The Community Clinic Voice News Digest highlights recent news, resources and events from our online community. For daily updates, discussions and more, visit: http://www.communityclinicvoice.org.
The Community Clinic Voice News Digest highlights recent news, resources and events from our online community. For daily updates, discussions and more, visit:
http://www.communityclinicvoice.org.
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Sue Dormanen, sdormanen@tides.org
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COMMUNITY CLINIC VOICE NEWS DIGEST FOR JUNE, 2010:
** COMMUNITY NEWS
** CAPITAL DEVELOPMENT
** CLINICAL
** DISPARITIES
** ENVIRONMENTAL HEALTH
** FUNDING
** HEALTH POLICY & TRENDS
** HEALTH REFORM
** IT & HEALTH CARE
** MEDI-CAL, MEDICARE
** OPERATIONS
** PATIENT-CENTERED MEDICAL HOMES
** QUALITY IMPROVEMENT
** WORKFORCE
** UPCOMING EVENTS
** COMMUNITY NEWS:
A SNAPSHOT OF THE COMMUNITY CLINIC VOICE: ONLINE COMMUNITIES AS A TOOL FOR THE NONPROFIT FIELD - Our thanks to Voice members who participated in the interviews and focus groups that informed this evaluation of our online community. The resulting Snapshot explores the Voice model, including its structure, evolution, members and the benefits gained from utilizing the Voice. One goal of the evaluation was to formulate "lessons learned" in building an online community, to share with those who want to create a similar resource in other areas. We hope these considerations will be useful to anyone interested in funding, designing or managing online communities as a tool to support the work of the nonprofit sector.
** CAPITAL DEVELOPMENT:
CAPITAL PROJECT ACTIVITIES TIMELINE - A capital project is made up of multiple parts including: Business Planning, Predevelopment, Capital Campaign, and Financing. This chart from Andra Lichtenstein of Capital Incubator provides an at-a-glance overview of the component parts of a major capital project showing activities as they integrate both sequentially and simultaneously.
AND SEE: Debt Financing Options for Capital Projects
** CLINICAL:
RFA EXPANDING DIABETIC RETINOPATHY SCREENING TO SAFETY-NET AND RURAL CLINICS IN CALIFORNIA: CAMERAS AND TRAINING AVAILABLE - The California HealthCare Foundation, in partnership with UC-Berkeley, is working to improve access to recommended diabetic retinopathy screening for patients with diabetes in community health centers, public hospital clinics, and rural health centers in California by supporting the integration of remote diabetic retinopathy screening services into primary care settings. The program will provide cameras and technical assistance, including EyePACs, and a learning community. Rolling Deadline; apply by September 30.
AND VISIT THE NEW EYEPACS GROUP ON THE VOICE - A video on EyePACS is available.
CA DECLARES WHOOPING COUGH EPIDEMIC: PERTUSIS CD TRAINING DISK AVAILABLE - Since January, the state has confirmed 910 whooping cough cases and five infant deaths, more than four times higher than this point in 2009, putting the state on pace for the worst outbreak of the disease in 50 years.
PRIMER ON INTEGRATING PRIMARY CARE AND BEHAVIORAL HEALTH CARE - This new report from the Milbank Memorial Fund describes eight models along a continuum—from minimal collaboration to full integration—and provides an implementation planning guide. Integration will be a critical component of health care reform in the coming decade, the report concludes.
SAMHSA, ONC PUBLISH NEW FAQS ON SUBSTANCE ABUSE CONFIDENTIALITY REGS FOR HEALTH INFORMATION EXCHANGE - The regulations govern the use and disclosure of information about alcohol and drug abuse in patient records maintained at federally funded substance abuse programs. As follow-up to the release of the FAQs, SAMHSA and ONC will convene an August 4 meeting and webinar to gather comments regarding the utility of the FAQs.
STIMULATING INNOVATION IN THE DELIVERY OF ORAL HEALTH - A special issue of the Journal of Public Health Dentistry examines how well the oral health care delivery system meets the needs of specific populations and the role the workforce can play in improving the care delivery model.
UCSD’s STUDENT-RUN FREE CLINIC PROJECT PART OF SAN DIEGO'S SAFETY NET - The University of California at San Diego’s Student-Run Free Clinic Project, founded in 1997, serves more than 2,000 people a year. As a result of the national faculty training program they created, more than 15 other locations across the country have started student-run free clinic projects.
