I am Kendra Morgan. And I am a senior program manager here at Webjunction, and we have been spending the last nine months here working on the health happens in libraries program, and two of our excellent presenters today are part of that project team, and this is a project that is funded by the institute of museum and library services. This is the sixth Webinar in a series that we have offered since July, when the program launched, and we're excited today to be able to talk a bit about the importance of partnerships. So, joining us as my colleague Liz Morris, who is the project coordinator for Health Happens in Libraries. And McCrae Parker, who is a senior program manager, who is part of the team at zerodivide, who are our partners in this project. We do know it's a critical part of the success of this program that we are working together collaboratively using our individual expertise to bring an excellent program to the library field. So, we're very grateful for that partnership. And with that, I will go ahead and turn it over to Liz, who will kick off the presentation. >> Thank you very much, Kendra. So, as Kendra mentioned, I am Liz Morris, the project coordinator for Health Happens in Libraries. I have had the opportunity to connect with a number of libraries over this initial enrollment period for the affordable care act. And in the process of doing so, I have learned a lot, both about the context of patronees, as well as the strategies and resources that libraries have deployed to meet those needs. And I am happy to spend time with all of you today reflecting on the best practices, that have emerged in our work with libraries, and as well as hearing from all of you about what you have learned and how you are thinking about, about sustaining affordable care act services for future enrollment periods. As a brief overview, of what we'll cover in today's Webinar, I would like to spend is a few minutes on a project update, sharing how our team and partners have, have prioritized activities over the past several months. I have, I would like to discuss the broader context of patrons seeking affordable care act, information support, and areas highlighted regarding the library's unique role to support those needs. I will turn it over to my colleague McCrae from zero divide who will share best practices for effective partner engagement, and he will also share some recommendations for how you can approach further integrating affordable care act services in your library activities moving forward, and also will share details on some of the, some of the project activities that, that will be, we'll be doing over the next months, as well. So, just, just as a bit of a heads up, we may both refer to the Affordable Care Act in shorthand as aca. We will monitor the discussion and chat and pause for questions throughout the conversation as well as at the end, and we encourage you to use chat to share your thoughts with us and with each other. So, we will, actually, go ahead and, and start the conversation with a poll. I encourage all of you to, to review the question on the screen, and use the polling feature in Webex to respond. You will -- sorry, sorry, sorry. [Laughter] You will shortly see the polling option on your screen. you can use the left-hand arrow in the corner to maximize or minimize it. As you provide your response. Feel free to use the options relevant to you and your library or share additional information in chat. Part of the reason that we wanted to start with this question is because we know how important it is for libraries to customize their ACA services to unique community needs, and we know that patron demand and related services have really occurred on a continuum of engagement. Including everything from, from libraries providing reference, to the enrollment website, to bringing enrollment specialists into their space, to educate patrons and everything in between. So, whatever role a library plays, and whatever level of demand you experience, it's important that, that you take the approach that best meets the needs in your community, and we have seen that happening a lot over the past several months. So, thank you for, for being willing to share your experiences with us. So, you will see that, that the results have popped up on the right hand corner of the screen, and it looks like people are doing a wide range of things. It looks like ACA library guides are really popular. As well as a good number of paper applications being provided in the libraries, and we have heard that's useful to obtain paper applications, review the content, think about the content before pursuing an application. So, that's, that's a great resource, as well. And of course, hosting guest speakers, or hosting enrollment specialists is, is a huge value-add for patrons, so thank you for sharing that information and for being willing to share more with each other in chat. As a reminder about chat, the panels on the right-hand side of the screen, you can use that small triangle, so if your chat panel was hidden while you were responding to the poll, you can click on that small arrow to expose the panel again. >> Thank you. >>> Ok. So, a brief project update. I would like to share this update with all of you, understanding that many of you are already engaged in our project activities, and contributing to our community of practice in a lot of ways. This project overview is to provide a foundation for our subsequent discussion today, and context for you to provide feedback to us about how we can continue to, to provide resources that are relevant to your work. So, our project launched in July of 2013 with the goal to support public library E-health services and staff capacity to respond to patron information needs regarding the Affordable Care Act. From our perspective, E-health services and Affordable Care Act information needs are integrated in a number of ways. Specifically, for the purposes of our project, we define E-health as the growing intersection of digital technologies and personal healthcare management. This includes activities such as searching for a