Healing Communities - Jackson Healthcare

Transcription

Healing Communities
How 10 Hospital Programs Are Changing Lives
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www.hospitalcharitableserviceawards.org
Introduction
The Hospital Charitable Service Awards were created by Jackson Healthcare to build a community of individuals and hospitals around
evidence-based best practices in community benefit and charitable services.
In 2011, the second year of the Awards program, 197 hospital programs were accepted as official nominees.
All hospital-funded community programs were eligible to participate regardless of the size, tax or ownership model. Each program was
evaluated by an independent advisory board of hospital executives based upon five criteria areas: community impact, innovation,
collaboration, transferability and best practice.
What follows are the ten programs deemed “Programs of Excellence,” whose commitments to their communities reach beyond “community
benefit” and “free care.” Each has demonstrated measurable improvements in community health and increased access to healthcare
education and services.
Here are the stories of these model programs: their journeys, their successes, their heroes and the lessons they have learned along the way.
Without fail, program leaders credit the unwavering commitment of the leadership of their sponsoring hospitals, the heart-warming selflessness
of the employees and volunteers who give so much – and so freely – for the sake of their fellow community members and the unparalleled
generosity of their partners and collaborators throughout the community who work with them to meet the ultimate goal of improving the health
and well-being of the individuals they serve.
We hope this ebook…
…drives greater awareness of the amazing gifts hospitals offer their communities,
…celebrates the accomplishments of hospital programs that stand as beacons of community service for the underserved,
…shares evidence-based best practices for delivering and funding community health programs, and
…connect hospitals with innovative approaches and new opportunities to better serve communities locally and throughout the world.
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Table Of Contents
The ARCHES Project ..................................................................................................................... 4
Thomas Jefferson University Hospitals – Philadelphia, Pennsylvania
The Breathmobile® Program ......................................................................................................... 9
Los Angeles County + University of Southern California Medical Center – Los Angeles, California
CARE Maternal/Child Health Clinic .......................................................................................... 13
Saint Alphonsus Regional Medical Center – Boise, Idaho
Community Fitness Initiative (CFI)-Lexington ......................................................................... 19
Lexington Regional Health Center – Lexington, Nebraska
The Concussion Program ............................................................................................................ 23
Children’s Hospital Colorado – Aurora, Colorado
Diabeticos Saludables (Healthy Diabetics) ................................................................................. 27
Memorial Health System of South Bend – South Bend, Indiana
Forensic Nurse Examiner Program .............................................................................................. 31
Bon Secours St. Mary’s Hospital – Richmond, Virginia
Healthier Laramie County ............................................................................................................. 35
Cheyenne Regional Medical Center – Cheyenne, Wyoming
Homeless Initiative ........................................................................................................................ 39
Cook Children’s Health Care System – Fort Worth, Texas
Memorial FIT Kids ......................................................................................................................... 43
Memorial Healthcare – Owosso, Michigan
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The ARCHES Project
Thomas Jefferson University Hospitals – Philadelphia, Pennsylvania
“Joe” had recently been released from prison, and was intent on changing his path in life
and providing for his family. However, he had little luck in finding work.When he did find a
job, he had trouble keeping it because of poor health. His luck changed one day when he
stumbled upon the JOINED-UP Program, a diabetes prevention and self-management
education program and workforce development project housed at a community center
in his neighborhood.
“We provided diabetes screening and found out he was diabetic,” said Dr. James Plumb,
director of the Thomas Jefferson University Hospitals Center for Urban Health.
“Joe” was connected with a primary care physician through the program, and he began
to learn about his diagnosis and how to manage his condition. He graduated from the
program, and successfully developed his own weatherization business.
“He talks a lot about the difference it made having people willing to sit with him and explain
things in a way that made sense. This program gave him an opportunity to learn about his
illness and do something about it,” Dr. Plumb said.
The JOINED-UP program is just one of numerous initiatives of The ARCHES Project
designed specifically to serve individuals in need in their own neighborhoods.
The Program
The ARCHES Project was launched in 1998 when Thomas Jefferson University Hospitals
(TJUH) created its Center for Urban Health. The center exists to improve the health and wellbeing of Philadelphia citizens by marshalling the resources of TJUH, the Thomas Jefferson
University Department of Family and Community Medicine, and various community
organizations through the programs of The ARCHES Project.
James Plumb, MD, MPH and Rickie Brawer, PhD, MPH accept
the Program of Excellence award on behalf of the ARCHES
Project at the 2012 Hospital Charitable Service Awards
Conference in Atlanta, Georgia.
Contact THE ARCHES PROJECT
James Plumb, MD, MPH
Director
Center for Urban Health
@
Click the icons to engage with the Center for Urban Health at the
Thomas Jefferson University Hospitals via email, through YouTube
or on the web and find out more about The ARCHES Project.
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The ARCHES Project
ARCHES stands for Access and Advocacy; Research,
Evaluation, and Outcomes Measurement; Community
Partnerships and Outreach; Health Education, Screening
and Prevention Programs; Education Health Professions
Students and Providers; and Service Delivery Systems
Innovation. Each of these components represents a
domain or theme of the ambitious multi-faceted initiative
designed to promote community health through a wide
variety of need-driven, neighborhood-based programs.
Although Thomas Jefferson University Hospitals (TJUH)
serves the Philadelphia region, ARCHES programs are
community-based efforts within neighborhoods that
experience the greatest disparities in health status
and access as identified by a comprehensive needs
assessment. In addition to traditional outreach activities,
such as health screenings and health promotion programs,
ARCHES programs work with multiple existing programs
and community partners to assess needs and create
programs designed to meet those needs, using the
assets of the community.
TJUH encourages its employees and students to participate by serving in leadership positions within the community-based organizations and
initiatives, or by volunteering their time to assist those organizations in meeting the needs of the communities served.
“A lot of our work is based on our relationships,” Dr. Plumb explained, noting that the involvement of employees who live in the neighborhoods
served by programs really helps promote those relationships.
ARCHES partners include schools, homeless shelters, senior centers, faith-based communities, and other broad-based efforts that recognize
neighborhood economic, social and physical environments as underlying determinants of health and disease.
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The ARCHES Project
“We actually work with communities,” added Dr. Rickie Brawer, Codirector of the Center for Urban Health. “We work with them where they
are, and we bring resources. We do a community assessment, and
we come up with a plan to address the needs.”
An effort is made to also ensure that programs reflect community
voice and culture.
Community Partnerships and Outreach
•Federation of Community Centers – JOINED-UP Program, which is
a diabetes prevention and self-management education program in
a green workforce development project
•Haddington Community Health Collaborative, which is a 15-year
partnership with a 60+ member collaborative focused on youth
development and improving the health of the community
Examples of key initiatives of The ARCHES Project, as they apply to a
few of the ARCHES domains, include:
Access and Advocacy Programs
•The Philadelphia Urban Food and Fitness Alliance, which serves
to improve access to healthcare, affordable food and safe places
for physical activity through policy and systems changes
•Environmental Stewardship, which includes an EPA interdisciplinary
pharmaceutical waste management project and a Farm-to-Institution
program, as well a campus-based Farmer’s Market
•Jeff HOPE, which works to provide the homeless with laboratory,
radiology and pharmacy services through various partnerships
Research Evaluation, and Outcomes Measurement
•Public Health Management Corporation, which provides support
for a local community health database that is used for community
assessments and evaluations
•Center of Excellence in Obesity Research, which applies the chronic
care model to weight management in primary care practices linked
to community resources
Altogether, ARCHES programs have provided care for more than
35,000 homeless adults and children, and provided diabetes self
management education for 1,500 adults. ARCHES has also provided
breast health education to homeless women, addressed matters of
housing and insurance access, developed a refugee health center
serving hundreds of refugees from numerous countries and provided
cardiovascular and prostate health education to 9,000 AfricanAmerican men.
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The ARCHES Project
Keys to Success
The commitment of the senior management is a major component of the success of The ARCHES Project, Drs. Plumb and Brawer said.
The administration considers the project to be part of the hospital’s mission. They support it through powers of persuasion and resources, and
they create a culture where staff members can be a part of the process. The employees and students, such as medical students and nursing
students, who take advantage of the opportunities to serve are another important factor in the success, as is the “consistent, sustainable
presence,” in the neighborhoods of interest, Dr. Plumb said.
The relationships that arise from this approach are long-term,
relationships, Dr. Brawer added, noting that the community residents
served recognize the programs’ commitment to them.
“I believe we have a reputation of wanting to be there to really make
a difference. We are there, we show up, we work hard, and it’s not
about building careers,” she said, adding that she impresses upon the
students who volunteer that it is a privilege to do this work.
But the heroes of the program, she and Dr. Plumb said, are “the
folks who open their hearts and minds to let us come in.”
“They are wrestling with extraordinary challenges, and the odds are against them. And yet they let me into their houses, their churches, their
confidence,” Dr. Plumb said.
Following The ARCHES Project’s Lead
