Annual Report J u ly 2 0 0 8 – J u n e 2 0 0 9
Bethlehem Partnership For a Healthy Community Table of Contents Mission................................................................................................................................1 Advisory Board Members/Agencies..............................................................................1 2008 – 2009 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................................................................................................19 Minority Health Initiatives..........................................................................................21 Adolescent Career Exploration Mentoring Programs.................................................23 HealthStop..................................................................................................................25 Nurse-Family Partnership...........................................................................................26 Tobacco Cessation Program........................................................................................27 Strategic Goals...........................................................................................................29 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. To 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.
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Advisory Board Members/Agencies 2008 – 2009 Mary Carr Northampton County Drug & Alcohol Division Iris Cintrón Bethlehem Area School District Bonnie S. Coyle, MD St. Luke’s Hospital & Health Network Kevin Dolan Northampton County Children, Youth & Families Division Sandra E. Figueroa-Torres Life Academy Kathy Halkins Bethlehem Area School District Arnette Hams Lehigh Valley Hospital and Health Network Diana Heckman ALERT Partnership Sara Klingner VNA of St. Luke’s Hospital Lissette Lahoz Neighborhood Health Centers of the Lehigh Valley Judith Maloney Bethlehem Health Bureau Pat McGettigan, MS The Wellness Community – Greater Lehigh Valley 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 Jennifer Swann Lehigh University Javier Toro South Bethlehem Neighborhood Center
2008 – 2009 PARTICIPATING/FUNDING AGENCIES Abbott Labs AIDSNET ALERT Partnership Allentown Diocese Allentown Health Bureau Allentown Lions Club Allentown School District Allentown Vision Center American Cancer Society American Heart Association American Lung Association Auxiliary of St. Luke’s Hospital & Health Network Bangor Area School District B. Braun Medical 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 Busy Workers Society, Central Moravian Church Casa Guadalupe Center Catasauqua Area School District 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 Christ Evangelical Congregational Church of Williams Township 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 DeSales University Dr. Jason Kishel 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 Fund to Benefit Children & Youth Services Genentech, Inc. GIANT Food Stores, LLC Give the Gift of Sight Foundation Glaxo-Smith Kline Pharmaceuticals Gilead Sciences 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 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 NJ State Parks Police North Central AHEC Northampton Community College • Dental Hygiene Program Northampton County • Children, Youth & Families • Coroner’s Office • Drug & Alcohol • Juvenile Justice Center • Meals on Wheels • MH/MR • Drop-In Center
Northeast Ministries Our Lady of Perpetual Help Church Partnership for a Tobacco-Free Northeast PA Pearle Vision Center, Bethlehem Square 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 Projecto Claridad Quakertown Community School District Quilts for Kids, Emmaus Chapter Richard Ritter Pharmacy Roche Pharmaceuticals Rotary Club of Bethlehem Sacred Heart Hospital Safe Harbor Sayre Early Child Center 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 HomeStar Medical Equipment & Infusion Service St. Luke’s Hospital & Health Network St. Luke’s School of Nursing St. Peter’s Church Star and Candle Shop, Central Moravian Church South Bethlehem Neighborhood Center The Special Kids Network Tibotec Pharmaceuticals Touchstone Theater Trinity Episcopal Church Turning Point of the Lehigh Valley Two Rivers Health & Wellness Foundation Union UCC Church, Neffs United Way of the Greater Lehigh Valley Unity House University of Pittsburgh Valley Wide Smile Valley Youth House Victory House Visual Impairment & Blindness Services of Northampton County VNA of St. Luke’s Hospital Volunteer Center of the Lehigh Valley Walter’s Pharmacy Wal-Mart Store #3563, Route 191 Weed & Seed Wegmans Weis Markets White Deer Run Wilson Area School District
Bethlehem Partnership Annual Report
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Dental Health Initiative As we continue to work on increasing access to dental care in the Lehigh Valley, we have been fortunate to develop partnerships with supporters that believe in our mission to provide access to quality, individualized, compassionate and cost-effective oral health care to residents of the communities we serve.
Pediatric Dentist Joins the Dental Health Initiative
The Dental Health Initiative continues to grow! 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.
Dental Van Plans are underway for the replacement of our Dental Van, with support from the Lehigh Valley Coalition for Kids. The Dental Van serves 32 sites, which include 16 schools in the Bethlehem Area School District and 16 other sites that include schools in Bangor, Easton, Quakertown, Slatington and Wind Gap, as well as local community agencies. Over 1,300 children had exams, cleanings, X-rays and basic restorative care this year; approximately 30 percent of these children have no dental insurance, further deterring access to much-needed dental care. However, the DHI provided over $133,000 in uninsured care, with support from partners such as the Bethlehem School District, the Bethlehem Health Bureau and the Family Connection in Easton.
FY 2005
FY 2006
FY 2007
FY 2008
FY 2009
Visits
2345
2808
2984
2788
3244
New Patients
733
592
701
547
614
#Restorations (Fillings)
1648
1940
2308
1651
1971
#Sealants
1772
1812
1777
2136
2129
Chart 1
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With the help of grants awarded by the Health Services and Resources Administration, the Highmark Foundation and a private donor, we were able to work toward our goal of hiring a pediatric dentist and opening a second dental center in Easton with primary focus on the oral health care needs of children. Dr. Ralph Civjan, pediatric dentist, joined our program in September 2008 and had been providing specialized care at the Dental Health Center at Union Station and the operating room (OR) until the new dental center opened in Easton in July 2009. Since Dr. Civjan joined the Dental Health Initiative, OR care increased by 68 percent; 233 children were seen for the first time, allowing them to establish a dental home at the Dental Health Center.
Access to Care / Health Services Improvement
Our Dental Partners
Dental Health Center at Union Station
We’d like to thank Northampton Community College (NCC) as it continues to partner with us. On the three Preventive Marathon Days, 129 cleanings, fluoride treatments and diagnostic X-rays were performed on children from Donegan, Fountain Hill, Freemansburg and Marvine elementary schools.
The Dental Health Center (DHC) at Union Station celebrated its fifth year, providing almost 5,000 patient visits to children and adults. The demand for access to our services there continues to grow, with approximately 500 patients currently on our waiting list.
At the Restorative Marathon Day in May, nine volunteer dentists — Dr. Leyla Abdulhay, Dr. Joseph Deering, Dr. Stephen Gschrey, Dr. Hadi Ghazzouli, Dr. Julie Hong, Dr. Karen Lehman, Dr. Donald Rother, Dr. John Staivecki and Dr. John Worsley — and their assistants joined us to provide 40 children with 66 fillings, almost doubling our numbers from last year! This event has become a highlight of the Dental Health Initiative, providing an opportunity for local dentists to give back to their community by providing care to those that need it most. The children were also treated to activities focused on oral health presented by the Bethlehem Health Bureau staff and a special presentation by Sargeant Ralph Napoleon, NJ State Parks Police. St. Luke’s Community Health Department staff helped us tremendously by keeping the children safe and entertained. Thanks to all who made it a success! The Sealant Program with NCC also continues to thrive; 2,129 sealants were placed on 552 children, greatly reducing the risk of tooth decay, while helping the dental hygiene students in their program to meet their clinical requirements.
St. Luke’s Dental Residency Program, having graduated its fourth class in June, has been an integral part of the DHI. With three residents providing care, many patients have claimed the DHC as their dental home. Plans are underway to add a fourth resident next year, which will enable us to increase access to care at the different sites.
Thank You! A heartfelt thank you to all who participated in our quest to continue to provide healthy, bright smiles to our community.
