Bethlehem Partnership 2010

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.

Annual Report J u ly 2 0 0 9 – J u n e 2 0 1 0

B e t h l e h e m Pa rt n e r s h i p a n d H e a lt h y p e o p l e 2 0 1 0

2010

What a landmark year! Everyone in the public/community health field knows the importance of Healthy People 2010. Our goals and objectives are defined and measured by it. We look to it for guidance and structure as we build programs and services. And now we’ve arrived at the year, and it provides us with the wonderful opportunity to reflect on our work, our ambitions, to evaluate where we’ve been and where we want to go, and to chart new paths to improve our work.

Public and community health initiatives brought remarkable and unprecedented improvement in the lives of Americans during the 20th century. The challenge for the 21st century, as set out by Healthy People 2010, is twofold: 1) to assure that our rate of health advancement continues unabated; and 2) to make certain that all Americans benefit from advancements in quality of life, regardless of their race, ethnicity, gender, disability status, income or educational level.

Mary Carr Northampton County Drug & Alcohol Division Iris Cintrón Bethlehem Area School District Bonnie S. Coyle, MD St. Luke’s Hospital & Health Network

At the local level, the Bethlehem Partnership has been committed to these goals of promoting health and wellness for all residents for the past 15 years. The Health Care Reform Act challenges us even more as a community to promote equity and access to care, healthy behaviors and prevention as a way of improving the health status of all members of society.

Kevin Dolan Northampton County Children, Youth & Families Division

So, as we continue our work in the year 2010, what a perfect time to look back and celebrate our accomplishments, to examine and evaluate what our priorities for health improvement are, and to develop or refine a new, improved and evidence-based strategy to make Bethlehem and the surrounding Lehigh Valley the healthiest place to live and work for all residents!

Kathy Halkins Bethlehem Area School District

Let’s all join together as a community to look at and celebrate what we’ve achieved through our efforts at supporting Healthy People 2010, and look ahead to what we can accomplish as we move toward the goals of Healthy People 2020.

Table of Contents Mission....................................................................... 1 Advisory Board Members/Agencies.................................................. 1 2009 – 2010 Participating/ Funding Agencies . .................................................. 2 Access to Care/Health Services Improvement Dental Health Initiative............................................ 3 Vision Initiative........................................................ 5 The Fowler Family Center at Donegan.................... 7 HIV Initiative.......................................................... 11 Asthma Initiative.................................................... 15

Adolescent Health Initiatives................................ 17 Maternal Child Health........................................... 20 Minority Health Initiatives..................................... 25 Minority Flu and Pneumococcal Immunization Campaign........................................ 27 Adolescent Career Exploration Mentoring Programs.............................................. 29 HealthStop............................................................. 32 Tobacco Cessation Program................................... 33 Strategic Goals.......................................................... 35

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.

1

Advisory Board Members/Agencies 2009 – 2010

Sandra E. Figueroa-Torres Life Academy

Arnette Hams Lehigh Valley Hospital and Health Network Diana Heckman ALERT Partnership Sara Klingner, MSN, RN, CNM VNA of St. Luke’s Hospital Lissette Lahoz Neighborhood Health Centers of the Lehigh Valley Judith Maloney Bethlehem Health Bureau Marci Ronald United Way of the Greater Lehigh Valley Lilia Santiago Coalition for a Smoke-Free Valley Shelba Scheffner, MPH, CHES Eastcentral PA Area Health Education Center Karen Schiavone American Cancer Society

2 0 0 9 – 2 0 1 0 PARTI C I PATIN G / F UNDIN G A G EN C IES 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 Community Police Bethlehem Health Bureau Bethlehem Housing Authority Bethlehem Parking Authority Bethlehem Police Department 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 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 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 Donegan Fowler Family Center Dr. George McGinley Dr. Ann Hunsicker Dr. John Staivecki Dr. Joseph Gaudio Dr. Karen Lehman Dr. Patrick Ludwig East Stroudsburg University Easton Area Community Center 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 Highmark Foundation Lehigh Valley Hospital & Health Network • C enter for Women’s Medicine Lehigh Valley Hospital & 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

Lehigh Valley Health Network Lens Crafters – Promenade Luxxotica 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 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 Northampton County • Children, Youth & Families • Coroner’s Office • Department of Corrections • Drug & Alcohol • Juvenile Justice Center • Meals on Wheels • MH/MR • Drop-In Cente • 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 Penn Argyl School District Pennsylvania Asthma Partnership Pennsylvania Department of Health Pfizer, Inc. Phillipsburg School District Pinebrook Services for Children Planned Parenthood of Northeastern Pennsylvania Pride of the Greater Lehigh Valley Private Industry Council of the Lehigh Valley/PA Careerlink Lehigh Valley Projecto Claridad Quilts for Kids, Emmaus Chapter Regal Cinemas

Richard Ritter Pharmacy Roche Pharmaceuticals Rotary Club of Bethlehem Sacred Heart Hospital Safe Harbor 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 Tibotec Pharmaceuticals 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 Volunteer Center of the Lehigh Valley Walter’s Pharmacy Wal-Mart Store #3563, Route 191 Weed & Seed Wegmans Weis Markets Wilson Area School District

Bethlehem Partnership Annual Report • 2

Dental Health Initiative Healthy People 2010 Objectives:

21-1 Reduce the proportion of children and adolescents who have dental caries experience in their primary or permanent teeth.

21-2 Reduce the proportion of children, adolescents and adults with untreated dental decay.

21-8 Increase the proportion of children who have received dental sealants on their molar teeth.

21-10 Increase the proportion of children and adults who use the oral health care system each year.

21-11 Increase the proportion of children and adolescents under age 19 years at or below 200 percent of the Federal poverty level who received any preventive dental service during the past year.

We have had many exciting things happen in the Dental Health Initiative (DHI) this year. The ability for us to provide dental care to our community has greatly increased with the addition of a new Dental Center in Easton, a Dental Suite at a local middle school and the highly anticipated arrival of our new, three chair Dental Van. Our supporting partners have been generous in helping us achieve our goal of bringing dental care to those that need it most.

Dental Van Program The Dental Van Program served 31 sites and provided care to almost 1100 children.

On February 13, 2010, we debuted the new Dental Van, HealthStar III, at an event organized in conjunction with Regal Cinemas and the screening of “The Tooth Fairy,” a movie starring Bethlehem native Dwayne “The Rock” Johnson. With contests, prizes and tours of the new Dental Van, we provided an opportunity for the community to come out and celebrate with us. The new Van began providing services in April 2010 and has allowed us to treat more children for restorative care, making full use of all three patient chairs. Our older van has not been retired yet! Plans are underway to use the older van as we expand services into Allentown, starting on a part time basis. We hope that by next year we will have two full time vans operating in the Bethlehem and Allentown communities.

As part of the Dental Van Program, through grant funding received from R.K. Laros Foundation, we are excited to have been able to set up a Dental Suite at the Family Center in the new Broughal Middle School in Bethlehem. This is one of our high-need schools and being able to provide on-site dental care has been invaluable. We hope to make further use of that room, on a regular basis, with the possibility of providing care to adults as well. Patient chairs, generously donated by Dr. Joseph Gaudio, have also FY 2006

FY 2007

FY 2008

FY 2009

FY 2010

Visits

2808

2984

2788

3244

2921

New Patients

592

701

547

614

468

#Restorations (Fillings)

1940

2308

1651

1971

1916

#Sealants

1812

1777

2136

2129

2013

Chart 1 3 • Access to Care / Health Services Improvement

been set up at Liberty High School in Bethlehem and Paxinosa Elementary School in Easton.

The Dental Van Program served 31 sites, which include schools in the Bethlehem Area School District and other schools and community agencies across the Lehigh Valley and beyond.

Care was provided to almost 1100 children — cleanings, x-rays and basic restorative care. Twenty-five percent of the children seen have no dental insurance, further deterring access to much needed dental care. The Dental Health Initiative is committed to providing care to the uninsured children in our community.

With support from partners such as the Bethlehem School District, the Bethlehem Health Bureau and Family Connection in Easton, the DHI provided over $111,000 in subsidized and free care.

Easton Dental Center and the Dental Health Center at Union Station July 20, 2009 marked an important day in the history of the Dental Health Initiative. After months of planning, The Easton Dental Center opened its doors. With the generous support of the Health Resources and Services Administration, the Highmark Foundation and a private donor, this three chair center was outfitted to provide dental care to children and adults four days a week. Patient chairs were generously donated by Dr. Patricia Ludwig, a local Bethlehem dentist.

Centrally located in the city of Easton, the Center has been a haven for patients in dire need of dental care. Almost 2,400 patient visits were recorded this past year. Through our outreach into the medical and dental communities, many referrals have been made to the Center, not only for Easton residents, but for patients from other outlying areas who otherwise would find it difficult to access care in their own community. We plan to expand adult care by opening five days a week this year.

and their assistants provided 27 children with 21 fillings. These children, from local Bethlehem schools, received much needed dental care and enjoyed activities throughout the day that focused on oral health care, with help from the Bethlehem Health Bureau staff. What a wonderful example of people coming together to serve their community. In kind acknowledgment of the work the Bethlehem Partnership does, the Restorative Marathon Days organized by the Northampton Community College Hygiene Program and the Dental Health Initiative were recognized with a Humanitarian Award by the Second District Valley Forge Dental Association this past March.

In the interest of “prevention is key” the Sealant Program in conjunction with NCC continued by providing 456 children with 2,013 protective sealants during the last school year, in an effort to lower the risk for decay.

Though scheduling issues prevented us from organizing a Marathon Day at Dr. Ann Hunsicker’s office this year, we are gearing up to partner with her again next year. Dr. Hunsicker has generously opened up her office doors and provided free care to children from local Bethlehem schools. We hope to continue this partnership with Dr. Hunsicker and appreciate her efforts in giving back to her community.

