ISSUE 4, 2023
The Blossoming of Women’s Health DAPHealth.org
Photo by Michael Davis
DAP HEALTH 1695 N. Sunrise Way Palm Springs, CA 92262 8 a.m. – 5 p.m. | Monday – Friday 760.323.2118 PRESIDENT AND CEO David Brinkman CHIEF OF BRAND MARKETING Steven Henke SENIOR COMMUNICATIONS MANAGER AND EDITOR Daniel Vaillancourt SENIOR MARKETING MANAGER, CREATIVE DIRECTOR Dustin Gruber
hello.
As we near the end of 2023, what an honor it is to welcome you to DAP Health magazine’s fourth issue. As this is the first edition to be published since DAP Health absorbed the Borrego Health system earlier this year, I’m especially gratified to see so many of our newest employees quoted within these pages. The cover story — “The Blossoming of Women’s Health” — represents a longtime dream become a reality at DAP Health, especially now that more than half of our patients are women and girls. As with every issue, the other articles featured here run the gamut. Some profile valued donors, volunteers, or employees. Others proudly highlight DAP Health programs and services. And yet others cover issues and topics of interest to any reader who cares deeply about the state of health care in our region of Southern California and beyond. How does shame prevent people from accessing care? How can we take a closer look at social drivers of health negatively impacting populations, and then strive to eradicate those barriers? Why is providing traumacentered care such a wise practice? It’s a tremendous feat to express our mission between the covers of this magazine while also serving a diverse audience comprised of new or longtime patients, employees, donors, volunteers, community and health care partners, and fellow concerned citizens (whether they be well-aware of what we do or newcomers unfamiliar with our organization). I’m very proud of what our team of dedicated staffers, subject matter expert sources, and creative freelancers has achieved. It’s my hope that by reading — and sharing — this publication, more and more people will come to understand a little more about the who, what, when, where, and why of DAP Health. And so, enjoy every word and image! David Brinkman, MBA CEO, DAP Health
ART DIRECTOR Tes Schaff PHOTOGRAPHERS Michael Davis, Lani Garfield, Peter Grant, Zach Ivey, Rodrigo Izquierdo, David A. Lee, Noé Montes, and Yohana Moreno WRITERS Jacob Anderson-Minshall, Greg Archer, Staci Backauskas, Kent Black, Ron Blake, Ellen Bluestein, Maggie Downs, Trey Burnette, Daniel Hirsch, Barbara Kerr, Kay Kudukis, Jim Macak, and Victoria Pelletier BOARD OF DIRECTORS Patrick Jordan, Chair Lauri Kibby, Vice Chair Fred Drewette, Treasurer Mark Hamilton, Secretary BOARD MEMBERS Kevin Bass, Carolyn Caldwell, Ginny Ehrlich, Dr. Frank Figueroa, Bruce W. Finch, Eve E. FrombergEdelstein, Karyl E. Ketchum, Athalie LaPamuk, and Scott Nevins ABOUT US DAP Health’s goal is to protect and expand health care access for all people regardless of who or where they are, their health status, or whether they have health insurance. In 2023, the nonprofit (founded by community volunteers in 1984 as Desert AIDS Project) made a successful bid to absorb the Borrego Health System, enabling it to serve a total of more than 100,000 patients of all populations, genders, and ages — from newborns to seniors — at a total of 25 Southern California clinics located within 240 rural and urban zip codes from the Salton Sea to San Diego. COVER DAP Health PrEP Navigator Livi Moreno photographed by Zach Ivey in The Daphne Dress and H&M heels from Revivals.
3
4
Imagine......................................................................... Page 6 Aiming to erase desert homelessness alongside Lift to Rise Where Barbie Fears to Tread...................................... Page 8 DAP Health is determined to move the needle in women’s health Against All Odds........................................................ Page 12 Chief Operating Officer Corina Velasquez defies every expectation Breaking Down Barriers............................................ Page 17 How social determinants of health are the enemies of health equity Impactful Planning.................................................... Page 20 Why major donors Karla Kjellin-Elder and Jeff Elder chose to create a bona fide legacy The Plight of the Migrant Farmworker.................... Page 24 Bringing aid to an essential yet marginalized population Can I Tell Them Who I Am?....................................... Page 28 Out & Equal’s Jean-Marie Navetta is a local who’s a national expert in diversity, equality, and inclusion in the workplace All in the Family......................................................... Page 31 For married couple Andy and Johnny Glorioso, DAP Health is all in a day’s work Together for Better Health........................................ Page 34 How DAP Health and Borrego Health joined forces for good A New Outlook........................................................... Page 40 Desert Healthcare District and Foundation’s Will Dean brings the message to the people A Prescription for Positive Change.......................... Page 44 At DAP Health, elevating patient care is all about innovating The Benefits of Trauma-Informed Care................... Page 46 Acknowledging our broken parts is what lets the light shine in A Safe Space in a Sea of Hate.................................. Page 48 Providing superior gender-affirming care saves lives Il Maestro at the Cash Register............................... Page 52 Revealing Revivals volunteer Phil McKinley’s double life Let’s Stop the Shame Game .................................... Page 55 We need to get rid of the embarrassment that’s a barrier to care Caregiving for the Caregivers ................................. Page 58 How can you care for others if you can’t care for yourself? Ending the Hunger..................................................... Page 60 FIND Food Bank and DAP Health understand food is a human right The Benefits of Becoming a Social Butterfly.......... Page 64 Volunteering is a surefire way to combat loneliness
5
IMAGINE
Lift to Rise is partnering with DAP Health and others to erase desert homelessness. Words by Kay Kudukis • Photos by Noé Montes for Lift to Rise
Collective impact: a network of community members, organizations, and institutions advancing equity by learning, aligning, and integrating actions to achieve systemslevel change. Even before 2011, when the term was first coined in a paper published in the Stanford Social Innovation, Heather Vaikona had been putting “collective impact” into practice in England, networking organizations to get behind a common cause to drive toward something. In 2014, having returned from overseas and serving as the resource development director for United Way of the Desert, Vaikona was invited to an investor meeting. “The significant amount that all local funders were investing in was FIND Food Bank,” Vaikona says, which sounded fantastic until data showed food insecurity was still a thing. It was a symptom of something bigger. “Folks said, ‘What would it mean if we formed a coalition to try to tackle the root cause issues?’ Everyone in the room said, ‘Yeah, you figure it out, and come back and tell us.’” Vaikona hit the road, lifted the hood at all the existing coalitions, and listened. “I heard loud and clear the importance of having an academic data partner using a results framework.” Enter USC Professor Gary Painter, a leading economist who prompted Vaikona and FIND Food Bank to successfully apply for a $500,000 grant from Feeding America on behalf of FIND.
“We did a valley-wide needs assessment between 2015 and 2016,” she says. “Gary did quantitative data analysis: If we were to move one or two or three indicators, what would radically shift conditions for all residents? And then qualitatively, we asked 1,500 residents to identify their biggest obstacle to economic stability and it was overwhelming. Everyone said ‘housing.’” The data matched. The Coachella Valley’s number one industry, with a whopping $7.1 billion dollars (2022) is, not surprisingly, tourism. The number-two industry surprises some: Agriculture brings in $600 million annually. That means the valley is home to thousands of hospitality and farmworkers, many undocumented. Statistics show that 40% of the Coachella Valley’s workforce is employed in hospitality and service sector jobs that pay between $15,000 and $33,000 annually. The average onebedroom apartment in Palm Springs currently averages $1,822. That’s $21,864 per year. On the lower income end, it’s a non-starter; on the high end, factor in utilities, food and household goods, car, phone, and gas expenses, and you’re in the red. Affordability is an extraordinarily civilized word used to define a crisis in America resulting in 600,000 homeless Americans, which increased since 2022 by 11%. It was already a problem in 2018 when Lift to Rise, the low-income investment fund founded by now CEO Heather
Above: Lift to Rise received a $15 million allocation from the state budget to go into We Lift: The Coachella Valley’s Housing Catalyst Fund to encourage affordable housing development. Pictured from left to right are Lift to Rise board member Matt Horton, Lift to Rise President and CEO Heather Vaikona, Lift to Rise board member Nadia Villagrán, Assemblymember Eduardo Garcia, and Lift to Rise board member Bea Gonzalez. Right: Lift to Rise celebrated its firth birthday in July. 6
Vaikona, was born. Its mission? To build 10,000 affordable homes in the Coachella Valley by 2028. And then, COVID-19 hit. DAP Health Care Coordinator Specialist Regional Coordinator Veronica Garcia grew up in Coachella as one of six kids raised by a single mom who worked as a farmworker and at a citruspacking plant. Weeks into the pandemic, people she knew socially were coming in, scared of facing homelessness. “In the beginning, there was no work, and if there was, they didn’t hire as many farmworkers,” she says. “It was really hard on the East Valley.” Garcia gets emotional describing the impact Lift to Rise had on her community after the org showed up at one of her staff meetings to share details about its United Lift Rental Assistance Program. Vaikona explains why: “We deployed emergency cash assistance to 5,000 folks and beyond, and the great thing about that is we got to see everyone’s applications and analyze the data. More than half said they weren’t going to be able to pay their rent. We already had this rock-solid partnership with Riverside County, and honestly, the Riverside County Board of Supervisors does not get enough credit. They made the largest allocation of Cares Act funding in the country to build what became our United Lift Rental Assistance Program.” The balance in Lift to Rise’s PayPal account — linked to a donation button on the org’s website, which rarely got any action — suddenly ballooned by $100,000 in two hours. Vaikona and her team had no idea what was going on until an excited phone call from a colleague announced that Lift to Rise had just been featured on PBS Newshour. At the end of the day, a small army of like-minded Americans had independently donated $600,000. Last year, Lift to Rise received the California Nonprofit of the Year Award and, along with other organizations, partnered with DAP Health and Coachella Valley Housing Coalition to fund a 61-unit affordable complex called Vista Sunrise II, currently being built on DAP Health’s Sunrise campus in Palm Springs. It will house those with chronic illnesses who are facing homelessness, and residency will include health care services provided by DAP Health. By its fifth birthday, Lift to Rise had plenty to celebrate. Here’s its highlight reel:
• Due to its advocacy, Governor Newsom created a $600 million kitty, made catalyst funds eligible, and Vaikona expects they’ll be capitalized with at least $40 million by 2024. • We Lift — its housing catalyst fund in partnership with Riverside County, Rural Community Assistance Program, Low Income Investment Fund (LiiF), and 70 community partners — has funded seven projects totaling 500+ affordable housing units, and has deployed $3.5 million in loans, with 1,600 units under construction. • Its Resident Leadership Table, comprised of 14 community leaders, is dedicated to Lift to Rise’s mission. • Its Collaborative Action Network, made up of more than 60 partners, sets strategic pathways to housing security through economic mobility. As impressive as that is, Vaikona will not go gently into that good night, resting on laurels. She expresses a viewpoint that leaves those conflating altruism with economic challenges rather … uncomfortable. “We don’t have a resource problem when it comes to homelessness. We have a value problem [relating to] how we view those who are unhoused,” she says. “Our economy is based on significantly underpaid labor. In that way, the We don’t have a resource economy is problem when it comes to exploitative. It is not homelessness. We have a value Mother problem [relating to] how we Nature, view those who are unhoused. something we have no control over; it’s a complex set of individual behaviors and choices and transactions.” If someone told them to build three million houses right now, Vaikona says they could do it if it weren’t for all of the barriers imposed by people. And here’s the most difficult pill to swallow, according to Vaikona: “It’s really ‘Who do we love?’ and frankly, ‘Who don’t we love, and why?’ If we love people, we will go to the wall to ensure their care. It’s a real existential question: What does it mean to be alive on planet Earth? Why am I here? And what do I owe my fellow human? We’re holding structures and mental models about who is deserving and not deserving of support and care. We could solve all of our problems very quickly if we operated from a different value system. I think we have to step back and look at our obligation to each other. We can choose to build a radically different future than the one that we live in.”
Imagine all the people, living life in peace. ~ John Lennon & Yoko Ono.
7
Where Barbie Fears To Tread With “Barbie” being the biggest movie of 2023, it’s a perfect time to not only raise awareness, but to actually do something about the state of women’s care. It may surprise you to know that DAP Health is already the projected leader. Words by Kay Kudukis 8
Whether or not you liked the movie “Barbie,” you have to admit it’s causing … feelings. But since neither Barbie nor Ken have genitalia, or any internal organs, it has kept some salient points, like women’s health care, from being explored on screen. Still, they could have thrown in a scene where America Ferrera’s character chooses a blue razor over a pink one while explaining that the latter is, save for color, exactly the same as the former but that, since it’s marketed “for women,” it’s available at a 13% price hike. Or that in 21 states, feminine hygiene products are still taxed as luxury items — which is some very dark state humor. Both are victims of the unwritten “pink tax” that requires women to pay more for bare necessities. The film’s all-girl Supreme Court screamed “goals” and, independently of “Barbie,” DAP Health thought that was a good idea too. There are now six women on the nonprofit’s board of directors, and we’ve “poked the bear,” so to speak, and asked them to weigh in with their experiences and concerns. “You can find numerous stories where women ‘know’ there is an issue and they are ignored by their doctor,” says DAP Health Board of Directors Vice Chair Lauri Kibby, an investor and entrepreneur in Palm Springs. “As if the ‘hysteria’ label continues to exist — though much more subtle.” If you’re late to the game, in the mid20th century, women with “unexplained malaise” were diagnosed with hysteria. Bottom line? We need a big wakeup call in the medical community, which even today has an astoundingly limited understanding of the intricacies of a woman’s body and how it relates to her well-being. “The medical profession has has been bound by the assumption that women’s health management and issues are similar to male health management and issues,” Kibby continues. “This could not be further from the truth. As a consequence, research methodologies, and even provision of care, has mimicked male health care, resulting in insufficient — and often delayed — diagnosis, and in many cases, the cause of serious prognosis or early death.” Dignity Health St. Mary Medical Center Hospital President and CEO Carolyn Caldwell of Long Beach, also a DAP Health board member, calls attention to something of which many women are guilty. “They are often so busy taking care of their families, they forget to take care of themselves,” she says. “It is critical that the health care powers that be educate women on the importance of self-care.”
Left: DAP Health PrEP Navigator Livi Moreno photographed by Zach Ivey in a dress by Peepa’s Palm Springs from Revivals. Barbie® image courtesy of Mattel, Inc.
Due to a historically patriarchal health care system, women are prone to increased and often untreated forms of heart disease, mental illness, cancers, and other complex medical issues unique to women.