We Need Your Support 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 Seda, manager, Dental Operations, St. Luke’s Hospital & Health Network, at 610-954-2465.
In the second year of what we hope continues to be an annual event, a special thanks goes to Dr. Ann Hunsicker (and her staff) who opened her office to 20 children, providing free dental care. Fifty-six fillings were done that day (more than double compared to last year). The children enjoy visiting Dr. Hunsicker’s kid-friendly office, where they can play video games in the waiting room and watch TV while receiving their care.
Bethlehem Partnership Annual Report
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Vision Initiative Even though the support of the Vision Initiative continues to increase each year, Chart 1 shows that the number of students needing vision referrals is also increasing — as well as the access-to-care needs. A large part of our program this past year was the Give the Gift of Sight Community Mission. In October 2008, the Vision Initiative had another opportunity to host the Give the Gift of Sight Foundation’s mobile vision van in the Lehigh Valley. This organization is part of the Luxxotica Retail Partners. Freedom High School graciously opened its doors to these volunteers so they could provide vision services to students not only from the BASD, but also from eight different school districts plus the Children’s Home of Easton.
Healthy People 2010 Objective: 28-4: Reduce blindness and visual impairment in children and adolescents aged 17 years and under.
The Vision Initiative continues to work hard to provide resources that will assist students who are in need of vision care and who have access-tocare issues. During this past program year, our partners pulled their resources together to offer the following services to the Bethlehem Area School District:
Within four and a half days: • 794 students were served. • 6 20 of these students needed glasses (78 percent). • 5 36 of these glasses were made on the Give the Gift of Sight vision van at Freedom High School (86 percent). • T he remaining 85 pairs of glasses required special lenses and were made by two local Lens Crafters stores and then were delivered to the students’ schools.
• 19,985 students had vision screenings provided by the school nurses. • 2,958 of these students were referred for vision exams. • 925 of these students had their vision referral completed.
3000
•O f the 925 completed referrals, the Vision Initiative assisted with 59.4 percent of these referrals.
2500
• T hose students who were referred for care through the Vision Initiative had a 90.3 percent completion rate.
2000
Through our local supporters, a vision voucher program is offered to the students of the BASD who do not have access to vision care. Throughout the school year, school nurses are able to provide a vision voucher to these students and they are able to go to a local, participating provider for vision care and a pair of glasses, if they are needed. This past year, 209 students benefited from this program (this also includes the Vision Service Plan through the National Association of School Nurses.)
Vision Totals: Exam, Referral, Initiative Support
1500 1000 500 0
2004 - 05
Referred Chart 1 5
Access to Care / Health Services Improvement
2005 - 06
2006 - 07
2007 - 08
Completed Referrals
2008 - 09
VI Support
This truly was an amazing accomplishment for the Vision Initiative that involved volunteers from New Jersey to Ohio. And there was no better reward than to witness a child being able to clearly see the world around them for the first time. For the coming program year, our goal is to have our portable vision clinic up and running on a monthly basis. We would like to take the mobile vision clinic to schools that have a high percentage of students needing eye exams and glasses and be able to help them complete their vision referrals.
Our ultimate goal is for all children to be able to have the eye care that they desperately need in order to be successful in their academic career and to be able to live their lives to the fullest.
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 email her at kindigj@slhn.org.
“The best lesson plans, teaching methods and new technology mean nothing to a student who cannot see clearly.� — Superintendent, Cincinnati Public Schools
Bethlehem Partnership Annual Report
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The Fowler Family Center at Donegan 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 include comprehensive family and women’s health care services, immunizations, the Asthma Initiative and Dental Health Initiative.
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 Lehigh Valley Council for Youth, United Way of the Greater Lehigh Valley, the Pennsylvania Department of Health, St. Luke’s Hospital & Health Network, the Bethlehem Area School District and the Bethlehem Partnership, is entering its 12th 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: 1. Prenatal and Children’s Health 2. Healthy Childhood Development 3. School Readiness and Success 4. Family Stability 5. Safe Communities
With funding from the United Way, the Fowler Family Center completed its first full year of implementing its Youth Succeeding in School Initiative to promote academic success for at-risk students. One hundred ninety seven children and their families were enrolled in the program during the year, with 122 children completing the program. The most common reason for not completing the program was due to transiency issues. For the 122 children and their families receiving the comprehensive case management service, the following findings and outcomes were identified: • 5 1 (42 percent) clients reported that Spanish was their primary or preferred language spoken. All 51 clients (100 percent) received case management services in Spanish. • 1 00 percent of enrolled clients reported at least very good satisfaction with the program on a customer satisfaction evaluation. 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. • 7 5 percent of the students in third, fourth and fifth grades who had 4Sight evaluations in September and May of the program improved their reading level by at least one level. • 6 9 percent of enrolled students either improved or maintained the acceptable standard reading grade from the first to the fourth marking period, and 67 percent of enrolled students improved or maintained the acceptable standard math grade. • 6 6 (54 percent) students received needed dental care on the Dental Van, at NCC marathon days or at Union Station Dental Clinic. • T he number of enrolled children who had insurance increased from 89 (73 percent) to 106 (86 percent).
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Access to Care / Health Services Improvement
As part of the Youth Succeeding in Schools Initiative, Reading Rocks! was implemented at Donegan Elementary School. As a result of this program, led by Lehigh University Education student Jessica Harris, the following activities were accomplished:
In addition to the accomplishments of the Youth Succeeding in School program, the Fowler Family Center also provided the following programs and services to students attending Donegan and their families:
• 2,600 books were distributed to Donegan students to promote reading.
•D ental care was provided through 209 visits on HealthStar II, and 44 children received dental care through the NCC Marathon Days.
Prenatal and Children’s Health
• A reading competition was kicked off with an assembly for the entire school in March 2009. A Lehigh football player and a St. Luke’s physician told their personal stories of succeeding in life by focusing on reading and succeeding in school.
• T he family clinic, staffed by Family Center and St. Luke’s Hospital employees, provided primary and preventive care through 2,364 visits to low-income children and families. Four percent of individuals seen were uninsured.
• 168 students participated in a six-week reading competition, reaching established goals set for their grade level. • Over 80 students participated in an ASPIRE Reading Buddy program from March until May 2009.
•A women’s health clinic — partially funded by the BHB, St. Luke’s and Maternal and Family Health Services, Inc. — provided care during 219 visits for 94 low-income women, 59 percent of whom were uninsured and 41 percent of whom were on Medical Assistance.
• Over 50 Lehigh University students/athletes and 40 St. Luke’s staff served as volunteer readers during the after-school program.
• T he BHB provided 1,767 immunizations to low-income children through an on-site immunization clinic.
• A final assembly was held in May with a rousing performance by Lehigh University’s Step Team and an appearance by Iron Pigs mascot, Ferrous. Certificates and awards were distributed to all individual students achieving established goals.
Chart 1 shows the number of visits to the women’s health clinic and the pediatric clinic over the last 10 program years.
• 162 students who completed the program attended an Iron Pigs baseball game in May as their reward. • 25 students participated in a Summer Reading Theater Program — an evidence-based educational strategy in which students read and perform a book each day during the week-long program. The students then attended a field trip to Barnes and Noble Bookstore to select books to continue their reading successes.
Fowler Family Center Patient Visits 2500
2364
1964 1998
2000 1757
1680
1552
1500
With funding from the United Way, the Fowler Family Center completed its first full year of implementing its Youth Succeeding in School Initiative to promote academic success for at-risk students. One hundred ninety seven children and their families were enrolled in the program during the year, with 122 children completing the program.
