#community health centers

[gpstudios]

Celebrating National Health Center Week: Honoring the Pillars of Community Health

National Health Center Week celebrates the vital role of Community Health Centers in providing accessible, high-quality care to underserved communities, improving health outcomes, and fostering community well-being.

Every year, during the first full week of August, communities across the United States come together to celebrate National Health Center Week (NHCW). This week is a time to recognize the incredible work done by Community Health Centers (CHCs) in providing accessible, high-quality healthcare to millions of Americans, regardless of their ability to pay. In 2024, NHCW runs from August 4-10, and it’s…

[hislop3]

Legislation Grab Bag

Within the normal news cycle, legislation often gets ignored, especially in this hyper volatile election cycle we have begun. I’m expecting very little in terms of reform or new legislation on important healthcare issues to come forward, and, so far, I’m right. With near gridlock due to small opposing majorities in both houses of Congress, compromise will be kicking the same can down the road, a…

[maryannmccarra-fitzpatrick]

For individuals who have no #insurance

#CommunityHealthCenters

https://health.westchestergov.com/services/community-health-centers

[scrollsofhumanlife]

Carolyn Epps nee Ford

Born November 16 1958 in Georgetown, South Carolina

Marrero, Louisiana

[impostorsshow]

I'm actually so obsessed with him it's not even funny if i'm not listening to a TikTok or music directly related to him I can't focus free me free me

This is @/cherubpuppet's OC for a object show [au? pitch? wip show? How do I categorize this] and I've been destroyed by the fact that ruler art is infinitely superior [and 10x longer] and i don't have a good enough grasp on lip gloss's personality to make fanfiction so I am frozen in "want make fanart but fanart takes effort :["

[transnonbinarysupport]

“Are you a transgender man, transmasculine, or nonbinary person who uses testosterone? Make a difference with LGBTQIA+ health research! PRIDEnet is conducting 1-on-1 interviews to understand transgender and nonbinary people’s experiences accessing healthcare related to their pelvic and sexual health. Examples include accessing healthcare for common genital infections (like bacterial vaginosis, yeast infection, and UTIs), genital atrophy, endometriosis, pelvic pain, and polycystic ovarian syndrome (PCOS), among other topics. Participants will receive a $50 gift card! Participation is confidential, online, and flexible to your schedule. Learn more and sign up at: https://goto.stanford.edu/tmgyn"

[macbxth-pdf]

Shout out to the ladies at the community center I go to who BLESSED IT with the dental dams. Cause why are dental dams so damn expensive!!!!

[creepyscritches]

Ouuugh fuck yes the opthalmologist said I appear to be a strong candidate for LASIK :3c gotta coordinate with my other doctors for their opinions, but just this year my eyes finally stabilized enough to even HAVE these conversations in the first place!!! It probably wouldn't be something I pull the trigger on for at least another year, but very exciting to not be eliminated as a candidate bc of my autoimmune stuff :') it was also super cool as always to learn how providers explain some of these conditions + procedures on a patient level then a clinical level. Eager to talk shop with the opthalmology SME on my team :3

[mxwhore]

can i just flex for a little bit and say that i love our mayor so much. like he could be embezzling funds like 90% of the other mayors in this shithole but id still forgive him

[religion-is-a-mental-illness]

By: Leor Sapir, Joseph Figliolia

Published: Nov 8, 2023

Fenway Community Health Center in Boston, the largest provider of transgender medicine in New England and one of the leading institutions of its kind in the United States, was named a defendant in a lawsuit filed last month. The plaintiff, a gay man who goes by the alias Shape Shifter, argues that by approving him for hormones and surgeries, Fenway Health subjected him to “gay conversion” practices, in violation of his civil rights. Carlan v. Fenway Community Health Center is the first lawsuit in the United States to argue that “gender-affirming care” can be a form of anti-gay discrimination.

