Tagged With "social determinants of mental health"
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12 Myths of the Science of ACEs
The two biggest myths about ACEs science are: MYTH #1 — That it’s just about the 10 ACEs in the ACE Study — the CDC-Kaiser Permanente Adverse Childhood Experiences Study . It’s about sooooo much more than that. MYTH #2 — And that it’s just about ACEs…adverse childhood experiences. These two myths are intertwined. The ACE Study issued the first of its 70+ publications in 1998, and for many people it was the lightning bolt, the grand “aha” moment, the unexpected doorway into a blazing new...
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71 ACEs Initiatives Join ACEs Connection in 2019
We are proud to celebrate the 71 community initiatives that joined the ACEs Connection network in 2019. They are listed below, and can be found along with all existing ACEs Connection communities via the ACEs Connection map. Communities in the United States: Midwest ACEs Indiana Coalition Ardmore (OK) Behavioral Health Collaborative: Chisago County (MN) ACEs Initiative Franciscan Health ACEs Connection FH–Jasper & Newton Counties (IN ) FH–LaPorte County (IN) FH–Lake County (IN)...
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A Nurse Survivor Shares Her Story and Concerns
Yesterday was another trauma informed care training to nurses. I'm still very amazed at the biases that occur around sex, drugs, abortion, alcoholism, mental health or other challenges. As typical I received a follow up email from a survivor with their thoughts, not about the training but about the response of other humans around human behaviors and actions. The nurse survivor that emailed me felt so empowered to make a change that she has requested that I share her story with others in the...
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ACEs & African Americans Community on ACEs Connection
ACEs Connection envisions a resilient world where ALL people thrive. We are an anti-racist organization committed to the pursuit of social justice. In our work to promote resilience and prevent and mitigate ACEs, we intentionally embrace and uplift people who have historically not had a seat at the table. ACEs Connection celebrates the voices and tells the stories of people who have been barred from decision-making and who have shouldered the burden of systemic and economic oppression as the...
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ACEs Connection's Inclusion Tool makes sure nobody's left out
We developed ACEs Connection's Diversity, Equity & Inclusion Tool — called the Inclusion Tool, for short — to ensure that ACEs initiatives across the world focus on being inclusive when forming a steering committee, recruiting leaders, providing education about ACEs science, recruiting members, or providing resources and services within their communities. The more inclusive your ACEs initiative is, the more diverse it will be, giving your initiative a real shot at achieving equity and...
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Action needed today by trauma advocates to urge Congress to address mental health and trauma in current COVID-19 legislation
The follow is a message from Dan Press, Legal Advisor to the Campaign for Trauma-Informed Policy and Practice ), about the need to contact Congress regarding a COVID 19 funding bill being considered this weekend. He is urging ACEs science/trauma advocates and leaders to send emails to their U.S. Senators and Representatives immediately to address the mental health and trauma implications of this pandemic. All – I hate to bother you on a Sunday, but we urgently need you to contact Congress to...
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Benchmarks' PFE 4th Annual Conference: "Envisioning Resilient Communities"
Benchmarks' PFE 4th Annual Conference will be held on Wednesday, September 11, 2019 (9:00am-5:00pm) and Thursday, September 12, 2019 (8:30am-3:00pm) at the Hawthorne Inn & Conference Center in Winston-Salem, NC. Benchmarks' Partnering for Excellence (PFE) redesigns the local child welfare/behavioral health system, changing the way DSS, LME/MCOs, local providers and the wider community understand the need for accessible, appropriate health services for children, youth and families who...
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Benchmarks' PFE 4th Annual Conference: "Envisioning Resilient Communities"
Benchmarks' PFE 4th Annual Conference will be held on Wednesday, September 11, 2019 (9:00am-5:00pm) and Thursday, September 12, 2019 (8:30am-3:00pm) at the Hawthorne Inn & Conference Center in Winston-Salem, NC. Benchmarks' Partnering for Excellence (PFE) redesigns the local child welfare/behavioral health system, changing the way DSS, LME/MCOs, local providers and the wider community understand the need for accessible, appropriate health services for children, youth and families who...
