Coronavirus Halloween 2020

 

Our monthly blog is on occasion about our National Health Observances, with the additional bonus this year (eek!) of having to weave COVID-19 into the monthly narrative. As we continue to live the misfortune of 2020 with COVID-19 dampening a lot of our usual fun, it only seemed appropriate to start the fall season with something upbeat. Halloween 2020 will be here soon and now is the time to start preparing. Yes, we can look for creative ways to enjoy Halloween with our families during a pandemic.

The State of Michigan has released COVID-19 recommendations for a safe celebration:

https://www.michigan.gov/som/0,4669,7-192-29942-540429--,00.html

The CDC has also released Halloween guidelines:

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html#halloween

Traditional trick-or-treating is considered a high-risk activity by the CDC. Some communities may discourage or cancel it this year. There are safety tips if families choose to trick-or-treat and alternate activities that can be thought about, too. The CDC link above also categories low, moderate and high-risk activities for the season.

For trick-or-treaters and parents:

• Share with your children that this year may be different than last year but let them know some the of the new ways you plan to celebrate and still have a lot of fun
• Talk with your children about safety and social distancing guidelines. Keep a six-foot distance from others not in your group. Discuss it with them before you go out and make sure they are following the guidelines throughout the night.
• Sanitize your hands frequently while out treat-or-treating, especially before eating or after coughing and sneezing
• Make sure children are sanitizing their hands frequently throughout the night and after they are finished trick-or-treating
• Inspect your children’s candy for anything out of the ordinary before they eat it. You may want to wipe the candy down or let it sit a few days before giving it to your child.
• Participate in one-way trick-or-treating on the street and guide children to stay to the right to ensure social distancing
• Trick or treat with people you live with
• Avoid congregating in groups around houses
• Wear a face mask covering both mouth and nose
•  A costume mask (such as a Halloween mask) is not a substitute for a cloth mask
• Do not wear a costume mask over a protective cloth mask if wearing both causes difficulty breathing. Instead, consider using a Halloween-themed cloth mask.
• Only go to houses with safety measures in place
• If anyone is feeling ill, stay home
• Check out https://www.halloween2020.org/ presented by Harvard Global Health Institute to find activities and ways to celebrate Halloween this year based on levels of COVID-19 risks in your area

Tips for homeowners:

• Wear a mask
• Use duct tape to mark six-foot lines in front of your home and leading to your driveway and front door
• Position a distribution table between yourself and trick-or-treaters to make sure they stay 6 feet away
• Distribute candy on a disinfected table or use some other method to eliminate direct contact. Perhaps have pre-packaged treat bags
• Consider handing out candy in an open space where distancing is possible, rather than from the front door
• Do not hand out candy if you feel ill

The Michigan.gov guidance also urges us to consider hosting virtual parties instead of in-person Halloween parties. If a gathering is hosted, it should be limited to 10 people or less per Executive Order 2020-176, social distancing should be maintained, cloth masks should be worn, and food and party favors should be set out individually to prevent cross contamination.

There are also some other fun and creative ways to celebrate:

• Reverse trick-or-treating. Have kids dress up in their costumes and set up shop in the front yard or porch. Organize neighbors to drive or walk around and hand out candy.
• Drive-up trick-or-treating. Instead of walking house to house, pick a few homes of close friends or relatives and drive there. Call or text to let them know you have arrived, go up to the front door, and back again to the car.
• Halloween Zoom party. If you can handle another Zoom meeting in your life, invite family and friends to a Halloween-themed zoom party with costumes being required.
• Go trick-or-treating in your own house. It may not sound exciting to you, but younger children may enjoy it. Instead of going door to door, just set up candy or treat stations throughout your house, put on Halloween music and lighting, and go trick-or-treating
• Have a driveway or garage candy giveaway. Driveways are usually wider than sidewalks so there is more of a chance for social distancing.
• Car parade. Organize a neighborhood trick-or-treating car parade with cars covered in Halloween decorations. Drive up and down your block and throw candy to each driveway. It keeps everyone at a safe distance.
• Make a spooky room. Make a spooky room or area in your house. Put up lights and cobwebs and use boxes that they have decorated. Laugh a lot to show them this is fun and not scary. Perhaps make a tunnel for the entry to the room that they must crawl through or a maze on the inside. Go to the dollar store for decorations, but do not wait too long. With the way things are going this year, all the decorations will be gone.
• Decorate your yard this year. Use your imagination with making ghosts and goblins at home or using lights and other things you purchase at the store. Let the kids help when they can, even if it is just putting tape on something.
• Go to the cider mill. There are plenty of safe ways to do it. Who doesn’t love donuts and cider and walking around to see the displays? You might want to rethink the hayride this year. Do not go at crowded times is my mantra and keep your distance from others. Make sure to bring your hand sanitizer.
• Pumpkin decorating. Let the little kids pick out their own pumpkin. There are plenty of small ones out there and it gives them a chance to express themselves. To make it easy for you and them, look for ways to only decorate the outside of the pumpkin. Items such as mix and match face stickers, strings, cloth, glitter glue, markers, and acrylic paint are all different ways that the little ones can individualize their pumpkin as they see fit. They will be proud at what they have accomplished.
• Movie night. Make it spooky and dress up. Do it as a family or let them watch with their friends while video chatting with everyone starting the movie at the same time. Make sure the movie is appropriate for their age group.

Yes, this year is different, and trick-or-treating may not feel right for everyone. People have health concerns and going door-to-door can be out of our comfort zone. This is also a chance to get creative and, perhaps, start some new Halloween traditions in the family. Kids seem have a magical way of having fun no matter what the situation. As adults, let’s aim for that, too.

  

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National Food Safety Education Month

September is Food Safety Education Month where the focus is how we can keep our food safe and prevent food poisoning. According to the CDC, 1 in 6 Americans (or 48 million people) get sick, 128,000 are hospitalized and 3000 die from eating contaminated food every year. Although anyone can get sick from food poisoning, there are some groups who are more vulnerable. These include:

• Children younger than 5 years old
• Adults 65 and older
• People who have weakened immune systems or take medications that lower the body’s ability to fight sickness and germs
• Women who are pregnant

In order to protect yourself and your family, follow the steps of safe food handling when preparing and cooking food at home:

• Clean: wash hands, utensils and surfaces often while cooking
• Separate: raw meat, poultry, seafood and eggs as they can spread germs. Keep them separated from cooked food and fresh produce.
• Cook: use a food thermometer to make sure the internal temperature of the food is such that the germs are killed
• Chill: refrigerate perishable foods and leftovers within 2 hours

I did want to mention COVID-19. Since COVID-19 is a respiratory virus, not a foodborne illness, there is currently no evidence to support the transmission of COVID-19 in association with food. Since COVID-19 causes respiratory illness, the greatest risk is being around people who have the virus and are symptomatic. As with any food safety, though, similar actions to prevent foodborne illness can be taken to stop the spread of COVID-19. These include hand hygiene, using gloves when necessary, covering your cough or sneeze with a tissue, and cleaning and disinfecting surfaces.

Stay healthy by being clean is always the motto whether COVID-19 is with us or not. By following food safety guidelines, we can all reduce the incidence of not only foodborne illness, but that awful virus, too.

https://www.cdc.gov/foodsafety/index.html

https://www.eatright.org/homefoodsafety/safety-tips/food-poisoning/national-food-safety-education-month 

National Health Center Week is Coming!

The theme for this years National Health Center Week of August 9-15 is “Community Health Centers: Lighting the Way for Healthier Communities Today and in the Future.” The reason for having an annual celebration for community health centers is to raise awareness about their mission and accomplishments. The goals are special for this year, too. They include celebrating and honoring the front-line providers, the staff and the patients who lost their lives in our current COVID-19 pandemic.

During this COVID-19 pandemic, many community health centers have been providing telehealth services to their patients, in addition to their in-office services. Telehealth can be made available for not only regular medical needs, but also urgent care and behavioral health services.

In case you’re not familiar with what a community health center is, let me give you some background. Five decades long is the timeline for the existence of community health centers. Community health centers are in high-need communities serving populations with limited access to health care. Many are recognized as an FQHC (Federally Qualified Health Center); FQHCs are held to the highest standards of regulations under the federal government. Some are called FQHC Look-Alikes which means they don’t receive grant funding but may receive many of the same benefits. Many community health centers have also achieved PCMH (patient-centered medical home) recognition.

