**FTS-HRSA OA**

**Moderator: Debbie Comeau**

**January 16, 2008**

**1:00 pm CT**

Coordinator: Good afternoon and thank you for standing by. At this time,
all participants are in a listen-only mode until the question and answer
portion of the conference. At that time, if you would like to ask a
question, you can press star 1 on your phone.

I would like to remind all parties this conference is being recorded. If
you have any objections, you may disconnect at this time.

I would now like to turn the call over to your host today, (Sabrina
Chapel). Ma\'am, you may begin.

(Sabrina Chapel): Thank you, (Stacy). Hello (unintelligible).

Man: Oh yeah.

(Sabrina Chapel): (Unintelligible) speakers. (Stacy)?

Coordinator: Yes.

(Sabrina Chapel): We do have three speakers that will need to come off
of...

Coordinator: Mute.

(Sabrina Chapel): ...listen-only mode.

Coordinator: Okay. If they would just press star 0, I\'ll go ahead and
open their lines.

(Sabrina Chapel): Okay, thank you. So if our speakers are on, please
press star 0 and your line will be opened.

Woman: (Unintelligible).

(Sabrina Chapel): Okay. Well, good afternoon and maybe probably good
morning for some of us depending on your location. This is (Sabrina
Chapel) from the Georgia Health Policy Center here in Atlanta, Georgia.
In the room with me, I have several of our Georgia health policy members
\-- (Ethan Joslow), (Beverly Tyler), and (Amanda Martinez), and probably
some of our (TA) providers are also on the call.

We\'re very pleased to have you join us today for our quarterly
technical assistance call. And our call today is about health education
and outreach. And to more a little bit specific, our goal for today is
to assist you in addressing the challenges to enrollment and retention
of community members in health education programs.

To accomplish this goal, we have invited three wonderful speakers to
spend about 20 minutes to give you a basic overview of their program, to
discuss the barriers to community member participation.

And today they\'re going to share some of their best practices or
effective strategies to overcome that challenge. And then we\'ll also
have time for questions, answers, and learnings across our call today.

I\'m going to go ahead and introduce our guest speakers today. We have
four guest speakers. We have Heather Findlay and Miguel Cortez. They are
coming out of the Family Health Centers in Washington; (Calvin Young)
from Healthy Communities of Louisiana out of Ruston, Louisiana; and
(Mary) Dogotch \-- Margie, I\'m sorry, excuse me, Margie Dogotch, and
she\'s coming out of Hood River, Oregon, the Family Health Center.

Everyone should have received at this point three Word documents. These
documents relate to La Clínica del Cariño\'s organization and Margie\'s
presentation.

If you do not have these materials, these materials are posted on the
HRSA Rural Health web site. As well, you are - you will be able to
access the recording of this call. There will be an audio replay
approximately one hour after this call. And the audio replay information
is available on your flyer. If you don\'t have that number, please feel
free to email me. I\'ll be more than happy to assist you with that.

So without any further delay, and again, hopefully all of our presenters
have pressed the appropriate buttons and they\'re able to speak. If not,
we\'ll get (Stacy) to further assist us with that.

I want to thank each one of our speakers. Again, (Calvin), Heather,
Miguel, and Margie, thank you so very much for your willingness to share
your lessons learned and your experiences with us today. We\'re really
pleased to have you on our call.

We\'re going to start our call with a presentation from Heather Findlay
and Miguel Cortez. I\'d ask that everyone would hold your questions
until the end of the call. Make sure you place our phone on mute. And
Heather and Miguel, the floor is yours.

Miguel Cortez: Well, thank you very much. Good morning, everybody.
We\'re glad to join you in this teleconference. And looking at the
outline for the presentations (unintelligible) the program goals and
objectives that we have.

The main goal for our outreach is to increase access to high quality,
comprehensive health services for migrant, seasonal farm workers and
their families.

Among - to support that goal, we have eight objectives. The number one
is to develop health education activities and basically to that
community, including fields and orchards.

The second objective is to produce culturally and linguistically (ready)
programs to reach the community. And we want to increase the numbers of
orchard workers to our clinics.

We want to improve early entry into prenatal care. We want to increase
the receipt of (MMS) services. We want to increase compliance with
immunizations. We are developing Spanish language childbirth education
classes. We want to provide cultural competency trainings for all staff.

And then we also have a second goal, which is to increase the
sustainability of health promotion activities for the Latino migrant
seasonal farm worker population in Okanogan, Washington.

For that, we have two objectives. One is to develop and to implement
revenue generation plan, taking funds from local county and state
governments, private foundations, corporate giving, and individual
contributions.

The other objective is to receive qualitative and quantitative program
evaluations through the three-year program period.

So for that, for the first goal, we need to document and we need to come
up with ways to measure our accomplishments and the same thing for goal
number two.

Following the outline of the presentation, we move to target population.
We\'re reaching out to Hispanic/Latino migrants and seasonal farm
workers in Okanogan County.

This - the second part of the presentation has to do with a description
of educational curriculum, the outreach, the setting.

Basically we have curriculum and materials that have to do with to
support the objectives for goal number one, which is chronic conditions
such as diabetes prevention and treatment, prenatal care, pregnancy,
immunizations, how to properly schedule medical appointments at the
clinic, how to avoid unnecessary visits to the emergency room.

We want to promote physical activity. We want to decrease obesity,
promote, nutrition, (decrease) injury prevention at work. We want to
promote some kind of a educational community awareness programs. We want
to increase other agencies, we want to encourage them to provide
cultural and linguistic - linguistically appropriate services.

We\'re - we want to increase ladies to be aware of breast exams and how
to go about it. We want to coordinate services, provide access to care
with specific services. We want to work with alcohol, substance abuse.
We want to work with that among the adolescent population and certainly
STDs and HIV.

For the second, the setting is the orchards, the labor camps, the
community at large. Our methodology includes health information events.
In addition to health information, we want to implement health education
events, Spanish radio health programs, cultural training. And basically
for the outreach and recruitment strategies, we\'re doing this through
the (Promissora) program.

For the second part of the outline of the presentation, I really don\'t
have much to say since we are not there yet.

Any questions so far?

Hello?

Coordinator: If you would like to ask a question on the phone, please
press star-1 now.

One moment, sir.

Miguel Cortez: (Unintelligible).

Coordinator: No questions at this time.

Miguel Cortez: Hello?

(Sabrina Chapel): Hello, this is (Sabrina Chapel).