The case underscores an important clinical reality: gender dysphoria has multiple developmental pathways, and many who experience it will turn out to be gay. Even the Endocrine Society concedes that many of the youth who outgrow their dysphoria by adolescence later identify as gay or bisexual. Decades of research confirm as much. Gender clinicians in the U.K. used to have a “dark joke . . . that there would be no gay people left at the rate [the Gender Identity Development Service] was going,” former BBC journalist Hannah Barnes reported. Rather than help young gay people to accept their bodies and their sexuality, what if “gender-affirming” clinicians are putting them on a pathway to irreversible harm?

Due partly to Shape’s lifelong difficulty in accepting himself as gay, his lawyers are not taking the usual approach to detransition litigation. Rather than state a straightforward claim of medical malpractice or fraud, they allege that Fenway Health has violated Section 1557 of the Affordable Care Act (ACA), which bans discrimination “on the basis of sex” in health care. In 2020, the Supreme Court ruled in Bostock v. Clayton County that “discrimination because of . . . sex” includes discrimination based on homosexuality. Citing this and other precedents, Shape’s lawyers argue that federal law affords distinct protections to gay men and lesbians—upon which clinics that operate with a transgender bias are trampling.

Shape grew up in a Muslim country in Eastern Europe that he describes in an interview as “very traditional” and “homophobic.” His parents disapproved of his effeminate demeanor and interests as a child. They wouldn’t let him play with dolls, and his mother, he says, made him do stretches so that he would grow taller and appear more masculine.

At 11, Shape had his first of several sexual encounters with older men. “I was definitely groomed,” he recounts. Shape proceeded to develop a pattern of risky sexual behavior, according to his legal complaint. He told his medical team at Fenway Health about his childhood sexual experiences, calling them “consensual.” The Fenway providers never challenged him on this interpretation, he alleges. They never suggested that he might have experienced sexual trauma or, say, explored how these events might have shaped his feelings of dissociation. (The irony is that Fenway Health describes its model of care as “trauma-informed.”)

As with the social environment they inhabited, Shape’s parents were “deeply homophobic,” he says. When Shape came out to his parents as gay at 15, they took him to a therapist, hoping that he would be “fixed.” But when he graduated high school at that same age, he moved to Bulgaria for college, and in 2007, at 17, he came to the United States for a summer program at the University of North Carolina. He later moved to Massachusetts to pursue an MBA at Clark University and immigrated to the U.S.

Though he had known about cross-dressers and transsexuals as a child (he had taken interest in Dana International, the famous Israeli transsexual who won the Eurovision Song Contest in 1998), it was only at Clark that he was introduced to the idea that some people are transgender. Other students began asking him about his pronouns and telling him about “gender identity.” After getting to know a “non-binary” person and a transgender woman, Shape started to make sense of his life retrospectively. As a boy going through puberty, he had developed larger-than-average breasts and was curvier than the other boys. It was hard for him to be accepted in the gay community, he told me, because gay men tend to value masculinity. His discomfort with social expectations about how men are supposed to look and behave, his sexual attraction to other men, his ongoing psychological and emotional distress: these were all signs, he learned from online forums, that he must have been “born in the wrong body.”

Shape quickly developed self-hatred and a strong desire to escape his body. When he started cross-dressing and presenting socially as a woman, things changed. It had been hard for him to win acceptance as an effeminate gay man, but he encountered far less hostility presenting as a woman. A subtle but important shift in his thinking took place.

“People wouldn’t take me seriously when I was a man who presented socially as a woman,” he says. “I had to actually be a woman.” Shape became immersed in online transgender culture, which told him that sex is a social construct, and that hormones and surgeries can actually turn him into a woman. As a result, Shape developed highly unrealistic expectations about what hormones and surgeries could do for him. An example noted in his legal filing: he stopped using condoms because he wanted to get pregnant.

