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University of Wisconsin–Madison

Assessing and Improving Community Health in Wisconsin

Children's Hospital of Wisconsin

Implementation Approaches

Ongoing initiatives:

-It’s UR Choice

  • Children’s Hospital has created fun and engaging e-learning programs, offered at no cost to all schools across Wisconsin, designed to inspire students to lead healthier lives. Using online and classroom lessons, It’s UR Choice helps students in grades 4 through 8 make smart choices when faced with the pressures of using and abusing alcohol, tobacco and other drugs. It meets national health education standards and was developed using evidencebased or informed research.

-Behavioral health advocacy

  • Children’s also supports efforts and policies that aim to reduce substance abuse, which we know has an impact on mental health. Children’s has been a long-time leader in advocating for stronger DUI laws, including enhanced penalties for DUI with a child in the car. In addition, along with the Wisconsin Hospital Association and other partners, Children’s supported a series of policy initiatives collectively known as the HOPE legislation. The HOPE Agenda (Heroin, Opiate, Prevention, and Education) is a legislative package that has received unanimous bipartisan support, aimed at combating our state’s heroin epidemic. Children’s will continue to advocate for policies that address access to and treatment for drug use and abuse.

Priority: Physical activity, nutrition, obesity and weight management

Ongoing Initiatives:

-Clinical Nutrition Community Outreach

  • Children’s Hospital offers a variety of nutrition education programs throughout the community. At the COA Goldin Center in Milwaukee, we’ve provided healthy snacks at Community Fun Nights every other month and offered the What’s On Your Plate program, which introduces families to a healthy lifestyle curriculum on nutrition, cooking and physical activity. Our Clinical Nutrition staff frequently present on nutrition education to groups statewide, from educating families affected by Cystic Fibrosis and Phenylalanine ketonuria (PKU), to talking with 1st through 4th graders at STARMS Health Fair, to showing foster care youth how to cook and grocery shop as they prepare to live on their own.

-Mission: Health

  • Children’s Hospital has created fun and engaging e-learning programs, offered at no cost to all schools across Wisconsin, designed to inspire students to lead healthier lives. Using online and classroom lessons Mission: Health helps students in grades K5 through 8 establish healthy habits, increase physical activity and avoid childhood obesity. It meets national health education standards and was developed using evidence-based or informed research.

-Physical activity, nutrition, obesity and weight management advocacy

  • In collaboration with American Heart Association, Children’s supported legislation that requires daily 30 minutes of physical education in elementary schools to ensure that children have a safe and supportive environment to exercise and build team skills. This legislation has not become law, and we will continue to focus resources on advocating for this policy. Along with other medical partners, Children’s opposed legislation that would allow unpasteurized “raw milk” to be sold to consumers. Children’s will continue to look for ways to support access to healthy foods and increased physical activity in our communities.

-Whole School, Whole Community, Whole Child

  • Since 2009, our school nurses and community health navigators have worked with nine K-8 schools (ten for the 2016-17 school year) in the Milwaukee Public Schools district to implement the Centers for Disease Control and Prevention and Association for Supervision and Curriculum Development Whole School, Whole Community, Whole Child model. Strategies range from education for students, staff and families to healthy meal nights to classroom physical activity breaks. This coordinated approach to school health improves students’ health and their capacity to learn through the support of families, communities and schools.

Ongoing initiatives:

-It’s UR Choice

  • Children’s Hospital has created fun and engaging e-learning programs, offered at no cost to all schools across Wisconsin, designed to inspire students to lead healthier lives. Using online and classroom lessons, It’s UR Choice helps students in grades 4 through 8 make smart choices when faced with the pressures of using and abusing alcohol, tobacco and other drugs. It meets national health education standards and was developed using evidencebased or informed research.

-Behavioral health advocacy

  • Children’s also supports efforts and policies that aim to reduce substance abuse, which we know has an impact on mental health. Children’s has been a long-time leader in advocating for stronger DUI laws, including enhanced penalties for DUI with a child in the car. In addition, along with the Wisconsin Hospital Association and other partners, Children’s supported a series of policy initiatives collectively known as the HOPE legislation. The HOPE Agenda (Heroin, Opiate, Prevention, and Education) is a legislative package that has received unanimous bipartisan support, aimed at combating our state’s heroin epidemic. Children’s will continue to advocate for policies that address access to and treatment for drug use and abuse.