** DISPARITIES:
RACIAL DISPARITIES IN ASTHMA EXIST EVEN AMONG CHILDREN WITH EQUAL ACCESS TO HEALTH CARE - A new study suggests that eliminating racial and ethnic disparities in health care likely requires a multifaceted approach beyond universal health insurance coverage.
** ENVIRONMENTAL HEALTH:
CHILDHOOD ASTHMA AND ENVIRONMENTAL HEALTH - On the local level, interventions in community-based locations used by children -- playgrounds, schools and school-yards, and public housing units -- and the implementation of policies such as those designed to reduce idling by buses around schools, and notify neighborhoods about pesticides, can help reduce asthma triggers; so can federal efforts that address global warming and climate change.
UCLA, COUNTY WIN HEALTH IMPACT ASSESSMENT GRANT TO EXAMINE THE IMPACT OF POLICY ON PEOPLE'S HEALTH - Two HIAs will assess the potential health effects of a proposed subway and other mass-transit alternatives and implications of different municipal water-conservation policies.
INCREASING ACCESS TO HEALTHY FOOD IN THE CENTRAL VALLEY - This brief from The California Endowment discusses strategies for improving nutrition environments through farmers markets and produce stands, and includes findings from environmental assessments of The Central California Regional Obesity Prevention Program.
** FUNDING:
COLLABORATION PRIZE FOR NONPROFIT IMPACT & NONPROFIT COLLABORATION DATABASE - Apply by July 16 for a national award presented to nonprofit organizations that collaborate effectively to gain greater impact.
HRSA AFFORDABLE CARE ACT NURSE MANAGED HEALTH CLINICS PILOT GRANTS - The program supports the training and practice development site for nurse practitioners to build the capacity of primary care provider workforce. Ten grants will be awarded for a total of $15 million. Applications are due July 19, 2010
CDC RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH FOR COMMUNITIES (REACH) - Support for local communities to strategically organize to implement and evaluate evidence-based policy, system, and environmental change interventions that eliminate racial and ethnic health disparities in chronic diseases. Apply by July 21.
EXPANDED NATIONAL HEALTH SERVICE CORPS OPPORTUNITIES - As many as 4,000 new NHSC clinicians are going to be placed in underserved communities by September 2010 and your site can take advantage of this opportunity immediately. The threshold for organizational participation has been changed to expand access. Apply by July 29, 2010.
CONNECTIONS FOR CARDIOVASCULAR HEALTH GRANT PROGRAM - A new $25 million program of the AstraZeneca HealthCare Foundation will award grants of at least $150,000 to nonprofits doing innovative work in the field of cardiovascular health. Apply by July 31.
SIERRA FOUNDATION RESPONSIVE GRANTS PROGRAM ACCEPTING APPLICATIONS - The second round of the 2010 Responsive Grants Program will make $500,000 available for competitive grants up to $25,000 each to support projects that improve health and quality of life in Northern California. Apply by August 9.
SUMMER 2010 EMERGENCY LOAN FUND NOW AVAILABLE FOR CLINICS FACING A MEDI-CAL CHECKWRITE DELAY - 2010 will be another very difficult budget year with a $20 billion deficit for the Legislature and Governor to tackle. CPCA already is aware that a two week Medi-Cal check write delay will occur in June. Significant changes have been made to the emergency loan fund to make it easier than ever to access.
FOR MORE CURRENT GRANTS & RFPs, visit the Voice Library
CONGRATULATIONS NETWORKING FOR COMMUNITY HEALTH RFP 12 GRANTEES: 33 PROJECTS FUNDED ACROSS CA - Community Clinics Initiative (CCI) is pleased to announce the list of grantees selected for the Networking for Community Health Program, designed to help clinics strengthen and expand their working relationships with both traditional and non-traditional partners toward the goal of improving community health.
HRSA ANNOUNCES NEW PROCESS FOR GRANTEES APPLYING FOR FY 2011 NON-COMPETITIVE FUNDING -Grantees will now be required to submit an annual Budget Period Progress Report in lieu of a Budget Period Renewal (BPR) application. The entire process will take place through HRSA's Electronic Handbooks.
