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THE PROJECT ECHO® DIABETES
REFLECTIONS
NEWSLETTER
THERE'S A LOT TO SEE INSIDE!
2 What's ECHO® All About?
3 The Geography of ECHO Diabetes
4 ECHO Champion Spotlight
5 Support Coach Spotlight
6 Featured Articles
7 Tele-ECHO Curriculum
8 Presentations & Publications
9 Our Latest Press Release
10 ECHO® Resources
JULY 2021
WHAT IS ECHO ALL ABOUT? ®
A NOTE FROM THE PROJECT ECHO DIABETES LEADERSHIP GROUP
DR. ASHBY THE PROJECT EXTENSION FOR In June of 2021 we welcomed 10 new spokes
WALKER COMMUNITY HEALTH OUTCOMES to the ECHO Diabetes program in Florida
(UF) (ECHO®) DIABETES PROGRAM EMPOWERS and California – officially launching the
PRIMARY CARE PROVIDERS (PCP) TO implementation of a stepped-wedge design
DELIVER BEST-PRACTICE DIABETES CARE and pragmatic clinical trial aimed at evaluating
TO THEIR UNDERSERVED PATIENTS. patient-level, provider-level, and spoke-level
DR. MICHAEL outcomes. Over 100 PCPs and staff members
Funded by a $7.69 million grant from the Leona
HALLER representing our existing and new spokes
M. and Harry B. Helmsley Charitable Trust, The
(UF) attended virtual kick-off events in Florida
University of Florida and Stanford University
and California. In December of 2021 we will
are implementing ECHO Diabetes in Florida
welcome 10 additional centers in the second
and California to reach the most vulnerable
phase of the stepped-wedge design.
patients living with diabetes and participating
DR. DAVID MAAHS health centers (or “spokes”). They receive We are profoundly grateful for the opportunity
(Stanford) tele-education for PCPs, real-time support to work alongside our spokes to improve
with complex medical decision-making, the lives of people living with diabetes from
access to Diabetes Support Coaches for underserved communities.
patient engagement, and access to an online
repository of diabetes care resources. The
DR. ANANTA ECHO Diabetes hub team is a multidisciplinary
ADDALA group of dedicated diabetes specialists
(Stanford) including endocrinologists, APRNs, certified
diabetes care and education specialists
(CDCES), clinical health psychologists,
medical sociologists, epidemiologists, and
DR. RAYHAN LAL public health professionals. The ECHO® model
(Stanford) is particularly promising for reaching patients
at risk for health disparities as underserved
communities are much more likely to visit
a PCP than a subspecialist and have more
continuity of care therein.
THANK YOU FOR YOUR SUPPORT!
2
THE GEOGRAPHY OF ECHO DIABETES
THE ECHO DIABETES PROGRAM SPANS (1) Identifying Federally Qualified Healthcare representing elevated health risks for
A DIVERSE RANGE OF GEOGRAPHIC Centers (FQHC) and (2) using provider communities. Our pioneering methods were
CATCHMENT AREAS IN TWO OF THE MOST geocoding and the Neighborhood Deprivation published in a feature article in the Journal
POPULOUS STATES IN THE U.S.: FLORIDA Index (NDI). of Clinical Endocrinology and Metabolism
AND CALIFORNIA. in September of 2020 and the article can be
The NDI is calculated based on 20 different
found here.
In a strategic effort to recruit health centers neighborhood factors covering 7 domains
serving medically underserved communities, including poverty, occupation, housing, Using these methods, Florida is working with
a dual-pronged approached to identify high- employment, education, racial composition, 18 spokes with 62 different clinic locations and
need catchment areas was used that involved: and residential stability with higher NDI scores California is working with 23 spokes with 45
different clinic locations.