But many women are single parents who work, and seeing a doctor or having tests requires time off, not to mention the cost of childcare, so they skip it. That only compounds whatever ill might be silently brewing. “Due to a historically patriarchal health care system, women are prone to increased and often untreated forms of heart disease, mental illness, cancers, and other complex medical issues unique to women,” adds Palm Springs’ Eve E. Fromberg-Edelstein, an attorney and partner at Fromberg Edelstein Fromberg who also sits on the nonprofit’s board. NPR cites a study showing middle-aged women with chest pain are twice as likely to be diagnosed with a mental illness (instead of a heart condition) than their male counterparts, indicating women’s medical concerns are often dismissed at higher rates than those of men. “Listening to women and responding to their concerns is a step in the right direction,” suggests Kibby, who also spearheaded DAP Health’s new Women of Impact initiative (see sidebar). “Training doctors and medical students that there are differences, and changing methods of research to include the biology of women, are all preliminary steps to changing the culture of women’s health care.” “I will say this,” adds board member and Palm Springs business owner Athalie LaPamuk of her involvement in Women of Impact. “I was initially drawn to serving on this particular committee because, for the last eight years I have lived in the desert, I have continued to see my gynecologist in New York City once a year. That just seemed normal given the lack of women’s care options here. Hopefully, our women’s health initiative at DAP Health can change that. I think it’s been proven that a community is only as healthy as its women, so this is very important.” DAP Health Associate Chief of Operations Nereida (Nedy) Terrazas served at Borrego Health for over 20 years, and has been involved in women’s health care since 2014. She comes into her new role within the integrated system with experience, ideas, and big plans, including practical ones such as moving from paper medical records to the much more 9
Training doctors and medical students that there are differences, and changing methods of research to include the biology of women, are all preliminary steps to changing the culture of women’s health care.
10
efficient electronic ones. She also wants to address the issue of women missing appointments. “We are looking into an Uber health account so we can begin offering transportation services to our patients,” she says. Many families have only one car, and during clinic hours, the husband often uses it for work. Terrazas seconds Caldwell’s concerns that lacking selfcare is a major issue. “Your health should always be a priority,” she says. “Women tend to be the caregivers and make the health care decisions for our families. If we’re not well, who will replace us? Preventative care keeps us healthy so we can take care of our families. We cannot afford to skip it.” Professor Karyl E. Ketchum, Ph.D. — who also serves on DAP Health’s board — is the department chair of women, gender, and queer studies at California State University, Fullerton. She brings good tidings: “Healthy women are better able to engage in economic activities, both within and outside the home, contributing to increased household income, economic growth at the community level, and improved living standards.” With such strong and strongly empowered women in place within its leadership and workforce, DAP Health (which estimates that more than half of its patient population is female) is set to galvanize women throughout Southern California thanks to much-needed improvements in female-specific health care. What a perfect premise for a … “Barbie” sequel! Fade in: Palm Springs Barbie, in vintage Bob Mackie, sips a chilled beverage in her immaculately appointed Midcentury Modern doll house as Pregnant Midge gushes over the award-winning, holistic, patient-centric care she is receiving at DAP Health. Barbie is inspired to create an “In the Pink” world tour, and to kick off her opening speech, she uses the words of yet another member of DAP Health’s governing body in Palm Springs, U.S. Soccer Foundation Chief Revenue Officer Ginny Ehrlich: “So many are headed in the wrong direction when it comes to women’s health. But not DAP Health. Instead of stripping women of their ability to determine what’s right for their own bodies and well-being, we are offering them the respectful and comprehensive health services they need … and deserve!”
Women of Impact, the newest initiative for DAP Health, came together through the passion of a powerful group of community, board of directors, and staff members dedicated to setting the “gold standard” of health care for women and children in our community. “We all know there are severe gaps and barriers to good quality care for the women in our community and the families they care for,” says WOI Chair and DAP Health Board of Directors Vice Chair Lauri Kibby. “Our goal with Women of Impact is to fund programs that will address those gaps and educate the public about how they can be part of this movement.” You can join Women of Impact — or get more information about the WOI tours that began this fall at Centro Medico Cathedral City — by contacting James Lindquist at jlindquist@daphealth.org or Chas Kidder at ckidder@daphealth.org.
Greta Gerwig, call me.
Left: DAP Health's Women of Impact Committee members photographed by Zach Ivey. 11
12
Against All Odds THE AVERAGE AGE OF A CHIEF OPERATING OFFICER IS 51. CORINA VELASQUEZ HAD EARNED THAT ESTEEMED TITLE BY 36. Words by Kay Kudukis • Photo by Zach Ivey
Being a medical assistant (MA) wasn’t the dream of Corina Velasquez in grade school. She was into poetry and prose. She was good at it too. Won an award and everything. In high school, that dream morphed into one of law school and a seat on the bench. All that changed with one test. “I dropped out of high school midway through because I got pregnant with my daughter,” Velasquez says. She was 17 when she gave birth. It didn’t take long for her to realize that, domestically, she was in a bad situation. She left the father within two years.
Corina is simply a force to be reckoned with,” says DAP Health CEO David Brinkman. “Her journey is such an inspiring one. She’s a doer whose presence is nonetheless so warm and welcoming. I’m tremendously excited to have her keep doing what she does best for us now that we are one, integrated health care agency.
“Statistics say I’d still be at my house on government assistance, but I didn’t let my fear of not being good enough stop me,” she says. She returned to her studies, became a certified phlebotomist, and took a job working in-patient at Eisenhower Health.
But Velasquez had her sights set on becoming an MA, so it was back to school. After a few internships, she got her first paid MA position at Borrego Health’s Centro Medico Cathedral City, which had previously been a private practice. Velasquez was also able to draw blood in the small, one-doctor clinic, where it was hard enough to get a patient through the door, much less go elsewhere for blood tests. It was a great time in Velasquez’s life. She was 24, had a full-time job in an exciting field, and she’d found love again. They had two daughters, but after 10 years together (three of them married), they divorced. They’re such good co-parents, people think they’re still a couple. Born in Ventura County, Velasquez completed kindergarten in Coachella after her single mom moved the family of four there, courtesy of a new job. A middle child, she was sandwiched between an older brother and younger sister. Eventually, her mom purchased a mini-mart where Velasquez
worked after school and on weekends. That came in handy when she was transferred back to her old stomping grounds, subbing for the Coachella clinic’s MA, Carmen Ruiz, who now pulls double duty as the clinic manager at both Palm Springs Family Health and Desert Hot Springs Specialty Care. Both are Borrego Health centers now under DAP Health’s auspices. As Velasquez learned more about federally qualified healthcare centers (FQHCs), she asked her mom to refer mini-mart customers to their clinic, emphasizing their zerodiscrimination policy, discounted medications, and sliding scale fees. When Ruiz returned from maternity leave, she discovered that, due to Velasquez’s expert outreach, Coachella had gone from treating six patients a day to routinely more than 30. “I had worked with the company for a couple of years, and it was very different working with Corina,” Ruiz emphasizes. “Very different than working with anyone else. We would just look at each other and I’d say, ‘Did you see what’s going on in the lobby?’ And she’d say, ‘Yeah, I got it.’” Ruiz is referring to drop-in patients and the workload ahead. “Corina knew exactly what I was talking about. She was always going the extra mile, and I was the same way. We made a really good team.” Velasquez agrees. “Carmen and I had this amazing working relationship where we could communicate without even talking. Just boom, boom! It was awesome.” When Borrego Health graduated from paper to electronic health records (EHR), it chose to conduct training at the small Coachella facility. Trainers came in but didn’t bring step-bystep learning tools. “I created screenshots at the nurses’ station so I could remember, because I knew the instructors weren’t going to be there forever,” Velasquez recalls. Shortly thereafter, she happily accepted a promotion to become the trainer of the new system — for all Borrego Health MAs. Velasquez also began learning about quality and compliance. Soon she was auditing charts, helping with audit tools, and in 2011, was asked to manage a brand-new clinic. She would be stocking, staffing, and problem-solving. She did so well that it was requested that she find her replacement, and do it all over again. Wet, lather, rinse, repeat. Every clinic, from soup to nuts. At the same time, changes were going on at the upper levels of the organization. The VP of operations was promoted to COO, the regional director of operations became VP, and Velasquez applied to be — and was appointed — regional director in 2012, where she stayed until her 2015 promotion to VP of patient access. 13
Her rise to the C suite came in 2021. With Borrego Health then serving more than 120,500 patients (roughly 463,000 annual visits) throughout Riverside and San Diego counties, being chief operating officer was a big job. It’s an even bigger job now that she serves in that capacity at DAP Health. It’s a role that was previously absent at the organization — one created just for her. “Corina is simply a force to be reckoned with,” says DAP Health CEO David Brinkman. “Her journey is such an inspiring one. She’s a doer whose presence is nonetheless so warm and welcoming. I’m tremendously excited to have her keep doing what she does best for us now that we are one, integrated health care agency.” Here’s an anecdote from her early years, which shows why Velasquez has been so successful: She was working with a provider who had a reputation for being “a little too direct” (as she gently puts it), when he snapped at her in front of a patient. “I went into his office when we were done, shut the door, and said, ‘Let that be the last time that happens. I’m here to work with you. So, let’s make this a good day.’ He just looked at me, then smiled and said, ‘We’re gonna do just fine.’ After that, it was a really good relationship. At the end of the day, everybody wants the same thing. Sometimes, they just need a different map on how to get there.” Now 39, Velasquez can look back and offer advice to other young adults, no matter their situation. “Even when you don’t believe in yourself, be curious enough to ask the questions because that can open so many doors to things that you never thought you’d even be in the right vicinity of.” Before DAP Health’s acquisition of Borrego Health, when things were up in the air, Ruiz one day felt inspired to call Velasquez to say, “I just want to thank you. I know what you’ve done, and what you’re capable of doing. We don’t know exactly what you do for us behind the scenes, but things happen because of you. Good things.” As it turns out, Velasquez has core values — strength, truth, justice, optimism—that she shares with Wonder Woman. Like Velasquez, Wonder Woman has profound healing, telepathy, and supernatural leadership powers. Isn’t it interesting that Wonder Woman and Velasquez have never been seen in the same place at the same time. Make of that what you will.
14
Velasquez and daughters Ashley (22), Kamea (8), and Kaiah (7) photographed by Yohana Moreno in the fall of 2022.
15
Balance for Your Mind & Body
Classes available at no cost to DAP Health patients
urbanyoga.org
Located on the DAP Health campus 1695 N. Sunrise Way, Palm Springs, CA 92262
Break
ing D
own
s r e i r r Ba BY ADDRESSING SOCIAL DETERMINANTS OF HEALTH — THOSE NONMEDICAL FACTORS THAT INFLUENCE PATIENT OUTCOMES — DAP HEALTH IS CREATING EQUITY. Words by Ellen Bluestein
In its efforts to deliver care based on the needs of the individual, DAP Health’s innovative, whole-person approach continues to extend beyond the medical to address the systemic and societal forces that often prevent patients from receiving that care. Known as social determinants of health (SDOH), these factors are the outside influences that impact a patient’s ability to seek or maintain health care. “They’re the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and qualityof-life outcomes and risks,” says DAP Health Chief of Community Health C.J. Tobe. “Typically, there are five different categories that social determinants of health are broken into: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and then social and community context.” Each can have a profound effect on health outcomes. 17
Now that DAP Health oversees a total of 25 clinics in Riverside and San Diego counties, this broadened area of service brings increased challenges to care. “We recognize that addressing social determinants of health is important to improve patient outcomes,” says Enhanced Care Management Operations Supervisor Claudia Barron. “First and most importantly, we conduct patient assessments, and we go beyond medical conditions. Our case management teams are trained to address social determinants of health, like housing insecurity, transportation barriers, financial challenges. And we also understand that every patient is unique and has their unique challenges. So, we focus on creating personal care plans. We also get trained by our health plans so that we can connect patients with resources.” “We early on learned that having a great doctor and fabulous medicine is not enough,” says Senior Director of Social Services Zayda Welden, who oversees the nonmedical programs and services for HIV clients. “All these other factors are so important, or as important, as having the best infection specialist.”
Clients have the best intentions, but if they cannot get here because they are living in the back dumpster of some building that offers shade — and if they leave, someone else will come in and take the place — they’re not going to leave. If someone is not able to walk to the bus stop two miles to get on the bus and come in for the appointment, they’re not going to come in. If they don’t have money to buy gas, they’re not going to come in. So, we can have the best clinic and the best treatment available. If they are not coming in, then our work is not done.
Welden continues: “Clients have the best intentions, but if they cannot get here because they are living in the back dumpster of some building that offers shade — and if they leave, someone else will come in and take the place — they’re not going to leave,” she says. “If someone is not able to walk to the bus stop two miles to get on the bus and come in for the appointment, they’re not going to come in. If they don’t have money to buy gas, they’re not going to come in. So, we can have the best clinic and the best treatment available. If they are not coming in, then our work is not done.” To address this barrier, DAP Health has instituted transportation programs. “We have the ability to give clients bus passes and gas cards,” says Welden. “Now, not everybody has a car, so we have bus passes available for them. We have two kinds: one that is for seniors and disabled individuals, and one that is a regular monthly bus pass.” It should be noted that, at this time, the medical transportation benefit is funded through grant programs limiting access to HIVpositive clients living in specific geographic areas who qualify. Welden also cites food insecurity as a negative social determinant of health. “Every patient who comes into the clinic gets asked a few questions in regard to food insecurity,” she says. “If they say, ‘Yes, I need a bag of food for the next two or three days,’ then we will provide that bag of food, no questions asked.” DAP Health’s nutritionist carefully chooses the nonperishable items that go into the bags, ensuring that they are both shelf stable and nutritionally substantive. 18
“A lot of people downplay the importance of access to good, nutritious food,” says Tobe. “That’s going to be a social determinant of health — making sure people are able to eat several balanced meals per day. There’s fresh water. We found out that in our Oasis clinic, there’s not fresh water. That’s another social determinant of health.” At said Oasis clinic (also known as Centro Medico Oasis, located in the town of Thermal), most clients work in agriculture, an often-grueling business with long hours and low pay that can profoundly affect health and well-being. “What we’ve gathered from talking to patients is that not all of them have or work for a company full-time where they get vacation, benefits, and all that,” says Oasis Clinic Manager Israel Ochoa. “The majority of them get three sick days, so once they’re gone, they don’t get paid. A lot of them would rather work unless it’s really, really necessary, or they’re really sick. They don’t have the luxury of benefits.”
Some clients also don’t have the luxury of literacy. “Centro Medico Oasis is 95% Spanish-speaking,” says Ochoa. However, for roughly 60% of the community, the first language is Purépecha, a Spanish dialect from Central Mexico. While these clients speak Spanish, there are some differences that prevent them from fully understanding it. When it comes to reading and writing, it’s Purépecha, not Spanish, that’s used. Most of the staff at the clinic speak English and Spanish, but there are times — during mental health appointments, for example — when clients and providers need interpretation assistance. For that, an online translation service is employed.