BLUE SHIELD OF CALIFORNIA FOUNDATION'S NEW PRESIDENT & CEO - Peter Long, a California leader with a distinguished career in health philanthropy, will join the Foundation on July 6.
** HEALTH POLICY & TRENDS:
NEW INVESTMENT IN
COMMUNITY PREVENTION & PUBLIC HEALTH, PRIMARY HEALTH CARE WORKFORCE - HHS announced $250 million in new Affordable Care Act investments to support community and clinical prevention activities and develop the nation’s public health infrastructure. Another $250 million was announced to increase the number of clinicians and strengthen the primary care workforce.
COMMUNITY-BASED PREVENTION AND EDUCATION FOR A RURAL AREA - Ukiah Valley Medical Center and local community partners are developing a community-based preventative health and wellness program, including health screening and education.
SURVEY FINDS FREE CLINICS CARE FOR MILLIONS ANNUALLY - Free clinics report serving an average of 747 new patients per year and 1,796 total unduplicated patients; an estimated 1.8 million individuals make approximately 3.5 million medical and dental visits to free clinics annually, according to a report published in the Archives of Internal Medicine. The clinics' average operating budget was $287,810, with more than 90% of funding received from charitable donations. Formal integration of free clinics into the safety net has the potential to strengthen the overall health system, according to the author.
BREAKING DOWN THE BARRIERS: A NATIONAL NEEDS ASSESSMENT ON FARMWORKER HEALTH OUTREACH - Migrant health professionals revealed the top farmworker barriers to health care to be lack of transportation (67%), lack of knowledge of available services (58%), cost of health care services (48%), lack of insurance (35%), and lack of comfort with health care services/facilities (22%). Fear due to immigration and discrimination also play a pivotal role in preventing farmworkers from accessing health care services.
NACHC COMMENTS ON FEDERAL EFFORTS TO DEFINE CRITERIA FOR MEDICALLY UNDERSERVED - The core of NACHC’s comments focused on its concerns that, while HRSA’s notice had adequately addressed the issue of availability of health services and providers, it had not adequately addressed the issue of access to those services.
AFFORDABLE CARE ACT EXPANDS TAX BENEFIT TO HEALTH PROFESSIONALS WORKING IN UNDERSERVED AREAS - Health care professionals who received student loan relief under state programs that reward those who work in underserved communities may qualify for refunds on their 2009 federal income tax returns as well as an annual tax cut going forward.
COMMONWEALTH FUND: NEW SEVEN-NATION STUDY RANKS U.S. LAST ON HEALTH SYSTEM PERFORMANCE - Despite having the most expensive health care system, the United States ranks last in overall performance compared with six other industrialized countries.
** HEALTH REFORM:
STRENGTHENING PRIMARY CARE: THE EXPANSION OF HEALTH CENTERS THROUGH HEALTH REFORM - According to a report from the George Washington University School of Public Health and Health Services, the $11 billion investment in additional federal grants for non-profit community health centers from 2011 to 2015 can lead to a doubling of the number of Americans who get their care at community health centers to almost 40 million, two-thirds of the population living in current federally-designated medically underserved areas. It will also reduce overall medical costs by $180 billion while raising primary care capacity.
HOW WILL THE HEALTH CARE SYSTEM CHANGE UNDER HEALTH REFORM? - According to Commonwealth Fund president Karen Davis, under the new reforms, patients will be more likely to have an EMR, a physician practice that is accessible 24/7 and helps arrange specialist appointments, and better access to community health centers able to serve more patients, among other provisions.
AND SEE: THE COMMONWEALTH FUND ON REALIZING THE POTENTIAL OF REFORM - A special report on who will be most helped and how, and ways in which the health care system will begin to provide more patient-centered, accessible, and coordinated care to all.
MOVING FORWARD ON HEALTH REFORM: RISKS & REWARDS - The June 2010 issue of Health Affairs begins to tackle the hundreds of implementation issues inherent in health reform and offers prescriptions for averting trouble. Formulating post-reform strategies is likely to prove challenging for the nation’s health care providers; the legislation holds the potential for transformation of the delivery system into one focused less on volume of services and more on value and patient outcomes.
HEALTH REFORM IS GOOD DEAL FOR STATES: FEDERAL GOVERNMENT WILL PICK UP NEARLY ALL COSTS OF MEDICAID EXPANSION - Contrary to claims that the health reform law’s Medicaid expansion will place an unaffordable burden on states, the federal government will bear 96% of the costs of the expansion, which will cover 16 million low-income children and adults while raising state Medicaid spending by just 1.25 percent compared to what states were projected to spend without health reform.
