Bethlehem Partnership Annual Report 2011 by KSA&D Interactive

achieved, thereby improving the quality of life . It is believed that through community ship and shared responsibility, the physical, , emotional and spiritual wellness of individuals mmunities can be achieved, thereby improving ality of life for all. It is believed that through unity ownership and shared responsibility, the al, mental, emotional and spiritual wellness of uals and communities can be achieved, y improving the quality of life for all. It is d that through community ownership and responsibility, the physical, mental, emotional ritual wellness of individuals and communities achieved, thereby improving the quality of life . It is believed that through community ship and shared responsibility, the physical, , emotional and spiritual wellness of individuals mmunities can be achieved, thereby improving ality of life for all. It is believed that through unity ownership and shared responsibility, the al, mental, emotional and spiritual wellness of uals and communities can be achieved, y improving the quality of life for all. It is d that through community ownership and responsibility, the physical, mental, emotional ritual wellness of individuals and communities achieved, thereby improving the quality of life . It is believed that through community ship and shared responsibility, the physical, , emotional and spiritual wellness of individuals mmunities can be achieved, thereby improving ality of life for all. It is believed that through unity ownership and shared responsibility, the al, mental, emotional and spiritual wellness of uals and communities can be achieved, y improving the quality of life for all. It is d that through community ownership and responsibility, the physical, mental, emotional ritual wellness of individuals and communities achieved, thereby improving the quality of life . It is believed that through community ship and shared responsibility, the physical, , emotional and spiritual wellness of individuals mmunities can be achieved, thereby improving ality of life for all. It is believed that through unity ownership and shared responsibility, the al, mental, emotional and spiritual wellness of uals and communities can be achieved, y improving the quality of life for all. It is d that through community ownership and responsibility, the physical, mental, emotional ritual wellness of individuals and communities achieved, thereby improving the quality of life . It is believed that through community ship and shared responsibility, the physical, , emotional and spiritual wellness of individuals mmunities can be achieved, thereby improving ality of life for all. It is believed that through unity ownership and shared responsibility, the al, mental, emotional and spiritual wellness of uals and communities can be achieved, y improving the quality of life for all. It is d that through community ownership and responsibility, the physical, mental, emotional ritual wellness of individuals and communities achieved, thereby improving the quality of life

A n n u a l R e p o r t J U LY 2 0 1 0

through

JUNE 2011

It is believed that through community ownership and shared responsibility, the physical, mental, emotional and spiritual wellness of individuals and communities can be achieved, thereby improving the quality of life for all.

Bethlehem Partnership and Healthy People 2011 The Mission of the Bethlehem Partnership for a Healthy Community The Bethlehem Partnership for a Healthy Community is a collaborative initiative of a broad range of local business, government, educational and community organizations. It is believed that through community ownership and shared responsibility, the physical, mental, emotional and spiritual wellness of individuals and communities can be achieved, thereby improving the quality of life for all. The Mission of the Bethlehem Partnership for a Healthy Community is to improve the health status and quality of life of children and families residing in Bethlehem and Fountain Hill. The Bethlehem Partnership’s Three Main Strategic Goals are to: 1. Improve access to care. 2. Promote child and adolescent health. 3. Eliminate health disparities. The Bethlehem Partnership for a Healthy Community is a community-wide effort aimed at improving the health and quality of life of residents and the community by making the Bethlehem and Fountain Hill communities a better place to live, work, raise a family and enjoy life.

Table of Contents Mission.............................................................................. 1 Advisory Board Members/Agencies............................ 1 2010 – 2011 Participating/ Funding Agencies . ......................................................... 2 Access to Care/Health Services Improvement Dental Health Initiative................................................... 3 Vision Initiative................................................................ 5 The Fowler Family Center at Donegan Elementary School........................................... 8 HIV Initiative.................................................................. 12 Asthma Initiative........................................................... 15 Adolescent Health Initiatives........................................ 17 Maternal and Child Health Programs............................ 20 Minority Health Initiatives............................................. 29 Minority Influenza and Pneumococcal Immunization Campaign................................................ 32 Adolescent Career Mentoring Initiatives...................... 34 Service Learning............................................................ 37 Tobacco Cessation Program.......................................... 40 Strategic Goals.................................................................. 42

Advisory Board Members/Agencies 2010 – 2011 Mary Carr Northampton County Drug & Alcohol Division Iris Cintrón Community Volunteer Bonnie S. Coyle, MD St. Luke’s Hospital & Health Network Kevin Dolan Northampton County Children, Youth & Families Division

Sandra E. Figueroa-Torres Life Academy Kathy Halkins Bethlehem Area School District Arnette Hams Lehigh Valley Hospital and Health Network Sara Klingner, MSN, RN, CNM VNA of St. Luke’s Hospital Dale Kochard Lehigh University

Lissette Lahoz Neighborhood Health Centers of the Lehigh Valley Judith Maloney Bethlehem Health Bureau Jill Pereira United Way of the Greater Lehigh Valley Rose Jasmine Quiles Latinos for a Healthy Community

Vivian Robledo-Shorey Bethlehem Area School District Lilia Santiago Coalition for a Smoke-Free Valley Shelba Scheffner, MPH, CHES Eastcentral PA Area Health Education Center Janet Tate Bethlehem Area School District

2010 – 2011 Participating/Funding Agencies Abbott Labs AIDSNET ALERT Partnership Allentown Diocese Allentown Health Bureau Allentown Lions Club Allentown School District Allentown Vision Center American Cancer Society American Heart Association American Lung Association Auxiliary of St. Luke’s Hospital & Health Network Bangor Area School District Benco Dental Berson Martocci LLP Bethlehem Area School District Bethlehem Health Bureau Bethlehem Housing Authority Bethlehem Parking Authority Bethlehem Police Department Bethlehem Public Library Bethlehem Township Lions Club Bethlehem YMCA Bethlehem YWCA Borough of Fountain Hill Boys & Girls Clubs of Easton & Southside Bethlehem Bucks County Health Improvement Partnership Dental Program Busy Workers Society, Central Moravian Church CADA (Council on Alcohol & Drug Abuse) Youth Program Casa Guadalupe Center Cathedral Church of the Nativity CDS Global Center City Ministries Center for Humanistic Change Children’s Coalition of the Lehigh Valley Children’s Home of Easton City of Bethlehem Coalition for a Smoke-Free Valley Colonial Northampton I.U. #20 Communications Data Services Communities In Schools of the Lehigh Valley, Inc. Community Action Council of the Lehigh Valley Community Services for Children, Inc. Community Services Foundation – Buxmont Academy Connell Funeral Home Council of Spanish Speaking Organizations of the Lehigh Valley Crime Victims Council of the Lehigh Valley Custom Gift Baskets & Flowers Department of Health & Human Services

Department of Public Welfare DeSales University Diamonz Nite Club & Restaurant Donegan Fowler Family Center Dr. George McGinley Dr. Ann Hunsicker Dr. John Staivecki Dr. Joseph Gaudio Dr. Karen Lehman Dr. Patrick Ludwig Dr. Victor Dy East Stroudsburg University Easton Area Community Center Easton Area Public Library Easton Area OB/GYN Easton Area School District Easton Police Department Ebenezer Bible Fellowship Church Embassy Bank of the Lehigh Valley Emmaus Chapter of Quilts for Kids Families First, Pen Argyl Family Answers Family Connection, Easton Fighting AIDS Continuously Together (FACT) Fitzpatrick, Lentz & Bubba Law Offices For Eyes Optical Fund to Benefit Children & Youth Services Genentech, Inc. GIANT Food Stores, LLC Glaxo-Smith Kline Pharmaceuticals Gilead Sciences Haven Youth Group (associated with PRIDE of the GLV) Highmark Foundation Lehigh Valley Health Network • C enter for Women’s Medicine Lehigh Valley Health Network • Hemophilia Center – JDMCC Highmark Blue Shield Holy Infancy R.C. Church HomeStar Medical Equipment & Pharmacy Services Just Born, Inc. King’s Way Lehigh University Lehigh Valley Charter School of the Performing Arts Lehigh Valley Child Care Lehigh Valley Council for Children Lehigh County • Children,Youth & Families • Child Advocacy Center Lehigh Valley Dental Hygienists’ Association Lehigh Valley Dental Society Lens Crafters – Promenade

Luxottica Retail Partners Marvine Family Center Maternal Family Health Services Medoptic Metropolitan Community Church of the Lehigh Valley Migrant Education Program Moms Club, St. Thomas Moore Church Moravian Academy Moravian College Morning Star Rotary Ms. Pat Buffman Muhlenberg University Nazareth Area School District Neighborhood Health Centers of the Lehigh Valley New Bethany Ministries New Directions Treatment Services, Inc. • Latinos for Healthy Communities North Central AHEC Northampton Community College • Dental Hygiene Program • Health Center Northampton County • Children, Youth & Families • Coroner’s Office • Department of Corrections • Drug & Alcohol • Juvenile Justice Center • Meals on Wheels • MH/MR • Drop-In Center • Northampton County Emergency Management Services Northampton School District Northeast Ministries One Sight Our Lady of Perpetual Help Church Partnership for a Tobacco-Free Northeast PA Pearle Vision Center, Bethlehem Square Pen Argyl School District Pennsylvania Asthma Partnership Pennsylvania Department of Health Pfizer, Inc. Phillipsburg School District Pinebrook Services for Children Planned Parenthood of Northeastern Pennsylvania PNC Bank Pride of the Greater Lehigh Valley Private Industry Council of the Lehigh Valley/PA Careerlink Lehigh Valley Project Linus Projecto Claridad Quilts for Kids, Emmaus Chapter Regal Cinemas Richard Henry Construction Richard Ritter Pharmacy

Roberto Clemente Charter School Roche Pharmaceuticals Rotary Club of Bethlehem Sacred Heart Hospital Safe Harbor Saucon Valley Bowling League Saucon Valley School District Sayre Early Child Center Second District Valley Forge Dental Association Second Harvest Food Bank Service Tire Truck Centers Shannon Kearney, MD Slater Family Network, Bangor Smith Barney, Winchester Rd. Office, Allentown Specialty Minerals Corporation St. Luke’s Hospital & Health Network • St. Luke’s HomeStar Medical Equipment & Infusion Services • St. Luke’s School of Nursing • Visiting Nurse Association of St. Luke’s Home, Health & Hospice St. Peter’s Church Star and Candle Shop, Central Moravian Church The Special Kids Network The Quilt Nannies Tibotec Pharmaceuticals Tobacco Free Northeast PA Touchstone Theater Trinity Episcopal Church Turning Point of the Lehigh Valley Twin Rivers Two Rivers Health & Wellness Foundation Union UCC Church, Neffs United Way of the Greater Lehigh Valley Unity House University of Pittsburgh US Health Resources and Services Administration Valley Wide Smile Valley Youth House Victory House Visual Impairment & Blindness Services of Northampton County VNA of St. Luke’s • Board of Directors Volunteer Center of the Lehigh Valley Walter’s Pharmacy Wal-Mart Store #3563, Route 191 Weed & Seed Wegmans Weis Markets WIC Wilson Area School District

Bethlehem Partnership Annual Report • 2

Dental Health Initiative Healthy People 2020 Objectives: OH-1: Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth. OH-2: Reduce the proportion of children and adolescents with untreated dental decay. OH-7: Increase the proportion of children, adolescents and adults who used the oral health care system in the past year. OH-8: Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year. OH-12: Increase the proportion of children and adolescents who have received dental sealants on their molar teeth. The Dental Health Initiative strives to provide healthy, bright smiles to our community. In doing so, we believe that we are making an impact on the health and well-being of all of our patients — we are their dental home! It has been a year of accomplishments and a year of challenges, as the sharp realities of difficult financial times have brought us an influx of patients that need care and have limited places to go. We continue to fight the good fight — by finding ways to increase access and improve on our processes and by being leaders in providing dental care to our community. The Dental Van continues to be in high demand! Thanks to the Lehigh Valley Coalition for Kids, our new, three chair Dental Van brought care to those that need it most. The van visited over 30 schools and agencies throughout the area — Allentown, Bangor, Bethlehem, Easton, Pen Argyl and Quakertown — we go where we are needed! We are happy to have expanded our presence in Allentown, by partnering with the school district to bring care to their children. Luis A Ramos and Union Terrace Elementary Schools are two welcome additions to our roster of sites! We are also proud that: 1,262 children received care, 678 of which completed their care. 1,191 dental cleanings were done — that’s a lot of clean, happy teeth!

