And welcome to everyone who is on the line today. We appreciate you joining us. We're looking forward to today's session. Today's webinar is part of our "Health Happens in Libraries" program. We are working on with our partners at zero divide. We have been fortunate throughout this grant to develop new partnerships with other health service agencies, such as the centers for Medicare and Medicaid services and the national networks of libraries of medicine, and we find that these partnerships are adding so much to the content on Webjunction and have been of great interest to library staff around the country and these partnerships have really been very valuable. We thank everyone who has been working with us who help bring health literacy, eHealth, information about the Affordable Care Act to libraries over the last seven months. Today's webinar -- move ahead here. We have three great presenters. Kelli Ham and Alan Carr, joining us from the National Network of Libraries of Medicine, the Pacific Southwest Region. And then we have Milly Lugo-Rios, who is from the Santa Ana Public Library, and they're going to share their experiences with resources that can assist with connecting patrons to health information resources, and we're very pleased to have them. Please join me in welcoming Alan Carr and Kelli Ham. >> Alan: Thank you very much for that introduction. And welcome everyone to today's session. Good morning, or good afternoon, as the case may be. Kelli and I are delighted to be here today as representatives of the National Network of Libraries of Medicine to let you know how you might be able to take advantage of the NN/LM and also to tell you more about our program. We're very pleased to be joined by one of our public library network members. I'm going to start things off today with an overview of the NN/LM program. Some of you may already be familiar with it. So it will be a fresher for you. Then we will pause briefly for questions, and then Kelli will present more specific details about the consumer health aspects of the NN/LM program. The NN/LM program is funded by the national library of medicine. There are eight regions in the network covering all areas of the U.S. And each region has a designated regional medical library. Many different types of libraries participate in the network, including academic, hospital, public, and community organizations. We use a broad definition of membership to essentially include any organization that distributes health information. There is no cost involved with membership. It's simply a matter of visiting the RML web site in your area and completing an online application. After joining the network, a representative from your organization will be added to an email announcement list to receive news about new or revised NLM resources, funding opportunities, webinars, and other items of interest. All of of the regions have at least one blog that acts as a newsletter, and presence on Facebook and Twitter, which anyone can follow. The benefits of NN/LM membership include the ability to order educational brochures about NN/LM resources that you can use in your libraries or in health outreach events, and the opportunity to apply for regional outreach funding awards, which, for example, could be used for activities such as community health fairs. Print handouts for many NN/LM resources are also available from the RML web sites. Everyone is also welcome to use any of NN/LM's resources, which are freely available through the internet and taxpayer supported. And the very last listing on this slide has the URL for the NN/LM network. Once you visit that link you will see a map similar to this one. You can click on the region where you're located to reach the home page for a particular RML. All of the RMLs have a join the network button, which leads to an online application to complete and submit. Each RML is home to the branch office of the National Network of Libraries of Medicine, in the Pacific Southwest Region, the designated RML, UCLA Louise Darling Biomedical Library. As I mentioned, NN/LM is funded by the national Library of medicine. The mission of the NN/LM is to promote resources -- promote resources and improve knowledge of and -- for all types of health professionals and the public, our two key outreach audiences. This slide gives us a snapshot of the current NN/LM membership by institutional category, and an important message that we want to convey through today's session is that we actively recruit public libraries into the network because we realize that the importance of the role of disseminating health information to the public. RML's work closely with public libraries and promote partnerships between public libraries and the medical libraries and their communities. Public libraries are one of our biggest recruitment success stories, growing faster than any other membership category. As you can see from this slide, the national network currently has over 6,000 members with public libraries comprising about 20% of the membership. This slide gives you an idea of the variety of services and mechanisms that the RMLs use to promote NN/LM resources. This includes training sessions for librarians and health professionals, both in person sessions, as well as remotely through webinars and classes. We also exhibit at professional and consumer health meetings, where we use educational brochures and online demonstrationsdemonstrations. Funding opportunities for network members who want to provide outreach