Public Charge: Update on the Supreme Court Ruling

Image of Supreme CourtOn Monday, Jan. 27, the U.S. Supreme Court temporarily cleared the new “Public Charge” regulation to go forward nationwide. The new rule will go into effect on Feb. 24 throughout the nation (except for Illinois), even as lawsuits challenging the rule work their way through the court system. The rule will not be retroactive, so no one will be held to the new rule until after Feb. 24. At Mosaic Medical we want to share information about this rule in order to support our immigrant patients, staff and their families.

What is “Public Charge”?

The U.S. Department of Homeland Security (DHS) assesses individuals seeking admission to the U.S. or applying for a green card to determine if they would be a “public charge.” This is defined as an individual “who receives one or more public benefit for more than 12 months . . . within any 36-month period (such that, for instance, receipt of two public benefits in one month counts as two months).”

The expanded rule cleared on Monday broadens the public charge definition. For the first time the definition now includes: non-emergency Medicaid (OHP), “SNAP” (also known as “food stamps”), and Section 8 housing assistance.

Please note these are NOT considered “public charges”:

  • Medicaid (OHP) for kids under 21
  • Medicaid (OHP) for pregnant women, including 60 days post-partum
  • Emergency Medicaid (CAWEM)
  • Oregon’s Cover All Kids program

(see the linked documents below for more exemptions)

Mosaic Medical sliding scale discounts do not count as a public charge. Also, a child’s use of Medicaid (OHP) does not create a public charge issue for the parent of that child. It is only programs used by the person applying for U.S. entry or a green card that are considered. Programs used by children/family members of those applying are NOT considered.

Public Charge Information Sheets

We encourage everyone to review the links below to the Oregon Health Authority fact sheets and FAQs in English and Spanish.

Immigration Legal Resource

To seek advice from an immigration attorney contact Oregon Immigration Resource.


Note: This post will be updated as further information becomes available.

Information provided by: Elaine Knobbs-Seasholtz, Director of Strategy and Development, Mosaic Medical


Winter Well-Being and How to Stay Active

Winter well-being and how to stay active

Photo of the author taken by Warren Cruze. Location: Dolomites of Cortina d’Ampezzo in Italy.

Sharing her thoughts on winter well-being and how to stay active, our guest blogger is Tina Bollman, Behavioral Health Coordinator at Mosaic Medical and Subject Matter Expert for the American Council on Exercise

Baby, it’s Cold Outside!

Many people find that it can be difficult to stay on track with healthy activity goals and New Year resolutions after the holiday festivities end. Coping with winter well-being and how to say active in cold, rainy or snowy weather can be challenging. And, the shorter days can make you feel tired, moody and less likely to be active. It’s all too easy to find reasons to skip a workout today and hope to do better tomorrow. However, while this may feel good in the moment, it can turn into a bad cycle.

The benefits of staying active

Regular exercise not only helps us to maintain a healthy weight but also improves our overall health, with benefits like:

  • Better sleep
  • Improved energy level
  • Lower blood pressure
  • Lower blood cholesterol
  • Reduced risk of heart attack
  • Lower risk of type 2 diabetes
  • Develops stronger bones, muscles and joints
  • Better recovery from illness and periods of bed rest

Exercise affects your mental health

Did you know that being active is also shown to change levels of chemicals in your brain? These changes have positive effects on your mental and emotional health. In fact, finding time to move and be active is practically a “magic bullet” for feeling better, immediately. It’s long been said that if the many benefits of exercise could be put into a pill, it would be prescribed to everyone!

Studies show that exercising:

  • Gets your mind off of worries
  • Improves your mood
  • Relieves stress
  • Improves sleep patterns
  • Reduces tiredness
  • Increases mental alertness and sharper thinking
  • Brings a feeling of success and better self-esteem
  • Helps you feel more relaxed and positive about life

A little exercise is better than none

Even a little bit of activity is better than none. And, this is probably the single most important thing to focus on. Short bouts of exercise, even 5-10 minutes at a time, is very helpful. You do not have to train daily at the gym, run miles and miles, or sweat buckets to become healthier. Thirty minutes of moderate exercise, (like walking, hiking, snowshoeing, skiing, dancing, or cycling) five times a week will get you all of these wonderful health benefits.

Exercising in cold weather has extra benefits

So what about these super wintry conditions? It turns out that doing outdoor activities in cold temperatures brings extra benefits. Here’s why you shouldn’t avoid getting outside in the winter months:

    • Exercising in the cold can burn more calories as your body produces heat
    • There is no heat and humidity to deal with, making you feel more energetic
    • Sunlight exposure improves mood and reduces depression
    • Cold exposure during exercise can boost immunity to colds and flu

And don’t forget those gorgeous rosy cheeks!

Stay safe and have an alternate plan to exercising outside

To stay safe while exercising outside be sure to have an alternate plan in case the weather is just too terrible. To help with that, here are Four Fun and Effective Treadmill Workouts to try, which can easily be modified for your current fitness level.

Those who suffer with asthma should check with their doctor before exercising outside in winter weather as cold air can trigger an asthma attack. And everyone can learn from these tips for Keeping Cold-weather Physical Activity Safe.