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ACEs Science Champions Series: Byron Hall: A mentor rich with experience counsels teen parents in NC
Byron Hall mentors adolescent parents for the Community Enrichment Organization , a nonprofit in Tarboro, NC, which partners with a program that supports to keep adolescent parents in school. One of the parents he mentors is 13 years old. At the age of 17, Hall was an adolescent parent himself, growing up with a single parent in the Bronx, NY, then an African American community where drug-dealing and prostitution were common. For the counselor, helping these young men and women, who are...
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Cultivating Deliberate Resilience During the Coronavirus Disease 2019 Pandemic [jamanetwork.com]
By Abby R. Rosenberg, JAMA Pediatrics, April 14, 2020 Coronavirus disease 2019 (COVID-19) is affecting our health care community in unprecedented ways. As a pediatric oncologist who studies resilience in the context of illness, I started thinking about what this pandemic means for our professional resilience a few weeks ago, when the first US patient with fatal COVID-19 died in my home city of Seattle, Washington. Promoting resilience among health care workers and organizations starts with...
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Efforts to Reduce Black Maternal Mortality Complicated by COVID-19 [chcf.org]
By Xenia Shih Bion, California Health Care Foundation, April 20, 2020 Latoyha Young had a birth plan. She was going to have the baby in Sacramento with community doula Joy Dean by her side. Dean was funded by the county’s Black Child Legacy Campaign , which works to reduce the disproportional number of Black infant and child deaths in Sacramento. But in mid-March, when Young went into labor just as Governor Gavin Newsom ordered Californians to stay at home to avoid spreading the novel...
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Foster Care Case Numbers Continue to Climb in NC, as Opioid Crisis Affects Families [northcarolicahealthnews.org]
By Sarah Ovaska-Few, North Carolina Health News, September 24, 2019 North Carolina could use more people like Lisa Link, as the state grapples with record numbers of children entering and staying in the already stretched foster care system. Link, an auto broker and owner of a small used-car lot in Charlotte, opted five years ago to become a foster parent after years of helping with family members’ children. She was single, in her early 40s, and wanted to help children coming out of difficult...
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GABOR MATÉ JOINS EP. 3 on May 21 with Darrell Hammond and Filmmaker Michelle Esrick. [crackedupmovie.com]
CRACKED UP THE EVOLVING CONVERSATION TRAUMA AS THE ROOT CAUSE OF ADDICTION With DARRELL HAMMOND DIRECTOR MICHELLE ESRICK and RENOWNED TRAUMA AND ADDICTION EXPERT GABOR MATÉ, M.D. author of In the Realm of Hungry Ghosts: Close Encounters With Addiction MODERATED BY JANE STEVENS, FOUNDER OF ACES CONNECTION Hosted by ACES Connection Thursday May 21st at 2pm PDT / 3p MT / 4p CT / 5pm EDT FREE FOR ALL WHO REGISTER! IF YOU REGISTER, BUT CAN NOT ATTEND, YOU WILL RECEIVE A RECORDING WITHIN ONE WEEK.
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How do these pediatricians do ACEs screening? Early adopters tell all.
Last week, three pediatricians — with a combined experience of 15 years integrating ACEs science into their practices — reflected on the urgency they felt several years ago that prompted them to begin screening patients for childhood adversity and resilience when there was practically no guidance at all. Along their journey , they accumulated a list of lessons learned for other pediatricians and family clinics to use. The three pediatricians participated in the ACEs Connection webinar,...
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How Gratitude Helps Your Brain and Mental Health (thebestbrainpossible.com)
Research has proven many significant benefits in cultivating gratitude for mental and physical health. Studies show that the practice of gratitude can increase happiness levels by an average of 25 percent and overall health by, for example, increasing the quantity and quality of sleep. Beneficial outcomes can be achieved by such simple practices as praying, writing in a gratitude journal, placing a thankful phone call, making a mental gratitude list, or writing a thank-you letter to someone.
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How The Eastern Cherokee Took Control Of Their Health Care [KHN.org]
By Katja Ridderbusch, Kaiser Health News, July 22, 2019. CHEROKEE, N.C. — Light pours through large windows and glass ceilings of the Cherokee Indian Hospital onto a fireplace, a waterfall and murals. Rattlesnake Mountain, which the Cherokee elders say holds ancient healing powers, is visible from most angles. The hospital’s motto — “Ni hi tsa tse li” or “It belongs to you” — is written in Cherokee syllabary on the wall at the main entrance. “It doesn’t look like a hospital, and it doesn’t...