Priority: Sexual health

Ongoing Initiatives:

-School nurses

  • Children’s Hospital’s school nurses play a vital role by leading sexual health education for Milwaukee Public Schools’ Human Growth and Development Curriculum. Nurses use the Always Changing Puberty Education program, which was reviewed by the American Association for Health Education, with fourth and fifth graders. Since 2011, school nurses have been facilitating this curriculum at nine partner schools. An additional school will be added for the 2016-17 school year. In addition to implementing classroom education, the nurses offer additional support (such as small-group discussion) for specific students or specific topics.

-Making Proud Choices!

  • As part of the United Way’s teen pregnancy initiative, Children’s Hospital administers the Making Proud Choices! teen pregnancy prevention curriculum to middle and high school students in foster care and Milwaukee Public Schools

-Sexual health advocacy

  • Children’s successfully advocated for increases in funding for help to victims of child sex-trafficking. In addition, we supported policy that protects children against invasion of their privacy. Children’s will continue to look for ways to support policy relating to children’s sexual health and well-being.

Ongoing initiatives:

-It’s UR Choice

  • Children’s Hospital has created fun and engaging e-learning programs, offered at no cost to all schools across Wisconsin, designed to inspire students to lead healthier lives. Using online and classroom lessons, It’s UR Choice helps students in grades 4 through 8 make smart choices when faced with the pressures of using and abusing alcohol, tobacco and other drugs. It meets national health education standards and was developed using evidencebased or informed research.

Ongoing initiatives:

-Children’s Community Health Plan

  • Created by Children’s Hospital, this insurance plan serves children and adults who are covered by BadgerCare Plus, ensuring that more families get access to high-quality health care. Our health plan facilitates a variety of health promotion initiatives for its families, including a Healthy Moms Healthy Babies prenatal care program, asthma outreach, out-of-home care and healthy shopping education

-Care4Kids

  • The Wisconsin Department of Health Services and the Wisconsin Department of Children and Families have partnered with Children’s Hospital and our health plan for low-income families (Children’s Community Health Plan) to administer Care4Kids. This innovative program offers comprehensive and coordinated health services for children in foster care in six southeastern Wisconsin counties. This includes Milwaukee County, which accounts for approximately two-thirds of the 3,000 children enrolled in the program. Through Care4Kids, we partner with primary care providers who recognize the unique needs of these children. The program creates a “medical home” team, consisting of the child welfare worker, family members, foster parents and other health care providers. This team develops a comprehensive health care plan based on the specific needs of the children – taking into account their physical, behavioral health, dental and vision care needs

-School nurses

  • It’s not always easy for children to get the health care they need. School nurses can fill a critical gap by making sure that kids get vision and hearing screens, care for chronic conditions such as diabetes and asthma, and health and wellness education. The nurses, who work within nine partner schools in Milwaukee (increasing to ten for the 2016- 17 school year), also help coordinate care with physicians, social workers and other community resources.

Ongoing Initiatives:

-Whole School, Whole Community, Whole Child

  • Since 2009, our school nurses and community health navigators have worked with nine K-8 schools (ten for the 2016-17 school year) in the Milwaukee Public Schools district to implement the Centers for Disease Control and Prevention and Association for Supervision and Curriculum Development Whole School, Whole Community, Whole Child model. Strategies range from education for students, staff and families to healthy meal nights to classroom physical activity breaks. This coordinated approach to school health improves students’ health and their capacity to learn through the support of families, communities and schools.

-Population Health Management and Payment Innovation

  • Children’s Hospital has dedicated this division to serve as a center for research and development of best-practice programs to prevent illness, improve wellness and manage health needs of populations. Population Health develops and tests new payment models to support best-practice programs and transition our health system from being paid to treat sick children to being paid to keep children healthy. Within this research center exists our Clinical Navigation Program, which helps Milwaukee families navigate complex health care systems so they can get the services they need.

-Institute for Child and Family Well-Being

  • This joint initiative between Children’s Hospital’s Community Services division and the University of WisconsinMilwaukee’s Helen Bader School of Social Welfare aims to improve the lives of children and families by designing and implementing effective programs, conducting cutting-edge research and evaluation, and promoting change through policy and advocacy. To fulfill this mission, the institute promotes community collaboration to bridge unnecessary divides between practice, research and policy.