provider, or insurance coverage, or health information online using the internet to schedule appointments or refill prescriptions or accessing personal electronic health records records online. >>> We know that, that access to, to and use of technology is an increasingly prevalent component of personal health care management, and we also know that meaningful technology used is one of the essential features of the Affordable Care Act. At the patron level, this is most evident in the creation of the health insurance marketplace for uninsured individuals to apply for and enroll in health care coverage. We'll discuss key marketplace resources a bit later in this presentation, but really I want to emphasize here that a key element of the marketplace is a focus on online platforms to facilitate enrollment. In addition, many of the information and training resources that are available for community-based organizations, supporting enrollment, are also hosted online. So, the rise of E-health, the prevalence of web-based affordable care act resources, and the established role of libraries as trusted technology providers, and referral sources, led to the expectation that patrons would turn to their libraries for support and understanding the ACA. So, this, then, is the foundation from which we and our partners launched our work, and I would like to spend just a brief amount of time talking about our partners because as Kendra mentioned earlier, cross sector collaboration and partnership is a really key, key, critical element of success for, for the marketplace and this project. So, although the affordable care act was signed into law, in 2010, the opening of the marketplace represented the first major piece of the legislation requiring direct consumer education outreach and engagement. And in addition to libraries, many health and community service organizations have been active contributors to the marketplace support. So, from a project perspective, we have benefited from our partnership with zero divide, and it was a social impact consult firm who providing excellent E-health and community technology expertise to our work, and are involved with our day-to-day project activities. We have also worked closely with the national network of libraries of medicine, which is a division of the national group. They have eight regional medical libraries across the country facilitating community access to health information to organizations such as hospital libraries, academic libraries, and public libraries. Public libraries are, actually, one of their fastest growing categories of membership. And membership is free, so public libraries are able to access the support for reliable health information topics at no cost. The national network has shared our project resources broadly with their regional libraries, and have also actively been engaged in outreach to state and local libraries regarding the Affordable Care Act. I will share that representatives from the Pacific southwest regional medical library presented an excellent program Webinar in January on health information resources for library staff, so if you have time in the future to check out that archive, I would encourage you to do so. And the centers for Medicare and Medicaid services have also been a critical partner in this work. They are the Federal agency administers the Federal health insurance marketplace, and healthcare.gov. They oversee Medicare, Medicaid and the children's health insurance program, as well. They have provided our team with timely information on Federal ACA resources and details about ongoing stakeholder events, such as conference calls and Webinars. So, that's been really useful. They also host the champions for coverage program, which is an opportunity for, for the community organizations to, to self identify themselves as advocates for health reform and, and since the launch of the marketplace, in October of 2013, over 100 state or public library organizations have identified themselves as champions for coverage. So, libraries have been playing a key role in this space since the beginning, and of course, the institute of museum and library services, provides funding and leadership support for the work, as well. So, as we have prioritized our work, a key priority has been to, to establish an active learning community at webjunction.org. We use the space to scale and sustain resources that have been created by ACA and community health experts. We also use the space to customize information specifically for the library community. So, this has included program Webinars, we have had over 9500 attendees participate in our live Webinars or archive sessions since the program launched, which has been exciting. We also maintain information on key Affordable Care Act resources. This includes links to Federal and state marketplace sites, as well as examples of ACA live guides produced by state and public libraries. Our goal in doing so is that if a library staff member was, was just starting to look into ACA resources, at our site, they could easily be connected to the resources that are most relevant to their state, and learn about, about how other libraries are responding to ACA in their communities. And we also provide regular resource updates to our project distribution list, which has over 3,500 subscribers from libraries, as well as community partner organizations. Our resource updates include project announcements and access to new materials from, from a variety of subject matter experts, and because, because, because communications is a two-way street, another driving priority in our work has been to, to emphasize library engagement. So, we knew when this project launched that many libraries were going to be proactive in making ACA resources available to their communities, and so listening to and learning from libraries has been a fundamental piece of our work. This has been particularly important because of the unique operating environments for the marketplace across the states. As many of you may be aware, the structure of the marketplace, including governance and policies and resources, is