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It took 3 years, 6 versions to develop ACEs screener that works for parents & providers
It’s irrefutable: Widespread research shows that adverse childhood experiences (ACEs) are common. That’s why researchers in a recent study insist: “It behooves pediatric providers to take an active role in preventing and identifying childhood adversity in order to reduce the health consequences of toxic stress.” In other words, if you want your kids to have a good shot at a healthy life, make sure they — and you — are educated about and screened for ACEs and resilience. In a recent study —...
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Mapping the Link Between Life Expectancy and Educational Opportunity [childtrends.org]
By Renee Ryberg, Nadia Orfali Hall, Claire Kelley, Jessica Warren, and Kristen Harper, Child Trends, January 2020 In 2015, an average 15-year-old could expect to live to age 79. However, teens living in the 1 percent of neighborhoods with the lowest life expectancies could expect to live to 70—a lifespan nine years shorter. Educational attainment, a key social determinant of health, is one of the most powerful predictors of life expectancy. This association has strengthened over the past 20...
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New Study Reveals Annual Cost of Childhood Adversity in California Is Approximately $113 Billion [prnewswire.com]
SAN FRANCISCO , Jan. 28, 2020 /PRNewswire/ The Center for Youth Wellness announces the release of an in-depth study on the health-related cost of adverse childhood experiences (ACEs) in the state of California . A number of studies have investigated the cost of child maltreatment, but the current study, entitled " Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences ," is the first to examine the cost associated with adult health...
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Nurturing relationships in childhood boost adult mental health, relationships
We're proud to announce major research that suggests that positive childhood experiences — such as supportive family interactions, caring relationships with friends, and connections in the community — are associated with reductions in chances of adult depression and poor mental health, and increases in the chances of having healthy relationships in adulthood. This association was true even among those with a history of adverse childhood experiences.
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People Are Buying Houses Unaware of 'Forever Chemicals' in Their Well Water [northcarolinahealthnews.org]
By Greg Barnes, North Carolina Health News, January 6, 2020 No one told Army veteran Carter Bryant about groundwater contamination near the Chemours Fayetteville Works plant when he bought a home there in July. Bryant said he knew almost nothing about GenX and other per- and polyfluoroalkyl substances — commonly known as PFAS or “forever chemicals” — before he and his family moved in. About two months later, Bryant said, he received a notice from Chemours stating that contaminants in his...
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Personal stories from witnesses, U.S. representatives provided an emotional wallop to House Oversight and Reform Committee hearing on childhood trauma
Room erupts in applause for the grandmother of witness William Kellibrew during July 11 House Oversight and Reform Committee hearing. The power of personal stories from witnesses and committee members fueled the July 11 hearing on childhood trauma in the House Oversight and Reform Committee* throughout the nearly four hours of often emotional and searing testimony and member questions and statements (Click here for 3:47 hour video). The hearing was organized into a two panels—testimony from...
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Promoting a Community Approach for Mental Well-Being in Our Littlest Citizens [chronicleofsocialchange.org]
By Andrea L. Lowe, The Chronicle of Social Change, June 10, 2019. Several years ago , my sister and I watched my 2-year-old nephew’s behavior change dramatically. He started wetting the bed, throwing temper tantrums and getting frustrated so quickly. In any other child, it might have been normal “terrible twos,” but in him we knew something was definitely wrong. At the time, my sister and her husband were getting divorced. Ultimately, we found out that my nephew thought it was his fault,...
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Resilience Week [resilienceweek.co]
By UNC TV, November 6, 2019 UNC-TV Public Media North Carolina presents the statewide broadcast premiere of the special documentary feature Resilience: The Biology of Stress & the Science of Hope, Tuesday, November 19, at 8 PM, as part of Resilience Week—a statewide initiative to build awareness of childhood trauma, prevention and resilience. The hour-long film focuses on adverse childhood experiences (ACEs), what Dr. Robert Anda and Laura Porter of ACE Interface have termed, “the...
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Resilience Week [resilienceweek.co]
By UNC TV, November 6, 2019 UNC-TV Public Media North Carolina presents the statewide broadcast premiere of the special documentary feature Resilience: The Biology of Stress & the Science of Hope, Tuesday, November 19, at 8 PM, as part of Resilience Week—a statewide initiative to build awareness of childhood trauma, prevention and resilience. The hour-long film focuses on adverse childhood experiences (ACEs), what Dr. Robert Anda and Laura Porter of ACE Interface have termed, “the...