1847
1434
1000 668 558
500 156
0
239
230
307
301
349
414
315
285
219
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Fiscal Year Women’s Health Clinic
Pediatric Clinic
Chart 1
Bethlehem Partnership Annual Report
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The Fowler Family Center at Donegan cont. Healthy Childhood Development • 14 children were referred to pre-school programs such as SPARK and HeadStart. • 19 families were referred to the Parent as Teacher Program. • 32 kindergarten families received home visits. • 83 families were provided assistance with applying for MA/CHIP health insurance.
School Readiness and Success • Approximately 129 school referrals were acted upon through home visits and telephone calls. Referral issues included bringing parents to school meetings, ADHD assessments, custody issues, interpreting classroom behavior, parent health-related issues and follow-up on attendance, head lice, immunizations, food and housing. • 33 WrapAround and IST meetings were held for students to promote school success. • The Welcome Classroom Initiative assisted 57 families. • The after-school ASPIRE Program had 441 participants. • Parent engagement was promoted throughout the year through the following events: open house (179 parents), parent workshop on discipline (15 parents), Lights on Afterschool (27 parents), PBS programs (17 parents), holiday celebrations (77 families), Three Kings Day (60 families) and an end-of-year picnic (30 parents).
Family Stability and Safe Communities • F airfield Inn and Suites by Marriott held a gift collection for the holiday season providing more than 25 families with special Christmas gifts. • 1 5 families were helped with employment referrals. • 1 9 families received rental assistance and housing referrals. • F ood bank assistance referrals were made to 36 families. • 1 2 families were provided bilingual counseling services. • T ransportation services to access health services, county services, employment information, food and housing were provided for 32 families. • Bus tickets were distributed to 71 families.
9
Access to Care / Health Services Improvement
Fairfield Inn and Suites by Marriott held a gift collection for the holiday season providing more than 25 families with special Christmas gifts.
PA DOH Primary Care Challenge Grant process at St. Luke’s Family Practice at the Fowler Family Health Center at Donegan The expansion grant goals included development of an infrastructure that supports provision of medical and dental care for uninsured adults and children as well as those with difficulties accessing regular care. Entering the final months of this grant funding the Partnership has accomplished much to develop and implement processes that create a safety net for some of our community’s most needy families. The health center shifted from pediatrics only to family practice over the past two years. In addition to making this significant transition in patient care population, the partners involved in this service program also: • Developed processes to improve access to medical insurance and other social service application support (lead partners: St. Luke’s and BASD).
Specific to this past year, the grant funds and efforts of our partners have supported: 1. Expansion of dental care for 34 Donegan patients (99 visits). 2. One full year of adult care, with adult visits accounting for approximately 30 percent of visits at the center. 3. The provision of care for uninsured individuals with four percent (103/2585) of visits provided for individuals without medical insurance or hospital subsidy.
For more information about the Fowler Family Center at Donegan or to volunteer, please call 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.
• Implemented processes to improve asthma management for health center clients (lead partners: BHB and St. Luke’s). • Created a screening and referral process for dental care needs (lead partner: St. Luke’s). • Created and implemented a protocol that is in alignment with hospital financial assistance plan policies while also respecting the needs of our patient community. • Developed processes to more clearly link patients on the Mobile Youth Health Center and general mobile health services to Donegan so that community members seen through these outreach sites could continue care through the health center.
The Fowler Family Center at Donegan, sponsored by the Lehigh Valley Council for Youth, United Way of the Greater Lehigh Valley, the Pennsylvania Department of Health, St. Luke’s Hospital & Health Network, the Bethlehem Area School District and the Bethlehem Partnership, is entering its 12th year of operation serving nearly 500 students and their families.
Bethlehem Partnership Annual Report
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HIV Initiative Prevention Program The Prevention Program at ASC continues to focus their efforts on preventing the transmission of HIV/AIDS and other sexually transmitted infections (STIs) in both Northampton and Lehigh counties. The staff of the prevention program is continuously thinking of new ways to reach out and inform the community. The program collaborates with many local agencies, schools and government facilities. In addition to community education, the program also provides HIV risk-level screenings at medical facilities, street-level outreach to high-risk populations and HIV testing. Prevention activities are divided into four categories: 1. Outreach
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.
Programming for the AIDS Services Center at St. Luke’s Hospital (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: St. Luke’s Auxiliary, Two Rivers Health and Wellness Foundation, PA Department of Health, AIDSNET, the University of Pittsburgh and United Way of the Greater Lehigh Valley.
11
Access to Care / Health Services Improvement
2. Interventions Delivered to Individuals (IDIs or one-to-one education sessions) 3. Interventions Delivered to Groups (IDGs or small-group level education sessions) 4. Health Communications/Public Information (HC/PI or large-group level education sessions) For the 2008 – 2009 program year, the prevention staff concentrated its efforts on providing higher quality prevention interventions. Of the 5,692 completed outreach contacts, four percent progressed to IDIs, where individuals made a conscious commitment to behavior change to reduce their risk of contracting HIV or other STIs. IDIs were integrated into HIV Counseling and Testing so that the staff member and participant would be able to get a more comprehensive risk reduction session. Of the 229 IDI participants, 67 percent made a commitment to behavior change, a four percent increase from the year before. Of the 1,540 individuals who participated in IDGs, 99 percent completed all group activities and identified and committed to behavior changes. Of the 3,416 HC/PI participants, 94 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 (CPS). With this system, participants are able to interact with staff members by using infrared remotes to answer questions and are able to provide useful feedback while remaining anonymous. The participants report that the CPS makes learning fun and interactive.
Contacts for Prevention Interventions
completed from July 2008 to June 2009. Of the 403 tests, three preliminary positive results were identified, with one being a confirmed positive. A total of 512 risk factors were reported because several individuals reported more than one risk factor.
HC/PI
Type of Contact
CRCS CRCS is an intensive one-to-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.
IDG
IDI
In FY 09, 78 patients participated in CRCS. The following are the demographics of these patients: Outreach
• 55 percent were male; 45 percent were female. 0
1000
2000
3000
4000
5000
6000
Prevention Interventions 2008 - 2009
• S ix percent were under the age of 25; 34 percent were 26 – 45 years old; 51 percent were 46 – 65 years old; nine percent were over 65 years old.
2006 - 2007
2007 - 2008
• 2 6 percent were African American/Black; 59 percent were white; 15 percent reported other; 56 percent were Hispanic/Latino.
Chart 1
Patient risks are grouped into five categories:
HIV Testing
1. No risk
ASC is an approved Pennsylvania Provider Agreement site from the Pennsylvania Department of Health. This agreement allows ASC to provide free, confidential and anonymous HIV testing to the community. ASC has been able to provide rapid testing to the community using Ora-Quick Rapid HIV tests for over a year. From July 2008 to June 2009, 403 tests, a 67 percent increase from the previous year, were
2. Low risk 3. Moderate risk 4. Significant risk 5. High risk
Risk Reported for Completed HIV Tests July 2008 - June 2009 6% 14%
Sex Without a Condom Sex With a Person Who is an IDU
5%
Sex With a Person Who is a MSM (Men Who Have Sex with Men) Sex With a Person Who is HIV+
1%
12%
62%
Intravenous Drug User (IDU) Has Shared needles With Others
Chart 2
Bethlehem Partnership Annual Report
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HIV Initiative cont. Risks range from maintaining a stable lifestyle and being medically adherent, to no or minimal use of condoms, homelessness, domestic violence, multiple sexual partners and drug/alcohol abuse. Chart 3 depicts the percent of patients classified in each risk category at the beginning (June 2008) and end (July 2009) of the program year.
