cimg class=\"size-large wp-image-16886\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8052_L1006938-lpr-640x427.jpg\" alt=\"A woman waits to see Dr. Gustin Ho at his office in San Francisco's Chinatown. Ho says 99 percent of his current patients are ethnically Chinese, but that for CCHP, "diversity is the way to go." (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A woman waits to see Dr. Gustin Ho at his office in San Francisco's Chinatown. Ho says 99 percent of his current patients are ethnically Chinese, but that for CCHP, \"diversity is the way to go.\" (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16885\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8051_L1006929-lpr.jpg\">\u003cimg class=\"size-large wp-image-16885\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8051_L1006929-lpr-640x427.jpg\" alt=\"CCHP's motto, "caring for generations," in action at the entrance to Dr. Gustin Ho's medical practice in Chinatown. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">CCHP's motto, \"caring for generations,\" in action at the entrance to Dr. Gustin Ho's medical practice in Chinatown. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16884\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8050_L1006926-lpr.jpg\">\u003cimg class=\"size-large wp-image-16884\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8050_L1006926-lpr-640x427.jpg\" alt=\"A man reads a Chinese-language newspaper in San Francisco's Chinatown. In the 19th century, the Chinese community was often excluded from mainstream healthcare, and in response, it founded its own Tung Wah medical dispensary. That grew into Chinese Hospital, and later, into CCHP. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A man reads a Chinese-language newspaper in San Francisco's Chinatown. In the 19th century, the Chinese community was often excluded from mainstream healthcare, and in response, it founded its own Tung Wah medical dispensary. That grew into Chinese Hospital, and later, into CCHP. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\u003cfigure id=\"attachment_16883\" class=\"wp-caption alignleft\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8049_L1006890-lpr.jpg\">\u003cimg class=\"size-large wp-image-16883\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/RS8049_L1006890-lpr-640x427.jpg\" alt=\"Chinese Community Health Plan's main office, in San Francisco's Chinatown. The historically Chinese-American HMO joined Covered California this year. (Marcus Teply/KQED)\" width=\"640\" height=\"427\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chinese Community Health Plan's main office, in San Francisco's Chinatown. The historically Chinese-American HMO joined Covered California this year. (Marcus Teply/KQED)\u003c/figcaption>\u003c/figure>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "E-Cigarettes May Not Have Tobacco, But Still Pose Risks",
"title": "E-Cigarettes May Not Have Tobacco, But Still Pose Risks",
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"content": "\u003cfigure id=\"attachment_16838\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/178781443-e1387476727418.jpg\">\u003cimg class=\"size-large wp-image-16838\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/178781443-640x409.jpg\" alt=\"Woman using an e-cigarette. (Getty Images)\" width=\"640\" height=\"409\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Woman using an e-cigarette. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Kenny Goldberg, KPBS\u003c/strong>\u003c/p>\n\u003cp>While cigarettes are a familiar sight in just about any convenience store, now they're sharing space with a related product: e-cigarettes. They're not tobacco based. Instead, e-cigarettes are battery-operated devices that heat liquid nicotine and turn it into vapor. Electronic cigarettes are catching fire, especially with young people, because they offer the experience of smoking, without burning tobacco. The FDA has yet to regulate them, but many cities aren't waiting. On Thursday, the New York City Council is expected to vote on a ban, following similar moves by many California cities.\u003c/p>\n\u003cp>At Vapor Craze, an e-cigarette shop near San Diego State University, Jeff Pascua puffs away. Or, as he calls it, vapes. Every few moments, Pascua reloads his e-cigarette from a small plastic bottle.\u003c/p>\n\u003cp>\"It’s called the e-liquid juice,\" Pasqua says. \"Two types: VG and PG,\" or vegetable glyceride and propylene glyceride.\u003c/p>\n\u003cp>Pascua used to smoke cigarettes. Then he heard about e-cigarettes and decided to give them a try. He says vaping helps him curb his cravings for a real smoke.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"It’s just there when I need that feeling, you know? Breaking a habit is hard to do,\" Pasqua says.\u003c/p>\n\u003cp>Vapor Craze sells more than two dozen flavors of e-liquid juice. Pascua prefers the banana walnut flavor known as Monkey Business. While he knows the juice contains nicotine, he’s not worried about it.