CALIFORNIA
Anderson Valley Health Center Salud Para La Gente
Communicare Samahan Health Centers
Desert AIDS Project Santa Rosa Community Health
Dora Street Health Center Shasta Cascade Health Centers
Harmony Health Medical Center Shasta Community Health Center
Health Service Alliance Shingletown Medical Center
Hill County Clinic Solano County Family
Humboldt Independent Health Services
Practice Association St. Agnes Medical Center
La Clinica Tahoe Forest
Mendocino Coast Clinics Multispecialty Clinics
Open Door Community United Indian Health Services
Health Centers Valley Diabetes and Obesity
Ritter Center New
Existing
FLORIDA
Banyan Health Systems Miami Beach Community
Borinquen Medical Center Health Centers
Community Health Centers Orange Blossom Family Health
Care Center
Community Health Centers
of Pinellas Premier Community Healthcare
Community Health UF Student Health Care Center
of South Florida Tampa Family Health Centers
Empower U Treasure Coast
Healthcare Network of SWFL Community Health
Jessie Trice Community UF Family Medicine
Health System New
Existing
SPOKES AVERAGE NDI MIN NDI MAX NDI
Overall (CA & FL) 1.420 -3.644 7.745
CA 0.930 -3.644 6.740
FL 1.783 -2.033 7.745
SPOKES NDI 1.76 OR HIGHER - N (%) NDI LESS THAN 1.76 - N (%)
Overall (CA & FL) 46 (43%) 62 (57%)
CA 16 (35%) 30 (65%)
FL 30 (48%) 32 (52%)
SPOKES HRSA METRO AREA - N (%) HRSA RURAL AREA - N (%)
Overall (CA & FL) 93 (86%) 15 (14%)
CA 32 (70%) 14 (30%)
FL 61 (98%) 1 (2%)
A score of 1.76 or higher is the threshold of significance for the NDI,
signifying a high health risk area. For information on defining rural
population, click here.
3
ECHO CHAMPION SPOTLIGHT
WHO MAKES ECHO DIABETES POSSIBLE? WE'D LIKE TO SHED SOME LIGHT ON SOME VERY SPECIAL
PROFESSIONALS WHO BRING THE ECHO DIABETES PROGRAM TO LIFE.
DR. LAWRENCE
Chief Medical Officer of Jessie Trice,
Miami Florida (ECHO Diabetes Champion)
DR. LAWRENCE GREW UP IN
LIBERTY CITY AND ATTENDED
MIAMI NORTHWESTERN SENIOR
HIGH SCHOOL.
She continued her education as a pre-med
student at Spelman College in Atlanta and
completed medical school at the University
of Arizona School of Medicine. Dr. Lawrence
returned home to complete her residency
in family medicine at the University Miami/
she was the Medical Director of the Dr. John
Jackson Hospital. She continued her studies
T. Macdonald Foundation School of Health
and preparation of her life’s work as an
Initiative, provided hands-on leadership to the DR. LAWRENCE continues to be actively
educator by completing a fellowship at the
Jefferson Reaves Family Health Center, as well involved in health care issues aimed at
University of North Carolina at Chapel Hill as a
being the preceptor for University of Miami improving the health status of the community.
fellow in faculty development programs.
Family Medicine residents. She is now serving Her overall goal is to reduce health care
Dr. Lawrence is devoted to serving as the Chief Medical Officer for Jessie Trice disparities and adverse social determinants
underserved communities who are faced with Community Health System (JTCHS) where of health by bringing needed current and
adverse social determinants. She has held a she promotes needed policies and procedures innovative strategies and tools to the
variety of leadership positions at the University centered on excellent health delivery systems, population served by JTCHS.
of Miami, Department of Family Medicine and provides clinical oversight to the organization,
Office of Community Affairs. Most recently and delivers direct patient care.
CRAIG RHOADES, PA, RD
Harmony Health, Marysville California
(ECHO Diabetes Champion)
I WAS BORN IN ALTURAS, A
SMALL RURAL TOWN IN THE
VERY NORTHEASTERN PART OF
CALIFORNIA.
I attended school at Butte Community College
followed by Chico State and graduated with a BS
in Nutrition. I was accepted in a dietetic internship
through Fresno State. After completing masters
studies with internship and boards I worked as
a clinical Registered Dietitian (RD) for 3 years
and was accepted in PA school at UC Davis
Medical. I have worked as a PA for 13 years and
RD for 19 years. I enjoy family medicine and focus
on disease prevention and wellness through DO YOU KNOW SOMEONE WHO
diet and lifestyle. I have also volunteered for the
Western Farmworkers Association for the past YOU THINK WE SHOULD EMAIL US AND
TELL US WHY!
8 years, donating medical services and time to
help migrant workers without insurance. I have SHED A SPOTLIGHT ON?
been fortunate to be a part of Stanford ECHO® for
nearly 3 years. I enjoy spending time with family,
woodworking and Crossfit.