WHAT HEALTHCARE REFORM MEANS FOR CALIFORNIA - A 2010 forum featuring members of the UC Berkeley’s School of Public Health, as well as representatives from the Senate Health Committee and the Governor’s Office, is available for viewing of UCTV's Website.
** IT & HEALTH CARE:
CMS LAUNCHES OFFICIAL WEBSITE FOR EHR INCENTIVE PROGRAMS - The site provides information on who is eligible for the programs, how to register, meaningful use, upcoming EHR training and events, fact sheets on the incentive programs and definition of Meaningful Use, and more.
HEALTH INFORMATION EXCHANGE CONFERENCE - The 4th annual conference is hosted by Redwood Mednet, July 9th in Santa Rosa. The conference will specifically address the current status of ARRA investments in health IT.
PROMISE OF TELEMEDICINE IN THE CENTRAL VALLEY: A DIFFICULT ADVENTURE - Telemedicine a tantalizing hope for the San Joaquin Valley, challenged by transportation and poverty, says a report from California Healthline. A recent study found Valley health care providers ranked navigating laws and regulations as almost twice the perceived barrier as physical infrastructure or concerns about the quality of care. A proposed rule by CMS (see below) would create a more streamlined credentialing and privileging process for physicians and practitioners providing telemedicine services.
CMS PROPOSED RULE ON CREDENTIALING AND PRIVILEGING OF TELEMEDICINE PROVIDERS: COMMENT BY JULY 26 - CSRHA urges rural stakeholders to review the regulation and provide comments, as it is believed to includes significant changes that address many of the concerns raised over the past year.
PRESENTATIONS AVAILABLE ON eHEALTH IN RURAL CALIFORNIA: VENDOR SELECTION AND CERTIFICATION - CSRHA Webinar presentations by Speranza Avram, Executive Director, CalHIPSO, and Rosario Arreola Pro, Health Systems Developmental Director, CA Rural Indian Health Board are available online. A HIT vendor directory is being developed for California.
HIT POLICY COMMITTEE'S ENROLLMENT WORKGROUP SEEKS COMMENTS BY JULY 1 - The Workgroup , chaired by Aneesh Chopra and Sam Karp of the California HealthCare Foundation, requests public comment on federal, state, local or tribal government initiatives to simplify and streamline eligibility and enrollment in health and human services programs.
ONC ISSUES TEMPORARY EHR CERTIFICATION RULE - The temporary certification program establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify EHR technology. Use of “certified EHR technology” is a core requirement for providers who seek to qualify to receive incentive payments under the Medicare and Medicaid Electronic Health Record Incentive Programs provisions authorized in HITECH.
TRAINING STRATEGIES: EHR DEPLOYMENT TECHNIQUES - In making the transition from traditional paper files to electronic health records, some of California's community clinics and health centers have joined together in networks to collaborate on developing best practices. This issue brief on training strategies is one of a series of lessons learned through the California Networks for Electronic Health Record Adoption (CNEA) initiative.
HITECH REVISITED - The first comprehensive review of the HITECH Act’s implementation suggests that HITECH is a major step forward, and expresses optimism that its investments can lead to measurable improvements in the health care system, especially when complemented by the types of payment reforms included in recently-enacted health care reform legislation.
eHEALTH INITIATIVE TO RELEASE 2010 NATIONAL PROGRESS REPORT ON EHEALTH: FREE WEBINAR JULY 1 - The webinar will examine the progress in the five key focus areas of the report: Aligning Incentives; Engaging Consumers; Improving Population Health; Managing Privacy, Security & Confidentiality; and Transforming Care Delivery. eHI has launched the 2010 Annual Survey on Health Information Exchange (HIE). This year’s survey is designed to capture health information exchange activities; results will be released on July 22 at the National Forum on Health Information Exchange in Washington, DC.
CPOE TEST SHOWS HIGH ERROR RATES - A Web-based simulation tool to test the ability of computerized physician order entry (CPOE) systems has found the systems on average miss half of routine medication orders and a third of potentially fatal errors, according to the Leapfrog Group. They call on hospitals that have CPOE to use the simulation tool as an integral part of their quality assurance and improvement processes; 96% of hospitals that have gone through the simulation twice have improved in one or more test categories.
