Mission childrens hospital by Mission Philanthropy

Mission Childrenâ&#x20AC;&#x2122;s Hospital

Areas of Critical Need Table of Contents Mission Children’s Hospital Child Life Program

Mission Children’s Hospital Child Safety Program

Mission Children’s Hospital Dental Program: The Toothbus

Mission Children’s Hospital Diabetes Management Program

Mission Children’s Hospital Regional Asthma Disease Management Program

Mission Children’s Hospital Safe Kids WNC

Mission Children’s Hospital Neonatal Intensive Care Unit

The Olson Huff Center for Child Development

Mission Children’s Hospital Pediatric Advanced Care Team

Mission Children’s Hospital Pediatric Hematology/Oncology

Mission Children's Hospital

Mission Children’s Hospital — The best care for your child. At Mission Children’s Hospital, we bring superior, compassionate care to each pediatric interaction, whether treating a common injury, a childhood disease or illness, or a life-threatening condition. Our dedicated Children’s teams take time to connect with kids, building lasting relationships, and encouraging cooperation (and even fun!) in care and treatment. Mission Children’s Hospital is the only children’s hospital in western North Carolina. Located in Asheville, North Carolina, the Hospital has 130 beds, averages 3,000 patient admissions to its pediatric inpatient units, 4,500 outpatient pediatric surgeries and nearly 14,000 pediatric emergency department visits annually. We support children and their families through all stages of life – neonatal and pediatric intensive care, pediatric and adolescent specialty care, and pediatric and adolescent psychiatric care. Through our comprehensive pediatric programs, Children’s delivers exceptional treatment and community resources for a variety of childhood health needs: • Through play, activities and fun, our exclusive Child Life team eases the stress and anxiety that comes from a scary and stressful hospital stay. • Each year, the incomparable Child Safety team provides medical evaluations and assistance for nearly 700 children with alleged cases of abuse or neglect. • School-aged children in remote regions of western North Carolina (WNC) benefit from accessible pediatric dental care, provided by way of The Toothbus®, a forty-foot-long mobile dental office. • Each year, the Diabetes Management program treats and manages care for 50 children with newly-diagnosed diabetes, working together with children and families to ensure lifelong health. • Our Regional Asthma Disease Management Program specialists help 400,000 North Carolina kids focus less on breathing, and more learning and growing. • Safe Kids WNC provides community education, awareness and resources to reduce accidental, childhood injury – the leading cause of death in children under 14 years of age. • With the care and coordination of our outstanding Neonatal Intensive Care Unit (NICU), approximately 700 ill and premature newborns receive life-saving care at Children’s. • The Olson Huff Center treats the whole child, seamlessly integrating a child’s emotional, psychological and medical needs to provide superior behavioral health treatment. • Our Pediatric Advanced Care provides unparalleled critical care for hospitalized pediatric patients ranging in age from newborn to 18 years. • The highly-skilled and specialized Pediatric Hematology/Oncology team focuses solely on the management and treatment of complex cancers and blood disorders just for kids.

Mission Children's Hospital provides care to all children, regardless of their family's ability to pay. In order to continue providing quality, familycentered services to children in WNC, we need your help to fund the following programs.

Mission Children’s Hospital

Mission Children’s Hospital Child Life Program

CHILD LIFE SPECIALISTS USE THERAPEUTIC PLAY TO EASE STRESS AND ANXIETY FOR CHILDREN UNDERGOING LIFE-CHANGING MEDICAL EXPERIENCES.

Mission Children’s Hospital Child Life Program

Child Life Program The Child Life Program of Mission Children’s Hospital plays an important role in helping pediatric patients and their families cope with hospitalization and treatment. As the only Child Life program in western North Carolina, the team serves children of all developmental levels and unique medical needs. This program provides each child with Child Life staff to help ease the stress and anxiety of the medical experience. Child Life specialists offer expressive, play-based and coping activities to children and families to support inpatient and outpatient hospital visits, and developmentally appropriate education for procedures and/or diagnoses. Our specialists work closely with caregivers and the medical team to address each child’s concerns and stressors in order to provide a comfortable hospital experience. The ten Child Life child development experts work to ensure that life remains as normal as possible for the children receiving care at Mission Health. The team supports inpatient pediatrics, pediatric intensive care, neonatal intensive care, emergency medicine, surgery, outpatient specialty clinics, radiology, and hematology/oncology. According to the Child Life Council, children process information from the world around them much differently than adults; they have distinct needs for managing stress and trauma. Without the assistance of Child Life professionals, children of all ages face stressors that may inhibit natural development and have lasting, negative effects on their wellbeing. By empowering children, our Child Life specialists make the medical experience less frightening and even fun! The Child Life Program works with pediatric patients from infants up to age 21, as well as their siblings and caregivers. Using play, the specialist can assess, educate, and prepare children and their families for care and procedures. Therapeutic play is also used to help children and their families cope with and process their medical experience; play creates a healing environment where stress and anxiety are reduced. Furthermore, it provides an outlet for emotions, aids the clinical staff in assessments, speeds recovery, and restores a sense of control to the child in an unfamiliar environment. The team provides service to more than 18,000 children per year, easing their minds, soothing their worries, and empowering them in their diagnoses.

CHILD LIFE SPECIALISTS CAN: • Prepare children for medical procedures or treatment using language that children understand • Introduce coping strategies to reduce anxiety and enhance cooperation with the healthcare team • Provide support and distraction during medical procedures • Offer opportunities for play and expressive activities, encouraging normal development and a sense of fun despite challenging circumstances • Promote family-centered care by providing information, advocacy, and support to families of pediatric patients

Mission Children’s Hospital Child Life Program

RESEARCH HAS SHOWN THAT: • Preparing children for medical procedures reduces fear and anxiety, and results in better long- term adjustment to medical challenges. • Engaging hospitalized children in therapeutic play with a trained professional reduces emotional distress, increases cooperation, and decreases negative physiological responses. • Child Life interventions can increase cooperation and help reduce procedural and post- procedural pain. • Providing support for family members enhances psychosocial outcomes for young patients. A parent or caregiver’s behavior and anxiety levels are strongly correlated with how a child will respond to hospitalization.