The key to winter well-being and staying active is commitment

The key is to commit to some kind of activity – even just a few minutes – on most days of the week. Making a small change today, and repeating it = a new healthy habit. Regardless of the weather, it is possible to develop habits that help your winter well-being and how to stay active. In summary, just keep at it, and the benefits of exercise will begin to change you for the better, mentally and physically!


Tina Bollman is the Behavioral Health Coordinator at Mosaic Medical. She is a Subject Matter Expert for the American Council on Exercise and holds certifications as a Group Fitness Instructor, Personal Trainer and Health Coach.



Mental Health Services Are Closer to Home with Tele-Mental Health

An in-depth look at the innovative work of our Behavioral Health team to reduce barriers to mental health services for our rural patients.

The Need for Mental Health Care

There is no question that a lack of access to proper mental health care is one of Central Oregon’s biggest public health struggles. Every day Mosaic providers acutely feel the impact of poor access to specialty mental health care for our patients. Our patients feel the impact too. So much so that their collective voice has elevated improving timely access to specialty mental health services as a top priority for our state and region to address.

State and National Statistics

According to the U.S. Centers for Disease Control and Prevention, 25% of American adults suffer from a mental illness. Almost half of Americans will experience a mental health issue at some point in their life, or someone close to them (peer or family member) will be impacted with a mental health concern. It is estimated that 15 million American children are in need of specialty mental health services. To further compound matters, of all the 50 states plus the District of Columbia, Oregon ranks 49th in the nation for access to mental health services. And Oregon is one of the states with the highest percentages of mental illness.
Furthermore, Oregon has severe mental health care provider shortages, with no less than one mental health care provider for every 1,000 people. Even Bend is considered a mental health care provider shortage area according to the Health Resources & Service Administration (HRSA).

Mental Health and Physical Health

Individuals with poorly treated or under-treated mental health conditions have greater health issues compared to the general population. For example, individuals with depression are twice as likely to develop type 2 diabetes mellitus. And their risk for stroke and myocardial infarction is three-and five-fold times higher than people without depression. Mental illness in general is associated with an increased risk of hepatitis, tuberculosis, and poor dental health. It has been estimated for individuals who have severe and persistent mental illness (e.g. those with schizophrenia, bipolar disorder) that life expectancy is reduced by at least 10 years as compared to the general population.

Individuals with mental health conditions use a significant number of health care services. For example, nearly 12 million visits made to United States hospital emergency departments in 2007 involved individuals with a mental disorder, substance use disorder, or both. While poor physical outcomes in individuals with mental health issues are related to many factors, fair access to skilled interdisciplinary care both in specialty mental health and medical settings are top contributors.

Innovative Solutions are Needed Now

Innovative solutions are needed to increase access to all forms of specialty mental health care, and they are needed now. Tele-mental health services which include tele-psychiatry is one of the most promising developments to provide patient-centered, affordable, and effective interventions for individuals in need of mental health care.

Mosaic Pilots Tele-Mental Health Visits

In an effort to improve access to mental health care in our rural sites, in June of 2019 Mosaic began a pilot program offering tele-mental health visits for adult patients at our Prineville clinic. Our pilot program includes both traditional specialty tele-mental health visits as well as a consultative model. Traditional tele-mental health visits treat approximately 30% of the population. The consultative model, called Collaborative Care, treats 70% of the population. Collaborative Care is also called consultative psychiatry and is a routine part of advanced primary care practice. If you are interested in learning more, visit the AIMS Center at the University of Washington website.

“In the consultative model, our tele-mental health providers provide our Primary Care Providers (PCPs) and Behavioral Health Consultants (BHCs) with expert advice on how to effectively treat the most common mental health conditions in primary care (e.g. depression),” said Kimberly Swanson, Ph.D. and Mosaic’s Behavioral Health Director. “Our patients in Prineville now have equitable and timely access to skilled interdisciplinary care right within their primary care medical home. We are proud to say we now offer 28 hours of tele-mental health services each week in Prineville.”

Tele-Mental Health Basics

“Tele-mental health generally refers to the delivery of mental health assessment and ongoing care via telecommunication technology,” said Michael Thomas, Mosaic’s Director of Technology and Clinical Informatics. “The patient is checked in at one of our clinics and roomed in a space set up for telemedicine. Staff ensures that the video and audio connection with the tele-mental health provider is established. The provider can be at another Mosaic clinic or any other location with an adequate internet location. The visit proceeds just as if the provider was in the room with the patient. The provider documents in Epic at their location, then notifies the clinic staff that the visit is over and terminates the connection.”

Tele-Mental Health Providers

At Mosaic, our tele-mental health providers include the following:

Care Manager: A licensed clinical social worker. Our Care Manager is different from a Behavioral Health Consultant working in our clinic in that she/he provides a slightly longer and more in-depth behavioral treatment for a variety of health and mental health conditions.

