Health Equity Report

HEALTH EQUITY REPORT

FACING THE NEED FOR CHANGE AND HEALING

FACING THE NEED FOR CHANGE AND HEALING For more than a year, millions of people across our nation have joined in a collective call for racial justice and an end to systemic racism. This demand has been heard loud and clear by people from all walks of life.

UMass Memorial Health has joined this call to action with the clear understanding that systemic racism permeates the business world, educational system and even our health care industry. We can’t stand by and let it continue. It’s our duty as human beings, healers, caregivers and leaders to end the racial disparities and racist behaviors that impede our health care mission. We are proud of the work we’ve done together on our anti-racism journey. Here are some examples of the actions we’ve taken together during the last year and a half: •

We formed a Health Equity Steering Committee to assess and guide our internal health equity and anti-racism work. The committee is charged with making recommendations for improving the equity in the care we provide and making UMass Memorial Health a more inclusive workplace.

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Joining forces with the City of Worcester, we created a COVID-19 Equity Task Force to address the racial disparities we were seeing as COVID-19 spread. We kept our doors open and shifted clinical and surgical priorities. Our caregivers at Marlborough Hospital worked with community partners such as the City of Marlborough, the Town of Hudson and faith-based organizations to provide COVID-19 vaccines for underserved populations. HealthAlliance-Clinton Hospital caregivers did similar anti-racism work through their collaboration with the Community Health Network of North Central Massachusetts.

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When we asked caregivers for their ideas for improving diversity, equity and inclusion for our patients, their families and our caregivers, we received more than 100 ideas. We are taking action to implement many of them.

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Our two public Health Equity Open Forums started a community dialogue about racial disparities in our region and how we can partner with local advocates and organizations to address COVID-19 vaccine equity.

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We developed a $1 million program to fund ideas for promoting equity in our health care delivery and fostering a more equitable and inclusive workplace culture.

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As part of our Anchor Mission, UMass Memorial Health has pledged to triple our purchases with minority- and women-owned businesses over the next five years.

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Our newly launched Office of Diversity, Equity, Inclusion and Belonging is setting the direction of our work in this area. Having a clear path will enable us to make the improvements necessary to become a more inclusive organization for our caregivers and a more welcoming place for our patients and families.

These are a few examples of the work happening across our system to reach our goals — of being better at giving equitable care to all patients and becoming a more welcoming, inclusive place for our patients, their families and our caregivers alike.

Despite the exhausting and challenging time our caregivers have been experiencing during the COVID-19 pandemic, it also created space for hope, and showed us how we can work together to be better. Against unknown odds of guaranteed success, our caregivers showed up during the pandemic to work in the spirit of inclusion and fought together, cried together and found a way to heal together.

Through this shared experience, we are finding the courage to fight racism and inequities in our health system and beyond — together.

While it can seem overwhelming to try to turn the tide and bring an end to racism, doing our part in health care contributes to the greater change we want to see in our country and across the globe. We recognize we have a long way to go, as a society and as a health system, but we are committed to doing the challenging work, facing the hard truth, and making the changes we want to see for meaningful improvement. This may be a long journey, but together, we can better. Progress is the only path.

Eric Dickson, MD

Brian Gibbs, PhD

President and CEO UMass Memorial Health

Chief Diversity, Equity, Inclusion and Belonging Officer, UMass Memorial Health

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Wave 1 City of Worcester Positive Cases

PART I: GATHERING INFORMATION

DATA REVEALS DISPARITIES When hospitals, civic leaders and community advocates began to gather data on the spread of COVID-19 in cities across the country, one thing became apparent — minority groups were feeling the impact disproportionately.

This was also true in the cities UMass Memorial Health serves. In Worcester, Latino community members accounted for 37% of positive tests, despite representing only 25% of the population. Similarly, African Americans made up nearly a quarter of the city’s cases at the beginning of the pandemic but represent just 14% of the Worcester population.

With more than 20 organizations joining the effort, the task force broadened its mission. As we launched our testing program, we made prevention and education information available, too. From August 2020 through January 2022, we administered more than 105,000 tests in venues throughout Worcester, including downtown at the Mercantile Center. While we initially tested about 75 people each hour, the process improvement techniques we employed helped us enhance the accuracy of the testing while also boosting our speed to nearly 300 people an hour. Throughout this time, the COVID-19 Equity Task Force continued to analyze the data on COVID-19 spread to identify the hot spots to concentrate their efforts where it was needed the most. By optimizing our processes for testing, we were well prepared to implement a similar lowbarrier vaccination program for at-risk populations when the vaccines were approved and available.