Patient Risk Category 50%
Clinical Care Services
46%
45%
Primary and specialty care services were provided to 129 HIV-positive individuals, a 13-percent increase from FY 2008 and a 54-percent increase from FY 2007. Clinical services are provided at St. Luke’s Union Station Health Center. Services include ambulatory/outpatient medical care, case management services, nutrition counseling, risk reduction counseling, dental care and treatment adherence counseling. Chart 4 depicts the mode of exposure to HIV for patients receiving services at St. Luke’s Union Station Health Center:
42%
40% 35% 30% 25%
27% 23%
20% 14%
15%
housing assistance and emergency food assistance. This past year, the case management staff provided services to 251 HIV-positive clients and one HIV-affected client. This is a 19-percent increase in clients served from FY 2008 to FY 2009. Clients enrolled in case management services receive their HIV-related medical care from several practices including St. Luke’s Union Station, St. Luke’s Allentown Family Health Center, New Direction Treatment Services, Easton Community HIV/AIDS Office, AIDS Activities Office and several private physicians.
13% 9%
10%
9%
8%
9%
5% 0%
Mode of Exposure to HIV No Risk
Low Risk
Beginning Risk Status
Moderate Risk
Signifcant Risk
High Risk
1% 5% 1%
End Risk Status
Chart 3
15%
45%
From July 2008 through June 2009, there was a 14 percent decrease in patients who had no risk and a 9 percent increase in the low risk category. Program data indicates that the increase in the low-risk category is attributed to patients having more financial, legal and housing issues that directly impacted risk status. Also, three patients were referred to the Bethlehem Health Bureau for Partner Counseling and Referral Services.
31% 1% 2%
Case Management and Supportive Services
MSM
Heterosexual Contact
Case management services assist persons living with or affected by HIV/ AIDS to achieve and maintain optimum health and quality of life by facilitating the coordination of health and support 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,
IDU
Blood Transfusion
MSM/IDU
Perinatal Transmission
Hemophilia/ Coagulation Disorder
Undetermined
13
Access to Care / Health Services Improvement
Chart 4
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. Chart 5 shows several performance measure results over a two-year period compared to national benchmark data (NA indicates no national benchmark).
Advisory Board ASC would like to thank Advisory Board members for their dedication to the HIV Initiative. Current members are Frank Ford; Tom Lichtenwalner; Bonnie Coyle, MD; Peter Ender, MD; Carla Arbushites; Jane George; Nancy Adams; Scott Hock; Alf Halvorson; and Kay Gilbreath. The ASC Advisory Board is currently expanding to include additional community members dedicated to supporting HIV/AIDS initiatives. Board nominations can be forwarded to Hollie Gibbons, MPH, RD, manager of Disease Prevention Initiatives, at 610-954-2301 or gibbonh@slhn.org.
Performance Measure
Benchmarks
FY 2008
FY 2009
Two Primary Care Visits >= 3 Months Apart
NA
87.06%
87.85%
Percentage of Patients with >=2 CD4 Counts
62.50%
63.53%
79.44%
100%
77.42%
95.65%
94.40%
100%
90%
NA
63.53%
100%
TB Screening
56.20%
58.82%
55.47%
Cervical Cancer Screening
70.8%
52.17%
55.56%
Syphilis Screening
80.00%
60.78%
70.63%
Hepatitis C Screening
90.90%
75.49%
90.70%
AIDS patients on Highly Active Anti-Retroviral Treatment (HAART) CD4<200 with PCP prophylaxis Percentage of pregnant women prescribed ART
Chart 5
This past year, the case management staff provided services to 251 HIV-positive clients and one HIV-affected client. This is a 19-percent increase in clients served from FY 2008 to FY 2009.
Bethlehem Partnership Annual Report
14
Asthma Initiative The Asthma Initiative is a multi faceted program that offers school-age children and their families educational support, nursing interventions, and opportunities for safe and healthy recreational activities. The program goals are to: 1. I dentify children with asthma who have not been diagnosed and refer them for treatment. 2. I dentify and educate children with a known diagnosis of asthma who were not being adequately treated. 3. P rovide public education and awareness as well as continuing education on NIH guidelines to area providers.
Service Improvement
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.
This past year, the Bethlehem Partnership and the Bethlehem Health Bureau (BHB) continued to provide education to the families that utilized the ED by sending educational mailings and supplies to their homes. In addition to the mailings, the BHB conducted home visits to complete environmental assessments and provide further asthma education to families living in the City of Bethlehem. Thirty-five families agreed to home visits this past year.
Fiscal Year
2004
2005
2006
2007
2008
2009
Total # of Patients
225
193
248
242
216
199
Total # of ED and Inpatient Encounters
285
234
302
209
257
247
Total # of ED Visits
221
190
265
261
211
211
Total # of Inpatient Admissions
64
44
37
48
46
36
Chart 1
15
The Asthma Initiative has collaborated with the St. Lukeâ&#x20AC;&#x2122;s Hospital Emergency Department (ED) to monitor the rate of pediatric ED visits. During this past year, a Lehigh University Community Fellow, Elizabeth Roth, monitored these rates and mapped the reported residency of patients. This has helped us to conceptualize asthma management of the population at large and aided us in identifying areas of need. The following table depicts the number of pediatric ED and inpatient visits for patients living in Bethlehem zip codes.
Access to Care / Health Services Improvement
The Bethlehem Partnership’s Asthma Initiative, a collaborative effort among St. Luke’s Community Health Department, the Bethlehem Health Bureau and the Bethlehem Area School District, was nationally recognized by receiving the 2009 Environmental Leadership Award in Asthma Management. Providing this service may have directly impacted ED utilization for pediatric patients living in the Bethlehem Area School District. For instance, the number of pediatric patients seen for asthma-related visits has consistently decreased over the past three years with a 20-percent decrease from FY 2006 to 2009. This trend is also present with the number of ED and inpatient encounters showing an 18-percent decrease from FY 2006 to 2009. The number of ED visits decreased by 20 percent from FY 2006 to 2008 and remained the same at 211 visits for FY 2008 and 2009. The rate of pediatric patients who had multiple visits to the ED has also been monitored. The following table depicts the total number of pediatric patients that had multiple visits to the ED and the total number of visits amongst these patients for the past five years.
Total # of Asthma-related ED Visits vs. # of Multiple Visits 120 108
100 80
80 69
69
60
36
2. Use of the ED as a source of primary care. 3. Old and poor housing stock containing indoor triggers. 4. Housing proximity to congested roadways. Also, mapping the residency of the patients who utilized the ED for asthma symptoms provided valuable information in identifying neighborhoods most in need of community outreach, which were then targeted for World Asthma Day flyer distribution in May 2009 and for a day of ozone awareness in July 2009.
Provider Education This past year, the Asthma Initiative received a Pennsylvania Asthma Partnership grant to educate health care providers about the National Asthma Education and Prevention Program guidelines. Through this project, we trained 180 health care providers from the following medical residency programs: emergency medicine, family practice and internal medicine. We thank Shannon Kearney, DO, for collaborating with the Asthma Initiative to provide the residency training.
We are proud to acknowledge that the Bethlehem Partnership’s Asthma Initiative, a collaborative effort among St. Luke’s Community Health Department, the Bethlehem Health Bureau and the Bethlehem Area School District, was nationally recognized by receiving the 2009 Environmental Leadership Award in Asthma Management awarded by the U.S. Environmental Protection Agency (EPA).
39
28
28
32
For more information about this initiative, please call Julie Kindig, RN, nurse coordinator at 610-954-6204 or email her at kindigj@slhn.org.