Community health centers provide a safety net for people who might not otherwise have access to these services. Many have a sliding scale fee based on income and household size. Some provide supportive services such as transportation, education and translation services. Community health centers are committed to providing a range of affordable family health services. Many are a kind of “one-stop shopping” with a multidisciplinary health care team and may also provide women’s health services, child and adolescent health, behavioral health, dental health, laboratory services, radiology, and have pharmacies on-site. All are caring for the underserved in their communities by providing health care to those who need it.

Each day of the week for August 2020 has a special focus:

• Sunday, 8/9: Public Health in Housing Day
• Monday, 8/10: Healthcare for the Homeless Day
• Tuesday, 8/11: Agricultural Worker Health Day
• Wednesday, 8/12: Patient Appreciation Day
• Thursday, 8/13: Stakeholder Appreciation Day
• Friday, 8/14: Health Center Staff Appreciation Day
• Saturday, 8/15: Children’s Health Day

As we continue to deal with the COVID-19 pandemic, remember how our community health centers provide high-quality, affordable, and comprehensive health care to the communities they serve.

http://www.healthcenterweek.org

Preparation for Onsite Trainings and Events

As we re-open Practice Transformation Institute (PTI) to onsite training and events, we want you to know that we are working hard to make this “new normal” as safe as possible. As there is a risk of exposure to COVID-19 in any public place due to the contagiousness of the disease, we are following the Centers for Disease Control (CDC) guidelines to lower that risk during every PTI training and event. We closely monitor changes in the guidelines and other public health updates and will continue to revise our protocols as necessary.

All employees have successfully completed COVID-19 worksite preparation and protection training that supports the readiness and return to work strategies to reopen safely. These included viewing safety videos, participating in Zoom trainings, watching webinars and successfully passing a test with a high score.

Everything that PTI does is our best effort to keep our attendees, employees, speakers and community safe. We thank you for your patience as we begin these next steps in the delivery of our programs and for your continued support of PTI.

Yours in good health,

The PTI Team

June is PTSD Awareness Month

Post-traumatic stress disorder, otherwise known as PTSD, is a mental health problem. It can cause us to have anxiety, nightmares, upsetting memories and a lot of other symptoms. If you have these types of symptoms and they last more than a couple of months, PTSD could be the cause.

During this month, we always think about our veterans and the sacrifices they endured in the line of duty. Many of them have PTSD due to their experiences. But PTSD can also have an impact on people who have been in a car accident, had a sexual assault, or been involved in another type of life-threatening event. A disaster such as a hurricane, tornado, earthquake, flood, or fire can be a life-threatening event. A life-threatening event can also be a pandemic like we are currently experiencing with COVID-19.

There are over 8 million people in the United States who have PTSD. That doesn’t account for all the new cases caused by COVID-19 that we don’t even know about yet. Spread the word that there are treatments available and they can lead to an improved quality of life. The best chance of getting better is by working with a mental health professional for self-help and coping. Practicing mindfulness and participating in support groups are good choices. Many people don’t get the help they need because they don’t know it is out there. Please help raise PTSD awareness this month. The links below can help.

https://www.ptsd.va.gov/covid/COVID_managing_stress.asp

https://www.ptsd.va.gov/gethelp/selfhelp_coping.asp

https://www.ptsd.va.gov

https://www.ptsd.va.gov/covid/COVID_healthcare_workers.asp

https://www.cdc.gov/coronavirus/2019-ncov/about/coping.html

Where Do We Go from Here?

Interesting times. Challenging times. Uncertain times. Horrible times. Times we will never forget. Everyone will have their personal way of documenting this period of our lives. It would be nice to put COVID-19 into a locked box and throw it into the ocean abyss, that bottomless portion of the ocean that remains in perpetual darkness. This virus, and all that has come with it, has been a darkness for humanity. These are times we hope to never see again. Unfortunately, science tells us otherwise.