services, access to high quality health information, we provide advice and training about how to use new and emerging technologies to improve access to information. For example, mobile resources and we provide assistance in resource sharing, particularly to our network members that participate in NN/LM stock line interlibrary loan system. This slide gives you an idea of the variety of NN/LM communication channels. Email and telephone remain the most preferred communication methods. As I mentioned, all of the regions have a web site. Some regions have added rotating slide shows to the home page. We use our slide show to highlight RML activities and other news. All regions have a blog news letter. In our case it is called "latitudes", and NewsBits that we use to share brief items about new, updated resources, webinars of interest, technology tips and other information. Social media including Facebook and Twitter, are relatively new communication channels for the RMLs during this contract period. Every region has very active Facebook page and Twitter feed. In our case, we make about half a dozen Facebook posts during weekdays, and one tweet per hour. We found that it is a great way to increase communication with network members and allows us to share more information without overloading email in boxes. If you are a user of social media, I encourage you to take a look at the link, which is on today's session handout, and that link will have a list of blogs, Facebook pages, and Twitter feeds for all of the regions. In addition to the overall NN/LM mission, every five-year contract involves several special national initiatives, where the regions work together collaboratively. Four of the current initiatives are listed on this slide. The first one for K-12 outreach, probably would have the most relevance for public libraries who work closely with schools in their area and have many students come to their libraries to work on research. The community college initiative for outreach may also be of interest to public libraries. Clinical trials initiative more geared towards medical librarians and health professionals. MedlinePlus connect a service that primary care providers use as part of the electronic health records systems to access consumer health information. Kelli will talk more about K-12 resources later in the program. This slide lists selected NLM resources that may be of particular interest for public libraries. First one, pub med, med line, provides access to professional journal literature in biomedicine. Medline a free service through the pubmed gate way, and it became heavily utilized by health professionals and consumers. Since it is designed more for health professionals, in 1998, national Library of medicine, a resource designed with consumers and patients. MedlinePlus is the best way to start looking for background health information for an extensive array of health topics. Health topics pages do include links to pubmed if that additional information is needed or desired. Many of NLM's environmental health resources are also designed for consumers and several are listed on the slide. And Kelli will be talking more about these resources later in the program. The Clinical Trials.gov resource, therapy for serious diseases, particularly for cancercancer. This slide is a snapshot of the MedlinePlus home page. As I mentioned, specifically designed for patients, family, and their friends. The MedlinePlus web site receives over 10 million unique visitors each month. It has a wealth of authoritative and reliable consumer level health information in a variety of formats, including multimedia resources, news stories, images, medical encyclopedia, and tutorials. MedlinePlus provides full functionality in English and Spanish, and selected information in over 45 additional languages. There are no advertisements on MedlinePlus, and everything in MedlinePlus is vetted to meet strict quality guidelines. MedlinePlus is updated on a daily basis. This slide gives you a more clear picture of the volume and variety of content on MedlinePlus, looking at the upper left corner of the slide, you can see that there are roughly 1,000 health topics pages in English and Spanish. These pages have links to thousands of documents that are written and maintained by the national institutes of health, its various institutes and centers. Other government agencies, such as the CDC and other trusted health organizations. MedlinePlus also has a large section with drug information, both prescription and over-the-counter drugs, also including dietary supplements and herbal recommend -- remedies. MedlinePlus also has medical news that comes out daily and is updated. And in the upper right, you can see there are about 150 tutorials on various health topics, as well as a number of surgery and anatomy videos. The surgery videos are about 60 minutes. Tend to be about 60 minutes. And so, for example, if you are going to have a hip or knee replacement, and wanted to see how that procedure would work, you could view the video about that procedure, if you wanted to. And lastly, I want to talk about, if there was an academy award given for the hot health topic of 2013, think it would have to go to the Affordable Care Act. The ACA -- all of the RMLs have been heavily involved with the ACA initiative since the numberer meeting of of the American library association. All of the RMLs have an ACA guide on their web site. In our region, we have utilized the LibGuide format. The link appears