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:



Mosaic Medical welcomes Capt. James C. Gemelas to our Board of Directors

Image of Capt. James C. Gemelas

Capt. James C. Gemelas has been a resident of Jefferson County since 1993.

Mosaic Medical is pleased to announce the addition of Capt. James C. Gemelas, a Commissioned Officer with the United States Public Health Service, to the board of directors governing our nonprofit community health center organization.

Gemelas has been a resident of Jefferson County since 1993, living in Madras with his wife of 26 years and raising two children. He works for the Indian Health Service as a clinical pharmacist and informaticist at the Warm Springs Health & Wellness Center. Prior to that he served as a staff pharmacist at Fort Defiance Indian Hospital on the Navajo reservation in Arizona, and at the Blackfeet Indian Hospital in Montana.

“As a Commissioned Officer, working in the Indian Health Service system has exposed me to many aspects of healthcare,” said Gemelas. “I feel that my experience will help me to be an active contributor to the Mosaic board.”

Gemelas receives his healthcare at Mosaic Medical, which he feels provides him with another valuable perspective to bring to the board, which is governed by a patient majority.

“We are very happy to welcome Jim to our board of directors,” said Megan Haase, Mosaic Medical CEO. “He brings a wealth of insight and experience to our team, and his understanding of and deep connections to residents of Jefferson County will enhance our ability to meet the needs of the people living in that area.”

In his spare time, Gemelas enjoys staying active and volunteering in the community. Gemelas served as the volunteer coordinator for the Madras Aquatic Center MAC Dash Sprint Triathlon from 2008-2018, helped establish the Relay for Life in Jefferson County, and is an active volunteer at his church.


Staying Active as a Family!

Being active with our children matters a great deal to my spouse and I; our most cherished memories with our family have largely taken place outside.  While we deeply value time in nature, the effort it takes to get two small children and an overly eager dog out the door for the activities we love can feel downright overwhelming.  All winter long I made jokes about how our children’s gloves were conspiring against us – how is someone’s glove ALWAYS missing?  When I feel myself sinking into the sense of dread that comes with the preparations needed to get our family out the door, I try to focus on our last outing and the memories etched in my mind of my oldest making snow angels or our toddler laughing as the wind blew through her wispy hair.  I also remind myself that everyone will feel better after we get our wiggles out and breathe fresh air, which helps me press on and find that missing glove!

We have learned to scale back our ambitious plans for all-day hikes that our pre-kid life might have included.  Now we focus on activities that let us all be active, even if that means just going for a walk in our neighborhood or biking on a quiet Forest Service road.  We live close enough to our school that we walk or ride bikes a few days a week, which is nice way for everyone to ease into the day and decompress on the route home.  When we go on more adventurous outings we give our kids the chance to try a bit on their own and have a fallback plan for when their endurance runs out – like a backpack for the little one or on-the-fly scavenger hunts to keep our older child motivated.

Planning for hunger, thirst, weather changes, diaper blowouts, and lost gloves takes effort, but after every activity we do outside we come away feeling more connected as a family and calm in our bodies.

For parents of young kids who want to be more active as a family but find the whole endeavor overwhelming I recommend you:

  • Keep it simple.  Kids find magic in jumping in muddy puddles outside your apartment or sliding down the pile of snow you just created digging out your car, so don’t feel like you have to hike to some new vista or log your personal best speed on your bike.
  • Take a mental snapshot by checking in with your five primary senses: feel the warm sun on your arms, notice the vanilla smell of the pine trees nearby, listen to your little one’s cheerful singing, cherish the puffy clouds and blue sky, and savor the lingering flavor of those great snacks you remembered to pack!
  • Check in afterwards with everyone to hear what they want to remember about the outing – you might be surprised by what your kids noticed that you didn’t even register!  The process of checking in afterwards also helps reinforce the benefit of the activity and makes us feel less overwhelmed the next time we are trying to get out the door.
  • Remember there will be challenges – and that is a good thing!  Our kids learn so much more about themselves when they have to overcome something difficult than they do when everything is taken care of for them. Give them praise for trying hard and doing their best.

Written by Lindsey Overstreet, LCSW


Guest column in Bend Bulletin: Mosaic Medical Makes Central Oregon a better place

By Rod Ray

This fall, I was invited to join the Mosaic Medical board of directors. Little did I know, I was about to have a life experience.

