PUBLIC HEALTH INSTITUTE
555 12th Street 10th Floor, Oakland, CA 946074046 www.phi.org

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Organizations Filed Purposes: PUBLIC HEALTH INSTITUTE GENERATES AND PROMOTES RESEARCH, LEADERSHIP AND PARTNERSHIPS TO BUILD CAPACITY FOR STRONG PUBLIC HEALTH POLICY, PROGRAMS, SYSTEMS AND PRACTICES.

CHILDREN'S ONCOLOGY GROUP COORDINATING CENTER: MONROVIA, CA: THE PUBLIC HEALTH INSTITUTE SERVES AS THE FISCAL PARTNER FOR THE CHILDREN'S ONCOLOGY GROUP COORDINATING CENTER (COGCC) IN MONROVIA, CALIFORNIA. COGCC IS THE PRIMARY HEADQUARTERS FOR THE CHILDREN'S ONCOLOGY GROUP (COG), PROVIDING ADMINISTRATIVE AS WELL AS STATISTICAL AND DATA MANAGEMENT SUPPORT. THE CHILDREN'S ONCOLOGY GROUP AND ITS COORDINATING CENTER IN MONROVIA HAVE TWENTY YEARS OF EXPERIENCE IN CARRYING OUT EFFICIENT, HIGH IMPACT RESEARCH FOR CHILDREN WITH CANCER. COG, A NATIONAL CANCER INSTITUTE (NCI) SUPPORTED CLINICAL TRIALS GROUP, IS THE WORLD'S LARGEST ORGANIZATION DEVOTED EXCLUSIVELY TO CHILDHOOD AND ADOLESCENT CANCER RESEARCH. THE NCI COOPERATIVE GROUP SYSTEM FOR CLINICAL RESEARCH BEGAN IN 1955 WITH A CONSORTIUM FOCUSED ON CHILDHOOD CANCER RESEARCH. BY THE END OF THE 1990S THERE WERE NINE GROUPS FUNDED BY THE NCI TO CONDUCT RESEARCH IN ADULTS WITH CANCER, AND FOUR COOPERATIVE GROUPS FUNDED WITH A FOCUS ON CHILDHOOD CANCER RESEARCH. IN THE YEAR 2000 THE FOUR PEDIATRIC GROUPS VOLUNTARILY MERGED EFFORTS TO CREATE THE CHILDREN'S ONCOLOGY GROUP. THE COG COORDINATING CENTER STAFF COMPRISE A NUMBER OF MULTI-DISCIPLINARY TEAMS SUPPORTING CLINICAL TRIAL OPERATIONS. TEAMS ARE MADE UP OF PROTOCOL COORDINATORS, DATA MANAGEMENT PROFESSIONALS AND STATISTICIANS. ADDITIONAL STAFFING GROUPS INCLUDE OPERATIONS AND FINANCE, QUALITY ASSURANCE & SITE AUDITING, INFORMATION TECHNOLOGY, COMPLEX CLINICAL PROJECTS, PHARMACEUTICAL INDUSTRY RELATIONS, AND GROUP MEMBERSHIP. EACH WORK GROUP HAS A MANAGER OR DIRECTOR WITH CONSIDERABLE INDEPENDENCE AND FLEXIBILITY IN MANAGING HIS/HER AREA TO ENSURE RAPID AND EFFICIENT RESPONSE TO COG NEEDS. FULLY STAFFED HEADCOUNT IS APPROXIMATELY 110 WITH 7 ADDITIONAL UNIVERSITY OF SOUTHERN CALIFORNIA FACULTY STATISTICIANS WORKING OUT OF THE OFFICES IN MONROVIA. COG HAS BEEN STRUCTURED TO MAXIMIZE EFFICIENCY, PROMOTE COLLABORATION, AND RETAIN THE FLEXIBILITY TO FOCUS RESOURCES ON THE MOST PROMISING SCIENTIFIC ADVANCES. EXTENSIVE COLLABORATION AND INTEGRATION IS FOUND THROUGHOUT COG'S ORGANIZATION. FOR EXAMPLE, THE STRATEGIC DECISION TO ESTABLISH THE FREESTANDING COG COORDINATING CENTER IN MONROVIA, CA, COMPOSED OF COG'S OPERATIONS CENTER CO-LOCATED WITH KEY COMPONENTS OF COG'S