Center for the Advancement of Underserved Children

Community-based Initiatives

Pediatric residents' completion of the month-long rotation is accompanied by their field placement as members of multi-dimensional teams with our community-based organizations partners. With the guidance of community and faculty mentors, these teams complete community-identified projects within community-based organizations' communities. Over the course of ten years, pediatric residents have completed 42 community-based initiatives
 

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Children's Health Alliance of Wisconsin - February 2008

Improving Access to Oral Health Care

Established in 1994, CHAW is dedicated to collaboration, education and advocacy. The Alliance continues to build a strong network of partners dedicated to addressing emerging children's health issues (lead, asthma, oral health, childhood obesity, trauma preparedness, mental health, early childhood systems). CHAW strives to improve the health and well-being of Wisconsin children by addressing key health issues through collaborative efforts with diverse organizations, communities and individuals.

1. Advocate for the importance of good oral health.
2. Educate future health care providers on Oral Health.
3. Provide fluoride and dental supplies for adult population & current dental health resources

Overview of Project Design:

Advocacy

• Scheduled appointments with our State Senators & Representatives

•  Literature searched to develop “talking points” & fact sheet

•  Met with representatives to discuss

-    The plight of oral health care access for children with Medicaid from a pediatrician’s perspective

-    Two Cents for Tooth Cents (SB 117)

-    Reimbursement rates for Medicaid Dental providers should be considered

Education

• Met with Dr. Studders and Matt Crespin to educate ourselves

• Coordinated with MCW Saturday Clinic to seek interest & arrange educational opportunities

• Modified Powerpoint Presentation to adjust learning level for MCW Medical Students

-    Oral Health epidemiology, pathophysiology, risk assessment, prevention and intervention

-    Tutorial and hands-on practice of fluoride varnish application

• Creation of an online continuing education ANGEL Module

-    Developed pediatrics oral health curriculum for medical students including annual lecture

•  IRB amendment “Healthy Teeth = Healthy Kids” Study approved (2.21.08)

-    Completed CITI certification, Added as co-investigators

-    Developed of a new survey tool to assess current knowledge base & interest regarding oral health

Clinical Outreach and Resources

• Saturday Clinic for the Uninsured

-    Provided medical students with fluoride varnish application in addition to other dental supplies

-    Created patient handout for FAQs about Fluoride Varnish

• Provider Lists for distribution in the community

-    Updated Milwaukee County Pediatric Dental Provider List for Medicaid and Uninsured Patients

-    Given transmission of disease, created an Adult Dental Provider list for low-income populations

• Oral Health Exam Resource Card

 

Results: Milwaukee Area Pediatric Dental Providers: 20 provider groups with 30 providers total; 7 out of 30 (23%) of these providers willing to provide discounted or free services to those uninsured/paying out of pocket. Oral Health Presentation to medical students was co-presented with Dental attending: 50 Attendees, 68% survey completion rate (n=34). Results: Only 29% confident and more than adequately equipped to perform an oral exam on a child and 96% welcome more information on oral health care.

Initiative Product:      Dental provider list for uninsured and Medicaid eligible children and adults. 

                                   Online course with pediatrics oral health curriculum and an annual lecture.

 

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FAM Allies provides linked and integrated services in places where children and their parents/caregivers learn about and manage asthma. These places include homes, childcare centers and schools, community centers, hospitals and churches.

Residents: LaVaughn Cotton, MD; Katherine Gonzaga, MD; Jill Keyes, MD

Faculty Advisor: John Meurer, MD, MBA
Community Mentor: Erin Lee

Goal: Teach MPS 5^th and 6^th graders asthma prevention, risk factors, triggers, medical management and asthma physiology

1)   Prepare and submit an IRB protocol that will evaluate the effectiveness of the school-based asthma education

2)   Understand the framework of an asthma coalition and its connection between health care providers and the community

3)   Advocate to state legislators for state wide smoking ban

• Completed CITI Training- Human Subject certification
• Conducted a literature search and review
• Reviewed evidenced-based school based asthma education
• Prepared IRB protocols for both Children’s Hospital of Wisconsin & Milwaukee Public Schools
• Refined curriculum and evaluation pre/post test tool

Results: Taught at 10 classrooms: 345 total children and 14 teachers; Classes ranging from 20 to 80 students. Posttests administered

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Infant Mortality: Improving Outcomes Through Provider Education

The City of Milwaukee Health Department ensures that services are available to enhance the health of individuals and families, promote healthy neighborhoods and safeguard the health of the Milwaukee community. This Health Department is a leader in assuring that Milwaukee is the healthiest city in the nation, with the best personal health care, environmental health, and population-based preventive services possible. 

