Health & Wellness Alliance for Children

Common Agenda

What is The Alliance?

Who We Are• Coalition of community organizations established to improve the health and well being of

children in Dallas County 

• An organized & engaged group of community stakeholders aligned around a

common agenda for positive change in pediatric health (initially focusing on

pediatric asthma)

• Funded and supported by Children’s Medical Center

Who We Represent • The voice of children and their families

• Social service organizations

• Educators, universities, school districts & day care centers

• Faith-based organizations

• Hospitals and health clinics

• Government entities

• Donors

The Health and Wellness Alliance for Children – “It’s About the Kids” 2

Challenges and Focus - Asthma

Why Focus on Children’s Health?• Dallas County has cutting edge medical facilities and a community dedicated to its

children, yet the current state of children’s health in Dallas County is not in line with

the community’s vision:

- 29% of our kids live in poverty

- 18% do not have health insurance

- 28% have inadequate food and nutrition

Why Initially Focus on Asthma?• 60,000 children in Dallas have asthma, nearly 9% of all Dallas children

• Asthma is a manageable condition, yet:

- In 2010, 3 children per day visited a Dallas County hospital for their asthma

- In Texas, 54% of children with asthma missed at least one school day per year

due to their condition

- The cost of unmanaged asthma in Dallas (to families and medical facilities) is estimated at

$60M per year

• We can apply what we learn about the social and environmental determinants of

asthma to address other conditions in the futureThe Health and Wellness Alliance for Children – “It’s About the Kids” 3

The Health and Wellness Alliance for Children – “It’s About the Kids”

The Asthma Wellness Equation

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The Alliance Goals - Asthma

EVERY child with asthma achieves their fullest health, well-being and potential

• The Alliance seeks to reduce or eliminate the burden that asthma places on children,

families and the community by developing strategies that address each of the

components

of the asthma wellness equation.

• Indicators that the Alliance is evaluating to track progress include the following:

1. Hospitalizations due to asthma

2. Emergency department visits due to asthma

3. Average asthma control test score

The Health and Wellness Alliance for Children – “It’s About the Kids” 5

Approach to Achieving Our Goal:Collective Impact

Five Conditions of Collective Impact

The Health and Wellness Alliance for Children – “It’s About the Kids”

1. Common Agenda• Common understanding of the problem • Shared vision for change

2. Shared Measurement• Collecting data and measuring results• Focus on performance management• Shared accountability

3. Mutually Reinforcing Activities• Differentiated approaches• Willingness to adapt individual activities• Coordination through joint plan of action

4. Continuous Communication• Consistent and open communication• Focus on building trust

5. Backbone Support• Separate organization(s) with staff• Resources and skills to convene and coordinate participating organizations

Improved Access toHealth Care

Asthma-Healthy Physical Environments

Equipping Children and Families For Asthma

Wellness

High Quality Health Care

Connecting groups will support strategies across working groups

Working groups of community partners plan and implement strategies

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Steering Committee provides guidance and oversight

The Health and Wellness Alliance for Children – “It’s About the Kids”

Structure of Work

Policy Group Data Group

EVERY child with asthma achieves their fullest health, well-being and potential

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FSG.ORG

© 2013 FSG

Every child with asthma achieves their fullest health, well-being, and potential.1. Child hospitalizations due to asthma in Dallas County 2. Child emergency department visits due to asthma in Dallas County 3. Asthma control test (ACT) scores for children in Dallas County

Health and Wellness Alliance Goals & Indicators

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Create awareness and sense of power among children and families regarding asthma management.

Equipping Children & Families for Asthma

Wellness

% of children / families who report asthma interfering with home/work/school on the Asthma Control Test

# parents or # kids participating in education sessions# community members trainedKnowledge change after education

Remove barriers for families to get the necessary care and medications they need to manage asthma.

Improved Access to Health Care

Medication possession ratio % of children with asthma who have had a preventive care visit in the last 12 months

Families perspective on whether they can get the primary care they need to manage asthma

ER & hospital repeat visit rates

# alternative primary care appointments created# of navigation guides distributed.

Create safe places for children to live, learn and play free from asthma triggers.