Tested Beyond Belief Young Noah’s Story of Support from Mission’s Child Life Program Learning your child has cancer is one of the most difficult things any parent can endure. Earlier this year, Michele and Billy Woods received news that their 5-year-old son, Noah, has acute lymphoblastic leukemia (ALL). “Being told your child has cancer is something I find very hard to describe. It truly shakes the foundation of who you are and can test you beyond belief,” said Michele. In January, his parents took Noah to his pediatrician because of a fever. “He did blood work and referred us to Mission,” said Michele. “We met Drs. [Douglas] Scothorn and [Krystal] Bottom at the Mission Children’s Hospital suite in the SECU Cancer Center. On that day, Noah was admitted to the hospital to run more tests to confirm the diagnosis of ALL.”

Support at Every Stage For diagnoses like these, Mission’s Child Life program provides support to the family. “When children are first discovered to have a diagnosis such as cancer or any type of life-threatening illness, Child Life immediately becomes involved to help the patient and siblings cope with and understand what is happening to their bodies, and why they are having to stay in the hospital,” said Julian Cate, CCLS, Certified Child Life Specialist, Mission Chil-dren’s Hospital. “Child Life has helped tremendously at every stage of his treatment,” said Michele, adding that Noah has had IV chemotherapy, intrathecal chemo and chemo by mouth, along with a long regiment of steroids. “Miss Julian helped Noah understand what cancer is. [She] drew a life-size picture of Noah and had Noah draw black circles in the picture. She then had Noah fill empty syringes with paint and he was able to squirt the black circles. She explained the black circles were his cancer and the paint was the chemo medicine that will get rid of the cancer,” Michele said. “Noah still refers to his cancer as the ‘black spots’ in his blood and has his ‘artwork’ hanging in his playroom at home.”

Mission Children’s Hospital Child Life Program

Dealing with the New “Normal”

Minimizing Stress

Noah has handled his treatment like a champ. “Kids are incredible,” said Michele. “It is unreal to watch how well he has learned to accept that the doctor visits and procedures are now part of the ‘normal’ for him. He still gets very anxious when his port is being accessed, and he does not grasp how long this treatment is going to last. Physically, he tries to be as normal as possible, although he gets tired and will voluntarily lie down to take a nap.”

Clark agrees that the Child Life program has helped Noah tremendously. “They have helped him realize that the clinic is not a scary place, but rather a place where he receives the help and medications he needs to get better,” she said.

And he’s kept his sense of humor, too. “Noah likes to bring in toys when he comes, and scare the staff with them,” said Melanie Clark, RN, nursing supervisor of the pediatric hematology/oncology outpatient clinic at SECU Cancer Center. “His favorites are rubber snakes and spiders. I do not like spiders, and Noah figured that out very quickly. The other day, while I was working with him, he very quietly placed a rubber spider on my shoulder and made me jump. He laughed and giggled for several minutes about the fact that he ‘got me.’ Being able to bring a smile to Noah’s face and hear him laugh are the most rewarding times of all!”

“The Child Life program is all about collaborating with the medical team to help the patients and their families cope to the best of their ability with the stressors of a healthcare crisis,” said Cate. “I believe that between Noah’s inpatient experience and his many outpatient clinic appointments, the Child Life team has been able to maximize his coping and minimize his stress surrounding a very life-changing event in his world.” Noah’s parents feel fortunate to be supported by so many friends and family members. “Above all, our faith has gotten us past the dark times. We have learned to take one day at a time and to find the blessings hidden in the hardship,” said Michele. “We feel very blessed to be at Mission and have found a ‘family’ who treats us as if they were treating their own. Everyone involved in Noah’s care has been wonderful and we could not ask for better treatment.”

Mission Children’s Hospital Child Life Program

Child Life specialists understand the fears and concerns of children of various ages and tailor the play accordingly, using a variety of tools. For example, a private foundation generously funded the acquisition of video goggles that allow children to watch their favorite movies and cartoons, or listen to music, while undergoing MRIs. This technology also allows technicians to seamlessly prompt and communicate with the child during the procedure. More importantly, this innovative intervention virtually eliminates the need to sedate children undergoing MRIs, which gained Mission Children’s Hospital national recognition. Even before children undergo their MRI, the Child Life team utilizes child-sized puppets (purchased with grant funding) to demonstrate the procedure to the child. Recently, the program also received funding from Mattel for interactive “loose parts” play equipment. Mission Health research nurses are studying the impact of this new equipment on communication skills, anxiety, and patient satisfaction, thereby contributing to the Child Life knowledge base. The long-term vision is to provide a healing atmosphere of child- and family-centered care for Mission’s most vulnerable pediatric patients and families across the region. The program strives to effectively partner pediatric patients and families with the medical team to create an individualized care plan that meets their unique developmental needs, addresses pain, and provides supportive strategies for growth, leaving them better able to cope with future medical encounters.

Funding Needs Funding is needed to help provide these services to our pediatric population. Child Life services are not reimbursed through insurance or Medicaid, yet are critical for both pediatric patients and their caregivers. The average cost of a Child Life consultation is around $15 per child served. Our Child Life Specialists also work with children from families with an ill adult, helping them process the medical experience. Additionally, child Life specialists serve as a resource to educate providers and staff across the Mission Health System. The program costs are approximately $500,000 annually. Your support helps ensure that Mission Children’s Hospital patients are empowered in their medical care and have an optimal experience with the best outcomes possible.

Mission Children’s Hospital Child Life Program

Mission Children’s Hospital Child Safety Program

THE CHILD SAFETY TEAM AT MISSION CHILDREN'S HOSPITAL PROVIDES CRITICAL, INVALUABLE SERVICES TO ABUSED OR NEGLECTED CHILDREN, GUIDING THEM DOWN NEW PATHWAYS OF HOPE, HEALING AND LOVE.