We take great pride in our Dental Health Initiative and appreciate the efforts of our dental staff, community partners and supporting partners. It is our goal to continue to provide access to topquality dental care to the residents of our community.

The Dental Health Center at Union Station, our home base of operations, continues to see an increase of patients needing dental care. With almost 5,400 patient visits last year, many patients view us as the “last stop” in being able to get the care they need. In conjunction with the General Practice Residency Program, patients can get specialty care in addition to general dental treatment.

Oral Health Partners The Northampton Community College’s (NCC) Dental Hygiene Program continues to work hand-in-hand with us — as in years past. NCC hosted three Preventive Marathon Days, 130 cleanings, fluoride treatments and diagnostic x-rays were performed on children from Donegan, Fountain Hill, Freemansburg and Marvine Elementary Schools.

NCC also continues to host the Restorative Marathon Day each May. This past year, two volunteer dentists for our local community, along with two of our Dental Residents — Dr. Jessica Krausz, Dr. Karen Lehman, Dr. Jayme Mace, Dr. John Staivecki

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 Maribel Rivera, Manager, Dental Operations, St. Luke’s Hospital & Health Network, at (610) 954-2465.

Bethlehem Partnership Annual Report • 4

vision Initiative Healthy People 2010 Objectives:

28-4 Reduce blindness and visual impairment in children and adolescents aged 17 years and under.

More than 25 percent of all children return to school each year with undetected vision problems that may interfere with learning. Nearly 80 percent of what a child learns is obtained visually. Research indicates that 70 percent who have difficulty in reading have some form of visual impairment, such as ocular motor, perceptual or binocular dysfunction. Parents, health care providers and educators owe it to our children to address vision problems before they negatively impact academic performance and social interaction.

Students of the Bethlehem Area School District (BASD) were offered assistance with vision care through several different strategies this past school year. For the first time in four school years the “One Sight Vision Van” (formerly “Give the Gift of Sight” Vision Van supplied by the Luxoticca Company), did not come to the Lehigh Valley. We have been very fortunate to have this service come to our area three years in a row. However, having this past school year off from the program has allowed our partners to focus more on our own resources to provide vision services to BASD students.

“The best lesson plans, teaching methods and new technology mean nothing to a student who cannot see clearly.”

For this past school year: • 19,507 students had vision screenings provided by the school nurses • 2,848 of these students were referred for vision exams • 807 of these students had their vision referral completed • Out of the 807 completed referrals, the vision initiative assisted with 21 percent of these referrals.

• Th ose students who were referred for care through the vision initiative had a 71 percent completion rate.

Chart 2 shows the need for the vision initiative services. Vision initiative support dropped significantly this year due to the “One Sight” vision van not coming to the Lehigh Valley.

— Superintendent, Cincinnati Public Schools

NEED FOR VISION INITIATIVE SERVICES 3000 2500 2000 1500 1000 500 0

2004-2005

2005-2006 Referred

Chart 2 5 • Access to Care / Health Services Improvement

2006-2007

2007-2008

Completed Referrals

2008-2009 VI Support

2009-2010

Vision Voucher Program Our primary resource is the vision voucher program. Any student who is referred for vision care, and does not have access to it, is assigned a vision voucher through the school nurse. Students then take this voucher to a participating vision initiative partner who provides a vision exam and a pair of glasses (if required).

Through the vision vouchers and the Vision Service Plan offered through the National Association of School Nurses, 170 students were able to receive vision care.

Portable Vision Program We are pleased to announce that our portable vision program is up and running again. This past spring we had a volunteer ophthalmologist join our team. Dr. George McGinley has been volunteering his time with the portable vision clinic. At the end of this past year, we were able to take the equipment out to do three portable vision clinics. Two of these clinics were held within the BASD: William Penn Elementary School and Broughal Middle School. One clinic was held at the St. Luke’s Family Practice at Donegan. After receiving vision exams at the clinics, a total of 15 pairs of glasses were given to individuals who were in need of them. We would like to thank our partners Dr. George McGinley and Steven Roseman from PEARLE Vision Center who helped us with these clinics. We also appreciate the staff of each of these schools and clinics who helped us to connect with the students and community members with needs.

We look forward to continuing our work with all of our partners as we regularly schedule monthly portable vision clinics throughout the Lehigh Valley. Through our new HealthStar I Medical Van and our new and updated vision equipment, we will be able to reach even more students in need of vision services. This will help the schools in completing their vision referrals, but more importantly it will allow the students to perform better in school.

One Sight Returns As we prepare for the coming school year, our vision initiative will be off to a great start as the Luxottica, “One Sight Vision Van” returns to the BASD in October. For two days we will be focusing on vision exams for students who have failed their vision screenings in school. By the end of the two days, the majority of students needing glasses will receive them with the remaining students receiving their glasses within a week.

This will assure that the students will be well prepared for their school work for the present school year.

If you would like more information about the Vision Initiative or would like to offer your resources to this program, please call Julie Kindig,RN, Nurse Coordinator at 610-954-6204 or e-mail her at kindigj@slhn.org.

Bethlehem Partnership Annual Report • 6

The Fowler Family Center at Donegan Healthy People 2010 Objectives:

1-1 Increase the proportion of persons with health insurance.

7-10 Increase the proportion of local health service areas or jurisdictions that have established a community health promotion program that addresses multiple HP 2010 focus areas.

The Fowler Family Center at Donegan, sponsored by the United Way of the Greater Lehigh Valley, the Pennsylvania Department of Health, Northampton County, St. Luke’s Hospital, the Bethlehem Area School District and the Bethlehem Partnership, is entering its thirteenth year of operation serving nearly 500 students and their families.

Staffed by family development specialists, a family-to-family advocate, and a part-time secretary, 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 utilizes 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 is 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.

80 percent of kindergarteners increased their reading score by at least one level.

Youth Succeeding in School With funding from the United Way, the Fowler Family Center completed its second full year of implementing its Youth Succeeding in School Initiative to promote academic success for at-risk students. One hundred eighty-seven students and their families were enrolled in the program throughout the year, and 105 completed the program during the year, meeting our program goal of at least 100 children completing the program.

For the 105 children and their families receiving the comprehensive case management service, the following findings and outcomes were identified: •F orty-seven (45 percent) of clients reported that Spanish was their primary language. An additional 33 (31 percent) students/families reported speaking both English and Spanish at home.

All clients received case management services in their preferred language.

• A customer satisfaction survey was administered at two separate times during the year, with a 46 percent response rate. Of those clients who completed the survey, 90 percent reported a high degree of satisfaction with the program and services received. The most commonly reported valuable aspects of the program were: making new citizens feel welcome; receiving needed dental care; receiving referrals to social services; and receiving help to connect with medical care.

• Fourty-nine percent of the students in third, fourth and fifth grade who had reading evaluations in September and May of the program year improved their reading level by at least one level.

Sixty-eight percent increased their math scores by at least one level. For grades one and two, 72 percent increased their reading score by at least one level. Finally, 80 percent of kindergarteners increased their score by at least one level.

7 • Access to Care / Health Services Improvement

• The number of children enrolled who had insurance increased from 64 percent to 85 percent.

• Eighty-seven (82 percent) of YSS enrolled students participated in the Reading Rocks! Initiative.

Reading Rocks! is a joint program between St. Luke’s Hospital and Lehigh University to promote literacy in the South Bethlehem community. Reading Rocks! has worked closely with the Youth Succeeding in School Initiative at Donegan Elementary School for the past two years. As a result of this program, led by Roseann Corsi from Lehigh University and Sue Schantz from St. Luke’s Hospital, the following activities were accomplished during the past year: • Through generous donations from Cops N Kids, more than 2,000 books were distributed to Donegan students to promote reading.

• Fall and Spring Reading Rocks! competitions were held during the school year, with nearly 150 students participating each semester.

• Kickoff assemblies were held before each program with Lehigh athletes sharing their stories and encouraging Donegan students to participate in the program to achieve their reading goals.

• Over 70 Lehigh University students/athletes and 30 St. Luke’s staff served as volunteer readers during the (fall/spring) after-school program. These valued volunteers conduct one-on-one reading sessions with at risk Donegan students.

They also engage them in entertaining activities to promote creativity and physical activity.

• Students who achieved their goals were acknowledged at assemblies at the end of each program. A celebration was held at a Lehigh University basketball game for Fall program participants. Over 300 students and family members attended this celebratory event. More than 60 students who achieved goals during the spring program attended Lehigh’s Wide World of Sports event for a day of fun activities.

This summer we implemented a pilot project to take Reading Rocks! outside and into the community. During the months of June and July, Reading Rocks! partnered with the Southside Branch of the Bethlehem Public Library to incorporate the library’s summer theme: Water. The initiative had the same goals as Reading Rocks! After some careful brainstorming and planning, Reading Rocks Makes a Splash! was born.

Two graduate student interns from East Stroudsburg University and Lehigh University researched reading programs for elementary school students that incorporated elements of learning with physical activity. They decided to develop scavenger hunts for the kids throughout their Southside Bethlehem neighborhoods.

The hunts were designed to help them practice reading while getting some exercise. Three scavenger hunts were held at Donegan Elementary and Yoscow Park, Lehigh University and Sand Island.

For each location, a course was planned, accompanied by a worksheet that the students completed along the way. The worksheet required the students to not only read and answer questions, but also follow the directions to the end of the course. After each activity, the students were instructed to visit the library to claim their prize for completing the activity as well as enjoy some of the library’s activities for that week.

Bethlehem Partnership Annual Report • 8

The Fowler Family Center at Donegan cont.

Books from Cops n’ Kids and small games from the Community Health Department were donated to be used as prizes. If students completed all three activities, they were rewarded with Iron Pigs tickets.