I sometimes plan my blogs a couple of months in advance. This month was going to be about melanoma and skin cancer detection, along with sun safe behaviors. After all, May is melanoma and skin cancer detection and prevention month. Ah, good times when we could talk about things like that. I’m longing for the past and I’m yearning for a future that includes doing things with my family and friends and going on vacation again. I had to cancel a Mexico vacation that I was greatly looking forward to. You see, I love laying and walking on the beach, listening to the waves, swimming in the surf, sipping a margarita under a palapa, and eating my favorite Mexican food. It was depressing to cancel the trip, but fortunately I didn’t lose any money and was able to get eCredit for my plane tickets. The wonderful resort in Mexico that I love gave me my deposit back and I will return there when it is safe. For what so many other people have gone through, my trip longing is selfish. I have family members going to the hospital every day, working in horrendous circumstances, hoping they don’t catch the invisible evil or bring it home. I have family members and friends who went through the virus, some easier than others. I listen to the news every day and I pray for our collective health as a country and world.

Where do we go from here? Some of our states have started opening in what we hope is a slow and measured way with attention paid to science. We hope there is no upswing in cases and deaths as the states open. We hope for more testing to see where the virus has been and where it is going. We hope for a vaccine or other treatment that prevents or makes the worse symptoms less horrendous. We all long for some normalcy to our lives.

Keeping that in mind, I will end my blog with a bit of normalcy about my planned subject for the May blog. Let’s not forget that May is melanoma and skin cancer detection and prevention month. After all, our weather is on the upswing and we now have more sunny days. The link below has some great information on how to do skin self-exams, the health benefits of safe sun protection and best practices.

https://www.aad.org/public/public-health/skin-cancer-awareness

Who loves the sun? Not everyone, as Lou Reed and the Velvet Underground so aptly sang back in the day. But for me, I am a sun lover. Give me a warm, sunny day, any day. And get me back on that Mexico beach under a palapa with sunscreen, cute hat and sunglasses as safely and quickly as possible. 

Content by Carla Irvin, BSN

Coping with COVID-19

These are stressful times impacting all of us both personally and professionally in different ways. Many of us have patients and loved ones we are worried about. Some are worried about childcare during a month of no school. A simple trip to the grocery store is no longer simple. Here are some quick tips to lessen the toll this might have on your mental health along with some great resources that might be helpful to you, your patients and your practice colleagues:

• Maintain perspective - Don't panic but follow recommended precautions. This is serious but not the apocalypse 
• Keep informed but choose your sources wisely  - politicized news sources are not always helpful (https://www.cdc.gov/coronavirus/2019-ncov/index.html). Take breaks from the topic
• Take care of your body (get plenty of fluids, exercise, healthy eating, rest and good sleep. Limit junk food, caffeine, alcohol)
• Find ways to relax - (now is good time to start mindfulness meditation - my favorite apps are "Stop, Breathe and Think" and "Insight Timer". "CBT-I Coach" is great if you have insomnia. A good app for children is "Stop, Breathe & Think Kids") 
• In a time of restrictions and social distancing find new ways to engage in meaningful and fun activities
• Recognize and challenge unhelpful thinking patterns and negative ruminating 
• Stay connected to others (even if virtually)

Coping Resources:

https://www.ptsd.va.gov/covid/COVID_managing_stress.asp

https://www.cdc.gov/coronavirus/2019-ncov/about/related-stigma.htm

https://www.ptsd.va.gov/covid/COVID_healthcare_workers.asp

https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html

https://www.cdc.gov/coronavirus/2019-ncov/about/coping.html

https://store.samhsa.gov/system/files/sma14-4894.pdf

By: Lori Lackman Zeman, PhD, LP, ABPP

Board Certified Health Psychologist

Get Your Colonoscopy Today!

Colorectal cancer is the second leading cause of cancer death but is highly preventable when caught early. How can you catch it early? Have a colonoscopy. A colonoscopy is an exam used to find abnormalities and changes in the rectum and large intestine. It is a safe and simple procedure where a long, thin, flexible and lighted tube with a camera allows the doctor to view the inside of the colon. If polyps or other types of abnormal tissue are found, they can be removed at that time. Biopsies can also be taken during the exam.

Screening for colon cancer should start at age 50 if you are at average risk and with no other risk factors other than your age. There are other screening options besides a colonoscopy, but having one is the screening gold standard as it scans the entire colon.

What are some risk factors for colon cancer?