Mission Children’s Hospital Child Life Program

Child Safety Team Through the work of its Child Safety Team, Mission Health furthers its commitment to improving the health and wellbeing of children by addressing the issues of family violence, child maltreatment, and neglect. The appalling reality is that child abuse is common. Abuse reports are made on more than five million children each year – nearly ten children every minute. One in five children will experience abuse or neglect, and most children reported for abuse/neglect are under five years of age. In the 21-county region of western North Carolina served by Mission Children’s Child Safety Team, there were 18,626 children with concerns for abuse/neglect in 2013. The Child Safety Team at Mission Children’s Hospital provides medical evaluations for nearly 700 children with concerns of abuse or neglect. Mission’s program is part of a statewide network of child abuse specialists, and with 20 counties, serves one of the largest areas. The Child Safety Team assesses children referred with a concern for possible physical, sexual, or emotional abuse. The child’s evaluation is performed by a specially-trained child interviewer and a forensic pediatrician. The child’s interview is video recorded, the child is examined and injuries are documented. The video recording can, in some cases, serve as evidence to ensure a child does not have to face his abuser and testify in court, reducing emotional trauma for the child. Upon evaluation, the team arranges appropriate mental health and support services for the child and family so they can begin the healing process. Investigators use the Child Safety Team’s detailed report to make decisions about the child’s safety and seek prosecution of the perpetrator. The clinical staff frequently testify in court regarding their findings. In 2014 alone, the team received 168 subpoenas for testimony, and testified in more than 53 cases. Additionally, the team provided more than 280 hours of education to investigators, medical personnel, and legal professionals.

Mission Children’s Hospital Child Life Program

“Last year we saw more than 500 children from 18 different counties in WNC…providing this specialized care to children is expensive and the reimbursements that get from insurance simply DON'T cover the complete cost of the care needed for these children, that is why we rely on the community’s support so that we can continue our work.” – Dr. Cynthia Brown, Physician, Mission Child Hospital, MCS Child Safety Team

Mission’s forensic practitioners provide consultation for the most complex cases involving suspected neglect or abuse of children from birth to 21 years of age. The program works closely with law enforcement officials, social services agencies, and child advocacy centers throughout western North Carolina. Child abuse has a long reach and is very costly. The pain of physical injuries is immediate, but the lack of nurturing and extreme stress children ofabuse and neglect experience can harm their developing nervous and immune systems. Research shows this leads to long-term health problems and a shorter lifespan. Appropriate intervention can change the trajectory for these children. In 2010, the average lifetime cost of child abuse for each victim was $210,012.

Mission Children’s Hospital Child Life Program

Challenges Facing The Child Safety Team There are many challenges facing the Child Safety Team. Because the program serves the entire western North Carolina region, there is often a waiting list for children who need to be seen. In addition: • Many important services provided by the Child Safety Team are not reimbursed. • The cost of the evaluation is not fully covered by insurance or other funders, and is subsidized by Mission Hospital. • As the science in this field is always evolving, the Child Safety Team staff provides educational programs for investigators on the medical aspects of child abuse to maintain an evidence-based approach. • To maintain this critical service for the children of western North Carolina, we rely on community support to help us meet the increased volume in Buncombe County and outlying clinics, expand our educational outreach in western NorthCarolina, and fund current staff.

Funding Needs The Child Safety Team requires financial support to sustain these necessary services for children and families. The average annual cost to operate this program is $560,000. We will use funds for meeting the clinical needs by: • Maintaining highly qualified staff (two specialized medical providers, two forensic interviewers, a coordinator, and a medical assistant) • Providing peer review for medical providers and forensic interviewers involved in child abuse cases to ensure quality services in our region • Offering education/training in child abuse recognition for pediatricians, family practitioners, nurses, EMTs, emergency department personnel, and mental health providers • Improving services to children through collaborative evaluations and interventions with law enforcement detectives, Child Protective Service workers, attorneys, and prosecutors involved in the investigation and prosecution of child abuse • Enhancing understanding of the physical and emotional impact of abuse in children in our community, and facilitating community prevention efforts

Mission Children’s Hospital Child Life Program

Funding will allow the Child Safety Team to better meet this critical community need. Currently some children may wait two to three weeks for an appointment. Funding will allow for improved access to services for 80% of all cases received by the Child Safety Team. A Family Advocate will meet with families before leaving the Child Advocacy Center to serve as a navigator to multiple social needs, includ-ing but not limited to: housing, food, legal, child care, and counseling. By providing these critical services, the Child Safety Team plays an invaluable and irreplaceable role in redirecting abused or neglected children in our communities towards a pathway of hope, healing, and love.

Mission Childrenâ&#x20AC;&#x2122;s Hospital Child Life Program

Mission Children’s Hospital Dental Program: The Toothbus

EVERY CHILD IN OUR COMMUNITY DESERVES A CONFIDENT SMILE, AND THAT BEGINS WITH HEALTHY TEETH.

Mission Children’s Hospital Dental Program: The Toothbus

The Mission Toothbus Dental care is the single most common chronic disease and greatest unmet health need of children in western North Carolina. Every child in our community deserves a confident smile, and that begins with healthy teeth. Mission Children’s Dental Program knows that it is never too early to begin childhood dental care. The mouth is a gateway to the body, and the condition of the mouth, teeth and gums can affect lifelong health. Baby teeth are not just important for a pretty smile, but are essential for speech, chewing food properly, and laying the foundation for permanent adult teeth. Healthy teeth are critical to overall health.

The ToothBus brings the same services offered in a traditional dental office to remote areas with limited dental care options. The bus traverses rural, mountainous roads to visit elementary schools and care for children while at school, so parents don’t have to miss work. The primary goal of the ToothBus program is to see patients at least once a year, and act as their primary dental home. Our program also provides child-friendly surgical care (an operating room and general anesthesia as-needed) when children have special needs or require extensive dental work.

Poor childhood dental care can result in serious infections and other long-term, high-risk problems, such as cardiac disease. In addition, oral health problems, such as oral pain, infections, and missing teeth can affect a child’s physical, mental, and social wellbeing, and result in unnecessary and avoidable complications. Teaching proper dental care is essential to avoid these harmful outcomes, and this is a major focus of the Mission Children’s Dental Program. Our dentists and staff are dedicated to improving the health of at-risk children by addressing their dental needs at little or no cost to their families. Surgically trained dentists and dental assistants bring preventative and restorative dental care directly to kids in their own communities with the ToothBus, a 40-foot mobile dental clinic.

This program offers services otherwise unavailable to children in rural areas of western North Carolina. Because dental diseases affect a child’s long-term health, Mission is heavily involved in the program. This program is critical to advancing Mission’s community health goals, since hospital partnerships are formed for population-based reimbursement, which is determined by how healthy we keep our community.