Julie Thompson, a physician assistant and Medical Director of the Trans Health Program at Fenway Health, made no effort to perform differential diagnosis on Shape, his legal filing alleges. Shape told Thompson about his childhood sexual encounters, his troubled history of risky sexual activity, and his struggles with social and familial rejection on account of his homosexuality. Allegedly, she wrote these difficulties off as byproducts of society not accepting him as a “trans woman”—an approach known as “transgender minority stress.” Shape’s ongoing mental-health problems, it was determined, were due to “internalized transphobia.”

As Shape’s filing puts it, the Fenway clinic operated with a strong “transgender bias.” Every problem or counter-indication that came up was explained away as part of the stress that transgender people experience in an unwelcoming society. The clinicians at Fenway Health apparently assumed that sexual orientation and gender identity are two distinct and independent phenomena.

Shape was put on estrogen at age 23. According to his filing, he was not given “any explanation of the numerous potential adverse side effects of estrogen or its potentially unknown effects.” As Shape kept taking estrogen, he became even more emotional, depressed, and unstable. Notably, he did not dislike his male genitals—a fact that should have attracted more scrutiny from his clinicians—but seemed more distressed over his high sex drive and desire for intercourse with men. Though he says he frequently told his providers that he hoped “sex reassignment surgery” would reduce his sex drive, this statement did not cause them to reconsider whether estrogen was appropriate.

As the Fenway team allegedly saw it, Shape’s deterioration was evidence that he hadn’t gone far enough in his transition. They recommended that he attend First Event, a Boston-based conference held annually since 1980, where transgender people can meet one another, share ideas, interact with vendors, and find medical providers who will agree to perform procedures on them. Marci Bowers, the genital surgeon who is president of the World Professional Association for Transgender Health, has attended the conference in the past. According to Shape, the point of going to First Event was to find a surgeon who would operate on him.

He did just that, and in 2014, at 24, Shape underwent facial feminization surgery and breast implantation. Less than a year later, a surgeon surgically castrated him and conducted what’s euphemistically called “bottom surgery.” It didn’t work. As a result, Shape had to undergo several additional surgeries, the last one borrowing tissue from his colon. Still, the problems persisted.

It took Shape a few years to realize that he had made a terrible mistake. The problem he had been trying to solve all his life was not “internalized transphobia” but failure to accept himself as an effeminate gay man. His legal filing states that he had what the Diagnostic and Statistical Manual of Mental Disorders called, at the time he made contact with the clinic, “ego-dystonic homosexuality.” Because they failed to detect this and other mental-health problems, the Fenway team, argue Shape’s lawyers, “outrageously, knowingly, recklessly, and callously” led him to believe that he was really a heterosexual woman whose problems could be solved by de-sexing himself as male.

Shape was promised “gender euphoria.” Instead, he told me that he now sees himself as “mutilated.” His treatments have left him with “osteoporosis and scoliosis” as well as “mental fog,” according to his legal filing. Shape is now “faced with the impossible choice of improving his cognitive state and suffering the psychological and physical effect of phantom penis, or taking estrogen and suffering mental fog and fatigue, but no phantom penis and low libido.” He has also endured fistulas as a complication of his genital surgery and “suffers from sexual dysfunction and is unable to enjoy sexual relations.” He experiences dangerous inflammation. And not getting the mental health therapy he needed very likely caused Shape’s mental health to deteriorate throughout the several years that he was a patient at Fenway Health.

Shape now wants to have his breast implants removed. But insurance does not cover the procedure because it is not technically “gender affirming.” And since he cannot afford the hefty price tag, Shape has no choice but to live with the implants.

Understandably, criticism of gender medicine has focused largely on its use in minors. Its use in adults, however, is not without controversy. In the past, when clinicians spoke of adult transgender medicine, they were referring mainly to adult men who sought to change their bodies in their forties. Many had already spent years in marriage and were fathers of children.

That is no longer the case. Though data are limited, the main patient demographic in adult transgender clinics today appear to be 18-24-year-olds. In Finland, for example, adult referrals rose approximately 750 percent between 2010 and 2018, with 70 percent of referrals being 18-22-year-olds.