unique depending upon which state you are in. So, one of the first things that we did was, was conducted an, a needs assessment with library representatives. The needs assessment launched in August of 2013 prior to the opening of the marketplace, and our goal was really to understand state library priorities for supporting public libraries with the ACA. It was an interesting time to conduct the survey because expectations for community organizations were evolving daily based on the rapid pace of communication about, about available resources. And, and application requirements from the marketplace. However, despite the rapid pace of change, and the unknown demand for services, 88% of the responding state library agencies indicated that they were already providing or planned to provide ACA resources to support public libraries and community needs. This was a pretty significant response given that on the ground needs and resources were still being determined in most states. We conducted interviews over the past few months while the open enrollment period was open with state library representatives. We have worked to connect with representatives from states with different marketplace types, and as well as with diverse levels of uninsured populations. these conversations helped us understand the importance of drawing connections between ACA services and other types of, of complex patron inquiries like taxes, and it also helped us to gain insight into, into the growing dialogue around other types of health information services, being provided at state and public libraries, with some of the resources that we'll discuss today, and they also inform. And we have collected local library stories in the form of case studies and stories self submitted by libraries. We love receiving those stories and highlighting them on our project page. So, please feel free to share them at any time. >>> So, at a high level some of the things that we have learned that will carry through the conversation today, are as we mentioned, the library engagement with ACA services really occurs on a continuum. There is no, no one side fits all approach. These services have been influenced by a variety of circumstances, including patron awareness and demand, political support or barriers, and the props and capacity of local outreach and enrollment specialists. We have also learned that health literacy is critical for patron engagement, and is a fundamental aspect of any health information behavior, and that this, this competency is the competency that libraries are poised to influence in their communities. And we have also learned on, that partners, that partners or referral sources for the ACA can be found in a variety of settings and are key for supporting library capacity and goals. So, before I move into a discussion of broader patron ACA needs, I will pause and see if there are any questions. I can answer from chat or things that have popped up there? Nothing has popped up yet but feel free to add your comments or questions into the chat, and we can follow-up with both Liz and McCrae. >> Excellent. Thanks, Kendra. Ok. So as a bit of framing, the discussion in this and following sections will be fairly resource-heavy, and I am going to give the broad disclaimer that I am in no way a policy expert. But, there are a lot of organizations that are working hard to capture and communicate data about the status of health reform and individual and community impacts. So, I would like to share that with you. As Jennifer mentioned earlier, all resources will be posted at the Webinar archived page, which will, will, will also be e-mailed to you after the session. So, we have discussed the function of the marketplace as a platform for individuals to research, compare, apply, and enroll in health care coverage. Many individuals who apply through the marketplace may be eligible for subsidies on the cost of their insurance, and they may also be able to determine their eligibility for Medicaid as part of marketplace enrollment. However, eligibility and cost considerations are highly dependent on individual circumstances, and on details provided in the application process, which is why partnering with, or referring to enrollment specialists is really important for this information service because they can, they can help patrons navigate that complexity. One of the most important things that a library staff member can do to support patrons with the ACA is to be mindful of the marketplace serving your state. Whatever the marketplace is serving your state, whether it's healthcare.gov or another site, they will likely have the most accurate and up to date information for your community, including details on the potential partners, training, and communication resources. And another key thing that library staff can do to support patrons is to remain mindful of the time line for the open enrollment period. Much like tax season, these will be the time periods when demand for ACA support will likely increase. As many of you may be aware the initial enrollment period is coming to an end, at the end of this month. The next period has been announced as November 15, 2014, through February 15, 2015. However, individuals may experience what's known as qualifying life events, that allow them to get coverage outside of open enrollment. Details on both qualifying life events and special enrollment periods are included at the link provided, but some examples include getting married, having or adopting a child, and moving to a new area, with different insurance options, and, or having a major change in income or household status. There are other factors to consider, but those are a few of the examples. Another note on the timeline, there is no timeline for individuals to apply for public assistance through programs such as Medicaid or the children's health insurance program. So, just overall, verifying and being mindful of these timelines and resources for special enrollment can help you guide patrons who may have inquiries between enrollment periods. So, who are these patrons? The marketplace targets the