Mission Children’s Hospital Dental Program: The Toothbus

Bringing Dental Care Directly To Children In The Region

The Need: Increasing Access and Quality of Care

Healthcare models prove that bringing medical care directly to the patient is the most effective way to reach the greatest number of people. Mission’s Children’s Dental Program confirms these reports; struggling families can rest easy, as the dentist comes to their child. The ToothBus visits 33 elementary schools in seven counties across western North Carolina. Every child who participates in the program receives a regular check-up, cleaning, and restorative care from our exceptional dentists. 100% of children served by the ToothBus are either covered by Medicaid/Health Choice, or are uninsured.

The ToothBus program operates at an annual loss, as it operates on charitable donations. Operating costs include staff salaries, supplies, utilities, and fuel. The ToothBus runs from 6:30 a.m. to 3:30 p.m., Monday through Thursday, to deliver care directly to regional children. The ToothBus program is composed of five dentists, 11 dental assistants, and two bus drivers, and across the ToothBus fleet, the monthly fuel cost is roughly $1,000. This innovative program has received national recognition and continues explore new strategies to improve oral health with local communities. Since the program’s inception, great strides have been achieved in decreasing rates of childhood dental disease.

On the ToothBus, children not only receive dental care, but also a healthy dose of education on good oral hygiene, eating habits and maintaining healthy teeth throughout their lives. Our goal is to expand these education opportunities so we can reach more families in western North Carolina. The delivery of care through the Toothbus significantly impacts health outcomes in our region. Annually, the Toothbus provides care for nearly 1,200 children. In addition, over 1,000 children receive more extensive care with treatment under general anesthesia in an operating room.

Thanks to philanthropic support, Mission Health System can continue this transformational innovation in dental health and wellness to in-need areas throughout western North Carolina. Over time, our community’s health and financial welfare will improve with your support of this initiative. Philanthropic support of $130,000 annually is needed to sustain and enhance this innovative program for western North Carolina.

• More children will have access to dental care close to home. • More families will receive education on proper oral health care. • Children benefit from improved self-esteem. • School attendance improves. • Children experience improved levels of concentration and engagement in the classroom.

Mission Children’s Hospital Dental Program: The Toothbus

Mission Children’s Hospital Diabetes Management Program

MISSION CHILDREN’S HOSPITAL SEES 50 CHILDREN WITH NEWLY-DIAGNOSED DIABETES EACH YEAR.

Mission Children’s Hospital Diabetes Management Program

Diabetes Management Program For many of our young children, there is a frightening problem on the rise: diabetes, a condition in which the pancreas does not produce enough insulin, leading to rising blood sugar levels. Children with type 1 Diabetes produce no insulin, and are often diagnosed at young ages and require intensive medical care. These children and their families must learn to monitor and manage their blood sugar hourly throughout the day. Long thought to be an adult disease, type 2 diabetes is now a skyrocketing diagnosis in the pediatric population due to the increased prevalence of childhood obesity. Type 2 diabetes impacts about one in three U.S. children. Both type 1 and type 2 diabetes diagnoses in children require skillful interventions, coordination of care, and ongoing support for the child and his family. Diabetes affects an estimated 23.6 million people in the United States and is the seventh leading cause of death. This challenging illness lowers life expectancy by up to 15 years, increases the risk of heart disease two to four times, and is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness. According to 2012 findings from the American Diabetes Association, both type 1 and type 2 diabetes are rising among U.S. Children. There are approximately 50 newly-diagnosed children with diabetes within the Mission Health System each year. 50% of these pediatric patients are admitted to the hospital, but those visits could be avoided with proper maintenance.

Mission Childrenâ&#x20AC;&#x2122;s Hospital Diabetes Management Program

Implementation of Pediatric Diabetes Care Team According to the American Diabetes Association’s Standards of Medical Care, diabetes care for children requires a special team of medical, educational, nutritional, and behavioral professionals. The team consists of a physician, diabetes educator, dietitian, social worker, or psychologist, working in conjunction with the patient and family. Children should be seen by the team at diagnosis and in follow-up, as agreed upon by the primary care provider and the diabetes team.

The goals of the pediatric diabetes program are to: • Reduce the disease and economic burden of diabetes • Improve the quality of life and increase access for children who have diabetes by limiting the need for inpatient hospitalization with newly diagnosed diabetes • Provide Nurse Certified Diabetes Educator support in our clinic for families who are struggling with management

The Mission Reuter Children’s Outpatient Center includes many critical components of the Pediatric Diabetes Care Team. Together these teams provide multiple hours of individual attention in the clinical setting. The child and family sees the physician, but spend the most time with the registered nurse, certified diabetes educator, and dietitian. The intensity of these services requires hospital admission. However, with these supports in place, the clinical team can immediately accommodate newly-diagnosed or struggling patients and families in the clinic, avoiding hospital admission. For patients seen in the outpatient setting, it takes three to four hours for a provider to care for the patient and family and educate on diabetes. With increasing caseloads, there are not currently enough resources to replicate this innovative care model for all children and families with diabetes. However, this new model of care can prevent disruptive and costly hospitalizations, and will be necessary in achieving a more comprehensive approach to population health.

Mission Children’s Hospital Diabetes Management Program

Funding Needs The total cost of diabetes in the U.S. is $245 billion (2012). This total is composed of $176 billion in direct medical costs and $69 billion in indirect costs, including disability, work loss, and premature mortality. From the perspective of both the patient and the healthcare system, it is most cost-effective to manage patients in the outpatient setting. In addition, outpatient education allows for increased flexibility in accommodating family schedules and/or learning constraints, and improves the coping skills of patients and families. Implementation of the Pediatric Diabetes Care Team will provide for the following forecasted improvements:

“Topanga was diagnosed with Type 1 Diabetes when she was eight years old, her body does not produce insulin, so she has to take injections every day for the rest of her life. Dr. Arts said to me, ‘I want you to remember Topanga is a kid first and diabetes is second.’ That really hit home for me and helped us cope with our new normal. At Mission Children’s Hospital, I know my kid is going to be treated like family and still get the best possible care around.” – Amanda Wiggins, Topanga’s mother

1. Reduce number of newly diagnosed patients admitted into the Emergency Department by 25% 2. Increase access of new diabetes patients by 10% in Reuter Children’s Outpatient Clinic 3. Decrease costs of care for children with diabetes by reducing inpatients admission 4. Improve patient outcomes with comprehensive care 5. Enhance the patient and family experience by educating and providing easy access to comprehensive care in a child-friendly, ambulatory setting The funding needed to implement these diabetes teams and service is $460,000 annually. Philanthropic support is essential for Mission to continue providing lifesaving care to build lives of health, hope, and joy for community children in-need.