From environment to education, work to worship, many factors influence health outcomes. “Negative social determinants of health…don’t discriminate. Anybody can face them,” concludes Tobe. Identifying and implementing programs to address them is the key to combatting them. “It’s really all about creating different access points or ways for people to obtain different services,” he continues. “It’s coming up with innovative ways to be able to eliminate that red tape, reduce those barriers, and meet people where they are that’s going to help support people living their healthiest and best life. “With this marriage between DAP Health and Borrego Health, I think we’ll be able to take a lot of the foundational work that we’ve done…[and] then build on that infrastructure and replicate different programs — or even create new programs to address different social determinants of health for our complex patient population.”
40%
30%
Socioeconomic Factors
Health Behaviors
Education
Diet & Exercise
Job Status
Tobacco Use
Income
Community Safety
Family Social Support
Drug Use
Alcohol Use
Sexual Activity
50% can be traced back to your zip code!
10% Physical Environment
20% Health Care
Access to Care Quality of Care Only 20% include those moments in a health care environment
20% of a person’s health and well-being is related to access to care and quality of services
The physical environment, social determinants and behavioral factors drive 80% of health outcomes
Source: Institute for Clinical Systems Improvement; Going Beyond Clinical Walls: Solving Complex Problems, 2014 Source: American Hospital Association — Addressing Social Determinants of Health, 2018
19
Impactful Planning
Karla Kjellin-Elder and Jeff Elder wanted to give back. Then they discovered planned giving at DAP Health and created a bona fide legacy. Words by Greg Archer • Photo by Peter Grant
20
The way the light catches on the silver lettering of the Karla Kjellin-Elder & Jeff Elder Social Services Wing signage at DAP Health encourages another look. Maybe it’s the modern design — sleek, long, and lean — or the way the name spreads out so boldly along the wall. Regardless, you’re bound to notice and possibly wonder: Who are the Elders? It’s fun keeping up with the engaging couple. In conversation, it becomes vividly apparent that Karla Kjellin-Elder and Jeff Elder have long been committed to giving back to their community. This is true as it relates to DAP Health, specifically when the couple began to mindfully plot out their estate plan. They saw all too clearly how a legacy gift assists the nonprofit in continuing to ensure the overall health and well-being of the community.
DAP Health does — nurture the whole person, not just the ailments, not just a condition. That’s why the term ‘social services,’ to me, sounded like a big hug.” That department at DAP Health connects clients to social services for which they are eligible. This includes ensuring individuals have access to food, housing, transportation, home health care support, and more. “We want to give, and be part of the community,” Jeff says. “If you’re part of a community, you help make it a healthy community, a really functioning community.”
They’re both quick to point out that when it came to establishing some kind of legacy gift, they wanted it to benefit DAP Health. To that Top row (left to right): son Parker Kjellin-Elder (28), end, they created their firstgranddaughter Juliet Harrington (12), daughter Allison Harrington (42), ever trust, and divided it into daughter Tess Mason-Elder (39), and son Barret Elder (42). five parts — one each for their Bottom row (left to right): Granddaughters Marina Elder (8), Zara Rose Harrington (7), and Vivienne Elder (10). Photo courtesy of the Elders. four children, and one part for a charity of their choosing. Their The Elders first got intention was clear. Each child would need to donate 10% of involved with HIV/AIDS-related services with AIDS Services whatever they received in the inheritance to a charity of their Foundation Orange County, which now is under the Radiant choice, but to make the donation in the Elders’ name. Health Centers umbrella. They had lived in Orange County at the time and eventually rooted themselves in the organization “We set up a donor-advised fund, and that fund is how — Karla was extensively involved with the food pantry, while we donate 90% of the money,” notes Jeff. “There are two Jeff was on the board and organizations we give a lot of money to — DAP Health and The became president. When they Living Desert. And so, when we pass away at some point, our moved to La Quinta in 2018, children can give to various charities, and we would expect that they realized it was time to a big portion of that will probably go to DAP Health.” take a tour of DAP Health. If you’re part of a
community, you help make it a healthy community, a really functioning community.
get involved.”
“It was unbelievable and overwhelming what DAP Health was doing,” admits Jeff of discovering the organization’s reach. “AIDS Services Foundation hadn’t been able to do all that yet. You saw what could really happen out here in the desert. So, we got very excited about the organization and wanted to
Planning it all in advance brought about a stronger sense of clarity and vision for the Elders. “To me, it’s like having or donating to a utility. It’s just something you do,” Karla says of philanthropy. “So yes, you can take your inheritance and give it to your kids, but it’s also important, I think, to have a portion of your money go to a charity, just like a portion of your income goes to a utility and a portion goes to rent.” There are several kinds of donations accepted by DAP Health. To be sure, individuals can give money. But assets can also be considered. This can be anything from donor-advised funds, life insurance, and real estate to retirement plan assets and appreciated securities.
The Elders began attending various galas and Partners for Life events, suddenly finding themselves among people who were passionate about helping. The more involved they became with the nonprofit, they donated their time and resources, and learned more about planned giving — specifically, opportunities for “naming rights.” DAP Health’s social services wing was brought up.
“There’s an entry point for everyone when it comes to planned giving,” says DAP Health Interim Chief Development Officer Chris Boone. “You can volunteer at one of our four Revivals store, you can give money, you can participate in our annual Health Equity Walk, go to a gala. There’s something for everyone.”
“‘Social services’ sounded like a motherly thing,” Karla shares. “I think DAP Health strives to be a kind of family for people who may have lost theirs because of ailments or whatever. That’s very sad, to think that somebody is basically homeless, even if they have a home, because they have nobody to nurture and care for them. That’s the good thing
End-of-life conversations, however, may not always feel comfortable. “Sometimes, having those kinds of conversations can be difficult, because you’re talking about end of life and the decisions you’re trying to make,” Boone says. “But at the end of the day, the conversation is always centered around, ‘What do you want to leave, and what do you want to be remembered for doing in this world?’ Planned 21
giving is all about impact, and helping others in your community.” Moving forward and into 2024, Boone says he and the DAP Health team are excited about new possibilities that have emerged. In addition to sharp attention on planned giving, the goal is to have the organization’s Vision Forward capital campaign wrapped up in the next year, which, he says, “is a fantastic milestone. We can’t wait to celebrate our success thanks to donors like the Elders.” Another significant opportunity to expand DAP Health’s impact is the recent acquisition of the Borrego Health system, which saw the nonprofit go from serving 10,000 patients a year at two locations in the Coachella Valley to more than 100,000 patients a year at 25 clinics located throughout 240 rural and urban zip codes from the Salton Sea to San Diego. The list of services offered now includes OB-GYN, pediatrics, urgent care, pharmacy, and veterans’ health — all of which will be covered under DAP Health. “We’re really excited about it because it really opens the door to a whole new community of folks to help. And that’s going to be huge. It’s a big thing to chew on,” Boone notes.
The Elders admit they were nicely taken aback when they first saw their names on the wall at DAP Health. Deep down, it felt like a full-circle moment for the couple, who have long been donating their time and resources to charitable organizations, and, in turn, making an impact. “We tell people, ‘If you have money, give money. If you have time, give time. And if you have both, give both,’” states Jeff. “We’ve been fortunate. Some people hoard their money, so that when they die, their kids have this giant inheritance. We gave our kids a good education and raised them well. And they seem like they’re OK. Our plan really is about getting as much as we can out of life while we’re still alive, but whatever is left, a big piece of that should still go to charity because we really should be helping.” Learn more about planned giving at PlannedGiving.DAPHealth.org.
Leave a legacy of love
Would you like to make a profound impact that will last long after you’re gone? By remembering DAP Health in your will or trust, or by beneficiary designation, you can provide lifesaving health care to the most vulnerable members of our diverse communities throughout the region of Southern California we all call home. If you believe all people deserve access to health care, no matter who or where they are, please visit PlannedGiving.DAPHealth.org. DAP Heath is a 501(c)3 non-profit organization. Our federal tax ID number is 33-0068583.
24
The Plight of the Migrant Farmworker
THE HEALTH CARE NEEDS OF AN ESSENTIAL YET MARGINALIZED COMMUNITY REQUIRE SPECIAL ATTENTION THAT IS LONG OVERDUE. Words by Trey Burnette
Migrant field workers are one of society’s most indispensable people. They’re the frontline of not only the United States’ $162.7 billion agricultural industry but, arguably — considering their hands are the first to touch the harvested food consumed by virtually all Americans — of the nutrition and health care industries.
Of the 2.5 million farmworkers who live and work in the U.S., 500,000 to 800,000 reside in California. Their age falls between 14 and 61, and most have been working for 18 years. Some 34% of them identify as women. Another 400,000 are minors.
In 2021, the U.S. Department of Health and Human Services They’re also one of the most marginalized and neglected reported that, of the 1,015,162 agricultural workers and populations. A whopping 23% their family members who received of farmworkers in the U.S. live in health services, the most common poverty. The average individual’s diagnoses were being overweight/ annual income falls between obesity (25.5%), hypertension $12,500 and $14,000 ($17,500 to (11.4%), diabetes (9%), anxiety $19,999 for families). And neither disorders, including post-traumatic Nationally, 64% of workers does the National Labor Relations stress disorder (5%), other mental are estimated to be Act of 1935 (which permits private health issues (7%), and asthma undocumented — that figure sector employees to organize into (2.5%.) But that isn’t the full scope trade unions, engage in collective of the health issues facing this is 75% in California — and bargaining, and go on strike) nor community, because only 56% most government programs, the Fair Labor Standards Act of of U. S. field workers have health except for emergencies and 1938 (which preserves the right to insurance. In California, that number a minimum wage and “time-and-adrops to 37%. No matter where they sliding-scale payments, require half” overtime pay for toiling more are, many never seek help. documentation. Fortunately, than 40 hours a week, plus prohibits on January 1, 2024, Medi-Cal Israel Ochoa manages DAP the employment of minors in Health’s Centro Medico Oasis in the “oppressive child labor”) cover most expands full-scope health care agricultural town of Thermal, just workers. Beyond the low pay and for all income-eligible residents southwest of Mecca. He is the son of lack of many workplace protections, of California, regardless of migrant farmworkers, and most of his health care is one of the most days are spent serving farmworkers significant stressors for farmworkers. immigration status. and their families. His assessment Some 25% of them depend on of his clinic’s patients aligns with the community health centers. national statistics. He says access 25
to affordable, nutritious food is a leading cause of their health issues. Fieldwork is arduous manual labor; the workers are up before sunrise and have to power through an excruciating workday. They rely on inexpensive sugary beverages like Gatorade, colas, and juices to stay hydrated and maintain energy, and eat a lot of processed food that “keeps” and can be eaten throughout their long workdays. Furthermore, their children’s diets are not immune to their parents’ work schedules. Typically, 2.5 families live in one mobile trailer, and the kids are usually left with breakfast food they can make without having to turn on a stove — cereal, Pop-Tarts, or microwavable dishes. All eligible California children can get a no-cost breakfast and lunch at school, but obtaining those meals in the summer is difficult, if not impossible, because moms and dads can’t afford, or aren’t allowed, to take time off work. Fear of being fired is also why workers don’t take personal or medical time off. They’re generally contracted, getting paid in two ways: by the hour ($15.50, plus 40 cents per box of product harvested and packed) or just by the box (about $4.25 per). Workers should get three sick days per season,
26
but aren’t paid if they don’t work. Most avoid reporting job injuries for similar reasons. There are many other barriers to prosperity for farmworkers in the U.S. The lack of legal residence status is an obstacle. Nationally, 64% of workers are estimated to be undocumented — that figure is 75% in California — and most government programs, except for emergencies and sliding-scale payments, require documentation. Fortunately, on January 1, 2024, Medi-Cal expands full-scope health care for all income-eligible residents of California, regardless of immigration status. Obtaining preventive and routine care at a clinic will help people avoid emergency room visits and more severe illnesses. Veronica Garcia is a care coordinator specialist regional coordinator and certified enrollment counselor at DAP Health. Alongside five siblings, she was raised in Coachella by her single farmworker mother, who also toiled at a citrus-packing plant. She does frontline community work and says her employer has an excellent outreach program. With the expanded Medi-Cal program, more people will be counseled and given health care. Outreach is critical because
health workers can personally converse with farmworkers and clarify program misunderstandings. Many people think government programs, like Medi-Cal or the Medically Indigent Services Program, are debt services, so people hesitate to utilize them. In addition to program education, Dr. Frank Figueroa — a councilmember for the city of Coachella who serves on DAP Health’s board of directors, as he did on Borrego Health’s board of trustees — says other fears about using programs can be laid to rest. He, whose grandparents and parents were farmworkers, states there’s the belief that those applying for permanent residence, work visas, or citizenship will be “flagged,” only to face negative consequences like losing rights they currently have, or could gain in the future. Undocumented workers are scared
of deportation if they seek help. Applying DAP Health’s educational outreach to explain legal rights, enrollment, and using health care benefits will spur great progress in the health of this population. Education is also a challenge toward that progress. It’s estimated that 78% of farmworkers lack a high school diploma, with ninth grade being the average level of education. Just over 1% of these employees have a college degree, so there is a need to improve technology literacy. Riverside County Supervisor Manny Perez, a son of migrant farmworkers, says that one of the many things that make DAP Health a superior federally qualified health center (FQHC) is its ability to provide affordable housing, a significant need for farmworkers as rents increase. He also strongly advocates for community clinics because they can address specific community needs like nutrition education through ancillary services. While Perez believes community health centers like Centro Medico Oasis are expertly poised to provide care for the rural poor, Ochoa insists finding health care providers to serve in remote locations such as Thermal is a challenge. All true. But it’s a challenge DAP Health is determined to meet as it endeavors to bring better wellness to this vital yet often-forgotten populace.
27
CAN I TELL THEM WHO I AM?