· Personal medical history (inflammatory bowel disease, Crohn’s disease, ovarian/breast/endometrial cancers, previous colon cancer or polyps, and people of African American or Hispanic descent)
· Physical inactivity
· Being overweight or obese
· Hereditary risks (increased risk with a close relative who has had it)
· A diet high in red and/or processed meats, low fruit/vegetable intake
· Smoking
· Alcohol intake above moderation

How can you reduce your risk?
· Get recommended screenings
· Eat fruits and vegetables every day
· Aim for whole grains in bread, cereals, nuts and beans
· Limit red and processed meats
· Be physically active and aim for 30 minutes of activity 5-7 times a week
· Lose weight if you need to
· Stop smoking
· Limit your alcohol consumption

Why is it done?

· Investigate certain signs and symptoms you may be having such as abdominal pain, bleeding, chronic constipation or diarrhea
· If you’ve had polyps found on a previous colonoscopy, a follow-up one will look for and remove additional polyps

Information on how to do the prep will be given to you from your physician. It is done the day before the procedure to clean out the colon. There are tips that can help manage your time prepping for the procedure.

https://fightcolorectalcancer.org/blog/colonoscopy-prep-tips/?gclid=Cj0KCQiAkKnyBRDwARIsALtxe7hbyceBQAJI8-GpSggS9ocBd77v1Jd3AShU4Hr19DG0idoM0U1qZqoaAgUHEALw_wcB

Sedation is given during the colonoscopy, so you don’t have discomfort. You’ll be able to discuss anesthesia options with the anesthesiologist and nurse anesthetist prior to the procedure.

Be sure to check with your insurance company if you have a co-pay or deductible or other cost sharing for the procedure. You might also want to check if they offer any incentives for having a screening.

For this March Colorectal Awareness month, don’t put off a colonoscopy any longer. Talk to your doctor for your options and get it scheduled pronto.

https://fightcolorectalcancer.org  

February is National Children's Dental Health Month

This National Health Observances Month is brought to you by the American Dental Association. This is the designated month of the year for health care professionals and educators to promote the benefits of good oral health for children and their families.

Tooth decay is one of the common and chronic childhood diseases. It is more common than asthma and allergies. Preventive dental care is especially important for children due to their teeth, gums and mouth still developing. Teaching good dental habits early is the best way to protect your child’s teeth down the road.

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry both recommend that all children see a pediatric dentist by age one. Unfortunately, many children lack good oral hygiene habits and the opportunity for dental care. Medical insurance is a strong predictor of access to dental care and it is proven that children without health insurance are less likely to have these opportunities for dental care. This can lead to all kinds of health issues for the future such as pain, infections, and can lead to problems with speaking, learning and playing. According to the Centers for Disease Control and Prevention (CDC):

• About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.1
• 1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth.1
• Children aged 5 to 19 years from low-income families are twice as likely (25%) to have cavities, compared with children from higher-income households (11%). 
• The link below has guidance for babies, children and pregnant women. https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html

There are some tips below to help young children practice brushing and make it a good experience for all.

Choosing a toothbrush. Use a soft-bristled toothbrush designed for brushing an infant’s or child’s teeth. There are also a variety of child’s battery and electric toothbrushes on the market.

Holding a toothbrush. If the child has trouble holding a toothbrush, try making the handle thicker by putting it inside a tennis ball. The toothbrush handle can also be strapped to the child’s hand with a wide rubber band, a hair band, or Velcro. Toothbrushes with thick handles can also be found in retail and discount stores.

Teaching the child how to brush. Break the process into small steps that the child can understand and practice. Ask a dentist, dental hygienist or early childhood specialist for help, if needed. Another way is to place a hand over the child’s hand to guide the toothbrush as the child brushes.

Using toothpaste with fluoride. Use toothpaste with fluoride that the child likes and that feels good in his or her mouth. An adult should always place toothpaste on the toothbrush.

• For children under age 3: Use a small smear of fluoride toothpaste (or an amount about the size of a grain of rice). 
• For children ages 3–6: Use a pea-size amount of fluoride toothpaste. 