-Southeast Regional Center for Children and Youth with Special Health Care Needs

The Southeast Regional Center is one of five regional centers across the state, funded through the Wisconsin Department of Health Services’ Title V Children and Youth with Special Health Care Needs Program and Maternal Child Health Program located in the Division of Public Health. Children’s Hospital facilitates the grant for the Southeast Center, prioritizing:

  1. Medical Homes – Children and youth receive coordinated, ongoing and comprehensive care.
  2. Transition – Youth receive the services necessary to make transitions to all aspects of adult life, including adult health care, work and independence.
  3. Family Leadership – Families are partners in shared decision-making for the child’s optimal health.

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Priority: Health literacy

Ongoing Initiatives:

-Language services

  • This program provides face-to-face, telephone and video relay interpreters for patient families who do not speak English or who have limited speech proficiency or hearing or speech issues. In addition to in-person interpreters, Children’s Hospital can also connect families via telephone to interpreters in 150 languages. This service is available 24 hours a day, seven days a week, at no cost to families.

-Patient Family Education Committee

  • In partnership with patient families, the Children’s Hospital Educational Services Department and Patient and Family Education Committee reviews materials for patients and families to ensure readability so that caregivers have a clear understanding of how to best care for their children. Patient handouts are usually written at a 5th through 7th grade reading level and are offered in English and Spanish.

-Community health navigators

  • First launched in 2011, this program focuses on four partner neighborhoods in Milwaukee: Amani/Franklin Heights, Metcalfe Park, Midtown and Lindsay Heights. Community health navigators increase residents’ public health knowledge and self-sufficiency through a range of activities, including outreach, community education, informal counseling, social support and advocacy. They also collaborate with internal and external partners to connect families to needed resources and influence the medical and social determinants of health.

-School nurses

  • It’s not always easy for children to get the health care they need. School nurses can fill a critical gap by making sure that kids get vision and hearing screens, care for chronic conditions such as diabetes and asthma, and health and wellness education. The nurses, who work within nine partner schools in Milwaukee (increasing to ten for the 2016- 17 school year), also help coordinate care with physicians, social workers and other community resources.

-Health literacy advocacy

  • Children’s took an active role in supporting the passage of legislation that requires CPR training to be taught in high school curriculums across the state. This important skill equips young people to perform life-saving treatment on their peers, siblings or friends during an unfortunate, tragic event.

-Health literacy research

  • Children’s Research Institute is conducting research related to development of a health literacy intervention to reduce pediatric non-urgent emergency department use. In parents with low health literacy, a lack of caregiving skills to adequately care for acute pediatric illness may lead to non-urgent emergency department visits. Our study is designed to better understand the association of health literacy with the management of acute pediatric illness. By empowering parents to recognize non-urgent illness and manage them appropriately at home or with the primary care physician, it may be possible to improve the child’s care and the family’s health care experience.

Ongoing Initiatives:

-School nurses

  • It’s not always easy for children to get the health care they need. School nurses can fill a critical gap by making sure that kids get vision and hearing screens, care for chronic conditions such as diabetes and asthma, and health and wellness education. The nurses, who work within nine partner schools in Milwaukee (increasing to ten for the 2016- 17 school year), also help coordinate care with physicians, social workers and other community resources.

Priority: Asthma

Ongoing Initiatives:

-Wisconsin Asthma Coalition

Since 2001, Children’s Hospital has supported this diverse, statewide coalition that works to take control of asthma through implementation of the Wisconsin Asthma Plan. The Wisconsin Asthma Plan is a blueprint for managing asthma across the state, and includes the following activities:

  • School and childcare walkthrough program – This program provides an environmental assessment of schools and childcare centers for environmental asthma triggers and offers low- and no-cost remediation strategies.
  • Improving outcomes in practical asthma management – This initiative offers in-person education for primary care provider teams on how to implement the national asthma guidelines within their clinical practice.
  • Asthma medication assistance – At chawisconsin.org/meds, the coalition has compiled an online resource of all prescription assistance programs and coupons available for asthma medications.
  • Spacers/valved-holding chambers for inhalers – In 2015, Wisconsin Medicaid discontinued providing spacers for inhalers in pharmacies, which resulted in unintended consequences. The coalition successfully worked to reverse this ruling.
  • School-based asthma management program – This is a national initiative of the American Academy of Allergy, Asthma and Immunology and the National Association of School Nurses. It involves a four-step process to improve the system of care and communication between families, clinicians and schools.