Mission Children’s Hospital Diabetes Management Program

Mission Children’s Hospital Regional Asthma Disease Management Program

400,500 NORTH CAROLINA CHILDREN HAVE BEEN DIAGNOSED WITH ASTHMA. THE REGIONAL ASTHMA DISEASE MANAGEMENT PROGRAM HELPS CHILDREN FOCUS LESS ON BREATHING, AND MORE ON GROWING AND SUCCEEDING.

Mission Children’s Hospital Regional Asthma Disease Management Program

Innovative Asthma Care For Children In Their Community Over 10 million children in the U.S. have asthma. Closer to home in North Carolina, over 400,000 children have been diagnosed by a healthcare provider with asthma. Sadly, many of these children suffer from otherwise preventable asthma-related symptoms, causing them to miss school, visit emergency departments, and even go through hospital admittance. To improve the lives of asthmatic children in N.C., Mission Children’s Hospital developed the Asthma Program, which provides non-traditional interventions and delivery of care and services directly to the locations children and their families learn, live, and play. Our program provides children and families best practices in asthma care and education in their local settings – homes, childcare centers, schools, and other community sites. Many families live with challenging social and environmental circumstances, facing daily exposure to multiple asthma triggers. Our program supports families by addressing issues such as housing conditions, transportation, and access to care to ensure children have strong school performance, maintain good nutritional status, and live in healthy homes. Mission Children’s expert staff helps families build skills for managing environmental asthma triggers, and connects them with necessary community resources to guide children back to health and well-being. The program aims to improve quality of life for asthmatic children so each child can focus less on breathing, and more on growing, learning and succeeding.

“I found myself having problems in gym class and not knowing when to use my inhaler; that is when the asthma program came to my school and helped me understand my disease. They helped me learn how to take my inhaler as prevention, not just when I was having problems. I didn’t know that!” – Addauvie Smith-Jackson, 11 years old

Mission Children’s Hospital Regional Asthma Disease Management Program

Comprehensive Asthma Treatment and Management For The Children of Western North Carolina The Regional Asthma Disease Management Program embraces a holistic approach to patient care through clinical assessments, home or in-school visits form a respiratory therapist, and individualized asthma plans. The team also conducts educational workshops for parents, children, schools, and medical providers on asthma risk, prevention, and treatment protocols. Through environment assessment and remediation to remove asthma triggers in the home, child care setting and schools, children can reduce their symptoms and require less medication. This multifaceted, community approach demonstrated positive impact in a 2012 study of 61 children with a 92% decrease in emergency visits, 87% reduction in hospitalizations, and 70% reduction in the average days of missed school. These results are remarkable in proving the programâ&#x20AC;&#x2122;s positive, daily impact on the lives and futures of children. To further meet the needs of regional children, we need support for this innovative and successful population-health approach to asthma care.

WITH YOUR SUPPORT, WE CAN: 1. Improve access to coordinated care for children with asthma in western NC 2. Provide comprehensive services where children spend their time (home, day care, and school) 3. Enhance communication among providers and patients through virtual health technology 4. Collaborate with and support primary care providers to ensure they can best serve children with asthma in the medical home 5. Create asthmatic-friendly environments through community collaboration to help support families and schools 6. Reduce visits to the hospital for children with asthma, allowing them to live healthier, happy lives

Funding Needs Because this program offers services in a non-traditional way and in non-medical locations, health insurance, including Medicaid, does not reimburse for this care. We are working to create a program that will be sustained through future-population health initiatives, and to demonstrate the return on this investment to health insurance companies. During this transition, donations help us improve health care for our highest risk, asthmatic children, one child at a time.

Mission Childrenâ&#x20AC;&#x2122;s Hospital Regional Asthma Disease Management Program

Mission Children’s Hospital Safe Kids WNC

SAFE KIDS WNC STRIVES TO PREVENT INJURIES IN CHILDREN, THE LEADING CAUSE OF DEATH IN CHILDREN UNDER 14 YEARS OF AGE.

Mission Children’s Hospital Safe Kids WNC

Safe Kids WNC Safe Kids WNC, a program of Mission Children’s Hospital, is committed to reducing accidental injury among children in western North Carolina. The primary goal of Safe Kids WNC is to prevent injuries in children, the leading cause of death to children age 14 and under. When a child’s life is tragically cut short from a preventable, accidental injury, the entire family is negatively impacted. Safe Kids WNC aims to address the most prevalent childhood injuries in our region through evidence-based target programs, increased public awareness and education of preventable childhood injuries, and collaboration with community agencies in efforts to keep our children safe. We strive to teach children and their caregivers how to avoid accidental injuries and death by partnering with state and national agencies and child advocacy groups to educate the public. Safe Kids focuses on key populations where injuries most often occur: traffic injury (passenger, pedestrian, bicycle), poisoning, choking/suffocation, drowning, falls, fire, and burns. Thus, we provide key education on the most prevalent injury areas, including safety in and around vehicles, bike and pedestrian safety, poison and choking prevention, fire and burn prevention, drowning prevention, and falls prevention. Safe Kids WNC has been a local coalition of Safe Kids Worldwide since 1994. Our coalition partners include schools, fire departments, EMS, law enforcement, medical professionals, and business leaders. Through these partnerships, we reach at-risk families, ultimately preventing both injury and death.

Did you know? Car crashes are a leading cause of death to children in the US.

Did you know? 73% of car seats are not installed correctly.