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Sheltering in Place: ACEs-Informed Tips for Self-Care During a Pandemic
Millions of lives have been affected in unprecedented ways by the Coronavirus (COVID-19). We are all grappling with uncertainty—our daily routines interrupted, not knowing what is to come. For those of us who have Adverse Childhood Experiences (ACEs), these times can be particularly distressing. At the Center for Youth Wellness (CYW), we know that childhood trauma can have a significant impact on an individual’s health and well-being – both physiologically and psychologically. Since the...
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The Black Community, COVID-19 & Trauma [sdvoice.com]
By Latanya West, San Diego Voice, May 15, 2020 In January 2019, Governor Gavin Newsom appointed Dr. Nadine Burke Harris as California’s first-ever Surgeon General. An award-winning physician, researcher and advocate, Dr. Burke Harris’ career has been dedicated to serving vulnerable communities and combating the root causes of health disparities. Her work is equally dedicated to changing the way our society responds to one of the most serious, expensive and widespread public health crises of...
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The Kids Aren’t All Right [theatlantic.com]
COVID-19 doesn’t appear to be a major concern for children’s health, but the youngest among us will still bear the larger burdens of trauma and economic fallout. One of the lonely silver linings of the COVID-19 pandemic is that the disease doesn’t appear to be that bad for kids. Although children are certainly not immune, and a study of the outbreak in Wuhan indicates that infants are susceptible to severe complications, most healthy kids don’t seem to face a significant risk of death. So...
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Thinking About Racial Disparities in COVID-19 Impacts Through a Science-Informed, Early Childhood Lens [developingchild.harvard.edu]
By Jack P. Shonkoff and David R. Williams, Center on the Developing Child, April 27, 2020 The COVID-19 virus is ruthlessly contagious and, at the same time, highly selective. Its capacity to infect is universal, but the consequences of becoming infected are not. While there are exceptions, children are less likely to show symptoms, older adults and those with pre-existing medical conditions are the most susceptible, and communities of color in the United States are experiencing dramatically...
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Tools and how to use them is focus of second webinar on Community Resiliency Model, May 14, 2020
The second of two free Community Resiliency (CRM) webinars with Elaine Miller-Karas , key creator of the CRM, will be held Thursday, May 14, from 11 a.m. - 12:30 p.m. ET, (10 a.m. CT; 9 a.m. MT, and 8 a.m. PT) and will include the practical application of tools of the model. CRM is an ACEs science-based biological model for helping individuals become emotionally regulated during natural disasters and other dysregulating times. Miller-Karas will be joined by CRM trainers from Wilmington, NC:...
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Webinar: Cultivating Our Best Selves in Response to COVID-19 | Tuesday, March 17 at Noon PDT
How to use the skills of the Community Resiliency Model (CRM) for self and others to be the calm in the storm as we face the unknown. Free Webinar Tuesday, March 17 at Noon PDT Speakers: Elaine Miller-Karas, LCSW Linda Grabbe, PhD, FNP-BC, PMHNP-BC Zoom Webinar Registration Link: https://zoom.us/j/715837300 Additional ways to join are listed at the bottom of this post. About the webinar leaders: Elaine Miller-Karas is the Executive Director and co-founder of the Trauma Resource Institute and...
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Webinar Oct. 17 — Integrating ACEs science in pediatrics: Early adopters share lessons from the field
An ACEs Connection webinar co-sponsored with 4 CA In 2017, California became the first state in the country to pass a law supporting universal screening for adverse childhood experiences (ACEs) in the 5.3 million children in the state’s Medicaid program. As clinicians around California await the state’s announcement of what this new policy will entail, many are wondering what it takes to integrate ACEs science in a pediatric practice. Meet Drs. Deirdre Bernard-Pearl, R.J. Gillespie and...
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Whole People Series & Study Guide (www.pbs.org)
There's a fantastic five-part series, Whole People , done by PBS, " spotlighting the impact of Adverse Childhood Experiences (ACES) through personal and community stories. It explores the long-term costs to personal well-being and our society. While much work needs to be done, there are many innovative developments to prevent and treat ACES. We all play a role in becoming a whole people." It's amazing. The five topics covered are as follows: Childhood Trauma Healing Communities A New...
