Health & Wellness Alliance for Children

Health & Wellness Alliance for Children Steering Committee Meeting August 15, 2013

Agenda • Meeting Overview and Alliance Updates • Common Agenda • Implementation • Indicators • Next Steps

Meeting Goals Goals for August Meeting • Provide an update of the Alliance’s activity since we last met • Discuss the Common Agenda and any feedback you have • Understand the Steering Committee’s role going forward • Review the implementation process for the Common Agenda • Agree on Health and Wellness Alliance indicators for the big goal

Introductions and Pair Share Exercise Share with your partner: In the last 3 months, what is something you’ve been involved with that makes you optimistic we can improve children’s health in Dallas?

Other Updates • Steering Committee luncheon with Children’s Health Alliance of Wisconsin • Upcoming community data collection

Steering committee meetings provided significant input to the common agenda Steering Committee Meetings Common Agenda • Meeting 1 - March • Guiding principles • Meeting 2 - April • Problem definition • Meeting 3 - May • Problem definition cont. • Opportunity spaces • Meeting 4 - June • Goal • Working Groups

Review: challenge

Review: Guiding principles What We Believe Children’s Right to Care. We believe that children deserve access to health, which includes access to medical care as well as the other opportunities and resources that support health. Value of Children’s Health. We believe that a child’s health has value, to his or her community, family, and self. Honor Children’s Role. We honor the role and opinions of a child in his or her own health and wellness. Respect and support the family. We believe that a family, regardless of how it is defined, is the guiding force for a child’s health knowledge, attitudes, and actions. We recognize that those family units need information, resources, and other supports to achieve the highest level of well-being for themselves and their children. Systemic Challenge. We believe that a child’s health is influenced by factors beyond his or her control, including society, environment, family, education, and health systems. Long-Term Commitment. We strive for long-term commitment of time, effort, and funds to the work of the Alliance and long-term solutions that engage the members of the community in achieving change for their children. Cross-Sector Collaboration. We respect the different perspectives, resources, and expertise of all our partners, recognizing that no one individual or organization can effect transformational change in the lives of children in the community. Honor Diversity. We believe in developing solutions that honor the diversity of the people in community, free of judgment and with appreciation for culture, language, and belief. Learning Orientation. We are a learning collaborative, using evidence to help us select among best practices, as well as measuring the effectiveness of our efforts in the community.

Review: goal Everychild 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 • The Alliance will seek to reduce disparityacross children’s asthma-related outcomes

Review: Approach to Achieving Our Goal Five Conditions of Collective Impact Common Agenda • Common understanding of the problem • Shared vision for change • Collecting data and measuring results • Focus on performance management • Shared accountability Shared Measurement • Differentiated approaches • Willingness to adapt individual activities • Coordination through joint plan of action Mutually Reinforcing Activities Continuous Communication • Consistent and open communication • Focus on building trust • Separate organization(s) with staff • Resources and skills to convene and coordinate participating organizations Backbone Support

Review: Structure to do the work Everychild with asthma achieves their fullest health, well-being, and potential. Backbone Staff Support Steering Committee and Advisory Council provide guidance and oversight Steering Committee Advisory Council Working groups of community partners plan and implement strategies Asthma-Healthy Physical Environments Improved Access to Health Care High Quality Health Care Equipping Children and Families For AsthmaWellness Connecting groups will support strategiesacross working groups Policy Group Data Group

Questions? Any remaining questions, concerns, or edits on this Common Agenda? Anything that would prevent you from agreeing to support it?

Governance and Infrastructure Strategic Planning Collective impact efforts typically have three phases Community Involvement Phase I Initiate Action Phase II Organize for Impact Phase III Sustain Action and Impact Components for Success Evaluation And Improvement Identify champions and form cross-sector group Create infrastructure (backbone and processes) Facilitate and refine Map the landscape and use data to make case Create common agenda (common goals and strategy) Support implementation (alignment to goal and strategies) Facilitate community outreach Engage community and build public will Continue engagement and conduct advocacy Analyze baseline data to ID key issues and gaps Establish shared metrics (indicators, measurement, and approach) Collect, track, and report progress (process to learn and improve)

The alliance will focus on phase II for the rest of 2013 = Working Group Meeting(s) = Steering Committee Meeting