uninsured, or those who lack health coverage for a variety of reasons. Over the next few slides, I'll be speaking to some findings and data points from the Kaiser family foundation, who have done extensive research and outreach around health reform. This data is from a survey that they conducted in 2013 to establish a baseline at the start of open enrollment for understanding individual experiences with health insurance coverage, health care use, barriers to care and financial security. I encourage you to spend time at the Kaiser foundation site, specifically, in their health reform and uninsured topic areas to learn more about this because they have a lot of accessible and, and easily, easily shared information. So, according to Kaiser, at the start of open enrollment, approximately 47 million people weren't sured, uninsured. This group is comprised of non elderly adults. One of the primary barriers to coverage is cost. There are several reasons for this. But largely, not all employers offer health care coverage, and not all adults are working. The last two points are of particular interest to a discussion of patron needs, specifically, that, that the what can of coverage is a long-term issue for many of the uninsured, and many uninsured individuals lack connection to the health care system. So, in terms of the lack of coverage, this chart indicates that, that 47% of the uninsured were uninsured for five years or more, with 18% of those never having had insurance coverage. And this, and this following chart speaks to a connection to the health care system. The report notes that, that having a usual source of care is an indicator of being linked to the health care system, and having regular access to services. However, uninsured individuals, when compared to others, lack this connection. For example, only 51% of uninsured individuals have a usual source of care compared to 82% who may have coverage through an employer. Also, only 31% of uninsured individuals have a regular doctor at a usual source of care, compared to 71% who may have coverage through an employer. So, understanding the patterns of the connection from the health care system may also help provide insight into some of the barriers to awareness of the marketplace, itself. This chart is from a Kaiser tracking poll that was conducted just last month in February of 2014. It indicates 24% of uninsured individuals are aware of the March 31 outline for the open enrollment period. Additionally, 63% of the uninsured report knowing only a little or nothing at all about the health insurance marketplace, and this is an opportunity for, for libraries and other community organizations to further coordinate outreach and education to information patrons about their options in the marketplace, and to, to connect them to resources to understands how to effectively utilize the options. So, the discussion of, of the health care system, excuse me, connection to the health care system, and the awareness of resources through the marketplace, also ties into a broader area as health literacy. The resources here and on the following slides are health literacy resources from the national network of libraries of medicine. Health literacy is, is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. According to the national assessment of adult literacy, literacy of the adults in the United States is somewhat limited. Overall, 36% of adults have limited health literacy, with 22% indicating basic health literacy and 14% indicating below basic health literacy. In the context of the affordable care act, we have learned that many patrons, in addition to seeking information about their obligations as part of the law, needs support, understanding or accessing definitions of basic health insurance concepts. Healthcare.gov provides excellent definitions for the basic health insurance concepts, and they also provide interactive resources for individuals to learn how to apply those concepts, including videos and road maps for, for using health care coverage for the first time. So, those are great resources to be able to share with your patrons who may be new to this area. This slide breaks down some of the key skills required for health literacy. Of the skills required, information literacy is the clear area where library staff expertise can reinforce the health literacy of patrons who may come in with ACA or other health information questions, computer literacy is also a skill set that patrons are increasingly turning to their libraries to for support. This includes access to the specific skills training such as setting up an email account, or identifying reliable information on the web. It's work that libraries help patrons with every day. So, because every individual is unique, and because the level of, of capacity or comfort individuals display in seeking information on personal health insurance or other health needs is very diverse, it's really important and useful for library staff to organize around the, the key unique assets that they bring to, to, to supporting patrons in these areas. These assets include community assessment capacity, access to reliable resources, and the skills to partner and refer as necessary. So, from an assessment perspective, there are some key resources that you can connect with to remain aware of how the ACA marketplace is evolving in your state. There is likely to be some level of adaptation or modification to marketplace resources, and outreach strategies, as leaders reflect on lessons learned, from this initial open enrollment period. So some of these resources that you can look to, to track these changes at the state level include state reform, which is an online network for health reform collaborators, and they have daily listserv and is email updates, and great Webinars, and they have state-specific discussion forums and data sharing. I have mentioned the Kaiser family foundation, and in addition to providing resources on specific health topic areas, they include state profiles recording health reform, and resources, and enroll America is a national outreach and advocacy network that