Making the ACA Work for Clients & Communities:

Transcription

1 + Making the ACA Work for Clients & Communities: September 18, 2013 Barbara DiPietro Director of Policy National HCH Council

2 + Agenda for the Day Part 1: Outreach & Enrollment National Goals & Issues Barbara DiPietro SAMHSA Perspectives & Resources David Dickinson CA Primary Care Association Beth Malinowski Insured the Uninsured Project Kandis Driscoll Discussion Part 2: Delivery of Care & Access National Goals & Issues Barbara DiPietro Orange County Health Department Mark Refowitz Communities of Color & Other Subpopulations: Association of Asian Pacific Community Health Organizations (AAPCHO) Mary Ann Foo Discussion Health Care & Housing Are Human Rights

3 + National Goals of Health Reform Increase access to care Improve health outcomes Lower costs to individuals Reduce total spending Improve quality of care Health Care & Housing Are Human Rights

4 + The Affordable Care Act (ACA) P.L as amended by P.L Major Components: Private insurance reforms (includes Exchanges) Medicaid reforms Quality improvements Prevention of chronic disease/public health Strengthening health care workforce Improve transparency and accountability Improve access to medical technologies Revenue provisions Health Care & Housing Are Human Rights

5 + Limited Public Awareness Enroll America findings (Jan 2013) 78% of uninsured adults lack awareness of new coverage options 83% of Medicaid expansion group Sources of info: doctor, family, friend, state/federal health agency Kaiser findings (April 2013) 42% unaware law is still active 58% of uninsured don t know how law will impact them Sources of info: family/friends, newspapers, cable tv TOP PRIORITY: OUTREACH & ENROLLMENT..and engagement in services Health Care & Housing Are Human Rights

6 Sources: 2011 UDS Data, HRSA; 2011 Census Data

7 Median Medicaid/CHIP Eligibility Thresholds, January % 185% Minimum Medicaid Eligibility under Health Reform - 133% FPL ($25,390 for a family of 3 in 2012) 63% 37% Children Pregnant Women 0% Working Parents Jobless Parents Childless Adults SOURCE: Based on the results of a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2012.

8 + ELIGIBILITY OPTION 63 million currently enrolled: children, pregnant women, elderly, disabled, and some parents of children 15 million newly eligible (starting January 1, 2014): Law gives states option to expand Medicaid to non-disabled adults earning 138% FPL Almost $16,000/year for singles About $25,500/year for family of million currently eligible, un-enrolled: 4.4 million adults (67% take-up rate) 2.9 million children (84% take-up rate) 85 million possible Medicaid enrollees (1in 4, assuming 100% take-up) 1.9 million in CA <138% FPL newly eligible 583,000 in CA currently eligible

9 + Medicaid Expansion Financing Expansion group only: Higher federal match to states 100%: 2014 through %: %: %: %: 2020 and thereafter Current eligible groups: Current federal match ( FMAP ) Supreme Court decision: Made expansion to newly eligible population an option, rather than a mandate Maintenance of Effort: Law prohibits states from reducing eligibility or changing benefits until 2014 Health Care & Housing Are Human Rights

10 Current Status of State Medicaid Expansion Decisions, as of September 16, 2013 WA OR NV CA ID AZ UT MT 2 WY CO NM ND SD NE KS OK MN WI IA 1 IL MO AR 1 MS MI 1 OH IN KY TN 1 AL VT NY PA 1 WV VA NC SC GA ME NH 2 MA CT RI NJ DE MD DC AK HI TX LA FL 2 Debate Ongoing (3 States) Moving Forward at this Time (26 States including DC) Not Moving Forward at this Time (22 States) NOTES: 1 -Exploring an approach to Medicaid expansion likely to require waiver approval. 2-Discussion of a special session being called on the Medicaid expansion. SOURCES: Based on KCMU analysis of recent news reports, executive activity and legislative activity in states. Data reportedhere are as of September 3. It is important to note that per CMS guidance, there is no deadline for states to implement the Medicaid expansion. Requirements for legislation to implement the Medicaid expansion vary across states.