The Alliance Structure will grow over the next 6 months Advisory Council will form in Fall 2013 Backbone Staff Support Steering Committee Advisory Council Working Groups will kickoff in September Asthma-Healthy Physical Environments Improved Access to Health Care High Quality Health Care Equipping Children and Families For AsthmaWellness Data group will form in Fall 2013, policy group potentially in Winter 2014 Backbone is almost fully staffed Policy Group Data Group

The Steering Committee Will Continue to Provide Strategic Direction • Steering Committee Responsibilities • Leadership • Adopt and commit to the goal • Champion the effort broadly in the Dallas community • Provide direction for strategies • Bring system-wide perspective in approving final strategies • Modify strategies to ensure progress towards overall goals • Participate in working groups as a member (optional) • Align actions of your organization to the goals, indicators, and strategies of HWAC where possible • Develop and implement policy and advocacy agenda alongside working groups • Learning • Monitor progress of activities against common agenda goals and indicators • Review data and use it to change strategies or structures to achieve goals • Oversight • Determine resource needs to ensure sustainability, in coordination with backbone • Provide guidance to backbone organization • Structure and provide ongoing guidance to working groups

Meetings Are Sequenced to Drive Strategy-Setting in Phase II • SC Meeting #5 • Sign-off on Common Agenda • Identify indicators • Review implementation • SC Meeting #6 • Review WG sample strategies • Explore community engagement opportunities • SC Meeting #7 • Create feedback for WGs on strategies and coordinate across WGs • Learn about shared measurement • SC Meeting #8 • Approve or modify initial WG strategies and indicators • Approve shared measurement roadmap August September October November December • WG Meetings #3 • Respond to SC feedback on strategies • Identify draft indicators • Identify initial implementation steps • WG Meetings #1 • Introduce Alliance, WG process, WG scope • Get to know each other • WG Meetings #2 • Review draft strategies and related topical research

The data and policy groups will help connect working groups Data Group • Who: a group of stakeholders with relevant expertise in data collection, analysis, and reporting, may include a representative from each working group and from Steering Committee • What: work alongside the backbone staff to identify/ support data needs and drive learning across the effort • Example Activities: create surveys and other data collection tools, gather data from partners (e.g., DFWHC), provide guidance to WGs on data related questions • Meet: as needed Policy Group • Who: a group of stakeholders with relevant expertise in advocacy and policy work, may include a representative from each working group and from Steering Committee • What: work alongside the backbone staff to drive forward the policy agenda identified by working groups and • Example Activities: align policy initiatives across working groups, help plan community organizing, provide advise on legislative proposals, etc. • Meet: as needed

Questions? Any remaining questions about the timeline for implementation? Any remaining questions about the structure of the Alliance?

The Alliance Big Goal will be tracked by several indicators Everychild with asthma achieves their fullest health, well-being, and potential. Potential indicators that the Alliance may use to track progress toward its goal are: • Decrease child hospitalizations due to asthma • Decrease emergency department visits due to asthma • Increase asthma control test score of children with asthma • Decrease days of school children miss due to asthma • Decrease days of work parents miss due to child’s asthma • Increase quality of life score of children with asthma • The Alliance will collect data by race where possible across these child asthma-related outcomes Severity

Data is most readily available to support hospital-related indicators Severity

the big goal Will be the Ultimate Focus of All Alliance Work Alliance Goal: Everychild with asthma achieves their fullest health, well-being, and potential. • Draft Indicators: • Child hospitalizations due to asthma 4. Days of school children miss due to asthma • Emergency department visits due to asthma 5. Days of work parents miss due to child’s asthma • Asthma control test score of children with asthma 6. Quality of life score of children with asthma Equipping Children and Families for Asthma Wellness Improved Access to Health Care Asthma-Healthy Physical Environments High-Quality Health Care Goal: Create awareness and sense of power among children and families regarding asthma management. Goal: Ensure that medical care providers have accessible and consistent information about childhood asthma. Goal: Remove barriers for families to get the necessary care and medications they need to manage asthma. Goal: Create safe places for children to live, learn and play free from asthma triggers. • Draft Indicators: • Worry Score (Quality of Life Tool) • Communication Score (Quality of Life Tool) • % of families who have and use an Asthma Action Plan • Draft Indicators: • % of children with asthma who have visited a primary care physician in the last year • % of children with asthma covered by insurance • % of asthma patients who fill and/or refill prescriptions • Draft Indicators: • % of households where particular asthma triggers are found • # of high ozone days • % of schools who have maintain indoor air-quality guidelines of Tools for Schools program • Draft Indicators: • % of children with asthma who have an appropriate asthma medication prescribed • Asthma Control Test Score (note: also an overall indicator)