-Asthma Care and Environmental Services

  • Launched in 2015 at nine Milwaukee Public Schools, Children’s Hospital’s Asthma Care and Environmental Services program provides intensive self-management education to school-aged children and their families, along with an environmental assessment.

-Asthma advocacy

  • Children’s supported legislation to include e-cigarettes on the statewide smoking ban list and supported limiting e-cigarette use on school property.

-Asthma research

  • Children’s Research Institute is conducting research related to home-based reduction of asthma triggers. Asthma exacerbations in children can lead to costly medical care, morbidity and mortality. Our study will measure home irritant exposures to asthma trigger symptoms and analyze participants’ genetic data to identify any genetic alterations in relevant pathways of asthma. We also will implement a targeted irritant trigger education program in the homes of low-income Milwaukee children.

Priority: Behavioral health

Ongoing Initiatives:

-Child Psychiatry Consultation Program

  • There is a critical shortage of child psychiatrists in Wisconsin and nationwide. To help fill the provider gap, the Charles E. Kubly Child Psychiatry Consultation Program offers on-call child psychiatrists, a psychologist and resource coordinators who provide ongoing education and consultation to primary care providers on behavioral health issues. This helps primary care providers treat kids with mental health issues in their medical homes so that kids can more quickly get the treatment they need. Since the program began in 2012, it has enrolled primary care providers in clinics across southeastern and north-central Wisconsin, including Milwaukee. The goal is to expand the program statewide by 2018.

-School-based mental health

  • School-based mental health services are a vital tool for meeting the needs of children with behavioral health issues. Therapists spend between a half day a week to full-time hours dedicated to a particular school, where they provide assessment and psychotherapy to children who require immediate mental health intervention. The therapists also offer consultation and education about mental health to educators to support positive classroom interventions for kids and adolescents who are struggling with mental and behavioral challenges. This initiative launched in 2012 and now includes schools between Altoona and Racine, plus group therapies in Madison-area school districts. The two Milwaukee sites — Greater Holy Temple Christian Academy and Pierce Elementary — have therapists providing therapy sessions to students, as well as offering consults to teachers and parents.

-Integrated behavioral health

  • This pilot project, first launched in November 2015, uses an integrative care model to reach underserved populations in four central-city medical practices in Milwaukee: Midtown Clinic, Next Door Pediatrics, COA Goldin Center and the Northside YMCA. A psychologist or psychotherapist is part of the medical team at each site, making it easy for primary care providers to make an immediate and in-person referral for patients who need mental health intervention. The psychologist or psychotherapist offers mental health screening; consultation to patients, families and the medical team; brief interventions; and ongoing psychotherapy.

-Outpatient clinics

  • Children’s Hospital offers outpatient mental health services at 15 clinics statewide, including three outpatient clinics in Milwaukee: the Psychiatry and Behavioral Medicine Center, Child and Family Counseling Milwaukee, and Sojourner Family Peace Center. Services include individual, group and family therapy; trauma-focused therapy; and (at some locations) medication management/psychiatric services and psychological testing

-It’s UR Choice

  • Children’s Hospital has created fun and engaging e-learning programs, offered at no cost to all schools across Wisconsin, designed to inspire students to lead healthier lives. Using online and classroom lessons, It’s UR Choice helps students in grades 4 through 8 make smart choices when faced with the pressures of using and abusing alcohol, tobacco and other drugs. It meets national health education standards and was developed using evidencebased or informed research.

-Behavioral health advocacy

  • Policy makers have identified behavioral health as a major priority area to improve outcomes for children, youth and adults alike. Children’s has worked with elected officials to support policies that increase mental health access in school settings and also on policy that addresses bureaucratic hurdles that make providing care difficult. Children’s also supported the creation of the Child Psychiatry Consultation Program to assist frontline providers in providing enhanced care to children and adolescents with mild or moderate mental health care needs and is currently advocating for increased funding for this program. Children’s will continue to advocate for better access and funding for behavioral health care coordination and collaboration across providers.
  • Children’s also supports efforts and policies that aim to reduce substance abuse, which we know has an impact on mental health. Children’s has been a long-time leader in advocating for stronger DUI laws, including enhanced penalties for DUI with a child in the car. In addition, along with the Wisconsin Hospital Association and other partners, Children’s supported a series of policy initiatives collectively known as the HOPE legislation. The HOPE Agenda (Heroin, Opiate, Prevention, and Education) is a legislative package that has received unanimous bipartisan support, aimed at combating our state’s heroin epidemic. Children’s will continue to advocate for policies that address access to and treatment for drug use and abuse.