Twelve students from a summer ASPIRE program and five additional individual students participated in the pilot project. The scavenger hunts were very popular with the students, and we are looking to expand this program to serve a larger number of students next year.

In addition to the accomplishments of the Youth Succeeding in School and Reading Rocks! program, Fowler Family Center also provided the following programs and services to students attending Donegan and their families: Family Health Care Services •D ental care was provided through 13 visits on HealthStar II, and 157 children received dental care through the NCC Marathon Days.

• Th e family clinic, staffed by Family Center and St. Luke’s Hospital employees, provided primary and preventive care through 2343 visits to low-income children and families.

Ten percent of individuals seen were uninsured.

•A women’s health clinic, partially funded by BHB, SLHHN, and Maternal and Family Health Services, Inc. provided care during 185 visits for 83 low-income women.

•B HB provided 914 immunizations to low-income children through an on-site immunization clinic.

Chart 2 shows the number of visits to the women’s health clinic and the family practice clinic (previous to 2007 — pediatrics only clinic) over the last ten program years.

FOWLER FAMILY CENTER PATIENT VISITS The family clinic provided primary and preventive care through 2343 visits to low-income children and families.

2500

2364

1964

2000 1757

2343

Women’s Health Clinic

1998

Family Practice Clinic

1847 1680

1552

1500

1434

1000 668 558

500 230

0

2000

307

301

349

414 315

9 • Access to Care / Health Services Improvement

219

185

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Fiscal Year Chart 3

285

During this past program year, Donegan has completed the transition to a full family practice setting. Completing grant funding received thru the Dept. of Health, this clinical practice has continued its goal of providing access to care to those most in need in a supported setting. Family Center staff support medical interpretation language needs as well as social service access support. The challenging economy has seen an increase in uninsured adults but with the support of the St. Luke’s Family Assistance Plan many of these individuals were able to access free or low-cost care (almost a 100 percent increase in participation with this community benefit, 105 to 194).

For more information about the Fowler Family Center at Donegan or to volunteer, please contact Linda Henning Estrada, supervisor, ASPIRE program and the Fowler Family Center at Donegan, Bethlehem Area School District, at 610-849-9345 or email her at lestrada@beth.k12.pa.us.

Bethlehem Partnership Annual Report • 10

HIV Initiative Healthy People 2010 Objectives:

13-5 Reduce the number of cases of HIV infection among adolescents and adults.

13-13 Increase the proportion of HIV-infected adolescents and adults who receive testing, treatment and prophylaxis consistent with current Public Health Service treatment guidelines.

13-14 Reduce deaths from HIV infection.

13-15 Extend the interval of time between an initial diagnosis of HIV infection and AIDS diagnosis in order to increase years of life of an individual infected with HIV.

Of the 1,591 individuals who participated in IDGs, 100 percent of the participants completed all group activities and identified and committed to behavior changes.

HIV infection is a nearly 30 year epidemic with about 1.5 million infections and over 500,000 deaths in the US. Recently, a national HIV/AIDS strategic plan has been adopted with the following three goals: 1) Reduce the number of people who become infected with HIV; 2) Increase access to care and improve health outcomes for people living with HIV; and, 3) Reduce HIV-related health disparities.

The Bethlehem Partnership is committed to promoting these national goals in our local area. The AIDS Services Center at St. Luke’s Hospital (ASC) has taken the lead on addressing this important local public health issue. Programming for the ASC 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.

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

This year, the ASC prevention staff focused efforts towards increasing HIV education and risk reduction counseling to individuals through IDIs. High-risk individuals who participate in IDIs develop a personal risk reduction plan and complete risk reduction skill building activities committing to reducing or changing risk behaviors. In FY 2010, the total number of IDIs completed more than doubled as compared to FY 2009; 480 compared to 229 respectively. This can be attributed in part to conducting IDIs in structured settings where participants are attending the facility for other services/programs as opposed to recruiting participants through street outreach. For instance, IDIs were completed at Trinity Episcopal Church, New Bethany Ministries, St. Luke’s Family Practice at Fowler Family Center,

11 • Access to Care / Health Services Improvement

St. Luke’s HealthStar Mobile Van, Northampton County Prison, Unity House, Twin Rivers, Moravian College, Northampton Community College and Safe Harbor shelter.

HIV Testing

It has been our experience that IDI participants are reluctant to participate in intensive risk reduction counseling if it entails making several separate scheduled appointments. Of the 480 IDI participants, only 1 percent participated in multiple counseling sessions. Since the prevention staff is at most of the above mentioned facilities either weekly or biweekly, they attempt to provide brief prevention messages to previous IDI participants (when encountered) if they are unwilling to continue to participate in multiple counseling sessions.

Street outreach is often used to recruit participants for IDIs and HIV rapid testing. Of the 4,309 completed outreach contacts, 67 percent were completed to recruit for IDIs while 33 percent were completed to recruit for HIV testing. Of the 2,893 outreach contacts completed to recruit for individual risk reduction counseling, 4.9 percent progressed to participating in IDIs. Of the 1,591 individuals who participated in IDGs, 100 percent of the participants completed all group activities and identified and committed to behavior changes. Of the 3,992 HC/PI participants, 96 percent stated that their knowledge of HIV increased after the presentations. This information was captured through a pre-and -post test and an evaluation using the interactive E-Instruction Classroom Performance System. With this system, participants are able to interact with the staff members by using infrared remotes to answer questions and are able to provide useful feedback while remaining anonymous.

ASC is an approved Pennsylvania Provider Agreement (PPA) site from the Pennsylvania Department of Health (PA DOH) which allows ASC to provide free confidential and anonymous rapid HIV testing to the community. Two hundred seventy-six tests were completed from July 2000 to June 2009. Of these tests, one confirmed positive test result was given. Of the tests completed, 409 risk factors were reported because several individuals reported more than one risk factor. Fifty-six percent of the people getting tested reported having sex without a condom as their main risk factor. Additionally, 13 percent reported either having protected sex or no risk factors yet wanted to be tested.

ASC was awarded a PA DOH mini-grant to conduct HIV testing through social networking this past year. Research relating to Social Network Testing indicates, approximately 6 percent of people being tested through social networking are newly diagnosed with HIV. As a Pennsylvania funded PPA testing site, ASC has maintained a 1 percent or less positivity rate. By using procedures for social network testing, we hope to increase our positivity rate to a minimum of 3 percent or higher. In addition to increasing the organization’s positivity rate, we will increase enrollment in IDIs by providing risk reduction counseling to those who are referred for testing.

Thus far, prevention staff have trained fifteen HIV positive “recruiters” who will then recruit ten people each within their social network to be tested, thereby potentially testing a total of 150 high-risk individuals.

2006-2007 2007-2008 2008-2009 2009-2010 CONTACTS FOR PREVENTION INTERVENTIONS 2006-2010

Prevention Interventions

OUTREACH

IDI

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

IDG

HC/PI

0

1000

2000

3000

4000

5000

6000

Number of Contacts Chart 4

Bethlehem Partnership Annual Report • 12

HIV Initiative cont.

RISK REPORTED FOR COMPLETED HIV TESTS 3%

7%

9% 3%

56%

5% 4% 3% 2% 8%

Sex without a Condom

Sex with a Person who is HIV+

Male Having Sex with Male (MSM)

Sex for Drugs or Money or while High/Intoxicated

Injection Drug User or Shared Needles

General Public or No Risk

Sex with an MSM (female) or with Partner of Unknown Status

Bisexual

Sex with a Person who is an IDU

Protected Sex

Chart 5

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 contracting HIV through high-risk behaviors. CRCS gives HIV-positive individuals the opportunity to learn how to stay healthy and how to prevent transmission of HIV without a requirement for ongoing engagement.

the clinical care staff worked closely with St. Luke’s Dental Services to improve oral health in HIV positive patients.

This past year 100 patients participated in CRCS as compared to 78 in fiscal year 2009. Of the 100 participants, 80 percent reported having no risk factors. The remaining 20 percent reported moderate or high-risk behaviors including struggling with drugs, alcohol or medication adherence, sexually active without consistent use of a condom, multiple sexual partners, financial and housing problems and having issues with disclosure of HIV status. Compared to FY 2009, there was a 3 percent decrease in the number of patients who reported moderate or high-risk behaviors.

# OF PATIENTS RECEIVING PRIMARY AND SPECIALTY CARE 2010

Fiscal Year

2009

2008

2007 0

20

40

60

80

100

Number of Patients

Chart 6 13 • Access to Care / Health Services Improvement

120

140

160

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. This past year, the case management staff provided services to 270 HIV-positive clients, an 8 percent increase from fiscal year 2009 and a 28 percent increase from fiscal year 2008. Sixty-eight percent of the clients receiving case management services are at or below the Federal poverty line.

Clients enrolled in case management services receive HIV-related medical care from several practices throughout the Lehigh Valley.

This past year, ASC helped 69 clients with either emergency or monthly housing assistance by way of rent or utility payment, apartment security deposits and permanent housing placement.

An additional, 55 family members, adults and children, received assistance by ASC providing housing services to the 69 clients.

outpatient medical care, case management services, nutrition counseling, risk reduction counseling, dental care and treatment adherence counseling.

The clinical care team monitors Group I and II HRSA HIV/AIDS Bureau (HAB) HIV Core Clinical Performance Measures as part of a Quality Management Plan. Data is collected, monitored on a monthly basis and discussed at a HIV Clinical Care Committee meeting. The table below shows several performance measure results over a three-year period compared to national benchmark data (NA indicates no national benchmark).