Asthma-Healthy Physical Environments 

Prevalence of triggers in targeted households

% of schools in Dallas County who implement indoor air-quality guidelines of Tools for Schools program

# daycares implementing indoor air quality guidelines# of day cares or schools implementing flag program

Ensure that medical care providers have accessible and consistent information about childhood asthma.

High-Quality Health Care

Controller to rescue medication ratio

% of children who visit hospital or ER who have PCP follow up within 14 days

% of children who have had ACT score recorded

% of children who have an asthma action plan

# of organizations who agree to use universal AAP# physicians participating in asthma-specific training

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FSG.ORG

© 2013 FSG

Working Group Strategies DRAFT

Equipping Children and Families for Asthma WellnessTesting a holistic approach in Jubilee Park to include:• Screening for asthma (health fair-style) with information on

resources for medical care, insurance, and other items• Parent/caregiver education class with opportunity for parent

to identify specific actions he/she can take • Followup with parents to address challenges (phone and in-

person)Future strategies to include:• Create peer groups (same age, older to younger kids) to

teach, support, and encourage children with asthma• Deliver in-home education for parents/children• Train community residents to serve as community health

workers OR other asthma health literacy educators from the community to provide asthma education to families in their neighborhoods in variety of settings

Improved Access to Health Care• Make asthma medications more affordable by: 1.) Publishing guides for patients on how to get low-cost and

free medications 2.) Studying insurance coverage policies and, if necessary, advocating for expanded coverage of medications 3.) Working with pharmaceutical companies to provide medications

• Expand alternative forms of primary care such as shared medical appointments, walk-in clinics for asthma patients

• Create an asthma hotline or mobile app that families can use to address questions and concerns about asthma 24/7

• Create resources guides and/or navigational services to help families identify free and low cost asthma-related health care services and transportation

• Increase the portion of physicians who will accept Medicaid/CHIP patients by increasing the reimbursement

Asthma-Healthy Physical Environments• Assess and identify schools with high levels of allergens

and implement EPA indoor air quality tools

• Partner with day cares to implement indoor air quality tools

• Work with city inspectors to add relevant environmental questions to daycare checklists

• Targeted in-home environmental trigger identification and interventions in areas of high distressed housing

• Enact anti-idling policies in areas frequented by children/families

• Coordinate high-ozone day programs (flags, billboard warnings) with clear messages for citizen action, using new technology as possible

• Align with existing North Texas air quality initiatives  

High-Quality Health Care• Work towards universal usage of standardized asthma

action plans by all providers in Dallas. This involves encouraging providers who don’t use a plan to do so, recommending the use of standardized plan(s) by all providers, and recommending that electronic health record systems contain standard asthma plan components

• Train providers (MDs, PAs, NPs) on ERP-3 guidelines and provide tools and techniques to have effective conversations with patients about asthma management

• Identify key messages/education tools related to asthma wellness for non-healthcare providers who may have contact with children with asthma. Families WG will work to equip those partners (i.e. coaches, daycare workers, teachers, faith community)

Ron J. Anderson, M.D., MACP Retired President and CEO Parkland Health & Hospital SystemJulie Bagley President Elect Junior League of DallasCheryl Boswell VP, Community Health and Well-Being YMCA of DallasBrent A. Brown Director bcWorkshopBill Dawkins Chief Financial Officer H.I.S. BridgebuildersJennifer Edwards UPSTREAM Population HealthRebecca Gruchalla, M.D. Prof. of Medicine & Pediatrics, UTSW Div. Dir. Allergy & Immunology Children’s Medical Center of DallasHolly Hassmann Vice President and Executive Director Health and Wellness Alliance for ChildrenSusan Hoff Chief Strategy Officer United Way of Metropolitan DallasLarry James President and CEO CitySquare