Those concerning numbers prompted the City of Worcester and UMass Memorial to establish a citywide COVID-19 Equity Task Force. This joint effort focused primarily on making it as easy as possible for individuals throughout the community to get COVID-19 testing.

COVID-19 Positive Patients: Race and Ethnicity Cases as of 7/28/2020: 5,469 (City of Worcester only) New COVID+ Cases Race and Ethnicity (6/28 - 7/28)

Our analytics team used geospatial mapping analysis to identify areas with the highest recent number of COVID-19 cases. With data provided by Jeanne Shirshac, Vice President of Health Policy and Public Programs at UMass Memorial, and her team, we reported weekly on the infection rates in Worcester and surrounding communities. The team used data from the state’s integrated case tracking system to break down the numbers by age, sex/gender and race/ethnicity. We also studied information from hospitalized patients and community testing sites to find areas with high COVID-19 rates.

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In Worcester, 31% of COVID+ patients are Hispanic and 13% are Black/African American.

Overall population in Worcester: Hispanic (21%) and Black/African American (12%).

HEALTH EQUITY REPORT FACING THE NEED is FOR CHANGE AND HEALING Among recent newly confirmed COID+ cases, the majority still Hispanic (37%). | 5

LISTENING TOURS PROMOTE OPEN DIALOGUE In the summer and fall of 2020, as social protests against police killings of Black people were happening across the country, Eric Dickson, MD, President and CEO of UMass Memorial Health, wanted to learn more about the depth of these issues and how they impacted our workforce. He felt there was no better way to gain knowledge than to listen to caregivers throughout the system.

Dr. Dickson created a series of listening sessions with Employee Resource Groups, some of the diversity committees throughout the UMass Memorial system and — by open invitation — all interested caregivers. The goal of these sessions was to have an honest and open dialogue about racism, diversity, equity, and inclusion within UMass Memorial Health and communities it serves.

“The sessions were a great exchange of ideas, questions, thoughts, suggestions. Quite frankly, we uncovered some harsh realities that prove there is more work to do to make UMass Memorial a more inclusive workplace for our caregivers and a place for patients to receive more equitable treatment and care,” Dr. Dickson wrote in a message to all caregivers after the sessions.

Dr. Dickson summarized the lessons learned from the sessions as follows: •

Unconscious bias exists and can only be overcome with conscious action.

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We must take an equity pause before making a decision to think about its potential impact on ALL community members.

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The “Golden Rule” — treating others as you wish to be treated — doesn’t apply. We must treat people how they want to be treated.

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Our caregivers want to make change happen.

Dr. Dickson believes that significant change will require significant action. And he also believes that the organization is up to that challenge.

“At times, as the CEO, some of the stories of discrimination that our caregivers have shared are hard to hear,” he said. “I wish I could say that we were perfect as an organization and that no caregiver at any time will experience bias or discrimination based on the color of their skin, gender identity, or sexual orientation. We just aren’t there yet — I’m not sure any organization is — but that means we must get better and having these open conversations have been the right way to start our improvement journey together.”

“Quite frankly, we uncovered some harsh realities that prove there is more work to do to make UMass Memorial a more inclusive workplace for our caregivers and a place for patients to receive more equitable treatment and care.”

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HEALTH EQUITY FORUMS - “GOING PUBLIC” During the first months of the coronavirus pandemic, UMass Memorial, the City of Worcester and the other 20-plus members of the COVID-19 Equity Task Force were wrestling with issues of health equity. Data analysis revealed that minority communities were disproportionately impacted by the pandemic, and the Task Force met routinely to discuss a comprehensive strategy to address inequities. But the larger community was not yet involved in the conversation.