4
SUPPORT COACH SPOTLIGHT
THE ECHO DIABETES SUPPORT COACH IS AN INTEGRAL PART OF WHAT MAKES ECHO® SO SPECIAL.
HERE'S JUST A FEW PEOPLE WHO GIVE THEIR TIME AND EFFORT TO SUPPORT THEIR PEERS IN NEED.
outlook on diabetes. The encounters with her treatment for the past 12 years. About 4 years
sparked my passion of wanting to help people ago, my older brother passed away from
with diabetes. complications related to T1D. These events
have inspired a desire in me to help patients
Over the years as I cared for my daughter and
living with diabetes in my local community.
her diabetes, I felt it was my duty to advocate
For the past 2 years I have inspired others
and spread diabetes awareness. My family and
living with diabetes by sharing my personal
I joined every support group in our community
stories, organizing social events and working
to support parents of newly diagnosed
with providers by creating weekly groups
children. We experienced and know that
where patients are able to consistently seek
diabetes education and awareness provides
education and treatment.
empowerment.
In addition, I have one-on-one coaching
My daughter’s journey of living with diabetes
sessions with each mentee that made the
has inspired me to continue my career in the
decision to work with me. During these
diabetes medical field. I thank her every day
encounters, we discuss challenges they may
for being such an amazing inspiration to me.
face and I work to provide solutions or help
She is my hero.
them overcome any problems related to
AMY MCCLELLAND diabetes based on similar problems I may have
ECHO Diabetes Support Coach, California faced. In cooperation with my teammates, we
have developed a resource guide designed
MY NAME IS AMY MCCLELLAND, to assist patients and providers with local
AND I AM A DIABETES SUPPORT resources specifically for patients living with
COACH WITH STANFORD diabetes.
UNIVERSITY’S ECHO DIABETES.
In short, working as a Diabetes Support Coach
ECHO® is the beginning of my professional has not only changed my life, but those who
career working with people with diabetes. I mentor as well. Many have shared how they
I am also employed with Harmony Health wished this existed many years ago.
Medical Clinic Family Resource Center in my
hometown of Marysville, California, where
I provide support in obtaining insurance
approval for diabetes devices, and work with
people with diabetes who have high A1cs and
need support in getting to the clinic for help.
Harmony Health has played an important role
in keeping my family healthy over the last 21
years.
LEON BAIN DO YOU KNOW A SUPPORT
ECHO Diabetes Support Coach, Miami, Florida
Eleven years ago, my daughter was COACH WHO YOU'D LIKE TO
MY NAME IS LEON BAIN, AND I
diagnosed with type 1 diabetes (T1D). It was
a very difficult time for our family. While my
AM A DIABETES SUPPORT COACH SHED A SPOTLIGHT ON?
daughter was hospitalized and receiving
WITH UNIVERSITY OF FLORIDA,
care for diabetes, we had the most amazing
ECHO DIABETES.
EMAIL US AND
experience; everyday a Diabetic Health About 22 years ago, I was diagnosed with type
TELL US WHY!
Worker would come and talk with us. She 2 diabetes (T2D) and received treatment for
had answers to all of our questions. She was almost 10 years. Eventually, an endocrinologist
one of the most inspiring people and had a changed the diagnosis to T1D at which
huge impact on my daughter and my family’s point I began receiving the appropriate
5
FEATURED ARTICLES
A PIPELINE FOR HEALTH EQUITY: DIABETES TECHNOLOGY TO UNDERSERVED COMMUNITIES
IN THE U.S. THERE ARE WELL-DOCUMENTED DISPARITIES IN TABLE 1
UTILIZATION OF DIABETES TECHNOLOGIES LIKE CONTINUOUS
Pilot Data for Use of Diabetes Support Coaches and Continuous
GLUCOSE MONITORS (CGM) AND INSULIN PUMPS BASED ON
Glucose Monitors*
SOCIOECONOMIC STATUS AND RACIAL AND ETHNIC MINORITY
STATUS. 3 MONTH CHANGE IN HBA1C
n Mean Change SD 95% CI p-value
Through critical community partnerships with spokes established in the
24 -0.44 1.39 (-1.03, 0.15) 0.1375
ECHO Diabetes platform, and generous contributions from the Leona
6 MONTH CHANGE IN HBA1C
M. and Harry B. Helmsley Charitable Trust (HCT) and Insulin For Life,
n Mean Change SD 95% CI p-value
undeserved communities are able to access these vital technologies.