11 + CBO Projected Medicaid Enrollment (Non-elderly) 15 million adults newly eligible Source: Congressional Budget Office, May Available at:

12 + Outreach & Enrollment Law requires states establish procedures for outreach and enrollment activities to vulnerable & underserved populations (ACA 2201) Children Unaccompanied homeless youth Children and youth with special health care needs Pregnant women Racial and ethnic minorities Rural populations Victims of abuse or trauma Individuals with mental health or substance-related disorders Individuals with HIV/AIDS

13 + Essential Health Benefits (EHB) 10 Categories are required: Ambulatory services Emergency services Hospitalization Maternity/newborn care Mental health, substance use disorder & behavioral health treatment Prescription drugs Rehabilitative/habilitative services Laboratory services Preventive/wellness services Pediatric services, to include oral and vision care Health Care & Housing Are Human Rights

14 + New Requirements for EHB No annual/lifetime limits on coverage No discrimination based on gender, age, disability, life expectancy, health status Behavioral health services must be in parity with medical services (Mental Health Parity and Addiction Equity Act) Apply to all private plans inside and outside Exchange and those newly Medicaid eligible Does not apply to current Medicaid groups or private selfinsured plans Scope, amount & duration of services not dictated Gaps remain: dental, vision, case management, etc.

15 + A Word on the State Marketplaces Exchanges are shopping centers for health insurance for individuals and small employers Must be implemented by January 1, 2014 Subsidies and credits, based on income (100%-400% FPL) Focused on individual and small group markets Must contain insurance with Essential Health Benefits Anticipate covering 7 million in million in 2016 Health Care & Housing Are Human Rights

16 + Subsidies for those % FPL Single Person FPL % Annual Income Maximum Premium (as a % of income) Enrollee Monthly Share 133% $14, % $ % $16, % $ % $21, % $ % $27, % $ % $32, % $ % $38, % $ % $43, % $ Health Care & Housing Are Human Rights

17 + Eligibility Between Two Systems Medicaid (0-138% FPL) % Exchange (100%+) Subsidies/credits: % FPL

18 + Enrollment Requirements: ALL STATES No wrong door (online, phone, mail, in person) Single, streamlined application Electronic verification of income & identity No paper documentation No in-person interviews Use of modified adjusted gross income (MAGI) Enrollment assistance available Accommodations for disabilities and LEP Timely processing Coordinated Exchange, Medicaid & CHIP Automatic re-verification every 12 months Health Care & Housing Are Human Rights

19 + Enrollment Assistance Navigators: Required, work through Exchanges, provide info, help with enrollment In-Person Assisters/non-Navigator: Optional, wider range of assistance (funding through planning grants); availability depends on type of exchange Certified Assistance Counselor: formalize existing positions, such as health center staff Outstationed Eligibility Worker: State Medicaid workers placed in FQHCs or hospitals Informal Assistance: Friends and family You don t have to be certified to help! Health Care & Housing Are Human Rights

20 REMEMBER: The Affordable Care Act is a solid step in the right direction but it does not establish a right to health care & does not establish universal coverage

21 + Those Remaining Uninsured (U.S.) Remaining Uninsured: 37%: Medicaid-eligible but un-enrolled 25%: Undocumented/ineligible immigrants Sources: CBO, May Available at: RWJF, March Available at:

22 + Those Exempt from the Mandate Religious conscience (member recognized religious sect) Health care sharing ministry Individuals not lawfully present Incarcerated individuals Individuals who cannot afford coverage/hardships (>8% of household income) Taxpayers with income below filing threshold Members of Indian tribes Months during short coverage gaps Health Care & Housing Are Human Rights

23 + More Information Barbara DiPietro, Director of Policy or National Health Care for the Homeless Council: Bring about reform of the health care system to best serve the needs of people who are homeless, to work in alliance with others whose broader purpose is to eliminate homelessness, and to provide support to Council members. Good source material available at: National HCH Council: Kaiser Family Foundation: HHS: CMS: Enroll America: NACHC:

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25 SAMHSA s Enrollment Coalition Initiative David Dickinson SAMHSA Regional Administrator DHHS Region X (AK, ID, OR, WA) West Coast Health & Housing Training September 18, 2013 Irvine, CA

26 Overview Behavioral health needs of the newly eligible uninsured. Marketing and enrollment assistance research. SAMHSA Enrollment Coalitions Initiative SAMHSA Enrollment Training Efforts SAMHSA Provider Training Efforts Further Enrollment resources

27 HEALTH COVERAGE IN 2014 Coverage Options for Adults without Medicare or Employer-Based Coverage 27 Income as a percent of the federal poverty level Medicaid Exchange with Tax Credits Exchange or Private Plan A Continuum of Coverage Everyone Fits Somewhere!