Psychiatric Mental Health Nurse Practitioner: Has completed an advanced nursing degree and specializes in psychiatry. Our Psychiatric Mental Health Nurse Practitioner assesses, diagnoses and treats mental health conditions to help manage symptoms resulting from psychiatric or substance disorders. They are an expert in psychopharmacology and have in-depth experience and knowledge of psychiatric medications and how to prescribe them effectively.

Tele-Mental Health Versus Face-to-Face Visits

Some patients and providers have expressed concern that patients are not getting comparable care via tele-mental health versus conventional face-to-face visits. However, research indicates tele-mental health is just as satisfying, more cost effective, well accepted by patients and equally as impactful as in-person visits. Additionally, there is some emerging evidence that some patients may actually prefer tele-mental health visits to in-person treatment. Learn more: Telepsychiatry Effectiveness and Feasibility

Tele-Mental Health and the Patient

In most cases the process of getting specialty mental health help for a patient changes little about the patient experience. Patients at our Prineville clinic first visit their PCP or BHC to discuss their concerns. The PCP or BHC then creates an internal referral to see one of our tele-mental health providers, and Prineville clinic front desk staff or HIT-Referral staff schedules the patient appointment for tele-mental health. The patient is seen within our Prineville clinic, and they check in for their tele-mental appointment like they would for any other appointment. Any follow- up appointments are conducted in the much the same way.

Patient Privacy

“Though our patients have not voiced concern about privacy while accessing tele-mental health, our telemedicine equipment and network protocols are HIPAA compliant,” said Thomas. “Recently, Mosaic has worked with OCHIN to embed telemedicine within EPIC (our electronic medical record system). This simplifies the entire process by allowing the video visit to launch right from EPIC instead of a separate application. Video awareness within EPIC scheduling functionality becomes much easier. With integrated video during these visits, the availability of a patient for the audio/video link up becomes evident, simplifying communication, and keeping it in the EPIC schedule view.”

The Provider’s Perspective

Our rural providers in Prineville have been supportive and enthusiastic about the addition of telepsychatry services.

“We all have recognized the fact that our community has not had adequate access to mental health care services. Since we started this pilot, the feedback from the providers has been very positive. We’ve all seen positive changes in PHQ9 scores of patients that have been referred to telepsychiatry,” said Diana Burden, Prineville Clinical Medical Director.  “In addition, we’ve had positive anecdotal responses from our patients when they have followed up with us in the clinic.”

Collaboration with our telepsych providers has been very congenial. The initial guidelines that were developed provided a clear foundation for communication, as well as practice policy. The pilot leadership group solicits feedback from the provider group regarding communication between providers, and determines if there are any changes that need to be made with regards to clinic or procedure flow. In addition, Prineville providers have monthly joint meetings to discuss the patients we share with our tele-mental health providers. This ensures that we are meeting the needs of our patients. We also have daily access to the tele-mental health providers if we feel we need to discuss mutual patients with urgent needs more frequently.

“Overall, the provider group in Prineville feels very positive about the addition of our telepsychatry services, and we look forward to our ability to expand to the pediatric population in the future,” said Burden.

The Clinic Perspective

“As with many changes, piloting telepsychiatry seemed daunting to our team in the beginning. There were not only logistical challenges (support staffing, space, etc.), but also doubts about our community’s willingness to engage with the program,” said Laura Pedraza, Prineville Clinic Manager. “Thanks to the thorough preparation that went into implementing the program, these fears were quickly dispelled. To our surprise, patients were willing to give telepsychiatry a chance, and then kept coming back!”

The positive community response assisted our decision to commit to staffing additional time with a Medical Assistant in order to expand program hours. We currently have tele-mental health services available 28 hours each week.

“Thanks to careful provider selection, we have engaged and caring telepsychiatry providers who partner well with our team and patients in the delivery of tele-mental health services,” said Pedraza. “We are happy to say that the telepsychiatry program has now been fully adopted as an extension of our clinic’s services.”

On the Horizon

  • On January 27, 2020, we are excited to expand our Prineville pilot program to include children and adolescents. Crook Kids (School-Based Health Center) will also be able to refer their patients for tele-mental health services.
  • In the spring of 2020 we will expand tele-mental health to our Madras Clinic and Madras High School Based Health Center. We are thrilled that our tele-mental health providers for Madras are also bilingual and bicultural.
  • We are exploring the idea of leveraging technology within Mosaic through “Tele-BHC.” Other Federally Qualified Health Centers (FQHCs) in Oregon have begun using a similar model e.g. Yakima Valley Farm Workers Clinic. Through Tele-BHC we envision being able to cover all six of our School-Based Health Centers 100% of the time as well as improve mental health support and coverage at all Mosaic clinics.

Special thanks to Mosaic’s Behavioral Health team for preparing this overview of our Tele-Mental Health pilot program in Prineville. For article citations and further information please contact Kimberly Swanson, Ph.D. Mosaic’s Director of Behavioral Health at


Mindful Holiday Eating and Drinking

Mindful holiday eating and drinking can help us navigate the season healthfully.