This past year, the clinical care staff worked closely with St. Luke’s Dental Services to improve oral health in HIV positive patients attending St. Luke’s Union Station Health Center. In July 2009, 29.5 percent of patients reported having an oral exam at least once in the measurement year. After implementing a quality management plan known as Plan, Do, Study, Act (PDSA), the oral health performance measure has increased to 56.3 percent in June 2010. The clinical care staff is currently using the PDSA cycle to improve the cervical cancer screening and TB screening performance measures.

Clinical Care Services Primary and specialty care services were provided to 145 HIVpositive individuals, a 12 percent increase from FY 2009. Since 2007, clinical care services have been steadily growing as depicted in the graph below. Clinical services are provided at St. Luke’s Union Station Health Center. Services include ambulatory/

Performance Measure

Questions relating to the HIV Program can be directed to Hollie Gibbons, Manager of Disease Prevention Initiatives, at 610-954-2301 or emailed to gibbonh@slhn.org.

Benchmarks

FY 2008

FY 2009

FY 2010

Two Primary Care Visits >= 3 Months Apart

NA

87.06%

87.85%

93.6%

Percentage of Patients with >=2 CD4 Counts

62.50%

63.53%

79.44%

91%

100%

77.42%

95.65%

100%

94.40%

100%

90%

94.1%

NA

63.53%

100%

100%

TB Screening

56.20%

58.82%

55.47%

71%

Cervical Cancer Screening

70.8%

52.17%

55.56%

66.8%

Syphilis Screening

80.00%

60.78%

70.63%

80.1%

Hepatitis C Screening

90.90%

75.49%

90.70%

96%

Adherence Assessment and Counseling

55.7%

NA

11.39%

96.5%

NA

NA

51.94%

99%

84.7%

NA

40%

88%

AIDS patients on Highly Active Anti-Retroviral Treatment (HAART) CD4<200 with PCP prophylaxis Percentage of pregnant women prescribed ART

HIV Risk Counseling Lipid Screening Chart 7

Bethlehem Partnership Annual Report • 14

Asthma Initiative Healthy People 2010 Objectives:

24-2 Reduce hospitalizations for asthma.

24-3 Reduce hospital emergency department visits for asthma.

24-6 Increase the proportion of persons with asthma who receive formal patient education, including information about community and self-help resources, as an essential part of the management of their condition.

The Asthma Initiative has been serving the Bethlehem area for 13 years. This program offers school age children and their families educational support, nursing interventions, and asthma assessments.

The program goals are to: • Identify children with asthma who have not been diagnosed and refer them for treatment • I dentify and educate children with a known diagnosis of asthma who are not being adequately treated •P rovide public education and awareness as well as provide continuing education on National Asthma Education and Prevention Program (NAEPP) guidelines to area providers.

Asthma Facts

The Allentown area is ranked number 14 out of 100 of “The Most Challenging Places to Live with Asthma” for 2010.

• An estimated 20 million Americans suffer from asthma (one in 15 Americans).

• Asthma is the most common chronic condition among children.

• Nearly 5 million asthma sufferers are under age 18.

• Asthma is the third-ranking cause of hospitalization for children.

• Asthma is the number one cause of school absenteeism among children.

• Each day 11 Americans die from asthma.

• The Allentown area is ranked number 14 out of 100 of “The Most Challenging Places to Live with Asthma” for 2010. This is up from number 15 in 2009.

Service Improvement The Asthma Initiative continues to work with the St. Luke’s Hospital – Bethlehem Campus, Emergency Department (ED). The rate of pediatric ED visits are monitored, which assists us in identifying areas of need within Bethlehem. This past year Lehigh University Community Fellow, Jessica Stuart, tracked ED utilization rates and mapped the reported residency of patients. This helps us to focus on the communities where further education and asthma care are needed. The following table depicts the number of pediatric ED and inpatient visits for patients living in Bethlehem zip codes.

Fiscal Year

2004

2005

2006

2007

2008

2009

2010

Total # of Patients

225

193

248

242

216

199

273

Total # of ED and Inpatient Encounters

285

234

302

209

257

247

345

Total # of ED Visits

221

190

265

261

211

211

275

Total # of Inpatient Admissions

64

44

37

48

46

36

70

Chart 8

15 • Access to Care / Health Services Improvement

Every family who had a child that was seen in the ED was sent an asthma education packet and asthma supplies. An attempt was also made to contact each one of these families with a follow-up phone call to see if they needed any other assistance with their child’s asthma care. Families living in the City of Bethlehem were also offered a home visit to complete an environmental assessment and provide further asthma education. These home visits are provided in partnership with the Bethlehem Health Bureau (BHB).

Sixty home visits were completed this past year, which is a 42 percent increase compared to last year.

As the graph below shows, the number of ED visits and inpatient admissions for pediatric asthma has increased in the past year. ED visits alone increased by 23 percent this past year. In FY 2010 there was also a 20 percent increase in the number of patients with multiple encounters to the ED, compared to a 16 percent increase in FY2009. Forty-five percent of the asthma pediatric ED patients for FY2010 were from the 18015 zip code area. This geographic area holds well under 50 percent of the Bethlehem population.

Some potential explanations for this heavy use of the ED by residents in South Bethlehem and Fountain Hill: 1) uncontrolled asthma due to lack of primary care, 2) use of the ED as a source of primary care, 3) old and poor housing stock containing indoor triggers, and 4) housing proximity to congested roadways.

However, there was a 29 percent average increase across all of the Bethlehem zip code areas for pediatric asthma ED use for this past year. Economic hardship for families is one of the primary reasons for the increase use of the ED as well as access to care issues.

Education in the School This past spring a new asthma program was piloted at Donegan Elementary School. Asthmatic students, who were identified by the school nurse or through the St. Luke’s ED, were invited to

PEDIATRIC ASTHMA STATISTICS 2009-10 350

A total of 11 students participated in this program. The nursing staff at Donegan Elementary School was appreciative of this program, as were the families. They felt that the one-to-one education and care improved the health of the students. Since piloting this program, nursing staff from other Bethlehem Area School District (BASD) schools have requested the asthma program. In the fall of the 2010 school year, the asthma program will continue at Donegan Elementary School in addition to expanding to the Fountain Hill Elementary School. Both of these schools are within the 18015 zip code area which is the geographical area that has a high number of pediatric asthma ED visits. Our goal is to once again decrease ED visits, but more importantly help keep the students’ asthma under control.

In addition to the above program the following asthma programs and care were provided at the BASD: • An Asthma Focus Group was held at Donegan Elementary School with parents of asthmatic students.

• Asthma care was provided to middle school and high school students through the Mobile Youth Health Center. Many of these students were then connected to the St. Luke’s Family Practice at Donegan for primary care services.

• Provided asthma information to the BASD nurses as well as asthma supplies, asthma education resources, and asthma contacts within the community.

Organization Involvement • PA Asthma Partnership – Executive Committee • American Lung Association – Greater Lehigh Valley Asthma Camp • Environmental Protection Agency (EPA) – Faculty for the National Asthma Forum • Asthma Community Network – member • Association of Asthma Educators (AAE) – member

# of ED & Inpatient Encounters

300

participate in this program. Parental consent was given for each child who participated and parents agreed to be involved with the program. Once a month for three months, a nurse practitioner, Debra Cline, visited the school and saw each of the participating students individually for approximately 20 minutes. During this time, asthma education was provided and an asthma assessment was completed. Each visit was followed-up with a phone call to the child’s parent to reinforce asthma education. Appropriate referrals were made to other community resources for families in need.

# of ED Visits

250 200 150 100 50 0

2004

2005

2006

2007

2008

Fiscal Year

2009

2010

For more information about this initiative, please call Julie Kindig, RN, Nurse Coordinator at 610-954-6204 or email kindigj@slhn.org.

Chart 9 Bethlehem Partnership Annual Report • 16

Adolescent health Initiatives Healthy People 2010 Objectives:

1-1 Increase the proportion of persons with health insurance.

19-3c Reduce the proportion of children and adolescents who are overweight or obese.

27-2b Reduce cigarette smoking by adolescents.

The Adolescent Health Initiatives program has been serving the adolescent population in the Bethlehem community for 12 years. Partnering with the Bethlehem Area School District (BASD) and the Valley Youth House Shelter, this program served a total of 532 adolescents this past fiscal year.

The Mobile Youth Health Center (MYHC) is the means in which we are able to reach so many adolescents. Adolescents seen at BASD schools numbered 418. The HealthStar I mobile unit is equipped and designed to provide clinical services to the students while missing a minimum amount of class time. Some of these students needed multiple visits for follow up care. The MYHC saw an increase in services this past year with a total of 1,292 visits. This is a 13 percent increase from the previous year.

UNDUPLICATED MYHC PATIENTS As families struggle financially due to the effects of the economy, many students are lacking health insurance, a primary physician, or both.

300

250

200

150

100

50

0

2005-2006 Liberty HS

Chart 10 17 â&#x20AC;˘ Access to Care / Health Services Improvement

2006-2007

2007-2008

Freedom HS

2008-2009

Broughal MS

2009-2010 Northeast MS

The primary goals of the MYHC, which also correlate with the Healthy People 2010 Objectives, are that each adolescent will: 1. Receive access to health care 2. Have an appropriate Body Mass Index 3. Be tobacco free

Access to Health Care As families struggle financially due to the effects of the economy, many students are lacking health insurance, a primary physician, or both. The MYHC works to identify these families and then we attempt to connect them with the community resources and medical care they need. This past year we assisted 126 adolescents and their families who had access-to-care issues.

This was 24 percent of the total individuals that we served. Out of these 126 adolescents, 93 of them had no health insurance.

The remaining 406 adolescents may have had health insurance and a primary care physician, but they faced access-to-care challenges in other ways. Often lack of transportation, cost of insurance co-pays, being under insured, and parents not being able to take time off of work, prevent the adolescents from receiving the necessary health care. Some adolescents do not have a stable adult in their life, which leaves them on their own to find their way through the health care system. In all of these scenarios, the MYHC team works together with the school nurses, guidance counselors and family center staff to support these families in receiving the necessary health care.