School screenings increasingly show a high need for dental care in our schoolaged population. We are challenged with making a connection with parents — to inform, educate and motivate them to use our services for their children.

Almost $156,000 in uninsured care was provided to 403 children. Other important statistics: FY 2007

FY 2008

FY 2009

FY2010

FY2011

Visits

2984

2788

3244

2921

2901

New Patients

701

547

614

468

536

#Restorations (Fillings)

2308

1651

1971

1916

1673

#Sealants

1777

2136

2129

2013

2063

We are having a positive impact — we are cleaning more, sealing more and filling less, which further emphasizes our mission of prevention!

3 • Access to Care / Health Services Improvement

Despite these accomplishments, it has been a year of reflection — how many more children are being missed? School screenings increasingly show a high need for dental care in our school-aged population. We are challenged with making a connection with parents — to inform, educate and motivate them to use our services for their children. We continue to work closely with our community partners to come up with ideas of how to close that gap.

Easton Dental Center and the Dental Health Center at Union Station The Easton Dental Center has experienced a year of tremendous growth. While continuing to provide much needed specialized pediatric dental care, our adult population has benefited from expanded days of service, provided by our Attending Dentists and our Dental Residents. A total of 4,353 patient visits were recorded this year. We are happy to be a part of this community, bringing patients the care that they need right in their own neighborhood. The Dental Health Center at Union Station has experienced a large increase of patient visits this year. A total of 6,014 visits were made to this four-chair site. The General Practice Residency Program is

based at this Center, under the guidance of our new Dental Director, Dr. Mohammed Qahash. Three Dental Residents provide general dental and specialty care in the areas of endodontics, orthodontics, oral surgery, pediatric dentistry, periodontics and prosthodontics. This has made this Center a place to receive the most comprehensive dental care a patient can need.

Oral Health Partners Northampton Community College’s (NCC) Dental Hygiene Program, in partnership with the Dental Health Initiative, continued to provide preventive services to three high-need elementary schools in the Bethlehem Area School District. The dental hygiene students provided children from Donegan Elementary, Fountain Hill Elementary and Marvine Elementary with 130 cleanings, fluoride treatments and X-rays during four Preventive Marathon Days. Through the Sealant Program, also a collaborative effort with NCC, 2,063 sealants were placed on 422 children, greatly reducing the risk of tooth decay. With almost 32 percent of the children seen being uninsured, we want to recognize the Bethlehem Area School District, the Bethlehem Health Bureau and Family Connection for helping bridge the gap in providing care.

Thanks Thank you to our community partners, supporting partners and dental staff. We could not do this important work without you! As we look to the future, we challenge ourselves to continue to strive to provide healthy smiles throughout our community.

Please Partner with Us The Dental Health Initiative strives to be self-sustaining, but depends on the generosity of partners in this project. If you would like more information or can offer resources to our Programs, please call Bonnie Coyle at (610) 954-2100. Bethlehem Partnership Annual Report • 4

Vision Initiative Healthy People 2020 Objectives: V-2: Reduce blindness and visual impairment in children and adolescents aged 17 years and under. In 1998 the Bethlehem Area School District (BASD) reported that only six percent of children who failed their vision screening completed their vision referral. So began our efforts to reduce visual impairment. We collaborated with local partners and provided students with vision vouchers — essentially ‘coupons’ that allowed them to receive eye exams, glasses and education from one of our five community partner agencies/businesses, and all at no cost to the families. 1200 1200 Since then, our partners and community efforts to meet the need have expanded and encompass different 1200 1200 1000 1000 approaches to serve our community. With the generous support of local philanthropy and volunteerism, this initiative thrives.

1000 1000

800 Our initiative efforts have served 774 individuals this800 year (first year that included uninsured, low income adults). Graph 1 breaks down by service how we achieved this great result — a combination of the One 800 800 Sight vision van visit, our vision voucher program, and portable vision clinics. By adding our own portable 600600 vision clinics on a regular basis, we were able to increase our services by 41 percent for the 2010-11 program to continue meeting the needs, utilizing our 600year. This service expansion builds our capacity 600 400400 own community resources. 400 400 200 200 1200 00 1000

200200 Total Number of Individuals Served by the Vision Initiative 2010-11 00 2006-2007 2006-2007 2007-2008 2007-2008 2008-2009 2008-2009 2006-2007 2007-2008 2007-2008 2008-2009 2008-2009 2009-2010 2010-2011 2006-2007 2009-2010 2010-2011 Total Number Vision Vouchers Total Number Vision Vouchers Total Number Total Number

Vision Vouchers Vision Vouchers

Sight OneOne Sight VanVan

Portable Clinic Portable Clinic

800 600 Our initiative efforts have served 774 individuals this year. We achieved this great result with a combination of the One Sight vision van visit, our vision voucher program, and portable vision clinics.

400 200 0 Graph 1

2006-2007

2007-2008

2008-2009

2009-2010

2010-2011

Total Number Vision Vouchers One Sight Van Portable Clinic Hosting the One Sight vision van (sponsored by Luxottica Company) occurred in the fall of 2010. This vision van provides up to a week of services to children needing vision care. We were lucky that 271 children from our local community received vision services through this program. Local vision care professionals volunteer their time to conduct eye exams and fit the children. School-based service provisions also enhance the capacity of the program to serve larger numbers of needy children. These services were offered primarily to the BASD and the ASD this time around.

5 • Access to Care / Health Services Improvement

OneOnS

The vision voucher program supplemented the need arising after the One Sight vision visit and is specifically for the BASD and ASD students. Through this program, 169 students received services this year. This program requires parents to take their child to the partnering provider for services outside the school day. Reinvigoration of our portable vision clinical services started in May 2010 when Dr. George McGinley, a local ophthalmologist, joined our Vision Initiative and began volunteering two days per month in providing vision exams with our portable vision equipment. His commitment of time, along with the continued commitment of Steven Roseman (Bethlehem Square PEARLE Vision), has allowed the Vision Initiative to provide portable vision clinics on a regular basis, decreasing the cost of the services and permitting the Vision Initiative to increase the number of individuals served. Due to this, our Portable Vision Equipment program was able to expand to schools and medical clinics/ family centers throughout Northampton and Lehigh counties. The medical clinics identified low income adults who were in need of vision care and referred them to the portable vision clinic as well, thereby expanding our services to adults in need. Graph 2 depicts the portable clinical numbers for this program year. Within one year the portable vision clinic has served six school districts and three medical clinics/family centers (with some Allentown/Lehigh County sites receiving multiple visits based

Allentown School District 4000

portable vision clinic 250 Adults Seen Children Seen

200

Total Glasses Made

150

100

2010-2011

Graph 2

Bethlehem Area School District 3000

3500

2500

3000 2000

2500 2000

1500

1000

1000 500

500 0

2010-2011 Referred

Completed Referral

VI Supported

-2

3 00

Referred

Graph 3

-2

4 00

-2

5 00

-2

6 00

-2

7 00

Completed Referral

-2

8 00

-2

9 00

-2

0 01

VI Supported

Graph 4 Bethlehem Partnership Annual Report • 6

Vision Initiative continued on need). While our Vision Initiative efforts have been in the Bethlehem Area School District (BASD) for years, our efforts in Allentown are more recent. Graphs 3 and 4 on the previous page demonstrate need and efforts in both school districts. Only 21 percent (780 out of 3647) of the ASD students have documented vision referral completion and we were able to directly support 26 percent (203 out of 780) of the completed referrals.

Looking ahead to 2011-12 While continuing to meet the needs in our community, we are also collaborating with our partners and setting as a goal the specific improvement that can be achieved when concentrated efforts are focused on a specific high-need school. With the support of our partners, one school in each of the ASD and BASD districts will be identified and efforts expended to raise completion of vision referrals to above 40 percent. Additional schools in ASD are being identified by our newest Vision Initiative partners, the Sacred Heart Hospital and Lehigh Valley Hospital and Health Network (as part of a separate ASD-specific community partnership).

With the support of our partners, one school in each of the ASD and BASD districts will be identified and efforts expended to raise completion of vision referrals to above 40 percent.

School districts served (# days) with portable services:  Allentown (6)  Bangor Area (1)  Bethlehem Area (1)  Catasauqua (1)  Easton Area (1)  Whitehall-Coplay (1) Family Centers served with portable services:  Neighborhood Health Centers of the LV – La Vida Nueva clinic (3)  Mosser Family Center (1)

If interested in more information or offering your time or talent to the Vision Initiative, please call Julie Kindig, RN, Nurse Coordinator, at 484-526-6204 or e-mail her at kindigj@slhn.org.

7 • Access to Care / Health Services Improvement

The Fowler Family Center at Donegan Elementary School Improving access to comprehensive, quality health care services is one of the overarching goals of HP2020 — “Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone.”

Healthy People 2020 Objectives: AHS-6 Reduce the proportion of individuals who are unable to obtain or are delayed in obtaining necessary medical care, dental care or prescription medicines. AH-1 Increase the proportion of adolescents who have had a wellness checkup in the past 12 months (12 – 21 years old) NWS-10.2 Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. The Bethlehem Partnership completed its thirteenth year of supporting community health improvement activities at The Fowler Family Center at Donegan. The Center is a unique collaboration of many community agencies, with funding provided by the United Way of the Greater Lehigh Valley, the Pennsylvania Department of Health, Northampton County, St. Luke’s Hospital & Health Network, and the Bethlehem Area School District.

referrals so that these families could benefit from these services. Nine percent of the individuals seen were uninsured, helping to improve access to care in our community.

St. Luke’s Family Practice @ Donegan Fowler Family Center

Throughout the years, the center has partnered with many other community agencies to actively provide services aimed at promoting five main outcomes: Prenatal and Children’s Health; Healthy Childhood Development; School Readiness and Success; Family Stability; and Safe Communities. The Family Center staff utilize a case management model to assess at-risk children and their families, develop action plans and provide outreach support and referral services to meet basic health, social and educational needs of students to assure they can succeed in school. Staff are instrumental in the implementation of other Partnership initiatives, demonstrating the effectiveness of collaborative efforts to achieve mutual goals. Co-located services provided by the Bethlehem Health Bureau (BHB) and St. Luke’s Hospital & Health Network (SLHHN) include comprehensive family and women’s health care services, immunizations, and the Asthma and Dental Health Initiatives.

Number of Patient Visits by Payor Group

Donegan Family Practice at Fowler Family Center St. Luke’s Family Practice @ Donegan Fowler Family Center continues to grow and offer comprehensive care for the entire family. Our goal is to provide family-focused, quality care for our culturally diverse community. St. Luke’s employees provided primary and preventive care through 2,514 visits to low-income families, while the Family Center Staff helped identify resources and programs and initiated

Managed Care Plans Medicare

Uninsured

Commercial Insurance

Medical Assistance

Graph 5

Bethlehem Partnership Annual Report • 8

The Fowler Family Center at Donegan Elementary School continued Healthy Children St. Luke’s Family Practice at Donegan is consistently maintaining close to a 70 percent wellness check up completion rate for our adolescent population and is proud to report even higher rates for younger children (all >90 percent completion). It is our goal to ensure that all aspects of the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program are completed, including developmental screenings, dental and vision referrals, completion of asthma action plans, immunizations, and routine lab studies.

Ease of Access We experienced a higher than desired non-emergent ER utilization. Therefore, to improve access for acute needs of our clients, we developed opportunities for same day visits (i.e., holding slots open for acute visits, double booking, etc.). As a result, we have noted a reduction in non-emergent ER utilization by our patients during this past year (from 22 percent to 14.4 percent by Amerihealth Mercy).

Health Promotion Along with St. Luke’s Nutrition Department, Donegan school staff, and select Donegan first and second grade students, St. Luke’s Family Practice @ Donegan participated in a pilot study in a program targeting childhood obesity. This “Healthy Habits” class was designed to promote student health and education pertaining to nutrition and exercise. The children and their parents were involved in this 14-week program; participants had a 55 percent decrease in their body mass index (BMI) ratios by the end of the program. Tentative plans are to continue into new program year.