Organizations interested in launching programs the size and scope of The ARCHES Project should consider first appointing an institutionwide steering committee with representatives from various departments and from neighborhoods to be served. Then they should consider
starting a discussion about what types of programs make the most sense, Dr. Plumb said.
Also, don’t spread too thin, Dr. Brawer advised, adding that staying within resources, and growing at a supportable pace is important.
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The ARCHES Project
Do something and do it really well rather than trying to do too much at first, she said, adding that ARCHES started with a couple geographic
areas, and waited for the right opportunities to grow.
Evaluate the programs to ensure they are achieving the desired outcomes, and share the results with the community.
“People want to know that we are making progress,” she said, adding that it is important to celebrate accomplishments, even the small ones.
“It’s really about networks and relationships,” she said.
In more recent years, The ARCHES Project began working with people to enact change at the systems and policy level, such as building health
into workforce development and working with the whole person. “Joe’s” story illustrates the value of this approach.
“It’s really thinking at a different systems level, and asking ‘What else does this person need?’” Dr. Brawer said.
Results are seen when multiple partners work on different facets at the same time, she said.
Indeed, a program that screens for blood pressure and offers some health advice doesn’t do much good when that individual is sent home to a
chaotic environment where they find it impossible to follow the advice. But working with partners to address the gamut of social determinants of
health – adequate housing, safe neighborhoods, access to nutritious food – allows integration of health issues into the fabric of the community
through comprehensive community development programs.
“I think that’s been our strength, and we’re proud of our work,” Dr. Plumb said.
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The Breathmobile Program
Los Angeles County + University of Southern California Medical Center – Los Angeles, California
Nationally, the prevalence of asthma is about 8% to 10%, but in some inner-city areas
in Southern California, the prevalence is as high as 25%. Uninsured children from lowincome families are disproportionately affected because of a lack of access to preventive
and ongoing medical care. Many seek care only when they experience acute asthma
attacks. The Breathmobile Program is now helping more than 12,000 of those children
breathe easier.
The Program
The Breathmobile Program was created expressly to provide preventative asthma care
services at no out-of-pocket costs for those children in need. The program, a project of the
Los Angeles County + University of Southern California (LAC+USC) Medical Center in
collaboration with the California Chapter of The Asthma and Allergy Foundation of America,
the Los Angeles County Department of Health Services and the Los Angeles Unified
School District, was launched in 1995. The goal: to overcome barriers to healthcare and
improve the health of low-income asthmatic children and their families, who have limited
access to care and medications.
A huge underserved population is one of the biggest challenges for LAC+USC, and
children with asthma are among those who frequently end up using the emergency
room for “band-aid” episodic care, rather than receiving the ongoing care they need to
manage their conditions, according to Dr. Lyne Scott, Chief of the Division of Allergy and
Immunology at LAC+USC Medical Center and Co-Director of the program.
A member of The Breathmobile Program staff treats a
student aboard one of the Breathmobiles® at a local school.
Contact THE Breathmobile Program
Philip Moore
Administrator
The Breathmobile Program,
LAC+USC Healthcare Network
Click the icons to engage with the LAC + USC Medical Center on
the web and find out more about The Breathmobile Program.
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Currently, the Breathmobile Program provides preventive
care at 92 schools county-wide, and children are served
regardless of their insurance status or ability to pay.
“If they can’t afford their medications, we provide samples
for them,” Dr. Scott said.
The program, initially a single 34-foot mobile clinic staffed
by a team of asthma care specialists that delivers asthma
care at the school sites. Patients are seen every 6-8
weeks for pulmonary function testing, allergy skin testing
and extensive education regarding allergen avoidance,
medication use and technique, as needed.
Patients are provided with a written asthma action plan at
the end of each visit. Care team members are bilingual,
providing services in English or Spanish (or other languages
by telephone translator), depending on patient preference.
This is a particularly important part of the program, given
that 85% of the children served are Hispanic.
The program has been a resounding success.
“We now have four Breathmobiles, and as of July 2011, we had served more than 12,000 unique patients at more than 68,000 patient visits,”
Dr. Scott reported.
An important clinical objective of the program, helping patients achieve and maintain asthma control, is achieved by 80% of participants by their
third visit. Almost all (96%) achieve control by visit six.
Importantly, children who remain in the program for at least one year are likely to maintain their asthma control at subsequent visits.
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Further, according to Dr. Scott, an average 87% reduction in
hospitalization, and a 65-70% reduction in emergency department
visits, as well as about a 78-80% reduction in missed school days have
been seen among those who remain in the program for at least a year.
Given that 60.5% of patients live at or near the federal poverty level, it is
also key that services – and medications as needed – are provided at
no cost to the families. Initial funding was provided by the Asthma and
Allergy Foundation of America, and since then LAC+USC Medical
Center has provided funding for ongoing operation and staffing. The
total provided is about $2 million per year for total program operations.
Insurance reimbursements for billable insurance plan supplement
program costs, but the medical center covers deficits. The school
district provides parking pad structures and electrical outlet plugs for
the mobile units.
The team approach is also a plus. Each team consists of a specialtytrained asthma provider (either a medical doctor or nurse practitioner),
two registered nurses (or an RN and a respiratory therapist) and a
patient financial service resource worker. This – along with the bilingual
approach – ensures that the majority of patients’ needs are met.
“What we have found is that at any one time, our kids have well controlled
asthma at 67-70% of visits,” she said, noting that usually only about 40%
of those receiving ongoing care will achieve such control.
These improvements in outcomes equate to more than $1,150,000
in avoided costs each year. Reduced absenteeism means schools
receive more than $112,000 additional revenue.
Keys to Success
One of the greatest reasons for the Breathmobile Program’s success
is that it is school-based. This eliminates a major barrier – lack of
transportation – for parents trying to get their children routine care,
Dr. Scott noted.
Dr. Scott also credits the vision of the program founder, Dr. Craig
Jones, as well as the collaborative efforts of program partners, and
others – such as those who helped design an electronic medical
records system specific to the needs of the program – with its
continued success.
These, she said, are the heroes of the Breathmobile Program, along
with the hospital administration which provides unfailing support,
and the staff, “who are just so incredibly dedicated.”
The school district and individual school sites also deserve a great
deal of credit for their support and for the resources they provide to
ensure the program’s success.
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The support, the successes and the lessons learned have helped shape ambitious future goals, as well. Plans are in the works for
expanding services to HeadStart Programs within the Los Angeles area to extend the program’s reach to preschool children with asthma.
“We’re also working with various insurance entities to increase reimbursement for those patients who have insurance coverage,” Dr.
Scott said.
Following the Breathmobile Program’s Lead
The Breathmobile Program demonstrates the effectiveness of
regularly scheduled, preventive, team-based care delivery in
chronic diseases such as asthma for reducing overall disease-related
morbidity and improving outcomes. Not only can this program be
replicated elsewhere – as it has at 12 distinct sites with a total of
19 Breathmobiles throughout the U.S. – but the model can also be
applied to other areas of chronic disease management.
Program administrators, and the Asthma and Allergy Foundation of
America, are happy to work with other organizations to help establish
similar programs, Dr. Scott said, noting that assistance with the
Breathmobile EMR system, training and data-gathering are available
to those interested in “the Breathmobile way of care.”
Last year, a study of results “across demographic and geographics” was published in the Journal of Allergy and Clinical Immunology in
conjunction with six of the other sites.
“For any organization that wants to start a program, we would be more than happy to share with them and get it going, because the impact
for the kids is tremendous as is the reduction in costs related to asthma morbidity,” she said.
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CARE Maternal/Child Health Clinic
Saint Alphonsus Regional Medical Center - Boise, Idaho
An estimated 7,700 refugees from across the globe have made Boise, Idaho, their home
over the past 15 years. Early on, the area healthcare community recognized a need for
developing culturally sensitive ways to meet the varied healthcare necessities of these
new residents. The refugees had profound medical needs, often spoke little, if any,
English, and were overwhelmed by the unfamiliar nature of western medicine. In addition
to the cultural and language barriers that interfered with providing care, many refugees
had experienced profound emotional and physical trauma from torture and assault, and
from being forced to flee their homes to resettlement camps. The need for culturally
suitable care – that could bridge communication gaps and make providing care easier –
was most apparent in maternity and child health.
The Program
In many cases, women arriving as refugees were pregnant when they relocated, or
became pregnant soon after. Too often, they sought prenatal care very late in their
pregnancies, or went without care entirely until delivery, jeopardizing their health and
that of their babies. In 2005, Saint Alphonsus Medical Center set out to find effective,
culturally sensitive ways to improve the refugees’ health and help them navigate the local
healthcare system. The hospital’s Family Center, under the direction of Judith Hobbs,
took on the role of working with area resettlement agencies and providers to identify the
barriers that prevented refugees from seeking care – and that prevented area providers
from delivering that care effectively.
Kimi Runyan, Judith Hobbs and Corey Surber accept the
Program of Excellence award on behalf of CARE Maternal/
Child Health Clinic at the 2012 Hospital Charitable Service
Awards Conference in Atlanta, Georgia.
Contact THE CARE Maternal/Child Health Clinic
Judith Hobbs
Director
Saint Alphonsus Regional Family Center
Click the icon to engage with the Saint Alphonsus Regional Medical