provides state profiles, and they provide really useful tool kits for consumer outreach and engagement and cross sector collaboration, so I would encourage you to check them out, as well. I will also mention that, that enroll America, recently held a Webinar series on community outreach and education for the marketplace, and mentioned libraries specifically as strong and responsive partners for the enrollment community. The presenters in that Webinar also spoke very well to the best practices around respecting capacity and organizational goals, when engaging libraries as partners, and so, our role as community connectors is known in the enrollment community and, and a great relationship to potentially build off of. And of course, also, look to communicate with your state libraries. Although, some may be constrained with the amount of information that they can provide. Were he know that may be are making resources available, and helping translate from other complex policy considerations for public libraries. And another key action that libraries can take is to explore community health demographics. There are a number of resources to do this, although the ones that we have heard most frequently about from libraries over the past several months, include looking to, to state or local health department web pages, and which often provide data summaries or tools about local public health priorities and resources in a community. These can be accessed through the centers for disease control and prevention sites. And another great resource is, is the Robert wood Johnson foundation, who provides county level and statewide information on a number of key community health factors. Some of these include things like healthy behavior, such as smoking and factors related to social and environmental indicators like water safety or education. And they also provide detailed guidance on helping you to understand ways to turn community health data into action. So, it's a great resource. And where possible, potentially at your city's website, it's also useful to access city data and compare city data to county data to really understand and narrow in on the profiles and the community your library serves. The libraries provided access to critical community support for the ACA marketplaces. Beyond the great skills of library staff, they have access to technology resources and guidance. Space for programming and hosting community partners and, and accessible hours for, for diverse schedules, and it's these fax that we have heard over and over again that have been really valuable for communities and community partners to, to support the patron engagement with the marketplace. So, I would like to speak very briefly to a couple of the libraries that we have profiled through our work. Miami public library in Oklahoma serves a community of 13,000 residents. Part of their mission is to enhance the quality of life for residents by providing lifelong learning. They access community health data using the Robert wood Johnson foundation county health thinking, and realized a real community need for learning about healthy behaviors. Although the Miami library is in a small community and the closest ACA Flagstaff navigator organization is 30 miles away, they worked with an ACA advocacy organization to host an information session at the library to bring ACA support to their residents as directly as possible. And they have also hosted healthy behavior workshops on movement and exercise and in partnership with the local health center and a senior center, and they are hosting another workshop on healthy eating in may. So, Miami is a great example of how libraries can use community data to articulate the need for, for health information at your library, and to align that need, with the, with established library goals and, and San Antonio public library in Texas, serves a, a large urban population and, and they, incorporated ACA services with their existing health and wellness services. Their existing services included things like an online guide on multiple health topics, and as well as health programming with local organizations such as the red cross and the American Heart Association. To respond to affordable care act requests, they dedicated computer space at designated times at four branch libraries as well as specific times for navigators to be able to be available at the library to help people enroll. Application spaces were made available to all community members, and many information sessions were provided in English, as well as Spanish. So, San Antonio is a great example of how a library can use the space and technology resources to engage patrons and trained partners in ACA needs. So, with that, I will, I will turn it over to, to McCrae to talk a bit further about partner engagement. >> Thanks, Liz. Once again, McCrae, I'm a senior program manager here at zero divide based in San Francisco, and I am very pleased to join you today, and share what we have learned about partner engagement through the work with the health happens in library project. I am also looking forward to learning about your experiences as staff in the field. You know, along the way in this portion of the presentation, I hope that we can present you with best practices, models and resources for, for effective engagement. It will support your work and also, inspire your, your continuing work. So, let's begin sharing and learning. By hearing from you. What types of partnerships have you developed to support ACA activities at your library? What has contributed to, to the success of these partnerships? If folks could take a moment and think about that question, and type your responses into the chat window, that would be great to, to start us off. Really looking forward to, to, to hearing from folks in the field. As to what they have been up to. Thanks. We are hearing about those partnerships that come through working with county hospital organizations and, and their ability to, to provide navigator staff, so, it's great to see that reflected in the comments window there. Partnerships with local colleges and