Donegan Healthy Habits Class 4.0 3.5

Week 1

Week 14

3.0 2.5 2.0 1.5

St. Luke’s Family Practice @ Donegan Fowler Family Center continues to grow and offer comprehensive care for the entire family.

1.0 0.5 0.0

<75%

75-85%

85-90%

% BMI / AGE Graph 6

9 • Access to Care / Health Services Improvement

90-95%

>95%

In addition to this pilot, our general patients had access to a participatory nutrition-focused event prepared by Moravian College senior level nursing students. This educational event, held during a pediatric flu clinic, allowed the children to learn about healthy eating, nutritious food choices, proper portion control, and the importance of exercise. Each child received healthy snacks donated by Weis Markets to reinforce this message. Sadly, our BASD partner lost funding to support family center staff in the district at the end of this school year. The family support services provided through these centers were an important component for the community in which Donegan is located (social service support, specific family programs, medical interpretation services, etc.). Specific efforts and new partnerships will be required to continue supporting this South Bethlehem community.

Other Family Health Care Services In addition to the Family Practice Clinic, the following health care programs were offered to children and families living in the South Bethlehem area: Dental care was provided through 19 visits on HealthStar II, and 44 children received dental care through the NCC Marathon Days.

completing homework to teacher’s satisfaction (37.8 percent), participating in class (42.5 percent), being attentive in class (35.9 percent), academic performance (56.6 percent), and coming to school motivated to learn (33.9 percent). Some teachers commented on the survey that the books provided to the students by their Family Developments Specialists as part of the program improved their student’s ability and eagerness to read in and out of the classroom. Fifty-eight percent of students in grades three, four and five increased their standardized test scores in reading by one or more levels from the fall to spring assessments. In math, 76 percent increased their scores by one or more levels. Using a different standardized test, for grades one through five, 47 percent increased their scores one or more levels. Onehundred percent of kindergartners increased their reading scores by at least one level. The number of children enrolled who had insurance increased from 85 percent to 100 percent. Seventy-six percent of enrolled YSS students participated in the Reading Rocks! initiative and 89 percent received books from their Family Development Specialists.

A women’s health clinic, partially funded by the BHB, SLHHN, and Maternal and Family Health Services, Inc., provided care during 243 visits for 107 low-income women, many of whom were uninsured. BHB provided 503 immunizations to low-income children through an on-site immunization clinic.

Youth Succeeding in School This year the Fowler Family Center completed its third full year of implementing its Youth Succeeding in School (YSS) Initiative. Funded by the United Way, the program promotes academic success for at-risk students at Donegan Elementary. The program served 120 students and their families throughout the year with 106 completing the program, meeting our program goal of at least 100 students completing the program. The following findings and outcomes were identified for the 106 children and their families receiving the comprehensive case management services: Seventy-three (68.9 percent) clients reported that Spanish was their primary language. One-hundred percent of clients received services in their primary language. A survey was administered to teachers of each of our students at the end of the program, measuring student’s level of improvement in the classroom. Of the surveys filled out, teachers reported that the majority of students made improvements in the following areas during this program year:

Reading Rocks! Reading Rocks! is a joint program between St. Luke’s and Lehigh University to promote literacy in the South Bethlehem community. For the past three years, Reading Rocks! has worked closely with the Youth Succeeding in Schools Initiative at Donegan Elementary School. Led by Roseann Corsi from Lehigh University, Sue Schantz from St. Luke’s Hospital & Health Network and a Lehigh University student volunteer, this program resulted in the following accomplishments this year: Fall and spring Reading Rocks! competitions were held during the school year, with nearly 120 students participating each semester. During kickoff assemblies held prior to the start of each semester, Lehigh student athletes shared their stories and encouraged Donegan students to participate in the program and to achieve their reading goals.

Bethlehem Partnership Annual Report • 10

The Fowler Family Center at Donegan Elementary School continued Each week dozens of Lehigh University students/athletes and St. Luke’s staff volunteered to read during the after-school program. Volunteers and at-risk students were placed in a one-on-one mentorship setting for reading or homework sessions. They also had time at the end of each session to engage in entertaining activities to promote creativity and physical activity. This year ten laptops were donated by the Northampton County Medical Alliance for use in the Reading Rocks! and other Partnership programs. Volunteers used the laptops to help students create newsletters to show their family and friends their accomplishments in the after-school program. Students who achieved their reading goals were acknowledged at end-of-semester assemblies and treated to pizza parties.

Book Drive This past year, St. Luke’s and the Lehigh University Athletics Department held its third annual Book Drive. With support from various sites throughout St. Luke’s Hospital & Health Network, an astounding 13,000 children’s books were collected. These books are distributed to children throughout the community through the Reading Rocks! and YSS programs.

Needs Assessment This past year the executive board of the Fowler Family Center conducted a Needs Assessment survey of the Donegan Elementary community. The survey was distributed for the purpose of creating a new strategic plan for the Fowler Center. The self-administered survey included questions regarding safety issues and the strengths and weaknesses of South Bethlehem. A total of 206 surveys were collected and analyzed. Important findings include: Eighty-nine percent of respondents agreed with the statement that “South Bethlehem is a good place to live.”

I Feel safe in my neighborhood

The three most commonly reported issues within Bethlehem neighborhoods were drug abuse, gangs and youth violence/bullying.

Strongly Agree

Eighty-five percent of respondents agreed with the statement “I feel safe in my neighborhood.”

St. Luke’s Family Practice at Donegan is consistently maintaining close to a 70 percent wellness check up completion rate for our adolescent population and is proud to report even higher rates for younger children.

Agree Disagree

A copy of the full report is available at the St. Luke’s Community Health office.

Strongly Disagree

Graph 7

For more information about our services at Donegan or to partner with us to support this community effort, please contact Donna Bryant Winston at bryantdm@slhn.org.

11 • Access to Care / Health Services Improvement

HIV Initiative Healthy People 2020 Objectives: HIV-3: Reduce the rate of HIV transmission among adolescents and adults. HIV-10: Increase the proportion of HIV-infected adolescents and adults who receive HIV care and treatment consistent with current standards. HIV-14: Increase the proportion of adolescents and adults who have been tested for HIV in the past 12 months. June 2011 marked the 30 year anniversary of the onset of the AIDS epidemic in the United States. Approximately 56,000 new infections continue to occur each year, and the number of HIV/AIDS related deaths has topped 500,000 nationwide. Programming for the AIDS Services Center (ASC) at St. Luke’s Hospital & Health Network consists of HIV prevention education, rapid HIV testing, Comprehensive Risk Counseling Services (CRCS), case management and social support services and clinical care services. The HIV Initiative receives funding from the following organizations: Two Rivers Health and Wellness Foundation, Pa. Department of Health, AIDSNET, the University of Pittsburgh and the United Way of the Greater Lehigh Valley.

Contacts for prevention Interventions • 2006-2011

Prevention Program

The program collaborates with many local organizations, schools and government facilities to provide HIV education, HIV risk-level screenings at medical facilities, street-level outreach to high-risk populations and rapid HIV testing. ASC prevention staff completed 417 IDIs during the fiscal year to assess individual HIV risk and create a risk reduction plan. Ten percent of these IDIs were conducted with individuals returning for multiple sessions. This success is mainly attributed to conducting IDIs in structured settings where participants are attending the facility for other services/programs. ASC staff regularly visits Trinity Episcopal Church’s soup kitchen, New Bethany Ministries’ soup kitchen, Bethlehem Health Bureau’s women’s clinic at Donegan Fowler Family Center, Unity House, and Northampton Community College. The use of street outreach to recruit for IDIs yielded 71 participants, or 17 percent of all IDIs.

6000

5000

2006-2007

2009-2010

2007-2008

2010-2011

2008-2009

Number of Contacts

The Prevention Program at ASC focuses on preventing the transmission of HIV/AIDS and other Sexually Transmitted Infections (STIs) in Northampton and Lehigh Counties. Prevention activities are divided into four categories: 1. Outreach 2. Interventions Delivered to Individuals (IDIs or one-to-one education sessions) 3. Interventions Delivered to Groups (IDG’s or small group level education sessions) 4. Health Communications/Public Information (HC/PI or large group level education sessions)

4000

3000

2000

1000

HC/PI

IDG

IDI

Outreach

Prevention Interventions

Graph 8 Of the 1,530 individuals who participated in IDGs, 100 percent of the participants completed all group activities and identified and committed to behavior changes. Of the 3,426 HC/PI participants, 96 percent stated that their knowledge of HIV increased after the presentations.

Bethlehem Partnership Annual Report • 12

HIV Initiative continued HIV Testing ASC is an approved Pennsylvania Provider Agreement (PPA) site from the Pennsylvania Department of Health (PADOH) which allows ASC to provide free, confidential and anonymous rapid HIV testing to the community. From July 2010 to June 2011, ASC prevention staff administered 240 HIV tests. Of these tests, two confirmed positive test results were given. ASC achieved Percent its 2010 goal of maintaining a 1 percent positivity rate for Risks Reported for Reporting testing during the year. Completed Tests Risk The most common risk factor reported during testing was Unprotected sex 75 unprotected sex (75 percent). Several individuals reported Sex w/ partner of more than one risk factor. Additionally, 15 percent reported 25 unknown HIV status either having only protected sex or having no risk factors in the past year, yet they wanted to be tested. Sex while intoxicated 25 and/or high on drugs

CRCS

CRCS is an intensive one-on-one risk reduction program offered to HIV-positive individuals and high-risk HIV-negative individuals, in order to decrease their risk of personal harm and/or transmission of HIV or of contracting HIV if uninfected. The number of patients participating in CRCS almost doubled from 2008 to 2011. Of the 143 participants in fiscal year 2011, most of which are from the St. Lukeâ&#x20AC;&#x2122;s Hospital Union Station Health Center Specialty Clinic, 20 percent reported moderateor high-risk behaviors relating to drug and alcohol, sexual activity and medication adherence. There was a 1 percent increase in reported risk behaviors from fiscal year 2010.

Male having sex with male (MSM)

Sex w/ anonymous partner

Sex w/ partner who is HIV+

Sex w/ intravenous drug user (IDU)

Sex worker

IDU

Sex w/ MSM

Sex w/ sex worker

Case Management and Supportive Services Case Management services assist persons living with, or affected by, HIV/AIDS to achieve and maintain optimum health and quality of life by facilitating coordination of health and supportive services. The case management staff works to connect clients to assistance for a variety of HIV-related care services and quality of life needs, including medical care, oral health care, emergency financial assistance, medical transportation assistance, housing assistance and emergency food assistance. In fiscal year 2011, the total number of clients served decreased by 9 percent as compared to 2010, yet these clients where in greater need of services possibly due to the economic crisis. The 245 clients enrolled in case management in 2011 accounted for 6,587 visits throughout the year.

Approximately 56,000 new infections continue to occur each year, and the number of HIV/AIDS related deaths has topped 500,000 nationwide. 13 â&#x20AC;˘ Access to Care / Health Services Improvement

CRCS Performed from 2008-2011 160

Number of Clients in case management 300Number of Contacts

Number of Contacts

140

250

120 100

200

150

100

20 0

0 2008-2009

2009-2010

2008

2010-2011

Graph 9

2011

Graph 10

Clinical Care Services

Number of patients receiving primary and specialty care

The number of patients receiving HIV primary and specialty care over the past several years has been steadily increasing. Staff contributes this increase to patients losing their jobs and private health insurance, patients moving to the Lehigh Valley from New York, New Jersey, Florida, Puerto Rico and the Dominican Republic and a strong referral pattern from community organizations and within the St. Lukeâ&#x20AC;&#x2122;s Hospital & Health Network.

160

140 120 Number of Patients

Each year the clinical care team develops a quality management project to improve clinical performance measures. In fiscal year 2011, the quality management project was to improve cervical cancer screening rates. November 2009 baseline cervical cancer screening rates were 34.55 percent and improved to 75 percent in June 2011. Steps implemented to improve the results included having a female physician assistant conducting cervical cancer screenings on-site four days per week and increasing clinical staff awareness and patient education of the need for the cervical cancer screenings. The project results were presented at the Annual Pennsylvania Ryan White All Parts Summit in Harrisburg as part of a regional HIV quality management group known as HIVQual.