Faculty Advisor: Emmanuel Ngui, DrPh, MSc
Community Mentor: Jill Paradowski, RN, MSN

Goal: Optimize the role of pediatric and family practice health care providers in the prevention of infant morality in the Milwaukee area

1)   Assess provider knowledge and resources regarding infant mortality

2)   Determine providers whose patient populations are at a disproportionate risk

3)   Educate providers on strategies and tools

4)   Provide patient education resources

• Conducted a review of the most recent infant mortality data for Milwaukee

–   FIMR

–   History of Milwaukee’s/National community-based interventions

• Assessed causes that are best-addressed in the pediatric setting

–   Smoking cessation

–   Co-sleeping

–   Sleep environment (i.e. back to sleep)

• Identified evidence-based resources available to practitioners

–   Unaware of resources

–   Unable to access the resources

• Pooled resource folders

–   Reordering information

• Determined strategies to incorporate the message into visits
• Educated Healthcare Providers

–   High-risk patient population targeted

–   Lunch and Learn model: summary of morality data & compiled resources/strategies for prevention

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Fight Asthma Milwaukee Allies - October 2007                                                                                        

School-based Asthma Education     

 

Faculty Advisor: John Meurer, MD, MBA
Community Mentor: Erin Lee

Goal: To improve asthma awareness/education and care to patients and providers in our community

1)   Advocate for community health, FAM allies and policy development

2)   Improve asthma education for 5th and 6th grade students

3)   Assess and improve access and asthma educational handouts for patients and providers at local clinics

• Attended FAM Allies environmental subcommittee meeting
• Contributed to Community Pediatric Asthma Focus Group at the DHC
• Participated in Asthma Wellness Day
• Reviewed FAM allies policy statements regarding environmental hazards and asthma
• Advocated on statewide smoking ban in Madison with legislators

• Reviewed the literature of directed education towards adolescent patients & FAM allies teaching materials
• Discussed success and challenges of past FAM school based projects
• Adjusted current curriculum to age appropriate audience
• Contacted Kathleen Murphy and requested a list of MPS in high risk zip codes (53206, 53208)
• Contacted school principals & offered Teaching sessions

• Assessed literacy levels of all asthma handouts/material at DHC (English and Spanish)
• Discussed materials with Dr Meurer and Carol Robinson, RN
• Attended asthma meeting with faculty, nurses and social workers on how to improve asthma care at DHC

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Residents: Kris Catrine, MD; Sharon Dhaliwal, MD; Lindsay Gould, MD; Mary Health, MD; Mark Vanderlugt, MD

Faculty Advisor: Timothy Corden, MD

Goal: Promote public policies which improve the health of adolescents and families in Wisconsin

Objectives: Conducted child advocacy through letter writing campaign, lobbying, voter registration and community awareness

1) Educate ourselves about public policy techniques

2) Become familiar with the legislative process

3) Inform legislators about effects of public smoking on the health of our patients

4) Discuss health risks of teen cell phone use while driving with the legislators

5) Increase awareness of legislative advocacy among our medical colleagues

•    Reviewed of current bills affecting children’s health

•    Determined policy interests & potential for passage

•    Chose two policy issues:

- SB 150 (Breathe Free Wisconsin)

- AB 464 (Cellular phone restrictions) 

Understand Communication Strategies

• We are the medical experts, Keep things simple, Don’t alienate legislators
• Give concrete messages, You can speak with them as often as you like

• Developed two letters urging our representatives to support AB 150 & SB 464
• Distributed letters to residents

• Submitted to 5 Statewide Newspapers: The Capital Times, La Crosse Tribune, Milwaukee Journal Sentinel, Appleton Post Crescent, Shepherd Express

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2006-2007 Community Initiatives

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Children's Health Alliance of Wisconsin – February 2007
Healthy Teeth: Determining Obstacles to Accessing Dental Care

Established in 1994, CHAW is dedicated to collaboration, education and advocacy. The Alliance continues to build a strong network of partners dedicated to addressing emerging children's health issues (lead, asthma, oral health, childhood obesity, trauma preparedness, mental health, early childhood systems). CHAW strives to improve the health and well-being of Wisconsin children by addressing key health issues through collaborative efforts with diverse organizations, communities and individuals. CHAW is the recognized leader that inspires and champions innovative approaches to ensure the health and well-being of children.

