In 2021, direct care staff turnover in our agency was close to 35%. We are a treatment foster family agency and residential therapeutic program for youth and families impacted by the child welfare and juvenile justice systems. In a field where stability and consistency of healthy relationships is vital to the success of our clients, this was a crisis.

Imagine an under-resourced place in East San Jose where Vietnamese immigrants live with significant health and social disparities. The community is painfully aware that due to legacy of war, political persecution, and mass displacement, they have been through significant multigenerational trauma. They prioritized and advocated for the building of a trusted place where they can receive mental health services in their own language or through an interpreter that they trust.

As the population ages, we see many senior parents moving in with their adult children and grandchildren. Many of these caregivers need to work outside of the home, which leaves the seniors alone and unprotected. There are daytime options for supervised care, but Symphonie is an Adult Day Health Care (ADHC) center with an increased emphasis on quality and high-value care. Adult Day Health Centers provide supervised low acuity health care during the day which helps to lower rates of institutionalization. Symphonie provides care to both the special needs adult, but also to caregivers.

Nationwide, Black patients who are admitted to the hospital experience disparities in pain management, patient communication, length of stay, and readmission rates. This disparity is seen at UCSF Health, where black inpatients have lower patient communication scores, higher lengths of stay in the hospital, and higher readmission rates than the rest of the patient population. In addition, there is limited engagement and input from community members in the care that hospitalized patients receive at UCSF Health.

The City of Compton, California and community of North Long Beach, California continue to experience extraordinary barriers to lifesaving medical care. With the highest rates of maternal mortality, infant mortality, and homicide in Los Angeles County, these areas lack essential lifesaving medical services including, a high-risk hospital-based birthing center, a neonatal intensive care unit, and a level-one trauma center.

Sexually transmitted diseases (STDs) have increased exponentially in the past several years nationally and statewide. Yuba County as a small rural county in northern California has one of the highest rates of congenital syphilis with a crude rate of greater than 112.9 congenital syphilis cases per 100,000 live births. From 2017 to 2022, the rate of syphilis increased from 17 to 84.1 cases per 100,000.

Primary care practices in the safety-net face increasing demands for services as the COVID-19 pandemic has elevated health awareness and state initiatives continue to expand Medi-Cal coverage. At Los Angeles General Medical Center (LA General), the largest primary care site within the Los Angeles County Department of Health Services (DHS), we noted that the years of deferred care, rapid primary care panel growth, and marked workforce attrition pushed our clinics to the breaking point.

People in Monterey County with complex physical health, behavioral health, and social needs often experience fragmented and ineffective care, leading to poor outcomes and high service use and cost. In response to improving health outcomes for our Monterey County residents, Monterey County Behavioral Health launched the Monterey Integrated System Transformation Initiative. This countywide initiative is designed to help all services become aligned with our most important values for the people who need our help the most.

Contingency management (CM), which involves paying people to use less meth or engage in treatment, is the most effective treatment tool for methamphetamine use disorder. Compared to CM, other treatments (like medications, counseling, detox, and rehab) do not work well for meth use.

Medicaid patients remain in acute care settings (acute hospitals, long term acute care hospitals, skilled nursing facilities) because there are no safe, clinically appropriate discharge options. This results in an increased number of administrative or denied days because the patients are no longer clinically acute and are just awaiting placement. Patients who could be in an inpatient bed or in a skilled nursing facility are instead stuck boarding in the emergency department or an inpatient bed.