2009 2010 Fiscal Year

100 80 60 40 20 0

2007

2008

2009 Fiscal Year

2010

2011

Graph 11

For more information about this initiative, please call Hollie Gibbons, MPH, RD, Manager of Disease Prevention Initiatives, at 484-526-2301 or email her at gibbonh@slhn.org. Bethlehem Partnership Annual Report â&#x20AC;˘ 14

Asthma Initiative Healthy People 2020 Objectives RD-2: Reduce hospitalizations for asthma. RD-3: Reduce hospital Emergency Department visits for asthma. RD-4: Reduce activity limitations among persons with current asthma. RD-6: Increase the proportion of persons with current asthma who receive formal patient education. RD-7: Increase the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines. Asthma affects people of every race, sex and age. However, significant disparities in asthma morbidity and mortality exist, in particular for low-income and minority populations. Children less than 18 years of age have the highest rate of asthma of all age groups. Pediatric asthma rates are the highest in the Northeastern region of the United States. Pennsylvania has the 5th highest prevalence out of all states at over 9.8 percent. Northampton County has the 13th highest prevalence out of all Pennsylvania counties at 11.5 percent. And Allentown is ranked number 18 out of 100 for the 2011 Asthma Capitals — “The Most Challenging Places to Live with Asthma” (this is down from number 14 for 2010). The Asthma Initiative focuses on the National Institute of Health (NIH) Asthma Guidelines’ four components of asthma care: 1. Assessment and Monitoring 2. Patient Education 3. Control of Environmental Factors 4. Medications

Children less than 18 years of age have the highest rate of asthma of all age groups. Pediatric asthma rates are the highest in the Northeastern region of the United States.

This past year, efforts focused on the first three components of the guidelines. As in past years, every pediatric patient who is seen in the St. Luke’s Emergency Department (ED) and who lives within the city of Bethlehem is offered an asthma home visit. The Bethlehem Health Bureau partners with us to provide these home visits which assess triggers, environmental factors contributing towards asthma exacerbation and provides asthma education to families. A total of 37 home visits were completed this past year. Home visit data indicated that a majority of families (70 percent) reported that weather triggered their child’s asthma. Additionally, in assessing environmental factors, a majority of the homes faced the street (86 percent) and over half were close to exhaust (56 percent). The smoking status of household members is also assessed to identify secondhand smoke exposure

15 • Access to Care / Health Services Improvement

Pediatric ED and Inpatient Visits for Patients Living in Bethlehem Zip Codes Fiscal Year

2004

2005

2006

2007

2008

2009

2010

2011

Total # Patients

225

193

248

242

216

199

273

190

Total # of ED and Inpatient Encounters

285

234

302

209

257

247

345

244

Total # of ED Visits

221

190

265

261

211

275

209

Total # of Inpatient Admissions

as a trigger for asthma exacerbation. One-third of households reported tobacco use, although all report smoking outside of the home. This is an 8 percent decrease from FY 2010. Sixty-four percent of families were aware of high ozone days which can often lead to respiratory distress. For the past eight years, the Asthma Initiative has monitored pediatric asthma visits to St. Luke’s Hospital, Bethlehem Campus. In FY 2010, data indicated a 37 percent increase in the total number of visits. This data prompted many questions as to why ED utilization increased this particular year. To further study the FY 2010 data, Drexel University School of Public Health student Hope Kincaid, MPH candidate, conducted a chart audit including patients who were seen in the ED for asthma and were assigned for primary care to St. Luke’s Family Practice, KidsCare and the St. Luke’s Family Practice at Donegan Fowler Family Center. A total of 164 medical charts were audited.

In addition to the above findings, when comparing study results to the NIH asthma guidelines, the study revealed opportunities for improvement for the inclusion of asthma action plans in medical charts, documentation of asthma classification, symptoms and triggers, continuity of providers for asthma visits, and scheduled asthma visits. Also, patient education surrounding proper use of the ED and a PCP notification system for asthma patients who visited the ED was identified as an area needing further investigation. An asthma workgroup has been formed to develop a quality improvement project to improve baseline data collected in the study and to ensure NIH asthma guidelines are being met.

The purpose of the study was to assess primary care usage patterns for patients who visited the ED and to compare study results to NIH asthma guidelines. Eighty-nine percent of the patients audited had Medicaid. Study results revealed that half of the ED visits in FY 2010 occurred during primary care practice hours. The majority of patients had at least one general visit to their assigned primary care provider (PCP) the year prior to their ED visit. Additionally, the majority of patients did not have an asthma-specific visit in the year prior to their ED visit. Upon discharge from the ED, asthma patients are referred to their PCP for a follow-up visit. Only 22 percent of the patients in the study had a follow-up PCP visit after their ED visit. Home visit data revealed a similar pattern for PCP follow-up rates. Only 37 percent of patients who had a home visit reported making a follow-up PCP appointment.

For more information about this initiative, please call Julie Kindig, RN, Nurse Coordinator, at 484-526-6204 or email kindigj@slhn.org. Bethlehem Partnership Annual Report • 16

Adolescent Health Initiatives Healthy People 2020 Objectives I ncrease the proportion of persons with health insurance. Increase the proportion of adolescents who are connected to a parent or other positive adult caregiver. NWS-10: Reduce the proportion of children and adolescents who are considered obese (aged 12-19 years). TU-2.2: Reduce tobacco use (cigarettes) by adolescents (past month). TU-3.1: Reduce the initiation of tobacco use among children, and adolescents, aged 12-17 years. AHS-1: AH-3:

Mobile Youth Health Center The adolescent goal of Healthy People 2020 is to improve the healthy development, health, safety and wellbeing of adolescents and young adults. It is during the adolescent years that behavioral patterns are established and health risks often develop or peak. Social problems are becoming an increasing concern among this age group, including homicide, suicide, motor vehicle crashes, substance use/abuse, smoking, sexually transmitted infections (including HIV), teen and unplanned pregnancies, and homelessness. The high-risk behaviors of adolescents also create a large financial burden, which includes the long-term costs of chronic diseases â&#x20AC;&#x201D; all of which are preventable. Our partners acknowledge these areas of concern among the adolescents of the greater Bethlehem area. As our program continues to expand, we are seeing increased needs among our youth. It is primarily through the Bethlehem Area School District (BASD), Allentown School District (ASD) and Valley Youth House (VYH) that we are able to reach out to these adolescents to help meet their needs and guide them towards healthier lifestyles as appropriate.

The adolescent goal of Healthy People 2020 is to improve the healthy development, health, safety and well-being of adolescents and young adults. 17 â&#x20AC;˘ Access to Care / Health Services Improvement

The addition of our second Health Star mobile medical unit allowed the expansion of services via the Mobile Youth Health Center (MYHC) this year. HealthStar M2 continued to provide medical services on a regular basis to the BASD: Freedom and Liberty High Schools, and Broughal and Northeast Middle Schools. HealthStar M1 continued services in the ASD at Raub Middle School and began new services at Trexler Middle School and Dieruff High School. For the 2010-11 fiscal year, visits to the MYHC increased, as they have consistently done over the last few years. Graph 12 includes BASD, ASD and adolescents seen through the Valley Youth House program. While the total number of visits continues to increase, the number of unduplicated individuals remains stable. We attribute this increase to adolescents with acute and chronic illnesses and those with social issues that need more follow up and care. As the complexity of adolescent health increases, so does the need for consistency in care and reinforcement in health education. Through the MYHC and the collaborative efforts of school staff, medical services are provided to students who have parental consent. Each student completes an Adolescent Health Assessment (AHA) to assess needs for referrals or health education, including referrals or services offered specifically dealing with accessing medical home/ insurance, tobacco cessation, nutrition counseling, or behavioral health services, as needed. HP2020 objectives provide targets for us to work towards. Locally, we use a screening assessment tool that allows us to compare our local

responses to national baseline and target markers. Specific to three areas, our adolescents either come close to or are above expected targets: Increase the proportion of adolescents with a caring adult in their lives. This has been a steady outcome locally, staying at around 80 percent over the years. This last year, 81.4 percent of our adolescents report feeling their parents listen to them, as compared to the national baseline of 75.7 percent (target 83.3 percent). Reduce the proportion of children and adolescents who are considered obese (aged 12-19 years). Our data indicates that 20 percent (131/653) of adolescents seen through our programs are >95th percentile compared to the national baseline of 17.9 percent (target 16.1 percent). Reduce tobacco use among adolescents. Our data indicates that 13 percent (84/653) have used tobacco (cigarettes) in the past month. Of special note is that the youth served through the Valley Youth House Shelter report 26 percent (32/125) do currently smoke. The national baseline is 19.5 percent (target 16 percent). Increase the proportion of individuals with health insurance. Chart 13 shows the increase in the number of individuals that report no health insurance. This number has increased by 9 percent over the past five years and 4 percent within the past year alone (unemployment and economic hardship are common reasons). Overall in the schools, 67 percent of those evaluated report having medical insurance. The national baseline is 83.2 percent (target 100 percent).

Number of Visits and Unduplicated Clients • 2010-11

Individuals with No Health Insurance Seen by the MYHC

2000

40%

Mobile Youth Health Center

Total Visits

1500

30%

1000

20%

500

10%

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Graph 12

Unduplicated Clients

Total Visits

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011

Graph 13

Bethlehem Partnership Annual Report • 18

Adolescent Health Initiatives continued Liberty High School Resource Room The school nurses and guidance counselors are the lead partners in providing small groups for students who struggle with specific topics. Community partners facilitate these groups that students voluntarily attend. This year 22 students participated in the fall session and 16 participated in the spring session. For the 2011-12 program year, our focus will be on identifying adolescents who have several high-risk factors. The MYHC staff is modifying the Adolescent Health Assessment in order to gain additional information that will not only provide us needed information to offer more effective and complete preventive services, but will also allow us to align our data more closely to HP 2020 goals measurement.

Resource Room groups and sponsoring partners  Balancing Weight Management — Bethlehem Health Bureau  Parenting — St. Luke’s School of Nursing  Prenatal — St. Luke’s School of Nursing and Catholic Charities  Relationship Identity Communication Health Esteem Support (RICHES) — St. Luke’s School of Nursing  Taking Control — Valley Youth House Through the MYHC and the collaborative efforts of school staff, medical services are provided to students who have parental consent.

If you would like more information about the Adolescent Health Initiatives or would like to partner with us in achieving a healthier community for our adolescents, please call Julie Kindig, RN, Nurse Coordinator, at 484-526-6204 or e-mail her at kindigj@slhn.org.

19 • Access to Care / Health Services Improvement

Maternal and Child Health Programs Healthy People 2020 Objectives: MICH-1 Reduce the rate of fetal and infant deaths. MICH-1.9 Infant deaths from sudden unexpected infant deaths (includes SIDS, accidental suffocation and strangulation in bed). MICH-8 Reduce low birth weight (LBW) and very low birth weight (VLBW). MICH-8.1 Low birth weight (LBW). MICH-8.2 Very low birth weight (VLBW). MICH-9 Reduce Preterm Births. MICH-10 Increase the proportion of pregnant women who receive early and adequate prenatal care. MICH-10.1 Prenatal care beginning in first trimester. MICH-11 Increase abstinence from alcohol, cigarettes and illicit drugs among pregnant women. MICH-11.1 Alcohol. MICH-11.2 Binge Drinking. MICH-11.3 Cigarettes. MICH-20 Increase the proportion of infants who are put to sleep on their backs. MICH-21 Increase the proportion of infants who are breastfed (ever). IVP-37 Reduce child maltreatment deaths. IVP-38 Reduce nonfatal child maltreatment. The Bethlehem Partnership is strongly committed to the overarching Healthy People 2020 goal to improve the health and well-being of women, infants, children and families. The Partnership supports three maternal and child health nurse home visiting programs â&#x20AC;&#x201D; The Nurse Family Partnership (NFP), Parent Advocate in the Home (PATH) and Visiting Nurse Advocate for the County (VNAC). Each of these programs has a different focus of effort with the goal being to create positive environments where children can just be children and grow in a safe, healthy and nurturing home. Our nurses use role modeling, education, perseverance and the holistic nursing approach to support many of these families to reach positive outcomes that benefit the family as a whole whenever possible; and if not, then at least the child/children involved. Over 700 families were served by these three programs this past year. In addition, The Partnership was the recipient of a Cribs for Kids grant, and actively participates in the newly formed Lehigh Valley Breastfeeding Coalition.