Miguel Cortez: Yes, any questions? I\'m kind of done.

(Sabrina Chapel): Yeah, Miguel, we\'re going to save questions till the
end of the - today\'s - all three presentations. Is - does Heather have
any additional information she would like to share?

Heather Findlay: I could just add a little to what Miguel said, just
maybe more a higher level view.

We received the first year of the outreach grant last year, of course,
partway into the agricultural season. And so Miguel - so at our center,
for instance, right now and over the last few months, Miguel\'s been
really working on the evaluation portion.

And we - so we did a little bit of work out in the fields as Miguel
described for - like last August and September. But what we - and we
were able to hire two (unintelligible).

And so a lot of that work started. But we\'re really gearing up to have,
you know, much more activity and a stronger outreach program probably
starting up in about April.

We were really fortunate with our community here, the Public Health
Department and one of the local hospitals have already been working
together and we\'ve been part of that as well.

So there were already some really strong community relationships built.
So that really a, you know, if I\'m thinking of challenges that other
organizations might have, that I think would be a real good starting
point is to develop those relationships because that\'s really what has
allowed Miguel and the rest of the outreach program people to be able to
move forward and just dive into the program so quickly, you know.

And they certainly went out and have made direct contracts with orchard
owners and, you know, some of the growers. And so that, you know,
that\'s one thing that I was really observing that it\'s so important to
develop community relationships and that, you know, you can\'t just sort
of design a program and implement it.

It\'s really based on conversations and connections. And so, you know,
Miguel\'s been a really strong, you know, person to be able to do that
because he already also had connections in the Latino community here
through other programs that he\'d been working on.

So we really had a foot up in that regard. And so that I think was a
pretty, you know, we were able to overcome that barrier mainly because
of those important relationships.

And so the other thing, too, that we have going here are in the schools,
the Latino parents have these parent advisory councils. And so that was
one type of community group that was of the Latino and Hispanic migrant,
seasonal populations.

And so they already had been coming together for certain purposes. And
we were able to tie into that and take our program and our information
to them, you know.

So that was another target audience that we were able to reach, because
that\'s so important is how do you at a health center come up with a
program and then, you know, actually to get buy in and participation,
you really have to connect with those community members, who might not
be all that familiar with our health center or used to getting
healthcare in that, you know, in that form.

And so the other piece, too, that we have here is a group called Fuerza
Latina. And so that is another sort of a - just a civic group of the
Latino population. And so they are really involved in wanting to know
what we are doing and how we\'re doing it.

And they gave us a lot of input on what they\'d like to see, what are
their health issues, what are their concerns. So we take - you know, and
we were able to use that as input for our grant, you know, and also in
designing the program, we\'re trying to address those concerns that they
themselves have brought forward to us.

So, you know, I think that would be all I would need to add. Miguel is
definitely the driver of this program. And I\'m, you know, trying to
provide administrative support and all that.

But really, Miguel\'s done a great job of just putting this whole thing
together for us. And we\'re really excited about it and we\'ve certainly
got a lot of excellent community feedback so far.

(Sabrina Chapel): Well, again, this is (Sabrina Chapel). Thank you,
Heather and Miguel, for your presentation. And again, we\'re going to
open it up for questions towards the end of today\'s call, just so that
we can stay to the time limits here. So hopefully everyone has written
down their question and can ask Heather and Miguel their questions at
the end of today\'s call.

We\'re going to go ahead and move to the second presenter. That is
Margie Dogotch. Margie, the floor is yours.

Margie Dogotch: Is my line open? Do you hear me?

Woman: We hear you, Margie.

Woman: We hear you loud and clear.

Margie Dogotch: Great.

Woman: Thank you.

Margie Dogotch: Well, I\'m joined this morning by (Ebereso Romero), also
who\'s going to help me present our part. I think I\'ll talk about the
program overview section, and then when we get to recruitment and
retention, I\'m going to - (Ebereso)\'s going to address that part
because he\'s one of the primary facilitators with our group.

We\'re located in Hood River, Oregon. We have a partnership with another
real active community organization, The Next Door, which I think has
really contributed to our project.

The big overview goal was Step to Wellness is intended to improve the
emotional and physical wellbeing of our rural community residents by
providing individual and group support and education to people with
diabetes and obesity.

And then we have four goals under that. I won\'t go over all four of
them. The three of our program goals, however, we designed our groups to
address those three, so I will cover those.

One of the main reasons for the groups was to improve participants\'
ability to manage their diabetes and obesity - and/or obesity, address
mental health issues that impact participants\' self-management of
diabetes and/or obesity, and improve the recognition and the importance
of physical activity to mental and physical health and support the
development of group and individual exercise plans.

Our target population was a little different than the case management
part of our program, which required the participants to be actual
patents at our clinic. And we opened the groups up to the entire
community, although I will say in keeping with the mission of our
community and migrant health center, our grant had a special emphasis
with serving, you know, low income, uninsured, underinsured, and
especially the Hispanic residents of our community.

Curriculum I think is a real key, key of the retention actually in our
program. We designed it using a popular education methodology. It\'s a
combination of information, tools, support. We have a fall series of 15
weeks and a spring series also of 15 weeks. We do them in both English
and Spanish at two different times.

The key thing with the popular education model is it\'s (unintelligible)
model based on the belief that a given group possesses within it much if
not most of what it needs in order to make changes. So with that in
mind, the groups are structured in a real interactive way with
activities that are designed to develop group rapport and support.

Also key I think is both of the facilitators of (unintelligible) are
(lay) health promoters who function has participants in the group also,
sharing their own efforts to make healthy changes in their lives. And I
think that also contributes.

So that\'s the end of my section. So (Ebereso) will talk about our
recruitment and retention challenges.

(Ebereso Romero): Oh, hello. I am (Ebereso) and I\'m a - one of the
(unintelligible) here in Hood River, Oregon. And first I will talk about
recruitment and then I will talk about retention.

About recruitment, recruiting within the English speaking population has
been harder. But we (unintelligible) has been very active in the
community outside of our work environments has been very helpful because
we are able to hook up with people in the community and we were able
overcome the problem with the Spanish-speaking population.

They - we had had (unintelligible) problem of forming our groups with a
Hispanic population being much easier (unintelligible) clinic
(unintelligible) are very happy to have us, you know, (unintelligible)
to attend one of our groups.