19 -1.21 1.49 (-1.93, -0.49) 0.0023
To date, more than 2000 CGM sensors have been provided to patients
at participating spokes in Florida and California. Pilot data from these
efforts found that providing underserved populations with access *Demographics: Data are from n=24 adults ages 18 and older from two large FQHCs in Miami; 19
T1D, 5 T2D MDI; 12 Non-Hispanic Black, 12 Hispanic; 14 Female and 10 male
to CGM and Diabetes Support Coaches combined for a synergistic
Note: (all HbA1c data presented here are from pre-COVID time period)
reduction in HbA1c (Table 1). The HCT provided additional COVID relief
funds to spoke sites which were utilized to provide other supplies like
insulin, test strips, gas cards, grocery vouchers, and funding for Wi-Fi
connection to families in need during the pandemic.
PEER POWER: USING DIABETES SUPPORT COACHES IN A TIME OF COVID-19
THE PROJECT ECHO® DIABETES PROGRAM Given the devastating impact of COVID-19 AN ECHO DIABETES SUPPORT
PROVIDES COMMUNITY PARTNERS WITH for underserved communities, the work of COACH RECIEVES THE FOLLOWING
ACCESS TO A DIABETES SUPPORT COACH. the Diabetes Support Coaches has never ACCREDITATION AND TRAINING:
been more imperative to addressing systemic
Through an innovative combination of the American Association of Diabetes
inequalities in the U.S. During COVID the
Community Health Worker (CHW) role and Care & Education Specialists (ADCES)
Diabetes Support Coaches have hosted virtual
peer support models, the Diabetes Support Diabetes Paraprofessional Level 1
town hall meetings and increased efforts of
Coaches reside in the geographic areas certification
patient engagement throughout Florida and
they serve and, importantly, they also have
California at Federally Qualified Health Centers University of California San Francisco
first-hand knowledge of what it is like to
that ECHO Diabetes is partnering with. (UCSF) Center for Excellence in
live with diabetes. The Diabetes Support
Primary Care Health Coach Training
Coaches spearhead regular social events
for communities with diabetes, create local Access to the American Diabetes
resource guides (in English, Spanish, and Association’s Community Health
Creole), facilitate support groups, and serve Worker (CHW) annual membership and
as a one-on-one peer mentor for patients with toolkit
diabetes.
HIPAA, human subjects, and IRB
compliance trainings
6
ECHO DIABETES TELE-ECHO CURRICULUM
PLEASE JOIN US FOR OUR UPCOMING TELE-ECHO SESSIONS!
WE'RE LOOKING FORWARD TO SEEING YOU AND LEARNING WITH YOU.
WEEK CLINIC DATE LECTURE TOPIC WEEK CLINIC DATE LECTURE TOPIC
JUNE SEPTEMBER
The Pillars of Success:Knowledge,
78 6/10/2021 90 9/2/2021 Introducing Diabetes Technology to Patients
Community& Resilience
Screening forDepression and Diabetes
79 6/17/2021 GlycemicTargetsandGlucoseMonitoring 91 9/9/2021
Burnout
Carb Counting andDietary Management in
80 6/24/2021 Continuous GlucoseMonitoringSystems 92 9/16/2021
T1D
JULY 93 9/23/2021
Making a Diagnosis of Diabetes
in Primary Care
T2D Management in Established
81 7/1/2021 Atherosclerotic Cardiovascular Disease 94 9/30/2021 Diabetes & Hypertension Management
(ASCVD)
T2D Management inHeart Failure (HF)
82 7/8/2021
andChronic Kidney Disease(CKD) OCTOBER
T2D Management: Promoting Weight Loss
83 7/15/2021 95 10/7/2021 Dyslipidemia & Diabetes
Using Glucose-Lowering Medications
T2D Management: When Medication Cost is
84 7/22/2021 96 10/14/2021 Exercise Strategies in T1D & T2D
a Major Issue