28 2014 Projected Enrollment Enroll at least 15 million people in new coverage options Millions } 7 million in Exchange coverage } 8 million in Medicaid or CHIP Source: February 2013 CBO estimates 28

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30 Persons Who Are Uninsured 29% Individuals who are uninsured with behavioral health conditions 71% Individuals who are uninsured Source: NSDUH

31 Methods for Estimating Population Characteristics From NSDUH, calculated the national prevalence rates for SMI, serious psychological distress (SPD), and SUD by income group with demographic populations of interest (e.g., uninsured non-hispanic whites with income <138% FPL with SMI) Multiplied national prevalence rate by the ACS State population by income group with this demographic characteristic (e.g., national % of uninsured year olds with income <138% FPL with SMI * ACS State number of year olds with income <138% FPL) Calculated the percent distribution with condition in the State across demographic groups such as race, age, and education (e.g., percent with SMI with < high school, high school, or college education) 31

32 PREVALENCE OF BH CONDITIONS AMONG MEDICAID EXPANSION POP 18.0% Uninsured Adults Ages with Incomes < 138% FPL (18 Million) Percent with Condition 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 7.0% 14.9% 14.2% 4.0% Percent with a Serious Mental Illness (1,283,000) CI: 6.3%-7.7% Percent with Serious Psychological Distress (2,731,742) CI: 14.0%-15.9% Percent with a Substance Use Disorder (2,603,405) CI: 13.2%-15.2% CI = Confidence Interval Sources: National Survey of Drug Use and Health 2010 American Community Survey

33 PREVALENCE OF BH CONDITIONS AMONG Marketplace POPULATION Uninsured Adults Age with Incomes between % FPL (19.9 Million) 18.0% Percent with Condition 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 6.0% 13.3% 14.6% 4.0% Percent with a Serious Mental Illness (1,195,600) CI: 5.5%-6.6% Percent with Serious Psychological Distress (2,650,247) CI: 12.4%-14.2% CI = Confidence Interval Sources: National Survey of Drug Use and Health 2010 American Community Survey Percent with a Substance Use Disorder (2,909,294) CI: 13.7%-15.6%

34 Prevalence of Behavioral Conditions Among Medicaid Expansion Population: California, US Uninsured Adults Ages with Incomes < 139% of the Federal Poverty Level (California: 2,463,476) Prevalence Rate 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 7.0% 4.4% 14.9% 10.4% 14.2% 10.3% Serious Mental Illness CA CI: 3.1% - 6.2% U.S. CI: 6.3% - 7.7% Serious Psychological Distress CA CI: 8.2% - 13% U.S. CI: 14% % Substance Use Disorder CA CI: 7.9% % U.S. CI: 13.2% % National California I Confidence Interval 34 CI = Confidence Interval Sources: National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey

35 Prevalence of Behavioral Conditions Among Health Insurance Exchange Population: California, US 18% 16% Uninsured Adults Ages with Incomes Between % of the Federal Poverty Level (California: 2,968,796) Prevalence Rate 14% 12% 10% 8% 6% 4% National California I Confidence Interval 35 2% 0% 6.0% 4.2% 13.3% 11.0% 14.6% 13.3% Serious Mental Illness CA CI: 2.8% - 6.1% U.S. CI: 5.5% - 6.6% Serious Psychological Distress CA CI: 8.7% % U.S. CI: 12.5% % Substance Use Disorder CA CI: 10.8% % U.S. CI: 13.7% % CI = Confidence Interval Sources: National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey

36 Prevalence of Behavioral Conditions Among Medicaid Expansion Population: Oregon, US 35% 30% Uninsured Adults Ages with Incomes < 139% of the Federal Poverty Level (Oregon: 265,775) Prevalence Rate 25% 20% 15% 10% I National Oregon Confidence Interval 5% 0% 7.0% 10.2% 14.9% 18.9% 14.2% 12.2% Serious Mental Illness OR CI: 5.2% % U.S. CI: 6.3% - 7.7% Serious Psychological Distress OR CI: 11.9% % U.S. CI: 14% % Substance Use Disorder OR CI: 7.4% % U.S. CI: 13.2% % 36 CI = Confidence Interval Sources: National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey

37 Prevalence of Behavioral Conditions Among Health Insurance Exchange Population: Oregon, US 30% 25% Uninsured Adults Ages with Incomes Between % of the Federal Poverty Level (Oregon: 271,410) Prevalence Rate 20% 15% 10% I National Oregon Confidence Interval 37 5% 0% 6.0% 6.2% 13.3% 13.8% 14.6% 19.1% Serious Mental Illness OR CI: 2.4% % U.S. CI: 5.5% - 6.6% Serious Psychological Distress OR CI: 8.5% % U.S. CI: 12.5% % Substance Use Disorder OR CI: 12.3% % U.S. CI: 13.7% % CI = Confidence Interval Sources: National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey

38 SAMHSA Analysis Performed an environmental scan of nearly 80 organizations and publications Conducted nine in-depth Interviews with national, state and local organizations working directly with uninsured individuals with behavioral health conditions Held three listening sessions composed of individuals with behavioral health conditions representing CMS enrollment sub segments 38

39 Challenges and Barriers Unfamiliarity with health insurance and its value Lack of awareness that they are eligible Cost concerns (premiums, co-pays and deductibles) Distrust of government programs Lack of decision-making skills Churn Uncovered services; exclusion for preexisting conditions Individuals with SUD new to health care system Complicated enrollment process

40 Research: What benefits and messages work for SAMHSA audiences? Consumers liked the CMS messages. Healthy & Young: Keep messages simple and positive (maintain good health, make smart decisions); highlight eligibility, access to quality care, how to enroll and available financial savings. Sick, Active & Worried: Use positive messages (stay independent, feel in control, be more financially secure) and personal testimonials, featuring availability, ease of enrollment and affordability. Passive & Skeptical: Design a positive message (make good decisions, stay independent and feel in control) using a reference or visual with people like me. Consumers did not want a specific BH message about health insurance.

41 Marketing and Outreach Tactics Motivate people through information by trusted sources that access to insurance, benefits and services is available to them; Disseminate information through appropriate channels using appropriate tools; and Provide one-on-one assistance for enrollment through defined intermediaries.

42 SAMHSA Enrollment Coalitions Initiative Collaborate with national organizations whose members/constituents interact regularly with individuals with mental health and/or substance use conditions to create and implement enrollment communication campaigns Promote and encourage the use of CMS materials Provide training and technical assistance in developing enrollment communication campaigns using these materials Provide training to design and implement enrollment assistance activities Channel feedback and evaluate success 42

43 Supporting Intermediaries Intermediary focused efforts formed in five categories:

44 SAMHSA Enrollment Coalitions Initiative Supporting coalition groups in their commitment to promoting access to insurance for their constituents Inviting coalition groups to shape enrollment support policy, planning, training and materials development Providing leadership for other organizations 44

45 Three Stages of the Effort SAMHSA and coalitions will create training and technical assistance to encourage enrollment of individuals with M/SUD 45 SAMHSA will work with coalition organizations to offer training to their members/ constituents to develop enrollment campaigns and provide enrollment assistance (two rounds of this stage) Members/ Constituents will implement activities to motivate and assist their clients/ patients to enroll

46 Timeline Laying the Groundwork Coalition formation Health insurance literacy training and technical assistance February May 2013 Preparing for Enrollment Enrollment campaign training Enrollment assistance training June September 2013 Enrolling Eligible Individuals Continuation of enrollment campaigns Enrollment assistance October March

47 SAMHSA s Enrollment Outreach Initiative Getting Ready for the Health Insurance Marketplace toolkits resource include articles, brochures, fact sheets, presentations, videos, posters, cards, outreach messages, flyers, widgets, and social media resources (GENERAL)

48 Health Reform Websites SAMHSA Health Reform Overview o (SAMHSA Health Reform Site) o (Healthcare Integration) o (Financing Focus Newsletter) DHHS Fact Sheets: State-by-State exchange funding & plans o CMS Exchange Overview: State Exchange Blueprint o CMS Resources: o o (Parity) 48