AFTER 17 YEARS AT PFLAG, PALM SPRINGS RESIDENT — AND OUT & EQUAL’S NEW VICE PRESIDENT OF LEARNING — KNOWS ALL ABOUT DIVERSITY, EQUALITY, AND INCLUSION IN THE WORKPLACE. Words by Victoria Pelletier • Photos by David A. Lee
Jean-Marie Navetta’s bio at PFLAG ended with the quip, “Jean-Marie is, most importantly, living proof that philosophy majors can get real jobs.” Of course, Navetta is far more than a “philosophy major.” Educator, advocate, leader, prophet, sage, dreamer, superwoman? Now we’re getting closer. Navetta’s illustrious career in the diversity, equity, and inclusion (DEI) space through LQBTQ+ education and advocacy points to her why in life. She envisions a world wherein no one needs to ask the question she’s often asked herself on the first day of a new job: “Can I tell them who I am?” For those committed to actualized DEI in business and beyond it, the universal answer must become, “Yes, you can!” And one must not lose any sleep over it. I recently sat down for a Zoom interview with the Palm Springs resident as she prepared to take on a new professional role as vice president of learning at Out & Equal, “the premier organization working exclusively on LGBTQ+ workplace equality,” per the nonprofit’s website. “Through our worldwide programs, Fortune 500 partnerships, and our annual Workplace Summit conference, we help LGBTQ+ people thrive and support organizations creating a culture of belonging for all.” The biggest takeaways from our conversation? Inclusion begins with education, and full inclusion means changing systems and the culture. Navetta is deeply committed to all of the above. She reminds me — and all of us, for that matter — that changing systems and culture is especially daunting in the current, uber-polarized environment. “DEI work was a given,” Navetta notes as she looks back on her early pro years, adding that “opposition has become far more sophisticated in how they are resisting it; this level of sophistication should cause us to be concerned and be more vigilant and relentless in our work.” Bottom line? There’s plenty of work to do to overcome the regression that is afoot in government, business, and broader culture. Navetta remembers the first time she encountered PFLAG. A teenager at the time, she observed a Pride parade from the sidelines and thought, “Wow…if only.” After earning that golden philosophy degree, Navetta considered law school for a while before settling into communications roles. Heart and mind stirred during those early years in the workplace. She recognized the forward momentum of the inclusion movement and knew she wanted to be a part of an unscripted future in DEI. A work stint in Washington, D.C. provided the entry point for a career in her education and advocacy work. While working as a press secretary there, Navetta volunteered with a local PFLAG chapter. Impressed by her passion, intellect, and 28
ability, the chapter director submitted her resume to PFLAG HQ, knowing Navetta’s drive and skills were needed at the national level. The pivot from communications to advocacy and education was now underway for Navetta, and would grow for the next 17 years with PFLAG. “I had to find my space in the movement,” she says while reflecting on her early days in DEI, so she gobbled as much information as possible, taking deep dives into topics like butch/femme identity. Navetta had experienced, personally, that queerness could lead to discrimination and even hostility in the workplace. Like many in the LGBTQ+ community, she has been leery at times about “being out” in the office, and she understands that many workers remain confused by the difference between acceptance and full inclusion and belonging. “Look around,” she declares with a resolute voice. We need workplace advocacy because, “we’re losing ground on the policy and cultural acceptance fronts.” Of course, the current political climate does not help advance DEI efforts in education or in business. In the most sobering moments of our conversation, Navetta laments the insidious ways elected representatives stoke regressive legislative action. “Legislation is designed to shut discussions down, and it makes you realize we have to do more.” Pondering the impacts of her work as a DEI champion and guide for businesses, Navetta adds, “Restrictions on how we talk about things in education, government, in documents, Legislation is etc. means that one of the designed to shut last places we can have discussions down, this conversation is in the workplace.” and it makes you
realize we have to
Effective DEI work in the do more. workplace can move the broader cultural conversation forward, though. “Look at marriage equality — there was phenomenal grassroots activism, yet the influence of private sector employers was incredibly powerful in driving change and judicial decisions forward.” Navetta sees business shaping many more DEI advancements. “Let’s use the time and place where people spend more time than anywhere else [work] to educate and advance LGBTQIA+ rights, inclusion.”
Citing court challenges to DEI based on religious freedom arguments, I ask Navetta if she thinks companies might reverse course on DEI progress because of recent legislation and court rulings. Despite the legislative and judicial headwinds, she feels positive about the prospects of businesses staying the course. “Most of the companies that
we see committed will continue on their path forward; most companies understand that [DEI] helps with business performance.” Indeed, Navetta’s new role at Out & Equal gives her the leverage to scale up her DEI educational work in a way that could have broad, global impact. Immediately, her leadership at the organization’s workplace summit — the world’s largest of the kind — will provide opportunities to present a diverse portfolio of LGBTQIA+ programs to a significant, cosmopolitan audience. Our superwoman with the golden philosophy degree remains a global force in the DEI space. She feels supported by her wife of 23 years, Jude Medeiros, plus a cohort of generous colleagues. Then there’s the considerable quality of life she has found by moving from grey and chilly San Francisco to warm and sunny Palm Springs in 2018. The local international airport certainly makes her frequent travel less of a burden, and the community of friends the couple has cultivated recharges Navetta’s oft-depleted batteries come evening or the weekend. She’s even found time to volunteer to teach queer youth about their history at the LGBTQ Community Center of the Desert’s satellite space in Coachella. Basically, Navetta believes she was born at the perfect time into a difficult world, buoyed by infinite possibilities. “I am excited to be educating LGBTQIA+ leaders and the next generation,” she offers with a look of satisfaction. I, like many of you, look forward to the day Navetta’s question — Can I tell them who I am? — is always answered in the affirmative.
29
REVIVALS. RE-LOVE THE PRE-LOVED ™
The Valley’s Best Thrift Store revivalsstores.com
All in the Family
HOW SPOUSES ANDY AND JOHNNY GLORIOSO FOUND THEMSELVES BOTH WORKING IN SEXUAL WELLNESS AT DAP HEALTH — AND LOVING IT. Words by Trey Burnette • Photos by David A. Lee
Andy and Johnny Glorioso at DAP Health's Orange Clinic 31
32 32
Andy Glorioso, who’s been HIV+ since 1986, has worked in HIV/AIDS social services for 23 years. In 2018, he finished his last day of work at San Diego’s largest clinic, jumped in his packed car, and drove out to Palm Springs. The next morning, he was at his new job at DAP Health, where he currently serves as PrEP navigation manager.
Once they leave the clinic, we don’t know what happens,” says Andy of the patients under the men’s care. “But every once in a while, I get an email that says, ‘Thank you. My experience and the information I received was life-changing.’ Then I know what we did — what we are doing — is working.
While Andy was settling into Palm Springs, Johnny was relocating from San Francisco — where he’d worked for more than two decades as an E.R./trauma nurse — to similarly create his new desert home. He first discovered the Orange Clinic (as DAP Health’s Palm Springs sexual wellness clinic is known) as a patient. He has been on PrEP for five years, and still uses the clinic for quarterly checkups. From the beginning, he loved the availability of free services and the openness of providers.
Both men understand stigma and anxiety are intricately linked to sexual behavior and health, and that normalizing frank talk about sex and sexual wellness is the first step in caring for their respective patients. Their mission is to empower through education. After a patient tests negative for HIV, Andy can get them started on PrEP, the pre-exposure prophylaxis that uses antiviral medications to help prevent the spread of the virus. There are a variety of drugs available — some are daily pills; another is a bimonthly injection. Using a judgment-free attitude, Andy helps patients decide which path is best for theirs needs. Using the same “come as you are” mindset, Johnny does patients’ PrEP follow-up, testing them for HIV and sexual transmitted infections (STIs). He soothes those who test positive for either, explaining treatment of the former and quick and easy cures for the latter. “Once they leave the clinic, we don’t know what happens,” says Andy of the patients under the men’s care. “But every once in a while, I get an email that says, ‘Thank you. My experience and the information I received was lifechanging.’ Then I know what we did — what we are doing — is working.” Though both had a connection to DAP Health, the two first met on a dating app mere weeks after each moved to Palm Springs. Their first chat was a long one. The next night, they saw a movie. Within a few months, they’d moved in together. Marriage happened six months after that, with Andy taking Johnny’s last name.
By 2022, Johnny was working as a sexual health nurse at The Dock, as the Orange Clinic was known when it debuted within the Barbara Keller LOVE Building in 2015. The space opened its rebranded doors in the newly renovated, former county structure christened the Annette Bloch CARE Building across the way in January 2023. The sexual wellness clinic in Indio was unveiled in July 2022. The two present clinics currently serve about 1,075 patients per month. In late 2023, a third DAP Health sexual wellness clinic will open at the Stonewall Medical Center in Cathedral City.
It’s not just within the walls of DAP Health that the Gloriosos are making a difference. Part of the sexual wellness outreach team, they both participate at local events such as Pride, Leather Pride, International Bear Convergence, and White Party Palm Springs. The Orange Clinic has also partnered with several live-in rehabs in the valley, offering education and free testing. And it’s not just at work that Andy and Johnny are peppered with questions about sexual wellness. They’re social, and people know what they do for a living, so friends and acquaintances aren’t shy about seeking professional advice, either face to face or via Facebook Messenger. The men are more than happy to bring interested parties into the DAP Health family. The couple loves living in Palm Springs and working at DAP Health. They were drawn to the city and the organization for their respective progressive attitudes and values. DAP Health, like the men, cares about community. They agree the nonprofit is different from any other place they’ve worked — or visited as patients. “We treat and educate people, at no cost to them, all without an ounce of shame,” says Johnny, adding that birth control, pregnancy testing, and other support services are also available. “It’s work that each of us takes to heart.” Then there’s the fact that they’re always near each other from nine to five. “The real joy for me is seeing my husband throughout the course of the day,” says Andy. “We generally have a good time together, so we also have fun together at work.” “Except when the natural way we relate to each other in private spills over,” adds Johnny with a wink and a smile. “To give you an example, when I was gone for a few hours recently, Andy apparently decided to clean out all of my work drawers the way he thought they should be. And when I came back, I couldn’t find anything — just like at home!” 33
Together
for Better Health DAP HEALTH AND BORREGO HEALTH BECOME ONE INTEGRATED HEALTH CARE SYSTEM WITH A SINGULAR GOAL — TO PROTECT AND EXPAND LOCAL ACCESS TO CULTURALLY COMPETENT CARE FOR MORE THAN 100,000 PATIENTS. Words by Daniel Vaillancourt
On August 1, 2023, DAP Health and Borrego Health became one in a union sanctioned by both the Bankruptcy Court and the Health Resources & Services Administration (HRSA). Since then, the integrated health care system has operated with some 850 employees serving more than 100,000 patients of all ages, genders, ethnicities, orientations, and socioeconomic status at a total of 25 Southern California clinics located within 240 rural and urban zip codes from the Salton Sea to San Diego. Prior to the two federally qualified health centers (FQHCs) joining forces, DAP Health’s DAP Health now boasts programs and services 850 employees serving included primary care, infectious diseases, more than 100,000 patients gender-affirming care, of all ages, genders, LGBTQ+ care, mental ethnicities, orientations, and health, dentistry, harm reduction, recovery socioeconomic status at a services, affordable total of 25 Southern California housing, and social clinics located within 240 rural services. The Borrego Health disciplines now and urban zip codes from the under DAP Health’s vast Salton Sea to San Diego. umbrella include family medicine, women’s health (including OB-GYN), pediatrics, veterans’ health, geriatrics, urgent care, and pharmacy services. “It’s an honor to unite Borrego Health and DAP Health’s missions, as well as our region’s most exceptional, dedicated, and passionate health care professionals,” says DAP Health CEO David Brinkman. “Together, we will build a brighter future where every individual — regardless of who or where they are — has equal opportunity to live a healthy and fulfilling life.
CEO David Brinkman photographed by Michael Davis.
“We will achieve this by replicating our time-tested, holistic, patient-centered care model, which addresses all applicable social determinants of health (SDOH) negatively affecting the patient population at each of our clinics. By addressing these SDOH — whether they pertain to language and literacy, housing, nutrition, transportation, education, employment and income, addiction, violence, and/or racism and other discrimination — we remove barriers to care, increase our patients’ quality and length of life, and create true health equity.” “When all of us at Borrego Health were looking for a like-minded FQHC to take us under its wing, three things mattered most,” says DAP Health Chief Operating Officer Corina Velasquez, who served in the same capacity at Borrego Health. “Continued access to health care for our more than 100,000 patients. Continued employment for our more than 600 employees. And mission match — an organization that would share our values and our vision for continually creating more health equity in this region. In DAP Health, we hit the proverbial trifecta … and then some!” Of note: • Every DAP Health and Borrego Health location will remain open, retaining its original name, branding, and signage for the time being. • Some 99% of Borrego Health employees accepted DAP Health’s invitation to join the combined entity. There were no layoffs or forced relocations among existing DAP Health employees. • Fellow FQHCs Innercare and Neighborhood Healthcare — allies of DAP Health who have regional and cultural expertise in Riverside and San Diego Counties, respectively — will offer guidance, support, and community connections on an as-needed basis. • DAP Health’s mission — including its commitment to LGBTQ+ health care, HIV care, gender-affirming care, and the Coachella Valley community — will expand as a result of its absorption of Borrego Health. Over the next 12 months, DAP Health’s fortified executive leadership team — consisting of individuals from both organizations — will analyze all social determinants of health (those nonmedical factors that negatively impact patients’ health outcomes) at all the clinics served. It will actively engage fellow community organizations, government agencies, educational institutions, and businesses to improve health outcomes for all, whether that be by adding programs and services or improving physical facilities. By combining a plethora of strengths, DAP Health will achieve new levels of excellence in delivering comprehensive, accessible, and culturally sensitive care to its diverse patient populations.
Chief Operating Officer Corina Velasquez photographed by Zach Ivey. 35
A Tale of Two Cultures HOW DAP HEALTH AND BORREGO HEALTH MARRIED THEIR EXPERTISE INTO ONE UNIFIED VISION. Words by Barbara Kerr
At DAP Health’s Sunrise campus in Palm Springs, one client is receiving HIV specialty care and a connection to social services, including food and housing, as another receives gender-affirming care.
direct patient care, from housing to food insecurity — and marrying that with Borrego’s ability to deliver complex care, from women’s health to pediatrics, adults, and specialty. I’m really excited for the future and what’s to come.”
At Borrego Health’s Coachella Valley Community Health Center in Coachella, physicians are providing obstetrics, pediatric, and dental care for a migrant family, plus specialized care for a veteran’s family.
Deanna Drake — who earned a master’s in public health from the University of Minnesota, Twin Cities — is a senior manager at Facktor Health, a nationally recognized consulting firm with expertise in development, innovation, and integration for federally qualified health center (FQHC) health plans and hospitals. The company has been supporting DAP Health and Borrego Health throughout this integration, and will continue for the foreseeable future.