And once we are - we went to the first two sessions in 2006, we started
to receive referrals within the participants that were (unintelligible)
groups, so they themselves are referring other people to us and to the
point that sometimes we have more than we can handle.

So this - to this point, to this day, we have not needed to promote our
program in the local media. More than that, we have been even here
putting people on the waiting list for the following classes.

And we use readiness assessment in (unintelligible) to emphasize the
(unintelligible) when we are recruiting and with our goal of ensuring
that participants truly understanding and getting ready to make changes
that they are expected to make, you know, or to commit to when they
attend the group.

And sometimes the recruiting (unintelligible) they allow us time to
assess the readiness of the participants. So in other words, when we
started recruiting one month in advance before started the group in
order to process the readiness assessment, the intake, as well as
processing the lab appointments and lab results the participant gets at
the end as well as - at the beginning as well as at the end of the
program.

The entire program is free, include those lab exams and measurements and
exercise evaluations. That\'s about recruitment.

Regarding retention, the (unintelligible) curriculum is very
interactive. We (unintelligible) a lot of - or use a lot of visuals. And
it\'s very participatory. We pretend and use (unintelligible) evaluation
plans, all to support the group bonding or the bonding of the group.

The group always meets in a circle in order to feel more supported by
each other. And it\'s more dynamic in that way. And with the
(unintelligible) they were very well known in the community. Again, this
has been working very well.

And one thing has been working good for us is that one of
co-facilitators is a male, myself, and the other one is a female. So
this I think is a good balance.

And we invite several experts to share information. For example,
(unintelligible), a nutritionist, a psychologist, (unintelligible), and
so forth (unintelligible) also.

And this mix of expert guests and peer facilitators has been working
very well. Information is presented in a mix of demonstration,
(unintelligible) setting in diabetes classes.

We have (five) classes on nutrition and five classes on mental health,
two classes on (unintelligible) and one class on diabetes.

Exercise is more (unintelligible) in only one of the classes. But we do
20 minutes of exercise on every class that we do, all settings. But
participants are allowed to share their weekly goals and to set new
goals for the following week. And on every class, we do that.

In the location of the class is highly rated by the participants as they
find the place, the location, very safe, easy to access. It\'s a large
place. So they are very happy with it. And we have (unintelligible)
parking lot. Participants are very happy with the site where the
information is presented.

And we provide healthy food on every class and also (unintelligible). We
also allow children to attend. So those children are like 8 to
10-years-old, you know. And we do (unintelligible) to each participant
on every week prior to the - like two days prior to the class.

Okay, so I think that\'s all I have to day, unless she - Margie has
something else to (add).

Margie Dogotch: Well, the only thing I would want to add is (Ebereso) is
a bit modest in when he talks about the health promoters being well
known in the community. I really identified with I think it was what
Heather said earlier about the developing relationships in the community
and developing connections is being really important for the success of
programs.

And I think our choice for the two facilitators for our groups was
pretty key in that. Between the two of them, they have very deep, long
connections throughout the community and it\'s been a huge factor in our
ability to attract people to our program and keeping them in the
program.

(Ebereso Romero): Okay, any questions.

Margie Dogotch: Any questions?

(Sabrina Chapel): Well, I know people are probably just dying to ask
questions. This is (Sabrina Chapel) again from Georgia Health Policy
Center.

Margie Dogotch: Okay.

(Sabrina Chapel): And I know I\'m writing down some questions here to
ask you all. But again, we\'re going to ask that everyone kind of holds
their questions just to the end of our last presenter.

(Ebereso) and Margie, thank you so very much for your presentation. Very
enlightening and I look forward to questions from the rest of the group
at the end of our call.

((Crosstalk))

(Sabrina Chapel): ...on to our last presenter, last but not least,
(Calvin Young) from Ruston, Louisiana, Healthy Communities of Louisiana.
(Calvin), I\'m going to go ahead and pass the mic to you.

(Calvin Young): Okay, can you guys hear me?

(Sabrina Chapel): We can hear you loud and clear. Thank you.

(Calvin Young): Okay, good.

Yes, I\'m (Calvin Young) with the Health Communities of Louisiana, The
Obesity Project. And we are a program, we are a health education and
preventive services program.

And I\'ll just read you a couple of our goals. We have a number of goals
\-- I won\'t go into all of the details \-- to encourage the adoption of
heart healthy eating patterns and physical activity habits that will not
only help prevent or reduce the prevalence of overweight and obesity and
their related cardio health disease risk factors in adolescents and
adults, and to reduce the prevalence of elevated blood glucose in the
target populations of at-risk adults in Bienville, Lincoln, and Jackson
parishes, and thereby contribute to reducing diabetes morbidity and
mortality rates, and to develop a comprehensive, culturally sensitive
health education and screening program to increase the at-risk
population knowledge of health education through an intensive,
faith-based family, community, and school-based health literacy program.

And in year three, we will develop a community health education,
research, and disease prevention center (unintelligible) that will be
community and church-based (unintelligible) local HBCU to ensure
sustainability. HBCU is historically black colleges and universities.

So what we have is a health education program. Our target population is
predominately African Americans. We have about 99% African Americans
that we service. We target people, individuals in three parishes \--
Lincoln, Bienville, and Jackson parishes here in Louisiana.

A little bit on our program \-- we are a multi-pronged program. Number
one, we do outreach. We go out into the community and any place we can
find individuals that are at risk \-- barber shops, beauty salons,
daycare centers, recreation, you name it \-- we go out and we do
outreach (unintelligible) screens.

Now those screens are designed to look at individual values, to let them
know that most of them are living with silent killers (unintelligible)
hypertension, diabetes, and obesity.

And what we do is we go out and we measure blood pressures. We measure
glucose. We do percent body fat and BMI. And once we do that, most of
our individuals as you know are at risk and (unintelligible) at-risk
populations, so they would have adverse numbers.

So we show them those numbers in order to get them to start to think
about their health. Their blood pressure more than likely will be
elevated. Their glucose could be elevated.

A lot of them will have high BMI/hip ratios, very high circumferences
and that kind of stuff. So we look at those values, show it to them, and
we get those values to convince them to come into our center, which is a
health education center.

Now once we convince them to come into the center, we give them a little
more extensive tests and that kind of stuff. So once we get them in the
center, we give them a more extensive test and a whole workup.

Once we give them that workup, we\'ll talk to them about social issues.
We\'ll talk to them about their living conditions. We\'ll to them about
insurance. We\'ll talk to them about insurance. We\'ll talk to them
about their family doctors, these kinds of things.