Bethlehem Partnership Annual Report â&#x20AC;˘ 20

Maternal and Child Health Programs continued Community-wide Efforts Lehigh Valley Breastfeeding Coalition In December 2010, the U.S. Surgeon General issued a Call to Action to promote specific steps that people can take to participate in a society-wide approach to support mothers and babies who are breastfeeding. This approach will increase the public health impact of everyone’s efforts, reduce inequities in the quality of health care that mothers and babies receive, and improve the support that families receive in employment and community settings. The Bethlehem Health Bureau answered this Call to Action by creating the Lehigh Valley Breastfeeding Coalition to bring community agencies, businesses and medical and public health advocates to improve breastfeeding rates in our local community. The coalition has met twice during 2011 and is actively developing a strategic plan based on recommendations from the Surgeon General’s report for this important maternal and child health issue. Cribs for Kids Background: Research consistently shows that bed-sharing with an infant in an adult bed or nontraditional surface is hazardous to the infant due to inherent risks of entrapment; wedging of the infant’s body and head between the mattress or another object such as bed railings; possible overlaying by the parent, sibling or other adult sharing the bed; and dangerous soft bedding resulting in suffocation. Armed with this knowledge, S.I.D.S. of PA created the ‘Cribs for Kids’® Campaign. This innovative intervention campaign, the first of its kind in the country, provides a crib and educational materials to low-income families who cannot afford to purchase a crib, thus creating a safe sleep environment for their infants. Since SIDS and co-sleeping deaths disproportionately affect families with low income and minority families who cannot afford to purchase a crib, S.I.D.S. of PA determined that targeting underserved communities through a comprehensive communication plan and educational campaign, which promotes healthy sleep conditions for infants and expands The ‘Cribs for Kids’® Campaign, will most effectively reach families in high-risk or underserved communities. Every family deserves to receive clear, consistent, repetitive and culturally appropriate information regarding a safe-sleep environment for their baby, as well as the tool with which to implement this safe environment — a safety-approved crib. The provision of the portable crib is a crucial educational component to the safe sleep campaign, because once the community is enlightened about SIDS risk and safe sleep, the means with which to implement the safe environment must be part of the intervention. The goal must be achievable for the family to feel successful.

The Bethlehem Partnership is strongly committed to the overarching Healthy People 2020 goal to improve the health and well-being of women, infants, children and families. 21 • Access to Care / Health Services Improvement

During this past year, one of our partners, the Bethlehem Health Bureau, took the lead in establishing a Cribs for Kids program that will serve the Northampton County area. The number of infant deaths in our area related to unsafe sleep practices motivated this community effort. Initial referrals were received from St. Luke’s Hospital and St. Luke’s VNA (including programs reported on in this section); the Office of Children, Youth and Families of Northampton County; CareNet; Family Answers; and Bethlehem Housing Authority. The focus of our efforts include low-income families, as well as individuals and relatives of low-income Hispanic mothers who are providing unlicensed daycare or babysitting services in their home. By the end of the program year, 15 families had received safe sleep kits (portable crib, sleep sack and pacifiers), as well as safe sleeping education and evaluation of their immunization status since program implementation in February 2011. We anticipate in the coming year to more than double this outcome and subsequently spread the message of the importance of safe sleeping for our babies in the local community.

Nurse-Family Partnership The Nurse-Family Partnership (NFP) is a voluntary, evidencebased home visitation program in which registered nurses visit low-income, first-time mothers from early in pregnancy through the first two years of the child’s life, to accomplish three goals:

Trends in marital status and income appear to be changing in our client population. In a cumulative overview (2001 – 2011), 93.1 percent of the clients enrolled are unmarried. However, quarterly trends in FY10-11 indicate a shift in marital status. Current trends are depicted in the graph below:

Percent of Clients who reported being married at intake 20

Improve families’ economic self-sufficiency Based on more than 30 years of research by Dr. David Olds, the NFP has been recognized by the RAND Corporation, the Brookings Institution and the Coalition for Evidence-Based Policy as a “program that works.” The NFP program at the VNA of St. Luke’s began in December 2001 as part of a state-wide initiative to expand services to needy mothers and infants. In July 2008, the NFP programs from Easton and Allentown joined the VNA of St. Luke’s program, resulting in a significantly expanded program with nine full-time and three parttime registered nurses serving 250 clients, making it one of the largest NFP sites in Pennsylvania. The following report includes information from the beginning of this program (2001) through June 30, 2011. The impressive results achieved by our nurses can best be appreciated when compared with state and national program averages and benchmarks. Participant Characteristics: The median age of clients at intake is 19 years (range 13 – 37 years)

Q3 2010-11 Quarter

*Quarter 2 data not available from NSO

Improve pregnancy outcomes Improve child health and development

Graph 14 It is unclear what environmental and socioeconomic factors are impacting this trend. Data show that the median age of our clients Total Number Vision Vouchers has not increased, but the number of older clients has risen, and the number of very young clients has declined. Having an increased number of older and fewer very young clients may have increased our percentage of those married overall. Additionally, economic factors such as decreased median income and increased cost of living may impact families and encourage marriage. Cumulative Race/Ethnicity Characteristics: 48.1 percent nonHispanic; 37.9 percent Hispanic; 38.7 percent white; 9.8 percent African-American/Black; 1.3 percent American Indian or Alaska Native; 1.0 percent multi-racial; 0.2 percent Asian; with 0.8 percent declining to self identify and 48.3 percent missing demographic information (due to new standards in the collection of race and ethnicity information). The cumulative median household income is reported as $16,000. Current household trends are suggesting that family income levels are decreasing while costs for food, gas and other necessities are increasing, putting our families at even greater risk.

Bethlehem Partnership Annual Report • 22

Maternal and Child Health Programs continued Median Household income trends VNA of St. Luke’s NFP $25,000 $20,000 $15,000 $10,000 $5,000

2008-2009

2009-2010

2010-2011

Graph 15 Program Implementation Entry into the program early in pregnancy is correlated with a longer stay in the program during the infancy phase. The NFP nurses work hard to enroll clients before 16 weeks gestation. Cumulative data indicates that 67.7 percent of mothers were enrolled by 16 weeks gestation and 98.6 percent were enrolled by 28 weeks gestation. One-hundred percent enrollment by 28 weeks was not achieved due to transfers into our program from the Easton and Allentown sites when the sites merged in 2008. The national program benchmark is to enroll 60 percent by 16 weeks gestation, which the VNA of St. Luke’s has exceeded. NFP referrals come from a variety of community agencies. Eighty-one percent of referrals come from health care providers and others come from WIC, soup kitchens, schools and current clients. In looking at attrition data, clients enrolled in the Bethlehem NFP program tend to remain in the program for a longer time when compared to the State and National NFP programs.

NFP Attrition Rates 2010-2011 The Nurse-Family Partnership (NFP) is a voluntary, evidencebased home visitation program in which registered nurses visit low-income, first-time mothers from early in pregnancy through the first two years of the child’s life.

Total Visits

NFP Benchmark

Unduplicated Clients Unduplicated Clients

National

State

VNASL 0%

Graph 16

23 • Access to Care / Health Services Improvement

10%

20% % Lost by Attrition

30%

40%

Additionally, the VNA of St. Luke’s NFP program completes more visits through all phases of the program, as compared to the State and National NFP averages. The chart below illustrates the mean percentage of clients meeting the expected number of visits for each program phase.

The VNA of St. Luke’s Preterm Birth rates are significantly lower than the State and National NFP averages:

Comparative preterm Birth rates 15

2010-2011 Completed/Expected Visits

Toddler

NFP Benchmark

Infancy

Pregnancy

Birth Rate

National

State

5 VNASL

100

Toddler

ite

Infancy

Pregnancy

dS 20 tate 06 s -09 am pto nC 20 oun 06 ty -09 Le hig hC 20 oun 06 ty -09 Na tio na 20 l NF 10 P -11 St ate 20 NF 10 P -11 St .L uk e’ 20 s NF 10 P -11

% of Clients Meeting Visit Expectations

rth

Graph 17 NFP

Graph 18

Program BenchmarkOutcomes The VNA of St. Luke’s NFP has shown an 18 percent reduction in smoking during pregnancy compared to the State and National NFP average reduction of 15 percent and 16 percent, National respectively. We have seen a decline in this outcome from prior years which appear to be attributable to the severe reduction in state funds available for smoking cessation programs. State

VNA of St. Luke’s NFP program is exceeding both State and National averages for low birth weight and very low birth weight. Low Birth Weight Percent

VNASL

VNASL 0 STATE

Ob HP jec 202 tiv 0 es

408.2

Very Low Birth Weight Percent 60

80 1.2

9.4

1.8

NATIONAL

8.8

1.4

HP 2020 Target

7.8

1.4

100

Toddler Infancy

The National NFP benchmark for immunizations at 24 months is 90 percent. The VNA NFP data show our immunization rate Pregnancy is 92.3 percent. The VNASL NFP data show 23 percent of mothers reported subsequent pregnancies by 24 months postpartum, better than the State and National NFP averages of 30 percent and 32 percent, respectively. The National NFP benchmark is <25 percent. Of those clients who were 18 or older at intake, workforce participation increased from 38 percent at intake to 68.7 percent at program completion. (State NFP average = 55.8 percent; National NFP average = 55.8 percent). Despite slightly lower income levels, our families are working at a greater rate.

For more information regarding this program please contact Sara Klingner MSN, RN, Program Manager, Nurse-Family Partnership, VNA of St. Luke’s, at 484-526-2778 or Klingns@slhn.org. Bethlehem Partnership Annual Report • 24

Maternal and Child Health Programs continued Parent Advocate in The Home (PATH) The overarching goals of our PATH program are to provide parenting and mentoring for families (regardless of age of parents or number of children in home) so that the child/children are in a nurturing, loving home with a decreased risk for child maltreatment. We continue to experience an abundance of referrals and opportunities to positively impact families living in the Northampton/Lehigh Counties through funding from various sources. Graph 19 shows our growth over the past five years, with referrals continuing to come in each day. The families served by PATH are getting younger each year, with 69 percent of parents being 21 years of age or younger.

PATH: Number of families served by year 350 300 Families

250 200 150 100 50 0

2006-07

2007-08

2008-09

2009-10

2010-11

Graph 19 Matching PATH goals to national expectations for similar home-based programs has been a naturally evolving one as it was a mission program developed ‘in house’ by our VNA and developed slowly over the years — challenging and yet rewarding.

PATH Birthweights compared to healthy people 2020 Low Birth Weight (<2500 Grams)

PATH staff diligently works with each family to stress the importance of growth and development of their child.

PATH Births HP2020 Target Goals

Very Low Birth Weight (<1500 Grams) >2500 grams

Graph 20

25 • Access to Care / Health Services Improvement

100

We began monitoring and collecting data regarding birth weight this past year as more and more of our families are enrolling during the prenatal phase (as opposed to years past when enrollment into PATH was after birth). Current yearâ&#x20AC;&#x2122;s statistics are demonstrated in Graph 20 and compare our outcomes to Healthy People 2020 goals. Encouragement and monitoring of access to early and adequate prenatal care is a goal of our staff, with regular contact a necessity to stress the importance of this care for successful outcome of the pregnancy. PATH staff also diligently works with each family to stress the importance of growth and development of their child. Staff utilizes the Ages and Stages series of screening questionnaires to support teaching, monitoring and referral as needed for further medical and Early Intervention services. Across the board, at least 90 percent of all children screened (ages 12-months, 24-months and 36-months) met expected levels, with all others receiving referrals for further evaluation as appropriate (six to be monitored further and seven referred). Parents routinely provide feedback via our annual satisfaction survey that they appreciate and value the stress placed on growth and development of their child and what they as parents can do to support that as well as the support received should referrals for further services be warranted. Finally, as a program aimed at preventing the incidence of maltreatment, PATH demonstrates success. This past year, only two of the 310 cases (0.6 percent) were referred and opened by the Office of Children, Youth, and Family Services for more intense monitoring and services. We are always open to re-accepting those families at a later time, as needed and appropriate.