\u003c/p>\n\u003cp>\"From what I’ve read and seen and heard people talk about, nicotine is just like caffeine, good in moderation,\" Pasqua said. \"I’m not saying everyone should do it, but in moderation it’s not harmful enough.\"\u003c/p>\n\u003cp>E-cigarettes were invented in China and introduced in the U.S. in 2006.\u003c/p>\n\u003cp>Since then, they’ve become a multi-billion dollar industry. But unlike tobacco products, e-cigarettes aren’t regulated by the FDA. As a result, \u003ca href=\"http://www.youtube.com/watch?v=XQYyXGqlx2U\" target=\"_blank\">ads like these\u003c/a> are all over TV.\u003c/p>\n\u003cp>\u003cstrong>California Cities Regulating E-Cigarettes\u003c/strong>\u003c/p>\n\u003cp>More than 40 California cities aren’t waiting for the FDA to act. They’ve taken their own steps to restrict e-cigarettes. Earlier this month, the Los Angeles city council voted to ban sales to minors and require e-cigarette vendors to be licensed. The Richmond and Carlsbad city councils have gone even further. They’ve approved a ban on e-cigarettes wherever smoking is prohibited.\u003c/p>\n\u003cp>Stan Glantz directs the Center for Tobacco Control Research and Education at U.C. San Francisco.\u003c/p>\n\u003cp>\"E-cigarettes aren’t as polluting as conventional cigarettes, but they’re still polluting the air,\" he said.\u003c/p>\n\u003cp>Glantz explains e-cigarette vapor contains nicotine, heavy metals, and ultra-fine particles. He says regardless of what the FDA eventually decides, it still has no authority to regulate where e-cigarettes are used.\u003c/p>\n\u003cp>\"If you want to have clean indoor air, which is something we’ve a long tradition of now in California, it just makes no sense to reintroduce the kind of air pollution that e-cigarettes create,\" Glantz argues. \"So it’s very sensible that cities are moving in this area.\"\u003c/p>\n\u003cp>A bill to restrict e-cigarettes throughout California cleared the state Senate earlier this year. It’s awaiting action in the state Assembly. In the meantime, the \u003ca href=\"http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html\" target=\"_blank\">Centers for Disease Control says \u003c/a>1.8 million teens used e-cigarettes last year -- double the year before. Word on the street is that e-cigarettes are cool and high tech. The big question is: are they dangerous?\u003c/p>\n\u003cp>Dr. Thomas Novotny is a former U.S. assistant surgeon general. He’s also a professor in San Diego State’s graduate school of public health. He says we don't know what the hazards are because research on e-cigarettes has not yet been done. But he surmises the biggest risks are nicotine addiction and what he called the \"re-normalization\" of smoking.\u003c/p>\n\u003cp>\u003cspan>\"This is really disturbing, because it’s taken us decades to get smoking to be less than socially acceptable and to be restricted in public places, so that people are free from the exposure\" and to reduce the number of teens who take up the habit, he says.\u003c/span>\u003c/p>\n\u003cp>Back at Vapor Craze, Vance Pope doesn’t buy the arguments against e-cigarettes. Pope works at the shop. He says flavors like \"sugar daddy\" and \"juicy booty\" aren’t designed for kids. He says his store doesn’t let kids under 18 buy e-cigarettes.\u003c/p>\n\u003cp>\"I don’t condone anyone under 18 to do it,\" Pope says, \"but as long as they’re 18, I feel like that’s their choice.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The FDA has been talking about regulating e-cigarettes since 2009. An announcement could come later this month.\u003c/p>\n\n",
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"excerpt": "While cigarettes are a familiar sight in just about any convenience store, now they're sharing space with a related product: e-cigarettes. They're not tobacco based. Instead, e-cigarettes are battery-operated devices that heat liquid nicotine and turn it into vapor. Electronic cigarettes are catching fire, especially with young people, because they offer the experience of smoking, without burning tobacco. The FDA has yet to regulate them, but many cities aren't waiting. On Thursday, the New York City Council is expected to vote on a ban, following similar moves by many California cities.\r\n\r\nAt Vapor Craze, an e-cigarette shop near San Diego State University, Jeff Pascua puffs away. Or, as he calls it, vapes. Every few moments, Pascua reloads his e-cigarette from a small plastic bottle.",
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"description": "While cigarettes are a familiar sight in just about any convenience store, now they're sharing space with a related product: e-cigarettes. They're not tobacco based. Instead, e-cigarettes are battery-operated devices that heat liquid nicotine and turn it into vapor. Electronic cigarettes are catching fire, especially with young people, because they offer the experience of smoking, without burning tobacco. The FDA has yet to regulate them, but many cities aren't waiting. On Thursday, the New York City Council is expected to vote on a ban, following similar moves by many California cities.\r\n\r\nAt Vapor Craze, an e-cigarette shop near San Diego State University, Jeff Pascua puffs away. Or, as he calls it, vapes. Every few moments, Pascua reloads his e-cigarette from a small plastic bottle.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16838\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/178781443-e1387476727418.jpg\">\u003cimg class=\"size-large wp-image-16838\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/178781443-640x409.jpg\" alt=\"Woman using an e-cigarette. (Getty Images)\" width=\"640\" height=\"409\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Woman using an e-cigarette. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Kenny Goldberg, KPBS\u003c/strong>\u003c/p>\n\u003cp>While cigarettes are a familiar sight in just about any convenience store, now they're sharing space with a related product: e-cigarettes. They're not tobacco based. Instead, e-cigarettes are battery-operated devices that heat liquid nicotine and turn it into vapor. Electronic cigarettes are catching fire, especially with young people, because they offer the experience of smoking, without burning tobacco. The FDA has yet to regulate them, but many cities aren't waiting. On Thursday, the New York City Council is expected to vote on a ban, following similar moves by many California cities.\u003c/p>\n\u003cp>At Vapor Craze, an e-cigarette shop near San Diego State University, Jeff Pascua puffs away. Or, as he calls it, vapes. Every few moments, Pascua reloads his e-cigarette from a small plastic bottle.\u003c/p>\n\u003cp>\"It’s called the e-liquid juice,\" Pasqua says. \"Two types: VG and PG,\" or vegetable glyceride and propylene glyceride.\u003c/p>\n\u003cp>Pascua used to smoke cigarettes. Then he heard about e-cigarettes and decided to give them a try. He says vaping helps him curb his cravings for a real smoke.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"It’s just there when I need that feeling, you know? Breaking a habit is hard to do,\" Pasqua says.\u003c/p>\n\u003cp>Vapor Craze sells more than two dozen flavors of e-liquid juice. Pascua prefers the banana walnut flavor known as Monkey Business. While he knows the juice contains nicotine, he’s not worried about it.\u003c/p>\n\u003cp>\"From what I’ve read and seen and heard people talk about, nicotine is just like caffeine, good in moderation,\" Pasqua said. \"I’m not saying everyone should do it, but in moderation it’s not harmful enough.\"\u003c/p>\n\u003cp>E-cigarettes were invented in China and introduced in the U.S. in 2006.\u003c/p>\n\u003cp>Since then, they’ve become a multi-billion dollar industry. But unlike tobacco products, e-cigarettes aren’t regulated by the FDA. As a result, \u003ca href=\"http://www.youtube.com/watch?v=XQYyXGqlx2U\" target=\"_blank\">ads like these\u003c/a> are all over TV.\u003c/p>\n\u003cp>\u003cstrong>California Cities Regulating E-Cigarettes\u003c/strong>\u003c/p>\n\u003cp>More than 40 California cities aren’t waiting for the FDA to act. They’ve taken their own steps to restrict e-cigarettes. Earlier this month, the Los Angeles city council voted to ban sales to minors and require e-cigarette vendors to be licensed. The Richmond and Carlsbad city councils have gone even further. They’ve approved a ban on e-cigarettes wherever smoking is prohibited.\u003c/p>\n\u003cp>Stan Glantz directs the Center for Tobacco Control Research and Education at U.C. San Francisco.\u003c/p>\n\u003cp>\"E-cigarettes aren’t as polluting as conventional cigarettes, but they’re still polluting the air,\" he said.\u003c/p>\n\u003cp>Glantz explains e-cigarette vapor contains nicotine, heavy metals, and ultra-fine particles. He says regardless of what the FDA eventually decides, it still has no authority to regulate where e-cigarettes are used.\u003c/p>\n\u003cp>\"If you want to have clean indoor air, which is something we’ve a long tradition of now in California, it just makes no sense to reintroduce the kind of air pollution that e-cigarettes create,\" Glantz argues. \"So it’s very sensible that cities are moving in this area.\"\u003c/p>\n\u003cp>A bill to restrict e-cigarettes throughout California cleared the state Senate earlier this year. It’s awaiting action in the state Assembly. In the meantime, the \u003ca href=\"http://www.cdc.gov/media/releases/2013/p0905-ecigarette-use.html\" target=\"_blank\">Centers for Disease Control says \u003c/a>1.8 million teens used e-cigarettes last year -- double the year before. Word on the street is that e-cigarettes are cool and high tech. The big question is: are they dangerous?\u003c/p>\n\u003cp>Dr. Thomas Novotny is a former U.S. assistant surgeon general. He’s also a professor in San Diego State’s graduate school of public health. He says we don't know what the hazards are because research on e-cigarettes has not yet been done. But he surmises the biggest risks are nicotine addiction and what he called the \"re-normalization\" of smoking.\u003c/p>\n\u003cp>\u003cspan>\"This is really disturbing, because it’s taken us decades to get smoking to be less than socially acceptable and to be restricted in public places, so that people are free from the exposure\" and to reduce the number of teens who take up the habit, he says.\u003c/span>\u003c/p>\n\u003cp>Back at Vapor Craze, Vance Pope doesn’t buy the arguments against e-cigarettes. Pope works at the shop. He says flavors like \"sugar daddy\" and \"juicy booty\" aren’t designed for kids. He says his store doesn’t let kids under 18 buy e-cigarettes.\u003c/p>\n\u003cp>\"I don’t condone anyone under 18 to do it,\" Pope says, \"but as long as they’re 18, I feel like that’s their choice.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The FDA has been talking about regulating e-cigarettes since 2009. An announcement could come later this month.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "After Years of Budget Cuts, More Psychiatric Resources Coming",
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"content": "\u003cfigure id=\"attachment_16785\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-e1387328697174.jpg\">\u003cimg class=\"size-large wp-image-16785\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-640x421.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"421\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\u003c/p>\n\u003cp>Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.\u003c/p>\n\u003cp>On a recent night Fox walked San Francisco's Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.\u003c/p>\n\u003cp>He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn't well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn't let me stay longer, so they made me leave.”\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>San Francisco General’s psychiatry department is down to 20 acute beds, and all of them were full. The Navy vet said he became even more depressed because he wasn’t getting the help he needed. “So I felt like ending it. And that’s what happened.”\u003c/p>\n\u003cp>A few hours after he left the hospital, he said he tried to jump in front of a bus, but a friend pulled him away at the last moment, and he wasn't hurt.\u003c/p>\n\u003cp>At one time this man might have been admitted for treatment. In 2000, for example, San Francisco General had ten times more inpatient psychiatric beds than it has now. But since then there has been a big shift in how psychiatric care is delivered, away from locked hospitals.\u003c/p>\n\u003cp>\u003cstrong>Residential vs. Hospital-Based Treatment\u003c/strong>\u003c/p>\n\u003cp>Dr. Mark Leary, deputy director of U.C. San Francisco’s psychiatry department at S.F. General, said high staffing requirements make inpatient care the most expensive way to treat severely ill patients. Hospital care is also restrictive and, as some mental health advocates believe, inhumane. Leary said San Francisco closed 180 emergency inpatient psychiatry beds and shifted the funding into residential care.\u003c/p>\n\u003cp>“We have community services where patients can get intensive treatment in a residential setting,” said Leary. “They're there in a house with mental health staff. They can receive medications, psychotherapy, social support, and safety in that setting, and it doesn't require a hospital to deliver it,” he said.\u003c/p>\n\u003cp>That sounds like just the type of treatment people such as the Navy veteran need. Yet he and other homeless people with a mental illness remain on the streets. Fr. Fox said San Francisco may have good community services, but it still lacks the one thing many mentally ill homeless people need. “If they need a bed, it's a disaster. There's hardly any places,” said Fox.\u003c/p>\n\u003cp>A hard-to-reach contingent of people cycle in and out of the ER, sometimes taking their medication, sometimes not, but never really recovering. This population of patients needs more structured intervention, says Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital in Mountain View. “We have streets full of people with significant mental illness who are not receiving the care that they need,” said Fitzgerald. “And when they're in an acute crisis, often they're not going to go to drop-in clinics. It's not meeting the patient where they're at or what they need,” he said.\u003c/p>\n\u003cp>\u003cstrong>Crisis Stabilization\u003c/strong>\u003c/p>\n\u003cp>The problem, according to Fitzgerald, is that people in a crisis often need to be stabilized first, before they can transition to community services. Yet there hasn't been an adequate support system to help them take that crucial first step.\u003c/p>\n\u003cp>Next year, funding from a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB82\" target=\"_blank\">new law\u003c/a> will begin to provide that missing link.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable,” said Sen. Darrel Steinberg (D-Sacramento) who sponsored the law. In addition, \"the people who can help somebody get from those settings to a place where they can begin to get help.\u003c/p>\n\u003cp>Steinberg's law, the Investment in Mental Health Wellness Act, targets those gaps by providing $206 million in funding for 2000 new crisis stabilization beds, for mobile response teams and for 600 new triage workers. Steinberg says the new providers are key. The plan is to station these mental health professionals at jails and county emergency rooms to identify people in crisis and connect them with the new services.\u003c/p>\n\u003cp>Counties will be vying for the new funds, and some already have begun submitting grant proposals. A few mental health providers are even starting to feel hopeful. “We'll see how it rolls out. We'll see if the funding continues,” said Fitzgerald. “Certainly at least it's funding, and the focus on crisis stabilization is a good plan,” he said.\u003c/p>\n\u003cp>For now, after years of facing budget cutbacks, Fitzgerald is actually optimistic. He said there may finally be a chance of getting effective mental health treatment to the people who have been the hardest to reach.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125459282&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the third of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\">psychiatric inpatient services for adults\u003c/a>. In part two, she examined \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/17/how-californias-mentally-ill-children-suffer-few-hospital-beds-statewide/\" target=\"_blank\">the lack of services for children\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"excerpt": "Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\r\n\r\nFox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16785\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-e1387328697174.jpg\">\u003cimg class=\"size-large wp-image-16785\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/12/153486560-640x421.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"421\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Elaine Korry\u003c/strong>\u003c/p>\n\u003cp>Don Fox prepared for his late-night rounds. He collected a few warm blankets and protein bars, then hit the streets, seeking out people in crisis who needed food and warmth. “Our principle is, we hang out where people are,” said Fox. “We walk the streets in those areas, make eye contact, and ask if they need help.”\u003c/p>\n\u003cp>Fox is an Episcopal priest with San Francisco Night Ministry, a program founded by volunteer clergy in 1964 to serve a then-emerging population of mentally ill homeless people. A half-century later, the problem hasn't gone away.\u003c/p>\n\u003cp>On a recent night Fox walked San Francisco's Civic Center, where he met a 53-year-old Navy veteran slumped on the sidewalk. The man, a slight figure in a torn sweatshirt and Oakland A’s cap, said he had been homeless and in and out of jail for about six years.\u003c/p>\n\u003cp>He said that a few months ago, he had run out of his anti-psychotic medication, Risperdal. Late one night he started to feel suicidal and went to San Francisco General Hospital for help. “I wasn't well, put it that way,” he told me. He spent the early morning hours in the emergency department, but then said he was told to leave. “I was telling them that I needed to stay a little longer. They wouldn't let me stay longer, so they made me leave.”\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco General’s psychiatry department is down to 20 acute beds, and all of them were full. The Navy vet said he became even more depressed because he wasn’t getting the help he needed. “So I felt like ending it. And that’s what happened.”\u003c/p>\n\u003cp>A few hours after he left the hospital, he said he tried to jump in front of a bus, but a friend pulled him away at the last moment, and he wasn't hurt.\u003c/p>\n\u003cp>At one time this man might have been admitted for treatment. In 2000, for example, San Francisco General had ten times more inpatient psychiatric beds than it has now. But since then there has been a big shift in how psychiatric care is delivered, away from locked hospitals.\u003c/p>\n\u003cp>\u003cstrong>Residential vs. Hospital-Based Treatment\u003c/strong>\u003c/p>\n\u003cp>Dr. Mark Leary, deputy director of U.C. San Francisco’s psychiatry department at S.F. General, said high staffing requirements make inpatient care the most expensive way to treat severely ill patients. Hospital care is also restrictive and, as some mental health advocates believe, inhumane. Leary said San Francisco closed 180 emergency inpatient psychiatry beds and shifted the funding into residential care.\u003c/p>\n\u003cp>“We have community services where patients can get intensive treatment in a residential setting,” said Leary. “They're there in a house with mental health staff. They can receive medications, psychotherapy, social support, and safety in that setting, and it doesn't require a hospital to deliver it,” he said.\u003c/p>\n\u003cp>That sounds like just the type of treatment people such as the Navy veteran need. Yet he and other homeless people with a mental illness remain on the streets. Fr. Fox said San Francisco may have good community services, but it still lacks the one thing many mentally ill homeless people need. “If they need a bed, it's a disaster. There's hardly any places,” said Fox.\u003c/p>\n\u003cp>A hard-to-reach contingent of people cycle in and out of the ER, sometimes taking their medication, sometimes not, but never really recovering. This population of patients needs more structured intervention, says Michael Fitzgerald, executive director of Behavioral Health Services at El Camino Hospital in Mountain View. “We have streets full of people with significant mental illness who are not receiving the care that they need,” said Fitzgerald. “And when they're in an acute crisis, often they're not going to go to drop-in clinics. It's not meeting the patient where they're at or what they need,” he said.\u003c/p>\n\u003cp>\u003cstrong>Crisis Stabilization\u003c/strong>\u003c/p>\n\u003cp>The problem, according to Fitzgerald, is that people in a crisis often need to be stabilized first, before they can transition to community services. Yet there hasn't been an adequate support system to help them take that crucial first step.\u003c/p>\n\u003cp>Next year, funding from a \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB82\" target=\"_blank\">new law\u003c/a> will begin to provide that missing link.\u003c/p>\n\u003cp>“What's lacking in the system is the crisis beds that allow somebody to get stable,” said Sen. Darrel Steinberg (D-Sacramento) who sponsored the law. In addition, \"the people who can help somebody get from those settings to a place where they can begin to get help.\u003c/p>\n\u003cp>Steinberg's law, the Investment in Mental Health Wellness Act, targets those gaps by providing $206 million in funding for 2000 new crisis stabilization beds, for mobile response teams and for 600 new triage workers. Steinberg says the new providers are key. The plan is to station these mental health professionals at jails and county emergency rooms to identify people in crisis and connect them with the new services.\u003c/p>\n\u003cp>Counties will be vying for the new funds, and some already have begun submitting grant proposals. A few mental health providers are even starting to feel hopeful. “We'll see how it rolls out. We'll see if the funding continues,” said Fitzgerald. “Certainly at least it's funding, and the focus on crisis stabilization is a good plan,” he said.\u003c/p>\n\u003cp>For now, after years of facing budget cutbacks, Fitzgerald is actually optimistic. He said there may finally be a chance of getting effective mental health treatment to the people who have been the hardest to reach.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/125459282&color=ff6600&auto_play=false&show_artwork=true\" frameborder=\"no\" scrolling=\"no\" width=\"100%\" height=\"166\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Editor’s note: This is the third of three stories about psychiatric inpatient services airing this week on \u003ca href=\"http://www.californiareport.org/\" target=\"_blank\">The California Report.\u003c/a> In part one, reporter Elaine Korry looked at the lack of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/16/sharp-drop-in-psychiatric-beds-leaves-severely-mentally-ill-with-few-places-to-go/\" target=\"_blank\">psychiatric inpatient services for adults\u003c/a>. In part two, she examined \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/12/17/how-californias-mentally-ill-children-suffer-few-hospital-beds-statewide/\" target=\"_blank\">the lack of services for children\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"meta": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/californiareport",
"meta": {
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"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
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"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"here-and-now": {
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
"id": "how-i-built-this",
"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
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"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"order": 18
},
"link": "/podcasts/jerrybrown",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
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"source": "npr"
},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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"rss": "https://feeds.npr.org/510360/podcast.xml"
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