Body Mass Index Childhood obesity continues to be a national and local issue. As Body Mass Indexes rise among adolescents, so does the number of youth with chronic diseases such as hypertension, high cholesterol, and diabetes.

The Body Mass Index (BMI) is a reliable screening tool for most people to indicate their body fat. An adolescent’s BMI is then charted on a growth chart that compares their weight to other adolescents that are the same age and gender. This identifies those individuals who are considered overweight, obese or even underweight. Being underweight or overweight could lead to health problems.

A BMI that falls under the fifth percentile is considered to be underweight. A BMI falling above the 95th percentile is considered to be overweight or obese. This past year, 2 percent of the 532 adolescents cared for fell under the fifth percentile. The number falling above the 95th percentile reached 23 percent. This is a 4 percent increase of adolescents that are considered overweight or obese compared to the previous year.

The MYHC staff continues the “Healthy Steps” nutrition program with adolescents who are overweight or who are at risk of becoming overweight. Students who are seen by the MYHC and who are interested in making healthy lifestyle changes concerning eating and exercise habits, meet one-to-

one with a MYHC staff person on an average of once a month.

Guidance, encouragement and education concerning nutrition are given. Family members are also encouraged to get involved with these changes and to work together as a family to create healthier lifestyles.

Fifty-one percent of high school students seen by the MYHC reported that they do not exercise or participate in sport activities that make them sweat and breathe hard for 20 minutes or more at a time at least three or more times during the week.

Twenty-four percent reported that they were not satisfied with their eating habits.

Tobacco Use The adolescents that are seen through the MYHC continue to have a lower percentage of tobacco users than the Healthy People 2010 goal. Their goal has been for 16 percent or less of adolescents to be using tobacco. For the MYHC this past year 13 percent of the adolescents seen used tobacco products.

Our work continues in decreasing this percentage even more.

Students at Freedom and Liberty High Schools who are seen through the MYHC and who are identified as tobacco users, are offered a one-to-one tobacco cessation program which is held at the school once-a-month. This program is facilitated through one of our partners, St. Luke’s Family Practice Residency Program, which is led by Dr. Cam Lam. Through the counseling of a doctor, a smoking assessment is done and students are given education and encouragement to quit using tobacco. The relationships that are built between the students and the doctors are what make this program successful.

Students who do not feel comfortable meeting with a doctor, or who might not be ready to quit using tobacco yet, are followed up through the MYHC. They receive consistent tobacco education and encouragement towards making the decision to stop using tobacco.

MYHC Services Expanded In October of 2009, the MYHC expanded its services to a fourth school in the BASD: Northeast Middle School. Within the first month the need of our services was evident. We quickly began connecting students and their families to community resources.

Many were assisted in applying for health insurance. A few were in need of medication that they could not afford. We were able to help them and assist each family in creating a long-term plan for getting medications and medical care. Other students had chronic medical issues that needed follow-up and care. For those who had a medical home, we re-connected them with their primary care physician and stressed the importance of follow-up, as we checked in on these students as needed. Students without a medical home were connected with our St. Luke’s Family Practice at Donegan. This provided continuity of care with the staff from the Family Practice and the MYHC working closely together.

Bethlehem Partnership Annual Report • 18

Adolescent health Initiatives cont.

The school nurse, guidance counselors, and the family development specialist were all helpful in identifying students who needed our services. Working as a team, we were able to assist families. This resulted in students receiving necessary medical care, allowing them to be in school and focused on learning.

Resource Room at Liberty High School Goal: To support adolescents in achieving a status of health that promotes academic and personal success.

Liberty High School has a unique resource for their students through the Resource Room. Groups are offered to students to help them in specific areas of their lives. This past school year five groups were offered: •B alancing Weight Management — facilitated by the Bethlehem Health Bureau • Parenting — facilitated by the St. Luke’s School of Nursing • Prenatal — facilitated by the St. Luke’s School of Nursing •R elationship Identity Communication Health Esteem Support (RICHES) — facilitated by the St. Luke’s School of Nursing • Taking Control — facilitated by Valley Youth House The school nurse and the guidance department are the lead partners for this program. The groups meet weekly each fall and spring for approximately 10 weeks at a time. This year approximately 30 students participated in this program.

The facilitators challenge the students and help them to help each other work through issues that come into their lives.

These groups have become an important part of the high school. The faculty and staff can refer students to these groups who they feel could benefit from the extra support, encouragement and guidance. Students can also request to be in these groups. The facilitators challenge the students and help them to help each other work through issues that come into their lives. Students that know they have peers that are going through some of the same challenges that they are provides a safe community for them to share.

For this coming school year we are excited to have a new Resource Room coordinator. Sue Dalton, one of the nurses at Liberty High School, will be working with the facilitators and students in promoting, organizing, and following-up with this program. We look forward to seeing this program develop even more.

If you would like more information about the Adolescent Health Initiatives or would like to offer your resources to our programs, please call Julie Kindig, RN, Nurse Coordinator at 610-954-6204 or e-mail her at kindigj@slhn.org.

19 • Access to Care / Health Services Improvement

Maternal Child Health Healthy People 2010 Objectives:

16-6 Increase the proportion of pregnant women who receive early and adequate prenatal care.

16-10 Reduce low birth weight (LBW) and very low birth weight (VLBW).

16-11 Reduce preterm births.

16-17 Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women.

15-33a Reduce maltreatment and maltreatment fatalities of children.

Over 550 families served through the Partnership’s Nurse Family Partnership (NFP), Parent Advocate in the Home (PATH) and Visiting Nurse Advocate for the County (VNAC) programs benefit from different approaches, staff mix and focus of effort.

The goal is to create positive environments where children can just be children, while they grow, in a safe, healthy and nurturing home. Our nurses use perseverance, role modeling, education and the holistic nursing approach to support many of these families. They achieve positive outcomes that benefit the family as a whole whenever possible. If not, they strive to be of benefit to the child/children involved.

Nurse Family Partnership (NFP) The Nurse-Family Partnership (NFP) is a voluntary, evidencebased program of home visitation in which nurses work with low-income, first-time mothers. They work with these mothers from early in pregnancy through the first two years of the child’s life to accomplish three goals: 1. Improve pregnancy outcomes; 2. Improve child health and development; and 3. Improve families’ economic self-sufficiency. Based on more than 25 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 ability to get maximum return on investment is dependent on three important factors: 1. Highly educated registered nurses who deliver the program via home visits to their clients; 2. The program is implemented with fidelity to the intervention model tested in the randomized trials; 3. Services are delivered at sufficient scale to benefit from basic operational efficiencies. 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 two part-time registered nurses serving approximately 250 clients, making it the largest NFP in the Commonwealth.

One of our activities over the past year resulted in a book entitled Stories from the Heart: Voices of the Nurse Family Partnership. Begun when a mother gave one of our nurses an engaging poem describing her experience, the idea of gathering stories and feelings from mothers and nurses quickly spread throughout the program. With help from a friend with desktop publishing expertise, a lovely 8½ x 11 collection of stories, poems, pictures and impressions became a reality. Something of which we are all proud, Stories is available for purchase at www.LuLu.com, a publisher which prints to order.

The following report includes information from the beginning of this program in late 2001 through June 30, 2010. The impressive results achieved by our nurses can be best appreciated when compared with national program averages and benchmarks.

Participant Characteristics • 1,614 women have been enrolled as of June 30, 2010: median age 19 (range 13 – 37 years); 94 percent unmarried; median household income $17,500.

• Race/Ethnicity: 42 percent non-Hispanic white; 44 percent Hispanic; 5.5 percent multi-racial; 8.1 percent African American/Black; 2 percent other.

Bethlehem Partnership Annual Report • 20

Maternal Child Health cont.

Program Implementation Entry into the program early in pregnancy is related to longer stays in the program during the infancy phase.

• 6 6 percent of mothers enrolled in the program by 16 weeks of pregnancy, and 97 percent were enrolled by 28 weeks gestation. (The VNA program is at virtually 100%. The 97 percent results from transfers into our program from other NFP’s.) The national program benchmark is to enroll 60 percent by 16 weeks gestation. Referrals totaling 78 percent come from health care providers but others come from WIC, soup kitchens, schools, and current clients.

Participants receive more visits during each of the three program phases, on average, than participants in other NFP’s. In addition, visit lengths in each program phase averaged at least 80 minutes; the NFP benchmark is a minimum of 60 minutes.

• Completed/Expected Visits:  Pregnancy: 86 percent (NFP benchmark = 80 percent, national NFP = 73 percent)  Infancy: 52 percent (NFP benchmark = 65 percent, national NFP = 39 percent)  Toddler: 49 percent (NFP benchmark = 60 percent, national NFP = 26 percent)

Program Outcomes

The Nurse-Family Partnership (NFP) is a voluntary, evidence-based program of home visitation in which nurses work with low-income, firsttime mothers.

• 20 percent reduction in smoking during pregnancy. The decline in this outcome is attributable to the severe reduction in state funds available for smoking cessation programs (16 percent national NFP average) • 9 percent premature birth rate (9.7 percent national NFP average) • 8.8 percent low birth weight rate (9.3 percent national NFP average) • Immunization rates were 90.7 percent at 24 months of age (national NFP average 90.8 percent).

• 23 percent of mothers reported subsequent pregnancies at 24 months postpartum (NFP benchmark = <25 percent; national NFP average = 32 percent) • Of those clients who were 18 or older at intake, workforce participation increased from 40.2 percent at intake to 67.7 percent at program completion (national NFP average = 55.8 percent)

For more information regarding this program please contact Sara Klingner MSN, RN Program Manager, Nurse-Family Partnership, VNA of St. Luke’s, 610--954-2778, Klingns@slhn.org.