Suzanne Kubelka Director, Health Services DISDTori Mannes President and CEO Child Care GroupLeonor Marquez Chief Executive Officer Los Barrios Unidos Comm. ClinicJulie Martellini, PhD Epidemiology Program Planner Dallas County Health & Human ServicesJohn Martinez President Regional Hispanic Contractors Assoc.Cynthia Mickens Founder and CEO Cynthia Mickens MinistriesSue Pickens Director, Population Medicine Parkland Health & Hospital SystemPeter Roberts** EVP, Population Health and Network Dev. Children’s Medical Center of DallasMichael Samuelson Sr. Consultant Population Health Samuelson Health and Wellness Solutions

Eduardo Sanchez, M.D.** Deputy CMO American Heart AssociationPaula Selzer Regional Coordinator Children’s Environmental Health US Environmental Protection Agency Reg. 6John Siburt Vice President of Programs CitySquareJoyce Tapley Chief Executive Officer The Martin Luther King, Jr. Family ClinicAnne Thomas Executive Director AVANCE DallasCandace M. Thompson Community Outreach Manager Jubilee Park & Community CenterLarry Tubb Sr. Vice President, System Planning Cook Children’s Medical CenterRhonda L. Walton, M.D. Pediatrician CitySquare Community Health ServicesKeith Zimmerman Chief Executive Officer Medical City Children’s Hospital

**Steering Committee Co-ChairThe Health and Wellness Alliance for Children – “It’s About the Kids”

HWAC Steering Committee MembersSteering Committee Members as of April 1, 2014

**Steering Committee Co-ChairThe Health and Wellness Alliance for Children – “It’s About the Kids”

HWAC Working Group Members Working Group Members as of April 1, 2014

Asthma Healthy Physical EnvironmentsBrent Brown, bcWorkshop (Co-chair)

Paula Selzer, EPA (Co-chair)

Brooke Etie, LMSW, Dallas Housing Association

Loletha Horton, YMCA of Metropolitan Dallas

Nick Kunz, bcWorkshop

John Martinez, Regional Hispanic Contractors Association

Mindy Mize, North Texas Council of Governments

Kathryn McCartney, Head Start of Greater Dallas

Susan Spalding, M.D., Parkland

Whitney Vandiver, North Texas Council of Governments

Danielle Wesley, Children’s Medical Center

High Quality Health Care Leann Kridelbaugh, M.D., MyChildren’s (Co-chair)

Joyce Tapley, The Martin Luther King, Jr. Family Clinic (Co-chair)

Beth Dittman, Mesquite ISD, Health Services

Barry Lachman, M.D., Parkland Community Health Plan/Asthma Action Coalition

Tori Mannes, Child Care Group

Lori Millner, Texas Area Health Education Center East, UT Southwestern

Veronica Moore, Health and Human Services

Cassandra Singleton, PediPlace

Jill Strachan-Batson, M.D., Parkland Youth Family Centers

Equipping Children and Families for Asthma WellnessCheryl Boswell, YMCA of Metropolitan Dallas (Co-chair)

Anne Crowther, Children’s Medical Center (Co-chair)

Bonner Allen, Junior League of Dallas

Lisa Bracken, Educational Consultant and Project Management

Nathan Edgerton, United Way

Phyllis Kane, MyChildren’s

Cynthia Mickens, Methodist Health Center

Lister Robinson, Children’s Medical Center

David Thomas, Bryan’s House

Candace Thompson, Jubilee Park and Community Center

Improved Access to Health Care Anne Thomas, AVANCE Care (Co-chair)

Lois Trammell, Children’s Medical Center (Co-chair)

Valerie Bradley, City of Mesquite

Bill Dawkins, H.I.S. Builders

Bob English, DART

Suzanne Kubelka, Dallas Independent School District

Anthony Luedicke, R.Ph., Walgreen’s Pharmacy

Donna Persaud, M.D., Parkland

Hernan Reyes, M.D., HRSA

Larry Robins, PediPlace

Martha Rodriguez, Health and Human Services

John Siburt, CitySquare

Joanne Tenery, Parkland Community Health Plan

Matthew Thieman, PharmD, Walgreen’s Pharmacy

Ray Tsai, M.D., MyChildren’s