Discussion • Characteristics of Strong Indicators • The indicators must be valid measures linked to child asthma outcomes in Dallas County • The indicators must be easily understandable to a range of stakeholders, including healthcare providers working with children, schools, and the broader public (including children and parents) • The data must be produced by a trusted source (or sources) • All or most of the indicators must be affordable to gather and report and may already be collected • Priority is given to indicators that are comparable with the state or nation • Where possible, the data should be available consistently over time, should be recent, and should be easily disaggregated by age, sex, race, income, geography, and other variables • Each indicator should be able to be influenced to a significant degree by local action, and be useful in the day to day work of the Steering Committee, working groups, and others What indicators do we want to use to measure progress towards the Alliance overall goal?

Wrap Up Homework • Read the Roadmap for Implementation when you receive it by email • Consider if you want to participate as a member in any of the Working Groups; reply to Michael with your interest by August 19 • Consider if you want to participate as a member in the Policy or Data group; reply to Michael by August 23 • Mark your calendar for upcoming meetings: • Friday, Sept. 27, 9:00-11:30 AM, United Way of Metropolitan Dallas • Wednesday, Oct. 30, TBD time and place • Tuesday, Dec. 3, TBD time and place • Note that SC meeting length will depend on agenda and could be between 1-2.5 hours Next Steps • Developing Roadmap for Implementation • Working Groups will kickoff in September • Orientation for co-chairs • Research on strategies

Appendix: Working group Charters

Asthma-Healthy Physical Environments Working Group Description Working Group Responsibility • Goal: • Create safe places for children to live, learn and play free from asthma triggers • Description: • This working group will convene relevant parties and develop strategies to ensure all children with asthma have access to healthy private and public spaces, including an asthma-safe home and school and recreational spaces. Strategies might include: • Homes: Providing in-home environmental assessments (in collaboration with Improved Access to Health Care working group) • Schools: Increase use of EPA’s Tools for Schools program • Air Quality: Aligning research and policy positions on clean air policies • Rationale: • A child’s asthma is worsened by the presence of asthma triggers in their environment. This includes smog, pollen and ozone in the air they breathe as well an indoor triggers such as cockroach and other pest residue, pet dander, mold and dust. Secondhand smoke is also a known irritant for children with asthma. • Selecting evidence-informed strategies to make progress against each outcome (short-term) and continuously improving strategies in an ongoing way (longer-term) • Reviewing research on effective strategies within Dallas County while also looking at national best practice • Using data to inform identification of strategies and ongoing refinement • Suggesting refinement of indicators based on strategy development (as needed) • Identify local agencies to support or execute strategies • Focusing on implementation of strategies and activities • Coordinating activities among member agencies and others in the community to implement strategies • Dedicating time to tactics of events and activitiese.g., identifying volunteers, materials, and resources required • Providing progress updates to the Steering Committee and responding to their feedback Member Responsibility • Attending monthly 2 hour meetings (potentially 1 hour after strategies are selected and implemented) • Committing to 6-12 months of membership • Championing the effort broadly in the Dallas community • Aligning the actions of your agencies to the goals, indicators, and strategies of this working group where possible