Residents: Sima Patel, MD; Alexandria Saulsberry, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentor: Matt Crespin, RDH

Goal:  To address the problem of poor oral health by understanding community obstacles to accessing dental care

Objectives:

1. Conduct focus groups to obtain parent and youth perspectives on oral health
2. Determine availability of dentists that accept children with Medicaid
3. Compile a list of dental providers for parents
4. Observe models of oral health delivery

Overview of Project Design:
Tooth decay is the most common chronic childhood disease.  Nationally, 80% of dental disease among children is found in 20% of children (~18 million) that are primarily Black, Hispanic, American Indian/Alaskan Native & low-income. To asses the problem of poor oral health, pediatric residents strived to understand community obstacles to accessing dental care. They became familiar with internal review board approved study protocol, were amended as Co-Investigators, completed Human Subjects Research training and learned how to conduct a focus group.

Pediatric Residents:

• Conducted two focus groups; adults (n=5) and youth (n=8)
• Reviewed transcripts & identified general themes
• Determined availability of dentists that accept children with Medicaid by identifying providers' on Medicaid HMO websites and cross referencing practices with community lists

Results:

• Three general themes were identified from the focus groups:
  • Gaps in knowledge
  • Accessing dental care is frustrating
  • Concerns about quality of care and safety, especially with regard to alternative dental   care services
• 29 calls were conducted to determine availability of dentists:

  • 17 accept new Medicaid patients & see children: 12 - <3 years, 5 - >4-9 years

  • All accept T19, the HMO acceptance varies
  • 4 accept uninsured children <3 years
  • Wait time range (1 wk. - 4 mos.)
  • Practices (4) outside city have shorter wait time

Future Directions:

• Some evidence that children have had better exposure to dental education than adults
  • There may be some benefit to continuing & expanding dental education for school-age children
• While actual dental visits are satisfactory, there is frustration with the process of getting an  appointment & waiting room experience
  • Frustration could be alleviated if hours were more convenient for both parents and children, and if waiting rooms were more child-friendly
• Proceed cautiously when considering alternative models (mobile units, school-based, CBOs)  to increase access to oral health care
  • There needs to be increased public education regarding these services

Initiative Outcome: Medicaid Dental Provider List

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Downtown Health Center – January 2007
Is the Message Getting Through?

Downtown Health Center (DHC) is a general pediatric ambulatory clinic in central city Milwaukee serving families through various services including Pediatric resident education, BadgerCare enrollment, Adolescent Health Program, Smoking Cessation Program, Homeless Shelter health care and primary medical care.

Residents: Brian Branchford, MD; Sarah Godbert, MD; Natalya Miller, MD; Jackie Nohl, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentor: Claudia Kabler-Babbit

Goal:  To assess and improve health literacy in an urban population

Objectives:

1. Assess early literary resources within zip codes of existing DHC patient population
2. Evaluate readability level of DHC patient education materials
3. Administer STOFHLA/BABAR to assess health literacy, parental attitudes and practices regarding reading with children
4. Obtain parent opinions about book selection for ROR-M

Overview of Project Design:
Pediatricians have a unique opportunity to encourage parents to read aloud to their preschool children. Patients with inadequate health literacy face obstacles (higher hospitalization rate, lower compliance, less likely to participate in prevention, increase in health care costs). To begin to evaluate health literacy levels in Milwaukee, pediatric residents collaborated with Reach Out and Read Milwaukee (ROR-M) at the Downtown Health Center (DHC), a general pediatric ambulatory clinic in the central city. Pediatric residents were amended as study co-investigators and completed an institutional review board human subjects training.

Pediatric Residents:

• Assessed early literary resources within zip codes of the DHC, ROR target population (6 mos-6 yrs) and performed a physical search of early literacy resources for book purchase and/or loan.
• Utilized the Fry Formula, patient education material was reviewed to determine its grade level.
• Conducted 16 Before and After Books Reading Survey (BABAR) and Short Test of Functional Health Literacy in Adults (STOFHLA) to assess health literacy, parental attitudes and practices regarding reading with children.
• Elicited parents (8) for their opinions regarding ROR-M book preference.