That changed in late October 2020 when the task force partners held the first of two virtual Health Equity Open Forums. Leaders from across Central Massachusetts came together for the events, which were live streamed via Facebook and open to the

public. Along with Dr. Dickson, panelists included Matilde Castiel, MD, City of Worcester Health and Human Services Commissioner; U.S. Representative Jim McGovern, Congressman for the Second District of Massachusetts; Sarai Rivera MSW, D.Min., Worcester City Councilor and chair of the Council’s Committee on Public Health; and Tayyaba Salman, MD, a hospitalist at UMass Memorial Health – HealthAlliance-Clinton Hospital. The forum was moderated by Gina Plata-Nino, Esq., an attorney with the Central West Justice Center and a member of the COVID-19 Health Equity Task Force.

The events featured lively discussion of the health care inequities and disparities that have long existed but that have been brought to light during the pandemic. Each expressed their belief in the importance of government and health care systems playing a role in reducing the disparities. Many also cited systemic racism as the underlying cause of health care disparity. Dr. Dickson said there is a larger challenge.

“Unfortunately, there’s not a vaccine under development for racism,” he said. The Facebook Live event is available on UMass Memorial’s YouTube channel.

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“The power of influence is significant, so when a large, trusted anchoring institution leads the way on healthy equity, it is encouraging. I appreciated the practical and honest approach of the panel on this issue… an ongoing conversation with concrete steps and resources.”

HEALTH EQUITY MILESTONES Since 2020, UMass Memorial Health achieved a number of milestones that helped grow the foundation for equity and inclusion in our organization

— Gina Plata-Nino, Worcester Together Coalition and Staff Attorney for Central West Justice Center

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UMass Memorial Health Board of Trustees made a commitment to improve the organization’s health equity work internally and externally by approving the creation of the Office of Diversity, Equity, Inclusion & Belonging

UMass Memorial Health hired Brian Gibbs, PhD, to serve as the organization’s first Chief Diversity, Inclusion, Equity and Belonging Officer.

Employee resource groups (ERGs) were both established and reenergized.

The UMass Memorial Medical Center Department of Obstetrics and Gynecology created an anti-racism pledge and a new TeamBirth partnership aimed at improving maternal health and birth outcomes, which are currently worse for women of color.

The UMass Memorial Health senior leadership team conducted an organizational equity assessment and participated in a racial literacy training.

At UMass Memorial Medical Center, the chairs of each medical department appointed a diversity and equity specialist.

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PART II: TAKING ACTION

BRINGING COVID-19 PREVENTION STRATEGY TO NEIGHBORHOODS Even in the earliest weeks and months of the pandemic, data flowing into the COVID-19 Equity Task Force made it clear that safety information and resources were not reaching enough of Worcester’s residents. As COVID-19 rates soared, especially in the city’s Black and Latino communities, UMass Memorial Health caregivers collaborated with the City of Worcester, Worcester State University’s Latino Education Institute (LEI), the Worcester Community Action Council and other community

“The pandemic revealed how much work we have to do in our communities to ensure that people have ready access to health care. It’s only by building partnerships and working together that we’ll be able to overcome these barriers.” organizations to develop and launch a COVID-19 prevention strategy.

visiting supermarkets and bodegas, churches and neighborhood centers,” said Mónica Lowell, Vice President, Community Health Transformation and Community Benefits, UMass Memorial Medical Center. Lowell credited two UMass Memorial Medical Center providers who especially championed the effort, Kimiyoshi Kobayashi, MD, Chief Quality Officer, and John Broach, MD, Director of the Division of Emergency Medical Services and Disaster Management.

At these neighborhood-based pop-up sites, the UMass Memorial team, with assistance from LEI student volunteers, showed people how to use PPE effectively, answered questions and distributed printed information in more than 30 languages.

For the first several months, when PPE supplies were limited, the team gave out hundreds of washable cloth masks sewn by Community Relations staff member Daisy Ramirez and Marketing and Communications staff member Susan MacNeil, with assistance from Community Health Worker Maggie Rodriguez and community member Kathryn Beauregard. Overall, they gave out more than 320,000 masks by January 2022.

First, they examined the causes and possible remedies for the disparity. Lack of transportation, language barriers, close contact with other people at home or work, low income and other social determinants of health were all factors. While not every identified problem had an immediate solution, it quickly became clear that locating education initiatives where people could get to them easily — in their neighborhoods, rather than less accessible locations — would be the most effective approach.

The situation gave the UMass Memorial Ronald McDonald Care Mobile team a chance to pivot from their ongoing mission of offering preventative medical and dental services to people without health or dental insurance. On April 22, 2020, they launched a new education campaign in Worcester: Our Feet Hit the Street.

