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Il Maestro at the Cash Register

 Maestro at the Cash Register

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

 

As seen in DAP Health Magazine Issue 4 

Discovering Hidden Treasures at Palm Desert Revivals

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.’”

From Small-Town Roots to Big City Bargains

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. 

A Home Filled with Misty's Gems

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 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.

The Broadway Maestro Behind the Cash Register

Philip Wm. McKinley is a theatre director, choreographer, writer, and producer who has staged plays and spectacles from Broadway to Tokyo to Salzburg. Among his nearly countless productions have been “Spiderman: Turn Off the Dark,” one of the 20 all-time highest-grossing productions in Broadway history. His direction of “The Boy from Oz” with Hugh Jackman garnered five Tony nominations, and his production of “Zombie Prom” became a legendary off-Broadway cult classic. He staged “Ben Hur Live” in Europe with 350 actors and 100 animal performers, and directed seven editions of the Ringling Brothers and Barnum & Bailey’s “The Greatest Show on Earth.” Along the way, he has picked up five Tony nominations, seven Barrymore nominations, an Emmy nomination, and a treasure chest of other awards. 

Balancing Stardom with Service

McKinley says he had an idyllic, small-town childhood. He 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 successful ascension of that city’s theatrical ladder.

When McKinley met DAP Health Volunteer Services Manager Marcie Lerner, he decided not to reveal his occupation, only that he was out of town quite often. Lerner told him they had a lot of snowbird volunteers. He could come in whenever he had the time. 

Embracing Community and Connection

McKinley found his groove at the Palm Desert store, and says he especially looks forward to working Sunday mornings with Lauren, a young volunteer, whom he helps with sorting through designer clothes. “I love my team,” he says, “And I love my customers. They’re such characters. Colleen Heidemann became a Vogue model when she was 69. She’s a regular Revivals shopper. Whenever she comes in, she’s dressed to the nines.”

A Home Filled with Misty's Gems

McKinley says the community he has found in the Palm Desert store strikes a familiar emotional chord in his Midwestern heart. He recalls Tom, the store’s greeter, who sat in a chair at the front, wearing a funny hat, and welcoming everyone who walked in the door. He’s in awe of Carol, who started as a shopper, and has become a hugely popular jewelry maker. And there’s Connie, a 97-year-old staff member who comes in every day. “She’s a teeny tiny thing, but she does everything…works as cashier, works in the back, you name it. She’s phenomenal.”

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.”

A Safe Space in a Sea of Hate

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

 

As seen in DAP Health Magazine Issue 4

 

Navigating the Storm: The Landscape of Gender-Affirming Care

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 undoubtedly the recent criminalization of gender-affirming care.

The Battle Against Discrimination: Upholding 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 life-saving health care. (When that happens, suicide rates also rise.)

Just this year, 19 states (Texas being the largest) have restricted some (often all) gender-affirming care for anyone under 18. Despite the propaganda, genital surgeries aren’t and haven’t been offered to trans kids, but these laws can eliminate access to hormone therapy and puberty blockers. Criminalizing gender-affirming care intensifies the already significant barriers trans people face when seeking medical services.

Anthony Velasco, a senior nurse practitioner specialist who led the development of DAP Health’s gender wellness program, explains, “In my research on stigma and primary care access among transgender and gender-diverse people, many reported experiencing violence and victimization when accessing care.”

A Beacon of Hope: DAP Health's Gender Wellness Program

DAP Health aims to turn that tide and improve access to gender-affirming medical care across Southern California.

“Creating safe spaces for all people, regardless of their gender identities” is a natural extension for DAP Health, Velasco says. “We exercise social justice by continuously engaging our communities, interrogating social injustices, and addressing health inequities.”

The same could be said for Velasco, who uses he/they pronouns. He identifies as a “queer person of color, an immigrant, and a first-generation student” who provides care for “systemically and historically minoritized communities.”

