Health & Wellness Alliance for Children Common Agenda

1. Health & Wellness Alliance for Children Common Agenda

2. What is The Alliance? • Who We Are • Coalition of community organizations established to improve the health and well being of children in Dallas County  • An organized & engaged group of community stakeholders aligned around a common agenda for positive change in pediatric health (initially focusing on pediatric asthma) • Funded and supported by Children’s Medical Center • Who We Represent • The voice of children and their families • Social service organizations • Educators, universities, school districts & day care centers • Faith-based organizations • Hospitals and health clinics • Government entities • Donors 2 The Health and Wellness Alliance for Children – “It’s About the Kids”

3. Challenges and Focus - Asthma • Why Focus on Children’s Health? • Dallas County has cutting edge medical facilities and a community dedicated to its children, yet the current state of children’s health in Dallas County is not in line with the community’s vision: • - 29% of our kids live in poverty • - 18% do not have health insurance • 28% have inadequate food and nutrition • Why Initially Focus on Asthma? • 60,000 children in Dallas have asthma, nearly 9% of all Dallas children • Asthma is a manageable condition, yet: • - In 2010, 3 children per day visited a Dallas County hospital for their asthma- In Texas, 54% of children with asthma missed at least one school day per year due to their condition- The cost of unmanaged asthma in Dallas (to families and medical facilities) is estimated at $60M per year • We can apply what we learn about the social and environmental determinants of asthma to address other conditions in the future 3 The Health and Wellness Alliance for Children – “It’s About the Kids”

4. The Asthma Wellness Equation 4 The Health and Wellness Alliance for Children – “It’s About the Kids”

5. The Alliance Goals - Asthma • EVERY child with asthma achieves their fullest health, • well-being and potential • The Alliance seeks to reduce or eliminate the burden that asthma places on children, families and the community by developing strategies that address each of the components of the asthma wellness equation. • Indicators that the Alliance is evaluating to track progress include the following: • 1. Hospitalizations due to asthma • 2. Emergency department visits due to asthma • 3. Average asthma control test score 5 The Health and Wellness Alliance for Children – “It’s About the Kids”

6. Approach to Achieving Our Goal:Collective Impact Five Conditions of Collective Impact • 1. Common Agenda • Common understanding of the problem • Shared vision for change • 2. Shared Measurement • Collecting data and measuring results • Focus on performance management • Shared accountability • 3. Mutually Reinforcing Activities • Differentiated approaches • Willingness to adapt individual activities • Coordination through joint plan of action • 4. Continuous Communication • Consistent and open communication • Focus on building trust • 5. Backbone Support • Separate organization(s) with staff • Resources and skills to convene and coordinate participating organizations The Health and Wellness Alliance for Children – “It’s About the Kids”

7. Structure of Work EVERY child with asthma achieves their fullest health, well-being and potential Backbone Staff Support Steering Committee provides guidance and oversight Working groups of community partners plan and implement strategies Asthma-Healthy Physical Environments High Quality Health Care Improved Access toHealth Care Equipping Children and Families For AsthmaWellness Connecting groups will support strategies across working groups Policy Group Data Group The Health and Wellness Alliance for Children – “It’s About the Kids”

8. Health and Wellness Alliance Goals & Indicators • Every child with asthma achieves their fullest health, well-being, and potential. • Child hospitalizations due to asthma in Dallas County • Child emergency department visits due to asthma in Dallas County • Asthma control test (ACT) scores for children in Dallas County Big Goal + Indicator Working Group Equipping Children & Families for Asthma Wellness Improved Access to Health Care Asthma-Healthy Physical Environments High-Quality Health Care Working Group Goal Create awareness and sense of power among children and families regarding asthma management. Remove barriers for families to get the necessary care and medications they need to manage asthma. Create safe places for children to live, learn and play free from asthma triggers. Ensure that medical care providers have accessible and consistent information about childhood asthma. % of children / families who report asthma interfering with home/work/school on the Asthma Control Test Medication possession ratio % of children with asthma who have had a preventive care visit in the last 12 months Families perspective on whether they can get the primary care they need to manage asthma ER & hospital repeat visit rates Prevalence of triggers in targeted households % of schools in Dallas County who implement indoor air-quality guidelines of Tools for Schools program • Controller to rescue medication ratio • % of children who visit hospital or ER who have PCP follow up within 14 days • % of children who have had ACT score recorded • % of children who have an asthma action plan DRAFT Working Group Indicators # parents or # kids participating in education sessions # community members trained Knowledge change after education # alternative primary care appointments created # of navigation guides distributed . # daycares implementing indoor air quality guidelines # of day cares or schools implementing flag program # of organizations who agree to use universal AAP # physicians participating in asthma-specific training DRAFT Strategy Indicators