49 SAMHSA Store:

50 Key Takeaways High prevalence of substance abuse and mental health conditions among the uninsured 2014 will potentially bring coverage to 11 million individuals with substance abuse and or mental health conditions Significant changes are happening to eligibility and enrollment systems Community organizations serving the homeless population must play an active role in outreach and enrollment

51 OCTOBER 1, 2013!!!

52 Thank YOU! CONTACT INFO: David Dickinson, MA Regional Administrator - Region X (Alaska, Idaho, Oregon, Washington) Substance Abuse & Mental Health Services Administration U.S. Department of Health and Human Services th Avenue, MS RX-02 Seattle, WA Phone: david.dickinson@samhsa.hhs.gov 52

53 Contact Information Jon T. Perez, Ph.D. Regional Administrator, HHS IX Substance Abuse and Mental Health Services Administration 90 Seventh Street, 8th Floor San Francisco, CA Slide 53

54 California s Community Clinics and Health Centers: A One Stop Shop for Care Beth Malinowski Associate Director of Policy September 18, 2013

55 Presentation Overview Community Clinic and Health Center (CCHC) 101 CCHC as the Place to Go for Enrollment What CCHC are doing to prepare for October 1 st Getting the Message Out: CaliforniaHealth + and The California Endowment (TCE)

56 Who We Are State-wide Association We Provide a Voice Advocacy Policy Support Training Technical Assistance Over 900 Health Center Sites Over 5 million Californians Served

57 Health Center 101: Who Do we Serve? Everyone Diverse Patient Population Native American/ Asian/Pacific Islander Black White (non Hispanic) Hispanic 0% 20% 40% 60% 42% report that English is not their primary language Over 3 million patients under 100% FPL Over 30% of patients are uninsured More than 150,000 homeless patients

58 Health Center 101: Where are We? Everywhere

59 Health Centers as Sites of Enrollment Past, Present, and Future

60 Historic Success in Enrollment Training Staff to be Certified Application Assisters (CAA) Collaboration with Schools Using Social Media Community-Based Outreach and Eligibility Staffing Model Partnering with Counties and strategic placement of Out- Stationed Eligibility Workers

61 Partnering with Homeless Organizations for Enrollment Gardner Family Health Network s Healthcare for the Homeless Project Partner with trusted community organizations Bring CAA on Mobile Unit Use of Enrollment Referral Cards

62 National Support for Enrollment HRSA Health Center Outreach and Enrollment Assistance Supplemental Funding Nationally: $150 Million Awarded 1,159 Health Centers California: $21 Million Awarded 125 Health Centers

63 What California Health Centers are doing to Prepare for October 1 st and Open Enrollment Hiring Up, Becoming CEEs, Training CECs, and Readying to use CalHEERS

64 Becoming Certified Enrollment Entities A Certified Enrollment Entity (CEE) is an entity or organization eligible to be trained and registered to provide in-person assistance to consumers and help them apply for Medi-Cal Expansion and Covered California coverage. Over 120 health centers have begun the application process

65 Training Certified Enrollment Counselors A Certified Enrollment Counselor (CEC) is an individual who is affiliated with a CEE and trained and certified by Covered California. California health centers aim to have between trained CECs

66 Readying to Use CalHEERS The California Healthcare Eligibility, Enrollment and Retention System ( CalHEERS ) will offer a simple, direct method for individuals to enroll in Medi-Cal, Healthy Families or the California Health Benefit Exchange (the Exchange). The new system will automatically and seamlessly determine an individual or family s eligibility for coverage programs based on income level and other eligibility criteria. CECs will be trained to utilize this new portal CalHEERSwill go live on October 1 st for coverage beginning January 2014

67 Getting the Message Out Come to your CCHC to get enrolled today!

68 CaliforniaHealth+ an innovative new vision and brandto educate patients about the benefits of California s community clinics and health centers (CCHCs) represents the plus that CCHCs offer their patients by going beyond primary care to encompass a whole health approach

69 The CaliforniaHealth+ Vision Activities Raise visibility and educate consumers about unique value of CCHCs through branding and marketing Outcomes Current patients stay Newly eligible patients choose CCHCs Workforce grows Impact Increased access to high quality primary care Reduced health disparities

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71 Toll free Finding Your Enrollment Site

72 Partnership with TCE CPCA is partnering with The California Endowment on its media outreach and enrollment campaign called Get Covered or Asegurate.