Center on the web and find out more about the CARE Maternal/Child
Health Clinic.
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Within a year, the Family Center was providing specialized childbirth education to refugee maternity patients, providing support for mothers
delivering at Saint Alphonsus Family Maternity Center, and helping to increase providers’ comfort level in serving these unique patients. These
outreach efforts were formalized with the opening of the CARE Maternal/Child Health Clinic in 2008, which introduced peer health advisors
from refugee patients’ own countries or cultures of origin. These advisors assisted with scheduling and keeping of appointments, and worked to
promote healthy habits to improve pregnancy outcomes.
“The providers didn’t have the expertise for caring for these patients, and they really wanted to reach across that cultural divide,” said Judith
Hobbs, Director of the Saint Alphonsus Family Center.
Barriers interfered with both supplying appropriate care,
and made providers’ efforts burdensome. Appointments
took as long as five times longer than traditional
mainstream appointments. Even with the assistance of
interpreters it was difficult to determine how much of the
information was retained and applied, Hobbs said.
Further complicating matters – for both patients and
providers – was the patients’ inherent mistrust of “seemingly
invasive Western medicine.”
Although the vision from the beginning was to launch
a full-spectrum response, resources and time were
limited, so the hospital took one step at a time. Since
the maternal and child health needs were so visible
and immediate, they started there, and eventually
expanded to include primary care through Saint
Alphonsus Medical Group (SAMG), equally dedicated
to serving the needs of vulnerable populations.
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Among the services provided by the CARE Maternal/Child Clinic
are childbirth preparation, early parenting and nutrition classes
adapted to the unique needs and cultural framework of the refugees.
A multi-language DVD series was developed to provide patients
with another tool to help them prepare for their first prenatal exam
and to provide culturally relevant postpartum discharge instructions.
“We see caring for the refugees in our practice as our passion and not
an obligation,” said Kimi Runyan, New American Business Services
Coordinator for SAMG. “The number of providers in town willing to
take on refugee care is few, and the needs of the refugee community
are growing. The SAMG-Federal Way clinic has become one of the
leading providers in refugee care in the Boise area because we strive
for providing more efficient and quality care for this population.”
By 2009, the case management and education programs had evolved
into a one-stop prenatal and pediatric clinic. Educational modules are
presented to groups of patients in similar stages of pregnancy, followed
by private examinations. Services now also include assistance with
navigation of the healthcare system, live interpretation in as many
as 15 languages, culturally relevant early parenting and child safety
outreach, pediatric care and immunizations for infants, and access to
an “incentive store” in which refugee families redeem points earned
for healthy behaviors in exchange for basic infant care items. More
than 100 expectant mothers and their families are served each year.
Saint Alphonsus Medical Center also recently unveiled an expanded
mobile primary care service. The Curbside Care Clinic, affectionately
known as “Curby,” is a 30-foot RV updated to include a waiting area,
mini-laboratory, and private examination room. The program is an
extension of an effort by SAMG primary care doctors, who in the early
days of the refugee outreach efforts, began making house calls to
more than 1,300 refugee patients seeking family medical care. Curby
allows the continuation of these types of visits, while also providing
privacy and equipment to respond to unpredictable medical needs.
Keys to Success
Meeting refugees at their place of need, both literally and figuratively,
was an absolute necessity for the success of the Saint Alphonsus
refugee outreach efforts. It was realized that, first and foremost, the
program had to bridge gaps in understanding and communication,
and create trusting relationships with the refugees, Hobbs said.
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Achieving that required multidisciplinary collaboration remains a cornerstone of the Saint Alphonsus refugee outreach programs. Integral
partners have included the Boise State University Nursing Program, the Central District Health Department, the English Language Center
and area resettlement agencies.
An important lesson learned was to never assume anything about if or how educational message were getting across. The cultural gaps,
in too many cases, were too wide to allow any assumptions. Providers at the clinic learned early on not to assume messages were getting
across. Cultural gaps were too wide. One story demonstrates the potential danger of assuming refugees automatically would know what
to do without instruction. New mothers were provided diaper bags that contained infant formula, donated by the formula manufacturer. No
explanation was given. Some mothers were found to have used the contents of enclosed cooling packs, which displayed the company’s
logo, to feed their newborns.
“That story is one that sticks with me,” says Jillien Morga, the Saint Alphonsus Health System Director of Grant Development, who has supported
the hospital’s outreach through fundraising efforts. “When our refugee moms deliver and receive a diaper bag provided to the hospital by a formula
company, to them that means that we are suggesting the use of formula, so there is already a misunderstanding about our recommendations
regarding formula versus breastfeeding.”
Add to that the misguided assumptions that these women would understand how to use the formula. Not only was the women’s trust put
at risk, but so was the health their infants. Morga notes that the CARE Clinic has since replaced the manufacturer bags with ones customdesigned for the refugee families.
“That is just one example of so many different ways that someone not familiar with this environment could misinterpret information,” Morga
said, adding that it became apparent to the CARE Clinic leadership that a complete overhaul of the approach to communication and
education was necessary. “They had to look at everything through the patients’ eyes,” she said.
That was no small task, given that the refugees represented numerous cultures, each with different perspectives. “The CARE Clinic leadership
has learned that every incoming culture is a different learning curve, and every woman is a different learning curve,” Morga said.
Addressing that challenge required going directly to the refugee communities.
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“The CARE Clinic went to the wise women of these communities
– the women whose peers already looked up to them and trusted
them for guidance and information – and invited them in and trained
them in healthcare systems, and asked them how to best deliver
care,” Morga said. She noted that it’s not just about language
interpretation and translation, because there are concepts and
ideas that simply don’t translate. “How do you take a patient who
doesn’t know numbers or time, and explain medication dosing?
These women were able to help devise ways to explain that kind of
information. It’s interpreting in a true sense.”
“The role of the health adviser is the innovation that has made the
CARE Clinic so effective in building trust and increasing both patient
and provider understanding,” Hobbs said.
Morga credits Hobbs for her dedication to this effort through her role at the Family Center, as well as the hospital administration, which has
embraced the effort and supports it as one of its main approaches to community benefit. Morga said, SAMG physicians have worked to
develop the skills needed to serve this unique patient population, and have welcomed refugees into their practices when other providers
have largely wanted to close their doors. SAMG is also currently working to incorporate health advisors into the primary care model, to
provide supportive services and promote a greater level of patient-provider understanding than is available through interpretation services.
“These programs would not have been successful without support from a variety of sources,” said Corey Surber, Director of Advocacy and
Community Benefit for the Saint Alphonsus Health System. “These include the Trinity Health Call to Care Fund, physicians and staff who are
passionate about caring for our community’s most vulnerable patients, and the refugee peer health advisors who help refugee patients
navigate and understand the health care system.”
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Today, a referral network ensures that most expectant refugee women are enrolled within 20 weeks of gestation. The Clinic also helps to enroll
eligible patients for coverage they are entitled to the WIC, the Supplemental Nutrition Assistance Program (formerly known as “food stamps”).
CARE ensures that almost 100% of patients referred for specialty care are successful in making and keeping their follow-up appointments.
Improvements have been seen in birth weight, gestational age at delivery, complication rates and APGAR scores. Also, almost 100% of infants
born through CARE receive all recommended immunizations and achieve age-appropriate developmental milestones on time. Health educators
report increased understanding of infant care topics among new refugee parents.
And very importantly, refugees have reported dramatically increased levels of trust in western healthcare teams, resulting in increased
cooperation, understanding of medical guidance and improved self-care, said Hobbs.
The CARE Maternal/Child Health Clinic has been featured in the U.S. Agency for Healthcare Research and Quality Innovations Exchange, and
the Family Center has been approached by the World Health Organization for potential collaboration.
Following the CARE Maternal/Child Health Clinic’s Lead
One of the most important lessons learned in the development of the
CARE clinic is that cultural competency is a journey, not a destination,
Hobbs said.
Any program designed to meet the needs of refugees should
consider that merely translating educational content is not sufficient
for providing appropriate care. Information must be relevant, based
on cultural norms and understanding.
When these concept are kept in mind, the CARE project model,
as well Curbside Care, are highly replicable programs. In fact,
Saint Alphonsus Regional Medical Center has already responded
to requests to appear at national diversity conferences, and has
fielded requests to provide consultations. Plans are also under way
to assemble a toolkit to guide replication efforts.
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Community Fitness Initiative (CFI) - Lexington
Lexington Regional Health Center – Lexington, Nebraska
“When CFI first started, it was really exciting to have something to go to with
the family and not worry about the cost and feeling like it was burdensome
to go and have all of my kids with me. I have four children and being
involved is not always an easy thing to do. I feel that CFI does a great job
of wanting families to be together as often as possible in everyday life
happenings. They encourage family mealtimes and give great suggestions
for kids of all ages, they emphasize the importance of the family cooking
the meals as a group, and they encourage some form of exercise as a family.
… I am grateful that it is free and we have the opportunity to go and be
part of the program.”
– Mrs. Maria Aguirre, middle school teacher and mother of four
The Program