20 0
1. Uncontrolled asthma due to lack of primary care.
National Recognition
90
40
In FY 2008, there was a 36 percent decrease in the total number of multiple pediatric visits to the ED. This past year, there was a 16 percent increase in the total number of multiple pediatric visits. In studying this data further, Elizabeth Roth, Lehigh University Fellow, noted that in fiscal years 2008 and 2009, over half of the ED pediatric patients were from the 18015 zip code, even though this geographic area holds well under 50 percent of the Bethlehem population. There are a handful of potential explanations for this heavy use of the ED by residents in South Bethlehem and Fountain Hill:
2005
2006
2007
# of Patients with Multiple Visits
2008
2009
Total # of Visits
Chart 2
Bethlehem Partnership Annual Report
16
Adolescent Health Initiatives assisted 152 students (28 percent) from the BASD or the Valley Youth House Shelter who had access-to-care issues. This is a seven-percent increase from the previous program year.
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. Mobile Youth Health Center The lead resource of the Adolescent Health Initiatives is the Mobile Youth Health Center (MYHC). This program has been serving adolescents in our community for 11 years, through the Health Star I mobile unit. It is designed to reach out to the adolescents in the Bethlehem area by taking health care and health promotion/educational resources to them. Partnering with the Bethlehem Area School District (BASD), health services are provided to Broughal Middle School, Freedom High School and Liberty High School. The MYHC also provides physicals for the Valley Youth House Shelter. For the 2008 – 2009 school year, we provided services to 548 adolescents. Of that total, 422 of these adolescents were seen through the BASD, with the remaining 126 from the Valley Youth House Shelter. Many of these students were seen more than one time for follow-up care, which gave us a total of 1,130 visits to the MYHC.
Access to Health Care Access-to-care issues include students who do not have health insurance, a primary care physician or both. At each school that we work with, we try to identify the students who have access-to-care issues and then attempt to connect these students with the care they need. As our economy struggles, the need for the MYHC increases. For this past program year, the MYHC
17
Access to Care / Health Services Improvement
While helping these students, we also help their families by connecting them with health insurance and primary care physicians. A total of 107 students reported not having health insurance. Thirty five of these families were already in the process of applying for health insurance or were not interested in applying for it. The remaining 72 students were sent insurance applications and were offered assistance with the process. As of June 2009, 15 of these students (21 percent) were approved for health insurance, one family was rejected for state insurance, and nine families’ applications were still being processed. The follow up and assistance with these families were made possible by the Bethlehem Partnership’s Insurance Initiative. Some of the students and their families we serve are connected with insurance and a primary care physician but face other obstacles to receiving health care: lack of transportation; parents not being able to take time off work to take their child for health care; not being able to afford the co-pays for their insurance; being underinsured; or the parents/guardians are not involved with the student’s care — leaving the students to navigate the health care system on their own. Partnering with the school nurses allows us to serve these students, making it possible for them to improve their mental and physical health, as well as educating them about community resources available to them and their families. Our staff continues to refer these families to the services available in the health center at Donegan in an effort to connect them to a usual source of care.
Body Mass Index Body Mass Index (BMI) is a screening tool used as a reliable indicator of body fat for most people. This tool shows whether or not a person’s weight falls within a category that may lead to health problems. Nationally, childhood obesity has been on the rise, and we have seen this in the adolescents that we serve. For 2008 – 2009, 19 percent of the adolescents had a BMI of 29 or greater, which in adults is an indicator of being overweight or obese. Compared to the previous year, this is a four-percent increase. This program year we began tracking the students’ BMI percentile, which is a more accurate way of knowing whether or not a child is within a healthy weight range. A BMI that falls above the 95th percentile is considered to indicate being overweight or obese. Out of the students that we served within the BASD, 19 percent of them had a BMI that was greater than the 95th percentile.
This past program year we focused on nutrition — creating a more effective way to educate and help individuals in this area. Monthly one-to-one counseling was done with high school and middle school students who were interested in making healthy lifestyle changes concerning their eating and exercise habits. Thirty students participated in this counseling two or more times throughout the school year. Forty-three percent of these students either lost weight or their weight remained the same at the time of their last visit to the MYHC. Work needs to continue in this area to assure a healthy future for our teens. Our goal for the coming school year is to continue to focus on the nutrition education and provide support to the students and their families. We plan to do more detailed tracking of students who participate in the nutrition program and learn how we can be more effective in our role of supporting these students and families.
Resource Room at Liberty High School
Tobacco Use
• S tress Management — facilitated by Crossroads/Center for Humanistic Change.
Healthy People 2010 has a goal of decreasing the amount of tobacco use among adolescents to 16 percent. Locally, only 11 percent of the adolescents we served reported tobacco use, a three percent decrease from the previous year. Tobacco screening is done for every student seen on the MYHC and information and counseling is offered to those who do use tobacco. St. Luke’s Family Practice Residency Program, which is led by Dr. Cam Lam, also partners with us in providing a one-to-one smoking cessation program at the schools for students who are interested in quitting tobacco use. Students are extremely appreciative of the encouragement and support they receive, but they also comment on how much the doctors listen to them and help them in other areas of their lives as well. This has been a successful program that we plan to continue in the coming years.
Looking to the Future We are pleased to announce that the MYHC services will be expanding to the Northeast Middle School beginning October 2009. We will be adding a new goal to our program — working toward reducing physical assaults by focusing efforts on providing education regarding domestic violence and preventing family and partner abuse.
Adolescent Health Wellness Committee In January 2009, an Adolescent Health Wellness Committee was formed. All organizations within the Bethlehem area who work with adolescents were invited to be a part of this committee with initial meetings serving as a networking forum. Our goal is to improve the health status of adolescents living in our community. We plan to do this not only through medical services, but also through social events involving music, drama and physical activities. We invite all individuals and organizations who would like to be a part of improving the health of the adolescents of our community to join us at our monthly meetings!
Goal: T o support adolescents in achieving a status of health that promotes academic and personal success. This past program year the Resource Room offered six different support groups to the students of Liberty High School. These groups were: • B alancing Weight Management — facilitated by the Bethlehem Health Bureau. • Parenting — facilitated by St. Luke’s School of Nursing. • P renatal — facilitated by St. Luke’s School of Nursing. • R elationship Identity Communication Health Esteem Support (RICHES) — facilitated by St. Luke’s School of Nursing.
• T aking Control — facilitated by Valley Youth House. These groups meet weekly each fall and spring for approximately 10 weeks. This year, a total of 65 students participated in this program. Many of these students participated in both the fall and spring groups that were offered. When one group was asked, “What have you found most helpful about this group?” the answer was, “Being able to communicate with others.” The Resource Room program does not solve the students’ problems for them, but allows them to talk through their concerns and find ways to problem solve on their own. This is a very valuable life lesson. Being able to communicate well is the basis for being successful in life. The Resource Room has become an important part of Liberty High School. Kathy Halkins, one of the school nurses, points out that this program allows students to have a connection with someone in the school who is not a disciplinary person. They can share within these groups and not worry about getting in trouble. The partners who facilitate these groups do an excellent job with mentoring the students. It is their commitment and sincere interest in the students make this program successful.
If you would like more information about the Adolescent Health Initiatives, would like to offer your resources to our programs or would like to be part of the Adolescent Health Wellness Committee, please call Julie Kindig RN, nurse coordinator, at 610-954-6204 or email her at kindigj@slhn.org.