85 7/29/2021 Using & Interpreting Data from CGMs 97 10/21/2021 Diabetes and Complications Screenings
AUGUST 98 10/28/2021 Diabulemia and Disordered Eating
86 8/5/2021 Types of Insulin Analogs
NOVEMBER
Initiating Insulin and Dose Calculation in T1D
87 8/12/2021 99 11/4/2021 Motivational Interviewing
and T2D
Calculating Insulin Doses for T1D & T2D: NO TELE-ECHO SESSION TODAY:
88 8/19/2021 11/11/2021
Case-based Approach VETERAN’SDAY
Sick Day Management and
89 8/26/2021 Initiating Insulin Pump Therapy 100 11/18/2021
Severe Hyperglycemia
NO TELE-ECHO SESSION TODAY:
11/25/2021
THANKSGIVING
7
PRESENTATIONS & PUBLICATIONS
RECENT CONFERENCE PRESENTATIONS FROM ECHO DIABETES
ADVANCED TECHNOLOGIES & TREATMENTS FOR DIABETES POSTERS:
Oral, Virtual (June 5th)
471-P | Using Peer Power to Reduce Health Disparities: Implementation of
Using tele-education with the ECHO® model to reach primary care providers
a Diabetes Support Coach Program in Federally Qualified Health Centers
in rural areas to improve the level of care for people with diabetes
549-P | Understanding PCP Perspectives in a Project ECHO® T1D
AMERICAN DIABETES ASSOCIATION SCIENTIFIC SESSIONS
Program Using the Consolidated Framework for Implementation Research
Oral, Virtual (June 26)
Session Type: Symposium
Session Title: Systemic Racism and Disparities in Pediatric
Diabetes Management
Presentation Title: ECHO-Diabetes—Delivering Care to the Underserved
Presentation Time: 9:00am - 9:30am Eastern Time
ECHO DIABETES PUBLICATIONS TO DATE
PRIMARY CARE PROVIDERS IN THE NEIGHBORHOOD DEPRIVATION DEMOCRATIZING TYPE 1 DIABETES
CALIFORNIA AND FLORIDA REPORT INDEX AND PROVIDER GEOCODING SPECIALTY CARE IN THE PRIMARY
LOW CONFIDENCE IN PROVIDING TYPE 1 IDENTIFY CRITICAL CATCHMENT AREAS CARE SETTING TO REDUCE HEALTH
DIABETES CARE: Clinical Diabetes FOR DIABETES OUTREACH: Journal of DISPARITIES: Project Extension for
View Here >>> Clinical Endocrinology and Metabolism Community Healthcare Outcomes (ECHO®)
View Here >>> T1D (In press, BMJ Open Diabetes)
TELE-ROUNDS AND CASE-BASED
View Here >>>
TRAINING: PROJECT ECHO® BARRIERS TO TECHNOLOGY USE
TELEMENTORING MODEL APPLIED TO AND ENDOCRINOLOGY CARE FOR
COMPLEX DIABETES CARE: Pediatric UNDERSERVED COMMUNITIES WITH TYPE
Clinics of North America 1 DIABETES: Diabetes Care
View Here >>> View Here >>>
8
OUR LATEST PRESS RELEASE
PATIENTS WITH TYPE 1 DIABETES SAID THEIR EXPERIENCES WITH ENDOCRINOLOGISTS
CREATED A SIGNIFICANT BARRIER TO OPTIMAL CARE.
EXPERTS RECOMMEND THE USE OF of COVID-19 on underserved communities “I feel like sometimes I don’t even want to go
CONTINUOUS GLUCOSE MONITORS AS demonstrates the dire need to address to the doctor because I’m getting a lecture,”
THE GOLD STANDARD FOR MANAGING longstanding systemic inequalities in a participant said. “I’m getting like in trouble.
TYPE 1 DIABETES. health outcomes.” I feel like a little kid who’s going to the
Yet many adult patients, particularly those principal.”
For the study, researchers conducted 16 focus
with lower socioeconomic status and from
groups in Florida and California in 2018 and Many participants said they had stopped
underrepresented minority groups, are not
2019 with 86 adults with Type 1 diabetes. In going to endocrinology appointments because
receiving the technology or regular care from
order to include people who have traditionally they did not feel it was improving their overall
specialists known as endocrinologists.
been underrepresented in research, health.