Guest blog post by Kimberly Swanson, Ph.D., Director for Behavioral Health at Mosaic Medical

All of our best intentions and good health habits are put to the ultimate test this time of year, and mindful holiday eating and drinking can help us navigate the season healthfully. During the holiday season there are typically lots of distractions and we are often over-scheduled, rushing around to attend many parties and get-togethers. And of course there are an abundance of yummy treats at every turn. Added to all this, many people have trouble fitting in exercise during this busy time of year. It is not easy to stay on track with our health through the holidays, and before you know it we have overindulged and packed on some unwanted pounds. To help you enjoy the holiday season fully we have gathered together a few tips to help you celebrate while maintaining your health. Practicing mindful holiday eating and drinking can help to lessen the stress of the season.

Alcohol Guidelines

Alcohol and celebration can often go hand in hand. It is not unreasonable to have alcohol in your life, but alcohol has a lot of hidden calories (e.g. one pint of beer has as much calories as a sugar coated doughnut!) and can really impact your health.

Some key questions to consider for mindful drinking include:

1) Are you relying on it?

2) Are you or is someone close to you concerned about your drinking?

The Center for Disease Control (CDC) recommends that adult men have no more than two servings of alcohol in one sitting and adult women have no more than one serving in one sitting. Pregnant women are advised to avoid alcohol altogether. To limit alcohol consumption, try to alternate drinking alcohol with glasses of sparkling water.

Mindful Eating

Most of us eat because food is in front of us, whether or not we are truly hungry. And celebrations often have most, if not all of our favorite foods! Using the five “S’s” of mindful eating can help you enjoy all your holiday favorites while maintaining your health:

    1. Sit down: Studies show people eat 5% more when they stand and eat.
    2. Savor: Take a moment to really see the food in front of you, and to smell the aromas.
    3. Slowly Chew: Let the flavors rest on your tongue before taking the next bite.
    4. Stay in the moment: When we are socially engaged we cannot truly focus on what we are eating and drinking. Research shows us that when other people are indulging around us, we tend to indulge more too.  Put your fork down between bites of food while eating.
    5. Smile: Holiday meals and celebrations are the perfect time to give thanks for the abundance in our lives and for the people and efforts that went into providing the meal.

Holiday Hosting

If you are hosting for the holidays, below are some helpful tips to invest in both celebration and health:

    1. Include healthy food choices on your menu such as vegetables, fruits and lean meats.
    2. Baking, broiling and barbequing are healthy ways to prepare foods versus frying or adding fat and grease.
    3. Avoid sampling foods more than necessary while preparing – the calories can add up fast!
    4. Avoid grazing by putting food away after the meal is over.
    5. Give guests left over dishes to take home with them.

Being a Healthy Guest

If you are a guest at someone else’s home over the holidays, here are more helpful tips:

    1. Don’t skip meals beforehand in preparation for overindulging.
    2. Keep plate sizes and portion sizes small.
    3. Skip dressings, butter and gravy.
    4. Drink mostly water and limit alcoholic beverages.
    5. Plan some form of exercise before or after eating.

Need Support?

If you find you need help staying on track this holiday season with mindful holiday eating and drinking, or you find that the indulgences added up, never fear, we are here to help you get on track and stay on track! The first step is reaching out to your Mosaic provider. Your Mosaic Medical provider can direct you to several community and Mosaic resources:

  • Walk with Ease
  • Nutrition Kitchen
  • Eat for Life – a 4 months program for Type II Diabetes
  • Living Well with Chronic Medical Conditions
  • Mindfulness Group
  • Are you or a loved one concerned about your drinking? Talk to your Mosaic provider today.  We care about you and are here to help.

Not a Mosaic patient? Give us a call at 541-383-3005 and we can help you join the Mosaic Medical family.

Kimberly Swanson, Ph.D., is a Licensed Clinical Psychologist working full time as the Director for Behavioral Health at Mosaic Medical where she oversees both the Primary Care Integrated Behavioral Health team and embedded Substance Use Team (Transitions).  Dr. Swanson completed a yearlong leadership fellowship 2015-2016 in health care transformation through the Oregon Health Authority. Dr. Swanson presently chairs the regional Pain Standards Task Force (PSTF) for the Central Oregon Health Council. She was awarded the 2017 Deschutes County Health Hero award for the positive public health impact of PSTF. Dr. Swanson also currently serves on the Leadership Group for the Central Oregon Suicide Prevention Alliance and is a new Advisory Board Member for the Central Oregon chapter for the National Alliance for the Mentally Ill.


Screen Time for Kids: A Pediatrician’s Perspective

Guest blog post from Rebecca Hicks, MD, IBCLC. Dr. Hicks is a pediatrician with Mosaic Medical who is passionate about promoting healthy family connections (and limiting screen time for kids!).

What an amazing fall we have had in Central Oregon! The warm weather and beautiful autumn colors have lasted a full month longer than the last few years. But as I checked the weather forecast this morning, I see that the warm weather will soon come to an end. Snow is in the forecast for nearly every day next week. Time to break out the winter coats!

My family and I moved here a few years ago, and I have to say that the weather was not Central Oregon’s biggest selling point for my husband and I. What brought my family to Bend was hope. Hope for a more family-centered life where we could enjoy each other’s company more often without fighting hours of traffic on our way home from work. Hope for more opportunities to enjoy nature without crowds of people at every place we visited. Hope for a place to raise our three children without the stresses and intensity that faced them in the San Francisco Bay Area where we lived for 12 years prior to moving here. And Central Oregon has delivered…on 2 out of 3.

