Changing Minds and Inspiring Hope: Media Strategies For Reducing Prejudice and Discrimination...

Changing Minds and Inspiring Hope:

Media Strategies For Reducing Prejudice and Discrimination Associated with Mental Illness in Spanish-speaking

Communities

October 11, 2005

http://www.promoteacceptance.samhsa.gov/

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SponsorThis teleconference is sponsored by the SAMHSA Resource Center to Address Discrimination and Stigma Associated with Mental Illness (ADS Center).

The ADS Center is a program of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS).

The ADS Center provides practical assistance in designing and implementing anti-stigma and anti-discrimination initiatives by gathering and maintaining best-practice information policies, research, and programs to counter stigma and discrimination. We actively disseminate anti-stigma and anti-discrimination information and practices to individuals, States, local communities, and public and private organizations.


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SurveyWe value your suggestions. Within 24 hours of this teleconference, you will receive an e-mail request to participate in a short, anonymous, online survey about today’s training material. Survey results will be used to determine what resources and topic areas need to be addressed by future training events. The survey will take approximately 5 minutes to complete.

Survey participation requests will be sent to all registered event participants who provided e-mail addresses at the time of their registration. Each request message will contain a web link to our survey tool. Please call 1–800–540–0320 if you have any difficulties filling out the survey online. Thank you for your feedback and cooperation.

Written comments also may be sent to the SAMHSA ADS Center via e-mail at [email protected].


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Address

• SAMHSA ADS Center11420 Rockville PikeRockville, MD 20852

• Toll free: 1-800-540-0320Fax: 240-747-5470Web: http://www.promoteacceptance.samhsa.gov

The Moderator for this call is Michelle Hicks


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Questions?

At the end of the speaker presentations, you will be able to ask questions. You may submit your question by pressing 01 on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received. On hearing the conference operator announce your name, you may proceed with your question.


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SpeakersSergio Aguilar-Gaxiola, M.D., PhD.

Sergio Aguilar-Gaxiola is Visiting Professor of Clinical Internal Medicine in the Department of Internal Medicine, School of Medicine, University of California, Davis. He is also Founding Director of the newly developed Center for Reducing Health Disparities at UC Davis Health System. Dr. Aguilar-Gaxiola is the on-site Principal Investigator of the Mexican American Prevalence and Services Survey (MAPSS), the largest mental health study conducted in the U.S. on Mexican Americans. He is a member of the National Advisory Mental Health Council (NAMHC), National Institute of Mental Health (NIMH). He holds several World Health Organization (WHO) advisory, board, and consulting positions; and is the Coordinator for Latin America and the Caribbean of the WHO World Mental Health (WMH) initiative.


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SpeakersElizabeth Salazar, NAMI Montgomery County (MD)

Latino Community Outreach Coordinator for the National Alliance on Mental Illness (NAMI) of Montgomery County, MD. Ms. Salazar has coordinated the first successful mental health education program in Spanish titled “De Familia a Familia” © in Maryland for Latino families of Montgomery County. The Family-to-Family Education Program, aims to eliminate stigma in Latino families by educating them on mental illness. Prior to working with NAMI Montgomery County, Ms. Salazar was the Community Outreach Coordinator for the New Jersey Mental Health Institute in Mercerville, NJ, where she coordinated the same family education program in six counties throughout the state through a SAMHSA-funded program titled Changing Minds, Advancing Mental Health for Hispanics.


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SpeakersCaroline Clauss-Ehlers, Ph.D., Freelance Journalist

Freelance Writer New York, N.Y., USA. She writes a column for Hoy one of the largest Spanish language newspapers. She holds a Rosalynn Carter Fellowship For Mental Health Journalism 2004-2005. Her topic was to explore the impact stigma has on access to mental health treatment, utilization of mental health services, and coping for Latino families. Caroline is also a bilingual psychologist and Assistant Professor of Counseling Psychology at Rutgers University. She is co-editor of the book Community Planning to Foster Resilience in Children (Kluwer Academic Publishers, 2004) and author of the book entitled Diversity Training for Classroom Teaching: An Instructional Manual for Students and Educators (Springer, 2006). She is editor of the upcoming volume The Encyclopedia of Cross-Cultural School Psychology (Springer, 2007).