on the slide. Breaking news, training events, and state-specific information with separate tabs for each state in our region. This slide also shows a sampling of ACA training activities that have been offered in our region. And we've also published quite a few items in the latitudes and NewsBits blogs. A story related to the ACA, September midday at the oasis educational webinar session, which featured Dr. Dylan Roby, professor at the UCLA school of public health and resident health insurance expert. The session was highly anticipated, and very well attended, and it was recorded and archived and is available for viewing on our web site. So, that is going to conclude my overview of the NN/LM program. At this point, we'll pause for questions and then resume with Kelli's presentation. >> Kendra: Thank you, Alan. This is Kendra. Can you reiterate for all of the people participating today, feel free to post questions into chat. And I will be happy to forward those and ask them of Alan. Can you repeat again about how people can sign up to participate and find their region? >> Alan: Certainly. With the link NN/LM.GOV, that would be the place to start with a visit. And then once you do that, you will see the map with the various regions outlined, and there will be a link for each region. You choose the region where you're based, and that will bring you to the home page of that particular regional medical library, and all of the RML web sites have prominently on their home page a button that says join the network. So, you will click on that, which will take you to an online application to complete and submit. >> Kendra: Fantastic, thank you. As a reminder, it is free. And I think one, as a consumer of health information, I have been a big fan of MedlinePlus for a long time. And I think one of the things that makes me feel more comfortable is that the information has been vetted. I love the internet, but it can sometimes be a little misleading or provide some inaccurate information, particularly when it comes to health care, and it has been great to have MedlinePlus as a consumer resource and to be able to depend on that, and in the chat, I would love to see some comments from folks about what types of health information resources you provide to your patrons, other things that you would like to share with the audience. And we have a question about joining NN/LM. And is that done as an individual or an organization? Does a library staff member join or does the library join? >> Alan: Well the membership is institution-based, but a particular individual from an institution could fill out the application on behalf of the institution. One thing the application will ask is for a designated liaison person who would then be the one that would be added to the email news announcement list. So, quite often, whoever is going to act as the liaison actually does complete the application. >> Kendra: Great. Thank you for that clarification. Did you share a bit of information about relationships with community colleges as well? >> Alan: Certainly. With this current contract that we're in for 2011-2016, outreach to community colleges has been one of the national initiatives. We have always done outreach to community colleges, but with the national initiative, we've been a bit more focused on it. So, for example, in our region, we have reached out -- we've had particular success with community colleges in California. And we put together a webinar series of four different sessions on pubmed, MedlinePlus, and a couple of other resources, and we put that on -- in a series during the course of one month. We had representatives from about 30 community colleges attend. And we're also actively reaching out to community colleges and encouraging them, whenever we have an opportunity, whenever we're traveling, we always make a point to try to visit the community college in the area, and attempt to recruit them to join the network. >> Kendra: That's great. Thanks Alan. Before we transition over to Kelli, just a reminder to everyone, if your library has developed a page with health resources for patrons or have you favorites that you would like to share, please post those in the chat. It becomes part of the archive, which is a great way to share some of your knowledge with your colleagues around the country. And with that, we will transfer over to Kelli Ham. >> Kelli: Hi everybody. And thank you for that. So, I will now talk a little bit more about the consumer health program and how public libraries can improve the health and health literacy of their entire communities. I would like you to consider the image that is on the screen right now. Imagine a person who has recently received a diagnosis of diabetes. And immediately you can see how that topic will morph into many other sub-topics. If this person comes to the library, they're going to have many questions for you, many concerns. And they may really be wondering where to start. They may need information that's written at an easy to understand level. They may need information in another language. They may be a caregiver for somebody. And so the question is, where do you start? How do you help this person? So, my part of the presentation will really go into detail about how we help libraries answer these kinds of questions and provide better services for the target audiences that they serve. I'd like to start with a little bit of discussion about health literacy, and that is, as you can see on the screen, it is really the person's