I am a pediatrician and my husband is a school principal. Our professional lives are jam packed with daily interactions with kids and youth and have been for many years. And over the last decade, we have both become more and more concerned with what we see in those interactions.

Overall, the trends that I see among children and adolescents in my practice and in nationwide studies are worrisome. Resiliency, connection, emotional intelligence, time spent outdoors, and time spent with friends among youth are at or near all time lows. At the same time, language delay, poor executive functioning, ADHD, low self esteem, anxiety, depression, and even suicide are at or near all time highs. As a pediatrician, I care deeply about the physical and mental health of every single child. And I have to wonder what the causes are of these trends and what I can do to make this better.

There is a philosophical principle called “Occam’s razor” that I often think of when contemplating questions like these. It says this: The simplest solution is most likely the right one. For example, if you look outside and see that the sky is gray and cloudy, the ground is wet, and people are carrying umbrellas, the simplest and most obvious answer that ties all of those together is that it is raining. Sure, it’s possible that there are three separate explanations for those three observations, but the simplest and most obvious is the most likely.  

So what is the simplest and most obvious change that I can observe about today’s youth that is different than it was 10 years ago? Smart phones and soaring screen time for kids.

But as a doctor, I don’t let philosophical principles alone guide my opinions or the medical advice that I give to my patients. I rely on evidence. So for the past three years I have delved into the scientific evidence on the effects of excessive screen time in children and adolescents. Here is what I have found: Excessive screen time in children and youth is associated with (in ascending age order): language delay, poor executive functioning, ADHD, low self esteem, anxiety, depression and even suicide.

And this is the hope that Central Oregon has not fulfilled for my family. Children and youth here are not only as impacted by stresses and intensities as what we saw in the Bay Area, but in some ways it is even worse here. Rates of depression and anxiety that pediatricians in Central Oregon face have skyrocketed in recent years. Suicide among persons age 10-24 in Deschutes county has increased 200% in the last 15 years. Excessive screen time is certainly not responsible for all of these cases, but there is a looming question of whether excessive screen time for kids is contributing to these recent increases.

Researchers are really still in the infancy of collecting data on excessive screen time. Much of the data that we have on excessive screen time so far is associational, but several longitudinal studies (which better point to cause and effect) have been published supporting a directional association between excessive screen time and later poor health outcomes like these. And families can recognize that this is happening in their own homes without knowing anything about the data.

Almost daily I have parents in my office in tears, desperate for help in gaining back connection with their tweens and teens, and desperate for help in getting their kids to turn off screens.

It doesn’t take a medical degree to understand that giving kids and teens unlimited access to entertainment media without limits is a bad idea. But it does take a lot of hard work and guidance for parents to figure out how exactly to navigate this for their families and determine a healthy amount of screen time for kids.  

My advice…you have to pair high limit setting with high levels of warmth, compassion and caring. But families need more details of how to do this. So I have created free talks that I give to students, parents, healthcare professionals and anyone who wants to know more about the effects of excessive screen time on kids. And I created a website dedicated to helping families navigate screen time. My goal is to reach as many families in Central Oregon as I can. Every child deserves to live in a place where face-to-face connection, time spent with friends and family, and time spent outdoors is the norm. I’m here to help make Central Oregon that place, for your kids…and for mine.

 Most sincerely,

Rebecca Hicks, MD, IBCLC

Read the latest from Dr. Hicks on her blog:  “Screen Time Smarts for the Holidays”

Learn more on this topic on the website created by Dr. Hicks:

Dr. Hicks completed her medical internship and residency training at Stanford University. She practiced pediatrics in the San Francisco Bay area for nine years prior to moving to Bend with her husband and three young children. Dr. Hicks works as a pediatrician at Mosaic Medical. “Living and working in Silicon Valley fueled my passion for informing parents of the risks of excessive screen time for children. I strive to help children have balance, allowing them to benefit and learn from technology without letting it take over their lives.”


Gender Affirmative Healthcare Workgroup: Creating Inclusive Care for All

Gender Affirmative Healthcare is included in Inclusity Poster for Mosaic Medical The Transgender and Gender Affirmative Healthcare Workgroup at Mosaic recently concluded more than 18 months of work to ensure that Mosaic Medical serves all community members in a welcoming and inclusive way. The workgroup includes more than twenty employees from across the system, all serving in many different roles. Each of the workgroup members are fully committed to helping Mosaic meet the need for transgender healthcare in Central Oregon.

We acknowledge that we still have more to learn and refine to better support our transgender community. And, we wanted to share the important work this passionate group has accomplished to date.