But most importantly, we will pretty much assign them to a health
education plan. So if the individual comes in with high glucose levels
and high blood pressure, they\'re assigned to our diabetes education
plan and our hypertension education class that is facilitated by a nurse
educator. Okay, so that\'s the way we get individuals in to the classes
and that kind of stuff. And so we don\'t have any problem that way.

Also at the beginning of our projects, we did a big, big media blitz.
And I would encourage anyone to put that in their particular proposals
to have funds to do a big, big media blitz.

I\'m talking about PSAs, all kinds of on the show, on air, radio shows,
TV, whatever you can do, signs, posters, whatever you can do, a big
blitz. And we did that the very first year and we had a lot, a lot of
people to come in. I mean, we just was flooded with people coming in. At
the same time, we was going to the churches and we was doing all our
outreach.

But the particular - the peculiar thing about our population is that we
are housed in actually Grambling, Louisiana, which is a college
university town. Now in particular because in this particular town,
there is a haves and have-nots section of the town.

And what happens is that we were finding that the have or the
bourgeoisies or the upper class people, professors and all these kinds
of people, they were not accessing our program.

Now that\'s not really necessarily our population, but we would like to,
you know, see why. So we did a little research and stuff. And we find
pretty much that what it - what happens with that particular group is
that they see the program as a - kind of a hand out, a public health
type thing, so they did not want to be associated with being a consumer.

But they - so what we did was we used them as individuals to help us get
the other populations. So they not necessarily want to be a consumer,
but they would love to have black tie events.

They would love to put out fundraisers. They would love to assist us in
getting to the real population we need. So we kind of handled that
problem right there and got them very much involved.

The next thing is that when we open our doors after the big media blitz,
we find that with the African American population and our population,
you have to always stay on target and stay on your audience.

You can never think that because you get a big media blitz this month
that they going to continue to come three, four, five months later. You
have to continue to put the word out there.

You have to continue to be in their face with good advertising, social
marketing, these kinds of things, because they tend to forget, you know.
You can talk to a group and later they tend just to kind of forget. So
you have to stay on top of them that way.

Now some of the modalities that we use that are very effective in for
what we have, number one is we use a - I guess you could say a community
advocate. We go into the community and find a man or woman that has a
lot of respect in the community and someone who is health conscious.

And it\'s really good if they come to you. That\'s what we do, you know.
We sit back and let them come to us. That means that they are very
motivated. So we have several that came to us, said what can we do to
work with you guys?

And we trained them. We sent them through lay training, this kind of
good stuff. And we let them go into the community and get the clientele
and get the population going and stirred up. And we find that they work
very well. We get them out of churches. We get them out of social clubs,
community groups, and (unintelligible).

So the modalities that we use, we use a lot of - as you know, our
program has a big media component. We do a health and lifestyle radio
show once every week.

And on that particular show, we have a real world radio show where we
talk about health education issues just like the client was in our
office, okay? It\'s a real health education session and we talk about
obesity, diabetes, cardiovascular disease, and whatever we\'re talking
about. So we have that particular show that comes on once a week.

We do a lot of PSAs, some great PSAs about prostate cancer and disease,
about obesity, diabetes, and we use our health educators and myself and
others to actually reach these, present these PSAs on radio. And they
are very, very fun, very, very upbeat, and we get a lot of compliments
on that. So we keep the media going that way.

Also we do a lot of stuff in the faith-based community. We have about 50
churches that we service all the time. And we go out and we do all kinds
of screenings in the church, which brings in our populations, you know,
(unintelligible) bring their congregants to our center, this kind of
stuff. So we get participation that way.

Now let\'s see, we also go to the schools. We were kind of lacking in
going to the schools because of the thing in the schools and they\'re on
tight schedules and trying to meet the testing schedule and stuff like
that.

So we haven\'t been doing a whole heck of a lot in the schools and the
school populations, but we find that same population in after school
stuff and also on weekend stuff. We have a group down in a little, small
community where we have a great, great leader down there in Bienville
Parish in little group called (City Grove). And they are just wonders.

And they have a lot, a lot of young people in that community. And we do
a lot of our adolescents and young people-type programs in that
particular community. And we find it to be very, very successful.

Let\'s look at - well, I guess you could say some of the barriers, some
of the barriers at first were the ones I mentioned. You know, we have
(unintelligible) of socioeconomic people here.

The more socially challenged people really participate in the program
very well. The ones that are real economic depth or had a little more
money, these kind of things, didn\'t participate in our program as much
and we used them in other ways.

The other thing is that with our populations, we find that you always
have to stay on top of the game and you have to (unintelligible) to them
all the time about the program. You\'ve got to be fresh and that kind of
stuff.

Another thing that we do is we do a lot of (unintelligible) based stuff.
We have - we use (Prochaska)\'s theory of change. And we find what stage
these individuals are in in our program.

As soon as they come into our classes, we run them through this
particular battery of tests and find what stage they are in \--
pre-contemplators, contemplators, are they ready and whatever. So
therefore, we are able to design programs that (unintelligible) we
don\'t waste a lot of time.

People that are not ready, to be honest with you, we don\'t waste a lot
time on them. Once we schedule them and once we test them, if they\'re
really, really not ready, then we give them the information, we give
them everything they need and let them kind of sit back and make their
mind up.

Also we did a community readiness profile. And I have a great model I
can send to you guys from Colorado University. And we actually looked at
the community and see if they were ready for this kind of program, you
know?

We found that our community was in a stage of kind of semi-ready and
some even had resistance to the particular program because they didn\'t
pretty much understand what was going on.

So that\'s pretty much what we do. Like I said, most of our programs are
targeted to diabetes and weight loss programs. We have eight-week
programs for each one of those, diabetes health education class. We have
a hypertension health education class, prostate cancer, and one for
cardiovascular disease (unintelligible).

And we use state-of-the-art curriculum, use it from the American Heart
Association, American Diabetes Association, the NIH, and this kind of
stuff, that\'s been field tested and these kind of things. And we also
kind of support our population (unintelligible).

But we haven\'t had too many, many major obstacles. We have been able to
overcome most of them. We have a great coalition known as the (North
Louisiana Primary Prevention Coalition), a group of about 17 individuals
representing eight or ten agencies that we have quarterly meetings and
we talk about things and we talk about recruitment and retention, we
talk about sustainability and how the program would work, so we get a
lot of support from there.

