1 00:00:05,240 --> 00:00:08,400 >> MY NAME IS 2 00:00:08,400 --> 00:00:10,600 MARRAH LACHOWICZ SCROGGINS, 3 00:00:10,600 --> 00:00:13,960 PROGRAM DIRECTOR AT THE NATIONAL 4 00:00:13,960 --> 00:00:15,040 HEART LUNG AND BLOOD INSTITUTE. 5 00:00:15,040 --> 00:00:17,400 I ALSO SERVE AS THE INSTITUTE 6 00:00:17,400 --> 00:00:18,840 CO-CHAIR FOR WOMEN'S HEALTH 7 00:00:18,840 --> 00:00:19,440 WORKING GROUP. 8 00:00:19,440 --> 00:00:21,440 ON BEHALF OF A TRANS-NIH 9 00:00:21,440 --> 00:00:22,640 ORGANIZING COMMITTEE FOR THIS 10 00:00:22,640 --> 00:00:24,240 WORKSHOP, I WOULD LIKE TO EXTEND 11 00:00:24,240 --> 00:00:26,120 WELCOME TO ALL ATTENDEES WHO 12 00:00:26,120 --> 00:00:27,680 WILL JOIN TODAY FOR THE BUILDING 13 00:00:27,680 --> 00:00:29,960 UNIFYING SYSTEMS OF CARE 14 00:00:29,960 --> 00:00:31,240 ADDRESSING CO-MORBIDITIES IN 15 00:00:31,240 --> 00:00:32,440 WOMEN AND GIRLS WORKSHOP 16 00:00:32,440 --> 00:00:34,920 SPONSORED BY THE NATIONAL HEART 17 00:00:34,920 --> 00:00:37,040 LUNG AND BLOOD INSTITUTE. 18 00:00:37,040 --> 00:00:38,520 THE PURPOSE OF THE WORK SHOP IS 19 00:00:38,520 --> 00:00:40,080 TO ADDRESS THE NEED TO DEVELOP 20 00:00:40,080 --> 00:00:42,240 SUPPORT CONTINUUMS OF CARE WHICH 21 00:00:42,240 --> 00:00:44,560 WOULD ADVANCE HEALTH OF RACIAL 22 00:00:44,560 --> 00:00:46,440 ETHNIC DIVERSE WOMEN OF 23 00:00:46,440 --> 00:00:47,440 REPRODUCTIVE AGE WITH COMPLEX 24 00:00:47,440 --> 00:00:48,040 HEALTH CONDITIONS. 25 00:00:48,040 --> 00:00:49,920 TO ACHIEVE THIS GOAL THIS 26 00:00:49,920 --> 00:00:52,240 WORKSHOP WILL ADDRESS CURRENT 27 00:00:52,240 --> 00:00:53,160 GAPS AND OPPORTUNITIES TO 28 00:00:53,160 --> 00:00:56,240 IMPLEMENTING COMMUNITY ENGAGE 29 00:00:56,240 --> 00:00:57,560 RESEARCH DESEENED TO INCREASE 30 00:00:57,560 --> 00:00:59,040 ADOPTION OF INTEGRATED SET OF 31 00:00:59,040 --> 00:01:01,320 EVIDENCE BASED PRACTICES 32 00:01:01,320 --> 00:01:02,840 DELIVERED AID CROSS HEALTHCARE 33 00:01:02,840 --> 00:01:05,360 SYSTEMS INCLUDING PRIMARY 34 00:01:05,360 --> 00:01:07,440 SPECIALTY BEHAVIORAL HEALTH AND 35 00:01:07,440 --> 00:01:09,160 COMMUNITY HEALTH BASED SETTINGS. 36 00:01:09,160 --> 00:01:10,840 THE WORKSHOP PLANNING COMMITTEE 37 00:01:10,840 --> 00:01:12,840 INCLUDES TWO WORKSHOP CO-CHAIRS 38 00:01:12,840 --> 00:01:14,640 DR. CHANDER AND DR. JOHNSON, 39 00:01:14,640 --> 00:01:18,200 ALONG WITH A TRANS-NIH 40 00:01:18,200 --> 00:01:18,760 ORGANIZING COMMITTEE WHO ARE 41 00:01:18,760 --> 00:01:21,240 MEMBERS OF A TRANS-NIH WORKING 42 00:01:21,240 --> 00:01:24,640 GROUP ON ADDRESSING COMMON 43 00:01:24,640 --> 00:01:25,760 CO-MORBIDITIES IN WOMEN AND 44 00:01:25,760 --> 00:01:26,680 GIRLS. 45 00:01:26,680 --> 00:01:29,240 THESE INCLUDE DR. LAURIE DONZE 46 00:01:29,240 --> 00:01:32,120 FROM NHLBI DR. TAMARA JOHNSON, 47 00:01:32,120 --> 00:01:37,760 DR. DEIDRE ROACH FROM NIAAA AND 48 00:01:37,760 --> 00:01:40,440 DR. SMITH AND HOLLY MOORE FROM 49 00:01:40,440 --> 00:01:40,840 NIDA. 50 00:01:40,840 --> 00:01:42,200 YOU CAN SUBMIT QUESTIONS DURING 51 00:01:42,200 --> 00:01:43,840 THE Q&A MODULE DURING THE 52 00:01:43,840 --> 00:01:45,040 WORKSHOP TO ENGAGE ANY 53 00:01:45,040 --> 00:01:46,200 PRESENTERS AND MEMBERS OF THE 54 00:01:46,200 --> 00:01:47,240 PLANNING COMMITTEE WILL 55 00:01:47,240 --> 00:01:47,800 FACILITATE CONVERSATION 56 00:01:47,800 --> 00:01:48,960 THROUGHOUT THE WORKSHOP AND MANY 57 00:01:48,960 --> 00:01:50,840 OF THEM WILL ALSO BE MODERATING 58 00:01:50,840 --> 00:01:52,000 TODAY'S SESSIONS. 59 00:01:52,000 --> 00:01:53,760 THE CO-CHAIRS WILL LEAD THE 60 00:01:53,760 --> 00:01:55,440 WORKSHOP CLOSE OUT SESSION LATER 61 00:01:55,440 --> 00:01:56,320 TODAY WHERE THE GROUP WILL 62 00:01:56,320 --> 00:01:58,040 DISCUSS ANY REMAINING GRANT -- 63 00:01:58,040 --> 00:01:59,480 GAPS IN HEALTHCARE DELIVERY 64 00:01:59,480 --> 00:02:01,200 SYSTEM, AND HOW WE CAN BE 65 00:02:01,200 --> 00:02:02,440 LEVERAGING VARIOUS OPPORTUNITIES 66 00:02:02,440 --> 00:02:04,720 TO REPRODUCTIVE TRANSITION 67 00:02:04,720 --> 00:02:05,720 PERIOD, TO IMPLEMENT EVIDENCE 68 00:02:05,720 --> 00:02:07,640 BASED PRACTICES THAT WILL 69 00:02:07,640 --> 00:02:10,280 FACILITATE THE DELIVERY OF AN 70 00:02:10,280 --> 00:02:11,640 INTEGRATIVE INTERVENTION THAT 71 00:02:11,640 --> 00:02:14,040 ADDRESS INTERSEXUALITY OF COMMON 72 00:02:14,040 --> 00:02:15,880 CO-OCCURRING CONDITIONS IN WOMEN 73 00:02:15,880 --> 00:02:18,360 AND ALSO ADDRESS RACIAL ETHNIC 74 00:02:18,360 --> 00:02:20,120 DISPARITIES AND ENGAGEMENT 75 00:02:20,120 --> 00:02:21,880 RECEIPT AND RETENTION IN CARE 76 00:02:21,880 --> 00:02:24,560 AND TREATMENT AMONG HISTORICALLY 77 00:02:24,560 --> 00:02:26,040 MARGINALIZED WOMEN WITH THESE 78 00:02:26,040 --> 00:02:26,440 CO-MORBIDITIES. 79 00:02:26,440 --> 00:02:29,040 NOW I AM GOING TO TURN THIS 80 00:02:29,040 --> 00:02:31,320 WORKSHOP OVER TO OUR TWO 81 00:02:31,320 --> 00:02:33,360 CO-CHAIRS, DR. CHANDER AND 82 00:02:33,360 --> 00:02:35,400 JOHNSON TO GIVE A BRIEF RECAP OF 83 00:02:35,400 --> 00:02:37,000 THE MEETING YESTERDAY BEFORE WE 84 00:02:37,000 --> 00:02:38,040 START SESSION 4 OF THE WORKSHOP. 85 00:02:38,040 --> 00:02:40,640 THANK YOU. 86 00:02:40,640 --> 00:02:41,760 >> GOOD MORNING. 87 00:02:41,760 --> 00:02:43,440 THANKS, EVERYONE FOR JOINING US 88 00:02:43,440 --> 00:02:43,960 YESTERDAY. 89 00:02:43,960 --> 00:02:46,920 WE HAD A NUMBER OF FANTASTIC 90 00:02:46,920 --> 00:02:48,480 PRESENTATIONS THAT WE BRIEFLY 91 00:02:48,480 --> 00:02:53,920 WANTED TO RECAP. 92 00:02:53,920 --> 00:02:55,400 SO THOUGH EXISTING PRIOR TO 93 00:02:55,400 --> 00:02:56,440 PANDEMIC WHAT WAS CLEAR 94 00:02:56,440 --> 00:02:58,640 YESTERDAY AND I THINK CLEAR TO 95 00:02:58,640 --> 00:03:00,640 ALL OF US IS NEVER MORE THAN 96 00:03:00,640 --> 00:03:02,520 EVER HAVE HARMS OF OUR 97 00:03:02,520 --> 00:03:06,840 FRAGMENTED SYSTEM BEEN MORE 98 00:03:06,840 --> 00:03:08,040 SALIENT, A PARTICULARLY AMONG 99 00:03:08,040 --> 00:03:09,080 WOMEN AND GIRLS. 100 00:03:09,080 --> 00:03:09,920 SILOED SYSTEMS WITH DISEASE 101 00:03:09,920 --> 00:03:13,480 BASED MODELS DO NOT RECOGNIZE 102 00:03:13,480 --> 00:03:14,840 OVERLAP OF MULTIPLE CHRONIC 103 00:03:14,840 --> 00:03:16,840 CONDITIONS AND THE TOLL THEY CAN 104 00:03:16,840 --> 00:03:18,320 TAKE WHEN NOT RECOGNIZED AS 105 00:03:18,320 --> 00:03:20,920 INTERACTING OR LINKED. 106 00:03:20,920 --> 00:03:22,840 AS NOTED IN THE KEYNOTE BY DR. 107 00:03:22,840 --> 00:03:24,560 SIMON THIS FRAGMENTED SYSTEM 108 00:03:24,560 --> 00:03:26,440 OPERATES WITHIN THE CONTEXT OF 109 00:03:26,440 --> 00:03:31,400 LARGE INEQUITIES, THAT MUST BE 110 00:03:31,400 --> 00:03:33,120 ADDRESSED ACROSS HEALTH SYSTEMS 111 00:03:33,120 --> 00:03:34,800 WITHIN RESEARCH AND AMONG POLICY 112 00:03:34,800 --> 00:03:37,400 MAKERS AND IS NOTED BY DR. WILK, 113 00:03:37,400 --> 00:03:41,040 PAYMENT REFORM WHEREBY 114 00:03:41,040 --> 00:03:45,840 INCENTIVES NEED TO BE ALIGNED IN 115 00:03:45,840 --> 00:03:47,040 SESSION TWO WE DISCUSSED 116 00:03:47,040 --> 00:03:48,640 INTEGRATED MODELS OF CARE FOR 117 00:03:48,640 --> 00:03:50,640 WOMEN IN PREGNANCY FROM CLINICAL 118 00:03:50,640 --> 00:03:51,920 DECISION SUPPORT TO SUBSTANCE 119 00:03:51,920 --> 00:03:53,840 USE DISORDERS, COMPUTER 120 00:03:53,840 --> 00:03:55,400 DELIVERED INTERVENTIONS THAT 121 00:03:55,400 --> 00:03:59,400 ALLOW UNIFORM SCREENING AND 122 00:03:59,400 --> 00:04:02,920 DELIVERY FOR SUBSTANCE USE AMONG 123 00:04:02,920 --> 00:04:04,080 WOMEN EVEN NOT SEEKING TREATMENT 124 00:04:04,080 --> 00:04:05,880 TO UNIFORM DELIVERY OF 125 00:04:05,880 --> 00:04:07,800 POSTPARTUM CARE THROUGH THE ROSE 126 00:04:07,800 --> 00:04:11,120 INTERVENTION DESCRIBED BY DR. 127 00:04:11,120 --> 00:04:13,800 JOHNSON, THAT DESTIGMATIZING 128 00:04:13,800 --> 00:04:14,600 POST PARTEM DEPRESSION THROUGH 129 00:04:14,600 --> 00:04:20,000 UNIVERSAL ACCESS. 130 00:04:20,000 --> 00:04:21,840 TECHNOLOGY REALLY CAN BE 131 00:04:21,840 --> 00:04:26,640 LEVERAGED TO DERIVE MIGRATION OF 132 00:04:26,640 --> 00:04:28,280 PREGNANCY CARE AND PROMOTE 133 00:04:28,280 --> 00:04:29,440 INTEGRATION WITHIN COMMUNITY 134 00:04:29,440 --> 00:04:30,160 RESOURCES. 135 00:04:30,160 --> 00:04:33,480 I THINK VERY RELEVANT TO OUR 136 00:04:33,480 --> 00:04:35,480 DISCUSSION ARE DR. JOHNSON'S 137 00:04:35,480 --> 00:04:37,680 NOTES THAT REALLY LOW INCOME 138 00:04:37,680 --> 00:04:39,040 WOMEN ARE OFTEN NOT 139 00:04:39,040 --> 00:04:40,680 APPROPRIATELY RESOURCED FOR 140 00:04:40,680 --> 00:04:42,240 COORDINATING CARE TRANSITION. 141 00:04:42,240 --> 00:04:44,480 AND SO THEY FALL OUT OF CARE. 142 00:04:44,480 --> 00:04:48,000 AND WE NEED TO BE THINKING ABOUT 143 00:04:48,000 --> 00:04:49,640 SYSTEMS AND REIMBURSEMENT 144 00:04:49,640 --> 00:04:52,640 CHALLENGES AND CONSIDER TASK 145 00:04:52,640 --> 00:04:55,880 SHIFTING AND THINK THROUGH HOW 146 00:04:55,880 --> 00:04:58,000 POLICY CHANGES CAN BE USED TO 147 00:04:58,000 --> 00:04:59,800 FACILITATE CARE INTEGRATION. 148 00:04:59,800 --> 00:05:03,320 FINALLY DURING SESSION THREE WE 149 00:05:03,320 --> 00:05:04,400 DISCUSSED IMPLEMENTING ESSENTIAL 150 00:05:04,400 --> 00:05:06,840 COMPONENTS OF INTEGRATED HEALTH 151 00:05:06,840 --> 00:05:08,520 SYSTEMS FOR WOMEN AND GIRLS AND 152 00:05:08,520 --> 00:05:09,560 DISCUSSED SOME OF THE CHALLENGES 153 00:05:09,560 --> 00:05:13,040 AND SUCCESSES. 154 00:05:13,040 --> 00:05:15,360 WE DISCUSSED A NEW PARADIGM 155 00:05:15,360 --> 00:05:16,600 WHICH INCLUDES MIND BODY 156 00:05:16,600 --> 00:05:18,600 PRACTICES TO COMBAT STRESS AND 157 00:05:18,600 --> 00:05:20,840 ENHANCE RESILIENCY. 158 00:05:20,840 --> 00:05:23,840 NOTING SOME OF THE BARRIERS TO 159 00:05:23,840 --> 00:05:25,480 INTEGRATIVE MEDICINE DR. 160 00:05:25,480 --> 00:05:27,080 FIECHTNER DESCRIBED CONNECT FOR 161 00:05:27,080 --> 00:05:28,000 HEALTH A TRANSLATIONAL 162 00:05:28,000 --> 00:05:29,280 INTERVENTION TO ADDRESS 163 00:05:29,280 --> 00:05:31,440 CHILDHOOD OBESITY. 164 00:05:31,440 --> 00:05:33,080 WHERE HEALTHY WEIGHT CLINIC 165 00:05:33,080 --> 00:05:34,560 PARTICIPATION DECREASED BODY 166 00:05:34,560 --> 00:05:36,320 MASS INDEX AND WAS LINKED TO 167 00:05:36,320 --> 00:05:37,800 IMPROVEMENTS IN HEALTHY 168 00:05:37,800 --> 00:05:41,840 LIFESTYLES AND BEHAVIORS. 169 00:05:41,840 --> 00:05:43,200 PERHAPS VERY INTERESTINGLY 170 00:05:43,200 --> 00:05:44,840 IMPORTANTLY NATIONAL 171 00:05:44,840 --> 00:05:46,880 IMPLEMENTATION WOULD EQUATE TO 172 00:05:46,880 --> 00:05:49,760 9.2 MILLION IN HEALTHCARE COSTS. 173 00:05:49,760 --> 00:05:53,240 OVER TEN YEARS. 174 00:05:53,240 --> 00:06:02,840 DR. MASINTER DESCRIBED PREGNANCY 175 00:06:02,840 --> 00:06:06,200 COMPLICATIONS LINKED TO PCP BY 176 00:06:06,200 --> 00:06:07,760 SIX MONTHS. 177 00:06:07,760 --> 00:06:09,760 MAJOR ISSUE OF MORBIDITY AND 178 00:06:09,760 --> 00:06:12,720 MORTALITY AND SHE FOUND THAT 179 00:06:12,720 --> 00:06:13,960 THOUGH MANY INDIVIDUALS DIDN'T 180 00:06:13,960 --> 00:06:15,040 MAKE TRANSITION TO PRIMARY CARE 181 00:06:15,040 --> 00:06:19,800 EVEN AMONG HIGH RISK PATIENT, 182 00:06:19,800 --> 00:06:23,960 THIS IS INSURANCE LOSS, AND 183 00:06:23,960 --> 00:06:25,400 OTHER ISSUES SO THEY ARE 184 00:06:25,400 --> 00:06:29,280 PLANNING A QI INITIATIVE, TO 185 00:06:29,280 --> 00:06:30,440 WORK THROUGH THIS. 186 00:06:30,440 --> 00:06:34,040 AND FINALLY DR. CHAMBERS 187 00:06:34,040 --> 00:06:35,400 DISCUSSED A MODEL CONTINUUM OF 188 00:06:35,400 --> 00:06:37,760 CARE IN INDIGENOUS COMMUNITIES. 189 00:06:37,760 --> 00:06:40,960 THAT USES CBPR COMMUNITY BASED 190 00:06:40,960 --> 00:06:42,200 PARTICIPATORY RESEARCH AND 191 00:06:42,200 --> 00:06:43,520 COMMUNITY HEALTH WORKERS TO 192 00:06:43,520 --> 00:06:46,120 INTERVENE ACROSS THE LIFE SPAN. 193 00:06:46,120 --> 00:06:49,760 SO AS YOU CAN SEE WE HAS A 194 00:06:49,760 --> 00:06:51,800 COMPREHENSIVE AND RICH 195 00:06:51,800 --> 00:06:53,280 DISCUSSION AND NUMBER OF 196 00:06:53,280 --> 00:06:54,520 PRESENTATIONS YESTERDAY. 197 00:06:54,520 --> 00:06:56,440 TODAY WE ARE GOING TO CONTINUE 198 00:06:56,440 --> 00:06:59,960 THIS DISCUSSION AS WE MOVE ON TO 199 00:06:59,960 --> 00:07:01,400 DISCUSS CURRENT MODELS THAT ARE 200 00:07:01,400 --> 00:07:05,800 BEING TESTED AND USED AND 201 00:07:05,800 --> 00:07:07,600 FINALLY THINKING ABOUT HOW TO 202 00:07:07,600 --> 00:07:09,240 BUILD INFRASTRUCTURE FOR 203 00:07:09,240 --> 00:07:10,120 INTEGRATIVE HEALTHCARE SYSTEMS 204 00:07:10,120 --> 00:07:11,680 FOR WOMEN AND GIRLS. 205 00:07:11,680 --> 00:07:13,960 WITH THAT I WILL PASS THIS ON 206 00:07:13,960 --> 00:07:19,160 OVER. 207 00:07:19,160 --> 00:07:21,240 >> THANK YOU FOR THAT WONDERFUL 208 00:07:21,240 --> 00:07:21,680 SUMMARY. 209 00:07:21,680 --> 00:07:24,320 NEXT WE'LL START WITH OUR 210 00:07:24,320 --> 00:07:27,160 SESSION FOUR WHICH IS TITLED, 211 00:07:27,160 --> 00:07:28,600 SAMPLING OF ACTUAL MODELS OF 212 00:07:28,600 --> 00:07:30,840 CONTINUUMS OF CARE CHALLENGES 213 00:07:30,840 --> 00:07:32,040 AND SUCCESSES, THIS IS GOING TO 214 00:07:32,040 --> 00:07:36,400 BE A CONTINUATION OF THE SESSION 215 00:07:36,400 --> 00:07:37,920 THREE WE HAD YESTERDAY WITH 216 00:07:37,920 --> 00:07:41,280 ADDITIONAL NEW MODELS WE WANT TO 217 00:07:41,280 --> 00:07:43,760 CONSIDER THEIR UTILITY AND SEE 218 00:07:43,760 --> 00:07:45,240 WHAT WE CAN LEARN FROM THEM. 219 00:07:45,240 --> 00:07:47,760 THIS SESSION WILL BE MODERATED 220 00:07:47,760 --> 00:07:53,080 BY DR. KEESHA HIGHSMITH. 221 00:07:53,080 --> 00:07:54,120 >> THANK YOU SO MUCH, GOOD 222 00:07:54,120 --> 00:07:54,640 MORNING. 223 00:07:54,640 --> 00:07:56,320 IT IS MY PLEASURE TO MODERATE 224 00:07:56,320 --> 00:07:57,520 THIS SESSION. 225 00:07:57,520 --> 00:07:58,640 THIS SESSION WILL BE STRUCTURED 226 00:07:58,640 --> 00:08:00,560 SIMILAR TO THE OTHER SESSIONS 227 00:08:00,560 --> 00:08:01,000 FROM YESTERDAY. 228 00:08:01,000 --> 00:08:02,560 I WILL INTRODUCE THE PANELISTS 229 00:08:02,560 --> 00:08:04,560 AT THE BEGINNING OF THE SESSION, 230 00:08:04,560 --> 00:08:05,840 EACH PRESENTER WILL PRESENT 231 00:08:05,840 --> 00:08:07,720 THEIR MODEL OF CARE AND KEY TAKE 232 00:08:07,720 --> 00:08:10,640 AWAYS FOLLOWED BY A PANEL 233 00:08:10,640 --> 00:08:11,640 DISCUSSION, DURING THE 234 00:08:11,640 --> 00:08:12,800 PRESENTATIONS PLEASE FEEL FREE 235 00:08:12,800 --> 00:08:15,160 TO ENTER YOUR QUESTIONS IN THE 236 00:08:15,160 --> 00:08:17,960 Q&A BOX AT THE BOTTOM OF THE 237 00:08:17,960 --> 00:08:19,320 SCREEN WE WILL ASK QUESTIONS 238 00:08:19,320 --> 00:08:20,680 DURING THE PANEL DISCUSSION OR 239 00:08:20,680 --> 00:08:22,080 IN SOME CASES PANELISTS MAY 240 00:08:22,080 --> 00:08:29,880 INCLUDE A WRITTEN RESPONSE IN 241 00:08:29,880 --> 00:08:31,480 THE Q&A BOX. 242 00:08:31,480 --> 00:08:34,200 NOW THE ESTEEMED PANELISTS THE 243 00:08:34,200 --> 00:08:36,000 FIRST IS DR. GEETANJALI CHANDER, 244 00:08:36,000 --> 00:08:37,120 PROFESSOR OF MEDICINE AND 245 00:08:37,120 --> 00:08:38,880 EPIDEMIOLOGY AT THE JOHNS 246 00:08:38,880 --> 00:08:40,160 HOPKINS UNIVERSITY ASSOCIATE 247 00:08:40,160 --> 00:08:41,720 DIRECTOR FOR THE JOHNS HOPKINS 248 00:08:41,720 --> 00:08:42,640 PROGRAM FOR HIV OUTCOMES 249 00:08:42,640 --> 00:08:43,480 RESEARCH. 250 00:08:43,480 --> 00:08:46,440 AND THE RESEARCH DIRECTER FOR 251 00:08:46,440 --> 00:08:48,200 JOHNS HOPKINS CENTER FOR 252 00:08:48,200 --> 00:08:48,440 ADVANCE. 253 00:08:48,440 --> 00:08:49,160 OF COMMUNITY CARE. 254 00:08:49,160 --> 00:08:51,680 HER WORK SPANS EPIDEMIOLOGY, 255 00:08:51,680 --> 00:08:52,720 CLINICAL TRIALS AND 256 00:08:52,720 --> 00:08:54,680 IMPLEMENTATION RESEARCH FOCUS 257 00:08:54,680 --> 00:08:56,840 INTERSECTION OF HIV RISK, HIV 258 00:08:56,840 --> 00:08:58,200 INFECTION, AND UNHEALTHY ALCOHOL 259 00:08:58,200 --> 00:08:59,440 USE. 260 00:08:59,440 --> 00:09:02,120 SHE HAS A PARTICULAR INTEREST IN 261 00:09:02,120 --> 00:09:04,440 ALCOHOL REDUCTION INTERVENTIONS 262 00:09:04,440 --> 00:09:06,240 FOR WOMEN WITH AND AT RISK FOR 263 00:09:06,240 --> 00:09:08,960 HIV INFECTION IN BALTIMORE CITY. 264 00:09:08,960 --> 00:09:11,320 OUR NEXT PANELIST IS DR. SHERRY 265 00:09:11,320 --> 00:09:11,800 MCKEE. 266 00:09:11,800 --> 00:09:14,560 DR. MCKEE IS A PROFESSOR OF 267 00:09:14,560 --> 00:09:16,040 PSYCHIATRY AT YALE SCHOOL OF 268 00:09:16,040 --> 00:09:17,960 MEDICINE, WHERE SHE IS THE 269 00:09:17,960 --> 00:09:19,760 FOUNDER AND DIRECTOR OF YALE 270 00:09:19,760 --> 00:09:20,840 BEHAVIORAL PHARMACOLOGY 271 00:09:20,840 --> 00:09:22,440 LABORATORY. 272 00:09:22,440 --> 00:09:23,800 AND THE CLINICAL DIRECTOR OF 273 00:09:23,800 --> 00:09:25,440 FORENSIC DRUG DIVERSION CLINIC. 274 00:09:25,440 --> 00:09:27,800 DR. MCKEE'S RESEARCH OVER THE 275 00:09:27,800 --> 00:09:30,040 PAST 20 YEARS HAS BEEN DIRECTED 276 00:09:30,040 --> 00:09:31,440 AT DEVELOPING EFFECTIVE 277 00:09:31,440 --> 00:09:32,640 TREATMENTS FOR ADDICTION WITH A 278 00:09:32,640 --> 00:09:35,680 PARTICULAR FOCUS ON WOMEN AND 279 00:09:35,680 --> 00:09:37,520 MORE RESENTLY CRIMINAL JUSTICE 280 00:09:37,520 --> 00:09:38,640 POPULATIONS. 281 00:09:38,640 --> 00:09:40,480 HER TRANSLATIONAL WORK SPANS 282 00:09:40,480 --> 00:09:42,040 HUMAN LABORATORY PARADIGMS, 283 00:09:42,040 --> 00:09:43,480 CLINICAL TRIALS, SURVEY RESEARCH 284 00:09:43,480 --> 00:09:46,640 AND EPIDEMIOLOGICAL RESEARCH TO 285 00:09:46,640 --> 00:09:48,200 UNCOVER THE MECHANISMS 286 00:09:48,200 --> 00:09:49,320 UNDERLYING POOR OUTCOMES AND 287 00:09:49,320 --> 00:09:51,040 TRANSLATE FINDINGS INTO IMPROVED 288 00:09:51,040 --> 00:09:54,080 INTERVENTIONS FOR WOMEN AND MEN. 289 00:09:54,080 --> 00:09:56,640 OUR THIRD PANELIST IS DR. FAYE 290 00:09:56,640 --> 00:09:57,040 TAXMAN. 291 00:09:57,040 --> 00:10:00,040 DR. TAXMAN IS A UNIVERSITY 292 00:10:00,040 --> 00:10:01,880 PROFESSOR AT THE CHAR SCHOOL 293 00:10:01,880 --> 00:10:03,440 POLICY GOVERNMENT AT GEORGE 294 00:10:03,440 --> 00:10:03,840 MASON UNIVERSITY. 295 00:10:03,840 --> 00:10:08,520 SHE IS A HEALTH SERVICE 296 00:10:08,520 --> 00:10:08,840 CRIMINOLOGY. 297 00:10:08,840 --> 00:10:10,520 SHE'S RECOGNIZED FOR SEAMLESS 298 00:10:10,520 --> 00:10:12,520 SYSTEMS OF CARE MODEL AND LINKED 299 00:10:12,520 --> 00:10:15,080 THE CRIMINAL JUSTICE SYSTEM WITH 300 00:10:15,080 --> 00:10:15,640 OTHER HEALTHCARE AND SERVICE 301 00:10:15,640 --> 00:10:17,360 DELIVERY SYSTEMS AND FOR 302 00:10:17,360 --> 00:10:19,320 RE-ENGINEERING PROBATION AND 303 00:10:19,320 --> 00:10:20,600 PAROLE SUPERVISION SERVICES. 304 00:10:20,600 --> 00:10:22,880 SHE CONDUCTED EXPERIMENTS TO 305 00:10:22,880 --> 00:10:24,040 EXAMINE DIFFERENT PROCESSES TO 306 00:10:24,040 --> 00:10:25,800 IMPROVE TREATMENT ACCESS AN 307 00:10:25,800 --> 00:10:27,800 RETENTION TO ASSESS NEW MODELS 308 00:10:27,800 --> 00:10:30,080 OF PROBATION SUPERVISION, 309 00:10:30,080 --> 00:10:32,640 CONSISTENT WITH THE RISK NEED 310 00:10:32,640 --> 00:10:34,000 RESPONSIVITY FRAME WORKS AND TO 311 00:10:34,000 --> 00:10:35,040 TEST NEW INTERVENTIONS. 312 00:10:35,040 --> 00:10:37,280 SO I WILL NOW TURN IT BACK OVER 313 00:10:37,280 --> 00:10:38,440 TO DR. CHANDER TO START HER 314 00:10:38,440 --> 00:10:39,600 PRESENTATION. 315 00:10:39,600 --> 00:10:41,400 THANK YOU FOR THAT LOVELY 316 00:10:41,400 --> 00:10:41,800 INTRODUCTION. 317 00:10:41,800 --> 00:10:45,000 TODAY I WILL TALK ABOUT A 318 00:10:45,000 --> 00:10:46,080 PROJECT THAT WE HAVE BEEN DOING 319 00:10:46,080 --> 00:10:49,480 THAT USES COMMUNITY BASED 320 00:10:49,480 --> 00:10:50,440 PARTICIPATORY RESEARCH TO 321 00:10:50,440 --> 00:10:52,600 ADDRESS ALCOHOL USE AND OTHER 322 00:10:52,600 --> 00:10:56,760 CO-MORBIDITIES ACROSS THE HIV 323 00:10:56,760 --> 00:10:58,080 PREVENTION AND CARE CONTINUE 324 00:10:58,080 --> 00:10:59,000 WOMB, IT IS IMPORTANT TO 325 00:10:59,000 --> 00:11:02,320 ACKNOWLEDGE DR. HEIDI HUTTON, MY 326 00:11:02,320 --> 00:11:05,520 PARTNER IN THIS WORK AND AT THE 327 00:11:05,520 --> 00:11:08,720 END I WILL ALSO RECOGNIZE OUR 328 00:11:08,720 --> 00:11:12,280 COMMUNITY ADVISORY BOARD. 329 00:11:12,280 --> 00:11:14,200 NEARLY HALF OF ALL WOMEN REPORT 330 00:11:14,200 --> 00:11:17,080 ANY ALCOHOL USE IN THE PAST ONE 331 00:11:17,080 --> 00:11:18,640 MONTH IN THE UNITED STATES WITH 332 00:11:18,640 --> 00:11:20,560 12% OF WOMEN REPORTING HEAVY 333 00:11:20,560 --> 00:11:22,240 EPISODIC DRINKING THREE TIMES 334 00:11:22,240 --> 00:11:23,800 PER MONTH WITH AN AVERAGE OF 335 00:11:23,800 --> 00:11:25,120 FIVE DRINKS PER DRINKING 336 00:11:25,120 --> 00:11:25,560 EPISODE. 337 00:11:25,560 --> 00:11:30,160 AND IN 2019, 4% WOMEN MET 338 00:11:30,160 --> 00:11:31,280 CRITERIA FOR PAST USE ALCOHOL 339 00:11:31,280 --> 00:11:34,040 USE KISS ORDER PAST YEAR ALCOHOL 340 00:11:34,040 --> 00:11:35,200 USE DISORDER. 341 00:11:35,200 --> 00:11:37,080 WOMEN EXPERIENCE AD VERSION 342 00:11:37,080 --> 00:11:38,600 EFFECTS OF ALCOHOL USE AT LOWER 343 00:11:38,600 --> 00:11:39,040 LEVELS. 344 00:11:39,040 --> 00:11:40,480 THIS IS DUE TO DIFFERENCES IN 345 00:11:40,480 --> 00:11:42,800 BODY WATER, DIFFERENCES IN 346 00:11:42,800 --> 00:11:46,400 ALCOHOL DEHYDROGENASE, AND AT 347 00:11:46,400 --> 00:11:48,200 LOWER LEVELS OF ALCOHOL USE 348 00:11:48,200 --> 00:11:50,080 WOMEN HAVE INCREASED IMPAIRMENT 349 00:11:50,080 --> 00:11:53,400 WHICH CAN RESULT IN HANG OVERS 350 00:11:53,400 --> 00:11:55,560 BLACKOUTS, AND CAN ALSO RESULT 351 00:11:55,560 --> 00:11:58,160 IN ALCOHOL RELATED ILLNESSES 352 00:11:58,160 --> 00:12:00,720 INCLUDING LIVER DISEASE, 353 00:12:00,720 --> 00:12:02,520 NEUROLOGICAL CONDITIONS, CARDIAC 354 00:12:02,520 --> 00:12:04,280 DISEASE, AFTER SHORTER PERIOD OF 355 00:12:04,280 --> 00:12:07,960 DRINKING COMPARED TO MEN AND I 356 00:12:07,960 --> 00:12:11,960 THINK AS NOTED AMONG MANY 357 00:12:11,960 --> 00:12:13,920 PRESENTATION, ALCOHOL USE AMONG 358 00:12:13,920 --> 00:12:15,800 WOMEN CAN BE CO-MORBID WITH 359 00:12:15,800 --> 00:12:17,600 OTHER SUBSTANCE USE AND MENTAL 360 00:12:17,600 --> 00:12:19,240 HEALTH KISS ORDERS INCLUDING 361 00:12:19,240 --> 00:12:21,240 ANXIETY DEPRESSIONND AND TRAUMA 362 00:12:21,240 --> 00:12:22,920 WHICH ARE MORE PREVALENT AMONG 363 00:12:22,920 --> 00:12:24,920 WOMEN WITH ALCOHOL USE 364 00:12:24,920 --> 00:12:25,800 DISORDERS, OTHER SUBSTANCE USE 365 00:12:25,800 --> 00:12:27,400 IS ASSOCIATED WITH ALCOHOL USE 366 00:12:27,400 --> 00:12:29,400 AND ALSO ASSOCIATED WITH 367 00:12:29,400 --> 00:12:31,000 VIOLENCE AND INTIMATE PARTNER 368 00:12:31,000 --> 00:12:35,200 VIOLENCE. 369 00:12:35,200 --> 00:12:36,080 ALCOHOL USE CONTRIBUTE 370 00:12:36,080 --> 00:12:37,840 SIGNIFICANTLY TO HIV RISK AMONG 371 00:12:37,840 --> 00:12:40,000 WOMEN AND INCLUDING DECREASE 372 00:12:40,000 --> 00:12:43,840 CONDOM USE AND CONDOM 373 00:12:43,840 --> 00:12:44,920 NEGOTIATION, INCREASE SEXUAL 374 00:12:44,920 --> 00:12:47,200 RISK BEHAVIORS, MANY UNINTENDED 375 00:12:47,200 --> 00:12:48,440 CONSEQUENCES AMONG WOMEN 376 00:12:48,440 --> 00:12:51,000 INCLUDING SEX WITH NEW PARTNERS 377 00:12:51,000 --> 00:12:52,880 OR CONDOMLESS SEX AND AMONG 378 00:12:52,880 --> 00:12:54,560 WOMEN WITH HIV UNHEALTHY ALCOHOL 379 00:12:54,560 --> 00:12:56,400 USE IS ASSOCIATED WITH LOWER 380 00:12:56,400 --> 00:12:58,400 ADHERENCE TO ANTI-REROW VIRAL 381 00:12:58,400 --> 00:13:00,280 THERAPY, LOWER DURABLE VIRAL 382 00:13:00,280 --> 00:13:03,200 SUPPRESSION, AND INCREASE 383 00:13:03,200 --> 00:13:06,400 TRANSMISSION RISK BEHAVIORS. 384 00:13:06,400 --> 00:13:07,800 IN THE UNITED STATES MOST RECENT 385 00:13:07,800 --> 00:13:10,600 DATA REFLECT THERE WERE 37,968 386 00:13:10,600 --> 00:13:14,200 NEW DIAGNOSES IN THE UNITED 387 00:13:14,200 --> 00:13:17,400 STATES OF THOSE 19% WERE AMONG 388 00:13:17,400 --> 00:13:18,880 WOMEN AND IT IS ALWAYS I THINK 389 00:13:18,880 --> 00:13:21,000 SO OFTEN WHEN WE THINK OF HIV 390 00:13:21,000 --> 00:13:22,600 INFECTION WE DON'T THINK OF 391 00:13:22,600 --> 00:13:25,560 WOMEN WHO ARE BEING INFECTED BUT 392 00:13:25,560 --> 00:13:28,960 19% IS A FAIR NUMBER. 393 00:13:28,960 --> 00:13:30,200 MOST NEW HIV DIAGNOSES ARE 394 00:13:30,200 --> 00:13:34,800 ATTRIBUTED TO HETEROSEXUAL 395 00:13:34,800 --> 00:13:36,880 CONTACT, 85%. 396 00:13:36,880 --> 00:13:38,960 WITH THAT CONTEXT IN MIND I WANT 397 00:13:38,960 --> 00:13:40,640 TO PRESENT DATA FROM A STUDY 398 00:13:40,640 --> 00:13:43,120 DONE BY DR. HUTTON. 399 00:13:43,120 --> 00:13:45,400 IN THE BALTIMORE CITY HEALTH 400 00:13:45,400 --> 00:13:48,360 DEPARTMENT STI CLINICS. 401 00:13:48,360 --> 00:13:50,400 AMONG 671 STI ATTENDEES THAT 402 00:13:50,400 --> 00:13:53,520 WERE ATTENDED -- TESTED FOR 403 00:13:53,520 --> 00:13:55,600 GONORRHEA, AND UNDERWENT 404 00:13:55,600 --> 00:13:56,840 CONCURRENT QUERYING SUBSTANCE 405 00:13:56,840 --> 00:13:59,800 USE AND SEXUAL RISK BEHAVIORS, 406 00:13:59,800 --> 00:14:01,800 21% RECORDING SEX WHILE UNDER 407 00:14:01,800 --> 00:14:04,480 INFLUENCE OF ALCOHOL, 30% WOMEN 408 00:14:04,480 --> 00:14:06,520 REPORTED HEAVY EPISODIC DRINKING 409 00:14:06,520 --> 00:14:09,720 COMPARED TO 42% IN MEN AND 410 00:14:09,720 --> 00:14:11,160 IMPORTANTLY WOMEN WITH HEAVY 411 00:14:11,160 --> 00:14:14,160 EPISODIC DRINKING ENGAGED AT 412 00:14:14,160 --> 00:14:15,400 ANAL SEX TWICE THE RATE OF WOMEN 413 00:14:15,400 --> 00:14:17,440 AND THREE TIMES THE AMOUNT OF 414 00:14:17,440 --> 00:14:19,600 WOMEN WHO ABSTAINED. 415 00:14:19,600 --> 00:14:22,120 LIKELY TO HAVE MULTIPLE SEX 416 00:14:22,120 --> 00:14:23,160 PARTNERS AND GONORRHEA WAS FIVE 417 00:14:23,160 --> 00:14:25,080 TIMES HIGHER WITH HEAVY EPISODIC 418 00:14:25,080 --> 00:14:27,960 DRINKING. 419 00:14:27,960 --> 00:14:30,400 THESE DATA REFLECT THE RISK THAT 420 00:14:30,400 --> 00:14:34,640 CAN OCCUR WITH ALCOHOL USE? 421 00:14:34,640 --> 00:14:37,000 THE CONTEXT OF SEX. 422 00:14:37,000 --> 00:14:38,960 HERE I PRESENT BASELINE DATA 423 00:14:38,960 --> 00:14:40,280 FROM A CLINICAL TRIAL WE DID 424 00:14:40,280 --> 00:14:41,800 WHERE WE TESTED A COMPUTER 425 00:14:41,800 --> 00:14:43,280 DELIVERED INTERVENTION IN THE 426 00:14:43,280 --> 00:14:44,000 STI CLINICS. 427 00:14:44,000 --> 00:14:46,400 I'M NOT GOING TO REVIEW THE 428 00:14:46,400 --> 00:14:48,040 STUDY, BUT WHAT I WANT TO DO IS 429 00:14:48,040 --> 00:14:50,840 POINT OUT THE BASELINE DATA. 430 00:14:50,840 --> 00:14:54,880 SO WHAT WE FOUND WAS THAT AMONG 431 00:14:54,880 --> 00:14:59,000 439 WOMEN IN THE TRIAL, 65% HAD 432 00:14:59,000 --> 00:15:03,200 CONCURRENT SUBSTANCE USE. 433 00:15:03,200 --> 00:15:08,120 CLOSE TO 30% HAD CURRENT PANIC 434 00:15:08,120 --> 00:15:10,480 SYMPTOMS, 37% CURRENT PTSD 435 00:15:10,480 --> 00:15:12,800 SYMPTOMS, AND I THINK REALLY 436 00:15:12,800 --> 00:15:14,560 MOST IMPORTANTLY, TWO-THIRDS OF 437 00:15:14,560 --> 00:15:17,200 THE WOMEN IN THIS SAMPLE HAD AN 438 00:15:17,200 --> 00:15:18,600 ALCOHOL USE DISORDER. 439 00:15:18,600 --> 00:15:20,680 WE WERE SURPRISED BY THIS, WE 440 00:15:20,680 --> 00:15:26,360 HAVE NOVEMBE NOT EXPECTED HIGH RATES OF 441 00:15:26,360 --> 00:15:28,280 MODERATE TO SEVERE ALCOHOL USE 442 00:15:28,280 --> 00:15:28,640 DISORDER. 443 00:15:28,640 --> 00:15:31,320 WE WERE INTERESTED TO REALLY TRY 444 00:15:31,320 --> 00:15:33,480 AND LOOK AT THE CHARACTERISTICS 445 00:15:33,480 --> 00:15:34,600 OF WOMEN WHO WERE COMING INTO 446 00:15:34,600 --> 00:15:36,720 THE CLINIC WITH ALCOHOL USE 447 00:15:36,720 --> 00:15:37,840 DISORDER BECAUSE WE WERE SO 448 00:15:37,840 --> 00:15:40,040 SURPRISED. 449 00:15:40,040 --> 00:15:42,560 NOT SURPRISINGLY THEY WERE MORE 450 00:15:42,560 --> 00:15:45,160 LIKELY TO HAVE CONCURRENT 451 00:15:45,160 --> 00:15:47,680 SUBSTANCE USE INCLUDING 452 00:15:47,680 --> 00:15:50,800 MARIJUANA, COCAINE AND OPIOID 453 00:15:50,800 --> 00:15:52,200 USE. 454 00:15:52,200 --> 00:15:54,440 WE ALSO LOOK AT CO-MORBIDITIES 455 00:15:54,440 --> 00:15:56,400 AMONG WOMEN WITH ALCOHOL USE 456 00:15:56,400 --> 00:15:57,840 DISORDER AND AGAIN I THINK NONE 457 00:15:57,840 --> 00:16:01,480 OF US ARE SURPRISED BY THE FAR 458 00:16:01,480 --> 00:16:05,240 HIGHER PREVALENCE OF PTSD 459 00:16:05,240 --> 00:16:06,800 SYMPTOMS AMONG WOMEN WITH 460 00:16:06,800 --> 00:16:09,240 ALCOHOL USE DISORDER VERSUS 461 00:16:09,240 --> 00:16:10,200 WITHOUT. 462 00:16:10,200 --> 00:16:12,400 DEPRESSIVE SYMPTOMS, GENERALIZE 463 00:16:12,400 --> 00:16:15,200 ANXIETY SYMPTOMS AND A FAR 464 00:16:15,200 --> 00:16:17,200 HIGHER PREVALENCE OF CUMULATIVE 465 00:16:17,200 --> 00:16:21,640 MENTAL HEALTH DISORDERS. 466 00:16:21,640 --> 00:16:23,760 MOVING ACROSS THE HIV PREVENTION 467 00:16:23,760 --> 00:16:26,040 AND CARE CONTINUUM, NOW WE 468 00:16:26,040 --> 00:16:29,040 TALKED A LITTLE BIT ABOUT HIV 469 00:16:29,040 --> 00:16:31,400 RISK AND NOW LET'S TALK ABOUT 470 00:16:31,400 --> 00:16:33,240 HIV, COMPARED TO ALL WOMEN, ALL 471 00:16:33,240 --> 00:16:35,920 PEOPLE DIAGNOSE WITH HIV, WOMEN 472 00:16:35,920 --> 00:16:39,560 HAVE LOWER VIRAL SUPPRESSION, 473 00:16:39,560 --> 00:16:42,080 76% OF WOMEN WITH HIV RECEIVED 474 00:16:42,080 --> 00:16:47,040 SOME CARE, 58% RETAINED IN CARE, 475 00:16:47,040 --> 00:16:48,960 AND 63% WERE VIRAL LOGICALLY 476 00:16:48,960 --> 00:16:51,080 SUPPRESSED. 477 00:16:51,080 --> 00:16:52,880 THESE ARE UNPUBLISHED DATA FROM 478 00:16:52,880 --> 00:16:55,720 THE JOHNS HOPKINS HIV CLINICAL 479 00:16:55,720 --> 00:16:58,000 COHORT WHERE WE DID OVER 1700 480 00:16:58,000 --> 00:17:00,800 COMPUTERS ASSISTED INTERVIEWS 481 00:17:00,800 --> 00:17:04,960 AMONG 600 WOMEN, 36% REPORTED 482 00:17:04,960 --> 00:17:09,600 CURRENT ALCOHOL USE, AND 43% MET 483 00:17:09,600 --> 00:17:13,680 CRITERIA FOR UNHEALTHY ALCOHOL 484 00:17:13,680 --> 00:17:16,560 USE ON THE AUDIT C AND WOMEN WHO 485 00:17:16,560 --> 00:17:18,000 DRANK WERE TWICE AS LIKELY TO 486 00:17:18,000 --> 00:17:19,400 REPORT DEPRESSIVE SYMPTOMS AND 487 00:17:19,400 --> 00:17:20,960 TRAUMA SYMPTOMS. 488 00:17:20,960 --> 00:17:23,800 THEY WERE ALSO LESS LIKELY TO 489 00:17:23,800 --> 00:17:26,240 REPORT GREATER THAN 90% 490 00:17:26,240 --> 00:17:28,960 ADHERENCE AND LESS LIKELY TO BE 491 00:17:28,960 --> 00:17:30,640 VIRAL LOGICALLY SUPPRESSED. 492 00:17:30,640 --> 00:17:32,200 I WILL QUICKLY RUN THROUGH THESE 493 00:17:32,200 --> 00:17:35,680 DATA SO I DON'T GO OVER TIME. 494 00:17:35,680 --> 00:17:37,360 BECAUSE I HAVE MORE TO TALK 495 00:17:37,360 --> 00:17:37,680 ABOUT. 496 00:17:37,680 --> 00:17:40,160 WE DID STRUCTURED CLINICAL 497 00:17:40,160 --> 00:17:42,160 DIAGNOSTIC INTERVIEWS AMONG 498 00:17:42,160 --> 00:17:45,120 WOMEN IN THE CLINIC, JOHNS 499 00:17:45,120 --> 00:17:48,080 HOPKINS HIV CLINIC AND FOUND 500 00:17:48,080 --> 00:17:50,520 VERY, VERY HIGH PREVALENCE OF 501 00:17:50,520 --> 00:17:54,200 LIFETIME MENTAL HEALTH DISORDERS 502 00:17:54,200 --> 00:18:01,520 AND IN TERMS OF LIFETIME PTSD, 503 00:18:01,520 --> 00:18:07,480 35% CURRENT PTSD, ABOUT 17%. 504 00:18:07,480 --> 00:18:09,680 LIFETIME PANIC WAS ALSO HIGH AS 505 00:18:09,680 --> 00:18:12,200 MAJOR DEPRESSION. 506 00:18:12,200 --> 00:18:15,040 SO I SHOW THESE DATA REALLY 507 00:18:15,040 --> 00:18:17,600 DEMONSTRATE THAT WE CAN'T REALLY 508 00:18:17,600 --> 00:18:20,280 THINK ABOUT ALCOHOL USE AMONG 509 00:18:20,280 --> 00:18:23,000 WOMEN WITHOUT THINKING ABOUT 510 00:18:23,000 --> 00:18:25,800 OTHER CO-MORBID CONDITIONS. 511 00:18:25,800 --> 00:18:27,480 AND THOSE INCLUDE OTHER MENTAL 512 00:18:27,480 --> 00:18:28,840 HEALTH DISORDERS, OTHER 513 00:18:28,840 --> 00:18:31,000 SUBSTANCE USE DISORDERS IN 514 00:18:31,000 --> 00:18:32,840 ADDITION TO CHRONIC DISEASES 515 00:18:32,840 --> 00:18:35,480 SUCH AS HIV. 516 00:18:35,480 --> 00:18:37,800 SO UNHEALTHY ALCOHOL USE OCCURS 517 00:18:37,800 --> 00:18:39,840 WITHIN THIS CONTEXT OF 518 00:18:39,840 --> 00:18:41,600 CO-MORBIDITIES AND OTHER 519 00:18:41,600 --> 00:18:42,400 DETERMINANTS, AND THERE IS 520 00:18:42,400 --> 00:18:44,400 REALLY A NEED FOR INTEGRATED 521 00:18:44,400 --> 00:18:45,400 INTERVENTIONS THAT ADDRESS 522 00:18:45,400 --> 00:18:46,920 ALCOHOL USE IN THE CONTEXT OF 523 00:18:46,920 --> 00:18:49,360 MENTAL HEALTH AND SUBSTANCE USE 524 00:18:49,360 --> 00:18:52,120 CO-MORBIDITY AND REPRODUCTIVE 525 00:18:52,120 --> 00:18:52,520 HEALTH. 526 00:18:52,520 --> 00:18:54,240 FAILING THAT GOAL WE NEED TO 527 00:18:54,240 --> 00:18:55,600 INCREASE COORDINATION OF CARE 528 00:18:55,600 --> 00:18:58,360 BETWEEN AGENCIES THAT PROVIDE 529 00:18:58,360 --> 00:18:59,680 THESE DIE LOAD SERVICES AND 530 00:18:59,680 --> 00:19:01,160 INCREASE PUBLIC AWARENESS OF 531 00:19:01,160 --> 00:19:04,160 TREATMENT RESOURCES. 532 00:19:04,160 --> 00:19:06,240 AS SUCH WE HAVE LOOKED AT ALL 533 00:19:06,240 --> 00:19:07,600 THESE DATA AND SAID WE NEED 534 00:19:07,600 --> 00:19:08,960 PROGRAMS TAILORED TO WOMEN THAT 535 00:19:08,960 --> 00:19:10,880 ADDRESS REPRODUCTIVE HEALTH, 536 00:19:10,880 --> 00:19:14,960 ALCOHOL EXPOSED PREGNANCIES, 537 00:19:14,960 --> 00:19:17,320 CHILD CARE FAMILY CARE, HIV 538 00:19:17,320 --> 00:19:20,200 STIGMA ALCOHOL USE MENTAL HEALTH 539 00:19:20,200 --> 00:19:20,800 DISORDERS. 540 00:19:20,800 --> 00:19:23,920 WE DEVELOPED A PROGRAM CALLED 541 00:19:23,920 --> 00:19:25,800 SHARP WOMEN. 542 00:19:25,800 --> 00:19:27,600 CHAMP WOMEN IS A COMMUNITY BASED 543 00:19:27,600 --> 00:19:28,840 PARTICIPATORY RESEARCH PROJECT 544 00:19:28,840 --> 00:19:35,600 FUNDED BY NIAAA U-34 IN CBPR WE 545 00:19:35,600 --> 00:19:36,800 ADDRESS SOCIAL STRUCTURAL AND 546 00:19:36,800 --> 00:19:38,480 PHYSICAL ENVIRONMENTAL 547 00:19:38,480 --> 00:19:41,560 INEQUITIES THROUGH ACTIVE 548 00:19:41,560 --> 00:19:43,400 INVOLVEMENT OF COMMUNITIES 549 00:19:43,400 --> 00:19:44,080 MEMBERS ORGANIZATIONAL 550 00:19:44,080 --> 00:19:45,080 REPRESENTATIVES AND RESEARCHERS 551 00:19:45,080 --> 00:19:46,760 IN ALL ASPECTS OF THE RESEARCH 552 00:19:46,760 --> 00:19:48,200 PROCESS. 553 00:19:48,200 --> 00:19:49,640 PARTNERS CONTRIBUTE EXPERTISE TO 554 00:19:49,640 --> 00:19:52,720 ENHANCE UNDERSTANDING OF A GIVEN 555 00:19:52,720 --> 00:19:53,960 PHENOMENA AND INTEGRATE 556 00:19:53,960 --> 00:19:54,960 KNOWLEDGE THEY NEED WITH ACTION 557 00:19:54,960 --> 00:19:56,000 TO BENEFIT THE COMMUNITY 558 00:19:56,000 --> 00:20:01,720 INVOLVED. 559 00:20:01,720 --> 00:20:04,760 PRIOR TO GRANT SUBMISSION AND 560 00:20:04,760 --> 00:20:06,080 CO-DEVELOPED AIMS WHAT WE GOT 561 00:20:06,080 --> 00:20:08,960 OUT OF OUR MEETINGS WAS THAT 562 00:20:08,960 --> 00:20:10,400 INDIVIDUALS REALLY SAID IT WAS 563 00:20:10,400 --> 00:20:14,800 IMPORTANT TO ADDRESS DEPRESSION 564 00:20:14,800 --> 00:20:16,200 AND TRAUMA AND STRESS AMONG 565 00:20:16,200 --> 00:20:17,600 WOMEN WITH ALCOHOL USE, THERE 566 00:20:17,600 --> 00:20:18,800 WAS A STRONG BELIEF ALCOHOL IS 567 00:20:18,800 --> 00:20:21,960 USED TO COPE WITH STRESS MOOD 568 00:20:21,960 --> 00:20:22,880 AND TRAUMA. 569 00:20:22,880 --> 00:20:24,400 THEY SUGGESTED LINKING WOMEN 570 00:20:24,400 --> 00:20:26,600 WITH ALCOHOL USE AND CO-MORBID 571 00:20:26,600 --> 00:20:28,600 DEPRESSIVE SYMPTOMS OR TRAUMA TO 572 00:20:28,600 --> 00:20:31,800 LOCAL ORGANIZATIONS THAT PROVIDE 573 00:20:31,800 --> 00:20:33,000 COUNSELING SUPPORT AND OTHER 574 00:20:33,000 --> 00:20:35,000 RESOURCES AS A WAY AUGMENTING 575 00:20:35,000 --> 00:20:38,800 ALCOHOL INTERVENTIONS. 576 00:20:38,800 --> 00:20:40,200 THE IMPORTANCE OF SENSITIVE TO 577 00:20:40,200 --> 00:20:43,520 ALCOHOL RELATED STIGMA AND 578 00:20:43,520 --> 00:20:45,280 CONSIDER THIS IN WHERE AND HOW 579 00:20:45,280 --> 00:20:48,280 INTERVENTION WAS DELIVERED. 580 00:20:48,280 --> 00:20:50,400 SO WE HAVE OUR SHARP WOMEN 581 00:20:50,400 --> 00:20:52,280 COMMUNITY ADVISORY BOARD OR 582 00:20:52,280 --> 00:20:53,560 COMMUNITY COLLABORATIVE. 583 00:20:53,560 --> 00:20:55,800 IT INCLUDES RANGE OF 584 00:20:55,800 --> 00:20:57,480 STAKEHOLDERS, IT DOESN'T INCLUDE 585 00:20:57,480 --> 00:20:59,920 ALL BUT THE GREATER BALTIMORE 586 00:20:59,920 --> 00:21:02,240 HIV HEALTH SERVICES PLANNING 587 00:21:02,240 --> 00:21:03,520 COUNCIL, THE PRIOR DIRECTOR OF 588 00:21:03,520 --> 00:21:05,200 THE BALTIMORE CITY HEALTH 589 00:21:05,200 --> 00:21:07,520 DEPARTMENT STT HIV AND TB 590 00:21:07,520 --> 00:21:09,880 CLINICAL SERVICES OLDER WOMEN 591 00:21:09,880 --> 00:21:10,960 EMBRACING LIFE, HEALTHCARE FOR 592 00:21:10,960 --> 00:21:14,960 THE HOMELESS, HOUSE OF RUTH, A 593 00:21:14,960 --> 00:21:16,200 TRANSITIONAL HOUSING AND 594 00:21:16,200 --> 00:21:18,080 INTERVENTION CENTER FOR DOMESTIC 595 00:21:18,080 --> 00:21:19,000 VIOLENCE. 596 00:21:19,000 --> 00:21:22,120 PREP CLINICS, SUBSTANCE USE, 597 00:21:22,120 --> 00:21:24,480 PROGRAMS IN BALTIMORE AND MOST 598 00:21:24,480 --> 00:21:27,920 IMPORTANTLY, MANY WOMEN 599 00:21:27,920 --> 00:21:30,440 REPRESENTING ORGANIZATIONS MANY 600 00:21:30,440 --> 00:21:31,800 WOMEN REPRESENT ORGANIZATIONS OF 601 00:21:31,800 --> 00:21:33,400 LOCAL COMMUNITY AND WE HAVE FOUR 602 00:21:33,400 --> 00:21:35,720 ADDITIONAL WOMEN FROM THE 603 00:21:35,720 --> 00:21:36,800 COMMUNITY NOT AFFILIATED WITH 604 00:21:36,800 --> 00:21:39,400 ONE OF THE ORGANIZATIONS. 605 00:21:39,400 --> 00:21:45,120 SO WE WORKED TO DEVELOP A COMMON 606 00:21:45,120 --> 00:21:46,640 MISSION TO ESTABLISH ACTIVE 607 00:21:46,640 --> 00:21:47,720 INTERACTIVE COLLABORATIVE OF 608 00:21:47,720 --> 00:21:48,920 WOMEN REPRESENTING ALL POINTS OF 609 00:21:48,920 --> 00:21:51,160 CARE IN THE COMMUNITY TO IMPROVE 610 00:21:51,160 --> 00:21:52,680 THE PHYSICAL MENTAL AND 611 00:21:52,680 --> 00:21:53,960 SPIRITUAL HEALTH OF COMMUNITY 612 00:21:53,960 --> 00:21:56,200 WOMEN BY MARSHALLING THE CAB 613 00:21:56,200 --> 00:21:57,600 SKILLS TO INFORM ADVISE AND 614 00:21:57,600 --> 00:21:59,080 PROVIDE ADVOCACY, CONNECTIONS TO 615 00:21:59,080 --> 00:22:00,560 CARE AND CREATION OF 616 00:22:00,560 --> 00:22:04,240 OPPORTUNITIES FOR CARE. 617 00:22:04,240 --> 00:22:06,920 WE DEVELOPED CORE VALUES 618 00:22:06,920 --> 00:22:07,920 INCLUDING RESPECT TRUST 619 00:22:07,920 --> 00:22:09,040 CO-LEARNING DEVELOPMENT 620 00:22:09,040 --> 00:22:11,400 PARTNERSHIP, SHARING OF IDEAS 621 00:22:11,400 --> 00:22:12,440 AND OPENFUL RESPECTFUL AND 622 00:22:12,440 --> 00:22:13,440 CARING FORMAT. 623 00:22:13,440 --> 00:22:15,360 PRIVACY AND CONFIDENTIALITY AND 624 00:22:15,360 --> 00:22:17,480 COMPASSION. 625 00:22:17,480 --> 00:22:19,400 WE SIMILARLY DEVELOPED OUR SHARK 626 00:22:19,400 --> 00:22:21,000 WOMEN MISSION WHICH IS TO 627 00:22:21,000 --> 00:22:22,160 IMPROVE THE HEALTH WELL BEING 628 00:22:22,160 --> 00:22:24,040 AND QUALITY OF LIFE OF WOMEN 629 00:22:24,040 --> 00:22:27,440 WITH AND AT RISK OF HIV THROUGH 630 00:22:27,440 --> 00:22:28,680 ACCESSIBLE RELEVANT STRENGTH 631 00:22:28,680 --> 00:22:30,240 BASED COMMUNITY INFORMED WORK 632 00:22:30,240 --> 00:22:32,600 THAT ADDRESSES UNHEALTHY ALCOHOL 633 00:22:32,600 --> 00:22:35,360 USE ALONE AND INTERSECTION WITH 634 00:22:35,360 --> 00:22:36,480 MENTAL HEALTH OTHER SUBSTANCE 635 00:22:36,480 --> 00:22:37,960 USE AND REPRODUCTIVE HEALTH. 636 00:22:37,960 --> 00:22:40,400 WITH A MISSION TO CREATE A SHARP 637 00:22:40,400 --> 00:22:43,200 INTERVENTION SUSTAINABILITY 638 00:22:43,200 --> 00:22:45,880 COMPREHENSIVE AND INSTILLS HOPE 639 00:22:45,880 --> 00:22:47,440 WITH CORE VALUES OF SHARP 640 00:22:47,440 --> 00:22:50,160 PROGRAM LISTED BELOW. 641 00:22:50,160 --> 00:22:51,720 SO AFTER CAB FORMATION WE HAD A 642 00:22:51,720 --> 00:22:54,160 NUMBER OF PARTNERSHIP 643 00:22:54,160 --> 00:22:55,160 ACTIVITIES. 644 00:22:55,160 --> 00:22:56,720 WHICH INCLUDED DEFINING 645 00:22:56,720 --> 00:22:58,800 DESCRIBING THE COMMUNITY 646 00:22:58,800 --> 00:23:00,400 CONTACT, IDENTIFYING HEALTH 647 00:23:00,400 --> 00:23:01,320 PRIORITIES STRENGTH AND 648 00:23:01,320 --> 00:23:03,880 RESOURCES AND BARRIERS TO CARE. 649 00:23:03,880 --> 00:23:05,520 THIS INCLUDED IN DEPTH 650 00:23:05,520 --> 00:23:06,640 INTERVIEWS WITH STAKEHOLDERS 651 00:23:06,640 --> 00:23:07,560 ACROSS THE COMMUNITY FROM 652 00:23:07,560 --> 00:23:10,560 MULTIPLE ORGANIZATIONS ALONG 653 00:23:10,560 --> 00:23:13,200 WITH WOMEN LIVING WITH AND AT 654 00:23:13,200 --> 00:23:14,160 RISK FOR HIV. 655 00:23:14,160 --> 00:23:16,240 WE DISCUSSED RECRUITMENT AND 656 00:23:16,240 --> 00:23:18,120 RETENTION STRATEGIES, WE WORK 657 00:23:18,120 --> 00:23:22,320 TOGETHER ON INTERVIEW GUIDES, 658 00:23:22,320 --> 00:23:24,000 RECRUITMENT MATERIALS, ON 659 00:23:24,000 --> 00:23:24,640 ENHANCEMENT OF COMPUTER 660 00:23:24,640 --> 00:23:27,400 DELIVERED INTERVENTION, 661 00:23:27,400 --> 00:23:30,560 SELECTION OF COMMUNITY HEALTH 662 00:23:30,560 --> 00:23:31,400 WORKER. 663 00:23:31,400 --> 00:23:34,200 SO REALLY TRULY A PARTNERED 664 00:23:34,200 --> 00:23:34,960 ACTIVITY. 665 00:23:34,960 --> 00:23:40,000 I WANT TO PRESENT VERY BRIEFLY 666 00:23:40,000 --> 00:23:43,640 SOME INITIAL RESULTS FROM OUR IN 667 00:23:43,640 --> 00:23:47,200 DEPTH INTERVIEWS WE DID AND I 668 00:23:47,200 --> 00:23:49,000 WILL GO THROUGH THEM QUICKLY. 669 00:23:49,000 --> 00:23:52,000 SO WE WERE VERY INTERESTED IN 670 00:23:52,000 --> 00:23:53,480 HIV PREVENTION AND ACTUALLY WAS 671 00:23:53,480 --> 00:23:56,600 A MAJOR GOAL OF THIS U-34 THAT 672 00:23:56,600 --> 00:23:57,400 CAME FROM OUR COMMUNITY. 673 00:23:57,400 --> 00:24:00,000 THEY SAID YOU MUST ADDRESS PREP 674 00:24:00,000 --> 00:24:00,440 AMONG WOMEN. 675 00:24:00,440 --> 00:24:03,200 SO WE ASKED STARTED TO ASK WOMEN 676 00:24:03,200 --> 00:24:05,320 IN THE COMMUNITY WHAT THEY HEARD 677 00:24:05,320 --> 00:24:07,720 ABOUT HIV PRE-EXPOSURE 678 00:24:07,720 --> 00:24:08,240 PROPHYLAXIS. 679 00:24:08,240 --> 00:24:09,920 SO ONE WOMAN SAID I HEARD ABOUT 680 00:24:09,920 --> 00:24:11,680 IT BUT I THOUGHT IT WAS FOR 681 00:24:11,680 --> 00:24:13,960 PEOPLE WITH HIV AND ANOTHER SAID 682 00:24:13,960 --> 00:24:15,720 HONESTLY I'M NOT SURE ABOUT 683 00:24:15,720 --> 00:24:17,560 WOMEN BUT LOOKS LIKE EVERYTHING 684 00:24:17,560 --> 00:24:19,640 I WAS SERING WAS GEARED TOWARD 685 00:24:19,640 --> 00:24:20,760 MEN SO I FEEL LIKE THERE WAS 686 00:24:20,760 --> 00:24:21,480 SOME WOMEN IN THE COMMERCIAL 687 00:24:21,480 --> 00:24:24,160 THAT I THOUGHT THIS WAS REALLY 688 00:24:24,160 --> 00:24:26,040 TARGETED TOWARDS GAY MEN, SO 689 00:24:26,040 --> 00:24:27,520 THERE WAS THIS IDEA PREP FOR HIV 690 00:24:27,520 --> 00:24:32,800 PREVENTION WASN'T FOR WOMEN. 691 00:24:32,800 --> 00:24:33,400 ANOTHER WOMAN SAID YES YOU CAN 692 00:24:33,400 --> 00:24:34,960 GET A PILL IF YOU HAVE HIV, 693 00:24:34,960 --> 00:24:36,920 ANOTHER SAID IT WAS MENTIONED IN 694 00:24:36,920 --> 00:24:38,240 ONE TREATMENT GROUPS, WE WERE 695 00:24:38,240 --> 00:24:39,520 TALKING ABOUT HIV AND I WAS 696 00:24:39,520 --> 00:24:41,080 SHOCKED THEY HAD IT. 697 00:24:41,080 --> 00:24:42,800 SO REALLY HERE IS THIS 698 00:24:42,800 --> 00:24:45,480 MEDICATION THAT ONE CAN TAKE TO 699 00:24:45,480 --> 00:24:46,920 PREVENT HIV BUT THE WORD ISN'T 700 00:24:46,920 --> 00:24:50,120 GETTING OUT THERE. 701 00:24:50,120 --> 00:24:54,120 THAT WOMEN COULD USE IT. 702 00:24:54,120 --> 00:24:55,800 SO IT WAS INTERESTING, ANOTHER 703 00:24:55,800 --> 00:24:57,160 ONE SAID I HEARD ABOUT PREP AND 704 00:24:57,160 --> 00:24:58,720 I HAVE A GRANDDAUGHTER TAKING 705 00:24:58,720 --> 00:24:59,800 IT, IT'S EVERYWHERE. 706 00:24:59,800 --> 00:25:00,760 YOU DON'T HEAR ABOUT IT AT 707 00:25:00,760 --> 00:25:05,200 SCHOOLS. 708 00:25:05,200 --> 00:25:07,440 WHEN WE ASK PROVIDERS ONE SAID 709 00:25:07,440 --> 00:25:08,800 SO NOT MANY WOMEN, WHAT DO YOU 710 00:25:08,800 --> 00:25:10,800 THINK WE CAN DO TO SORT OF GET 711 00:25:10,800 --> 00:25:13,240 PROVIDERS THINK A LITTLE BIT 712 00:25:13,240 --> 00:25:14,080 MORE ABOUT PREP? 713 00:25:14,080 --> 00:25:15,920 THE PROVIDER SAYS I DON'T KNOW I 714 00:25:15,920 --> 00:25:17,000 THINK THERE HAS TO BE 715 00:25:17,000 --> 00:25:18,040 FUNDAMENTAL CHANGE IN MARKETING 716 00:25:18,040 --> 00:25:20,400 BECAUSE ALL THE MARKETING DONE 717 00:25:20,400 --> 00:25:21,840 THAT I SEE EVEN ONES THAT WE HAD 718 00:25:21,840 --> 00:25:24,200 HANGING IN CLINIC ARE FOR MSM 719 00:25:24,200 --> 00:25:28,640 AND CLEARLY THEY ARE HIGH RISK 720 00:25:28,640 --> 00:25:30,000 THAT WOULD MAKE SENSE TO STARTS 721 00:25:30,000 --> 00:25:32,200 THE ROLE OUT OF PREP THAT WAY 722 00:25:32,200 --> 00:25:33,120 BUT I FEEL THERE NEEDS TO BE 723 00:25:33,120 --> 00:25:34,880 SOME CHANGE IN THE MARKETING 724 00:25:34,880 --> 00:25:40,520 FOOTPRINT. 