Highlights of Workgroup Accomplishments:
    • Transgender Clinical Care: One of our group’s first actions was to tackle the intricacies of transgender clinical care. Several of our providers joined the 12-month TransECHO project out of the Fenway Institute. Several providers also joined the Central Oregon Trans Healthcare Coalition.
    • Gender Affirmative Forms and Charting: At the same time, we began revising our new patient registration forms to be gender affirmative. We also began implementing the Sexual Orientation Gender Identity (SOGI) fields in EPIC (our electronic patient charting system).
    • Resource Lists: Group members created community resources lists and smart phrases for our youth and adult transgender patients. To access the resource lists, click here: Transgender Youth Resources and Transgender Adult Resources.
    • Staff Training: Transgender healthcare and support is new to many of us. In support of learning for all of our staff and as part of our Service Excellence Program, training was offered for all staff (completed this past summer). Training will be held quarterly for new staff moving forward. This training is intended to help staff understand the positive outcomes of providing gender affirmative care. Also covered in the training are preferred terminology and use and transgender identity concepts.
    • Pride Participation: In order to support the general LGBTQ+ community we have participated in the Bend Pride event for the last two years. We participated in the Prineville Pride event for the first time this year. We plan to continue our annual presence at these events. We hope to create awareness in the community about our increased focus on gender affirmative healthcare.
    • Community Education: Our commitment to advancing community understanding about transgender population needs led us to organize a City Club of Central Oregon forum on this issue. Our own Ellie Millan, PNP and Mosaic’s Pediatric Medical Director served as a panelist. The forum was extremely successful, with over 170 community leaders and members attending.
    Looking Ahead:
  • As the 18-month workgroup effort came to a close, group members remain committed. Efforts will continue to support our gender affirmative clinical knowledge and refine our vast number of patient documents to be more inclusive. We will also continue to work on staff-related gender affirmative supports such as HR paperwork and optional usage of pronouns in staff email signatures. We are grateful to the many staff members who have supported this effort and to the entire Mosaic team for taking part in this learning journey together. Together, we are truly working to provide quality care for all.


Mobile Community Clinic Replacement Campaign Nears Completion

Mobile Community Clinic is in need of replacement


Years ago the team at Central Oregon Veterans Outreach (COVO) conceived of an effort to take a mobile health clinic out to homeless camps in the area. In 2013 they donated their mobile van to Mosaic Medical, and the Mobile Community Clinic (MCC) program came to life.

“Back then the people at Mosaic were the only ones open to starting a mobile health clinic for the homeless, and we are grateful to see how much reach this program has today,” said Rabbine Harpell, an original founder of COVO and longtime volunteer with the organization. “We really commend Mosaic for caring for our community.”

Today the MCC travels throughout Deschutes County, providing quality, accessible healthcare to more than 700 individuals experiencing homelessness and at-risk youth. The MCC offers care on a walk-in basis at locations where people are already accessing services, such as cold weather shelters and food banks. The mobile clinic weekly schedule includes stops at Shepherd’s House, The Loft, The Drop, United Methodist Church, J Bar J Youth Services and Church of God. And, beginning in the next few months, Mission Church and COVO will host the MCC.

“We have become a place where people know they will be treated fairly, and where they will be safe and welcomed,” said Kathy Skidmore, Executive Officer of COVO. “People have come to trust us, and so it is logical to offer the mobile clinic services here on site and partner with Mosaic once again.”

Mosaic's Mobile Community Clinic travels to where patients are already receiving services.“It is always wonderful to be able to offer more services,” said J.W. Terry, Executive Director of COVO. “The more people we can help like this the better off the whole community is.”

Those experiencing homelessness have an increased risk for bronchitis, pneumonia, sunburn, skin infections, frostbite and other issues. And due to a lack of transportation, many people are not able to make it to one of the other 14 regional Mosaic clinics for care, so access to healthcare on the mobile clinic is critical.

The current MCC, a 27-year-old converted RV, has now reached the end of its service life. It can no longer be relied upon to safely travel the many miles required around the region to reach patients, and inclement winter weather often forces the cancellation of visits during the time of year when access to care is needed the most. Mosaic has raised 75% of the funds needed to purchase a new, reliable mobile clinic, and is now asking the community to help raise the remaining $60,000.

“We are grateful to COVO for their leadership and innovation in founding the mobile clinic program,” said Angela Saraceno, Development Coordinator at Mosaic Medical. “As the number of individuals experiencing homelessness continues to grow, we need support from the community now more than ever to expand the level of care we can provide year-round.”

Join Mosaic Medical in this effort to ensure access to healthcare for everyone in our community. To make a donation in support of a new mobile community clinic click here.

Thank you to our friends in the media for helping us to share our story with the community:

KTVZ NewsChannel 21

Central Oregon Daily News

Cascade Business News

The Source Weekly Give Guide

Are you interested in learning more about our partners at Central Oregon Veterans Outreach? Visit their website at


Suicide Prevention: Learn How to Save Lives

National Suicide Prevention Month Guest blog post by Kimberly Swanson, Ph.D.

Most people think the trauma of suicide will  never happen to them. In our society it is all too common to think that it is something that only happens to other people. So, of course, the moment a friend or loved one tells you they have been having suicidal thoughts–or you notice yourself having thoughts of suicide or planning suicide–it can be a moment fraught with a complex soup of emotions including shame, confusion, fear, anger, disbelief, sadness, concern, hopelessness, compassion, urgency, relief, and more. You might feel dumbstruck, overwhelmed or ill-prepared to handle the situation. However, you can be prepared to help with suicide prevention.