21 • Access to Care / Health Services Improvement

Parent Advocate in The Home (PATH) Program Nursing efforts under the PATH program are designed to empower parents through education and mentoring. The program is designed to support the growth and development of the children in a safe, loving home and to prevent child maltreatment. They not only teach parenting, they promote early literacy and childhood development. It is not uncommon to see our PATH nurses not only teaching basic parenting, but also practicing nursery rhymes like Itsy Bitsy Spider. They teach parents how to lovingly interact through crafts or reading, while showing how these simple activities promote parent/ child bonds that help create a nurturing home environment.

PATH served 297 families this program year (212 active at end of year). While PATH is designed to follow a family from enrollment (prenatally or anytime after birth) through three years of age, we do have families that demonstrate growth and

stability sooner than that age frame, while others require a bit more time. Our program is designed to allow for the flexibility needed to meet the needs of the families involved.

Some notable outcomes for this program year: • Overall, 94 percent of infants/toddlers demonstrate age appropriate growth/development using the Ages & Stages Questionnaire Survey and ASQ: Social Emotional Survey.

• Participants in Lehigh County make up 72 percent of participants, Northampton county participants make up 26 percent.

• Eighty three percent (increase of 4 percent from last year) of discharged program parents are either actively pursuing or have completed at least their high school diploma, with a few actively pursuing higher education at time of discharge.

We are seeing an increasing number of pregnant women entering the program so we are strengthening our prenatal component to support adequate prenatal care and then measure for healthy birth outcomes.

s ago. She r a e y o w t e s r u her PATH n t e m t s who needed r d fi n a e s h s ie n it e il h b w a is d with d ears ol e time and h t Ricki was 27 y e hospital as a first time mom l l a y b a b e h hold t y th was referred b nting skills. Ricki wanted to ceptive to assistance from re are help with her p out feeding issues. Ricki was round 16 months during a es. A ied ab was very worr trong opinions about many issu al level for m r o n a t a g in k had s l was not tal e a h ic the outset but M ayed a little l t e a d h t t s d u e j v s r a e s w b h o was hael’s speec ic M t hen Michael a routine visit it h w t , l t u n f e e m p e o g h a r y u r o e as v h enc his age. Mom w o take any action. After muc r the full e t f A . n io t n e v t ant Early Inter l l a c e bit and did not w w y which he is p t a a r h e t h d t e h e c r e g e a p s m eeded actual n turned two, mo l e a h g together to ic in M k r t o a w h t e r r a a e e l s c as nur evaluation, it w . The therapist and PATH be a mom who wants to be a iving f to currently rece icki. Ricki has proven hersel nizations and doctor visits. immu nd R help Michael a son. She is conscientious with other needed s s e c c a o t m o m r he ichael pporting this u M s d n n good parent to o a i g k in ic k r R o g w is helpin tly also We are curren rvices. The PATH program ave happened if alone. al se not h specialty medic ss needed services that may e flourish and acc

Bethlehem Partnership Annual Report • 22

Maternal Child Health cont.

Visiting Nurse Advocate for the County (VNAC) Program Nurses in the VNAC program provide intensively focused services to 1) support families in crisis, 2) provide parenting education and case management for families and, 3) advocate for the safety of the infant/child even if that may mean the family unit is not maintained or reunited.

Partnering to create safety nets for the children involved and promote positive growth in the families are key components of the VNAC program. Whereas PATH nurses teach the nursery rhymes to children/ parents, VNAC nurses are more like the determined spider of the rhyme Itsy Bitsy Spider — with a goal in mind from which it won’t be deterred. The spider in the rhyme wants to get to the top; our VNAC nurses work in partnership with many other agencies, schools, and families to foster a safe, healthy and nurturing home environment for their clients and their children. They never forget the ultimate goal no matter how often it rains or how hard it seems.

The itsy bitsy spider went up the water spout.

Down came the rain, and washed the spider out.

Out came the sun, and dried up all the rain, and the itsy bitsy spider went up the spout again.

During this past program year the VNAC program provided nursing case management and parenting educational services to 123 families. Not surprisingly a large percentage of families have substance abuse (63 percent), mental health illness (60 percent) and MHMR (57 percent) issues present.

•O ur nurses provided a total of 8, 913 hours of service, a 670 hour increase from last year.

•E leven percent of cases (n=14) were for Lehigh County and the remaining 89 percent (n=109) were for Northampton County.

• 4 4 percent of cases (n=54) were court involved, requiring more intense involvement by our nurses.

• 8 7 percent of children had a weight that fell between the 10 percent and 85 percent percentile in weight for age.

RISK INDICATORS FOR VNAC CASES 2009-2010 120 2008-2009 100

2009-2010

80 60 40 20 0

Chart 11

23 • Access to Care / Health Services Improvement

Child Abuse

Domestic Violence

Mental Health

Substance Abuse

Medical Concerns

Criminal System Involvement of at Least One Parent

Inappropriate Parenting Skills

During this past year both PATH and VNAC programs have diligently worked to identify a tool that would help measure progress in an objective, consistent manner. PATH and VNAC are more than just individual cases, they work hard to reduce incidence of child abuse and maltreatment and promote healthy, nurturing homes for the children and families involved.

Beyond the statistics and results they currently collect, identification and implementation of the Life Skills Progression Tool at scheduled intervals will help our nurses identify areas of need. This helps families set measurable and attainable goals in any/all of the eight domains measured: Relationships, Education (of parents), Health/Medical Care, Mental Health & Substance Abuse, Basic Essentials, and Child focused scales.

This in turn will allow for us to determine trends and opportunities for community level efforts that will promote family success.

Community Level Efforts Outside of the program service realm there is community level involvement by members of the Partnership in review boards for child death and near death incidents in both counties as well as supporting the creation of a Northampton County Child Advocacy Center. It is believed that a Child Advocacy Center will strengthen the efforts to achieve the overarching goal of promotion of safer communities for children.

For more information for either the PATH or VNAC programs, please contact Melissa Craig, RN at 610-954-6203 or craigmm@slhn.org.

Bethlehem Partnership Annual Report â&#x20AC;˘ 24

Minority Health Initiatives Healthy People 2010 Objectives:

1-1 Increase the proportion of persons with health insurance.

1-5 Increase the proportion of persons with a usual primary care provider.

1-6 Reduce the proportion of families that experience difficulties or delays in obtaining health care or do not receive needed care for one or more family members.

This past year was momentous for our nation’s health. Our leaders finalized a health care reform process that will dramatically change how our health care system works in the coming years. These efforts are to improve accessibility and equity for our country’s families and individuals while outlining measures to assure affordability and better handle the expenses of our current health care system.

The Partnership is committed to impacting the language and cultural needs in a manner that addresses the requirements of our increasingly diverse community.

While our national efforts proceed, our local efforts will continue to utilize a partnership approach to addressing the access-to-care needs of our uninsured/disconnected and minority community members.

Our efforts continue, family by family, to connect them to health insurance coverage and a primary care provider. At each access point which includes all of the Partnership initiatives, insurance coverage and accessibility is addressed with appropriate support and referrals offered. In addition advocacy to avoid or eliminate delays in obtaining health care are a routine part of our daily work.

Community Health Center Network: The Bethlehem Partnership strongly supports the Neighborhood Health Centers of the Lehigh Valley with their goal of establishing a Federally Qualified Health Center (FQHC) in the Lehigh Valley. This goal is part of the broader initiative of reducing minority health disparities in our local area. Vida Nueva and the Caring Place are actively providing care to under and uninsured families from the Allentown area, and an application for FQHC look-alike status has been submitted. A committee has been formed to submit a proposal for full FQHC funding. The overall goal is to create a community health center network with access sites in Allentown, Bethlehem and Easton.

Access to Culturally & Linguistically Responsive Services: “The demographics of the United States have changed considerably over the last several decades.

Today, more than 37 million U.S. residents are foreign born, 54 million people speak a language other than English at home, and 24 million people speak English less than “very well” and are classified as limited English proficient (LEP). Research has shown that a lack of sensitivity and responsiveness to cultural and language needs impacts quality, safety, and patient satisfaction. In addition, one-half of the U.S. population lacks the skills to function within the health care system.”

— Hospitals, Language, and Culture: A Snapshot of the Nation The Partnership is committed to impacting the language and cultural needs in a manner that addresses the requirements of our increasingly diverse community. A number of the programs listed in this section are addressing specific, individual needs. One such effort that continues each year is that the Bethlehem Area School District (BASD) Donegan Family Center staff continues to provide medical interpretation services at the St. Luke’s Family Practice located in the school. This service alone directly improves the visit for both family and provider. Results of a recent patient survey indicated that 78 percent of respondents strongly agreed or agreed that the interpretation services helped them “understand information given to me by a doctor or another person” (16 percent didn’t know or question was not applicable).

25 • Access to Care / Health Services Improvement

In addition to this, specific system interventions to better facilitate access to linguistically and culturally responsive services (within the healthcare system) continue. For example, St. Luke’s Hospital & Health Network has a plan of action to be implemented in the coming year to address these needs at each network entity, recognizing each entity serves communities that may have different needs. We are confident these action steps will directly impact many families and look forward to reporting on our progress in the coming year.

Bethlehem Partnership Annual BASD Minority Award

Medical Insurance/Access to Care Project

Community Services for Children, Inc (CSC) – HeadStart Services

In an effort to promote educational opportunities for minorities, the Bethlehem Partnership supports a scholarship for the BASD’s Minority Senior Awards ceremony. This past year, the Bethlehem Partnership for a Healthy Community Scholarship was awarded to Lilia Bonilla at Freedom High School. She will attend Cedar Crest College in the fall.