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DiscussantBill Lichtenstein, President, Lichtenstein Creative Media

Bill Lichtenstein is president of Lichtenstein Creative Media, an independent media production company located in Cambridge, MA, which created and is producing the Hispanic Mental Health Strategic Communications Campaign. LCM produces The Infinite Mind, public radio’s most honored and listened to health and science program with one million listeners weekly. LCM also produced West 47th Street, an award-winning documentary film which follows four people with mental illness, over three years.

Bill's award-winning documentary work in TV, film and radio spans more than 30 years. A former producer for ABC News 20/20, World News Tonight and Nightline, Bill founded LCM in 1990, following his diagnosis and recovery from manic depression. The company has distinguished itself by its production of films and TV and radio programs that show that people can - and do - recover from serious mental illness.


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DiscussantCristina Magaña, Ph.D.

Cristina Magaña, a clinical psychologist by training, is at California State University, Fresno serving as a co-investigator and collaborator to Dr. Sergio Aguilar-Gaxiola on NIMH-funded studies aimed at addressing health disparities within the Latino community. Cristina’s undergraduate and graduate work has focused on improving the health status of immigrant communities and has extensive experience within the migrant farm working community including outreach and education efforts to improve service access and eradicate the stigma of mental illness.


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Changing Minds and Inspiring Hope: Media Strategies for

Reducing Stigma Within Spanish-speaking Communities

Sergio Aguilar-Gaxiola, M.D., Ph.D.UC Davis, Center for Reducing Health Disparities

SAMHSA Resource Center to Address Discriminationand Stigma Associated With Mental Illness

October 11, 2005


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Learning Objectives

• Identify factors impacting stigma and stigma-reduction in Spanish-speaking communities;

• Effectively work with Spanish-language news media to communicate about mental illness and mental health services; and

• Describe successful projects and initiatives already utilizing mass media as an educational and outreach tool within Latino communities.


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Stigma

• Stigma towards mental illness is a prominent obstacle to effectively providing mental health services to Latinos

Source: Mental Health: a Report of the Surgeon General. 1999; Mental Health: Culture, Race, and Ethnicity-A Supplement to Mental Health, 2001.


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Factors Related to Stigma

Individual level factors:•conceptualization of mental illness;•patient preferences;•refusal of treatment;•poor adherence;•low health literacy.Source: Creating Culturally Competent Mental Health Systems for Latinos: Perspectives from an Expert Panel, NTAC Report, Cultural Diversity Series, 2001.


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Latino Population Trends

There were over 40 million Latinos in the U.S. in 2004 (excluding the population of Puerto Rico – an additional 4 million)•75% of the U.S. Latino population are immigrants or children of immigrants;•45% are foreign born;•Most of Latino population growth results from fertility not immigration.Source: Current Population Survey, March 2002, PGP-5


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Language Use Among Latino Adults

Source: Hispanics in Motion, Pew Hispanic Center, 2005


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Media Preference by Generation

Source: Changing Channels and Crisscrossing Cultures, Pew Hispanic Center, 2004


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Percent Distribution of Hispanics by Type: 2002

Mexican66.9%

Puerto Rican 8.6%

Cuban 3.7%

Central and South American

14.3%

Other Hispanic

6.5%

Source: Current Population Survey, March 2002, PGP-5


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Age•Among Hispanics, Mexicans have the largest proportion of people under age 18 (38 percent)

Educational Attainment•Among Hispanics, Mexicans 25 years and older have the lowest proportion of people with a high school diploma or more

Poverty•Among Hispanics, Mexicans have the lowest income

Source: Current Population Survey, March 2000, PGP-4


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Specific Utilization BarriersFour Categories of Barriers:•Support system•Institutional•Perceptual•Other (volunteered by respondent)


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Support System Barriers (N=90)(Multiple responses possible)

• I wouldn’t have childcare = 19• My friends might find out = 16• My spouse/partner might disapprove = 14• My family would be upset = 11• My religious leader might find out = 4


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Institutional Barriers (N=90)(Multiple responses possible)

• I wouldn’t know where to go = 47• I have no way to pay = 45• There are no treatment centers near my home = 25• I can’t go to the clinic during open hours = 20• I can’t go as frequently as needed = 20• My employer might find out = 18• I’ve tried to get help but was unable to = 17• No one speaks my language = 14


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Perceptual Barriers (N=90)(Multiple responses possible)

• I should be able to handle it on my own = 58• I think it will go away on its own = 42• I don’t have a bad enough problem to seek services = 41• It’s embarrassing = 40• I’m afraid of what they will tell me = 37• I’m worried about what others might think or say = 33• Others will think I’m crazy = 33• I have difficulty getting out of my home = 28• I'm a man, men don't get these symptoms/problems = 14• I'm a woman, women don't get these symptoms/ problems = 6


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Other Barriers (English)(Multiple responses possible)

• “I already lived with it all my life. I trained myself to the situations I get in. When I'm depressed I cry in my car before I drive.”

• “I feel that I could deal with it myself. I don’t need anybody to guide me. I'll deal with it by talking to friends, relaxation, and prayer. “

• “They don't understand because of culture. Do not trust them.”

• “You don’t have someone to push you to follow through because sometimes you can’t/don’t want to do it.”


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Other Barriers (Spanish)(Multiple responses possible)

• “A nadie le importo yo ni mis problemas. Perdería mi tiempo. Para que le cuentas tus problemas a la gente - en que te van a ayudar?”

• “Ignorar. No saber hasta donde llega una enfermedad mental. Miedo de que no me entiendan, me digan que no, que estoy loco y que me ignoren.”

• “Miedo a que me juzguen; busco pretextos.”


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Top Five Barriers

Institutional and perceptual barriers account for the participants’ top five barriers to mental health services, including:

1.“I should be able to handle it on my own”

2.“I don’t know where to go”

3.“I wouldn’t have a way to pay”

4.“I think it will go away on its own”

5.“I don’t have a bad enough problem to seek help”


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Special Opportunity in Mental Health Funding:

“Increasing Access to Culturally and Linguistically Appropriate Mental Health Services for Low-Income, Underserved,

Rural Populations”


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Program Activities Flyer


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Community Theater


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Pláticas Comunitarias


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Program Services Flyer

Created by Suzi Arvizu


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Live radio interviews

Community forums


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Latino Mental Health Strategic Communications Campaign

• Lichtenstein Creative Media

Researchers are collaborating oninnovative strategic communications campaign.

Efforts include TV, print, radio, Internet and other new technologies to reach Latino populations across the country. Campaign and materials will be designed to be used “bottom up,” rather than “top down” to be most relevant to each community and population.


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Latino Mental Health Strategic Communications Campaign

Goals•To utilize “best practice” methods in public health educational outreach and social marketing to shift attitudes and behaviors regarding recognition, acceptance, and treatment of mental illness among Latinos.

•To increase the number of Latinos accessing and utilizing best practice, culturally- competent mental health care.

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Changing Minds and Inspiring Hope: Media Strategies For Reducing Stigma Within Spanish-speaking Communities

A Resource for Advocates Reaching Out to Media Outlets

Elizabeth SalazarLatino Community Outreach Coordinator

NAMI Montgomery County, MD


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Reaching Out to the Latino Community through Media Outlets

Steps for reaching out to the media:

• STEP 1: Create language-ready materials

• STEP 2: Know your audience

• STEP 3: Network, network, network!

• STEP 4: Disseminate information about you program using all media contacts and outlets


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STEP 1: Create language-ready materials

Prior to reaching out to the Latino community you should have resources available in Spanish. These resources should include pamphlets about your organization and mental illness, but also a “press packet” ready to send out to media outlets.


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STEP 2: Know your audience

The Latino communities that exist throughout the U.S. are not a homogenous group, they consist of communities made up of families from all parts of Latin America. In order to reach your target community, you must know your audience and the resources (media outlets) they use to obtain information.


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STEP 3: Network, network, network!

The best way to reach out to the Latino community in your neighborhood is to build partnerships and networks with organizations that already serve this population. Meeting with your county or state Hispanic Liaison is a good way to find out which organizations are working for this community.


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STEP 4: Disseminate information about you program using all media contacts and outlets

A good way to establish media contacts is to see what other Latino-serving organizations are using and what partnerships already exist between newspapers or radio stations and Latino groups. Ask to meet with all your contacts and provide written information about your program and which other organizations you work with.