Results:

• They identified that 79% of patients come from 10 zip codes. Overall, there were 13 (Range 0-5) early literacy resources identified in those 10 zip codes.
• Over half (68%) of patient educational material was recorded as 7th grade and higher (Range 7th-17th).
• BABAR results showed that reading books was one of their favorite activities (69%) and part of their bedtime routine (50%). More than half (75%) had more than 11 books in their home and most (63%) possessed library cards.
• STOFHLA results established health literacy levels by determining parents' ability to comprehend basic medical concepts and what they must do in order to stay healthy. Parents had either an Adequate Reading Level (92%) or Marginal Reading Level (8%).
• Most (88%) parents bought books for their children in addition to the ROR-M books that they received at their doctor's appointment and felt that the ethnicity of characters is not very important. Parents (63%) preferred books with words & pictures and have a moral/lesson. Half of the parents allowed their child to choose their own books.

Future Directions:

• Continue assessment of community literacy resources
• Continue BABAR/STOFLA
• Develop parent handout of literacy resources (community & commercial)
• Educate future pediatricians on Don't forget to give books at each WWC
• Educate parents on the importance of reading to their children
• Talk to your patients about reading
• Start ROR at your future practice

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Neighborhood House – November 2006
Healthiest Foods, They're Grrreat!

The Neighborhood House is a neighborhood center that serves close to 10,000 central city families predominately Southeast Asian / African American through early childhood education, youth/family programming, outdoor/environmental education, and an Indochinese learning center.

Residents: Megan Deisz, MD; Stephen Hong, MD; Whitney McCall, MD; Tara White, MD
Faculty Advisor: John Meurer, MD
Community Mentor: Debi Schwid

Goal:  Primary prevention of obesity though family-centered and system-based dietary modification

Objectives:

1. Teach families how to make healthy dietary choices at the grocery store
2. Improve the nutritional quality of the meal plan at Neighborhood House

Overview of Project Design:
In March 2006, United Neighborhood Centers of Milwaukee (UNCOM) was awarded $450,000 to evaluate the effectiveness of education about nutrition and physical activity on the health behaviors of children.  The objective of the project is to control overweight and to identify risk factors for diabetes and heart disease among children and families who are clients. Among participants, we specifically aim to:

1. Increase non- or low-fat milk, water, vegetable, and fruit consumption
2. Decrease sweetened beverage, soda, chips, and fast food consumption
3. Increase physical activity

Pediatric residents were invited to develop evidence-based health promotion activities that addressed the above aims specifically at the Neighborhood House. Evaluation will be conducted through the grant's IRB approved pre and post survey.

Pediatric Residents:

1. Taught families how to make healthy dietary choices at the grocery store
   • Discussed medical reasons for making healthy food choices and consequences of not making healthy choices
   • Taught food label-reading, portion sizes and food pyramid
   • Designated affordable alternatives/options available through WIC
   • Provided parents guidance for age appropriate behaviors to make grocery shopping with kids a positive educational experience
   • Developed a quick reference tool to take to grocery store for making healthy food choices
   • Residents accompanied parents through grocery store where they identified healthiest options in each department (Dairy, Grains, Snacks/Beverages, Meat)
2. Improved the nutritional quality of the meal plan at Neighborhood House
   • Reviewed 4 month's worth of menus were reviewed for appropriate nutritional content, variety and use of fresh fruits/vegetables.
   • Made suggestions to improve the nutritional quality of food service at NH by providing the healthiest options available, including balanced meals, alternative proteins and healthy snacks:
     • Provide skim milk to all children over 2 years of age
     • Limit juice intake to a maximum of three times per week
     • Increase use of alternative proteins such as tofu or beans
     • Increase use of fresh fruits/vegetables
     • Increase the use of multigrain breads/crackers and brown rice
     • Minimize the use of breaded meats to two times per month
   • Based recommendations regarding appropriateness of nutritional content on residents' references from USDA food pyramid guidelines and established AAP recommendations 

Results:

• Follow-up phone calls will be made to inquire about changes made to both the NH menu and individual parents' grocery shopping
• Additional evaluation will be conducted through the grant's IRB approved pre and post survey.