Suicide is a preventable cause of death.

Here is the thing about thinking you or someone you care about won’t have thoughts of suicide: It causes us not to learn, prepare, plan or talk when we really ought to be learning, preparing, planning and talking. There is a myth that the mere mention of the word suicide by friends and loved ones lead individuals to take their lives. The reality is that those harboring suicidal thoughts actually benefit from openly talking about their feelings. This is why so many suicide prevention campaigns are titled “Let’s Have the Conversation.”

Suicide has become a local and national public health crisis.

Suicide affects all people, not just those with mental illness. In fact, studies have shown that 54% of all individuals who have died by suicide did not have a diagnosable mental health disorder.  Additionally, though we don’t know exactly why, the rates of suicide continue to rise. Within the past year alone 41,000 individuals in the United States have died by suicide, and it is the tenth leading cause of death overall. Central Oregon has higher rates of suicide than other parts of Oregon.

What you can do to prepare and learn to save a life, possibly even your own life:
  • Attend a suicide prevention training. Deschutes County has many trainings throughout the year. Visit or contact Whitney Schumacher at  to find a training that works for you.
  • Know the signs. There are signs of suicide that warrant both a conversation and seeking help:
  • Social withdrawal
  • Lack of interest
  • Taking risks
  • Frequent intoxication
  • Statements such “I would be better off dead,” or “Life is not worth living.”
  • Seek help. The first source of help for anyone who is not already receiving mental health care is your Primary Care Provider (PCP). Your PCP can help with accessing mental health services. At Mosaic, there are Behavioral Health providers in all of our clinics who will work with your PCP to provide you total care and a full assessment.
  • Get urgent or emergent help. Suicide is a life-threatening issue. If you feel the situation is dire, several emergent/urgent options are available for immediate help:
    • Call a Crisis Line

Crook County 541-323-5300, ext. 1

Deschutes County 51-322-7500, ext. 9

Jefferson County 541-475-6575

Central Oregon Youth Line 1-877-968-8491

    • Call 911
    • Go to the nearest emergency room
Additional resources to explore:

Central Oregon Suicide Prevention Alliance

Deschutes County Suicide Prevention

Central Oregon Mental Health Provider Directory

Centers for Disease Controls and Prevention

Kimberly Swanson, Ph.D., is a Licensed Clinical Psychologist working full time as the Director for Behavioral Health at Mosaic Medical, where she oversees both the Primary Care Integrated Behavioral Health team and embedded Substance Use Team. Dr. Swanson completed a year-long leadership fellowship 2015-2016 in health care transformation through the Oregon Health Authority. Dr. Swanson presently chairs the regional Pain Standards Task Force for the Central Oregon Health Council. She was awarded the 2017 Deschutes County Health Hero award for the positive public health impact of PSTF. Dr. Swanson also currently serves on the Leadership Group for the Central Oregon Suicide Prevention Alliance.



Healthy Back to School Tips from Mosaic

Healthy back to school tips

The next school year is right around the corner and it’s time to think about setting your family up for a happy and successful return to the classroom. Here are ten healthy back to school tips to help you and your child make an emotionally and physically healthy transition back to school.

1. Plan and practice your routine

There can be a lot to keep track of when school starts. Practicing your daily routine can help your family make a smooth transition. Consider your morning routine as well as after-school activities, meal-times, household chores and homework as well as preparation for the next day. For older children, a part of their routine could include setting aside specific time each day for chores and for homework so they don’t wait until the last minute to finish it.

2. Get sleep on track

With early wake-up calls ahead, it’s important for children and teens to get back to better sleeping patterns so they get enough quality sleep. Pediatricians recommend that children age six to 12 get nine to 12 hours of sleep a night, and that teens get eight to 10 hours a night.

Here are a few ways to help your kids get the sleep they need:

  • Power off the devices. The light from screens and devices interrupts the brain’s sleep cycle. All devices should be turned off an hour before bedtime to give the brain enough time to transition into sleep.
  • Consider darkening shades. In the Northwest it can stay light well past bedtime. Darkening shades or blackout curtains can help kids get to sleep easier.
  • Ease off caffeine. Your child or teen should stop drinking anything with caffeine–including coffee, tea, sodas and energy drinks–after noon. That way, by bedtime, the stimulant will be out of their system.

3. Work on nutrition

If your kids pack a lunch to school, take some time to plan out what they take to help them with proper nutrition. Be sure to include fruits and vegetables and encourage water over soda or juice. If you have a picky eater, continue to introduce new foods, be a role model for healthy eating, and try not to use food or treats as a reward.

4. Encourage sports and activities outside of school

Giving your child an opportunity to do what they love will give them an emotional boost. This can be participating in community organizations, school or recreational sports, and other activities they love. You can also help them from overextending themselves by setting limits and giving them down time.