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Which Media Outlets?

• Printed media: local and state-wide newspapers, magazines and other Spanish and English language publications

• Broadcast media: local and metropolitan-wide television and radio programming; including community calendars and public service announcements

• Other media: internet-based resources such as on-line publications, websites and local community calendars

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Printed MediaIt is important to target both local and state-wide publications in both languages. Spanish-language newspapers exist in most states and should be contacted at the launch of any mental health program or event. It is also important to create a relationship with these contacts in order to facilitate future collaborations.

•Tip #1: Have a press release ready

•Tip #2: Include testimonials from program participants in articles or “press packets” if possible


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Broadcast MediaContacting broadcast media might be more difficult than contacting print media, but it is not impossible. Local programming usually includes health and educational segments, as well as community calendars, which can be used to create greater awareness on mental illness or publicize resources available to the Latino community.

•Tip #3: Always use studies and statistics on mental health, stigma and the Latino community in order to highlight the importance and immediacy of your program or advocacy campaign.


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Other Media

• Although on-line resources are not as utilized by most Latinos as print and broadcast media, its use is growing. In addition, on-line resources are heavily used by younger Latinos. Information about your program on the web can help send the message that help is out there and that families are not alone, especially for those that are not yet comfortable with meeting or speaking with someone about mental illness.


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Closing Remarks

Using the media to reach out to families about mental illness plays a huge role in eliminating stigma. Reaching out to the media should be a part of all outreach plans for educational, advocacy and direct service mental health organizations. It is vital for families to see mental health-related articles and programming in the media in order to feel more comfortable in talking about the issue and seeking assistance for themselves or their loved ones.


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Contact Information

Elizabeth Salazar

Latino Community Outreach Coordinator

NAMI Montgomery County

10730 Connecticut Avenue

Kensington, MD 20895

(301) 949-5852

[email protected]


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Working With Latino Media: A Journalist’s PerspectivePresentation for the SAMHSA ADS Center Teleconference Training Changing Minds and Inspiring Hope: Media Strategies for Reducing

Stigma within Spanish-Speaking Communities

Caroline S. Clauss-Ehlers, Ph.D.Columnist and Child Psychologist

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Overview of Presentation

1. Background on Latino Media as a Growing Market

2. Tool-Kit for Latino Media Outreach

3. Rosalynn Carter Fellowships for Mental Health Journalism


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Background

• 40 million Latinos in the U.S.• Latinos comprise 13% of the U.S. population• U.S. Census Bureau predicts that the Latino population

will triple between 2000 and 2050


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Background (continued)

• The Ethnic Media Sector is Growing throughout the U.S.• Ethnic Media Considered “The Most Powerful New Force

in American Journalism” (Irvine Quarterly, Vol. 2 (3), 2003.


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• Spanish-language Media Have an Intimate Reach to their Audience

• Latinos are Information Seekers• Look to Trusted Sources

– Calls Generated from Column in HOY

– Child Segments on Univision


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• Growing Media Outlets in Spanish• Two Major Networks: Univision and Telemundo• Over 700 Publications w/Latino Editorial Content• Media Week found that Latino Radio and TV

programming growing rapidly


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• Three new Latino Channels in 2004:1. ESPN DEPORTES

2. HISTORY CHANNEL EN ESPAÑOL

3. SI TV PRODUCTIONS


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Tool-Kit for Pitching Mental Health Stories to Latino Media

Network Brownout Report looked at the portrayal of Latinos in network television news. It found the following:•Latinos felt network news coverage too negative•Less than 1% of news stories Latino related despite 13% representation in overall population


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Tool-Kit for Pitching Mental Health Stories to Latino Media (continued)

• Your role with Latino Media can be seen as Filling in Huge Gaps in Information

• Information as a Great Entry into Media Sources


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• Look at How the Mental Health Issue Relates to the Latino Community

• Two Examples that Relate to My Work:– Latina Women and Depression: Story Written for HOY

– Psychosomatic Symptoms as a Cultural Expression of Emotional Distress: Descriptions Interviewees Gave When Being Interviewed About How They Experienced Symptoms