Future Directions:

• Ask what children are eating at school, Head Start, after-school programs, etc. and advocate for improvements to organizational meal plans
• Talk to families about healthier choices they can make at the grocery store
• Help families understand food label
• Encourage families to utilize Growing Power and other farmer's markets (and consider it yourself!)

Initiative Outcome: Reference Tool for Grocery Shopping

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Next Door Foundation – October 2006
Promoting Healthy Lifestyles at the Next Door Foundation

The Next Door Foundation (NDF) is a child-centered and family focused agency in central city Milwaukee serving 2,500 children and families through various programs including Birth to 3, Early Head Start, Family Literacy, Fatherhood Initiative and parenting education.

Residents: Andrew Alexander, MD, Jennifer Pope, MD, Ebrahim Shakir, MD, Anjali Sharma, MD
Faculty Advisor: John Meurer, MD
Community Mentor: Carla Rutherford, RN

Goal:  To promote an active lifestyle and educate families and staff of the Next Door Foundation (NDF) to make healthy food choices

Objectives:

1. Determine access, availability and cost of produce at local food markets and inform families of our results to allow for optimal nutritional choices.
2. Obtain baseline health status using 4 physical fitness parameters from the Presidential Physical Fitness Test and calculating body mass index from height and weight
3. Promote water consumption over high sugar beverages by taste-testing sugar-free flavored water
4. Educate on amount of energy needed to burn calories of common snacks and beverages

Overview of Project Design:
Head Start (3-5 year olds):
Objective 1:   Educate parents and children on healthy snack options that are affordable, tasty and easy to prepare. 
Activity:  Prepared three healthy snacks (vegetable, fruit, dairy) with children at parent pick up time. Recipes were given to parents and encouraged to make at home.

Objective 2:   Promote a healthy lifestyle through daily physical activity.
Activity:  Demonstrated indoor activity ideas (obstacle courses, moving to music) with children so Head Start teachers' could work physical activity into their lesson plans

Leaders of Tomorrow (6-12 year olds):
Objective 1: Inform adolescents and their parents on healthy alternatives to traditional meals/recipes. 
Activity 1: Provided an one hour didactic on understanding food pyramid, good food choices and portion sizes using MyPyramid.com interactive computer games
Activity 2: Prepared a meal utilizing healthier options to their traditional favorites (fried chicken, pizza, mashed potatoes, greens, chocolate cookies) & created additional recipes for ongoing cooking classes with staff

Objective 2: Encourage behavior modifications for an active indoor lifestyle.
Activity: Taught yoga and Tae Kwon Do as indoor winter activities options
 
NDF (Staff):
Objective 1:  Educate staff on nutrition content of snack foods provided in the workplace to become role models for a healthier lifestyle.
Activity:  Education on healthier snack choices taped to each vending machine. Head Start nurse will continue to post various health messages on machines each month.

Objective 2: Propose relocating all workplace vending machines to staff only locations and encourage staff to make better choices by providing healthier snack options.
Activity 1: Contacted vending company and healthier options (pretzels, baker chips, wheat thins, popcorn, water, fruit flavored water, fruit, yogurt) were requested and put in machines
Activity 2: Eliminated one vending machine and another two moved to staff only locations

Pediatric Residents:
-   Aimed to increase activity and healthy food choices in 6 to 12 year old urban youth through an interactive after-school educational program at the Neighborhood House of Milwaukee.

-   Created a curriculum including the Fun Physical Fitness Challenge, teaching on healthy food and drink choices, and importance of drinking water is to be implemented at each of the sites to promote healthy lifestyle changes.

Results:
-   Evaluation will be conducted through the grant's IRB approved pre and post survey.

Future Directions:
-  NDF staff will continue making healthy snacks for Head Start population and Leaders of Tomorrow will continue cooking healthy alternatives to popular meals as well as introduce more physical activity in after school programming

Initiative Product: Healthy, affordable, delicious snacks for kids

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Neighborhood House of Milwaukee - September 2006
Activity and Food Choices in 6 to 12 year olds at the Neighborhood House of Milwaukee

The Neighborhood House is a neighborhood center that serves close to 10,000 central city families predominately Southeast Asian / African American through early childhood education, youth/family programming, outdoor/environmental education, and an Indochinese learning center.