universities have also proven to be really powerful partnerships to develop, to provide and to fill in on needs and services of, of various patrons. And, of course, enrolling assistance, as was touched upon in Liz's portion of the presentation, of course, has proven to be a key service for, for patrons, showing, showing at the library to, to, to begin their navigation through, through the complexity of ACA enrollment. Well, thanks for that. This, this -- we support what we've been finding out there in the field. That, you know, in terms of ACA and E-health services, you know, the strong partnerships, that can occur between organizations with similar backgrounds, clear loyalties in interest, and clear communication channels, around responsibility and, and accountability for success, you really do enjoy sort of the rewards of providing great benefit to community. You know, so far, our work has eliminated, illuminated, and reinforced the idea that effective partnerships, regardless of the ACA implementation climate, and in a given state, has great potential to shape individual behavior and outcomes and transform networks and communities as they relate to ACA enrollment support and E-health services. You know, health insurance decisions are, are very personal decisions, applications are complex and dependent upon very unique circumstances. Like taxes, they also are dependent upon individual circumstances. That in many case, require professional advice and guidance to support decision-making. And there are sensitive time lines, dependent upon, upon the particular state or policies that are, that have been enacted. And so, referral and connection to qualifying community organizations becomes important here. And as trusted community institutions, libraries have served as the first step for community members seeking information and support, and factors such as capacity and resources can affect a library's ability to serve all needs, but, really, that's where, where partnerships can play a major role in filling those needs. And so, libraries, as trusted institutions, are uniquely positioned to serve as significant health providers and connectors in communities and certainly through the work over the last several months, we have found that to be the case. Where this begins, is with something of an inventory. That leads to a greater understanding of the library's role in this network of providing health and ACA enrollment support. I would like to surface this idea and notion that it's something called p cubed, an understanding of populations. Understanding who your existing patrons are and who the new or potential patrons might be. Programs. This idea of taking stock of existing programs that occur within the library that are health focused, and some that may not be. But, perhaps, could lead to the potential development of programming for, for new audiences. And partnerships. Again, taking stock of what are those existing partnerships that the library has established within the community. Who are those that, that need to be undertaken to serve the unique needs that have been identified with the group, and are there community service organizations in the, in the community already conducting work. That, that have begun to approach the library as a partner. So really quickly I want to back up a moment and review some of the potential partnership landscape and how to identify some useful resources related to populations, programs, and potential partnerships. Now, some of you may have heard about these, and maybe already using them. The first I would like to -- to point out is the zip code locator tool. Provided by, by healthcare.gov. Note that if you are in a state that's operating its own marketplace, this may redirect you there. Although, zip code locator tool does provide up to date information and details on support available to organizations around ACA enrollment. The second resource that I would like to direct people to would be the website that has been built out around community health centers, as part of the ACA local health centers and every state, we're provided with funding to provide local outreach and enrollment efforts, and these centers host a wealth of information related to ACA enrollment, and workers to assist with outreach enrollment efforts that could be happening at the library. And this third one, community commons, is a robust interactive mapping networking and learning utility for broad base healthy sustainable and livable communities. It's very, a very powerful tool, and it is, basically, a free access to, to, you know, over 7,000 geo-side data layers by state, county, and zip code track. It provides opportunities to do contextualize mapping and visualization of communities, and it also supports a set of, of pure learning communities, forums, interactive commons is what they call them, where folks can, can exchange ideas with, with colleagues from, from around the country. To develop, to develop health and E-health services. Briefly, a great example of leveraging these kinds of data resources, really, can be found in the Miami public library that, that Liz referenced early. Beyond the ACA employment, this library, and it's partners are now engaging, you know, existing library students in health literacy workshops on, on additional topics beyond the ACA enrollment and, and workshops looking at, at things such as healthy behaviors, effective health communications, and you know, and these students, you know, who, who are, basically, from the community oftentimes are, are coming through the door with, with low literacy levels or with, with English as a second language, but they also are serving as, as Gateways to, to provide information and support out into the communities through their pure networks and families. And one of the things in talking with Marci, who is the director of the library there, she noted that because of the, you know, overwhelming amount of health statistics and data, they were able to locate, that it really did information the, you know, the real need that was happening in the community for residents, to learn about, about