HHS AWARDS RECOVERY ACT FUNDS TO EXPAND USE OF HEALTH INFORMATION TECHNOLOGY - HHS this month announced $83.9 million in competitive grants to help networks of health centers adopt electronic health records and other health information technology systems. Eight grants totalling $18.46 million were awarded in California.
** MEDI-CAL, MEDICARE:
PRESIDENT
SIGNS MEDICARE PHYSICIAN PAY BILL; STATES PUSH FOR EXTENDED MEDICAID AID
- HR 3962 postpones a 21% pay cut in Medicare physician reimbursements
until Nov. 30, instead providing a 2.2% pay increase. Meanwhile, CMS
has proposed an additional 6.1% reduction to Medicare's physician
payment rates beginning in 2011. State officials plan to lobby lawmakers
to reconsider a Medicaid state assistance package after the larger
Senate "extenders" bill failed to advance. The loss of about $1.8
billion in additional Medicaid funding would force California to find
additional cuts or revenue to address the state's $19.1 billion budget
deficit.
HOW TO DESIGN, DELIVER NEW, IMPROVED MEDI-CAL - For the new Medicaid to be successful, it will need a new public image, according a new report from the Kaiser Commission on Medicaid and the Uninsured, "Optimizing Medicaid Enrollment: Perspectives on Strengthening Medicaid's Reach under Health Care Reform."
UPDATED MEDICAID PRIMER - Kaiser Family Foundation provides an overview of the basic components of Medicaid, and examines how Medicaid will change and expand as it serves as the mechanism to provide expand coverage under health reform.
ORDERING/REFERRING PROVIDERS IN PECOS: NEW DEADLINE JULY 6 - All those providers who refer/order for their Medicare patients are required to be actively enrolled or revalidated in the Provider Enrollment, Chain and Ownership System (PECOS) national database.
** OPERATIONS:
WORKFLOW REDESIGN: A MODEL FOR CALIFORNIA CLINICS - An issue brief from California HealthCare Foundation describes a workflow redesign project that showed promising successes. To help clinics optimize patient flow, the Optimizing Primary Care Collaborative was launched in 2007 by CPCA to help clinic teams set goals, collect data, and measure effects.
FTC DELAYS RED FLAGS RULE TO DEC 31 - Congress is considering a bill that would exempt doctors from the rule that aims to minimize identity theft.
CASE STUDIES IN CREATIVE CLINIC DESIGN - A new issue brief from California HealthCare Foundation describes how Hill Country Health and Wellness Center (Round Mountain, California) and Open Door's Del Norte Community Health Center (Crescent City, California) have built welcoming, spacious facilities that have transformed the clinics from care providers to community focal points.
AND SEE: CLINIC DESIGN - TRANSFORMING PRIMARY CARE ENVIRONMENTS - A website intended for community health centers and other safety net clinics planning upgrades to their facilities.
ENVIRONMENTAL POLICY STATEMENT FOR YOUR NONPROFIT - Help meet increasing funder requests for proof of sustainable operations by creating a public environmental policy for your nonprofit center. Download a sample from the Thoreau Center for Sustainability.
HRSA ISSUES DRAFT FEDERAL TORT CLAIMS ACT POLICY MANUAL: COMMENT BY AUG 6 - Once finalized, the FTCA Policy Manual will be the primary policy source for information on FTCA for Health Center Program grantees and related stakeholders.
NACHC COMPLIANCE RESOURCE CATALOG - William Evans Jr., Corporate Compliance Officer at Del Norte Clinics, Inc. recommends this as an excellent compliance resource.
** PATIENT CENTERED MEDICAL HOMES:
NEW FINDINGS ON MEDICAL HOME CAPACITY IN UNDERSERVED AREAS: MANY KEY ELEMENTS ALREADY IN PLACE - Primary care practices that serve poor and minority neighborhoods were found to be more likely than other practices to have key components of the medical home primary care model in place, according to a Commonwealth Fund-supported study, published June 15, 2010 in the Archives of Internal Medicine.
PATIENT-CENTERED MEDICAL HOMES: SEVEN KEY ISSUES - The present and future of the patient-centered medical home (PCMH) model of primary care is explored in depth in the June issue of the Journal of General Internal Medicine.