Equipping Children and Families For Asthma Wellness Working Group Description Working Group Responsibility • Goal: • Create awareness and sense of power among children and families regarding asthma management • Description: • This working group will convene relevant parties and develop strategies to ensure that children with asthma and their families are: • Aware of the condition and have a knowledge base about asthma • Have access to usable information they need to manage asthma effectively • Are equipped, comfortable and confident enough to act on that information • This group will use a variety of methods, including social and traditional media and working through affiliated organizations such as churches. • Rationale: • A family’s foundation for wellness and ability to act to manage asthma is based upon children and their families having a strong sense of self, a balanced outlook, a sense of personal power, and connected knowledge about asthma. • Selecting evidence-informed strategies to make progress against each outcome (short-term) and continuously improving strategies in an ongoing way (longer-term) • Reviewing research on effective strategies within Dallas County while also looking at national best practice • Using data to inform identification of strategies and ongoing refinement • Suggesting refinement of indicators based on strategy development (as needed) • Identify local agencies to support or execute strategies • Focusing on implementation of strategies and activities • Coordinating activities among member agencies and others in the community to implement strategies • Dedicating time to tactics of events and activitiese.g., identifying volunteers, materials, and resources required • Providing progress updates to the Steering Committee and responding to their feedback Member Responsibility • Attending monthly 2 hour meetings (potentially 1 hour after strategies are selected and implemented) • Committing to 6-12 months of membership • Championing the effort broadly in the Dallas community • Aligning the actions of your agencies to the goals, indicators, and strategies of this working group where possible

High-Quality Health Care Working Group Description Working Group Responsibility Goal: Ensure that providers have accessible and consistent information about childhood asthma Description: This working group will convene relevant parties and develop strategies to equip care providers (e.g., doctors, school nurses, parents, others) with evidence-based information to treat childhood asthma and easy-to-use tools to share with others. It will develop in-home case management for families and access to related support services, and support communications and effective collaboration between key stakeholders in asthma management. This group will also help to inform strategies of other WGs that have clinical implications. Rationale: The quality of medical care for children with asthma varies. Whether a child is appropriately diagnosed and managed depends on how well-informed their medical providers are about childhood asthma, how effectively their providers can communicate with the child and family, and how well coordinated the medical care is among various providers. • Selecting evidence-informed strategies to make progress against each outcome (short-term) and continuously improving strategies in an ongoing way (longer-term) • Reviewing research on effective strategies within Dallas County while also looking at national best practice • Using data to inform identification of strategies and ongoing refinement • Suggesting refinement of indicators based on strategy development (as needed) • Identify local agencies to support or execute strategies • Focusing on implementation of strategies and activities • Coordinating activities among member agencies and others in the community to implement strategies • Dedicating time to tactics of events and activitiese.g., identifying volunteers, materials, and resources required • Providing progress updates to the Steering Committee and responding to their feedback Member Responsibility • Attending monthly 2 hour meetings (potentially 1 hour after strategies are selected and implemented) • Committing to 6-12 months of membership • Championing the effort broadly in the Dallas community • Aligning the actions of your agencies to the goals, indicators, and strategies of this working group where possible

Improved Access To Health Care Working Group Description Working Group Responsibility • Selecting evidence-informed strategies to make progress against each outcome (short-term) and continuously improving strategies in an ongoing way (longer-term) • Reviewing research on effective strategies within Dallas County while also looking at national best practice • Using data to inform identification of strategies and ongoing refinement • Suggesting refinement of indicators based on strategy development (as needed) • Identify local agencies to support or execute strategies • Focusing on implementation of strategies and activities • Coordinating activities among member agencies and others in the community to implement strategies • Dedicating time to tactics of events and activitiese.g., identifying volunteers, materials, and resources required • Providing progress updates to the Steering Committee and responding to their feedback • Goal: • Remove barriers for families to get the necessary care and medications they need to manage asthma • Description: • This working group will convene relevant parties and develop strategies to address the barriers to accessing and paying for care, including: • Accessibility: This may include making primary care more convenient or using creative ways to deliver primary care such as shared medical appointments and phone assistance programs • Affordability: This may include helping eligible families enroll and re-enroll in Medicaid programs and ensuring that relevant medications are affordable for them • Rationale: • In Dallas County, 18% of children are uninsured. Families enrolled in CHIP and Medicaid face difficulties finding providers who accept their insurance. Lack of ability-to-pay poses a barrier for many families to access the preventive doctor’s visits and medications they need to manage asthma. Even for children with payment coverage, non-financial barriers to primary care include lack of local clinics, limited clinic hours, transportation issues, and language differences. Member Responsibility • Attending monthly 2 hour meetings (potentially 1 hour after strategies are selected and implemented) • Committing to 6-12 months of membership • Championing the effort broadly in the Dallas community • Aligning the actions of your agencies to the goals, indicators, and strategies of this working group where possible

Health & Wellness Alliance for Children