5. Get a sports physical and wellness exam

At Mosaic Medical we can combine a sports physical and annual wellness exam in order to cover more than the focused sports physical. Any student who plays a school sport in Oregon needs a sports physical. Every child (whether they play sports or not) deserves a complete annual wellness exam that covers many more aspects of health and wellness than the focused sports physical. If your child is due for either, we can help.

Sometimes the only time we see a child or teenager is for the sports physical, so we can use that visit to talk about other subjects with them, and make sure we take care of all their needs.

6. Update immunizations

Immunizations for school-age children help protect them from diseases like measles, mumps, pertussis, meningitis, and chickenpox. Before going back to school, having immunizations up-to-date is important for your children’s safety and for the safety of others.

7. Check vision

Good vision is critical to children’s success in the classroom. Many children will not complain if they are not seeing clearly. This makes an eye exam important. A screening eye exam can be performed at your child’s annual wellness exam. Some signs of vision problems include:

  • Complaint of headaches while reading or using digital devices
  • Sitting too close to a TV or other screen
  • Squinting when viewing things in the distance, like the SmartBoard or a ball in gym class
  • Losing their place while reading, or slipping behind in reading ability
  • Poor concentration

Kids with glasses and contacts should have regular eye exams to ensure their vision is not changing as they grow. We want to make sure they have the right prescription. Vision should be checked with glasses and contacts on in your child’s annual wellness visit.

8. Have meaningful conversation (don’t take “fine” for an answer)

Depression, anxiety, and stress are big health risks for kids throughout school. Children will rarely say that they are being bullied or that they are experiencing stress. Ask your child about specific classes, what the teachers are like, and what’s happening with their friends at school. Avoid asking “How was school?” to avoid the dreaded and noncommittal answer “Fine.”

If you suspect your child is having any difficulty with depression, anxiety, bullying, or other stresses, talk with their teachers as soon as you can. Your pediatrician can also help discover and address any issues and find appropriate services for your child.

9. Have a plan if your child gets sick

In case you are unable to immediately retrieve your child at school if they get sick, having a trusted family member, friend, babysitter or child care facility to help pick up your child can be a great support for your family. This also ensures that your child will get the care they need if they get sick.

10. Take some quality time together

Take some time to reconnect with your child outside of the challenges of their school and activity schedule. Life can get pretty frenetic and stressful, and finding a way to simply reconnect is important. Take a walk, get back to nature, play a board game, or just take some time to talk as a way to ground and strengthen your relationship.

We hope these healthy back to school tips help you and your family to get the school year off to a great start! And please don’t hesitate to reach out to Mosaic Medical for the health advice and care your family needs.

The information included in these healthy back to school tips was provided by Dwight Carpen, a board certified family nurse practitioner with expertise in  pediatrics. His special areas of focus include weight management, the impact of exercise on mental health and school performance, and the role of diet and exercise on chronic disease management. Dwight works for Mosaic Medical at our Madras High School-Based Health Center, one of our seven full service pediatric clinics located across the region. Learn more about our School-Based Health Centers here, and learn more about our integrated, holistic pediatric services on our website.



National Health Center Week Aug. 4-10, 2019

Graphic with details on National Health WeekRooted in Communities: National Campaign Celebrates Health Centers

Mosaic Medical is proud to be part of a national campaign to increase awareness of the ways Community Health Centers are providing affordable healthcare throughout the nation. National Health Center Week 2019 is being celebrated from Aug. 4-10 with the theme of “Rooted in Communities.”

As part of a nationwide network of locally-run health centers that serve more than 28 million people in the United States, Mosaic Medical is on the front lines of many national public health challenges including providing opioid treatment. Nearly half of health centers (44 percent) are located in rural communities and serve as a lifeline in areas where the nearest doctor or hospital can be as far as 50 miles or more away.

Over the last five decades, Community Health Centers have focused on:

  • Reducing unnecessary hospitalizations and unnecessary visits to the emergency room;
  • Treating patients for a fraction of the average cost of one emergency room visit;
  • Serving more than one in six Medicaid beneficiaries for less than two percent of the national Medicaid budget;
  • Lowering the cost of children’s primary care by approximately 35 percent; and
  • Treating 65,000+ patients with Medication Assisted Therapy for opioid use disorder.

Health centers are at the forefront of a nationwide shift in addressing environmental and social factors as an integral part of primary care, reaching beyond the walls of conventional medicine to address additional factors that may cause sickness. These factors include lack of nutrition, mental illness, homelessness and addiction. Led by Community Health Centers, success in managing chronic disease in medically vulnerable communities has helped reduce health care costs for American taxpayers.

Over the course of their existence, health centers have saved countless lives, reduced and prevented chronic disease in the most challenged of patients, provided patients with affordable options for care that prevents costly hospital emergency room visit and responded to national health crises, such as the opioid epidemic. Because of their long record of success in innovation, managing healthcare costs, and reducing chronic disease, leaders in Congress have declared health centers a model of care that offers a “bipartisan solution to the primary care access problems” facing our nation. Through decades and through bipartisan administrations, Congress has consistently seen the value in growing the federal investment in the health center system of care.

To learn more about National Health Center Week, visit:

To learn more about Mosaic Medical, visit: