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Summary of Advance Care Planning Community Education 2014 – 2019

My Care, My Plan Steering Committee

  • 2019: 12 events, reaching 305 people
  • 2018: 18 events, reaching 471 people
  • 2017: 9 events, reaching 276 people
  • 2016: 9 events, reaching 520 people
  • 2015: 21 events, reaching 577 people
  • 2014: 5 events, reaching 78 people

Total for 2014 – 2019: 74 events, reaching 2,227 people


  • January 15: Quarterly presentation/workshop, Santa Rosa, at Partnership Health Plan site. 37 attendees.
  • February 4: Sequoia Gardens mobile home park, Santa Rosa, workshop. 11 attendees.
  • February 19: Sutter Cancer Support Services, Santa Rosa, presentation/workshop. 8 attendees.
  • February 26: CCCC and Partnership Healthplan meeting in Fairfield—mid-grant check-in for new community coalitions. MCMP co-chair Taylor McCandless presented PPT update on MCMP.
  • March 6: Leisure Lake mobile home park, Petaluma, workshop. 22 attendees.
  • March 7: Sonoma Oncology Nurses Association, Santa Rosa, workshop. 25 attendees.
  • April 16: Quarterly presentation/workshop, Santa Rosa, at Partnership Health Plan site. 37 attendees.
  • April 18: Vintage House, Sonoma, afternoon and evening workshops. 20 attendees.
  • June 7: Burbank Heights, Sebastopol, presentation/workshop. 30 attendees.
  • June 27: Press DemocratClose to Home article written by Taylor McCandless, MCMP Co-Chair, “When Parents and Kids Become 'Legal Strangers.'”
  • July 16: Quarterly presentation/workshop, Santa Rosa, Sonoma County Health Services Dept. site (new time: 5:30 – 7:30 pm). 25 attendees.
  • July 18: Sonoma Speciality Hospital, Sebastopol, presentation/workshop. [no data on attendees]
  • August 12: CCCC and Partnership Healthplan meeting in Fairfield—final meeting for new community coalitions. MCMP Steering Committee member Juliana Balistreri presented PPT update on MCMP.
  • October 17: Osher Lifelong Learning Institute/Sonoma State (class on advance care planning), Rohnert Park, presentation/workshop. 90 attendees.
  • October 17: Tabling at Weill Hall "Re-imagine End-of-Life" (Theater of War) event, Rohnert Park.
  • October 29: Quarterly presentation/workshop—cancelled due to Sonoma County evacuations and fires.

Total for 2019:  12 events, reaching 305 people


  • January 16: Quarterly presentation/workshop, Santa Rosa, at Redwood Credit Union site. 47 attendees.
  • March 1: Oakmont community, Santa Rosa, presentation/workshop. 53 attendees.
  • April 8: Press Democrat Close to Home article written by Dorothy Foster, MCMP Co-Chair, “Alzheimer’s is No.3: Are you ready?”
  • April 11: Hospice of Petaluma, Petaluma, presentation/workshop. 30 attendees.
  • April 13: Vintage House, Sonoma. MCMP-sponsored event in conjunction with Sonoma Valley Hospital, Hospice by the Bay, Vintage House, Elder Resource Alliance and Sonoma Valley Community Health Center. Presentation by Steven Pantilat MD, Professor of Medicine in the Department of Medicine at UCSF and Hellman Distinguished Professor in Palliative Care and the founding Director of the UCSF Palliative Care Program. “Living Well with Serious Illness.” 75 attendees.
  • April 13: Vintage House, Sonoma, afternoon and evening ACP events as follow up to Dr. Pantilat’s presentation. 18 attendees.
  • April 18: Memorial Hospice, Santa Rosa, presentation/workshop. 42 attendees.
  • April 17: Quarterly presentation/workshop, Santa Rosa, at Partnership Health Plan site. 43 attendees.
  • April 25: King’s Valley Apartments, Cloverdale, workshop. 6 attendees.
  • May 22:  CCCC and Partnership Healthplan "Kick-Off" meeting in Fairfield for new community coalitions. MCMP co-chair Taylor McCandless presented PPT overview of MCMP's history per invitation as a "mature" coalition.
  • July 12: Sebastopol Senior Center, Sebastopol, presentation/workshop. 27 attendees.
  • July 17: Quarterly presentation/workshop, Santa Rosa, at Redwood Credit Union site. 37 attendees.
  • July 31: Meeting/presentation to Executive Director of Sonoma County Medical Association regarding potential collaboration/sponsorship.
  • August 21: Vigil Light Senior Housing, Santa Rosa, workshop. 17 attendees.
  • September 15: Veterans group presentation, Santa Rosa. 8 attendees.
  • September 20: Cloverdale Senior Center workshop. 6 attendees.
  • October 18: Quarterly presentation/workshop, Santa Rosa, at Redwood Credit Union site. 35 attendees
  • November 13: Vinecrest Senior Apartments, Windsor, workshop. 5 attendees.
  • November 14: Sonoma West Medical Center, Sebastopol, presentation/workshop. 20 attendees.
  • December 4: Bell Manor Senior Apartments, Windsor, workshop. 2 attendees.


Total for 2018: 18 events, reaching 471 people


  • January: KZST Radio live interview with Gary Johanson, MD, about the need for quality ACP.
  • January 22: Church of the Roses, Santa Rosa, workshop. 40 attendees.
  • January 24: First quarterly presentation (Sonoma County HSD, Adult and Aging conference room), Santa Rosa. 16 attendees.
  • January 31: Spring Lake Village retirement community, Santa Rosa, workshop. 20 attendees. 
  • February 14: MCMP 3rd Strategic Planning session. Priorities identified: Expand efforts to engage and support physicians in provided ACP education to patients; establish a speakers bureau to expand MCMP’s capacity to conduct more community education on ACP; build public awareness of the need for ACP and the resources that are available to help individuals and providers.
  • March 14: CCCC Individual Leader Award awarded to Susan Keller, MCMP Steering Committee member and Founder of the Journey Project—A Community Network Project.
  • March 14: CCCC Organization Award to West County Health Center for their collaboration with CCCC and MCMP performing outreach and education to underserved, low income adults.
  • April: KRCB ran MCMP’s three videos for one week in advance of National Health Care Decision Day.
  • April: E-mail blasts about National Healthcare Decisions Day to community partners.
  • April 17: KSRO live interview with MCMP co-chair Taylor McCandless during morning drive time.
  • April 18: Quarterly presentation (Adult and Aging Carnelian Room), Santa Rosa. 43 attendees.
  • April 20: Vintage House, Sonoma, "Who Will Speak for You When You Can’t Speak for Yourself?" Presentation sponsored by Sonoma Valley Hospital. 50 attendees.
  • April 20: Vintage House, Sonoma, workshop. 10 attendees.
  • April 25: Quarterly presentation (Sonoma County HSD, Adult and Aging conference room), Santa Rosa. 52 attendees.
  • June 15: Press Democrat Close to Home article written by Dorothy Foster, Steering Committee co-chair, “Why it’s important to have that talk about death and dying."
  • June 27: KRCB interview on advance care planning with MCMP co-chairs McCandless and Foster.
  • July 11: Quarterly presentation (Sonoma County HSD, Adult and Aging conference room), Santa Rosa. 33 attendees.
  • August 11: Oakmont Gardens Senior Living, Santa Rosa, presentation/workshop; 12 attendees.
  • October 17: Quarterly presentation cancelled due to Sonoma County fires

Total for 2017: 9 events, reaching 276 people


  • January: MCMP gave presentations to 75 community members 
    Distributed the three MCMP videos to 25 CHI members and partners, including several physician leaders who identified potential uses, such as playing the videos in waiting rooms, incorporating into staff training, and other ways. 
  • March and April: MCMP partnered with West County Health Centers, the Sebastopol Senior Center, and the Rialto Theater to conduct screening and discussion of the “Being Mortal” documentary. More than 100 people attended
  • April 14: Vintage House, Sonoma, "Planning Ahead—It Always Seems to Early, Until It’s Too Late." Panel discussion with Robert Cohen MD, CMO, Sonoma Valley Hospital, Taylor McCandless MSW, and “Chip” Allen, MSW. More than 40 people attended
  • KRCB Radio aired an interview with Steering Committee Chair Jane Eckels on the importance of ACP (aired in the week leading up to National Health Care Decision Day).
    KRCB TV aired the three MCMP videos multiple times the week before National Health Care Decision Day
  • April 16: Press Democrat Close to Home article written by Jane Eckels, Steering Committee chair, on the importance of ACP.
  • May: Gary Johanson MD, member of MCMP Steering Committee, received the 2016 Compassionate Care Leader Award at the CCCC's annual Palliative Care Conference in Newport Beach
  • July: MCMP received an Aging Achievement Award at the National Association of Area Agency on Aging’s (n4a”s) annual conference in San Diego. While attending, Diane Kaljian, Sonoma County Adult and Aging Services and Area Agency on Aging (AAA) Director and CHI board member and Jenay Cottrell, analyst with Adult and Aging, gave a presentation on how AAAs can provide support and staffing to ACP community initiatives.
  • Presentation to CHI by Luke Entrup, Director of Programs and Innovation for West County Health Centers, on how WCHC has integrated ACP conversations into its daily workflow with patients based on the MCMP/Community Foundation Grant awarded in May 2015. Stats include: Training of 97 facilitators from 15 local health and human services agencies, who in turn provided education to 289 residents. WCHC conducted 245 individual conversations with patients about ACP. 
  • St Joseph Community Benefit program translated MCMP’s PowerPoint ACP presentation into Spanish. The program incorporated a segment on ACP into its ongoing “Your Heart, Your Life Curriculum.”
  • July: Presentations at sites including Sonoma County Section on Aging, Varenna at Fountaingrove (Santa Rosa retirement community), Seven Flags Mobile Home Park in Sonoma. Over 200 people reached.
  • July: The Sitting Room, Penngrove, presentation—10 attendees
  • July: Vintage House Senior Center, Sonoma, panel discussion (in conjunction with Sonoma Valley Hospital)—20 attendees
  • MCMP partnered with Cinnabar Theater in Petaluma to conduct a panel discussion on ACP following a matinee performance of “The Quality of Life,” an award-winning play about timely social issues and difficult personal decisions affecting end of life—75 attendees
  • Members of MCMP Steering Committee met with Mary Maddux Gonzales, MD, to explore ways MCMP could collaborate with the Sonoma County Medical Association to work with and support physicians in advancing greater integration of ACP into their practices and health systems.
  • Sonoma County Behavioral Health Division presentations
    Presentation to Sonoma County Medical Association Board of Directors on MCMP’s work to better engage and support physicians in furthering their efforts to have ACP conversations with their patients. 
  • September: Leadership Transition—Jane Eckels, MCMP Steering Committee chair since 2014 announced her departure. Dorothy Foster, LMFT, psychotherapist in private practice and Taylor McCandless, MSW, with Sonoma Valley Hospital’s Healing at Home program begin as co-chairs in October. 
    Decision made to offer quarterly community presentations/workshops beginning in January 2017. Promotional efforts made to the community as well as physicians to encourage referal of patients to these free sessions. Promotional flyers developed and distributed to liaisons identified by CHI members. Liaisons charged with ensuring that promotional flyers for MCMP quarterly sessions are available to clinic and hospital patients.


Total for 2016: 9 events, reaching 520 people


  • January 6: Petaluma People Services Center, Petaluma, presentation; 10 attendees
  • KRCB video shoot for sharing of community/provider ACP stories
  • Core Faculty developed a "workshop" curriculum to assist community members in understanding and completing AHCDs.
  • February 5: Sebastopol Senior Center, Sebastopol, presentation; 6 attendees
  • February 13: Sebastopol Senior Center, Sebastopol, workshop; 9 attendees
  • February 19: HSD Care Management presentation to staff social workers; 8 attendees
  • February 24: Vintage House, Sonoma, presentation; 4 attendees
  • March 3: Vintage House, Sonoma, presentation/workshop; 3 attendees
  • March 12: Petaluma Community Center, Petaluma, presentation; 6 attendees
  • March 14: Petaluma Community Center, Petaluma, workshop; 8 attendees
  • April 8: Hospice of Petaluma, Petaluma, presentation; 33 attendees
  • April 14: Village Network, Petaluma, presentation; 15 attendees
  • April 15: Memorial Hospice, Santa Rosa, presentation; 22 attendees
  • April 20: Vintage House, Sonoma, presentation; 8 attendees
  • April 21: Village Network, Petaluma, presentation/workshop; 14 attendees
  • May 2: Parkinson’s Disease Support Group, Santa Rosa, presentation; 23 attendees
  • Grant from Community Foundation of Sonoma County enabled MCMP to partner with West County Health Centers and St Joseph Health Community Benefits Promotores de Salud to bring ACP education to underserved, low-income adults, including in the Latino community. As part of the grant, CCCC customized training sessions for members of both organizations and provided consultation to those organizations to assist them in incorporating ACP and palliative care education into their work with patients and clients. Both West County and St Joseph continued their work into the first half of 2016
  • June 10: Petaluma Senior Center, Petaluma, presentation; 5 attendees
  • June 25: Cloverdale Senior Center, Cloverdale, presentation; 3 attendees
  • July 8: Oakmont community, Santa Rosa, presentation; 48 attendees
  • July 15: Oakmont community, Santa Rosa, workshop; 35 attendees
  • July 16: California Health Care Foundation grant of $2,000--to be used for Public Screening of the PBS Frontline documentary "Being Mortal" (on Atul Gawande’s book), followed by ACP workshops
  • “Being Mortal” screenings in Sonoma at Vintage House and the Sebastiani Theatre attracted nearly 200 people.
  • Another 75 people attended two follow-up workshops in Sonoma in late September and early October on how to complete an AHCD.
  • September 17: Russian River Senior Center Guerneville; 10 attendees
  • September 24: Vintage House Sonoma presentation; 32 attendees
  • Sonoma Medicine Magazine, Fall 2015 issue: "Getting Advance Care Planning Right” by Gary Johanson MD
  • November: Three short MCMP videos produced and aired by KRCB television station—videos available for MCMP ongoing education and shown on MCMP website
  • MCMP Strategic Planning sessions (2)


Total for 2015: 21 events, reaching 577 people


  • Committee On Healthcare Improvement (CHI) charters as its first initiative, the "Advance Care Planning Community Initiative"
  • Advance Care Planning (ACP) Community Initiative first meeting conducted with Judy Thomas, Executive Director Coalition for Compassionate Care of California (CCCC) and Lori Houston, Department of Health Services—31 community members in attendance
  • ACP Community Initiative Steering Committee formed, composed of health professionals from private, public, and nonprofit sectors of the community, with County backbone support from: Jenay Cottrell, Program Planning & Evaluation Analyst, Sonoma County Human Services Department (HSD), Adult and Aging Services Division; and Lori Houston, Program Planning & Evaluation Analyst, Health Policy, Planning, and Evaluation Unit, Sonoma County Department of Health Services (DHS). First Steering Committee meeting held in March.
  • April 30-May 1: Compassionate Care of California (CCCC) facilitator training in Sacramento, attended by County staff and Steering Committee members.
  • Core Faculty identified
  • Core Faculty meetings with local health care physicians/providers held in July, August, and November to develop a presentation format adapting materials from the CCCC
  • Presentation to the Steering Committee by Jenay Cotrell, HSD, providing results of survey conducted by Judy Erickson, Program Planning & Evaluation Analyst, HSD: "Advance Care Planning Coalitions, Sustainable Model Summary."
  • California Healthcare Foundation Grant received ($20,000): One of five coalitions in California receiving grant funding. Administered and facilitated by CCCC. Grant to be used for general outreach as well as events with the Petaluma ACP Collaborative. Also, development of a website and several short videos with Sonoma County residents and providers sharing their stories about the need for ACP. Grant funding has also engaged the Community Network Journey Project to inform the Steering Committee on ways to work with the local faith community. Also as part of this grant, members of the Initiative will participate in a webinar conducted by the Journey Project on ways to bring ACP education to the Latino population.
  • Community Foundation Grant received ($35,000): to assist the Initiative in bringing ACP and palliative care education to low-income adults through December 2015. Goal is to reach at least 200 people with ACP and palliative care education and to increase the number of completed Advance Health Care Directives (AHCD)
  • October 2: Human Services Department (HSD) pilot presentations to staff of the Adult and Aging Division and Family Youth and Children’s Services; 2 presentations with 30 total attendees
  • October 19: "Whose Life is it Anyway?" Presentation at Shi Shalom/First Congregational Church Sonoma; 21 attendees
  • ACP Community Initiative named: My Care, My Plan: Speak Up Sonoma County (MCMP). MCMP logo developed
  • MCMP website launched—
  • October 23: Presentation to St Joseph Health Community Benefit staff; 21 attendees
  • Conversations with Petaluma Health Center, Petaluma Valley Hospital, Petaluma Healthcare District, Village Network of Petaluma and other Petaluma area organizations about developing presentations and workshop, train-the-trainer events. Goal is to establish a model in Petaluma that could be replicated elsewhere within the county (Health Action Charter Group locations). The model is called Petaluma ACP Collaborative.
  • November 19: Bethlehem Towers, Santa Rosa, presentation; 6 attendees


Total for 2014: 5 events, reaching 78 people