Assessing and Improving Community Health in Wisconsin

Columbia St. Mary’s Hospital Ozaukee

Columbia_St Marys
13111 N PORT WASHINGTON RD
MEQUON, WI 53097
Ozaukee County
Hospital Website
Community Health Needs Assessment
Community Health Implementation Plan

Implementation Approaches

-Participate in INVEST Alcohol Team to modify Ozaukee alcohol culture

  • CSM Leader will be an active member of the team to identify partnership opportunities

-Collaborate with CSM Community Physician Clinics for better assessment of teens within the clinical setting.

  • Embed the CRAFFT tool (an evidence-based survey, to elicit substance abuse habit and risk factors, and determine need for more intensive assessment) within electronic health record as standard part of adolescent physical

  • Train CSM CP staff in use of the CRAFFT and SBIRT(Screening, Brief Intervention, and Referral to Treatment) tools

-Establish partnership with school districts to screen and refer at-risk youth for ongoing education

  • Community Educator to establish relationship with key staff in Ozaukee schools to identify students with problem behaviors and their parent

-Support INVESTs school–based initiatives

  • CSM will work with Ozaukee INVEST through a strategic initiative to leverage volunteer engagement and fund a person to work directly with schools to improve student nutrition and nutrition understanding.
  • Support INVEST to allow hiring of school based staff through AmeriCorps program

-Create infrastructure to link local farmers to institutional cooks and kitchens

  • Collaborate with INVEST to create Farm Food Hub
  • CSM will use the Food Hub to purchase food for Associate Cafeteria

-Increase availability of Suboxone clinics supported by CSM

  • Discuss recruitment challenges and opportunities with physician champion
  • Develop action response that will increase MD involvement

-Collaborate with CSM Community Physician Clinics for better assessment of teens within the clinical setting.

  • Embed the CRAFFT tool (an evidence-based survey, to elicit substance abuse habit and risk factors, and determine need for more intensive assessment) within electronic health record as standard part of adolescent physical
  • Train CSM CP staff in use of the CRAFFT and SBIRT(Screening, Brief Intervention, and Referral to Treatment) tools

-Establish partnership with school districts to screen and refer at-risk youth for ongoing education

  • Community Educator to establish relationship with key staff in Ozaukee schools to identify students with problem behaviors and their parent

-Expand mental health availability through hiring of staff into existing CSM programming.

  • Recruit and hire additional staff

-Increase the number of children in Ozaukee County receiving dental sealants through Smart Smiles.

  • Develop partnership with Ozaukee County Health Department to support summer sealant program
  • Identify outreach plan and media partner

-Review the existing Huiras Clinic services and procedures to determine services to uninsured and underinsured people as the clinic adapts to the insurance eligibility changes. Revise procedures and policies to fit current patient and community needs. Consider health literacy and supplemental services to improve patient use of primary care.

  • Convene planning group to consider current scope and procedures. The planning group will include clinic staff and physicians, CSM Community Physician leadership and CSM leadership
  • Develop and implement plan to offer clinic and supplemental services to support health literacy and access in Ozaukee County

-Participate in community efforts to document transportation needs and develop a collaborative response to the need for transportation to medical appointments.

  • Participate in non-profit collaboration to address the need for transportation
  • Assist in development of community plan

-Review the existing Huiras Clinic services and procedures to determine services to uninsured and underinsured people as the clinic adapts to the insurance eligibility changes. Revise procedures and policies to fit current patient and community needs. Consider health literacy and supplemental services to improve patient use of primary care.

  • Convene planning group to consider current scope and procedures. The planning group will include clinic staff and physicians, CSM Community Physician leadership and CSM leadership
  • Develop and implement plan to offer clinic and supplemental services to support health literacy and access in Ozaukee County

-Become a Wisconsin Well Woman Program provider in the new model of service (Breast Cancer)

  • Submit provider proposal and complete contracting requirements for WWWP provider status
  • Develop partnerships with Ozaukee and Washington County WWWP service coordinator

-Expand Outreach through CSM Mammography Outreach Strategy and through increased community partnerships.

  • Develop Outreach Strategy in collaboration with Diagnostic and Clinic Leadership
  • Create new partnerships to host outreach events particularly in settings to attract hard to reach populations
  • Develop Washington County collaboration

-Expand mental health availability through hiring of staff into existing CSM programming.

  • Recruit and hire additional staff

-Support INVEST Coalition in communitywide approaches

  • Attend INVEST workgroup to identify opportunities for CSM