725 00:25:40,520 --> 00:25:42,200 SO WE ALSO LOOKED AT CLIENTS 726 00:25:42,200 --> 00:25:43,200 DETERMINANTS OF ALCOHOL USE. 727 00:25:43,200 --> 00:25:44,560 REALLY INTERESTED IN TRYING TO 728 00:25:44,560 --> 00:25:49,000 GET A SENSE OF WHAT SPECIFICALLY 729 00:25:49,000 --> 00:25:50,160 MIGHT BE TRIGGERS AS WE STARTED 730 00:25:50,160 --> 00:25:51,560 TO THINK ABOUT HOW WE WERE GOING 731 00:25:51,560 --> 00:25:54,000 TO TAILOR INTERVENTION. 732 00:25:54,000 --> 00:25:57,480 AND COMMUNITY CAME UP IN TERMS 733 00:25:57,480 --> 00:25:58,920 OF STRESS, I HAVE GROWN UP AND 734 00:25:58,920 --> 00:26:01,880 LIVED IN THE COMMUNITY ALL OF MY 735 00:26:01,880 --> 00:26:03,640 LIFE SO I KNOW IT EPS PRONE TO 736 00:26:03,640 --> 00:26:05,000 VIOLENCE DRUGS, ALL TYPES OF 737 00:26:05,000 --> 00:26:05,360 THINGS. 738 00:26:05,360 --> 00:26:06,400 HOUSING CAME UP AS A CAUSE OF 739 00:26:06,400 --> 00:26:09,160 STRESS. 740 00:26:09,160 --> 00:26:11,040 I TOOK MY KIDS TO MY SISTER, I 741 00:26:11,040 --> 00:26:12,040 DIDN'T WANT THEM TO SLEEP MT. 742 00:26:12,040 --> 00:26:12,400 CAR. 743 00:26:12,400 --> 00:26:13,800 ONCE I RAN OUT OF MONEY I LOST 744 00:26:13,800 --> 00:26:16,480 MY JOB SO MY HOUSE, MY A MY JOB, 745 00:26:16,480 --> 00:26:17,800 ALL MY MONEY WAS GONE AND IT WAS 746 00:26:17,800 --> 00:26:20,880 GOING AND THEN THE SECOND CAR 747 00:26:20,880 --> 00:26:22,520 GOT TOWED I HAD TO GIVE MY DOG 748 00:26:22,520 --> 00:26:24,640 TO A FOSTER FAMILY BECAUSE I HAD 749 00:26:24,640 --> 00:26:26,000 NOWHERE TO PUT HIM. 750 00:26:26,000 --> 00:26:27,200 WORK STRESS, STRESS AND 751 00:26:27,200 --> 00:26:28,160 AGGREGATION AND WHAT YOU GO 752 00:26:28,160 --> 00:26:29,440 THROUGH IN YOUR JOB AND WITH 753 00:26:29,440 --> 00:26:30,040 YOUR CHILDREN AND STUFF LIKE 754 00:26:30,040 --> 00:26:30,840 THAT. 755 00:26:30,840 --> 00:26:32,520 LEADS TO A LOT OF FRUSTRATION 756 00:26:32,520 --> 00:26:34,840 AND STRESS. 757 00:26:34,840 --> 00:26:37,520 WOMEN DISCUSS USING ALCOHOL TO 758 00:26:37,520 --> 00:26:38,000 COPE. 759 00:26:38,000 --> 00:26:39,560 AT THE TIME I WAS DRINKING IS 760 00:26:39,560 --> 00:26:41,880 THE ONLY THING THAT HELP COPE 761 00:26:41,880 --> 00:26:43,880 WITH WAKING UP AT EIGHT CLOCK 762 00:26:43,880 --> 00:26:46,160 AND GO TO WORK THEN PARTY TO 763 00:26:46,160 --> 00:26:47,680 RELIEVE STRESS OF HAVING TO GO 764 00:26:47,680 --> 00:26:49,720 TO CLASS EVERY DAY I 8 IN THE 765 00:26:49,720 --> 00:26:51,240 MORNING AND RFAING OVER WEST 766 00:26:51,240 --> 00:26:53,360 BALTIMORE AND LIVED IN THE EAST. 767 00:26:53,360 --> 00:26:55,000 THEY WANT TO HAVE FUN BUT WHY? 768 00:26:55,000 --> 00:26:56,400 BECAUSE YOUR LIFE SUCKS, BECAUSE 769 00:26:56,400 --> 00:26:57,480 YOU HAVE A DEAD END JOB, YOU 770 00:26:57,480 --> 00:26:59,160 DIDN'T GO TO COLLEGE YOU HAVE 771 00:26:59,160 --> 00:27:00,920 KIDS, YOU ARE A YOUNG AGE SO YOU 772 00:27:00,920 --> 00:27:02,600 WANT TO GO OUT EVERY FRIDAY TO 773 00:27:02,600 --> 00:27:03,200 DRINK AND COPE. 774 00:27:03,200 --> 00:27:04,440 COPE WITH THE PAIN AND STRESS OF 775 00:27:04,440 --> 00:27:05,120 YOUR LIFE. 776 00:27:05,120 --> 00:27:06,120 BECAUSE YOU CAN'T COPE WITH IT 777 00:27:06,120 --> 00:27:11,120 YOURSELF. 778 00:27:11,120 --> 00:27:13,560 ANOTHER PERSON SAID I FEEL 779 00:27:13,560 --> 00:27:16,600 BETTER, WHEN I TOOK A DRINK I 780 00:27:16,600 --> 00:27:18,560 WASN'T THINKING ABOUT RAPE EVERY 781 00:27:18,560 --> 00:27:19,640 DAY OR IT WAS NOT THE ONLY TIME 782 00:27:19,640 --> 00:27:23,000 I THOUGHT ABOUT IT. 783 00:27:23,000 --> 00:27:25,160 SEXUAL TRAUMA WAS SALIENT, CAME 784 00:27:25,160 --> 00:27:28,160 UP IN ALL OUR INTERVIEWS. 785 00:27:28,160 --> 00:27:28,960 UNSOLY AT THIS TIMED. 786 00:27:28,960 --> 00:27:34,560 SO MUCH SO THAT WE REACHED 787 00:27:34,560 --> 00:27:35,600 SATURATION, AFTER THREE OR FOUR 788 00:27:35,600 --> 00:27:39,040 INTERVIEWS ON THIS THEME. 789 00:27:39,040 --> 00:27:41,400 SO BALLPARK WHAT PERCENT OF 790 00:27:41,400 --> 00:27:42,920 WOMEN HAD CHILDHOOD SEXUAL 791 00:27:42,920 --> 00:27:43,280 EXPERIENCES. 792 00:27:43,280 --> 00:27:46,880 TO BE HONEST PROBABLY 95% OF 793 00:27:46,880 --> 00:27:49,240 THOSE WHO ARE -- USE SUBSTANCES. 794 00:27:49,240 --> 00:27:50,400 RIGHT NOW A LOT OF WOMEN OUT 795 00:27:50,400 --> 00:27:51,920 THERE THAT HAVE BEEN ABUSED, I 796 00:27:51,920 --> 00:27:53,600 WOULD SAY 30% EXPERIENCE SEXUAL 797 00:27:53,600 --> 00:27:55,960 ABUSE. 798 00:27:55,960 --> 00:27:58,600 I WOULD SAY 89% AND THEIR MIND 799 00:27:58,600 --> 00:28:01,480 IS GONE AND HERE THEY ARE IN 800 00:28:01,480 --> 00:28:04,400 DRUG AND ALCOHOL TREATMENT. 801 00:28:04,400 --> 00:28:04,920 75%. 802 00:28:04,920 --> 00:28:06,280 DO WOMEN UNDERSTAND THE 803 00:28:06,280 --> 00:28:07,760 CONNECTION BETWEEN SEXUAL ABUSE 804 00:28:07,760 --> 00:28:11,200 AND LATER ALCOHOL AND DRUG USE? 805 00:28:11,200 --> 00:28:12,600 I DON'T THINK SO BECAUSE ALL 806 00:28:12,600 --> 00:28:14,040 THEY ARE TRYING TO DO IS GET RID 807 00:28:14,040 --> 00:28:15,000 OF THE PAIN. 808 00:28:15,000 --> 00:28:16,520 JUST NUMBING IT, THAT'S ALL I 809 00:28:16,520 --> 00:28:18,640 WANT TO DO. 810 00:28:18,640 --> 00:28:21,000 YES, IT DID, IT REALLY DID, MADE 811 00:28:21,000 --> 00:28:22,400 ME DRINK MORE, MADE ME DRINK 812 00:28:22,400 --> 00:28:23,320 MORE TO FORGET IT AND NOT TO 813 00:28:23,320 --> 00:28:24,000 THINK ABOUT IT. 814 00:28:24,000 --> 00:28:29,000 TO BLOCK IT OUT OF MY MEMORY. 815 00:28:29,000 --> 00:28:31,000 THEN WE ASKED ABOUT ALCOHOL 816 00:28:31,000 --> 00:28:31,560 TREATMENT. 817 00:28:31,560 --> 00:28:35,040 AND THIS WAS ALSO REALLY 818 00:28:35,040 --> 00:28:36,920 IMPORTANT BECAUSE WHAT YOU WILL 819 00:28:36,920 --> 00:28:39,440 SEE, I PUT PROVIDER COMMENTS 820 00:28:39,440 --> 00:28:40,600 NEXT TO CLIENT ONES IS NOT 821 00:28:40,600 --> 00:28:43,600 EVERYONE KNOW WHERE IS TO GO. 822 00:28:43,600 --> 00:28:45,280 ONE PERSON SAID I DON'T KNOW, 823 00:28:45,280 --> 00:28:46,560 THEY DON'T ASK THE WORK GROUPS, 824 00:28:46,560 --> 00:28:47,880 NOT THAT I KNOW OF IN BALTIMORE 825 00:28:47,880 --> 00:28:49,000 CITY, HARD TO FIND BECAUSE IT IS 826 00:28:49,000 --> 00:28:53,920 NOT PROMOTED IN SCHOOLS, 827 00:28:53,920 --> 00:28:56,600 COLLEGES, NOT EVEN COMMUNITY 828 00:28:56,600 --> 00:28:57,000 COLLEGES. 829 00:28:57,000 --> 00:28:58,680 SOMEONE SAID AA. 830 00:28:58,680 --> 00:29:00,400 SOMEONE SAID EVELYN JORDAN 831 00:29:00,400 --> 00:29:01,840 CLINIC THAT'S CLOSED. 832 00:29:01,840 --> 00:29:03,000 THERE'S NOT MANY PLACES. 833 00:29:03,000 --> 00:29:04,800 SO WHEN DID YOU FINALLY FIND 834 00:29:04,800 --> 00:29:05,200 GOOD TREATMENT? 835 00:29:05,200 --> 00:29:06,600 WHEN FOR THE FIRST TIME SOMEBODY 836 00:29:06,600 --> 00:29:08,000 WAS DEALING WITH MY ALCOHOL USE 837 00:29:08,000 --> 00:29:10,320 AND MY MENTAL HEALTH. 838 00:29:10,320 --> 00:29:12,600 SOMEBODY WAS DEALING WITH TWO 839 00:29:12,600 --> 00:29:14,400 ENTITIES, NOT BEING ONE BUT 840 00:29:14,400 --> 00:29:14,880 BEING TWO. 841 00:29:14,880 --> 00:29:16,000 ME UNDERSTANDING I DON'T KNOW 842 00:29:16,000 --> 00:29:17,120 WHEN THIS ONE IS WORKING OR THAT 843 00:29:17,120 --> 00:29:20,000 ONE IS WORKING. 844 00:29:20,000 --> 00:29:21,400 I AM GOING TO READ THIS NEXT 845 00:29:21,400 --> 00:29:21,880 ONE. 846 00:29:21,880 --> 00:29:25,400 BESIDES AA TO THEIR PRIMARY CARE 847 00:29:25,400 --> 00:29:28,200 DOCTORS, DO PCPs TALK TO YOU 848 00:29:28,200 --> 00:29:28,800 ABOUT ALCOHOL? 849 00:29:28,800 --> 00:29:30,920 NO, THEY TALK ABOUT SEX AND THEY 850 00:29:30,920 --> 00:29:31,400 TALK ABOUT DRUGS BUT NOT 851 00:29:31,400 --> 00:29:34,400 ALCOHOL. 852 00:29:34,400 --> 00:29:35,000 ONE MINUTE. 853 00:29:35,000 --> 00:29:36,560 SO I WILL RUSH. 854 00:29:36,560 --> 00:29:40,320 THE PROVIDER SAID I'M GOING TO 855 00:29:40,320 --> 00:29:41,120 RUN THROUGH THIS QUICKLY. 856 00:29:41,120 --> 00:29:42,640 MOST OF THE PROVIDERS SAID THEY 857 00:29:42,640 --> 00:29:44,360 DIDN'T KNOW WHERE TO SEND 858 00:29:44,360 --> 00:29:45,600 PATIENTS WITH ALCOHOL USE 859 00:29:45,600 --> 00:29:47,600 DISORDER. 860 00:29:47,600 --> 00:29:50,040 WHAT WERE THE SOLUTIONS? 861 00:29:50,040 --> 00:29:54,000 THESE WERE GENERATED BY PATIENTS 862 00:29:54,000 --> 00:29:55,360 ONES THAT PEOPLE TALKED ABOUT 863 00:29:55,360 --> 00:29:56,440 MENTAL HEALTH TREATMENT AND I'M 864 00:29:56,440 --> 00:29:59,200 GOING TO BRING UP USE OF PEERS. 865 00:29:59,200 --> 00:30:00,760 WOMEN LIKE ME, THEY WANT TO DO 866 00:30:00,760 --> 00:30:01,440 THAT, THEY HAVE A LITTLE 867 00:30:01,440 --> 00:30:04,000 EXPERIENCE IN IT. 868 00:30:04,000 --> 00:30:05,600 THEY NEED TO BE SOMEBODY THAT 869 00:30:05,600 --> 00:30:07,800 DEALT WITH IT THEMSELVES. 870 00:30:07,800 --> 00:30:09,240 A LOT OF FEEDBACK IMPORTANCE OF 871 00:30:09,240 --> 00:30:13,120 USING PEERS IN THE INTERVENTION. 872 00:30:13,120 --> 00:30:15,200 HERE IS A QUOTE, YOU CAN'T 873 00:30:15,200 --> 00:30:16,600 ADDRESS THE DRUG TREATMENT OR 874 00:30:16,600 --> 00:30:19,600 THE ALCOHOL USE OR THE COCAINE 875 00:30:19,600 --> 00:30:20,800 ADDICTION YOU CAN'T ADDRESS THAT 876 00:30:20,800 --> 00:30:21,800 WITHOUT GIVING THEM THE CUSHION 877 00:30:21,800 --> 00:30:24,640 OF THE HOLISTIC APPROACH 878 00:30:24,640 --> 00:30:25,200 ADDRESSING EVERYTHING ELSE 879 00:30:25,200 --> 00:30:27,200 BECAUSE IF I HAD TO COME INTO A 880 00:30:27,200 --> 00:30:28,960 PROGRAM, AND I WAS HOMELESS, IF 881 00:30:28,960 --> 00:30:30,160 I HAD TO GO ON THE STREET EVERY 882 00:30:30,160 --> 00:30:31,160 DAY I WOULDN'T HAVE STAYED 883 00:30:31,160 --> 00:30:33,240 SOBER. 884 00:30:33,240 --> 00:30:34,520 SO WHAT HAVE WE DONE? 885 00:30:34,520 --> 00:30:37,240 WE HAVE CREATED BASED ON CLOSE 886 00:30:37,240 --> 00:30:39,960 WORK WITH OUR COMMUNITY ADVISORY 887 00:30:39,960 --> 00:30:41,480 BOARD, A HYBRID MODEL OF THE 888 00:30:41,480 --> 00:30:44,120 COMPUTER AND COMMUNITY HEALTH 889 00:30:44,120 --> 00:30:45,320 WORKER INTERVENTION, WHERE THE 890 00:30:45,320 --> 00:30:48,280 COMPUTER IS USED AS AN 891 00:30:48,280 --> 00:30:51,000 ENGAGEMENT TOOL, IT WORKS AT THE 892 00:30:51,000 --> 00:30:52,320 INTERSECTION OF UNHEALTHY 893 00:30:52,320 --> 00:30:53,760 ALCOHOL USE BUT DISCUSSES TRAUMA 894 00:30:53,760 --> 00:30:56,160 AND OTHER MENTAL HEALTH ISSUES, 895 00:30:56,160 --> 00:30:58,480 PEOPLE HAVE PERCEIVED THIS AS 896 00:30:58,480 --> 00:31:01,680 LESS JUDGMENTAL AND WE USE 897 00:31:01,680 --> 00:31:04,640 INFORMATION MOTIVATIONAL 898 00:31:04,640 --> 00:31:06,200 BEHAVIORAL MODEL. 899 00:31:06,200 --> 00:31:09,440 HEAVILY ADAPTED, WITH 900 00:31:09,440 --> 00:31:10,360 INFORMATION FROM OUR CAB. 901 00:31:10,360 --> 00:31:11,680 WE DEVELOPED A COMMUNITY HEALTH 902 00:31:11,680 --> 00:31:13,560 WORKER MANUAL, IN PARTNERSHIP 903 00:31:13,560 --> 00:31:15,880 WITH COMMUNITY MEMBERS. 904 00:31:15,880 --> 00:31:17,600 AND WE ARE CURRENTLY PILOTING 905 00:31:17,600 --> 00:31:21,520 THIS IN THE HIV CLINIC AND SOON 906 00:31:21,520 --> 00:31:23,000 STI CLINICS IN BALTIMORE CITY 907 00:31:23,000 --> 00:31:24,400 WITH THE GOAL OF REALLY GETTING 908 00:31:24,400 --> 00:31:27,240 WOMEN TO THE RESOURCES THAT THEY 909 00:31:27,240 --> 00:31:27,840 NEED. 910 00:31:27,840 --> 00:31:30,160 I WILL END HERE SO AS TO NOT GO 911 00:31:30,160 --> 00:31:31,640 MORE THAN ONE MINUTE OVER. 912 00:31:31,640 --> 00:31:32,360 THANK YOU. 913 00:31:32,360 --> 00:31:36,200 I WOULD LIKE TO ACKNOWLEDGE OUR 914 00:31:36,200 --> 00:31:38,280 CAB OUR PARTICIPANTS, SCIENTIFIC 915 00:31:38,280 --> 00:31:40,720 COLLABORATOR AND NIAAA. 916 00:31:40,720 --> 00:31:43,840 >> THANK YOU SO MUCH DR. CHAMBER 917 00:31:43,840 --> 00:31:44,560 FOR THAT PRESENTATION. 918 00:31:44,560 --> 00:31:46,040 NOW WE WILL MOVE OVER TO DR. 919 00:31:46,040 --> 00:31:48,160 MCKEE. 920 00:31:48,160 --> 00:31:49,520 TODAY I WILL TALK COLLABORATIVE 921 00:31:49,520 --> 00:31:52,720 CARE MODEL THAT WE DEVELOPED TO 922 00:31:52,720 --> 00:31:57,000 SUPPORT THE SPECIAL REENTRY FROM 923 00:31:57,000 --> 00:31:57,720 INCARCERATION. 924 00:31:57,720 --> 00:31:59,520 A COUPLE OF SLIDES ABOUT CURRENT 925 00:31:59,520 --> 00:32:00,720 TRENDS IN THE CRIMINAL JUSTICE 926 00:32:00,720 --> 00:32:02,720 SYSTEM, AND THEN I WILL SPEND 927 00:32:02,720 --> 00:32:03,840 MAJORITY OF THE TIME TALKING 928 00:32:03,840 --> 00:32:06,360 ABOUT THE DEVELOPMENT OF 929 00:32:06,360 --> 00:32:08,120 INTEGRATED SYSTEM OF CARE FOR 930 00:32:08,120 --> 00:32:12,880 SIT SEN RETRY AND INITIAL 931 00:32:12,880 --> 00:32:14,120 OUTCOMES HIGHLIGHTING 932 00:32:14,120 --> 00:32:18,360 (INAUDIBLE). 933 00:32:18,360 --> 00:32:19,800 THE UNITED STATES HAS THE 934 00:32:19,800 --> 00:32:21,440 HIGHEST INCARCERATION RATES IN 935 00:32:21,440 --> 00:32:23,560 THE WORLD CURRENTLY AND ACCOUNTS 936 00:32:23,560 --> 00:32:25,720 FOR MORE THAN ONE FIFTH OF THE 937 00:32:25,720 --> 00:32:28,240 WORLD PRISONERS, WITH 938 00:32:28,240 --> 00:32:31,520 APPROXIMATELY 2.2 MILLION PEOPLE 939 00:32:31,520 --> 00:32:33,240 IN CUSTODY ON A GIVEN DAY. 940 00:32:33,240 --> 00:32:36,440 THIS IS ALSO TRUE FOR WOMEN. 941 00:32:36,440 --> 00:32:38,960 THAT INTERESTING TO NOTE THAT 942 00:32:38,960 --> 00:32:42,280 THE U.S. COMPRISES ABOUT 4% OF 943 00:32:42,280 --> 00:32:45,160 THE WORLD FEMALE POPULATION BUT 944 00:32:45,160 --> 00:32:47,200 ACCOUNTS FOR OVER 30% OF THE 945 00:32:47,200 --> 00:32:53,000 WORLD INCARCERATED WOMEN. 946 00:32:53,000 --> 00:32:56,320 ALONG WITH INCARCERATION COMES 947 00:32:56,320 --> 00:32:59,120 HYBRID RECIDIVISM FOR RETURN TO 948 00:32:59,120 --> 00:32:59,920 INCARCERATION. 949 00:32:59,920 --> 00:33:01,920 THIS DATA HERE FROM CONNECTICUT 950 00:33:01,920 --> 00:33:04,080 LOOKS VERY SIMILAR ACROSS THE 951 00:33:04,080 --> 00:33:07,680 US. WE SEE THAT THERE'S RATES 952 00:33:07,680 --> 00:33:14,360 OF 64% OF NEW ARRESTS AND 54% OF 953 00:33:14,360 --> 00:33:17,400 RETURN TO PRISON WITHIN A THREE 954 00:33:17,400 --> 00:33:20,600 YEAR TIME STAMP. 955 00:33:20,600 --> 00:33:23,560 AND WHEN YOU LOOK AT THE REASONS 956 00:33:23,560 --> 00:33:27,520 FOR RECIDIVISM, AGAIN THE DATA 957 00:33:27,520 --> 00:33:30,600 FROM CONNECTICUT IS SHOWING THAT 958 00:33:30,600 --> 00:33:32,960 DRUG RELATED CRIMES SO THIS IS 959 00:33:32,960 --> 00:33:34,720 NON-VIOLENT DRUG RELATED CRIME 960 00:33:34,720 --> 00:33:36,600 THAT ACCOUNTED FOR 45% OF 961 00:33:36,600 --> 00:33:38,840 RECIDIVISM. 962 00:33:38,840 --> 00:33:41,920 AND THIS IS AN ISSUE THAT I HAVE 963 00:33:41,920 --> 00:33:45,320 BEEN FOCUSED ON THAT WE ARE 964 00:33:45,320 --> 00:33:46,760 CRIMINALIZING NON-VIOLENT 965 00:33:46,760 --> 00:33:48,440 ADDICTION RELATED BEHAVIOR 966 00:33:48,440 --> 00:34:01,400 RATHER THAN TREATING ADDICTION. 967 00:34:01,400 --> 00:34:03,320 WE APPLIED FOR FUNDING FROM SAM 968 00:34:03,320 --> 00:34:05,600 A IS A, THE MENTAL HEALTH 969 00:34:05,600 --> 00:34:07,320 SUBSTANCE USE SERVICE 970 00:34:07,320 --> 00:34:08,880 ADMINISTRATION WHICH FUNDS 971 00:34:08,880 --> 00:34:09,440 SERVICE DELIVERY GRANTS AND 972 00:34:09,440 --> 00:34:11,440 RESPONDED TO RFA TO EXPAND OR 973 00:34:11,440 --> 00:34:14,400 ENHANCE SUBSTANCE USE TREATMENT 974 00:34:14,400 --> 00:34:16,400 AND RELATED RECOVERY AND REENTRY 975 00:34:16,400 --> 00:34:16,760 SERVICES. 976 00:34:16,760 --> 00:34:18,920 SO WITH THIS FUNDING, WE 977 00:34:18,920 --> 00:34:21,200 DEVELOPED THE LIVING FREE 978 00:34:21,200 --> 00:34:26,080 PROGRAM WHICH IS A COLLABORATIVE 979 00:34:26,080 --> 00:34:27,600 CARE MODEL AND PAIRS ADDICTION 980 00:34:27,600 --> 00:34:29,440 AND MENTAL HEALTHCARE WITH 981 00:34:29,440 --> 00:34:30,720 PRIMARY HEALTHCARE AND PEER 982 00:34:30,720 --> 00:34:36,120 MENTORSHIP SUPPORT. 983 00:34:36,120 --> 00:34:37,240 THIS REPRESENT HEARSAY A 984 00:34:37,240 --> 00:34:39,160 PARTNERSHIP BETWEEN US AT YALE 985 00:34:39,160 --> 00:34:40,840 AND STATE PARTNERS DEPARTMENT OF 986 00:34:40,840 --> 00:34:41,880 CORRECTIONS AND MENTAL HEALTH 987 00:34:41,880 --> 00:34:48,480 AND ADDICTION SERVICES. 988 00:34:48,480 --> 00:34:50,480 FROM THE VERY OUTSET WE WANTED 989 00:34:50,480 --> 00:34:53,600 TO KNOW FROM OUR PARTNERS WHAT 990 00:34:53,600 --> 00:34:55,000 WOULD SUPPORT SUSTAINABILITY OF 991 00:34:55,000 --> 00:34:58,080 SUCH A PROGRAM. 992 00:34:58,080 --> 00:34:59,760 THEY ARE PRIMARY TWO RESPONSES 993 00:34:59,760 --> 00:35:02,200 TO THE QUESTION WAS, IS THE 994 00:35:02,200 --> 00:35:04,200 PROGRAM COST EFFECTIVE, AND DOES 995 00:35:04,200 --> 00:35:10,720 THE PROGRAM REDUCE RECIDIVISM. 996 00:35:10,720 --> 00:35:14,240 SO THE TARGET POPULATION WE ARE 997 00:35:14,240 --> 00:35:15,920 RECRUITING TO THE PROGRAM, THEY 998 00:35:15,920 --> 00:35:17,480 HAVE TO BE PRESENTED WITH 999 00:35:17,480 --> 00:35:19,920 SUBSTANCE USE DISORDER IN NEED 1000 00:35:19,920 --> 00:35:21,680 OF TREATMENT AND THIS ACCOUNTS 1001 00:35:21,680 --> 00:35:24,960 FOR 80% OF THOSE CURRENTLY 1002 00:35:24,960 --> 00:35:25,480 INCARCERATED. 1003 00:35:25,480 --> 00:35:28,520 SO FAR WE HAVE RECRUITED 650 1004 00:35:28,520 --> 00:35:33,160 WOMEN AND MEN INTO OUR PROGRAM. 1005 00:35:33,160 --> 00:35:34,280 THEY MAY HAVE CHRONIC HEALTH 1006 00:35:34,280 --> 00:35:36,920 CONDITIONS IN THE CONNECTICUT 1007 00:35:36,920 --> 00:35:40,520 PRISON SYSTEM CHRONIC HEALTH 1008 00:35:40,520 --> 00:35:42,560 CONDITION, EXISTS AMONG 40% OF 1009 00:35:42,560 --> 00:35:44,440 THOSE INCARCERATED. 1010 00:35:44,440 --> 00:35:46,560 MUST BE INCARCERATED FOR THREE 1011 00:35:46,560 --> 00:35:49,120 MONTHS PER RFA, THE GRANT. 1012 00:35:49,120 --> 00:35:51,120 AND IT CAN BE ANY DISCHARGE 1013 00:35:51,120 --> 00:35:52,920 STATUS, SO CAN BE ACTUALLY END 1014 00:35:52,920 --> 00:35:55,320 OF SENTENCE OR ON SOME LEVEL OF 1015 00:35:55,320 --> 00:35:57,320 COMMUNITY SUPERVISION SUCH AS 1016 00:35:57,320 --> 00:35:58,480 PROBATION OR PAROLE. 1017 00:35:58,480 --> 00:36:00,720 WHEN WE DID A NEEDS ASSESSMENT 1018 00:36:00,720 --> 00:36:01,920 FOR THIS PROGRAM WE DISCOVERED 1019 00:36:01,920 --> 00:36:03,760 THAT A THOUSAND INDIVIDUALS WERE 1020 00:36:03,760 --> 00:36:07,840 BEING RELEASED PER YEAR BACK TO 1021 00:36:07,840 --> 00:36:10,400 THE GREATER NEWHAVEN AREA THAT 1022 00:36:10,400 --> 00:36:14,240 MET ELIGIBILITY CRITERIA. 1023 00:36:14,240 --> 00:36:16,920 SO WE STARTED PROVIDING SERVICES 1024 00:36:16,920 --> 00:36:19,320 WHILE THE PERSON IS STILL 1025 00:36:19,320 --> 00:36:19,920 INCARCERATED. 1026 00:36:19,920 --> 00:36:22,640 AND WE WORK WITH OUR DOC 1027 00:36:22,640 --> 00:36:26,240 PARTNERS WITH REGARD TO 1028 00:36:26,240 --> 00:36:28,320 RECRUITMENT, SO THEY ARE ABLE TO 1029 00:36:28,320 --> 00:36:29,600 IDENTIFY INDIVIDUALS WHO ARE 1030 00:36:29,600 --> 00:36:31,720 ABOUT TO LEAVE INCARCERATION SO 1031 00:36:31,720 --> 00:36:32,840 WITHIN SIX MONTHS RELEASE THAT 1032 00:36:32,840 --> 00:36:36,920 MEET ELIGIBILITY CRITERIA. 1033 00:36:36,920 --> 00:36:39,640 WE THEN HAVE THEM MEET WITH 1034 00:36:39,640 --> 00:36:42,640 ADDITION COUNSELOR AND HAVE THEM 1035 00:36:42,640 --> 00:36:44,400 CONSENT TO TREATMENT WE THEN DO 1036 00:36:44,400 --> 00:36:46,960 ANOTHER MEETING WITH THEM IN THE 1037 00:36:46,960 --> 00:36:48,880 FACILITY WITHIN TWO MONTHS OF 1038 00:36:48,880 --> 00:36:50,320 RELEASE AT THIS POINT THEY MEET 1039 00:36:50,320 --> 00:36:51,680 WITH THEIR ADDICTION COUNSELOR 1040 00:36:51,680 --> 00:36:53,600 AND PEER MENTOR. 1041 00:36:53,600 --> 00:36:56,720 THERE IS A MOTIVATIONAL 1042 00:36:56,720 --> 00:36:58,800 ENHANCEMENT APPROACH TO INCREASE 1043 00:36:58,800 --> 00:36:59,640 MOTOR DIVISION TO ENGAGE 1044 00:36:59,640 --> 00:37:00,160 COMMUNITY TREATMENT ONCE 1045 00:37:00,160 --> 00:37:01,280 RELEASED. 1046 00:37:01,280 --> 00:37:04,200 AND ALSO AT THIS MEETING START 1047 00:37:04,200 --> 00:37:06,440 TO DEVELOP INDIVIDUALIZED 1048 00:37:06,440 --> 00:37:07,720 TREATMENT PLAN FOR INTEGRATED 1049 00:37:07,720 --> 00:37:11,720 CARE. 1050 00:37:11,720 --> 00:37:14,520 WE THEN ALSO PROVIDED AN 1051 00:37:14,520 --> 00:37:17,160 ESCORTED VISIT TO OUR CLINIC. 1052 00:37:17,160 --> 00:37:18,920 CLINICAL DIRECTOR OF THE CLINIC 1053 00:37:18,920 --> 00:37:20,000 HERE IN THE PICTURE LOCATE 1054 00:37:20,000 --> 00:37:23,520 MISDEMEANOR THE LOVELY AREA OF 1055 00:37:23,520 --> 00:37:24,640 CONNECTICUT. 1056 00:37:24,640 --> 00:37:27,200 WE DID A VISIT ONE MONTH PRIOR 1057 00:37:27,200 --> 00:37:29,120 TO RELEASE AND THE GOALS OF THIS 1058 00:37:29,120 --> 00:37:30,640 MEETING ARE FOR THEM TO SEE THE 1059 00:37:30,640 --> 00:37:32,840 PHYSICAL LOCATION OF THE CLINIC, 1060 00:37:32,840 --> 00:37:34,800 CONTINUE TO BUILD THERAPEUTIC 1061 00:37:34,800 --> 00:37:36,840 RELATIONSHIP AND MEET WITH THE 1062 00:37:36,840 --> 00:37:39,840 ENTIRE TEAM INCLUDING ADDICTION 1063 00:37:39,840 --> 00:37:42,600 PSYCHIATRIST SO WE CAN START TO 1064 00:37:42,600 --> 00:37:45,440 EVALUATE NEEDS FOR MATCH FOR 1065 00:37:45,440 --> 00:37:47,360 PSYCHIATRIC MEDICATION, UPON 1066 00:37:47,360 --> 00:37:48,080 RELEASE. 1067 00:37:48,080 --> 00:37:51,400 CURRENTLY DOC DOES HAVE LIMITED 1068 00:37:51,400 --> 00:37:53,560 PROVISION PROVIDING THAT DURING 1069 00:37:53,560 --> 00:37:55,560 INCARCERATION BUT THIS IS BY NO 1070 00:37:55,560 --> 00:37:58,800 MEANS STATEWIDE AT THIS POINT. 1071 00:37:58,800 --> 00:38:00,240 SO UNDERSTANDING MEDICATION 1072 00:38:00,240 --> 00:38:01,800 NEEDS UPON RELEASE IS REALLY 1073 00:38:01,800 --> 00:38:04,360 CRITICAL. 1074 00:38:04,360 --> 00:38:06,880 ONE THE PERSON IS RELEASED FROM 1075 00:38:06,880 --> 00:38:08,720 INCARCERATION, THEY ENGAGE IN 1076 00:38:08,720 --> 00:38:11,800 ADISTRIBUTION TREATMENT AT THE 1077 00:38:11,800 --> 00:38:12,640 FOURTH CLINIC. 1078 00:38:12,640 --> 00:38:17,400 THIS IS VICKIE HERE AT THE FRONT 1079 00:38:17,400 --> 00:38:19,240 DOOR, WE HAVE A TEAM APPROACH 1080 00:38:19,240 --> 00:38:20,320 THE AID CARE, ALL CLINICIANS ARE 1081 00:38:20,320 --> 00:38:22,160 TRAINED IN EVIDENCE BASED CARE, 1082 00:38:22,160 --> 00:38:25,080 ALL MY CLINICIANS ARE EITHER 1083 00:38:25,080 --> 00:38:26,560 Ph.D. OR MA LEVEL CLINICIAN. 1084 00:38:26,560 --> 00:38:30,160 AND AGAIN TO SAY HA OUR CLINIC 1085 00:38:30,160 --> 00:38:33,160 IS A STATE FUNDED CLINIC, IT IS 1086 00:38:33,160 --> 00:38:36,880 A SATELLITE CLINIC OF THE LOCAL 1087 00:38:36,880 --> 00:38:40,400 STATE FUNDED HOSPITAL LOCATED IN 1088 00:38:40,400 --> 00:38:40,720 NEWHAVEN. 1089 00:38:40,720 --> 00:38:43,040 ALL TREATMENT IS PERSON CENTERED 1090 00:38:43,040 --> 00:38:47,480 AND INDIVIDUAL SO EACH PERSON'S 1091 00:38:47,480 --> 00:38:49,360 PRIMARY MODALITY AS INDIVIDUAL 1092 00:38:49,360 --> 00:38:51,040 THERAPY GROUPS ADJUNCTIVE WE 1093 00:38:51,040 --> 00:38:53,520 HAVE HARM REDUCTION APPROACH, WE 1094 00:38:53,520 --> 00:38:55,960 PRACTICE TRAUMA VIOLENCE AND 1095 00:38:55,960 --> 00:38:58,400 GENDER INFORMED CARE, MEDICATION 1096 00:38:58,400 --> 00:38:59,880 ASSISTED TREATMENT, IS KEY, WE 1097 00:38:59,880 --> 00:39:01,760 HAVE A WELL DEVELOPED OPIOID 1098 00:39:01,760 --> 00:39:04,240 OVERDOSE PREVENTION PLAN. 1099 00:39:04,240 --> 00:39:05,320 THE LENGTH OF TREATMENT IS 1100 00:39:05,320 --> 00:39:06,720 MINIMUM THREE MONTHS BUT THERE 1101 00:39:06,720 --> 00:39:08,600 IS NO MAXIMUM SO WE DO HAVE 1102 00:39:08,600 --> 00:39:14,640 CLIENTS WHO STAY FOR SOME 1103 00:39:14,640 --> 00:39:15,440 MONTHS, SOME YEARS IN CERTAIN 1104 00:39:15,440 --> 00:39:16,240 CASES. 1105 00:39:16,240 --> 00:39:17,600 WE HAVE EMPLOYMENT SPECIALIST AS 1106 00:39:17,600 --> 00:39:20,600 PART OF THE TEAM AND CAN SUPPORT 1107 00:39:20,600 --> 00:39:23,200 SOBER HOUSING WITH GRANT FUNDS. 1108 00:39:23,200 --> 00:39:25,640 SO IN ADDITION TO ALL THE 1109 00:39:25,640 --> 00:39:27,320 QUANTITATIVE DATA WE COLLECT WE 1110 00:39:27,320 --> 00:39:29,640 ALSO COLLECT QUITE A BIT 1111 00:39:29,640 --> 00:39:31,120 QUALITATIVE DATA. 1112 00:39:31,120 --> 00:39:33,440 SO I WILL PRESENT QUOTES FROM 1113 00:39:33,440 --> 00:39:34,120 OUR CLIENT. 1114 00:39:34,120 --> 00:39:37,200 WITH REGARD TO ADDICTION CARE 1115 00:39:37,200 --> 00:39:39,520 NOW AND CLEAN, I'M NOT GETTING 1116 00:39:39,520 --> 00:39:41,320 MAD GETTING CRAZY, THINKING 1117 00:39:41,320 --> 00:39:42,760 STUPID THINGS, YOU KNOW WHAT I 1118 00:39:42,760 --> 00:39:44,080 MEAN, I'M CLEAR HEADED. 1119 00:39:44,080 --> 00:39:45,200 I'M THINKING NOW. 1120 00:39:45,200 --> 00:39:47,120 I DID LEARN SOME COPING SKILLS, 1121 00:39:47,120 --> 00:39:49,120 HOW TO TAKE MYSELF OUT OF THAT 1122 00:39:49,120 --> 00:39:51,520 HE MOMENT AND PUT MYSELF IN THE 1123 00:39:51,520 --> 00:39:52,520 PRESENT BECAUSE I HAVE PANIC 1124 00:39:52,520 --> 00:39:54,320 ATTACKS AND I'M LEARNING WAYS TO 1125 00:39:54,320 --> 00:39:55,720 COPE WITH THEM AND ONLY THROUGH 1126 00:39:55,720 --> 00:39:59,080 THIS PROGRAM THAT I HAVE LEARNED 1127 00:39:59,080 --> 00:40:02,600 THOSE WAYS. 1128 00:40:02,600 --> 00:40:04,200 JAWANNA IS A CLINICIAN THAT 1129 00:40:04,200 --> 00:40:05,640 SPECIALIZES IN TRAUMA INFORMED 1130 00:40:05,640 --> 00:40:06,040 CARE. 1131 00:40:06,040 --> 00:40:07,720 I USED TO GET NUMB MYSELF AND I 1132 00:40:07,720 --> 00:40:08,640 DON'T THINK ABOUT THE TRAUMA SO 1133 00:40:08,640 --> 00:40:10,040 THAT IS A VERY BIG PART. 1134 00:40:10,040 --> 00:40:11,920 THAT IS WHAT THE ONE ON ONE 1135 00:40:11,920 --> 00:40:13,760 COUNSELING WAS, GREAT FOR ME 1136 00:40:13,760 --> 00:40:16,240 LIKE WITH TRAUMA BECAUSE THERE 1137 00:40:16,240 --> 00:40:17,480 WERE THINGS I WOULDN'T WANT TO 1138 00:40:17,480 --> 00:40:19,040 TALK ABOUT IN A GROUP SETTING, 1139 00:40:19,040 --> 00:40:20,920 IT WAS NICE TO HAVE ONE ON ONE 1140 00:40:20,920 --> 00:40:22,160 COUNSELING WHERE YOU CAN TALK 1141 00:40:22,160 --> 00:40:24,520 ABOUT THINGS LIKE THAT AND THERE 1142 00:40:24,520 --> 00:40:25,760 WERE ALWAYS DIFFERENT 1143 00:40:25,760 --> 00:40:27,920 UNDERSTANDING IN EVENTS, THEY 1144 00:40:27,920 --> 00:40:31,520 WERE ALWAYS REALLY COOL. 1145 00:40:31,520 --> 00:40:34,400 SO WITH REGARD TO OUR OPIOID 1146 00:40:34,400 --> 00:40:36,720 OVERDOSE PREVENTION PLAN ALL THE 1147 00:40:36,720 --> 00:40:38,600 STARTS WITH STAFF TRAINING, WE 1148 00:40:38,600 --> 00:40:40,480 HAVE NALOXONE ON SITE AT CLINIC 1149 00:40:40,480 --> 00:40:43,360 WE CAN PROVIDE CLIENTS, WE START 1150 00:40:43,360 --> 00:40:47,520 TO IDENTIFY RISK OF OVERDOSE, 1151 00:40:47,520 --> 00:40:50,520 PRE-RELEASE WITH THE FIRST 1152 00:40:50,520 --> 00:40:51,520 APPOINTMENT TO UNDERSTAND WHERE 1153 00:40:51,520 --> 00:40:53,520 THEY ARE PERSONS PRESENTING WITH 1154 00:40:53,520 --> 00:40:56,320 OPIOID DEPENDENCE ISSUE. 1155 00:40:56,320 --> 00:40:58,720 WE EVALUATE MEDICATION 1156 00:40:58,720 --> 00:40:59,720 PRE-RELEASE VERY STRONGLY 1157 00:40:59,720 --> 00:41:02,080 ADVOCATE FOR THE PERSON TO TAKE 1158 00:41:02,080 --> 00:41:05,960 A MATCH, POST RELEASE WE ENGAGE 1159 00:41:05,960 --> 00:41:08,080 CLIENTS, MEDICATION AS SOON AS 1160 00:41:08,080 --> 00:41:09,520 POSSIBLE, HAVE VERY CLOSE 1161 00:41:09,520 --> 00:41:11,520 MONITORING, PROVIDE THEM WITH 1162 00:41:11,520 --> 00:41:14,320 NALOXONE AND ALSO TO OFFER TO 1163 00:41:14,320 --> 00:41:16,160 TRAIN FRIENDS AND FAMILY TO 1164 00:41:16,160 --> 00:41:19,920 ADMINISTER NALOXONE. 1165 00:41:19,920 --> 00:41:22,120 WE HAVE INTEGRATIVE PRIMARY 1166 00:41:22,120 --> 00:41:24,120 HEALTHCARE PROVIDED BY THE 1167 00:41:24,120 --> 00:41:27,160 TRANSITION CLINIC LED BY EMILY 1168 00:41:27,160 --> 00:41:27,680 WANG. 1169 00:41:27,680 --> 00:41:29,880 THE CLINIC EMPLOYS COMMUNITY 1170 00:41:29,880 --> 00:41:32,440 HEALTH WORKERS TO HELP CLIENTS 1171 00:41:32,440 --> 00:41:34,560 NAVIGATE HEALTHCARE SYSTEMS. 1172 00:41:34,560 --> 00:41:37,320 AND IMPORTANT TO NOTE THAT 1173 00:41:37,320 --> 00:41:41,560 ACCESS TO PRIMARY CARE IS RAPID 1174 00:41:41,560 --> 00:41:43,800 UPON RELEASE. 1175 00:41:43,800 --> 00:41:47,880 WE ALSO PROVIDE PEER SUPPORT 1176 00:41:47,880 --> 00:41:49,320 MENTORSHIP, THIS PORTION OF THE 1177 00:41:49,320 --> 00:41:53,040 PROGRAM IS LED BY SHEER REEL 1178 00:41:53,040 --> 00:41:55,240 BELAMINE AN EXPERT IN PEER 1179 00:41:55,240 --> 00:41:56,440 MENTORS SO WE HAVE STAFF WITH 1180 00:41:56,440 --> 00:41:57,760 LIVED EXPERIENCE WITH ADDICTION 1181 00:41:57,760 --> 00:42:00,000 AND INCARCERATION TO HELP OUR 1182 00:42:00,000 --> 00:42:07,240 CLIENTS NAVIGATE REENTRY SO THEY 1183 00:42:07,240 --> 00:42:09,680 PROVIDE CASE MANAGEMENT, CONTACT 1184 00:42:09,680 --> 00:42:11,200 IS FREQUENT STARTING WHEN THE 1185 00:42:11,200 --> 00:42:14,080 PERSON IS STILL INCARCERATED, 1186 00:42:14,080 --> 00:42:17,680 THEN CAN BE DAILY MULTIPLE DAILY 1187 00:42:17,680 --> 00:42:18,360 CONTACT UPON RELEASE. 1188 00:42:18,360 --> 00:42:22,440 THE PEER MENTORS ALSO LEAD A 1189 00:42:22,440 --> 00:42:24,200 WEEKLY GROUP, THAT IS WHY I DID 1190 00:42:24,200 --> 00:42:25,400 ALL THESE GROUPS, THEY HELP ME 1191 00:42:25,400 --> 00:42:27,520 AT THE BEGINNING, I DIDN'T THINK 1192 00:42:27,520 --> 00:42:29,400 IT WOULD, I'M 60 YEARS OLD I 1193 00:42:29,400 --> 00:42:30,520 SAID WHAT THE HELL ARE THEY 1194 00:42:30,520 --> 00:42:34,200 GOING TO TELL ME. 1195 00:42:34,200 --> 00:42:36,200 SO WITH REGARDS TO SYSTEM OF OUR 1196 00:42:36,200 --> 00:42:37,560 DATA I'M GOING TO PRESENT SOME 1197 00:42:37,560 --> 00:42:41,120 DATA ON OUR FIRST 260 1198 00:42:41,120 --> 00:42:41,480 PARTICIPANTS. 1199 00:42:41,480 --> 00:42:44,920 WE CAN SEE THAT JUST OVER A 1200 00:42:44,920 --> 00:42:48,520 THIRD OF OUR PARTICIPANTS WERE 1201 00:42:48,520 --> 00:42:50,800 WOMEN. 1202 00:42:50,800 --> 00:42:51,880 ABOUT 63% MEN. 1203 00:42:51,880 --> 00:42:54,320 FAIRLY WELL MATCHED IN TERMS OF 1204 00:42:54,320 --> 00:42:55,040 AGE. 1205 00:42:55,040 --> 00:42:59,760 INTERESTING DIFFERENCE IN RACIAL 1206 00:42:59,760 --> 00:43:00,720 COMPOSITION, 64% WHITE. 1207 00:43:00,720 --> 00:43:08,040 WE SEE THAT IS ABOUT 60% BLACK 1208 00:43:08,040 --> 00:43:10,400 FOR MEN. 1209 00:43:10,400 --> 00:43:13,320 WE DID THIS ANALYSIS VERY EARLY 1210 00:43:13,320 --> 00:43:15,360 ON LOOKING AT INCARCERATION 1211 00:43:15,360 --> 00:43:16,840 HISTORY AMONG OUR SAMPLES 1212 00:43:16,840 --> 00:43:18,560 BECAUSE WE WANTED TO UNDERSTAND 1213 00:43:18,560 --> 00:43:22,320 WHO WE WERE RECRUITING INTO THE 1214 00:43:22,320 --> 00:43:23,280 PROGRAM. 1215 00:43:23,280 --> 00:43:28,800 AND WE FOUND OUT THAT ABOUT 20%, 1216 00:43:28,800 --> 00:43:31,280 MAJORITY OF 90% INCARCERATED 1217 00:43:31,280 --> 00:43:35,120 MULTIPLE TIMES, ABOUT 20% 1218 00:43:35,120 --> 00:43:36,000 INCARCERATED MORE THAN 15 TIMES 1219 00:43:36,000 --> 00:43:37,720 IN THEIR LIFETIME, IN AND OUT OF 1220 00:43:37,720 --> 00:43:38,280 INCARCERATION. 1221 00:43:38,280 --> 00:43:39,440 WHEN WE LOOK AT THE REASONS FOR 1222 00:43:39,440 --> 00:43:42,400 THIS INCARCERATION THE TOP SIX 1223 00:43:42,400 --> 00:43:45,520 MOST PREVALENT REASONS WERE FOR 1224 00:43:45,520 --> 00:43:48,160 NON-VIOLENT CRIMES, VIOLATION OF 1225 00:43:48,160 --> 00:43:49,720 PROBATION, BREACH OF PEACE, 1226 00:43:49,720 --> 00:43:52,520 FAILURE TO APPEAR, LARCENY, 1227 00:43:52,520 --> 00:43:54,280 VARIOUS DRUG RELATED CRIMES, ET 1228 00:43:54,280 --> 00:43:57,040 CETERA. 1229 00:43:57,040 --> 00:43:59,800 WHEN WE LOOK AT PRIMARY 1230 00:43:59,800 --> 00:44:01,720 SUBSTANCE ABUSE CLINICIAN RATED, 1231 00:44:01,720 --> 00:44:03,760 WE SEE SOME INTERESTING GENDER 1232 00:44:03,760 --> 00:44:05,040 DIFFERENCES THAT WOMEN WERE MORE 1233 00:44:05,040 --> 00:44:07,800 LIKELY TO HAVE AN OPIOID USE 1234 00:44:07,800 --> 00:44:10,240 DISORDER, AND COCAINE USE 1235 00:44:10,240 --> 00:44:10,720 DISORDER. 1236 00:44:10,720 --> 00:44:12,320 WHEREAS MEN MORE LIKELY TO HAVE 1237 00:44:12,320 --> 00:44:15,120 AN ALCOHOL USE DISORDER OR 1238 00:44:15,120 --> 00:44:17,120 CANNABIS USE. 1239 00:44:17,120 --> 00:44:22,040 WE SEE NO DIFFERENCE IN RATES OF 1240 00:44:22,040 --> 00:44:24,520 POLYSUB STANCE USE BUT WOMEN ARE 1241 00:44:24,520 --> 00:44:27,360 USING MORE RISKY PATTERNS OR 1242 00:44:27,360 --> 00:44:29,680 COMBINATIONS OF MORE LIKELY 1243 00:44:29,680 --> 00:44:31,880 COMBINED HEROIN COCAINE, MEN 1244 00:44:31,880 --> 00:44:35,720 MORE LIKELY TO COMBINE ALCOHOL 1245 00:44:35,720 --> 00:44:37,720 AND CANNABIS. 1246 00:44:37,720 --> 00:44:39,680 PSYCHIATRIC MORBIDITY, WE SEE 1247 00:44:39,680 --> 00:44:41,440 THAT WOMEN WERE MORE LIKELY TO 1248 00:44:41,440 --> 00:44:43,840 HAVE PSYCHIATRIC DIAGNOSES THAN 1249 00:44:43,840 --> 00:44:45,720 MEN, AND WHEN WE LOOK AT OUR 1250 00:44:45,720 --> 00:44:47,840 MOST COMMON DIAGNOSES WE CAN SEE 1251 00:44:47,840 --> 00:44:50,280 GREATER RATES IN WOMEN ACROSS 1252 00:44:50,280 --> 00:44:51,640 THE BOARD. 1253 00:44:51,640 --> 00:44:52,880 INTERESTING WE SEE ONCE YOU HAVE 1254 00:44:52,880 --> 00:44:54,880 A PSYCHIATRIC DISORDER YOU ARE 1255 00:44:54,880 --> 00:44:56,840 PRETTY EQUALLY LIKELY TO HAVE 1256 00:44:56,840 --> 00:45:02,760 ANOTHER PSYCHIATRIC DISORDER IN 1257 00:45:02,760 --> 00:45:03,680 WOMEN THAN MEN. 1258 00:45:03,680 --> 00:45:05,360 WOMEN MORE LIKELY TO HAVE 1259 00:45:05,360 --> 00:45:08,320 GREATER SUICIDE RISK THAN MEN. 1260 00:45:08,320 --> 00:45:13,600 WOMEN WERE ALSO MORE LIKELY TO 1261 00:45:13,600 --> 00:45:15,720 HAVE GREATER RATES OF VIOLENCE 1262 00:45:15,720 --> 00:45:23,160 AND TRAUMA. 1263 00:45:23,160 --> 00:45:25,120 WE ALSO NOTED WOMEN WERE MORE 1264 00:45:25,120 --> 00:45:26,280 LIKELY TO ENDORSE SYMPTOMS 1265 00:45:26,280 --> 00:45:28,680 RELATED TO THE TRAUMA, SUCH AS 1266 00:45:28,680 --> 00:45:32,200 NIGHTMARES, AVOIDANCE, BEING ON 1267 00:45:32,200 --> 00:45:35,720 -- NUMB OR DETACHED. 1268 00:45:35,720 --> 00:45:37,120 WOMEN WERE ALSO MORE LIKELY TO 1269 00:45:37,120 --> 00:45:40,440 HAVE GREATER RATES OF CHRONIC 1270 00:45:40,440 --> 00:45:42,720 HEALTH CONDITIONS, I LISTED THE 1271 00:45:42,720 --> 00:45:46,560 MOST COMMON HEALTH CONDITIONS 1272 00:45:46,560 --> 00:45:48,360 HERE WE DIDN'T SEE ANY 1273 00:45:48,360 --> 00:45:50,920 DIFFERENCE BETWEEN MEN AND WOMEN 1274 00:45:50,920 --> 00:45:52,120 ON THE HEALTH CONDITIONS 1275 00:45:52,120 --> 00:45:52,680 REPORTING. 1276 00:45:52,680 --> 00:45:54,720 WITH REGARDS TO TREATMENT 1277 00:45:54,720 --> 00:45:56,040 OUTCOME, WE SEE NO DIFFERENCES 1278 00:45:56,040 --> 00:45:57,920 IN THE RATE OF ENGAGEMENT 1279 00:45:57,920 --> 00:46:01,720 BETWEEN MEN AND WOMEN. 1280 00:46:01,720 --> 00:46:04,680 WE SEE THAT ALTHOUGH WOMEN HAD 1281 00:46:04,680 --> 00:46:06,000 HIGHER RATES OF HEALTH 1282 00:46:06,000 --> 00:46:07,560 CONDITIONS THEY WERE LESS LIKELY 1283 00:46:07,560 --> 00:46:10,680 TO ENGAGE IN PHYSICAL 1284 00:46:10,680 --> 00:46:11,240 HEALTHCARE. 1285 00:46:11,240 --> 00:46:15,200 NONETHELESS WE WERE ABLE TO 1286 00:46:15,200 --> 00:46:17,880 VERIFY AND HELP SUPPORT RECENT 1287 00:46:17,880 --> 00:46:20,040 HIV AND HEP C TESTING TO OUR 1288 00:46:20,040 --> 00:46:23,320 CLIENTS. 1289 00:46:23,320 --> 00:46:25,320 WOMEN AND MEN HAD SIMILAR 1290 00:46:25,320 --> 00:46:27,000 NUMBERS OF CHILDREN BUT WOMEN 1291 00:46:27,000 --> 00:46:28,760 WERE MORE LIKELY TO HAVE 1292 00:46:28,760 --> 00:46:31,520 CHILDREN CUSTODIAL CARE SO THIS 1293 00:46:31,520 --> 00:46:35,240 WOULD BECOME A MAJOR FOCUS OF 1294 00:46:35,240 --> 00:46:37,920 THEIR TREATMENT MEN AND WOMEN 1295 00:46:37,920 --> 00:46:40,440 WERE EQUALLY LIKELY TO ENGAGE IN 1296 00:46:40,440 --> 00:46:45,320 MATH AND EQUALLY LIKELY TO 1297 00:46:45,320 --> 00:46:46,720 ACCESS NARCAN KIT. 1298 00:46:46,720 --> 00:46:49,080 WE HAD A METHADONE PARTNER RIGHT 1299 00:46:49,080 --> 00:46:51,800 IN THE BUILDING WITH US AND WE 1300 00:46:51,800 --> 00:46:55,120 PROVIDED NALOXONE. 1301 00:46:55,120 --> 00:46:57,880 RATES OF HOUSING AND EMPLOYMENT 1302 00:46:57,880 --> 00:47:01,080 WERE HIGH AND NO DIFFERENCE 1303 00:47:01,080 --> 00:47:05,840 BETWEEN MEN AND WOMEN. 1304 00:47:05,840 --> 00:47:07,720 WHEN WE LOOK AT WHO COMPLETED 1305 00:47:07,720 --> 00:47:09,880 THREE MONTHS OF TREATMENT WE 1306 00:47:09,880 --> 00:47:12,320 HAVE SIMILAR RATES BETWEEN MEN 1307 00:47:12,320 --> 00:47:15,520 AND WOMEN, AFTER THE MINIMUM 1308 00:47:15,520 --> 00:47:17,520 TREATMENT PERIOD WE ARE AT A 1309 00:47:17,520 --> 00:47:20,360 POINT WHERE CLINICIAN EVALUATES 1310 00:47:20,360 --> 00:47:22,120 PERSON STABLE ENOUGH TO BE 1311 00:47:22,120 --> 00:47:25,240 DISCHARGED FROM TREATMENT. 1312 00:47:25,240 --> 00:47:28,120 WE HAD OVER 20% MEN AND WOMEN 1313 00:47:28,120 --> 00:47:31,560 ELECT TO STAY LONGER FOR LONGER 1314 00:47:31,560 --> 00:47:32,680 TERM TREATMENT, SUPPORTED IN 1315 00:47:32,680 --> 00:47:35,200 ADDICTION CARE AND WE ALSO HAD 1316 00:47:35,200 --> 00:47:37,640 EQUALLY HIGH RATES OF ABSTINENCE 1317 00:47:37,640 --> 00:47:39,880 FOR MEN AND WOMEN AT THE POINT 1318 00:47:39,880 --> 00:47:42,640 OF TREATMENT COMPLETION. 1319 00:47:42,640 --> 00:47:44,600 IN TERMS OF LONGER TERM 1320 00:47:44,600 --> 00:47:47,280 OUTCOMES, LOOKING AT SIX MONTHS 1321 00:47:47,280 --> 00:47:49,520 FOLLOWING DISCHARGE WE SEE THAT 1322 00:47:49,520 --> 00:47:51,040 WOMEN CONTINUE TO HAVE HIGHER 1323 00:47:51,040 --> 00:47:55,000 RATES OF DEPRESSION AND ANXIETY 1324 00:47:55,000 --> 00:47:56,120 BUT IMPORTANTLY THERE WERE ALSO 1325 00:47:56,120 --> 00:47:59,240 MORE LIKELY TO CONTINUE TAKING A 1326 00:47:59,240 --> 00:48:00,720 PSYCHIATRIC MEDICATION TO TREAT 1327 00:48:00,720 --> 00:48:02,320 THOSE SYMPTOMS. 1328 00:48:02,320 --> 00:48:04,640 RATES OF NEW TRAUMA AND 1329 00:48:04,640 --> 00:48:07,520 VICTIMIZATION WERE LOW BUT STILL 1330 00:48:07,520 --> 00:48:10,840 TOO HIGH AT 5% FOR WOMEN. 1331 00:48:10,840 --> 00:48:12,800 WHEN WE LOOK AT RATES OF 1332 00:48:12,800 --> 00:48:14,040 ABSTINENCE AT SIX MONTHS POINT 1333 00:48:14,040 --> 00:48:16,520 YOU SEE HIGH RATES FOR ALCOHOL, 1334 00:48:16,520 --> 00:48:19,840 SOMEWHAT LOWER FOR DRUGS. 1335 00:48:19,840 --> 00:48:21,520 AND AGAIN NO DIFFERENCE BETWEEN 1336 00:48:21,520 --> 00:48:23,880 MEN AND WOMEN. 1337 00:48:23,880 --> 00:48:27,600 WHEN WE LOOK AT RECIDIVISM, WHAT 1338 00:48:27,600 --> 00:48:30,600 WE DO HERE IS A VERY PRELIMINARY 1339 00:48:30,600 --> 00:48:33,480 LOOK BUT THE GREEN BAR IS THE 1340 00:48:33,480 --> 00:48:36,440 STATE AVERAGE OF RETURN TO 1341 00:48:36,440 --> 00:48:37,720 PRISON WITHIN 36 MONTH WINDOW, 1342 00:48:37,720 --> 00:48:43,000 WE SEE NO DIFFERENCE BETWEEN MEN 1343 00:48:43,000 --> 00:48:45,560 AND WOMEN. 1344 00:48:45,560 --> 00:48:47,360 WE SEE CRIMES WHICH THEY RETURN 1345 00:48:47,360 --> 00:48:51,000 TO PRISON WERE EVENLY SPLIT 1346 00:48:51,000 --> 00:48:53,120 BETWEEN FELONY AND MISDEMEANORS 1347 00:48:53,120 --> 00:48:56,720 AND VIOLENT AND NON-VIOLENT 1348 00:48:56,720 --> 00:48:57,080 CRIME. 1349 00:48:57,080 --> 00:48:58,400 BUT CERTAINLY GOING TO BE DOING 1350 00:48:58,400 --> 00:49:00,840 A MUCH CLOSER LOOK AT THIS 1351 00:49:00,840 --> 00:49:03,120 OUTCOME AND GOING TO BE FORMING 1352 00:49:03,120 --> 00:49:04,960 A CONTROL GROUP WITH 1353 00:49:04,960 --> 00:49:06,640 ADMINISTRATIVE DATA AND USING 1354 00:49:06,640 --> 00:49:11,000 PROPENSITY MATCHING. 1355 00:49:11,000 --> 00:49:13,040 SO IN SUMMARY WOMEN HAVE HIGHER 1356 00:49:13,040 --> 00:49:16,120 RISK OF SUBSTANCE USE AND 1357 00:49:16,120 --> 00:49:17,680 RISKIER COMBINATIONS OF 1358 00:49:17,680 --> 00:49:18,440 SUBSTANCES. 1359 00:49:18,440 --> 00:49:20,680 THERE'S GREATER PSYCHIATRIC 1360 00:49:20,680 --> 00:49:22,320 CO-MORBIDITIES SUICIDE RISK, 1361 00:49:22,320 --> 00:49:23,920 VIOLENCE TRAUMA AND CHRONIC 1362 00:49:23,920 --> 00:49:25,120 HEALTHCARE CONDITIONS AMONG THE 1363 00:49:25,120 --> 00:49:26,600 WOMEN WE ARE TREATING. 1364 00:49:26,600 --> 00:49:29,520 LESS LIKELY TO ENGAGE IN PRIMARY 1365 00:49:29,520 --> 00:49:31,520 HEALTHCARE, MORE LIKELY TO HAVE 1366 00:49:31,520 --> 00:49:35,080 ONGOING PSYCHIATRIC SYMPTOMS, 1367 00:49:35,080 --> 00:49:36,640 THOUGHTS ON THE OTHER SIZE OF 1368 00:49:36,640 --> 00:49:40,840 THIS, THEY ENGAGED IN TREATMENT 1369 00:49:40,840 --> 00:49:43,040 AT SAME RATES AS MEN, HOUSED 1370 00:49:43,040 --> 00:49:45,480 EMPLOYEES SIMILAR RATES OF 1371 00:49:45,480 --> 00:49:47,560 TREATMENT COMPLETION ABSTINENCE 1372 00:49:47,560 --> 00:49:51,840 AND RECIDIVISM, ENGAGE IN 1373 00:49:51,840 --> 00:49:53,240 ONGOING TREATMENT TO MANAGE 1374 00:49:53,240 --> 00:49:55,600 THEIR PSYCHIATRIC SYMPTOMS. 1375 00:49:55,600 --> 00:50:00,120 SO WITH THAT I WILL CONCLUDE AND 1376 00:50:00,120 --> 00:50:03,000 THANK ALL THE WONDERFUL 1377 00:50:03,000 --> 00:50:04,640 CLINICIANS, CLINICAL PARTNERS 1378 00:50:04,640 --> 00:50:06,720 AND STATE PARTNERS INVOLVED IN 1379 00:50:06,720 --> 00:50:07,000 PROGRAMS. 1380 00:50:07,000 --> 00:50:08,840 THANK YOU. 1381 00:50:08,840 --> 00:50:13,360 >> THANK YOU, DR. MCKEE FOR THAT 1382 00:50:13,360 --> 00:50:14,400 WONDERFUL PRESENTATION ON MODELS 1383 00:50:14,400 --> 00:50:16,120 OF CONTINUUM OF CARE TO IMPROVE 1384 00:50:16,120 --> 00:50:17,520 OUTCOMES OF WOMEN RETURNING TO 1385 00:50:17,520 --> 00:50:18,560 THE COMMUNITY FROM 1386 00:50:18,560 --> 00:50:18,960 INCARCERATION. 1387 00:50:18,960 --> 00:50:21,640 NOW WE WILL TURN IT OVER TO DR. 1388 00:50:21,640 --> 00:50:25,520 FAYE TAXMAN. 1389 00:50:25,520 --> 00:50:29,240 THANK YOU VERY MUCH AND I TOO 1390 00:50:29,240 --> 00:50:32,280 WANT TO THANK EVERYONE FOR THE 1391 00:50:32,280 --> 00:50:34,800 INVITATION TO PARTICIPATE IN 1392 00:50:34,800 --> 00:50:36,600 THIS PARTICULAR SEMINAR AS WELL 1393 00:50:36,600 --> 00:50:39,680 AS TO HAVE AN OPPORTUNITY TO 1394 00:50:39,680 --> 00:50:42,280 TALK ABOUT SYSTEMS OF CARE 1395 00:50:42,280 --> 00:50:43,920 MODELS REGARDING THE LEGAL 1396 00:50:43,920 --> 00:50:47,880 SYSTEM AND OTHER CARE SYSTEMS. 1397 00:50:47,880 --> 00:50:50,960 SO MY PRESENTATION TODAY WILL 1398 00:50:50,960 --> 00:50:52,400 DRAW UPON THE HISTORY OF 1399 00:50:52,400 --> 00:50:54,960 DIFFERENT WAYS IN WHICH WE 1400 00:50:54,960 --> 00:50:56,960 APPROACH SYSTEMS OF CARE IN THE 1401 00:50:56,960 --> 00:50:59,920 LEGAL SYSTEM AND I DO THIS FOR 1402 00:50:59,920 --> 00:51:01,640 PARTICULAR PURPOSE OF TRYING TO 1403 00:51:01,640 --> 00:51:04,120 REALLY GET US AT A PLACE OF 1404 00:51:04,120 --> 00:51:05,800 THINKING ABOUT SOME OF THE MORE 1405 00:51:05,800 --> 00:51:07,480 COLLABORATIVE MODELS BUT ALSO 1406 00:51:07,480 --> 00:51:09,360 SOME OF THE DECISION SUPPORT 1407 00:51:09,360 --> 00:51:12,880 MODELS THAT WE HEARD ABOUT 1408 00:51:12,880 --> 00:51:16,320 YESTERDAY FROM DR. OSMER AS WELL 1409 00:51:16,320 --> 00:51:19,080 AS FROM MY COLLEAGUES TODAY. 1410 00:51:19,080 --> 00:51:22,800 I WANT TO BEGIN -- OOPS SORRY. 1411 00:51:22,800 --> 00:51:25,440 I WANT TO BEGIN BY ACKNOWLEDGING 1412 00:51:25,440 --> 00:51:26,480 THAT THIS PRESENTATION DRAWS 1413 00:51:26,480 --> 00:51:29,000 UPON A NUMBER OF DIFFERENT 1414 00:51:29,000 --> 00:51:30,360 STUDIES, BUT I AM PRIMARILY 1415 00:51:30,360 --> 00:51:33,000 GOING TO BE TALKING ABOUT THE 1416 00:51:33,000 --> 00:51:35,480 MA'AMPET STUDY I DID WITH DR. 1417 00:51:35,480 --> 00:51:37,560 SCOTT WALTER WHOSE IS AT THE 1418 00:51:37,560 --> 00:51:38,640 UNIVERSITY OF NORTH TEXAS AND IT 1419 00:51:38,640 --> 00:51:42,840 WAS A COMPUTERIZED MOTIVATIONAL 1420 00:51:42,840 --> 00:51:45,160 INTERVIEWING ASSESSMENT TOOL 1421 00:51:45,160 --> 00:51:48,240 COMBINED WITH SOME DECISION 1422 00:51:48,240 --> 00:51:48,720 SUPPORT GUIDANCE. 