Residents: Paula Behnke, MD; Roman Criollo, MD; Kevin Dalhman, MD; Alisen Huske, MD; Grant Syversen, MD, Jennifer Schreiber, MD
Faculty Advisor: John Meurer, MD
Community Mentor: Audra Hale, Coordinator of after school programs

Goal: To increase activity and healthy food choices in 6-12 year old inner city youth through an interactive after school educational program at the Neighborhood House (NH)

Objectives:

1. Determine access, availability and cost of produce at local food markets and inform families of our results to allow for optimal nutritional choices.
2. Obtain baseline health status using 4 physical fitness parameters from the Presidential Physical Fitness Test and calculating body mass index from height and weight
3. Promote water consumption over high sugar beverages by taste-testing sugar-free flavored water
4. Educate on amount of energy needed to burn calories of common snacks and beverages

Overview of Project Design:

• Our program consisted of four main interventions which are outlined under the goals. Children participated in our activities through the after-school program.
• These programs were performed as part of a larger initiative resulting from a grant provided to the United Neighborhood Centers of Milwaukee, a group of non-profit organizations whose overall objective is to control overweight and risk factors for diabetes and heart disease among children and families.

Pediatric Residents:

• Aimed to increase activity and healthy food choices in 6 to 12 year old urban youth through an interactive after-school educational program at the Neighborhood House of Milwaukee.
• Created a curriculum including the Fun Physical Fitness Challenge, teaching on healthy food and drink choices, and importance of drinking water is to be implemented at each of the sites to promote healthy lifestyle changes.

Results:

• Quality of produce was significantly different between those stores closest to NH and those stores in suburban Milwaukee
• Unfortunately, those items located closest to the NH were those of poorest quality
• Kids reported that they should eat more fruits and vegetables when snacking
• Now aware of nutrition information on packaging
• Counselors will remove unhealthy items from prize box
• They will also focus on physical activity promotion

Future Directions:

• Neighborhood House has agreed to conduct the Presidential Physical Fitness test, and calculate BMI, and record data monthly for a total of 6 months. Follow-up surveys will be administered to collect data on water consumption and physical activity.

Initiative Product: Physical Fitness Log
 

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2005-2006 Community Initiatives

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Next Door Foundation - March 2006
A Head Start on Nutrition: A Nutritional Strategies Addressing the Health Needs at Next Door Foundation

The Next Door Foundation (NDF) is a child-centered and family focused agency in central city Milwaukee serving 2,500 children and families through various programs including Birth to 3, Early Head Start, Family Literacy, Fatherhood Initiative and parenting education.

Residents: Paul Bauer, MD; Brenda Mandeline, MD; Jennifer Weinberg, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentors: Carla Rutherford, RN

Goal: Encourage families to prepare more healthy meals at home, provide dietary strategies to combat lead poisoning, and promote overall improved nutrition practices

Objectives:
1. Identified nutrition as the most important parent concern
2. Recipe book for families
3. Nutrition advocacy is an essential part of infant and toddler health
4. Early childhood education has a vital role in supporting families' efforts at keeping their children healthy

Overview of Project Design:
This project addressed how good nutrition can help reduce lead levels, high blood pressure and obesity in our community through education and prevention activities.

Pediatric residents:

• Designed and implemented two Nutrition Education Classes, one hour each, 30 parents
  • Residents were chiefs/instructors
  • Cooking class was targeted to parents
  • In-Session nutrition education, food tasting
• Designed cook-book of healthy recipes for parents to take home
  • Encouraged families to cook more at home
  • Provided dietary strategies to combat lead poisoning
  • Encouraged improved nutrition

Results:
NDF administered health concerns survey to Head Start parents (n=40)

• Most Important to Families
  • Nutrition information (50%)
  • Lead Poisoning (25%)
  • Overweight (25%)
• Concern for Lead Poisoning
  • Yes (25%) No (75%)
• Have been given information on how to reduce lead levels: 90%
• Meals at home
  • 90% have <6 meals/week at home
• 80 % are parents of 4 yo

Future Directions:

• Nutrition advocacy is an essential part of infant and toddler health
• Early childhood education has a vital role in supporting families' efforts at keeping their children healthy

Parent Handout: Head Start on Nutrition Cookbook

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Neighborhood House of Milwaukee - February 2006
Improving Healthy Food Choices

Neighborhood House (NH) is a non-profit social service agency at the near West side of Milwaukee that promotes diversity and the value of human dignity. It offers social, educational, and recreational activities to improve the quality of life in the community and empowers individuals and families to develop self-sufficiency for economic and personal growth. It serves diverse clientele primarily African American with an increasingly population of Asian, Native American and Hispanics.