Standing Firm: The Fight for Inclusive Healthcare

Now that DAP Health has absorbed the Borrego Health system, it is poised to further elevate lifesaving gender-affirming care with Cathedral City’s LGBTQ+ clinic Stonewall Medical Center. Dr. Jason Halperin will be leading that charge — 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 Beach has witnessed the chilling effects the anti-trans backlash has had locally. “In all of Southern California, there are two clinics in L.A., one clinic in San Diego, and our clinic in Palm Springs that will see trans youth,” they say, adding that there were two or three more in 2021, but providers are being “scared away” by the criminalization of trans care.

As trans people, families with trans kids, and trans adults flee other states, DAP Health is committed to boosting Stonewall Center’s beacon and serving as a safe haven where care is accessible to everyone.

The nonprofit already has “a proven track record of shifting the norm to a more equitable one,” Velasco says. “As we expand our clinics within and around the Coachella Valley, we continue to be committed to opening our doors even wider so we can provide more services to our trans and gender-diverse patients.”

Breaking Barriers: Overcoming Obstacles to Care

Empowering trans, nonbinary, and other gender-expansive people to walk through DAP Health’s doors is Beach’s job. There are numerous barriers to care that trans and nonbinary folks face, including social determinants of health like lower incomes and lack of transportation.

Just connecting isolated trans and nonbinary folks with each other is difficult in rural areas with a widely dispersed population, says Beach. Another issue is “misinformation in general,” they say. Many don’t know what care is available, or that it is accessible, even for those who need financial assistance.

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. “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.

The Road Ahead: Expanding Services and Support

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 patient-centered 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 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.”

Shining the Light: A Call to Action

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.”

The Benefits of Trauma-Informed Care

The Benefits of Trauma-Informed Care

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 • Photo by Rodrigo Izquierdo

 

As seen in DAP Health Magazine Issue 4

 

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 trauma-informed 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 on-duty 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 four-day 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 trauma-informed 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.

A Prescription for Positive Change

Manny Muro

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

As seen in Issue 4 of DAP Health magazine.

Integrative Healthcare at DAP Health

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.

Tailored Wellness Approach

“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.”

The Role of Mental Health Integration

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.”

Complementary Services Offered

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 well-being, 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.”

Addressing Social Isolation and Loneliness

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-to-day 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.”

Personal Development Opportunities

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.”

Enriching Programs Beyond Medical Care

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:

Mind and body wellness modalities, including acupuncture, chair massage, chiropractic care, Reiki, Transcendental Meditation, and yoga, which can help with pain management.

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.

Philosophy of Holistic Health

“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."

A New Outlook

Will Dean

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 

As seen in Issue 4 of DAP Health Magazine

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. 

Meeting People Where They Are

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.

Communication as Key to Healthcare Access

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.”

Advocating for Equal Access

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.”

From Journalism to Healthcare Advocacy

Dean’s sensitivity for reaching people comes from a decades-long 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.”

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.” 

Transition to Healthcare Leadership

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.

Embracing Diversity and Inclusion

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.

All in the Family

All in the Family

How spouses Andy and Johnny Glorioso found themselves both working in sexual wellness at DAP Health — and loving it.

As seen in Issue 4 of DAP Health magazine 

Words by Trey Burnette • Photos by David A. Lee

 

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. 

A Shared Mission: Andy and Johnny's Path to DAP Health 

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. 

Empowering Patients: The Role of PrEP in HIV Prevention

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.

Breaking Stigma: Normalizing Conversations About Sexual Health

“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.” 

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.

Love and Work: How Andy and Johnny Balance Life at DAP Health

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.

Community Impact: Beyond the Clinic Walls

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.

Advocating for Change: The Gloriosos' Commitment to Sexual Wellness

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!”

Can I Tell Them Who I Am?

Jean-Marie Navetta

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.

As seen in Issue 4 of DAP Health magazine 

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.”

Navigating Identity: Jean-Marie's Journey in DEI Advocacy

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.”

Education as Empowerment: Transforming Workplace Culture

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.

Challenges and Progress: Overcoming Obstacles in the DEI Movement

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 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.

Business as Catalyst: The Role of Corporations in Advancing LGBTQ+ Rights

“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.” 

Global Impact: Jean-Marie's Vision for DEI Education at Out & Equal

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, etc. means that one of the last places we can have this conversation is in the workplace.”