Mosaic Medical is a private nonprofit, community health center, also known as a federally qualified health center, which delivers integrated primary care services to over 26,000 Central Oregon residents. It has 15 clinic locations and 320 employees throughout Bend, Prineville, Redmond and Madras — this includes six walk-in school-based health centers open to any child from birth through age 18 and embedded clinics with other partners such as affordable housing agencies and county offices.

Founded in Prineville in 2002 to serve vulnerable and low-income populations, Mosaic Medical clinics are open to anyone seeking care, with a “sliding scale” of fees adjusted to their ability to pay.

However, the “word is out” on the quality of care, and 16 percent of Mosaic Medical patients have private insurance, and 20 percent have Medicare. The model then is to provide the same high-quality care, convenience, and “integrated services” to all patients — no matter what their means.

Financially, this all works, in part, due to a government agency called the Health Resources and Services Administration.

HRSA awards grants to improve access to quality health care. This grant effectively “makes up the difference” for Mosaic so the budget will balance while offering quality health care to the financial spectrum of our population. Late this fall, Mosaic Medical passed its once-every-three-year HRSA audit with no findings — one of the only community health centers in the state to do so.

Mosaic Medical thinks “outside the box” on medical care by having integrated services like behavioral health providers, nutritionists and clinical pharmacists on-site. And by thinking further about the whole health of its patients, Mosaic recently brought oral health care front and center in the organization. It has been shown that good dental care, especially for youth, is another key factor in preventing medical issues. And, as almost all of us have experienced, dental pain and loss of teeth can majorly impact a person’s daily living and health.

In response to this need, two years ago, Mosaic opened its first dental clinic in the middle of its Redmond medical clinic and integrated dental hygienists into all its main clinics. This spring, Mosaic Medical will open a dental clinic in Bend in the same building as the main Bend pediatric and family medicine clinic near the hospital.

This brings me back to my point: right in our midst in Central Oregon, we have one of the nation’s best examples of a federal and local partnership helping solve our health care issues in the most positive way. This takes vision and leadership, a great staff, and support from the community. And finally, it takes a great board of directors. The board of Mosaic Medical is mandated to be made up of at least 51 percent patients so as to stay responsive to community needs and issues. Over the last three months, working with this group of insightful, caring board members made up of a broad spectrum of experience and situation, has been the life experience I have come to treasure.

And together, we are addressing sickness and factors that cause sickness, such as lack of nutrition, mental illness, homelessness and addiction. This is making Central Oregon a better place.

— Rod Ray serves on the Mosaic Medical board of directors and lives in Bend.



Mosaic Medical partners with local nonprofit, Saving Grace

(Bend, OR) – Beginning this month, Mosaic Medical will take another step toward meeting patient needs where they live. A Mosaic doctor will be making regular visits to the Saving Grace emergency shelter to provide medical care to residents. Many of these women have not been able to access medical care for some time – some may have fled directly from an abusive partner and may have been prohibited by that person from seeking medical attention entirely.

“A former client of ours had been living in a camper in a rural area prior to staying at our shelter,” said shelter manager, Ashby Rodriguez. “They had multiple, untreated broken ribs from over the years of abuse from the same partner. In fact, this is a common situation for women in a physically abusive situa­tion.”

Many women arrive at Saving Grace with their children, who may have also been unable to receive med­ical care. “In order to access the medical care that most residents require during their stay,” Rodriguez continued, “they must navigate challenges like mobility, transportation, childcare, and current injuries. Having Mosaic Medical come to the shelter to provide care to our residents eliminates these barriers and makes it far easier for them to receive the health services they need.”

A Mosaic doctor and medical assistant will provide a variety of services to Saving Grace residents, includ­ing preventative services like general exams and well-child checkups, as well as vaccinations and pre­scription medications. “Medications are often left behind when someone leaves an unsafe relationship, or someone needs a refill after staying in our shelter for a time,” Rodriquez explained.

“It’s a tremendous benefit to have community partners like Mosaic Medical, who understand the needs of domestic and sexual violence survivors,” said Trish Meyer, Interim Executive Director at Saving Grace.

“Meeting them in a safe space can make all the difference for the women and children we serve – ulti­mately leading to better health outcomes for our community.”

About Saving Grace:
Saving Grace provides comprehensive family violence and sexual assault services in Central Oregon and pro­motes the value of living life free from violence. About

Mosaic Medical:
Mosaic Medical is a local nonprofit community health center organization with primary care clinics in Prineville, Bend, Madras and Redmond. Additionally, Mosaic Medical serves the community with six school-based health centers and a mobile clinic program. We accept most insurance including commercial, OHP and most Medicare and fees are based on a sliding scale for qualifying patients with limited or no insurance.