Maria’s story is just one example of how CFI-Lexington’s efforts to improve the health and
well-being of Lexington’s citizens have extended beyond the schools and into the homes
and family lives of the children it serves. Inspired by the healthful messages and activities
of the program – and by the positive effects they were having on her children – Maria
not only encouraged them to stay active in the program, she took the messages to heart
herself and began a fitness and nutrition program. She has lost more than 80 pounds, and
for the Aguirres, participation in CFI-Lexington activities remains a family affair.
CFI-Lexington is a community-based collaboration dedicated to improving the health and
well-being of Lexington’s citizens, especially students. Lexington Regional Health Center,
in partnership with the Lexington Public Schools, the City of Lexington and the Lexington
Community Foundation, sponsors the program, which provides school- and community-
Tiffany R. Carlson accepts the Program of Excellence award on
behalf of the Community Fitness Initiative (CFI) - Lexington
at the 2012 Hospital Charitable Service Awards Conference in
Atlanta, Georgia.
Contact CFI - Lexington
Tiffany R. Carlson
Program Coordinator
CFI-Lexington
@
Click the icons to engage with the Lexington Regional Health Center
via email, through Facebook or on the web and find out more
about the Community Fitness Initiative.
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based fitness camps and activities, including wrestling
camp, dance camp, a summer “splash and dash” event
and a football league. Additionally, one week each year is
deemed “Healthy Kids Week,” during which elementary
school students are presented with a number of healthrelated challenges, followed by an in-school fun run.
Health forums, held one Saturday a quarter during the
school year, provide educational programs on topics
such as growing fresh produce and healthy cooking. A
program entitled Integrating Physical Activity in the School
Day (iPASD), provided in collaboration with the University
of Nebraska at Kearney, combines physical activity with
daily curriculum in all elementary schools. More than
1,330 students participate each year, according to Tiffany
Carlson, program coordinator.
These activities represent the core programming of
CFI-Lexington, but many other events and activities are
held throughout the year. The success of the program is
apparent, from the excited children who ask Ms. Carlson
when the next CFI camp or event is, to improvements on the “health report cards” sent home with each student every year.
“CFI-Lexington decided upon inception that our success would be measured by changes in the body mass index of elementary students in
our community,” Ms. Carlson said, explaining that with the help of school nurses, who provide an enormous amount of support for the schoolbased aspects of the program, BMI data are collected and provided on the report card.
Since the third year of the program, the percentage of students who fall into the at-risk category (BMI greater than the 85th percentile), and
the overweight (BMI greater than the 95th percentile) category has decreased by 6%.
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“Although the incidence of at-risk and overweight students is still high, awareness and encouragement to lead a healthy lifestyle is beginning to
make a difference in the community,” Ms. Carlson said.
Even a local medical clinic has reported seeing the benefits of CFI-Lexington.
“Plum Creek Medical Group has been one of the various recipients of CFI’s influence. From the onset of the program, we noted the significant
prevalence of childhood obesity and the need to help our community become involved in programs that target youngsters so that they may
develop healthy lifestyles. CFI has, through its programming, developed education and activities for families. We at PCMG have been
able to see progress in weight loss through BMI measurements as wellness exams We have also had more parents bring their children in for
weight loss counseling due to the increased knowledge of the consequences of obesity, such as diabetes, hypertension, heart disease and
stroke,” said Dr. Francisca Acosta-Carlson, a family physician at the clinic, and the chief of staff at Lexington Regional Health Center.
Another success story involves Bryan Elementary School, which recently received a Bronze National Recognition Award through the American
Heart Association’s Alliance for a Healthier Generation program. Bryan Elementary’s remarkable efforts to transform itself into a healthier place for
students and staff were made possible, in part, by programs provided through CFI.
Keys to Success
CFI’s educational partnerships, along with “an extremely dedicated
and supportive community” and a shared goal of improving the quality
of life of Lexington’s residents are the foundation for the program’s
success, according to Ms. Carlson.
Buy-in and input from the public school system was a must. The fact
that the iPASD program is now a mandatory educational component
reflects the school system’s commitment.
Several school system representatives sit on CFI’s steering committee,
including teachers, school nurses and even the superintendent. They
serve as links to the target population.
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The city is also an integral partner in CFI’s success, allowing
coordination and collaboration with existing city-sponsored events,
access to city-owned facilities for free or at a reduced price and
access to other services that complement CFI’s efforts. A partnership
with the Lexington Community Foundation, which allows CFI to
operate as an affiliate under the 501(c3) designation, opens the door
for grant funding.
CFI reaches out to other business and community groups as needed
for individual events. This provides another avenue of support that
has contributed to the program’s success, Ms. Carlson said.
All of these partners, along with the hospital administrators who have
“believed 100% in the program,” she said. The parents and students
who continue to support the program events and activities are the
heroes of CFI-Lexington, Ms Carlson added. “We’re so proud of
what we’ve accomplished. These students will be better off because
of this program.”
Following CFI-Lexington’s Lead
CFI-Lexington is a highly replicable program, but there are a few
points to keep in mind.
First, be patient. According to Rael Woehrle, a CFI committee
member, changing unhealthy habits is not quick or easy, Ms. Woehrle
said, noting that improvements in students’ BMI weren’t apparent
until after the program’s third year.
A program like this requires a slow, staged process, and a willingness
to adapt as needs are identified and as it becomes apparent what is
working, and what is not.
Forging - and nurturing - partnerships with schools and the community
is also a must, as is a concerted effort to overcome inevitable
communication and cultural barriers.
“Weight and obesity are extremely sensitive subjects,” Ms. Woehrle
said. “We found that instead of being weight specific, a focus on
health, lifestyle and physical activity is the best approach for
overcoming hurdles.”
Also, it is important that cost never be an issue. As challenging as it
can be, grant and other funding sources should be sought to ensure
that programs are accessible to all, she said.
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The Concussion Program
Children’s Hospital Colorado – Aurora, Colorado
Fourteen-year-old Jake Snakenberg didn’t have to die.
And yet, less than 24 hours after the high school fullback took a standard tackle on the
football field, he was gone. Jake had suffered a catastrophic response to a concussive
brain injury.
It became immediately clear to everyone involved that there existed a major gap in the
general understanding of concussion.
Something had to be done to bridge that gap.
The Program
It took seven years and the concerted effort of numerous organizations and politicians, but
in March 2011, Colorado Senate Bill 40 – the Jake Snakenberg Youth Concussion Act was passed. Children’s Hospital Colorado joined others in crusading for the life-saving bill.
It was signed into law in an even more comprehensive version than originally sought, and
protects a wider range of children who might be affected by concussion. After this effort in
Colorado, Children’s Hospital Colorado went on to support similar legislation in Wyoming.
The “Concussion Bill,” as it is also known, ensures that coaches of all organized sports for
kids aged 11 to 18 are trained to recognize the signs and symptoms of concussion. It also
requires that athletes suspected of having concussions be removed from practice and play
until an appropriate healthcare professional evaluates and clears them.
Heidi Baskfield accepts the Program of Excellence award
on behalf of The Concussion Program at the 2012 Hospital
Charitable Service Awards Conference in Atlanta, Georgia.
Contact THE Concussion PROGRAM
Heidi Baskfield, JD
Director of Public Affairs
Children’s Hospital Colorado
@
Click the icons to engage with Children’s Hospital Colorado
via email, through Twitter, Facebook or on the web and find
out more about The Concussion Program.
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The need for the bill was very apparent to Children’s Hospital
Colorado. By the time the hospital became involved with the
legislation in 2009, the number of children treated in its own
outpatient concussion program had been rising at an average
rate of 32% per year for three years. Seven out of every 10
concussions were sports- or recreation-related, and most
occurred in children aged 11 to 17 years, according to Heidi
Baskfield, Director of Public Affairs for Children’s Colorado.
Today, a multidisciplinary “Concussion Team,” created by
the hospital after the bill’s passage, uses a comprehensive
approach to concussion awareness, treatment and prevention.
The team – which includes members from the government
affairs, community relations, marketing, public affairs and
internal communications departments, as well as doctors and
representatives from Children’s Health Advocacy Institute –
works with local organizations to teach coaches and parents
how to recognize, treat and prevent concussions.
Training is provided free to all who are interested at the main
hospital campus and several off-site locations.
As of early 2012, Children’s Hospital Colorado concussion experts had trained more than 1,335 primary care providers, nurses, coaches,
parents and athletes, and in more than 35 training sessions, Ms. Baskfield said.
The Concussion Team was also attracted media attention by enlisting the help of affected families who shared their stories. The Concussion
Program was featured by The Associated Press, The Denver Post, as well as several local radio and television stations and newspapers.
News of the program reached more than one million people.
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Most likely because of increased awareness to concussions in the
community, Children’s Hospital Colorado experienced a 20% increase
in 2011 of concussion patients. While the ultimate goal is to reduce the
risk of concussion and keep children out of the hospital, this increase
likely represents improved recognition of the concussion symptoms.
Keys to Success
Now that the initial surge of enthusiasm from the passing of the
Concussion Bill has subsided, Children’s Colorado has transitioned
from a proactive outreach strategy to a maintenance strategy. The
hospital plans a quarterly education series at various locations. For
parents, coaches, schools, and others who are interested members
of the Concussion Team continue to field questions about the program
from interested community members, and the marketing and physician relations teams continue to distribute educational information packets