Effective DEI work in the 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.

The Plight of the Migrant Farmworker

Portrait of Farmworker

The Plight of the Migrant Farmworker

 

The health care needs of an essential yet marginalized community require special attention that is long overdue.

As seen in Issue 4 of DAP Health magazine 

Words by Trey Burnette

Invisible Yet Indispensable: The Role of Migrant Farmworkers

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. 

The Health Crisis: Neglected Needs of a Marginalized Population

They’re also one of the most marginalized and neglected populations. A whopping 23% of farmworkers in the U.S. live in poverty. The average individual’s annual income falls between $12,500 and $14,000 ($17,500 to $19,999 for families). And neither does the National Labor Relations Act of 1935 (which permits private sector employees to organize into trade unions, engage in collective bargaining, and go on strike) nor the Fair Labor Standards Act of 1938 (which preserves the right to a minimum wage and “time-and-a-half” overtime pay for toiling more than 40 hours a week, plus prohibits the employment of minors in “oppressive child labor”) cover most workers. Beyond the low pay and lack of many workplace protections, health care is one of the most significant stressors for farmworkers. Some 25% of them depend on community health centers. 

Barriers to Wellness: Challenges Faced by Farmworkers

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 reported that, of the 1,015,162 agricultural workers and their family members who received health services, the most common diagnoses were being overweight/obesity (25.5%), hypertension (11.4%), diabetes (9%), anxiety disorders, including post-traumatic stress disorder (5%), other mental health issues (7%), and asthma (2.5%.) But that isn’t the full scope of the health issues facing this community, because only 56% of U. S. field workers have health insurance. In California, that number drops to 37%. No matter where they are, many never seek help.

Expanding Healthcare Access: Medi-Cal's Impact on Undocumented Residents

Israel Ochoa manages DAP Health’s Centro Medico Oasis in the agricultural town of Thermal, just southwest of Mecca. He is the son of migrant farmworkers, and most of his days are spent serving farmworkers and their families. His assessment of his clinic’s patients aligns with the national statistics. He says access 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.

Community Outreach: Bridging Gaps in Healthcare Education

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, 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. 

Empowering Through Education: Overcoming Educational Hurdles

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. 

Addressing Essential Needs: Affordable Housing and Nutrition Education

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.

Impactful Planning

Karla Kjellin and Jeff Elder give back
Karla Kjellin and Jeff Elder

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.

As seen in Issue 4 of DAP Health magazine 

Words by Greg Archer • Photo by Peter Grant

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. 

Empowering Social Services: The Impact of Legacy Gifts at DAP Health

The Elders first got involved with HIV/AIDS-related services with AIDS Services Foundation Orange County, which now is under the Radiant Health Centers umbrella. They had lived in Orange County at the time and eventually rooted themselves in the organization — Karla was extensively involved with the food pantry, while Jeff was on the board and became president. When they moved to La Quinta in 2018, they realized it was time to take a tour of DAP Health.

“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 get involved.”

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.

A Vision for the Future: Expanding Impact Through Planned Giving

“‘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 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.”

Leaving a Lasting Legacy: The Elders' Commitment to Community Welfare

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 end, they created their first-ever trust, and divided it into five parts — one each for their four children, and one part for a charity of their choosing. Their intention was clear. Each child would need to donate 10% of whatever they received in the inheritance to a charity of their choice, but to make the donation in the Elders’ name.

“We set up a donor-advised fund, and that fund is how we donate 90% of the money,” notes Jeff. “There are two organizations we give a lot of money to — DAP Health and The Living Desert. And so, when we pass away at some point, our children can give to various charities, and we would expect that a big portion of that will probably go to DAP Health.”

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.

“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.”

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 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.

Breaking Down Barriers

Breaking down barriers

Breaking Down Barriers 

By addressing social determinants of health — those nonmedical factors that influence patient outcomes —DAP Health is creating equity.

 

As seen in Issue 4 of DAP Health magazine

 

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 quality-of-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. 

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.”

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 HIV-positive 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. 

“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.”

social determinants of health