A new study from University of Florida and investigators targeted individuals who had
“We hope these findings generate an
Stanford University researchers finds the most “no shows” at two or more consecutive
awareness about the importance of cultivating
commonly cited reason patients with type 1 endocrinology appointments, had been
positive provider-patient relationships and
diabetes don’t receive optimal care is negative hospitalized in the past year for a serious
treating people with type 1 diabetes with
interactions with endocrinologists. complication known as diabetic ketoacidosis
empathy and respect in clinical encounters,”
and had received primary care at a Federally
“The feelings of shame, stigma and judgment Walker said. “These findings also point
Qualified Health Center, which provides care
people with type 1 diabetes experience in to the ripple effect of industry-driven
to underserved groups.
clinical encounters creates a barrier for rules surrounding what it takes to obtain
obtaining technologies and for receiving Participants noted system-level barriers to technologies like continuous glucose monitors
preventive care from an adult endocrinologist,” receiving continuous glucose monitors — as these rules create barriers for providers as
said lead author Ashby Walker, Ph.D., an small devices implanted under the skin that well as patients.”
assistant professor in the department of health automatically measure blood sugar — such
Walker said the next step is to develop
services research, management and policy in as financial coverage or navigating insurance
and evaluate multilayered interventions to
the UF College of Public Health and Health company policies.
address health disparities in type 1 diabetes
Professions, part of UF Health, the university’s
But the most pervasive barrier to care that include efforts focused on provider-level
academic health center.
identified was participants’ communication implicit bias.
The study, which appears in the journal with endocrinologists in face-to-face
“We must also train and recruit a richly diverse
Diabetes Care, is one of the few to consider interactions. Several participants said they
‘next generation’ of endocrinologists and
the perspectives of underserved communities received discouraging statements from
equip them with tools for addressing health
in an effort to identify potential barriers to endocrinologists when they asked about
disparities,” she said.
care, Walker said. receiving a continuous glucose monitor,
including feedback that the patient had poor Written by JILL PEASE
“We must be intentional about understanding
control over their disease or would not be Public Relations Director, College of Public
the lived experiences of communities that
able to handle the technology. Participants Health and Health Professions
face elevated health risks in order to develop
frequently described feeling demeaned,
meaningful interventions,” said Walker, the CLICK HERE FOR THE FULL ARTICLE >>>
belittled and misunderstood as a person living
director for health equity initiatives at the
with type 1 diabetes.
UF Diabetes Institute. “Moreover, the impact
9
ECHO RESOURCES ®
FEELING CONNECTED TO A COMMUNITY ALSO MEANS HAVING ACCESS TO GREAT RESOURCES.
DO YOU HAVE SOME USEFUL RESOURCE LINKS? LET US KNOW!
UNM's MetaECHO conference
The METAECHO Conference is a global
American Diabetes Association gathering for Project ECHO®. Surrounded by
Health Equity Now hundreds of ECHO partners over three and
a half days, we gather for world-renowned
The ADA has just held their 35th Annual
keynote speakers, share cutting-edge
Clinical Conference on Diabetes, which is
research and evaluation methods and learn
normally held in Florida, but was virtual this
how funding and policy are being impacted by
year. The event sessions were recorded and
ECHO work. We also hear inspirational ECHO
are available here. All sessions will be recorded
Talks and learn how ECHO programs are
and available online until JULY 11, 2021,
being run around the world.
so if you were unable to attend during the
conference dates, you will still be able to view Along the way, we celebrate each other's
and receive CE credits. ECHO passion.
HELPFUL LINKS
Beyond Type 1 Getinsulin.org
Beyond Type 1 is a nonprofit organization changing Beyond Type 1 advocates for high quality, modern
what it means to live with diabetes. Through insulin to be available to people with diabetes
platforms, programs, resources, and grants, Beyond regardless of employment or insurance status,
Type 1 is uniting the global diabetes community and across all demographics, without barriers, and at an
providing solutions to improve lives today. affordable and predictable price point.
Beyond Type 2 JDRF Toolkits
Launched in 2019, Beyond Type 2 is a program of Downloadable e-books to help you navigate all
the nonprofit organization Beyond Type 1. Beyond aspects of life with T1D.
Type 2 is a place for everyone impacted by Type 2
diabetes to share their stories, get connected to the Diabetes Wise
community, and find resources on topics from daily
Helping You Find The Right Diabetes Devices For
management to mental health.
Your Life.
HAVE SOME QUESTIONS?
PLEASE CONTACT US!
IN FLORIDA
CLAUDIA ANEZ
canez@ufl.edu
IN CALIFORNIA
LAUREN FIGG
lefigg@stanford.edu
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