as needed.
Children’s Hospital Colorado exceeded its goals and expectations for this program in its inaugural year.
When the program first started in 2003, the focus was on collaborating with multiple departments within the hospital, said Dr. Michael
Kirkwood, co-director of the Concussion Program.
“We worked with marketing and physician relations to develop educational materials, and then did outreach to pediatricians, family practitioners,
schools, sports organizations and athletic personnel,” he said.
Next, grant funding provided the means to create informational handouts. Then, details about the program began to appear in peerreviewed publications.
Among the keys to the program’s recent success were the ability to draw on previous hospital experience with the existing hospital concussion
program, and collaboration with the groups – including the Brain Injury Association of Colorado – that started the push for the legislation,
Ms. Baskfield said.
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The hospital took the lead on promoting the parts of the bill that
addressed training coaches and parents to spot concussions, and
that required athletes be pulled from play when a concussion was
suspected, she said.
Following The Concussion Program’s Lead
The collaborative work, which included involvement from the
Snakenberg family, resulted in the most comprehensive concussion
legislation in the country. The incredible push by hospital personnel
to illuminate the issue helped capture local and national media
attention, that further enhanced the program’s success.
“If we had known it would be so great, we would have had more of
everything – more staff, more collateral and more speakers to educate
coaches, parents and school personnel,” Ms. Baskfield said.
“So we really have grown substantially just in relatively short period
of time, and at this point we have a very integrated set of providers to
deliver a multidisciplinary approach,” Dr. Kirkwood said.
Those providers, and the ones who have cared for concussion patients
for years at Colorado Children’s, are among the heroes of the program.
Their commitment to caring for and protecting children compelled them
to work to get the legislation passed, Ms. Baskfield said. They came to
the government affairs team early on, saying, “This is really important.
The hospital should pay attention and get involved.”
Dr. Kirkwood also credited the Concussion Team for its expertise and
ability to drive interest in the program.
“We’re proud of the superb collaboration across multiple disciplines,
but the true heroes of the program are the parents and children who
experience the stress of injury and work in collaborative ways to get
the kids back to health,” he said.
One important lesson learned in the process of getting this program
up and running is to be prepared for an overwhelming response, Ms.
Baskfield and Dr. Kirkwood stressed.
For communities and hospitals interested in combining a legislative
process with program development as was this case for Children’s
Hospital Colorado, the process is lengthy, but rewarding. A legislative
strategy combined with an advocacy strategy is an exceptional
means for building awareness. In Colorado the penalties for failing
to comply were intentionally minimized, because the goal was
to create awareness and improve safety for those who participate in
athletics, not to discourage participation.
Also, enlisting support on both sides of the political aisle is important. A
bipartisan approach is always best, Ms. Baskfield said.
However, a strategy that involves legislation is not necessary for
developing a good concussion program, she said.
“At the very least, any hospital can provide education and information,”
she said.
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Diabeticos Saludables (Healthy Diabetics)
Memorial Health System of South Bend – South Bend, Indiana
“At first it was such a dark diagnosis. It was like, ‘you’ve got diabetes, now
you’re just one step from being dead.’ And now, thanks to this program,
I don’t feel that way at all. I feel like diabetes is just something I have, but
it’s manageable.”
– Charles Love, Diabeticos Saludables client
The Program
Diabeticos Saludables was the brain-child of Memorial Health System of South Bend
employee Leonora Battani. She encountered a patient hospitalized for complications
from diabetes.” The patient - a Mexican immigrant who spoke no English, could not read
Spanish and had no health insurance - had never even heard of diabetes. He knew his
condition only as “The Evil Eye.” Although he had tools at his disposal to help with
managing his disease, he had no idea how to use them properly.
At that moment in 2003, Ms. Battani recognized the need for a program that could
transcend both cultural and language barriers and open the door to improved care
for Latino patients. Ms. Battani proposed Diabeticos Saludables through a Memorial
Health System program that encourages employee innovation to drive change and create
high impact in a variety of areas.
Cost savings, which could be used to educate patients and improve their outcomes,
was among those potential areas of impact.
Leonora Oates De Dattani accepts the Program of Excellence
award on behalf of the Diabeticos Soludables (Healthy
Diabetics) program at the 2012 Hospital Charitable Service
Awards Conference in Atlanta, Georgia.
Contact Diabeticos Saludables
Leonora Battani
Manager of Language & Latino Outreach Services
Memorial Health System of South Bend
@
Click the icons to engage with the Memorial Health System of
South Bend via email or on the web and find out more about
Diabeticos Saludables.
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“The reasons that first patient was in the hospital could have been prevented with self-care. As an uninsured patient, his hospital stay resulted
in over $82,000 of expenses that were not paid. This same amount of money, invested in an education program, could provide many people
with the knowledge and tools to manage their condition and prevent them from being hospitalized in the first place,” Ms. Battani said.
Preventing hospitalization could also positively impact the
quality of life of many of the community’s neediest members.
Hospital administrators saw the potential value of such a
program and Diabeticos Saludables was born.
Patient education was the initial focus. In the early stages of
the program Ms. Battani and an assistant taught programs at
a community free clinic. The response was overwhelming and
immediate, and awareness of the program increased rapidly.
By 2004, the program moved out of the clinic and into its
own facility, and the program’s scope expanded to meet
the needs of the growing client base. Ms. Battani and her
team recognized a need for helping clients understand and
manage their conditions, so a case-management component
was added. Case managers often joined patients on doctor
visits, serving as both interpreter and advocate.
Ms. Battani recalled one remarkable case involving a woman
who had seven miscarriages as a result of gestational
diabetes. When she became pregnant again, she approached
Diabeticos Saludables, seeking assistance with managing her condition.
“We worked with her through 30 weeks of her pregnancy, going to the physician with her, making sure she understood everything. We talked
with her, visited her in her home, did whatever was needed to help her understand and recognize signs of a problem that should be addressed
by her doctor,” Ms. Battani said. “She gave birth to a beautiful seven-pound baby girl, and we all cried. It was one of the most touching stories.”
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That represents one of many positive stories of clients helped through
this program, she said.
Diabeticos Saludables comprises case management and a four-unit
monthly educational component, developed under the guidance of
the American Diabetes Association. Clients are expected to attend
Zumba classes twice monthly. The classes are not only healthful
habits that promote improved diabetes control, but they also are a
time of fun, fellowship, encouragement and trust-building.
Between 2004 and 2008, the number of clients participating in the
program increased from 26 to 277. Now, more than 340 participate.
The results have been so astounding that the medical community
began to take notice. Many physicians tell Ms. Battani that they always
know when their patients have been part of Diabeticos Saludables.
“Our patient are those who expect to have their feet checked, who
have their blood sugar levels consistently recorded, and who are
being proactive about their condition,” she said. In 2009, Ms. Battani
was asked to expand the program to include not just Latinos, but all
medically underserved, hard-to-reach diabetics.”
Today the program serves a diverse group of people. Classes are
provided in English and Spanish. Clients are provided with free blood
sugar meters and test strips, and are held accountable for using them
and reporting the readings.
Of the 340 clients served by Diabeticos Saludables in 2010, not one
experienced a diabetes-related hospitalization, and participants’
hemoglobin A1C levels were lowered by an average of two points
over a one-year period. This indicates markedly improved blood
sugar control and suggests that the program is generating positive
returns in many arenas.
Keys to Success
Diabeticos Saludables is a relatively straightforward and inexpensive
program. A five-member team consists of a program manager,
information coordinator and three case managers. About 25% of the
revenue needed to meet the annual $93,700 budget is generated by
interpretation services provided by the team, and additional support
is provided by Memorial Health System of South Bend.
Several factors contribute to the program’s success, according to
Rebecca Zakowski, Replication and Program Specialist for Memorial
Health System.
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One factor is collaboration with community partners, including a county
health coalition, a health center, a neighborhood clinic, an area university
health service and several local physician practices.
Another is the diversity of the program team, which is a reflection of
the diversity of the client base. This allows trust-building, because the
team members can relate well to the clients and their needs, she said.
The true heroes of the program, though, are the patients, Ms. Battani said.
“They make it work, because they make the changes. We are just
the guiding hand,” she said, explaining that despite the challenges of
low income and very little literacy, they have great attitudes, and “do
marvelous things to improve their health.”
Ms. Zakowski insisted that Ms. Battani – who had the vision for the program and who has worked tirelessly to ensure its success – is a hero, too, as
is the hospital administration, which provides unfailing support.
Goals for the near future include extending the program to include families. Long-term goals include a full-service health clinic that would allow
a myriad of health conditions to be addressed in culturally supportive and appropriate ways.
Following Diabeticos Saludables’ Lead
Diabeticos Saludables is a highly replicable program, particularly given its relatively low cost.
Among the steps to developing a similar program: Working with community partners, paying careful attention to the patients to learn what they
need to achieve control of their health, and being willing to grow and change as needed are among the steps to developing a similar program.
For those interested in learning from the experiences of Diabeticos Saludables, program pathways and resources have been assembled are
available, along with coaching, to those who want to serve the community in a similar way.
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30