Helping families connect to care and insurance coverage remains a challenge for the Partnership. The majority of referrals for assistance come through our outreach efforts with the mobile vans and community based clinics. While our department handles all referrals that come through us directly, our partners also support families during their daily work. For example, the St. Luke’s Family Practice at Donegan Fowler Family Center has staff that supports our clinical patients when appling for appropriate programs/services. Families that enter in thru the Bethlehem Health Bureau are also supported individually.

Below are the statistics for the Community Health Dept referrals received during this past program year. Of interest: • Fifty six percent (191) of our referrals came through our school-based adolescent efforts.

• In general our referrals grew markedly this past year and we believe that was definitely in part because of a part-time Family Liaison personnel who worked directly with other staff to support needs identified by clients at the Mosser Family Center clinic (106 referrals) in Allentown and the Raub MS mobile youth program (63 referrals) in addition to offering assistance to all 341 referred families. That personal, focused attention on insurance and access to care needs was of direct benefit to those programs.

• Of the 272 pending/incomplete referrals, 74 (27 percent are in the process at the time of reporting end date).

Last fall’s state budget impasse affected our local, low-income preschool aged children in very obvious ways, one being that the HeadStart classrooms were in delayed mode. As such the provision of physical exam and immunization services, the safety net that St. Luke’s Hospital provides for newly enrolled uninsured children, was conducted only once this past year.

Six children were provided this medical service during one day of service. Dental screenings and care are also provided through the St. Luke’s Dental program and did continue this past program year (stats included in Dental Initiative report).

These longstanding partnerships that provide a safety net for some of our most vulnerable children are an example of the Partnership’s commitment to the health and wellness of our children. Children are not kept from learning because of insurance status or lack of a medical home. The Community Services for Children staff dedicate time and energy to connect families to both of these. For those who can’t, the Partnership is proud to continue supporting with these on-site located services.

COMMUNITY HEALTH DEPARTMENT INSURANCE APPLICATION ASSISTANCE 400 350 300 250

Referred

Approved

Applied

Pending/Incomplete

200 150 100 50 0

2007-2008

2008-2009

2009-2010

Chart 12 Bethlehem Partnership Annual Report • 26

Fiscal Year

Minority Flu and Pneumococcal Immunization Campaign Healthy People 2010 Objectives: 14-29 Increase the proportion of adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease.

Pneumonia and Influenza are among the top ten causes of death in the United States, with nearly 40,000 deaths annually and many more hospitalizations. Annual epidemics of influenza occur typically during the late fall through early spring. During these epidemics, rates of serious illness and death are highest among persons aged ≥65 years, children aged <2 years, and persons of any age who have medical conditions that place them at increased risk for complications from influenza. Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications.

Minority populations are significantly less likely to receive vaccinations. Therefore they are at greater risk of illness and death from influenza and pneumonia.

The Center for Disease Control’s Advisory Committee on Immunization Practices has recommended that all persons aged 6 months and older should receive a flu vaccine annually.

Local partners combined efforts to provide flu and pneumococcal vaccines at multiple community — based sites and on the HealthStar I Mobile Van in the greater Bethlehem area for the ninth consecutive year. These efforts resulted in administering 400 flu and 9 pneumococcal vaccines to low-income/ minority residents. The 40 percent decrease in flu vaccines given from FY 2009 to FY 2010 is due to receiving a limited supply from the Pennsylvania Department of Health due to primarily focusing efforts on the H1N1 vaccine in FY 2010. The following graph highlights the number of flu and pneumococcal vaccines given from FY 2002 through FY 2010: For FY2009-2010, St. Luke’s Community Health was also the lead partner for holding H1N1 clinics.

A total of 11 H1N1 clinics were held in which 1,695 vaccines were given to the public. These were free clinics due to the PA Department of Health providing all of the H1N1 vaccine, plus the cost of supplies and staff.

SHIP-FUNDED IMMUNIZATION EFFORTS FY 2002-2010 FLU/PNEUMOCOCCAL VACCINES GIVEN PER YEAR 800 Influenza

Pneumococcal

600

400

200

0

Chart 13 27 • Access to Care / Health Services Improvement

2002

2003

2004

2005

2006

2007

2008

2009

2010

For the 2010 flu season, the Center for Disease Controlâ&#x20AC;&#x2122;s (CDC) Advisory Committee on Immunization Practices (ACIP) has recommended that all persons aged 6 months and older should be vaccinated annually. This is the first year that this recommendation has been given. The H1N1 vaccine will also be included in the 2010-11 seasonal flu vaccine, which will remove the need for two different types of flu vaccines for this flu season.

Fourteen of the survey respondents were age sixty-five and older. Of these respondents, 35% reported having received a pneumococcal vaccine.

H1N1 vaccine questions were also added to the minority flu survey this past year. Chart 14 depicts the responses to the H1N1 questions from 602 survey respondents.

For more information about the Flu Initiative, please call Julie Kindig, RN, Nurse Coordinator at 610-954-6204 or email kindigj@slhn.org.

We once again collaborated with students from Lehigh University to conduct outreach to raise awareness of flu vaccine availability and to complete flu vaccine surveys in minority and underserved areas. Outreach efforts resulted in a total of 602 surveys being completed. One hundred percent of survey respondents were minority/low income community members; 50 percent were age 19-50 years old; and 22 percent reported having a chronic disease. Chart 13 highlights data collected from minority flu surveys from FY 2002 through FY 2010.

If interested in joining any of the Minority Health Initiatives, please contact Melissa Craig, RN at 610-954-6203 or craigmm@slhn.org.

Influenza Vaccination Trends of Survey Respondents FY 2010 (N=602)

FY 2008 (N=950)

FY 2006 (N=633)

FY 2004 (N=227)

FY 2002 (N=107)

Ever had a flu vaccine

63%

63%

58%

68%

54%

Had a flu vaccine last year

41%

40%

32%

59%

44%

Yes

No

Unsure

Know the difference between the H1N1 vaccine and the seasonal flu vaccine

60%

39%

1%

Interested in receiving an H1N1 vaccine

52%

42%

6%

Chart 14

Chart 15

Bethlehem Partnership Annual Report â&#x20AC;˘ 28

Adolescent Career Exploration Mentoring Programs Healthy People 2010 Objectives:

7-1 Increase high school completion.

Throughout the years our partners have embraced the belief that each program participant in our School To Work program has the potential for a positive future and that through our efforts we could help them achieve that goal. As the years went along, the partners saw the wonderful things that could happen when a long-term commitment was made to the success of our youth.

Partners identified program expansion opportunities along the way that would provide mentoring and academic support activities, while strengthening marketable job skills. As a result, the Health Career Exploration and Next Step Programs were born. We have worked to create this stepwise model that promotes growth in a supported, mentored environment to the extent possible. We fully believe, based on the positive results, that our partnership efforts and model are working.

School to Work Program (STW) This past year marked the 13th year of the STW program. This program, designed to encourage English-acquisition high school students to complete high school and consider health careers through an interactive, hospital-based curriculum, has had another year of exceptional success.

This is the first step in introducing health career options to a group of youths that normally would not be privy to this exposure.

“We cannot always build the future for our youth, but we can build our youth for the future.”

— Franklin D. Roosevelt

STW PARTICIPANTS PURSUING HIGHER EDUCATION IN FIRST YEAR FOLLOWING HIGHSCHOOL GRADUATION 100 90 80 70 60 50

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006

40

2006-2007

30

2007-2008

20 10 0

Chart 16

29 • Access to Care / Health Services Improvement

2008-2009 2009-2010

This program year we enrolled 18 students with a 94 percent enrollment maintained for the entire year (one student relocated to Allentown). Informal connections continue through graduation (unless the youth is connected to one of our other two programs).

This past June, 12/14 (86 percent) of eligible senior grade students graduated covering three years of program students with the other two remaining committed to completing their high school diploma. Fifty-eight percent (7/12) have already been accepted into higher education and will start in the fall semester.

students the desire to progress in a similar pattern as they witness the advancement of these successful peers.

Health-Related Career Exploration Program

Next Step Program

The STW program has served as the primary access point for a hospital-based program that combines at least a one-year mentoring program with a paid work experience. Through a partnership between the CareerLink LV/ Private Industry Council and St. Luke’s Hospital, 15 adolescents from Northampton/Lehigh Counties are provided the opportunity to continue exploring health careers, while participating in a year-long work experience. Many are previous STW participants.

We completed a special expansion program this past year with funding under the Economic Recovery Act (ARRA). This funding allowed us to design the third step, the Next Step program, for recent high school graduates and young adults. The goal of the Next Step program is to provide additional training and job coaching that supports a successful transition from subsidized employment experiences to regular, unsubsidized employment in the health care environment. An underlying theme is to support these participants to pursue or successfully continue higher education while working, all with the support of a job coach.

These youth employees learn valuable job skills while being supported through mentoring and tutoring as needed to achieve academic and workplace success. Fourteen of the 15 youth employees successfully completed the program work year. One hundred percent of the six senior grade students graduated high school and are enrolled in a post-secondary education program; four of these are beginning this new phase of life with scholarships to assist them in overcoming the financial burdens of a college education.

One of the positive aspects of our program is the interaction that occurs between incoming students and those who are in their second year, as well as those who have completed the program and have transitioned into higher education. Seeing the pathways that the former participants are taking instills within the new

One particular success was Eric Rodriguez, who after working in the pharmacy was hired as a Pharmacy Technician and will be working in the same environment that mentored and trained him through his HCEP year. Other HCEP youth employees have transitioned into the Next Step Program for further training opportunities only available to HS graduates.