ability to obtain, process, and understand health information and services needed to make good, health care decisions. So, this is really important to be thinking about as we go through the rest of the program. So, it's commonly thought that easy to read materials will work for people with lower literacy. But even if something is easy to read, does it really mean it is understandable? The example on the left is a list of tips on staying healthy for a person who has diabetes. And it's recognizable, easy to read, because there are graphic images, the sentences are short, and the words are shorter syllables. There is extra white space. All of this would indicate that it is an easy to read item. Now, consider the lab test results. Those are notoriously difficult to understand and interpret. Librarians will often be asked for help in interpreting what those numbers mean. But we are never -- it is never appropriate to interpret test results. It's more important to know where to find the information that is at an easy enough level that a person can understand it on their own. And then there is the prescription label. I don't know if you can see the small print. One of the things on this label is very poorly written and it says do not chew or crush, swallow whole. Now, this is a classic example FL -- had -- of how something could be misinterpreted or confusing. It would be better if it were written in two separate sentences. Swallow whole. Do not crush -- an example of how if it is easy to read may be difficult to understand. One thing that is very important, notion of functional health literacy. This refers to the ability to understand and follow directions and ask questions for better understanding. And it is important because low health literacy is really a predictor of poor health outcomes. And, so, conversely, good, relevant information will result in better understanding and helps the person to make change or take the appropriate action and all of this leads to better health outcomes. And think about the last time you had to fill out an insurance form or some sort of a consent form. It is all very complicated. And so it kind of falls in this whole category of functional health literacy. I found this cartoon, and I thought it would be a good way to illustrate a couple of points. How information can be viewed -- same exact health information can be viewed very differently depending on a person's life experiences or where they are at any stage in their life. It can have to do with cultural background and their experiences and many other factors. So, it also indicates that health information isn't always straightforward. There is a lot of information out there that is provided with a spin or some sort of a bias. And people really just eat it up. They -- they love these kinds of things. But if either of these women came in to the library, their question might be quite serious and they may want specific information that supports their belief system, or to find out if what they're reading is really true. And the librarian's job is to provide the quality information that is free of that bias or spin. Just the quality information that will help the person learn about the topic and make decisions on their own. So, with consumer health and the role of the public libraries, there are many different components of these kinds of services, including health reference interview skills, evaluation, ethical and legal considerations. Knowledge of print and online resources, including the subscription data bases in your library. Mobile apps, social health sites, the list goes on and on. And why is it important? The library is really a trusted place. And it is important because the stakes can be so much higher for health questions than other kinds of reference. So, maybe the best resource would be a book or maybe it would be an interactive tutorial, video. But the trick is knowing first how to determine what the user needs through good health reference interview techniques and providing the best resources that really meet the needs of that specific patron and that specific question. And the impact can be enormous. When people or care givers have good information and are better informed, they're more empowered. They have better communications with their health care team, which is really the ultimate goal anyway, and they take better care of themselves or the people that they are caring for. And all of this leads to better quality of life. The impact can just be huge. How we help libraries with their consumer health efforts starts with training. And each of the NN/LM regions has a consumer health coordinator. We may go by a different title, something similar to that, but the focus would still be on consumer health. There are other coordinators in each region, too, but I'm talking specifically consumer health. With the training, we design and develop a variety of in-person online trainings of different lengths and focus to help public librarians. Our trainings range from the webinar to a four-hour hands on workshop. We can travel to specific locations. We do presentations at conferences. We also create online classes. Alan mentioned the moodle classes. It is an online course management system that we use as the platform for our online courses. They can be short classes or can go up to four week, intensive and comprehensive classes. And in the Pacific Southwest Region, we are fortunate to have a great partnership with info people. We have worked with them for