We are part of the city of Grambling, so we get support from the city
and the mayor\'s office and this kind of stuff. And by us being in a
university town, we\'re always on campus recruiting. We go to football
games and we go to all kinds of things like that, tailgating parties,
and we recruit individuals from those kinds of settings also.

So we are just out there beating the bushes as best we can. And we\'ve
found - we are in our third year. And what we have found is that we\'ve
just about accessed most of the population that really wants to be
accessed.

We are now attempting to look at a way to access what we will call the
bottom of the barrel, individuals that are just at the lowest rung of
Maslow\'s hierarchy of needs, those individuals that\'s got all kinds of
needs.

We\'re attempting to find ways to get to them because they\'re the ones
that most (unintelligible) these are the ones that are hardest to get to
because they have so many social problems.

There\'s so many social services they need to interact with. There\'s
all kinds of things, economic things going on with them. So we are
trying to develop a model to get to that group.

But most of the individuals in the three-parish area that really wanted
to access us have been through our center. We\'ve had thousands to come
through and we\'ve done thousands and thousands of screenings and health
educations out in the (field).

Okay?

(Sabrina Chapel): Thank you so much, (Calvin). Great presentation. And
again, I\'m going to thank everybody, Heather, Miguel, (Calvin), and
(Ebereso) for their - and also Margie for their wonderful presentations.

And I kind of just want to sum it up in my mind and then we\'ll toss it
out there for questions and answers. We\'ve heard a lot of great things
today on the phone and I\'m trying to capture as much as I can in terms
of some common themes that I\'ve heard across the speakers in terms of
what are some basic best practices or strategies that you all have been
implementing within your programs to get people in the door and to keep
them coming.

And so far \-- and if I\'m incorrect, please just correct me. I - what
I\'ve heard the speakers say is building community relationships and
partnerships are very vital to getting people in the door.

Quite often, these organizations are the one who can assist you in
referring people. They quite often are very well respected, working with
schools and advisory panels and also civic groups. Also you - many of
you noted that you get referrals from your participants who have
participated in the past or perhaps they keep coming back.

And my question for some of you all would be I\'d like to hear about,
you know, what are some of those participants saying. Why do they keep
coming back?

I believe Miguel or one of the other speakers talked about starting
recruitment early and not last-minute recruitment, and to keep people
using visuals, being very interactive, people being very attracted to
social networking and group dynamics, having to switch that up in
between your different sessions, and then also incorporating if you\'re
working with outreach workers or peer facilitators, ensuring that you
have an equal balance between male and female.

And obviously food is a great plus if you\'re able to provide it, and
then being able to have perhaps maybe some sort of childcare
arrangements or having the children attend the activities helps people
to come and keep coming back.

And having healthcare professionals partake in the events, perhaps help
to provide some of the education and screening and using a variety of
methods to even get the word out. Some of you talked about using various
flyers and mass media and a whole host of things to get people to learn
about your program.

What you brought about towards (the end of) the discussion today,
(Calvin), you added the importance to use theory into your activities
and your programs and be able to assess the readiness of the audience
that you\'re working with, and then as well as assessing the readiness
of a community.

So I think right there I probably listed at least 10 to 12 key
strategies that you all have mentioned here today. So hopefully you all
have noted some of those things down.

And I\'m now going to just open it up for question and answers. So
let\'s pose it up to the group.

(Stacy), do people need to press certain buttons to...

Coordinator: Yes, ma\'am.

If you would like to ask a question on the phone, please press star-1.
To withdraw your request, press star-2. Once again, to ask a question
from the phone, please press star-1.

(Sabrina Chapel): Okay, I heard someone beep in. Go ahead.

(Miguel): This is (Miguel) from (unintelligible) family health service.
I do have a question, though.

When it comes to recruitment and retention and also on access, when you
talk about one of the things that I\'ve heard is how you convince people
to come to the clinic.

So my questions to all of you is that besides the actual services they
receive, which is a great incentive, do you have any other incentives
that you\'ve given? For instance, gift certificates or, I don\'t know.
Do you have any of that?

(Calvin Young): Yes. This is (Calvin). Can you hear me?

(Miguel): Yes, (Calvin).

(Calvin Young): Okay.

We give out a - not so much gift certificate, but we give out a lot of
marketing things. We give out all kinds of little trinkets like
flashlights, umbrellas, portion plates for people (unintelligible)
weight loss classes.

We give out T-shirts. We give out fans for churches and these kind of
stuff, the little hand fans that they use in a lot of the Baptist
churches around here. We give out a lot of the water bottles with our
logos.

And all of this stuff was - got our logos and our name on there as
promotional items. Hand sanitizers, a number of things, stretch balls.
We got a stress card that people can put their hand on and tell how
stressed they are and this kind of stuff. It\'ll register their stress
levels.

So we give out a lot of stuff like that. For the kids, pencils and pens
and a lot of that kind of stuff that\'s got our advertising right there,
a telephone number and that kind of stuff.

(Miguel): Thank you very much.

(Calvin Young): Okay.

(Sabrina Chapel): Would anybody else like to address that question, any
of our other speakers?

Woman: (Unintelligible).

(Sabrina Chapel): Or any of the other people on the call? Again, star-1
will permit you to be heard on the call.

Coordinator: (Carrollton Blanton), your line is open.

(Carrollton Blanton): Okay.

What I wondered \-- this is for (Calvin). (Unintelligible) the
incentives that you have for the program...

(Calvin Young): Mm-hm.

(Carrollton Blanton): ...are you able to work with the pharmaceutical
companies or are you working with - what - who are your partners that
underwrite the incentive costs?

(Calvin Young): Yeah, some of the partners who underwrite the incentive
costs, we have a number of them. We have (unintelligible) you know this
a network, right, outreach, and so it\'s an outreach, so we have
partners.

We have the American Medical Association, the National Medical
Association partners. We have local partners with the Association of
Black Nurses. Let\'s see. We use our City of Grambling partnership.

We use just individuals within the town and city, Chamber of Commerce,
these kinds of things like that. We actually use those to underwrite
most of our costs for incentives and those kinds of things.

(Carrollton Blanton): Okay.

And how long has your program been established and providing the service
to the community?

(Calvin Young): We are in our third year. Particularly this program, we
are in our third year.

(Carrollton Blanton): And what is the - I guess the population that you
carry right now as far as the (unintelligible) but what is the I guess
demographic numbers?