Twelve young adults were accepted into this eight-month program and worked in various entry-level jobs within the St. Luke’s Hospital & Health Network. With this opportunity in mind, we encouraged recent HCEP graduates to consider this opportunity instead of automatically seeking unsubsidized employment outside of the health care environment. Six of 9 (66 percent) of the 2009 HS graduates transitioned into this program; four were past STW students; two were general community members who matched program requirements.

Eleven (92 percent) Next Step employees successfully completed the program with five (45 percent) obtaining unsubsidized employment by the end of the program — all five within the Bethlehem Partnership Annual Report • 30

Adolescent Career Exploration Mentoring Programs cont. network. The others were supported to seek and obtain unsubsidized employment by our job coach and will continue to have that support available to them. This is an exciting third step that prepares our participants to successfully merge into the traditional workforce environment.

Research In Partnership with the Lehigh University Fellowship Program, we were able to conduct a follow-up research project of the STW program. Efforts were made to reach out to the 179 STW participants in the full 12-year history of the program. Of this total, 135 were successfully located. Out of this number, 72 (53.3 percent response rate) participated in the survey.

The research question was “Does the STW program succeed in its goal of seeing its alumni graduate from high school, complete post-secondary education, and obtain jobs — specifically in health-related fields — in which their earnings place them above the U.S. poverty threshold?”

The findings not only supported the belief that the program is held in high regard by the participants and that it does influence post high school career decisions it also provided the program administrators and partners an opportunity to collect data that will support efforts to strengthen long-term occupational outcomes.

Of the Next Step Program: “The support was amazing! Experience a blessing!”

Some highlights: • 88 percent of respondents still live in the Lehigh Valley.

• 9 5 percent graduated high school; 74.1 percent enrolled in post-secondary education; 27.1 percent successfully completed them.

• 4 8.3 percent said they credited their decision to pursue higher education to the STW participation.

• 7 2.4 percent are employed; 42.9 percent (18) employed in health-related careers (16 at St. Luke’s).

•M ean hourly wages are $11.14 (highest $21.15; lowest $7.25).

The following program participants were awarded Minority Award book awards and scholarships as well as general community awards: Keyshla Almodovar

Graduated with honors; Cohen Scholarship; Roberto Clemente Scholarship

Louis Figueroa

Graduated with honors; Blanca Smith Scholarship; George Maunz STW Scholarship

Gladys Fernandez

Roberto Clemente Scholarship

Banafsha Mohammad Sharif

Ann Goldberg English Acquisition Scholarship

Cassandra Ortiz

Graduated with honors; CLA Student Scholarship

For more information about the research, programs, or to be involved in supporting our Adolescent Career Mentoring Initiative Programs, please contact either George Maunz at maunzg@slhn.org or Victoria Montero at monterv@slhn.org or 610-954-2100.

31 • Access to Care / Health Services Improvement

HealthstoP Healthy People 2010 Objectives:

1-1 Increase the proportion of persons with health insurance.

1-3 Increase the proportion of persons appropriately counseled about health behaviors.

1-4 Increase the proportion of persons who have a specific source of ongoing care.

Access to health care services is challenging for many members of the community living in the greater Bethlehem area and the Lehigh Valley. HealthStop with HealthStar I continued in its fourth year of providing health screenings and education, prevention education and referral services for individuals living in traditionally low-income neighborhoods.

HealthStop is designed to provide services during the warmer months, which allows staff to interact with the community members outdoors. HealthStop visits designated locations on a rotating monthly basis so that targeted neighborhoods have access to services and staff able to follow-up with the clients. Additionally, a nurse practitioner provides support to patients whose results warrant follow-up. HealthStop provided services in the following areas for this program year: Marvine/Pembroke, South Bethlehem, Parkridge/West Bethlehem, Easton Circle, New Bethany Ministries, Trinity Soup Kitchen, Unity House, and Safer Harbor.

HealthStop also attempted to provide services to neighborhoods surrounding Easton Community Center and Cheston Elementary School but was unsuccessful in that no patients were seen.

From July 2009 – June 30, 2010, 349 individuals utilized the HealthStop program with the following results: • 31 percent (n=108) of individuals reported having no insurance.

• 58 people received a rapid HIV test and pre/post-test counseling. No positives were found.

• 2 people had a Hepatitis C screening and received a Hepatitis C test.

• 32 percent (n=113) had a cholesterol screening completed.

44 percent of those who received a cholesterol screenings had either a borderline high or high result.

• 11 percent (n=37) had Body Mass Indices (BMI) completed and 68 percent were determined to be either overweight or obese.

• 44 percent (n=154) had their blood pressure checked and 40 percent had pre-hypertension, stage-one or stage-two hypertension results.

• 160 people (46 percent of HealthStop clients) received a free flu shot during the month of October.

In addition to the above services, smoking cessation counseling was added to the HealthStop program in May 2010. Referrals to medical providers, the insurance program and communitybased programs (STD clinics, drug and alcohol programs, etc.) are made, especially if screening results indicated high values.

There was a 40 percent decrease in the number of people served by HealthStop from FY 2009 to 2010. This is in part due to cancelling several HealthStop dates due to heavy rain, HealthStar I being out of service and poor utilization in the Easton area. Additionally, in October several locations scheduled to administer flu vaccine were cancelled due to a limited supply of minority flu vaccine.

Bethlehem Partnership Annual Report • 32

Tobacco Cessation Program Healthy People 2010 Objectives:

27-1 Reduce tobacco use by adults.

27-2 Reduce tobacco use by adolescents.

27-5 Increase smoking cessation attempts by adult smokers.

27-6 Increase smoking cessation during pregnancy.

Tobacco use is the single most preventable cause of death and disease in the United States.

Approximately 45 million Americans currently smoke cigarettes. Each year more than 438,000 Americans die from smoking related diseases. For every person who dies from tobacco use, another 20 suffer with at least one serious tobacco related illness. In addition, second-hand smoke causes premature death and disease in children and adults who do not smoke. There is no risk-free level of exposure to second-hand smoke.

The Centers for Disease Control and Prevention have promoted Best Practices for Comprehensive Tobacco Control Programs, which clearly documents that comprehensive tobacco control programs reduce smoking rates, tobacco-related deaths and diseases caused by smoking. The Bethlehem Partnership is actively involved in collaborative efforts to implement strategies in our local area to reduce the public health burden of tobacco use.

Tobacco use is the single most preventable cause of death and disease in the United States.

The St. Lukeâ&#x20AC;&#x2122;s Tobacco Cessation Treatment Center receives tobacco cessation funding from the Pennsylvania Department of Health (PA DOH) through the Partnership for a Tobacco-Free Northeast.

The funding is used to promote tobacco cessation among adults and adolescents and to promote the free Pennsylvania Quitline.

Due to PA DOH funding changes in September 2009, inpatient tobacco cessation consultation services are no longer provided and several outpatient sites no longer receive tobacco cessation counseling services. The Tobacco Cessation Treatment Center continues to provide counseling services at the Community Health office, Union Station Health Center and the Allentown Family Health Center.

Patients enrolled in outpatient tobacco cessation counseling meet with a tobacco cessation specialist for individualized counseling. They discussed pharmacotherapy, stress management skills, potential danger situations or triggers, roadblocks and rewards of quitting tobacco, and techniques to prevent relapse of tobacco use. Telephone support is provided in addition to the face-to-face counseling.

This past year, we provided cessation counseling to a total of 189 outpatients of which 121 were from Northampton County, 63 from Lehigh County, 3 from Monroe Country and 2 from Carbon County.

In general, patients who enrolled in the outpatient program have been long-term, heavy smokers, need multiple quit attempts before succeeding and often experience many barriers to achieving cessation.

Our program continues to see many patients who are successful in quitting tobacco early in their cessation attempt, but as the year progresses, they relapse due to the return of triggers and barriers which initially prevented them from achieving cessation. For example, stress and socializing with other smokers are often identified as reasons for relapse. Also, working with primarily uninsured and underinsured individuals continues to pose many challenges. This population tends to be transient and is often lost to follow-up and has multiple stressors in their lives. This program year, 48 percent of outpatients reported having Medicaid as their primary insurance or were uninsured.

33 â&#x20AC;˘ Access to Care / Health Services Improvement

Of the 189 outpatients enrolled in the tobacco program this past year, 58 percent made a minimum of one quit attempt and 31 percent quit using tobacco through the completion of the program. The number that became lost to follow-up at some point throughout the one year program was 48 percent.

We are continuously looking for effective strategies to assist the population of “hard-core,” transient smokers to achieve cessation. This year, a twelve week pilot group cessation program was conducted at Unity House. Participants had the opportunity to learn about the negative health effects of smoking, chemicals that are in cigarette smoke, carbon monoxide, contraindications with smoking and certain mental health medications, second-hand smoke, pharmacotherapy, stress management, addiction to cigarettes, physical activity, nutrition and healthy food choices. Twelve participants enrolled in the program during week one. By week 12, five participants remained in the program with one making a quit attempt, two moving towards thinking about quitting and two remaining precontemplative.

Despite working with this difficult population, the patients who achieve cessation are grateful for the program. According to the St. Luke’s Tobacco Cessation Treatment Center satisfaction survey data, patients enrolled in outpatient counseling attribute their cessation success to having one-on-one cessation counseling versus making quit attempts on their own. Additionally many of these patients needed weekly or biweekly telephone follow-up calls.

For more information about this initiative, please call Hollie Gibbons, MPH, RD, Manager of Disease Prevention Initiatives at 610-954-2301 or email her at gibbonh@slhn.org.

Bethlehem Partnership Annual Report • 34

S t r at e g i c G o a l s

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

35

Annual Report J u ly 2 0 0 9 â&#x20AC;&#x201C; J u n e 2 0 1 0 Funding for this report provided by St. Lukeâ&#x20AC;&#x2122;s Hospital & Health Network