Forensic Nurse Examiner Program
Bon Secours St. Mary’s Hospital – Richmond, Virginia
“Sondra,” an elderly victim of a brutal sexual attack in her own home by a stranger, arrived
at the emergency department battered and traumatized. Instead of being subjected to
a methodical clinical examination in a typical chaotic emergency department, she
was placed in the caring hands of a Bon Secours St. Mary’s Hospital Forensic Nurse
Examiner. The specially-trained nurse escorted her to a private, quiet, comfortable
setting outside of the emergency department where she was examined, and evidence
was carefully collected. The nurse called a rape crisis center in her community to ensure
she received the follow-up care the woman needed to cope with physical and emotional
effects of the violent attack. A counselor from the center made contact before “Sondra”
even left the hospital. The chain of support flowed seamlessly, and not only did
“Sondra” receive the support she so desperately needed, but because of the expertise
of the forensic nurse examiner in evidence collection, her attacker was identified and
ultimately convicted.
The recovered evidence was obscure, but by knowing exactly where to look, the nurse
helped give “Sondra” the justice and closure she needed, and helped put a criminal
behind bars.
“I feel confident that this particular piece of evidence would have been missed if it hadn’t
been for the nurse’s training. Under the old system, the ED staff would never have been
trained to look there and to package it properly,” said Bonnie Price, a forensic nurse and
the director of the program. “She would have been discharged with a sheet advising her
to see a doctor. She may not have had counseling support unless she sought it out on her
own. The process certainly wouldn’t have been seamless.”
Mary Catharine Ginn-Kolbert accepts the Program of
Excellence award on behalf of the Forensic Nurse Examiner
Program at the 2012 Hospital Charitable Service Awards
Contact THE FORENSIC NURSE EXAMINER PROGRAM
Bonnie Price, DNP, RN, SANE-A, SANE-P
Director
@
Click the icons to engage with St. Mary’s Hospital via email or on the
web and find out more about the Forensic Nurse Examiner Program.
Instead, because of the Forensic Nurse Examiner program, “Sondra” considers herself
“one of the lucky ones.”
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“The St. Mary’s nurse testified in court for me, which helped send the defendant to prison for a long time. Without her collecting that
evidence and telling me about support groups out there that could help me, I would not have made it,” she said.
The Program
In 1993, two years before forensic nursing was recognized
officially by the American Nurses Association, three
Bon Secours St. Mary’s Hospital nurses saw a need
for specialized care for sexual assault victims of all ages.
“We knew the emergency room wasn’t the optimal
setting for patients coming in reporting sexual assault or
abuse,” said Ms. Price, one of those three nurses who
eventually became the founding members of the Bon
Secours St. Mary’s Forensic Nurse Examiner Program.
Furthermore, nurses at that time typically received little or
no training in working with this vulnerable and underserved
population. So when, by coincidence, she and her
colleagues learned about a five-day Sexual Assault Nurse
Examiner training program, they were eager to attend.
Less than four hours after the training ended, one of them
was called upon to put her new skills to work in the ER.
In the first year, the team performed 42 examinations, and as local law enforcement became aware of these specially trained nurses who could
properly collect evidence and who would testify in court, they began bringing more victims to St. Mary’s. Today, the St. Mary’s forensic nurses
care for more than 100 victims in 23 jurisdictions each month. In addition to sexual assault, the program also receives requests to help victims of
domestic abuse, elder abuse and other assaults.
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More than half of the victims the nurses see are under the age of
18 years, and most of these are pediatric patients under the age
of 5 years.
These are striking, heart-wrenching statistics that underscore the
need for the program.
With support from St. Mary’s parent health system (Bon Secours),
and generous corporate and individual donors, the program now
includes 10 forensic nurses who are on-call 24 hours a day, 7 days
a week.
This is achieved through extensive training and collaboration with
various community partners, which run the gamut from small domestic
violence shelters to large organizations such as the Commonwealth
Attorney’s office. Each is a champion for the program, willingly sharing
a wealth of knowledge, experience and wisdom, she added.
“One really smart thing we did was to form an advisory board early
on, made up of all the multidisciplinary agencies that we work with,”
she said. The group would meet and help point the program in the
right direction.
Another factor in the program’s success was the development of
the Regional Hospital Accompaniment Response Team, an alliance
of representatives from a number of organizations that serves as an
advocacy program for people who have experienced domestic and/
or sexual violence.
“These trained volunteer advocates assist victims with emotional support
during hospital visits and with follow-up referrals and information,
including counseling, intervention, advocacy and resources.”
Keys to Success
“Our program is about changing lives. It’s about giving back to our
patients some sense of the control they lost during their attack,” Ms.
Price said.
These partners, along with hospital administrators, Bon Secours
(which has embraced this program as part of its mission) and the
nurses who dedicate their lives to this program, are among the
heroes of the Forensic Nurse Examiner Program. First and foremost,
the heroes are the women, children and men who come through this
most horrific, traumatic experience and emerge as survivors, Ms.
Price said.
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Following St. Mary’s Lead
The Bon Secours St. Mary’s Forensic Nurse Examiner Program has
achieved much success in its 18 years, and has been instrumental in
helping a number of hospitals launch similar programs by training
more than 1,000 nurses across the United States and around the world.
Among the advice program coordinators offer to others interested in
starting similar programs:
Develop an Advisory Board. From the start, the program leaders
established an advisory board of community officials, survivors of
sexual assault, rape crisis advocate agencies, law enforcement, social
services organization representatives, attorneys, forensic scientists,
medical examiners, the forensic nurse team and hospital leadership.
The board is essential for helping to guide the overall direction of the program and for identifying areas of need, so the program can continually
expand to reach underserved communities.
Build parameters. When starting out, the need can appear so great compared with the availability of trained nurses that it is easy to become
overwhelmed. Start small by serving a few communities, and expand the program to new areas – and to include additional services – as the
resources become available.
Consider the family. Victims aren’t the only ones affected by violence. Families and communities are affected as well, and in many cases,
patients may disclose to the forensic nurse that domestic and/or sexual violence occurs in their own home. Or, perpetrators may be trusted
members of the community (such as parents, coaches, teachers, or clergy) who abuse numerous individuals before being caught. This can be
devastating not only to the current victim, but to the entire community, and it is important that the needs of all of those affected be considered.
Look out for each other. Forensic nursing is immensely rewarding, but also physically and emotionally harrowing. Reality differs vastly from
the television dramas that suggest an examination is quick and painless, with guaranteed criminal conviction and emotional resolution. In fact,
an exam takes about 4.5 hours, and the on-call nurses often work grueling hours. The emotional toll this job takes on nurses is real and
pronounced, and an ongoing effort to recognize and address these effects is essential to the success of the program.
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34
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Healthier Laramie County
Cheyenne Regional Medical Center – Cheyenne, Wyoming
Healthier Laramie County is all about expanding access to healthcare, and improving the
health and quality of life for patients like “Sally,” an uninsured patient with diabetes who lives
well below the poverty line. She was going to the emergency department at Cheyenne
Regional Medical Center four or five times each month because of complications with
her diabetes. But now because of Healthier Laramie County, instead of just “patching
her up and sending her home,” an effort is made to ask questions about why she is
back, and what can be done to help her avoid ED visits. In her case, the problem was
largely one of a lack of access to necessary medications and nutritious foods.
One initiative of Healthier Laramie County is a pharmacy program, where patients such
as “Sally” can be referred to receive free or reduced-cost medications, which are either
donated or provided by the hospital, according to Dr. Phyllis Sherard, Director, Office
of Community Health Improvement.
“We’ve been able to send her to our health and wellness center to provide her with a
medical home. She is able to get her medications from the pharmacy there, and she
gets assistance from a health coach. The coach, who works with her on her behaviors,
realized her primary source of food was a food bank where she was provided with high
carbohydrate foods that are like poison for a diabetic,” Dr. Sherard said.
Since the food bank is also a partner of Healthier Laramie County, the program enlisted
the help of a dietitian to ensure that diabetics who rely on the food bank are provided
with diabetic-appropriate food boxes.
Diane Hoggerty and Tracy Brosius accept the Program of
Excellence award on behalf of Healthier Laramie County at
the 2012 Hospital Charitable Service Awards Conference in
Atlanta, Georgia.
Contact THE Homeless Initiative
Dr. Phyllis Sherard
Director
Office of Community Health Improvement
Click the icon to engage with Cheyenne Regional Medical Center on
the web and find out more about Healthier Laramie County.
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“We’re addressing many of the reasons why Sally was
continually in the emergency room,” Dr. Sherard said, adding
that “Sally has also been connected with health-related
social services, and hasn’t been seen in the emergency room
for more than a year!”
The Program
Sally’s story is one that has been repeated many times involving
patients suffering from of chronic diseases since Healthier
Laramie County’s inception in 1997. Cheyenne Regional Medical
Center set out to improve the health of the community with a
deliberate, thoughtful, data-driven process – recommended by
the Centers for Disease Control and Prevention – to identify the
greatest needs in vulnerable populations.
Very early on, it was determined that the focus of the program
would be addressing all detriments to health, not just on
providing charity care. The program would work to encourage
people to change negative health behaviors and improve the
health of the community through safety and improved air and
water quality, Dr. Sherard explained.
Cheyenne Regional sponsors a team of 65 community partners that supports Healthier Laramie County and identifies subject matter experts
from across the country who form workgroups that select the best or most promising practices for meeting the community’s needs.
“These workgroups are charged with envisioning how these conditions can be improved with existing resources, as well as where new resources
may need to be acquired to achieve improved conditions of well being,” she said.
Disciplined data collection and analysis remain the cornerstone of effective strategic planning and communication among the partners. Periodic
needs assessments set priorities for the program, and serve as a guide for purposeful and efficient placement of community benefit resources.
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The most recent needs assessment in 2009 illustrated that the
county’s safety-net system was not adequately serving the most
vulnerable populations: low-income, uninsured and under-insured
people. Cheyenne Regional Medical Center believed that by improving
access to primary care and medications, and by enhancing patient
engagement, substantial cost reductions would result. Fiscal year
2010 data indicated that “self-pay” patients were billed $31 million in
hospital charges. More than half of the self-pay patients did not have
a primary care provider, and about one-third of the charges were for
care of patients with chronic diseases.
The program’s response to these needs led to an increase from 471
patients receiving 2,110 prescriptions from the centralized pharmacy
in 2009, to 1,595 patients receiving 12,220 prescriptions in 2010. Also, in 2011 Laramie County moved up in the rankings from 17th to 16th of 23
Wyoming counties in terms of overall health.
The program’s ultimate goal is to make Laramie County the healthiest in the state and in the country.
Among the program’s achievements as it responded to various needs assessments, are:
•Establishment in 2000 of a free clinic known as the Cheyenne Health and Wellness Center, which in 2005 became a non-profit, federally qualified
community health center providing primary acute, chronic and preventive health care services to those who might not otherwise have
access to primary healthcare or dental care.
•Passage of a state statute in 2006 allowing donated medication to be dispensed by licensed pharmacists to low-income, uninsured residents.
This led to the opening of the Laramie County Centralized Pharmacy, which provides one-stop prescription assistance to people in need.
•Establishment in 2010 of a patient-centered medical home, a safety-net pilot program to engage with patients who struggle with chronic
disease and access to care.
Not only have these initiatives improved the health status of Laramie County residents, but they have also reduced the costs of providing care
to vulnerable populations, Dr. Sherard said.