Our program objectives all work towards supporting families to achieve a safe and nurturing living environment for the child/children involved, or advocating for the safety and welfare of the child/children involved, which may include advocating for termination of parental rights. We kept these main goals in mind with each of the 156 families with which we worked this past year as well. Reasons for referrals to VNAC are varied, with specific risk categories being most frequently involved (i.e., mental health, domestic violence, drug/alcohol related, child abuse/neglect, or inappropriate parenting skills). Starting this year, we added specific discharge assessments that will monitor for overall improvement from time of admission to discharge for all cases. We also began collecting data specific to the health and well-being of the children assigned to us. Parenting involves nurturing, role modeling and providing for the well-being of children, including nutritional status. Our goals are to maintain family units as much as possible, but also to improve the environment and quality of relationship for the families involved: 1. One of our goals is to successfully close cases based on goals identified by OCYF. Graph 21 demonstrates that 78 percent of all cases closed successfully with the OCYF goals met. Only nine cases had a change in goal to termination of parental rights. The vast majority were successfully closed with preservation of the family unit.

OCYF goal met for VNAC by time of D/C

In addition, our PATH staff utilizes the Life Skill Progression tool, an evidence-based assessment tool, to objectively measure and monitor attainment of specific life skills demonstrated to attribute to positive outcomes for the family. Generally, we are observing an improvement in status for each family in most of the domains, and are specifically monitoring one selected cohort to more closely demonstrate growth over the three-year program.

Visiting Nurse Advocate for the County (VNAC) GOAL: Support families to achieve a safe, nurturing level of functioning for the child/children in the family unit. The VNAC program provides intensively focused services to 1) support families in crisis, 2) provide parenting education and case management for families, and 3) advocate for the safety and welfare of the child/children involved. In as much as our VNAC program begins services after the family unit has been referred to the Office of Children, Youth and Families (OCYF) at each county (Lehigh and Northampton), our efforts to prevent maltreatment, fatal or nonfatal, are initiated upon case opening and monitored until case closure.

Yes No Still Open

Graph 21

Bethlehem Partnership Annual Report â&#x20AC;˘ 26

Maternal and Child Health Programs continued 2. Children assigned to VNAC will remain at or improve in percentage compared to national growth measures for BMI or weight for age. Graph 22 depicts results for this program year. Of the amount not falling within range (between 10th and 85th percentiles), 37 percent (18/48) were opened with a Failure to Thrive diagnosis by their medical provider. These cases require substantial monitoring, education and advocacy for both the child and family.

VNAC: weight for age of children within range at time of admission vs. discharge 100 Yes

Unknown or Still Open

80 60 40 20 0 Graph 22

VNAC works case by case to improve the overall health and safety of the children of our community. 27 â&#x20AC;˘ Access to Care / Health Services Improvement

Admission

D/C

3. A large percentage of our cases involves parenting education needs and nursing case management. VNAC has begun using an evidence-based tool, Life Skill Progression Tool, to not only assess a family’s possession of specific life skills, but also objectively monitor progression to obtaining necessary life skills (i.e., safe relationships, attendance to medical/mental health needs, basic essentials met, child development, etc.). This assessment is done quarterly on each family and helps determine goals for the coming quarter(s). Graph 23 demonstrates that the majority of families are improving or able to function within ‘acceptable ranges’ despite whatever the reason is for Children and Youth involvement. The two most notable areas of improvement were in the Relationships and Access/Use of Appropriate Healthcare domains, with almost 20 percent improving into the acceptable range.

In general, VNAC works case-by-case to improve the overall health and safety of the children of our community. In as much as representatives are also involved in the formation of a Northampton County Child Advocacy Center, we are collaborating with other community representatives to bring a source of constant, centered child advocacy to this county, similar to that found in Lehigh County. Also, representatives serve on the Fatal and Near Fatal Review committees for the counties.

VNAC clients: Life SKill Progression Assessments from Admission to Discharge Child Scales

Worsened/ stayed below range

Basic

Worsened/ stayed below range

Mental Health

Improved but below range

Health Care

Improved but below range

Education/Employment

Relationships

Stable within/ above range

Graph 23

Relationships

Mental Health - D/A

Education/Employment

Basic Essentials

Health Care

Child Scales

Stable within/ above range

For more information about the PATH and VNAC programs, please contact Melissa Craig, 484-526-6203 craigmm@slhn.org.

Bethlehem Partnership Annual Report • 28

Minority Health Initiatives Healthy People 2020 Objectives AHS-1.1 Increase the proportion of persons with medical insurance. AHS-3 Increase the proportion of persons with a usual primary care provider. During the past two decades, one of Healthy People’s overarching goals has focused on disparities. In Healthy People 2000, the goal was to reduce health disparities among Americans. In Healthy People 2010, it was to eliminate, not just reduce, health disparities. In Healthy People 2020, that goal was expanded even further: to achieve health equity, eliminate disparities and improve the health of all groups. Since the Partnership began, our efforts have contained a strong emphasis on reducing and eliminating health disparities experienced by our increasingly diverse community. One of our main efforts threaded throughout all our projects has been the facilitation of access to a usual source of primary care — a medical ‘home.’ Our Partnership efforts will continue, potentially in new ways, as they intersect with other community efforts and partners so we achieve the most we can in an efficient and non-duplicative manner. This past year was robust with activities that attend to the needs of our uninsured and disconnected families. While perhaps appearing disconnected, each project attends to populations within our community that have experienced and continue to experience, health disparities and access to care issues.

Mosser Family Center — Mobile Medical Services Providing a means for uninsured individuals/families to access basic medical services prompted the team from the Mosser Family Center to approach St. Luke’s, requesting a partnership that would primarily serve the families living in the East Side of Allentown service area. The family center staff support families living in this area for many other community related needs, and the hospital would meet medical needs. Since the start of this partnership in 2008, over 685 clients have received service, the vast majority being new to the service/area.

Our Partnership efforts will continue, potentially in new ways, as they intersect with other community efforts and partners so we achieve the most we can in an efficient and nonduplicative manner.

This weekly clinic is staffed by a Nurse Practitioner, a nurse, and a Family Liaison who not only attend to medical needs, but also referrals and assistance linking them to medical insurance and a medical home. The importance of the liaison cannot be underscored in these projects to support the application process. The number of individuals that completed the process was highest during the year (2009-10) that we had support for the entire year. This most current year, over 50 percent of all insurance referrals came from this one site, with 50 percent involving families that were uninsured.

29 • Access to Care / Health Services Improvement

Our goal for 2011-12 is to provide more timely and complete follow-up for all referrals (i.e., insurance, medical home, social services, etc.) so that we can create more than just a one-time access point — our goal is to be a true linkage site for the families we serve. Other potential models of care, including the HealthLeads model, are in consideration for us to best serve these needy families.

Mobile medical services at mosser family center 300 270

Uninsured

240

Insured

180

Goals for the coming year include integrating behavioral health Uninsured services into their practices by partnering with a local organization and re-submission of the 330 funding application. Also included will be the proposed expansion to South Bethlehem, an already designated medically underserved area.

150

Access to Culturally and Linguistically Responsive Services

210

120 90 60 30 0

2008-09

2009-10

2010-11

Graph 24 Community Health Center Network The Bethlehem Partnership remains committed to the success of the Neighborhood Centers of the Lehigh Valley’s (NHCLV) quest for Federally Qualified Health Center status as a means of providing quality service to those most in need. During this past year, NHCLV successfully received the FQHC look-a-like status and has been providing services to the community. While the designation is the first step, there remain other steps to formally and successfully achieve a fully funded status for this local center with two current Allentown based sites (Vida Nueva at Casa and New Life at the Caring Place). This community needs the FQHC funding and, if achieved through the 330 federal application process, the care needed for the 65 percent of clients visiting the NHCLV sites that are uninsured (most of these between the ages of 18-50 years) is a realistic goal. Partnering with the health systems in the area allowed for development of the infrastructure needed to develop this network (primarily Lehigh Valley Hospital and Health Network and Pool Trust Foundation), as well as expansion of services that includes on-site portable vision and dental care (St. Luke’s Hospital & Health Network) and referrals to Sacred Heart Hospital Dental Clinic.

As our local community grows and further diversifies, the need for health systems and services that are culturally and linguistically responsive is imperative. Developing a community health center network helps to connect those disconnected. Providing community based services such as those through HeadStart or the Mosser Family Center mobile clinic, helps to provide initial access services for those new to the community or disconnected as well. Encouraging and facilitating quality services at each partnering health entity are imperative as well. As part of the 2002 State Health Improvement Plan (SHIP) grant and 2006 community call to action (signed by community leaders), St. Luke’s Hospital & Health Network has continued to pursue opportunities to facilitate quality access for those with communication barriers or limited English proficiency. To this end, great progress has been made and, with the support of a business partner, access to ASL sign language interpretation in a timelier manner and medical interpretation services over the phone are now going to be more readily accessible to everyone coming into contact with this health system. Medical Insurance/Access to Care Project Challenging times are upon us and the difficulties achieving medical insurance coverage for families (especially adults) demonstrate that need. In Lehigh and Northampton Counties, the rate of uninsured (all ages) is 21 percent and 19 percent, respectively, as per the 2010 Census data. When we look at some of the local programs, the rates of individuals accessing our services far outweigh those percentages: 33 percent of our mobile youth center clients and 32 percent of the mobile dental van clients are uninsured. Nearly 100 percent of families accessing services through our Mosser Family Center are uninsured.

Bethlehem Partnership Annual Report • 30

Minority Health Initiatives continued In general, the BPHC partners focus efforts on connecting uninsured families with a source of care and assistance with the medical insurance application process. Graph 25 reflects our collective efforts since 2007, specifically, the efforts of the BPHC clinical initiatives and the Bethlehem Health Bureau for this year (as opposed to years prior that included more partners).

Insurance Assistance Initiative Results 2010-11 500 450 400 350 300 250 200 150 100 50 0

Referred

2007-08

Applied

Approved

Pending/Incomplete

2008-09

2009-10

2010-11

Graph 25

Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”

Bethlehem Partnership Annual BASD Minority Award 500

Each 450year the Partnership supports and promotes academic achievement and educational opportunities for our local minority youth. This past year, the BPHC scholarship was awarded to Raymundo Rosa who also was a 400 “School To Work” Liberty High School student. Raymundo will be attending Northampton Community 350 in the fall. College

300

Community Services for Children, Inc. (CSC) — HeadStart Services 250

The 200longstanding partnership for our youngest children in a learning environment continues with CSC. While CSC staff diligently work with families to connect each to a medical home with medical insurance, 150 there are still those that need some help up front. This last year, we provided entry related physical 100 examination and immunizations to 20 uninsured children. In addition, ten children received screening and50needed restorative dental care through our Dental Initiative.

Overall, the CSC staff reports that of the 2008-09 1,099 children accessing 2009-10 their services, 91 percent 2010-11 of all children 2007-08 completed their physical exams, with 95 percent being up to date on immunizations, and 85 percent completed the requisite dental exam. Not discounting the high-need nature of the families with which they work, their efforts are to be commended. It is interesting to note that 19 percent (208) of these children have asthma, the number one medical health condition of children in their programs.

For more information regarding the Partnership efforts regarding these projects, please contact Melissa Craig, 484-526-6203 or craigmm@slhn.org.

31 • Access to Care / Health Services Improvement

Minority Influenza and Pneumococcal Immunization Campaign â&#x20AC;˘ FY 2011 Healthy People 2020 Objectives: IID-12: I ncrease the percentage of children and adults who are vaccinated annually against seasonal influenza. IID-13: Increase the percentage of adults who are vaccinated against pneumococcal disease. The Pa. Department of Health reports that, nationally, it is estimated that over 36,000 people die from flu-related complications each year. In Pennsylvania, approximately 1,000 deaths occur each year.