(Calvin Young): Mm-hm.

You mean the population - oh, of the target population what numbers are
we seeing? Which one (unintelligible) you asking?

(Carrollton Blanton): Well, both. The population of the community as -
that you\'re serving...

(Calvin Young): Mm-hm.

(Carrollton Blanton): ...and the people who are retained in your
program.

(Calvin Young): Now the population of the community we are serving,
we\'re up in North Central Louisiana, not down south near New Orleans.
We are up in North Central.

We service these three parishes, Bienville, Lincoln, and Jackson. And
that is well over probably 100,000 people, all of those three parishes
that are in that whole service area.

Our target population is African Americans that are at risk, which
brings it down to probably around 40-some thousand people in the area.

We typically I guess in a year, we do something around about 10,000
contacts and people. I\'d have to look at our evaluated report, but
somewhere around 10,000, 20,000, 30,000. It\'s up there from people that
we contact in the community, out in the streets, and come into the
clinic.

Now with our on-air program, every time we are on air, we probably hit
at least 70,000 to 100,000 people on the air every time we have a show.
So that\'s kind of hard to monitor, but we\'ve been monitoring it
somewhat.

But we have (unintelligible) coverage on air and we have been getting
out in the streets doing a lot of population density stuff in the
streets. And like I said, we do the football games.

As you know, Grambling State University at the home football games,
that\'s 15,000 to 20,000 people. And we are out there at the tailgating
parties where you have some 18,000 people sitting out there all the
time. So we are going through a number of people throughout the year.

(Carrollton Blanton): Okay, thank you.

(Calvin Young): Okay.

(Sabrina Chapel): Let\'s keep those questions coming.

All right, someone just dialed in?

(Miguel): Hello, this is (Miguel) again.

Would any of you elaborate more on evaluation indicators, outcome
measures, perhaps some specific examples?

Thank you.

Margie Dogotch: This is Margie. Can you hear me?

(Miguel): Oh, hi Margie. Yes.

Margie Dogotch: Okay.

In terms of evaluation, and I - actually that was something I thought we
should\'ve mentioned. We do a lot of evaluation with the groups that we
run and we ask for a lot of feedback from our participants and we, you
know, we tally it at the end. And that really helps us a lot in terms of
designing our groups. And we\'ve done a lot of changes with them as a
result.

In terms of outcome measures, we also do a fair amount of that with our
pre and our post. We do a lipid panel, a blood sugar, and a hemoglobin
A1c if they\'re diabetic.

That gets done pre and post. We do their weight, their waist
circumference, and their blood pressure. And then we look at all of
those again at the end. And we had somebody design a little Access
database for us so we can track our - the changes and compare it with
the goals that we had, for example, around weight loss, our goal
(unintelligible) the participants that completed the series would have a
25% weight loss.

And right now, what we\'re reaching is - and that\'s up 5% to 10% \-- is
about 39% are actually accomplishing that in the 15 weeks of our group.
And we look at each one of those measures.

We also do an exercise evaluation around exercise tolerance. That one\'s
a little harder for us to evaluate. We do a 12-minute (Cooper) walk
test. And there\'s a lot of variables that make it difficult to - for me
to feel like we\'re standardizing that very well.

And our primary goal with the exercise is just to try and get people to
develop exercise plans. I\'m less concerned about people being able to,
you know, up their intensity. I\'m more concerned with them getting out
there five days a week and doing something.

So we really focus on the modeling of that particular one, including
exercise, in each one of our groups and that sort of thing. So I
hesitate to even kind of look at that one. But the other ones we feel
more competent with what we\'re seeing.

(Miguel): Thank you. That\'s great. I really appreciate that.

Margie Dogotch: You\'re welcome.

(Beverly): (Calvin) and Margie, this is (Beverly).

Margie Dogotch: Hi.

(Beverly): How are you doing today? And appreciate your doing this.

I have a question for both of you. Both of you mentioned doing readiness
testing for people.

Margie Dogotch: (Unintelligible).

(Beverly): What do you do when - if you did the readiness testing or
assessment and people aren\'t ready? Do you just sort of not bring them
into the programs? Or do you try to have somebody that moves them to
ready?

(Calvin Young): Yes.

When you find people that are not ready, pre-contemplators, that for all
of the readiness scale, for our (Prochaska)\'s scales of change, there
are interventions for all of them.

The not-ready folks, there are special interventions for them to attempt
to get them ready. People that are sort of ready, there\'s a special
intervention for them.

For people that are really ready, there\'s an intervention for them. And
people who are actually doing something, there\'s an intervention for
them. So we have an intervention designed for each one of those stages.

We don\'t just let them go off into the sunset. But the key is is that
the interventions for the ones that are not ready, we don\'t - because
of the time and because of the cost and these kind of things, we don\'t
put a - as much emphasis on getting them ready as people that are ready
to go because we have X amount of time, we have X amount of monies and X
amount of people, so we have to service people that are really ready to
go and plan on going.

(So) there are things that we do for the pre-contemplators to try to get
them ready. And it\'s mostly about education and changing their mindset
and these kinds of things.

Margie Dogotch: And for us, (Beverly), I - we\'re in the process
actually of looking at our readiness assessment tool. A lot of it is
just going through the process with the person. We hope they arrive at a
point where they understand they\'re ready or not.

We ask questions like are you ready to make changes in how you eat in
the next 30 days, are you ready to begin an exercise program, are you
going to have transportation problems, are you - you know, we kind of go
down the list.

In our case, we do have some other options. For some people, groups
don\'t work. Well, we have an individual case management program we can
offer them that provides more flexibility perhaps with their lives.

Or maybe 16 weeks is too much. They\'d like to just come and meet with
somebody for two or three visits and, you know, learn some strategies on
managing their weight. And we can offer that.

We\'ll ask people, you know, we say look, we\'re in a three-year
program, you know? If this is not quite ready for you now, would you
like us to contact you again when we do this series in the spring? And
sometimes people will say yes, put me on that list. It isn\'t going to
work for me now, but I\'d like to contemplate in the future.

The other thing we\'re toying with right now is changing our readiness
assessment. In fact, we\'ve actually started to do it. We\'re trying it
out now with our spring series is having our readiness assessment
actually be a readiness contract so that we go through and we explain
really carefully exactly what the program entails and then we list what
we as the Steps to Wellness staff commit to bring to the table and then
what we expect from the participant and go through that with them and
ask them if they think - if they\'re ready to commit to doing this. And
then they sign and we sign. And we\'ll see how that works. We\'re just
now beginning to do that.