1423 00:51:48,720 --> 00:51:50,280 I'M ALSO GOING TO BE DRAWING 1424 00:51:50,280 --> 00:51:55,040 UPON A PROJECT THAT IS LED BY 1425 00:51:55,040 --> 00:51:58,880 DR. KATE ELKIMGTON AND GAIL 1426 00:51:58,880 --> 00:52:00,640 WASSMAN OUT OF COLUMBIA 1427 00:52:00,640 --> 00:52:02,400 UNIVERSITY, CALLED PROJECT 1428 00:52:02,400 --> 00:52:07,320 ECONNECT WHICH IS DESIGNED TO 1429 00:52:07,320 --> 00:52:08,520 PUSH DECISION SUPPORT, MODELS TO 1430 00:52:08,520 --> 00:52:13,640 BE ABLE TO DO ACTUALLY DIRECT 1431 00:52:13,640 --> 00:52:16,200 PLACEMENT INTO CARE AND THEN I'M 1432 00:52:16,200 --> 00:52:19,200 GOING TO ALSO HIGHLIGHT SOME OF 1433 00:52:19,200 --> 00:52:21,000 THE SPECIFIC MODELS THAT WE HAVE 1434 00:52:21,000 --> 00:52:23,680 DEVELOPED ON DECISION SUPPORT 1435 00:52:23,680 --> 00:52:26,120 DEALING WITH THE CRIMINAL LEGAL 1436 00:52:26,120 --> 00:52:27,080 SYSTEM. 1437 00:52:27,080 --> 00:52:30,720 SO DR. MCKEE ALREADY PRESENTED 1438 00:52:30,720 --> 00:52:31,920 SOME OF THIS INFORMATION BUT I 1439 00:52:31,920 --> 00:52:33,880 THINK IT IS REALLY RELEVANT FOR 1440 00:52:33,880 --> 00:52:36,640 US TO LOOK AT THE BIG PICTURE. 1441 00:52:36,640 --> 00:52:39,400 SO WHAT IS THE LIFE LIKELIHOOD 1442 00:52:39,400 --> 00:52:41,440 OF A WOMAN BEING INVOLVED IN THE 1443 00:52:41,440 --> 00:52:45,200 JUSTICE SYSTEM? 1444 00:52:45,200 --> 00:52:47,240 ESSENTIALLY WE -- THE FINDINGS 1445 00:52:47,240 --> 00:52:50,560 ARE THAT ONE IN 56 WOMEN IN OUR 1446 00:52:50,560 --> 00:52:52,440 SOCIETY IN THE U.S. SOCIETY WILL 1447 00:52:52,440 --> 00:52:55,440 BE INVOLVED IN THE LEGAL SYSTEM 1448 00:52:55,440 --> 00:52:57,760 BUT THAT THERE ARE VARIATIONS IN 1449 00:52:57,760 --> 00:53:01,960 THAT INVOLVEMENT AND OF COURSE 1450 00:53:01,960 --> 00:53:03,840 MINORITIES BLACK AND BROWN WOMEN 1451 00:53:03,840 --> 00:53:05,640 HAVE GREATER LIKELIHOODS OF 1452 00:53:05,640 --> 00:53:09,080 BEING INVOLVED IN THE LEGAL 1453 00:53:09,080 --> 00:53:09,440 SYSTEM. 1454 00:53:09,440 --> 00:53:13,680 DR. MCKEE SPOKE TO US ABOUT THIS 1455 00:53:13,680 --> 00:53:15,520 ISSUE ABOUT THE HIGH RATE OF 1456 00:53:15,520 --> 00:53:16,760 INCARCERATION AND HOW THAT 1457 00:53:16,760 --> 00:53:22,280 ACTUALLY IS TRUE FOR WOMEN AS 1458 00:53:22,280 --> 00:53:26,240 WELL AS FOR -- IN THE SYSTEM. 1459 00:53:26,240 --> 00:53:28,240 BUT WHAT I WANT TO BRING 1460 00:53:28,240 --> 00:53:31,280 ATTENTION TO IS THE FACT THAT 1461 00:53:31,280 --> 00:53:33,480 ALTHOUGH WE HAVE 1.9 MILLION 1462 00:53:33,480 --> 00:53:38,320 PEOPLE INCARCERATED WHAT THAT 1463 00:53:38,320 --> 00:53:42,640 ACTUALLY IS AROUND 200,000 OR 1464 00:53:42,640 --> 00:53:44,280 ACTUALLY WOMEN BUT ACTUALLY OUR 1465 00:53:44,280 --> 00:53:46,840 LARGER SYSTEMS ARE PEOPLE ON 1466 00:53:46,840 --> 00:53:49,280 PROBATION AND PAROLE WHERE WE 1467 00:53:49,280 --> 00:53:52,080 HAVE ALMOST 5 MILLION ADULTS ON 1468 00:53:52,080 --> 00:53:55,600 PROBATION PAROLE IN THE UNITED 1469 00:53:55,600 --> 00:53:59,040 STATES AND WHAT WE ACTUALLY FIND 1470 00:53:59,040 --> 00:54:05,280 IS 25% OF THOSE WOMEN, 25% PRO 1471 00:54:05,280 --> 00:54:07,080 BIG POPULATION ARE WOMEN, AND 1472 00:54:07,080 --> 00:54:10,280 MORE IMPORTANTLY THIS IS A 1473 00:54:10,280 --> 00:54:11,760 FEEDER FOR INCARCERATION BECAUSE 1474 00:54:11,760 --> 00:54:14,080 FAILURE IN THE COMMUNITY 1475 00:54:14,080 --> 00:54:16,840 ACTUALLY FEED THE INCARCERATION 1476 00:54:16,840 --> 00:54:18,680 RATES BOTH IN OUR LOCAL JAILS AS 1477 00:54:18,680 --> 00:54:22,000 WELL AS IN STATE PRISONS. 1478 00:54:22,000 --> 00:54:24,760 WE ALSO KNOW GIRLS IN THE 1479 00:54:24,760 --> 00:54:27,200 JUVENILE JUSTICE SYSTEM ARE 1480 00:54:27,200 --> 00:54:30,720 HIGHLY PREVALENT AT 30% ARREST, 1481 00:54:30,720 --> 00:54:35,680 ACTUALLY HAVE TO DO WITH GIRLS 1482 00:54:35,680 --> 00:54:40,880 AND 15% OF THE INCARCERATED 1483 00:54:40,880 --> 00:54:42,560 YOUTH ARE GIRLS SO THE PREVALENT 1484 00:54:42,560 --> 00:54:43,880 -- THE IMPORTANCE OF THIS TOPIC 1485 00:54:43,880 --> 00:54:46,800 IS THAT WE HAVE A LOT OF WOMEN 1486 00:54:46,800 --> 00:54:50,880 AND GIRLS IN THE LEGAL SYSTEM. 1487 00:54:50,880 --> 00:54:54,440 AT HIGHER RATES AND OF COURSE 1488 00:54:54,440 --> 00:54:56,400 MINORITIES LOW INCOME THAT WE 1489 00:54:56,400 --> 00:54:58,760 HAVE ALREADY DISCUSSED. 1490 00:54:58,760 --> 00:55:01,480 I DO WANT TO RAISE THE ISSUE 1491 00:55:01,480 --> 00:55:03,280 ABOUT THE HEALTH ISSUES. 1492 00:55:03,280 --> 00:55:05,680 THE THING WE KNOW ABOUT THE 1493 00:55:05,680 --> 00:55:07,360 LEGAL SYSTEM IS A RESULT OF THE 1494 00:55:07,360 --> 00:55:10,040 WAR ON DRUGS, AND OUR SOCIAL 1495 00:55:10,040 --> 00:55:13,120 WELL PAIR POLICIES, OR LACK OF 1496 00:55:13,120 --> 00:55:14,680 SOCIAL WELFARE POLICIES, WE HAVE 1497 00:55:14,680 --> 00:55:18,240 A HIGHER CONCENTRATION OF PEOPLE 1498 00:55:18,240 --> 00:55:19,440 INVOLVED IN THE LEGAL SYSTEM 1499 00:55:19,440 --> 00:55:21,400 THAT HAVE SUBSTANCE USE 1500 00:55:21,400 --> 00:55:24,040 DISORDERS, MENTAL HEALTH 1501 00:55:24,040 --> 00:55:27,680 DISORDERS, AND INFECTIOUS 1502 00:55:27,680 --> 00:55:28,200 DISEASES. 1503 00:55:28,200 --> 00:55:31,520 AND WOMEN WERE IN THE LEGAL 1504 00:55:31,520 --> 00:55:33,760 SYSTEM ACTUALLY HAVE HIGHER 1505 00:55:33,760 --> 00:55:36,880 RATES THAN NORM FOR THE SYSTEM 1506 00:55:36,880 --> 00:55:37,800 OVERALL. 1507 00:55:37,800 --> 00:55:39,440 WHEREAS ABOUT 50% OF PEOPLE 1508 00:55:39,440 --> 00:55:42,080 LEGALLY INVOLVED HAVE SOME SORT 1509 00:55:42,080 --> 00:55:44,760 OF SUBSTANCE USE DISORDER, WE 1510 00:55:44,760 --> 00:55:49,120 FIND THAT WOMEN ARE CLOSER TO 70 1511 00:55:49,120 --> 00:55:52,040 TO 80% SUBSTANCE USE DISORDERS 1512 00:55:52,040 --> 00:55:55,160 AND MORE WOMEN HAVE CO-OCCURRING 1513 00:55:55,160 --> 00:55:57,480 DISORDERS AS WELL AS CO-MORBID 1514 00:55:57,480 --> 00:56:00,480 HEALTH CONDITIONS. 1515 00:56:00,480 --> 00:56:03,040 SO GREAT NEED IS TO THINK ABOUT 1516 00:56:03,040 --> 00:56:07,320 HOW WE CONNECT PEOPLE IN THE 1517 00:56:07,320 --> 00:56:10,160 LEGAL SYSTEM WITH SERVICES IN 1518 00:56:10,160 --> 00:56:11,920 THE COMMUNITY OR PROVIDE 1519 00:56:11,920 --> 00:56:13,960 SERVICES WITHIN THE LEGAL SYSTEM 1520 00:56:13,960 --> 00:56:16,720 IF SOMEONE IS IN AN 1521 00:56:16,720 --> 00:56:20,280 INCARCERATION SETTING. 1522 00:56:20,280 --> 00:56:21,920 THERE ARE DIFFERENT POINTS WHICH 1523 00:56:21,920 --> 00:56:25,080 WE ACTUALLY LOOKED AT AND TESTED 1524 00:56:25,080 --> 00:56:28,880 OUT SYSTEMS OF CARE OVER THE 1525 00:56:28,880 --> 00:56:32,480 LAST ABOUT 35, 40 YEARS. 1526 00:56:32,480 --> 00:56:34,240 THESE SYSTEMS IMPACT WOMEN AND 1527 00:56:34,240 --> 00:56:36,680 GIRLS WHO ARE ON THE STREET, WHO 1528 00:56:36,680 --> 00:56:39,000 HAVE BEEN ARRESTED, WHO ARE IN 1529 00:56:39,000 --> 00:56:42,200 JAIL WHO ARE IN PRISON, ON 1530 00:56:42,200 --> 00:56:44,000 PROBATION AND PAROLE. 1531 00:56:44,000 --> 00:56:45,480 THEY ALSO INVOLVE DIFFERENT 1532 00:56:45,480 --> 00:56:48,480 SERVICE SYSTEMS, MENTAL HEALTH, 1533 00:56:48,480 --> 00:56:51,840 SUBSTANCE ABUSE, MEDICAL CARE, 1534 00:56:51,840 --> 00:56:53,320 EMPLOYMENT SYSTEMS AND THE 1535 00:56:53,320 --> 00:56:55,320 MODELS THAT WE HAVE BEEN RELYING 1536 00:56:55,320 --> 00:56:59,840 UPON ARE MODELS THAT REALLY 1537 00:56:59,840 --> 00:57:03,280 BASICALLY FOCUS IN ON 1538 00:57:03,280 --> 00:57:06,480 IDENTIFYING WOMEN OR GIRLS OF 1539 00:57:06,480 --> 00:57:08,280 NEED, AND NEED HERE DEPENDS UPON 1540 00:57:08,280 --> 00:57:10,040 WHETHER WE ARE TALKING MENTAL 1541 00:57:10,040 --> 00:57:11,720 HEALTH OR SUBSTANCE ABUSE 1542 00:57:11,720 --> 00:57:12,360 SERVICES. 1543 00:57:12,360 --> 00:57:13,960 THAT IDENTIFICATION PROCESS 1544 00:57:13,960 --> 00:57:16,680 USUALLY OCCURS WITH SCREENING 1545 00:57:16,680 --> 00:57:19,560 AND ASSESSMENT IN THE LEGAL 1546 00:57:19,560 --> 00:57:21,520 SYSTEM, THE REFERRAL PROCESS 1547 00:57:21,520 --> 00:57:25,760 ALSO OCCURS IN THE LEGAL SYSTEM 1548 00:57:25,760 --> 00:57:28,600 BUT THEN OFTEN TIMES THE EFFORT 1549 00:57:28,600 --> 00:57:31,480 FROM THE REFERRAL IS TO ACTUALLY 1550 00:57:31,480 --> 00:57:33,360 INITIATE SERVICES IN ANOTHER 1551 00:57:33,360 --> 00:57:36,040 SYSTEM LIKE A COMMUNITY MENTAL 1552 00:57:36,040 --> 00:57:38,040 HEALTH SYSTEM OR A SUBSTANCE 1553 00:57:38,040 --> 00:57:41,080 ABUSE TREATMENT SYSTEM. 1554 00:57:41,080 --> 00:57:43,680 WHAT WE ACTUALLY FIND, THIS IS 1555 00:57:43,680 --> 00:57:46,400 WHERE THE CASCADE OF CARE MODELS 1556 00:57:46,400 --> 00:57:48,880 THAT HAVE BECOME MORE PREVALENT 1557 00:57:48,880 --> 00:57:52,480 AND USED IN OUR STUDIES HAVE 1558 00:57:52,480 --> 00:57:54,880 BASICALLY SHOWN US THAT WHILE AS 1559 00:57:54,880 --> 00:57:56,840 WE HAVE SCREENING ASSESSMENT 1560 00:57:56,840 --> 00:57:58,760 TOOLS THAT CAN BE PUT IN PLACE 1561 00:57:58,760 --> 00:58:02,240 IT IS AT THE REFERRAL AND 1562 00:58:02,240 --> 00:58:05,400 INITIATION STAGE IN WHICH THIS 1563 00:58:05,400 --> 00:58:08,480 TRANSITION OF CARE DOES NOT 1564 00:58:08,480 --> 00:58:09,160 OCCUR. 1565 00:58:09,160 --> 00:58:11,280 AND THAT ESSENTIALLY WE DON'T 1566 00:58:11,280 --> 00:58:13,960 GET THE BENEFITS THAT WE WOULD 1567 00:58:13,960 --> 00:58:16,600 SEE FROM THE RECIDIVISM 1568 00:58:16,600 --> 00:58:18,080 REDUCTION PROGRAMS OR PROGRAMS 1569 00:58:18,080 --> 00:58:20,360 TO DEAL WITH SUBSTANCE USE AND 1570 00:58:20,360 --> 00:58:23,800 MENTAL HEALTH DISORDERS IN THE 1571 00:58:23,800 --> 00:58:26,480 SAME WAY BECAUSE OF THE FACT 1572 00:58:26,480 --> 00:58:29,040 THAT NOT ENOUGH WOMEN AND GIRLS 1573 00:58:29,040 --> 00:58:31,240 ARE ACTUALLY INITIATING 1574 00:58:31,240 --> 00:58:33,080 TREATMENT SERVICES. 1575 00:58:33,080 --> 00:58:38,720 SO THAT BECOMES THE MAJOR 1576 00:58:38,720 --> 00:58:40,640 BOTTLENECK, HOW TO DEVELOP 1577 00:58:40,640 --> 00:58:42,480 SYSTEMS OF CARE WHICH WE LINK 1578 00:58:42,480 --> 00:58:45,280 THE LEGAL SYSTEM WITH THE 1579 00:58:45,280 --> 00:58:47,680 DIFFERENT VARIETIES OF SOCIAL 1580 00:58:47,680 --> 00:58:49,840 SERVICES OR MEDICAL SERVICES IN 1581 00:58:49,840 --> 00:58:53,720 THE COMMUNITY. 1582 00:58:53,720 --> 00:58:56,560 SO JUST TO GO OVER SOME OF OUR 1583 00:58:56,560 --> 00:58:58,880 CHALLENGES, OUR CHALLENGES HAVE 1584 00:58:58,880 --> 00:59:00,520 TO DO WITH THE STATE OF 1585 00:59:00,520 --> 00:59:02,880 PRACTICE. 1586 00:59:02,880 --> 00:59:05,600 WHEN I SAY THAT I AM TALKING 1587 00:59:05,600 --> 00:59:07,040 ABOUT FACT THAT ESSENTIALLY MOST 1588 00:59:07,040 --> 00:59:09,360 OF OUR PRACTICE IS AROUND 1589 00:59:09,360 --> 00:59:12,880 DIFFERENT VARIETIES OF CASE 1590 00:59:12,880 --> 00:59:13,960 MANAGEMENT SYSTEMS, IN WHICH WE 1591 00:59:13,960 --> 00:59:16,480 HAVE SOME SORT OF LINKAGE OR 1592 00:59:16,480 --> 00:59:20,280 SOME SORT OF ASSESSMENT PROCESS, 1593 00:59:20,280 --> 00:59:22,880 USING A STANDARDIZE SCREENING 1594 00:59:22,880 --> 00:59:24,760 ASSESSMENT TOOL AND THEN THERE 1595 00:59:24,760 --> 00:59:28,840 IS A CASE PLAN DEVELOPED AND 1596 00:59:28,840 --> 00:59:31,480 TENDENCY IS FOR THOSE CASE PLANS 1597 00:59:31,480 --> 00:59:37,080 TO ACTUALLY BE DELIVERED BY THE 1598 00:59:37,080 --> 00:59:39,520 PERSON IN NEED. 1599 00:59:39,520 --> 00:59:41,720 IN THIS CASE WOMEN IN THE LEGAL 1600 00:59:41,720 --> 00:59:42,320 SYSTEM. 1601 00:59:42,320 --> 00:59:48,000 ESSENTIALLY WE ALSO KNOW THAT WE 1602 00:59:48,000 --> 00:59:50,080 HAVE A DERTH OF SERVICES IN THE 1603 00:59:50,080 --> 00:59:52,240 COMMUNITY SO EVEN IF A WOMAN OR 1604 00:59:52,240 --> 00:59:54,160 GIRL WAS HIGHLY MOTIVATED, THE 1605 00:59:54,160 --> 00:59:56,600 OPPORTUNITIES TO BECOME INVOLVED 1606 00:59:56,600 --> 00:59:58,840 IN SERVICES ARE COMPLEX. 1607 00:59:58,840 --> 01:00:01,400 THEY ARE EVEN MORE COMPLEX 1608 01:00:01,400 --> 01:00:03,040 BECAUSE OF THE CASE MANAGEMENT 1609 01:00:03,040 --> 01:00:05,600 MODELS THAT WE HAVE RELIED UPON. 1610 01:00:05,600 --> 01:00:10,440 IN A RECENT TRIAL CONDUCTED BY 1611 01:00:10,440 --> 01:00:12,200 THE -- ABOUT SIX RESEARCH 1612 01:00:12,200 --> 01:00:15,960 CENTERS AS PART OF THE JJ TRIALS 1613 01:00:15,960 --> 01:00:19,320 THAT INVOLVED 33 COMMUNITIES 1614 01:00:19,320 --> 01:00:20,880 ACROSS THE UNITED STATES, WE 1615 01:00:20,880 --> 01:00:23,480 LOOKED AT SOME BASELINE 1616 01:00:23,480 --> 01:00:24,520 INFORMATION ABOUT HOW IS THE 1617 01:00:24,520 --> 01:00:27,280 SYSTEM REALLY WORKING. 1618 01:00:27,280 --> 01:00:28,280 IN THIS CASE TALKING ABOUT THE 1619 01:00:28,280 --> 01:00:30,040 SYSTEMS, I'M TALKING ABOUT A 1620 01:00:30,040 --> 01:00:33,400 SYSTEM WHERE THE LEGAL SYSTEM IS 1621 01:00:33,400 --> 01:00:36,800 RESPONSIBLE FOR SCREENING GIRLS 1622 01:00:36,800 --> 01:00:37,680 AND BOYS IN THIS CASE BECAUSE WE 1623 01:00:37,680 --> 01:00:39,320 ARE TALKING ABOUT THE JUVENILE 1624 01:00:39,320 --> 01:00:41,680 JUSTICE SYSTEM, WHERE SUBSTANCE 1625 01:00:41,680 --> 01:00:43,560 USE AND/OR MENTAL HEALTH 1626 01:00:43,560 --> 01:00:47,080 PROBLEMS AND THE LEGAL SYSTEM IS 1627 01:00:47,080 --> 01:00:50,280 RESPONSIBLE FOR SORT OF THOSE 1628 01:00:50,280 --> 01:00:54,360 REFERRALS THAT WOULD ACTUALLY BE 1629 01:00:54,360 --> 01:00:55,680 -- WOULD HELP PEOPLE INITIATE 1630 01:00:55,680 --> 01:00:57,520 CARE. 1631 01:00:57,520 --> 01:01:02,360 SO WE FOUND IN THIS PARTICULAR 1632 01:01:02,360 --> 01:01:05,640 TRIAL THESE PROBATION AND PAROLE 1633 01:01:05,640 --> 01:01:09,040 SITES, THAT ABOUT 70% OF THE 1634 01:01:09,040 --> 01:01:11,080 YOUTH THAT WERE SCREENED FOR 1635 01:01:11,080 --> 01:01:11,960 SUBSTANCE USE PROBLEMS ABOUT 1636 01:01:11,960 --> 01:01:15,880 HALF OF THOSE NEEDED TREATMENT. 1637 01:01:15,880 --> 01:01:18,840 AND INDICATORS OF FACTORS WITHIN 1638 01:01:18,840 --> 01:01:23,440 THE JUSTICE SYSTEM THAT WERE 1639 01:01:23,440 --> 01:01:24,800 CONTRIBUTING TO THIS NEED FOR 1640 01:01:24,800 --> 01:01:25,680 TREATMENT WHETHER OR NOT THE 1641 01:01:25,680 --> 01:01:26,480 YOUTH HAD ALCOHOL OR DRUG 1642 01:01:26,480 --> 01:01:29,280 CHARGE. 1643 01:01:29,280 --> 01:01:31,440 IF THE YOUTH HAD AN ALCOHOL OR 1644 01:01:31,440 --> 01:01:33,120 DRUG CHARGE, THE PROBATION 1645 01:01:33,120 --> 01:01:35,320 PAROLE OFFICER WAS MUCH MORE 1646 01:01:35,320 --> 01:01:40,840 LIKELY TO INCREASE THE REFERRAL 1647 01:01:40,840 --> 01:01:41,480 RATES. 1648 01:01:41,480 --> 01:01:44,680 HOWEVER, WE FOUND OF THOSE YOUTH 1649 01:01:44,680 --> 01:01:47,280 THAT NEEDED TREATMENT REFERRED 1650 01:01:47,280 --> 01:01:49,560 ONLY 20% REFERRED TO TREATMENT 1651 01:01:49,560 --> 01:01:52,680 BY THE JUSTICE AGENCY. 1652 01:01:52,680 --> 01:01:55,000 AND THAT THERE IN LIES PART OF 1653 01:01:55,000 --> 01:01:58,760 THIS SYSTEM OF CARE OF TENSION 1654 01:01:58,760 --> 01:02:02,040 THAT EXISTS IS THE JUSTICE 1655 01:02:02,040 --> 01:02:04,080 ACTORS TEND TO DO THE SCREENING 1656 01:02:04,080 --> 01:02:06,840 AND ASSESSMENT USING 1657 01:02:06,840 --> 01:02:09,480 STANDARDIZED TOOLS BUT THEY 1658 01:02:09,480 --> 01:02:13,400 DON'T NECESSARILY ENGAGE IN 1659 01:02:13,400 --> 01:02:14,240 REFERRING CLIENTS TO TREATMENT 1660 01:02:14,240 --> 01:02:17,160 AND THEY DON'T NECESSARILY FOCUS 1661 01:02:17,160 --> 01:02:18,960 ATTENTION ON TRYING TO HELP 1662 01:02:18,960 --> 01:02:21,480 CLIENTS INITIATE TREATMENT. 1663 01:02:21,480 --> 01:02:24,680 THE FACTORS THAT CONTRIBUTED TO 1664 01:02:24,680 --> 01:02:25,800 REFERRALES WASNGEIE 1665 01:02:25,800 --> 01:02:29,680 GO INT COMMUNICATIONS 1666 01:02:29,680 --> 01:02:31,280 WITH OTHER SERVICE AGENCIES WHEN 1667 01:02:31,280 --> 01:02:33,240 THERE WERE ISSUES RELATED TO 1668 01:02:33,240 --> 01:02:35,160 COLLABORATIVE PRACTICES. 1669 01:02:35,160 --> 01:02:39,120 ALL THOSE INCREASE THE TREATMENT 1670 01:02:39,120 --> 01:02:40,360 INITIATION RATES BUT WE HAVE 1671 01:02:40,360 --> 01:02:43,160 FOUND IN THE PARTICULAR SYSTEMS 1672 01:02:43,160 --> 01:02:45,520 IS THERE IS INCONSISTENCY 1673 01:02:45,520 --> 01:02:47,680 BETWEEN THE SERVICE SCREENING 1674 01:02:47,680 --> 01:02:50,400 FOR NEEDS AND REQUIREMENTS AND 1675 01:02:50,400 --> 01:02:53,920 PUT INTO CASE PLANS, SO THE 1676 01:02:53,920 --> 01:02:55,480 INFORMATION FROM STANDARDIZE 1677 01:02:55,480 --> 01:02:57,480 SCREENING ASSESSMENT TOOLS IS 1678 01:02:57,480 --> 01:02:59,680 NOT NECESSARILY GETTING INTO THE 1679 01:02:59,680 --> 01:03:03,480 CASE PLANS, THE CASE PLANS 1680 01:03:03,480 --> 01:03:05,080 TYPICALLY REFLECT THE LEGAL 1681 01:03:05,080 --> 01:03:06,240 REQUIREMENT AND EVEN THOUGH 1682 01:03:06,240 --> 01:03:08,680 THERE'S BEEN AN INCREASE USE TO 1683 01:03:08,680 --> 01:03:11,080 CUSTOMIZE GENDER RESPONSIVENESS 1684 01:03:11,080 --> 01:03:13,880 AND INSTRUMENTS AND TREATMENT 1685 01:03:13,880 --> 01:03:16,200 PROGRAMS THESE HAVEN'T 1686 01:03:16,200 --> 01:03:19,480 NECESSARILY TRANSLATED INTO 1687 01:03:19,480 --> 01:03:20,160 DIFFERENT REFERRAL STRATEGIES 1688 01:03:20,160 --> 01:03:21,920 AND THE TENDENCY OF MOST 1689 01:03:21,920 --> 01:03:23,280 AGENCIES ARE TO USE GENERIC 1690 01:03:23,280 --> 01:03:25,080 TOOLS. 1691 01:03:25,080 --> 01:03:27,920 SO WE HAVE AN ISSUE IN TERMS OF 1692 01:03:27,920 --> 01:03:29,400 THE LEGAL SYSTEM IN TERMS OF 1693 01:03:29,400 --> 01:03:32,240 WHAT THE ROLES AND 1694 01:03:32,240 --> 01:03:35,120 RESPONSIBILITIES ARE FOR THESE 1695 01:03:35,120 --> 01:03:36,880 SYSTEMS OF CARE AND THE 1696 01:03:36,880 --> 01:03:39,600 EXPECTATION THAT WE HAVE THAT 1697 01:03:39,600 --> 01:03:42,880 THE LEGAL SYSTEM WILL ENGAGE 1698 01:03:42,880 --> 01:03:46,480 USING STANDARDIZED SCREENING 1699 01:03:46,480 --> 01:03:52,080 ASSESSMENT TOOLS TO FOSTER 1700 01:03:52,080 --> 01:03:53,520 TREATMENT SERVICES FOR YOUTH AND 1701 01:03:53,520 --> 01:03:55,480 WOMEN BUT IN FACT THAT HAS NOT 1702 01:03:55,480 --> 01:03:57,080 WHAT IS HAPPENED IN REALITY AND 1703 01:03:57,080 --> 01:03:58,480 WHAT WE HAVE SEEN IN MANY 1704 01:03:58,480 --> 01:04:00,080 STUDIES OF VARIOUS DIFFERENT 1705 01:04:00,080 --> 01:04:01,960 CASE MANAGEMENT MODELS AS WELL 1706 01:04:01,960 --> 01:04:04,120 AS STUDIES OF TRYING TO 1707 01:04:04,120 --> 01:04:06,240 IMPLEMENT EVIDENCE BASED 1708 01:04:06,240 --> 01:04:07,360 PRACTICES WITHIN JUSTICE 1709 01:04:07,360 --> 01:04:08,080 SETTINGS. 1710 01:04:08,080 --> 01:04:12,040 WE DON'T SEE THOSE THAT RESULT 1711 01:04:12,040 --> 01:04:15,000 IN GREATER REFERRAL RATES OR 1712 01:04:15,000 --> 01:04:15,600 GREATER TREATMENT INITIATION 1713 01:04:15,600 --> 01:04:17,080 RATES. 1714 01:04:17,080 --> 01:04:18,680 SO WE HAVE HAD THREE GENERATIONS 1715 01:04:18,680 --> 01:04:21,760 OF TRYING TO DEVELOP SYSTEMS OF 1716 01:04:21,760 --> 01:04:22,320 CARE. 1717 01:04:22,320 --> 01:04:24,320 THE FIRST GENERATION IS I HAVE 1718 01:04:24,320 --> 01:04:27,280 BEEN TALKING ABOUT IS A 1719 01:04:27,280 --> 01:04:28,400 STANDARDIZE INSTRUMENT CASE 1720 01:04:28,400 --> 01:04:30,560 MANAGEMENT PROCESS, WHERE THERE 1721 01:04:30,560 --> 01:04:33,440 HAS BEEN EFFORTS TO REALLY FOCUS 1722 01:04:33,440 --> 01:04:36,520 ATTENTION ON USING STANDARDIZED 1723 01:04:36,520 --> 01:04:39,000 RISK AND NEEDS ASSESSMENT TOOLS, 1724 01:04:39,000 --> 01:04:42,080 STANDARDIZED SCREENING TOOLS, 1725 01:04:42,080 --> 01:04:44,120 AND TRAINING JUSTICE STAFF ON 1726 01:04:44,120 --> 01:04:46,480 CASE MANAGEMENT AND SOME 1727 01:04:46,480 --> 01:04:48,480 COGNITIVE BEHAVIORAL TECHNIQUES. 1728 01:04:48,480 --> 01:04:51,120 ESSENTIALLY IF YOU LOOK AT THE 1729 01:04:51,120 --> 01:04:53,040 LITERATURE, THAT IS RESULTED IN 1730 01:04:53,040 --> 01:04:55,560 LOW UPTAKE AND REFERRAL, AND 1731 01:04:55,560 --> 01:04:58,480 TREATMENT INITIATION. 1732 01:04:58,480 --> 01:05:01,000 THE SECOND GENERATION HAS 1733 01:05:01,000 --> 01:05:03,520 FOSTERED ON TRYING TO INTEGRATE 1734 01:05:03,520 --> 01:05:08,840 CLINICAL SKILLS WITHIN JUSTICE 1735 01:05:08,840 --> 01:05:09,480 ENVIRONMENTS AND FOR THE DIRECT 1736 01:05:09,480 --> 01:05:12,920 PURPOSE OF BEING ABLE TO 1737 01:05:12,920 --> 01:05:16,080 IDENTIFY WOMEN AND YOUTH THAT 1738 01:05:16,080 --> 01:05:17,960 HAVE SOME TYPE OF SUBSTANCE USE 1739 01:05:17,960 --> 01:05:20,320 OR MEDICAL NEED. 1740 01:05:20,320 --> 01:05:23,640 AND TRYING TO INCREASE THOSE 1741 01:05:23,640 --> 01:05:24,520 REFERRALS AGAIN. 1742 01:05:24,520 --> 01:05:28,080 SO MOTIVATIONAL INTERVIEWING, 1743 01:05:28,080 --> 01:05:29,880 SOME KIPES OF CONTINGENCY 1744 01:05:29,880 --> 01:05:32,520 MANAGEMENT, ALL EVIDENCE BASED 1745 01:05:32,520 --> 01:05:34,760 PRACTICES, EXPERT MODELS THE 1746 01:05:34,760 --> 01:05:36,520 SCREENING BRIEF INTERVENTION 1747 01:05:36,520 --> 01:05:37,960 REFERRAL AND TREATMENT MODELS, 1748 01:05:37,960 --> 01:05:40,280 SOME OF THE COMPUTERIZED 1749 01:05:40,280 --> 01:05:42,120 INTERVENTIONS AND APPLICATIONS. 1750 01:05:42,120 --> 01:05:44,520 IN SOME CASES, THESE EFFORTS 1751 01:05:44,520 --> 01:05:48,280 HAVE EXPANDED THE REACH BUT 1752 01:05:48,280 --> 01:05:52,400 THERE IS LIMITED UPTAKE AND FROM 1753 01:05:52,400 --> 01:05:54,080 IMPLEMENTATION LENS WILL IS 1754 01:05:54,080 --> 01:05:57,000 QUESTIONS ABOUT THE CAPACITY OF 1755 01:05:57,000 --> 01:05:58,680 LEGAL SYSTEMS TO BE -- AND STAFF 1756 01:05:58,680 --> 01:06:01,760 THAT WORK IN LEGAL SYSTEMS TO BE 1757 01:06:01,760 --> 01:06:04,200 ABLE TO EFFECTIVELY USE THESE 1758 01:06:04,200 --> 01:06:07,200 CLINICAL SKILLS. 1759 01:06:07,200 --> 01:06:08,840 MORE RECENTLY THERE IS A 1760 01:06:08,840 --> 01:06:12,240 MOVEMENT TO CLINICAL PATHWAYS OR 1761 01:06:12,240 --> 01:06:16,280 ENHANCE DECISION SUPPORT SYSTEMS 1762 01:06:16,280 --> 01:06:18,360 WHERE THE EFFORT IS TO TAKE 1763 01:06:18,360 --> 01:06:23,440 INFORMATION FROM SCREENING AND 1764 01:06:23,440 --> 01:06:24,880 ASSESSMENT TOOLS AND USE THAT 1765 01:06:24,880 --> 01:06:32,520 INFORMATION TO BE ABLE TO TO 1766 01:06:32,520 --> 01:06:33,880 BETTER IDENTIFY WHICH TREATMENT 1767 01:06:33,880 --> 01:06:34,880 SERVICES ARE BETTER SUITED SO 1768 01:06:34,880 --> 01:06:35,880 THIS ADDS TO THE INFORMATION 1769 01:06:35,880 --> 01:06:38,320 THAT THE JUSTICE ACTOR HAS BY 1770 01:06:38,320 --> 01:06:41,280 ACTUALLY GIVING THEM A DIRECT 1771 01:06:41,280 --> 01:06:43,880 PATHWAY IN TERMS OF HOW TO 1772 01:06:43,880 --> 01:06:46,960 ADDRESS THE SERVICES THAT YOUTH 1773 01:06:46,960 --> 01:06:48,600 NEED OR THAT WOMEN NEED. 1774 01:06:48,600 --> 01:06:51,040 SO THESE FOCUS MUCH MORE ON 1775 01:06:51,040 --> 01:06:56,240 INTEGRATED SYSTEMS OF CARE, AND 1776 01:06:56,240 --> 01:06:56,920 ESSENTIALLY PROACTIVE 1777 01:06:56,920 --> 01:06:57,920 INTEGRATION EFFORTS, THAT'S WHAT 1778 01:06:57,920 --> 01:07:04,400 I'M GOING TO TALK ABILITY TODAY. 1779 01:07:04,400 --> 01:07:06,400 BRIEFLY, A LOT OF WORK IS DONE 1780 01:07:06,400 --> 01:07:11,960 ON STANDARDIZE INSTRUMENTS AND 1781 01:07:11,960 --> 01:07:14,840 CASE MANAGEMENT STRATEGIES, 1782 01:07:14,840 --> 01:07:15,920 ESSENTIALLY WE FIND TOOLS THAT 1783 01:07:15,920 --> 01:07:20,120 ARE AVAILABLE DO NOT REALLY 1784 01:07:20,120 --> 01:07:21,880 INFLUENCE REFERRAL DECISIONS OR 1785 01:07:21,880 --> 01:07:25,200 EFFORTS TO ACTUALLY MONITOR AND 1786 01:07:25,200 --> 01:07:28,840 FACILITATE TREATMENT INITIATION. 1787 01:07:28,840 --> 01:07:34,680 TO GIVE AN EXAMPLE FROM KATE 1788 01:07:34,680 --> 01:07:35,880 ELKINGTON'S PROJECT eCONNECT 1789 01:07:35,880 --> 01:07:39,080 STUDY, THIS IS A STUDY TO PUT IN 1790 01:07:39,080 --> 01:07:42,920 PLACE A CLINICAL DECISION 1791 01:07:42,920 --> 01:07:44,280 PATHWAY FOR YOUTH INVOLVED IN 1792 01:07:44,280 --> 01:07:46,200 THE JUSTICE SYSTEM. 1793 01:07:46,200 --> 01:07:47,680 THAT PARTICULAR STUDY IS FOCUSED 1794 01:07:47,680 --> 01:07:52,000 ON TRYING TO IDENTIFY YOUTH WHO 1795 01:07:52,000 --> 01:07:57,600 HAVE HIGH PREVALENCE FOR SUICIDE 1796 01:07:57,600 --> 01:08:00,160 IDEIATION OR SOME SUICIDE 1797 01:08:00,160 --> 01:08:01,640 RELATED BEHAVIOR. 1798 01:08:01,640 --> 01:08:04,160 AT BASELINE FOR THE TEN COUNTIES 1799 01:08:04,160 --> 01:08:09,080 THAT PARTICIPATED MANY THE 1800 01:08:09,080 --> 01:08:12,080 STUDY, DR. ELKINGTON AND HER 1801 01:08:12,080 --> 01:08:14,480 TEAM WHICH I'M INVOLVED WITH AS 1802 01:08:14,480 --> 01:08:16,440 CO-PI ESSENTIALLY COLLECTED DATA 1803 01:08:16,440 --> 01:08:19,680 THAT DEMONSTRATED THAT THERE WAS 1804 01:08:19,680 --> 01:08:23,760 UNMET BEHAVIORAL HEALTH NEEDS 1805 01:08:23,760 --> 01:08:26,280 FOR MINORITY GIRLS AS COMPARED 1806 01:08:26,280 --> 01:08:28,280 TO WHITE GIRLS THAT INVOLVED IN 1807 01:08:28,280 --> 01:08:30,080 THE LEGAL SYSTEM. 1808 01:08:30,080 --> 01:08:34,080 AND THAT THERE WAS A LOWER 1809 01:08:34,080 --> 01:08:35,760 LIKELIHOOD THAT MINORITY GIRLS 1810 01:08:35,760 --> 01:08:38,800 WOULD BE REFERRED TO BEHAVIORAL 1811 01:08:38,800 --> 01:08:41,640 HEALTH TREATMENT, DIDN'T SEEM TO 1812 01:08:41,640 --> 01:08:43,520 HAVE THE SAME -- HEALTH 1813 01:08:43,520 --> 01:08:46,520 DISPARITY DIDN'T SEEM TO OCCUR 1814 01:08:46,520 --> 01:08:48,200 WITHIN FOR BOYS BUT IT WAS 1815 01:08:48,200 --> 01:08:53,240 DRAMATIC FOR GIRLS. 1816 01:08:53,240 --> 01:08:54,280 >> MINUTE 30 SECONDS. 1817 01:08:54,280 --> 01:08:59,960 >> I'M SORRY? 1818 01:08:59,960 --> 01:09:01,320 >> MINUTE 30 SECONDS. 1819 01:09:01,320 --> 01:09:01,720 >> OH. 1820 01:09:01,720 --> 01:09:02,200 OKAY. 1821 01:09:02,200 --> 01:09:03,440 I APOLOGIZE. 1822 01:09:03,440 --> 01:09:05,520 ANOTHER DECISION SUPPORT TOOL 1823 01:09:05,520 --> 01:09:07,760 THAT HAS BEEN DEVELOPED IS 1824 01:09:07,760 --> 01:09:08,880 CALLED MAPPET. 1825 01:09:08,880 --> 01:09:11,320 IN MAPPET WE INTEGRATED 1826 01:09:11,320 --> 01:09:15,120 DIFFERENT WAYS OF BEING ABLE TO 1827 01:09:15,120 --> 01:09:17,600 DRAW CARE. 1828 01:09:17,600 --> 01:09:20,560 TO IDENTIFY DIRECT SERVICES 1829 01:09:20,560 --> 01:09:22,280 NEEDED. 1830 01:09:22,280 --> 01:09:24,080 SO THIS IS A WEB-BASED SERVICE 1831 01:09:24,080 --> 01:09:26,160 AND WE SAW HERE THAT SCREENING 1832 01:09:26,160 --> 01:09:29,560 LED TO SOME INCREASE INITIATION 1833 01:09:29,560 --> 01:09:33,480 AND CARE BUT IT DID NOT RESULT 1834 01:09:33,480 --> 01:09:38,600 IN LONG TERM IMPACT IN TERMS OF 1835 01:09:38,600 --> 01:09:40,680 INITIATION OF CARE AND EXPERT 1836 01:09:40,680 --> 01:09:41,800 HAS NOT RESULTED IN INITIATION 1837 01:09:41,800 --> 01:09:42,640 OF CARE. 1838 01:09:42,640 --> 01:09:44,640 SO THE CLINICAL DECISION SUPPORT 1839 01:09:44,640 --> 01:09:46,480 TOOLS THAT I REALLY WANT TO 1840 01:09:46,480 --> 01:09:48,840 FOCUS MY ATTENTION ON, I DIDN'T 1841 01:09:48,840 --> 01:09:51,960 USE MY TIME WISELY IS REALLY, I 1842 01:09:51,960 --> 01:09:55,280 WILL DRAW HERE FROM DR. 1843 01:09:55,280 --> 01:09:58,360 ELKINGTON'S STUDY. 1844 01:09:58,360 --> 01:10:00,320 THIS PARTICULAR TOOL IDENTIFIES 1845 01:10:00,320 --> 01:10:03,840 SCREENING ASSESSMENT USING AN 1846 01:10:03,840 --> 01:10:06,160 APP AND IDENTIFY THREE DIFFERENT 1847 01:10:06,160 --> 01:10:11,760 CLASSES OF PATHWAYS, CLASS 1 IS 1848 01:10:11,760 --> 01:10:15,280 YOUTH THAT WERE IN -- IMMINENT 1849 01:10:15,280 --> 01:10:17,800 RISK OF SUICIDE, CLASS 2 IS 1850 01:10:17,800 --> 01:10:19,840 CRISIS BUT NOT EMINENT AND CLASS 1851 01:10:19,840 --> 01:10:21,360 3, THOSE INDIVIDUALS NOT IN 1852 01:10:21,360 --> 01:10:22,080 CRISIS. 1853 01:10:22,080 --> 01:10:25,120 THIS IS ALL PART OF THE APP 1854 01:10:25,120 --> 01:10:30,040 ITSELF IS THE INFORMATION 1855 01:10:30,040 --> 01:10:32,120 SCREENING FED INTO THE APP AND 1856 01:10:32,120 --> 01:10:34,440 IT ACTUALLY SERVES THE PURPOSE 1857 01:10:34,440 --> 01:10:36,160 OF DRIVING WHAT TYPE OF 1858 01:10:36,160 --> 01:10:39,120 CONNECTION. 1859 01:10:39,120 --> 01:10:41,080 WHAT THIS DID IS YOU ACTUALLY 1860 01:10:41,080 --> 01:10:43,880 HAD TREATMENT PROVIDERS AND 1861 01:10:43,880 --> 01:10:45,320 JUVENILE JUSTICE STAFF WHO 1862 01:10:45,320 --> 01:10:50,680 DEVELOPED THESE PATHWAYS 1863 01:10:50,680 --> 01:10:51,600 SPECIFIC TO EACH COUNTY. 1864 01:10:51,600 --> 01:10:53,280 GENERAL EFFECTS OF USING THE APP 1865 01:10:53,280 --> 01:10:58,080 TOWARD THAT YOU CAN SEE INCREASE 1866 01:10:58,080 --> 01:10:59,520 IDENTIFICATION OF YOUTH NEEDED 1867 01:10:59,520 --> 01:11:04,320 IN MORE IMMEDIATE CLINICAL 1868 01:11:04,320 --> 01:11:06,880 SERVICES, AND GREATER INDICATION 1869 01:11:06,880 --> 01:11:09,160 OF LINKAGE TO CARE, PART WAS 1870 01:11:09,160 --> 01:11:11,680 PROBATION OFFICERS WERE GIVEN 1871 01:11:11,680 --> 01:11:13,680 DIRECTIVES IN TERMS OF WHAT 1872 01:11:13,680 --> 01:11:15,600 TYPES OF SERVICES AND WHICH 1873 01:11:15,600 --> 01:11:17,320 SERVICE PROVIDERS IN THE 1874 01:11:17,320 --> 01:11:22,240 COMMUNITY TO PROVIDE CARE. 1875 01:11:22,240 --> 01:11:23,880 WE SAW IN PRELIMINARY RESULTS, 1876 01:11:23,880 --> 01:11:27,920 THIS OCCURRED DURING COVID BY 1877 01:11:27,920 --> 01:11:29,280 USING THIS PARTICULAR APP WE 1878 01:11:29,280 --> 01:11:34,720 WERE ABLE TO INCREASE PERCENTAGE 1879 01:11:34,720 --> 01:11:36,880 OF YOUTH, WE DIDN'T SEE AS MANY 1880 01:11:36,880 --> 01:11:42,320 SCREENED BUT WE WERE ABLE TO 1881 01:11:42,320 --> 01:11:43,800 IDENTIFY INCREASE IN BEHAVIORAL 1882 01:11:43,800 --> 01:11:45,280 HEALTH NEEDS, REFERRALS TO 1883 01:11:45,280 --> 01:11:46,720 TREATMENT INCREASE AND 1884 01:11:46,720 --> 01:11:47,680 INITIATION INTO TREATMENT 1885 01:11:47,680 --> 01:11:57,880 INCREASE. 1886 01:11:57,880 --> 01:12:00,280 WE WERE ABLE TO ADDRESS HEALTH 1887 01:12:00,280 --> 01:12:01,760 DISPARITY FOR MINORITY AND WHITE 1888 01:12:01,760 --> 01:12:03,320 GIRLS IN TERMS OF REFERRAL TO 1889 01:12:03,320 --> 01:12:06,520 TREATMENT. 1890 01:12:06,520 --> 01:12:08,440 SO ANOTHER PRODUCT THAT WE HAVE 1891 01:12:08,440 --> 01:12:09,800 DEVELOPED IN THE -- NOT GOING TO 1892 01:12:09,800 --> 01:12:12,120 HAVE TIME TO TALK ABOUT TODAY, 1893 01:12:12,120 --> 01:12:14,160 IS ACTUALLY THIS EFFORT IN TERMS 1894 01:12:14,160 --> 01:12:19,280 OF TRYING TO PROVIDE USING 1895 01:12:19,280 --> 01:12:21,400 INFORMATION COLLECTED THROUGH 1896 01:12:21,400 --> 01:12:22,600 THE SYSTEM TOOLS IN TERMS OF 1897 01:12:22,600 --> 01:12:27,080 BEING ABLE TO IDENTIFY GAPS IN 1898 01:12:27,080 --> 01:12:28,480 SERVICE BUS MORE CHEEKILY DIRECT 1899 01:12:28,480 --> 01:12:30,160 YOUTH AND WOMEN TO PARTICULAR 1900 01:12:30,160 --> 01:12:32,000 PROGRAMS. 1901 01:12:32,000 --> 01:12:36,280 SO THE R AND R SIMULATION TOOL 1902 01:12:36,280 --> 01:12:38,760 SOMETHING MY TEAM DEVELOPED. 1903 01:12:38,760 --> 01:12:42,280 PART OF THE ADVANTAGE OF THAT 1904 01:12:42,280 --> 01:12:43,960 AND YOU CAN SEE HERE BRIEFLY, IS 1905 01:12:43,960 --> 01:12:47,760 WE WERE ABLE TO GET SYSTEMS TO 1906 01:12:47,760 --> 01:12:50,640 MODIFY THE TYPES OF SERVICES 1907 01:12:50,640 --> 01:12:51,400 AVAILABLE FOR INDIVIDUALS 1908 01:12:51,400 --> 01:12:54,200 INVOLVED IN THE JUSTICE SYSTEM. 1909 01:12:54,200 --> 01:12:55,880 AS WELL AS TO IMPROVE THE 1910 01:12:55,880 --> 01:12:59,800 QUALITY OF CARE. 1911 01:12:59,800 --> 01:13:01,680 SO I RAN THROUGH SOME OF THESE 1912 01:13:01,680 --> 01:13:04,680 LINKAGES VERY QUICKLY. 1913 01:13:04,680 --> 01:13:07,320 AND I APOLOGIZE FOR NOT USING MY 1914 01:13:07,320 --> 01:13:09,320 TIME AS WISELY, BUT I WANT TO 1915 01:13:09,320 --> 01:13:12,400 END BY BASICALLY SAYING WE -- A 1916 01:13:12,400 --> 01:13:14,840 MOVEMENT AWAY FROM MANUAL DRIVEN 1917 01:13:14,840 --> 01:13:17,720 SCREENING ASSESSMENT IS NEEDED. 1918 01:13:17,720 --> 01:13:19,480 THAT WE NEED MORE OF THESE 1919 01:13:19,480 --> 01:13:21,680 CLINICAL PATHWAYS THAT PROVIDE 1920 01:13:21,680 --> 01:13:23,880 DIRECT PROACTIVE PLACEMENT, 1921 01:13:23,880 --> 01:13:25,160 PARTICULARLY FOR PEOPLE INVOLVED 1922 01:13:25,160 --> 01:13:27,440 IN THE JUSTICE SYSTEM WHERE 1923 01:13:27,440 --> 01:13:30,520 JUSTICE ACTORS EVEN THROUGH LOTS 1924 01:13:30,520 --> 01:13:34,920 OF TRAINING AND WELL INTENDED 1925 01:13:34,920 --> 01:13:36,360 SYSTEM CHANGES STILL HAVE 1926 01:13:36,360 --> 01:13:40,440 DEMANDS OF BEING A LEGAL ACTOR. 1927 01:13:40,440 --> 01:13:44,640 THAT PLACES LESS EMPHASIS ON THE 1928 01:13:44,640 --> 01:13:46,400 IMPORTANCE OF INTERAGENCY 1929 01:13:46,400 --> 01:13:48,160 CONNECTION AND DEALING WITH 1930 01:13:48,160 --> 01:13:49,080 PEOPLE'S HEALTHCARE NEEDS. 1931 01:13:49,080 --> 01:13:51,960 SO WHAT WE HAVE BEEN ABLE TO SEE 1932 01:13:51,960 --> 01:13:53,840 FROM SOME NEW CLINICAL PATHWAY 1933 01:13:53,840 --> 01:13:55,480 STUDIES IS IMPROVED 1934 01:13:55,480 --> 01:13:58,000 IMPLEMENTATION OUTCOMES, RELATED 1935 01:13:58,000 --> 01:14:00,680 TO ACCEPTABILITY FEASIBILITY AND 1936 01:14:00,680 --> 01:14:03,680 WE HAVE BEEN ABLE TO DEMONSTRATE 1937 01:14:03,680 --> 01:14:05,880 REDUCE INEQUITIES IN HEALTH 1938 01:14:05,880 --> 01:14:08,160 DISPARITIES. 1939 01:14:08,160 --> 01:14:11,320 SO THANK YOU, SORRY FOR TAKING 1940 01:14:11,320 --> 01:14:12,400 EXTRA TWO MINUTES. 1941 01:14:12,400 --> 01:14:14,720 >> NO WORRIES THANK YOU SO MUCH 1942 01:14:14,720 --> 01:14:16,400 FOR SHARING THAT GREAT 1943 01:14:16,400 --> 01:14:16,960 INFORMATION. 1944 01:14:16,960 --> 01:14:20,480 THANK ALL PANELISTS FOR YOUR 1945 01:14:20,480 --> 01:14:21,520 GREAT PRESENTATIONS AND 1946 01:14:21,520 --> 01:14:23,680 OUTLINING SOME OF THE SUCCESSES 1947 01:14:23,680 --> 01:14:26,880 AND OF COURSE SOME CHALLENGES 1948 01:14:26,880 --> 01:14:30,880 THAT Y'ALL HAVE EXPERIENCED IN 1949 01:14:30,880 --> 01:14:32,200 YOUR PROGRAM. 1950 01:14:32,200 --> 01:14:33,960 SO WHAT I WANT TO WE ARE NOW 1951 01:14:33,960 --> 01:14:34,960 TRANSITIONING TO THE PANEL 1952 01:14:34,960 --> 01:14:36,080 DISCUSSION SO I WOULD LIKE TO 1953 01:14:36,080 --> 01:14:38,200 REMIND THE AUDIENCE THAT YOU CAN 1954 01:14:38,200 --> 01:14:39,680 ENTER YOUR QUESTIONS IN THE Q&A 1955 01:14:39,680 --> 01:14:42,760 BOX AT THE BOTTOM OF THE SCREEN 1956 01:14:42,760 --> 01:14:44,200 ALSO I WOULD LIKE TO ENCOURAGE 1957 01:14:44,200 --> 01:14:47,280 PANELISTS TO FEEL FREE TO ENGAGE 1958 01:14:47,280 --> 01:14:48,400 EACH OTHER WITH QUESTIONS AND 1959 01:14:48,400 --> 01:14:48,800 COMMENTS. 1960 01:14:48,800 --> 01:14:51,440 WHILE WE WAIT TO HEAR FROM THE 1961 01:14:51,440 --> 01:14:52,560 AUDIENCE, I WOULD LIKE TO START 1962 01:14:52,560 --> 01:14:54,760 BY ASKING THE PANELISTS ABOUT 1963 01:14:54,760 --> 01:14:57,200 IMPACT OF COVID, HOW HAS COVID 1964 01:14:57,200 --> 01:14:58,240 IMPACT YOUR PROGRAM? 1965 01:14:58,240 --> 01:15:00,760 AND ARE THERE MODIFICATIONS OR 1966 01:15:00,760 --> 01:15:01,880 ADJUSTMENTS THAT YOU HAVE TO 1967 01:15:01,880 --> 01:15:03,440 MAKE DUE TO COVID RESTRICTIONS 1968 01:15:03,440 --> 01:15:06,480 THAT YOU FOUND BENEFICIAL AND 1969 01:15:06,480 --> 01:15:10,200 PLAN TO SUSTAIN AND CONTINUE? 1970 01:15:10,200 --> 01:15:11,600 >> I CAN TALK ABOUT THAT 1971 01:15:11,600 --> 01:15:12,440 INITIALLY. 1972 01:15:12,440 --> 01:15:14,680 I KNOW I DID NOT GIVE A LOT OF 1973 01:15:14,680 --> 01:15:19,720 DETAIL OF OUR INTERVENTION SO I 1974 01:15:19,720 --> 01:15:23,120 WILL BRIEFLY DESCRIBE WHAT WE 1975 01:15:23,120 --> 01:15:24,320 ARE DOING AND HOW MODIFIED FOR 1976 01:15:24,320 --> 01:15:31,200 COVID. NOT SURPRISINGLY COVID 1977 01:15:31,200 --> 01:15:35,480 HAD IMPACT WE ARE RUNNING A 1978 01:15:35,480 --> 01:15:36,920 STUDY AND COULDN'T RECRUIT FOR 1979 01:15:36,920 --> 01:15:38,920 THE -- THE IRB SHUT DOWN, LOTS 1980 01:15:38,920 --> 01:15:40,240 OF THINGS HAPPENED AT BEGINNING 1981 01:15:40,240 --> 01:15:48,680 OF COVID. 1982 01:15:48,680 --> 01:15:49,880 SIMILAR TO FAYE WAS TALKING 1983 01:15:49,880 --> 01:15:50,840 ABOUT INDIVIDUALS GETS 1984 01:15:50,840 --> 01:15:52,560 ASSESSMENT SO WE ARE IDENTIFYING 1985 01:15:52,560 --> 01:15:55,480 OTHER CO-MORBID CONDITIONS AT 1986 01:15:55,480 --> 01:15:56,760 SAME TIME. 1987 01:15:56,760 --> 01:15:57,880 AS WELL AS ADHERENCE TO 1988 01:15:57,880 --> 01:16:00,360 MEDICATION. 1989 01:16:00,360 --> 01:16:02,680 AFTER THEY DO THIS COMPUTER 1990 01:16:02,680 --> 01:16:04,040 DELIVERED INTERVENTION WHICH 1991 01:16:04,040 --> 01:16:11,640 FOCUSES ON ALCOHOL BUT THEN ALSO 1992 01:16:11,640 --> 01:16:12,760 PROVIDES MORE INFORMATION ON THE 1993 01:16:12,760 --> 01:16:14,080 LINK BETWEEN SUBSTANCE USE AN 1994 01:16:14,080 --> 01:16:16,000 TRAUMA, BECAUSE WE LEARN FROM 1995 01:16:16,000 --> 01:16:16,960 INTERVIEWS INDIVIDUALS OFTEN 1996 01:16:16,960 --> 01:16:19,880 AREN'T MAKING THAT CONNECTION. 1997 01:16:19,880 --> 01:16:24,720 AND THEY ARE CONNECTED TO OUR 1998 01:16:24,720 --> 01:16:25,840 COMMUNITY HEALTH WORKER WHO 1999 01:16:25,840 --> 01:16:27,840 WORKS WITH THEM TO GET THEM 2000 01:16:27,840 --> 01:16:31,560 RESOURCES, SO THAT INCLUDES 2001 01:16:31,560 --> 01:16:32,240 MENTAL HEALTHCARE OTHER 2002 01:16:32,240 --> 01:16:33,800 SUBSTANCE USE CARE AND TACKLING 2003 01:16:33,800 --> 01:16:39,760 THINGS LIKE FOOD INSECURITY. 2004 01:16:39,760 --> 01:16:41,040 SO WHAT I WOULD SAY MANY TERMS 2005 01:16:41,040 --> 01:16:42,080 OF COVID, IT WAS CLEAR WE WERE 2006 01:16:42,080 --> 01:16:46,800 GOING TO HAVE TO MOVE MORE LESS 2007 01:16:46,800 --> 01:16:50,920 IN PERSON BASED INTERVENTION AND 2008 01:16:50,920 --> 01:16:57,280 TRY TO FIGURE WHAT WE WERE DOING 2009 01:16:57,280 --> 01:16:58,440 THROUGH TELEPHONE, ZOOM, OTHER 2010 01:16:58,440 --> 01:16:58,680 THINGS. 2011 01:16:58,680 --> 01:17:04,480 WHAT I WOULD SAY IS IN OUR 2012 01:17:04,480 --> 01:17:06,400 CLINIC MANY DO NOT HAVE INTERNET 2013 01:17:06,400 --> 01:17:10,560 ACCESS SO YOU COULDN'T TAKE THAT 2014 01:17:10,560 --> 01:17:11,480 FOR GRANTED. 2015 01:17:11,480 --> 01:17:15,320 SO A LOT WAS MOVED TO PHYSICAL 2016 01:17:15,320 --> 01:17:18,400 TELEPHONE, CELL PHONE OPPOSED TO 2017 01:17:18,400 --> 01:17:21,320 DO SOMETHING BECAUSE CELL PHONE 2018 01:17:21,320 --> 01:17:25,960 DOESN'T HAVE ENOUGH WIFI TO DO 2019 01:17:25,960 --> 01:17:27,640 VIDEO CALL. 2020 01:17:27,640 --> 01:17:31,760 WE HAD TO ADAPT AND LEARN TO 2021 01:17:31,760 --> 01:17:34,560 TEACH OUR COMMUNITY HEALTH 2022 01:17:34,560 --> 01:17:37,320 WORKER HOW TO BEST USE HER 2023 01:17:37,320 --> 01:17:38,880 SKILLS VIA TELEPHONE, IF YOU 2024 01:17:38,880 --> 01:17:40,760 CAN'T USE VIDEO. 2025 01:17:40,760 --> 01:17:43,440 AND WE CAN STILL WE DO STILL 2026 01:17:43,440 --> 01:17:45,200 ALSO DO NOW BECAUSE THINGS 2027 01:17:45,200 --> 01:17:48,680 OPENED UP MORE WE ARE DOING IN 2028 01:17:48,680 --> 01:17:49,920 PERSON MEETINGS BUT USUALLY THE 2029 01:17:49,920 --> 01:17:50,480 FIRST MEETING. 2030 01:17:50,480 --> 01:17:52,280 I THINK FOR US THE BIGGEST 2031 01:17:52,280 --> 01:17:56,640 CHANGE WAS MOVING FROM MORE LIKE 2032 01:17:56,640 --> 01:17:57,840 YOU ENVISION SOMETIMES THIS 2033 01:17:57,840 --> 01:17:59,520 PERSON IS GOING TO WALK THEM TO 2034 01:17:59,520 --> 01:18:00,480 EVERY APPOINTMENT THEY ARE GOING 2035 01:18:00,480 --> 01:18:03,320 TO GO TO. 2036 01:18:03,320 --> 01:18:09,120 TO THINKING HOW WE CAN FURTHER 2037 01:18:09,120 --> 01:18:11,160 YOU ARE USE OF TECHNOLOGY AMONG 2038 01:18:11,160 --> 01:18:15,720 A GROUP OF INDIVIDUALS NOT USING 2039 01:18:15,720 --> 01:18:17,080 TECHNOLOGY TO MUCH EXTENT PRIOR 2040 01:18:17,080 --> 01:18:20,800 TO THE PANDEMIC. 2041 01:18:20,800 --> 01:18:25,760 COVID PROVIDED MANY CHALLENGES. 2042 01:18:25,760 --> 01:18:27,760 >> I THINK FROM THE LEGAL SYSTEM 2043 01:18:27,760 --> 01:18:30,600 ONE OF THE BENEFITS THAT CAME 2044 01:18:30,600 --> 01:18:34,080 FROM COVID WAS THE LEGAL SYSTEM 2045 01:18:34,080 --> 01:18:37,680 ACTUALLY HAS LESS INTAKE. 2046 01:18:37,680 --> 01:18:39,800 ARRESTS WERE DOWN THOUGH THAT IS 2047 01:18:39,800 --> 01:18:45,920 NOW BEING REVERSED. 2048 01:18:45,920 --> 01:18:46,720 THE ADVANTAGE WAS ABLE TO 2049 01:18:46,720 --> 01:18:47,920 ACTUALLY HELP PEOPLE CONNECT TO 2050 01:18:47,920 --> 01:18:51,280 SERVICES IN THE COMMUNITY FOR 2051 01:18:51,280 --> 01:18:54,200 PEOPLE WHO HAD NEEDS. 2052 01:18:54,200 --> 01:18:56,440 BUT WHAT WE HAVE SEEN WITHIN THE 2053 01:18:56,440 --> 01:18:58,240 LEGAL SYSTEM IS THIS NEW 2054 01:18:58,240 --> 01:19:02,040 INTEREST IN SOME OF THESE 2055 01:19:02,040 --> 01:19:04,160 CLINICAL SUPPORT SERVICES, APPS 2056 01:19:04,160 --> 01:19:07,360 THAT ARE AVAILABLE, OTHER TYPES 2057 01:19:07,360 --> 01:19:11,600 OF TELEHEALTH, THAT IS AN 2058 01:19:11,600 --> 01:19:13,360 ADVANTAGEOUS BUT AS DR. CHANDER 2059 01:19:13,360 --> 01:19:15,960 INDICATED PART OF THE ISSUE IS 2060 01:19:15,960 --> 01:19:17,560 PEOPLE DON'T HAVE THE EQUIPMENT 2061 01:19:17,560 --> 01:19:18,960 TO BE ABLE TO DO THAT. 2062 01:19:18,960 --> 01:19:22,800 A LOT OF LEGAL AGENCIES 2063 01:19:22,800 --> 01:19:27,640 PROBATION PAROLE AGENCIES HAVE 2064 01:19:27,640 --> 01:19:28,960 DISTRIBUTED CELL PHONES SO 2065 01:19:28,960 --> 01:19:30,960 PEOPLE CAN GET ACCESS TO SOME OF 2066 01:19:30,960 --> 01:19:35,960 THOSE SERVICES. 2067 01:19:35,960 --> 01:19:39,360 FROM OUR PERSPECTIVE COVID IS 2068 01:19:39,360 --> 01:19:40,520 CHALLENGING BECAUSE WE HAVE 2069 01:19:40,520 --> 01:19:41,640 BEENN'T BEEN ABLE TO GO TO 2070 01:19:41,640 --> 01:19:43,840 FACILITIES SINCE START OF COVID 2071 01:19:43,840 --> 01:19:49,560 SO WE DID HAVE TO SHIFT 2072 01:19:49,560 --> 01:19:51,680 TELEHEALTH SO ALL OUR PHONE 2073 01:19:51,680 --> 01:19:53,720 CONTACT, ALL PHONE CONTACT NOW A 2074 01:19:53,720 --> 01:19:55,480 LOT ARE STILL INCARCERATED, IT 2075 01:19:55,480 --> 01:19:59,280 DOES IMPACT ON ENGAGEMENT. 2076 01:19:59,280 --> 01:20:01,320 SO I LOOK TO THE DAY WE CAN GO 2077 01:20:01,320 --> 01:20:03,720 BACK INSIDE OUR JAILS AND 2078 01:20:03,720 --> 01:20:04,680 PRISONS. 2079 01:20:04,680 --> 01:20:07,480 AND THEN AS FAR AS CLINICAL 2080 01:20:07,480 --> 01:20:10,720 SERVICES, WE ARE STILL PROVIDING 2081 01:20:10,720 --> 01:20:12,240 THROUGH THE HYBRID MODEL WE ARE 2082 01:20:12,240 --> 01:20:16,960 SEEING PEOPLE IN PERSON, ARE 2083 01:20:16,960 --> 01:20:17,600 DOING TELEHEALTH AND WE FIND 2084 01:20:17,600 --> 01:20:18,960 THAT THAT IS BENEFICIAL. 2085 01:20:18,960 --> 01:20:22,800 THERE IS ALSO SOME CHANGES WITH 2086 01:20:22,800 --> 01:20:26,840 REGARD TO STANDARDS OF CARE AND 2087 01:20:26,840 --> 01:20:28,040 WHAT IS POSSIBLE PRESCRIBING 2088 01:20:28,040 --> 01:20:28,600 THAT. 2089 01:20:28,600 --> 01:20:31,040 SO YOU CAN DO HOME INDUCTION NOW 2090 01:20:31,040 --> 01:20:33,080 THROUGH TELEHEALTH. 2091 01:20:33,080 --> 01:20:34,840 THAT IS BEING GOOD TOOL TO GET 2092 01:20:34,840 --> 01:20:37,320 PEOPLE ON A MAP AND QUICKLY IN 2093 01:20:37,320 --> 01:20:43,120 THROUGH THE ERA OF COVID. 2094 01:20:43,120 --> 01:20:43,920 IN GENERAL THE OTHER SPEAKERS 2095 01:20:43,920 --> 01:20:47,000 ARE IDENTIFYING THERE IS SOME 2096 01:20:47,000 --> 01:20:47,880 TECHNOLOGY CHALLENGES WITH 2097 01:20:47,880 --> 01:20:50,400 PEOPLE HAVING ACCESS TO WIFI, 2098 01:20:50,400 --> 01:20:58,520 HAVING ACCESS TO CELL PHONES, 2099 01:20:58,520 --> 01:20:59,680 DATA PLANS. 2100 01:20:59,680 --> 01:21:01,360 SO I AM LOOKING FORWARD TO THE 2101 01:21:01,360 --> 01:21:03,280 DAY WHEN WE NO LONGER HAVE COVID 2102 01:21:03,280 --> 01:21:03,840 RESTRICTIONS. 2103 01:21:03,840 --> 01:21:08,400 >> I THIS I WE ALL ARE. 2104 01:21:08,400 --> 01:21:09,920 DR. MCKEE I HAVE A QUESTION 2105 01:21:09,920 --> 01:21:13,280 SPECIFICALLY FOR YOU. 2106 01:21:13,280 --> 01:21:15,200 SOME OF THE KEY TAKE AWAYS YOU 2107 01:21:15,200 --> 01:21:17,160 IDENTIFIED OF HIGHER RISK OF 2108 01:21:17,160 --> 01:21:19,720 SUBSTANCE USE, GREATER 2109 01:21:19,720 --> 01:21:21,000 PSYCHIATRIC CO-MORBIDITIES LESS 2110 01:21:21,000 --> 01:21:22,840 LIKELY TO ENGAGE IN PRIMARY 2111 01:21:22,840 --> 01:21:24,200 HEALTHCARE, BUT THERE ARE 2112 01:21:24,200 --> 01:21:25,760 ENGAGED IN TREATMENT IN THAT AT 2113 01:21:25,760 --> 01:21:27,120 THE SAME RATES AS MEN. 2114 01:21:27,120 --> 01:21:29,280 THEY ARE HOUSED AND EMPLOYED, 2115 01:21:29,280 --> 01:21:32,080 HAVE SIMILAR RATES OF TREATMENT 2116 01:21:32,080 --> 01:21:37,520 COMPLETION RECIDIVISM AS MEN, 2117 01:21:37,520 --> 01:21:42,640 AND ENGAGE IN SIMILAR THAT 2118 01:21:42,640 --> 01:21:44,720 EXACERBATE -- COMPLETION OF RATE 2119 01:21:44,720 --> 01:21:47,400 OF RECIDIVISM BETWEEN WOMEN AND 2120 01:21:47,400 --> 01:21:47,560 MEN? 2121 01:21:47,560 --> 01:21:51,240 >> WHAT WE KNOW SO FAR IS LOOKED 2122 01:21:51,240 --> 01:21:58,320 AT I CAN SAY THAT THAT WOMEN 2123 01:21:58,320 --> 01:22:01,000 VERY MUCH IDENTIFY INDIVIDUAL 2124 01:22:01,000 --> 01:22:03,880 TREATMENT AS KEY FOR THEM, VERY 2125 01:22:03,880 --> 01:22:06,840 OFTEN WE SEE THAT THAT WOMEN 2126 01:22:06,840 --> 01:22:07,960 MIGHT BE IN TREATMENT SOME 2127 01:22:07,960 --> 01:22:09,600 MONTHS BEFORE THEY START TALKING 2128 01:22:09,600 --> 01:22:11,080 TRAUMA AND REALLY STARTING TO 2129 01:22:11,080 --> 01:22:13,400 DEAL WITH THE IMPACT OF TRAUMA 2130 01:22:13,400 --> 01:22:17,880 HAS HAD ON THEIR ADDICTION. 