“Armed with information in several languages, masks and sanitizers, they went where our patients live,

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“The pandemic revealed how much work we have to do in our communities to ensure that people have ready access to health care,” Lowell said. “It’s only by building partnerships and working together that we’ll be able to overcome these barriers.”

MEETING PEOPLE WHERE THEY ARE – ACCESSIBLE COVID-19 TESTING In May and June 2020, Worcester began preparing for Black Lives Matter rallies which would bring thousands of people into close contact with one another in Worcester. To keep both rally participants and residents safe, UMass Memorial Health collaborated with Worcester Public Health Department and community-based organizations to set up COVID-19 testing sites.

UMass Memorial Health originally planned to offer COVID-19 testing after the rallies at the Medical Center’s University Campus, the UMass Memorial Health – Marlborough Hospital campus and at New England Sports Center. We soon recognized that rally participants would be diverse in age, race, ethnicity, gender, income and traveling on foot, by car or bus from various cities, towns and neighborhoods and therefore our testing locations needed to be easily accessible.

ZIP code data showed neighborhoods predominantly made up of people of color were underrepresented in being tested, even though coronavirus rates were disproportionately high among Black and Latino residents in the region. When UMass Memorial joined the state’s Stop the Spread testing campaign, the Ronald McDonald Care Mobile team once again sprang into action and helped create pop-up neighborhood testing sites – so we could meet people where they were.

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VACCINATIONS Between December 2020 and the end of June 2021, UMass Memorial Health administered more than 100,000 doses of COVID-19 vaccines to individuals.

That number by itself is staggering — but is even more impactful to understand how these vaccine doses were provided, and why.

As early as January 2021, UMass Memorial knew that the organization would be one of the primary providers of vaccines in Central Massachusetts.

That meant setting up clinics in central locations that could reach broad swaths of the population, as well as coming up with innovative solutions to reach populations that had been disproportionally “It was very clear from the data that we needed to make sure those neighborhood resources were in place — not just during the pandemic but for the future,” said Jeanne Shirshac, the Vice President of Health Policy and Public Programs at UMass Memorial Health and the CFO and Treasurer of the UMass Memorial Health – Accountable Care Organization. “This was an opportunity for us to improve health care access for everyone in our communities.”

Shirshac provided data that showed the areas with the highest rates of COVID-19, and the UMass Memorial team arranged for COVID-19 pop-up testing in those neighborhoods, making sure that residents could walk or take a bus to get there.

Additional testing events at Main South Community Development Corporation and behind Worcester City Hall, for example, routinely drew 600 to 700 people at a time.

“We needed to connect with people in locations that are comfortable for them, in addition to being accessible,” said Michelle Muller, FNP, Manager for the UMass Memorial Ronald McDonald Care Mobile team. “For many people that means being

impacted by the COVID-19 pandemic. In Worcester, that included communities of color and those that were considered low-income.

Jeanne Shirshac accessed data that showed younger residents in communities of color had the highest rates of COVID-19 infection even though the Commonwealth of Massachusetts decided that adults over 75 should be the first to be vaccinated.

To reach those communities, UMass Memorial Health created the Mobile Vaccine Equity Enhancement Program (MVeeP). Led by Dr. Broach, the MVeeP was relentless in its creative approaches to reach people in need. Beginning in February 2021, the MVeeP held more than 100 separate vaccination events in an array of locations — beauty salons, churches, public housing authorities, inhome for homebound seniors, manufacturing sites

able to speak their native language in their own neighborhood or organization in their community, like a church or community center.”

By the beginning of November 2020, it was too cold to continue outdoor testing. With the help of new hires, temporary employees, public school nurses and volunteers, UMass Memorial moved its main testing hub indoors to the Mercantile Center in downtown Worcester. The location was easily accessible on foot, by bus or car, with plentiful parking nearby.

By Thanksgiving, the team was doing up to 1,000 tests three days a week. By mid-January 2021, the total was up to 1,400 on each testing day. At times, people waited in lines that extended around the building. As vaccines became readily available in the spring, the numbers of people seeking tests declined to 100 or less, and the Mercantile Center became a vaccination site. But by August, UMass Memorial was offering two days of testing each week, since demand increased with the spread of the Delta variant.