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Why Is the Pandemic Killing So Many Black Americans [podcasts.apple.com]
By The Daily, The New York Times, May 20, 2020 Some have called the pandemic “the great equalizer.” But the coronavirus is killing black Americans at staggeringly higher rates than white Americans. Today, we explore why. Guest: Linda Villarosa, a writer for The New York Times Magazine covering racial health disparities, who spoke to Nicole Charles in New Orleans, La. about the death of her husband, Cornell Charles, known as Dickey. He was 51. For more information on today’s episode, visit...
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Yes, Stress Really is Making You Sick [newsweek.com]
By Adam Piore, Newsweek, March 2, 2020 In the mid-2000s, Dr. Nadine Burke Harris opened a children's medical clinic in the Bayview section of San Francisco, one of the city's poorest neighborhoods. She quickly began to suspect something was making many of her young patients sick. She noticed the first clues in the unusually large population of kids referred to her clinic for symptoms associated with attention deficit hyperactivity disorder—an inability to focus, impulsivity, extreme...
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What Do Coronavirus Racial Disparities Look Like State by State [npr.org]
By Maria Godoy and Daniel Wood, National Public Radio, May 30, 2020 In April, New Orleans health officials realized their drive-through testing strategy for the coronavirus wasn't working. The reason? Census tract data revealed hot spots for the virus were located in predominantly low-income African-American neighborhoods where many residents lacked cars. In response, officials have changed their strategy, sending mobile testing vans to some of those areas, says Thomas LaVeist , dean of...
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THURSDAY!! Cracked Up, The Evolving Conversation: Generational Trauma - Breaking the Cycle [crackedupmovie.com]
CRACKED UP THE EVOLVING CONVERSATION Episode 4: Generational Trauma - Breaking the Cycle with Darrell Hammond, Comedian, actor, SNL Legend Michelle Esrick, Filmmaker, activist Bessel van der Kolk, MD, Author of The Body Keeps the Score Jane Stevens, Founder of ACES Connection and special guest Jane Fonda Academy Award-winning actor, producer, author and activist Thursday June 25th at 1pm PDT / 2p MT / 3p CT / 4pm EDT Hosted by ACEs Connection THE PRICE OF THIS LIVE EVENT IS $12.50 We have...
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A Better Normal Tuesday, June 30th at Noon PDT: Reinterpreting American Identity, a Community Discussion
"I think that all of us, regardless of our racial or ethnic background, feel relieved that we no longer have to deal with the racism and the sexism associated with the system of slavery. But we treat the history of enslavement like we treat the genocidal colonization of indigenous people in North America, as if it was not that important, or worse, as if it never happened." —Angela Davis, "The Meaning of Freedom" Please join us for the ongoing community discussion of A Better Normal, our...
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Do safe, stable, and nurturing relationships work? New research has important findings for responding to ACEs
While we know that adverse childhood experiences (ACEs) can cause risk behaviors, research has told us that the presence of protective factors can help mitigate the effects of ACEs. Common risk behaviors such as smoking tobacco and alcohol misuse can be a result from the trauma of childhood disadvantage. In responding to ACEs, public health research proposes that protective factors such as safe, stable, nurturing relationships (SSNRs) with a caring adult can mitigate the long-term effects of...
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Structural Racism and its Impact on Black Maternal Health (New Security Beat)
By Deekshita Ramanarayan, July 21, 2020, New Security Beat. “The past months have been profoundly difficult for our nation, and for Black communities in particular,” said Representative Lauren Underwood (D-IL-14) at a recent March of Dimes event on the impact of structural racism on maternal health. COVID-19 has highlighted health outcome inequity caused by race and racism. Though Black people constitute 13 percent of the U.S. population, the CDC estimates they represent over 30 percent of...
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Greater Richmond Trauma Informed Community Network, first to join ACEs Cooperative of Communities, shows what it means to ROCK!
In 2012, Greater Richmond SCAN and five other community partners hatched a one-year plan to educate the Richmond, Virginia, community about ACEs science and to embed trauma-informed practices. Eight years later, the original group has evolved into the Greater Richmond Trauma-Informed Community Network (GRTICN) with 495 people and 170 organizations. And they're just scratching the surface.
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Donald Trump is the product of abuse and neglect. His story is common, even for the powerful and wealthy.