These stories reflect just a few of the comprehensive services provided by DAP Health, serving the Coachella Valley since 1984, and Borrego Health, serving Riverside and San Diego counties since the 1980s. Now, the two organizations have become one, offering compassionate health care with dignity and respect across Southern California. Looking to the future, leaders of both organizations are committed to nurturing a true partnership. Corina Velasquez has a unique understanding of the mission and culture of Borrego Health. Sixteen years ago, she joined the organization as a medical assistant. In 2021, she became its chief operating officer, a role she now fills at DAP Health. “I think the culture is in the need to deliver care to the underserved, making sure that you’re here for your neighbors, your friends, your family,” she says. “Because that’s who they are to our employees. “This organization has been through a lot over the past couple of years, much like many other organizations in terms of COVID-19 and how that’s changed things. But with Borrego, it goes a step further with all the things we’ve had to deal with.” Velasquez credits the staff for their dedication. “So many of them could have left. But when you look at the staff that are still here — and you ask about their tenure — it’s anywhere from five, 10, 15 years and climbing.” To answer questions and ease concerns, Velasquez, Borrego Health Vice President of Clinic Operations Nereida “Nedy” Terrazas, and DAP Health CEO David Brinkman took part in an extensive listening tour prior to the official start of the two organizations joining forces. “We went to every single one of our brick-and-mortar clinics over the course of about five to six weeks,” Velasquez reveals. The goal was not only for Velasquez, Terrazas, and Brinkman to answer tough questions, but for the latter to start to get to know Borrego Health employees, and vice versa. “It was very important to me to travel near and far, accompanied by Corina and Nedy, to visit the many people with whom we would soon be working so closely, in their own workplaces,” says Brinkman. “What was most moving to me was not only to see how long most have been in health care, but to witness firsthand the love and passion they have for the work; the dedication they have to the patients they feel it’s their duty and honor to serve. All of that was immediately apparent from our very first conversations.” Velasquez believes DAP Health is a perfect partner in terms of patient care. “It is such an alignment of DAP Health’s ability to do the wraparound services — all of the things that are not 36
Drake notes that both organizations were established to meet an unmet need for a population that didn’t have access to care. “I think what’s really similar is how they started — their motivations for caring for people,” she says. “And what’s changed, over time, is who those populations are. “Many people choose to continue working at these two organizations for the exact same reason. They’re passionate about caring for their patients. And those are patients who are typically quite underserved, vulnerable, and subjected to marginalization or discrimination.” What does that mean to those who turn to the new, blended organization for care and support? “Say you’re a busy mom and you’ve got three kids,” Drake suggests. “You want to know: When I call to make an appointment for my child, is it the same phone number? Can I use my same insurance? Will my doctor or my nurse practitioner be there? “They want that stability — that reassurance that the care they’ve been receiving will continue and it’s as accessible as it always has been. They want to hear, ‘I’ll be here for you. Yes, it’s the same phone number. Yes, you can use your same insurance.’ It’s really important to get that information to those patients directly through their providers.” What could the health care partnership look like within the two years? Drake has a powerful and inspiring vision. “It’s an organization filled with very talented leaders — and very mission-driven staff — who have learned from each other to create a system that is truly exemplary,” she said. Looking to the future, Drake says, “In terms of the quality of the care they’re providing, the quality of their facilities, the excellence in their approach to social determinants of health, they’ve taken the best of both entities and blended that into a strong, unified vision and a mission-driven organization.”
TIMELINE September 12, 2022 Borrego Health files for bankruptcy and solicits potential acquisitors to assimilate its assets, and to serve its more than 100,000 patients (which include people of all genders, as well as children — individuals as diverse as migrant farmworkers in rural areas to refugees and recent immigrants in urban settings). February 5, 2023 DAP Health makes public the fact that — having retained Facktor Health (a firm with expertise in FQHC acquisitions) and having formed an alliance with fellow regional FQHCs Neighborhood Healthcare and Innercare — it has made a bid to absorb Borrego Health in order to advance DAP Health’s nearly 40-year-old mission of protecting and expanding health care access, especially for marginalized populations. February 15, 2023 The Borrego Health board of trustees selects DAP Health to absorb the Borrego Health system based on a process conducted through Borrego Health’s Bankruptcy Court proceedings. The final sale is still subject to the approval of both the Bankruptcy Court and the Health Resources & Services Administration (HRSA). March 1, 2023 The Bankruptcy Court approves DAP Health’s bid to acquire all assets of Borrego Health, launching a regulatory transition process involving the California Department of Health Care Services (DHCS) and HRSA. Working with the consultants at Facktor — and having created various committees devoted to human resources, communications, IT, operations, etc. — DAP Health works through not only its DHCS and HRSA requirements, but the logistics involved in hiring Borrego Health’s 600 employees, all of whom are offered positions at DAP Health. DAP Health and Borrego Health leaders — in addition to that at Innercare and Neighborhood Healthcare, plus Facktor consultants — focus on implementing a well-thought-out plan that will lead to the smoothest transition for all involved. July 31, 2023 HRSA officially approves the absorption of all Borrego Health assets by DAP Health. August 1, 2023 DAP Health and Borrego Health begin operating as one integrated health system. DAP Health CEO David Brinkman answers questions from employees at Borrego Medical Center in Borrego Springs as Chief Operating Officer Corina Velasquez and Clinic Manager Cyndi Bainbridge look on. Photo by Daniel Vaillancourt.
INFORMATION FOR PATIENTS Does DAP Health own Borrego Health? Yes. DAP Health purchased Borrego Health and is responsible for managing all Borrego Health employees and for operating all Borrego Health clinics. Why did DAP Health choose to acquire Borrego Health? DAP Health chose to acquire Borrego Health to protect and expand care for Borrego Health patients, and to increase its footprint so it can bring its awardwinning, holistic, patient-centric model of care to more communities throughout Southern California. Is the name of any DAP Health and/or Borrego Health clinic/center changing? No. For at least the next 12 months, each clinic/center will retain its original name, branding, and signage. How will this acquisition affect patient care? Programs and services for all DAP Health and Borrego Health patients will remain the same everywhere, and in many cases will be improved as DAP Health adds more providers and support staff. There will be no interruption in care, which patients can access as they normally have. Will patient care teams remain the same, and will patients retain their same provider/doctor? Yes. All providers and care teams are now employees of DAP Health. However, most will continue to serve at the clinics where they have been working and caring for patients. Will all Borrego Health and DAP Health clinics/ centers have access to all patients’ medical records? Yes. Once you are registered as a patient at the clinic, you can authorize staff to request your records. Can a patient transfer their care between Borrego Health and DAP Health? Now that DAP Health and Borrego Health are one system, any patient who wishes to visit another clinic location should call to speak to a representative about registering at that clinic as a patient. Will there be changes in insurance requirements? No. All insurance requirements remain the same. Do existing Borrego Health patients need to change the facility name on their insurance card if they want to be seen at DAP Health? No. Existing patients can continue to use their current insurance cards. Only new enrollees will be issued a new card that indicates that DAP Health is their medical home.
37
10
17
10
27
Desert Hot Springs
10
215
21
14
22
18
San Jacinto
215
28
5
4 3
Palm Springs
26
Nuevo
16
23 10
Cathedral City 24
13
Palm Desert
15
25
Indio
20 10
12
Coachella
6
215
Thermal
15
1
Mecca
Anza 1
15
Anza Community Health Center 58581 U.S. Highway 371, Suites F-G-H, Anza Borrego Medical Center • 4343 Yaqui Pass Road, Borrego Springs Centro Medico Cathedral City 69-175 Ramon Road, Suite D-4, Cathedral City Centro Medico Cathedral City • 69-185 Ramon Road, Cathedral City Centro Medico Cathedral City General Dentistry 69-195 Ramon Road, Suite C-3, Cathedral City Centro Medico Coachella • 55497 Van Buren Street, Thermal Centro Medico El Cajon • 133 West Main St Suite 100, El Cajon Centro Medico El Cajon • 155 West Main St Suite 100, El Cajon Centro Medico Escondido 1111 East Washington Avenue, Suites A-B-G, Escondido Centro Medico Escondido • 1121 East Washington Avenue, Escondido Centro Medico Oasis • 88775 Avenue 76, Suite 1, Thermal Coachella Valley Community Health Center 49869 Calhoun Street, Floor 1, Coachella COD Student Health Center • 43500 Monterey Avenue, Palm Desert DAP Health Sunrise • 1695 North Sunrise Way, Palm Springs DAP Health Sexual Wellness Services 81-719 Dr. Carreon Boulevard, Suite D1, Indio Desert Hot Springs Community Health Center Main Campus 66675 Pierson Boulevard, Desert Hot Springs Desert Hot Springs Health and Wellness (Dental) 11750 Cholla Drive, Suite B, Desert Hot Springs Jay Hoffman Health Center • 29490 Lakeview Avenue, Nuevo La Mesa Pediatrics • 8881 Fletcher Parkway, Suite 200, La Mesa Martha’s Village Clinic • 83791 Date Avenue, Indio Palm Springs Family Health 1100 North Palm Canyon Drive, Suites 104-106, Palm Springs Revivals Thrift Store • 611 South Palm Canyon Drive, Palm Springs Revivals Thrift Store • 68401 CA-111, Cathedral City Revivals Thrift Store • 72885 CA-111, Palm Desert Revivals Thrift Store • 82-150 CA-111, Indio San Jacinto Health Center • 651 North State Street, San Jacinto Specialty Care Center • 12520 Palm Drive, Desert Hot Springs Stonewall Medical Center 68555 Ramon Road, Suites 101-103-104-105, Cathedral City Vista Village Pediatrics • 950 Civic Center Drive, Suite A, Vista Woolcott Dental Clinic 590 Palm Canyon Drive, Suite 212, Borrego Springs
2 3 4 5 6 7 8 9
15
10 11 12 13 14 15
15
29
16 10
Escondido
17
9
18 19 20 21
15
22 23 24 25 26 27 28
5
29 30
15
From the Salton Sea to San Diego, there is now a DAP Health clinic near you, ready to provide equitable access to health care.
11
Salt
30
Borrego 2
LEGEND DAP Health clinic Revivals Thrift Store
5
8
15
5
8
San Diego 38
19
8
7
El Cajon La Mesa 805
8
8
FREE STI TESTING
& TREATMENT SCHEDULE AN APPOINTMENT
Not everyone has the same opportunity to access care Not everyone has the same opportunity to access care Not everyone has the same opportunity to access care
40
Not everyone has the same opportunity to access care
A NEW OUTLOOK
FOR DESERT HEALTHCARE DISTRICT AND FOUNDATION DIRECTOR OF COMMUNICATIONS AND MARKETING WILL DEAN, IT’S ALL ABOUT SHOWING UP. Words by Daniel Hirsch • Photos by Lani Garfield
Will Dean knows how to deliver a message to people. “It’s about meeting people where they are, whether that’s in their actual workplace, like the farm fields, or in their churches,” he says. As director of communications and marketing for the Desert Healthcare District and Foundation, Dean’s job is to raise awareness about the efforts of the District’s partners to equitably advance health and wellness throughout the Coachella Valley. For him, meeting people where they are takes many forms. It’s in standard communications work: relaunching a website, drafting press releases, updating social media. Or it could mean promoting farmside mobile clinics to ensure agricultural workers have access to vaccines, as Dean did for the District throughout the COVID-19 pandemic. As Dean explains, health care access relies on communication — about what people needing care understand about their resources, and about what providers are able to hear from prospective patients. “Not everyone has the same opportunity to access care. There are barriers that people face, such as language barriers or lack of transportation,” he says. “Listening to people and their stories is so important to understanding why they may not seek care.” Dean’s ability to communicate on behalf of health care campaigns has benefited DAP Health. Since 1999, the nonprofit has received $3.5 million from the District’s grant program. This funding has supported everything from efforts to computerize patient records to running an HIV-testing van parked outside of gay bars. According to former District CEO Dr. Conrado Bárzaga, Dean effectively advocates for equal access to health care because he’s committed to hearing directly from the people that benefit from it. “He goes to the homeless encampment where we’re serving those community members… It really enhances the work, to tell the stories from a very truthful perspective,” says Bárzaga. “He’s someone who is always looking to do what’s right, to communicate in a very sensitive manner the importance of bringing equity to the distribution of health care.” 41
Dean’s sensitivity for reaching people comes from a decadeslong career as a journalist. It may also come from the acute understanding of the experience of not always being the recipient of the stories and media that one might want or need. Growing up in the 1970s in Hardinsburg, Kentucky — a rural county seat with a population of roughly 2,000 people — Dean was a voracious magazine reader. He’d read anything he could grab, from Reader’s Digest to TV Guide. But as a young Black person who knew he was gay from an early age, Dean would rarely see himself reflected in the media he consumed. Copies of Jet and Ebony provided what Dean describes as “a variety of examples of Black excellence and possibility,” but finding Black LGBTQ+ stories proved harder. The eye for good writing and deep appreciation for meaningful representation stayed with Dean throughout his journalism career, starting in his 20s at the Park City Daily News in Bowling Green, Kentucky and working for papers like the Savannah Morning News. After a mid-career Knight Fellowship at the University of Missouri School of Journalism, Dean landed in Palm Springs for a community editor role at Gannett daily The Desert Sun. There, he fulfilled a dream he’d had ever since he was that magazine-devouring boy: running a magazine all his own. From 2012 to 2018, he edited Desert Outlook, a monthly LGBTQ+ publication published by his employer. “It came about because our then executive editor, Greg Burton, called
all the editors into a meeting and asked us if we thought an LGBTQ+ publication would work here,” says Dean. “And, if I recall correctly, everyone said no — except me.”
He’s someone who is always looking to do what’s right, to communicate in a very sensitive manner the importance of bringing equity to the distribution of health care.
Starting in 2012, Dean ran Desert Outlook with a passionate meticulousness, leading a small team of writers and designers. The monthly printed stories on same-sex marriage and the migration of HIV patients to the desert. Dean fondly remembers interviewing actor Cheyenne Jackson, who gave Dean an equally memorable muscle-bound hug. It was a public-facing role that had Dean attending events multiple times a week— restaurant openings, political gatherings, theatre premieres, and more. “He had high standards, and he was very conscientious about basically everything he did,” says Michael Jortner, an Outlook contributor and longtime friend of Dean. “He would be on every photo shoot to make sure it was as close to what he was looking for. And it was the same with the writers.” After Outlook published its last issue in May 2018, Dean didn’t stop to rest. He started work at the District that June. He filled a position that has made great use of his journalism skills and editorial eye, overseeing the publication of the District’s first history book — telling the story of how the foundation formed in 1948 to build Palm Springs’ first hospital, only to grow to grant $80 million to local health care nonprofits. Working with Riverside University Health System, Dean is poised to launch a public health campaign about harm reduction related to fentanyl overdosing. The demands of Desert Outlook and the District pushed Dean to take a “social hibernation” from the arts, culture, and community events that have so defined his time in Palm Springs. (Dean has also been on the boards of various organizations, such as Dezart Performs and Brothers of the Desert.) It’s a slow-down that Dean says he’s newly emerging from. Recently, he’s worked on his own writing projects, such as contributing a profile of jazz drummer Daniel “Big Black” Ray to Palm Springs Life. Dean is also launching a new, roving social club called The Mix Palm Springs, which focuses on fostering and celebrating diversity in social spaces. A recent summer camp-themed event at resto bar Reforma featured the lawn game cornhole (AKA bean bag toss) and s’mores. “It’s highly curated at the moment,” says Dean of this new venture, which is currently open by invitation only. “But that’s also part of ensuring that people know it’s a safe, welcoming space.” Attention to detail. Respecting people’s needs. Showing up. All in a day’s work for Will Dean.
42
LGBTQ+ CARE IS HEALTH CARE
44
A Prescription for Positive Change BY ADDING WELLNESS PROGRAMS TO CONVENTIONAL MEDICINE, DAP HEALTH ELEVATES PATIENT CARE. Words by Ellen Bluestein • Photo by Zach Ivey
At DAP Health, health care means more than just a routine physical or a sick visit. It means treatment that addresses the whole person and extends beyond conventional medicine to include complementary wellness programs and services.