37

Keys to Success
The data-driven approach to community planning that characterizes Healthier Laramie County is at the core of the program’s success. It is this
process that has guided Cheyenne Regional Medical Center’s continued financial investment in the program, Dr. Sherard said.
She also credits the collaborative and disciplined approach to identifying and addressing needs. It takes time for health system
development to mature, and patience is required as partners progress through various states of system enhancement, she said.
The heroes of Healthier Laramie County are those who exercise that patience as they build trust and take small steps in the process
of change. This includes the hospital’s board, which recognized that in order to improve health in the community, all determinants
of health had to be addressed. It also includes the volunteers and organizations that have remained engaged over the years, diligently
identifying the gaps and developing partnerships so that resources can be leveraged to bridge those gaps.
Following Healthier Laramie County’s Lead
Collaboration is not just about systems, it’s about people, Dr.
Sherard said.
“When you bring multiple likeminded organizations to the table it can be
a very messy process,” she said. “Building consensus and avoiding
the inevitable turf wars can be overcome by team-building and an
objective approach to setting priorities.”
Her advice?
“Use data, use data, use data!” she said. “The fact that the direction
we set was based on data removed a lot of that conflict.”
That said, the program is certainly replicable, and Cheyenne Regional
Medical Center is willing to share its experiences with others interested
in launching similar programs.

38

Homeless Initiative
Cook Children’s Health Care System – Fort Worth, Texas
“They don’t fail you. They don’t give up on you.”
– A 10-year-old homeless boy on the care he received through
Cook Children’s Homeless Initiative
The Program
“Anna,” a struggling young mother of two children, was pregnant with her third child when
she arrived at the homeless shelter. She received the food and lodging she so desperately
needed but she also received something more. Cook Children’s Health Care System’s
Homeless Initiative ensured that her children also got much-needed healthcare. When
she finally had the opportunity to transition back to the community, the program’s nurse
case manager encouraged her to seek care for her baby at one of Cook Children’s
neighborhood clinics, once he was born. The Homeless Initiative staff didn’t know whether
they would see “Anna” again. But she had taken the case manager’s advice to heart. One
day, after a two-hour bus trip with two children and a newborn, she arrived at the clinic,
which became a medical home for her children.
“A two-hour bus ride with a baby and two children! To me that’s such a powerful testament
to what this mom learned about how important it is to get her children’s health care needs
met,” said Ginny Hickman, Assistant Vice President of Community Health Outreach for
Cook Children’s Health Care system.
That’s what the Homeless Initiative is all about.
Ginny Hickman accepts the Program of Excellence award
on behalf of the Homeless Initiative at the 2012 Hospital
Charitable Service Awards Conference in Atlanta, Georgia.
Contact THE Homeless Initiative
Ginny Hickman
Assistant Vice President
Community Health Outreach
@
Click the icons to engage with Cook
Children’s Health Care System via
email, through Twitter, Facebook,
YouTube, Pinterest or on the web and find out more about The
Homeless Initiative.

39

Homeless Initiative
Before Cook Children’s launched the Homeless Initiative,
“Anna” and other parents like her in Tarrant County, Texas,
felt they had little access to child healthcare. About
90% of healthcare services for homeless children were
accessed through hospital emergency departments;
well-child healthcare needs were woefully neglected.
In late 2007 and early 2008, in response to needs identified
by the mayor of Fort Worth and by a Blue Ribbon Task
Force on Health Care for the Homeless, Cook Children’s
began developing a plan to meet those needs and to
provide seamless care for homeless children.
Cook Children’s found that routine healthcare and sick
child care were not being accessed by shelter residents,
and the possibility of securing or maintaining a medical
home was not something homeless families even thought
about. The shelters provided lodging, food and case
management services, but resources for addressing health
and psychosocial needs of the children were limited.
“Our goal was to create a medical home for these children and to provide them with case management services needed to minimize the
negative impact of being homeless,” Ms. Hickman said.
Cook Children’s now provides these services in three homeless shelters in Tarrant County and through five neighborhood clinics. The clinics
provided the ideal setting for medical homes for both shelter residents and those who transitioned back into the community.
In addition, Cook Children’s provides a dedicated social work case manager to attend to non-health care needs, partners with the county public
health department to provide tuberculosis testing and flu vaccines at the shelters, funds transportation to the clinics and provides educational
classes on various parenting and health-related topics at the shelters.

