how was the data collected analyzed: Multiple approaches to data analysis were used in this study. In-depth interviews were analyzed using the framework method (32). The framework method is a systematic and iterative approach to analyzing qualitative data in teams for research that aims to describe and explain a phenomenon. It is within the family of thematic analysis and includes several structured steps to carry out the analysis. For this project, the specific steps used are detailed. First, the audio files were transcribed and reviewed for accuracy. Researchers read through the transcripts to become familiar with them and created notes and memos to record impressions of the data. Codes were developed inductively through transcript reviews; two of the authors reviewed two transcripts each and drafted a codebook with definitions of codes and examples. Four researchers (two Ph-D prepared, one doctoral student in social work, and one medical student) completed line-by-line coding of three transcripts. Following this coding exercise, the team met and discussed the meanings of codes and any gaps in the current codebook. Once the codebook was finalized, the four researchers each independently coded all transcripts, meeting regularly to discuss the coding process and any emergent themes in the data. The codebook included 21 parent codes; 12 of the parent codes included several child codes, as well. Any coding discrepancies were discussed in team meetings using a consensus approach