I don\'t know if (Ebereso) has anything to add?

(Calvin Young): Okay, can you hear me? This is (Calvin). Can you hear
me? This is (Calvin).

Woman: Yes.

Man: (Unintelligible).

(Calvin Young): Okay.

Woman: We hear you, (Calvin), loud and clear.

(Calvin Young): Okay, yeah, I can add also for the people that are not
ready, like she said, we do have one-on-one counseling. Sometimes we
find these individuals are sort of loners.

They may not like to be in group sessions, these kind of things. So we
have one-on-one counseling for them with our health educators that they
can participate in.

Also sometimes these individuals are more of the type that likes to do
things on they own. So we have a special self-help series of all three
or four classes. You know, we\'ve got a self-help for obesity, a
self-help for hypertension, and it\'s a whole series developed by one of
our nurse educators. And we can actually give them this self-help series
and they can come in and bring the tests and bring things back at their
own choosing.

So that works very well also. We just give them the package and say go
at it. Here are the instructions. Here\'s what you need to learn.
Here\'s the goals and objectives. Here is the curriculum and this kind
of stuff.

And you can do it on your own. And when you get to - need questions,
give us a call, when you have problems with anything, don\'t understand,
give us a call, that kind of stuff.

So we do have that for some of the people who like the self-help-type
modality.

Margie Dogotch: (Calvin), would you be willing to share the self-help
things?

(Calvin Young): Sure. Sure. Definitely. No problem. We can give you the
modules for the self-help thing, yeah, uh-huh.

Margie Dogotch: I would be really interested in looking at those.

(Calvin Young): Okay. And who am I speaking with?

Margie Dogotch: I\'m sorry, this is Margie.

(Calvin Young): Okay, okay, then good.

Woman: (Calvin), I\'ll send you Margie\'s contact information.

(Calvin Young): (Unintelligible).

Woman: Okay.

(Sabrina Chapel): And perhaps - this is (Sabrina Chapel).

Man: (Unintelligible).

(Sabrina Chapel): Yeah, perhaps at some point we\'ll be able to increase
the number of information and resource exchange. We\'re looking at the
Georgia Health Policy Center to how we can help facilitate that process.

So it sounds like you all have some wonderful tools and there\'s a lot
of, you know, others out there who would like to reinvent the wheel, but
possibly adapt and - adapt for their programs. So that\'s more to come
and we\'ll - we\'re going to try to help facilitate that process.

(Calvin Young): Mm-hm. Okay, good.

Margie Dogotch: That would be very useful.

(Sabrina Chapel): Great, great.

Are there any other questions? It\'s approximately 3:02. We have the
call slated to 3:30, you know, given if there\'s enough questions. But
is anyone out - else out there in I want to say radio land or conference
land who would be interested in asking a - any questions?

Coordinator: Once again, from the phone if you would like to ask a
question, please press star-1.

(Amanda): I have a question. This is (Amanda) from the Georgia Health
Policy Center. And something that you all talked extensively about was
cultivating t hose community relationships and I heard you talk about
churches and schools and even in some instances like the growers or the
farmers.

And oftentimes those schools and churches and farmers can be difficult
partners to cultivate relationships with. So I\'m wondering if the
speakers have like a specific strategy or a way that they were able to
approach people to convince them to get onboard and support the program.

(Calvin Young): Yeah, well, this is (Calvin). Can you hear me?

Woman: Yes, we can hear you, (Calvin).

(Calvin Young): Okay, good.

We did have some challenges with the faith-based community as part of -
I guess of the culture. You know, we\'re here in the Baptist Bible Belt
and a lot of our pastors and clergy are sort of hard to break into that
particular group of individuals. But by myself being a minister, so I
had a little inroads in that way.

But what we did was we worked through the Ministerial Alliance. Again,
we used individuals that these particular groups respected.

Whatever group you\'re going to attempt to break into, find someone in
that group or someone who has some - that group has respect for. That\'s
the way we do it.

You know, if you\'re going in a group of nurses, if you want to deal
with a group of (unintelligible) people, because we deal a lot of stuff
with training beauty salons and barbers how to use blood pressure cuffs
and that kind of stuff and we put blood pressure cuffs and stuff in the
barber shops.

In the beginning, we couldn\'t get any, any participation until we found
a particular barber that had a interest in health. And he kind of went
around and told everybody and that kind of stuff.

So the best way to break into any of those special groups is to find
someone in that particular group that loves healthcare, that is a
go-getter, that is very well respected in the group and in the community
and attempt to convince that once individual to work on your behalf.

And that\'s the way we got into the churches and that kind of thing. We
got pastors that were very interested. And once we got a pastor that was
very interested, then everyone else quote/unquote kind of got the
jealous effect.

(Unintelligible), you know, this church was in the news all the time, it
was in the newspaper with us all the time, this kind of stuff. So
everybody else wanted to get on the bandwagon later. So I think use a
strategy like that.

Margie Dogotch: I agree with (Calvin) about really connecting with
people that are well respected in the community.

In our case, we - part of our model with working with health promoters
is to recruit health promoters who are already well respected in the
community. It makes a huge difference.

In our case, the two facilitators or the health promoters for our
program are each very active in their own church communities. And in the
case of (Ebereso), he\'s very active in the Catholic Church and was able
to recruit the priest to come through our program.

And the priest was then highly successful in the program, so he\'s
become a huge advocate for it, which has made a big difference in that
community.

Both them are just real active in the community in a lot of other ways
outside of their job world. And I can\'t stress enough if you\'re going
to do a community program, it\'s really important to have the people
running those programs already be well respected members in the
community. I think it makes a huge difference.

(Sabrina Chapel): Thank you, Margie and (Calvin) for that information.

((Crosstalk))

Coordinator: We have a question from the phone.

(Miguel): Yes, this is (Miguel) again. This is great information.

I have a question regarding working with the churches. Obviously it\'s
important to work with every denomination, most or all denominations as
much as possible.

But my question to you is besides approaching the priests and ministers,
do you actually have any activities in the churches or church
properties?

Thanks.

(Calvin Young): Yes. This is (Calvin).

Yes, we do. What we do is that we do screens at the churches. We attempt
to develop nursing guilds and (unintelligible) nurses in the health
ministries. We do health fairs at the churches and along with the
churches.