73 Thank you. If you are interested in learning more about California's Health Centers leading in outreach and enrollment, feel free to contact me at

74 Making the ACA Work for Clients & Communities Kandis Driscoll Workgroup Director Insure the Uninsured Project West Coast Health & Housing Training

75 About ITUP ITUP is a non-partisan, non-profit health policy think tank based in Santa Monica, CA. We are funded by generous grants from The California Wellness Foundation, The California Endowment, Blue Shield of California Foundation, California Community Foundation, Kaiser Foundation Hospitals, California HealthCare Foundation, Lucile Packard Foundation for Children s Health, and L.A. Care Health Plan.

76 Covered CA Without Subsidies (Above 400% FPL) 400% FPL Covered CA With Subsidies ( % FPL) 300% FPL 250% FPL 200% FPL 133% FPL 0% FPL You may also be eligible for Medi-Cal Medically Needy, Cancer Screening & Treatment, AIDS Drug Assistance Program etc) (up to 250% FPL for Children) (up to 200% FPL for Pregnant Women) Medi-Cal (up to 133% FPL for all other groups) California Children's Services (CCS) (up to 250% FPL) Genetically Handicapped Persons Program (GHPP) (all income levels) Access for Infants & Mothers ( % FPL) Family PACT (up to 200% FPL) Healthy Way LA Unmatched (up to 133% FPL) Healthy Kids (up to 400% FPL)

77 Outreach, Education & Enrollment The goal of outreach, education and enrollment activities are three-fold: Reach people where they are Deliver information in a manner that is accessible and understandable for clients Enroll clients in the best health coverage option that meets their needs

78 Insurance Coverage in CA 1.97 million 1.08 million 844, , million 5.43 million 6.15 million million Employment-based Medicaid Uninsured Medicare Privately purchased Medicare & Medicaid Other public Healthy Families/CHIP

79 Eligibility in CA, ,800,000 1,600,000 1,400,000 1,200,000 1,000, , , , ,000 0 Eligible for Subsidized Exchange Coverage Newly Eligible for Medi-Cal Previously Eligible for Medi-Cal

80 TODAY: 7 million uninsured (under age 65) Medicaid Expansion 2019: Up to 3 million remaining uninsured Covered California Exchange Not eligible: Immigration status Eligible, but not enrolled: Medi-Cal Eligible, but not enrolled: Exchange

81 Outreach Strategies in California Santa Cruz County, Project Connect Targets frequent users of hospital emergency rooms and connects them to coordinating services, such as primary care services and homeless health and housing programs. *Strategy: Meet people where they are (e.g. at the point of service, in a moment of great need).

82 Outreach Strategies in California Fresno County Convenes a coalition of local stakeholders (e.g. community advocates, faith-based organizations, county departments) to discuss ACA implementation. Allows for information sharing, collaboration, strategizing from professional/residents that are personally connected to those they serve. *Strategy: Engage a diverse group of stakeholders who are well-connected with different populations in the community.

83 Outreach Strategies in California Los Angeles County, Everyone on Board (EOB) Convenes a coalition of local stakeholders (e.g. community advocates, county departments, providers, consumer advocates, faith-based organizations) to coordinate outreach and education strategies. Allows for unified messaging and collaboration. *Strategy: Collaborate on outreach material to promote a unified message within a large, diverse county.

84 Outreach Strategies in California Los Angeles County, ITUP s ObamaCare 101 Trainings for Clinic Staff and Community Providers Series of 3-hour educational trainings that provide a comprehensive overview of the Affordable Care Act 10 cities within Los Angeles County, 7 SPA s, 800 participants *Strategy: Utilize train-the-trainer model to educate those who interact with patients directly.

85 Messaging Unified Messaging Unified messaging is critical in effective outreach and education strategies. The more consistent the message, the more familiar a population will become, and the more effective the outreach will be. KEEP IT SIMPLE

86 Trusted Sources of Information Trusted Sources By utilizing trusted sources of information, individuals are able to receive the information in a familiar, unintimidating setting that allows them to be more responsive.

87 Like us on Facebook Follow us on Kandis Driscoll (310)