Priority: Violence

Ongoing Initiatives:

-Act Now!

  • Children’s Hospital has created fun and engaging e-learning programs, offered at no cost to all schools across Wisconsin, designed to inspire students to lead healthier lives. Using online and classroom lessons, Act Now! helps counselors and teachers, students, parents and caregivers increase awareness about bullying and has given students age-appropriate skills needed to prevent and stop bullying. ActNow! is a comprehensive e-learning resource that focuses on improving school culture across the school community through awareness, education and skill development for teachers, counselors, students and parents. It meets national health education standards and was developed using evidence-based or informed research.

-Milwaukee Child Advocacy Center

  • The Milwaukee Child Advocacy Center brings together multidisciplinary partners in child maltreatment investigations. It provides comprehensive medical, forensic interview and advocacy services for children and families in Milwaukee County.

-The Positive Parenting Program (Triple P)

  • As a pilot project in 2016, Triple P is a universal access, evidence-based program for caregivers of children ages 0-12. It aims to increase parents’ and caregivers’ knowledge of positive parenting techniques. Parents and caregivers are reached through five Children’s Hospital Primary Care clinics, community health navigators in four partner neighborhoods and school nurses in 10 Milwaukee Public Schools.

-Awareness to Action

  • A statewide program first launched by Children’s Hospital in 2006, Awareness to Action educates and advocates for adults to take action to prevent child sexual abuse. Education includes resources for adults on healthy sexual development and how to discuss sexual development with children.

-Period of PURPLE Crying

  • A newly launched (2016) pilot project, Period of Purple Crying is an evidence-based infant abuse prevention program that educates parents and caregivers about normal infant crying and the dangers of shaking an infant. Parents and caregivers are reached through Children’s Hospital’s Neonatal Intensive Care Unit and Emergency Department, five of the Children’s Hospital Primary Care clinics and one Children’s Hospital urgent care location.

-Prevent Child Abuse Wisconsin

  • This longstanding program aims to build community resources, provide training and public awareness, and carry out advocacy activities in order to strengthen child abuse prevention efforts. Recent projects facilitated in part by Prevent Child Abuse Wisconsin include the “Say Something, Do Something” and Pinwheels for Prevention Campaigns to encourage adults statewide to take action to assure children grow up in safe, stable and nurturing environments.

-Project Ujima

  • The mission of this community project is to stop the cycle of violent crimes by reducing the number of repeat victims of violence through individual, family and community interventions and prevention strategies. The program’s key elements include hospital-based services (medical care, peer support, crisis intervention and social and emotional assessment), home-based services (medical follow-up of injuries, evaluation of primary health care needs, psychological screening and counseling), community-based services (mentoring, youth development, family and youth support groups, gang interventions, job preparedness and advocacy to address legal, education and housing issues), and community and professional education about youth violence. Most of the program’s referrals come through the hospital’s emergency department, in addition to referrals from community partners.

-Violence advocacy

  • Children’s was a key partner in securing funding for the Sojourner Family Peace Center, a first-of-its-kind model to deliver adult and child focused services addressing family violence. Sojourner Family Peace Center provides care in a coordinated, centrally located facility. Children’s continues to advocate for stronger child protection laws.

-Violence research

  • Children’s Research Institute is conducting research related to integrating quality-of-life measures into violence prevention programs. Interpersonal violence ranks among the top five leading causes of youth seeking medical intervention and is associated with decreased five-year survival. Our study will expand on previous work investigating health related quality of life as a means for measuring outcomes in youth victims of violence. This research has the potential to lead to more effective methods for intervening in the lives of those who suffer from violent injury

Ongoing Initiatives

-Whole School, Whole Community, Whole Child

  • Since 2009, our school nurses and community health navigators have worked with nine K-8 schools (ten for the 2016-17 school year) in the Milwaukee Public Schools district to implement the Centers for Disease Control and Prevention and Association for Supervision and Curriculum Development Whole School, Whole Community, Whole Child model. Strategies range from education for students, staff and families to healthy meal nights to classroom physical activity breaks. This coordinated approach to school health improves students’ health and their capacity to learn through the support of families, communities and schools.