We sometimes put in blood pressure and glucose monitoring devices in the
churches and train a layperson or one of the church nurses how to use it
and that kind of stuff, along with a first aid kit.

So we actually do have things in the churches. We go to a lot of the
Sunday School Bible classes and this kind of stuff and do presentations
and those kinds of things.

And we actually have a presence in the church and by doing screenings
mostly and health fairs and those kinds of things and developing
awareness in the church or as a nursing guild or a health ministry or a
special Sunday where the pastor preaches about health and it\'s all
about health that particular Sunday. So those are the kind of things
that we do actually in the church.

(Miguel): Thank you.

Margie Dogotch: This is Margie again.

This is separate from our group program, but the outreach piece of our
grant that we do, we do go out into the orchards, especially during the
summer season when there\'s a lot of orchard work in our community.

One of the things that\'s made a huge difference for our access is the
(Latinica), which is - where we\'re based has had a program that
they\'ve developed for many years that during the cherry harvest we\'ve
worked with the growers to develop a relationship so that we can go into
the camps, go out into the orchards to provide information to workers on
access to healthcare issues.

And because of that relationship that\'s longstanding, it\'s made it
easy for us to also go into the camps to do other kinds of education
that we need to do, in the case of this grant, our diabetes and weight
management education.

So we\'ve - a lot of times, those relationships take years to develop
and are important relationships. And fortunately after many years, we
have good working relationships for the most part and makes our work a
lot easier. But it doesn\'t happen overnight I guess is my point.

Woman: Great.

Coordinator: We do have a couple of questions from the phone if you\'d
like to take those now.

(Sabrina Chapel): Yes, we would. Thank you.

Coordinator: Thank you.

Woman: (Unintelligible).

Coordinator: (Laura Washington), your line is open.

(Laura Washington): Hi.

(Unintelligible) I\'m from Demopolis, Alabama. And we run a rural
assistance program for churches and schools. And I wanted to just touch
on being able to do programs in the churches.

We\'re finding that a lot of people don\'t want to do anything if it\'s
going to take them off of their beaten path. Anything that they can do
while they\'re already involved in something that - with a healthy focus
is what they would want to participate in.

So what we\'ve done is we take a monthly calendar (unintelligible) the
church\'s calendar, and just one month, one day out of the month, maybe
on the - that they\'re having their weekly Bible study, we just ask for
one of those weekly Bible study nights where can come in and give a
healthy focus to their program, whether we talk about different health
topics and do health screenings.

And we have found that that helps us. So we\'re already - we kind of
have a date on their calendar already and they\'re already there and
they\'re willing to participate that way.

And as far as the schools go, we\'ve done basically the same thing
there. We\'ve gotten with the school nurse and the PE or the health
teacher and we just ask for the children\'s PE time one time a month so
that we can come in and deliver our services that way. That way we
don\'t - we\'re not taking them from their task. They\'re going to go
that class anyway. So that\'s the time that we use to deliver our
services.

(Sabrina Chapel): Thank you, (Laura).

We had another question, (Stacy)?

Coordinator: Yes. (Jane Wills), your line is open.

(Jane Wills): Yes, we were curious, are your lay health promoters
volunteers or are they paid? And do you compensate them for expenses and
travel and things like that?

Margie Dogotch: I assume that question is for me? I\'m Margie?

(Jane Wills): Yes, uh-huh.

Margie Dogotch: Yes, they are paid. And yes, all expenses are
compensated.

(Jane Wills): Thank you.

Margie Dogotch: Mm-hm.

(Sabrina Chapel): The other presenters can answer that question as well.

(Calvin Young): Yes, ours are paid also and expenses compensated also.

Woman: Are they paid while they\'re in training?

(Calvin Young): Yeah, we - for their time, for their - most of their
expenses and these kinds of things, that - we just take care of their
expenses.

Also we have a lot of volunteers that are not paid who do an excellent
job, like the community advocate types and (unintelligible) that just
want to do it for free.

These are mostly retired individuals that have a very - have had a very
successful life and career and they just want to give back. So we look
for those kinds of individuals a lot, those who just really want to give
back to their community.

Most of the time, they may have moved back into the community
(unintelligible) years of their retirement and may have gone off and
done very well and that kind of stuff and they are coming back to the
community and they want to give back and the people remember them when
they were younger and this kind of stuff and they just kind of want to
give back. So a lot of those are just straight volunteers and they are
not paid.

Woman: Thank you.

(Sabrina Chapel): (Stacy), do we have an additional question?

(Miguel): Yes, this is (Miguel) one more time.

For your volunteers, how do you deal with issues of liability?

Thank you.

(Calvin Young): Okay, well this is (Calvin).

Well, everything we do, we have a liability statement. Anytime anybody
participate in anything, our volunteers go through a training, a
volunteer session just like our employees. They - we sign contracts with
them (unintelligible). There\'s a liability statement, release of
liability that we sign for (unintelligible).

Also any time we have any kind of function, any type of activities, the
participants sign release of liability and these kinds of things. So
that\'s the way we do that.

You know, we make it known up front that we are not liable for any kind
of mishaps and these kinds of things. And they sign that before they
start doing anything. No one can participate in anything unless their
liability statement has been signed.

(Miguel): Thank you.

(Calvin Young): Mm-hm.

(Sabrina Chapel): Well, great. It - (Stacy), do we have any additional
questions?

Coordinator: There are none on the phone.

(Sabrina Chapel): Okay, well, thank you so very much for your
assistance.

If there are no additional questions and there\'s no additional
questions here from our Georgia Health Policy staff, we\'re going to go
ahead and conclude today\'s call.

Heather, Miguel, (Calvin), and (Ebereso) and Margie, thank you so much
for your willingness to share with us today. Your presentations were
fantastic and very, very motivating.

And I think that not only did the participants on the call today get
something out of it. I think we here, again, have found a, you know,
another great appreciation for what you do and have learned a lot today.

Again, just as a reminder that the audio replay of this call will be
available within the hour. And I\'m going to provide you all with the
number. That is 1-866-465-2115, again, 1-866-465-2115.

And again, the handout that we sent out via email is posted on the
hrsa.gov web site. And the information regarding our next call and topic
and content will follow shortly via the listserv.

Again, thank you all, including the presenters, for joining us on
today\'s call. And wish everyone to have a wonderful day.

All: Thank you.

END