HOW PHYSICIAN PRACTICES COULD SHARE PERSONNEL AND RESOURCES TO SUPPORT MEDICAL HOME - Commonwealth Fund experts show how groups of small practices can band together to provide medical home services, sharing the costs and improving their performance.
EVALUATION OF AAFP'S PATIENT-CENTERED MEDICAL HOME NATIONAL DEMONSTRATION - The project was the first and largest "proof-of-concept" project to determine whether the TransforMED Patient-Centered Medical Home model of care could be implemented successfully and sustained in today's healthcare environment. The demonstration project also developed several new Web tools targeted at patient-centered medical homes.
** QUALITY IMPROVEMENT:
HHS LAUNCHES COMMUNITY HEALTH DATA INITIATIVE - To help citizens, clinicians and local leaders use data to improve health and value of health care, the Community Health Data Initiative will make increasing amounts of federally generated community health data publicly available, in easily accessible and useful formats.
** WORKFORCE:
HHS ANNOUNCES NEW $250 MILLION INVESTMENT TO STRENGTHEN PRIMARY HEALTH CARE WORKFORCE - The new investments, made under the Affordable Care Act, will support the training and development of more than 16,000 new primary care providers over the next five years.
DOL AWARDS $14.7 IN HEALTH CARE CAREER GRANTS: L.A., S.F. & FRESNO INCLUDED - The grants will support projects designed to provide health care training and virtual service-delivery models.
** UPCOMING EVENTS:
For information
on all events, or to post your own notices, visit the Voice Calendar
July 1 - Free eHI Webinar: National Progress Report on eHealth
July 1 - CPCA Supervisor Skills Brown Bag Online Training Series - Runs Tues & Thurs in July
July 2 - ONC Call: Temporary Certification for EHRs (providers calls)
July 6-7 - NACHC Corporate Compliance Training in L.A, includes updated DVD Compliance Toolkit!
July 8 - CA eHealth Statewide Monthly Stakeholder Conference Call
July 9 - 4th Annual Health Information Exchange Conference, hosted Redwood Mednet, Santa Rosa
July 16 - La Maestra Community Health Center's Grand Opening, San Diego
July 19-20 - Healthcare Unbound: Conference on Telehealth & Other Care Innovations, San Diego
July 19-21 - 340B Coalition Conference: Improving Access to Pharmaceutical Care and Ensuring Compliance, Washington, DC
July 21 - Greenhealth Academy Training: Infrastructure and Process for Sustainability in Health Care, San Diego
July 21 - Recognizing Bioterrorism Agents - What Physicians Need to Know, El Centro
July 22 - eHI's National Forum on Health Information Exchange, Washington, DC
August 8-14 - National Health Center Week
August 13 - CCALAC Policy Café: Federal Focus: Life After Health Reform, L.A.
August 16-19 - National Quality Colloquium, Harvard & Online
August 18-19 - QM2: Quality Transformation for Health Centers, Sacramento
September 2 - Prospective Payment System (PPS) Basic Training, Sacramento
September 10 - La Maestra Annual Golf Tournament, San Diego
September 10-14 - NACHC Community Health Institute & Expo, Dallas TX
September 15-16 - eHI Northwest Medical Informatics Symposium, Spokane
September 17 - Specialty Care Iniative Grantee Convening, L.A. County - Save the date, details TBA
October 3-10 - Health Innovation Week, San Francisco - Includes The Health 2.0 Conference and three co-located conferences:
National Regional Extension Center (REC) & Health Information Exchange (HIE) Summit West
National Electronic Health Records (EHR) Summit West
Fourth National HIPAA Summit West
October 7-8, 2010 - CPCA Annual Conference, Sacramento
October 15 - CCALAC Policy Café: California’s November Ballot, L.A.
October 31 - November 3 - Region IX Leadership Development Conference "Leading the Way in the Era of Healthcare Reform," Universal City
(Pre-Conference Intensives on Critical Issues Facing CHC Clinical Leaders; "Becoming a Recognized PCMH")
November 10-12 - Rural Health Conf: Collaboration in Challenging Times, Sacramento
CPCA's On-Demand Trainings - Take courses online at your convenience.
http://www.cpca.org/programs/ondemand
For information on all events, or to post your own notices, visit the Voice Calendar