STATISTICS & DATA CENTER, HELPS ENSURE THE LONG-TERM STABILITY OF THE COG RESEARCH ENTERPRISE AND ALLOWS FOR UNINTERRUPTED RESEARCH OPERATIONS THROUGH LEADERSHIP TRANSITIONS. MORE THAN 90% OF THE 13,500 CHILDREN AND ADOLESCENTS DIAGNOSED WITH CANCER EACH YEAR IN THE UNITED STATES ARE CARED FOR AT COG MEMBER INSTITUTIONS, ALLOWING FOR APPROXIMATELY 50% TO 60% OF NEWLY DIAGNOSED CHILDREN WITH CANCER TO BE ENROLLED ONTO A COG CLINICAL TRIAL, WITH ALMOST 90% OF THOSE LESS THAN 5 YEARS OF AGE PARTICIPATING IN COG RESEARCH. AT ANY GIVEN TIME, THE COG COORDINATING CENTER IS SUPPORTING APPROXIMATELY 45 STUDIES IN DEVELOPMENT, 70 STUDIES ACTIVELY ENROLLING NEW SUBJECTS, AND 100 STUDIES CLOSED TO ENROLLMENT FOR WHICH DATA COLLECTION IS COMPLETING AND DATA ANALYSIS IS IN PROCESS. ANNUALLY, THE COG COORDINATING CENTER FACILITATES APPROXIMATELY 4,000 ENROLLMENTS ONTO COG THERAPEUTIC STUDIES AND MORE THAN 13,000 ENROLLMENTS ONTO NON-THERAPEUTIC STUDIES, WHICH INCLUDE BIOLOGY, SUPPORTIVE CARE, EPIDEMIOLOGY, QUALITY OF LIFE, BEHAVIORAL SCIENCE, AND LATE-EFFECT STUDIES. THE COORDINATING CENTER ALSO SUPPORTS THE ONGOING FOLLOW-UP DATA COLLECTION FOR THE MORE THAN 25,000 CHILDREN ANNUALLY WHO CONTINUE TO BE EVALUATED AT COG MEMBER INSTITUTIONS FOR STUDIES ON WHICH THEY HAVE COMPLETED THERAPY.

SUSTAINING TECHNICAL AND ANALYTIC RESOURCES (STAR) IS A FIVE-YEAR PROJECT OF THE PUBLIC HEALTH INSTITUTE IMPLEMENTED IN PARTNERSHIP WITH THE JOHNS HOPKINS UNIVERSITY, CONSORTIUM FOR UNIVERSITIES IN GLOBAL HEALTH, AND UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, AND SUPPORTED BY THE UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID). STAR OFFERS PAID FELLOWSHIPS AND INTERNSHIPS FOR DYNAMIC, MULTIDISCIPLINARY, MISSION-DRIVEN LEADERS AT ALL CAREER LEVELS. STAR PROVIDES PARTICIPANTS WITH IMMERSIVE EXPERIENCES AT GLOBAL HEALTH ORGANIZATIONS AND INSTITUTIONS TO BUILD CAPACITY AND CONTRIBUTE TECHNICAL EXPERTISE TO ADDRESS HIGH-IMPACT NEEDS. STAR FELLOWS AND INTERNS PARTICIPATE IN CUSTOMIZED AND CURATED LEARNING ACTIVITIES TO ENHANCE KNOWLEDGE AND SKILLS GROWTH, EXPAND PROFESSIONAL NETWORKS, AND SUPPORT CAREER DEVELOPMENT. IN 2019, THERE WERE 37 INTERNS WORKING IN THE USA AND AROUND THE GLOBE. IN ADDITION TO THE STANDARD PLACEMENT OF FELLOWS AND INTERNS AT USAID HQ, FIELD MISSIONS , STAR HAS A UNIQUE ADVANTAGE OF RECRUITING LOCAL COUNTRY OR THIRD COUNTRY NATIONALS AND PLACE THEM AT THE LOCAL MINISTRIES OF HEALTH FOR TWO-YEAR FELLOWSHIPS OR UP TO 12 MONTHS INTERNSHIPS. Thus far, STAR has placed fellows with the following organizations: -17 fellows at the Ministry of Health throughout various countries