40

Homeless Initiative
A nurse case manager collaborates with community partners to extend services to include dental and vision care. The social worker case
manager collaborates with more than 60 non-profit organizations to provide other much-needed services to the sheltered children.
Cook Children’s employees have shown their dedication to the Homeless Initiative, providing countless volunteer hours and donating
much-needed items.
The efforts of Cook Children’s Health Care System, its employees and the community mean more than 600 children received dental, vision,
behavioral health and specialty care as of September 2011.
A particularly telling statistic about the positive impact of the Homeless Initiative is that only 26% of emergency department visits for homeless
children now are for services that would be best provided in a primary care setting, compared with 90% prior to the Initiative. The most
significant outcome is that more than 200 children have continued to use the neighborhood clinics as medical homes after leaving the shelters.
“Those children now have the opportunity to receive comprehensive preventive healthcare and the ability to travel with ease through the range
of health services at Cook Children’s,” Ms. Hickman said.
Keys to Success
Homeless children are an especially vulnerable and often invisible
group whose need for routine primary healthcare and nurturing of
their development can easily be overlooked. In Tarrant County, those
needs are now being met by champions in the community and a
healthcare system that shed light on the problem, created and then
carried out a solution.
An action plan started with a national initiative under President George
W. Bush, and was followed-up with a local initiative led by then-Mayor
Mike Moncrief. Cook Children’s President and CEO, Rick W. Merrill,
also took up the cause and challenged Cook Children’s to “wrap our
system and its resources around the children,” Ms. Hickman said,
noting that he considered the guiding principle of the program to be
a willingness to “treat these children as if they were our own children.”

41

Homeless Initiative
The heroes of this initiative are people at both the national and local
levels, shelter staff and health system employees, all of whom supported
the program’s efforts. Ms. Hickman also cited as heroes the families
who were open to receiving services and education, and who have
pursued medical home-based care for their children even after leaving
the shelters.
Much of the success of the program lies in the willingness of those
who developed it to visit the shelters, talk with the staff and learn about
the problems and needs firsthand.
Using existing resources, such as the neighborhood clinics, as a way
to expand the program also contributed to its success.
One particularly “unintended and wonderful consequence” of
the program was the hiring of several homeless adults who were
identified through Cook Children’s work with the shelters. Security staff
members who assist with transportation recognized these individuals’
potential value as employees of Cook Children’s. Several have been
hired, and eventually moved on to other employment; and two have
stayed on and serve as exemplary employees, Ms. Hickman said. The
Homeless Initiative provided homeless adults with a way to re-enter
the workforce.
Following the Homeless Initiative’s Lead
The Homeless Initiative provides a unique model for other health
care organizations that want to launch similar programs to serve the
homeless children in their communities. It is a model that represents
the importance of working in collaboration with local government, local
shelters and multiple community agencies to identify and address true
needs rather than imposing the ideas of the program organizers.
Engaging the entire healthcare system, from administrators to physicians
and nurses to social services staff and beyond, is also imperative, Ms.
Hickman said, noting that top-down support and leadership is a must
to ensure appropriate resources are allocated to the program.
This allows those at the staff and community levels to coalesce around
something important and fulfilling.
“It can be a wonderful opportunity for a system to collaborate internally
in ways they haven’t before to achieve a greater good,” she said.

42

Memorial FIT Kids
Memorial Healthcare – Owosso, Michigan
When the Michigan Department of Community Health reported that almost 60% of
Shiawassee County residents were either obese or overweight, more than one-third weren’t
getting adequate physical activity and that almost 80% weren’t consuming recommended
amounts of fruits and vegetables, Memorial Healthcare knew something had to be done.
Funding provided by the Memorial Healthcare Foundation established Memorial FIT Kids
to educate more than 1,000 6th graders every year about the importance of reducing
cardiovascular disease risk factors. That message is getting through.
The Program
Memorial FIT Kids was launched in 2005 to combat the rapid increase in childhood
obesity in the Shiawassee County region of Michigan. Initial objectives were to determine
the cardiovascular disease risk factor profile of all 6th graders in the region, and to educate
students about creating healthy behaviors.
Assessments of all 6th graders between 2005 and 2008 in the 10 surrounding public school
districts in the region, and also in parochial schools indicated that 36% of the approximately
4,200 students had three or more cardiovascular disease risk factors, putting them in
danger of atherosclerosis at an early age.
All of the students participated in a one-hour educational program focusing on lowering
risk factors, and in 8th grade, they were resurveyed for assessment of body mass index,
physical activity level and dietary habits.
Rebecca Dahlke and Catherine Stevenson accept the
Program of Excellence award on behalf of the Memorial
FIT Kids at the 2012 Hospital Charitable Service Awards
Contact FIT Kids
Rebecca Dahlke
Facilitator
Memorial FIT Kids
@
Click the icons to engage with Memorial Healthcare via email,
through Facebook or on the web and find out more about Memorial
FIT Kids.

43

Memorial FIT Kids
In 2008, the program took a more proactive approach to the
educational component by partnering with a communityUniversity of Michigan Health System collaborative known
as Project Health Schools, which provides instruction to
reduce obesity and related long-term health risks.
Students now participate in a series of 10 classroom
lessons on cardiovascular health, which include fun,
interactive activities designed to encourage students to:
•Eat more fruits and vegetables
•Make better beverage choices by reducing highsugar drinks
•Exercise at least 150 minutes each week
•Eat less fast foods, and fewer fat-laden foods
•Spend less time in front of the TV and computer
A follow-up assessment of the first group of students
who went through the program demonstrated substantial
reductions in resting heart rate, total cholesterol and lowdensity lipoprotein cholesterol (LDL, or “bad” cholesterol),
and an increase in high-density lipoprotein cholesterol
(HDL, or “good” cholesterol). The students had increased their intake of fruits and decreased their intakes of fried foods. They also reported less
screen time.
In 2010-2011, the results were even more impressive, with significant improvement on 7 of 9 physiological screening factors, according to
Rebecca Dahlke, the program facilitator.
In addition to the Project Healthy Schools program, FIT Kids continues to provide two interactive lessons each school year, one on nutrition and
one on physical activity.

44

Memorial FIT Kids
“They love it,” Ms. Dahlke said of the kids’ reactions to the program.
She described one lesson that involves making homemade salsa with
the kids.
“It’s amazing to watch them make it – and eat it!” she said, adding
that many have no experience with cooking, so it really opens doors
for them to try new, healthy foods.
The Memorial FIT Kids program has filled a necessary gap in the
needs of the Shiawassee County region. It has become the go-to
organization for people and groups that want to tackle the problem
of childhood obesity, and has served as a strategic partner in similar
programs in the community, Ms. Dahlke said.
Keys to Success
Collaboration and ongoing partnership with organizations such as
University of Michigan, which has provided 6th grader screenings
for the FIT Kids program and developed the Project Healthy Schools
program, a cornerstone of FIT Kids’ success, Ms. Dahlke said.
The program’s relationship with schools is also an important component,
as is its partnerships with organizations such as the YMCA, which
provides the physical activity education in schools that aren’t part of
the Project Healthy Schools program.
“All of our schools show extreme enthusiasm in working with the program,”
she said. Ms. Dahlke noted that her background as an educator has been
a plus when it comes to building relationships with the school system.
“They trust me and they trust my programs, which makes a huge
difference in the ability to explore new things,” she said.
She also credits generosity in sharing information and best practices
among all organizations working to reduce childhood obesity.
Collection of measurable data has been a particularly useful aspect
of the program, as it helps document success and drive future goalsetting, and promotes the development of the true cornerstones of
change: education and intervention, she said.
The heroes of FIT Kids are these organizations, the school system (and
the excellent teachers who are so willing to promote the programs), the
University of Michigan – which serves as an excellent resource – and
Memorial Healthcare, which provides tremendous support, she said.
Following FIT Kids’ Lead
FIT Kids is a solid program that is really making a difference for children
in Shiawassee County, and it is most definitely a program that other
hospitals and communities can replicate, Ms. Dahlke said.
In fact, others have successfully done so, she added.
Working with other community organizations that have similar goals or
that have resources to share will help in the process, as will engaging
parents, which is easier said than done.
“Kids can’t do this on their own,” she said. “We need to provide them
with an environment that is hospitable to making healthier choices.”

45

What’s Your Story?
Many hospitals consistently push beyond their core mission of providing essential healthcare services and generously give back to the communities
they serve, through education, screenings and free care. It’s time these stories of compassion and commitment are recognized and rewarded.
Click the button to join the cause and share how your hospital makes a difference.
Nominate A Program
The Hospital Charitable Service Awards program is forging a network that helps hospitals
connect with one another to share their program models, experiences and successes in
improving the health of the communities they serve. We hope this collaborative spirit will
spread to other hospitals and communities for the benefit of all.
It is our mission to:
Jackson Healthcare
2655 Northwinds Parkway
Alpharetta, GA 30009
•Create greater awareness of the amazing gifts hospitals offer communities through
education, screenings and other community service programs
www.jacksonhealthcare.com
[email protected]
770-643-5500
•Celebrate the accomplishments of hospitals that go beyond the minimum community
benefit requirements and truly invest in caring for the underserved
•Share existing “best practices” for delivering and funding community benefit initiatives

Return to the previous page
•Connect hospitals with innovative approaches and new opportunities to serving
the underserved
Except where otherwise noted, this work is licensed under
http://creativecommons.org/licenses/by-nc-nd/3.0/
Published in 2012
Published in 2011
Sponsored by

Healing Communities - Jackson Healthcare

Transcription

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