9. Working Group Strategies DRAFT • Equipping Children and Families for Asthma Wellness • Testing a holistic approach in Jubilee Park to include: • Screening for asthma (health fair-style) with information on resources for medical care, insurance, and other items • Parent/caregiver education class with opportunity for parent to identify specific actions he/she can take • Followup with parents to address challenges (phone and in-person) • Future strategies to include: • Create peer groups (same age, older to younger kids) to teach, support, and encourage children with asthma • Deliver in-home education for parents/children • Train community residents to serve as community health workersOR other asthma health literacy educators from the community to provide asthma education to families in their neighborhoods in variety of settings • Improved Access to Health Care • Make asthma medications more affordable by: • 1.) Publishing guides for patients on how to get low-cost and free medications 2.) Studying insurance coverage policies and, if necessary, advocating for expanded coverage of medications 3.) Working with pharmaceutical companies to provide medications • Expand alternative forms of primary care such as shared medical appointments, walk-in clinics for asthma patients • Create an asthma hotline or mobile app that families can use to address questions and concerns about asthma 24/7 • Create resources guides and/or navigational services to help families identify free and low cost asthma-related health care services and transportation • Increase the portion of physicians who will accept Medicaid/CHIP patients by increasing the reimbursement • Asthma-Healthy Physical Environments • Assess and identify schools with high levels of allergens and implement EPA indoor air quality tools • Partner with day cares to implement indoor air quality tools • Work with city inspectors to add relevant environmental questions to daycare checklists • Targeted in-home environmental trigger identification and interventions in areas of high distressed housing • Enact anti-idling policies in areas frequented by children/families • Coordinate high-ozone day programs (flags, billboard warnings) with clear messages for citizen action, using new technology as possible • Align with existing North Texas air qualityinitiatives • High-Quality Health Care • Work towards universal usage of standardized asthma action plans by all providers in Dallas. This involves encouraging providers who don’t use a plan to do so, recommending the use of standardized plan(s) by all providers, and recommending that electronic health record systems contain standard asthma plan components • Train providers (MDs, PAs, NPs) on ERP-3 guidelines and provide tools and techniques to have effective conversations with patients about asthma management • Identify key messages/education tools related to asthma wellness for non-healthcare providers who may have contact with children with asthma. Families WG will work to equip those partners (i.e. coaches, daycare workers, teachers, faith community)