years to provide webinars on health related topics. This is an example of how we extend our reach. Infopeople is such a trusted training organization, and they have an extensive reach, and so it allows us to get the word out about our resources and services, and we're able to provide our services to infopeople at no cost. It is a win-win situation. We're very grateful for that partnership. And also with -- I just wanted to mention that my colleagues around the country are creating amazing training resources in each of the regions. So, we share information. It is a way that we can also borrow, if you will, the course material from our colleagues and provide that out in our own region. We're not duplicating efforts. Best of all, as mentioned before, all of our trainings and services are free. We also provide resources and one of our publications is the finding health and wellness at the library consumer health toolkit for library staff. This was a project that was funded through an IMLS grant with the California state library. Second edition came out in July of this last summer. So, the important thing to know about the tool kit is that it provides a set of core competencies for providing health information to the public. The first section defines the competencies and the rest of the publication provides sections of materials to help you meet those competencies and build skills. It can be used as a training tool for staff. Interactive file -- if you look at the table of contents, the links are clickable and the URLs are clickable, too. Check this out when you get a chance. An accessible text version is coming very soon. It is in the final review stages and should be published on the California state Library web site hopefully within the next week or two. If you are interested in finding this but you don't have the URL handy, don't remember what it is or where to find it. Go to Google and search for consumer health toolkit. It is usually the first result that pops up. Another thing that was mentioned earlier is our support for health-related projects through funding awards. And I chose this example just to show how one public library did something really phenomenal. Santa Clara County Library applied for funding and created several YouTube videos to show first-time users, primarily adult, older adult, senior users, how to find health information on MedlinePlus. There are several topics, but the one showing here is on diabetes, and this particular one is in English and Spanish both. These are just fabulous tutorials that really show the basics of searching and navigating through a page to find a topic. I highly recommend this for anyone who is a first time user of MedlinePlus or for older adults. It is a great example. We also try to look for opportunities where we can have greater impact than what we could do on our own. And one example, last year, we partnered with a university that had a large grant. An eHealth rural training. A component of it that was for eHealth rural training. We provided training for one librarian, who was the project manager. He trained several library field trainers who went out and conducted training for -- in 50 different training sessions. The impact of this was huge. Because 144 unique locations received training, and that -- the total number was 356 library staff. We never could have reached so many people in such a short amount of time. This happened between June and August last summer. So, it just is an example of how we can leverage these partnerships to do much more work in our region. So, just when we thought we had everything covered, we were thrown a curve ball with the Affordable Care Act. And we had to act really fast. And I know all of you did, too. We needed to learn as much as possible without the benefit of any resources to help us really. So, and in addition to this, we learned a new vocabulary, ACA, Obama care, exchange, marketplace, navigators, in addition to HealthCare.gov, there were all of the state-run exchanges. Hawaii health connecter and Nevada health link, cover California, and you know the ones in your states. This really was an unprecedented challenge. Like Alan said, should have won an academy award. I was imagine what this might look like tripping on the stair going up for the award on October 1st when the rollout had a few glitches. But that was a great analogy. There was a real time critical need for the information, but the information just wasn't available. All over our region, and across the country, libraries were planning for programs and got ready to the best of their ability, but then what happened when there were the glitches with the rollout, we were getting reports that there wasn't the influx right away. That happened later into December. So, it was -- it was really a hurry up and wait kind of issue. I think things have settled down somewhat now, but it certainly was a time of panic for a period of time. While all of this was happening, the national network of libraries in medicine, all kinds of activities were happening as you can see on the slide. We basically did all of these things. We took advantage of every webinar that Webjunction put out. We contacted our state libraries, but what we -- one of the things that we really needed to do was to coordinate and not duplicate efforts. So, we -- instead of creating new training, we ended up putting our efforts into a LibGuide, which acted as a resource and still will continue to be a resource for libraries as we go forward. So, public