“In order to cope,” writes Mary Trump, “Donald began to develop powerful but primitive defenses, marked by an increasing hostility to others and a seeming indifference to his mother’s absence and father’s neglect….In place of [his emotional needs] grew a kind of grievance and behaviors—including bullying, disrespect, and aggressiveness—that served their purpose in the moment but became more problematic over time. With appropriate care and attention, they might have been overcome.”
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Trauma-informed policing: Learn how three highly experienced community leaders strengthen ties between police and community
ACEs initiative participants in communities where there is tension between the community and law enforcement will want to join Becky Haas in a compelling conversation on law enforcement, ACEs science, COVID-19 and the Black Lives Matter movement and protests. Haas is a nationally recognized adverse childhood experiences (ACEs) science initiative builder and trainer. She and colleagues Renee Wilson-Simmons, the head of the ACE Awareness Foundation of Memphis, Tennessee, and Maggi Duncan,...
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Baby courts: A proven approach to stop the multigenerational transmission of ACES in child welfare; new efforts to establish courts nationwide
The organization Zero To Three estimates that in the U.S., a child is taken into the child welfare system every six seconds. “Many of society’s most intractable problems can be traced back to childhood adversity. Being in the child welfare system increases the likelihood of more adversity and criminality. Baby court is a proven approach to healing the trauma of both child and parent, and breaking the cycle of maltreatment,” says Mimi Graham, Ed.D ., director of the Florida State University...
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Does VP Candidate Kamala Harris know about ACEs? You bet!
Nadine Burke Harris, California’s Surgeon General, has a lot in common with the vice presidential candidate Kamala Harris—Jamaican heritage, surname, home state—and a commitment to addressing ACEs and toxic stress. As reported in the New Yorker article by Paul Tough, “The Poverty Clinic,” Dr. Harris told Kamala Harris, then San Francisco district attorney, about ACEs in 2008 and in response, she offered to help. District Attorney Harris then introduced her to professor of child and...
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Does racism make us sick? Amid a national reckoning, the question gains new importance [sfchronicle.com]
By Tatiana Sanchez, San Francisco Chronicle, August 24, 2020 Elaine Shelly has lived with multiple sclerosis for 30 years. But she said she still panics whenever she has to see a new neurologist because of racial discrimination she’s experienced in the past. Even getting a proper diagnosis for her illness was a battle. “I’d go to these neurologists who would tell me that Black people don’t get M.S. and that I must be mentally ill,” said Shelly, 63, of San Leandro. A former print journalist,...
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New ACEs initiatives learn about strategic plan development from from New Hanover (NC) Resiliency Task Force executive director Mebane Boyd
The desire to see other ACEs initiatives grow and flourish was evident at a recent meeting of the Resilient Columbus County (North Carolina) ACEs initiative when Mebane Boyd, executive director of the New Hanover Resiliency Task Force (also in North Carolina), shared with the Columbus County and neighboring Pender County groups how New Hanover created and works on its strategic plan. In the spirit of sharing, Boyd agreed to let ACEs Connection post the strategic plan and the video of the...
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The Best for our Children: Considering ACEs in Voter Engagement.
The presidential race is a big-ticket item, but hundreds of other state and local races will impact critical issues like school funding, childcare and early education, nutrition programs, and health care. Every seat in the NC General Assembly is on the ballot, along with the Governor’s race, a US Senate seat, congressional races, and more. When it comes to elevating the importance of racial equity, voting is vital to make marginalized voices heard. Policies and systems can be changed by our...
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Hope and Progress, No Matter What! — an ACEs Connection/Cambia Health Foundation “Better Normal”, Oct. 22, 2020
The election is upon us. In two short weeks, we voters in this country decide who will lead us for the next four years. We have the opportunity to embrace — as a national priority — the tenets of understanding, nurturing and healing that underlie the science of adverse childhood experiences and move in a direction that embraces cultural and racial equity and anti-racism. Or not.
What is clear is that no matter what, the ACEs movement will continue.
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The Intersection of Systematic Racism, the Pandemic, and SDoMH: Reality Mandates Change
Systematic racism is at the core of mental health disparities and social determinants of mental health (SDoMH).Upstream factors obstruct patient access to needed and appropriate assessment, timely intervention, with treatment for these populations often reflecting poorer quality, and ending prior to completion of treatment. COVID-19 and the recent pandemic have only amplified meso and micro-level gaps in care. considered, provided, and reimbursed.