2131 01:22:17,880 --> 01:22:18,680 AND LIFE IN GENERAL. 2132 01:22:18,680 --> 01:22:21,000 I THINK THAT PROVIDING 2133 01:22:21,000 --> 01:22:22,960 INDIVIDUAL THERAPY IS KEY FOR 2134 01:22:22,960 --> 01:22:26,840 TRAUMA INFORMED CARE. 2135 01:22:26,840 --> 01:22:28,840 I THINK IN GENERAL WHAT WE SEE 2136 01:22:28,840 --> 01:22:31,960 IS THAT WOMEN GET BIGGER DOSE OF 2137 01:22:31,960 --> 01:22:33,200 TREATMENT SO THEY STAY IN 2138 01:22:33,200 --> 01:22:36,480 TREATMENT LONGER AND JUST IN OUR 2139 01:22:36,480 --> 01:22:39,600 VERY ROUGH COST EFFECTIVENESS 2140 01:22:39,600 --> 01:22:43,120 ANALYSIS, IN GENERAL COSTING US 2141 01:22:43,120 --> 01:22:45,280 ABOUT 4,000 TO TREAT A MAN AND 2142 01:22:45,280 --> 01:22:53,280 CLOSER TO 7,000 FOR A WOMAN. 2143 01:22:53,280 --> 01:22:54,640 THAT IS COMPARISON TO IN 2144 01:22:54,640 --> 01:22:56,440 CONNECTICUT IT COSTS $52,000 A 2145 01:22:56,440 --> 01:23:01,480 YEAR TO INCARCERATE SOMEONE. 2146 01:23:01,480 --> 01:23:04,280 SUBSTANTIALLY LESS POPULATION. 2147 01:23:04,280 --> 01:23:05,560 >> YEAH. 2148 01:23:05,560 --> 01:23:08,520 HOW CAN YOUR FINDINGS BE USED TO 2149 01:23:08,520 --> 01:23:10,000 INFORM HEALTH SERVICES AND 2150 01:23:10,000 --> 01:23:10,760 SUBSTANCE USE TREATMENT TO 2151 01:23:10,760 --> 01:23:12,480 SUPPORT RECOVERY ANDEN RETENTION 2152 01:23:12,480 --> 01:23:14,680 AND RETENTION AND CARE? 2153 01:23:14,680 --> 01:23:15,680 SPECIFICALLY GENDER SPECIFIC 2154 01:23:15,680 --> 01:23:22,080 INTERVENTIONS? 2155 01:23:22,080 --> 01:23:24,680 >> I HI THE LINKAGES BETWEEN 2156 01:23:24,680 --> 01:23:27,840 STATE PARTNERS AND TREATMENT 2157 01:23:27,840 --> 01:23:28,640 SETTINGS IS KEY. 2158 01:23:28,640 --> 01:23:32,280 IT TAKES A LOT OF WORK TO DO THE 2159 01:23:32,280 --> 01:23:34,040 WARM HAND OFF BETWEEN DEPARTMENT 2160 01:23:34,040 --> 01:23:36,680 OF CORRECTIONS AND I THINK TRUE 2161 01:23:36,680 --> 01:23:38,080 OF MOST DEPARTMENT OF 2162 01:23:38,080 --> 01:23:39,480 CORRECTIONS, THEY ARE BIG AND 2163 01:23:39,480 --> 01:23:42,600 COMPLEX SYSTEMS AND IT CAN BE 2164 01:23:42,600 --> 01:23:44,640 DIFFICULT TO DO -- GET THAT WARM 2165 01:23:44,640 --> 01:23:47,600 HAND OFF INTO COMMUNITY 2166 01:23:47,600 --> 01:23:49,920 TREATMENT AND PEOPLE DO FALL BY 2167 01:23:49,920 --> 01:23:52,640 THE WAYSIDE, IN PARTICULAR WE 2168 01:23:52,640 --> 01:23:56,200 FINDS THE HARD TO ENGAGE THOSE 2169 01:23:56,200 --> 01:23:57,800 SO THAT MEANS THEY COMPLETED 2170 01:23:57,800 --> 01:24:00,440 THEIR TIME, NO COMMUNITY 2171 01:24:00,440 --> 01:24:03,160 SUPERVISION, ONCE RELEASED FROM 2172 01:24:03,160 --> 01:24:05,520 INCARCERATION AND THAT IS A 2173 01:24:05,520 --> 01:24:07,560 POPULATION THAT WE FIND REALLY 2174 01:24:07,560 --> 01:24:10,880 DIFFICULT TO ENGAGE. 2175 01:24:10,880 --> 01:24:12,440 WITH REGARD TO GENDER SPECIFIC 2176 01:24:12,440 --> 01:24:15,520 PIECE, TRAUMA INPERFORMED CARE 2177 01:24:15,520 --> 01:24:18,840 IS KEY, KEY IS ALSO ADDRESSING 2178 01:24:18,840 --> 01:24:23,480 THE OTHER PSYCHIATRIC 2179 01:24:23,480 --> 01:24:24,720 CO-MORBIDITIES IN A INTEGRATED 2180 01:24:24,720 --> 01:24:25,720 MANNER WITH ADDICTION AND 2181 01:24:25,720 --> 01:24:27,520 PHYSICAL HEALTHCARE, NOTHING 2182 01:24:27,520 --> 01:24:36,920 WORKS IN ISOLATION. 2183 01:24:36,920 --> 01:24:39,280 I WILL ASK DR. TAXMAN TO CHIME 2184 01:24:39,280 --> 01:24:41,440 IN, THINKING INSURANCE TREATMENT 2185 01:24:41,440 --> 01:24:45,200 INITIATION LINKAGE TO DIFFERENT 2186 01:24:45,200 --> 01:24:49,200 SERVICES, SPECIALLY AMONG THE 2187 01:24:49,200 --> 01:24:50,640 FOLKS INCARCERATED AND ABOUT TO 2188 01:24:50,640 --> 01:24:52,720 BE RELEASED. 2189 01:24:52,720 --> 01:24:55,280 RECONDUCTED INTO THE COMMUNITY. 2190 01:24:55,280 --> 01:25:02,840 SO CAN YOU TALK ABOUT THAT? 2191 01:25:02,840 --> 01:25:05,040 >> SO EVERYONE IS AWARE, IF A 2192 01:25:05,040 --> 01:25:08,360 PERSON IS INCARCERATED WHETHER 2193 01:25:08,360 --> 01:25:09,720 JAIL OR PRISON SETTING THEY ARE 2194 01:25:09,720 --> 01:25:13,000 NOT ELIGIBLE TO RECEIVE MEDICAID 2195 01:25:13,000 --> 01:25:13,280 ASSISTANCE. 2196 01:25:13,280 --> 01:25:19,480 THAT IS PART OF THE CURRENT LAW. 2197 01:25:19,480 --> 01:25:21,320 NOT LIKELY TO BE PASSED LAW, THE 2198 01:25:21,320 --> 01:25:23,680 BUILD BACK BETTER DID HAVE A 2199 01:25:23,680 --> 01:25:25,760 MODIFICATION TO THAT TO ALLOW 2200 01:25:25,760 --> 01:25:30,720 PEOPLE TO GET INSURANCE 30 DAYS, 2201 01:25:30,720 --> 01:25:32,680 AS WE LEARN LAST NIGHT THAT LAW 2202 01:25:32,680 --> 01:25:33,600 DOESN'T SEEM TO BE MOVING 2203 01:25:33,600 --> 01:25:33,960 FORWARD. 2204 01:25:33,960 --> 01:25:37,480 SO THAT'S ONE BARRIER. 2205 01:25:37,480 --> 01:25:41,560 IS THAT LOCAL JAILS AND PRISONS 2206 01:25:41,560 --> 01:25:46,720 BASICALLY LARGELY RESPONSIBLE BY 2207 01:25:46,720 --> 01:25:47,840 CONSTITUTION PROVIDED FOR 2208 01:25:47,840 --> 01:25:50,280 MINIMUM STANDARD OF CARE. 2209 01:25:50,280 --> 01:25:53,040 UNFORTUNATELY THAT STANDARD DOES 2210 01:25:53,040 --> 01:25:55,680 NOT INCLUDE MEDICATION FOR 2211 01:25:55,680 --> 01:25:59,240 OPIOID USE DISORDER ALCOHOL USE 2212 01:25:59,240 --> 01:26:05,480 DISORDER THOUGH SOME STATES LIKE 2213 01:26:05,480 --> 01:26:09,000 MASSACHUSETTS ENACTED A LAW THAT 2214 01:26:09,000 --> 01:26:13,160 REQUIRES JAILS TO PROVIDE 2215 01:26:13,160 --> 01:26:13,840 MEDICATION. 2216 01:26:13,840 --> 01:26:16,080 SO FUNDING IS A HUGE ISSUE. 2217 01:26:16,080 --> 01:26:19,000 ANOTHER IS WORK FORCE ISSUES. 2218 01:26:19,000 --> 01:26:22,960 OBVIOUSLY WE HAVE A DERTH OF 2219 01:26:22,960 --> 01:26:25,800 APPROPRIATE WORK FORCE STAFF IN 2220 01:26:25,800 --> 01:26:29,600 THE U.S. IT IS HARDER HIT WITH 2221 01:26:29,600 --> 01:26:31,680 INCARCERAL SETTINGS WHERE THOSE 2222 01:26:31,680 --> 01:26:35,520 ARE NOT NECESSARILY THE MOST 2223 01:26:35,520 --> 01:26:36,760 PLEASANT SETTINGS TO PROVIDE 2224 01:26:36,760 --> 01:26:38,120 CARE. 2225 01:26:38,120 --> 01:26:39,760 THERE HAVE BEEN SOME EFFORTS 2226 01:26:39,760 --> 01:26:42,200 LATELY TO LOOK AT DOING 2227 01:26:42,200 --> 01:26:47,880 TELEHEALTH SERVICES. 2228 01:26:47,880 --> 01:26:48,840 WITHIN SETS TO PROVIDE MEDICAL 2229 01:26:48,840 --> 01:26:51,160 CARE SERVICES BUT THOSE ARE 2230 01:26:51,160 --> 01:26:57,680 EXPERIMENTAL AT THIS POINT. 2231 01:26:57,680 --> 01:26:59,000 THE BIGGEST ISSUE ABOUT THE 2232 01:26:59,000 --> 01:26:59,880 HEALTH SYSTEM AN INTERACTION 2233 01:26:59,880 --> 01:27:03,640 WITH THE LEGAL SYSTEM FOR THE 2234 01:27:03,640 --> 01:27:06,480 MOST PART BALANCE IS PUTTING -- 2235 01:27:06,480 --> 01:27:09,080 BASICALLY HAVING THE LEGAL AS 2236 01:27:09,080 --> 01:27:09,880 MUCH INITIATE THAT'S THE 2237 01:27:09,880 --> 01:27:10,600 REFERRAL PROCESS THAT I WAS 2238 01:27:10,600 --> 01:27:14,720 REFERRING TO. 2239 01:27:14,720 --> 01:27:16,280 THE QUESTION DR. JOHNSON HASN'T 2240 01:27:16,280 --> 01:27:18,320 CHAT BOX IS ABOUT ARE THERE 2241 01:27:18,320 --> 01:27:21,480 OTHER MODELS IN WHICH THE 2242 01:27:21,480 --> 01:27:23,080 HEALTHCARE SYSTEM COULD DO SOME 2243 01:27:23,080 --> 01:27:28,520 OF THOSE INITIATIONS AND 2244 01:27:28,520 --> 01:27:33,720 SCREENING AT THE LOCAL LEVEL 2245 01:27:33,720 --> 01:27:36,920 JAIL CAN BE ACCOMPLISHED WITH 2246 01:27:36,920 --> 01:27:39,480 PARTNERSHIPS BETWEEN HEALTHCARE 2247 01:27:39,480 --> 01:27:41,400 PROVIDERS AND LO L DA JAILS, 2248 01:27:41,400 --> 01:27:44,840 THOSE LOCAL SYSTEMS ARE -- BEGIN 2249 01:27:44,840 --> 01:27:47,200 IN THE JAIL SYSTEM LIKE WHAT DR. 2250 01:27:47,200 --> 01:27:50,480 MCKEE WAS TALKING ABOUT IN HER 2251 01:27:50,480 --> 01:27:51,640 CONNECTICUT FROM APOLOGETIC. 2252 01:27:51,640 --> 01:27:54,440 THOSE ARE FAR AND FEW BETWEEN. 2253 01:27:54,440 --> 01:27:57,160 OUR BIGGEST BARRIER RIGHT NOW IS 2254 01:27:57,160 --> 01:27:59,640 ACTUALLY THE FUNDING ISSUE AND 2255 01:27:59,640 --> 01:28:02,480 THE COVERAGE OR LACK OF COVERAGE 2256 01:28:02,480 --> 01:28:05,120 FROM MEDICAID ASSISTANCE FOR 2257 01:28:05,120 --> 01:28:07,840 PEOPLE WHO LIVE IN MEDICAID 2258 01:28:07,840 --> 01:28:08,880 ELIGIBLE STATES, EXPANDED 2259 01:28:08,880 --> 01:28:12,440 STATES. 2260 01:28:12,440 --> 01:28:14,280 THERE WAS ANOTHER QUESTION IN 2261 01:28:14,280 --> 01:28:16,760 THE CHAT BOX THAT HAD TO DO 2262 01:28:16,760 --> 01:28:18,480 WITH eCONNECT PROJECT AND HOW 2263 01:28:18,480 --> 01:28:21,960 WE WERE ABLE TO DEAL WITH THE 2264 01:28:21,960 --> 01:28:24,280 HEALTH -- REDUCING HEALTH 2265 01:28:24,280 --> 01:28:24,640 DISPARITY. 2266 01:28:24,640 --> 01:28:26,080 I WOULD LIKE TO ADDRESS THAT 2267 01:28:26,080 --> 01:28:30,080 BECAUSE I THINK THAT'S EXCITING 2268 01:28:30,080 --> 01:28:33,920 FOR US. 2269 01:28:33,920 --> 01:28:35,280 UNFORTUNATELY WHEN WE HAVE 2270 01:28:35,280 --> 01:28:37,040 PROBATION PAROLE OFFICERS WHO 2271 01:28:37,040 --> 01:28:39,360 ARE TRAINED TO USE AN ASSESSMENT 2272 01:28:39,360 --> 01:28:42,560 TOOL BUT NOT NECESSARILY 2273 01:28:42,560 --> 01:28:47,120 FAMILIAR HOW TO USE THAT 2274 01:28:47,120 --> 01:28:48,840 INFORMATION TO MAKERRINGS FOR 2275 01:28:48,840 --> 01:28:49,840 CARE HENCE WE HAVE PROBLEM OF 2276 01:28:49,840 --> 01:28:53,760 LACK OF REFERRALS. 2277 01:28:53,760 --> 01:28:55,760 BUT COMPLY CATTED BY THAT ARE 2278 01:28:55,760 --> 01:28:57,760 THE INTERPERSONAL DYNAMICS THAT 2279 01:28:57,760 --> 01:28:59,840 OCCUR DURING INTAKE AND 2280 01:28:59,840 --> 01:29:07,120 ASSESSMENT PROCESSES IN WHICH 2281 01:29:07,120 --> 01:29:09,240 JUSTICE ACTORS MAKE DECISIONS 2282 01:29:09,240 --> 01:29:10,680 ABOUT PEOPLE'S THEIR 2283 01:29:10,680 --> 01:29:11,840 PRESENTATION OF SELF AND WHAT WE 2284 01:29:11,840 --> 01:29:13,920 HAVE FOUND IS PART OF THE 2285 01:29:13,920 --> 01:29:16,280 REASONS WE ARE MOVING TOWARD 2286 01:29:16,280 --> 01:29:21,240 STANDARDIZED INSTRUMENTS IS YOU 2287 01:29:21,240 --> 01:29:22,680 CAN DEAL WITH IMPLICIT BIASES 2288 01:29:22,680 --> 01:29:24,480 THAT OCCUR ON THE PART OF SOME 2289 01:29:24,480 --> 01:29:26,160 OF THE JUSTICE ACTORS. 2290 01:29:26,160 --> 01:29:30,480 SO THE eCONNECT SYSTEM IN THIS 2291 01:29:30,480 --> 01:29:32,320 PARTICULAR CASE IS AN EXAMPLE 2292 01:29:32,320 --> 01:29:35,960 WHERE THE STANDARDIZE ASSESSMENT 2293 01:29:35,960 --> 01:29:39,200 PROTOCOL THAT INVOLVED USING 2294 01:29:39,200 --> 01:29:45,160 THIS APP DIRECTED IDENTIFICATION 2295 01:29:45,160 --> 01:29:47,360 INDIVIDUALS IN TERMS OF DEGREE 2296 01:29:47,360 --> 01:29:50,840 OF PRICES SERVICES RELATED TO 2297 01:29:50,840 --> 01:29:53,920 SUICIDE, BASICALLY HELPED THE 2298 01:29:53,920 --> 01:29:56,520 OFFICER TO RETHINK SOME OF THE 2299 01:29:56,520 --> 01:30:00,480 JUDGMENTS THEY WERE MAKING ABOUT 2300 01:30:00,480 --> 01:30:01,480 YOUTH OR SEVERITY OF THE 2301 01:30:01,480 --> 01:30:03,840 INFORMATION PROVIDED. 2302 01:30:03,840 --> 01:30:05,960 SO IT IS TO SOME DEGREE 2303 01:30:05,960 --> 01:30:08,080 MECHANISM HERE IS REALLY DEALING 2304 01:30:08,080 --> 01:30:10,240 WITH IMPLICIT BIAS. 2305 01:30:10,240 --> 01:30:13,280 AND PROVIDING DIRECTIVE 2306 01:30:13,280 --> 01:30:18,040 INFORMATION THAT OFFICERS CAN 2307 01:30:18,040 --> 01:30:19,680 USE ABILITY URGENCY PROVIDING 2308 01:30:19,680 --> 01:30:21,520 DIFFERENT TYPES OF CARE. 2309 01:30:21,520 --> 01:30:22,720 >> THANK YOU FOR THAT. 2310 01:30:22,720 --> 01:30:24,200 THERE IS ANOTHER QUESTION FOR 2311 01:30:24,200 --> 01:30:30,320 ALL THE PANELISTS DR. TAXMAN WE 2312 01:30:30,320 --> 01:30:32,240 SEE DATA OFTEN SHOWING NEEDS OF 2313 01:30:32,240 --> 01:30:33,800 NON-WHITE WOMEN SEEM TO BE 2314 01:30:33,800 --> 01:30:34,200 IGNORED. 2315 01:30:34,200 --> 01:30:38,480 THEY ARE IN THE LEAST AMOUNT 2316 01:30:38,480 --> 01:30:39,680 DRESSED TONED DOWN WHAT ARE THE 2317 01:30:39,680 --> 01:30:41,320 OPERATING MECHANISMS TO DRIVE 2318 01:30:41,320 --> 01:30:42,680 THIS BIAS? 2319 01:30:42,680 --> 01:30:44,320 SPECIFIC THINGS AFFECTING ACCESS 2320 01:30:44,320 --> 01:30:45,880 AND PERSONAL DYNAMICS BETWEEN 2321 01:30:45,880 --> 01:30:47,240 PROVIDERS AND PATIENTS BIAS AND 2322 01:30:47,240 --> 01:30:48,600 WHAT IS COMMUNICATED ABOUT THE 2323 01:30:48,600 --> 01:30:51,080 PATIENT, ET CETERA. 2324 01:30:51,080 --> 01:30:54,840 >> I THINK I RAISED ONE WHICH IS 2325 01:30:54,840 --> 01:30:56,800 IMPLY SIT BIAS, I WOULD SAY 2326 01:30:56,800 --> 01:30:59,560 ANOTHER DYNAMIC THAT OCCURS 2327 01:30:59,560 --> 01:31:01,320 BETWEEN LEGAL SYSTEMS ACTORS AND 2328 01:31:01,320 --> 01:31:07,000 CLIENTS WHO COME IN, IS THE 2329 01:31:07,000 --> 01:31:09,480 LEGAL SYSTEM ACTORS ARE 2330 01:31:09,480 --> 01:31:10,480 OVERWHELMED WITH THE COMPLEXITY 2331 01:31:10,480 --> 01:31:12,480 OF NEEDS OF INDIVIDUALS AND 2332 01:31:12,480 --> 01:31:17,360 THEREFORE THE TENDENCY IS JUST 2333 01:31:17,360 --> 01:31:19,840 TO FALL BACK ON TRADITIONAL 2334 01:31:19,840 --> 01:31:21,560 MODEL, I AM HERE TO TREAT THE 2335 01:31:21,560 --> 01:31:26,200 CRIME AND NOT THE PERSON. 2336 01:31:26,200 --> 01:31:27,520 HERE TO ADDRESS THE CRIME NOT 2337 01:31:27,520 --> 01:31:27,920 THE PERSON. 2338 01:31:27,920 --> 01:31:31,560 SO PART IS A ROLE DEFINITION, 2339 01:31:31,560 --> 01:31:34,280 ANOTHER MECHANISM I THINK IS 2340 01:31:34,280 --> 01:31:38,640 THAT ESSENTIALLY YOU HAVE THESE 2341 01:31:38,640 --> 01:31:41,280 -- BECAUSE JUSTICE SYSTEM 2342 01:31:41,280 --> 01:31:42,960 DOESN'T RECOGNIZE THEMSELVES AS 2343 01:31:42,960 --> 01:31:44,520 SERVICE PROVIDER, YOU HAVE THE 2344 01:31:44,520 --> 01:31:46,280 LEGAL SYSTEM THAT IS ALWAYS 2345 01:31:46,280 --> 01:31:50,120 CONSTANTLY FOCUSING IN ON WHAT 2346 01:31:50,120 --> 01:31:52,080 IS THE ROLE IN THE LEGAL SYSTEM. 2347 01:31:52,080 --> 01:31:53,960 SO THAT IS WHY THESE SYSTEMS 2348 01:31:53,960 --> 01:31:58,520 MODELS ARE REALLY IMPORTANT. 2349 01:31:58,520 --> 01:32:00,240 >> ANY OTHER -- 2350 01:32:00,240 --> 01:32:05,120 >> I WOULD ALSO SAY THAT WE NEED 2351 01:32:05,120 --> 01:32:07,680 TO FOCUS ON STIGMA AND IN THE 2352 01:32:07,680 --> 01:32:09,280 POPULATION I TREAT THERE IS 2353 01:32:09,280 --> 01:32:14,080 MULTIPLE SOURCES OF STIGMA, 2354 01:32:14,080 --> 01:32:15,320 STIGMA FROM ADDICTION, CRIMINAL 2355 01:32:15,320 --> 01:32:19,400 JUSTICE HISTORY, AND CLIENTS 2356 01:32:19,400 --> 01:32:25,200 THEMSELVES DO IDENTIFY STIGMA AS 2357 01:32:25,200 --> 01:32:28,960 BARRIER TO SUCCESSFUL RECOVERY. 2358 01:32:28,960 --> 01:32:30,960 I KNOW THERE IS STARTING TO BE 2359 01:32:30,960 --> 01:32:33,200 WORK ABOUT ACTUALLY TRAINING 2360 01:32:33,200 --> 01:32:37,240 PEOPLE TO OVERCOME THEIR STIGMA 2361 01:32:37,240 --> 01:32:38,600 AND BIASES. 2362 01:32:38,600 --> 01:32:44,520 I KNOW ONE J COIN PROJECT 2363 01:32:44,520 --> 01:32:45,440 FOCUSED ON DEPARTMENT OF 2364 01:32:45,440 --> 01:32:46,440 CORRECTION WORKERS AND PROBATION 2365 01:32:46,440 --> 01:32:50,560 PAROLE OFFICERS SO THAT IS 2366 01:32:50,560 --> 01:32:53,560 SOMETHING WE NEED TO TAKE HEAD 2367 01:32:53,560 --> 01:32:53,720 ON. 2368 01:32:53,720 --> 01:32:59,000 >> TELLING MORE -- KELLY MOORE 2369 01:32:59,000 --> 01:33:01,240 AT EASTERN TENNESSEE UNIVERSITY, 2370 01:33:01,240 --> 01:33:05,360 HAS A STIGMA INTERVENTION WE ARE 2371 01:33:05,360 --> 01:33:06,680 TESTING OUT. FOR JUSTICE 2372 01:33:06,680 --> 01:33:07,280 WORKERS. 2373 01:33:07,280 --> 01:33:11,280 WHICH IS REALLY EXCITING. 2374 01:33:11,280 --> 01:33:13,000 SO I WASN'T SURE IF THAT WAS WHO 2375 01:33:13,000 --> 01:33:14,600 YOU WERE REFERRING. 2376 01:33:14,600 --> 01:33:17,440 >> THAT WAS WHO -- KELLY DID A 2377 01:33:17,440 --> 01:33:18,080 POST DOC WITH ME. 2378 01:33:18,080 --> 01:33:20,080 >> I'M MENTORING HER NOW. 2379 01:33:20,080 --> 01:33:23,520 SHE IS AWESOME. 2380 01:33:23,520 --> 01:33:25,280 SHE DEVELOPED THIS WONDERFUL 2381 01:33:25,280 --> 01:33:28,000 CURRICULUM THAT SHE'S DELIVERING 2382 01:33:28,000 --> 01:33:32,360 AS PART OF HER J COIN BRANDS. 2383 01:33:32,360 --> 01:33:34,800 >> THANK YOU. 2384 01:33:34,800 --> 01:33:36,560 WE HAVE TIME FOR ONE MORE 2385 01:33:36,560 --> 01:33:37,360 QUESTION. 2386 01:33:37,360 --> 01:33:40,080 THIS WAS FROM STEVEN SMITH. 2387 01:33:40,080 --> 01:33:43,480 HE WORKS -- STEVEN SMITH WORK AT 2388 01:33:43,480 --> 01:33:46,480 -- AT OUR LOWER BUCKS TREATMENT 2389 01:33:46,480 --> 01:33:47,600 24 HOUR ASSESSMENT PROGRAM. 2390 01:33:47,600 --> 01:33:49,840 THEY ALSO HAVE A B CARE 2391 01:33:49,840 --> 01:33:51,800 PROPONENT THAT DEALS WITH 2392 01:33:51,800 --> 01:33:53,480 OVERDOSE OF -- THE LOWER BUCKS 2393 01:33:53,480 --> 01:33:54,680 HOSPITAL CALL US WHEN AN 2394 01:33:54,680 --> 01:33:56,800 OVERDOSE OCCURS WHERE OVERDOSE 2395 01:33:56,800 --> 01:33:59,680 VICTIM SURVIVES THE EVENT. 2396 01:33:59,680 --> 01:34:02,120 AS A FAMILY RECOVERY SPECIALIST 2397 01:34:02,120 --> 01:34:03,960 MY ROLE IS TO TALK WITH OVERDOSE 2398 01:34:03,960 --> 01:34:05,080 VICTIM THAT OCCURS IN 2399 01:34:05,080 --> 01:34:05,960 INDIVIDUALS TO GET INVOLVED IN 2400 01:34:05,960 --> 01:34:06,240 TREATMENT. 2401 01:34:06,240 --> 01:34:09,520 HOW MUCH OF THIS TYPE OF SUPPORT 2402 01:34:09,520 --> 01:34:16,480 IS PROVIDED AND WHERE. 2403 01:34:16,480 --> 01:34:18,000 STEVEN SAYS THEY KNOW IT HAPPENS 2404 01:34:18,000 --> 01:34:20,320 IN PA IN PENNSYLVANIA OR 2405 01:34:20,320 --> 01:34:23,960 PHILADELPHIA. 2406 01:34:23,960 --> 01:34:24,960 DID ANYONE WANT TO ANSWER THAT 2407 01:34:24,960 --> 01:34:31,760 QUESTION? 2408 01:34:31,760 --> 01:34:33,200 >> I DON'T KNOW MUCH ABOUT THE 2409 01:34:33,200 --> 01:34:36,040 FAMILY, I JUST WROTE TO STEVEN, 2410 01:34:36,040 --> 01:34:37,680 BUT I WOULD BE REALLY INTERESTED 2411 01:34:37,680 --> 01:34:40,480 IN LEARNING MORE ABOUT THE 2412 01:34:40,480 --> 01:35:02,360 FAMILY RECOVERY SPECIALIST. 2413 01:35:02,360 --> 01:35:04,000 THE SPARK IT HAS CAUSE FOR ALLOW 2414 01:35:04,000 --> 01:35:05,600 THE CHAT TO KEEP GOING. 2415 01:35:05,600 --> 01:35:08,280 I DO ENCOURAGE THE PANELIST IF 2416 01:35:08,280 --> 01:35:11,480 YOU CAN TO IMPORTANT IF YOU ARE 2417 01:35:11,480 --> 01:35:13,520 ABLE TO RESPOND IN THE CHAT YOU 2418 01:35:13,520 --> 01:35:14,360 CAN WRITE BACK IN THE CHAT IF 2419 01:35:14,360 --> 01:35:15,840 YOU WANT TO RESPOND TO SOME OF 2420 01:35:15,840 --> 01:35:17,240 THOSE COMMENTS OR QUESTIONS. 2421 01:35:17,240 --> 01:35:20,200 SO NOW I WILL TURN IT OVER TO 2422 01:35:20,200 --> 01:35:22,880 MARRAH FOR THE NEXT SESSION. 2423 01:35:22,880 --> 01:35:24,840 >> MANY THANKS AGAIN, SESSION 2424 01:35:24,840 --> 01:35:27,000 FOUR SPEAKERS WHO CONTINUE FROM 2425 01:35:27,000 --> 01:35:27,920 SESSION THREE YESTERDAY MAKING 2426 01:35:27,920 --> 01:35:30,000 THE CASE FOR CONTINUUMS OF CARE. 2427 01:35:30,000 --> 01:35:33,840 BY PROVIDING EXAMPLES OF ACTIVE 2428 01:35:33,840 --> 01:35:34,240 PROGRAMS. 2429 01:35:34,240 --> 01:35:36,280 WITH TODAY FOCUS ON HIGH RISK 2430 01:35:36,280 --> 01:35:37,440 WOMEN AND THOSE WHO INTERFACE 2431 01:35:37,440 --> 01:35:38,560 WITH THE CRIMINAL JUSTICE 2432 01:35:38,560 --> 01:35:39,440 SYSTEM. 2433 01:35:39,440 --> 01:35:40,240 OUR FIRST PRESENTATION COVERED 2434 01:35:40,240 --> 01:35:43,080 THE SHARP COMMUNITY OF 2435 01:35:43,080 --> 01:35:43,720 PARTICIPATORY RESEARCH PROGRAM 2436 01:35:43,720 --> 01:35:45,200 THAT WAS DESIGNED TO ADDRESS 2437 01:35:45,200 --> 01:35:46,960 ALCOHOL USE DISORDER IN WOMEN 2438 01:35:46,960 --> 01:35:48,440 WITH CO-OCCURRING HEALTH 2439 01:35:48,440 --> 01:35:50,280 CONDITIONS INCLUDING MENTAL 2440 01:35:50,280 --> 01:35:50,920 HEALTH DISORDERS AND WOMEN WITH 2441 01:35:50,920 --> 01:35:54,600 HIV. 2442 01:35:54,600 --> 01:35:56,160 AS ALCOHOL USE INCREASE RISK FOR 2443 01:35:56,160 --> 01:35:57,680 INFECTION AND REDUCE MEDICATION 2444 01:35:57,680 --> 01:35:59,120 ADHERENCE FOR THOSE WHO ARE 2445 01:35:59,120 --> 01:36:01,040 INFECTED, THE PROGRAMS WERE 2446 01:36:01,040 --> 01:36:03,640 TAILORED TO WOMEN TO MEET THEIR 2447 01:36:03,640 --> 01:36:05,720 NEEDS TO REDUCE THEIR RISK. 2448 01:36:05,720 --> 01:36:07,600 THAT WERE ALSO RELEVANT AND 2449 01:36:07,600 --> 01:36:10,040 IMPACTFUL TO THE COMMUNITY BASED 2450 01:36:10,040 --> 01:36:13,120 ON TYPES OF ISSUES WOMEN WERE 2451 01:36:13,120 --> 01:36:14,920 EXPERIENCING IN THEIR LIVES. 2452 01:36:14,920 --> 01:36:16,680 SECOND TALK DISCUSSING 2453 01:36:16,680 --> 01:36:18,000 CONTINUUMS OF CARE FOR MODEL 2454 01:36:18,000 --> 01:36:19,240 REENTRY INTO SOCIETY FOR WOMEN 2455 01:36:19,240 --> 01:36:20,120 AFTER INCARCERATION. 2456 01:36:20,120 --> 01:36:22,040 AND THIS PROGRAM WAS DESIGNED TO 2457 01:36:22,040 --> 01:36:24,120 REDUCE RETURN TO INCARCERATION 2458 01:36:24,120 --> 01:36:26,480 BY COMBINING MENTAL HEALTH CARE 2459 01:36:26,480 --> 01:36:29,480 PRIMARY CARE AND PEER MENTOR 2460 01:36:29,480 --> 01:36:31,360 SUPPORT IN IN A COLLABORATIVE 2461 01:36:31,360 --> 01:36:32,560 CARE MODEL CALLED THE LIVING 2462 01:36:32,560 --> 01:36:32,920 FREE PROGRAM. 2463 01:36:32,920 --> 01:36:35,920 SERVICES PROVIDED MAP DURING THE 2464 01:36:35,920 --> 01:36:37,120 END OF INCARCERATION PERIOD 2465 01:36:37,120 --> 01:36:38,920 WHICH INCLUDED ADDICTION 2466 01:36:38,920 --> 01:36:40,360 COUNSELING, PEER MENTORING TO 2467 01:36:40,360 --> 01:36:43,560 MOTIVATE THEM TO GET TREATMENT 2468 01:36:43,560 --> 01:36:45,080 AT RELEASE, AND PLAN OF 2469 01:36:45,080 --> 01:36:46,320 INTEGRATED CARE INTO THE CLINIC 2470 01:36:46,320 --> 01:36:50,520 TO CONTINUE THERAPY TAYLORED TO 2471 01:36:50,520 --> 01:36:51,240 INDIVIDUAL WOMEN NEEDS. 2472 01:36:51,240 --> 01:36:52,840 OUR FINAL SPEAKER CONTINUED THE 2473 01:36:52,840 --> 01:36:54,520 DISCUSSION FOR WOMEN INTERFACING 2474 01:36:54,520 --> 01:36:56,280 WITH THE CRIMINAL JUSTICE SYSTEM 2475 01:36:56,280 --> 01:36:57,320 COVERED SEVERAL TOOLS AND 2476 01:36:57,320 --> 01:36:58,520 PROGRAMS TO GET WOMEN AND GIRLS 2477 01:36:58,520 --> 01:37:00,200 INTO CARE FOR THEIR HEALTH 2478 01:37:00,200 --> 01:37:00,440 ISSUES. 2479 01:37:00,440 --> 01:37:02,120 A GAP WAS REALLY FRAMED AROUND 2480 01:37:02,120 --> 01:37:03,960 HOW WE LINK PEOPLE WITH THE 2481 01:37:03,960 --> 01:37:06,640 SERVICES WITHIN THE COMMUNITY OR 2482 01:37:06,640 --> 01:37:07,520 WHILE INCARCERATED THAT 2483 01:37:07,520 --> 01:37:08,440 INTERFACE WITH THE CRIMINAL 2484 01:37:08,440 --> 01:37:09,840 JUSTICE SYSTEM. 2485 01:37:09,840 --> 01:37:11,720 REFERRAL AND INITIATION OF CARE 2486 01:37:11,720 --> 01:37:13,560 WERE FOUND TO BE KEY TO RECEIPT 2487 01:37:13,560 --> 01:37:14,880 OF THESE SERVICES. 2488 01:37:14,880 --> 01:37:17,200 AN EXAMPLE IS PROVIDED WHERE 2489 01:37:17,200 --> 01:37:18,440 INCARCERATED GIRLS LESS LIKELY 2490 01:37:18,440 --> 01:37:19,960 TO RECEIVE MENTAL HEALTH 2491 01:37:19,960 --> 01:37:20,800 SERVICES THAN BOYS. 2492 01:37:20,800 --> 01:37:23,000 AND THIS DISPARITY WAS INCREASED 2493 01:37:23,000 --> 01:37:25,960 FROM MINORITY GIRLS SO BARRIER 2494 01:37:25,960 --> 01:37:27,840 THERE TO REFERRAL AND INITIATION 2495 01:37:27,840 --> 01:37:30,720 WAS SYSTEMIC ISSUE WHERE THESE 2496 01:37:30,720 --> 01:37:31,960 GIRLS' NEEDS ARE IGNORED. 2497 01:37:31,960 --> 01:37:33,680 THIS SPEAKER PROVIDED EXAMPLES 2498 01:37:33,680 --> 01:37:35,280 WHERE WOMEN FROM MARGINALIZED 2499 01:37:35,280 --> 01:37:39,000 COMMUNITIES, REALLY NEED A 2500 01:37:39,000 --> 01:37:40,080 COMPREHENSIVE INTEGRATED SUPPORT 2501 01:37:40,080 --> 01:37:41,840 TO PREVENT FUTURE RISK FROM 2502 01:37:41,840 --> 01:37:42,600 CO-OCCURRING CONDITIONS. 2503 01:37:42,600 --> 01:37:44,040 I HOPE WE WILL CONTINUE TO THINK 2504 01:37:44,040 --> 01:37:45,920 OF THESE CRITICAL GAPS AND NEEDS 2505 01:37:45,920 --> 01:37:47,480 AS WE CONTINUE THROUGH OUR 2506 01:37:47,480 --> 01:37:47,960 SESSIONS TODAY. 2507 01:37:47,960 --> 01:37:49,520 AND AT THE DISCUSSION AT THE END 2508 01:37:49,520 --> 01:37:51,240 OF TODAY. 2509 01:37:51,240 --> 01:37:53,560 PARTICULARLY HOW CAN WE BEGIN TO 2510 01:37:53,560 --> 01:37:55,120 ADDRESS STRUCTURAL RACISM HANDLE 2511 01:37:55,120 --> 01:37:56,160 IMPLICIT BIAS. 2512 01:37:56,160 --> 01:37:58,680 SO AT THIS TIME WE ARE GOING TO 2513 01:37:58,680 --> 01:38:00,040 TAKE A SHORT BREAK BEFORE 2514 01:38:00,040 --> 01:38:02,000 CONTINUING INTO OUR LAST 2515 01:38:02,000 --> 01:38:13,440 SCIENTIFIC SESSION FOR TODAY. 2516 01:38:13,440 --> 01:38:14,440 >> THIS IS SESSION 2517 01:38:14,440 --> 01:38:15,560 FIVE BUILDING THE INFRASTRUCTURE 2518 01:38:15,560 --> 01:38:16,680 FOR INTEGRATED HEALTHCARE 2519 01:38:16,680 --> 01:38:17,800 SYSTEMS FOR WOMEN AND GIRLS 2520 01:38:17,800 --> 01:38:19,480 WHERE WE WILL DISCUSS COMMUNITY 2521 01:38:19,480 --> 01:38:21,400 ENGAGEMENT, ADDRESSING POLICY 2522 01:38:21,400 --> 01:38:23,160 FINANCING AND WORK FORCE 2523 01:38:23,160 --> 01:38:25,560 DEVELOPMENT. 2524 01:38:25,560 --> 01:38:26,280 REQUIREMENTS. 2525 01:38:26,280 --> 01:38:27,880 THIS SESSION WILL BE MODERATED 2526 01:38:27,880 --> 01:38:28,400 BY DR. ROACH. 2527 01:38:28,400 --> 01:38:35,320 LY TURN IT TO HER NOW. 2528 01:38:35,320 --> 01:38:37,520 >> GOOD AFTERNOON, WELCOME TO 2529 01:38:37,520 --> 01:38:38,960 FIFTH FINAL SESSION OF WORKSHOP 2530 01:38:38,960 --> 01:38:40,400 ENTITLED BUILDING THE 2531 01:38:40,400 --> 01:38:42,040 INFRASTRUCTURE FOR INTEGRATIVE 2532 01:38:42,040 --> 01:38:42,800 HEALTHCARE SYSTEMS FOR WOMEN AND 2533 01:38:42,800 --> 01:38:45,360 GIRLS. 2534 01:38:45,360 --> 01:38:48,440 ADDRESSING COMMUNITY ENGAGEMENT, 2535 01:38:48,440 --> 01:38:49,760 POLICY, FINANCING DATA 2536 01:38:49,760 --> 01:38:53,160 INTEGRATION AND WORK FORCE 2537 01:38:53,160 --> 01:38:55,720 DEVELOPMENT REQUIREMENTS. 2538 01:38:55,720 --> 01:38:57,200 I SERVE AS MEDICAL PROJECT 2539 01:38:57,200 --> 01:38:59,520 OFFICER WITH NATIONAL INSTITUTE 2540 01:38:59,520 --> 01:39:03,880 ON ALCOHOL ABUSE AN ALCOHOLISM. 2541 01:39:03,880 --> 01:39:05,680 IT IS MY GREAT PLEASURE AND 2542 01:39:05,680 --> 01:39:06,840 PRIVILEGE TO INTRODUCE OUR 2543 01:39:06,840 --> 01:39:08,720 SPEAKERS FOR THIS SESSION WHO 2544 01:39:08,720 --> 01:39:11,520 WHILE LISTED LAST OBJECT PROGRAM 2545 01:39:11,520 --> 01:39:12,160 WILL BE ADDRESSING SOME OF THE 2546 01:39:12,160 --> 01:39:13,760 MOST CRITICAL ISSUES HIGHLIGHTED 2547 01:39:13,760 --> 01:39:15,880 BY THIS WORKSHOP. 2548 01:39:15,880 --> 01:39:18,040 I'M SURE EVERYONE IN ATTENDANCE 2549 01:39:18,040 --> 01:39:20,920 WOULD AGREE IN THE ABSENCE OF 2550 01:39:20,920 --> 01:39:23,200 CRITICAL INFRASTRUCTURE, THAT IT 2551 01:39:23,200 --> 01:39:26,000 INCLUDES AT LEAST FIVE ESSENTIAL 2552 01:39:26,000 --> 01:39:27,360 ELEMENTS MANY THE TITLE OF THIS 2553 01:39:27,360 --> 01:39:29,000 SESSION TO DREAM OF BUILDING 2554 01:39:29,000 --> 01:39:30,720 UNITIED SYSTEMS OF HEALTHCARE TO 2555 01:39:30,720 --> 01:39:32,720 ADDRESS COMMON CO-MORBIDITIES IN 2556 01:39:32,720 --> 01:39:36,880 WOMEN AN GIRLS, IS TO DREAM THE 2557 01:39:36,880 --> 01:39:41,440 IMPOSSIBLE DREAM. 2558 01:39:41,440 --> 01:39:43,920 ONE OF OUR SCHEDULED SPEAKERS 2559 01:39:43,920 --> 01:39:45,400 DR. GAIL DAUMIT IS NO LONGER 2560 01:39:45,400 --> 01:39:47,000 ABLE TO PARTICIPATE BECAUSE OF A 2561 01:39:47,000 --> 01:39:47,960 FAMILY EMERGENCY. 2562 01:39:47,960 --> 01:39:49,840 WE WISH HER AND HER FAMILY WELL. 2563 01:39:49,840 --> 01:39:51,960 WE DO HAVE THREE DISTINGUISHED 2564 01:39:51,960 --> 01:39:54,240 PANELISTS TO LEAD THIS AFTERNOON 2565 01:39:54,240 --> 01:39:56,240 DISCUSSION AND IN THE INTEREST 2566 01:39:56,240 --> 01:39:57,600 OF TIME MY INTRODUCTIONS WILL BE 2567 01:39:57,600 --> 01:39:58,080 BRIEF. 2568 01:39:58,080 --> 01:40:02,800 BUT I DRAW YOUR ATTENTION TO THE 2569 01:40:02,800 --> 01:40:04,400 FULL LENGTH BIOS IN YOUR PROGRAM 2570 01:40:04,400 --> 01:40:04,760 BOOK. 2571 01:40:04,760 --> 01:40:08,240 FIRST WE WILL HEAR FROM DR. 2572 01:40:08,240 --> 01:40:10,360 CAITLIN CROSS BARNET, SOCIAL 2573 01:40:10,360 --> 01:40:12,000 SCIENCE RESEARCH ANALYST AT THE 2574 01:40:12,000 --> 01:40:15,400 CENTER FOR MEDICARE AND MEDICAID 2575 01:40:15,400 --> 01:40:16,880 INNOVATION RESEARCH AND 2576 01:40:16,880 --> 01:40:17,840 EVALUATION GROUP AND HAS 2577 01:40:17,840 --> 01:40:19,720 PARTICULAR EXPERTISE IN 2578 01:40:19,720 --> 01:40:21,840 QUALITATIVE AND MIXED METHODS 2579 01:40:21,840 --> 01:40:22,400 RESEARCH. 2580 01:40:22,400 --> 01:40:25,400 HER PRIOR PROJECTS INCLUDED 2581 01:40:25,400 --> 01:40:27,080 STRONG START FOR MOTHERS AND 2582 01:40:27,080 --> 01:40:28,200 NEWBORNS AND THE HEALTHCARE 2583 01:40:28,200 --> 01:40:30,280 INNOVATION AWARDS, AND HER 2584 01:40:30,280 --> 01:40:32,080 CURRENT PROJECTS ARE INTEGRATED 2585 01:40:32,080 --> 01:40:36,600 CARE FOR KIDS, AND THE MATERNAL 2586 01:40:36,600 --> 01:40:37,520 OPIOID MISUSE MODEL. 2587 01:40:37,520 --> 01:40:39,960 IN ADDITION TO REPRODUCTIVE AND 2588 01:40:39,960 --> 01:40:42,400 PEDIATRIC HEALTH, SHE FOCUSES ON 2589 01:40:42,400 --> 01:40:44,400 BEHAVIORAL HEALTH SUBSTANCE USE 2590 01:40:44,400 --> 01:40:46,480 DISORDERS, CARE TRANSFORMATION, 2591 01:40:46,480 --> 01:40:47,800 AND HEALTH EQUITY. 2592 01:40:47,800 --> 01:40:50,160 IN TODAY'S SESSION DR. CROSS 2593 01:40:50,160 --> 01:40:52,000 BARNET WILL PLACE THE SPOTLIGHT 2594 01:40:52,000 --> 01:40:53,880 ON COMMUNITY ENGAGEMENT, 2595 01:40:53,880 --> 01:40:56,000 PROVIDING AN OVERVIEW OF THE 2596 01:40:56,000 --> 01:40:57,920 INTEGRATED CARE FOR KIDS, AND 2597 01:40:57,920 --> 01:41:03,200 MATERNAL OPIOID MISUSE MODELS. 2598 01:41:03,200 --> 01:41:06,600 NEXT IS MS. RYAN ARGENTIERI, 2599 01:41:06,600 --> 01:41:08,400 DEPUTY DIRECTOR OFFICE OF 2600 01:41:08,400 --> 01:41:09,400 TECHNOLOGY AT THE OFFICE OF 2601 01:41:09,400 --> 01:41:11,720 NATIONAL COORDINATOR FOR HEALTH 2602 01:41:11,720 --> 01:41:13,560 IT. 2603 01:41:13,560 --> 01:41:16,400 IN THIS POSITION MS. ARGENTIERI 2604 01:41:16,400 --> 01:41:21,080 SUPPORTS ONS VERIFICATION 2605 01:41:21,080 --> 01:41:22,600 TESTING STANDARDS AND TECHNOLOGY 2606 01:41:22,600 --> 01:41:23,520 ANALYSIS PORTFOLIOS. 2607 01:41:23,520 --> 01:41:26,200 SHE LEADS COORDINATION OF CROSS 2608 01:41:26,200 --> 01:41:28,800 FUNCTIONAL PROGRAMS PROMOTING 2609 01:41:28,800 --> 01:41:30,400 INTEROPERABILITY AND STANDARDS 2610 01:41:30,400 --> 01:41:32,160 HARMONIZATION FOR HIGH PRIORITY 2611 01:41:32,160 --> 01:41:36,680 AREAS SUCH AS PUBLIC HEALTH DATA 2612 01:41:36,680 --> 01:41:37,160 MODERNIZATION AND SOME 2613 01:41:37,160 --> 01:41:38,400 DETERMINANTS OF HEALTH. 2614 01:41:38,400 --> 01:41:40,760 PARTNERING WITH MS. ARGENTIERI 2615 01:41:40,760 --> 01:41:44,160 FOR THIS PRESENTATION WILL BE 2616 01:41:44,160 --> 01:41:47,200 MS. JAWANNA HENRY WHO SERVES AS 2617 01:41:47,200 --> 01:41:48,320 ANALYST AND SOCIAL DETERMINANTS 2618 01:41:48,320 --> 01:41:51,360 OF HEALTH OR SODH -- SDOH LEAD. 2619 01:41:51,360 --> 01:41:53,360 FOR THE OFFICE OF TECHNOLOGY, 2620 01:41:53,360 --> 01:41:55,400 WITHIN THE OFFICE OF THE 2621 01:41:55,400 --> 01:41:56,640 NATIONAL COORDINATOR FOR HEALTH 2622 01:41:56,640 --> 01:41:57,480 IT. 2623 01:41:57,480 --> 01:41:59,560 WHERE SHE LEADS SEVERAL DATA 2624 01:41:59,560 --> 01:42:00,800 INTEGRATION INITIATIVES, THAT 2625 01:42:00,800 --> 01:42:03,160 FOCUS ON THE DEVELOPMENT AND 2626 01:42:03,160 --> 01:42:05,160 ADVANCEMENT OF STANDARDS TO 2627 01:42:05,160 --> 01:42:07,400 SUPPORT EXCHANGE AND USE OF DATA 2628 01:42:07,400 --> 01:42:10,800 AS THE SDOH LEAD, SHE CONDUCTS 2629 01:42:10,800 --> 01:42:12,560 STRATEGIC PLANNING AND 2630 01:42:12,560 --> 01:42:14,200 COORDINATION TO ALIGN WITH THE 2631 01:42:14,200 --> 01:42:16,080 DEVELOPMENT OF STANDARDS THAT 2632 01:42:16,080 --> 01:42:18,800 SUPPORT THE EXCHANGE OF SDOH 2633 01:42:18,800 --> 01:42:22,120 DATA AND EXPLORES INNOVATIVE USE 2634 01:42:22,120 --> 01:42:23,480 OF THOSE DATA. 2635 01:42:23,480 --> 01:42:26,760 ADDITIONALLY SHE CO-LEADS THE 2636 01:42:26,760 --> 01:42:28,200 BEHAVIORAL HEALTH PORTFOLIO 2637 01:42:28,200 --> 01:42:30,400 WITHIN THE OFFICE OF TECHNOLOGY 2638 01:42:30,400 --> 01:42:31,800 INCLUDING ELECTRONIC CLINICAL 2639 01:42:31,800 --> 01:42:33,880 DECISION SUPPORT, THE ADVANCING 2640 01:42:33,880 --> 01:42:37,400 PRESCRIPTION DRUG MONITORING 2641 01:42:37,400 --> 01:42:39,040 PROGRAM, AND ELECTRONIC HEALTH 2642 01:42:39,040 --> 01:42:39,760 RECORD INTEGRATION. 2643 01:42:39,760 --> 01:42:43,280 IN TODAY'S SESSIONS IN 2644 01:42:43,280 --> 01:42:44,760 ARGENTIERI AND MS. HENRY WILL 2645 01:42:44,760 --> 01:42:46,880 FOCUS THE SPOTLIGHT ON DATA 2646 01:42:46,880 --> 01:42:48,400 SCIENCE DEVELOPING THE 2647 01:42:48,400 --> 01:42:49,600 STRATEGICALLY COORDINATED 2648 01:42:49,600 --> 01:42:53,000 REGISTRY NETWORK OR CRN FOR 2649 01:42:53,000 --> 01:42:58,520 WOMEN'S HEALTH TECHNOLOGIES. 2650 01:42:58,520 --> 01:43:02,240 THANK YOU, I'M GETTING A MESSAGE 2651 01:43:02,240 --> 01:43:05,040 HERE OVER -- WELCOME, THANK YOU 2652 01:43:05,040 --> 01:43:09,240 TO OUR PANELISTS WE WILL JOIN 2653 01:43:09,240 --> 01:43:14,400 NOW WITH DR. CROSS BARNET. 2654 01:43:14,400 --> 01:43:18,120 >> THANK YOU, DR. ROACH. 2655 01:43:18,120 --> 01:43:24,600 ARE YOU PUTTING UP MY SLIDES? 2656 01:43:24,600 --> 01:43:25,640 >> WE'LL DO THAT. 2657 01:43:25,640 --> 01:43:26,160 >> GREAT. 2658 01:43:26,160 --> 01:43:42,880 THANK YOU. 2659 01:43:42,880 --> 01:43:46,920 >> THANK YOU SO MUCH. 2660 01:43:46,920 --> 01:43:48,000 DR. ROACH GAVE ME A THOROUGH 2661 01:43:48,000 --> 01:43:48,400 INTRODUCTION. 2662 01:43:48,400 --> 01:43:51,880 I WANT TO SAY I WILL DEFINITELY 2663 01:43:51,880 --> 01:43:54,400 TALK ABOUT INTEGRATIVE CARE FOR 2664 01:43:54,400 --> 01:43:55,800 KIDS AND OPIOID MISUSE MODEL BUT 2665 01:43:55,800 --> 01:43:58,200 I WILL START OFF WITH MOTHERS 2666 01:43:58,200 --> 01:44:00,120 AND NEWBORN WHICH TAUGHT LESSONS 2667 01:44:00,120 --> 01:44:01,680 IN THE WAYS WE SHAPE THE OTHER 2668 01:44:01,680 --> 01:44:02,400 PROGRAMS. 2669 01:44:02,400 --> 01:44:04,240 AND ALSO HAS RESULTS UNLIKE THE 2670 01:44:04,240 --> 01:44:05,720 OTHER TWO MODELS WHICH ARE JUST 2671 01:44:05,720 --> 01:44:09,600 GETTING STARTED. 2672 01:44:09,600 --> 01:44:10,120 FOR MOTHERS AND 2673 01:44:10,120 --> 01:44:12,640 MANY U BOURNS HAVE THE GOAL 2674 01:44:12,640 --> 01:44:14,400 PREVENTING PRE-TERM BIRTH, LOW 2675 01:44:14,400 --> 01:44:16,000 BIRTH WEIGHT IMPROVING BIRTH AND 2676 01:44:16,000 --> 01:44:17,240 HEALTH OUTCOMES FOR PARENTS AND 2677 01:44:17,240 --> 01:44:19,120 INFANTS AND LOWERING COSTS. 2678 01:44:19,120 --> 01:44:22,240 AND THE PROGRAM OPERATED FROM 2679 01:44:22,240 --> 01:44:25,960 2013 THROUGH 2017 SERVING 46,000 2680 01:44:25,960 --> 01:44:30,720 PREGNANT MEDICAID BENEFICIARIES, 2681 01:44:30,720 --> 01:44:33,400 PARTICIPANTS WERE BLACK AND 2682 01:44:33,400 --> 01:44:36,480 HISPANIC WITH 40% AFRICAN 2683 01:44:36,480 --> 01:44:38,440 AMERICAN AND 30% HISPANIC FROM 2684 01:44:38,440 --> 01:44:39,880 VARY COURTHOUSE BACKGROUNDS, 2685 01:44:39,880 --> 01:44:41,600 THAT WAS PARTIALLY INTENTIONAL 2686 01:44:41,600 --> 01:44:42,520 BECAUSE THE INTENT OF THE MODEL 2687 01:44:42,520 --> 01:44:44,600 IN REDUCING PRE-TERM BIRTH WAS 2688 01:44:44,600 --> 01:44:45,800 TARGET HIGHER RISK POPULATIONS 2689 01:44:45,800 --> 01:44:47,600 AN ESPECIALLY AMONG AFRICAN 2690 01:44:47,600 --> 01:44:48,560 AMERICAN WOMEN WE KNOW THERE IS 2691 01:44:48,560 --> 01:44:53,320 A LARGE DISPARITY IN PRETERM 2692 01:44:53,320 --> 01:44:56,200 BIRTH RATES. SO WE TESTED THREE 2693 01:44:56,200 --> 01:45:00,880 MODELS OF PRE-NATAL CARE, ONE 2694 01:45:00,880 --> 01:45:02,360 WAS TESTING CARE IN BIRTH 2695 01:45:02,360 --> 01:45:04,880 CENTERS AND IT IS IMPORTANT TO 2696 01:45:04,880 --> 01:45:06,240 REALIZE YOU DON'T HAVE GIVE 2697 01:45:06,240 --> 01:45:08,000 BIRTH IN A BIRTH CENTER TO GET 2698 01:45:08,000 --> 01:45:08,400 CARE. 2699 01:45:08,400 --> 01:45:13,160 SO THAT WAS TESTING IN THE 2700 01:45:13,160 --> 01:45:14,600 MIDWIFERY MODEL WHICH WAS 2701 01:45:14,600 --> 01:45:15,760 ENHANCED WITH PEER COUNSELING. 2702 01:45:15,760 --> 01:45:17,800 THE OTHERS WERE PRE-NATAL CARE 2703 01:45:17,800 --> 01:45:20,520 AND MATERNITY CARE HOMES SO 2704 01:45:20,520 --> 01:45:21,760 GROUP CARE BASICALLY WENT 2705 01:45:21,760 --> 01:45:22,880 ACCORDING TO CENTER AND 2706 01:45:22,880 --> 01:45:24,400 PREGNANCY MODEL FACILITATED 2707 01:45:24,400 --> 01:45:27,440 DISCUSSION ALONG WITH THE 2708 01:45:27,440 --> 01:45:28,280 PRE-NATAL VISIT SO NOT JUST A 2709 01:45:28,280 --> 01:45:34,240 QUOTE UNQUOTE CLASS BUT 2710 01:45:34,240 --> 01:45:35,600 INCURRENT RATED PREPRE-NATAL 2711 01:45:35,600 --> 01:45:37,400 CARE TO EDUCATION COMPONENT, 2712 01:45:37,400 --> 01:45:39,600 PEER SUPPORT AND MATERNITY CARE 2713 01:45:39,600 --> 01:45:41,920 HOMELESS WHICH OFFERED MA WHAT 2714 01:45:41,920 --> 01:45:42,920 YOU CONSIDER STANDARD CLINICAL 2715 01:45:42,920 --> 01:45:44,480 CARE MODEL BUT ENHANCED WITH 2716 01:45:44,480 --> 01:45:45,480 CARE COORDINATION AND SOMETIMES 2717 01:45:45,480 --> 01:45:47,400 WITH SOME OTHER SERVICES SUCH AS 2718 01:45:47,400 --> 01:45:49,280 NUTRITION COUNSELING OR ENHANCE 2719 01:45:49,280 --> 01:45:50,480 ACCESS TO BEHAVIORAL HEALTH 2720 01:45:50,480 --> 01:45:55,120 PROVIDERS. 2721 01:45:55,120 --> 01:45:57,400 THERE WERE 27 AWARDEES IN TOTAL 2722 01:45:57,400 --> 01:46:00,480 THAT HAD 211 CARE SITES IN 32 2723 01:46:00,480 --> 01:46:02,880 STATES, WASHINGTON D.C. AND 2724 01:46:02,880 --> 01:46:04,000 PUERTO RICO, YOU CAN SEE HERE 2725 01:46:04,000 --> 01:46:07,120 THEY ARE CONCENTRATED SOMEWHAT 2726 01:46:07,120 --> 01:46:09,640 IN THE SOUTH EAST BECAUSE THAT 2727 01:46:09,640 --> 01:46:13,720 IS AN AREA WITH HIGH PRE-TERM 2728 01:46:13,720 --> 01:46:18,200 BIRTH RATES SO GREEN SITES ARE 2729 01:46:18,200 --> 01:46:20,640 BIRTH CENTER CARE AND YELLOW 2730 01:46:20,640 --> 01:46:21,640 PRE-NATAL CARE AND BLUE 2731 01:46:21,640 --> 01:46:23,200 MATERNITY CARE HOMES AND A 2732 01:46:23,200 --> 01:46:24,200 COUPLE OFFERING MORE THAN ONE 2733 01:46:24,200 --> 01:46:25,440 MODEL OF CARE WITHIN THEIR 2734 01:46:25,440 --> 01:46:30,200 PROGRAMS. 2735 01:46:30,200 --> 01:46:31,400 NEXT SLIDE. 2736 01:46:31,400 --> 01:46:33,080 WE GOT PARTICIPANTS HAD HIGH 2737 01:46:33,080 --> 01:46:34,520 LEVELS OF NEED PROBABLY NOT 2738 01:46:34,520 --> 01:46:35,440 SURPRISING TO ANYBODY. 2739 01:46:35,440 --> 01:46:37,200 SO LOTS OF MEDICAL RISK FACTORS 2740 01:46:37,200 --> 01:46:39,640 PEOPLE COMING IN WITH 2741 01:46:39,640 --> 01:46:40,440 PRE-EXISTING DIABETES OR 2742 01:46:40,440 --> 01:46:41,880 HYPERTENSION OR HAVING AD A 2743 01:46:41,880 --> 01:46:44,200 PRIOR PRE-TERM BIRTH, OVERWEIGHT 2744 01:46:44,200 --> 01:46:49,280 AND OBESITY, DEPENDING ON THE 2745 01:46:49,280 --> 01:46:51,400 MODEL BETWEEN 25 AND 48% PEOPLE 2746 01:46:51,400 --> 01:46:53,400 COMING IN BMI 30 OR HIGHER LOW 2747 01:46:53,400 --> 01:46:54,760 LEVELS OF EMPLOYMENT OR 2748 01:46:54,760 --> 01:46:57,960 EDUCATION. 2749 01:46:57,960 --> 01:47:00,720 MOST PEOPLE OR THAT MAJORITY, I 2750 01:47:00,720 --> 01:47:01,840 WOULDN'T SAY MOST FINISHED HIGH 2751 01:47:01,840 --> 01:47:03,320 SCHOOL, VERY FEW WITH COLLEGE 2752 01:47:03,320 --> 01:47:05,200 DEGREES, FAIR NUMBER OF PEOPLE 2753 01:47:05,200 --> 01:47:08,720 WHO DIDN'T HAVE A DIPLOMA OR 2754 01:47:08,720 --> 01:47:11,040 GED, PEOPLE BENEATHER EMPLOYEE 2755 01:47:11,040 --> 01:47:15,480 NOR SCHOOL NOR RAISING SMALL 2756 01:47:15,480 --> 01:47:17,040 CHILDREN, LOG OF MENTAL HEALTH 2757 01:47:17,040 --> 01:47:19,000 CONCERNS, 25% POPULATION 2758 01:47:19,000 --> 01:47:21,000 STREAMED POSITIVE FOR DEPRESSION 2759 01:47:21,000 --> 01:47:24,960 AND ANOTHER 35% -- SOME OVERLAP 2760 01:47:24,960 --> 01:47:26,760 BUT 35% SCREEN POSITIVE FOR 2761 01:47:26,760 --> 01:47:28,520 ANXIETY SO INCREDIBLY HIGH 2762 01:47:28,520 --> 01:47:30,080 LEVELS OF DEPRESSION AND ANXIETY 2763 01:47:30,080 --> 01:47:33,080 MUCH HIGHER THAN WHAT IS 2764 01:47:33,080 --> 01:47:35,040 REPRESENTED IN THE PREGNANT 2765 01:47:35,040 --> 01:47:35,840 POPULATION IN GENERAL. 2766 01:47:35,840 --> 01:47:37,320 THIS IS MEDICAID AND CHIP 2767 01:47:37,320 --> 01:47:37,680 POPULATION. 2768 01:47:37,680 --> 01:47:38,960 HIGH LEVELS OF FOOD EPISECURITY 2769 01:47:38,960 --> 01:47:41,720 AN HOUSING INSECURITY. 2770 01:47:41,720 --> 01:47:43,800 NEXT SLIDE PLEASE. 2771 01:47:43,800 --> 01:47:46,200 SO IN OUR CASE STUDY, WE HAD A 2772 01:47:46,200 --> 01:47:50,120 ROBUST CASE STUDY COMPONENTS WE 2773 01:47:50,120 --> 01:47:52,200 VISITED TALKED WITH SITES TWICE 2774 01:47:52,200 --> 01:47:54,200 IN PERSON AND TWICE VIRTUALLY, 2775 01:47:54,200 --> 01:47:57,160 COMPARED TO TYPICAL CARE MOST 2776 01:47:57,160 --> 01:47:58,240 CARE OFFERED MORE TIME WITH 2777 01:47:58,240 --> 01:47:59,600 CLINICAL PROVIDER OR WITH 2778 01:47:59,600 --> 01:48:01,040 ANCILLARY PROVIDER SUCH AS CARE 2779 01:48:01,040 --> 01:48:03,600 COORDINATOR. 2780 01:48:03,600 --> 01:48:05,360 MORE COMPREHENSIVE INTENSIVE 2781 01:48:05,360 --> 01:48:06,800 PATIENT EDUCATION CONTINUITY 2782 01:48:06,800 --> 01:48:07,760 RELATIONSHIP BUILDING, SOMETIMES 2783 01:48:07,760 --> 01:48:09,400 WITH THE PROVIDER SOMETIMES WITH 2784 01:48:09,400 --> 01:48:12,400 ANCILLARY PROVIDERS. 2785 01:48:12,400 --> 01:48:13,800 MORE INVOLVEMENT OF PARTNERS AND 2786 01:48:13,800 --> 01:48:15,280 FAMILY MEMBERS IN THE GROUP CARE 2787 01:48:15,280 --> 01:48:17,480 AND BIRTH CENTER MODEL, AND MORE 2788 01:48:17,480 --> 01:48:19,920 EFFORTS TO ADDRESS BARRIERS TO 2789 01:48:19,920 --> 01:48:21,320 CARE SUCH AS TRANSPORTATION TO 2790 01:48:21,320 --> 01:48:24,600 GET TO APPOINTMENTS. 2791 01:48:24,600 --> 01:48:25,000 NEXT LIED PLEASE. 2792 01:48:25,000 --> 01:48:28,600 SO I WILL SHOW YOU RESULTS FROM 2793 01:48:28,600 --> 01:48:30,000 THE START STOP EVALUATION. 2794 01:48:30,000 --> 01:48:32,080 ALL ARE RISK MATCH COMPARISON 2795 01:48:32,080 --> 01:48:33,520 GROUP SO NOT COMPARING MANY THE 2796 01:48:33,520 --> 01:48:34,800 BIRTH CENTER MODEL WHICH DID 2797 01:48:34,800 --> 01:48:37,320 HAVE AN OVERALL LOWER RISK 2798 01:48:37,320 --> 01:48:38,360 POPULATION TO THE KINDS OF 2799 01:48:38,360 --> 01:48:39,440 PEOPLE WHO WOULD HAVE ENROLLED 2800 01:48:39,440 --> 01:48:41,800 IN MATERNITY CARE MODEL. 2801 01:48:41,800 --> 01:48:44,960 ALL RISK MATCHED AGAINST OTHER 2802 01:48:44,960 --> 01:48:46,240 MEDICAID PARTICIPANTS IN THEIR 2803 01:48:46,240 --> 01:48:49,440 STATE WHO HAVE SIMILAR RISK 2804 01:48:49,440 --> 01:48:56,080 LEVELS CORK TO RECORDS AND 2805 01:48:56,080 --> 01:48:57,200 DIAGNOSTIC CLAIMS. 2806 01:48:57,200 --> 01:48:58,680 I HAVE RESULTS ABOUT EQUITY 2807 01:48:58,680 --> 01:49:00,000 ISSUE, THOSE ARE BASED ON 2808 01:49:00,000 --> 01:49:02,000 PROGRAM DATA LOOKING AT THE 2809 01:49:02,000 --> 01:49:03,280 THREE PROGRAMS RELATIVE TO EACH 2810 01:49:03,280 --> 01:49:03,480 OTHER. 2811 01:49:03,480 --> 01:49:05,480 FOR PEOPLE WHO ACTUALLY 2812 01:49:05,480 --> 01:49:05,880 ENROLLED. 2813 01:49:05,880 --> 01:49:09,080 BUT THE OUTCOMES DATA IS FROM 2814 01:49:09,080 --> 01:49:10,520 PROPENSITY SCORE WEIGHTED 2815 01:49:10,520 --> 01:49:11,000 COMPARISON GROUP. 2816 01:49:11,000 --> 01:49:14,680 NEXT SLIDE PLEASE. 2817 01:49:14,680 --> 01:49:16,120 SO JUST OVERALL RESULTS OF THE 2818 01:49:16,120 --> 01:49:17,640 MODEL WE FOUND IN BIRTH CENTERS 2819 01:49:17,640 --> 01:49:20,760 THE COSTS WERE FAR LOWER FOR THE 2820 01:49:20,760 --> 01:49:23,640 PARENT INFANT DYAD, $2,000 LOWER 2821 01:49:23,640 --> 01:49:25,000 PER DYAD. 2822 01:49:25,000 --> 01:49:29,080 FROM -- WE MEASURED FROM THE 2823 01:49:29,080 --> 01:49:30,280 BASICALLY THE EIGHT MONTHS 2824 01:49:30,280 --> 01:49:34,600 BEFORE PERSON HAD THEIR BIRTH UP 2825 01:49:34,600 --> 01:49:35,600 THROUGH ONE YEAR AFTER BIRTH. 2826 01:49:35,600 --> 01:49:37,680 THEY HAD LOWER UTILIZATION, 2827 01:49:37,680 --> 01:49:41,240 LOWER HOSPITAL VISITS, LOWER ED 2828 01:49:41,240 --> 01:49:42,000 VISITS, BETTER ESPECIALLY 2829 01:49:42,000 --> 01:49:44,600 INFANTS. 2830 01:49:44,600 --> 01:49:46,320 HIGHER QUALITY PRE-TERM BIRTH 2831 01:49:46,320 --> 01:49:48,560 RATES 25% LOWER AMONG THOSE 2832 01:49:48,560 --> 01:49:50,000 BIRTH CENTERS AND COMPARABLE 2833 01:49:50,000 --> 01:49:51,000 POPULATION. 2834 01:49:51,000 --> 01:49:53,920 LOW BIRTH WEIGHT RATES WERE 20% 2835 01:49:53,920 --> 01:49:57,360 LOWER AND CESAREAN RATES 40%, 2836 01:49:57,360 --> 01:49:58,800 AGAINST A RISK MATCHED 2837 01:49:58,800 --> 01:50:00,560 POPULATION AND HALF BIRTH CENTER 2838 01:50:00,560 --> 01:50:01,920 PARTICIPANTS GAVE BIRTH AT 2839 01:50:01,920 --> 01:50:03,040 HOSPITAL WHETHER BY CHOICE OR 2840 01:50:03,040 --> 01:50:06,000 NECESSITY. 2841 01:50:06,000 --> 01:50:07,960 FROM EQUITY PERSPECTIVE IMPROVED 2842 01:50:07,960 --> 01:50:12,240 OUTCOMES FOR RACIALETH I RACIAL ETHNIC 2843 01:50:12,240 --> 01:50:12,760 GROUPS. 2844 01:50:12,760 --> 01:50:15,040 THE EQUITY GAP BETWEEN WHITE AND 2845 01:50:15,040 --> 01:50:16,360 BLACK PARTICIPANTS DID -- WAS 2846 01:50:16,360 --> 01:50:19,280 SMALLER IN BIRTH CENTERS 2847 01:50:19,280 --> 01:50:21,200 RELATIVE TO POPULATION AS A 2848 01:50:21,200 --> 01:50:21,560 WHOLE. 2849 01:50:21,560 --> 01:50:23,120 BUT THAT AGAIN IS NOT AGAINST 2850 01:50:23,120 --> 01:50:24,360 THE WEIGHTED COMPARISON GROUP. 2851 01:50:24,360 --> 01:50:26,600 THAT IS LOOKING A PROGRAM DATA. 2852 01:50:26,600 --> 01:50:28,560 GROUP PRE-NATAL CARE WE FOUND 2853 01:50:28,560 --> 01:50:30,080 LOWER COST PARTICULARLY IN 2854 01:50:30,080 --> 01:50:33,520 PRE-NATAL PERIOD, SLIGHTLY LOWER 2855 01:50:33,520 --> 01:50:35,400 UTILIZATION, QUALITY WAS 2856 01:50:35,400 --> 01:50:37,920 MODESTLY HIGHER SLIGHT DECREASE 2857 01:50:37,920 --> 01:50:40,600 IN PRE-TERM BIRTH RATES INCREASE 2858 01:50:40,600 --> 01:50:42,160 VAGINAL BIRTH AFTER CESAREAN AN 2859 01:50:42,160 --> 01:50:44,920 IMPROVED OUTCOMES FOR WHITE AN 2860 01:50:44,920 --> 01:50:46,120 BLACK PARTICIPANTS IN GROUP 2861 01:50:46,120 --> 01:51:03,640 PRE-NATAL CARE RELATIVE TO MA 2862 01:51:03,640 --> 01:51:04,160 TERMTY CARE HOME MODEL. 2863 01:51:04,160 --> 01:51:04,760 HOMES HAD HIGHER COSTS ALMOST 2864 01:51:04,760 --> 01:51:05,120 $1,000 PER DYAD. 2865 01:51:05,120 --> 01:51:05,680 RESULTS ON UTILIZATION WERE 2866 01:51:05,680 --> 01:51:06,280 MIXED, NOT VERY STRONG RESULTS 2867 01:51:06,280 --> 01:51:06,800 EITHER WAY BUT SOME THINGS 2868 01:51:06,800 --> 01:51:07,200 HIGHER SOME LOWER. 2869 01:51:07,200 --> 01:51:07,800 QUALITY AGAIN MODESTLY LOWER 2870 01:51:07,800 --> 01:51:08,320 ALTHOUGH EFFECTS WERE NOT 2871 01:51:08,320 --> 01:51:08,760 PARTICULARLY ROBUST. 2872 01:51:08,760 --> 01:51:10,440 AND FROM EQUITY DIDN'T SEE ANY 2873 01:51:10,440 --> 01:51:12,120 IMPROVED OUTCOMES FOR ANY GROUP. 2874 01:51:12,120 --> 01:51:17,000 NEXT SLIDE PLEASE. 2875 01:51:17,000 --> 01:51:20,320 SO WHY DIDN'T -- STRONG START 2876 01:51:20,320 --> 01:51:21,320 NOT SEE MORE RESULTS? 2877 01:51:21,320 --> 01:51:22,800 SOME PANELIST IT IS LAST SESSION 2878 01:51:22,800 --> 01:51:24,120 GOT AT SOME OF THESE ISSUES 2879 01:51:24,120 --> 01:51:25,880 BECAUSE EVERYBODY WAS SCREENED 2880 01:51:25,880 --> 01:51:27,120 THOROUGHLY SO IT WAS 2881 01:51:27,120 --> 01:51:30,080 INSTRUMENTAL AND IDENTIFYING 2882 01:51:30,080 --> 01:51:31,000 NEEDS BUT THERE ARE INSUFFICIENT 2883 01:51:31,000 --> 01:51:32,080 RESOURCES IN MOST COMMUNITIES 2884 01:51:32,080 --> 01:51:33,760 FOR IDENTIFYING THOSE NEEDS. 2885 01:51:33,760 --> 01:51:35,720 SOME OF THE BIGGEST GAPS ARE IN 2886 01:51:35,720 --> 01:51:40,720 MENTAL HEALTH SERVICES, DOMESTIC 2887 01:51:40,720 --> 01:51:41,840 VIOLENCE REFERRALS 2888 01:51:41,840 --> 01:51:43,280 TRANSPORTATION AND ALSO FOR 2889 01:51:43,280 --> 01:51:45,200 GENERAL HEALTH SAFE AND WEATHER 2890 01:51:45,200 --> 01:51:48,640 APPROPRIATE EXERCISE OPTIONS. 2891 01:51:48,640 --> 01:51:50,200 SO WE SAW REAL DIFFICULTY 2892 01:51:50,200 --> 01:51:51,640 GETTING PEOPLE WITH VEER MENTAL 2893 01:51:51,640 --> 01:51:53,560 HEALTH ISSUES IN TO THE CARE 2894 01:51:53,560 --> 01:51:56,400 THAT THEY NEEDED. 2895 01:51:56,400 --> 01:51:58,600 THERE ARE NOT PSYCHIATRISTS AT 2896 01:51:58,600 --> 01:52:01,200 ALL WHO WILL ACCEPT MEDICAID 2897 01:52:01,200 --> 01:52:02,040 PARTICIPANTS. 2898 01:52:02,040 --> 01:52:03,840 WHEN THERE ARE THEY INFREQUENTLY 2899 01:52:03,840 --> 01:52:05,680 SPECIALIZE IN PREGNANCY SO 2900 01:52:05,680 --> 01:52:07,640 PEOPLE WITH SEVERE MENTAL HEALTH 2901 01:52:07,640 --> 01:52:11,920 CONDITIONS WOULD HAVE A HARD 2902 01:52:11,920 --> 01:52:14,080 TIME FINDING ANYBODY TO DO 2903 01:52:14,080 --> 01:52:15,040 MEDICATION MANAGEMENT DURING 2904 01:52:15,040 --> 01:52:16,600 PREGNANCY AND WAIT TO SEE HOW 2905 01:52:16,600 --> 01:52:18,080 MORE GENTLEMEN TALL HEALTH 2906 01:52:18,080 --> 01:52:19,320 PROVIDER LIKE SOCIAL WORKER 2907 01:52:19,320 --> 01:52:22,360 COULD TAKE MONTHS AND MONTHS. 2908 01:52:22,360 --> 01:52:24,160 WE SAW EVEN MEDICAID PROVIDES 2909 01:52:24,160 --> 01:52:25,280 TRANSPORTATION AND THAT IS A 2910 01:52:25,280 --> 01:52:27,440 REQUIRED BENEFIT OF MEDICAID, IT 2911 01:52:27,440 --> 01:52:29,520 CAN BE COMPLICATED TO SET UP, 2912 01:52:29,520 --> 01:52:31,080 PEOPLE OFTEN COULDN'T BRING 2913 01:52:31,080 --> 01:52:33,200 CHILDREN WITH THEM ON THE 2914 01:52:33,200 --> 01:52:34,200 TRANSPORT AND WHILE THEY SAID 2915 01:52:34,200 --> 01:52:35,600 PEOPLE WERE GENERALLY GOOD ABOUT 2916 01:52:35,600 --> 01:52:37,000 PICKING THEM UP AND GETTING THEM 2917 01:52:37,000 --> 01:52:41,000 TO APPOINTMENT, THEY WERE NOT SO 2918 01:52:41,000 --> 01:52:42,680 GREAT PICKING THEM UP FROM I A 2919 01:52:42,680 --> 01:52:44,120 POINTMENT TO HOME SO THEY WERE 2920 01:52:44,120 --> 01:52:46,160 RELUCTANT THE USE THE SERVICE 2921 01:52:46,160 --> 01:52:48,360 EVEN IF ABLE TO BOOK 48 HOURS IN 2922 01:52:48,360 --> 01:52:49,280 ADVANCE AND OTHER REQUIREMENTS 2923 01:52:49,280 --> 01:52:52,720 INVOLVED. 2924 01:52:52,720 --> 01:52:54,600 SO IN OUR CASE STUDY ANALYSIS WE 2925 01:52:54,600 --> 01:52:56,600 ALSO LOOKED AT WHAT HELPED TO 2926 01:52:56,600 --> 01:52:57,400 EXPLAIN SOME OF THE POSITIVE 2927 01:52:57,400 --> 01:53:00,200 RESULTS THAT WE SAW, PROVIDERS 2928 01:53:00,200 --> 01:53:01,400 SPEND MORE TIME WITH PATIENTS 2929 01:53:01,400 --> 01:53:02,880 PARTICULARLY THE PRIMARY 2930 01:53:02,880 --> 01:53:04,560 PRE-NATAL CARE PROVIDER SO NOT 2931 01:53:04,560 --> 01:53:06,200 JUST CARE COORDINATOR BUT THE 2932 01:53:06,200 --> 01:53:08,120 PERSON WHO WAS PROVIDING CARE. 2933 01:53:08,120 --> 01:53:10,240 SO IN THE MIDWIFERY MODEL AND 2934 01:53:10,240 --> 01:53:13,760 BIRTH CENTER MODEL WE SAW THE 2935 01:53:13,760 --> 01:53:16,320 PRIMARY PROVIDERS SPENDING 2936 01:53:16,320 --> 01:53:18,480 USUALLY 30 TO 60 MINUTES PER 2937 01:53:18,480 --> 01:53:20,200 APPOINTMENT, 30 FOR TYPICAL AND 2938 01:53:20,200 --> 01:53:21,400 HOUR OR SOMETIMES LONGER FOR 2939 01:53:21,400 --> 01:53:23,760 MORE EXTEND AID POINTMENT. 2940 01:53:23,760 --> 01:53:26,960 IN GROUP CARE THE TIME 2941 01:53:26,960 --> 01:53:28,280 INDIVIDUAL TIME APPOINTMENT IS 2942 01:53:28,280 --> 01:53:31,400 SHORT, A QUICK HEALTH CHECK BUT 2943 01:53:31,400 --> 01:53:33,680 THEY SPEND 90 MINUTES WITH THE 2944 01:53:33,680 --> 01:53:35,240 PROVIDER AFTERWARDS IN THE GROUP 2945 01:53:35,240 --> 01:53:37,800 WITH FACILITATED DISCUSSION. 2946 01:53:37,800 --> 01:53:40,160 BETTER CARE CONTINUITY, DIVERSE 2947 01:53:40,160 --> 01:53:41,720 CENTERS HAD SMALL STAFF SO EVEN 2948 01:53:41,720 --> 01:53:43,200 IF THEY WERE PERSONALLY SEEN 2949 01:53:43,200 --> 01:53:44,720 MORE THAN ONE MIDWIFE IT WAS A 2950 01:53:44,720 --> 01:53:47,160 COUPLE OF MIDWIFES, AGAIN WITH 2951 01:53:47,160 --> 01:53:48,480 LONG APPOINTMENTS THERE WAS TIME 2952 01:53:48,480 --> 01:53:49,800 FOR RELATIONSHIP BUILDING EVEN 2953 01:53:49,800 --> 01:53:51,320 IF THEY WERE SEEING MULTIPLE 2954 01:53:51,320 --> 01:53:53,000 PEOPLE. 2955 01:53:53,000 --> 01:53:54,760 AND WITH GROUP PRE-NATAL CARE IT 2956 01:53:54,760 --> 01:53:57,160 WAS THE SAME PROVIDERS WHO WERE 2957 01:53:57,160 --> 01:53:58,960 LEADING ALL THE SESSIONS. 2958 01:53:58,960 --> 01:54:00,200 THERE WAS FOCUS ON 2959 01:54:00,200 --> 01:54:01,200 INDIVIDUALIZED HEALTH EDUCATION 2960 01:54:01,200 --> 01:54:02,760 FOR PEOPLE AGAIN ESPECIALLY 2961 01:54:02,760 --> 01:54:05,480 NOTED IN THE BIRTH CENTER AND 2962 01:54:05,480 --> 01:54:08,440 CENTER PREGNANCY MODELS AND MORE 2963 01:54:08,440 --> 01:54:10,800 EXTENSIVE PSYCHOSOCIAL SUPPORT, 2964 01:54:10,800 --> 01:54:12,000 CARE COORDINATORS PROVIDED THAT 2965 01:54:12,000 --> 01:54:15,280 IN THE MA ATTORNEY UNTIL CARE 2966 01:54:15,280 --> 01:54:16,280 HOME HOMEDS AS WELL AS WHAT WE 2967 01:54:16,280 --> 01:54:18,640 SAW FROM PROVIDERS AND ANCILLARY 2968 01:54:18,640 --> 01:54:20,560 SUPPORT IN OTHER TWO MODELS. 2969 01:54:20,560 --> 01:54:22,400 LACK OF COMMUNITY RESOURCES, 2970 01:54:22,400 --> 01:54:24,320 REAL PROBLEM, LOTS OF VARIATION 2971 01:54:24,320 --> 01:54:26,400 IN SERVICES THOUGH WE DID NOT 2972 01:54:26,400 --> 01:54:28,400 FIND THAT SERVICE INTENSITY. 2973 01:54:28,400 --> 01:54:31,120 CORRELATED AT ALL WITH OUTCOMES. 2974 01:54:31,120 --> 01:54:33,680 IN OUR MATERNITY CARE HOME 2975 01:54:33,680 --> 01:54:34,800 MODELS MORE CARE COORDINATION 2976 01:54:34,800 --> 01:54:36,200 VISITS, MORE CONTACT WITH 2977 01:54:36,200 --> 01:54:39,080 PROVIDERS SO FORTH WE DID NOT 2978 01:54:39,080 --> 01:54:40,280 SEE ANY DIFFERENCES IN THE 2979 01:54:40,280 --> 01:54:43,560 OUTCOMES AMONG THOSE MODELS. 2980 01:54:43,560 --> 01:54:45,560 RISK FACTORS MAY NOT HAVE BEEN 2981 01:54:45,560 --> 01:54:47,000 ACCOUNTED FOR IN THE DATA 2982 01:54:47,000 --> 01:54:49,000 SOURCES WE TRIED TO DO A JOB OF 2983 01:54:49,000 --> 01:54:49,920 CONTROLLING, WE HAD INFORMATION 2984 01:54:49,920 --> 01:54:51,800 FROM VITAL RECORDS AND WHEN WE 2985 01:54:51,800 --> 01:54:54,000 ADDED CONTROLS FROM MEDICAID 2986 01:54:54,000 --> 01:54:55,200 DIAGNOSTIC CLAIM, FOR INSTANCE 2987 01:54:55,200 --> 01:54:56,680 SOMETHING IDENTIFIED SOMEONE WHO 2988 01:54:56,680 --> 01:54:59,320 HAD A HIGH RISK REFERRAL FOR 2989 01:54:59,320 --> 01:55:01,080 SEVERE HYPERTENSION, THINGS 2990 01:55:01,080 --> 01:55:03,200 ALONG THOSE LINES, THEY DIDN'T 2991 01:55:03,200 --> 01:55:05,600 HAVE MUCH EFFECT ON WHAT WE SAW 2992 01:55:05,600 --> 01:55:06,640 RESULTS WISE. 2993 01:55:06,640 --> 01:55:08,400 SO WITH THE BIRTH CENTERS I KNOW 2994 01:55:08,400 --> 01:55:09,840 THERE HAD STATISTICIAN IT WAS 2995 01:55:09,840 --> 01:55:11,680 WORKING ON THIS, CONVINCED SOON 2996 01:55:11,680 --> 01:55:13,200 AS WE PUT IN DIEG NOS ACTION I 2997 01:55:13,200 --> 01:55:14,840 CODES WE SEE THOSE POSITIVE 2998 01:55:14,840 --> 01:55:17,000 EFFECTS DISAPPEAR AND INSTEAD 2999 01:55:17,000 --> 01:55:20,600 REMAINED WILDCAL. 3000 01:55:20,600 --> 01:55:23,040 THE CORE COMMUNICATION AMONG 3001 01:55:23,040 --> 01:55:24,360 PROVIDERS SOMETIMES IN SAME 3002 01:55:24,360 --> 01:55:25,680 CLINIC BUT WHEN PEOPLE WERE 3003 01:55:25,680 --> 01:55:26,920 GETTING CARE FROM MULTIPLE 3004 01:55:26,920 --> 01:55:28,240 SOURCES SO BEHAVIORAL HEALTH 3005 01:55:28,240 --> 01:55:29,960 PROVIDERS NOT COMMUNICATING WITH 3006 01:55:29,960 --> 01:55:31,960 THE PRE-NATAL CARE PROUD 3007 01:55:31,960 --> 01:55:34,280 VIEWERS, NOT PRIMARY HEALTH 3008 01:55:34,280 --> 01:55:35,600 PROVIDERS SPECIALISTS IN THE 3009 01:55:35,600 --> 01:55:37,040 INFORMATION PEOPLE GOT FROM THE 3010 01:55:37,040 --> 01:55:39,200 PATIENT HERSELF AND NOT FROM 3011 01:55:39,200 --> 01:55:41,080 ACTUALLY COORDINATING ANY HEALTH 3012 01:55:41,080 --> 01:55:43,760 RECORDS OR TALKING TO ANY OTHER 3013 01:55:43,760 --> 01:55:45,280 PROVIDER. 3014 01:55:45,280 --> 01:55:47,040 CORE COMMUNICATION BETWEEN CARE 3015 01:55:47,040 --> 01:55:48,400 COORDINATION AND CLINICAL 3016 01:55:48,400 --> 01:55:49,400 PROVIDERS SO THOUGH THEY WERE 3017 01:55:49,400 --> 01:55:52,040 USUALLY IN THE SAME 3018 01:55:52,040 --> 01:55:53,280 INSTITUTIONS, THEY DIDN'T TALK 3019 01:55:53,280 --> 01:55:55,960 TO EACH OTHER MUCH, THE CLINICAL 3020 01:55:55,960 --> 01:55:58,400 PROVIDERS TENDED TO REALLY WANT 3021 01:55:58,400 --> 01:56:00,000 THE CARE COORDINATORS TO TAKE ON 3022 01:56:00,000 --> 01:56:01,800 BURDENS TO LIGHTEN LOADS, WE 3023 01:56:01,800 --> 01:56:03,160 KNOW THAT THERE IS A LOT OF 3024 01:56:03,160 --> 01:56:05,680 PRESSURE ON PROVIDERS, NOT LOT 3025 01:56:05,680 --> 01:56:07,240 OF TIME FOR APPOINTMENTS AND 3026 01:56:07,240 --> 01:56:08,440 THAT ARE REIMBURSEMENT SYSTEM 3027 01:56:08,440 --> 01:56:10,440 TENDS TO REWARD DOING PROCEDURES 3028 01:56:10,440 --> 01:56:12,280 RATHER THAN SPENDING TIME WITH 3029 01:56:12,280 --> 01:56:12,640 PEOPLE. 3030 01:56:12,640 --> 01:56:16,200 WE IN ONE OF OUR CLINICS CARE 3031 01:56:16,200 --> 01:56:17,400 COORDINATORS BAKING BROWNIES FOR 3032 01:56:17,400 --> 01:56:18,840 THE OBSTETRICIANS TO TRY TO TALK 3033 01:56:18,840 --> 01:56:20,520 TO THEM, THEY DIDN'T NECESSARILY 3034 01:56:20,520 --> 01:56:22,280 HAVE ACCESS TO THE ELECTRONIC 3035 01:56:22,280 --> 01:56:23,520 HEALTH RECORD SO THEY COULDN'T 3036 01:56:23,520 --> 01:56:24,960 SEE WHAT IS GOING ON WITH 3037 01:56:24,960 --> 01:56:25,880 PATIENTS AND ENTER NOTES ABOUT 3038 01:56:25,880 --> 01:56:27,800 THE PATIENTS. 3039 01:56:27,800 --> 01:56:28,920 AND EVEN WHEN THEY WERE ABLE TO 3040 01:56:28,920 --> 01:56:31,360 DO THAT, THEY TEND -- REPORTED 3041 01:56:31,360 --> 01:56:34,000 THAT OFTEN THE PROVIDERS WEREN'T 3042 01:56:34,000 --> 01:56:35,480 NEEDING THEM. 3043 01:56:35,480 --> 01:56:38,080 AND THEY DON'T NECESSARILY EACH 3044 01:56:38,080 --> 01:56:39,480 OTHER'S NOTES SO BECOMES REALLY 3045 01:56:39,480 --> 01:56:41,800 DIFFERENT PROVIDER EVERY VISIT 3046 01:56:41,800 --> 01:56:43,160 BECAUSE SHE OFTEN HAVING TO TELL 3047 01:56:43,160 --> 01:56:44,600 STORY EVERY TIME AND I GET 3048 01:56:44,600 --> 01:56:45,600 CONFLICTING ADVICE FROM 3049 01:56:45,600 --> 01:56:46,600 DIFFERENT PROVIDERS BECAUSE THEY 3050 01:56:46,600 --> 01:56:48,320 ARE SOMETIMES MORE THAN ONE 3051 01:56:48,320 --> 01:56:51,760 EVIDENCE BASE WADE OF ADDRESSING 3052 01:56:51,760 --> 01:56:52,200 A PROBLEM. 3053 01:56:52,200 --> 01:56:53,120 POOR COMMUNICATION BETWEEN 3054 01:56:53,120 --> 01:56:54,800 CLINICAL AND SOCIAL SERVICE 3055 01:56:54,800 --> 01:56:56,640 PROVIDERS, WE RARELY KNEW 3056 01:56:56,640 --> 01:56:58,920 WHETHER OR NOT RESULTS IN ANY 3057 01:56:58,920 --> 01:56:59,440 FOLLOW-UP. 3058 01:56:59,440 --> 01:57:01,440 NEXT SLIDE PLEASE. 3059 01:57:01,440 --> 01:57:03,200 SO WHAT LESSONS DID WE THEN 3060 01:57:03,200 --> 01:57:05,200 LEARN FOR MOVING THE NEEDLE ON 3061 01:57:05,200 --> 01:57:06,680 PRE-TERM BIRTH? 3062 01:57:06,680 --> 01:57:08,800 HOLISTIC TIME INTENSIVE CARE ON 3063 01:57:08,800 --> 01:57:11,560 HEALTH EDUCATION PSYCHOSOCIAL 3064 01:57:11,560 --> 01:57:12,800 SUPPORT WHICH SEEM EXEMPLIFIED 3065 01:57:12,800 --> 01:57:14,880 IN THE MIDWIFERY MODEL CAN BE 3066 01:57:14,880 --> 01:57:16,840 PRACTICED BY ANY PROVIDER AND 3067 01:57:16,840 --> 01:57:18,160 SETTING LIKE MIDWIVES PRACTICE 3068 01:57:18,160 --> 01:57:20,400 ACCORDING TO MEDICAL MODEL AND 3069 01:57:20,400 --> 01:57:23,040 OFTEN DO IN CLINICAL SETTINGS. 3070 01:57:23,040 --> 01:57:25,040 ANY PROVIDER PRACTICE ACCORDING 3071 01:57:25,040 --> 01:57:26,880 TO MIDWIFERY MODEL. 3072 01:57:26,880 --> 01:57:28,000 CONTINUITY BUILDS RELATIONSHIPS 3073 01:57:28,000 --> 01:57:30,320 IN CENTRALIZES INFORMATION. 3074 01:57:30,320 --> 01:57:31,880 ADDRESSING PHYSICAL MENTAL 3075 01:57:31,880 --> 01:57:32,840 SOCIAL HEALTH IS NECESSARY FOR 3076 01:57:32,840 --> 01:57:34,560 IMPROVING OUTCOMES. 3077 01:57:34,560 --> 01:57:38,160 EVIDENCE BASED PRE-NATAL CARE 3078 01:57:38,160 --> 01:57:40,000 NEEDS COMPLIMENTARY SYSTEMS 3079 01:57:40,000 --> 01:57:41,440 MEDICALLY -- MEDICALLY AND 3080 01:57:41,440 --> 01:57:43,200 BEHAVIORALLY AND IN THE 3081 01:57:43,200 --> 01:57:44,360 COMMUNITY SUPPORT IN A SYSTEM 3082 01:57:44,360 --> 01:57:46,000 THAT IS INTEGRATED. 3083 01:57:46,000 --> 01:57:47,600 WE ARE NOT PUTTING 3084 01:57:47,600 --> 01:57:48,840 RESPONSIBILITY ON PATIENT TO GO 3085 01:57:48,840 --> 01:57:51,400 TO 20 PLACES TO GET THINGS SHE 3086 01:57:51,400 --> 01:57:53,000 NEEDS OR SEEING ONE COMMUNITY 3087 01:57:53,000 --> 01:57:55,600 HEALTH WORKER BEING PAID $15 AN 3088 01:57:55,600 --> 01:57:57,480 HOUR IS GOING TO SOLVE THE 3089 01:57:57,480 --> 01:57:59,600 WORD'S PROBLEMS, VERY LARGE 3090 01:57:59,600 --> 01:58:00,960 ROBUST CLINICAL SYSTEM HASN'T 3091 01:58:00,960 --> 01:58:03,200 BEEN ABLE TO SOLVE ON ITS OWN. 3092 01:58:03,200 --> 01:58:04,640 IN COORDINATION TO KNOW WHERE IS 3093 01:58:04,640 --> 01:58:06,640 A LOSING GAME FOR EVERYONE SO 3094 01:58:06,640 --> 01:58:09,280 WHEN YOU IDENTIFY A PERSON HAS 3095 01:58:09,280 --> 01:58:11,280 INTENSE NEEDS BUT YOU CAN'T 3096 01:58:11,280 --> 01:58:13,200 OFFER HER ANYTHING THAT IS GOING 3097 01:58:13,200 --> 01:58:15,000 TO PROVIDE HELP WHERE SHE WILL 3098 01:58:15,000 --> 01:58:16,560 HAVE TO WAIT, SIX MONTHS OR IN 3099 01:58:16,560 --> 01:58:18,760 THE CASE OF HOUSING, SOMETIMES 3100 01:58:18,760 --> 01:58:20,160 FOR YEARS AND YEARS YOU ARE NOT 3101 01:58:20,160 --> 01:58:21,720 GOING TO SEE ANY IMMEDIATE 3102 01:58:21,720 --> 01:58:23,680 IMPACT ON BIRTH OUTCOMES BECAUSE 3103 01:58:23,680 --> 01:58:26,040 SHE HASN'T GOTTEN ASSISTANCE. 3104 01:58:26,040 --> 01:58:29,600 NEXT SLIDE PLEASE. 3105 01:58:29,600 --> 01:58:31,400 CARE COORDINATORS AND COMMUNITY 3106 01:58:31,400 --> 01:58:32,640 HEALTH WORKERS CAN BE VALUABLE 3107 01:58:32,640 --> 01:58:35,080 MEMBERS OF CARE TEAMS CERTAINLY 3108 01:58:35,080 --> 01:58:35,840 PARTICIPANTS APPRECIATED THE 3109 01:58:35,840 --> 01:58:39,520 EFFORTS THEY PUT IN. 3110 01:58:39,520 --> 01:58:41,000 OFTEN THEY SAY BECAUSE OF THIS 3111 01:58:41,000 --> 01:58:42,640 PERSON I GOT A CAR SEAT THAT WAS 3112 01:58:42,640 --> 01:58:43,800 GREAT BUT GETTING A CAR SEAT 3113 01:58:43,800 --> 01:58:45,760 ISN'T GOING TO PREVENT YOU FROM 3114 01:58:45,760 --> 01:58:47,240 HAVING PRE-TERM BIRTH. 3115 01:58:47,240 --> 01:58:48,440 THEY CAN'T SOLVE PERSONAL 3116 01:58:48,440 --> 01:58:51,000 SYSTEMIC PROBLEMS ALONE. 3117 01:58:51,000 --> 01:58:54,600 NEXT SLIDE. 3118 01:58:54,600 --> 01:58:56,600 >> ONE BIG THING WE LEARNED FROM 3119 01:58:56,600 --> 01:58:58,200 STRONG START WAS IMPORTANCE OF 3120 01:58:58,200 --> 01:59:00,400 INTEGRATION OVER COORDINATION. 3121 01:59:00,400 --> 01:59:02,600 NEXT SLIDE. 3122 01:59:02,600 --> 01:59:05,760 SO THE CONCEPT OF CARE 3123 01:59:05,760 --> 01:59:07,560 INTEGRATION IS THAT YOU ARE 3124 01:59:07,560 --> 01:59:08,600 CREATING TEAMS OF HEALTHCARE 3125 01:59:08,600 --> 01:59:10,880 SOCIAL SERVICES AND PAYER GROUPS 3126 01:59:10,880 --> 01:59:12,440 OFTEN THROUGH CO-LOCATED CARE 3127 01:59:12,440 --> 01:59:14,800 AND DATA SHARING WHICH IS 3128 01:59:14,800 --> 01:59:16,680 CRITICAL TO DELIVER EVIDENCE 3129 01:59:16,680 --> 01:59:18,120 BASED TREATMENT THAT MEETS 3130 01:59:18,120 --> 01:59:19,000 PATIENT NEEDS. 3131 01:59:19,000 --> 01:59:21,800 NEXT SLIDE. 3132 01:59:21,800 --> 01:59:23,120 SO WE HEARD STRONGLY WE DID A 3133 01:59:23,120 --> 01:59:25,200 LOT OF INTERVIEWS WITH SUBJECT 3134 01:59:25,200 --> 01:59:28,800 MATTER EXPERTS AND DID ACTUALLY 3135 01:59:28,800 --> 01:59:30,120 FOR PUBLIC REQUEST FOR 3136 01:59:30,120 --> 01:59:31,000 INFORMATION AND WHERE PEOPLE 3137 01:59:31,000 --> 01:59:33,680 IDENTIFY DATA SHARING AS ONE OF 3138 01:59:33,680 --> 01:59:35,400 THE MOST CRITICAL COMPONENTS OF 3139 01:59:35,400 --> 01:59:38,960 MOVING THE NEEDLE SO MATERNAL 3140 01:59:38,960 --> 01:59:40,400 OPIOID MISUSE MACK SURE WE HAVE 3141 01:59:40,400 --> 01:59:41,240 REQUIREMENTS IN PLACE THAT 3142 01:59:41,240 --> 01:59:43,640 MATERNITY AND INFANT CARE 3143 01:59:43,640 --> 01:59:47,480 BEHAVIORAL CARE AND PRIMARY CARE 3144 01:59:47,480 --> 01:59:48,080 OPIOID USE DISORDERS TREATMENT 3145 01:59:48,080 --> 01:59:49,400 BUZZ THE MODEL IS FOCUSED ON 3146 01:59:49,400 --> 01:59:50,840 PREGNANT AND POSTPARTUM PEOPLE 3147 01:59:50,840 --> 01:59:53,040 WITH OPIOID USE DISORDER WOULD 3148 01:59:53,040 --> 01:59:54,600 BE INTEGRATED WHERE EVERYBODY 3149 01:59:54,600 --> 01:59:56,040 CAN SEE EVERYBODY ELSE DATA AND 3150 01:59:56,040 --> 01:59:57,760 KNOW WHAT WAS GOING ON. 3151 01:59:57,760 --> 01:59:58,840 AND THERE WOULD BE WRAP AROUND 3152 01:59:58,840 --> 02:00:01,680 SERVICES WITH CARE COORDINATION 3153 02:00:01,680 --> 02:00:02,880 ENGAGEMENT REFERRALS WITH 3154 02:00:02,880 --> 02:00:05,520 ATTEMPT TO INTEGRATE THOUGHT 3155 02:00:05,520 --> 02:00:06,480 DATA SYSTEMS TO THE EXTENT 3156 02:00:06,480 --> 02:00:07,600 POSSIBLE AS WELL. 3157 02:00:07,600 --> 02:00:10,600 DATA SHARING WAS OPERATED BY 3158 02:00:10,600 --> 02:00:12,400 CARERY PARTNERS WITH SUPPORT 3159 02:00:12,400 --> 02:00:15,000 FROM STATE MEDICAID AGENCY AND 3160 02:00:15,000 --> 02:00:15,640 AWARDS MADE WERE MADE DIRECTLY 3161 02:00:15,640 --> 02:00:17,000 TO STATE MEDICAID AGENCIES. 3162 02:00:17,000 --> 02:00:18,600 YOU CAN GET MORE INFORMATION 3163 02:00:18,600 --> 02:00:20,920 ABOUT THE MODEL, CARE I HAVE THE 3164 02:00:20,920 --> 02:00:22,160 WEB SITES DOWN FOR ALL THE 3165 02:00:22,160 --> 02:00:23,920 MODELS AND THE SLIDES BUT THEY 3166 02:00:23,920 --> 02:00:25,400 ARE AVAILABLE ON THE INNOVATION 3167 02:00:25,400 --> 02:00:27,520 CENTER WEBSITE. 3168 02:00:27,520 --> 02:00:29,520 WE JUST -- WE WILL BE PUBLISHING 3169 02:00:29,520 --> 02:00:30,840 THE FIRST REPORT FROM THE 3170 02:00:30,840 --> 02:00:34,080 MATERNAL OPIOID MISUSE MODEL, 3171 02:00:34,080 --> 02:00:36,080 PROBABLY IN FEBRUARY. BUT I 3172 02:00:36,080 --> 02:00:37,560 WILL SAY ONE INTERESTING THING 3173 02:00:37,560 --> 02:00:39,240 WAS WE HEARD STRONGLY FROM THE 3174 02:00:39,240 --> 02:00:41,680 PROVIDERS WITHIN THE MODEL, 3175 02:00:41,680 --> 02:00:43,000 ITSELF, HOW IMPORTANT THIS DATA 3176 02:00:43,000 --> 02:00:45,400 SHARING WAS. 3177 02:00:45,400 --> 02:00:47,280 YET THAT WAS ALSO THE THING 3178 02:00:47,280 --> 02:00:49,080 WHICH WE GOT RESISTANCE SO 3179 02:00:49,080 --> 02:00:50,280 PEOPLE SAY WE HAVE TO SHARE 3180 02:00:50,280 --> 02:00:51,200 DATA, WE DON'T KNOW WHAT IS 3181 02:00:51,200 --> 02:00:53,200 GOING ON WITH PATIENTS WE CAN'T 3182 02:00:53,200 --> 02:00:54,440 SERVE PROPERLY WITHOUT BETTER 3183 02:00:54,440 --> 02:00:56,640 COMMUNICATION. 3184 02:00:56,640 --> 02:00:59,840 THEN SAY HOW DO YOU EXPECT US TO 3185 02:00:59,840 --> 02:01:01,080 ORGANIZE THESE DATA SHARING 3186 02:01:01,080 --> 02:01:02,400 SYSTEMS, WE CAN'T DO THAT. 3187 02:01:02,400 --> 02:01:04,320 HOW WOULD THE -- KNOW WHAT 3188 02:01:04,320 --> 02:01:05,320 BEHAVIORAL HEALTH PROVIDER IS 3189 02:01:05,320 --> 02:01:08,640 DOING? 3190 02:01:08,640 --> 02:01:11,280 THERE WAS A REAL DISCONNECT I 3191 02:01:11,280 --> 02:01:13,960 THINK BETWEEN WHAT PEOPLE KNOW 3192 02:01:13,960 --> 02:01:14,640 THEY NEED. 3193 02:01:14,640 --> 02:01:15,920 AND AMOUNT OF EFFORT THAT IT 3194 02:01:15,920 --> 02:01:19,720 TAKES TO ACTUALLY PUT THAT INTO 3195 02:01:19,720 --> 02:01:20,160 PLACE. 3196 02:01:20,160 --> 02:01:22,400 IT IS HARD, IT IS REALLY HARD. 3197 02:01:22,400 --> 02:01:24,200 THIS IS ONE OF THE REASONS 3198 02:01:24,200 --> 02:01:25,600 RELYING ON CARE COORDINATORS YOU 3199 02:01:25,600 --> 02:01:29,040 CAN HIRE A CARE COORDINATOR FOR 3200 02:01:29,040 --> 02:01:30,760 NOT MUCH MONEY IN THE GREATER 3201 02:01:30,760 --> 02:01:31,560 SCHEME OF THINGS. 3202 02:01:31,560 --> 02:01:33,320 AND FEEL LIKE YOU ARE DOING 3203 02:01:33,320 --> 02:01:33,800 SOMETHING. 3204 02:01:33,800 --> 02:01:37,000 YET THAT'S NOT FROM EVIDENCE WE 3205 02:01:37,000 --> 02:01:38,200 HAVE SEEN NOT ONLY HERE BUT IN A 3206 02:01:38,200 --> 02:01:39,640 LOT OF PLACES INCLUDING IN SOME 3207 02:01:39,640 --> 02:01:42,840 OF THE WHAT OUR OTHER PANEL U.S. 3208 02:01:42,840 --> 02:01:45,840 TOLD US WE DON'T SEE HAVING CARE 3209 02:01:45,840 --> 02:01:48,400 COORDINATOR ALONE WILL BE ABLE 3210 02:01:48,400 --> 02:01:50,080 TO IMPLEMENT MUCH CHANGE. 3211 02:01:50,080 --> 02:01:52,480 NEXT SLIDE PLEASE. 3212 02:01:52,480 --> 02:01:53,680 SO THE OTHER MODEL THAT WE ARE 3213 02:01:53,680 --> 02:01:54,480 CURRENTLY WORKING ON WHERE WE 3214 02:01:54,480 --> 02:01:57,080 HAVE LEARNED LESSONS FROM STRONG 3215 02:01:57,080 --> 02:01:58,960 START FROM OTHERS NEWBORN 3216 02:01:58,960 --> 02:02:00,800 INITIATIVE IS INTEGRATED CARE 3217 02:02:00,800 --> 02:02:03,600 INITIATIVE, THIS IS A BIGGER 3218 02:02:03,600 --> 02:02:05,400 LIFT THAN MOM THAT WE ARE 3219 02:02:05,400 --> 02:02:07,800 INTEGRATING CLINICAL CARE, 3220 02:02:07,800 --> 02:02:09,920 SCHOOLS HOUSING FOOD NUTRITION, 3221 02:02:09,920 --> 02:02:11,240 EARLY CARE AND EDUCATION. 3222 02:02:11,240 --> 02:02:12,840 TITLE 5 AGENCIES CHILD WELFARE 3223 02:02:12,840 --> 02:02:15,560 AND MOBILE CRISIS RESPONSE 3224 02:02:15,560 --> 02:02:16,200 SERVICES. 3225 02:02:16,200 --> 02:02:19,400 WE GAVE OUR AWARDEES TWO YEARS 3226 02:02:19,400 --> 02:02:21,400 TO RAMP UP THESE PROGRAMS, 3227 02:02:21,400 --> 02:02:23,000 HOPING THAT THAT WOULD GIVE 3228 02:02:23,000 --> 02:02:24,560 ENOUGH TIME TO GET SYSTEMS 3229 02:02:24,560 --> 02:02:27,720 BETTER COORDINATED. 3230 02:02:27,720 --> 02:02:29,240 IT HAS BEEN A REAL CHALLENGE. 3231 02:02:29,240 --> 02:02:31,400 THERE ARE A LOT OF PRIVACY 3232 02:02:31,400 --> 02:02:33,240 REGULATIONS AROUND SHARING DATA, 3233 02:02:33,240 --> 02:02:35,000 SYSTEMS DON'T NECESSARILY TALK 3234 02:02:35,000 --> 02:02:36,040 TO EACH OTHER. 3235 02:02:36,040 --> 02:02:38,720 WE HAVE HAD A LOT OF AWARDEES 3236 02:02:38,720 --> 02:02:41,920 WHO MANAGED TO DO THINGS IN INK 3237 02:02:41,920 --> 02:02:44,720 WITH EHR TO GET SCREENINGS PUT 3238 02:02:44,720 --> 02:02:46,280 IN THERE AND BE ABLE TO SHARE 3239 02:02:46,280 --> 02:02:48,280 WITH PROVIDERS AND NETWORK, 3240 02:02:48,280 --> 02:02:50,080 THERE ARE HEALTH INFORMATION 3241 02:02:50,080 --> 02:02:52,000 EXCHANGES IN MANY STATES AND 3242 02:02:52,000 --> 02:02:54,000 OTHER PLATFORMS THAT STATES HAVE 3243 02:02:54,000 --> 02:02:55,200 BEEN TRYING TO USE TO GET DATA 3244 02:02:55,200 --> 02:02:56,440 SHARING HAPPENING IN THESE 3245 02:02:56,440 --> 02:02:56,960 MODELS. 3246 02:02:56,960 --> 02:02:57,840 THERE HAVE BEEN MORE 3247 02:02:57,840 --> 02:02:59,120 REQUIREMENTS FOR THE PEOPLE 3248 02:02:59,120 --> 02:03:00,880 PARTICIPATING TO ACTUALLY USE 3249 02:03:00,880 --> 02:03:02,000 THOSE PLATFORMS. 3250 02:03:02,000 --> 02:03:03,400 BUT IT IS STILL A WORK IN 3251 02:03:03,400 --> 02:03:05,800 PROGRESS AND THE FACT THAT THERE 3252 02:03:05,800 --> 02:03:06,760 AREN'T NECESSARILY ADEQUATE 3253 02:03:06,760 --> 02:03:08,800 RESOURCES IN THE COMMUNITY IS 3254 02:03:08,800 --> 02:03:10,080 NOT SOMETHING THAT MEDICAID 3255 02:03:10,080 --> 02:03:14,240 PROGRAM ON ITS OWN CAN SOLVE. 3256 02:03:14,240 --> 02:03:15,800 SO THERE ARE MORE SLIDES IN 3257 02:03:15,800 --> 02:03:17,720 HERE, WHICH I'M NOT GOING TO -- 3258 02:03:17,720 --> 02:03:19,120 I PUT THEM IN FOR REFERENCE 3259 02:03:19,120 --> 02:03:21,000 PURPOSES IF ANYBODY WANTED MORE 3260 02:03:21,000 --> 02:03:22,360 DETAIL, WE ALSO AGAIN ON OUR 3261 02:03:22,360 --> 02:03:24,280 WEBSITE AT THE INNOVATION CENTER 3262 02:03:24,280 --> 02:03:26,200 HAVE A LOT OF INFORMATION ABOUT 3263 02:03:26,200 --> 02:03:27,720 ALL THESE MODELS INCLUDING ALL 3264 02:03:27,720 --> 02:03:29,640 THE EVALUATION REPORTS FROM 3265 02:03:29,640 --> 02:03:31,600 STRONG START AND AT A GLANCE 3266 02:03:31,600 --> 02:03:33,320 DOCUMENT THAT GIVES A NICE I 3267 02:03:33,320 --> 02:03:34,120 DON'T HAVE VIEW, SOMETHING LIKE 3268 02:03:34,120 --> 02:03:36,120 THAT WILL BE POSTED FOR MOM IN 3269 02:03:36,120 --> 02:03:38,360 FEBRUARY, THE FIRST ANNUAL 3270 02:03:38,360 --> 02:03:40,920 REPORT FOR INK WHICH WILL COVER 3271 02:03:40,920 --> 02:03:41,960 PRE-IMPLEMENTATION PERIOD WILL 3272 02:03:41,960 --> 02:03:43,960 BE OUT IN 2022 BUT PROBABLY NOT 3273 02:03:43,960 --> 02:03:48,800 UNTIL END OF THE YEAR. 3274 02:03:48,800 --> 02:03:55,000 SO THANK YOU VERY MUCH. 3275 02:03:55,000 --> 02:03:57,000 >> THANK YOU DR. CROSS BARNET 3276 02:03:57,000 --> 02:03:57,800 FOR THAT OUTSTANDING 3277 02:03:57,800 --> 02:03:58,400 PRESENTATION. 3278 02:03:58,400 --> 02:04:03,320 NEXT WE WILL HEAR FROM MS. RYAN 3279 02:04:03,320 --> 02:04:11,280 ARGENTIERI AND JAWANNA HENRY. 3280 02:04:11,280 --> 02:04:12,320 >> GOOD AFTERNOON, EVERYONE. 3281 02:04:12,320 --> 02:04:13,520 CAN YOU HEAR ME OKAY? 3282 02:04:13,520 --> 02:04:14,400 >> YES. 3283 02:04:14,400 --> 02:04:14,800 >> OKAY. 3284 02:04:14,800 --> 02:04:15,600 GREAT. 3285 02:04:15,600 --> 02:04:17,200 THANK YOU SO MUCH FOR HAVING US, 3286 02:04:17,200 --> 02:04:19,000 MY NAME IS RYAN ARGENTIERI, 3287 02:04:19,000 --> 02:04:21,720 DEPUTY DIRECTOR OF THE OFFICE OF 3288 02:04:21,720 --> 02:04:23,680 TECHNOLOGY AT ONC OFFICE 3289 02:04:23,680 --> 02:04:25,800 NATIONAL COORDINATOR FOR OIT 3290 02:04:25,800 --> 02:04:26,760 PART OF THE HEALTH AND HUMAN 3291 02:04:26,760 --> 02:04:27,640 SERVICES DEPARTMENT MOST OF YOU 3292 02:04:27,640 --> 02:04:28,040 KNOW THAT. 3293 02:04:28,040 --> 02:04:32,400 AND I'M JOINED BY JAWANNA HENRY 3294 02:04:32,400 --> 02:04:34,080 ONE OF OUR CHIEF ANALYSTS IN 3295 02:04:34,080 --> 02:04:36,520 OFFICE OF TECHNOLOGY AND JAWANNA 3296 02:04:36,520 --> 02:04:38,960 IS LEAD FOR OUR SOCIAL 3297 02:04:38,960 --> 02:04:43,920 DETERMINANTS OF HEALTH PORTFOLIO 3298 02:04:43,920 --> 02:04:45,280 AMONG OTHER WORK STREAMS HER 3299 02:04:45,280 --> 02:04:46,800 EXPERTISE WILL COME THROUGH AS 3300 02:04:46,800 --> 02:04:48,880 SHE GETS INTO THE PRESENTATION. 3301 02:04:48,880 --> 02:04:50,320 WE ARE GOING TO TALK TO YOU 3302 02:04:50,320 --> 02:04:51,880 ABOUT COORDINATED REGISTRY 3303 02:04:51,880 --> 02:04:54,240 NETWORK FOR WOMEN'S HEALTH. 3304 02:04:54,240 --> 02:04:58,840 >> WHY DON'T I DO DISPLAY 3305 02:04:58,840 --> 02:05:02,080 SETTINGS CO-OPT PLEASE. 3306 02:05:02,080 --> 02:05:02,480 PERFECT. 3307 02:05:02,480 --> 02:05:03,360 >> GREAT, THANKS. 3308 02:05:03,360 --> 02:05:08,800 WE WILL TALK TO YOU AND GIVE YOU 3309 02:05:08,800 --> 02:05:10,600 A BIT OF INFORMATION THREE 3310 02:05:10,600 --> 02:05:12,400 MINUTES OR LESS OMC AND WORK WE 3311 02:05:12,400 --> 02:05:14,880 DO TO SUPPORT IMPROVED 3312 02:05:14,880 --> 02:05:17,600 HEALTHCARE FOR WOMEN ACROSS THE 3313 02:05:17,600 --> 02:05:19,400 CONTINUUM AND JUST THE FOCUS 3314 02:05:19,400 --> 02:05:21,440 THAT ONC HAS BECAUSE WE REALIZE 3315 02:05:21,440 --> 02:05:24,400 MORE AND MORE THAT WHILE YOU 3316 02:05:24,400 --> 02:05:27,280 MIGHT BE BEENING FROM WORK FROM 3317 02:05:27,280 --> 02:05:28,240 A PATIENT PERSPECTIVE BECAUSE OF 3318 02:05:28,240 --> 02:05:29,680 THE WORK WE DO FOR PATIENT 3319 02:05:29,680 --> 02:05:31,480 ACCESS AND ELECTRONIC HEALTH 3320 02:05:31,480 --> 02:05:32,680 INFORMATION YOU MIGHT NOT BE 3321 02:05:32,680 --> 02:05:34,800 AWARE OF WHAT ONC IS AND HOW WE 3322 02:05:34,800 --> 02:05:36,760 MIGHT BE ABLE TO WORK CLOSELY 3323 02:05:36,760 --> 02:05:40,400 WITH YOU AND YOUR VARIOUS 3324 02:05:40,400 --> 02:05:41,440 ORGANIZATIONS. 3325 02:05:41,440 --> 02:05:43,600 SO NEXT SLIDE JAWANNA. 3326 02:05:43,600 --> 02:05:46,000 SO THIS IS A LITTLE BIT ABOUT 3327 02:05:46,000 --> 02:05:48,720 ONC AND WORK WE DO TO ESTABLISH 3328 02:05:48,720 --> 02:05:50,960 EXPECTATIONS AND STANDARDS FOR 3329 02:05:50,960 --> 02:05:52,640 DATA EXCHANGE AND CERTIFICATION. 3330 02:05:52,640 --> 02:05:54,960 WE DO THIS BY COORDINATING WITH 3331 02:05:54,960 --> 02:05:57,400 OUR FEDERAL PARTNERS BOTH WITHIN 3332 02:05:57,400 --> 02:05:59,320 HHS BUT INCREASINGLY OUTSIDE OF 3333 02:05:59,320 --> 02:06:01,360 HHS. 3334 02:06:01,360 --> 02:06:03,000 AS WELL AS STATE AND LOCAL 3335 02:06:03,000 --> 02:06:06,200 HEALTH OFFICIALS AND DOWNSTREAM 3336 02:06:06,200 --> 02:06:08,640 USERS AND DEVELOPERS OF HEALTH I 3337 02:06:08,640 --> 02:06:09,040 T. 3338 02:06:09,040 --> 02:06:11,000 SO WE ARE COMMITTED TO MAKING 3339 02:06:11,000 --> 02:06:15,960 SURE THAT OUR WORK AND 3340 02:06:15,960 --> 02:06:17,600 DEVELOPING ADVANCING STANDARDS 3341 02:06:17,600 --> 02:06:20,600 AN CERTIFICATION EXCHANGE DOES 3342 02:06:20,600 --> 02:06:24,240 HAVE THE BENEFIT FOR IMPROVING 3343 02:06:24,240 --> 02:06:25,280 PATIENT HEALTH FOR PEOPLE ACROSS 3344 02:06:25,280 --> 02:06:26,200 THE COUNTRY NO MATTER WHO THEY 3345 02:06:26,200 --> 02:06:30,600 ARE AND WHERE THEY COME FROM. 3346 02:06:30,600 --> 02:06:31,880 NEXT SLIDE. 3347 02:06:31,880 --> 02:06:33,840 SO WOMEN IN HEALTHCARE ARE 3348 02:06:33,840 --> 02:06:36,200 CONCERNED, WE ARE VERY FORTUNATE 3349 02:06:36,200 --> 02:06:37,840 TO BE IN AN ENVIRONMENT NOW WITH 3350 02:06:37,840 --> 02:06:40,040 NATIONAL COORDINATOR NOT THAT WE 3351 02:06:40,040 --> 02:06:41,680 HAVEN'T HAD IN PREVIOUS 3352 02:06:41,680 --> 02:06:44,200 ADMINISTRATION BUT NATIONAL 3353 02:06:44,200 --> 02:06:48,680 COORDINATOR DR. ARGENTIERI IS 3354 02:06:48,680 --> 02:06:50,480 FOCUSED BY DESIGN AND MAKING 3355 02:06:50,480 --> 02:06:51,800 SURE WE PRIORITIZE NEEDS OF 3356 02:06:51,800 --> 02:06:55,240 COMMUNITIES INCLUDING THOSE 3357 02:06:55,240 --> 02:06:56,440 PEOPLE AND POPULATIONS WHO ARE 3358 02:06:56,440 --> 02:06:59,440 NOT GETTING THE CARE THEY NEED 3359 02:06:59,440 --> 02:07:00,240 OR WHERE THERE ARE OPPORTUNITIES 3360 02:07:00,240 --> 02:07:02,000 TO IMPROVE CARE. 3361 02:07:02,000 --> 02:07:06,000 AND FOR WOMEN THAT MEANS ARMING 3362 02:07:06,000 --> 02:07:08,800 US SINCE I AM A WOMAN WITH 3363 02:07:08,800 --> 02:07:10,000 NECESSARY HEALTHCARE INFORMATION 3364 02:07:10,000 --> 02:07:12,000 THROUGH KEY TOUCH POINTS IN 3365 02:07:12,000 --> 02:07:13,320 THEIR LIVES. 3366 02:07:13,320 --> 02:07:14,640 WHETHER YOU BE SOMEONE WITH 3367 02:07:14,640 --> 02:07:18,120 CHILDREN OR GOING THROUGH THE 3368 02:07:18,120 --> 02:07:21,920 MATERNAL PROCESS, OR CAREGIVER 3369 02:07:21,920 --> 02:07:24,360 INCREASINGLY WE ARE SEEING MORE 3370 02:07:24,360 --> 02:07:25,320 AND MORE FOR YOURSELF YOUR 3371 02:07:25,320 --> 02:07:28,400 CHILDREN BUT EXTENDED FAMILY AND 3372 02:07:28,400 --> 02:07:30,360 FRIDAY, WE HELP TO MAKE SURE 3373 02:07:30,360 --> 02:07:32,400 WOMEN HAVE WHAT THEY NEED TO 3374 02:07:32,400 --> 02:07:34,600 SUPPORT SUCCESSFUL HEALTH 3375 02:07:34,600 --> 02:07:35,560 OUTCOMES, THROUGHOUT THE COURSE 3376 02:07:35,560 --> 02:07:38,440 OF THEIR LIVES. 3377 02:07:38,440 --> 02:07:40,840 NEXT SLIDE. 3378 02:07:40,840 --> 02:07:42,240 SO H IS A LITTLE INFORMATION 3379 02:07:42,240 --> 02:07:44,920 ABOUT OUR STANDARDS DEVELOPMENT 3380 02:07:44,920 --> 02:07:47,200 ACTIVITY AND HOW WE VIEW 3381 02:07:47,200 --> 02:07:49,080 ESPECIALLY WHERE WE ARE TALKING 3382 02:07:49,080 --> 02:07:50,120 SPECIAL INITIATIVES FOR EXAMPLE 3383 02:07:50,120 --> 02:07:53,480 WOMEN IN HEALTHCARE, WE START 3384 02:07:53,480 --> 02:07:55,520 WITH THIS STANDARDS AND DATA AS 3385 02:07:55,520 --> 02:07:57,960 FOUNDATION IN MIND THEN HOW THAT 3386 02:07:57,960 --> 02:08:00,240 DATA TRANSLATES TO POLICY 3387 02:08:00,240 --> 02:08:03,400 DECISIONS IMPLEMENTATION WITH 3388 02:08:03,400 --> 02:08:04,600 MARKET AND INDUSTRY STAKE 3389 02:08:04,600 --> 02:08:06,600 HOLDERS AND ULTIMATELY HOW THOSE 3390 02:08:06,600 --> 02:08:10,120 DECISIONS AND PIECES OF THAT 3391 02:08:10,120 --> 02:08:12,640 PUZZLE BUILD STRONGER 3392 02:08:12,640 --> 02:08:13,440 INFRASTRUCTURE AND WHERE HEALTH 3393 02:08:13,440 --> 02:08:17,480 INFORMATION IS CONCERNED MEANS 3394 02:08:17,480 --> 02:08:18,800 INTEROPERABILITY AND 3395 02:08:18,800 --> 02:08:20,800 INTEROPERABILITY WITH MINIMUM 3396 02:08:20,800 --> 02:08:24,400 BURDEN FOR ESPECIALLY PROVIDERS 3397 02:08:24,400 --> 02:08:27,040 BUT FOR ALL THROUGHOUT THE 3398 02:08:27,040 --> 02:08:27,800 PIPELINE THROUGH WHICH THAT 3399 02:08:27,800 --> 02:08:33,800 INFORMATION IS EXCHANGED. 3400 02:08:33,800 --> 02:08:34,920 MENTION SLIDE. 3401 02:08:34,920 --> 02:08:36,240 SOME OF THIS WILL BE WE CAN MAKE 3402 02:08:36,240 --> 02:08:37,200 AVAILABLE BUT THESE ARE SOME OF 3403 02:08:37,200 --> 02:08:39,200 THE AREAS OF PRIORITY AND SOME 3404 02:08:39,200 --> 02:08:41,400 OF THE RESOURCES THAT ONC MAKES 3405 02:08:41,400 --> 02:08:42,840 AVAILABLE IF YOU AREN'T AWARE OF 3406 02:08:42,840 --> 02:08:44,280 THESE THEN WE WOULD INVITE YOU 3407 02:08:44,280 --> 02:08:51,880 TO COME OVER TO OUR WEBSITE AND 3408 02:08:51,880 --> 02:08:53,200 SEE HOW THEY SUPPORT AND ADVANCE 3409 02:08:53,200 --> 02:08:54,840 YOUR WORK INCLUDING AUDIENCE 3410 02:08:54,840 --> 02:08:57,320 MEMBERS AND OTHER PANELISTS. 3411 02:08:57,320 --> 02:09:00,000 WITH THAT, I THINK I'M GOING TO 3412 02:09:00,000 --> 02:09:03,200 PASS TO JAWANNA TO TALK TO 3413 02:09:03,200 --> 02:09:04,880 GREATER DETAIL ABOUT OUR 3414 02:09:04,880 --> 02:09:07,320 PROGRAMS THAT WE ARE EXCITED 3415 02:09:07,320 --> 02:09:08,560 ABOUT PRODUCT THAT HELPS TO 3416 02:09:08,560 --> 02:09:10,000 SUPPORT WOMEN HEALTH ISSUES. 3417 02:09:10,000 --> 02:09:11,240 JAWANNA. 3418 02:09:11,240 --> 02:09:13,400 >> THANK YOU, RYAN FOR DOING 3419 02:09:13,400 --> 02:09:16,400 THAT INTRODUCTION AN OVERVIEW OF 3420 02:09:16,400 --> 02:09:18,920 ONC AS RYAN MENTIONED I AM GOING 3421 02:09:18,920 --> 02:09:20,080 TO NOW TAKE THE REST OF THE TIME 3422 02:09:20,080 --> 02:09:21,560 TO TALK ABOUT A SPECIFIC PROJECT 3423 02:09:21,560 --> 02:09:23,080 RELATED TO WOMEN'S HEALTH AND 3424 02:09:23,080 --> 02:09:25,000 THAT'S THE PATIENT CENTERED 3425 02:09:25,000 --> 02:09:27,440 OUTCOMES RESEARCH OR PCOR TRUST 3426 02:09:27,440 --> 02:09:29,600 FUNDED WOMEN'S HEALTH TECHNOLOGY 3427 02:09:29,600 --> 02:09:31,400 COORDINATED REGISTRY NETWORK. 3428 02:09:31,400 --> 02:09:34,240 NOW WHEN WE TALK PCOR WE ARE 3429 02:09:34,240 --> 02:09:36,880 TALKING A PROJECT FUNDED THROUGH 3430 02:09:36,880 --> 02:09:40,960 THIS TRUST FUND AND THROUGH ASP 3431 02:09:40,960 --> 02:09:42,800 AS INTERDEPARTMENTAL PROJECT TO 3432 02:09:42,800 --> 02:09:45,440 BUILD P 4 CAPACITY, PCOR 3433 02:09:45,440 --> 02:09:46,400 PRODUCES NEW SCIENTIFIC EVIDENCE 3434 02:09:46,400 --> 02:09:49,400 TO INFORM AND SUPPORT HEALTHCARE 3435 02:09:49,400 --> 02:09:51,360 DECISIONS AND PATIENT FAMILIES 3436 02:09:51,360 --> 02:09:52,960 AS WELL AS HEALTHCARE PROVIDERS. 3437 02:09:52,960 --> 02:09:56,120 SO AS I MENTION THIS IS AN 3438 02:09:56,120 --> 02:09:57,080 INTRADEPARTMENTAL PROJECT YOU 3439 02:09:57,080 --> 02:09:58,400 CAN SEE ALL OUR PARTNERS LISTED 3440 02:09:58,400 --> 02:10:01,400 HERE. 3441 02:10:01,400 --> 02:10:03,200 AND OUR ADMINISTRATION WAS LEAD 3442 02:10:03,200 --> 02:10:07,320 FOR THIS PROJECT. 3443 02:10:07,320 --> 02:10:09,880 NOW I WILL GO INTO DETAILS. 3444 02:10:09,880 --> 02:10:10,800 OF THE PROJECT. 3445 02:10:10,800 --> 02:10:12,680 WHEN WE ARE TALKING REGISTRIES 3446 02:10:12,680 --> 02:10:15,080 ON WHAT THEY DO, REGISTRIES 3447 02:10:15,080 --> 02:10:16,000 PROVIDE KEY INFRASTRUCTURE THAT 3448 02:10:16,000 --> 02:10:18,560 CAN BE USED FOR POLYIMPROVEMENT 3449 02:10:18,560 --> 02:10:20,800 AND EVALUATION OF PATIENT CARE 3450 02:10:20,800 --> 02:10:22,400 AND OUTCOMES MOST OF THE 3451 02:10:22,400 --> 02:10:25,600 REGISTRIES TO DATE ARE USED FOR 3452 02:10:25,600 --> 02:10:31,880 SINGLE PURPOSE, AND CAN BE TIME 3453 02:10:31,880 --> 02:10:33,600 AND COST INTENSIVE TO MAINTAIN. 3454 02:10:33,600 --> 02:10:35,400 BUT TRANSFORMED FOR ANALYSIS AND 3455 02:10:35,400 --> 02:10:36,000 RESEARCH PURPOSES. 3456 02:10:36,000 --> 02:10:43,000 BUT ONE OF THE ISSUE IS BECAUSE 3457 02:10:43,000 --> 02:10:44,040 SINGLE USE PURCHASE REGISTRY 3458 02:10:44,040 --> 02:10:45,600 LIMIT STUDY DESIGNS TO ONE 3459 02:10:45,600 --> 02:10:48,400 PARTICULAR THERAPY WHETHER IT BE 3460 02:10:48,400 --> 02:10:51,160 MEDICATION OR DEVICE INSTEAD OF 3461 02:10:51,160 --> 02:10:53,920 BEING ABLE TO PRODUCE DESIGN TO 3462 02:10:53,920 --> 02:10:58,760 LOOK AT COMBINATION OF THERAPIES 3463 02:10:58,760 --> 02:10:59,680 THAT INCLUDE MORE. 3464 02:10:59,680 --> 02:11:03,720 SO OUR VISION FOR THE WHTCRN WAS 3465 02:11:03,720 --> 02:11:05,320 TO LOOK AT THESE DATA SOURCES 3466 02:11:05,320 --> 02:11:07,000 AND LOOK FOR OPPORTUNITIES FOR 3467 02:11:07,000 --> 02:11:07,760 INTEROPERABILITY AND 3468 02:11:07,760 --> 02:11:10,600 HARMONIZATION AND THE ABILITY TO 3469 02:11:10,600 --> 02:11:12,840 USE PREVIOUS WORK SUCH AS 3470 02:11:12,840 --> 02:11:14,720 STRUCTURED DATA CAPTURE WHICH IS 3471 02:11:14,720 --> 02:11:15,960 A RESOURCE THAT WAS DEVELOPED 3472 02:11:15,960 --> 02:11:18,000 THROUGH OUR OFFICE TO B BE ABLE 3473 02:11:18,000 --> 02:11:20,880 TO RECEIVE DATA. 3474 02:11:20,880 --> 02:11:22,000 DISPLAY THAT DATA AS WELL AS 3475 02:11:22,000 --> 02:11:26,280 STORE THAT DATA FOR REGISTRIES 3476 02:11:26,280 --> 02:11:27,800 SO NOT JUST DATA PORTION BUT 3477 02:11:27,800 --> 02:11:29,360 OPPORTUNITY FOR ALL OUR 3478 02:11:29,360 --> 02:11:30,600 STAKEHOLDERS, LOOKING AT 3479 02:11:30,600 --> 02:11:34,120 HEALTHCARE PROVIDERS, PATIENT 3480 02:11:34,120 --> 02:11:35,600 AGENTS, RESEARCHERS HEALTH 3481 02:11:35,600 --> 02:11:40,120 SYSTEM Z AS WELL AS EHR VENDORS. 3482 02:11:40,120 --> 02:11:43,720 WE LOOK AT GOALS FOR CRN PROJECT 3483 02:11:43,720 --> 02:11:45,040 THIS OVERALL WAS SOMETHING THAT 3484 02:11:45,040 --> 02:11:47,000 WAS COORDINATED HARMONIZED 3485 02:11:47,000 --> 02:11:48,400 EFFICIENT AS WELL AS TARGETED. 3486 02:11:48,400 --> 02:11:50,160 L SO WHEN WE TALK ABOUT 3487 02:11:50,160 --> 02:11:51,720 COORDINATED WHAT WE ARE LOOKING 3488 02:11:51,720 --> 02:11:54,600 AT OR FOR IS A COMPREHENSIVE 3489 02:11:54,600 --> 02:11:57,280 APPROACH TO IMPROVING EVALUATION 3490 02:11:57,280 --> 02:11:58,480 IN THEM HEALTH TECHNOLOGIES 3491 02:11:58,480 --> 02:11:59,760 ACROSS CARE SETTINGS. 3492 02:11:59,760 --> 02:12:01,120 THAT HARMONIZING PIECE WANT TO 3493 02:12:01,120 --> 02:12:04,800 MAKE SURE THAT AS THIS RESCUE 3494 02:12:04,800 --> 02:12:09,000 NETWORK DEVELOPED IT WAS 3495 02:12:09,000 --> 02:12:10,800 INTEROPERABLE PLATFORM TO LINK 3496 02:12:10,800 --> 02:12:11,800 REGISTRIES TO ETCH OOH OTHER AS 3497 02:12:11,800 --> 02:12:13,600 WELL AS OTHER DATA NETWORKS. 3498 02:12:13,600 --> 02:12:15,640 MAKE SURE TOOLS FOR COLLECTING 3499 02:12:15,640 --> 02:12:18,040 THAT DATA IN THE REGISTRIES AND 3500 02:12:18,040 --> 02:12:21,800 BEING ABLE TO EXTRACT IT AND 3501 02:12:21,800 --> 02:12:24,320 LINK IT WHERE EFFICIENT AND USE 3502 02:12:24,320 --> 02:12:25,640 DIFFERENT SOURCES OF DATA SUCH 3503 02:12:25,640 --> 02:12:29,000 AS CLAIMS AND INFORMATION FROM 3504 02:12:29,000 --> 02:12:30,920 EHR THAT FLOWS TO THAT REGISTRY 3505 02:12:30,920 --> 02:12:32,520 NETWORK AND LASTLY MAKE SURE 3506 02:12:32,520 --> 02:12:33,200 THERE WAS A TARGETED APPROACH SO 3507 02:12:33,200 --> 02:12:36,000 BEING ABLE TO ADDRESS 3508 02:12:36,000 --> 02:12:37,280 PERFORMANCE OF DEVICES AND 3509 02:12:37,280 --> 02:12:40,200 THERAPIES FOR TREATMENT 3510 02:12:40,200 --> 02:12:43,000 SPECIFICALLY FOR PELVIC FLOOR 3511 02:12:43,000 --> 02:12:43,600 DISORDERS AND FEMALE 3512 02:12:43,600 --> 02:12:46,800 STERILIZATION. 3513 02:12:46,800 --> 02:12:50,000 AS I WILL MENTION WHCCRN PROJECT 3514 02:12:50,000 --> 02:12:54,920 WAS INTERDEPARTMENTAL PROJECT 3515 02:12:54,920 --> 02:12:56,120 INCLUDE VARIOUS FEDERAL 3516 02:12:56,120 --> 02:12:56,480 AGENCIES. 3517 02:12:56,480 --> 02:12:58,560 WE LOOK AT THE RESPONSIBILITY OF 3518 02:12:58,560 --> 02:13:00,000 ONC OUR SCOPE WAS TO MAKE SURE 3519 02:13:00,000 --> 02:13:01,640 THAT WE DEVELOPED IMPLEMENTED 3520 02:13:01,640 --> 02:13:06,160 AND REFINED WOMEN HEALTH 3521 02:13:06,160 --> 02:13:07,600 TECHNOLOGY COORDINATED NETWORK 3522 02:13:07,600 --> 02:13:08,720 IMPLEMENTATION GUIDE AND ONCE 3523 02:13:08,720 --> 02:13:10,840 THAT GUIDE WANTED TO BE ABLE TO 3524 02:13:10,840 --> 02:13:12,480 USE IN A TEST ENVIRONMENT AS 3525 02:13:12,480 --> 02:13:16,760 WELL AS PRODUCTION ENVIRONMENT 3526 02:13:16,760 --> 02:13:18,920 SO USED AMONG CLINICALS AND 3527 02:13:18,920 --> 02:13:21,240 DIFFERENT PROVIDER SETTINGS AND 3528 02:13:21,240 --> 02:13:23,040 USE IN MANUFACTURING SETTING. 3529 02:13:23,040 --> 02:13:25,600 SO OUR PURPOSE WAS TO LOOK AT 3530 02:13:25,600 --> 02:13:27,440 THE DIFFERENT CRN CAPABILITIES 3531 02:13:27,440 --> 02:13:29,440 NOT TWO SPECIFIC ACTORS IN 3532 02:13:29,440 --> 02:13:31,120 INTERACTIONS AND THE TECHNICAL 3533 02:13:31,120 --> 02:13:33,880 SPECIFICATIONS FOR THE CRN 3534 02:13:33,880 --> 02:13:34,800 IMPLEMENTATION GUIDE AND TEST 3535 02:13:34,800 --> 02:13:35,960 THOSE OUT. 3536 02:13:35,960 --> 02:13:37,040 AGAIN IN THOSE DIFFERENT 3537 02:13:37,040 --> 02:13:38,000 ENVIRONMENTS THAT I MENTIONED IN 3538 02:13:38,000 --> 02:13:40,640 THIS SCOPE. 3539 02:13:40,640 --> 02:13:43,000 SO OUR APPROACH FOR THE PROJECT 3540 02:13:43,000 --> 02:13:45,240 OVERALL AGAIN WAS TO DEVELOP A 3541 02:13:45,240 --> 02:13:46,440 FRAMEWORK THAT WAS STRUCTURED 3542 02:13:46,440 --> 02:13:51,320 FOR DATA SHARING 3543 02:13:51,320 --> 02:13:52,320 INTEROPERABILITY AMONK AMONG THE 3544 02:13:52,320 --> 02:13:53,400 DIFFERENCE DATA SOURCES, WE WANT 3545 02:13:53,400 --> 02:13:56,000 TO MAKE SURE WE DID PEAK WORK SO 3546 02:13:56,000 --> 02:13:57,080 LOOKING AT THE OPPORTUNITY TO 3547 02:13:57,080 --> 02:13:58,560 REUSE EXISTING STANDARDS AND 3548 02:13:58,560 --> 02:14:01,320 RESOURCES TO BE ABLE TO LINK 3549 02:14:01,320 --> 02:14:03,720 DIFFERENT PATIENT DATA 3550 02:14:03,720 --> 02:14:06,400 INDIVIDUAL DATA ACROSS DISPARATE 3551 02:14:06,400 --> 02:14:07,400 DATA SYSTEMS SO YOU CAN SEE THE 3552 02:14:07,400 --> 02:14:09,280 RESOURCES PREVIOUSLY USED SUCH 3553 02:14:09,280 --> 02:14:12,920 AS US CORE, THE STRUCTURE DATA 3554 02:14:12,920 --> 02:14:14,680 CAPTURE, WE ALSO HAVE RESOURCE 3555 02:14:14,680 --> 02:14:18,720 FOR PATIENT REPORTED OUTCOMES 3556 02:14:18,720 --> 02:14:20,480 AND DATA ACCESS FRAMEWORK 3557 02:14:20,480 --> 02:14:21,160 SPECIFIC FOR RESEARCH. 3558 02:14:21,160 --> 02:14:24,360 OUR TASK WAS TO TEST CAPTURING 3559 02:14:24,360 --> 02:14:26,320 EXCHANGE OF DATA TO SUPPORT 3560 02:14:26,320 --> 02:14:27,400 WOMEN HEALTH TECHNOLOGY ISSUE 3561 02:14:27,400 --> 02:14:29,560 AND WE DID THIS BY INCORPORATING 3562 02:14:29,560 --> 02:14:31,160 SOME PRELIMINARY DATA ELEMENTS 3563 02:14:31,160 --> 02:14:35,840 INTO WHAT WE CALL HL 7 WHICH IS 3564 02:14:35,840 --> 02:14:38,280 HEALTH LEVEL 7 FAST HEALTHCARE 3565 02:14:38,280 --> 02:14:39,840 INTEROPERABILITY RESOURCES OR 3566 02:14:39,840 --> 02:14:42,200 FIRE RESOURCES PROFILES SO YOU 3567 02:14:42,200 --> 02:14:44,160 SEE HERE SOME OF THOSE SPECIFIC 3568 02:14:44,160 --> 02:14:47,320 DATA ELEMENTS INCORPORATED INTO 3569 02:14:47,320 --> 02:14:49,640 HL 7 FIRE RESOURCES SUCH AS THE 3570 02:14:49,640 --> 02:14:50,840 PATIENT CHARACTERISTICS, 3571 02:14:50,840 --> 02:14:52,400 TREATMENT DETAILS AND ONE THING 3572 02:14:52,400 --> 02:14:53,720 THAT WAS SPECIFIC FOR THIS 3573 02:14:53,720 --> 02:14:56,480 PROJECT IS LOOKING AT THE UNIQUE 3574 02:14:56,480 --> 02:14:58,680 DEVICE IDENTIFIER SPECIFICALLY 3575 02:14:58,680 --> 02:15:00,600 FOR IMPLANTABLE DEVICES. 3576 02:15:00,600 --> 02:15:02,680 THEN WE ARE ALSO TASKED WITH 3577 02:15:02,680 --> 02:15:04,160 MAKING SURE WE EVALUATE THE 3578 02:15:04,160 --> 02:15:06,200 COMPLETENESS OF THE HL 7 3579 02:15:06,200 --> 02:15:08,520 RESOURCES SO THEY WOULD DO -- WE 3580 02:15:08,520 --> 02:15:10,040 WOULD KNOW THAT THEY DID WHAT 3581 02:15:10,040 --> 02:15:12,200 THEY WERE SUPPOSED TO. 3582 02:15:12,200 --> 02:15:13,800 WHAT YOU SEE HERE IS THE MODEL 3583 02:15:13,800 --> 02:15:16,280 THAT WAS SET UP FOR BEING ABLE 3584 02:15:16,280 --> 02:15:17,720 TO COLLECT DATA YOU CAN SEE HERE 3585 02:15:17,720 --> 02:15:21,600 THE YELLOW REPRESENTS DATA 3586 02:15:21,600 --> 02:15:23,720 SOURCES THAT ARE EXTERNAL TO THE 3587 02:15:23,720 --> 02:15:25,040 WOMEN'S HEALTH TECHNOLOGY 3588 02:15:25,040 --> 02:15:26,480 PROJECT AND IN BLUE YOU SEE 3589 02:15:26,480 --> 02:15:28,680 THOSE THAT ARE SPECIFIC TO 3590 02:15:28,680 --> 02:15:31,400 COORDINATED REGISTRY NETWORK 3591 02:15:31,400 --> 02:15:32,920 DATA COLLECTION. 3592 02:15:32,920 --> 02:15:36,240 IN THIS MODEL YOU HAVE THOSE 3593 02:15:36,240 --> 02:15:38,000 DIFFERENT SYSTEMS AND AGAIN OUR 3594 02:15:38,000 --> 02:15:39,800 GOAL WAS TO MAKE SURE THERE WAS 3595 02:15:39,800 --> 02:15:41,920 SPECIFIC CAPABILITIES THAT 3596 02:15:41,920 --> 02:15:42,720 FRAMEWORK WOULD DO. 3597 02:15:42,720 --> 02:15:45,680 SO THAT FIRST ONE YOU CAN SEE 3598 02:15:45,680 --> 02:15:48,840 HERE, TO CREATE PUBLISH CRN 3599 02:15:48,840 --> 02:15:49,880 INSTRUMENT THAT WOULD GO INTO 3600 02:15:49,880 --> 02:15:51,600 THAT CRN INSTRUMENT AND DATA 3601 02:15:51,600 --> 02:15:54,960 REPOSITORY. 3602 02:15:54,960 --> 02:16:00,600 THE SECOND IS WATCH A SMART CRN 3603 02:16:00,600 --> 02:16:03,240 APP FROM EHR AND ONCE LAUNCHED 3604 02:16:03,240 --> 02:16:05,000 WE WANTED TO MAKE SURE THE 3605 02:16:05,000 --> 02:16:06,400 INFORMATION COULD BE RETRIEVING 3606 02:16:06,400 --> 02:16:09,000 AND RENDERED FROM AGAIN THAT 3607 02:16:09,000 --> 02:16:10,680 METADATA REPOSITORY. 3608 02:16:10,680 --> 02:16:14,120 THEN FEEDBACK INTO THE EXTERNAL 3609 02:16:14,120 --> 02:16:16,200 DATA SYSTEM, SO HERE, WHEN WE 3610 02:16:16,200 --> 02:16:18,280 GET TO FOUR YOU CAN SEE THERE IS 3611 02:16:18,280 --> 02:16:19,600 THIS OPPORTUNITY FOR COLLECTING 3612 02:16:19,600 --> 02:16:20,800 DIFFERENT TYPES OF DATA FROM 3613 02:16:20,800 --> 02:16:22,400 DIFFERENT RESOURCES, SO GETTING 3614 02:16:22,400 --> 02:16:26,520 IT FROM THE CRN, GETTING DATA 3615 02:16:26,520 --> 02:16:28,800 THAT WAS PRE-POPULATEEPOPULATEED FROM THE 3616 02:16:28,800 --> 02:16:31,160 EHR BUT GETTING DATA SPECIFIC TO 3617 02:16:31,160 --> 02:16:34,600 THE UDI UNIQUE DEVICE IDENTIFIER 3618 02:16:34,600 --> 02:16:37,320 FROM THE GLOBAL UNIQUE DEVICE 3619 02:16:37,320 --> 02:16:39,400 IDENTIFIER DATABASE AS WELL AS 3620 02:16:39,400 --> 02:16:42,200 TERMINOLOGY API TO FEED DATA 3621 02:16:42,200 --> 02:16:43,400 SOURCE WITH HOPES OF BEING ABLE 3622 02:16:43,400 --> 02:16:48,600 TO THEN SUBMIT ALL THAT DATA 3623 02:16:48,600 --> 02:16:50,040 BACK TO THE SELF-REGISTRY. 3624 02:16:50,040 --> 02:16:52,240 NOW THAT I PROVIDED YOU WITH AN 3625 02:16:52,240 --> 02:16:55,280 OVERVIEW OF THE COLLECTION OF 3626 02:16:55,280 --> 02:16:57,120 THAT DATA, YOU MAY WONDER WHAT 3627 02:16:57,120 --> 02:16:58,600 THAT LOOKS LIKE FROM SIDE OF 3628 02:16:58,600 --> 02:16:59,920 RESEARCHER SO YOU HAVE A 3629 02:16:59,920 --> 02:17:03,000 RESEARCHER WHO DEVELOPED A 3630 02:17:03,000 --> 02:17:04,880 PROJECT PROPOSAL RESEARCH 3631 02:17:04,880 --> 02:17:07,080 QUESTIONS TO ANSWER SO THEY COME 3632 02:17:07,080 --> 02:17:09,320 POSE A NET QUERY FOR A SPECIFIC 3633 02:17:09,320 --> 02:17:10,120 RESEARCH DATA THROUGH THE 3634 02:17:10,120 --> 02:17:12,040 RESEARCH PORTAL. 3635 02:17:12,040 --> 02:17:15,160 THAT IS THEN DISTRIBUTED TO THE 3636 02:17:15,160 --> 02:17:17,440 DATA PARTNER CLIENT THAT FEEDS 3637 02:17:17,440 --> 02:17:19,600 INTO QUERY FOR THE WOMEN HEALTH 3638 02:17:19,600 --> 02:17:21,120 REGISTRY THAT DATA IS COLLECTED, 3639 02:17:21,120 --> 02:17:24,600 AND SUBMITTED BACK TO THE CLIENT 3640 02:17:24,600 --> 02:17:27,040 AND BACK THROUGH RESEARCH PORTAL 3641 02:17:27,040 --> 02:17:30,400 AND BACK THROUGH THE RESEARCHER. 3642 02:17:30,400 --> 02:17:33,800 SOME OF THESE STOPS ARE MORE 3643 02:17:33,800 --> 02:17:34,880 ABOUT CHECKING SECURITY OF THE 3644 02:17:34,880 --> 02:17:37,760 DATA. 3645 02:17:37,760 --> 02:17:40,960 SO THIS TABLE IS JUST REALLY THE 3646 02:17:40,960 --> 02:17:42,200 TAKE ALL THAT IN SO THAT YOU CAN 3647 02:17:42,200 --> 02:17:43,120 SEE IT UP FRONT. 3648 02:17:43,120 --> 02:17:44,880 AS I MENTIONED THERE WAS SEVERAL 3649 02:17:44,880 --> 02:17:46,800 CAPABILITIES AND THIS BREAKS IT 3650 02:17:46,800 --> 02:17:48,480 DOWN TO YOUR THREE DIFFERENT 3651 02:17:48,480 --> 02:17:51,680 ACTORS THAT ARE SPECIFIC TO CRN 3652 02:17:51,680 --> 02:17:52,200 PROJECT. 3653 02:17:52,200 --> 02:17:54,840 THOSE CAPABILITIES WERE THEY HAD 3654 02:17:54,840 --> 02:17:56,320 BUILT ON TOP OF EACH OTHER. 3655 02:17:56,320 --> 02:18:00,120 AGAIN YOU HAVE THAT REPOSITORY 3656 02:18:00,120 --> 02:18:03,000 PUBLISH THE CRN INSTRUMENT 3657 02:18:03,000 --> 02:18:03,760 EXTERNAL DATA COLLECTION SYSTEM 3658 02:18:03,760 --> 02:18:07,760 WE WANTED TO BE ABLE TO RELEAVE 3659 02:18:07,760 --> 02:18:09,400 AND RENDER CRN INSTRUMENT AND 3660 02:18:09,400 --> 02:18:11,640 COLLECT DATA AS WELL AS 3661 02:18:11,640 --> 02:18:13,400 TRANSFORM THAT DATA INTO 3662 02:18:13,400 --> 02:18:15,600 RESOURCES SO EACH CAPABILITY IS 3663 02:18:15,600 --> 02:18:18,000 BUILDING ON THE OTHER. 3664 02:18:18,000 --> 02:18:20,000 FINALLY FOR OUR WOMEN HEALTH 3665 02:18:20,000 --> 02:18:22,000 REGISTRY MAKING SURE THAT WAS 3666 02:18:22,000 --> 02:18:25,040 THE ABILITY TO RECEIVE CRN 3667 02:18:25,040 --> 02:18:26,280 INSTRUMENT COLLECT THE DATA AS 3668 02:18:26,280 --> 02:18:31,520 WELL AS OTHER FIRE RESOURCES. 3669 02:18:31,520 --> 02:18:33,400 OUR PILOT TEAMS WE HAD TWO PILOT 3670 02:18:33,400 --> 02:18:37,400 SITES AND THE FIRST ONE WAS THE 3671 02:18:37,400 --> 02:18:38,160 AMERICAN GAIN LO DODGIC SOCIETY 3672 02:18:38,160 --> 02:18:40,800 KNOWN AS AUX, WOMEN HEALTH 3673 02:18:40,800 --> 02:18:41,800 REGISTRY, THEY WERE IMPORTANT 3674 02:18:41,800 --> 02:18:46,000 PILOT SITES BECAUSE THEY SERVE 3675 02:18:46,000 --> 02:18:47,640 AS A SITE THAT HAD HAIR OWN 3676 02:18:47,640 --> 02:18:51,200 REGISTRY AND THAT IS WE DID OUR 3677 02:18:51,200 --> 02:18:52,400 FIRST FEEDS PIE WILL THE TESTING 3678 02:18:52,400 --> 02:18:54,480 AND THE SECOND PHASE IT WAS A 3679 02:18:54,480 --> 02:18:56,240 FULL PROJECT TEAM MULTIPLE STAGE 3680 02:18:56,240 --> 02:18:57,800 HOLDERS SO THEY HAD 3681 02:18:57,800 --> 02:18:59,320 REPRESENTATIVES OF SUPPORT FOR 3682 02:18:59,320 --> 02:19:02,720 THE HIGH PERFORMANCE INTEGRATED 3683 02:19:02,720 --> 02:19:04,800 VIRTUAL ENVIRONMENT ALSO KNOWN 3684 02:19:04,800 --> 02:19:07,240 AS HIGH, DATA AGGREGATION 3685 02:19:07,240 --> 02:19:10,000 ANALYTICS PLATFORM, WE HAD THE 3686 02:19:10,000 --> 02:19:12,000 SOCIETY OF NEURODYNAMICS PELVIC 3687 02:19:12,000 --> 02:19:14,040 FED MINUTE IN UROGENITAL 3688 02:19:14,040 --> 02:19:15,000 RECONSTRUCTION. 3689 02:19:15,000 --> 02:19:16,720 ALSO KNOWN AS -- A FOUNDATION 3690 02:19:16,720 --> 02:19:19,120 DEDICATED TO IMPROVING THE 3691 02:19:19,120 --> 02:19:21,120 SCIENCE OF YOUROLOGY, AND THEN 3692 02:19:21,120 --> 02:19:23,400 THEY HAD AS A PART OF THE TEAM 3693 02:19:23,400 --> 02:19:26,600 NEW YORK PRESBYTERIAN HOSPITAL Z 3694 02:19:26,600 --> 02:19:28,360 AND THE POINT HERE IS TO TAKE A 3695 02:19:28,360 --> 02:19:30,120 LOOK AT THESE DIFFERENT PILOT 3696 02:19:30,120 --> 02:19:32,360 SITES AND LOOKING AT STRUCTURE 3697 02:19:32,360 --> 02:19:34,800 AND BEING ABLE TO SEE THAT THE 3698 02:19:34,800 --> 02:19:37,000 STRUCTURE OF THESE PILOT SITES 3699 02:19:37,000 --> 02:19:39,120 CAN LOOK DIFFERENT IN TRYING TO 3700 02:19:39,120 --> 02:19:40,440 DEVELOP COORDINATED REGISTRY 3701 02:19:40,440 --> 02:19:42,440 NETWORK. 3702 02:19:42,440 --> 02:19:47,440 AND USE OF THE REGISTRY. 3703 02:19:47,440 --> 02:19:48,800 MAIN ACTIVITIES INCLUDED 3704 02:19:48,800 --> 02:19:50,600 STANDING UP FIRE SERVERS ON 3705 02:19:50,600 --> 02:19:52,480 AMAZON WEB SERVICES AND THAT WAS 3706 02:19:52,480 --> 02:19:56,240 FOR BOTH AUX AS WELL AS HIDE 3707 02:19:56,240 --> 02:19:57,400 PLATFORM AGAIN WE WERE TASKED 3708 02:19:57,400 --> 02:19:59,800 WITH DEVELOPING TESTING, APPS 3709 02:19:59,800 --> 02:20:01,120 AND MAKING SURE THEY WERE 3710 02:20:01,120 --> 02:20:02,600 AVAILABLE ON MOBILE AND 3711 02:20:02,600 --> 02:20:05,760 CONNECTED DEVICES THROUGH FIRE 3712 02:20:05,760 --> 02:20:09,040 AND MACK SURE THEY SUPPORTED 3713 02:20:09,040 --> 02:20:10,720 PELVIC ORGANIZATION ORGAN 3714 02:20:10,720 --> 02:20:13,680 PROLAPSE KNOWN AS POP 3715 02:20:13,680 --> 02:20:15,320 INCONTINENCE AS WELL AS LONG 3716 02:20:15,320 --> 02:20:18,040 ACTING REVERSIBLE CONTRACEPTIVE 3717 02:20:18,040 --> 02:20:20,400 KNOWN AS ARC. 3718 02:20:20,400 --> 02:20:21,560 DURING THIS PROJECT WE HAD TO 3719 02:20:21,560 --> 02:20:23,200 WORK WITH A CLINICAL TEAM TO 3720 02:20:23,200 --> 02:20:25,000 HELP WITH DETERMINING REFINING 3721 02:20:25,000 --> 02:20:27,520 FINALIZING THE DATA ELEMENTS FOR 3722 02:20:27,520 --> 02:20:32,560 TERMINOLOGY AND PREPARATION FOR 3723 02:20:32,560 --> 02:20:33,400 STORING INSTRUMENT DATA 3724 02:20:33,400 --> 02:20:34,200 INSTRUMENT REPOSITORY. 3725 02:20:34,200 --> 02:20:36,080 WE WANTED TO MAKE SURE AS APP 3726 02:20:36,080 --> 02:20:37,560 WAS DEVELOPED THAT WE JUST 3727 02:20:37,560 --> 02:20:40,400 DIDN'T DEVELOP AN APP AND PUT IT 3728 02:20:40,400 --> 02:20:42,000 OUT THERE WITHOUT TESTING. 3729 02:20:42,000 --> 02:20:44,000 WE WANTED CLINICIAN FEEDBACK, 3730 02:20:44,000 --> 02:20:46,160 NOT JUST ON USABILITY BUT DESIGN 3731 02:20:46,160 --> 02:20:47,440 AS WELL AND WITH THIS PROJECT WE 3732 02:20:47,440 --> 02:20:49,720 WANTED TO MAKE SURE THAT WE BOTH 3733 02:20:49,720 --> 02:20:52,680 SPEND TIME TO UPDATE AND REFINE 3734 02:20:52,680 --> 02:20:55,680 THE APP IN FEEDBACK. 3735 02:20:55,680 --> 02:20:57,400 THESE SLIDES REALLY TAKE YOU 3736 02:20:57,400 --> 02:21:00,120 THROUGH SOME OF THE WORK THAT 3737 02:21:00,120 --> 02:21:02,840 WENT INTO MAKING SURE THAT THE 3738 02:21:02,840 --> 02:21:05,320 PLATFORM COULD PERFORM THESE 3739 02:21:05,320 --> 02:21:06,400 CAPABILITIES, ONE OF THE MAIN 3740 02:21:06,400 --> 02:21:08,520 ACTIVITIES WAS CREATE IN THE 3741 02:21:08,520 --> 02:21:12,400 CASE REPORT FORMS, PREVIOUSLY 3742 02:21:12,400 --> 02:21:13,440 ESTABLISHED POP DATA ELEMENT SO 3743 02:21:13,440 --> 02:21:15,400 THINK OF THIS AS HAVING A SURVEY 3744 02:21:15,400 --> 02:21:17,880 THAT YOU GIVE YOUR CLIENT TO 3745 02:21:17,880 --> 02:21:20,000 COLLECT DATA, AND WHAT WE HAD TO 3746 02:21:20,000 --> 02:21:22,440 DO IS WORK WITH CLINICAL WORK 3747 02:21:22,440 --> 02:21:24,120 GROUPS IN ORDER TO DEVELOP DATA 3748 02:21:24,120 --> 02:21:26,560 ELEMENTS THAT WOULD FEED INTO 3749 02:21:26,560 --> 02:21:29,760 AGAIN THAT CASE REPORTING FORM 3750 02:21:29,760 --> 02:21:32,720 FOR CRN INSTRUMENT. 3751 02:21:32,720 --> 02:21:34,480 DIFFERENT ACTIVITIES FOR FIRE 3752 02:21:34,480 --> 02:21:37,400 SERVER CREATING SMART FIRE APP, 3753 02:21:37,400 --> 02:21:38,600 THESE ACTIVITIES WITH JUST THE 3754 02:21:38,600 --> 02:21:40,120 BEGINNING ACTIVITIES FOR 3755 02:21:40,120 --> 02:21:41,160 CAPABILITIES ONE AND TWO. 3756 02:21:41,160 --> 02:21:43,280 WHEN YOU LOOK AT ACTIVITY THREE 3757 02:21:43,280 --> 02:21:44,480 AND FOUR IT IS REALLY BUILDING 3758 02:21:44,480 --> 02:21:46,480 OUT SOME OF THOSE THINGS THAT WE 3759 02:21:46,480 --> 02:21:49,480 DID FOR CAPABILITIES ONE AND TWO 3760 02:21:49,480 --> 02:21:50,280 MODIFYING SOME OF THE 3761 02:21:50,280 --> 02:21:51,840 INFORMATION FOR THE SMART ON 3762 02:21:51,840 --> 02:21:52,520 FIRE APP. 3763 02:21:52,520 --> 02:21:56,360 MAKING SURE THAT THE SERVERS ARE 3764 02:21:56,360 --> 02:21:59,480 PREPARED TO DEPLOY AND ALSO 3765 02:21:59,480 --> 02:22:00,840 WORKING ON THAT PORTION OF THE 3766 02:22:00,840 --> 02:22:03,520 PROJECT TO CREATE THIS OUT OF 3767 02:22:03,520 --> 02:22:05,000 POPULATION OF INSTRUMENT SO THAT 3768 02:22:05,000 --> 02:22:08,200 INCLUDED CREATION OF API 3769 02:22:08,200 --> 02:22:10,840 INSPIRED TO MAKE SURE IT WOULD 3770 02:22:10,840 --> 02:22:14,640 AUTOPOPULATE. 3771 02:22:14,640 --> 02:22:16,840 FOR THE FIFTH AND 6TH 3772 02:22:16,840 --> 02:22:18,720 CAPABILITIES IT WAS ADDING 3773 02:22:18,720 --> 02:22:21,000 ADDITIONAL MODELS TO THE 3774 02:22:21,000 --> 02:22:23,880 QUESTIONNAIRE TO THE APP, 3775 02:22:23,880 --> 02:22:24,800 REVAMPING THOSE QUESTIONSES 3776 02:22:24,800 --> 02:22:26,320 MAKING MODIFICATIONS TO MAKE 3777 02:22:26,320 --> 02:22:28,600 SURE THE STRUCTURES WERE ALIGNED 3778 02:22:28,600 --> 02:22:31,320 ACROSS THE DIFFERENT MODULES. 3779 02:22:31,320 --> 02:22:36,400 IN THE APP. 3780 02:22:36,400 --> 02:22:38,920 SO HERE I PUT THIS ONE IN THE 3781 02:22:38,920 --> 02:22:39,600 BACKGROUND BECAUSE SIMILAR TO 3782 02:22:39,600 --> 02:22:41,320 THE ONE UP FRONT BUT YOU CAN SEE 3783 02:22:41,320 --> 02:22:43,800 HERE THE DIFFERENT MODULES, THAT 3784 02:22:43,800 --> 02:22:45,160 WE WERE AVAILABLE THAT I 3785 02:22:45,160 --> 02:22:49,000 MENTIONED BEFORE, THE SUY 3786 02:22:49,000 --> 02:22:50,560 FIBROIDS, AND WHAT YOU SEE UP 3787 02:22:50,560 --> 02:22:52,320 FRONT IS ONCE YOU CLICK ON THAT 3788 02:22:52,320 --> 02:22:55,080 FORM, BEING ABLE TO SEE THE DATA 3789 02:22:55,080 --> 02:22:56,320 THAT COULD BE COLLECTED, SO 3790 02:22:56,320 --> 02:22:58,640 THERE IS AN OPPORTUNITY FOR 3791 02:22:58,640 --> 02:23:00,000 PRE-OPERATIVE INFORMATION, 3792 02:23:00,000 --> 02:23:02,600 ONTIVE INFORMATION LOOKING AT 3793 02:23:02,600 --> 02:23:03,200 POST-OPERATIVE INFORMATION AS 3794 02:23:03,200 --> 02:23:05,360 WELL AS ADDITIONAL INFORMATION 3795 02:23:05,360 --> 02:23:10,320 ABOUT UNSCHEDULE VISIT DATA. 3796 02:23:10,320 --> 02:23:12,840 ONCE YOU CLICK ON ONE OF THESE 3797 02:23:12,840 --> 02:23:15,080 MODULES, WHAT YOU WOULD SEE IS 3798 02:23:15,080 --> 02:23:16,400 THE OPPORTUNITY TO COLLECT 3799 02:23:16,400 --> 02:23:19,040 DEMOGRAPHIC INFORMATION AS WELL 3800 02:23:19,040 --> 02:23:21,800 AS SOME HISTORY INFORMATION 3801 02:23:21,800 --> 02:23:24,560 ABOUT THE CLIENT OR PATIENT. 3802 02:23:24,560 --> 02:23:26,440 AND WHAT WAS INCLUDED 3803 02:23:26,440 --> 02:23:28,640 SPECIFICALLY FOR SUY FOR THE 3804 02:23:28,640 --> 02:23:30,880 UNIQUE DEVICE IDENTIFIER IS 3805 02:23:30,880 --> 02:23:34,080 AGAIN THAT ABILITY TO AUTO 3806 02:23:34,080 --> 02:23:34,640 POPULATE. 3807 02:23:34,640 --> 02:23:36,600 SO HERE ONE WOULD BE ABLE TO 3808 02:23:36,600 --> 02:23:39,560 SCAN A DEVICE OR PUT THE UNIQUE 3809 02:23:39,560 --> 02:23:40,880 DEVICE IDENTIFIER INFORMATION 3810 02:23:40,880 --> 02:23:44,160 INTO THIS APP AND THEN HAVE IT 3811 02:23:44,160 --> 02:23:46,120 AUTOPOPULATE BASED ON THE GLOBAL 3812 02:23:46,120 --> 02:23:48,920 DEVICE IDENTIFIER DATA SYSTEM. 3813 02:23:48,920 --> 02:23:50,680 SOME OF THE LESSONS LEARNED FROM 3814 02:23:50,680 --> 02:23:53,680 THIS PROJECT IS REALLY A PROJECT 3815 02:23:53,680 --> 02:23:55,680 CAPACITY BEING ABLE TO ESTABLISH 3816 02:23:55,680 --> 02:23:57,960 REASONABLE EXPECTATIONS FOR THE 3817 02:23:57,960 --> 02:23:58,640 TIME LINE. 3818 02:23:58,640 --> 02:24:01,000 DIFFERENT THINGS THAT NEED TO BE 3819 02:24:01,000 --> 02:24:02,320 CONSIDERED IS DATA COLLECTION 3820 02:24:02,320 --> 02:24:04,840 WORK FLOW AND HOW THAT CAN VARY 3821 02:24:04,840 --> 02:24:06,320 FROM ORGANIZATION TO 3822 02:24:06,320 --> 02:24:07,720 ORGANIZATION, AS YOU SAW WE HAD 3823 02:24:07,720 --> 02:24:09,840 TWO DIFFERENT PILOT SITES ONE IN 3824 02:24:09,840 --> 02:24:11,600 WHICH WE WORKED WITH ONE 3825 02:24:11,600 --> 02:24:13,960 REGISTRY AND THEN ANOTHER IN 3826 02:24:13,960 --> 02:24:17,160 WHICH WE HAD FOUR ORGANIZATIONS 3827 02:24:17,160 --> 02:24:20,400 TO WORK WITH FOR THE ONE PILOT. 3828 02:24:20,400 --> 02:24:21,640 MAKE SURE YOU INCLUDE SUFFICIENT 3829 02:24:21,640 --> 02:24:25,560 TIME FOR BACK AND FORTH LUKE I 3830 02:24:25,560 --> 02:24:26,320 MEGAD BEFORE DURING -- LIKE 3831 02:24:26,320 --> 02:24:28,160 MENTIONED BEFORE DEVELOPING CASE 3832 02:24:28,160 --> 02:24:29,280 REPORT FORMS, THERE IS WORK THAT 3833 02:24:29,280 --> 02:24:31,800 WENT INTO THOSE WORK GROUPS AND 3834 02:24:31,800 --> 02:24:34,800 BEING ABLE TO GET TO THAT 3835 02:24:34,800 --> 02:24:35,600 FINALCATION REPORT FORM TO BE 3836 02:24:35,600 --> 02:24:40,960 USED FOR THIS PROJECT. 3837 02:24:40,960 --> 02:24:42,760 LOOK ACT THE INFRASTRUCTURE OF 3838 02:24:42,760 --> 02:24:44,360 THEIR REGISTRY AND UNDERSTANDING 3839 02:24:44,360 --> 02:24:48,880 HOW TO LIMIT HEALTH IT 3840 02:24:48,880 --> 02:24:49,560 IMPLEMENTATIONS. 3841 02:24:49,560 --> 02:24:51,040 THE OTHER THING IS LOOKING AT 3842 02:24:51,040 --> 02:24:52,760 FIRE RESOURCES THAT WERE 3843 02:24:52,760 --> 02:24:55,600 DEVELOPED BASED ON PREVIOUS 3844 02:24:55,600 --> 02:25:00,320 EFFORTS, IN ORDER TO BE MORE 3845 02:25:00,320 --> 02:25:01,680 EFFECTIVE FOR REGISTRIES ONE 3846 02:25:01,680 --> 02:25:03,240 FOCUS OF OUR PROJECT IS WORKING 3847 02:25:03,240 --> 02:25:05,600 ON PREVIOUS WORK USED PREVIOUS 3848 02:25:05,600 --> 02:25:07,720 WORK, TO BUILD THIS FRAMEWORK SO 3849 02:25:07,720 --> 02:25:08,600 USING PREVIOUS STANDARDS AND 3850 02:25:08,600 --> 02:25:12,560 PROFILES. 3851 02:25:12,560 --> 02:25:14,200 ONE BENEFIT IS WHEN YOU HAVE THE 3852 02:25:14,200 --> 02:25:15,800 OPPORTUNITY TO USE A PLATFORM 3853 02:25:15,800 --> 02:25:17,840 THAT CAN HOST SEVERAL 3854 02:25:17,840 --> 02:25:19,960 REGISTRIES, THAT OFFERS UP THE 3855 02:25:19,960 --> 02:25:21,640 OPPORTUNITY TO USE COMMON 3856 02:25:21,640 --> 02:25:23,120 COMPONENTS TO ACHIEVE MORE 3857 02:25:23,120 --> 02:25:26,000 EFFICIENCIES. 3858 02:25:26,000 --> 02:25:28,320 WHERE WE ARE WITH THE WOMEN 3859 02:25:28,320 --> 02:25:29,480 HEALTH COORDINATED RESCUE 3860 02:25:29,480 --> 02:25:30,840 PROJECT NOW IS BEING ABLE TO 3861 02:25:30,840 --> 02:25:31,960 SHARE WITH THE PEOPLE THAT YOU 3862 02:25:31,960 --> 02:25:35,160 CAN TAKE THIS WORK THAT WAS 3863 02:25:35,160 --> 02:25:36,160 FOCUSED ON WOMEN HEALTH 3864 02:25:36,160 --> 02:25:38,880 TECHNOLOGY AND BE ABLE TO USE 3865 02:25:38,880 --> 02:25:40,600 THAT IMPLEMENTATION GUIDE AS 3866 02:25:40,600 --> 02:25:41,680 COMMON REGISTRY REPORTING 3867 02:25:41,680 --> 02:25:44,560 FRAMEWORK SO LOOKING FOR OTHER 3868 02:25:44,560 --> 02:25:46,200 OPPORTUNITIES OTHER AREAS THAT 3869 02:25:46,200 --> 02:25:48,200 MAY INCLUDE WOMEN HEALTH BUT 3870 02:25:48,200 --> 02:25:49,880 LOOKING AT DIFFERENT AREA OF 3871 02:25:49,880 --> 02:25:52,880 HEALTH TO USE THIS PARTICULAR IG 3872 02:25:52,880 --> 02:25:55,640 AND LESSONS LEARNED FROM PILOT 3873 02:25:55,640 --> 02:25:56,280 IMPLEMENTATIONS. 3874 02:25:56,280 --> 02:25:57,800 WITH THE SPECIFIC IMPLEMENTATION 3875 02:25:57,800 --> 02:25:59,720 SIDE THERE IS MORE WORK THAT WE 3876 02:25:59,720 --> 02:26:01,600 NEED TO BE DONE OR THAT 3877 02:26:01,600 --> 02:26:02,560 CONTINUES TO BE DONE IN ORDER TO 3878 02:26:02,560 --> 02:26:04,880 MAKE SURE THAT THE DATA ELEMENTS 3879 02:26:04,880 --> 02:26:09,120 ARE HARMONIZED FOR SPECIFIC IG 3880 02:26:09,120 --> 02:26:12,480 AND UPDATED UNDER HL 7, WORKING 3881 02:26:12,480 --> 02:26:14,000 TO MAKE SURE THIS IS INCLUDED IN 3882 02:26:14,000 --> 02:26:17,240 FUTURE PCOR INITIATIVES, AND NOT 3883 02:26:17,240 --> 02:26:20,200 JUST PCOR BUT HERE SHARING THIS 3884 02:26:20,200 --> 02:26:21,520 SO THAT YOU WILL TAKE THE 3885 02:26:21,520 --> 02:26:23,200 INFORMATION THAT WE HAVE SHARED 3886 02:26:23,200 --> 02:26:26,080 TO THINK ABOUT HOW TO REUSE 3887 02:26:26,080 --> 02:26:26,920 WITHIN YOUR PROJECTS. 3888 02:26:26,920 --> 02:26:29,920 WITH THAT WE LOOK FOR EXPANSION 3889 02:26:29,920 --> 02:26:30,800 FOR CLINICAL PARTICIPANTS SO 3890 02:26:30,800 --> 02:26:32,800 THAT WE CAN INCREASE THE VALUE 3891 02:26:32,800 --> 02:26:36,160 OF REGISTRIES AND REGISTRY 3892 02:26:36,160 --> 02:26:37,560 SPECIFICALLY THAT ARE STANDARDS 3893 02:26:37,560 --> 02:26:38,360 BASED. 3894 02:26:38,360 --> 02:26:40,360 LOOKING AT THE OPPORTUNITY OF 3895 02:26:40,360 --> 02:26:42,200 THIS FRAMEWORK TO DECREASE 3896 02:26:42,200 --> 02:26:45,080 PROVIDER BURDEN ESPECIALLY FOR 3897 02:26:45,080 --> 02:26:47,000 RESEARCHERS AND BEING ABLE TO 3898 02:26:47,000 --> 02:26:48,280 COLLECT DATA SHARE DATA AND GET 3899 02:26:48,280 --> 02:26:51,520 THAT DATA BACK TO ANSWER SOME OF 3900 02:26:51,520 --> 02:26:52,200 YOUR QUESTIONS. 3901 02:26:52,200 --> 02:26:55,040 JUST AS CLOSING THESE ARE A LIST 3902 02:26:55,040 --> 02:26:57,200 OF FEDERAL PARTNERS AND THAT 3903 02:26:57,200 --> 02:26:59,960 PARTICIPATED IN THE PROJECT. 3904 02:26:59,960 --> 02:27:02,400 AGAIN, A COLLABORATIVE EFFORT 3905 02:27:02,400 --> 02:27:05,360 NOT JUST WITH ONC BUT DIFFERENT 3906 02:27:05,360 --> 02:27:08,000 REGISTRIES FOUNDATIONS, HOSPITAL 3907 02:27:08,000 --> 02:27:11,080 SYSTEMS, AND OTHER FEDERAL 3908 02:27:11,080 --> 02:27:12,200 AGENCIES. 3909 02:27:12,200 --> 02:27:13,240 THAT WERE INCLUDED. 3910 02:27:13,240 --> 02:27:16,200 WITH THAT I THINK WE ARE ABOUT 3911 02:27:16,200 --> 02:27:18,040 READY FOR QUESTIONS AS I BELIEVE 3912 02:27:18,040 --> 02:27:19,000 I'M THE LAST SPEAKER. 3913 02:27:19,000 --> 02:27:23,720 THANK YOU FOR YOUR TIME. 3914 02:27:23,720 --> 02:27:25,560 >> THANK YOU, MS. HENRY. 3915 02:27:25,560 --> 02:27:28,480 I WOULD LIKE TO SINCERELY THANK 3916 02:27:28,480 --> 02:27:33,600 DR. CROSS BARNET MS. ARGENTIERI 3917 02:27:33,600 --> 02:27:38,080 ANFOR YOUR THOUGHT PROVOKING 3918 02:27:38,080 --> 02:27:38,480 PRESENTATIONS. 3919 02:27:38,480 --> 02:27:40,120 WE HAVE TIME FOR A FEW QUESTIONS 3920 02:27:40,120 --> 02:27:43,000 FROM THE AUDIENCE, I ENCOURAGE 3921 02:27:43,000 --> 02:27:44,000 EVERYONE TO ENTER QUESTIONS IN 3922 02:27:44,000 --> 02:27:45,360 THE Q&A POD AT THE BOTTOM OF 3923 02:27:45,360 --> 02:27:46,000 YOUR SCREEN. 3924 02:27:46,000 --> 02:27:48,680 LET'S START NOW WITH TWO 3925 02:27:48,680 --> 02:27:53,160 QUESTIONS FOR DR. CROSS BARNET. 3926 02:27:53,160 --> 02:27:55,000 ONE, IS CAN YOU DESCRIBE THE 3927 02:27:55,000 --> 02:27:56,560 THREE CARE MODELS IN MORE 3928 02:27:56,560 --> 02:27:57,040 DETAIL? 3929 02:27:57,040 --> 02:28:00,360 THAT IS THE BIRTH CENTERS, THE 3930 02:28:00,360 --> 02:28:02,440 PRE-NATAL CARE AND MATERNITY 3931 02:28:02,440 --> 02:28:04,800 CARE, AND WHAT DO YOU SEE THE 3932 02:28:04,800 --> 02:28:06,160 PRIMARY BARRIERS TO INTEGRATING 3933 02:28:06,160 --> 02:28:06,360 CARE? 3934 02:28:06,360 --> 02:28:10,480 THE WHAT STRATEGIES INTEGRATE 3935 02:28:10,480 --> 02:28:11,400 RATHER THIS THAN COORDINATE 3936 02:28:11,400 --> 02:28:13,640 CARE? 3937 02:28:13,640 --> 02:28:16,200 >> WE ARE DESCRIBING CARE 3938 02:28:16,200 --> 02:28:16,800 MODELS. 3939 02:28:16,800 --> 02:28:18,440 THE BIRTH CENTERS WERE ALL 3940 02:28:18,440 --> 02:28:20,120 MEMBERS OF THE AMERICAN 3941 02:28:20,120 --> 02:28:22,120 ASSOCIATION OF BIRTH CENTERS AND 3942 02:28:22,120 --> 02:28:23,560 BECAUSE OF THAT HAVE HAD TO 3943 02:28:23,560 --> 02:28:26,720 FOLLOW THE STANDARDS THAT ARE 3944 02:28:26,720 --> 02:28:28,360 SET FOR BIRTH CENTERS WHICH ARE 3945 02:28:28,360 --> 02:28:30,200 AVAILABLE ON ABC'S WEBSITE AND 3946 02:28:30,200 --> 02:28:32,360 YOU CAN ALSO LOOK AT THE 3947 02:28:32,360 --> 02:28:35,200 ACCREDITATION OF BIRTH CENTERS 3948 02:28:35,200 --> 02:28:38,600 WHICH IS THE GROUP ACRONYM IS 3949 02:28:38,600 --> 02:28:41,000 CABC WHICH IS COMMITTEE FOR 3950 02:28:41,000 --> 02:28:42,880 ACCREDITATION OF BIRTH CENTERS, 3951 02:28:42,880 --> 02:28:46,800 IN ANY CASE A BIRTH CENTER -- 3952 02:28:46,800 --> 02:28:49,000 BIRTH CENTERS BY ALL PRACTICE 3953 02:28:49,000 --> 02:28:50,800 WHAT THEY CONSIDER DOB MIDWIFERY 3954 02:28:50,800 --> 02:28:54,880 MODEL OF CARE SO INTENSIVE TIME 3955 02:28:54,880 --> 02:28:57,400 LOW ENTERVENGES INDIVIDUALIZED 3956 02:28:57,400 --> 02:28:58,840 EDUCATION LOTS OF PATIENT 3957 02:28:58,840 --> 02:29:03,120 ACTIVATION AN SHARE DECISION 3958 02:29:03,120 --> 02:29:03,960 MAKING. 3959 02:29:03,960 --> 02:29:05,280 AND BIRTH CENTERS WERE ALL OVER 3960 02:29:05,280 --> 02:29:06,720 THE COUNTRY, IN RURAL AREAS IN 3961 02:29:06,720 --> 02:29:13,200 URBAN AREAS, BIRTH CENTERS DID 3962 02:29:13,200 --> 02:29:16,000 SERVE DISPROPORTIONATE NUMBER OF 3963 02:29:16,000 --> 02:29:17,080 WHITE PARTICIPANTS IN STRONG 3964 02:29:17,080 --> 02:29:19,280 START BUT MORE ROBUST 3965 02:29:19,280 --> 02:29:20,080 PARTICIPATION THROUGH STRONG 3966 02:29:20,080 --> 02:29:23,280 START THAN YOU SEE FOR NON-WHITE 3967 02:29:23,280 --> 02:29:25,480 WOMEN GENERALLY IN BIRTH CENTERS 3968 02:29:25,480 --> 02:29:27,400 AND WE DID HAVE A COUPLE OF 3969 02:29:27,400 --> 02:29:29,600 BIRTH CENTERS THAT PRIMARILY 3970 02:29:29,600 --> 02:29:32,440 SERVED BLACK AND LATINO WOMEN, 3971 02:29:32,440 --> 02:29:35,600 WOMEN WASHINGTON D.C. COMMUNITY 3972 02:29:35,600 --> 02:29:38,920 OF HOPE, FAMILY BIRTH CENTER HAD 3973 02:29:38,920 --> 02:29:40,280 OUTSTANDING RESULTS IF YOU LOOK 3974 02:29:40,280 --> 02:29:42,480 AT THE VOLUME TWO OF THE STRONG 3975 02:29:42,480 --> 02:29:44,360 START FOR MOTHERS AND NEWBORN 3976 02:29:44,360 --> 02:29:45,920 EVALUATION REPORT YOU CAN SEE 3977 02:29:45,920 --> 02:29:49,000 INDIVIDUALIZED REPORTS FOR EACH 3978 02:29:49,000 --> 02:29:52,440 SITE AND THEY HAD BIRTH CENTER 3979 02:29:52,440 --> 02:29:58,480 IN WASHINGTON D.C HAD BETTER 3980 02:29:58,480 --> 02:29:59,600 RESULTS THAN THE AVERAGE FOR 3981 02:29:59,600 --> 02:30:01,200 BIRTH CENTERS WHEN AGAIN LOOKING 3982 02:30:01,200 --> 02:30:02,440 AT RISK MATCHED COMPARISON 3983 02:30:02,440 --> 02:30:05,800 GROUP. 3984 02:30:05,800 --> 02:30:07,720 SO THAT WAS THAT. 3985 02:30:07,720 --> 02:30:09,240 THEY ALSO IMPLEMENTED PEER 3986 02:30:09,240 --> 02:30:10,880 COUNSELING AS PART OF THE STRONG 3987 02:30:10,880 --> 02:30:11,800 START INTERVENTION SO THERE WAS 3988 02:30:11,800 --> 02:30:16,120 A PEER COUNSELOR AVAILABLE TO DO 3989 02:30:16,120 --> 02:30:16,720 ADDITIONAL CARE TOWARD NATION. 3990 02:30:16,720 --> 02:30:18,600 HOWEVER, THEY FELT LIKE -- WELL 3991 02:30:18,600 --> 02:30:20,160 THE CARE COORDINATORS WERE 3992 02:30:20,160 --> 02:30:22,360 HELPFUL THEY WEREN'T REALLY HUGE 3993 02:30:22,360 --> 02:30:24,600 VALUE ADD SOME OF THEM KEPT A 3994 02:30:24,600 --> 02:30:25,920 COMPONENT OF IT AFTER STRONG 3995 02:30:25,920 --> 02:30:27,920 START ENDED FOR REFERRALS AND 3996 02:30:27,920 --> 02:30:30,120 THINGS LIKE THAT BUT IF YOU LOOK 3997 02:30:30,120 --> 02:30:32,720 BACK AT THE D.C. BIRTH CENTER IN 3998 02:30:32,720 --> 02:30:35,000 PARTICULAR THERE HAD BEEN A VERY 3999 02:30:35,000 --> 02:30:37,280 SIMILAR EVALUATION OF THAT 4000 02:30:37,280 --> 02:30:39,520 PARTICULAR BIRTH CENTER BEFORE 4001 02:30:39,520 --> 02:30:40,960 STRONG START WAS IMPLEMENTED AND 4002 02:30:40,960 --> 02:30:43,920 THE RESULTS THAT WE SAW IN THAT 4003 02:30:43,920 --> 02:30:46,200 BIRTH CENTER FIRST WAS NOT DONE 4004 02:30:46,200 --> 02:30:49,160 BY MY AGENCY THE FIRST 4005 02:30:49,160 --> 02:30:50,240 EVALUATION WAS DONE AS PART OF 4006 02:30:50,240 --> 02:30:51,240 THE SEPARATE PROJECT BUT THE 4007 02:30:51,240 --> 02:30:52,320 RESULTS THEY FOUND FOR THE BIRTH 4008 02:30:52,320 --> 02:30:54,000 CENTER OUTCOMES WERE ALMOST 4009 02:30:54,000 --> 02:30:56,200 IDENTICAL. 4010 02:30:56,200 --> 02:30:58,240 BETWEEN THE PRE-STRONG START AND 4011 02:30:58,240 --> 02:30:59,520 POST STRONG START POPULATION. 4012 02:30:59,520 --> 02:31:02,480 WHICH INDICATES THAT THE 4013 02:31:02,480 --> 02:31:03,840 ADDITIONAL SERVICES OF THE PEER 4014 02:31:03,840 --> 02:31:05,640 COUNSELOR REALLY DIDN'T -- THAT 4015 02:31:05,640 --> 02:31:08,000 WAS SORT OF OUR NATURAL 4016 02:31:08,000 --> 02:31:09,800 EXPERIMENT HERE DIDN'T HAVE A 4017 02:31:09,800 --> 02:31:10,360 LOT. 4018 02:31:10,360 --> 02:31:12,680 THE GROUP PRE-NATAL CARE, IF YOU 4019 02:31:12,680 --> 02:31:14,720 LOOK AT THE CENTERING PREGNANCY 4020 02:31:14,720 --> 02:31:16,720 MODEL AND THAT IS THE MOST 4021 02:31:16,720 --> 02:31:18,480 WIDELY PRACTICED MODEL THEY HAVE 4022 02:31:18,480 --> 02:31:20,600 CERTAIN TENANTS THEY EXPECT 4023 02:31:20,600 --> 02:31:22,320 PEOPLE TO FOLLOW SO YOU GET A 4024 02:31:22,320 --> 02:31:25,800 GROUP OF TEN WOMEN TOGETHER WHO 4025 02:31:25,800 --> 02:31:30,720 WERE OF SIMILAR GESTATIONAL AGE 4026 02:31:30,720 --> 02:31:32,880 THAT COME IN FOR APPOINTMENT 4027 02:31:32,880 --> 02:31:33,920 THAT LASTS AROUND TWO HOURS. 4028 02:31:33,920 --> 02:31:38,960 THE FIRST PART OF THAT IS PART 4029 02:31:38,960 --> 02:31:40,680 OF THE PATIENT TAKE THEIR OWN 4030 02:31:40,680 --> 02:31:42,200 WEIGHT BLOOD PRESSURE AND CHART 4031 02:31:42,200 --> 02:31:44,560 IT, THE MODEL DOES SUGGEST OR 4032 02:31:44,560 --> 02:31:45,880 ACTUALLY REQUIRE TECHNICALLY IF 4033 02:31:45,880 --> 02:31:47,440 YOU ARE ACCREDITED BY THEM, THAT 4034 02:31:47,440 --> 02:31:51,560 YOU PROVIDE HEALTHY SNACKS THERE 4035 02:31:51,560 --> 02:31:52,920 IS SOCIALIZATION TIME SO PEOPLE 4036 02:31:52,920 --> 02:31:54,880 HAVE A CHANCE TO JUST CHAT AND 4037 02:31:54,880 --> 02:31:56,240 BOND AND WHILE THEY ARE DOING 4038 02:31:56,240 --> 02:31:58,200 THEIR WEIGHT AND BLOOD PRESSURE 4039 02:31:58,200 --> 02:31:59,640 WHICH OBVIOUSLY DOESN'T TAKE 4040 02:31:59,640 --> 02:32:02,400 TIME GO IN A PRIVATE AREA, FOR 4041 02:32:02,400 --> 02:32:04,520 QUICK HEALTH SCREEN SO BELLY 4042 02:32:04,520 --> 02:32:06,800 CHECK HEART RATE ANSWERING ANY 4043 02:32:06,800 --> 02:32:09,920 MEDICAL QUESTIONS, AND IF THE 4044 02:32:09,920 --> 02:32:13,080 PERSON DOES HAVE MEDICAL NEEDS 4045 02:32:13,080 --> 02:32:14,280 THAT CHECK UP THEY HAVE A 4046 02:32:14,280 --> 02:32:15,800 SEPARATE APPOINTMENT FOR HIGH 4047 02:32:15,800 --> 02:32:19,320 RISK CONSULTATION. 4048 02:32:19,320 --> 02:32:20,480 BUT PROVIDING EVERYTHING IS FINE 4049 02:32:20,480 --> 02:32:23,800 YOU GO INTO THE FACILITY TO 4050 02:32:23,800 --> 02:32:25,760 CUSHION FOR 60 TO 90 MINUTES THE 4051 02:32:25,760 --> 02:32:28,560 GROUP TALKS ABOUT A TOPIC THAT 4052 02:32:28,560 --> 02:32:30,600 MIGHT BE SEWNS OF EARLY LABOR OR 4053 02:32:30,600 --> 02:32:31,800 PROBLEMS THAT YOU KNOW WHERE YOU 4054 02:32:31,800 --> 02:32:33,000 KNOW YOU NEED TO COULD YOUR 4055 02:32:33,000 --> 02:32:35,120 DOCTOR OR GO TO THE ER OR BREAST 4056 02:32:35,120 --> 02:32:37,880 FEEDING OR FAMILY PLANNING. 4057 02:32:37,880 --> 02:32:39,560 AND THERE ARE TEN SESSIONS, EACH 4058 02:32:39,560 --> 02:32:41,320 ONE FOCUSED ON ONE OF THESE 4059 02:32:41,320 --> 02:32:43,400 TOPICS AND THE WOMEN ARE -- IT 4060 02:32:43,400 --> 02:32:46,200 IS SUPPOSED TO BE FACILITATED 4061 02:32:46,200 --> 02:32:46,480 DID CUSHION. 4062 02:32:46,480 --> 02:32:47,440 SO THERE ARE -- DISCUSSION SO 4063 02:32:47,440 --> 02:32:49,040 THERE ARE PROVIDERS HELPING LEAD 4064 02:32:49,040 --> 02:32:50,960 THAT DISCUSSION BUT IT IS 4065 02:32:50,960 --> 02:32:51,520 SUPPOSED TO BE INFORMATION 4066 02:32:51,520 --> 02:32:53,640 SHARING AMONG THE PEOPLE AND NOT 4067 02:32:53,640 --> 02:32:58,480 QUOTE UNQUOTE CLASS. 4068 02:32:58,480 --> 02:33:00,200 THE MATERNITY CARE MODEL AS 4069 02:33:00,200 --> 02:33:01,520 INDICATED EARLIER JUST IT HAD 4070 02:33:01,520 --> 02:33:05,400 THE MOST VARIATION IN IT. 4071 02:33:05,400 --> 02:33:07,600 SO WE HAD SOME PEOPLE DOING IN 4072 02:33:07,600 --> 02:33:09,920 PERSON CONSULTATION, SOME DOING 4073 02:33:09,920 --> 02:33:11,400 TELEPHONE CONSULTATION, SOME 4074 02:33:11,400 --> 02:33:14,080 DOING A COMBINATION. 4075 02:33:14,080 --> 02:33:15,120 SOMETIMES THE CARE COORDINATOR 4076 02:33:15,120 --> 02:33:16,880 WAS A COMMUNITY HEALTH WORKER, 4077 02:33:16,880 --> 02:33:17,760 SOMETIMES A SOCIAL WORKER 4078 02:33:17,760 --> 02:33:21,400 SOMETIMES A NURSE. 4079 02:33:21,400 --> 02:33:23,800 SOMETIMES VARIETY OF THOSE 4080 02:33:23,800 --> 02:33:24,800 QUALIFICATIONS WHAT WE HEARD 4081 02:33:24,800 --> 02:33:25,920 MOST OFTEN WAS THE MOST 4082 02:33:25,920 --> 02:33:31,200 IMPORTANT QUALITIES IN CARE 4083 02:33:31,200 --> 02:33:32,200 COORDINATORS WAS PERSONAL 4084 02:33:32,200 --> 02:33:37,000 CHARACTERISTICS THAN 4085 02:33:37,000 --> 02:33:38,680 CREDENTIALING, THE ABILITY TO 4086 02:33:38,680 --> 02:33:39,920 THE WOMEN THEY WERE WORKING WITH 4087 02:33:39,920 --> 02:33:41,520 WAS THE MOST IMPORTANT THING 4088 02:33:41,520 --> 02:33:42,840 ABOUT WHAT THEY HAVE DONE. 4089 02:33:42,840 --> 02:33:45,600 SOME OF THE PROGRAMS HAD 4090 02:33:45,600 --> 02:33:47,400 PROTOCOL FOR MEETING LIKE YOU 4091 02:33:47,400 --> 02:33:49,000 GET -- YOU HAVE CONTACT IN YOUR 4092 02:33:49,000 --> 02:33:51,760 FIRST TRIMESTER SECOND TRIMESTER 4093 02:33:51,760 --> 02:33:53,080 THIRD AND POSTPARTUM, OTHERS 4094 02:33:53,080 --> 02:33:54,200 WERE EVERY TIME YOU COME IN YOU 4095 02:33:54,200 --> 02:33:56,600 TALK TO THE PERSON. 4096 02:33:56,600 --> 02:33:59,720 THEN CALL HER IN BETWEEN. 4097 02:33:59,720 --> 02:34:01,280 IF YOU NEED OTHER CONSULTATION 4098 02:34:01,280 --> 02:34:02,320 OR SHE WILL MEET YOU SOMEWHERE. 4099 02:34:02,320 --> 02:34:04,520 SO IT REALLY THE INTENSITY 4100 02:34:04,520 --> 02:34:05,880 VARIED TREMENDOUSLY, THE 4101 02:34:05,880 --> 02:34:07,440 QUALIFICATIONS OF THE PEOPLE 4102 02:34:07,440 --> 02:34:09,240 VARIED Z THE DEPTH IN WHICH THEY 4103 02:34:09,240 --> 02:34:10,200 TALKED ABOUT THINGS VARIED A 4104 02:34:10,200 --> 02:34:15,600 LOT. 4105 02:34:15,600 --> 02:34:19,000 BUT I DIDN'T MATTER WHAT IT WAS. 4106 02:34:19,000 --> 02:34:22,080 NONE HAD MUCH IMPACTMENT PEOPLE 4107 02:34:22,080 --> 02:34:24,280 LIKED IT, IT WASN'T AS IF PEOPLE 4108 02:34:24,280 --> 02:34:25,400 DIDN'T VALUE TIME THOSE FOLKS 4109 02:34:25,400 --> 02:34:27,360 PUT IN OR DIDN'T ENJOY TALKING 4110 02:34:27,360 --> 02:34:29,000 WITH THEM OR DIDN'T FEEL LIKE IT 4111 02:34:29,000 --> 02:34:33,320 IMPROVED THEIR CARE EXPERIENCE. 4112 02:34:33,320 --> 02:34:34,480 BUT AS FAR AS OUTCOMES DIDN'T 4113 02:34:34,480 --> 02:34:35,800 MOVE THE NEEDLE AND IT COSTS 4114 02:34:35,800 --> 02:34:38,920 MONEY. 4115 02:34:38,920 --> 02:34:41,200 SOME CASES COST MORE MONEY THAN 4116 02:34:41,200 --> 02:34:44,920 MEDICAID SYSTEM IN ADDITION TO 4117 02:34:44,920 --> 02:34:46,160 REFER FORD CARE AND GOING BUT 4118 02:34:46,160 --> 02:34:47,400 THAT DIDN'T IMPROVE OUTCOMES 4119 02:34:47,400 --> 02:34:47,600 EITHER. 4120 02:34:47,600 --> 02:34:52,040 WE KNOW THERE'S VERY LITTLE 4121 02:34:52,040 --> 02:34:54,720 MEDICALLY WE CAN DO TO PREVENT 4122 02:34:54,720 --> 02:34:55,640 PRE-TERM BIRTH. 4123 02:34:55,640 --> 02:34:57,320 MORE THAN ANYTHING IT TENDS TO 4124 02:34:57,320 --> 02:34:59,120 BE MONITORING SOMEBODY. 4125 02:34:59,120 --> 02:35:04,400 WHICH MIGHT HELP PREVENT 4126 02:35:04,400 --> 02:35:06,440 MORTALITY FOR MOM OR INFANT, NOT 4127 02:35:06,440 --> 02:35:07,640 LIKE WE DON'T WANT TO DO THAT 4128 02:35:07,640 --> 02:35:08,880 BUT IF YOU HAVE SOMEBODY WITH 4129 02:35:08,880 --> 02:35:12,320 SEVERE PREECLAMPSIA, SHE IS 4130 02:35:12,320 --> 02:35:14,400 LIKELY TO HAVE PRE-TERM BIRTH 4131 02:35:14,400 --> 02:35:17,640 ANYWAY, YOU WILL NOTE IF BLOOD 4132 02:35:17,640 --> 02:35:18,400 PRESSURE GOES HIGH ENOUGH YOU 4133 02:35:18,400 --> 02:35:19,760 HAVE TO DO EMERGENCY INDUCTION 4134 02:35:19,760 --> 02:35:23,120 OR C-SECTION, PRE-TERM BABY, YOU 4135 02:35:23,120 --> 02:35:24,440 MIGHT PREVENT BY CATCHING THE 4136 02:35:24,440 --> 02:35:25,600 CONDITION BEFORE IT BECOMES SO 4137 02:35:25,600 --> 02:35:28,440 SEVERE THE BABY DIES. 4138 02:35:28,440 --> 02:35:31,320 SO IT DIDN'T OHIO DIDN'T REALLY 4139 02:35:31,320 --> 02:35:36,040 IMPACT THE OUTCOMES AT ALL. 4140 02:35:36,040 --> 02:35:37,200 IN ANY MEANINGFUL WAY. 4141 02:35:37,200 --> 02:35:39,120 THERE IS A HOME VISITING ARM 4142 02:35:39,120 --> 02:35:40,440 THAT WAS DONE THROUGH HRSA. 4143 02:35:40,440 --> 02:35:42,920 THAT LOOKED A THE IMPACT OF 4144 02:35:42,920 --> 02:35:45,080 NURSE FAMILY PARTNERSHIP AND 4145 02:35:45,080 --> 02:35:46,760 HEALTHY FAMILIES AMERICA 4146 02:35:46,760 --> 02:35:49,160 PRE-NATAL CONTACT ON BIRTH 4147 02:35:49,160 --> 02:35:50,160 OUTCOMES AND DIDN'T FIND 4148 02:35:50,160 --> 02:35:51,640 SUBSTANTIAL IMPACT. 4149 02:35:51,640 --> 02:35:52,960 THERE WERE IMPACT OF THOSE 4150 02:35:52,960 --> 02:35:55,960 PROGRAMS FOR THE BABIES LATER 4151 02:35:55,960 --> 02:35:57,320 AND I DON'T KNOW WHETHER OR NOT 4152 02:35:57,320 --> 02:35:58,280 THAT HAD ANYTHING TO DO WITH 4153 02:35:58,280 --> 02:36:00,600 WHAT HAPPENED PRE-NATALLY BUT 4154 02:36:00,600 --> 02:36:02,400 THOSE HOME VISITING PROGRAMS DID 4155 02:36:02,400 --> 02:36:03,440 HAVE POSITIVE EFFECTS ON 4156 02:36:03,440 --> 02:36:05,400 CHILDREN BUT NO IMPACT ON BIRTH 4157 02:36:05,400 --> 02:36:08,520 OUTCOMES. 4158 02:36:08,520 --> 02:36:10,840 >> THANK YOU DR. CROSS BARNET. 4159 02:36:10,840 --> 02:36:12,840 >> DO YOU WANT ME TO ANSWER THE 4160 02:36:12,840 --> 02:36:14,680 SECOND COORDINATING CARE? 4161 02:36:14,680 --> 02:36:16,520 >> CERTAINLY, WE HAVE EXTRA 4162 02:36:16,520 --> 02:36:18,680 TIME. 4163 02:36:18,680 --> 02:36:21,800 >> SO CARE COORDINATION TENDS TO 4164 02:36:21,800 --> 02:36:25,240 BE ASSIGNED TO A SPECIFIC PERSON 4165 02:36:25,240 --> 02:36:28,000 WHO SAYS WHAT DO YOU NEED, THERE 4166 02:36:28,000 --> 02:36:29,760 MAYBE SCREENING ASSESSMENTS 4167 02:36:29,760 --> 02:36:31,120 DONE, HEALTH RELATED SOCIAL 4168 02:36:31,120 --> 02:36:33,400 NEEDS SCREENING, WE DID HAVE 4169 02:36:33,400 --> 02:36:35,720 THAT IN STRONG START WE SCREEN 4170 02:36:35,720 --> 02:36:37,680 FOR FOOD INSECURITY HOUSING 4171 02:36:37,680 --> 02:36:43,200 INSECURITY, DEPRESSION, ANXIETY, 4172 02:36:43,200 --> 02:36:45,600 SMOKING, ALCOHOL USE 4173 02:36:45,600 --> 02:36:48,200 UNEMPLOYMENT, WE SCREEN FOR A 4174 02:36:48,200 --> 02:36:48,720 LOT. 4175 02:36:48,720 --> 02:36:50,760 REALLY INITIALLY ANNOYED HOW 4176 02:36:50,760 --> 02:36:51,320 MUCH WE WERE SCREENING FOR 4177 02:36:51,320 --> 02:36:52,680 THOUGH A LOT OF THEM KEPT 4178 02:36:52,680 --> 02:36:54,200 SCREENING AFTER THE PROGRAM WAS 4179 02:36:54,200 --> 02:36:55,840 OVER SO THEY ONCE THEY 4180 02:36:55,840 --> 02:36:59,080 INCORPORATED INTO PRACTICE, I 4181 02:36:59,080 --> 02:37:00,640 THINK THAT IS INTERESTING TOO, 4182 02:37:00,640 --> 02:37:01,800 THEY SAY THEY WANT CARE 4183 02:37:01,800 --> 02:37:03,320 COORDINATION BUT RELUCTANT TO DO 4184 02:37:03,320 --> 02:37:04,560 THE SCREENING THAT YOU WOULD 4185 02:37:04,560 --> 02:37:08,040 NEED TO DO EFFECTIVE CARE 4186 02:37:08,040 --> 02:37:08,720 COORDINATION. 4187 02:37:08,720 --> 02:37:10,280 BUT THEN WHEN THEY INTEGRATED 4188 02:37:10,280 --> 02:37:12,520 THAT IT DIDN'T MATTER MUCH. 4189 02:37:12,520 --> 02:37:14,080 INTEGRATING CARE IS CHALLENGING 4190 02:37:14,080 --> 02:37:15,320 BECAUSE THERE'S SO MANY SYSTEMS. 4191 02:37:15,320 --> 02:37:17,600 WE DON'T HAVE ONE EHR THAT 4192 02:37:17,600 --> 02:37:20,720 EVERYBODY USE, SOME USE EPIC, 4193 02:37:20,720 --> 02:37:22,520 SOME HAVE THEIR OWN SYSTEMS. 4194 02:37:22,520 --> 02:37:24,800 THEY DON'T NECESSARILY TALK TO 4195 02:37:24,800 --> 02:37:25,520 EACH OTHER. 4196 02:37:25,520 --> 02:37:26,520 THERE ARE REGULATIONS AROUND 4197 02:37:26,520 --> 02:37:28,400 SHARING DATA WITHIN THE HEALTH 4198 02:37:28,400 --> 02:37:29,800 SYSTEM THROUGH HIPAA BUT IF YOU 4199 02:37:29,800 --> 02:37:33,200 ARE WORKING WITH KIDS, 4200 02:37:33,200 --> 02:37:35,800 INTEGRATED KIDS MODEL FRPA HAS 4201 02:37:35,800 --> 02:37:36,800 RESTRICTIONS ON WHAT YOU CAN 4202 02:37:36,800 --> 02:37:38,520 SHARE FROM THE SCHOOL SYSTEM AND 4203 02:37:38,520 --> 02:37:40,640 THE CHILD WELFARE SYSTEM HAS 4204 02:37:40,640 --> 02:37:43,520 VERY HIGHLY PROTECTED DATA 4205 02:37:43,520 --> 02:37:44,760 JUVENILE JUSTICE SYSTEMS OR 4206 02:37:44,760 --> 02:37:46,160 JUSTICE SYSTEMS IN GENERAL TEND 4207 02:37:46,160 --> 02:37:50,560 TO HAVE HIGHLY PROTECTED DATA TO 4208 02:37:50,560 --> 02:37:51,880 PROTECT PRIVACY, THAT IS 4209 02:37:51,880 --> 02:37:54,560 IMPORTANT BUT IT INTERFERES WITH 4210 02:37:54,560 --> 02:37:56,200 THE ABILITY OF PROVIDERS TO 4211 02:37:56,200 --> 02:37:58,840 UNDERSTAND EVERYTHING THAT IT 4212 02:37:58,840 --> 02:38:00,320 NEEDS TO TAKE TO PROVIDE SOMEONE 4213 02:38:00,320 --> 02:38:04,600 WITH CARE, WE DEFINITELY SAW, WE 4214 02:38:04,600 --> 02:38:08,120 DID FUND THROUGH BOTH INK AND 4215 02:38:08,120 --> 02:38:10,240 MOM WE GAVE MONEY TO IMPROVE 4216 02:38:10,240 --> 02:38:11,000 INFRASTRUCTURE TO DO THESE 4217 02:38:11,000 --> 02:38:13,360 SYSTEMS BUT WE STILL GOT PUSH 4218 02:38:13,360 --> 02:38:13,720 BACK. 4219 02:38:13,720 --> 02:38:15,800 SO MOM PEOPLE WOULD SAY, HOW DO 4220 02:38:15,800 --> 02:38:18,600 YOU EXPECT US TO DO THIS? 4221 02:38:18,600 --> 02:38:21,040 THAT IS WHAT WE GAVE YOU MONEY 4222 02:38:21,040 --> 02:38:21,560 FOR. 4223 02:38:21,560 --> 02:38:22,520 BECAUSE ACTUALLY LIKE PROVIDE 4224 02:38:22,520 --> 02:38:25,400 MEDICATION ASSISTED TREATMENT 4225 02:38:25,400 --> 02:38:27,400 FOR OPIOID USE DISORDER WE WANT 4226 02:38:27,400 --> 02:38:30,000 EVERYONE TO DO THAT WE WAN MORE 4227 02:38:30,000 --> 02:38:32,120 EFFECTIVE PROGRAMMING, MEDICARE 4228 02:38:32,120 --> 02:38:33,440 ALREADY COVERS THAT, YOU ARE NOT 4229 02:38:33,440 --> 02:38:35,360 COVERING THAT WITH OUR PROGRAM 4230 02:38:35,360 --> 02:38:36,600 FUNDS, THE PROGRAM FUNDS IMPROVE 4231 02:38:36,600 --> 02:38:39,560 THE SYSTEM. 