healthy behaviors, and to, to, you know, really move this to, to, to a very high level priority for the library. She's offered up in conversations with her about, about best practices and support in terms of the health literacy in the libraries, and these three points. You know, one, look to the state library to understand what health literacy priorities or resources have already existed. And that your library play already be or, or, perhaps, potentially can, can incorporate into its programming. Train stats on library health priorities and policies. To ensure their familiarity, that they have a certain level of familiarity with the subject matter. And, and two, access and use available data, to articulate the need for health literacy of supports in your community to decision-makers, and to, to potential partners. So, when thinking about approaching potential partnerships, you know, we have definitely been able to surface some, some key points here in our conversations and research with libraries in the field. And it really starts with the library taking a look at what are the primary assets that the library can provide to, to partners. During the initial ACA, open enrollment period, many libraries provided space and cross promotion for partner information sessions, and they provided access to reliable computer technology for patrons and enrollment as sisters, and they also opened up the library for evening and weekend hours to increase assets or access for, for patrons. We found libraries able to clearly establish their goals and relate those, connect those to, to patron needs, found success, and so, you know, this would surface the idea of libraries really identifying sort of their, their particular goals, and aligning those with patron needs. Theory point that we lifted here was, was really taking a look into, into the community and, and discovering what is the unique expertise that exists out there to meet the particular goals and needs that a library has identified for, for its patrons. Again, in the case of ACA, open enrollment, external expertise has been largely about, you know, the details of individual obligations and eligibility associated with the marketplace. And it also included relationships with trained individuals and organizations who can guide individuals through the application process. And finally, who in your library will be responsible for managing partnerships? You know, there capacity issues in libraries, but, the one thing to, to highlight here is that effective partner management includes but is not limited to consideration such as establishing regular communication, prioritizing resource sharing, and creating criteria for success, and documenting, and, and or, or, you know, creating momentums of understanding to -- memorandums of understanding to clarify expectations of library and the partners. So I just want to leave this slide and leave you with this, that when approaching partnerships, think both about sort of like the short-term and long-term benefits to your library partnerships. In the short-term, you know, be prepared to, to navigate whatever level of demand may come over time. Relate it to ACA. In the long-term, think about building relationships that support other community health initiatives and wellness efforts at your library. Partnership best practices. So, in our work we have uncovered some, some key competencies for building relationships with community organizations. They just want to, to highlight just a few of these here. The first is the networking and engaging in community. This has served many libraries well, and is, is, perhaps, well-known as libraries have, have a, a long established track record of, of working in community. In relation to ACA enrollment, you know, really, you want to lift up the work of libraries in Ohio. We spoke to some folks there, staff there and, and that, that, you know, were ahead of the rollout of ACA, had, had gathered with, with 50 organizations from their community, and in something called the "once group." They called it that because they met once a month. The organizations, community service organizations, and potential partners, to really begin to develop a clearinghouse of information, to develop a, a join communication plan, and to provide an opportunity to, to identify missing links into the community and, and all of this work, you know, continues to this day. I mean, it has great potential for, for work and programming that they plan to do in the future. Another key point to lift is that the identification of potential partners and opportunities, and to be able to articulate in some way the mutual advantage of entering into a partnership. A great example that we found, and is profiled at the Webjunction, website, is from the Wakegan public library where it participants as one of 25 organizations in the enroll lake county program. This is an initiative comprised of diverse community-based organizations seeking to increase health care for the county residents. In the case of, of Wakeg in that. , staff have been trained to become qualified inpersonal counselors, and as part of the partnership, what they are able to do is to enhance, actually, enrollment numbers there. In the initial enrollment period, of ACA, were scheduled to enroll about 1,000 community members. The last point here would be around sustaining partner relationships for future opportunities. We mentioned earlier the work of the San Antonio public library conducted an extensive work in partnership with groups like the red cross, the American Heart Association, the Susan G. Komen for the cure organization. But, you know, these really do set the stage for continuing work, and buildout for E-health services and general health literacy. And community. So, in terms of the partnership development, and engagement, one of the things that, that, that we know is, is that, that it really can serve a significant, in a significant way, to reach unique populations with distinct needs. And here at zero divide over the past 13 years our work focused on the technology to transform the lives of individuals