By the end of August 2021, the team had administered nearly 65,000 tests and held 128 testing days. And testing will continue as long as it is needed to stop the spread of COVID-19.

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HEALTH CARE AT THE STREET LEVEL: EMERGENCY MEDICINE’S ROLE IN THE PANDEMIC As a paramedic, a shift lieutenant and a training officer for Worcester Emergency Medical Services, Ronald Gigliotti was at the forefront when the pandemic first reached Massachusetts back in March of 2020.

and more. The team traveled throughout the region and hosted events in Worcester, Clinton, Lancaster, Leominster, Marlborough, Oxford, Shrewsbury, Spencer, Sutton, Webster and Westborough.

By the end of August 2021, the MVeeP had administered more than 5,300 doses of the COVID-19 vaccine to more than 3,100 individuals.

“We had to learn to bring health care to the street level. We learned a lot of new things about how we could do our jobs, and we created positions that I never would have thought in my 30 years would exist.”

“COVID-19 in a lot of ways fractured the systems,” he said. “The overall health infrastructure wasn’t really designed for the magnitude and gravity of what we were engaged in.”

In addition to MVeeP, UMass Memorial Health opened ambulatory vaccine clinics in strategic locations, including the Mercantile Center in downtown Worcester and the New England Sports Center in Marlborough. Since Mercantile Center is close to the Worcester Regional Transit Authority transportation hub, individuals traveling to the clinic by bus would only need to take one bus to get there.

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MEETING PSYCHIATRIC NEEDS DURING A PANDEMIC

Despite the initial turmoil of it all, something unusual was happening at UMass Memorial’s field hospital, located at the DCU Center in downtown Worcester. In addition to being the first field hospital in the state, the site was also unique in that its staff prioritized the needs of some of Worcester’s most vulnerable individuals — COVID-19 patients experiencing homelessness. Erik Garcia, MD, UMass Memorial Medical Center, and Medical Director of the Homeless Outreach and Advocacy Project at Family Health Center of Worcester, spoke proudly about the field hospital’s approach to caring for those experiencing homelessness. He said he had never seen a community partnership like it in all his years in medicine — a community partnership in which a hospital responds to people’s need for shelter and to protect public health, even though they don’t require hospital treatment.

“We had to learn to bring health care to the street

level. We learned a lot of new things about how we could do our jobs, and we created positions that I never would have thought in my 30 years would exist,” said Gigliotti, recalling how his team and UMass Memorial Health staff banded together to support each other and patients. Throughout Worcester, EMS employees conducted COVID-19 testing for individuals experiencing homelessness, transported patients who tested positive for COVID-19 to isolation shelters, and even helped staff the field hospital when patient volume went up.

Additionally, clinical staff who work inside the hospital under normal circumstances took to the city to bring care to those who needed it most.

“We saw doctors and nurses and nurse practitioners alongside paramedics on Main Street in Worcester doing what we had to get done because someone had to do it,” Gigliotti said.

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In UMass Memorial Health’s Psychiatric Treatment and Recovery Center (PTRC), a secure 26-bed unit in Worcester, treatment involves direct interaction with psychiatrists, nurses, occupational therapists and social workers — as well as with peers who are going through similar experiences. PTRC team members were concerned when medical protocols severely limited those personal connections for their patients who tested positive for COVID-19. Patients were transferred to medical units where they received the necessary treatment for their physical symptoms.

“We were unable to provide good mental health care to COVID-positive patients while they were in isolation on the medical floors, and we couldn’t bring them back to a unit where there were COVIDnegative patients,” said John Sullivan, MD, Interim Director of PTRC and Medical Director of the Adult Mental Health Unit at University Campus.

With just days to complete these complicated, interconnected changes, UMass Memorial was able to convert PTRC into a place that could effectively serve patients coping with a COVID-19 diagnosis on top of the challenges of significant mental illness.

“This was incredibly scary for staff,” said Candy Szymanski, MS, RN, Interim Associate Vice President, Hospital at Home, who served as Associate Chief Nursing Officer at the time. “The PTRC team was not accustomed to using PPE. We were able to get them comfortable with the whole situation, including comfortable with PPE. It was an amazing team effort to pull this off.”

Wearing PPE, the patients could interact with each other and move freely since all of them were positive for the coronavirus. They were able to resume the social aspects of their care — sharing meals and sitting in group therapy, for example — at the state’s first mental health treatment facility for patients who were COVID-19 positive.