Humans reach full cognitive maturity around age 25, which means that there is often little to distinguish a 20-year-old from a 17-year-old in terms of impulse control, emotional self-regulation, and the ability to set long-term goals and prioritize them over present desires. Citing “irrefutable evidence” that being under 25 means having “diminished capacity to comprehend the risk and consequences of [one’s] actions,” the progressive decarceration and racial-justice advocacy group The Sentencing Project argues that the idea that people are adults once they reach age 18 “is flawed.”

Shortly after its founding in 1971, Fenway Community Health Center was repurposed to support the unique needs of gay and lesbian residents of Boston. According to Katie Batza, a historian of the clinic, the hippies and antiwar activists who founded Fenway Health “quickly solidified its reputation as an important gay medical institution.” During the 1980s, the clinic helped tackle the AIDS epidemic. That it now maltreats gay men like Shape by converting them into trans women reflects a tectonic shift within the institution’s culture.

American medicine has always found itself balancing two competing tendencies: the paternalism of care by experts on one hand, and the relativism of nonjudgmental customer service on the other. What has happened over the course of Fenway Health’s five decades of existence is a gradual loss of that equilibrium. Fenway has long defined its mission in terms of responsiveness to the stated needs and desires of community members: the volunteers who ran the clinic and offered its services free of charge, Batza writes, “focused on providing care and building community among Fenway residents, caring less if a volunteer met outside standards of professional qualification, which were often set by the state or medical profession, that the clinic critiqued.”

In the 1990s, the clinic set up a dedicated transgender unit. At first, “things moved slowly,” recounts Marcy Gelman, a nurse practitioner who served as Fenway Health’s first dedicated provider for transgender patients, in a document published by the institute about the history of its program. She is now its associate director of clinical research. “Patients didn’t get hormones right away. We wanted to get to know them, and required them to see a therapist for several months . . . we wanted to be careful.” This process felt too restrictive for some patients, and “a few got really angry.” Fenway Health says its “commitment to ensure patient safety . . . led to some conflicts with patients and community members.”

In the 2000s, Fenway Health adopted a new model of care for its transgender-identified patients, which it called the “informed consent model.” This came in response to patients complaining about “needless gatekeeping” and concerns that the clinic’s “customer service training specific to transgender patients lagged behind the development of its clinical care.” Using funding from the Blue Cross/Blue Shield Foundation, Fenway Health made a number of new hires and expanded its program. It drew inspiration from another community health clinic, the Mazzoni Center in Philadelphia, which was smaller than Fenway but served four times as many patients. “One key to [the Mazzoni Center’s] success,” the Fenway document explains, “was the elimination of any requirement for counseling before hormones were provided.” Ruben Hopwood, a physician who joined the Fenway team in 2005, developed this model for Fenway; soon thereafter, the institution’s three-month counseling requirement gave way to “a single hormone readiness assessment visit.”

In 2012, the World Professional Association for Transgender Health published the seventh version of its Standards of Care. In the chapter on hormone therapy, WPATH recommended eligibility criteria for estrogen or testosterone, including “persistent, and well-documented gender dysphoria” and having ongoing “medical or mental health concerns . . . reasonably well-controlled.” However, WPATH also noted a newly emerging “informed consent model” and cited Fenway Health as one of three clinics that developed and practiced it.

The difference between the models, WPATH explained, was that SOC-7 put “greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment. This may include a comprehensive mental health assessment and psychotherapy, when indicated.” By contrast, Fenway Health’s model emphasizes “obtaining informed consent as the threshold for the initiation of hormone therapy in a multidisciplinary, harm-reduction environment. Less emphasis is placed on the provision of mental-health care until the patient requests it, unless significant mental health concerns are identified that would need to be addressed before hormone prescription.” Despite the obvious differences, WPATH insisted the two models were “consistent” with each other.

Currently, Fenway Health offers hormones on the informed-consent model. “Criteria for accessing hormone therapy,” it states, “are informed by the WPATH (World Professional Association for Transgender Health) guidelines.” In other words, Fenway Health defers to WPATH, which adopted its recommendations from Fenway Health.

Shape and his lawyers deny that Fenway’s informed consent process is “a safe and effective replacement for assessment, diagnosis, and treatment provided by an appropriately trained and licensed healthcare professional.” Fenway’s model, they argue, “relies heavily on patients’ self-diagnosis, which may be a result of confusion or a misunderstanding of medically defined terms.” It does not take into account a patient’s expectations from medical treatment, which, as in Shape’s case, can be highly unrealistic. It “does not inform patients about the risk of iatrogenic effects of affirmation.” Nor does it take into account a patient’s “medical decision-making capacity,” which may be impaired in the presence of “significant emotional distress” and “undue influence from persons in position of authority and trust.”

A key charge in Shape’s lawsuit is that Fenway Health is driven by “market expansion goals and political demands of transgender activists.” Approval for hormones and surgery, the clinic’s staff wrote in 2015, should be a “routine part of primary care service delivery, not a psychological or psychiatric condition in need of treatment.” A leading advocate for the no-gatekeeping model, which rests on the assumption that mismatch between one’s actual and perceived sex is a normal human variation and not a pathological condition, argues that adults and adolescents should be free to turn their bodies into “gendered art pieces.”

From Shape’s story, we can infer that Fenway Health, which could not be reached for comment, has yielded to a barely constrained medical consumerism. In 1997, the institute had eight transgender customers. By 2015, it had over 1,700. “The rapid and sustained growth of Fenway Health’s transgender health care, research, education, training, and advocacy,” the institute’s doctors proudly declare, “might be succinctly summarized by the mantra from the movie Field of Dreams: If you build it, they will come.”

==

If you haven't met Shape Shifter, see the following interviews:

Literally "trans the gay away."

[dontmeantobepoliticalbut]

A national physician group this week called for the complete termination of a Medicare privatization scheme that the Biden White House inherited from the Trump administration and later rebranded—while keeping intact its most dangerous components.

Now known as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model, the experiment inserts a for-profit entity between traditional Medicare beneficiaries and healthcare providers. The federal government pays the ACO REACH middlemen to cover patients' care while allowing them to pocket a significant chunk of the fee as profit.

The rebranded pilot program, which was launched without congressional approval and is set to run through at least 2026, officially began this month, and progressive healthcare advocates fear the experiment could be allowed to engulf traditional Medicare.

In a Tuesday letter to Health and Human Services Secretary Xavier Becerra and Centers for Medicare and Medicaid Services Administrator Chiquita Brooks-LaSure, Physicians for a National Health Program (PNHP) argued that ACO REACH "presents a threat to the integrity of traditional Medicare, and an opportunity for corporations to take money from taxpayers while denying care to beneficiaries."

The group, which advocates for a single-payer healthcare system, voiced alarm over the Biden administration's decision to let companies with records of fraud and other abuses take part in the ACO REACH pilot, which automatically assigns traditional Medicare patients to private entities without their consent.

CMS said in a press release Tuesday that "the ACO REACH Model has 132 ACOs with 131,772 healthcare providers and organizations providing care to an estimated 2.1 million beneficiaries" for 2023.

"As we have stated, PNHP believes that the REACH program threatens the integrity of traditional Medicare and should be permanently ended," Dr. Philip Verhoef, the physician group's president, wrote in the new letter. "Whether or not one agrees with this statement, we should all be able to agree that companies found to have violated the rules have no place managing the care of our Medicare beneficiaries."

Among the concerning examples PNHP cited was Clover Health, which has operated so-called Direct Contracting Entities (DCEs)—the name of private middlemen under the Trump-era version of the Medicare pilot—in more than a dozen states, including Arizona, Florida, Georgia, and New York.

PNHP noted that in 2016, CMS fined Clover—a large Medicare Advantage provider—for "using 'marketing and advertising materials that contained inaccurate statements' about coverage for out-of-network providers, after a high volume of complaints from patients who were denied coverage by its MA plan. Clover had failed to correct the materials after repeated requests by CMS."

Humana, another large insurer with its teeth in the Medicare privatization pilot, "improperly collected almost $200 million from Medicare by overstating the sickness of patients," PNHP observed, citing a recent federal audit.

"It appears that in its selection process [for ACO REACH], CMS did not prevent the inclusion of companies with histories of such behavior," Verhoef wrote. "Given these findings, we are concerned that CMS is inappropriately allowing these DCEs to continue unimpeded into ACO REACH in 2023."

While the Medicare pilot garnered little attention from lawmakers when the Trump administration first launched it during its final months in power, progressive members of Congress have recently ramped up scrutiny of the program.

Last month, Sen. Elizabeth Warren (D-Mass.) and Rep. Pramila Jayapal (D-Wash.) led a group of lawmakers in warning that ACO REACH "provides an opportunity for healthcare insurers with a history of defrauding and abusing Medicare and ripping off taxpayers to further encroach on the Medicare system."

"We have long been concerned about ensuring this model does not give corporate profiteers yet another opportunity to take a chunk out of traditional Medicare," the lawmakers wrote, echoing PNHP's concerns. "The continued participation of corporate actors with a history of fraud and abuse threatens the integrity of the program."

[celineszoges]

Libraries are now full service GLAMs; Galleries, Libaries, Archives, Museum. Librarians are now customer service associates. Anything you want, you can have at your local public library. Enjoy!

[bloomingtrans]

University lgbt center lore drop when?? (/lh)

im gonna be so real anon every time i think it cannot get worse it does!! but just one example: cis white gay director tries to make a ranked list of the most marginalized students on campus. puts black and brown students on the same line. and then adds christian students (not queer christians, just christians). guy who understands how marginalization works.

also when asked why the candidates for the new leadership position were all white (one of whom is his close friend from his old job at the student health center) he pointed to the one (1) latine person on the list and made some shrugging noises about “qualifications” 😑

[scrollsofhumanlife]

Carolyn Epps nee Ford working as a pharmacist in New Orleans in the 80s

Born November 16 1958 in Georgetown, South Carolina

Marrero, Louisiana

[ivygorgon]

AN OPEN LETTER to THE PRESIDENT & U.S. CONGRESS; STATE GOVERNORS & LEGISLATURES

Say NO to Loony-Bins: Immediate Action Required for Inpatient Psychiatric Care

2 so far! Help us get to 5 signers!

The current model of inpatient psychiatric care, which primarily focuses on safety and crisis stabilization, falls short in promoting sustained recovery. The prevalent emphasis on ultrashort lengths of stay often overlooks the need for comprehensive treatment plans.

A proposed model of care advocates for rapid diagnosis, goal-setting, and treatment modalities before initiating treatment, organized into three distinct phases: assessment, implementation, and resolution. This approach emphasizes individualized treatment and active patient involvement in treatment planning, addressing critical psychosocial aspects that are frequently neglected.

As we strive to reform the mental health care system, it's imperative to prioritize effective, recovery-oriented treatment strategies. This includes ensuring patient comfort and preferences are accommodated within reason. Considering patient preferences, like comfort items (such as safe stuffed animals; Share-Bears, if you will) and rescue medications (like melatonin,) is essential to upholding rigorous standards of care and safety.

Let's advocate for reforms that enhance patient-centered practices while adhering to established treatment guidelines and advancing recovery-oriented care.

Say no to “loony-bins;” those archaic relics that should be relegated to the distant past.

📱 Text SIGN PWORPV to 50409

🤯 Liked it? Text FOLLOW IVYPETITIONS to 50409

💘 Q'u lach' shughu deshni da. 🏹 "What I say is true" in Dena'ina Qenaga