and in underserved communities in the areas of education, workforce, and health. But, key to this transformational work has been the identification of unique and distinct needs of individuals and beyond SIMPLY providing access to technology, zero divide's approach hones in on these needs to design culturally competent interventions for the populations. So, more often than not our work is done in partnership with existing organizations and communities that has established trust and a track record within those communities. This work is especially significant when mounting work with, again, unique populations. You know, this is an example, we are probably all aware of some of the challenges of ACA enrollment and, and information distribution, with non English speakers, given the complexity of the marketplace, the complexity of the application, and limited English language proficiency, you know, there is a barrier to, to smooth and effective enrollment. And certainly, you know, recent news has detailed some of the challenges specifically for Spanish language speakers. You know, much of this disparity has been attributed to, to the translation of materials, but, you know, it's also true that, that market research shows that, that oftentimes, Spanish speakers prefer in-person dialogue, rather than information just being presented through a handout or a website. You know, when thinking about, about what an intervention might look like there, to engage those who, who, you know, who speak Spanish, it might look like a partnership with folks who, who are, are willing to meet with people one-on-one and in small groups, in community, and in libraries, library spaces. You know, further, you know, zero divide works with organizations here in California, have, have surfaced that there are other, other, you know, issues beyond just, just linguistic competencies. Recently, we met with an organization that was doing outreach work in western Sacramento, among the Hmong community, and found it was not only language proficiency that inhibited access to ACA information enrollment, but a particular literacy barrier among those populations in their native language. And so here you see on this slide, just some other communities where, you know, really, what it comes down to is a kind of cultural competency, and being able to assess the needs of these communities, and to determine the right, the right ways of communicating information to them. And so, we'll leave you with these points. When targeting a partner for engagement, is that organization known and trusted in the community? Do they have a demonstrated expertise with that particular population? Is the organization or network, a network that, to a group of other providers who may be engaged in extending that service? Could there be a coalition event, perhaps, that take place in your library? Of course, we have talked a bit about this. Will this partnership be mutually beneficial at reinforcing for the organizations involved, including the library? And once again, who is best, on your team. The whole, to hold the relationship? Just thinking about unique populations, one of the things that surfaced through the work, of course, has been, has been, you know, a resource divide, if you will, between, you know, small and large library systems. And so, with regard to connecting to unique populations, you know, one of the things that we have seen is that, that regardless of size, there have been really a tremendous, tremendous efforts put towards innovative practice and solutions in communities. Here, on this slide, we just want to feature some, some resources that, that really, you know, lift up that practice. The first is the rural assistance center, some of you may have heard of, which maintains a website that features an online library, tools, for, for assessment planning and, and impact measurement, and also, posts great examples of, of a collaboration and program models in support of community health in, in rural areas. >> McCrae. This is Liz, and thank you very much for sharing those resources. I want to, to just note really quickly that we're, actually, at the top of the hour. The hour has been, has gone by really quickly, and I want to, I want to, to be sure that we are mindful of participants' time. Can I ask you to speak really quickly to these, these key bullet points around sustaining services before we let people go? >> Sure. Let's just leave with these key points. You know, in thinking about partnership engagement and the needs of patrons, where it starts us with, with, you know, libraries really reflecting on their experience, you know, their expectation and is outcomes during the initial enrollment period. Thinking about, about the lessons learned there, that they can roll into, into future program efforts. And this, this, this notion of, of being able to connect with, with partners and community around shared priorities, between enrollment periods, you know. Before, before it gets hot and heavy, if you will, some communication and planning, and identifying of, of, perhaps, gaps for community and patrons. And finally, the idea of, you know, maintain these networks of partnership and referral. For, for future work. The work of the ACA is, is ongoing, and certainly the work of, of, of health and communities is ongoing, and, and so, you know, one oftentimes finds themselves returning to these partnerships and relationships that, that have been cultivated over the years to, to meet those needs. >> Great. Thank you very much, McCrae, and for sharing those great strategies and thoughts on partnerships. So, we are at the top of the hour, and I want to thank you for your time and contributions to our conversation. I look forward to reviewing some of your activities and, and chats, and we will be sharing our Webinar archives and a follow-up survey shortly. All of the resources that we have discussed today, as well as our slides will be available on the, on the Webinar page, and please feel free to email us at any time or to reach out directly with any, any other thoughts or questions, and thanks again for your time.