Kids and Screen Time

Written by: Mosaic Medical Pediatrician, Dr. Rebecca Hicks

The Holidays are here and for many parents, that means time to shop for gifts.  Buying our little ones holiday gifts can be a fun experience for parents…watching your little ones eyes light up when they get just exactly what they wanted!  For very littles, it might be a wooden toy train or a sweet baby doll on their wish list. But for older school age kids and tweens, more and more of their wish lists are filled with electronics and screens.  Yes, there is no doubt, most kids like to watch screens.  And while a bit of screen time each day is probably okay for many children, we know that excessive screen time can be very harmful to children.

A lot of research has come out lately showing us that too much screen time is NOT okay for children’s developing brains.  Kids’ brains are growing and changing every day!  And the environment a child is in…their activities, their interactions with other children and adults, the games they play, the words they hear, these things are all shifting the way a child’s brain develops.  When a child looks at screens for a significant part of their day, pathways are shifting in the brain, and not usually in a good way.

For infants and toddlers, as little as 30 minutes of screen time each day can lead to language delay.  For preschool age kids, more than 1-2 hours of screen time per day can lead to decreased focus, impatience, worse memory, and temper tantrums.  For school age kids, more than 2 hours per day of screen time is associated with shorter attention spans, poorer memory, slower processing speed, and lower language skills. For tweens and teens, more than 2 hours per day of screen time is associated with lower emotional intelligence, and worst of all, excessive screen time is associated with higher rates of unhappiness, depression and even suicidality.

Every child deserves to have the best possible environment to support healthy brain growth and good mental health.  One significant step in that direction for most kids and teens, is to decrease daily screen time.  For this Holiday Season, think about gifting non electronics to little ones and share in the joy of playing with classic toys and board games instead.  And if screens do make it onto the gift list, consider having those new screens come with rules about decreased screen time on the gift tag.  A new year is a great time to re-set family rules and decreased screen time for all just might be what your family needs to have a Healthy, Happy 2019.

If you are interested in learning more about the impact that screens have on your children, I’d love to see you in clinic and we can chat through the details.  I’ve got lots of tips for easing the transition.

Click here for some great additional information.


Eat for Life

Healthcare organizations across Central Oregon are coming together to improve the health and well-being of our neighbors, friends and family members that suffer from Type 2 Diabetes. High Lakes in Sisters, La Pine Community Health Center, Mosaic Medical, and St. Charles are now offering a new program called Eat for Life.

According to the latest regional assessment by the  Central Oregon Health Council 9.1% of adults in Oregon now have diabetes, , doubling rates from just 20 years ago (Oregon Health Authority, 2015). Disparities also exist between our communities in diabetes prevalence with 13% of Crook County residents, 8% of Deschutes County residents and 11% of Jefferson County diagnosed with diabetes.

For these adults, a key element of diabetes control is self-management (diet and exercise). Eat for life is designed to support patients with uncontrolled Type 2 Diabetes. The  four month program provides education and peer support about the importance of including more vegetables as part of a balanced diet to control diabetes. Each participant receives one-on-one goal setting with a nutritionist, nurse or provider, attends cooking classes that focus on cooking healthier meals and receives a monthly stipend to a local Grocery Outlet or to Melvin’s in Sisters to purchase fresh and frozen vegetables. 

“With the price of nutritious food increasing across Central Oregon, it is great to be part of a program that alleviates the cost of vegetables for those in our community who cannot afford them. We are actively improving the health of community and I couldn’t be prouder to be part of this unique program”, says Rhonda Bourgo, the owner of Grocery Outlet in Madras. 

Eat for Life began this month across Central Oregon.  Four groups in each community are planned for the next two years.  The program aims to help patients take control of their diabetes to live their healthiest life!


Spread Fun…..Not Flu!

The Centers for Disease Control and Prevention (CDC) recommends that all individuals, ages six months and older receive an annual flu vaccine.  In the United States the flu season runs from fall through winter, with the peak season has occurring anywhere from November through March.

We are currently offering flu vaccines in all of our clinics for established Mosaic Medical patients.  Many local pharmacies also provide flu vaccines as well.  If you have any questions, or would like to schedule your flu vaccine, give us a call at 541-383-3005.