4232 02:38:39,560 --> 02:38:41,800 SO OUT OF THE TEN AWARDEES WE 4233 02:38:41,800 --> 02:38:43,640 ORIGINALLY STARTED WITH, TWO 4234 02:38:43,640 --> 02:38:44,480 DROPPED OUT. 4235 02:38:44,480 --> 02:38:46,400 AND BUT AMONG THE REMAINING 4236 02:38:46,400 --> 02:38:47,400 EIGHT EVEN THOUGH THERE WERE A 4237 02:38:47,400 --> 02:38:50,000 LOT OF CHALLENGES THEY REALLY 4238 02:38:50,000 --> 02:38:51,280 FIGURED IT OUT, THEY WORKED WITH 4239 02:38:51,280 --> 02:38:53,400 THEIR EHR, THEY WORKED WITH 4240 02:38:53,400 --> 02:38:55,000 THEIR HEALTH INFORMATION 4241 02:38:55,000 --> 02:38:56,320 EXCHANGES, NOT SAYING PERFECT WE 4242 02:38:56,320 --> 02:38:58,320 DON'T HAVE ANY RESULTS YET WE 4243 02:38:58,320 --> 02:39:00,560 JUST STARTED ENROLLING PEOPLE IN 4244 02:39:00,560 --> 02:39:00,920 JULY. 4245 02:39:00,920 --> 02:39:03,800 SO WE WILL KNOW MORE AS TIME 4246 02:39:03,800 --> 02:39:06,720 GOES ON BUT INTEGRATING THOSE 4247 02:39:06,720 --> 02:39:08,840 SYSTEMS WAS CHALLENGING THEY HAD 4248 02:39:08,840 --> 02:39:10,720 18 MONTHS TO GET OFF THE GROUND, 4249 02:39:10,720 --> 02:39:13,400 TWO WANTED SICK MORE MONTHS, 4250 02:39:13,400 --> 02:39:14,720 EXTENSION -- SIX MORE MONTHS 4251 02:39:14,720 --> 02:39:16,080 EXTENSION SO TWO NOT STARTING 4252 02:39:16,080 --> 02:39:17,440 UNTIL JANUARY AND WE DON'T KNOW 4253 02:39:17,440 --> 02:39:19,560 HOW WELL IT WORKED WHAT WE DO 4254 02:39:19,560 --> 02:39:24,520 KNOW IS THE CARE COORDINATION 4255 02:39:24,520 --> 02:39:25,760 DOESN'T WORK ALONE SO WE ARE 4256 02:39:25,760 --> 02:39:27,200 TRYING TO BUILD ON THAT. 4257 02:39:27,200 --> 02:39:28,400 >> THANK YOU VERY MUCH, DR. 4258 02:39:28,400 --> 02:39:28,960 CROSS BARNET. 4259 02:39:28,960 --> 02:39:31,640 WE HAVE A QUESTION FOR 4260 02:39:31,640 --> 02:39:32,000 MS.ARGENTIERI. 4261 02:39:32,000 --> 02:39:33,800 CAN YOU SPEAK TO THE ETHICAL 4262 02:39:33,800 --> 02:39:36,000 ISSUES AROUND INTEGRATING 4263 02:39:36,000 --> 02:39:37,800 PATIENT RECORDS BETWEEN MULTIPLE 4264 02:39:37,800 --> 02:39:39,360 FAMILY MEMBERS, FOR EXAMPLE 4265 02:39:39,360 --> 02:39:41,440 MOTHER AND CHILD, TO FACILITATE 4266 02:39:41,440 --> 02:39:45,320 WHOLE FAMILY CARE, SUCH AS 4267 02:39:45,320 --> 02:39:46,440 PERINATAL DEPRESSION SCREENING 4268 02:39:46,440 --> 02:39:48,000 AND TWO GENERATION APPROACH TO 4269 02:39:48,000 --> 02:39:48,520 CARE? 4270 02:39:48,520 --> 02:39:51,240 SUCH AS REFERRALS FOR PARENTING 4271 02:39:51,240 --> 02:39:51,960 PROGRAMS? 4272 02:39:51,960 --> 02:39:55,920 AND ALSO DOES ONC HAVE 4273 02:39:55,920 --> 02:40:00,960 RECOMMENDATIONS FOR OR PROJECTS 4274 02:40:00,960 --> 02:40:02,800 AROUND BEST PRACTICE FOR THESE 4275 02:40:02,800 --> 02:40:06,200 TYPES OF INTEGRATIONS? 4276 02:40:06,200 --> 02:40:10,440 >> I'M NOT SURE IF RYAN IS ON 4277 02:40:10,440 --> 02:40:12,600 BUT I KNOW AROUND THAT I CAN'T 4278 02:40:12,600 --> 02:40:15,760 THINK OF ANYTHING TO ADD TO THAT 4279 02:40:15,760 --> 02:40:17,480 SPECIFIC -- BUT WHEN WE TALK 4280 02:40:17,480 --> 02:40:20,840 INTEGRATING PATIENT RECORDS, 4281 02:40:20,840 --> 02:40:23,080 JUST INTEGRATING DATA, FROM 4282 02:40:23,080 --> 02:40:24,400 DIFFERENT SOURCES WHAT WE ARE 4283 02:40:24,400 --> 02:40:26,000 LOOKING INTO IS INFORMED CONSENT 4284 02:40:26,000 --> 02:40:28,400 AND LOOKING AT SPECIFIC DATA 4285 02:40:28,400 --> 02:40:30,520 ELEMENTS TO GIVE PERMISSION. 4286 02:40:30,520 --> 02:40:32,280 FOR SPECIFIC DATA THAT MAYBE 4287 02:40:32,280 --> 02:40:37,040 ABLE TO BE SHARED. 4288 02:40:37,040 --> 02:40:46,120 ACROSS RECORDS. 4289 02:40:46,120 --> 02:40:49,200 >> FOR DR. CROSS BARNET. 4290 02:40:49,200 --> 02:40:50,520 SO INTERESTING SOCIAL 4291 02:40:50,520 --> 02:40:52,320 INTERACTION DIDN'T IMPROVE 4292 02:40:52,320 --> 02:40:52,680 OUTCOMES. 4293 02:40:52,680 --> 02:40:54,120 WHAT IS YOUR HYPOTHESIS WHY THIS 4294 02:40:54,120 --> 02:41:02,200 MIGHT BE? 4295 02:41:02,200 --> 02:41:06,120 >> SO WE DON'T KNOW IT NEVER 4296 02:41:06,120 --> 02:41:06,800 IMPROVED ANYTHING. 4297 02:41:06,800 --> 02:41:08,000 WE WERE MEASURING FACTORS, 4298 02:41:08,000 --> 02:41:10,320 LOOKING AT BIRTH OUTCOMES, WE 4299 02:41:10,320 --> 02:41:12,400 TRACE THE MOM AND BABY THROUGH 4300 02:41:12,400 --> 02:41:15,720 FIRST YEAR AS FAR AS COST COSTS WENT 4301 02:41:15,720 --> 02:41:17,000 AND UTILIZATION, EMERGENCY ROOM 4302 02:41:17,000 --> 02:41:18,160 VISITS, HOSPITALIZATION, THINGS 4303 02:41:18,160 --> 02:41:20,400 LIKE THAT. 4304 02:41:20,400 --> 02:41:23,280 SO COULD HAVE HELPED WITH 4305 02:41:23,280 --> 02:41:24,520 ENGAGEMENT WITH THE SYSTEM, MORE 4306 02:41:24,520 --> 02:41:25,760 TRUST IN HEALTHCARE PROVIDERS OR 4307 02:41:25,760 --> 02:41:26,160 THINGS LIKE THAT. 4308 02:41:26,160 --> 02:41:27,760 I DON'T WANT TO -- I DON'T WANT 4309 02:41:27,760 --> 02:41:31,320 TO IMPLY IT DIDN'T DO ANYTHING. 4310 02:41:31,320 --> 02:41:34,480 BUT IF YOU LOOK AT -- THERE'S 4311 02:41:34,480 --> 02:41:37,360 COCHRAN REVIEWS ABOUT MIDWIFERY 4312 02:41:37,360 --> 02:41:39,360 MODEL OF CARE LOOKING AT WHAT 4313 02:41:39,360 --> 02:41:41,360 THEY CALL MIDWIFERY CONTINUITY 4314 02:41:41,360 --> 02:41:42,600 MODEL WHICH IS WHAT IS PROVIDED 4315 02:41:42,600 --> 02:41:44,880 IN THE BIRTH CENTER AND ALSO 4316 02:41:44,880 --> 02:41:47,080 FOUND REDUCTION IN PRE-TERM 4317 02:41:47,080 --> 02:41:48,440 BIRTH THERE AND THAT WAS THROUGH 4318 02:41:48,440 --> 02:41:50,680 MORE RANDOMIZE CONTROL TRIALS AS 4319 02:41:50,680 --> 02:41:52,040 WELL SO FINDINGS AREN'T 4320 02:41:52,040 --> 02:41:53,360 NECESSARILY SUR SPRUCING. 4321 02:41:53,360 --> 02:41:55,360 I DO THINK ENGAGING WITH YOUR 4322 02:41:55,360 --> 02:41:58,400 ACTUAL PROVIDE ERATHER THAN 4323 02:41:58,400 --> 02:41:59,880 ANSWER LAYER PERSON IS -- CAN BE 4324 02:41:59,880 --> 02:42:02,840 REALLY CRITICAL. 4325 02:42:02,840 --> 02:42:06,000 FOR THAT PERSON BEING ABLE TO 4326 02:42:06,000 --> 02:42:07,720 MEET NEEDS. 4327 02:42:07,720 --> 02:42:10,400 IT CAN HELP ALSO TO BE HAVE MORE 4328 02:42:10,400 --> 02:42:13,320 CENTRALIZED WITH ONE PERSON SO 4329 02:42:13,320 --> 02:42:16,760 IF YOU SAY THIS PERSON HAS A 4330 02:42:16,760 --> 02:42:18,760 NUTRITIONAL NEED, AND THIS 4331 02:42:18,760 --> 02:42:19,960 PERSON HAS BEHAVIORAL HEALTH 4332 02:42:19,960 --> 02:42:22,240 NEEDS AND WE'LL SEND TO SOCIAL 4333 02:42:22,240 --> 02:42:23,520 WORKER FOR THERAPY, AND THIS 4334 02:42:23,520 --> 02:42:26,240 PERSON HAS THIS AND WE WILL SEND 4335 02:42:26,240 --> 02:42:26,760 TO THIS PERSON. 4336 02:42:26,760 --> 02:42:28,360 PROBABLY NONE OF US WANT TO TALK 4337 02:42:28,360 --> 02:42:30,480 TO HALF A DOZEN STRAININGSER 4338 02:42:30,480 --> 02:42:31,120 ABOUT OUR PERSONAL BUSINESS AND 4339 02:42:31,120 --> 02:42:33,720 THE MIDWIFERY MODEL REALLY 4340 02:42:33,720 --> 02:42:35,000 CENTERS MORE OF THAT WITH 4341 02:42:35,000 --> 02:42:37,520 PRIMARY PROVIDER NOT THAT SHE 4342 02:42:37,520 --> 02:42:38,640 WOULDN'T REFER OUT FOR SOMEBODY 4343 02:42:38,640 --> 02:42:40,080 WITH INTENSIVE NEED BUT THEY 4344 02:42:40,080 --> 02:42:40,920 TALK FOOD. 4345 02:42:40,920 --> 02:42:42,680 THERE IS A LOT OF TIME TO TALK 4346 02:42:42,680 --> 02:42:45,280 ABOUT WHAT ARE YOU'DING AND MAKE 4347 02:42:45,280 --> 02:42:46,400 A PLAN. 4348 02:42:46,400 --> 02:42:48,240 SO FORTH AND MORE FOLLOW-UP FROM 4349 02:42:48,240 --> 02:42:50,200 THAT PERSON. 4350 02:42:50,200 --> 02:42:52,440 SO IT IS JUST MORE AROUND THAT 4351 02:42:52,440 --> 02:42:53,960 REAL RELATIONSHIP BUILDING. 4352 02:42:53,960 --> 02:42:57,200 AS OPPOSED TO -- WE REALLY HAVE 4353 02:42:57,200 --> 02:42:58,920 I WILL SAY IN MATERNITY CARE 4354 02:42:58,920 --> 02:43:00,280 HOMES MORE LIKELY TO SEE 4355 02:43:00,280 --> 02:43:01,280 INFORMATION COMING THROUGH TO US 4356 02:43:01,280 --> 02:43:03,720 THAT WOULD SAY THINGS LIKE WE 4357 02:43:03,720 --> 02:43:06,480 WILL SEE 500 PREGNANCIES AND I 4358 02:43:06,480 --> 02:43:07,960 ALWAYS THINK TWO PREGNANCIES 4359 02:43:07,960 --> 02:43:10,080 WALK INTO A BAR, ONE SAYS TO -- 4360 02:43:10,080 --> 02:43:11,920 YOU KNOW, IT IS SUPPOSED TO 4361 02:43:11,920 --> 02:43:14,600 REALLY THINKING OF THEM AS 4362 02:43:14,600 --> 02:43:15,440 PEOPLE. 4363 02:43:15,440 --> 02:43:17,200 AND YOU HEAR THAT ALL TIME IN 4364 02:43:17,200 --> 02:43:18,400 MEDICINE. 4365 02:43:18,400 --> 02:43:21,240 WHERE PEOPLE ARE TIRED AND THEY 4366 02:43:21,240 --> 02:43:23,040 ARE SEEING PATIENT AFTER PATIENT 4367 02:43:23,040 --> 02:43:24,880 AFTER PATIENT, YOU START TALKING 4368 02:43:24,880 --> 02:43:26,440 ABOUT KIDMY THE ROOM THREE. 4369 02:43:26,440 --> 02:43:28,120 -- KIDNEY IN ROOM THREE. 4370 02:43:28,120 --> 02:43:29,360 THERE IS A FAIR AMOUNT OF THAT 4371 02:43:29,360 --> 02:43:34,040 THAT GOES ON IN THE KINDS OF 4372 02:43:34,040 --> 02:43:35,720 CLINICAL CARE PROVIDED FOR 4373 02:43:35,720 --> 02:43:36,200 PRE-NATAL CARE. 4374 02:43:36,200 --> 02:43:38,600 WE HAVE PEOPLE WHO ARE REALLY 4375 02:43:38,600 --> 02:43:40,400 OVERQUALIFIED FOR PROVIDER BASIC 4376 02:43:40,400 --> 02:43:41,640 PRE-NATAL CARE, DOING THAT JOB. 4377 02:43:41,640 --> 02:43:45,200 SO WE ARE PAYING A LOT OF MONEY 4378 02:43:45,200 --> 02:43:49,040 TO HAVE SOMEBODY WHO IS 4379 02:43:49,040 --> 02:43:50,600 OBSTETRICIAN OR MATERNAL FETAL 4380 02:43:50,600 --> 02:43:52,280 MEDICINE SPECIALIST, REALLY 4381 02:43:52,280 --> 02:43:54,160 OFFERING MUCH HIGHER LEVEL OF 4382 02:43:54,160 --> 02:43:57,480 CARE THAN AVERAGE PREGNANT 4383 02:43:57,480 --> 02:43:58,840 PERSON NEEDS. 4384 02:43:58,840 --> 02:44:01,080 THEN BECAUSE YOU ARE PAYING THEM 4385 02:44:01,080 --> 02:44:02,760 FOR THEIR EXPERTISE THEY DON'T 4386 02:44:02,760 --> 02:44:03,800 HAVE THE TIME TO SPEND WITH THIS 4387 02:44:03,800 --> 02:44:04,600 PERSON. 4388 02:44:04,600 --> 02:44:06,360 AND THEY ALSO DON'T HAVE THE 4389 02:44:06,360 --> 02:44:08,000 TRAINING AND RELATIONSHIP BASED 4390 02:44:08,000 --> 02:44:08,200 CARE. 4391 02:44:08,200 --> 02:44:09,840 THEY ARE TRAINED TO DEAL WITH 4392 02:44:09,840 --> 02:44:11,120 MEDICAL PROBLEMS. 4393 02:44:11,120 --> 02:44:12,360 WE ARE REALLY IMPORTANT PART OF 4394 02:44:12,360 --> 02:44:13,760 THE CARE TEAM. 4395 02:44:13,760 --> 02:44:17,440 WE DEFINITELY DON'T WANT OUR 4396 02:44:17,440 --> 02:44:18,880 BIRTH CENTER FOLKS REFER PEOPLE 4397 02:44:18,880 --> 02:44:20,320 ALL THE TIME WHEN THEY NEEDED A 4398 02:44:20,320 --> 02:44:22,120 HIGHER LEVEL OF CARE AND AS I 4399 02:44:22,120 --> 02:44:23,600 SAID WE HAD HALF THE PEOPLE 4400 02:44:23,600 --> 02:44:25,800 GIVING BIRTH IN THE HOSPITAL, 4401 02:44:25,800 --> 02:44:28,880 THERE WAS PEOPLE DEFINITELY HAD 4402 02:44:28,880 --> 02:44:32,400 CESAREANS, IT WAS NOT AS IF 4403 02:44:32,400 --> 02:44:34,200 THERE WERE -- WASN'T A NEED FOR 4404 02:44:34,200 --> 02:44:35,000 DOCTORS WITHIN THAT MODEL. 4405 02:44:35,000 --> 02:44:37,600 THERE IS. 4406 02:44:37,600 --> 02:44:39,640 BUT THE LOW RISK PEOPLE WERE 4407 02:44:39,640 --> 02:44:41,200 PROVIDED WITH APPROPRIATE LOW 4408 02:44:41,200 --> 02:44:42,440 RISK CARE THAT WAS MUCH MORE 4409 02:44:42,440 --> 02:44:46,840 FOCUSED ON THEIR SOCIAL NEEDS 4410 02:44:46,840 --> 02:44:48,000 THROUGH ONE SMALL HANDFUL OF 4411 02:44:48,000 --> 02:44:50,320 PEOPLE. 4412 02:44:50,320 --> 02:44:51,200 AND THEY WERE NOT NECESSARILY 4413 02:44:51,200 --> 02:44:53,440 HAVING TO GO TO 50 DIFFERENT 4414 02:44:53,440 --> 02:44:56,000 PLACES. 4415 02:44:56,000 --> 02:45:00,040 >> THANK YOU, DR. CROSS BARNET. 4416 02:45:00,040 --> 02:45:02,000 QUESTION FOR MS. HENRY. 4417 02:45:02,000 --> 02:45:03,480 WOMEN'S HEALTH TECHNOLOGIES 4418 02:45:03,480 --> 02:45:05,400 COORDINATED REGISTRY NETWORK 4419 02:45:05,400 --> 02:45:08,120 INTEREST GROUP WAS DEVELOPED TO 4420 02:45:08,120 --> 02:45:09,200 SERVE AS COMMON REGISTRY 4421 02:45:09,200 --> 02:45:11,920 REPORTING FRAMEWORK BUILT FROM 4422 02:45:11,920 --> 02:45:13,520 PREVIOUSLY DEVELOPED FAST 4423 02:45:13,520 --> 02:45:14,920 HEALTHCARE INTEROPERABILITY 4424 02:45:14,920 --> 02:45:15,360 RESOURCES. 4425 02:45:15,360 --> 02:45:18,920 ARE THERE OTHER RESOURCES 4426 02:45:18,920 --> 02:45:20,240 AVAILABLE TO SUPPORT RESEARCHERS 4427 02:45:20,240 --> 02:45:22,400 INTERESTED IN ENHANCING DATA 4428 02:45:22,400 --> 02:45:24,080 COLLECTION EFFORTS? 4429 02:45:24,080 --> 02:45:25,640 >> YES, THANK YOU, FOR THE 4430 02:45:25,640 --> 02:45:26,560 QUESTION. 4431 02:45:26,560 --> 02:45:28,840 SO SOME OF THE WORK THAT ONC IS 4432 02:45:28,840 --> 02:45:30,560 FOCUSED ON IS ADVANCING HEALTH 4433 02:45:30,560 --> 02:45:32,000 EQUITY OPPORTUNITIES THROUGH THE 4434 02:45:32,000 --> 02:45:34,720 USE OF CERTIFIED HEALTH IT RACE 4435 02:45:34,720 --> 02:45:37,400 AND ETHNICITY CAPABILITIES AS 4436 02:45:37,400 --> 02:45:38,000 WELL AS CODES. 4437 02:45:38,000 --> 02:45:40,600 SO WE WORKED WITH STAKEHOLDERS 4438 02:45:40,600 --> 02:45:42,600 TO INCLUDE SOCIAL DETERMINANTS 4439 02:45:42,600 --> 02:45:44,200 OF HEALTH DATA ELEMENTS AS WELL 4440 02:45:44,200 --> 02:45:46,160 AS SEXUAL ORIENTATION AND 4441 02:45:46,160 --> 02:45:48,920 GENDER, IDENTITY, DATA ELEMENTS 4442 02:45:48,920 --> 02:45:52,120 WHAT WE CALL USCDI THAT STANDS 4443 02:45:52,120 --> 02:45:54,560 FOR U.S. CORE DATA ELEMENTS FOR 4444 02:45:54,560 --> 02:45:55,440 INTEROPERABILITY. 4445 02:45:55,440 --> 02:45:57,880 AND THAT IS WHAT WE BASE THE 4446 02:45:57,880 --> 02:45:59,080 DEVELOPMENT OF SOME OF OUR 4447 02:45:59,080 --> 02:46:01,600 STANDARDS OFF OF SO WHEN YOU 4448 02:46:01,600 --> 02:46:03,720 TAKE SOMETHING LIKE COORDINATED 4449 02:46:03,720 --> 02:46:05,240 REGISTRY NETWORK AND DEVELOPMENT 4450 02:46:05,240 --> 02:46:07,120 OF THAT IMPLEMENTATION GUIDE 4451 02:46:07,120 --> 02:46:08,800 BECAUSE WE PROVIDED THESE NEW 4452 02:46:08,800 --> 02:46:12,720 DATA ELEMENTS IN THE U.S.CDI IT 4453 02:46:12,720 --> 02:46:14,920 PRESENTS THEM AS OPPORTUNITY TO 4454 02:46:14,920 --> 02:46:19,480 BE INCLUDED IN ADVANCING 4455 02:46:19,480 --> 02:46:20,280 IMPLEMENTATION GUIDE DEVELOP 4456 02:46:20,280 --> 02:46:22,920 FORD REGISTRY SO GOOD NEWS FOR 4457 02:46:22,920 --> 02:46:23,960 RESEARCHERS, THAT THESE DATA 4458 02:46:23,960 --> 02:46:26,480 ELEMENTS ARE OUT THERE FOR THEM 4459 02:46:26,480 --> 02:46:30,400 TO USE TO ENHANCE REGISTRIES AN 4460 02:46:30,400 --> 02:46:31,000 DATA COLLECTION EFFORTS. 4461 02:46:31,000 --> 02:46:34,960 >> THANK YOU, MS. HENRY. 4462 02:46:34,960 --> 02:46:38,120 >> HELLO. 4463 02:46:38,120 --> 02:46:39,760 >> QUESTION FOR DR. CROSS 4464 02:46:39,760 --> 02:46:40,600 BARNET. 4465 02:46:40,600 --> 02:46:42,440 I THINK YOU HAVE STARTED 4466 02:46:42,440 --> 02:46:47,360 ADDRESSING THIS. 4467 02:46:47,360 --> 02:46:48,720 SHOULD CARE COORDINATION BE PART 4468 02:46:48,720 --> 02:46:49,360 OF INTEGRATED CARE? 4469 02:46:49,360 --> 02:46:52,400 AND IF SO, HOW? 4470 02:46:52,400 --> 02:46:55,960 >> REALLY GREAT QUESTION. 4471 02:46:55,960 --> 02:46:57,720 I THINK A LOT OF PEOPLE DO NEED 4472 02:46:57,720 --> 02:46:58,080 IT. 4473 02:46:58,080 --> 02:46:59,760 I THINK ONE OF THE ISSUES THAT 4474 02:46:59,760 --> 02:47:01,600 YOU SEE, THIS SOMETHING THAT WE 4475 02:47:01,600 --> 02:47:02,800 CONFRONTED WITH INTEGRATED CARE 4476 02:47:02,800 --> 02:47:03,600 FOR KIDS IN PARTICULAR BECAUSE 4477 02:47:03,600 --> 02:47:06,080 WE ARE LOOKING AT SO MANY 4478 02:47:06,080 --> 02:47:07,400 SYSTEMS IS EVEN CARE 4479 02:47:07,400 --> 02:47:08,720 COORDINATION IS OFTEN NOT WELL 4480 02:47:08,720 --> 02:47:10,720 COORDINATE SOD YOU MAY HAVE A 4481 02:47:10,720 --> 02:47:11,680 CHILD WHO HAS SOMEBODY 4482 02:47:11,680 --> 02:47:13,120 COORDINATING ISSUES MANY THE 4483 02:47:13,120 --> 02:47:14,440 EDUCATION SYSTEM, SOMEBODY ELSE 4484 02:47:14,440 --> 02:47:18,080 WHO IS COORDINATING BEHAVIORAL 4485 02:47:18,080 --> 02:47:18,800 HEALTHCARE, COORDINATING SOME 4486 02:47:18,800 --> 02:47:22,000 SPECIALIZED MEDICAL NEED THEY 4487 02:47:22,000 --> 02:47:23,480 HAVE ASTHMA CARE SO THE FAMILY 4488 02:47:23,480 --> 02:47:25,160 IS NOT JUST DEALING WITH ALL 4489 02:47:25,160 --> 02:47:27,080 THESE MULTIPLE SOCIAL MEDICAL 4490 02:47:27,080 --> 02:47:28,440 ISSUES BUT ALSO DEALING WITH 4491 02:47:28,440 --> 02:47:30,760 HALF DOZEN CARE COORDINATORS. 4492 02:47:30,760 --> 02:47:34,600 ONE OF THE THINGS THAT INK TRIED 4493 02:47:34,600 --> 02:47:36,000 TO DO IS ESTABLISH SINGLE POINT 4494 02:47:36,000 --> 02:47:37,440 OF CARE. 4495 02:47:37,440 --> 02:47:39,280 SO BASICALLY SOMEBODY WHO 4496 02:47:39,280 --> 02:47:40,080 COORDINATES COORDINATION. 4497 02:47:40,080 --> 02:47:43,080 SO THAT THE FAMILIES ACTUALLY 4498 02:47:43,080 --> 02:47:45,960 ONLY INTERACTING WITH ONE 4499 02:47:45,960 --> 02:47:46,440 PERSON. 4500 02:47:46,440 --> 02:47:48,560 I ALSO THINK OF THIS ISSUES 4501 02:47:48,560 --> 02:47:51,880 AROUND DATA AND INFORMATION 4502 02:47:51,880 --> 02:47:53,480 SHARING MAKE CARE COORDINATION 4503 02:47:53,480 --> 02:47:54,000 IT MORE EFFECTIVE. 4504 02:47:54,000 --> 02:47:58,800 AN EXAMPLE WHICH IS LOW DOSE 4505 02:47:58,800 --> 02:48:01,000 ASPIRIN SOMETHING WE KNOW HELPS 4506 02:48:01,000 --> 02:48:03,960 PREVENT PREECLAMPSIA, THERE IS 4507 02:48:03,960 --> 02:48:05,040 RECOMMENDATIONS REINFORCED BY 4508 02:48:05,040 --> 02:48:09,720 THE U.S. PREVENTIVE SERVICES 4509 02:48:09,720 --> 02:48:11,400 TASK FORCE 60 MONTHS AGO AND 4510 02:48:11,400 --> 02:48:13,240 ASKED PEEP STRONG START IF THEY 4511 02:48:13,240 --> 02:48:15,200 WERE PROVIDING ASPIRIN TO 4512 02:48:15,200 --> 02:48:17,600 PATIENTS AT RISK FOR 4513 02:48:17,600 --> 02:48:19,000 PREECLAMPSIA, BECAUSE PEOPLE HAD 4514 02:48:19,000 --> 02:48:21,680 RISK FACTORS INCLUDING MODERATE 4515 02:48:21,680 --> 02:48:23,560 RISK FACTORS SO IF YOU HAVE 4516 02:48:23,560 --> 02:48:24,960 MULTIPLE MODERATE RISK FACTORS 4517 02:48:24,960 --> 02:48:30,000 YOU ARE ELIGIBLE FOR ATTEMPTING 4518 02:48:30,000 --> 02:48:30,400 ASPIRIN. 4519 02:48:30,400 --> 02:48:31,560 WE FOUND IT WAS RANDOM WHETHER 4520 02:48:31,560 --> 02:48:33,080 OR NOT PEOPLE DID, IT DIDN'T 4521 02:48:33,080 --> 02:48:34,840 SEEM CORRELATE WITH THE TYPE OF 4522 02:48:34,840 --> 02:48:36,200 PROVIDER, OR WHERE THEY WERE 4523 02:48:36,200 --> 02:48:37,240 PRACTICING, ASIDE FROM A COUPLE 4524 02:48:37,240 --> 02:48:39,040 OF ACADEMIC MEDICAL CENTERS THAT 4525 02:48:39,040 --> 02:48:40,800 DID IT CONSISTENTLY BUT EVEN 4526 02:48:40,800 --> 02:48:42,440 AMONG ACADEMIC MEDICAL CENTERS 4527 02:48:42,440 --> 02:48:44,640 WE HAD ONE THERE THEY WERE LIKE 4528 02:48:44,640 --> 02:48:46,360 OUR HEAD OB SUSOR DOESN'T THINK 4529 02:48:46,360 --> 02:48:47,400 IT WORKS SO WE DON'T DO IT. 4530 02:48:47,400 --> 02:48:50,040 THINGS LIKE THAT. 4531 02:48:50,040 --> 02:48:51,840 BUT IT WAS PROVIDER SPECIFIC SO 4532 02:48:51,840 --> 02:48:54,200 SOME OFFERED IT, SOME DIDN'T. 4533 02:48:54,200 --> 02:48:56,600 THE PERSON WOULD SEE MULTIPLE 4534 02:48:56,600 --> 02:48:57,760 PROVIDERS, AND SO SOME PEOPLE 4535 02:48:57,760 --> 02:49:00,960 WOULD BE RECOMMENDING IT AND 4536 02:49:00,960 --> 02:49:03,200 WHETHER SHE FOLLOWED UP DEPENDED 4537 02:49:03,200 --> 02:49:05,400 WHETHER OR NOT NEXT WAS READING 4538 02:49:05,400 --> 02:49:07,560 THE CHART AND WHEN WE TALK TO 4539 02:49:07,560 --> 02:49:08,600 COMMUNITY HEALTH WORKERS AND 4540 02:49:08,600 --> 02:49:12,120 CARE COORDINATORS NO MATTER 4541 02:49:12,120 --> 02:49:13,480 CREDENTIALS, MY FAVORITE QUOTE I 4542 02:49:13,480 --> 02:49:14,600 KNOW NOTHING ABOUT THE ASPIRIN 4543 02:49:14,600 --> 02:49:17,200 THING AND THERE WAS A LOT OF 4544 02:49:17,200 --> 02:49:18,520 THAT. 4545 02:49:18,520 --> 02:49:20,360 CARE COORDINATORS HAD NO IDEA 4546 02:49:20,360 --> 02:49:21,440 WHAT HAD BEEN PRESCRIBED TO 4547 02:49:21,440 --> 02:49:22,600 THESE FOLKS OR RECOMMENDED TO 4548 02:49:22,600 --> 02:49:22,960 THEM. 4549 02:49:22,960 --> 02:49:24,440 SO THERE WAS NO OPPORTUNITY FOR 4550 02:49:24,440 --> 02:49:27,000 THEM TO ANSWER QUESTIONS OR 4551 02:49:27,000 --> 02:49:28,440 FOLLOW-UP PEOPLE GET MIXED 4552 02:49:28,440 --> 02:49:30,120 MESSAGE IT IS PHARMACIST WOULD 4553 02:49:30,120 --> 02:49:31,480 BE LIKE OH NO YOU DON'T WANT TO 4554 02:49:31,480 --> 02:49:32,440 TAKE THAT. 4555 02:49:32,440 --> 02:49:33,760 AND THERE WAS JUST -- THERE 4556 02:49:33,760 --> 02:49:35,600 WASN'T ENOUGH COMMUNICATION TO 4557 02:49:35,600 --> 02:49:36,840 REALLY KEEP THAT GOING AND HELP 4558 02:49:36,840 --> 02:49:40,440 THE PERSON. 4559 02:49:40,440 --> 02:49:42,720 SO I THINK CARE COORDINATION IS 4560 02:49:42,720 --> 02:49:44,440 HELPFUL, IT DEPENDS IN PART WHAT 4561 02:49:44,440 --> 02:49:47,520 RESOURCES ARE AVAILABLE, WHAT 4562 02:49:47,520 --> 02:49:48,640 COMMUNICATION AMONG PROVIDERS 4563 02:49:48,640 --> 02:49:51,920 AND CARE COORDINATORS. 4564 02:49:51,920 --> 02:49:56,000 AND WHAT KIND OF COORDINATION 4565 02:49:56,000 --> 02:49:56,680 ACROSS THE BOARD. 4566 02:49:56,680 --> 02:49:57,840 YOU ALSO HAVE CONNECTION. 4567 02:49:57,840 --> 02:49:59,720 AN EXAMPLE FROM LOS ANGELES 4568 02:49:59,720 --> 02:50:02,480 STRONG START WE HAD -- THEY WERE 4569 02:50:02,480 --> 02:50:04,600 SERVING A VERY LARGE LATINA 4570 02:50:04,600 --> 02:50:07,480 COMMUNITY, AND THEY HIRED CARE 4571 02:50:07,480 --> 02:50:10,600 COORDINATORS WHO WERE THEMSELVES 4572 02:50:10,600 --> 02:50:11,800 LATINA. 4573 02:50:11,800 --> 02:50:14,320 BUT THEY TENDED TO BE OLDER AND 4574 02:50:14,320 --> 02:50:15,440 OFTEN QUITE RELIGIOUS. 4575 02:50:15,440 --> 02:50:18,280 AND THEY WERE DEALING WITH YOUNG 4576 02:50:18,280 --> 02:50:19,200 WOMEN MOST STRONG START 4577 02:50:19,200 --> 02:50:21,000 PARTICIPANTS WERE IN THEIR EARLY 4578 02:50:21,000 --> 02:50:21,640 20s. 4579 02:50:21,640 --> 02:50:22,840 AND THEY WEREN'T CONNECTING WITH 4580 02:50:22,840 --> 02:50:24,440 THE PEOPLE THEY WERE OFTEN 4581 02:50:24,440 --> 02:50:25,240 JUDGMENTAL OF THE THINGS THEY 4582 02:50:25,240 --> 02:50:27,360 WERE DOING, FELT LIKE THESE 4583 02:50:27,360 --> 02:50:29,040 GIRLS WERE WRONG FOR NOT BEING 4584 02:50:29,040 --> 02:50:30,760 MARRIED OR PARTYING TOO HARD OR 4585 02:50:30,760 --> 02:50:34,000 JUST NOT DOING THINGS SPECIFIC 4586 02:50:34,000 --> 02:50:37,040 WAY, SO JUST BECAUSE YOU ARE 4587 02:50:37,040 --> 02:50:38,200 PULLING SOMEBODY FROM A 4588 02:50:38,200 --> 02:50:40,000 COMMUNITY DOESN'T MEAN THEY ARE 4589 02:50:40,000 --> 02:50:41,600 -- IT IS NOT JUST LIKE OH LOOK 4590 02:50:41,600 --> 02:50:43,080 THEY ARE THE SAME COLOR LET'S 4591 02:50:43,080 --> 02:50:44,240 THROW THEM IN A ROOM TOGETHER. 4592 02:50:44,240 --> 02:50:45,440 YOU HAVE TO THINK MORE ABOUT THE 4593 02:50:45,440 --> 02:50:47,920 WAY PEOPLE ARE MAKING 4594 02:50:47,920 --> 02:50:48,560 CONNECTIONS AND WHETHER OR NOT 4595 02:50:48,560 --> 02:50:50,520 THEY REALLY ARE FROM THE SAME 4596 02:50:50,520 --> 02:50:53,080 BACKGROUND AND WHAT THAT MEANS. 4597 02:50:53,080 --> 02:50:54,800 I ACTUALLY WATCHED A CARE 4598 02:50:54,800 --> 02:50:55,640 COORDINATOR INTERACTING WITH 4599 02:50:55,640 --> 02:50:57,440 SOME PEOPLE AT ONE OF THE BIRTH 4600 02:50:57,440 --> 02:50:59,280 CENTERS AND SHE WAS A NURSE WHO 4601 02:50:59,280 --> 02:51:01,000 HAD HERSELF BEEN A MEDICAID 4602 02:51:01,000 --> 02:51:01,400 PARTICIPANT. 4603 02:51:01,400 --> 02:51:05,760 BUT SHE JUST HAD A VERY GRUFF 4604 02:51:05,760 --> 02:51:06,800 MANNER, AND I WOULDN'T HAVE 4605 02:51:06,800 --> 02:51:10,400 WANTED TO TALK TO HER. 4606 02:51:10,400 --> 02:51:12,320 SO SOME IS LIKE SOMEBODY MIGHT 4607 02:51:12,320 --> 02:51:13,600 LOOK LIKE THEY ARE THE RIGHT 4608 02:51:13,600 --> 02:51:14,560 KIND OF PERSON BUT ARE THEY 4609 02:51:14,560 --> 02:51:18,520 REALLY MAKING CONNECTIONS WITH 4610 02:51:18,520 --> 02:51:21,160 PEOPLE, THAT CAN BE A BIG PART 4611 02:51:21,160 --> 02:51:21,520 TOO. 4612 02:51:21,520 --> 02:51:22,280 THERE IS A LOT. 4613 02:51:22,280 --> 02:51:23,560 WHAT HAPPENS IS IT IS HARD TO 4614 02:51:23,560 --> 02:51:24,560 KNOW WHAT TO DO. 4615 02:51:24,560 --> 02:51:26,640 AND YOU HAVE THESE BUSY 4616 02:51:26,640 --> 02:51:28,760 PHYSICIANS WHO DON'T KNOW HOW TO 4617 02:51:28,760 --> 02:51:31,160 HAVE THE TIME TO HANDLE THESE 4618 02:51:31,160 --> 02:51:34,560 PROBLEMS, LIKE OH WE WILL HIRE A 4619 02:51:34,560 --> 02:51:36,120 CARE COORDINATOR, THEY WILL 4620 02:51:36,120 --> 02:51:37,800 HANDLE IT AND YET WHAT ARE THEY 4621 02:51:37,800 --> 02:51:42,320 HANDLING AND WHAT TOOLS, WHAT 4622 02:51:42,320 --> 02:51:45,400 COMMUNICATION IS THERE, IT SEEMS 4623 02:51:45,400 --> 02:51:47,280 LIKE AN EASY FIX AND IT IS NOT, 4624 02:51:47,280 --> 02:51:48,600 IF THIS PROBLEM WERE EASILY 4625 02:51:48,600 --> 02:51:51,120 FIXED WE WOULD HAVE FIXED IT. 4626 02:51:51,120 --> 02:51:54,440 >> I DON'T THINK ENOUGH CAN BE 4627 02:51:54,440 --> 02:51:56,120 SAID ABOUT THE IMPORTANCE OF 4628 02:51:56,120 --> 02:51:57,600 THAT POINT YOU JUST MADE ABOUT 4629 02:51:57,600 --> 02:52:01,520 LOOKING AT PEOPLE AS MONOLITHS 4630 02:52:01,520 --> 02:52:03,840 AND FAILING TO RECOGNIZE THERE 4631 02:52:03,840 --> 02:52:07,160 ARE INDIVIDUAL DIFFERENCES AN 4632 02:52:07,160 --> 02:52:08,720 MICROCULTURES WITHIN OUR RACIAL 4633 02:52:08,720 --> 02:52:10,520 ETHNIC GROUPS. 4634 02:52:10,520 --> 02:52:16,240 A QUESTION FROM MS. HENRY. 4635 02:52:16,240 --> 02:52:18,000 ADDITIONAL COMPONENTS A TEAM 4636 02:52:18,000 --> 02:52:19,000 SHOULD CONSIDER WHEN DEVELOPING 4637 02:52:19,000 --> 02:52:22,840 A COORDINATED HEALTH NETWORK OR 4638 02:52:22,840 --> 02:52:24,000 ANY INFRASTRUCTURE TO SUPPORT 4639 02:52:24,000 --> 02:52:27,240 HEALTHCARE SYSTEMS? 4640 02:52:27,240 --> 02:52:28,720 >> THANKS FOR THE QUESTION. 4641 02:52:28,720 --> 02:52:32,720 AS EMERGED IN THE PRESENTATION, 4642 02:52:32,720 --> 02:52:34,160 THERE ARE DIFFERENCES AMONG RING 4643 02:52:34,160 --> 02:52:37,000 INDUSTRIES ON THE PLATFORMSTHEY 4644 02:52:37,000 --> 02:52:38,080 CURRENTLY HAVE. 4645 02:52:38,080 --> 02:52:40,400 SO ONE THING TO HIGHLIGHT FROM 4646 02:52:40,400 --> 02:52:43,480 THE PRESENTATION IS THINKING 4647 02:52:43,480 --> 02:52:44,480 READINESS FOR HEALTH IT TOOLS 4648 02:52:44,480 --> 02:52:47,160 WHEN TALKING DIFFERENT 4649 02:52:47,160 --> 02:52:48,320 STAKEHOLDERS. 4650 02:52:48,320 --> 02:52:50,720 AND THE TEAM SEEKING TO USE, THE 4651 02:52:50,720 --> 02:52:53,600 OTHER THING IS JUST THINKING 4652 02:52:53,600 --> 02:52:55,920 MORE NOT JUST ABOUT 4653 02:52:55,920 --> 02:52:57,480 INFRASTRUCTURE OVERALL BUT ALSO 4654 02:52:57,480 --> 02:52:58,800 LOOKING AT WHAT GOVERNMENTS 4655 02:52:58,800 --> 02:53:01,520 LOOKS LIKE FOR THAT TEAM LOOKING 4656 02:53:01,520 --> 02:53:02,800 TO DEVELOP COORDINATOR REGISTRY 4657 02:53:02,800 --> 02:53:04,600 NETWORK, BEING ABLE TO REALLY 4658 02:53:04,600 --> 02:53:06,480 TALK ABOUT THE ROLES AND 4659 02:53:06,480 --> 02:53:08,600 RESPONSIBILITIES FOR EACH 4660 02:53:08,600 --> 02:53:10,600 STAKEHOLDER THAT YOU PLAN TO 4661 02:53:10,600 --> 02:53:13,560 HAVE AS PART OF THAT NETWORK. 4662 02:53:13,560 --> 02:53:15,160 ARE YOUR TEAM DEVELOPING OUT 4663 02:53:15,160 --> 02:53:16,320 HEALTH IT FOR RESEARCH OR 4664 02:53:16,320 --> 02:53:18,280 PROJECTS. 4665 02:53:18,280 --> 02:53:22,320 BUT NOT JUST THAT, LOOKING AT 4666 02:53:22,320 --> 02:53:24,440 THE OPPORTUNITY TAKING ONE IDEA 4667 02:53:24,440 --> 02:53:26,000 TO -- THAT MAY TAKE A YEAR OR 4668 02:53:26,000 --> 02:53:28,000 TWO HOW YOU EXPAND THAT WORK 4669 02:53:28,000 --> 02:53:32,000 OUT. 4670 02:53:32,000 --> 02:53:33,760 BEYOND INITIAL STAYS LOOKING 4671 02:53:33,760 --> 02:53:38,120 WAYS TO MAINTAIN SUSTAINABILITY. 4672 02:53:38,120 --> 02:53:40,200 LAST HIGHLIGHT, WE FOCUS ON 4673 02:53:40,200 --> 02:53:42,280 RESEARCH AND TALK ABOUT PATIENT, 4674 02:53:42,280 --> 02:53:45,040 THE CLIENT, AND WORKING WITH 4675 02:53:45,040 --> 02:53:47,600 CLINICIANS, BUT ONE THING THOUGH 4676 02:53:47,600 --> 02:53:49,240 IT MAY BE A HEALTH IT PRODUCT 4677 02:53:49,240 --> 02:53:52,000 YOU ARE DEVELOPING AND SO 4678 02:53:52,000 --> 02:53:55,040 NETWORK AMONG YOUR DEVELOPERS AS 4679 02:53:55,040 --> 02:53:57,000 WELL AS FEDERAL AGENCIES FOR US, 4680 02:53:57,000 --> 02:53:58,040 IN YOUR HEALTH SYSTEMS CONSIDER 4681 02:53:58,040 --> 02:54:01,000 THE ROLE OF THE PATIENT. 4682 02:54:01,000 --> 02:54:02,560 LOOK AT PATIENT ENGAGEMENT, MAY 4683 02:54:02,560 --> 02:54:05,800 PLAY A ROLE DEVELOPING OUT THESE 4684 02:54:05,800 --> 02:54:09,440 HEALTH IT TOOLS AND PLATFORMS. 4685 02:54:09,440 --> 02:54:11,600 >> THANK YOU. 4686 02:54:11,600 --> 02:54:13,280 I REGRET TO SAY WE HAVE ONE OUT 4687 02:54:13,280 --> 02:54:15,280 OF TIME FOR QUESTIONS BUT WE 4688 02:54:15,280 --> 02:54:18,440 WILL DO OUR BEST TO ADDRESS ANY 4689 02:54:18,440 --> 02:54:19,800 UNANSWERED QUESTIONS IN EMAIL 4690 02:54:19,800 --> 02:54:20,560 THE NEXT TWO WEEKS. 4691 02:54:20,560 --> 02:54:22,360 THANKS TO ALL OF OUR SPEAKERS 4692 02:54:22,360 --> 02:54:24,680 FOR THEIR OUTSTANDING 4693 02:54:24,680 --> 02:54:26,440 PRESENTATIONS AND THE VERY 4694 02:54:26,440 --> 02:54:27,400 ENGAGING Q&A SESSION. 4695 02:54:27,400 --> 02:54:29,400 PLEASE STAY WITH US NOW AS WE 4696 02:54:29,400 --> 02:54:31,280 MOVE TO WHAT PROMISES TO BE A 4697 02:54:31,280 --> 02:54:34,480 VERY LIVELY DISCUSSION AMONG OUR 4698 02:54:34,480 --> 02:54:36,600 CO-CHAIRS, PANELISTS FROM PAST 4699 02:54:36,600 --> 02:54:38,960 SESSIONS, AND OUR WORKSHOP 4700 02:54:38,960 --> 02:54:40,400 PLANNING COMMITTEE DURING OUR 4701 02:54:40,400 --> 02:54:41,080 WORKSHOP CLOSE OUT. 4702 02:54:41,080 --> 02:54:43,000 I WILL TURN IT OVER TO YOU, 4703 02:54:43,000 --> 02:54:45,880 MARRAH. 4704 02:54:45,880 --> 02:54:48,400 >> THANK YOU, DEIDRA. 4705 02:54:48,400 --> 02:54:49,800 SESSION FIVE PROVIDED TYPES OF 4706 02:54:49,800 --> 02:54:50,720 INFRASTRUCTURE WE NEED TO 4707 02:54:50,720 --> 02:54:53,160 SUPPORT CONTINUUMS OF CARE, FOR 4708 02:54:53,160 --> 02:54:54,800 UNDERRESOURCE AND MEDICALLY 4709 02:54:54,800 --> 02:54:56,400 UNDERSERVED WOMEN AN GIRLS. 4710 02:54:56,400 --> 02:55:00,160 OUR FIRST SPEAKER PRESENTED THE 4711 02:55:00,160 --> 02:55:01,560 MOM TO BASSINET MODEL DISCUSSING 4712 02:55:01,560 --> 02:55:02,560 INFRASTRUCTURE NEEDED TO ENSURE 4713 02:55:02,560 --> 02:55:03,880 INFANT HEALTH IS PROTECTED BY 4714 02:55:03,880 --> 02:55:06,200 TREATING THE MOTHERS CO-EXISTING 4715 02:55:06,200 --> 02:55:06,600 CONDITIONS. 4716 02:55:06,600 --> 02:55:09,200 THE OUTCOMES DATA WERE COMPARED 4717 02:55:09,200 --> 02:55:11,320 BY THE TYPE OF SYSTEM THAT THE 4718 02:55:11,320 --> 02:55:13,440 MOTHER INTERFACE WITH FOR CARE 4719 02:55:13,440 --> 02:55:16,800 AND RISK MATCH TO THE EHR WHERE 4720 02:55:16,800 --> 02:55:18,920 STRONG STARTS PROGRAM SHOW BIRTH 4721 02:55:18,920 --> 02:55:20,400 CENTERS AND GROUP PRE-NATAL CARE 4722 02:55:20,400 --> 02:55:22,800 DECREASED THE EQUITY GAP, BY 4723 02:55:22,800 --> 02:55:24,040 PROVIDERS ACTUALLY SPENDING MORE 4724 02:55:24,040 --> 02:55:26,480 TIME WITH THE PATIENT AND 4725 02:55:26,480 --> 02:55:28,440 PROVIDING INFRASTRUCTURE FOR 4726 02:55:28,440 --> 02:55:29,200 CARE CONTINUE ANNUITY. 4727 02:55:29,200 --> 02:55:31,520 BUT THERE WERE STILL REMAINING 4728 02:55:31,520 --> 02:55:33,080 STRUCTURAL BARRIERS, LIMITED 4729 02:55:33,080 --> 02:55:35,600 RESOURCES SUCH AS ACCESS TO 4730 02:55:35,600 --> 02:55:36,640 TRANSPORTATION, OR TYPES OF 4731 02:55:36,640 --> 02:55:38,360 SERVICES THAT WERE AVAILABLE 4732 02:55:38,360 --> 02:55:40,440 SUCH AS LIMITED ACCESS TO MENTAL 4733 02:55:40,440 --> 02:55:43,240 HEALTH WORKERS, OR LACK OF THE 4734 02:55:43,240 --> 02:55:44,200 NEEDED SOCIAL SERVICES FOR THE 4735 02:55:44,200 --> 02:55:45,760 WOMEN. 4736 02:55:45,760 --> 02:55:48,080 THE KEY TO SUCCESS HERE HOWEVER 4737 02:55:48,080 --> 02:55:49,920 WAS CONTINUITY WHERE 4738 02:55:49,920 --> 02:55:52,600 CENTRALIZING RESOURCES AND 4739 02:55:52,600 --> 02:55:54,400 INFORMATION REALLY BUILT 4740 02:55:54,400 --> 02:55:55,840 RELATIONSHIPS BY PROVIDING A 4741 02:55:55,840 --> 02:55:58,160 POINT OF INTERFACE FOR WOMEN TO 4742 02:55:58,160 --> 02:55:59,120 FIND RELIABLE CARE. 4743 02:55:59,120 --> 02:56:02,960 WE ALSO HEARD FROM ONC WITH 4744 02:56:02,960 --> 02:56:04,280 THEIR PROGRAMS TO EXPAND PATIENT 4745 02:56:04,280 --> 02:56:07,360 ACCESS FOR HEALTH EQUITY AN CARE 4746 02:56:07,360 --> 02:56:09,120 BY THEIR IMPLEMENTATION 4747 02:56:09,120 --> 02:56:10,120 TECHNOLOGY DESIGN AND HOW YOU 4748 02:56:10,120 --> 02:56:11,680 CAN IMPROVE ACCESS TO CARE FOR 4749 02:56:11,680 --> 02:56:14,240 WOMEN BY INCREASING THEIR HEALTH 4750 02:56:14,240 --> 02:56:15,240 INFORMATION KEY TOUCH POINTS 4751 02:56:15,240 --> 02:56:16,320 DURING THEIR LIVES. 4752 02:56:16,320 --> 02:56:18,800 THESE TALKS HIGHLIGHTED WHAT 4753 02:56:18,800 --> 02:56:24,320 INFRASTRUCTURE IS NEEDED, DATA 4754 02:56:24,320 --> 02:56:25,680 STANDARDS AND THOUSAND IMPLEMENT 4755 02:56:25,680 --> 02:56:26,600 THESE PROGRAMS. 4756 02:56:26,600 --> 02:56:28,720 INTERDEPARTMENTAL PROJECT WAS 4757 02:56:28,720 --> 02:56:29,720 IMPLEMENTED TO SUPPORT WOMEN'S 4758 02:56:29,720 --> 02:56:31,160 HEALTH HE CAN THENOLOGY IN A 4759 02:56:31,160 --> 02:56:32,400 COORDINATED REGISTRY NETWORK 4760 02:56:32,400 --> 02:56:33,960 WHERE THE VISION WAS TO 4761 02:56:33,960 --> 02:56:35,800 COORDINATE DATA WITH TARGETED 4762 02:56:35,800 --> 02:56:38,800 GOAL TO IMPROVE WOMEN HEALTH 4763 02:56:38,800 --> 02:56:40,200 USING SELECTED FEMALE SPECIFIC 4764 02:56:40,200 --> 02:56:41,520 HEALTH CONDITIONS AND HOW THE 4765 02:56:41,520 --> 02:56:43,400 PILOT PROGRAM WAS PLEA 4766 02:56:43,400 --> 02:56:44,720 AGREEMENTED FOR THE TECHNOLOGY 4767 02:56:44,720 --> 02:56:46,840 PROGRAM TO ADDRESS THESE COMPLEX 4768 02:56:46,840 --> 02:56:47,360 MEDICAL NEEDS. 4769 02:56:47,360 --> 02:56:48,800 MANY LESSONS LEARNED FROM THIS 4770 02:56:48,800 --> 02:56:51,120 PILOT AND RESOURCES ARE STILL 4771 02:56:51,120 --> 02:56:51,640 BEING GENERATE FORD THIS 4772 02:56:51,640 --> 02:56:52,480 PROGRAM. 4773 02:56:52,480 --> 02:56:54,840 SO NOW WE WILL ENTER OUR FINAL 4774 02:56:54,840 --> 02:56:56,080 PANEL DISCUSSION WHICH WILL BE 4775 02:56:56,080 --> 02:56:57,680 MODERATED BY OUR WORKSHOP 4776 02:56:57,680 --> 02:56:59,720 CO-CHAIRS DR.S CHANDER AND 4777 02:56:59,720 --> 02:57:00,200 JOHNSON. 4778 02:57:00,200 --> 02:57:02,400 AND IT WILL ALSO INCLUDE 4779 02:57:02,400 --> 02:57:04,000 PANELISTS FROM YESTERDAY AND 4780 02:57:04,000 --> 02:57:04,600 TODAY'S PANEL. 4781 02:57:04,600 --> 02:57:05,960 THIS IS AN OPPORTUNITY FOR THEM 4782 02:57:05,960 --> 02:57:07,200 TO HAVE AN OPEN DISCUSSION 4783 02:57:07,200 --> 02:57:08,960 AROUND SOME OF THE GOALS OF THE 4784 02:57:08,960 --> 02:57:12,920 WORKSHOP AND I WILL START BY 4785 02:57:12,920 --> 02:57:17,000 POSING A FEW FOR -- THERE IS A 4786 02:57:17,000 --> 02:57:19,800 COUPLE OF TOPICS I THINK I LIKE 4787 02:57:19,800 --> 02:57:21,600 Y'ALL TO TALK ABOUT AND I WILL 4788 02:57:21,600 --> 02:57:23,040 REPOST THEM IN THE CHAT SO WE 4789 02:57:23,040 --> 02:57:26,960 CAN CONTINUE THE CONVERSATION. 4790 02:57:26,960 --> 02:57:30,040 FIRST IS HOW DO WE PROMOTE 4791 02:57:30,040 --> 02:57:35,360 EDUCATION AND TRAINING FOR 4792 02:57:35,360 --> 02:57:36,400 INTEGRATIVE HEALTHCARE AND 4793 02:57:36,400 --> 02:57:37,200 CONTINUUMS OF CARE? 4794 02:57:37,200 --> 02:57:40,400 SECOND, WHAT IS REALLY NEEDED TO 4795 02:57:40,400 --> 02:57:41,640 SUPPORT INTEGRATION AND 4796 02:57:41,640 --> 02:57:42,200 COORDINATION OF HEALTHCARE 4797 02:57:42,200 --> 02:57:44,000 SERVICES TO MEET THE HEALTH AND 4798 02:57:44,000 --> 02:57:46,520 SOCIAL NEEDS OF RACIAL ETHNIC 4799 02:57:46,520 --> 02:57:47,840 UNDERSERVED WOMEN OF 4800 02:57:47,840 --> 02:57:48,480 REPRODUCTIVE AGE? 4801 02:57:48,480 --> 02:57:51,440 AND FINALLY, THIS IS REALLY 4802 02:57:51,440 --> 02:57:53,640 IMPORTANT AS WE HAVE A LOT OF 4803 02:57:53,640 --> 02:57:54,440 STAKEHOLDERS NOT ONLY THAT WERE 4804 02:57:54,440 --> 02:57:58,040 ON THE PANEL BUT ALSO IN THE OFF 4805 02:57:58,040 --> 02:57:59,200 YENS, HOW CAN WE LEVERAGE 4806 02:57:59,200 --> 02:58:01,760 EXISTING FEDERAL STATE AND LOCAL 4807 02:58:01,760 --> 02:58:03,800 RESOURCE, AND COLLABORATION TO 4808 02:58:03,800 --> 02:58:05,640 ALIGN COMMUNITY AND CLINICAL 4809 02:58:05,640 --> 02:58:14,280 SERVICES ALL WITH THE GOAL OF 4810 02:58:14,280 --> 02:58:15,400 DRESSING MULTI-MORBIDITY ACROSS 4811 02:58:15,400 --> 02:58:15,920 THE LIFE SPAN. 4812 02:58:15,920 --> 02:58:18,240 SO I WILL PUT IN THE CHAT AND 4813 02:58:18,240 --> 02:58:19,840 WELCOME DISCUSSION FROM ALL 4814 02:58:19,840 --> 02:58:37,720 PANELISTS. 4815 02:58:37,720 --> 02:58:40,200 WONDERING MS. ARGENTIERI IF MY 4816 02:58:40,200 --> 02:58:41,720 PANELIST VERSUS THOUGHTS, YOU 4817 02:58:41,720 --> 02:58:42,600 CAN RAISE YOUR HAND, MIGHT BE 4818 02:58:42,600 --> 02:58:48,640 EASIER TO FAIL SILL AT A TIME 4819 02:58:48,640 --> 02:58:50,520 VIA ZOOM. 4820 02:58:50,520 --> 02:58:51,920 -- FACILITATE VIA ZOOM. 4821 02:58:51,920 --> 02:58:52,080 KIM. 4822 02:58:52,080 --> 02:58:53,400 >> IN I DRESS THE FIRST QUESTION 4823 02:58:53,400 --> 02:58:55,400 HOW TO PROMOTE EDUCATION AND 4824 02:58:55,400 --> 02:58:55,880 TRAINING. 4825 02:58:55,880 --> 02:59:00,160 I THINK IT GETS BACK TO RAISING 4826 02:59:00,160 --> 02:59:02,360 AWARENESS THAT EM WITH'S HEALTH 4827 02:59:02,360 --> 02:59:03,360 INCLUDES EVERYTHING -- WOMEN'S 4828 02:59:03,360 --> 02:59:05,000 HEALTH INCLUDES ANY MELT 4829 02:59:05,000 --> 02:59:07,200 CONDITION NOT ONLY REPRODUCTIVE 4830 02:59:07,200 --> 02:59:07,680 HEALTH. 4831 02:59:07,680 --> 02:59:09,760 SO AS WE ARE ADDRESSING 4832 02:59:09,760 --> 02:59:11,800 EDUCATION IT IS GETTING THAT 4833 02:59:11,800 --> 02:59:13,400 POINT ACROSS ALL LEVELS OF 4834 02:59:13,400 --> 02:59:16,320 EDUCATION THAT THERE ARE SEX AND 4835 02:59:16,320 --> 02:59:18,800 GENDER IMPACT ON EVERYTHING. 4836 02:59:18,800 --> 02:59:20,160 IN THAT EDUCATION OF SEX AND 4837 02:59:20,160 --> 02:59:23,720 GENDER IMPACTS AREN'T ISOLATED 4838 02:59:23,720 --> 02:59:24,640 TO A SINGLE CONDITION. 4839 02:59:24,640 --> 02:59:28,400 SO I THINK IT ACTUALLY LOOKSES 4840 02:59:28,400 --> 02:59:29,760 LIKE A TOTAL RESTRUCTURING OR 4841 02:59:29,760 --> 02:59:33,160 REFRAMING OF HEALTH 4842 02:59:33,160 --> 02:59:38,680 PROFESSIONALS ENCATION FROM 4843 02:59:38,680 --> 02:59:41,440 UNDERGRADUATE TO CONTINUING 4844 02:59:41,440 --> 02:59:48,000 EDUCATION. 4845 02:59:48,000 --> 02:59:50,680 VAST MAJORITY OF RESEARCH 4846 02:59:50,680 --> 02:59:52,600 CONDITIONS ESPECIALLY MEN AND 4847 02:59:52,600 --> 02:59:54,160 WOMEN DIDN'T REPORT BASED ON SEX 4848 02:59:54,160 --> 02:59:56,000 OR GENDER SO IF WE ARE GOING TO 4849 02:59:56,000 --> 02:59:57,920 TRY TO CHANGE OUT HEALTH 4850 02:59:57,920 --> 02:59:59,600 CONDITIONS ARE TAUGHT ACROSS THE 4851 02:59:59,600 --> 03:00:01,480 CONTINUUM OF CARE, WE CAN'T DO 4852 03:00:01,480 --> 03:00:02,600 IT UNLESS WE HAVE THE DATA TO BE 4853 03:00:02,600 --> 03:00:06,800 ABLE TO DO THAT SO IT STARTS 4854 03:00:06,800 --> 03:00:09,000 WITH RESEARCH IMPROVING HOW IT 4855 03:00:09,000 --> 03:00:10,520 ET CETERA REPORTED, MAIMING SURE 4856 03:00:10,520 --> 03:00:11,720 IMPACT ON WOMEN AND SEX AND 4857 03:00:11,720 --> 03:00:14,200 GENDER DIFFERENCES ARE REPORTED, 4858 03:00:14,200 --> 03:00:15,600 TAKE THAT INTO ALL LEVELS OF 4859 03:00:15,600 --> 03:00:22,200 EDUCATION. 4860 03:00:22,200 --> 03:00:26,080 >> SOMETHING KIM SAID WHICH IS 4861 03:00:26,080 --> 03:00:27,000 POINTING OUT HEALTHCARE FOR 4862 03:00:27,000 --> 03:00:28,760 WOMEN AND GIRLS DOESN'T JUST 4863 03:00:28,760 --> 03:00:32,320 INVOLVE REPRODUCTIVE HEALTHCARE 4864 03:00:32,320 --> 03:00:35,720 I KNOW I'M ON A ONE WOMAN BATTLE 4865 03:00:35,720 --> 03:00:37,840 AGAINST THE TERM PRECONCEPTION 4866 03:00:37,840 --> 03:00:38,040 CARE. 4867 03:00:38,040 --> 03:00:39,600 THAT IS HEALTHCARE. 4868 03:00:39,600 --> 03:00:42,360 WE WANT PEOPLE TO BE HEALTHY, WE 4869 03:00:42,360 --> 03:00:43,240 PROVIDEROID HEALTHCARE WE ARE 4870 03:00:43,240 --> 03:00:44,680 NOT JUST PROVIDING HEALTHCARE 4871 03:00:44,680 --> 03:00:46,360 BECAUSE THEY ARE -- THEY MIGHT 4872 03:00:46,360 --> 03:00:48,720 GET PREGNANT ONE DAY BUT PERHAPS 4873 03:00:48,720 --> 03:00:51,000 BECAUSE THEY ARE VALUABLE FOR 4874 03:00:51,000 --> 03:00:51,600 THEMSELVES. 4875 03:00:51,600 --> 03:00:54,720 I THINK SOMETIMES THAT GETS LOST 4876 03:00:54,720 --> 03:00:56,680 ESPECIALLY I WORK IN MEDICAID 4877 03:00:56,680 --> 03:01:01,560 FIELD BECAUSE IT OFFERS MORE 4878 03:01:01,560 --> 03:01:03,360 CARE TO PEOPLE DURING PREGNANCY 4879 03:01:03,360 --> 03:01:05,360 BECAUSE MEDICAID THRESHOLD GOES 4880 03:01:05,360 --> 03:01:06,520 UP IN PREGNANCY SO YOU SEE 4881 03:01:06,520 --> 03:01:09,400 PEOPLE ENTERING THE ED KID 4882 03:01:09,400 --> 03:01:10,840 PROGRAM WHEN THEY ARE PREGNANT 4883 03:01:10,840 --> 03:01:12,280 EVEN IN STATES WITH MEDICAID 4884 03:01:12,280 --> 03:01:13,840 EXPANSION BECAUSE THE THRESHOLD 4885 03:01:13,840 --> 03:01:14,600 IS HIGHER FOR SOMEBODY WHO IS 4886 03:01:14,600 --> 03:01:17,840 PREGNANT. 4887 03:01:17,840 --> 03:01:18,760 WE SOMETIMES GET LOST THERE. 4888 03:01:18,760 --> 03:01:22,400 WE ARE SAYING OH, BECAUSE WE ARE 4889 03:01:22,400 --> 03:01:23,600 SERVING SO MANY ADULT WHOSE ARE 4890 03:01:23,600 --> 03:01:25,200 PREGNANT OR WOMEN WHO ARE 4891 03:01:25,200 --> 03:01:26,480 PREGNANT THAT ALL WE REALLY CARE 4892 03:01:26,480 --> 03:01:30,160 ABOUT IS WHAT IS GOING ON BEFORE 4893 03:01:30,160 --> 03:01:31,480 OR BETWEEN PREGNANCY RELATED TO 4894 03:01:31,480 --> 03:01:35,360 PREGNANCY OPPOSED TO RELATED TO 4895 03:01:35,360 --> 03:01:37,240 HELP FOR THEM. 4896 03:01:37,240 --> 03:01:39,440 SO I WOULD LIKE TO FOLLOW-UP ON 4897 03:01:39,440 --> 03:01:40,880 WHAT KIM SAYS WOMEN AND GIRLS 4898 03:01:40,880 --> 03:01:41,800 ARE IMPORTANT WHETHER PREGNANT 4899 03:01:41,800 --> 03:01:43,040 OR NOT OR WHETHER THEY ARE GOING 4900 03:01:43,040 --> 03:01:47,280 TO GET PREGNANT OR NOT. 4901 03:01:47,280 --> 03:01:48,680 >> HUNDRED PERCENT AGREE. 4902 03:01:48,680 --> 03:01:54,280 ONE FASTEST WAY TO GET SOMETHING 4903 03:01:54,280 --> 03:01:56,000 IN MEDICAL EDUCATION IS 4904 03:01:56,000 --> 03:01:56,840 ACCREDITATION STANDARDS. 4905 03:01:56,840 --> 03:01:58,680 I THINK THERE ARE MANY LEVERS 4906 03:01:58,680 --> 03:02:01,120 HOW TO CHANGE PATIENT BUT IF I 4907 03:02:01,120 --> 03:02:03,000 CAN DO ONE THING HAVE IT 4908 03:02:03,000 --> 03:02:04,800 ACCREDITATION STANDARDS IN SOME 4909 03:02:04,800 --> 03:02:05,840 CLEAR WAY THAT WOULD HELP IT GET 4910 03:02:05,840 --> 03:02:15,840 OUT. 4911 03:02:15,840 --> 03:02:18,200 >> WE HAVE A QUESTION IN CHAT. 4912 03:02:18,200 --> 03:02:23,000 I'LL READ THIS AS FOLKS THINK 4913 03:02:23,000 --> 03:02:24,160 FURTHER ABOUT THE INITIAL THREE 4914 03:02:24,160 --> 03:02:24,760 PART QUESTION. 4915 03:02:24,760 --> 03:02:26,200 SEEMS WE KNOW A LOT ABOUT WHAT 4916 03:02:26,200 --> 03:02:28,080 WE NEED, WHAT WORKS AND WHAT 4917 03:02:28,080 --> 03:02:28,600 DOESN'T. 4918 03:02:28,600 --> 03:02:29,760 DO YOU THINK WE NEED MORE 4919 03:02:29,760 --> 03:02:35,240 RESEARCH AT THIS POINT? 4920 03:02:35,240 --> 03:02:36,680 OR SENDING RESOURCES 4921 03:02:36,680 --> 03:02:37,400 IMPLEMENTING EFFECTIVE 4922 03:02:37,400 --> 03:02:39,960 STRATEGIES? 4923 03:02:39,960 --> 03:02:42,360 >> SOUNDS LIKE A PROMOMENT FOR 4924 03:02:42,360 --> 03:02:44,600 IMPLEMENTATION SCIENCE. 4925 03:02:44,600 --> 03:02:45,680 >> I WOULD SAY BOTH. 4926 03:02:45,680 --> 03:02:47,600 I THINK YES WE HAVE A LOT OF 4927 03:02:47,600 --> 03:02:53,040 DATA AND RESEARCH, WE NEED MORE. 4928 03:02:53,040 --> 03:02:54,400 SO IMPLEMENTING STRATEGIES BASED 4929 03:02:54,400 --> 03:02:55,880 ON DATA WE HAVE AND ALSO HAVING 4930 03:02:55,880 --> 03:02:57,360 CLEAR UNDERSTANDING OF WHERE WE 4931 03:02:57,360 --> 03:02:59,000 NEED MORE DATA AND FOCUSING 4932 03:02:59,000 --> 03:03:04,160 RESEARCH DOLLARS IN THOSE AREAS. 