Mission Children’s Hospital Safe Kids WNC

Reaching Out To Western North Carolina’s Children No child’s life should be put at peril because of unfortunate economics. However, some families are unable to provide adequate equipment to keep their children safe. We must maintain inventory of safety equipment (primarily car seats and bike helmets) to assist families in need so that a child’s risk of injury or death is reduced. Motor vehicle crashes are the number one cause of death to children under the age of 14 years. Unfortunately, car seats for some special-needs children are very expensive and not covered by health insurance. Many families are use old, expired, or recalled, and unsafe car seats that are improperly install. Using specialized seats can mean prove a significant difference in protecting a child from serious injury or death in an accident. In 2015, Safe Kids WNC proactively served our community by providing: • 307 conventional car seats to children in-need, along with car seat installation education for families • 98 special needs car seats to children in-need, along with intensive instruction for families • 230 children with education on bike safety and proper helmet fit • 17,000 people with injury prevention education and materials • 146 caregivers (with citations from local law enforcement) with child passenger safety education • 60 new teen parent classes on child safety through the YMCA Mother Love Program With help from our regional network of partners (fire, law, EMS), Safe Kids WNC assists an average of 1,000 families annually with car seat installation education. Safe Kids WNC provides critical supplies and educational materials, certification classes, and continuing education classes for car seat technicians to these agencies.

A bicycle helmet can only protect a child's head and brain if it is worn.

Mission Children’s Hospital Safe Kids WNC

The Future of Safe Kids WNC Through education, programs, events and safety resources, including car seats and bicycle helmets, Mission Safe Kids is an invaluable community resource for childhood injury prevention. We provide education and specialized car seats for Mission Health’s Trauma Center, along with Pediatrics, Mother Baby, Neonatal Intensive Care Unit (NICU) and Mission Children’s Outpatient units. In addition to our community work on injury prevention, the Safe Kids team works with all care areas at Mission to provide safe transport to any child leaving Mission Hospital. In order to meet growing needs, Safe Kids maintains car seat inventory and helmet inventory to assist children with various health conditions. We serve as a state resource for transporting children with special healthcare needs, and provide consultation to many families across the entire state. To continue operation and expansion, the following are annual funding opportunities: Special Needs Car Seats Conventional Car Seats Bicycle Helmets Training seats for certification classes Additional supplies, printed educational materials and classes

$40,000 $25,000 $5,000 $5,000 $23,200

Mission Children’s Hospital Safe Kids WNC

Mission Children’s Hospital Neonatal Intensive Care Unit

OVER 800 BABIES IN WNC BEGIN THEIR LIVES IN THE NICU EACH YEAR.

Mission Children’s Hospital Neonatal Intensive Care Unit

Neonatal Intensive Care Unit Mission Children’s Hospital (MCH) is the only Children's Hospital in western North Carolina (WNC) and is the only state-designated Level III Neonatal ICU (NICU) within WNC. The MCH NICU accommodates and treats any high-risk newborn born requiring intensive care from the 18-county region. Over 800 babies begin their lives in our NICU each year, some of whom are born weighing barely one pound, while others may require complex surgeries, occasionally at only a few hours of age. MCH’s NICU has 51 beds, each of which can accommodate ICU and intermediate-to-long-term care babies. An average of 40 babies are cared for in the NICU each day, and that number is increasing. Mission’s Level I neonatal (basic) well-newborn care includes: • Neonatal resuscitation at every delivery • Evaluation and delivery of postnatal care to healthy newborn infants • Stabilize and provide care for infants born at 35-37 week gestation who remain physiologically stable Mission’s Level III-B NICU cares for the most complex and critically-ill infants with immediate and on-site access to pediatric medical subspecialty consultants. This round-the-clock team provides: • Comprehensive care for extremely low-birthweight infants • Advanced respiratory support, such as high-frequency ventilation and inhaled nitric oxide as required • Prompt and on-site access to a full range of pediatric medical subspecialists • Advanced imaging and urgent testing interpretation, including computed tomography, magnetic resonance imaging, and echocardiography • Pediatric surgical specialists and pediatric anesthesiologists on-site to perform major surgery

Funding Needs The following areas have been identified as current needs for Mission Children’s Neonatal Intensive Care Unit: • Nine (9) Infant Radiant Warmers at a cost of $30,000 per warmer • A human milk additive (fortifier) for the smallest infants (less than 1250 grams): 65 infants x $9800 per infant = $637,000 per year is required to provide this special food additive • Remodel six (6) NICU parent sleep rooms at a total cost of $64,000 • Vermont Oxford Network Annual Membership of $32,900

Mission Children’s Hospital Neonatal Intensive Care Unit

Mission Children’s Hospital The Olson Huff Center For Child Development

THE OLSON HUFF CENTER FOR CHILD DEVELOPMENT ALLOWS FOR HOLISTIC TREATMENT OF THE CHILD BY INTEGRATING CARE FOR BOTH BEHAVIORAL AND MEDICAL HEALTH NEEDS.

Mission Children’s Hospital The Olson Huff Center for Child Development

The Olson Huff Center For Child Development Introduction The Olson Huff Center for Child Development is named in honor of Dr. Olson Huff, a developmental pediatrician who looks beyond the medical record to ensure that each child develops his or her full potential. Dr. Huff combines warmth of care with a steely resolve to improve a child’s life. He is known nationwide as a humanitarian dedicated to the betterment of children for over 35 years. The services provided by the Olson Huff Center for Child Development allow for the treatment of the whole child by integrating behavioral and medical health needs seamlessly. Our comprehensive team of developmental pediatricians, psychologists, social workers, and family therapists work to address each child’s health needs, as well as the emotional needs of the child and family. Our team strives to make healthy childhood behaviors the norm for every child; they work collaboratively to empower parents with strategies to address challenging behavior and teaching more adaptive behavior. In western North Carolina, there are more than 55,000 children with disabilities, and nearly 10,000 children with disabilities in Buncombe County alone. The prevalence of autism spectrum disorders has more than doubled in the past 15 years. Conservative population estimates of common issues addressed by the Olson Huff Center include: • 25,000 children with attention deficit hyperactivity disorder (ADHD) • 35,000 children with learning disabilities • 5,000 children with autism • 7,000 children with intellectual disability • 1,000 children with cerebral palsy