“When we made the decision to transform the unit, we essentially did it on the fly,” Dr. Sullivan said. “With necessity being the mother of invention, we learned a lot as we went, and we were happy with the outcomes.

We were able to balance psychiatric needs with the infection control issues of caring for COVID-positive patients. The hard work of our nursing and other frontline staff made a tremendous difference in the quality of treatment we were able to provide.”

The solution was to make PTRC into a COVIDonly unit in early April 2020. The transformation drew on operational and clinical resources throughout the UMass Memorial system.

Everything needed to be rethought — infection control, nutrition, laundry, environmental services, information technology, security, pharmacy, employee health and much more. Even the HVAC system needed to be altered to provide the negative pressure necessary to prevent air inside the unit from blowing into the hallway, which had to be kept free of the coronavirus.

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CLOSING THE RACIAL GAP IN NUMBERS OF WELL-CHILD VISITS In the autumn of 2020, Eric Dickson, MD, President and CEO, UMass Memorial Health, charged caregivers with identifying a health equity gap and proactively addressing it. Looking at data on rates of well-child visits, UMass Memorial’s team saw disparities based on race. A multidisciplinary team of physicians, data analysts, clinic management, and staff from the Office of Clinical Integration and the Office of Quality and Patient Safety — found the greatest disparity between white pediatric patients and Black and Latino patients.

During the year leading up to October 2020, which was used as a baseline, only 58% of Black patients and 64% of Latino patients had their annual well-child visit, compared with 72% of white patients. With clear evidence of a health equity gap, we set a goal of increasing the numbers of well-child visits to 64% for Black patients and 69% for Hispanic patients.

The resulting project earned the inaugural Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity. The Joint Commission and Kaiser Permanente established the award in 2021 to showcase health equity projects with demonstrated and sustained improvement—in this case a datadriven project with positive, sustainable outcomes.

“After seeing this data, we set out to identify and remove the obstacles that were preventing these families from getting their children here

“Well-child visits are among the most essential tools pediatricians have for maintaining and improving children’s health and well-being, and these gaps showed us that we needed to make some changes.”

for well visits,” said Arvin Garg, MD, Associate Chief Quality Officer for Health Equity at UMass Memorial. “Well-child visits are among the most essential tools pediatricians have for maintaining and improving children’s health and well-being, and these gaps showed us that we needed to make some changes.”

With the understanding that prioritizing well-child visits can be a challenge for families, we developed multifaceted interventions, including proactive scheduling and outreach. They proved to be effective methods of reducing cancellations and no-shows and getting many more children to well visits. As of September 2021, teams in pediatrics and family medicine had conducted well-child visits with 72% of our Black patients and 74% of our Latino patients, far exceeding the initial goals. The effort also narrowed the overall disparity between white, Latino and Black children.

“We haven’t completely closed the gap yet,” said UMass Memorial Health Chief Quality Officer and Chief Informatics Officer Eric Alper, MD. “But we’ve already made significant progress, and I believe we can improve further as we continue to focus on this issue. Our team is excited about addressing other areas where we can identify and address health care inequities.”

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LOOKING FORWARD As we reflect on the health inequities that became so urgent during 2020 with the spread of COVID-19, we also look ahead. Our goal as a health care community is to remove the causes of the inequities, but in the meantime, we must recognize their ongoing impact and mitigate their effects.

UMass Memorial will continue to strive toward addressing persistent health care disparities, racism

and other forms of discrimination. The pandemic has shown how deeply they affect our ability to deliver the high-quality care and our patients’ ability to access it. While our strategy will be driven by data, it will be informed by engaging with our UMass Memorial caregivers and the voices of those affected by discrimination and structural inequities.

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WHAT WOULD HAPPEN IF WE ALL FACED THE NEED FOR HEALING? If everyone found the courage to face the mirror, and take a deep look inside at the role we all play in inclusion. If we all faced the truth that even though progress is being made, there is more progress to make—then the world would not just change for the better, it would heal. At UMass Memorial Health, we will continue to be the face of change, a source of healing, and a place where everyone has a place.

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For additional copies or more information about UMass Memorial Health’s ongoing health equity work, contact the Office for Diversity, Equity, Inclusion and Belonging at deib@umassmemorial.org.