Each year the minority influenza and pneumococcal program partners with students from the Health, Medicine, and Society class at Lehigh University. Karen Hicks, PhD, is the professor of this class. Students conduct outreach efforts among minority and underserved areas to raise awareness of influenza vaccine availability. At the same time, they have individuals complete an influenza and pneumococcal vaccine survey to help us get a better understanding of the barriers that prevent this population from getting vaccinated.

Minority populations are significantly less likely to receive vaccinations, and therefore are at greater risk of illness and death from influenza and pneumonia. Our local partners join efforts to focus on these individuals to provide them with free influenza and pneumococcal vaccines. Immunization clinics are held at multiple community-based sites and on the Health Star mobile van. These sites are located throughout the greater Bethlehem area.

For 2010-11, there were 420 surveys completed throughout the greater Bethlehem area done through convenience sampling. Surveys were available in both English and Spanish. Students analyzed the survey data and presented the information during class. This data will be used to help design and implement future influenza and pneumococcal immunization campaigns.

For the 2010-11 influenza season, a total of 12 immunization clinics were held at community sites that provided easy access for the low-income and minority populations to obtain their vaccines. Shelters and soup kitchens were included in these sites. A total of 518 influenza vaccines and seven pneumococcal vaccines were administered to this population. This is a 30 percent increase in the number of influenza vaccines that were administered in the previous year.

Graph 26 shows a portion of the data the Lehigh students presented. The most commonly reported reasons for not getting a flu shot were being unsure if they needed a shot (14 percent) and their doctor never told them to get the flu shot (11 percent). Another 7 percent reported that they do not have a primary care doctor.

Reasons for not getting flu vaccine 16

Reaso

14 12 10 8 6 4

rd n't aff o Ca

sid Afr e e aid ffe of cts

tor n't kn ow to wh ge er ts e ho Af t r flu aid I fro 'll m get the th sh e ot

do c

ds n't ne e Do

n't lik e

ots

ho t cto me r ne to ver ge to t s ld ho t Do n't I n kn ee ow d s if ho t

Graph 26 16 14 12 10

Reason Bethlehem Partnership Annual Report â&#x20AC;˘ 32

Minority Influenza and Pneumococcal Immunization Campaign • FY 2011 continued Students noticed that many survey respondents lacked education about the health care system. Respondents were unaware of health resources, unsure of what health related questions to ask their primary care physician, or were underinsured or uninsured. It also seemed that many respondents did not understand the term “chronic disease.” Many reported not having a chronic disease but then circled the illness they had, not realizing it was a chronic disease. In future surveys this question will need to be clarified to ensure accurate data are being collected. 2010 2009 2008 2007 2006 2005 N =420 N=602 N=622 N=950 N=618 N=633

2004 N=70

2003 2002 2001 N=227 N=371 N=107

Ever had a pneumonia vaccine

23%

22%

24%

30%

22%

27%

40%

22%

31%

26%

Ever had a flu vaccine

64%

63%

65%

63%

60%

58%

47%

68%

73%

54%

Had a flu vaccine last year

46%

41%

44%

40%

34%

32%

53%

59%

51%

44%

N = number of people surveyed

In future influenza and pneumococcal immunization campaigns, students recommended conducting an education campaign, focusing efforts on the following points: The importance of getting a flu shot, especially for those with chronic illnesses Risks, if any, associated with getting a flu shot Preventative measures for flu and chronic diseases How to access health resources in the community

The Pa. Department of Health reports that, nationally, it is estimated that over 36,000 people die from flu-related complications each year.

For more information about this initiative, please call Julie Kindig, RN, Nurse Coordinator, at 484-526-6204 or email kindigj@slhn.org

33 • Access to Care / Health Services Improvement

Adolescent Career Mentoring Initiatives Healthy People 2020 Objectives: AH-5: Increase educational achievement of adolescents and young adults. AH-5.1 Increase the proportion of students who graduate with a regular diploma four years after starting 9th grade. AH-5.3: Increase the proportion of students whose reading skills are at or above the proficient achievement level for their grade, 12th grade. Over the 14 years that the Partnership has committed to improving educational achievement for at-risk youth, we have grown our programs into a multi-year step approach that is aimed at academic achievement, career exploration and job skill development. Specifically, our programs begin with in-school English Acquisition students in our School To Work program, a partnership with the Bethlehem Area School District that exposes these youth to career options while strengthening English language skills and overall academic performance. These and other eligible youth are then able to work in the Health Career Exploration Program, a subsidized employment program through a partnership with CareerLink Lehigh Valley, until they graduate high school. Finally, for those high school graduates that qualify and are accepted, our Next Step program (another CareerLink Lehigh Valley funding partnership) provides on-the-job training in subsidized entry level positions in St. Lukeâ&#x20AC;&#x2122;s Health Network. This training strengthens job skills and enables students to gain valuable skills and experience with the goal of obtaining unsubsidized employment in the health care arena. At every level, academic achievement is stressed with mentoring and support provided.

Looking ahead to the HP2020 goals, improving the percentage of students achieving high school graduation within four years, considering their language development needs, is a challenge. Increasing the proportion of students whose reading skills are at or above the proficient level for their grade will also be a challenge, but we believe our community efforts will demonstrate progress in these two areas as well as current progress achieved since 1997.

School To Work Program Graph 27 depicts the graduation rates of senior level students since 2001. Of the 12 (12/14) students who graduated this year, nine are pursuing higher education in the fall of 2011 and two plan to attend in the spring semester of 2012. We are fortunate to have the commitment of the hospital and partnering departments to provide observational experiences for the youth to explore potential careers while practicing their English (written and spoken) language skills. This year 23 different departments in the St. Lukeâ&#x20AC;&#x2122;s Hospital & Health Network participated in the program.

School To Work Graduation Rates 100

Rate

90 80 Percentage

70 60 50 40 30 20 10 0

2000-01

2001-02

2002-03

2003-04

2004-05

2005-06

2006-07

2007-08

2008-09

2009-10

2010-11

Year of Graduation

Graph 27

Bethlehem Partnership Annual Report â&#x20AC;˘ 34

Adolescent Career Mentoring Initiatives continued Health Career Exploration Program Seventeen high school students were enrolled in the program this year. Of these, 13 successfully completed the program in June 2011, with 100 percent (7/7) of seniors graduating high school. Five of the seven have enrolled in higher education and one is in the process of enrolling for the spring semester. Five students returned for a second year; three advanced to the Next Step Program; and one has attained unsubsidized employment outside of the hospital, so that nine of the 13 (69 percent) are still employed. There were 16 St. Luke’s Hospital & Health Network departments participating in the Health Career Program this year. Starting with the new program year, this particular program will only accept senior level grade students and expansion to the Allentown School District has been strengthened by the addition of the Roberto Clemente Charter School linkage to the St. Luke’s Hospital – Allentown Campus for 2011-12.

Over the 14 years that the Partnership has committed to improving educational achievement for atrisk youth, we have grown our programs into a multi-year step approach that is aimed at academic achievement, career exploration and job skill development.

Next Step Program Ninety percent (9/10) of program participants successfully completed the program. Next Step focuses on providing on-site skill development in specific areas to maximize opportunities at program end to achieve unsubsidized employment in a health care-related position. ‘Unsubsidized’ means they have secured regular employment with a salary coming directly from the employer.

35 • Access to Care / Health Services Improvement

Scholarships and Achievements Current Participants Bethlehem Partnership for a Healthy Community Scholarship Raymundo Rosa (School To Work Program) Roberto Clemente Program Marielis Colon (School To Work Program and HCEP Program) Roberto Clemente Scholarship Chanceline Ndihokubwyo (School To Work and HCEP Program) George Maunz School To Work Program Scholarship Marielis Colon (School To Work Program and HCEP Program) Neisha Sanchez (School To Work Program) Employees of St. Luke’s Hospital & Health Network Twenty-one youths from the Adolescent Career Mentoring Programs (since program inception) are currently employed by St. Luke’s Hospital & Health Network. The Adolescent Career Mentoring programs have given these youths the opportunity to pursue careers which were far beyond their initial goals when they entered high school. They are currently working in 13 different departments throughout the Health Network.

Media Coverage for Adolescent Career Mentoring Programs: The Morning Call Article – “A Healthy Chance” (February 2011) The Express-Times Article – “From School to Work to Success” (February 2011) U.S. Department of Labor Employment and Training Administration – Allied Health Access “How to Develop Programs for Youth in Allied Health Careers” (July 2010) APHA Conference “Step Stones For At-Risk Youth: Community partnership designed to provide English Acquisition students health career exploration and work experience opportunities” (November 2011)

Departments that participated in Next Step Program 1. Ambulatory Surgical Center 2. Outpatient Business Office 3. Pharmacy 4. Central Transport 5. Donegan Clinic 6. NICU 7. Lab 8. Union Station Medical Clinic 9. Radiology 10. Dental Clinic 11. Bio-Medical Engineering Unsubsidized Employment (Program Participants 2010 – 2011) 1. Noeli Sosa – St. Luke’s Laboratory 2. Alexander Ascencio – St. Luke’s Central Transport 3. Edwin Almodovar – St. Luke’s Pharmacy 4. Gina Ascencio – St. Luke’s NICU Unsubsidized Employment (Program Participants (2009 – 2011) 1. Heidee Rosado – Second position, St. Luke’s Laboratory

Program Contact Information: Victoria Montero, 484-526-2104 or monterv@slhn.org and George Maunz, 484-526-2311 or maunzg@slhn.org. Bethlehem Partnership Annual Report • 36

Service Learning Healthy People 2020 Objectives ECBP-7: Increase the proportion of college and university students who receive information from their institution on each of the priority health risk behavior areas (all priority areas; unintentional injury; violence; suicide; tobacco use and addiction; alcohol and other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; and inadequate physical activity). ECBP-14: Increase the inclusion of core clinical prevention and population health content in undergraduate nursing. The Institute of Medicine (IOM) recently recommended that “...all undergraduates should have access to education in public health.” The Educated Citizen and Public Health Initiative was developed in part by the Association for Prevention Teaching and Research (APTR), the Council of Colleges of Arts and Sciences (CCAS), the Association of Schools of Public Health, and Association of American Colleges and Universities to help address this IOM recommendation. Faculty develop public health curricula in all our nation’s colleges and universities. The Educated Citizen and Public Health Initiative serves the broader, higher education community, setting the stage for integration of public health perspectives within a comprehensive liberal education framework. Service learning opportunities are strongly encouraged as a method to increase general knowledge of community and public health and to create healthier communities. Service Learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility and strengthen communities. Service Learning provides college and university students with a “community context” to their education, allowing them to connect their academic coursework to their roles as citizens. The work of the Partnership is rich with learning opportunities for those learning about Community Health — both for the student as well as the preceptor. Throughout the years, we have been fortunate to partner with our local higher education institutions to provide opportunities for students to learn about community health while doing community health work.

Service learning opportunities are strongly encouraged as a method to increase general knowledge of community and public health and to create healthier communities.

In celebration of Healthy People 2010, St. Luke’s Hospital, the Bethlehem Health Bureau and Lehigh University’s HMS Department established an Outstanding Public Health Student Award to be presented annually to a Lehigh student for outstanding commitment and dedication to the field of public health as evidenced by community service efforts. The award is intended to promote awareness of the field of public health, recognize and celebrate the efforts of students who have committed to improving the health and well-being of residents in our local area. The 2011 recipient of the Outstanding Public Health Student Award is Caroline Kusi. Ms. Kusi was nominated by Professor Judith Lasker for her work, both locally and internationally, in promoting public health. She came to Lehigh University as part of the student ‘global citizenship’ program, and in that program she became involved in global health studies and programs. While at Lehigh University, she started an Undergraduate Public Health Club and served as its president. Her public health service learning activities included a study abroad experience in South Africa, a summer internship at the Lourdes Clinic in Camden, N.J., research and development of a social service and health promotion program for a free care clinic at Broughal Middle School; and an internship at Lehigh Valley Hospital. After graduation from Lehigh, Ms. Kusi chose to pursue an advanced degree in public health. She will clearly be a leader in the public health field as she pursues her career.