From reducing pain and combating loneliness to addressing addiction and recovery, DAP Health’s wellness department offers a robust slate of programs and services — all of which are free to clients and designed to supplement medical care. These include:
“It’s all-encompassing, it’s collaborative, and it goes beyond the physical well-being,” says DAP Health Chief Academic and Medical Service Officer Carol Wood, who previously served for six years as the organization’s chief of clinical operations. “It really includes emotional, social, and financial aspects of the patient’s life situation, and each patient is different.”
Mind and body wellness modalities, including acupuncture, chair massage, chiropractic care, Reiki, Transcendental Meditation, and yoga, which can help with pain management.
This integrative approach focuses on body, mind, and soul, and is tailored to an individual’s needs. “We try to address the patient where they are,” continues Wood. “What issues are affecting them that may be making it more difficult for them to be well. It might not be the medical side of things — that might not be the biggest issue.” DAP Health Director of Behavioral Health Sharareh Gandy, Psy.D. agrees. “I’ve seen a lot of health care shifting toward this integrative model. It’s considering the different parts of ourselves, the different things kind of going on in our lives that impact our overall wellbeing, including our physical well-being, our emotional well-being, our spiritual well-being. And so, it’s been wonderful to see health care acknowledge that and bring in multiple different services to work as one in helping people integrate not only their health care but integrate the different parts of themselves.” For mental health practitioners like Dr. Gandy, the shift has had tremendous impact. “I’ve been really excited for mental health to be integrated into the medical model,” she says. “Historically it’s been [that mental health care] has been that thing that’s over there, that’s super private. But now, it’s like, ‘Well, it’s here!’ It’s in our day-today lives, it’s part of who we are, it’s a part of our health care, and it’s really reduced a lot of stigma for people. Over the years — with that integrative model and with telehealth — that it’s just increased access to care…and people are a lot more involved and engaged in seeking out services.” By implementing complementary services, DAP Health acknowledges the importance of alternative therapies as part of routine medical care. “In the wellness department, we offer services like acupuncture, massage, yoga — all those things that aren’t really considered conventional health care,” says DAP Health’s Wellness Center Manager Cory Lujan. “Wellness itself is complementary. We’re to be used in conjunction with, or are married to, the medical side.”
Artistic expression, including clay sculpting, knitting, and quilting groups that bring together those with similar interests, alleviating social isolation and creating friendships. It also serves as a means of self-expression and encourages creativity, bolstering mental health. Social support groups on topics such as HIV and aging, recovery, stress management, healthy relationships, intimacy, liver health, smoking cessation, and diabetes prevention, all of which impart important information and best practices, help clients navigate their health journeys, and decrease social alienation by encouraging conversation. Personal development, including stylist and barber services, employment services, and computer proficiency classes that help clients acquire the skills necessary to be gainfully employed and move toward financial stability. A monthly mobile market from FIND Food Bank, which provides free, healthy food — including fresh fruits and vegetables — ensuring access to the nutrition clients need. Located on the DAP Health Sunrise campus in Palm Springs, the mobile market is open to the public. Various other programs and services, including a trending topics speaker series, lunch-and-learn presentations, and a book club that spark conversation and enrich lives by engaging clients’ minds and reducing social isolation. “It’s our philosophy, and we know it to be true, that housing is health care, food and nutrition are health care, spiritual wellness is health care,” concludes Wood. “It’s not all about just going to the doctor and getting a prescription. There are a lot of mental and spiritual things we can provide for our patients that are going to also impact their health outcomes in a positive way. That’s why we do these things. And if more interventions pop up on the radar that we believe might also help our patients, we at DAP Health are probably going to be the first ones to try them.”
Left: DAP Health Community Health Diagnostic Testing & Outreach Supervisor Manny Muro feels the flower power. 45
We are all broken, that’s how the light gets in We are all broken, that’s how the light gets in We are all broken, that’s how the light gets in
46
The Benefits of Trauma-Informed Care SOMETIMES, THE QUESTION TO ASK ISN’T JUST “WHAT’S WRONG WITH YOU?” BUT “WHAT HAPPENED TO YOU?” Words by Ron Blake • Photos by Rodrigo Izquierdo
We are all broken, that’s how the light gets in We are all broken, that’s how the light gets in
The admired, influential writer Maya Angelou said, “You can’t really know where you are going until you know where you have been.” That is trauma-informed care — a way of treating patients by taking a holistic approach incorporating what has happened to them in the past. Where they’ve been, including the trauma. Bringing a more complete picture of their life to the medical professionals who work to heal them. DAP Health recognizes that its medical professionals can’t truly help patients get healthy and happy until they explore beneath the surface to understand how trauma might have entered and affected each of their lives, often impacting how they respond to providers and treatment. The nonprofit’s Dr. Jill Gover, clinical supervisor of its behavioral health internship program, is part of a team of licensed clinical psychologists who are warmly embracing this type of philosophy, with the expectation that it will bring about more positive health outcomes for patients while effectively managing care and costs, which in turn helps reduce staff burnout and turnover. To quote another literary legend, the poet Robert Frost said, “The best way out is always through.” And that’s precisely what Dr. Gover and her colleagues are doing with DAP Health patients. They aren’t ignoring the traumas. They aren’t tiptoeing around them. They’re addressing them head-on. Using them as strengths — not as deficits or weaknesses — to move along the path to healing. The Power of Lived Experience The best way to more fully explain a concept like traumainformed care is to go on an odyssey of empathy that shows the importance and necessity of it through a lived experience. Last spring, I was in my local hospital’s emergency room in Phoenix, Arizona presenting with symptoms in my lower right leg that I thought were from a sports injury. The onduty physician looked at my lower extremity and ordered an ultrasound to determine if it was a blood clot. I was subsequently taken into a private room for that procedure. There, the male sonographer perfunctorily directed me to remove my shorts, socks, and shoes. I anxiously complied. He then began his duties, running a gel-covered device up and down the inside of my thigh. That’s when I flinched. My leg jerked away from the probing of his transducer. It felt like an instinctive response to danger. As it turns out, it really was — a fight or flight response normally exhibited in trauma. In response to my reaction, the sonographer harshly said, “It’s not a big deal. You need to relax.” He was scolding me for not remaining still so that he could complete his work. His flippant comment made that tense situation much worse. It awakened some bad memories for me. He had taken no time to learn anything about me as a person, nor about my history of trauma. Running that device up and down my inner thigh took me back to a horrific incident that happened on
an inky dark, cold night 12 years ago, when I was 42. Three men entered my home while I was asleep. I was held down, beaten, and raped. I suffered serious injury that has required a dozen years of physical therapy, surgery, and counseling. Thanks to perseverance, I’m happy to say I’m still here. We Must Avoid Retraumatizing Patients To this hospital employee, the ultrasound was no big deal. He performs these procedures routinely. I felt like just another statistic, and that this fellow was viewing it all from his perspective simply to finish his job. But for me, the touching of my inner thigh area triggered chilling, gruesome recollections. After the ultrasound was completed, the sonographer pointed me back to a room to await the examination results. I started gathering my items into my backpack. All I wanted was to leave. I had been retraumatized. I had lost trust in this hospital. But before exiting the building, I made one phone call, to my retired family physician. We chatted, and I explained all that was occurring. My former doctor said it sounded like it was a blood clot. He urged me to stay, wait for the results, and get treated if necessary. He knew all about my history, including that wickedly harrowing night long ago. I had trusted him for many years. I trusted him at this very moment. So, I stayed. It’s a good thing I did. The ultrasound results came back. It was a blood clot in my leg. Additional testing revealed the clot had spread maliciously throughout my lungs, presenting as pulmonary emboli. It was life-threatening. I was immediately transported to the intensive care unit for a fourday hospitalization. Had it not been for that fortuitous phone call to my retired physician, who had been expertly trained in trauma-informed care, I would have gone home. Given how pervasive the spread of the clots had become, I quite possibly would have died in my sleep that night. The Core Principles I felt I could trust that longtime medical friend of mine. He knew me and my trauma. He made me feel safe. He collaborated with me and spoke with me as an equal. He did not allow any biases to interfere with our discussion. He empowered me and reminded me of the resilience I had to overcome obstacles. He spoke with me as a peer advocate — someone who has survived trauma as well. My retired doctor used those six core principles of traumainformed care in his engagement with me on that particular occasion. Trust. Safety. Collaboration. Removal of biases. Empowerment. Peer advocacy. Those are the very same principles DAP Health’s Dr. Gover and her colleagues use today. Every day. The iconic novelist Ernest Hemingway said, “We are all broken, that’s how the light gets in.” DAP Health is dynamically combining that light and trauma-informed care to successfully guide patients to healing, health, and happiness. 47
A Safe Space in a Sea of Hate HOW DAP HEALTH IS ELEVATING LIFESAVING GENDER-AFFIRMING CARE IN SOUTHERN CALIFORNIA. Words by Jacob Anderson-Minshall
A wave of legislation targeting trans and nonbinary people — especially youth — is radically reshaping Americans’ rights in states across the nation. There are new restrictions on access to LGBTQ+ books, public restrooms, and participation in sports. But the greatest threat to trans lives is undoubtably the recent criminalization of gender-affirming care. The ACLU is currently tracking 492 anti-LGBTQ+ bills — more than in any previous period in U.S. history — nearly half specifically targeted at transgender, gender-nonconforming, and nonbinary people. In fact, against the advice of the American Medical Association and the American Academy of Pediatrics, at least 90 of those bills will prevent trans youth from accessing age-appropriate, medically necessary, and lifesaving health care. (When that happens, suicide rates also rise.)
— working out of both Stonewall and DAP Health’s clinic in Escondido — as the incoming director of specialty programs for gender-affirming care as well as those living with, or at risk of, contracting HIV. Dr. Halperin hails from New Orleans, a blue city in a deeply red state. It’s “an island of inclusion in a sea of oppression,” he says. But even in places that embrace diversity, like much of Southern California, Dr. Halperin maintains, “We must be aware of the national backlash against so many of the communities we serve, especially those of trans experience. [In Louisiana] I witnessed the impact of clinics that provided reproductive health services and gender-affirming care shuttered due to the politics of hate.”
Manager of Gender Health and Wellness Programs Mita Just this year, 19 states (Texas being the largest) have Beach has witnessed the chilling effects the anti-trans restricted some (often all) backlash has had locally. gender-affirming care for “In all of Southern anyone under 18. Despite California, there are two the propaganda, genital clinics in L.A., one clinic surgeries aren’t and in San Diego, and our haven’t been offered to clinic in Palm Springs trans kids, but these laws that will see trans can eliminate access youth,” they say, adding to hormone therapy that there were two or and puberty blockers. three more in 2021, Criminalizing genderbut providers are being affirming care intensifies “scared away” by the Senior Nurse Practitioner Director of Specialty Manager of Gender Health the already significant criminalization of Specialist Anthony Velasco Programs Dr. Jason Halperin and Wellness Programs Mita Beach barriers trans people trans care. face when seeking As trans people, families with trans kids, and trans adults flee medical services. other states, DAP Health is committed to boosting Stonewall Anthony Velasco, a senior nurse practitioner specialist Center’s beacon and serving as a safe haven where care is who led the development of DAP Health’s gender wellness accessible to everyone. program, explains, “In my research on stigma and primary The nonprofit already has “a proven track record of shifting the care access among transgender and gender-diverse people, norm to a more equitable one,” Velasco says. “As we expand many reported experiencing violence and victimization when our clinics within and around the Coachella Valley, we continue accessing care.” to be committed to opening our doors even wider so we can DAP Health aims to turn that tide and improve access to provide more services to our trans and gender-diverse patients.” gender-affirming medical care across Southern California. Empowering trans, nonbinary, and other gender-expansive “Creating safe spaces for all people, regardless of their people to walk through DAP Health’s doors is Beach’s job. gender identities” is a natural extension for DAP Health, There are numerous barriers to care that trans and nonbinary Velasco says. “We exercise social justice by continuously folks face, including social determinants of health like lower engaging our communities, interrogating social injustices, and incomes and lack of transportation. addressing health inequities.” Just connecting isolated trans and nonbinary folks with each The same could be said for Velasco, who uses he/they other is difficult in rural areas with a widely dispersed population, pronouns. He identifies as a “queer person of color, an says Beach. Another issue is “misinformation in general,” immigrant, and a first-generation student” who provides care they say. Many don’t know what care is available, or that it is for “systemically and historically minoritized communities.” accessible, even for those who need financial assistance. Now that DAP Health has absorbed the Borrego Health system, it is poised to further elevate lifesaving genderaffirming care with Cathedral City’s LGBTQ+ clinic Stonewall Medical Center. Dr. Jason Halperin will be leading that charge 48
To overcome those hurdles, Beach has done outreach at every LGBTQ+ event they could find. “I would go and put up posters and signs at coffee shops out in the middle of nowhere, and I would get one or two phone calls,” they say.
49
“But a lot of it is word of mouth.” Beach thinks DAP Health’s track record of “engaging with the community outside of the clinic’s doors” will help spread the word about safe, accessible, and competent gender-affirming care. Even before the two federally qualified health centers had joined forces, DAP Health’s gender wellness initiative had begun to make inroads. “We were able to increase the number of actively engaged transgender and gender-diverse patients by more than 400%,” Velasco adds. “Creating an interdisciplinary team and grounding our program using a trauma-informed and patientcentered approach was critical.” Working with different departments within DAP Health was also crucial in meeting the psychosocial needs of patients, like “housing, social services, access to food, care navigation,” Velasco says. And, with the expansion of DAP Health, “we will be able to offer these services to more trans people.” Beach is there to connect trans people to appropriate care even before they arrive. They help patients overcome their fears and share relevant details with providers. Making
50
potential clients feel welcome also takes representation. “From the front desk to the provider, somewhere in that chain, we have to have some trans and gender-diverse folks.” Beach, who is nonbinary and queer, is personally dedicated to that effort, currently studying to become a nurse practitioner “because I don’t see enough people that look like me.” Of course, providing competent gender-affirming medical care isn’t as easy as hiring a few trans or nonbinary folks. Providers need to understand trans care, and how it differs. “Trans health care isn’t typical health care,” Beach explains. “Typically, when people go to the clinic, it’s because they’re sick or because they have to go once a year for a checkup.” But trans people often need to see a provider more frequently, especially if they are receiving gender-affirming hormone therapy, which needs to be monitored. Circumstances can also complicate access to care, especially the dysphoria that can exist in a physical body that doesn’t reflect one’s true gender. For example, Velasco points to one study on cervical cancer screenings. When retesting was necessary, trans men waited nearly 420 days, compared to the 80 days cisgender women wait.
The experience of receiving gynecological care can be a fraught one for many trans men and nonbinary people assigned female at birth, Velasco explains. “Some trans people may find getting a Pap smear dysphoric, and, thus, avoid or delay getting testing and retesting.” Velasco adds, “Finding gender-affirming health care providers…can also be very challenging.” Culturally competent providers are especially important for youth, but their care is becoming the most criminalized in the U.S. Fortunately, it is still embraced in California. Following international protocols and recommendations from dozens of medical associations, the Stonewall Medical Center and Escondido will continue providing nonsurgical interventions for youth. Teens can be prescribed puberty blockers and/or gender-affirming hormone therapy. At DAP Health, services provided to trans and nonbinary patients already run the gamut, Velasco says, including primary care, behavioral health, dentistry, sexual wellness, chiropractic, and social services. “We hope to expand our gender-affirming services to include speech therapy (for voice feminization and masculinization), electrolysis/laser hair removal services, and legal clinics (for legal transition needs),” Velasco adds. “We hope to eventually expand our services to include surgical and post-surgical services to our [adult] trans and nonbinary patients.” Stigma increases against those who find themselves at the intersections of various identities, including gender identity, expression, and sexual orientation. Both Velasco (a credentialed HIV specialist) and Dr. Halperin (the former infectious disease director at New Orleans’ CrescentCare) understand another intersection. “People of trans experience and nonbinary communities have increased rates of HIV acquisition, especially those of color,” Dr. Halperin says. “We know that racism and stigma play the greatest role in driving these increased rates. Furthermore, when structures of power such as the police — or increasingly, legislatures — target and stigmatize communities, we will inevitably see worsening health outcomes due to exclusion.” That’s why, Dr. Halperin adds, DAP Health “must commit even more to this work. We must shine our light bright and far. Our clinics need to ensure easy and supportive accessibility to gender-affirming care. We must also continue to work in solidarity with those across our country.”
51
IL MAESTRO AT THE CASH REGISTER VOLUNTEER PHIL MCKINLEY LIVES A DOUBLE LIFE AT DAP HEALTH’S PALM DESERT REVIVALS. Words by Kent Black • Photos by Lani Garfield • Spiderman Images Courtesy of Phil McKinley
Not long ago, Phil McKinley had a magical moment at the Palm Desert Revivals store where he volunteers. “A guy came up to the register with a beautiful midcentury lamp. We had it priced at 30 bucks,” laughs McKinley, who has been donating his time for four years. The customer used the image search feature on his phone and showed McKinley similar lamps. “He didn’t know if it was real or not. I said, ‘Go home and steam the felt off the bottom and see if there’s a signature. If it’s there, you have a $4,600 lamp.’” A self-avowed shopaholic, McKinley recalls developing a keen eye for bargains growing up in the small farming community of Avon, Illinois. Many years later, one of his oldest friends in Beverly Hills introduced him to consignment shopping, and he was instantly smitten by the pre-loved. When he and his partner, David, bought their home in Rancho Mirage in 2016, he became a regular at Misty’s Consignments. On a tour of his lovely, midcentury gem that Frank Sinatra built as a gift to his daughter, Tina — but that she declined, leaving Sinatra to let visiting musicians use it — McKinley points out some particularly spectacular finds, such as the $14,000 sectional sofa they got for $840, and a rare koa wood rocker from Hawaii that he bought for pocket change and was later appraised at over $7,500. “The whole house is practically Misty’s,” he says. “I said to Misty, ‘Want to come over and see 52
what we bought from you?’ We had Misty and her whole crew over for a party.” McKinley’s Highway 111 perambulations soon made him a regular at Revivals’ Cathedral City and Palm Desert locations. He got to know Steve, the store manager, who pulled him aside one day and suggested he become a volunteer. Given his Midwestern values, it made sense. His father was a volunteer fireman, and his mother was on the local board of education. McKinley had volunteered at a mental health facility during college. The problem was his rather demanding day job.
Philip Wm. McKinley successful ascension of that is a theatre director, city’s theatrical ladder. choreographer, writer, and When McKinley met DAP Health producer who has staged Volunteer Services Manager plays and spectacles from Marcie Lerner, he decided not Broadway to Tokyo to to reveal his occupation, only Salzburg. Among his nearly that he was out of town quite countless productions have often. Lerner told him they had been “Spiderman: Turn Off a lot of snowbird volunteers. He the Dark,” one of the 20 could come in whenever he had all-time highest-grossing the time. productions in Broadway history. His direction of McKinley found his groove “The Boy from Oz” with at the Palm Desert store, Hugh Jackman garnered McKinley backstage with Patrick Paige as the Green Goblin and Reeve Carney and says he especially looks five Tony nominations, and as Spider-Man during a New Year’s Eve 2011 performance of forward to working Sunday his production of “Zombie “Spider-Man: Turn Off the Dark” at Broadway’s Foxwoods Theatre, mornings with Lauren, a young now known as the Lyric Theatre. That’s Anderson Cooper in the background. Prom” became a legendary volunteer, whom he helps with off-Broadway cult classic. sorting through designer clothes. “I love my team,” he says, He staged “Ben Hur Live” in Europe with 350 actors and “And I love my customers. They’re such characters. Colleen 100 animal performers, and directed seven editions of the Heidemann became a Vogue model when she was 69. She’s Ringling Brothers and Barnum & Bailey’s “The Greatest a regular Revivals shopper. Whenever she comes in, she’s Show on Earth.” Along the way, he has picked up five Tony dressed to the nines.” nominations, seven Barrymore McKinley says the community he has found in the Palm nominations, an Desert store strikes a familiar emotional chord in his Emmy nomination, Midwestern heart. He recalls Tom, the store’s greeter, who Not long ago, a shopper came and a treasure sat in a chair at the front, wearing a funny hat, and welcoming chest of other everyone who walked in the door. He’s in awe of Carol, who to the register, excited at his awards. started as a shopper, and has become a hugely popular rare find: a mint condition jewelry maker. And there’s Connie, a 97-year-old staff McKinley says program from ‘Spiderman: member who comes in every day. “She’s a teeny tiny thing, he had an idyllic, but she does everything…works as cashier, works in the Turn Off the Dark.’ small-town back, you name it. She’s phenomenal.” childhood. He
A co-worker opened the program to the title page and asked if the customer wanted the program signed by the director. My co-worker pointed to me and said, ‘He’s standing behind the register over there.’
and his playmates put on theatrical productions in the barn next door. “We’d invite all the neighborhood ladies and sell them lemonade.” He took piano from two elderly spinsters, and recalls staining their piano keys red from picking raspberries in their yard while his sisters had their lessons.
He went off to Augustana College, where he emerged with a degree in education and a job offer to teach junior high school near Las Vegas. One day, a teaching colleague slapped down a flyer for auditions being held at the Stardust and dared McKinley to take a chance. He got the job. For the next several years, he sang, danced, did comedy for shows three times per day, seven days a week, no vacations. He once performed hours after having all four wisdom teeth out. He fainted offstage after the first number, but was revived and made it out for his second number. He was unfazed. “It wasn’t a job…it was a career.” After meeting David, his partner convinced him to move to New York. They did, and McKinley began his highly
For the most part, McKinley manages to keep his superhero/ impresario identity under wraps at Revivals, though every once in a while, worlds collide. Not long ago, a shopper came to the register, excited at his rare find: a mint condition program from “Spiderman: Turn Off the Dark.” “A co-worker opened the program to the title page and asked if the customer wanted the program signed by the director,” McKinley recalls. “My co-worker pointed to me and said, ‘He’s standing behind the register over there.’ We had a good laugh. That was a fun moment.” Left to right: Volunteers David Leigh and Connie Lobo, McKinley, Revivals Palm Desert Manager Douglas Marriott, volunteer Lauren Boyd.
Spend Less. Decorate More.
Find yourself at revivalsstores.com
a h
S e
s ’ h t t Le top S
e m
e m
a G
HOW EMBARRASSMENT HOLDS PEOPLE BACK FROM SEEKING HEALTH CARE — AND HOW TO OVERCOME IT. Words by Maggie Downs 55
You know those times when you absolutely don’t want to go to the doctor? Maybe it’s that you’re uncomfortable answering questions about your sex life, or you don’t want to step on the scale. Perhaps you’re avoiding something else altogether. And the last thing you want is to have a conversation about drug and alcohol use. Such feelings of shame can hold people back from seeking medical care. It’s not only that there are few places that make us feel more vulnerable than a doctor’s office, but there’s also an undercurrent of anxiety about being judged, chastised, or dismissed. (Or all three.)
More people are talking about mental health, and it’s being integrated in different contexts, like at work and at school. It’s becoming part of the wholeperson experience, rather than a singular part of you. It also helps that mental health care is more accessible than ever before.
“Shame is a core emotion that can prevent us from taking care of ourselves,” says DAP Health Director of Behavioral Health Sharareh Gandy, Psy.D. “There’s the idea that there’s something wrong with us, so we want to hide — and the more we do, the more debilitating those feelings can become.”
This can be even more pronounced for those who carry trauma, feelings of social exclusion or inferiority, or extreme self-consciousness. So, this is particularly true for anyone who belongs to a marginalized group in which an aspect of one’s identity is stigmatized, such as gender, race, ethnicity, weight, disability, or health status. Researchers Luna Dolezal and Barry Lyons focused on shame for a study published in the international journal Medical Humanities in 2017, and found it to have a huge impact on care: “Shame is so pervasive, so corrosive of the self and so potentially detrimental to health, that there is considerable utility in considering it an affective determinant of health.” They added, “Despite shame being recognized as a powerful force in the clinical encounter, it is under-acknowledged, under-researched, and under-theorized in the contexts of health and medicine.” As a nurse practitioner of sexual wellness at DAP Health, Anna Daymon has seen firsthand how shame and fear can hold people back from tending to their own health. Daymon works in the Orange Clinic, which is dedicated to sexual health and is housed in the Annette Bloch CARE Building at the Palm Springs headquarters DAP Health Sunrise.
56
“There’s nothing like this clinic anywhere else,” Daymon says. “I always say we’re free from cost, judgment, and stigma.” Finding a safe, health-positive space is an enormous relief for patients, some of whom have never before experienced care without judgment. For instance, Daymon assisted a trans woman living with HIV who had been denied care elsewhere in the past. “Other people had put a lot of guilt on her for living with HIV,” Daymon recalls. “Luckily, she heard about DAP Health, immediately connected with our team, and was welcomed here. What she realized is that staying in care would be easy for her when stigma was nonexistent.” While shame — whether self-imposed or a factor of society — continues to hold people back from seeking mental health care or therapy, Dr. Gandy says there has been a noticeable shift in attitudes during recent years. “More people are talking about mental health, and it’s being integrated in different contexts, like at work and at school. It’s becoming part of the whole-person experience, rather than a singular part of you,” she says. “It also helps that mental health care is more accessible than ever before.” She attributes much of that shift to the COVID-19 pandemic and how nearly everyone grappled with fear, anxiety, and isolation. “People began to realize that mental health is part of us,” she says. “We all have mental health, just like we all have physical health. And once people recognized that, there was more openness to treat it and take care of it. That alone helped ease some of the stigma.” While it’s comforting to know that safe health care spaces exist and that there’s more openness regarding care, it can still be challenging to shake feelings of shame. So how do you get past that and get yourself into the clinic, doctor’s office, or lab? Here’s what the experts recommend: Understand that a health care provider isn’t going to judge you. “There’s no shame in taking care of yourself,” Daymon says. “That’s the biggest thing I want people to understand.” If you find yourself in a situation where a provider does pass judgment or dismiss your concerns, examine your options, and try to seek care elsewhere. Build a relationship with your provider. “It’s very important to build this relationship with your provider, and the first step is to be honest and vulnerable,” Dr. Gandy says. “So, when you find a provider that feels like a good fit, be honest about your needs. And if it turns out it’s not a good fit, that’s OK. Meet with a new provider.”
Consider a virtual appointment rather than an in-person one. “Telehealth allows people to approach care in a different way,” says Dr. Gandy. “It removes some of the barriers that come from going into a clinic or doctor’s office, so they can have a different experience.” Shift how you think about and discuss your medical issue. “People will come into the clinic and say, ‘I was bad’ or ‘I was dumb,’ and I have to say, ‘Stop,’” Daymon stresses. “‘It’s just sex. Let’s take care of you.’” Make a list of things you’d like to talk about. Inside a medical office, it can be easy to get overwhelmed and forget about the questions you’d like to ask or issues you want to discuss. Having a list will help you stick to your agenda for the visit and can boost your confidence by giving you talking points. Remind yourself that your health is the most valuable thing, and that you matter. “We’re pretty hard on ourselves,” Daymon says. “And there are so many people in the world who are going to be hard on us, let’s not be one of those people.” Be part of the change. Although this step goes beyond the individual, all of us can play a role in helping to change societal attitudes in a positive way. According to Dr. Gandy, what we need to ask ourselves is this: “What can we do as a community to help normalize seeking care, and increase awareness about mental health, spiritual health, emotional health, and physical health — everything that goes into overall well-being?”
Shame is so pervasive, so corrosive of the self and so potentially detrimental to health, that there is considerable utility in considering it an affective determinant of health.
57
CAREGIVING
FOR THE CAREGIVERS HOW DAP HEALTH’S APPROACH CAN BE A MODEL FOR OTHERS. Words by Maggie Downs
Even if you’re not a caregiver now, there’s a good chance you’ll fill the role someday. Currently, more than one in five Americans provide unpaid care for an adult or child with special needs, according to a 2020 report from AARP and the National Alliance for Caregiving. That’s an estimated 53 million U.S. adults, a dramatic increase from 43.5 million in 2015. It’s exhausting and challenging work: Navigating the health care system, scheduling appointments, and tending to the health, safety, and comfort of another person, often while juggling another job and one’s own home life. No wonder people have likened caregiving to on-the-job training where nobody has a manual. 58
Then there’s caregiving during a global pandemic. It’s stressful enough to care for another person even during the best of conditions, but COVID-19 added layers of fear, anxiety, and isolation to an already difficult task. These were the same challenges faced by the professional caregivers — the physicians, nurses, and care team members who have guided us through these tumultuous times. “The COVID situation was different from anything else a care provider might experience,” says DAP Health Chief Academic and Medical Service Officer Carol Wood, who previously served for six years as the organization’s chief of clinical operations.
“What made it distinctive is that just as their patients were having stress, so were every one of our care providers. It’s very different than if a patient presents with appendicitis; you’re not directly experiencing those same things.”
lot of faith. I rely on my coworkers because we work as a team. That’s super important. When my day is falling to pieces, my team is always there to listen. And I do the same for them. I have an open-door policy. I’m always here for them.”
Clinic Administrator Cyndi Bainbridge feels one of the most difficult aspects of the job has been connecting patients with the support they need beyond the clinic’s doors. “It’s very difficult,” she says. “As caregivers to the public, we are constantly dealing with the frustrations of the health care system, and we’re also trying to help people find resources when everything is stretched thin.”
Also important: Listening to others’ needs and guiding toward solutions. “We constantly ask the staff what they need, and we are mindful of what we can implement,” Wood says. “We don’t want to tell someone what would be beneficial. We ask them what would make a difference.”
In the midst of the pandemic, the folks at DAP Health knew that support was necessary to care for these essential caregivers. Changes were implemented almost immediately. “It didn’t take long for the leadership team to kick into high gear and say, ‘What can we do to help?’” says Employee Wellness Specialist Desiree Loredo. “Connecting and supporting our community was the most important thing.” The way DAP Health approached employee well-being can serve as a model for caregivers of any capacity. Here’s how they did it. Understand that exhaustion is inevitable and take steps to mitigate it before it happens. Burnout is a form of mental and physical exhaustion, and it’s a part of life for those who provide care. “We knew that burnout was going to happen, and especially in a time like COVID, that’s when the leadership team began discussing the mental and emotional health of employees,” says Loredo. “They came up with some strategies to alleviate the symptoms of burnout.” What DAP Health did was expand the employee wellness plan to include self-care days, massage therapy, a meditation program, healthy lifestyle lectures, even free financial wellness assessments. Offer social support. At a time when local resources were strained or nonexistent, Bainbridge says support within her own community became essential. In her office, that meant supporting her colleagues by being flexible on start times, helping out with childcare or petcare, and occasionally covering one another’s duties. “We found that we all have to work together, but we can manage,” she says. “We help each other.”
According to Loredo, boosting morale is another component of building an effective team. So, DAP Health uses an employee engagement platform to pass along kudos, in which staff members can recognize one another’s work and build a culture of gratitude. Prioritize health and wellness. One of the biggest challenges for caregivers is taking time to care for themselves. “We gave extra days off for self-care, and we had to strongly urge the staff to take them,” Wood says. “Caregivers tend to give of themselves until they can’t give anymore.” But taking time for one’s own physical and mental well-being is vital. That’s why DAP Health introduced wellness initiatives to help manage stress — they opened an employee gym, added massage chairs, and launched a Transcendental Meditation program. These tools are conveniently located onsite at the Sunrise campus in Palm Springs, to help incorporate exercise and breaks into one’s day. “We can’t give when our tanks are empty,” says Debra LaCoppola, the Palm Springs-based author of “Care 360°: A Handbook for Caregiving to Your Parent.” “You may be the best caregiver in the world, but if you don’t give that same care and attention to yourself, your consistent best is impossible.” Find your why. Remind yourself of why you’re doing this. “As difficult as it has been, this piece of my life has been the most meaningful,” Bainbridge says. “I feel like every day I make a real difference somewhere, so to me, that’s my peace. That’s really all you can hope for.” For LaCoppola, this is the result of putting all the other good, self-care practices in place. “Your caregiving will feel as though it is an act of love,” she says, “not survival.”
Maintain perspective. For those in leadership positions, Wood says it’s imperative to realize that employees have lives outside of work. With that in mind, be flexible and compassionate. “We have to recognize that everyone has issues outside of work that affects them,” she says. “We can’t pretend that it doesn't exist. We need to allow our staff the opportunity to have a good work/life balance.” For employees, that means tuning out work whenever you have the opportunity. “I tell people to turn off their cell phone,” Wood says. “Don’t spend every waking hour looking at emails and text messages. Physically and mentally remove yourself.” Build a strong and resilient team. Everybody is stretched thin everywhere, Bainbridge says. So, what’s the best way to cope? “We figure it out as a team,” she says. “For me, I have a
59
DAP HEALTH’S PARTNERSHIP WITH FIND FOOD BANK AIMS TO ADDRESS ONE OF THE MOST SERIOUS SOCIAL DETERMINANTS OF HEALTH: FOOD INSECURITY. Words by Jim Macak
Angela (not her real name) is middle-aged and permanently disabled with back injuries due to a work-related accident. She gets by with help from federal and state benefit programs. This includes an electronic benefits card from CalFresh (formerly the food stamp program) that allows her to spend $281 each month at grocery stores — a welcome benefit, she says, but not nearly enough to cover inflated food costs. Several years ago, Angela also started going to a DAP Health nurse practitioner whom she praises not only for the care he provides but for his genuine concern. Her already-favorable impression received an additional boost in June when that nurse practitioner was troubled by a spike in Angela’s blood sugar levels and broached the subject of her limited diet. Another nurse, as a follow-up, approached Angela and asked if she was aware of DAP Health’s food program. She said she wasn’t, and was soon provided with a large bag of food supplies: chunky mixed fruit, rice, beans, pasta, and more. “And I went, ‘Wow!’” she recalls. In July, Angela received a second bag from DAP Health. This is not just another example of the nonprofit’s longstanding provision of social services, but a growing link between health care and food insecurity, defined by the U.S. Department of Agriculture as an inability to reliably access sufficient, nutritious, and affordable food. Food insecurity and the anxiety it causes can lead to binge eating once food is available, which can trigger diabetes, bulimia, and obesity. The link between food insecurity and physical/psychological issues has prompted
e h t H g u n n i g d n
r e
E 60
61
DAP Heath to take on a more aggressive role in dealing with this, according to Senior Director of Social Services Zayda Welden, who reports that every single patient — no matter what they come in for, no matter whether it’s their first appointment or not — gets assessed for food insecurity thanks to three questions: Have you eaten today? Are you in need of food? Would you like a bag of food to go? According to Welden, from January through mid-July of 2023, 3,486 DAP Health patients were assessed for food insecurity, and 146 accepted bags of food.
On one particular day, the crowd of residents the unit’s presence usually attracts didn’t appear. Staff knocked on doors at the park, only to learn that border patrol agents had recently been in the area. Many residents were concerned about their legal status in the U.S. and were afraid of leaving their homes even to purchase food. Many hadn’t eaten in several days.
A case manager is also available to help patients apply for CalFresh benefits, or to provide referrals to FIND Food Bank — whose mission, according to findfoodbank. org, “is dedicated to relieving hunger, the causes of hunger, and
the problems associated with hunger through awareness, education, and mobilization of resources and community involvement,” and whose vision is “to create a community that is free of hunger and food insecurity.” Additionally, one of FIND Food Bank’s mobile units stops by DAP Health’s main campus parking lot on the second Saturday of every month. There, FIND staff and volunteers work with DAP Health volunteers to distribute 60,000 pounds of food each year to patients and non-patients alike. Says Welden: “Anyone in the community can come in and enjoy fresh produce — for free!” She points out that with DAP Health’s recent absorption of Borrego Health, the combined organization’s annual client base has shot up from about 10,000 to more than 100,000. In addition to its main campus, DAP has one mobile unit and a satellite sexual wellness clinic in Indio. Borrego Health brings with it seven more mobile units and 23 clinics in a two-county area. Welden says her hope is to expand DAP Health’s food insecurity program organization-wide. “We’re definitely going to have to partnership in a more active way with FIND,” she says. According to DAP Health Director of Mobile and SchoolBased Services Heidi Galicia, who also serves as the acting manager of Martha’s Village Clinic, a mobile unit makes stops at a mobile home park known for its immigrant community. On one particular day, the crowd of residents the unit’s presence usually attracts didn’t appear. Staff knocked on doors at the park, only to learn that border patrol agents had recently been in the area. Many residents were concerned
about their legal status in the U.S. and were afraid of leaving their homes even to purchase food. Many hadn’t eaten in several days. “Our supervisors got on the phone to FIND Food Bank,” Galicia says. “Within hours, we had FIND there, distributing food.”
Do You Suffer From Food Insecurity?
Overall, FIND helps 125,000 to 150,000 people monthly access food supplies in Riverside, San Bernadino, and Imperial counties. That’s a sharp increase over the 90,000 it served before the COVID-19 pandemic. And though coronavirus restrictions have eased and the overall percentage of those unemployed has dropped, the number of individuals FIND helps hasn’t decreased, according to FIND Food Bank President and CEO Debbie Espinosa. To her, the reason for this is simple: The cost of food, rent, gas, and utilities has increased substantially. “So even if you have employed people in these circumstances,” she says, “they’re called ‘under-employed.’” They’re simply not making enough money to make ends meet.
Take this short U.S. Department of Agriculture (USDA) survey — and add up the points next to your answers — to find out.
While DAP Health patients who suffer from food insecurity are offered staples and referred to FIND Food Bank for more, FIND, in turn, offers referrals to DAP Health for those suffering from physical and mental distress. DAP Health is a federally qualified health center (FQHC) that receives government subsidies to treat low-income residents. Those who lack insurance are offered a sliding fee scale based on income. According to Community Education and Enrollment Manager Joanna Ibarra, “it makes our services even more affordable for patients.” FIND’s Espinosa says she’s very interested in seeing how DAP Health further expands services — particularly in terms of food insecurity — and how, teaming with her organization, “we can help in creative and innovative ways to keep up with our community’s changing environment.”
In the last six months, is the following statement often, sometimes, or never true for you? “The food that I bought just didn’t last, and I didn’t have the money to get more.” Often (1) Sometimes (1) Never (0) In the last six months, is the following statement often, sometimes, or never true for you? “I couldn’t afford to eat balanced meals.” Often (1) Sometimes (1) Never (0) In the last six months, did you ever cut the size of your meals, or skip meals, because there wasn’t enough money for food? Yes (1) No (0) If you answered “Yes” to the previous question, how often did this happen? Almost every month (1) Some months, but not every month (1) Only one or two months (0) In the last six months, did you ever eat less than you felt you should because there wasn’t enough money for food? Yes (1) No (0) In the last six months, were you ever hungry but didn’t eat because there wasn’t enough money for food? Yes (1) No (0) Results Score 0: Low food insecurity Score 1: Medium food insecurity Score 2-4: High food insecurity Score 5-6: Very high food insecurity
63
THE BENEFITS OF BECOMING A SOCIAL BUTTERFLY
JOINING A CLUB OR VOLUNTEERING FOR A NONPROFIT SUCH AS DAP HEALTH GETS YOU OUT OF THE HOUSE, INTRODUCES YOU TO NEW PEOPLE, GIVES YOU A PURPOSE, AND LIFTS YOUR SPIRITS. Words by Staci Backauskas • Photos by Zach Ivey
Even though most major COVID-19 restrictions have ended, the isolation and loneliness caused by them linger for many of us. Being disconnected from the important people and meaningful experiences in our lives was traumatic. In addition, there was no distraction from the weariness, which raised questions about careers, relationships, and other important life choices. Then there was the worry and fear as we watched the virus spread through the world. No wonder we’re still feeling it.
For some, it means building a relationship with a higher power, or finding new hobbies that provide the opportunity to be around like-minded people. Others plan more frequent get-togethers with family and friends. Then there are those who feel more connected by volunteering.
Whether existential or literal, the issues the pandemic created contributed to more people seeking mental health treatment across the country. The Centers for Disease Control and Prevention (CDC) report those numbers increased across the board from 2019 to 2021, with a 5% jump in adults 18 to 44, while 46% of seniors said virus-related worries had a negative impact on their mental health, according to the National Institutes for Health. Then there’s this late breaking news as we go to press: According to the CDC, the rates of death by suicide in this country are at an all-time high. The hope was that when it was all over, we would return to our lives already in progress, no worse for the wear. Unfortunately, that hasn’t always been the case. “The fact that a lot of things were shut down created, and highlighted, what isolation and loneliness look and feel like,” says DAP Health Director of Behavioral Health Sharareh Gandy, Psy.D. “There was a disconnect among people and communities, and we saw a lot more depression and anxiety surfacing as a result.” Two years past the worst of the shutdown, how do we rebuild connection and community — and reap all of those benefits? According to the Center for Compassion and Altruism Research and Education at Stanford University, healthy social connection strengthens the immune system, improves recovery time from health challenges, and may even lengthen your life. Dr. Gandy agrees. “I think our human nature in general is to feel connected,” she says, adding that how we define that connectedness looks very different for each of us.
64
“I enjoy volunteering to assist the LGBTQIA+ community — my community — to survive and thrive,” says Jerry Hanson, who’s been giving of his time and talents at DAP Health for seven years, going so far as to use his skills and knowledge to help redesign the software for the volunteer program. “I love that [DAP Health] provides a safe, open place to just be who we are, the way we are, in a non-judgmental environment.” Jo Person is a recent addition to the volunteer team who splits her time between the Condom Club (preparing packets with condoms and lube that are distributed throughout the Coachella Valley) and the welcome desk (where she greets and helps patients and other visitors). Recently retired, Person
moved to the area a year ago. “It’s an opportunity to give back in some small way,” she shares. “I also saw it as a way to get out and meet some people.”
I love that [DAP Health] provides a safe, open place to just be who we are, the way we are, in a nonjudgmental environment.
DAP Health events like Partners for Life gatherings, fall’s Health Equity Walk, and spring’s Steve Chase Humanitarian Awards gala can each require up to 150 volunteers who are needed to work registration tables, oversee food stations, and set up tables and chairs. “The wealth of talent in the people we have here is amazing, and there are so many ways people can volunteer,” DAP Health Volunteer Services Manager Marcie Lerner. “We utilize volunteers on so many different levels.” The four Revivals thrift stores operated by DAP Health also need regular volunteers. “We’re open seven days a week,” says Lerner. “All of the donated merchandise needs to be processed, and our volunteers do the lion’s share of that.” Lerner adds that their importance extends to sharing DAP Health’s mission with people unfamiliar with the organization. “Volunteers also inform the customers that the proceeds from their purchase help provide programs and services to those who may not otherwise have access to affordable health care.”
relationships with colleagues and customers.”
Lerner adds that volunteers come from different backgrounds, ideologies, and walks of life, yet find common ground in supporting the nonprofit’s mission. But it’s not one-sided. “I hear people say, ‘I need to make connections. I need to socialize,’ especially when they first come to the community,” she says. “A lot of people move here and seek out volunteer services for socialization.” In addition to DAP Health, there are many nonprofit organizations around the Coachella Valley that benefit from volunteers. The city of Palm Springs has a “Friends of the City” program that provides services and programs to the community, and Volunteer Match has a list of Coachella Valley organizations looking for willing participants. No matter how you decide to connect, Dr. Gandy stresses the importance of doing the internal work to ensure the connections are a fit. “It’s beneficial to look at what we’re connected to and ask ourselves, ‘In what ways is that healthy for me?’” she says. “Are the things and people we’re connected to aligned with our values and what’s really important to us? Because that can be helpful in improving our emotional well-being.”
Kevin Harrigan has donated his time at Revivals for over a year. “Initially, for many customers, their interactions at Revivals were the first time they’d been out of quarantine,” he shares. These contacts broke the isolation and loneliness for many of the patrons. “Numerous customers began coming in daily for the warm embrace of our DAP Health family. And I, in turn, was brought out of my isolation, and benefited from supportive
Left to right: Denise Haslam, Doug Read, Kelly McCoy, and Don Gudie. 65
FREE PREGNANCY TESTING & BIRTH CONTROL CONSULTATION SCHEDULE AN APPOINTMENT
advocacy dental care ending epidemics equitable access food assistance gender-affirming care harm reduction health equity HIV care DAP Health is health care housing LGBTQ+ health mental health primary care recovery reproductive care sexual health social services women’s health
DAPHealth.org
STYLE NEVER GETS OLD