4933 03:03:04,160 --> 03:03:07,520 >> DEFINITELY AGREE. 4934 03:03:07,520 --> 03:03:08,520 SORRY. 4935 03:03:08,520 --> 03:03:09,640 I COMPLETELY AGREE. 4936 03:03:09,640 --> 03:03:10,440 I DON'T THINK WE HAVE ALL THE 4937 03:03:10,440 --> 03:03:16,320 ANSWERS. 4938 03:03:16,320 --> 03:03:17,680 BUT THERE ARE CERTAIN EVIDENCE 4939 03:03:17,680 --> 03:03:18,560 BASED TOOLS THAT SUITLY WE 4940 03:03:18,560 --> 03:03:21,000 SHOULD BE FOCUSING ON -- 4941 03:03:21,000 --> 03:03:23,240 ABSOLUTELY WE SHOULD BE FOCUSING 4942 03:03:23,240 --> 03:03:25,560 ON WIDE SCALE IMPLEMENTATION. 4943 03:03:25,560 --> 03:03:26,640 SORRY JENNIFER. 4944 03:03:26,640 --> 03:03:31,480 >> I WAS GOING TO SAY POSITION 4945 03:03:31,480 --> 03:03:34,240 TAKE AS RESEARCHER, PART OF THE 4946 03:03:34,240 --> 03:03:36,160 REASON I DO IMPLEMENTATION 4947 03:03:36,160 --> 03:03:38,360 SCIENCE IS IT IS A FALSE 4948 03:03:38,360 --> 03:03:42,640 DICHOTOMY CLEARLY YET IF I HAD 4949 03:03:42,640 --> 03:03:44,880 TO SAY IF I HEADACHIEST BETWEEN 4950 03:03:44,880 --> 03:03:46,960 TOMORROW WE WOULD DO EVERYTHING 4951 03:03:46,960 --> 03:03:51,080 WE KNEW WAS GOOD CARE WE DON'T 4952 03:03:51,080 --> 03:03:53,920 DO NOW VERSUS WHAT IS BETTER 4953 03:03:53,920 --> 03:03:55,440 CARE, I WOULD PROBABLY GO FOR 4954 03:03:55,440 --> 03:03:58,000 HELPING THE WORLD DO EVERYTHING 4955 03:03:58,000 --> 03:03:59,560 WE KNOW BECAUSE PART OF WHAT WE 4956 03:03:59,560 --> 03:04:04,120 TALK ABOUT TODAY IS WE ALL KNOW 4957 03:04:04,120 --> 03:04:05,400 THAT INTEGRATED CARE IS 4958 03:04:05,400 --> 03:04:06,600 IMPORTANT AND WE KNOW WOULDN'T 4959 03:04:06,600 --> 03:04:08,160 SHOULDN'T HAVE TO GO TO TEN 4960 03:04:08,160 --> 03:04:09,160 DIFFERENT PLACES TO GET THEIR 4961 03:04:09,160 --> 03:04:09,840 BASIC NEEDS MET. 4962 03:04:09,840 --> 03:04:11,880 WE KNOW IF PEOPLE ARE WATER 4963 03:04:11,880 --> 03:04:13,400 INSECURE THEY ARE PROBABLY NOT 4964 03:04:13,400 --> 03:04:15,120 HEALTHY AND YET HOW TO MAKE THAT 4965 03:04:15,120 --> 03:04:21,400 HAPPEN IS ACTUALLY HARD. 4966 03:04:21,400 --> 03:04:23,920 I AM A RESEARCHER, I BELIEVE IT 4967 03:04:23,920 --> 03:04:24,800 DOES THINGS BUT MORE AND MORE 4968 03:04:24,800 --> 03:04:28,400 INTERESTED MANY THE QUESTION OF 4969 03:04:28,400 --> 03:04:32,440 HOW DO YOU GET POLICY AND 4970 03:04:32,440 --> 03:04:34,880 SYSTEMS TO DO WHAT WE KNOW 4971 03:04:34,880 --> 03:04:39,160 CONTRIBUTES TO GOOD HEALTH. 4972 03:04:39,160 --> 03:04:40,960 >> JENNIFER YOU ARE SEEING 4973 03:04:40,960 --> 03:04:43,440 SOMETHING IMPORTANT WHICH IS 4974 03:04:43,440 --> 03:04:45,080 DISRUPTIVE INNOVATION IS 4975 03:04:45,080 --> 03:04:45,880 DISRUPTIVE. 4976 03:04:45,880 --> 03:04:48,200 PEOPLE DON'T LIKE THAT. 4977 03:04:48,200 --> 03:04:49,320 THEY LIKE WHAT THEY ARE 4978 03:04:49,320 --> 03:04:51,600 COMFORTABLE WITH, THEY LIKE THE 4979 03:04:51,600 --> 03:04:54,040 SYSTEMS THEY HAVE, ONE THING I 4980 03:04:54,040 --> 03:04:56,080 SEE A LOT WITH THE CARE 4981 03:04:56,080 --> 03:04:58,600 COORDINATION MODEL FOR MATERNITY 4982 03:04:58,600 --> 03:05:01,760 CARE GOING BACK TO PREGNANCY 4983 03:05:01,760 --> 03:05:03,400 CARE BUT WE KNOW WHAT WORKS 4984 03:05:03,400 --> 03:05:04,840 WE'LL NEED TO DO IT AGAIN, THERE 4985 03:05:04,840 --> 03:05:08,480 IS A LOT OF CONFIRMATION BIAS 4986 03:05:08,480 --> 03:05:11,600 PEOPLE USE CONTROL GROUPS THAT 4987 03:05:11,600 --> 03:05:12,480 ARE INAPPROPRIATE. 4988 03:05:12,480 --> 03:05:14,600 WE'LL USE THE ROLL CONTROL GROUP 4989 03:05:14,600 --> 03:05:16,120 PEOPLE WHO DIDN'T ENROLL IN 4990 03:05:16,120 --> 03:05:18,680 INTERVENTION OR REFUSED IT. 4991 03:05:18,680 --> 03:05:22,400 THEN WILL PROMOTE OUTCOMES BEING 4992 03:05:22,400 --> 03:05:23,520 LEGITIMATE THEY WOULDN'T EXCEPT 4993 03:05:23,520 --> 03:05:25,280 IF ON SOMETHING ELSE. 4994 03:05:25,280 --> 03:05:28,800 BUT BECAUSE IT IS SOMETHING THEY 4995 03:05:28,800 --> 03:05:30,920 LIKE THEY WANT TO KEEP IT THE 4996 03:05:30,920 --> 03:05:32,120 THING AROUND CARE COORDINATION 4997 03:05:32,120 --> 03:05:34,000 IT ISN'T DISRUPTIVE YOU HIRE 4998 03:05:34,000 --> 03:05:35,640 SOMEBODY THEY TAKE CARE OF YOUR 4999 03:05:35,640 --> 03:05:37,200 PROBLEMS, WHATEVER GOES ON IS IN 5000 03:05:37,200 --> 03:05:40,280 THEIR LITTLE REALM YOU KEEP 5001 03:05:40,280 --> 03:05:42,240 PRACTICING THE WAY YOU WANT TO 5002 03:05:42,240 --> 03:05:42,920 PRACTICE. 5003 03:05:42,920 --> 03:05:45,520 AND FEEL LIKE YOU ARE DOING 5004 03:05:45,520 --> 03:05:45,800 SOMETHING. 5005 03:05:45,800 --> 03:05:48,120 I FEEL LIKE THAT IS ONE OF MY 5006 03:05:48,120 --> 03:05:51,640 FRUSTRATIONS AROUND THIS IS HOW 5007 03:05:51,640 --> 03:05:54,800 DO YOU GET THESE POWERFUL 5008 03:05:54,800 --> 03:05:58,360 INTEREST GROUPS TO SAY ACTUALLY 5009 03:05:58,360 --> 03:06:00,320 THEY NEED TO DO THINGS 5010 03:06:00,320 --> 03:06:01,440 DIFFERENTLY, OR WE NEED TO 5011 03:06:01,440 --> 03:06:02,920 ACCEPT WE NEED TO DO THINGS 5012 03:06:02,920 --> 03:06:06,160 DIFFERENTLY. 5013 03:06:06,160 --> 03:06:07,400 >> I WOULD SUGGEST THINKING THE 5014 03:06:07,400 --> 03:06:09,160 REALLY BIG PICTURE MAKES SENSE 5015 03:06:09,160 --> 03:06:10,680 IN TERMS OF HAVING METRICS HOW 5016 03:06:10,680 --> 03:06:11,800 WELL WE ARE DOING. 5017 03:06:11,800 --> 03:06:15,480 AND JUST AS A SIMPLE EXAMPLE, I 5018 03:06:15,480 --> 03:06:16,600 WOULD SUGGEST PREVALENCE OF 5019 03:06:16,600 --> 03:06:19,320 VARIOUS RISKS AND CONDITIONS. 5020 03:06:19,320 --> 03:06:21,040 THE PROPORTION OF PEOPLE WHO ARE 5021 03:06:21,040 --> 03:06:23,480 AT RISK WHO ARE RECEIVING 5022 03:06:23,480 --> 03:06:25,600 SERVICES, AND THE EFFICACY OF 5023 03:06:25,600 --> 03:06:26,440 THOSE SERVICES. 5024 03:06:26,440 --> 03:06:29,280 IF WE LOOK AT THOSE OVER TIME 5025 03:06:29,280 --> 03:06:30,840 AND EXAMINE HOW WE ARE DOING 5026 03:06:30,840 --> 03:06:32,760 WE'LL HAVE A BETTER SENSE OF GEE 5027 03:06:32,760 --> 03:06:34,040 DO WE KNOW EVERYTHING THAT WE 5028 03:06:34,040 --> 03:06:35,640 NEED TO KNOW AND WE JUST NEED TO 5029 03:06:35,640 --> 03:06:38,720 DO MORE OF IT OR DO WE NEED TO 5030 03:06:38,720 --> 03:06:39,320 KNOW MORE? 5031 03:06:39,320 --> 03:06:42,840 MY SUSPICION IS ALL THOSE LINES 5032 03:06:42,840 --> 03:06:44,480 REALLY IMPORTANT LINES ARE LOT 5033 03:06:44,480 --> 03:06:45,600 FLATTER HAHN WE WOULD LIKE THEM 5034 03:06:45,600 --> 03:06:45,920 TO BE. 5035 03:06:45,920 --> 03:06:48,640 IT IS NOT JUST A MATTER OF 5036 03:06:48,640 --> 03:06:51,000 NEEDING TO TO MORE WHAT WE HAVE. 5037 03:06:51,000 --> 03:06:52,800 WE NEED TO KNOW MORE ABOUT HOW 5038 03:06:52,800 --> 03:06:54,400 TO DO BETTER. 5039 03:06:54,400 --> 03:06:57,520 I AGREE WITH THAT. 5040 03:06:57,520 --> 03:07:00,600 YOU TALK ABOUT DISRUPTED 5041 03:07:00,600 --> 03:07:01,200 INNOVATION. 5042 03:07:01,200 --> 03:07:04,240 TO GO COMPLETELY OUT ON A LIMB 5043 03:07:04,240 --> 03:07:07,080 THERE ARE HEALTH STUDIES THAT 5044 03:07:07,080 --> 03:07:08,640 SHOW RANDOMIZE TRIALS IN OTHER 5045 03:07:08,640 --> 03:07:11,680 COUNTRIES THAT SHOW PROVIDING 5046 03:07:11,680 --> 03:07:13,160 PEOPLE WITH MINIMUM INCOME 5047 03:07:13,160 --> 03:07:15,920 IMPROVE HEALTH OF THEM AND THEIR 5048 03:07:15,920 --> 03:07:17,840 FAMILIES, LONG MATERNITY, EVEN 5049 03:07:17,840 --> 03:07:20,160 THINGS HERE THAT WOULD BE SUCH 5050 03:07:20,160 --> 03:07:21,920 -- INCARCERATING PEOPLE TO THE 5051 03:07:21,920 --> 03:07:23,240 RATE WE DO IS NOT GOOD FOR 5052 03:07:23,240 --> 03:07:27,080 HEALTH OR SAFETY AND YET POLICY 5053 03:07:27,080 --> 03:07:28,640 WHERE PEOPLE WERE EMOTIONAL, 5054 03:07:28,640 --> 03:07:33,800 PEOPLE IS NOT RATIONAL AND SOME 5055 03:07:33,800 --> 03:07:36,040 OF THESE THINGS THE DATA IS 5056 03:07:36,040 --> 03:07:37,240 THERE AND POLICY AND PRACTICE 5057 03:07:37,240 --> 03:07:41,440 DOESN'T FOLLOW THE DATA SO HOW 5058 03:07:41,440 --> 03:07:47,080 DO WE GET THERE TO DO WHAT WE 5059 03:07:47,080 --> 03:07:51,680 KNOW NOW. 5060 03:07:51,680 --> 03:07:52,920 >> SO WE HAVE A FOLLOW-UP 5061 03:07:52,920 --> 03:07:54,560 QUESTION TO THE FIRST WHICH IS 5062 03:07:54,560 --> 03:07:55,600 WHERE SHOULD WE FOCUS OUR 5063 03:07:55,600 --> 03:08:11,480 RESEARCH? 5064 03:08:11,480 --> 03:08:13,720 I MIGHT ADD WHAT STEVEN SAID, 5065 03:08:13,720 --> 03:08:15,040 DR. TEMKIN RAISED YESTERDAY 5066 03:08:15,040 --> 03:08:18,160 THINKING RESEARCH GAPS AND THE 5067 03:08:18,160 --> 03:08:20,240 SILOS THAT WE ARE IN NOW, AND AS 5068 03:08:20,240 --> 03:08:20,920 PART OF THE PURPOSE OF THIS 5069 03:08:20,920 --> 03:08:22,000 WORKSHOP IS TO THINK ABOUT HOW 5070 03:08:22,000 --> 03:08:25,800 TO GET OUT OF THOSE SILOS. 5071 03:08:25,800 --> 03:08:27,800 AND WORK ACROSS DISCIPLINES, 5072 03:08:27,800 --> 03:08:35,400 WORK ACROSS HEALTH CONDITIONS 5073 03:08:35,400 --> 03:08:36,720 AND UNDERSTAND PREVALENCE AND 5074 03:08:36,720 --> 03:08:38,760 RISKMENT PART OF THE PROBLEM AS 5075 03:08:38,760 --> 03:08:40,000 DR. THEM KY MENTIONED YESTERDAY, 5076 03:08:40,000 --> 03:08:45,680 WE DON' DON'T HAVE CHRONIC CONDITIONS 5077 03:08:45,680 --> 03:08:47,800 AND WHAT PEOPLE'S 5078 03:08:47,800 --> 03:08:49,200 MULTI-MORBIDITIES ARE AND YOU AS 5079 03:08:49,200 --> 03:08:51,520 PRACTICERS AND RESEARCHERS ARE 5080 03:08:51,520 --> 03:08:55,640 ONES THAT HAVE THAT DATA. 5081 03:08:55,640 --> 03:08:57,880 SO MAYBE PART OF THE ANSWER TO 5082 03:08:57,880 --> 03:08:58,920 THAT QUESTION IS HOW TO THINK 5083 03:08:58,920 --> 03:09:00,920 ABOUT BREAKING DOWN THOSE SILOS 5084 03:09:00,920 --> 03:09:04,640 AND SORT OF ADDRESSING THOSE 5085 03:09:04,640 --> 03:09:08,080 GAPS WE HAVE IN RESEARCH OF THAT 5086 03:09:08,080 --> 03:09:08,800 INTERSEXUALITY BETWEEN HEALTH 5087 03:09:08,800 --> 03:09:12,800 CONDITIONS IN WOMEN AND GIRLS. 5088 03:09:12,800 --> 03:09:15,200 I THINK PART OF THAT WAS 5089 03:09:15,200 --> 03:09:16,800 MENTIONED PREVIOUSLY YES WE NEED 5090 03:09:16,800 --> 03:09:18,840 TO KNOW MORE ABOUT PREVALENCE OF 5091 03:09:18,840 --> 03:09:20,040 CONDITIONS, WE NEED TO KNOW 5092 03:09:20,040 --> 03:09:21,960 ABOUT SEX AND GENDER BASED 5093 03:09:21,960 --> 03:09:22,960 DIFFERENCES AND PREVALENCE BUT 5094 03:09:22,960 --> 03:09:24,800 WE NEED TO GO BEYOND THAT AND I 5095 03:09:24,800 --> 03:09:26,760 THINK THAT IS THE NEXT PHASE OF 5096 03:09:26,760 --> 03:09:29,960 RESEARCH IN MANY AREAS, NOT JUST 5097 03:09:29,960 --> 03:09:33,280 THE WHAT AND WHOM BUT WHY. 5098 03:09:33,280 --> 03:09:35,520 AS I MENTION IN MY TALK 5099 03:09:35,520 --> 03:09:37,200 YESTERDAY OSTEOARTHRITIS OF THE 5100 03:09:37,200 --> 03:09:39,520 KNEE PEOPLE DIDN'T DO AS WELL AS 5101 03:09:39,520 --> 03:09:41,720 MEN, WHAT WAS KNEE JERK RESPONSE 5102 03:09:41,720 --> 03:09:42,360 WE DESIGN FOR WOMEN, 5103 03:09:42,360 --> 03:09:43,720 INTERESTINGLY ENOUGH THAT DIDN'T 5104 03:09:43,720 --> 03:09:44,280 WORK. 5105 03:09:44,280 --> 03:09:45,200 DIDN'T WORK BECAUSE NOBODY AT 5106 03:09:45,200 --> 03:09:46,880 THAT POINT EXPLORED THE WHY. 5107 03:09:46,880 --> 03:09:48,840 WHEN YOU GET TO THE WHY YOU FIND 5108 03:09:48,840 --> 03:09:51,200 THAT THE WHY IS MUCH, MUCH MORE 5109 03:09:51,200 --> 03:09:53,200 CHALLENGING AND MUCH MORE 5110 03:09:53,200 --> 03:09:54,840 DIFFICULT TO PIECE OUT BECAUSE 5111 03:09:54,840 --> 03:09:56,800 THAT DOES GET INTO THE 5112 03:09:56,800 --> 03:09:58,600 INTERSEXUALITY OF THE PATIENT AS 5113 03:09:58,600 --> 03:10:00,680 WELL AS THE CONVERGENCE OF 5114 03:10:00,680 --> 03:10:02,160 MULTITUDE OF OTHER HEALTH 5115 03:10:02,160 --> 03:10:03,200 CONDITIONS. 5116 03:10:03,200 --> 03:10:05,200 SO AS WE LOOK -- YES LOOKING AT 5117 03:10:05,200 --> 03:10:06,200 PREVALENCE FOR THE CONDITIONS 5118 03:10:06,200 --> 03:10:07,960 FOR WHICH WE DON'T KNOW IF THERE 5119 03:10:07,960 --> 03:10:09,080 IS A DIFFERENCE BECAUSE WE 5120 03:10:09,080 --> 03:10:10,800 HAVEN'T LOOKED BUT FOR THOSE WE 5121 03:10:10,800 --> 03:10:12,440 KNOW THERE IS, WE NEED TO BE 5122 03:10:12,440 --> 03:10:14,680 LOOKING MUCH MORE SPECIFICALLY 5123 03:10:14,680 --> 03:10:16,680 AT WHY BECAUSE UNLESS WE 5124 03:10:16,680 --> 03:10:17,880 UNDERSTAND THE WHY WE ARE NOT 5125 03:10:17,880 --> 03:10:19,560 GOING TO KNOW EITHER A HOW TO 5126 03:10:19,560 --> 03:10:22,000 TREAT IT BETTER OR IDEALLY HOW 5127 03:10:22,000 --> 03:10:25,480 TO LOOK AT PREVENTION 5128 03:10:25,480 --> 03:10:26,560 INITIATIVES FURTHER UPSTREAM. 5129 03:10:26,560 --> 03:10:29,920 WHY INVARIABLY GETS US INTO 5130 03:10:29,920 --> 03:10:31,200 IMPACT CROSS CUTTING IMPACT OF 5131 03:10:31,200 --> 03:10:33,000 OTHER HEALTH CONDITIONS AND 5132 03:10:33,000 --> 03:10:34,560 IDEALLY THAT WOULD HELP START TO 5133 03:10:34,560 --> 03:10:40,680 BREAK DOWN SOME OF THE SILOS. 5134 03:10:40,680 --> 03:10:44,680 >> VERY GOOD QUESTION FOR OUR 5135 03:10:44,680 --> 03:10:46,200 NIH FOLKS DOES NIH INSTITUTE 5136 03:10:46,200 --> 03:10:48,480 FUNDING ANNOUNCEMENTS IN THIS 5137 03:10:48,480 --> 03:10:52,360 AREA, TO PROMOTE EXPLORING 5138 03:10:52,360 --> 03:10:53,600 (INAUDIBLE)? 5139 03:10:53,600 --> 03:10:56,400 >> THERE HAVE BEEN SOME ANNOUNCE 5140 03:10:56,400 --> 03:10:58,200 PES OVER THE LAST COUPLE OF 5141 03:10:58,200 --> 03:10:59,600 YEARS REGARDING CHRONIC 5142 03:10:59,600 --> 03:11:02,720 CONDITIONS AND MULTI-MORBIDITY, 5143 03:11:02,720 --> 03:11:05,480 THAT IS A DIRECTION THE NIH IS 5144 03:11:05,480 --> 03:11:06,480 RECOGNIZING AS IMPORTANT AND YOU 5145 03:11:06,480 --> 03:11:08,320 CAN SEE MULTIPLE INSTITUTES HAVE 5146 03:11:08,320 --> 03:11:11,280 SIGNED ON TO THOSE INITIATIVES. 5147 03:11:11,280 --> 03:11:12,120 THAT'S PART OF WHAT WE ARE 5148 03:11:12,120 --> 03:11:13,880 TRYING TO DO HERE AS PARTNERSHIP 5149 03:11:13,880 --> 03:11:18,400 IS TO THINK ABOUT THIS WITH MORE 5150 03:11:18,400 --> 03:11:21,240 NARROW LENS, WOMEN AN GIRLS FROM 5151 03:11:21,240 --> 03:11:22,560 HISTORICALLY MARGINALIZED GROUPS 5152 03:11:22,560 --> 03:11:24,120 THAT ARE MEDICALLY UNDERSERVED 5153 03:11:24,120 --> 03:11:28,080 IN ORDER TO MAKE AN IMPACT IN 5154 03:11:28,080 --> 03:11:31,400 COMMUNITY THAT IS REALLY NEEDS 5155 03:11:31,400 --> 03:11:32,080 IT. 5156 03:11:32,080 --> 03:11:34,000 YOU WILL SEE THAT THOSE 5157 03:11:34,000 --> 03:11:36,800 ANNOUNCEMENTS HAVE COME OUT AND 5158 03:11:36,800 --> 03:11:38,000 MORE PROBABLY FUTURE, I THINK 5159 03:11:38,000 --> 03:11:40,640 COMPOUNDED BY THE FACT THAT WE 5160 03:11:40,640 --> 03:11:42,560 REALIZED THE HUGE DISPARITIES 5161 03:11:42,560 --> 03:11:45,320 THAT HAVE EXISTED FROM THE COVID 5162 03:11:45,320 --> 03:11:45,680 PANDEMIC. 5163 03:11:45,680 --> 03:11:48,320 IT IS SHED LIGHT ON THAT AND YOU 5164 03:11:48,320 --> 03:11:50,280 KNOW THAT THE NIH HAS PUT A LENS 5165 03:11:50,280 --> 03:11:52,600 ON THAT BY CREATING SPECIFIC 5166 03:11:52,600 --> 03:11:54,800 PROGRAMS TO ADDRESS THOSE 5167 03:11:54,800 --> 03:11:57,640 DISPARITIES SO I THINK AS WE 5168 03:11:57,640 --> 03:11:59,640 COMMIT OUR FOCUS AWAY HOPEFULLY 5169 03:11:59,640 --> 03:12:01,200 FROM COVID WE WILL START TO 5170 03:12:01,200 --> 03:12:06,120 THINK ABOUT THESE OTHER 5171 03:12:06,120 --> 03:12:08,320 DISPARITIES IN A MORE GRANULAR 5172 03:12:08,320 --> 03:12:10,640 WAY. 5173 03:12:10,640 --> 03:12:11,920 >> I HAVE A COMMENT. 5174 03:12:11,920 --> 03:12:14,120 I THINK PART OF IT, THIS IS WHY 5175 03:12:14,120 --> 03:12:18,280 THIS MEETING IS SO IMPORTANT, WE 5176 03:12:18,280 --> 03:12:20,320 HAVE AN NIH DISEASE FOCUSED SO 5177 03:12:20,320 --> 03:12:23,040 WHEN WE REALLY TRY AND SAY 5178 03:12:23,040 --> 03:12:28,360 LISTEN, WE NEED TO MOVE BEYOND 5179 03:12:28,360 --> 03:12:30,200 SINGLE DISEASE TO HOW THESE 5180 03:12:30,200 --> 03:12:34,800 INTERACT BECAUSE THEY DO 5181 03:12:34,800 --> 03:12:37,360 INTERACT, SO IT IS HARD BECAUSE 5182 03:12:37,360 --> 03:12:40,200 I THINK WITH MY RESEARCH HAT ON, 5183 03:12:40,200 --> 03:12:42,800 YOU THINK GOSH I'M APPLYING TO 5184 03:12:42,800 --> 03:12:45,200 NIAAA, I BETTER JUST TALK ABOUT 5185 03:12:45,200 --> 03:12:48,160 ALCOHOL THOUGH I KNOW MANY 5186 03:12:48,160 --> 03:12:49,800 INDIVIDUALS HAVE CO-OCCURRING 5187 03:12:49,800 --> 03:12:50,920 OTHER SUBSTANCE USE MENTAL 5188 03:12:50,920 --> 03:12:52,600 HEALTH DISORDER, DIABETES, 5189 03:12:52,600 --> 03:12:56,640 HYPERTENSION SO IT'S BREAKING 5190 03:12:56,640 --> 03:12:57,960 DOWN THOSE SILOS, I THINK IS 5191 03:12:57,960 --> 03:13:00,920 GOING TO NEED TO OCCUR LIKE 5192 03:13:00,920 --> 03:13:04,400 AMONG CLINICIANS, AMONG SORT OF 5193 03:13:04,400 --> 03:13:07,320 HOSPITAL SYSTEMS, BUT ALSO EVEN 5194 03:13:07,320 --> 03:13:09,640 MORE BROADLY AMONG FUNDING 5195 03:13:09,640 --> 03:13:16,480 AGENCIES. 5196 03:13:16,480 --> 03:13:18,240 >> INTERNALLY WE TEND TO BE 5197 03:13:18,240 --> 03:13:19,800 BETTER WHEN WE THINK ABOUT 5198 03:13:19,800 --> 03:13:21,120 WOMEN'S HEALTH BECAUSE AS DR. 5199 03:13:21,120 --> 03:13:23,880 CLAYTON POINTED OUT YESTERDAY IN 5200 03:13:23,880 --> 03:13:26,760 HER EKG CHART WE KNOW WHERE 5201 03:13:26,760 --> 03:13:30,800 THESE CRITICAL TIME POINT ARE, 5202 03:13:30,800 --> 03:13:31,800 ACROSS LIFE SPAN FOR WOMEN AND 5203 03:13:31,800 --> 03:13:33,040 GIRLS AND ALL THESE DIFFERENT 5204 03:13:33,040 --> 03:13:34,360 CONDITIONS THAT AFFECT THE LIFE 5205 03:13:34,360 --> 03:13:38,440 COURSE ARE TRAJECTORY FOR HEALTH 5206 03:13:38,440 --> 03:13:41,400 AND THEN CHRONIC DISEASE SO WE 5207 03:13:41,400 --> 03:13:42,920 DO PRETTY GOOD WITH THOSE TYPES 5208 03:13:42,920 --> 03:13:46,480 OF PARTNERSHIPS INTERNALLY AT 5209 03:13:46,480 --> 03:13:49,840 THE NIH, WE HAVE INFRASTRUCTURE 5210 03:13:49,840 --> 03:13:52,880 LARGE TRANS-NIH HEALTH WORKING 5211 03:13:52,880 --> 03:13:55,000 GROUPS. 5212 03:13:55,000 --> 03:13:56,080 SO WE RECOGNIZE THAT, BUT 5213 03:13:56,080 --> 03:13:58,400 GETTING MOMENTUM TO MAKE NEW 5214 03:13:58,400 --> 03:13:59,400 INITIATIVES, IS SOMETHING THAT 5215 03:13:59,400 --> 03:14:02,480 DOES TAKE TIME. 5216 03:14:02,480 --> 03:14:04,240 THAT IS WHY WE CONVENE THIS 5217 03:14:04,240 --> 03:14:05,800 WORKSHOP TO HEAR FROM YOU AND 5218 03:14:05,800 --> 03:14:11,720 COMMUNITY STAKEHOLDERS. 5219 03:14:11,720 --> 03:14:13,160 >> I APPRECIATE THAT. 5220 03:14:13,160 --> 03:14:15,840 I WAS THINKING ABOUT THAT. 5221 03:14:15,840 --> 03:14:22,240 IN MY TRAINING HOW WAS IT 5222 03:14:22,240 --> 03:14:23,960 TRAIND? PICK YOUR INSTITUTE, 5223 03:14:23,960 --> 03:14:24,640 THAT WAS LONG TIME AGO. 5224 03:14:24,640 --> 03:14:25,600 ANY OTHER QUESTIONS AND 5225 03:14:25,600 --> 03:14:30,480 COMMENTS? 5226 03:14:30,480 --> 03:14:31,800 >> THINKING ABOUT HOW ONE OF THE 5227 03:14:31,800 --> 03:14:33,400 THINGS I HAVE BEEN THINKING 5228 03:14:33,400 --> 03:14:35,400 GIVEN ALL THIS ARE THERE 5229 03:14:35,400 --> 03:14:39,000 SOLUTIONS THAT CUT ACROSS MANY 5230 03:14:39,000 --> 03:14:43,120 OF THESE DIFFERENT CONDITIONS. 5231 03:14:43,120 --> 03:14:43,720 I WAS HAVE YOU BEEN BY THE 5232 03:14:43,720 --> 03:14:45,200 HEALTH IT TALK AND IT WAS MY 5233 03:14:45,200 --> 03:14:46,880 UNDERSTANDING THAT USING A 5234 03:14:46,880 --> 03:14:52,040 SINGLE IDENTIFIER FOR PEOPLE TO 5235 03:14:52,040 --> 03:14:54,040 COORDINATE HEALTH RECORDS ACROSS 5236 03:14:54,040 --> 03:14:56,000 SYSTEMS, IT IS SINGLE IDENTIFIER 5237 03:14:56,000 --> 03:14:59,520 ISSUE, IT IS ILLEGAL IN THE U.S. 5238 03:14:59,520 --> 03:15:01,120 BUT THAT IT IS ILLEGAL TO CREATE 5239 03:15:01,120 --> 03:15:02,800 A NUMBER YOU CAN USE TO LINK 5240 03:15:02,800 --> 03:15:07,000 HEALTH RECORDS ACROSS DIFFERENT 5241 03:15:07,000 --> 03:15:07,840 HEALTH SYSTEMS WITHIN THE US. 5242 03:15:07,840 --> 03:15:12,640 IS THAT TRUE? 5243 03:15:12,640 --> 03:15:15,320 >> I WOULD SAY THAT IS TRUE TISS 5244 03:15:15,320 --> 03:15:17,840 POINT IN TIME. 5245 03:15:17,840 --> 03:15:19,960 >> SO THAT IS ANOTHER FEEL LIKE 5246 03:15:19,960 --> 03:15:26,200 I'M HARPING ON THIS BUT IT IS 5247 03:15:26,200 --> 03:15:27,840 ANOTHER POLICY BARRIER BECAUSE 5248 03:15:27,840 --> 03:15:28,840 THAT SOLVES MANY OF THE PROBLEMS 5249 03:15:28,840 --> 03:15:33,200 WE ARE TALKING ABOUT IF WE COULD 5250 03:15:33,200 --> 03:15:34,120 ACTUALLY SHARE RECORDS BUT WE 5251 03:15:34,120 --> 03:15:36,200 CAN'T. 5252 03:15:36,200 --> 03:15:41,680 A LOT OF HEALTH SYSTEMS, CROSS 5253 03:15:41,680 --> 03:15:42,800 CUTTING THEMES ARE SYSTEMS 5254 03:15:42,800 --> 03:15:44,000 STRUGGLE WITH RESOURCES TO DO 5255 03:15:44,000 --> 03:15:45,360 WHAT THEY NEED TO DO, RESOURCES 5256 03:15:45,360 --> 03:15:51,240 TO COORDINATE ACROSS SYSTEMS ARE 5257 03:15:51,240 --> 03:15:53,400 SOMETIMES THEY CAN DO THEM BUT 5258 03:15:53,400 --> 03:15:55,560 CARE COORDINATORS PROGRAM NOT 5259 03:15:55,560 --> 03:15:56,720 INTEGRATEDED FROM PAYER AND SOME 5260 03:15:56,720 --> 03:15:59,680 OF THE THINGS TO INTEGRATE CARE 5261 03:15:59,680 --> 03:16:03,000 ARE IN THIS CASE NOT EVEN LEGAL. 5262 03:16:03,000 --> 03:16:06,240 SO SORT OF FUNDAMENTAL PROBLEM 5263 03:16:06,240 --> 03:16:07,800 WITH THE STRUCTURE OF THE HEALTH 5264 03:16:07,800 --> 03:16:08,320 SYSTEM. 5265 03:16:08,320 --> 03:16:09,040 >> YEAH. 5266 03:16:09,040 --> 03:16:12,040 SO WHILE THAT IS ONE DIRECTION 5267 03:16:12,040 --> 03:16:13,560 WE CANNOT TAKE WE ARE SCORING 5268 03:16:13,560 --> 03:16:15,200 OPPORTUNITIES FOR LOOKING AT 5269 03:16:15,200 --> 03:16:16,400 PATIENT MATCHING. 5270 03:16:16,400 --> 03:16:18,880 AND I THINK THAT QUESTION IS 5271 03:16:18,880 --> 03:16:20,880 SPECIFICALLY FROM YOU, JENNIFER. 5272 03:16:20,880 --> 03:16:22,680 I CAN SHARE RESOURCES, IF YOU 5273 03:16:22,680 --> 03:16:24,400 ARE INTERESTED IN SEEING THE 5274 03:16:24,400 --> 03:16:26,000 WORK WE HAVE BEEN DOING IN THAT 5275 03:16:26,000 --> 03:16:28,280 SPACE BECAUSE WE DO HAVE GROUP 5276 03:16:28,280 --> 03:16:30,600 OF PEOPLE DEDICATED TO FOCUSING 5277 03:16:30,600 --> 03:16:31,600 ON PATIENT MATCHING. 5278 03:16:31,600 --> 03:16:33,320 BECAUSE IT IS ONE OF THE ISSUES 5279 03:16:33,320 --> 03:16:34,880 THAT WE HAVE IN SEVERAL OF THE 5280 03:16:34,880 --> 03:16:37,840 PROGRAMS WE DO AS WELL. 5281 03:16:37,840 --> 03:16:39,640 >> MAY I ASK A QUESTION, WE ARE 5282 03:16:39,640 --> 03:16:40,880 CURIOUS IF OTHER PANELISTS AT 5283 03:16:40,880 --> 03:16:45,760 THE END OF THE DAY LIKE GIVEN 5284 03:16:45,760 --> 03:16:46,760 EVERYTHING WE HEARD IF YOU HAD A 5285 03:16:46,760 --> 03:16:49,280 WISH OR ONE THING YOU CAN DO TO 5286 03:16:49,280 --> 03:16:52,040 FIX HEALTHCARE FOR WOMEN AND 5287 03:16:52,040 --> 03:16:59,480 GIRLS WHAT WOULD IT BE? 5288 03:16:59,480 --> 03:17:01,400 >> I WILL START. 5289 03:17:01,400 --> 03:17:04,760 MINE IS LESS SOPHISTICATED THAN 5290 03:17:04,760 --> 03:17:08,240 MANY ON THE PANEL I HAVE LONG 5291 03:17:08,240 --> 03:17:10,240 HELD THE BELIEF IN MEDICINE, I 5292 03:17:10,240 --> 03:17:13,280 AM SPEAKING FROM THAT 5293 03:17:13,280 --> 03:17:14,160 PERSPECTIVE THIS EXPECTATION 5294 03:17:14,160 --> 03:17:17,520 INDIVIDUALS COME TO US AND WE 5295 03:17:17,520 --> 03:17:21,440 ARE SO STUCK IN THIS MODEL THAT 5296 03:17:21,440 --> 03:17:23,080 YOU HAVE TO COME TO CLINIC AND 5297 03:17:23,080 --> 03:17:25,800 TO THE HOSPITAL AND I THINK 5298 03:17:25,800 --> 03:17:27,600 REALLY STARTING TO THINK A 5299 03:17:27,600 --> 03:17:30,800 LITTLE BIT MORE ABOUT HOW WE 5300 03:17:30,800 --> 03:17:32,160 BRING OUR SERVICES INTO THE 5301 03:17:32,160 --> 03:17:33,200 COMMUNITY. 5302 03:17:33,200 --> 03:17:35,280 I KNOW FOLKS ARE DOING THIS, 5303 03:17:35,280 --> 03:17:37,280 THERE'S MORE AND MORE VAN BASED 5304 03:17:37,280 --> 03:17:38,280 CARE FOR INDIVIDUALS WITH 5305 03:17:38,280 --> 03:17:40,680 SUBSTANCE USE DISORDERS, WHETHER 5306 03:17:40,680 --> 03:17:43,760 DOING WOUND CARE AND SYRINGE 5307 03:17:43,760 --> 03:17:47,840 EXCHANGE AND SUCKS OXONE. 5308 03:17:47,840 --> 03:17:48,920 -- SUB OX SEWN. 5309 03:17:48,920 --> 03:17:50,640 IF WE CAN DO THAT MORE BROADLY 5310 03:17:50,640 --> 03:17:55,920 AND THINK OUTSIDE OF THE HASSLE 5311 03:17:55,920 --> 03:17:58,800 BUILDING AND CLINIC BUILDING, I 5312 03:17:58,800 --> 03:18:01,440 THINK WE'LL INCREASE ACCESS TO 5313 03:18:01,440 --> 03:18:03,200 CARE AND CHIP AWAY AT 5314 03:18:03,200 --> 03:18:04,240 DISPARITIES. 5315 03:18:04,240 --> 03:18:06,000 SO MANY TRANSPORTATION BARRIERS, 5316 03:18:06,000 --> 03:18:08,440 BARRIERS FOR PEOPLE TO GET AT 5317 03:18:08,440 --> 03:18:09,720 LEAST HERE IN BALTIMORE PEOPLE 5318 03:18:09,720 --> 03:18:11,240 TAKE THREE OR FOUR BUSES, AND 5319 03:18:11,240 --> 03:18:13,800 THE BUSS ARE NEVER ON TIME AND 5320 03:18:13,800 --> 03:18:16,680 IF IT IS RAINING OR SNOWING. 5321 03:18:16,680 --> 03:18:19,000 I FEEL LIKE IF WE CAN FIGURE OUT 5322 03:18:19,000 --> 03:18:21,000 A WAY TO MOVE A LITTLE BIT OUT 5323 03:18:21,000 --> 03:18:22,720 OF THE HEALTHCARE SYSTEM IN TO 5324 03:18:22,720 --> 03:18:26,120 THE COMMUNITY AND THEN FOCUS ON 5325 03:18:26,120 --> 03:18:27,680 INTEGRATING IN THE -- IN 5326 03:18:27,680 --> 03:18:30,280 CREATIVELY IN THAT WAY. 5327 03:18:30,280 --> 03:18:32,480 >> I WILL SAY EVERY IRB MEMBER 5328 03:18:32,480 --> 03:18:33,720 IN THE COUNTRY UNDERSTANDS SEX 5329 03:18:33,720 --> 03:18:35,720 AND GENDER DIFFERENCES AND THAT 5330 03:18:35,720 --> 03:18:37,920 ANY PROPOSAL THAT IS BROUGHT 5331 03:18:37,920 --> 03:18:39,400 BEFORE THEM THAT DOESN'T INCLUDE 5332 03:18:39,400 --> 03:18:42,720 DISCUSSION OF SEX GENDER EITHER 5333 03:18:42,720 --> 03:18:44,400 SENT BACK TO RESEARCHERS OR 5334 03:18:44,400 --> 03:18:45,560 RESEARCHERS EXPLAIN WHY SEX 5335 03:18:45,560 --> 03:18:48,200 GENDER IS NOT INCLUDED, I WOULD 5336 03:18:48,200 --> 03:18:51,240 INCLUDE THAT FOR IAKUK MEMBERS 5337 03:18:51,240 --> 03:18:55,000 FOR ANIMAL STUDIES. 5338 03:18:55,000 --> 03:18:55,600 EVERY JOURNAL IN THE COUNTRY 5339 03:18:55,600 --> 03:18:56,960 SIMILAR GUIDELINES, WILL NOT 5340 03:18:56,960 --> 03:18:58,320 PUBLISH ANYTHING THAT DOES NOT 5341 03:18:58,320 --> 03:19:01,880 DESCRIBE SEX GENDER DIFFERENCES 5342 03:19:01,880 --> 03:19:03,400 UNLESS AS STATED IN THE SAFER 5343 03:19:03,400 --> 03:19:05,440 GUIDELINES THE AUTHORS DESCRIBE 5344 03:19:05,440 --> 03:19:06,600 WHY SEX GENDER IS NOT RELEVANT 5345 03:19:06,600 --> 03:19:11,160 TO THEIR STUDY. 5346 03:19:11,160 --> 03:19:13,480 >> I'M LOVING THESE WISHES, 5347 03:19:13,480 --> 03:19:19,560 OTHER WISHES. 5348 03:19:19,560 --> 03:19:21,640 >> I FEEL LIKE WHAT WE ARE 5349 03:19:21,640 --> 03:19:22,880 TALKING ABOUT IS RELATED TO 5350 03:19:22,880 --> 03:19:24,080 POVERTY AND INSTITUTIONALIZED 5351 03:19:24,080 --> 03:19:28,200 RACISM SO THAT YOU SEE ALL THESE 5352 03:19:28,200 --> 03:19:28,800 CARE DOUBTS AND CARE PROBLEMS 5353 03:19:28,800 --> 03:19:30,520 AND PROBLEMS GETTING TO 5354 03:19:30,520 --> 03:19:31,880 APPOINTMENTS AND PROBLEM 5355 03:19:31,880 --> 03:19:34,760 SETTING, IN A FOOD AND SO ON, SO 5356 03:19:34,760 --> 03:19:38,240 FORTH IS NOT LIMITED ONLY TO BY 5357 03:19:38,240 --> 03:19:39,480 INCOME BECAUSE SOMETIMES THERE 5358 03:19:39,480 --> 03:19:41,400 ARE OTHER MENTAL HEALTH 5359 03:19:41,400 --> 03:19:43,160 RESOURCES MIGHT NOT BE WIDELY 5360 03:19:43,160 --> 03:19:46,120 AVAILABLE IN COMMUNITY NO MATTER 5361 03:19:46,120 --> 03:19:46,960 HOW MUCH MONEY YOU HAVE. 5362 03:19:46,960 --> 03:19:50,800 A LOT OF THIS IS WE HAVE SILOED 5363 03:19:50,800 --> 03:19:53,480 SYSTEMS IN GENERAL, AND OFTEN WE 5364 03:19:53,480 --> 03:19:55,920 PUT A LOT OF RESPONSIBILITY ON 5365 03:19:55,920 --> 03:19:57,000 SCHOOLS FOR SOLVING ALL THE 5366 03:19:57,000 --> 03:19:59,880 WORLD PROBLEMS AND I FELT LIKE 5367 03:19:59,880 --> 03:20:02,400 JUST AS WE SILOED ELEMENTS 5368 03:20:02,400 --> 03:20:05,480 WITHIN MEDICAL CARE, OR SILOED 5369 03:20:05,480 --> 03:20:06,920 ELEMENTS WITHIN DISEASE STUDY, 5370 03:20:06,920 --> 03:20:09,160 WE JUST HAVE -- WE TEND TO SEE 5371 03:20:09,160 --> 03:20:14,080 PEOPLE IN THESE RIGID SILOS AS 5372 03:20:14,080 --> 03:20:16,320 WELL, THIS IS YOUR EDUCATION 5373 03:20:16,320 --> 03:20:18,200 PART, HEALTH PART, AS OPPOSED TO 5374 03:20:18,200 --> 03:20:20,080 FACT THE WHOLE PERSON 5375 03:20:20,080 --> 03:20:20,800 EXPERIENCESES ALL THESE THINGS 5376 03:20:20,800 --> 03:20:23,760 AND IF YOU ARE ONLY ADDRESSING 5377 03:20:23,760 --> 03:20:27,200 THEM IN THESE VARIOUS COMPONENTS 5378 03:20:27,200 --> 03:20:28,960 COMPONENTS, YOU ARE NOT ABLE TO 5379 03:20:28,960 --> 03:20:32,600 HELP THAT PERSON IN THE WAY YOU 5380 03:20:32,600 --> 03:20:32,960 MIGHT LIKE. 5381 03:20:32,960 --> 03:20:34,200 I DON'T KNOW HOW WE SOLVE; THAT 5382 03:20:34,200 --> 03:20:36,760 IS A BIG PROBLEM SOLVING THING, 5383 03:20:36,760 --> 03:20:39,280 ADDRESSING POVERTY, SYSTEMIC 5384 03:20:39,280 --> 03:20:40,760 RACISM, WE DO HAVE THESE 5385 03:20:40,760 --> 03:20:48,160 SYSTEMIC ISSUES AND THE BAND AID 5386 03:20:48,160 --> 03:20:48,600 APPROACH SHARD. 5387 03:20:48,600 --> 03:20:51,160 IT IS HARD TO STOP A GIGANTIC 5388 03:20:51,160 --> 03:20:52,360 PROBLEM WITH A SMALL SOLUTION. 5389 03:20:52,360 --> 03:20:54,120 NO MATTER HOW EFFECTIVE THAT 5390 03:20:54,120 --> 03:20:55,200 SOLUTION MIGHT BE FOR THE LITTLE 5391 03:20:55,200 --> 03:20:59,960 PART OF THE PROBLEM SOLVING. 5392 03:20:59,960 --> 03:21:07,520 >> STEVE OR SHERRY OR OTHERS? 5393 03:21:07,520 --> 03:21:09,200 >> THERE IS A SMALL PART OF THE 5394 03:21:09,200 --> 03:21:13,800 PUZZLE IS INCREASING THE 5395 03:21:13,800 --> 03:21:16,080 REPRESENTATION OF RACIAL ETHNIC 5396 03:21:16,080 --> 03:21:18,760 MINORITIES IN THE WORK SHORES. 5397 03:21:18,760 --> 03:21:20,280 MY WISH IS MAJOR RESERGE 5398 03:21:20,280 --> 03:21:21,080 INITIATIVES GOING FORWARD BE 5399 03:21:21,080 --> 03:21:23,720 MINDFUL OF THAT ENHANCED SOME 5400 03:21:23,720 --> 03:21:25,920 COMPONENT THAT INCREASINGS 5401 03:21:25,920 --> 03:21:28,520 EDUCATION AND TRAINING. 5402 03:21:28,520 --> 03:21:31,920 FOR RACIAL ETHNIC MINORITY 5403 03:21:31,920 --> 03:21:32,600 CANDIDATES FOR HEALTHCARE 5404 03:21:32,600 --> 03:21:37,240 PROFESSIONS. 5405 03:21:37,240 --> 03:21:40,080 >> I THINK I WOULD ONLY ADD 5406 03:21:40,080 --> 03:21:41,880 JENNIFER SOMETHING MUCH SMALLER 5407 03:21:41,880 --> 03:21:43,440 AND MORE FOCUSED IN THE GREAT 5408 03:21:43,440 --> 03:21:45,120 IDEAS WE HEARD FROM OTHER 5409 03:21:45,120 --> 03:21:47,000 PANELISTS, THERE IS A TREMENDOUS 5410 03:21:47,000 --> 03:21:50,080 NEED IF NOT FOR SINGLE PAYER 5411 03:21:50,080 --> 03:21:52,600 HEALTHCARE WHICH I WILL JUST 5412 03:21:52,600 --> 03:21:54,760 STOP WISHING FOR FOR THE MOMENT 5413 03:21:54,760 --> 03:21:56,840 BUT AT LEAST DRAMATIC 5414 03:21:56,840 --> 03:21:59,000 SIMPLIFICATION OF BILLING. 5415 03:21:59,000 --> 03:22:02,280 AND CONSISTENCY OF PAYMENT, 5416 03:22:02,280 --> 03:22:02,960 EXTRAORDINARILY DIFFICULT TO 5417 03:22:02,960 --> 03:22:05,080 FIGURE THAT OUT TO GET PAID FOR 5418 03:22:05,080 --> 03:22:06,360 SOME OF THE WORK THAT WE ARE 5419 03:22:06,360 --> 03:22:08,560 TALKING ABOUT THAT WE KNOW CAN 5420 03:22:08,560 --> 03:22:10,320 IMPROVE HEALTH LIKE CASE 5421 03:22:10,320 --> 03:22:11,760 MANAGEMENT, LIKE BRIEF 5422 03:22:11,760 --> 03:22:12,880 INTERVENTIONS, LIKE COUNSELING, 5423 03:22:12,880 --> 03:22:14,440 LIKE INTEGRATED CARE. 5424 03:22:14,440 --> 03:22:16,800 IT IS JUST A GREAT BIG 5425 03:22:16,800 --> 03:22:21,240 CONVOLUTED COMPLICATED MESS THAT 5426 03:22:21,240 --> 03:22:22,320 PROVIDERS ON THE GROUND DON'T 5427 03:22:22,320 --> 03:22:24,080 HAVE CAPACITY OR TIME TO DIG 5428 03:22:24,080 --> 03:22:24,600 INTO. 5429 03:22:24,600 --> 03:22:28,000 SO THAT THEY GET REIMBURSEMENTS 5430 03:22:28,000 --> 03:22:29,800 THEY NEED, SO SIMPLIFICATION IN 5431 03:22:29,800 --> 03:22:32,080 THAT REGARD ALSO HELPS. 5432 03:22:32,080 --> 03:22:33,880 >> I WOULD ADD BASED ON WHAT I 5433 03:22:33,880 --> 03:22:38,760 SAID YESTERDAY, AS TO BETTER 5434 03:22:38,760 --> 03:22:40,080 FUND PREVENTION BECAUSE OUR 5435 03:22:40,080 --> 03:22:41,040 BILLING SYSTEM IS COMPLETELY 5436 03:22:41,040 --> 03:22:46,360 MESSED UP. 5437 03:22:46,360 --> 03:22:46,600 OTHER -- 5438 03:22:46,600 --> 03:22:49,120 >> THESE JAWANNA HENRY, I WANT 5439 03:22:49,120 --> 03:22:50,120 TO CLARIFY WHAT I SAID EARLIER 5440 03:22:50,120 --> 03:22:52,640 ABOUT UNIQUE PATIENT IDENTIFIER. 5441 03:22:52,640 --> 03:22:54,360 IS NOT TECHNICALLY LEGAL, BUT WE 5442 03:22:54,360 --> 03:22:57,400 ARE PROHIBITED FROM USING HHS 5443 03:22:57,400 --> 03:22:59,360 FUNDS TO CREATE A NATIONAL 5444 03:22:59,360 --> 03:23:03,680 UNIQUE PATIENT IDENTIFIER. 5445 03:23:03,680 --> 03:23:05,360 SO THAT IS FOR YOUR AWARENESS, 5446 03:23:05,360 --> 03:23:08,880 IF I DID HAVE ONE THING IS THAT 5447 03:23:08,880 --> 03:23:10,440 PEOPLE WOULD BECOME MORE AWARE 5448 03:23:10,440 --> 03:23:13,360 OF OUR STANDARDS AND HOW THEY 5449 03:23:13,360 --> 03:23:15,360 CAN USE THOSE STANDARDS TO GET 5450 03:23:15,360 --> 03:23:17,480 THE DATA THAT THEY NEED IN ORDER 5451 03:23:17,480 --> 03:23:19,600 TO ENHANCE RESEARCH SO YOU CAN 5452 03:23:19,600 --> 03:23:22,080 HAVE THE DATA TO FIND OUTCOMES 5453 03:23:22,080 --> 03:23:24,120 SO WE CAN IMPROVE PATIENT 5454 03:23:24,120 --> 03:23:29,200 OUTCOMES. 5455 03:23:29,200 --> 03:23:31,600 >> IN ADDITION TO THE BIG THING 5456 03:23:31,600 --> 03:23:34,080 I OFTEN THINK OF LIKE I DON'T 5457 03:23:34,080 --> 03:23:36,080 KNOW IF I HAVE THIS RIGHT INCAR 5458 03:23:36,080 --> 03:23:37,840 RATE HALF THE PEOPLE -- 5459 03:23:37,840 --> 03:23:39,600 INCARCERATE HALF THE PEOPLE, 5460 03:23:39,600 --> 03:23:41,080 MENTAL HEALTH BUT AGREE THAT HAS 5461 03:23:41,080 --> 03:23:42,840 TO DO WITH POVERTY AND RACISM 5462 03:23:42,840 --> 03:23:45,400 AND ALL THESE THINGS, I GUESS I 5463 03:23:45,400 --> 03:23:46,600 WISH ALSO THAT SOME OF THESE 5464 03:23:46,600 --> 03:23:49,840 ISSUES THAT TO ME IS A MECHANIC 5465 03:23:49,840 --> 03:23:53,680 PROVIDER ARE RESEARCHERS HEALTH 5466 03:23:53,680 --> 03:23:55,480 ISSUE WEREN'T SUCH POLITICAL HOT 5467 03:23:55,480 --> 03:23:56,400 BUTTON TOPICS. 5468 03:23:56,400 --> 03:23:58,520 TALKING CENTRALIZED HEALTHCARE 5469 03:23:58,520 --> 03:24:03,000 AND GOVERNMENT ROLE IN OUR LIVES 5470 03:24:03,000 --> 03:24:05,680 AND I WISH I GUESS THAT POLICY 5471 03:24:05,680 --> 03:24:10,280 AND LAW FOLLOWED THE DATA ABOUT 5472 03:24:10,280 --> 03:24:21,840 WHAT WE KNOW. 5473 03:24:21,840 --> 03:24:24,080 >> I WAS GOING TO ADDRESS MARRAH 5474 03:24:24,080 --> 03:24:26,520 HAD PUT A QUESTION IN THE CHAT 5475 03:24:26,520 --> 03:24:28,440 THAT SAYS I WONDER IF THERE ARE 5476 03:24:28,440 --> 03:24:30,120 LESSONS LEARNED FROM COMMUNITY 5477 03:24:30,120 --> 03:24:31,720 INTERVENTIONS FOR COVID TESTING 5478 03:24:31,720 --> 03:24:35,160 AND THAT SEEMS APPLIED TO WOMEN 5479 03:24:35,160 --> 03:24:38,680 HEALTH INTERVENTION AND JUST THE 5480 03:24:38,680 --> 03:24:40,600 OBVIOUS THOUGHT THAT CAME TO ME 5481 03:24:40,600 --> 03:24:42,400 THAT WHAT HAS BEEN HELPFUL AT 5482 03:24:42,400 --> 03:24:47,600 LEAST PARTIALLY IS THAT VACCINES 5483 03:24:47,600 --> 03:24:51,320 AT LEAST ARE FREE, YOU DON'T 5484 03:24:51,320 --> 03:24:52,360 NEED HEALTH INSURANCE THERE HAVE 5485 03:24:52,360 --> 03:24:56,600 BEEN EFFORTS TO GET THEM TO 5486 03:24:56,600 --> 03:24:59,600 PEOPLE POP UP VACCINE CLINICS. 5487 03:24:59,600 --> 03:25:02,600 AT BARS OR OTHER PLACES THAT 5488 03:25:02,600 --> 03:25:03,960 BRING THEM TO PEOPLE. 5489 03:25:03,960 --> 03:25:06,280 SO I THINK THOSE LESSONS COULD 5490 03:25:06,280 --> 03:25:07,760 BE CERTAINLY APPLIED TO WOMEN'S 5491 03:25:07,760 --> 03:25:12,040 HEALTH. 5492 03:25:12,040 --> 03:25:17,040 I WOULD ADD THE NUMEROUS EFFORTS 5493 03:25:17,040 --> 03:25:18,240 TO TRYING TO BUILD TRUST IN THE 5494 03:25:18,240 --> 03:25:22,320 COMMUNITY, THAT HAVE OCCURRED 5495 03:25:22,320 --> 03:25:25,800 THROUGH VACCINE EFFORTS WHICH I 5496 03:25:25,800 --> 03:25:27,360 THINK REALLY I MEAN I HAVEN'T 5497 03:25:27,360 --> 03:25:31,120 SEEN AS MUCH OF UNTIL THERE'S 5498 03:25:31,120 --> 03:25:39,000 ISSUE OF ADDRESSING HEAD ON 5499 03:25:39,000 --> 03:25:39,800 ISSUES OF TRUST. 5500 03:25:39,800 --> 03:25:41,000 >> ALSO MISINFORMATION. 5501 03:25:41,000 --> 03:25:43,000 I THINK WE ARE STILL TRYING TO 5502 03:25:43,000 --> 03:25:44,520 GET OUR HAND -- ARMS AROUND THAT 5503 03:25:44,520 --> 03:25:46,680 TO THE EXTEND TO WHICH IT HAS 5504 03:25:46,680 --> 03:25:48,800 BEEN SO SALIENT WITH COVID BUT I 5505 03:25:48,800 --> 03:25:51,560 THINK IT IS PROMPTING A LOT OF 5506 03:25:51,560 --> 03:25:53,240 MORE INNOVATIVE THINKING ABOUT 5507 03:25:53,240 --> 03:25:57,320 WHAT DO YOU DO WITH 5508 03:25:57,320 --> 03:25:58,200 MISINFORMATION AND HOW DO YOU 5509 03:25:58,200 --> 03:25:59,640 HELP PEOPLE UNDERSTAND WHAT IS 5510 03:25:59,640 --> 03:26:07,000 TRUE. 5511 03:26:07,000 --> 03:26:08,800 >> (INAUDIBLE) HAS LAID THERE, 5512 03:26:08,800 --> 03:26:11,160 THAT CRISIS AND COMMUNICATION, A 5513 03:26:11,160 --> 03:26:13,040 GAP IN COMMUNICATION, I HOPE WE 5514 03:26:13,040 --> 03:26:16,280 WILL LEARN FROM IT THAT WE 5515 03:26:16,280 --> 03:26:21,120 REALLY NEED TO INSTITUTIONALIZE 5516 03:26:21,120 --> 03:26:24,120 THE COMMUNICATION, METHODS FOR 5517 03:26:24,120 --> 03:26:27,160 COMMUNICATION BETWEEN RESEARCH 5518 03:26:27,160 --> 03:26:28,360 ENTERPRISE, THE PRACTICE 5519 03:26:28,360 --> 03:26:29,800 ENTERPRISE AND COMMUNITIES. 5520 03:26:29,800 --> 03:26:32,920 SO THAT IT IS NOT WHEN SOMETHING 5521 03:26:32,920 --> 03:26:35,800 LIKE THIS HAPPENS AGAIN, IT 5522 03:26:35,800 --> 03:26:37,560 WILL, CRISIS THOSE MECHANISMS 5523 03:26:37,560 --> 03:26:39,120 ARE IN PLACE. 5524 03:26:39,120 --> 03:26:42,640 AND WE HAVE BRIDGED THE GAP. 5525 03:26:42,640 --> 03:26:44,320 OR AT LEAST COME CLOSER TO 5526 03:26:44,320 --> 03:26:46,080 BRIDGING THE GAP, THE 5527 03:26:46,080 --> 03:26:47,200 COMMUNICATION GAP THAN WE ARE 5528 03:26:47,200 --> 03:26:49,040 RIGHT NOW. 5529 03:26:49,040 --> 03:26:52,360 >> I THINK ON MY WISH LIST I 5530 03:26:52,360 --> 03:26:56,360 WOULD PUT AT THE TOP HEALTH 5531 03:26:56,360 --> 03:27:00,560 EQUITY. 5532 03:27:00,560 --> 03:27:06,640 AND FROM THAT WILL FLOW MANY 5533 03:27:06,640 --> 03:27:10,360 DIFFERENT INSTITUTIONAL CHANGES 5534 03:27:10,360 --> 03:27:13,800 AND SCALE UP AND I REALLY LIKED 5535 03:27:13,800 --> 03:27:18,720 WHAT WAS SAID ABOUT DISRUPTIVE 5536 03:27:18,720 --> 03:27:20,200 TECHNOLOGIES. 5537 03:27:20,200 --> 03:27:24,000 SO I THINK IF WE USE THE 5538 03:27:24,000 --> 03:27:27,560 FRAMEWORK OF DISRUPTIVE 5539 03:27:27,560 --> 03:27:29,160 TECHNOLOGIES TO REFRAME HEALTH 5540 03:27:29,160 --> 03:27:31,680 EQUITY TO ADDRESS 5541 03:27:31,680 --> 03:27:32,880 MULTI-MORBIDITY IN WOMEN AN 5542 03:27:32,880 --> 03:27:37,360 GIRLS WE WILL REALLY COME UP 5543 03:27:37,360 --> 03:27:40,560 WITH A STRATEGY THAT WILL BE 5544 03:27:40,560 --> 03:27:42,160 VERY EFFECTIVE FOR US. 5545 03:27:42,160 --> 03:27:44,360 THEN I THINK THE OTHER THING, I 5546 03:27:44,360 --> 03:27:45,560 ALWAYS THINK ABOUT WHO IS NOT IN 5547 03:27:45,560 --> 03:27:47,480 THE ROOM. 5548 03:27:47,480 --> 03:27:49,560 IT IS WOMEN -- THE WOMAN 5549 03:27:49,560 --> 03:27:51,320 HERSELF. THE WOMAN WHO IS 5550 03:27:51,320 --> 03:27:56,360 LIVING THE COMPLEX COMPLICATED 5551 03:27:56,360 --> 03:27:58,440 LIFE THE USE OF LANGUAGE REFER 5552 03:27:58,440 --> 03:28:00,160 TO THE WOMAN AS PREGNANCY AS 5553 03:28:00,160 --> 03:28:02,200 OPPOSED TO A WOMAN. 5554 03:28:02,200 --> 03:28:07,120 AND I THINK THOSE WILL BE 5555 03:28:07,120 --> 03:28:25,800 INSIGHTFUL STRATEGIES. 5556 03:28:25,800 --> 03:28:33,960 >> ANY FINAL THOUGHTS? 5557 03:28:33,960 --> 03:28:37,800 WELL, I AM -- JUST ON BEHALF OF 5558 03:28:37,800 --> 03:28:40,920 THE WHOLE COMMITTEE AND JENNIFER 5559 03:28:40,920 --> 03:28:42,040 REALLY WANT TO THANK EVERYONE 5560 03:28:42,040 --> 03:28:43,840 FOR ATTENDING AND FOR REALLY 5561 03:28:43,840 --> 03:28:47,240 THIS ROBUST DISCUSSION AT THE 5562 03:28:47,240 --> 03:28:49,280 END OF ALL THE SESSIONS, I THINK 5563 03:28:49,280 --> 03:28:51,400 IT HAS BEEN OUTSTANDING. 5564 03:28:51,400 --> 03:28:53,000 AND I LOOK FORWARD TO SEEING 5565 03:28:53,000 --> 03:28:56,360 WHAT IS GOING TO COME. 5566 03:28:56,360 --> 03:28:57,840 >> THANK YOU ALL FOR THE 5567 03:28:57,840 --> 03:28:59,200 WONDERFUL IMPRESSIVE WORK YOU 5568 03:28:59,200 --> 03:29:01,480 ARE DOING AND FOR THE TIME TO 5569 03:29:01,480 --> 03:29:02,960 TELL US ABOUT IT AND THINK ABOUT 5570 03:29:02,960 --> 03:29:04,960 IT SO WE CAN GET TOGETHER AND 5571 03:29:04,960 --> 03:29:06,200 THINK ABOUT WHAT ARE THE CROSS 5572 03:29:06,200 --> 03:29:09,960 CUTTING THEMES AND HOW CAN WE 5573 03:29:09,960 --> 03:29:12,040 LEARN FROM EACH OTHER MAKE IT 5574 03:29:12,040 --> 03:29:13,000 ALL THE WHOLE SYSTEM WORK 5575 03:29:13,000 --> 03:29:15,200 BETTER. 5576 03:29:15,200 --> 03:29:18,600 >> THANK YOU BOTH. 5577 03:29:18,600 --> 03:29:20,360 FOR CO-CHAIRING THIS WORKSHOP, 5578 03:29:20,360 --> 03:29:21,720 WE APPRECIATE ALL YOUR INSIGHTS 5579 03:29:21,720 --> 03:29:24,160 AS WELL. 5580 03:29:24,160 --> 03:29:25,400 DEIDRA DID YOU WANT TO SAY 5581 03:29:25,400 --> 03:29:25,680 SOMETHING? 5582 03:29:25,680 --> 03:29:27,840 >> JUST ECHOING THANKS TO 5583 03:29:27,840 --> 03:29:30,520 CO-CHAIRS AND TO ALL OF OUR 5584 03:29:30,520 --> 03:29:32,160 PANELISTS FOR VERY INFORMATIVE 5585 03:29:32,160 --> 03:29:34,960 AND INSPIRING PRESENTATIONS. 5586 03:29:34,960 --> 03:29:37,720 I REALLY HAVE LEARNED A LOT FROM 5587 03:29:37,720 --> 03:29:41,000 THIS WORKSHOP AND MY FONDEST 5588 03:29:41,000 --> 03:29:42,640 DREAM IS TO KEEP THE 5589 03:29:42,640 --> 03:29:44,680 CONVERSATION GOING OVER THE 5590 03:29:44,680 --> 03:29:49,400 WEEKS AND MONTHS AHEAD TOWARDS 5591 03:29:49,400 --> 03:29:50,440 SOME ACTION. 5592 03:29:50,440 --> 03:29:51,080 MEANINGFUL ACTION. 5593 03:29:51,080 --> 03:29:52,640 >> YEAH. 5594 03:29:52,640 --> 03:29:54,560 LOGISTICALLY I WANT TO REMIND 5595 03:29:54,560 --> 03:29:57,040 ATTENDEES THAT ARE WITH US THAT 5596 03:29:57,040 --> 03:29:58,760 YOU DID DISTRIBUTE THE PROGRAM 5597 03:29:58,760 --> 03:30:00,200 BOOK WHICH WILL HAVE CONTACT 5598 03:30:00,200 --> 03:30:01,280 INFORMATION FOR THE SPEAKERS IF 5599 03:30:01,280 --> 03:30:02,960 YOU DECIDE TO FOLLOW-UP WITH 5600 03:30:02,960 --> 03:30:03,760 THEM DIRECTLY. 5601 03:30:03,760 --> 03:30:05,600 ALSO HAS OUR CONTACT INFORMATION 5602 03:30:05,600 --> 03:30:07,480 AT THE NIH IF YOU HAVE QUESTIONS 5603 03:30:07,480 --> 03:30:10,480 FOR US SPECIFICALLY TO DEIDRE'S 5604 03:30:10,480 --> 03:30:12,040 POINT WE WANT TO KEEP THE 5605 03:30:12,040 --> 03:30:13,400 CONVERSATION OPEN, THIS IS THE 5606 03:30:13,400 --> 03:30:17,520 FIRST STEP IN TRYING TO ADDRESS 5607 03:30:17,520 --> 03:30:20,640 MULTIMORBIDITIES, WE OF COURTS 5608 03:30:20,640 --> 03:30:22,000 UNCOVERED ALL CONDITIONS RELATED 5609 03:30:22,000 --> 03:30:22,600 TO WOMEN HEALTH. 5610 03:30:22,600 --> 03:30:24,680 WE HIGHLIGHTED A FEW COMMON 5611 03:30:24,680 --> 03:30:25,440 CO-OCCURRING CONDITIONS SO WE 5612 03:30:25,440 --> 03:30:29,120 WANT TO HEAR ABOUT OTHER 5613 03:30:29,120 --> 03:30:29,920 IMPORTANT CONDITIONS THAT HAVE 5614 03:30:29,920 --> 03:30:33,440 HIGH IMPACT FOR WOMEN AND 5615 03:30:33,440 --> 03:30:35,560 MULTI-MORBIDITY AND IN THEIR 5616 03:30:35,560 --> 03:30:37,640 LIVES SO OUR EMAILS ARE THERE 5617 03:30:37,640 --> 03:30:40,000 AND YOU CAN CONTACT US AT ANY 5618 03:30:40,000 --> 03:30:40,400 TIME. 5619 03:30:40,400 --> 03:30:42,080 THEN ALSO BOTH DAYS OF THIS 5620 03:30:42,080 --> 03:30:44,400 WORKSHOP WILL BE ARCHIVED ON THE 5621 03:30:44,400 --> 03:30:45,680 NIH VIDEOCAST. 5622 03:30:45,680 --> 03:30:50,000 SO YOU ARE WELCOME TO REVIEW THE 5623 03:30:50,000 --> 03:30:51,960 PRESENTATIONS OR SHARE WITH 5624 03:30:51,960 --> 03:30:52,880 COLLEAGUES WHO WEREN'T ABLE TO 5625 03:30:52,880 --> 03:30:54,120 MAKE THE MEETING THE LAST TWO 5626 03:30:54,120 --> 03:30:54,520 DAYS. 5627 03:30:54,520 --> 03:30:56,520 AND WITH THAT I WANT TO THANK 5628 03:30:56,520 --> 03:31:00,600 EVERYONE AGAIN FOR SUCH ENGAGING 5629 03:31:00,600 --> 03:31:01,760 WORKSHOP AND LOOK FORWARD TO 5630 03:31:01,760 --> 03:31:02,920 WORKING WITH ALL OF YOU AGAIN. 5631 03:31:02,920 --> 00:00:00,000 THANK YOU.