37 • Access to Care / Health Services Improvement

Outstanding Public Health Student Award Recipients: 2010 — John Lalomio 2011 — Caroline Kusi Beginning this year, our reports will highlight the specific initiatives and projects enriched by the work of these students as well as list those programs for which we provided observational experiences. Drexel University Minority Health Initiatives/Language Access — Two RNs to BSN nursing students Accomplishment: Progress in the Language Access at St. Luke’s Hospital & Health Network for medical interpretation Asthma Initiative — One MPH student Accomplishment: Pediatric Asthma research project related to ER utilization Minority Health/Donegan Family Practice at Fowler Family Center — One RN to BSN nursing student Accomplishment: Emergency Room utilization research

East Stroudsburg University AIDS Services Center @ St. Luke’s — One MPH student Accomplishment: Researched and developed a health literacy assessment for use in the St. Luke’s Southside Medical Center Specialty Clinic Lehigh University Minority Health Initiative/Minority Flu — 18 students as part of a Health, Medicine, and Society class Accomplishment: Community flu survey process as well as outreach for community clinics Literacy Initiative — The Lehigh University Athletic Department, Community Fellows, and undergraduate students participate in the Reading Rocks! Initiative and other literacy projects to improve reading levels of students in the Bethlehem area. Accomplishment: Significant improvement in reading levels for children participating in program. Minority Health Initiatives/Donegan Family Practice at Fowler Family Center — One student with a Spanish minor Accomplishment: Set groundwork for initiation of a volunteer-base for medical interpreter exposure for students interested in utilizing their language skills in a health care environment

Bethlehem Partnership Annual Report • 38

Service Learning continued A Community Fellow has worked with the Youth Succeeding in School Initiative at Donegan Elementary School to provide case management and social support to at-risk youth and their families. Accomplishment: Significant improvement in reading levels, math scores and grades for enrolled students Undergraduate students in the Introduction to Public Health class completed service learning projects for the Southside community. Accomplishment: A HealthLeads model was developed for the Broughal HEARTS clinic; an afterschool activity program was provided, a community gardens awareness campaign was conducted, and an assessment of healthy food choices was completed at Broughal Middle School; a recycling awareness campaign was conducted for Lehigh University students; and Reading activities were incorporated into the Cops-N-Kids annual spring event. Moravian College MCH Initiative/PATH program — Three teams of RNs to BSN Nursing students Accomplishment: Submission of a grant proposal to the Children’s Trust Fund to allow expansion of the program to focus on families with babies starting life in the NICU Minority Health Initiatives/Donegan Family Practice at Fowler Family Center-Five total Senior Nursing students in two teams Accomplishment: Participated in a successful pediatric Flu clinic. Organized a nutrition focused event with activities related to healthy eating and exercise for pediatric clients Accomplishment: Presented a hand-washing demonstration for the pediatric clients Muhlenburg College Asthma Initiative — Follow-up calls for pediatric patients post-discharge from Emergency Department Accomplishment: Assistance provided to children with asthma and their families to connect with primary care provider and necessary education Flu campaign Accomplishment: Assistance provided to assure minority and at-risk individuals were able to obtain flu vaccine. Employee Wellness programs — Monthly educational broadcast emails and educational presentations were provided for employees at the Bethlehem campus. St. Luke’s School of Nursing, Diploma program MCH Initiatives/PATH and VNAC — Student Nurse Association of PA (SNAP)

Service Learning provides college and university students with a “community context” to their education, allowing them to connect their academic coursework to their roles as citizens.

Accomplishment: Lead a book bag and school supply drive to provide these supplies for the parents and preschool children MCH Initiatives/PATH program- Fourteen nursing students Paired with assigned families (two per student) and worked with them throughout the semester to improve parenting and life skills while supporting growth and development of the child/children involved Observational Experiences St. Luke’s School of Nursing, Diploma program DeSales University, Nursing program

39 • Access to Care / Health Services Improvement

Tobacco Cessation Program • FY 2011 Healthy People 2020 Objectives TU-1: Reduce tobacco use by adults. TU-4.1: Increase smoking cessation attempts by adult smokers. The St. Luke’s Tobacco Cessation Treatment Center receives tobacco cessation funding from the Pennsylvania Department of Health (PADOH) through the Tobacco Free Northeast Pennsylvania at the Burn Prevention Network. Our program is structured to address the CDC Best Practices for Comprehensive Tobacco Control Programs which include: 1. Preventing tobacco initiation among youth and young adults 2. Promoting quitting among adults and youth 3. Eliminating exposure to secondhand smoke 4. Identifying and eliminating tobacco-related disparities among population groups.

All patients who end the cessation program are asked to complete a satisfaction survey. Of the 203 patients that ended the program, 130 patients completed a satisfaction survey. Ninety-eight percent of these patients reported that St. Luke’s cessation program was very helpful in their quit attempt. Additionally, cessation counseling is provided to youth on the mobile youth health center (MYHC) at all participating middle and high schools and Valley Youth House. MYHC staff provides cessation counseling and educational materials to every identified smoker. In fiscal year 2011, 9 percent of adolescents who received services from the MYHC were identified as current smokers. This is a 31 percent decrease from fiscal year 2010.

Preventing Tobacco Initiation among Youth and Young Adults To address preventing tobacco initiation, cessation counselors participated in several health fairs this past year, including Moravian College, Northampton Community College, the St. Luke’s Hospital – Bethlehem and Allentown Campuses employee health fair, and Saucon Valley Assisted Living community health fair. The health fairs give participants an opportunity to engage in educational activities relating to the negative health effects of smoking, the visual difference between healthy lungs and a smoker’s lungs and the chemicals found in tobacco products.

Promoting Quitting among Adults and Youth In fiscal year 2011, cessation counseling to adults was provided at St. Luke’s Community Health office, St. Luke’s Union Station Health Center, St. Luke’s Allentown Family Health Center, Northampton Community College, The Easton Community HIV/AIDS Organization and Unity House. Services were also expanded to Carbon County at St. Luke’s Nesquehoning Rural Health Center. Counseling consists of meeting with a cessation specialist to develop an individualized treatment plan which includes pharmacotherapy. According to data collected in fiscal year 2011, 217 patients enrolled in the tobacco cessation program and 203 ended the program this past year. Patients who ended the program enrolled in either fiscal year 2010 or 2011. These are patients who completed the program, withdrew, or were lost to follow-up. Seventeen percent of the 203 patients reported achieving and maintaining cessation at the end of the program.

Eliminating Exposure to Secondhand Smoke To address secondhand smoke exposure, the cessation program collaborated with the Bethlehem Health Bureau (BHB) and the Community Health Asthma Initiative. During asthma home visits, the BHB asthma nurse assesses the smoking status of household members to identify secondhand smoke exposure as a trigger for asthma exacerbation. Smoking households are provided with secondhand smoke education, as well as, referrals for tobacco cessation. In fiscal year 2011, one-third of households reported tobacco use. This is an 8 percent decrease from fiscal year 2010.

Bethlehem Partnership Annual Report • 40

Tobacco Cessation Program • FY 2011 continued The cessation program also partnered with the St. Luke’s Hospital Nurse Family Partnership (NFP), the Parent Advocate in the Home (PATH) and Visiting Nurse Advocate for the County (VNAC) Programs to promote secondhand smoke education to families enrolled in these programs. Program nurses have been trained to assess the smoking status of household members, provide education on secondhand smoke exposure and tobacco use, and make appropriate cessation referrals for those interested in quitting. This intervention is effective as evidence by the 18 percent reduction in smoking during pregnancy in the NFP program from 2001 to 2011. A public health intern from Muhlenberg College collaborated with the cessation program to lead a Great American Smoke Out event on November 17th of last year. Secondhand smoke educational table tents were placed in the St. Luke’s Hospital cafeteria. Employees were asked to sign a pledge to commit to providing a smoke free environment in their homes. Approximately 60 employees participated.

Identifying and Eliminating Tobacco-related Disparities among Population Groups Research shows that smoking prevalence is higher among low-income and mental health populations. Smoking is often used as a ‘coping mechanism’ to help deal with the stresses of living with mental illness or financial hardship. The St. Luke’s Tobacco Cessation Treatment Center has also identified tobacco-related disparities in patients enrolling in our program. High rates of transience, life stressors contributing to continued tobacco use, mental health illness and multiple quit attempts continue to be noticeable trends with patients enrolling in our tobacco cessation program. Of the 217 patients enrolled in cessation services this past year, 65 percent of patients reported having previous quit attempts prior to enrolling in the St. Luke’s Tobacco Cessation Treatment Center and 15 percent reported being previously enrolled in our program. Fifty-two percent were either uninsured or underinsured and 45 percent reported having a mental health diagnosis. Yet, despite these challenges, it is important that tobacco use is addressed among low-income, mental health populations. Cessation counseling approaches need to be specifically tailored to address the individual needs of each patient to help reduce the harm caused by tobacco use.

Insurance Type of patients enrolled in Fiscal Year 2011 Private Insurance Medicaid

Research shows that smoking prevalence is higher among low-income and mental health populations. Smoking is often used as a ‘coping mechanism’ to help deal with the stresses of living with mental illness or financial hardship.

Medicare St. Luke’s Financial Assistance Program Uninsured Other Graph 28

For more information about this initiative, please call Hollie Gibbons, MPH, RD, Manager of Disease Prevention Initiatives, at 484-526-2301 or email her at gibbonh@slhn.org.

41 • Access to Care / Health Services Improvement

Strategic Goals

Improve Access to Care Dental Health Initiative

Child/Adolescent Health Promotion and Education

Vision Initiative

Asthma Initiative

The Fowler Family Center at Donegan

Mobile Youth Health Center

HIV Initiative

Resource Room at Liberty High School

Tobacco Cessation Program

Maternal & Child Health Programs

Minority Health Disparities Reduction Minority Health Initiatives Adolescent Career Mentoring Programs HealthStop with HealthStar I

A n n u a l R e p o r t J U LY 2 0 1 0

through

JUNE 2011

Funding for this report provided by St. Lukeâ&#x20AC;&#x2122;s Hospital & Health Network

can be achieved, thereby improving the quality for all. It is believed that through com ownership and shared responsibility, the ph mental, emotional and spiritual wellness of indi and communities can be achieved, thereby imp the quality of life for all. It is believed that th community ownership and shared responsibil physical, mental, emotional and spiritual well individuals and communities can be ac thereby improving the quality of life for al believed that through community ownersh shared responsibility, the physical, mental, em and spiritual wellness of individuals and comm can be achieved, thereby improving the quality for all. It is believed that through com ownership and shared responsibility, the ph mental, emotional and spiritual wellness of indi and communities can be achieved, thereby imp the quality of life for all. It is believed that th community ownership and shared responsibil physical, mental, emotional and spiritual well individuals and communities can be ac thereby improving the quality of life for al believed that through community ownersh shared responsibility, the physical, mental, em and spiritual wellness of individuals and comm can be achieved, thereby improving the quality for all. It is believed that through com ownership and shared responsibility, the ph mental, emotional and spiritual wellness of indi and communities can be achieved, thereby imp the quality of life for all. It is believed that th community ownership and shared responsibil physical, mental, emotional and spiritual well individuals and communities can be ac thereby improving the quality of life for al believed that through community ownersh shared responsibility, the physical, mental, em and spiritual wellness of individuals and comm can be achieved, thereby improving the quality for all. It is believed that through com ownership and shared responsibility, the ph mental, emotional and spiritual wellness of indi and communities can be achieved, thereby imp the quality of life for all. It is believed that th community ownership and shared responsibil physical, mental, emotional and spiritual well individuals and communities can be ac thereby improving the quality of life for al believed that through community ownersh shared responsibility, the physical, mental, em and spiritual wellness of individuals and comm can be achieved, thereby improving the quality for all. It is believed that through com ownership and shared responsibility, the ph mental, emotional and spiritual wellness of indi and communities can be achieved, thereby imp the quality of life for all. It is believed that th community ownership and shared responsibil physical, mental, emotional and spiritual well individuals and communities can be ac thereby improving the quality of life for al believed that through community ownersh shared responsibility, the physical, mental, em and spiritual wellness of individuals and comm can be achieved, thereby improving the quality