in Africa and Asia -3 fellows at South Africa's USAID mission -1 fellow has been hired at Nepal's USAID mission -13 fellows at USAID Washington HQ -7 fellows working remotely or for other organizations. CONSORTIUM FOR UNIVERSITIES IN GLOBAL HEALTH SUPPORTS STAR'S ACADEMIC PARTNERSHIPS PROGRAM THROUGH THE COLLABORATION LABORATORY WHICH IS A GRANT-SUPPORTED, STRATEGIC APPROACH TO FACILITATING KNOWLEDGE-SHARING EXPERIMENTS BETWEEN ACADEMIC INSTITUTIONS, WHEREIN THEY WORK TO ACHIEVE A CONCRETE GOAL OR OBJECTIVE THAT ADVANCES THEIR WORK IN GLOBAL HEALTH. FOUR LABORATORY PARTNERSHIPS WERE ESTABLISHED AND MONITORED BY STAR TEAM TO EXAMINE THE SUCCESSES, CHALLENGES, AND REPORT ON LESSONS LEARNED THROUGHOUT THEIR PARTNERSHIP. TO MAXIMIZE LEARNING OPPORTUNITIES FOR STAR PARTICIPANTS, JHU FACILITATES ACADEMIC SUPPORT, TRAINING AND MENTORSHIPS. JHU WILL ALSO PROVIDE GUIDANCE ON GLOBAL HEALTH COMPETENCIES THAT WILL INFORM HOW ACADEMIA CAN BETTER EQUIP TOMORROW'S GLOBAL HEALTH PRACTITIONERS WITH THE KNOWLEDGE, SKILLS, AND ATTITUDES NEEDED FOR SUCCESS. UNIVERSITY OF CALIFORNIA, SAN FRANCISCO WILL FACILITATE STAR PARTICIPANTS' ACCESS TO RELEVANT CURRICULUM, TRAINING, AND MENTORING OPPORTUNITIES WITHIN ITS NETWORK OF SCHOOLS, INSTITUTES, AND CENTERS. THEY WILL ALSO ASSEMBLE A TECHNICAL ADVISORY GROUP, WHICH WILL ENGAGE MINISTRIES OF HEALTH AND NATIONAL ACADEMIC RESEARCH PARTNERS IN AN ONGOING DIALOGUE ABOUT GLOBAL HEALTH WORKFORCE NEEDS AND GAPS.

CA BRIDGE PROGRAM OVERVIEW THE CA BRIDGE PROGRAM IS DISRUPTING THE ADDICTION TREATMENT LANDSCAPE BY CHAMPIONING THE IDEA THAT SUBSTANCE USE DISORDER IS A CONDITION THAT CAN, AND SHOULD, BE TREATED BY MEDICAL PROFESSIONALS LIKE ANY OTHER LIFE-THREATENING MEDICAL CONDITION. MANY PEOPLE ASSUME THIS IS ALREADY POSSIBLE, BUT, IN FACT, MOST MEDICAL PROVIDERS DO NOT VIEW ADDICTION TREATMENT AS PART OF THEIR JOB. MOREOVER, THE STIGMATIZATION OF PEOPLE WHO USE DRUGS HAS BEEN COMMON PRACTICE WITHIN HEALTH CARE, CAUSING ADDITIONAL HARM AND INTERSECTING WITH OTHER SOCIAL DETERMINANTS OF HEALTH. HOWEVER, CA BRIDGE HAS DEVELOPED AN EFFECTIVE MODEL TO POSITIVELY CHANGE THE TRAJECTORY OF ADDICTION BY IDENTIFYING MOMENTS FOR EVIDENCE-BASED MEDICAL INTERVENTION. WHILE PEOPLE WHO COME TO EMERGENCY ROOMS IN OPIOID WITHDRAWAL ARE OFTEN DISCRIMINATED AGAINST, SOMETIMES GIVEN FLUIDS, AND SENT ON THEIR WAY WITH CONTACT INFO FOR A FEW SPECIALTY ADDICTION CLINICS ENCUMBERED WITH LONG WAITING LISTS, IT DOES NOT HAVE TO BE THIS WAY. HOSPITALS AND EMERGENCY ROOMS CAN BE CRITICAL POINTS OF CARE FOR SUBSTANCE USE DISORDER TREATMENT. THE CA BRIDGE MODEL LEVERAGES THESE HEALTH SYSTEMS