libraries have all kinds of needs with this. You all know all of this. What I can say is that there was a lot of concern about resources and the response everywhere was really, really positive. Now there is a real opportunity for libraries because there is more and more emphasis on health information. And I think that we will be seeing a lot more activity in public libraries. So the next several slides are going to provide some best practices and ideas that you can put into place as you go forward meeting these new challenges. First thing is build the core competencies and have a commitment towards learning. Possibilities are really ENDless. This is just kind of a quick look at some of of the things that you can do. But do take advantage of training whenever possible. Next you need to know who you serve. If you -- this may be the most important thing, knowing your community. If you know the demographics and languages in your community, you will know what resources you need to provide, whether you need things in your collection that will provide resources for those languages or where to go online to find those languages. When you have a good picture of your community that you serve, you can provide those relevant resources. I just want to mention a few things. On the handout, there is an entire section of good resources to find these statistics. As an example, you can go to the quick facts section in the U.S. census. That is kind of a no brainer and an obvious choice. But another thing you can do -- one of my colleagues alerted me to the language data map from the modern language association, and this is a place where you can see what languages are spoken in a given area and that is also on your handout. Now there are community health needs assessments. This was something that I learned as part of the Affordable Care Act, that nonprofit hospitals now are required to do a community health needs assessment every three years. And these reports are publicly available, and are just a gold mine of information, which will help you understand what's happening. The health status of your communities. It goes without saying just build health literacy in the library so that you can turn around and build the community health literacy. Pay attention to cultural competence and diversity and see if you can provide targeted training based on those health status needs. If you know that in your community there is a big incidents of diabetes and obesity, why not have some fun programs about healthy eating, like the example shown on the slide. Valentine's Day day cake makeovers. That sounds like a fun program. I would like to attend that one. This slide is just a quick compilation of some of the resources that will help you. The medical Library association section, consumer and patient health information section, CAPHIS. The web site has a lot of information about consumer health services and resources, and this is available to anybody. You don't have to be a member of MLA. There are classes that will be eligible for a specialization. If you take a number of these classes, you can receive a specialization from MLA and to learn more about that, visit the link on the slide. State libraries a great source of help either in support for travel funding or training opportunities, and, of course, get connected with the consumer health coordinator in your region. We have already talked about staying up to date. There are some ideas on the slide about ways you can stay up to date. You can sign up for updates on a specific health topic through MedlinePlus as an example. You can follow the Twitter feeds of the RML. All kinds of different things. The link to the listing of all of the RML blogs and Facebook pages and so forth is on the handout. So, with all of this emphasis on health and wellness, I would like to put in a plug for building a culture of health and wellness in the workplace. There are some great things happening out there. And I think if we are focused on it in our own lives and in our daily work, then that just naturally translates. A colleague of mine in the mid-Atlantic region told me about a project that they funded which was a wellness program, healthy libraries, healthy communities. And this wellness program for library workers included the creation of a LibGuide with resources, a blog, focused on workplace health information specific to the library field. And the coolest thing about this was, it was kind of three parts. They had workplace wellness activities and team efforts. They had virtual wellness Wednesday lunchtime programs, and then the program concluded with a big program and celebration, and the program was on the human animal bond and its effect on health and they brought in certified therapy dogs and their handlers. I know a lot of libraries are looking at bringing in therapy dogs for children's reading programs and that sort of thing. So, this was a wonderful idea, and the goal for the project said this. By modeling the wellness initiative, the participating library workers will initiate similar health and wellness efforts for their patron communities. So, consider this for your library. I think everyone will really benefit. The next two slides are on resources. I'm not going to go over these. These are all on your handout. We have talked about MedlinePlus extensively. There are other ones that -- pubmed health at the bottom, a hybrid site, information for clinicians and consumers, but it talks about treatments that actually do