Bethlehem Partnership Annual Report
18
Maternal Child Health Parent Advocate in The Home (PATH) Program Nursing efforts under the PATH program are designed to empower parents through education and mentoring. The goals of the program are to support the growth and development of the children in a safe, loving home and to prevent child maltreatment. The nurse advocates provide more than just education; they mentor the parents in learning life skills and reaching for goals; they role model early childhood reading and development concepts through reading, crafts and activities designed to promote bonding and learning; and they empower parents to seek out resources for themselves and their families.
Healthy People 2010 Objectives: 16-6: Increase the proportion of pregnant women who receive early and adequate prenatal care.
16-17: Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women.
15-33a: Reduce maltreatment and maltreatment fatalities of children.
“Anyone can count the seeds of an apple, who can count the apples in a seed?” — Early American proverb The families served by Maternal Child Health programs under the Partnership umbrella benefit from nurses who have in their focus the general welfare and well-being of each child they serve, albeit the referrals and families are referred through different streams. Both programs seek to positively impact the children in each family, and both look to provide long-lasting effects for the families involved. Much like the counting of apples from a seed, our Maternal Child Health programs look to take the seeds and sow wonderfully positive things from them in the future, even though they will not likely be present to witness those outcomes.
19
Access to Care / Health Services Improvement
During this past program year, PATH experienced tremendous growth, both in staffing as well as in families enrolled. Thanks to funding through Lehigh County OCYS Prevention grants and the United Way, our program expanded staffing to allow us to serve 231 active families. With new staff, we have also been able to offer Spanish-speaking families services by a bilingual/bicultural nurse and early-morning, evening and Saturday visit blocks. Some notable outcomes for this program year: • 9 7 percent of parents demonstrate completion of an age-appropriate parenting curriculum. •O verall, 94 percent of infants/toddlers demonstrate ageappropriate growth/development using the Ages & Stages Questionnaire Survey and ASQ: Social Emotional Survey. • P articipants in Lehigh County make up 69 percent of participants, Northampton County participants make up 30 percent, and one case came from Carbon County. • 79 percent of discharged program parents are either actively pursuing, or have completed, at least their high school diploma. A few were actively pursuing higher education at time of discharge. • 100 percent of families surveyed (n = 71) rated the quality of the program as “excellent.”
Visiting Nurse Advocate for the County (VNAC) Program Nurses in the VNAC program provide intensively focused services to:
Risk Indicators for VNAC Referrals 7 - 08 thru 12 - 08 25
1. Support families in crisis. 2. Provide parenting education and case management for families.
20
20
3. Advocate for the safety of the infant/child even if that may mean the family unit is not maintained or reunited. These nurses are primarily advocates for the health, safety and well-being of our community’s children, working hand in hand with the referring county Office of Children, Youth & Families. They perform their duties under stressful conditions and environments, and do so admirably with the children’s welfare always at the center of the work. Partnering to create safety nets for the children involved and promote positive growth in the families are key components of the VNAC program. Many will wonder how these nurses continue to maintain positive outlooks while working daily with cases of negligence and maltreatment, but if you see the faces of the children, if you see the growth they demonstrate and if you see the pride in parents who learn the skills and feel ready to handle the challenge of parenting, you will understand what keeps them going. While some cases involve lack of parenting knowledge and skills, many more involve medical neglect and abuse. During this past program year, the VNAC program provided nursing case management and parenting educational services to 165 families (a 64 percent increase from last program year). It is worth noting that of the 26 cases during this past year had as a goal termination of parental rights, and that 15 (58 percent) of those had that goal changed from reunification in the past year:
15 12 11
10 8 5
5
4
3
0
Child Abuse Domestic Violence MHMR Substance Abuse
Medical/Nursing Concerns Criminal System Involvement of at Least One Parent Inappropriate Parenting Skills
Chart 1
For more information or to offer your efforts to either the PATH or VNAC programs, please contact Melissa Craig, RN, at 610-954-6203 or craigmm@slhn.org.
• Chart 1 breaks down the ultimate goals of our VNAC cases for the past program year. • Our nurses provided a total of 8, 243 hours of service. • The most common risk factors present in families were mental health/mental retardation of one parent, mental illness in one/ both parents and evidence of ineffective parenting. • Court-involved cases are increasing (48 percent of all cases) and require much documentation, preparation and testimony by our nurses, not to mention the complexity of these cases compared to others.
Bethlehem Partnership Annual Report
20
Minority Health Initiatives Community Health Center Network The Bethlehem Partnership strongly supports the Neighborhood Health Centers of the Lehigh Valley and their goal of establishing a Federally Qualified Health Center (FQHC) in the Lehigh Valley, as part of the broader initiative of reducing minority health disparities in our local area. The doors to Vida Nueva opened this past year, and an application for FQHC “look-alike” status has been submitted. The overall goal is to create a community health center network with access sites in Allentown, Bethlehem and Easton.
Access to Culturally and Linguistically Responsive Services Healthy People 2010 Goal 2: Eliminate Health Disparities 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.
Many living in our community remain disconnected to a regular source of care, many are of minority population groups and many are uninsured. The Partnership focuses much energy on facilitating access for these families through various venues. This past program year was no different with some large as well as incremental steps taken to improve quality of care and access to care for our most needy families.
Sixty-two visits for uninsured individuals were provided in this access-to-care monthly clinic during the past program year. Of these, 66 percent (42/62) were for individuals living in either the Southside Bethlehem or Marvine/Pembroke areas of the city.
21
Access to Care / Health Services Improvement
Continuing to advocate for improved access to linguistic support in the hospital setting continues as one of the objectives of the Partnership’s past year’s efforts. Advocacy, assessment and allocation of funds to address equipment needs at various access points continue.
Marvine Family Center’s Community Health Clinic Sixty-two visits for uninsured individuals were provided in this accessto-care monthly clinic during the past program year. Of these, 66 percent (42/62) were for individuals living in either the Southside Bethlehem or Marvine/Pembroke areas of the city. All individuals were referred for insurance application support, and individuals with chronic conditions were referred to the Donegan Family Center clinic so access to medical management could be provided. This community clinic has served our community well over the past 11 years but, with the expansion of services at the Family Practice at Donegan Fowler Family Center for adults, the service ended as of June 30, 2009.
Medical Insurance/Access to Care Project The Insurance Initiative team met several times this past year with the goal of trying to get our “collective arms” around how best to capture the referral support provided in a way that shares and measures the need in our community. The partners agreed to collect specific, similar data for tracking purposes. They also submitted and received a marketing grant through the PA CHIP project (PA Dept. of Insurance) to reach out to needy communities, specifically minority community groups, to improve rates of referral and application to CHIP. The partners enthusiastically embraced the opportunity to reach out to the community and offer application assistance to eligible families. Unfortunately, as Charts 1 and 2 demonstrate, completing this process is time consuming and often not completed. Our partners will be regrouping in the new program year to determine how best to proceed with this very important initiative.
This past year, the Bethlehem Partnership for a Healthy Community Scholarship was awarded to Cesar Bustos at Freedom High School, who will attend Penn State University in the fall.
2007 – 08
Bethlehem Partnership Annual BASD Minority Award 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 Cesar Bustos at Freedom High School, who will attend Penn State University in the fall.
Community Services for Children, Inc (CSC) — HeadStart Services CSC continues to ensure that their program children are connected to medical homes and has done an excellent job yet again. This past year CSC reports that 99 percent of children were UTD with well care as per the program expectations. St. Luke’s HealthStar I mobile van and staff provided two days of service for 17 uninsured children this past year. Each child was provided a physical and any needed immunizations. The HealthStar II dental van also supports these children and provided dental care for an additional 42 children. If interested in joining any of the Minority Health Initiatives, please contact Melissa Craig, RN at 610-954-6203 or craigmm@slhn.org.