FOR RAPID ACCESS TO ADDICTION TREATMENT TO FUNDAMENTALLY SAVE MORE LIVES. THE GOAL OF CA BRIDGE IS TO TRANSFORM THE WAY PEOPLE WHO USE DRUGS GET HELP BY ENSURING THAT EVERY HOSPITAL IN CALIFORNIA PROVIDES 24/7 ACCESS TO EVIDENCE-BASED TREATMENT. TO ADVANCE THIS GOAL, WE ARE RAPIDLY BUILDING CAPACITY TO: -EXPAND MEDICATION FOR ADDICTION TREATMENT (MAT) IN CALIFORNIA HOSPITALS BY RAISING AWARENESS OF THE BENEFITS TO PATIENTS AND PROVIDERS. -HELP HOSPITALS IMPLEMENT THE CA BRIDGE MAT MODEL OF TREATMENT, CONNECTION AND CULTURE WITH RESOURCES, TRAINING, AND TECHNICAL SUPPORT. -DEMONSTRATE THE IMPACT OF HOSPITAL-BASED MAT PROGRAMS AND IMPROVE QUALITY OF CARE THROUGH RESEARCH AND EVALUATION. -PROMOTE SUSTAINABILITY OF HOSPITAL-BASED MAT PROGRAMS THROUGH POLICY AND SYSTEMS CHANGE. CORE ELEMENTS OF THE CA BRIDGE MODEL CA BRIDGE IS ADVANCING THE USE OF EVIDENCE-BASED MEDICATIONS FOR ADDICTION TREATMENT (MAT), MOST COMMONLY BUPRENORPHINE, WHICH HAS BEEN SHOWN TO REDUCE RELAPSE AMONG PEOPLE SUFFERING FROM OPIOID USE DISORDER. RECENTLY, A NUMBER OF HOSPITALS ACROSS THE COUNTRY HAVE STARTED PROVIDING MAT IN THEIR EMERGENCY ROOMS, BUT MANY USE RESTRICTIVE PROTOCOLS IN WHICH PATIENTS MUST UNDERGO MULTIPLE LAB TESTS, PSYCHOSOCIAL ASSESSMENTS, AND PAPERWORK BEFORE RECEIVING ANY TREATMENT. THE CA BRIDGE MODEL DRAMATICALLY LOWERS BARRIERS TO TREATMENT BY ELIMINATING MEDICALLY UNNECESSARY TESTS AND QUICKLY PROVIDING PATIENTS IN WITHDRAWAL WITH WHAT THEY ARE SEEKING-IMMEDIATE RELIEF FROM WITHDRAWAL SYMPTOMS. BY SIMPLIFYING THE PROCESS, THE CA BRIDGE MODEL WORKS IN THE REAL WORLD OF BUSY HOSPITAL EMERGENCY ROOMS. ONCE PATIENTS ARE STABILIZED, THEY ARE BETTER EQUIPPED TO ENGAGE IN CONVERSATION ABOUT LONG-TERM TREATMENT, WHICH THEY DO WITH A SUBSTANCE USE NAVIGATOR (SUN). THE SUN IS A PEER WHO COMES FROM THE COMMUNITY AND IS OFTEN IN RECOVERY. THE CA BRIDGE MODEL IS BASED ON A HARM REDUCTION PERSPECTIVE THAT EMPHASIZES RAPID, PATIENT-CENTERED CARE AND HUMAN CONNECTIONS. BY JUNE 2020, FIFTY-TWO HOSPITALS USING THE CA BRIDGE MODEL REPORTED: -MORE THAN 12,000 PATIENTS HAD BEEN IDENTIFIED WITH OPIOID USE DISORDER -MORE THAN 7,500 PATIENTS WERE PROVIDED WITH TREATMENT IN THE HOSPITALS -MORE THAN 5,600 PATIENTS WERE PRESCRIBED MEDICATION FOR ADDICTION TREATMENT (MAT), AND -NEARLY 5,000 PATIENTS WERE LINKED TO FOLLOW-UP CARE. THIS DEMONSTRATED SUCCESS HAD LEAD TO CONSIDERABLE GROWTH IN JUST A FEW YEARS, WITH 208 HOSPITALS IN CALIFORNIA IMPLEMENTING THE CA BRIDGE MODEL BY THE END OF 2020, HAVING EXPONENTIALLY GROWN FROM A PILOT OF JUST EIGHT HOSPITALS IN 2018.

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