• Try to Put a Mental Health Angle on the News Story– Hurricane Katrina and PTSD

– Back-to-School and Separation Anxiety


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• Incorporate Latino Experts– Dr. Sergio Aguilar-Gaxiola for article on stigma and holiday

blues

– Edwin Méndez-Santiago, Commissioner for the NYC Department for the Aging, for articles on depression among elderly Latinos


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Don’t Just Talk to Professionals•Capture the Voice of Latinos Who Have Experienced the Issue, for example:

– Talk to Latina mothers about their experience of post partum depression and fear of looking like “bad moms”


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Provide Information About Where to Turn for Help•Voicemail Number Provided at the End of Each Column•Include Telephone Numbers of Organizations to Contact


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Take a Multi-Pronged Approach to Latino Media Outreach:•Identify Local, State, and National Media Outlets•Growth of HOY over Years as a Columnist•Local and National/International Programs for Univision


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Develop a Relationship with Media Sources•Build Relationships with Producers•Be a Source of Information for Them•Be Responsive to Media


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Rosalynn Carter Fellowships for Mental Health Journalism

• Focus on developing a cadre of journalists who can accurately report on mental health issues in the media

• Fellows from All Types of Media Outlets• 2004-2005 Fellows from the U.S., New Zealand, and

South Africa


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Rosalynn Carter Fellowships for Mental Health Journalism (continued)

Proposed Project: The Stigma of Mental Illness in the Latino Community

•Write a Series of Columns for the Chicago Tribune’s Spanish Language Newspaper HOY

•Hoy published in New York, Chicago, and LA

•Talk to Individuals, Families, Professionals, and Community Organizations about Stigma

•Provide Information about a Series of Mental Health Problems

•Translate Columns to English for The Carter Center Archives


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Project Culminated in:•26 Columns written for HOY•8 Segments on Univision•3 Articles Written for the Bilingual Publication Salud Mental


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Investigative reporting was to focus on the following questions:

1.What role does stigma play when a Latino parent suspects that her child may be facing mental health challenges?

2.What impact does stigma have on access to mental health treatment for Latino families?

3.What impact does stigma have on the utilization of mental health services for Latino families?

4.Who do people turn to when they first experience symptoms?

5.What strategies can help decrease stigma in the Latino community?


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Question 1. What role does stigma play when a Latino parent suspects her child may be facing mental health challenges?•Romana’s story was one of a parent who initially knew very little about mental health issues and was misguided in terms of her son’s problems (i.e., she was told he needed special education, mental health intervention was never mentioned despite the presence of auditory and visual hallucinations)

•As Romana’s awareness increased and she began to advocate for her son, she confronted significant barriers, many related to a lack of cultural sensitivity (i.e., the family was told to stop speaking Spanish in the home).


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Questions 2 and 3. What impact does stigma have on access and utilization of services for Latino families?•Stigma has enormous influence on access and utilization of services.

•As stated by Dr. Sergio Aguilar-Gaxiola, five obstacles interfere with Latinos receiving mental health services:

1. People often do not know where to go to receive services.

2. Transportation is problematic as many do not have the means to get to the destined location to receive services.

3. Existing services are often located in cities and not in rural areas.

4. Frequently there are no professionals who know the language.

5. Stigma contributes to stereotypes associated with mental illnesses.


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Question 4. Who do people turn to when they first experience symptoms?•First important to examine who people do not turn to when they begin to experience symptoms.

•Investigative reporting indicated that Latinos do not seek out a mental health professional when first symptomatic

•Primary care physicians as a source but none of interviewees said PCP made a referral to a mental health professional

•Other Latinos did not tell anyone about their symptoms


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Question 4. Who do people turn to when they first experience symptoms? (continued)•Media is a source people turn to for help•Readers call for information

– Grandmother called about her grandson– Call made in conjunction with publication of the Ramiro Guevara article that

discussed his involvement with the juvenile justice system– When asked how she heard of the column, grandmother shared that her

daughter, the grandson’s mother, read the column while in jail, placed a call to the grandmother, and asked her to contact me regarding where her son could get help


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Question 5. What strategies can help decrease stigma in the Latino community?•Dr. Aguilar-Gaxiola recommended a public education campaign.•Three public education campaign goals:

1. People understand mental health problems are real2. People learn to recognize symptoms3. People realize that treatment does work