# referred
# applied
# approved
Pending/ Incomplete
SLFP at Fowler Family Center
107
39
33
66
Community Health of St. Luke’s Hospital
224
92
79
132
Easton Area School District
20
13
6
7
Bethlehem Health Bureau
46
39
12
8
397
183
130
213
# referred
# applied
# approved
Pending/ Incomplete
BASD Family Center Staff
147
—
—
—
Community Health of St. Luke’s Hospital
170
84
61
13
Easton Area School District
35
—
5
—
Bethlehem Health Bureau
29
29
7
22
Chart 1 2008 – 09
Chart 2
Bethlehem Partnership Annual Report
22
Adolescent Career Exploration Mentoring Programs years of program students. This is the seventh consecutive year that this high achievement has been accomplished by our students. Of the senior students, nine of the thirteen (69 percent) have already been accepted into higher education or are currently pursuing enrollment for a winter semester start.
STW Participants Pursuing Higher Education In First Year After Graduation 100
Healthy People 2010 Objective: 7-1: Increase high school completion. The Partnership is proud to embrace career mentoring that exposes local, often low-income adolescents to potential health care careers. Our programs expose them to many career opportunities while supporting the program participants to complete high school. We use team-building activities, classroom instruction, on-site experiences and work to reach our goal: high school graduation and transition into either full-time employment or enrollment in higher education programs of study.
School to Work (STW) Program
75% 70%
67%
70 60 50 40
42%
38%
30 20 10 2008
2007
2006
2005
2004
2003
2002
0
09
- 20
08
- 20
07
- 20
06
- 20
05
- 20
04
- 20
03
- 20
02
- 20
01
Access to Care / Health Services Improvement
77% 75%
2001
23
78%
80
- 20
This program year we enrolled 18 students, with 100-percent enrollment maintained for the entire year. The team keeps in touch and offers support for all past and current students throughout their high school career. This past June, all 13 eligible senior grade students graduated, covering three
90
2000
This past year marked the 12th year of the STW program. This program, designed to encourage English-acquisition high school students to complete high school through an interactive, hospital-based curriculum, has had another year of exceptional success. The STW program takes a healthand hospital-focused science and English curriculum, provided by our partners in the Bethlehem Area School District, and combines it with on-site observational experiences in the health care environment to facilitate understanding of the English language and expose the participating students to potential careers in health care. Many hospital departments participate in this program, with participating students observing in both in-hospital and off-site locations.
94%
Chart 1
Health-Related Career Exploration Program The STW program has served as an access point for a hospital-based program that combines a year-long mentoring program with a paid work experience. Through a partnership between the CareerLink LV/ Private Industry Council and St. Lukeâ&#x20AC;&#x2122;s Hospital, 15 adolescents (many STW students) are provided the opportunity to continue exploring health careers while participating in a year-long work experience.
Participating departments include the Laboratory, Neonatal Intensive Care Unit, Radiology, Community Health, Accounting, Women’s Health Center, Central Transport and several of the family practice offices. These youth employees learn valuable job skills while being supported through mentoring and tutoring as needed to achieve academic success. Our team develops an Individual Employment Plan with each youth and can often be found advocating for the youth employee as they learn skills necessary to perform successfully in a professional work environment. Fourteen of the 15 youth employees successfully completed the program work year. One hundred percent of the seven senior grade students graduated high school, and five of the seven have been accepted to and enrolled in higher education: four at Northampton Community College, and one at Penn State and one at Bloomsburg University.
HCEP Graduates Pursing Higher Education In Year Following Program Completion 100%
100
An exciting new opportunity presented itself this year for funding under the Economic Recovery and Reinvestment Act (ARRA). This allowed the Partnership to develop an exciting transitional program for recent high school graduates and young adults to expand their work experiences in a health care setting. The goal of the Next Step program is to provide these young adults with the additional training and job coaching that will support a successful transition from subsidized employment to unsubsidized employment in the health care environment. Twelve young adults were interviewed and accepted into this eight-month program and will be working in various entry-level jobs at 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 the health care environment and six of nine (66 percent) of the recent graduates transitioned into this program. Two of the 12 Next Step youth employees were never in any of the Partnership programs, but have community-based educational programs and experiences that are a great match and will provide them with an opportunity to achieve regular employment in their career fields (medical coding and dental assistant). We look forward to beginning this exciting new opportunity to engage and retain motivated and bright minority youth in helping to improve the health of our community.
80%
80
Next Step Program
71%
60
60%
For more information or to be involved in supporting our Adolescent Career Mentoring Programs, please contact either George Maunz at maunzg@slhn.org or Victoria Montero at monterv@slhn.org or 610-954-2100.
40
20
0
2005 - 2006
2006 - 2007
2007 - 2008
2008 - 2009
Chart 2
Several of the STW students and youth employees were awarded Minority Award book awards and scholarships as well as general community awards: Antonia Ramirez George Maunz STW Scholarship
“I love this program (Health Career Exploration Program) because we have to learn to be more independent, but at the same time we feel supported because there are people that always care about us.” — Kiara Almodovar
Kiara Almodovar CLA-Student Scholarship; Roberto Clemente Scholarship Shani Batiste Council of Spanish Speaking Organizations of the LV Scholarship Jeremiah Ragsdale Cauldron Award
Bethlehem Partnership Annual Report
24
HealthStop In FY 09, 587 community members utilized HealthStop, a 95-percent increase from FY 08. Of the 587 individuals utilizing the HealthStop program this program year: • 3 3 percent (n = 194) of individuals reported having no insurance; 49 percent (n = 288) reported having medical assistance. • 1 40 people received a rapid HIV test and pre/post-test counseling; one positive was found. • 1 0 percent ( n = 61 ) had a Hepatitis C screening and eight received a Hepatitis C test; five of the eight people tested positive for Hepatitis C.
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 continues to be a challenge for many members of the community living in the greater Bethlehem area and the Lehigh Valley. HealthStop with HealthStar I continued in its third 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 community members outdoors in their neighborhoods. HealthStop visits nine designated sites on a rotating monthly basis so that targeted neighborhoods have access to services and staff is able to follow up with the clients. HealthStop provided services in the following areas for the 2008 – 2009 program year: Marvine/Pembroke, South Bethlehem, Parkridge/West Bethlehem, Easton Circle, New Bethany Ministries, Trinity Soup Kitchen, Unity House and Safer Harbor.
25
Access to Care / Health Services Improvement
• 4 4 percent ( n = 258 ) had a cholesterol screening completed; 45 percent of those who received a cholesterol screening had either a borderline high or high result. • 1 8 percent ( n = 107 ) had Body Mass Indices (BMI) completed and 70 percent were determined to be either overweight or obese. • 47 percent ( n = 275 ) had their blood pressure checked and 48 percent had pre-hypertension, stage one or stage two hypertension results. • 2 80 people (47 percent of HealthStop clients) received a free flu shot during the month of October. In addition to the services offered, referrals to medical providers, the insurance program and community-based programs (STD clinics, drug and alcohol programs, etc.) were made, especially if screening results indicated high values. Also, an abstract titled HealthStop: Incorporating Health Screenings and Rapid HIV Testing Into a Mobile Health Screening Program was submitted and accepted at the 2009 National HIV Prevention Conference. The poster will highlight the reduction of stigma for HIV testing by incorporating health screenings into HIV testing.
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.
