USAID Zika Communication and Community Engagement Workshop

Panama City, PanamaNoevmber 16-18, 2016

Contents

List of Acyonyms ................................................................................................................. 3Workshop Overview ........................................................................................................ 4Day 1: Introduction/Taking stock of where we are - situational analysis .......................................... 4

Epidemiological Status .................................................................................................................................................. 4Social Science Update .................................................................................................................................................. 5Ministry of Health Panel .............................................................................................................................................. 6Group Activity .................................................................................................................................................................. 7

Day 2: Strategic Communication Framework - how to systematically plan or refine a communication response ....................................................................................................................... 8

Day 3: Implementation of community level risk communication activities ...................................9Overall Takeaways .......................................................................................................................................................... 10

Appendices: ........................................................................................................................... 11Registered Participants ................................................................................................................................................. 12Meeting Agenda .............................................................................................................................................................. 13

Presentation files are available on USAID’s Knowledge Management tool or at http://tiny.cc/ZikaMeetingNov16

Note on Presentation Files

ContactsFor questions on the workshop and USAID’s SBCC Efforts around Zika —

Arianna Serino: aserino@usaid.govFor questions about this report or access to materials —

Julie Gerdes: jgerdes@usaid.govFor general inquiries about USAID’s overall Zika response —

USAID’s Zika team: zika@usaid.gov

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List of Acyonyms

ASSIST: Applying Science to Strengthen and Improve Systems ProjectCDC: U.S. Centers for Disease Control and PreventionCOMISCA: The Council of Ministers of Health of Central AmericaHC3: Health Communication Capacity CollaborativeIFRC: International Federation of the Red Cross and Red Crescent SocietiesMCDI: Medical Care Development InternationalMOH: Ministry of HealthPAHO: Pan American Health OrganizationPASMO: Pan American Social Marketing OrganizationPSI: Population Services InternationalUNICEF: United National International Children’s Emergency FundUSAID: United States Agency for International Development WHO: World Health Organization

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Workshop Overview

On November 16-18, 2016, the United States Agency for International Development (USAID), with support from the International Federation of the Red Cross (IFRC) and technical collaboration of the United Nations International Children’s Emergency Fund (UNICEF), hosted a Zika Communications and Community Engagement Workshop. This document summarizes key takeaways from the workshop, which featured participation by stakeholders from USAID’s focus countries, including Ministries of Health, communications experts, PSI, CDC, PAHO, ASSIST, MCSP, COMISCA, and USAID’s community engagement grantees (see Appendix A for full participant list). The workshop was held in Panama City, a strategic location for stakeholders in Central America, northern South America, and the Caribbean. The organizations worked together over three days to take stock of key messages and behaviors being promoted in the Zika response, to develop strategic communication action and implementation plans, and to discuss the benefits, challenges, and best practices for community mobilization in the international Zika response.

Notably, the workshop concluded with the World Health Organization’s (WHO’s) announcement that the Zika virus was no longer to be considered a Public Health Emergency of International Concern (PHEIC). WHO authorities explained that by removing the term “emergency” from the crisis, programs with a longer-term scope dedicated solely and exclusively to combating the disease could be developed.

The following sections summarize each day of the workshop.

Day 1: Introduction/Taking stock of where we are - situational analysisThe first day of the workshop was devoted to setting the context and providing updates on the outbreak and lessons learned to date. In the spirit of scene-setting, this first morning included many presentations which laid the groundwork for interactive sessions during the afternoon and last two days.

After a brief introduction by Kellie Stewart, USAID’s Regional Zika Coordinator based in Honduras, presentations included the following:

• An overview of Zika epidemiology in the region by CDC’s Alexandre Macedo de Oliveira• A review of social science and operational research, presented by Juliet Bedford of

Anthrologica• Presentations on results from formative research efforts to date, including KAP studies

and focus groups from PSI, CDC, and PAHO• A review of CDC’s mass media campaign in Puerto Rico, presented by Dr. Nick DeLuca• UNICEF’s early lessons learned• PASMO’s research findings, presented by PSI’s Sussy Longo• A showcase of PAHO’s communication work, including their Mosquito Awareness Week,

by Cristina Mana• A Ministry of Health panel moderated by USAID El Salvador’s Eduardo Quevedo.

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Country

Suspected Cases

Confirmed Cases

Congenital Zika Syndrome

El SalvadorGuatemalaHondurasNicaraguaDominican RepublicHaitiColombiaEcuadorPerúVenezuelaParaguayAntigua and BarbudaBarbadosDominicaGranadaGuayana FrancesaJamaicaSaint Kitts and NevisSaint Vicent and the GrenadinesTrinidad and Tobago

113052785

317190

48842955

959292722

05875854639362511503130

64494721560

51466285

20233285

8826806124

224412143079

1006

1221738

643

41510

101

540002000100001

Epidemiological StatusThe CDC reported on trends around the following epidemiological data:

During his presentation of these trends, Alex Macedo (pictured at left) referenced surveillance challenges, including the limited nature of data across the region due

to differential reporting, laboratory practices, and case definitions. He also noted that at the time of the workshop, there was a downward trend in most countries, except for Mexico and some countries in Central America and the Caribbean, acknowledging that future trends are difficult to predict based on the epidemiological data to date.

Social Science UpdateAnthrologica’s Juliet Bedford presented a synthesis of social science and operations research conducted or planned across the region. Among the issues that emerged was the prevailing perception - in most countries - that Zika is similar to other vector born diseases, such as dengue and chikungunya, combined with a low level of understanding of Zika’s unique health impacts (Zike congenital syndrome and GBS) and its sexual transmission pathway. Another key theme was the perception that pregnant women are at greatest risk together with an inability to clearly define the risk, sentiments of anxiety and vulnerability among this group, and the recommendation that responsibility should not fall solely on the woman, but that support and shared responsibility must also come from partner, family and community. Her findings also noted that we must be mindful that Zika poses a familiar challenge - that the people at the greatest risk may also have the least agency to act.

The Pan American Social Marketing Organization (PASMO), part of the PSI network,

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presented findings on their research across Guatemala, Honduras, El Salvador, Nicaragua, and Panama. In February 2016, they conducted a study to understand knowledge, attitudes, and myths circulating around Zika. This study also aimed to validate the design of a Zika prevention kit. Through interviews and focus groups, PASMO found that many thought of Zika as fatal and that most pregnant women received information from health experts like doctors and health centers, or from communications channels. Health providers knew basic symptoms and knew that protocols were being developed, but information about the dissemination and nature of them was not clear.

PASMO’s omnibus survey covered nine countries and included men and women at least 18 years old (except for Nicaraguan participants, where the minimum age was 16). Each household had one interview, and the study included 9,852 interviews, of which about half were female. On average, participants received most of their information from TV, then radio, followed by government officials and posters. Most participants could name a symptom, complication, and form of transmission for Zika. For all findings, there were countries that deviated significantly from the average, leading to a lively discussion on what factors might influence differences among countries in the region.

Ministry of Health PanelAfter organizations gave an overview of understandings and practices in the region, government representatives provided workshop participants with their perspectives as primary stakeholders. The following public servants participated in the panel:

• Guatemala: Vivian Susana Ajcip Perez• Nicaragua: Ligia Aragon• Honduras: Karina Silva• El Salvador: Maria Theresa Escaloa• Haiti: Gislhaine D’Alexis• the Dominican Republic: Gina Duran

The panel answered questions about the challenges around Zika communication efforts, ways to navigate the stakeholder landscape, successes in coordination efforts, strategies for communicating risks of sexual transmission, and the difference in emergent and mainstreaming strategies. Audience members were able to probe into some of the findings that were presented in the morning. For instance, members of the Haiti team

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were asked to explain PASMO’s findings about their population’s high awareness of condom use as a contraceptive and as a Zika prevention measure. Ideas were generated about integrating Zika messages into other health programming. The role of the community, metaphorized as an engine, was also highlighted during the panel.

Group ActivityIn the afternoon, USAID’s Julie Gerdes led a breakout session to develop a list of key behaviors to be prioritized in Zika prevention and response. Participants were grouped to discuss key behaviors for:

• Preventing vertical transmission• Preventing sexual transmission• Preventing vector transmission• Supporting affected families• Minimizing environmental risks

Groups had lively, and even heated, discussions about efficacy versus feasibility, in an effort to prioritize feasible behaviors to promote in Zika messaging. Participants acknowledged that some of the most effective behaviors may be cost prohibitive or might have socio-cultural factors that barred their uptake. For example, while there was agreement that condom use by pregnant couples would be effective, the group noted that it was very difficult to ask a pregnant woman to suggest condom use to her husband, and that doing so might not only be ineffective, it could also initiate unintended conflict between the partners. They also discussed the lines of responsibility for behaviors; for instance, if a behavior involves the use of a commodity, participants questioned who is responsible for procuring and providing the commodity. Amid these conversations, the topic of male engagement emerged as a key theme in successfully enabling and promoting key behaviors.

The following is the list of behaviors that were identified as priorities:Behaviors to avoid sexual transmission:

• Use condoms.• Communicate with your partner.• Acquire services that provide condoms. The individual has to demand them from

the government. It is now both a right and duty. Behaviors to avoid vertical transmission:

• Women before and after being pregnant: pregnancies in partnerships, youth, and women of reproductive age (capacitation and information about the theme, especially for women) to achieve responsible planning. The woman should not be the only one responsible for the pregnancy; it is a shared decision. Do not promote a strategy of fear.

• Protection from the vector: cleaning inside and outside of the home.• Family planning in the partnership

Behaviors to avoid vector transmission: • Cleaning inside and outside of the home, use of pesticides to destroy larvae.• Avoid mosquito bites: repellent, nets, clothes. • Shared responsibility (of individuals and the state) to avoid the spread and to

incentivize education and prevention.

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Behaviors for Supporting Affected Families:• Assist with control from prenatal care until the first trimester. • Identify signals of alarm: Zika• Seek information from reliable sources. • Follow prenatal guidelines. • Go wherever you are referred during gestation: exams, pass to the second level.• Don’t self-medicate.• Use a condom to prevent transmission. • Belong to a medical institution.• Fathers and mothers seek appropriate and early attention for the child• Father and mother treat the child like a child and include the child as a member

of the family. • Present quality services in an equal and integrated manner; it is vital for people

to inform themselves about Zika, the consequences, and how to support affected families so that they don’t discriminate against the child.

• Provide an appropriate prenatal control. Behaviors related to environmental risks

• Administer secure water storage at all levels.• Eliminate standing water.

Day 2: Strategic Communication Framework - how to systematically plan or refine a communication response

The second day began with a list of the “top ten” takeaways from Day 1. The participants could all agree that the number 1 takeaway was the important role played by communities to mount an effective response, as articulated by one of the MOH panelists from Day 1, “Communities are the Engine” and “Planning used to be done at the office and now we develop our plans in the community”:

The rest of the second day was led by JHUCCP’s Health Communication Capacity Collaborative (HC3), USAID’s flagship project in social and behavior change communication. Gabrielle Hunter and Alice Payne Merritt led a presentation on an effort between HC3 and UNICEF on mapping Zika communication activities in four countries: Guatemala, El Salvador, Honduras, and the Dominican Republic. Results of this work found that the major focus of messages has been on transmission, prevention, symptoms,

Top Ten Takeaways from Day 110. Listening: Strengthen Surveillance

• Knowledge of Zika is Limited• “Zika is not a priority”

9. Focus• People at greatest risk are those with the

least agency to act8. Not all behaviors are equal

• Some behaviors are more widely accepted

7. Integrated Communication• Integrated communications works

6. Look beyond information dissemination• Priority Motivation: Healthy Baby

5. Gender is important• It’s not just about women

4. Coordination• Coordination since Ebola – partners,

information, implementation3. Media

• “Love/hate” relationship” with media 2. Focus on priority behaviors1. The Community is at the Heart of the Zika

Response• “Community Participation is the Engine”• “Planning used to be done at the office;

now we develop plans in the community!”

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and signals. Consequences of Zika were of medium focus, and stigma, psychosocial care and support for affected families, and advocacy were noted least often. The focus on family planning and what to do about suspected cases varied by country. The landscape also revealed that most communication materials addressed the general public, pregnant women, women of reproductive age, and that few materials specifically addressed the needs of health teams, journalists and families of affected children.

This presentation laid the groundwork for HC3’s workshop on the Strategic Communications Framework for Zika, which was introduced as a “roadmap” for adapting to local contexts. Participants received copies of the draft framework (see Appendix 3), which presents the socio-ecological framework of communication, differentiating four levels of intervention: individual; family, partnerships, and home; community; and social and structural. It also incorporates the extended parallel processing model, which provides a matrix for assessing efficacy and threat in order to develop a strategic response. After the tool’s introduction, HC3 facilitated country-specific group activities aimed at practicing adaptation of the tool for the country context. Each country group then presented a fictional scenario that involved developing strategies for specific in-country audiences and purposes.

During this activity, many groups focused on males as their central audience, which pointed to a perceived need to more deeply engage with this audience moving forward in the Zika response. The practice of both host country governments and implementing partners in thinking through male engagement was a sign that traction in this area is growing.

Other activities involved examining monitoring and evaluation approach to Zika communications as well as reviewing best practices in the development and validation of materials and messages. Participants discussed how to gauge quality, what aspects and metrics should be priorities, and who to engage in decisions about quality. Some conclusions were:

• SBCC materials should be clear and easy to understand by all members of the community;

• Materials should be focused and not overly cluttered;• Materials that conveyed an emotional benefit tended to be more effective;• Materials should be constantly revisited to consider new evidence;• Materials should communicate through visuals and not be overly text-dependent;• Materials should include a “Call to Action”

By the end of the day, participants had developed structured action plans for moving forward to operationalize country-specific Zika communication strategies. The positive momentum generated at the country level is expected to move countries forward in their Zika communication planning. In post-meeting evaluations, Day 2 activities received excellent feedback.

Day 3: Implementation of community level risk communication activitiesThe focus of the third day was community engagement and mobilization in the Zika response. At the time of the meeting, USAID’s community health implementing partners had begun workplanning, and the timing of the regional workshop allowed partners to share their approaches to address Zika at the community level as implementation began.

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The day started with an overview of USAID’s vision of community engagement, presented by Arianna Serino. Then, community partners were invited to present their projects, which include the following geographical scopes:

• Global Communities: Honduras• Save the Children: Colombia, Honduras, Dominican Republic, El Salvador,

Nicaragua• SSI: Nicaragua• MCDI: El Salvador and Guatemala• CARE: Ecuador and Peru• IFRC: Eastern and Southern Caribbean

These projects will implement community level campaigns to raise awareness, and will work through community leaders and institutions such as schools and churches to communicate Zika prevention behaviors to at-risk communities.

After these presentations, the morning concluded with a group activity led by USAID Dominican Republic’s Zika Coordinator, Elizabeth Conklin. During this activity, participants developed a set of best practices for implementing community engagement activities.

In the afternoon, K4Health’s Anne Ballard presented the Zika Communication Network (ZCN), and mPowering’s Alex Kellerstrass presented the ORB platform. These are knowledge sharing platforms used to share resources and materials accessible to anyone engaged in Zika response efforts. The ZCN is broad in nature and stores resources in English, Spanish, French, and Brazilian Portuguese. ORB offers mobile-optimized resources for frontline health workers

During registration on Day 1, participating organizations were asked to drop off copies of print materials that they had developed for the Zika response. At the end of Day 3, participants gathered in country-specific groups to complete an activity in which they reviewed materials based on use, design, and content. Groups then presented the preferred materials and the rationale for their selection, keeping in mind the “7 C’s of Effective Communication” quality criteria presented by HC3 on Day 2:

1. Capture the attention.2. Clarify the message.3. Communicate the benefit. 4. Consistency in broadcasting (repetition).5. Capture the heart and the mind.6. Create confidence.7. Call to action.

Overall TakeawaysThe final workshop evaluation showed that participants found it to be highly successful, with 100% of participants reporting that it was useful for their work. 96% found the workshop informative, and 93% found it engaging. All participants voted in favor of a future USAID Zika workshop.

Throughout the meeting, several themes emerged across both research and programming.

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Key research takeaways:• There still seems to be a lack of basic information around Zika. There are especially

low knowledge levels of microcephaly, sexual transmission, and the use of con-doms for protection.

• There is a sense of complacency in positioning Zika alongside other diseases like dengue/chikungunya.

• There is a need for strengthening psychosocial support.• There is a need to strengthen the of women’s support networks.• Research findings need to be disseminated at all levels. Stakeholders need to be

able to use data to inform programming and operationalize findings.

Key programmatic takeaways: • The community is the engine of change. Response planning should happen at this

level.• There is a need for more consistent messaging and quality in materials.• Country-level stakeholders in the Zika response should continue working together

and collaborating to prepare next steps in addressing gaps in each country’s response.

Overall, this meeting built momentum, as evidenced in part by the specific activities and meetings that were planned by each country to follow the workshop. It was perhaps timely that the workshop concluded with the announcement Zika was no longer considered an emergency, so that efforts in communication and behavior change could be re-framed from an emergency context to providing a continuing and sustained response effort.

Appendices*:1. List of Registered Participants2. Agenda

*Note: presentation files are available on USAID’s Knowledge Management tool or at http://tiny.cc/ZikaMeetingNov16

Appendix

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Alex KellerstrassAlex MacedoAlice Payne MerrittAlvaro SerranoAna Cecilia Fajardo Andrew GallAnibal VelasquezAnne BallardAnton SchneiderArianna SerinoArturo SánchezBerta AlvarezCarla SanchezCarlos Mancilla Carlos RodriguezCarlos SaenzCarmen CarrascoCarol RaoCarolina BreaCatalina VargasCecilia VillamanClaudia SamoyoaClelia Valverde Cristina ManaDagoberto RiveraDavid SimonDawn Byngh Denitza AndjelicDiani CabreraEduardo GularteEduardo QuevedoElizabeth ConklinEric BaranickErin Law

Eugenia MonterrosoFernando SolizGabrielle Hunter Garren LumpkinGina DuranGiovanna Núñez Gislhaine D’AlexisGladis Eneida Godínez Fuent-

es de SolizGuadalupe RazeghiGustavo AvilaHarold SuazoItza Baharona de MoscaJaime ChangJean Frantz LemoineJean Max Lelio-JosephJorge HermidaJosé Carlos QuiñonezJose David Lainez Jose Ivan FuentesJose Ruben GomezJulie GerdesJuliet BedfordKaren CordobaKaren PanameñoKarina SilvaKellie StewartKetan ChitnisLaura Chanchien ParajonLaura McCartyLigia AragonLigia CarmonaLisa NoguchiMaria (Itania) Charla

María GarcíaMaria Teresa Escalona TerronMariela Rodriguez Marisancha ThomasMatt Porter Melida ChaguacedaMjrko RennolaMonica PosadaNairoby RivasNancy PadillaNestór Sosa Nick DeLuciaNicole West-HaylesNorbert De AndaPablo AguilarPaule-Andree ByronPerla Alvarado ReyesSara FranklySean MaloneySebastian MillardSergio Fererra FebrelSilvia BarreraStaci MacCorkleSussy Lungo Suyapa Pavon Tife AdetunjiVictor Almonte DiazVirgilio JoyaVirginia BaffigoVivian Salomon Vivian Susana Ajcip

Pérez

Registered Participants

1

Appendix

13

2

Meeting Agenda

USAID Zika Communication and Community Engagement Workshop Nov 16-18, 2016. Intercontinental Miramar, Panama City

Final Agenda

Day 1: Context Wednesday, November 16

Time Session Speaker

8:30 - 9:15 8:30 - 8:55 8:55 - 9:00 9:00 - 9:15

Opening Session Moderator: Welcome: USAID Welcome: IFRC Welcome: UNICEF

Kellie Stewart Kellie Stewart Erika Diaz Carlos Mancilla

9:15 - 10:15 9:15 - 9:30 9:30 - 9:45 9:45 - 10:10 10:10 - 10:15

Setting the Context: Regional Updates Moderator: USAID Zika Response Regional Zika Epidemiological Overview Regional Social Science and Operational Research Overview Question and Answer

Kellie Stewart Kellie Stewart Alex Macedo Juliet Bedford

10:15 - 10:30 COFFEE BREAK

10:30 - 11:30 10:30 - 10:50 10:50 - 11:10 11:10 - 11:30

Evidence: Formative Research Moderator: PSI: Results of Qualitative and Quantitative Studies on Zika in

Central America, Dominican Republic and Haiti CDC: Formative Research for the Response in Puerto Rico PAHO: Knowledge, Attitudes, and Practices (KAP) Studies

Gustavo Avila Sussy Lungo Nick DeLuca Cristina Mana

11:30 - 1:00 LUNCH: Salon Bahia

1:00 - 1:50 1:00 - 1:20 1:20 - 1:40 1:40 - 1:50

Evidence: Experiences in Communication Programming Moderator: CDC: Zika Campaign Activities in Puerto Rico: Best Practices and

Insights Gained UNICEF: Risk Communication & Community Engagement: Initial

Lessons Learned PAHO: From Emergency Communication to Programmatic

Communication

Vivian Salomon Nick DeLuca Giovanna Nuñez/ Jose Lainez Cristina Mana

1:50 - 3:00

Moderated panel: Country Experiences Moderator: Eduardo Quevedo Ministries of Health

3:00 - 3:15 Introduction to Small Group Activity: Key Behaviors for Prevention and Care

Julie Gerdes

3:15 - 3:30 COFFEE BREAK

3:30 - 4:45 4:45 - 5:15

Small Group Activity: Key Behaviors for Prevention and Care Small Group Activity Report-Out

10 small groups Julie Gerdes

5:15 - 5:30 Day Summary and Wrap-Up Kellie Stewart

USAID Zika Communication and Community Engagement Workshop

Nov 16-18, 2016. Intercontinental Miramar, Panama City Final Agenda

Day 2: Planning Thursday, November 17

Time Session Speaker

8:30 - 9:15 8:30 - 8:45 8:45 - 9:00 9:00 - 9:15

Introduction Moderator: Recap Day 1 PAHO: Designing National Risk Communication Strategies -

Experiences COMISCA: Action Plan for Zika Prevention and Control in

Central America and the Dominican Republic

Anton Schneider Anton Schneider Cristina Mana Ligia Carmona

9:15 - 9:45 Mapping Zika Communication Activities Gabrielle Hunter

9:45 - 10:30

Overview of Strategic Communication for Prevention: A Framework for Local Adaptation

Alice Payne Merritt

10:30 - 10:45 COFFEE BREAK

10:45 - 12:45 Small Group Activity and Report-Out: Strategic Design and Audience Segmentation

8 small groups Alice Payne Merritt

12:45 - 2:00 LUNCH: Salon Bahia

2:00 - 3:00 Best Practices: Developing and Testing Materials and Messages (with “buzz group” discussion)

Alice Payne Merritt Gabrielle Hunter

3:00 - 4:00 Monitoring Communication Activities Small Group Activity and Report-Out

Alice Payne Merritt 8 small groups

4:00 - 4:15 COFFEE BREAK

4:15 - 5:15 Coordinated Communication Activities: Strategic Implementation Planning Small Group Activity and Report-Out

Gabrielle Hunter 8 small groups

5:15 - 5:30 Day Summary and Wrap-Up Anton Schneider

6:30 - 8:00 EVENING SOCIAL: Salon Bahia Light refreshments with cash bar

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USAID Zika Communication and Community Engagement Workshop

Nov 16-18, 2016. Intercontinental Miramar, Panama City Final Agenda

Day 3: Community Engagement Friday, November 18

Time Session Speaker

8:30 - 10:40 8:30 - 8:45 8:45 - 9:00 9:00 - 10:10 10:10 - 10:30

Community Engagement for Zika Moderator: Introduction to Community Engagement in the Zika Response Coordination for Community Engagement Community Engagement Partner Presentations Questions and Answer

Arianna Serino Arianna Serino Carlos Mancilla Partners

10:30 - 10:40 Introduction to Small Group Activity: Community Engagement Methods and Strategies

Elizabeth Conklin

10:40 - 11:00 COFFEE BREAK

11:00 - 12:30 Small Group Activity: Community Engagement Methods and Strategies

4 small groups

12:30- 1:30 LUNCH: Salon Bahia

1:30 - 2:30 Small Group Activity Report-Out: Community Engagement Methods and Strategies

Elizabeth Conklin

2:30 - 3:00 2:30 - 2:40 2:40 - 2:50

Knowledge Sharing Moderator: K4Health: Zika Communication Network mPowering: ORB Platform

Arianna Serino Anne Ballard Alex Kellerstrass

2:50 - 3:00 Introduction to Small Group Activity: Gaps in Implementation and Capacity Development Tools

Arianna Serino

3:00 - 3:15 COFFEE BREAK

3:15 - 4:15 4:15 - 4:45

Small Group Activity: Gaps in Implementation Tools and Materials Small Group Activity Report-Out

4 small groups Arianna Serino

4:45 - 5:00 Workshop Wrap-Up Kellie Stewart/ Arianna Serino

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