If a child cannot spit: Have the child tilt his or her mouth down so that the toothpaste can dribble out into the sink, a cup, or a washcloth. Since the fluoride in toothpaste is clearly meant to be swished but not swallowed, make sure to help or watch the child while brushing. When she is old enough, tell her to spit out the toothpaste after brushing.

Positioning the child. There are many ways a child can be positioned to make the child feel comfortable and allow an adult to brush his or her teeth.

Keeping the child engaged in brushing. Use a timer, a short song, or counting as a game to encourage brushing for 2 minutes.
https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Toothbrushing-Tips-for-Young-Children.aspx 

Cavities are preventable and fluoride has helped immensely in kids living in areas with fluoridated tap water. Brushing with fluoride toothpaste, getting dental sealants, and fluoride drops are also a big part of prevention. Note: The American Academy of Pediatrics recommends that you check with your pediatrician or pediatric dentist to find out if any additional fluoride supplements are necessary, or whether your child is already receiving the right amount. https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Fluoride-Supplements.aspx?gclid=CjwKCAiA66_xBRBhEiwAhrMuLZB5qCPGfgj1S6vswtCU3iQJWcNhL63uC0U0o_r5VEALRsW1JtGZCBoCPAYQAvD_BwE

For this children’s dental health month, there are links below for fun activities to be done at home. Scroll down to the bottom. There is a crossword puzzle, coloring sheet, calendar (to mark off when they brush) and a maze activity. Get your children involved in wanting to brush their teeth.
https://www.ada.org/en/public-programs/national-childrens-dental-health-month?utm_medium=VanityUrl

Those little teeth need our protection. Starting dental care early is a step in the right direction for building a life-long habit of good dental care.

2020 Educational Opportunities at PTI!

January 2020

Happy New Year and warm greetings from all of us here at Practice Transformation Institute (PTI). We are a non-profit organization that provides medical, nursing, dietetic, social work and other health care professional continuing education through our customized learning programs. We hope that you will consider letting us be a part of your personal and organizational education goals in 2020.

Continuing Medical Education. We are accredited by the Michigan State Medical Society (MSMS) to provide continuing medical education (CME) for physicians. If you’re interested in attaching CME to your learning event, let us help with our CME Joint Providership Program. We will make sure that your CME event is planned, implemented and evaluated in accordance with the MSMS requirements.

IACET. PTI is an International Association for Continuing Education and Training (IACET) accredited provider and adheres to the highest standards of the training profession. We follow the ANSI/IACET Standard for Continuing Education and Training. IACET CEUs are recognized by a wide range of organizations including professional organizations, regulatory boards, corporations and universities.

Care Coordination and Care Management Training (Self-Management). Care Coordination and Care Management Training is one of PTI’s signature ongoing programs. We have trained hundreds of interprofessionals with a knowledge base and skill set to enable high quality chronic disease care for patients in the ambulatory care setting. The program provides contact hours for nurses, continuing professional education units for dietitians, and continuing education hours for socials workers. IACET CEUs are also available.

National Diabetes Prevention Program. The Centers for Disease Control (CDC) and Prevention established the National Diabetes Prevention Program to help prevent or delay the onset of type 2 diabetes. The program is evidence-based with research showing that lifestyle modifications can cut the risk of type 2 diabetes in half. PTI has master trainers and lifestyle coaches who can bring this program to your organization.  

Learning Collaboratives. A learning collaborative is a learning and innovation community that links a variety of organizations together to rapidly test and implement meaningful, sustainable change within a specific topic area. PTI has been facilitating learning collaboratives for years and is a proven expert.

PATH (Personal Action on Health) Training and Workshops. PATH is Michigan’s name for the Self-Management Resource Center’s (SMRC) self-management programs that were developed and tested at Stanford University to help people learn techniques and strategies for the day-to-day management of chronic and long-term health conditions. PTI can do PATH leader trainings and workshops at your place or ours.

As you can see, PTI can provide a wide range of educational programs for health care professionals that can be customized to fit your organization’s need. Bring an idea to us and we can bring it to fruition. PTI knows the benefits of working collaboratively on interprofessional teams and how they help improve patient outcomes.

Our programs can be delivered at your facility, a facility of choice or at PTI. We want to help you jumpstart your education goals for 2020. Email Harmony at hkinkle@transformcoach.org for more information.  We hope to see you in 2020!