10. HWAC Steering Committee Members • Steering Committee Members as of April 1, 2014 Ron J. Anderson, M.D., MACP Retired President and CEO Parkland Health & Hospital System Julie Bagley President Elect Junior League of Dallas Cheryl Boswell VP, Community Health and Well-Being YMCA of Dallas Brent A. Brown Director bcWorkshop Bill Dawkins Chief Financial Officer H.I.S. Bridgebuilders Jennifer Edwards UPSTREAM Population Health Rebecca Gruchalla, M.D. Prof. of Medicine & Pediatrics, UTSW Div. Dir. Allergy & Immunology Children’s Medical Center of Dallas Holly Hassmann Vice President and Executive Director Health and Wellness Alliance for Children Susan Hoff Chief Strategy Officer United Way of Metropolitan Dallas Larry James President and CEO CitySquare Suzanne Kubelka Director, Health Services DISD Tori Mannes President and CEO Child Care Group Leonor Marquez Chief Executive Officer Los Barrios Unidos Comm. Clinic Julie Martellini, PhD Epidemiology Program Planner Dallas County Health & Human Services John Martinez President Regional Hispanic Contractors Assoc. Cynthia Mickens Founder and CEO Cynthia Mickens Ministries Sue Pickens Director, Population Medicine Parkland Health & Hospital System Peter Roberts** EVP, Population Health and Network Dev. Children’s Medical Center of Dallas Michael Samuelson Sr. Consultant Population Health Samuelson Health and Wellness Solutions Eduardo Sanchez, M.D.** Deputy CMO American Heart Association Paula Selzer Regional Coordinator Children’s Environmental Health US Environmental Protection Agency Reg. 6 John Siburt Vice President of Programs CitySquare Joyce Tapley Chief Executive Officer The Martin Luther King, Jr. Family Clinic Anne Thomas Executive Director AVANCE Dallas Candace M. Thompson Community Outreach Manager Jubilee Park & Community Center Larry Tubb Sr. Vice President, System Planning Cook Children’s Medical Center Rhonda L. Walton, M.D. Pediatrician CitySquare Community Health Services Keith Zimmerman Chief Executive Officer Medical City Children’s Hospital **Steering Committee Co-Chair The Health and Wellness Alliance for Children – “It’s About the Kids”

11. HWAC Working Group Members • Working Group Members as of April 1, 2014 Asthma Healthy Physical Environments Brent Brown, bcWorkshop (Co-chair) Paula Selzer, EPA (Co-chair) Brooke Etie, LMSW, Dallas Housing Association Loletha Horton, YMCA of Metropolitan Dallas Nick Kunz, bcWorkshop John Martinez, Regional Hispanic Contractors Association Mindy Mize, North Texas Council of Governments Kathryn McCartney, Head Start of Greater Dallas Susan Spalding, M.D., Parkland Whitney Vandiver, North Texas Council of Governments Danielle Wesley, Children’s Medical Center High Quality Health Care Leann Kridelbaugh, M.D., MyChildren’s (Co-chair) Joyce Tapley, The Martin Luther King, Jr. Family Clinic (Co-chair) Beth Dittman, Mesquite ISD, Health Services Barry Lachman, M.D., Parkland Community Health Plan/Asthma Action Coalition Tori Mannes, Child Care Group Lori Millner, Texas Area Health Education Center East, UT Southwestern Veronica Moore, Health and Human Services Cassandra Singleton, PediPlace Jill Strachan-Batson, M.D., Parkland Youth Family Centers Equipping Children and Families for Asthma Wellness Cheryl Boswell, YMCA of Metropolitan Dallas (Co-chair) Anne Crowther, Children’s Medical Center (Co-chair) Bonner Allen, Junior League of Dallas Lisa Bracken, Educational Consultant and Project Management Nathan Edgerton, United Way Phyllis Kane, MyChildren’s Cynthia Mickens, Methodist Health Center Lister Robinson, Children’s Medical Center David Thomas, Bryan’s House Candace Thompson, Jubilee Park and Community Center Improved Access to Health Care Anne Thomas, AVANCE Care (Co-chair) Lois Trammell, Children’s Medical Center (Co-chair) Valerie Bradley, City of Mesquite Bill Dawkins, H.I.S. Builders Bob English, DART Suzanne Kubelka, Dallas Independent School District Anthony Luedicke, R.Ph., Walgreen’s Pharmacy Donna Persaud, M.D., Parkland Hernan Reyes, M.D., HRSA Larry Robins, PediPlace Martha Rodriguez, Health and Human Services John Siburt, CitySquare Joanne Tenery, Parkland Community Health Plan Matthew Thieman, PharmD, Walgreen’s Pharmacy Ray Tsai, M.D., MyChildren’s **Steering Committee Co-Chair The Health and Wellness Alliance for Children – “It’s About the Kids”