work. Evident shows that certain things work or do not work in medicine. That might be a good resource for you to check out. And the K-12 resources, the ToxTown curriculum is an evidence-based curriculum that can be used as an after-school program as an example, which might be of interest in some libraries. If you are working with teachers and schools, these are resources that you should know about, and the entire list is that last link and they are also all on the handout. Best practices going forward with the ACA, continue doing what you're doing, and then just follow your basic health reference practices, maintain patron privacy, stay neutral, and don't provide advice, but provide the best resources and information for patrons. And that -- it basically applies across the board. Just have a plan going forward, and for this next phase of the -- with the Affordable Care Act. It's going to be different than it was in the ramp up, but now we have some time to focus on health information and continue forward from here. I'll leave you with a last few slides about MedlinePlus. There are several health topic pages related to the Affordable Care Act. You can see them on the screen. And remember that MedlinePlus is in Spanish also. Use the toggle button to toggle back and forth between the two sites. And when you do a search in MedlinePlus, you will bring up a search page and you will notice that the health insurance is listed in three places with the red circles. Clicking on any of those would take you to the health topic page. And here is a very quick search just the ACA. Over on the left, you notice a refine by keyword section. And next to the sub-topic, Affordable Care Act, there is a little plus sign, and when you click that, it expands it out. It shows you what all of these search results are based on the sub-topics, key words found within the topics. This is one of those little tricks that you could learn about during training that we would provide. This is one of the features that most people just don't even notice in MedlinePlus, but it can really help you refine your serve. -- your search. I will leave you with a few thoughts. Make sure that you communicate with your RML. You are our eyes and ears on the ground. If we hear from you, we will have a better idea of how we can help you provide the best services to your patrons. Use those teachable moments. Mention MedlinePlus whenever it is appropriate. Get the word out about these quality resources so that they can evaluate better when searching on their own. Become invested in improving health literacy. Make your community and library a healthier place. That concludes my part of the talk. We will turn it back over to you guys. >> Kendra: Thank you, Kelli. This is Kendra. We are going to save our questions for the end. One of the questions that did come up that it would be great for those of you participating today and listening, what examples do you have of successful health literacy programs in your public libraries? What have had good turnouts? What have been successful. With that, we would like to welcome Milly Lugo-Rios from the Santa Ana Public Library. >> Thank you. And thank you all of you for attending this program. My report is going to be brief. Santa Ana Public Library serves around 350,000 people. Now, one of the things that was covered in The presentation was to get to know your community. And I don't know about you, but in Santa Ana, we are not a representative of the county. So, when you are studying your community, I strongly advise that you also look at how your city compares to the overall picture. So, it will give you a more realistic information on the health needs of your community. So, you can see here, when I did this, that Santa Ana is 78% Hispanic, compared to the county, which is 34. 83% speak a language other than English, versus 45. So, these were very drastic comparisons. And this is what is going to motivate you to know what to address and what kind of programs to provide. One of the challenges that the Santa Ana Public Library faces, and I'm sure a lot of you do, too, is staffing. How do you maintain a wealth of health literacy to -- for your staff when the majority, like in our case, 24 of our staff members are part-time. Only nine are full-time that work sometimes at the desk, one or two hours. This is a big challenge. It's hard to schedule group training. So, we rely more and more on webinars, and the resources from the national medical libraries. The other challenge is collection. I know that many of our budgets are being really reduced. So, how does the medical information in our collection, how is that affected. One of the advice that I would give you, if you have the capability to run a report on the collection -- and I'm going to say 610 to 619, which covers most of our books, video, medical, health subjects, you want to make sure that the average age of the collection is not older than five. Seven for books in Spanish, and this is because they are so hard to get. Quality of material -- for those of you who are in Spanish-speaking community, it's very, very difficult. They're very difficult to evaluate. I usually gravitate towards translation of English books. How much are the books used? Santa Ana has a large Latino population and many are undocumented. The types of books and videos that get high uses are home remedies. Natural remedies. You need to be really in tune with those folks, and also trying to get the most recent one. We are lucky enough to