Nurse-Family Partnership The Nurse-Family Partnership (NFP) is a voluntary, evidence-based program of home visitation in which nurses work with low-income, first-time mothers from early in pregnancy and the first two years of the child’s life to accomplish three goals: 1. Improve pregnancy outcomes. 2. Improve child health and development.
were enrolled by 28 weeks gestation. The national program benchmark is to enroll 60 percent by 16 weeks gestation. Seventy-eight percent of referrals come from health care providers but others come from WIC, soup kitchens, schools and current clients. Participants receive more visits during all program phases, on average, than participants in the national NFP. In addition, visit lengths in each program phase averaged at least 80 minutes; the NFP benchmark is a minimum of 60 minutes.
3. Improve families’ economic self-sufficiency.
Completed/Expected Visits
Based on the long-term research of 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:
• P regnancy: 84 percent (NFP benchmark = 80 percent, state NFP = 77 percent).
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 randomized trials. 3. Services are delivered at a sufficient scale to benefit from basic operational efficiencies (generally 100 families seen by four nurses). The NFP program at the VNA of St. Luke’s began in December 2001 as part of a statewide 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 10 full-time and two part-time registered nurses serving over 279 clients. This report includes information from the beginning of the NFP program in late 2001 to June 30, 2009.
Participant Characteristics • 712 women enrolled as of June 30, 2009: median age 19 (range 13 – 37 years); 94 percent unmarried; median household income $17,500. • Race/Ethnicity: 44 percent non-Hispanic white; 44 percent Hispanic; five percent multi-racial; five percent African American/black; two percent other.
Program Implementation Entry into the program early in pregnancy is related to longer stays in the program during the infancy phase. Sixty-six percent of mothers were enrolled in the program by 16 weeks of pregnancy, and 96.1 percent
• I nfancy: 48 percent (NFP benchmark = 65 percent, state NFP = 44 percent). • T oddler: 47 percent (NFP benchmark = 60 percent, state NFP = 34 percent).
Program Outcomes • 2 2-percent reduction in smoking during pregnancy (14-percent state NFP average, 16-percent national NFP average). • 8 .7-percent premature birth rate (9.5-percent state NFP average, 9.7-percent national NFP average). • 8 .0-percent low birth weight rate (10.0-percent state NFP average, 9.3-percent national NFP average). • I mmunization rates were 87.8 percent at 12 months of age (state NFP average 89.6 percent, national NFP average = 84.2 percent). At 24 months, the immunization rate was 89.1 percent. • 2 3 percent of mothers reported subsequent pregnancies at 24 months postpartum (NFP benchmark = 25 percent or less; state NFP average = 30 percent; national NFP average = 32 percent). •O f those clients who were 18 or older at intake, workforce participation increased from 40.2 percent at intake to 68.4 percent at program completion. For those who were 17 years or younger at intake, the rate increased from 33.3 percent to 57.4 percent at program completion. For more information regarding this program, please contact Sara Klingner MSN, RNprogram manager, Nurse-Family Partnership, VNA of St. Luke’s, at 610-954-2778 or at klingns@slhn.org.
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Tobacco Cessation Program Outpatient Tobacco Cessation Counseling In FY 09, The Tobacco Cessation Treatment Center expanded services to three new sites — St. Luke’s Family Practice, Trinity Soup Kitchen and Unity House of Bethlehem — in addition to the following established sites: St. Luke’s Community Health Department office, Union Station Health Center and the Allentown Family Health Center. We also partnered with the Nurse-Family Partnership to provide prenatal and post-partum tobacco cessation services to first-time mothers through a home visitation program.
Healthy People 2010 Objectives: 27-1: Reduce tobacco use by adults. 27-5: Increase smoking cessation attempts by adult smokers.
27-6: Increase smoking cessation during pregnancy. The St. Luke’s Tobacco Cessation Treatment Center receives tobacco cessation funding from the Pennsylvania Department of Health (PA DOH) through the Coalition for a Smoke-Free Valley. The funding is used to promote tobacco cessation among adults and adolescents through inpatient and outpatient counseling, increase the utilization of the approved PA DOH tobacco cessation programs in the Lehigh Valley, and raise awareness among local employers about tobacco cessation and pharmacotherapy insurance coverage.
Inpatient Tobacco Cessation Consults The Tobacco Cessation Treatment Center offers tobacco cessation counseling and assessment for pharmacotherapy to patients admitted to the hospital. In FY 09, 465 inpatients consults were received. Of these, one third was determined to be former smokers of greater than one year. Of the remaining 310 inpatients, 46 percent were assessed to be precontemplative or contemplative upon admission and received brief bedside interventions. The remaining 54 percent were determined to be in the preparation or action stage, received cessation counseling and were referred for outpatient counseling. Also, of the 310 inpatients, 74 percent were admitted to the hospital with a cardiac diagnosis and 24 percent with a pulmonary-related diagnosis.
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Access to Care / Health Services Improvement
Patients enrolled in outpatient tobacco cessation counseling meet with a tobacco cessation specialist for individualized counseling to discuss 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 also provided in addition to the face-to-face counseling. Counseling services are also offered in Spanish. This past year, we provided cessation counseling to 292 outpatients. In general, patients who enrolled in the outpatient program have been long-term, heavy smokers who need multiple quit attempts before succeeding and often experience many barriers to achieving cessation. For example, 58 percent of outpatients smoked for 20 years or more and 69 percent smoked one or more packs per day. Eighty-eight percent of outpatients previously attempted to quit using tobacco products and 13 percent reported a mental health diagnosis such as depression, bipolar disorder, anxiety or schizophrenia.
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 that 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, 54 percent of outpatients reported having Medicaid as their primary insurance or were uninsured. Quit rates for FY 08 are being reported since all patients have fully completed the one-year program. Of the 285 patients enrolled in the outpatient tobacco program in FY 08, 84 percent became lost to follow-up at some point throughout the one-year program. Of the 45 patients that were fully engaged in the program, 49 percent (n = 22) quit using tobacco products. As previously mentioned, patients are more successful in quitting early in the cessation attempt but relapse as the year progresses and become lost to follow-up. The FY 08 data speaks to this trend. Of the 285 patients enrolled in the program, 25 percent were smoke free at their one-month follow-up, 17 percent were smoke free at three
months and 14 percent were smoke free at six months. The previously discussed 22 patients who reported being smoke free at one year accounts for only eight percent of the 285 patients enrolled throughout the year. We are continuously looking for effective strategies to assist the population of “hard-core” transient smokers to achieve cessation. 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-to-one cessation counseling versus making quit attempts on their own. Simply stated by an outpatient, “I could not have quit smoking without the help of a structured program. The counselors are very supportive and did not judge me when I was struggling to remain smoke free.”
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.
We are continuously looking for effective strategies to assist the population of “hard-core” transient smokers to achieve cessation. Despite working with this difficult population, the patients who achieve cessation are grateful for the program.
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Strategic Goals
Improve Access to Care Dental Health Initiative
Child/Adolescent Health Promotion and Education
Vision Initiative
Asthma Initiative
The Fowler Family Center at Donegan
Mobile Youth Health Center
HIV Initiative
Resource Room at Liberty High School Maternal & Child Health Programs
Minority Health Disparities Reduction Minority Health Initiatives Adolescent Career Exploration Mentoring Programs â&#x20AC;˘ School to Work Program â&#x20AC;˘ Health-Related Career Exploration Program HealthStop with HealthStar I
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Access to Care / Health Services Improvement
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J u ly 2 0 0 8 â&#x20AC;&#x201C; J u n e 2 0 0 9
Annual Report Funding for this report provided by St. Lukeâ&#x20AC;&#x2122;s Hospital & Health Network