Mission Children’s Hospital The Olson Huff Center for Child Development

Improving Access To Care Our goal is to maintain the Olson Huff Center (OHC) as a sustainable, nationally-recognized institute, and a regional center of excellence serving children with disabilities and their families. Demand for the Center’s services and programs continues to grow – as do the waiting lists. National data shows a lack of pediatric subspecialties available to children with disabilities, and deep need for training of primary care doctors in the care of children with disabilities. Local survey data among pediatric behavioral health providers also shows an urgent need for training in autism-related care. In 2013, over 2,000 new patients were evaluated by Developmental Pediatrics at the Olson Huff Center, and another 1,200 by physical therapy, occupational therapy, and speech therapy. And the demand is growing: each year the Olson Huff Center holds 20,000 pediatric patient visits across all disciplines. In order to meet referral demands and assist the health system in improving the primary care management of children with disabilities, the OHC is redesigning care to maintain our current staffing, while allowing providers time to educate, consult, and collaborate with regional care providers. Our care goals include providing timely and exemplary individualized, comprehensive, specialized, interdisciplinary, and family-centered care for regional children with disabilities. Such efforts involve: • Working with primary care practices, behavioral health services, schools, and other partners to build a regional network of care that has the capacity to manage the growing needs of this vulnerable, regional population • Ensuring sufficient staffing of talented clinicians to meet population health demands via a specialized care team of two physicians, three advanced practitioners, two psychologists, three therapists, a RN, LPN, medical assistant, referral coordinator, and care manager • Working with parents and other stakeholders to identify critical areas of need for regional children with disabilities, and seeking sustainable ways to meet those needs. • Working with primary care practices (Pediatric and Family Medicine) to enhance capacity to provide primary care medical home for children with disabilities • Providing ongoing training and supervision of regional behavioral health programs for the care of children with disabilities, including autism

Mission Children’s Hospital The Olson Huff Center for Child Development

WITH YOUR SUPPORT, WE CAN: • Create a staffing model to better meet community needs • Collaborate with primary care providers so they have the skills, tools, and support needed to better serve children with disabilities in their medical home • Provide access to a network of community-based behavioral resources and therapists for children with disabilities and their families • Provide clinician leaders a supportive environment to build programs and solve problems that benefit children with disabilities and their families

Funding Needs There are many Olson Huff therapies not reimbursed through insurance or Medicaid. The average cost for multiple therapy sessions averages of $1,000- $2,000 per child. The program costs $1,050,000 annually, and provides the critical support for these community services.

Mission Children’s Hospital The Olson Huff Center for Child Development

Mission Children’s Hospital Pediatric Advanced Care

OUR PEDIATRIC ADVANCED CARE TEAM HELPS CHILDREN WITH COMPLEX MEDICAL CONDITIONS MANAGE TO BE KIDS!

Mission Children’s Hospital Pediatric Advanced Care Team

Pediatric Advanced Care Team The Pediatric Advanced Care Program is an interdisciplinary team of pediatric palliative care specialists who provide comprehensive care, coordination and comfort for children with complex, life-altering or life-threatening illness, and their families. A Pediatric Advanced Care team is deployed at time of diagnosis to minimize fear and suffering for both the child and family, improve the patient experience, and provide the necessary education for the patient and family to make quality of life decisions. Predicting medical outcomes in children can be difficult because children respond differently to both drugs and therapies than adults; children are more resilient than adults, yet many children are born with rare medical conditions. These factors make diagnosis, prognosis and medical management more complex. At Mission Children’s Hospital: • Over 600 children are served each year with a life-threatening condition. • Last year, 109 families experienced a fetal or newborn death, however, only 11% were able to receive a palliative care consultation. • More than 25 children with newly-diagnosed sickle cell disease and 50 children with newly-diagnosed cancer are admitted to Mission Children’s Hospital annually. • Over 100 children with neurological disorders, such as cerebral palsy, congenital brain malformations and epilepsy, receive care. • Another 100 children represent a gastrointestinal diagnosis requiring surgery, feeding tubes and multiple therapies • There are 45 children living with Cystic Fibrosis in the region. Other diagnoses routinely receive services, including multiple sclerosis, down syndrome, Trisomy 13 and 18, congenital heart defects and complications. • The Neonatal Intensive Care Unit (NICU) continues to operate at full capacity with more than 700 babies admitted per year; approximately 20% qualify for palliative care at Mission

Mission Children’s Hospital Pediatric Advanced Care Team

SUMMER’S STORY Summer Worley’s first ten years of life were not easy. Summer’s complex medical history began with a premature birth. She received care at Mission Children’s Hospital Neonatal Intensive Care Unit for nearly three months, and experienced several significant prematurity complications requiring surgery. Today, Summer continues to see multiple subspecialists, takes many medications and suffer from chronic pain related conditions. Summer currently works with our Pediatric Advanced Care Team to optimize her pain management using a multi-modal approach including environmental, integrative and behavioral interventions in addition to medications. The team also offers skills and tools to encourage and strengthen Summer’s family as she grows. With help from our Pediatric Advanced Care Team, Summer’s pain is managed and management of her complex medical conditions is optimal. She can go to school, learn, interact and enjoy life as a normal kid.

It’s easy for families to grow overwhelmed by life-threatening illness and the complexities of the illness, along with the amount of information to organize, what to do first and how to manage all the information. • Palliative care places emphasis on encouraging patient comfort, in addition to treating physical and health needs. Pediatric patients, who are especially susceptible to anxiety, depression, and fear in a treatment setting, deserve a well-coordinated and compassionate palliative care program. • In addition, palliative care provides comfort for mothers who have endured miscarriages or stillbirths, as well as parents of children with serious illnesses. • Palliative care encompasses a broad range of treatment measures and tactics, and is often a concerted effort alongside more aggressive treatments. The focus on curative therapies, pain and symptom management, comfort provision, spiritual needs, and inpatient and outpatient education creates a well-rounded and adaptable program for local patients in need. Currently, the Pediatric Palliative Care Program is struggling to meet the area’s demands and expand its treatment capabilities. Our aim is to increase the scale, scope, and effectiveness of our program for the benefit of

Funding Needs Currently, pediatric palliative care is not fully funded by Medicaid. Medicare just approved coverage for adult palliative services under the Affordable Care Act. However, there’s no way to guarantee that Medicaid will follow the same path for pediatric palliative care. The average cost for sustaining this program is $300,000 annually.

Mission Children’s Hospital Pediatric Advanced Care Team

Mission Children’s Hospital Pediatric Hematology/Oncology

EACH YEAR, AN AVERAGE OF 35-45 NEW PEDIATRIC HEMATOLOGY AND ONCOLOGY PATIENTS, AND MORE THAN 250 FORMER PATIENTS, RECEIVE TREATMENT AT THE MISSION CHILDREN’S HOSPITAL — AVERAGING OVER 3,000 ENCOUNTERS A YEAR.