have a publication year of 2012 for that section of the book. Somebody, one of our attendees asked about programming. And I would like to talk a little bit about that. According to the statistics of our community, diabetes is a result of obesity. Stress because we are such a highly dense populated area. We try to get speakers from local organizations to speak on this. But I want to tell you something, you have to really know your community. In our community, many people have one, two, and three jobs. They have large families. So, if you don't provide child care attendance at your program cannot be guaranteed. We have had a programs where only two people attend and we have had programs that were packed. We have tried to analyze what was the major factor that affected the attendance. We did equal amount of promotion, equal amount of marketing, and right now it is still a mystery. It depends on the economy. If people are out there and trying to get -- get a job, there goes the program. So, it's very, very difficult, at least in my community, to have a consistent audience for health programs. One of the things also that is very much a challenge is the staff training. We have a lot of -- a lot of part-timers, but we are so happy that we have the National Network of Libraries of Medicine. We use all of their resources. We are constantly putting shortcut icons to the reference computers, and bringing those to the attention of of the librarians that are there, and part-timers, that many times staff the reference desk. Here are some of the sites that we like to use a lot. I haven't had -- I haven't heard mention the top 100 list, health web sites that you can trust. I find this very, very useful and, of course, you are already familiar with MedlinePlus and the consumer health tool kit. They are both very, very good. Speaking about the Affordable Care Act, I don't know how many librarians and how many of you have had the occasion to be the it person. Your boss all of the sudden says hey, we have this as a new item. You are in charge. That is how I felt when I got this Affordable Care Act project. My focus when I tried to go through all of the information that was available, how do I get this to our staff? How do I get this to our community? I concentrated first on our staff. I went ahead and found a Webjunction training presentation. Then I developed four easy to read newsletters for the staff with key information on the Affordable Care Act. We are an information driven site, center. That is our business, information. And sometimes I feel we are bombarded with information. So, I try to make these newsletters very simple to follow. And then I contacted a certified educator and when I got in touch with one is by attended town hall meetings around the community. I am just going to their tables and getting names. I had that trained, certified educator come to the library and speak to our staff. So, we went -- here is an example of the letter. Of the newsletter that we did. And then we have the community. So, we also had the certified educator come to the library. We have two branches. Our maybe library and -- we had simultaneous bilingual presentations, and it was, again, interesting to see the outcome. We had more participation in one library than the other. And then what we did, we went into partnerships with the cover orange county collaborative, and what this is is -- this is a group, orange county developed this group of service agencies, businesses, government representatives, and they're all involved in the implementation of the ACA. As librarians you have to really be out there. You can't wait for the information to get to you. You really have to go out and look for it. We also partner with the regional public information office of cover California, which is the marketplace for California. We have right now for the whole month cover -- certified enrollment officers at the library twice a week and here is an example of them, and it is a little cubbyhole, and we have one that is a Spanish speaker and another one an English speaker, Tuesday evenings and Saturday's. Days where people might not be working or are available. And that has worked out really well. Also ongoing information to our community. Here is some examples of good web pages. You don't have to reinvent the wheel. Just go ahead and look at these web pages and the links are in the -- will be in your handouts. And I'm trying to stay with time here. And finally, I just want to say health does happen at the library and it happens through education, communication, and collaboration among all of us. So the National Network of Libraries of Medicine, libraries become a network of networks, a platform for health care connectivity. >> Kendra: That is a great slide to end on. I agree with you. Health does happen in libraries. We are pleased to have had you and Kelli and Alan participating with us today and sharing your expertise and for all of the participants in the webinar, thank you for sharing your stories and resources in the chat box. Those will be part of the archives. Thank you for participating there. The "Health Happens in Libraries" section on Webjunction will continue to be updated as we get more information. And don't forget to sign up to be part of the NN/LM regional network, RML in your area. And you can stay up to date with what's happening on Webjunction by subscribing to Crossroads and visiting our "Health Happens in Libraries" web page. Thank you to everyone and have a great day.