•Train Primary Care Physicians•Make Fluency in a Second Language a Graduate School Requirement•Report on Mental Health Issues in the Latino Media•Develop Infrastructure that Serves Rural Communities•Increase Advertising About Services•Consider Transportation Issues


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For more information, contact:Sergio Aguilar-Gaxiola, M.D., Ph.D.Visiting Professor and Director, Center for Reducing Health DisparitiesUniversity of California, Davis Department of Internal Medicine 2921 Stockton Boulevard, Suite 1400 CRISP BuildingSacramento, CA 95817Ph: 916-703-9114 (direct line) Ph: 559-779-1797 (cell)F: 916-703-9124E: [email protected] or [email protected]

Elizabeth SalazarLatino Community Outreach CoordinatorNAMI Montgomery County 10730 Connecticut AvenueKensington, MD 20895Ph: 301-949-5852E: [email protected]

Bill LichtensteinPresident, Lichtenstein Creative MediaOne Broadway; 14th Floor Cambridge, MA 02142Ph: 617-682-3700E: [email protected]

Caroline Clauss-Ehlers, Ph.D.

Freelance Journalist Ph: 212-462-9464E: [email protected]

Cristina Magaña, Ph.D.Clinical PsychologistCalifornia State University, Fresno E: [email protected]


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Questions?

You may submit your question by pressing 01 on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received. On hearing the operator announce your name, you may proceed with your question. After you have asked your question, your line will be muted. The presenters will then have the opportunity to respond.


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Conclusion

Thank you very much for participating in the SAMHSA ADS Center conference call, “Changing Minds and Inspiring Hope: Media Strategies For Reducing Stigma Within Spanish-speaking Communities.”

The Resource Center to Address Discrimination and Stigma (ADS Center) is a project of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.


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Discussion Questions1. How has mental illness been addressed traditionally in our

community?

a. Have we adequately incorporated these traditions in our contemporary treatment delivery mechanism?

b. If so, what successes have we experienced?

c. If not, why not? How should we begin?

2. What are the social codes within the community we work that may assist or hinder stigma reduction efforts related to mental illness?


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Discussion Questions3. Do generational and/or gender differences affect the delivering and

receiving of services for a mental health conditions in the community we serve?

4. What are 2-3 key messages that non-Hispanic service providers should hear in order to combat stigma and provide effective treatment/support?

Please feel free to use these questions as the basis for your own group discussion about the issues addressed by today’s discussion.


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ResourcesBooks & Articles:

Aguilar-Gaxiola, S.A., et al. (2002). “Translating research into action: Reducing disparities in mental health care for Mexican Americans.” Psychiatric Services, 53(12): 1563-1568.

Clauss-Ehlers, C.S., Ed. (in preparation). Encyclopedia of cross-cultural school psychology. New York: Springer.

Clauss-Ehlers, C.S., & M.D. Weist, Eds. (2004). Community planning to foster resilience in children. New York, NY: Kluwer Academic Publishers.

Vega, W.A., et al. (1999). “Gaps in service utilization by Mexican Americans with mental health problems.” American Journal of Psychiatry, 156(6): 928-934.

The views expressed within these resources do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.


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ResourcesOn the Internet:

•NAMI Montgomery County (En Español) —http://www.namimc.org/namiespanol.html

•SAMHSA Elimination of Barriers Initiative (EBI, En Español) —http://www.nuestrasaludmental.samhsa.gov/

•Lichtenstein Creative Media — http://www.lcmedia.com

•Univision Communications, Inc. — http://www.univision.net

The views expressed within these resources do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

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SurveyThank you very much for participating in the ADS Center teleconference “Changing Minds and Inspiring Hope: Media Strategies For Reducing Stigma Within Spanish- speaking Communities.”

We value your suggestions. Within 24 hours of this teleconference, you will receive an e- mail request to participate in a short, anonymous, online survey about today’s training material. Survey results will be used to determine what resources and topic areas need to be addressed by future training events. The survey will take approximately 5 minutes to complete.

Survey participation requests will be sent to all registered event participants who provided e-mail addresses at the time of their registration. Each request message will contain a web link to our survey tool. Please call 1-800-540-0320 if you have any difficulties filling out the survey online. Thank you for your feedback and cooperation.

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