Mission Children’s Hospital Pediatric Hematology/Oncology

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The goal of the Mission Pediatric Hematology/Oncology Program is to deliver quality, family-centered, and community-based cancer services, while providing accessible care locations, and thus reducing travel costs and disruption for patients. The pediatric cancer team at Mission Children's Hospital consists of three board certified hematologists/oncologists who specialize in managing complex pediatric cancers and blood disorders. The program also includes pediatric nurse practitioners, pediatric nurses, social workers, pharmacists, Child Life therapists, palliative care and Arts for Life specialists.This group is exclusively trained and certified in pediatric cancer and blood disorders treatment, and holds a specialized accreditation in cancer care through the Children’s Oncology Group. In 2009, the program partnered with UNC Lineberger Cancer Center to broaden its offerings in research, clinical trials, patient navigators, education, telemedicine and survivorship. Each year, an average of 35-45 new pediatric hematology and oncology patients, and more than 250 former patients receive treatment at the Mission Children’s Hospital. This is an average of over 3,000 encounters a year. Nationally, cancer is the number one cause of death among children ages 5-14 years, and the second leading cause of death after accident-related childhood injuries.

• 1 in 285 children will be diagnosed with cancer each year. • 43 children per day (15,780 children/year) are expected to be diagnosed with cancer. • The most common types of childhood cancers are leukemia, cancers of the brain and central nervous system, and lymphoma. • Childhood cancer survival rates in the U.S. have increased from less than 20% in the 1960's to almost 80% today. • Cancers in very young children are highly-aggres sive and behave unlike malignant diseases at other times in life. • Treatment for childhood cancers can continue for several years, depending on the type of cancer and the type of therapy administered. • More than 95% of childhood cancer survivors will have a significant health-related issue by the time they are 45 years of age; these health-related issues are side-effects of either the cancer or more commonly, the result of cancer treatment. • Children with cancer report lower self-esteem, short- and long-term social, emotional and behavioral difficulties, higher anxiety and PTSD symptoms. • The average cost of a hospital stay for a child with cancer is $40,000 per stay. • The average cost of cancer treatment for a child is $500,000.

Mission Children’s Hospital Pediatric Hematology/Oncology

Childhood cancer treatment options may include surgery, radiation therapy, chemotherapy, and/or other treatments. In many cases, more than one treatment is given. The majority of patients respond best to chemotherapy treatment, as children tend to physically handle chemotherapy better than adults. However, cancer treatments such as chemotherapy and radiation therapy, often cause long-term side effects, requiring careful follow-up for the rest of a childâ&#x20AC;&#x2122;s life.

Challenges Unlike adult cancers, the cause of most childhood cancers is unknown. In addition, it is often difficult to detect the early stages of cancer in children and adolescents â&#x20AC;&#x201C; when cancer is easiest to treat. This is partially due to the fact that many childhood cancer symptoms are similar to the symptoms of common childhood diseases and injuries. Treatment of childhood cancer presents another ongoing challenge: while surgery, radiation, and chemotherapy save many lives and increase survival rates for multiple childhood cancers, they can also increase long-term health risks. Furthermore, for a family dealing with childhood cancer, the financial impact and emotional rollercoaster of cancer treatment, side effects and post-cancer care can be overwhelming.

Funding Needs The challenges and statistics for childhood cancer prove an urgent and ongoing need for comprehensive and sophisticated pediatric cancer services. While we have many caregivers, to ensure continuation of superior cancer care and family-based services, the Pediatric Hematology/Oncology program costs for western North Carolina are $800,000-$1,000,000 annually. Services requiring funding include: Licensed Clinical Social Worker to provide individual and group education, coping tools, guidance, and counseling. Social workers may also offer support networks to help caregivers handle physical and emotional stress, minimize the isolation during times of stress and loneliness, and reduce anxiety and sleep deprivation. In addition, social workers provide informative resources to help ease the financial strain of medical bills, along with guidance to navigate complex health insurance issues. Other social work services include support group programming, bereavement counseling, fertility counseling and survivorship clinic, and re-entry to school support.

Mission Childrenâ&#x20AC;&#x2122;s Hospital Pediatric Hematology/Oncology

Child Life Specialist to ease patient stress and anxiety of medical experiences, organize coping, expressive or play-based activities for inpatient and outpatient hospital visits, and provide developmentally-appropriate education for procedures and/or diagnoses. Educational art programs, provided by Arts for Life, are daily services for children and adolescents diagnosed with serious illness, or facing extended periods of treatment and/or frequent clinic visits. This program provides patients, as well as siblings and family members, a sense of control and self-confidence separate from illnesses, along with opportunities for creativity and self-expression. Arts programs have been shown to reduce stress and anxiety, and positively-enhance the healthcare experience. $10,000 annually Palliative Care, to be provided by a pediatric physician who can offer insight into the management of symptoms (such as pain, trouble breathing and nausea), and to guide the health team in understanding nuanced medical aspects of the childâ&#x20AC;&#x2122;s condition. Palliative care unites a team to think and act across department boundaries, improve quality of life, and make the journey a bit easier. $50,000 annually Vein Finder is a device that will illuminate veins, creating a more comfortable experience for patient and clinician alike. These devices are especially useful with infants and children, as well as patients who are dehydrated or have darker skin tones. Vein Finder makes the process as quick and painless as possible for patients. Two (2) portable devices $2,500 and two (2) stationary devices $6,500. Total = $9,000 Entertainment technology to be provided in six rooms, wirelessly linking guests to movies and music to reduce anxiety during treatment. Ideally, we would like to implement technology that provides patients with varied options to match their preferences. $6,000 Adolescent and Young Adult (AYA) age-relevant resources, support, patient activities and experiences, and cancer peer support network during a critical and lonely journey. $10,000 Beads of Courage is an "Arts in Medicine" program for children coping with serious illness, their families, and their healthcare providers. We give all oncology children a specific bead for every medical milestone they experience (surgeries, chemotherapy, hair loss, hospital stays, clinic days, needle pokes, medical accomplishments, and special events, such as birthdays and the end of treatment). These beads are a fun way to bring a sense of control and accomplishment back to the patient. $1,500

Mission Childrenâ&#x20AC;&#x2122;s Hospital Pediatric Hematology/Oncology