Residents: Marcos de la Cruz, MD; Lauren Destino, MD; Elizabeth Theil, MD
Faculty Advisor: John Meurer, MD, MBA
Community Mentors: Penny Williams, MS; Clarence Johnson

Goal: Promote healthy food choices and lifestyles among families at Neighborhood House
Objectives:

1. Conduct focus groups in children (ages 7-12) and parents regarding healthy food choices
2. Encourage healthy food choices through the use of dairy and fruit taste tests.
3. Establish a curriculum on the importance of fruit and dairy

Overview of Project Design:
NH is the pilot site for a nutrition and physical activity promotion grant. The purpose of the grant was to develop a curriculum that would improve the nutritional and exercise behaviors of children and their adult caregivers. To help do this NH implemented year long programs with monthly focus topics including nutrition and physical activity.

Pediatric residents:

• Secured approval for IRB addendum for project involvement
• Conducted focus groups in children ages 7-12 and parents regarding healthy food choices as it pertains to fruit
• Encouraged healthy food choices through the use of dairy and fruit taste tests
• Established a curriculum on the importance of fruit for teachers
• Created culturally appropriate handouts for parents on fruit and dairy promotion

Results:
Youth Focus Group (9 boys ages 12-14)

• Kids recognize healthy snacks and fruits but don't meet recommended goals for intake
• Children seem to get most of their fruit at school
• 100% of children said they would eat more fruit if recommended by their doctor

Parent Focus Group (5 parents):

• Parents recognize the problem of obesity
• Parents do buy fruit, cost is not a deterrent for the cheaper fruits
• Parents understand the importance of eating fruit but desire more information about the health benefits and ways to increase fruit intake
• Doctors have spoken to them about increasing fruit and vegetable in their diets
• Parents desire to decrease calorie and fat consumption but children are often resistant

Challenges for Pediatricians:

• Encouraging 5 servings of fruits and vegetables at every health check
• Emphasizing the health benefits of nutritious food choices and an active lifestyle
• Encouraging parents to role model

Parent Handout: Parent Focus Group Questions, Youth Focus Group Questions

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Starms Discovery Learning Centers - January 2006
Identifying Misinformation and Informational Gaps in Early Adolescent Sexual Health

Starms Discovery Learning Centers provide a positive atmosphere where children will acquire respect for self and others and a lasting love and desire for learning. Starms Centers are part of Milwaukee Public Schools.

Residents: Julie Baughn, MD; Jennifer Keis, MD; Jorie Pietscher, MD; Yolanda Wolff, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentors: Christine Maxwell, PhD

Goal: Identify misinformation and information gaps in adolescent sexual health

Objectives:

1. Conduct focus groups with the adolescents, teachers and parents to determine early adolescents' knowledge/attitudes about sexual health
2. Analyze results and provide feedback to teachers
3. Use information to design an appropriate reproductive health curriculum.

Overview of Project Design:
This project focuses on values and beliefs of adolescent sexual health from the view points of adolescents (7 - 8 graders), their parents and teachers. The purpose of this project is to identify the perceived perceptions of current observed high risk interpersonal sexual behaviors and identify ways teachers and parents can address the behavior with the ultimate aim of developing a culturally and age appropriate sexual health and personal well-being curriculum for 7 - 8 graders. The focus should be on the prevention of high risk interpersonal behaviors.

Pediatric residents:

• Inquired about the issues teachers and administrative staff are observing from middle school students at Starms Discovery School
• Discussed sexual health and curriculum concerns with school's nurse
• Observed inter-gender classroom/hallway behaviors at Starms
• Submitted IRB protocol to request permission to conduct focus groups with students and teachers.
• Researched strategies that are currently being provided nationally to deal with adolescent sexual health education

With IRB approval, another group of pediatric residents can continue this project by administering the adolescent, parent, and teacher focus groups, analyze the data, and advise on curriculum inclusion.

Challenges:

• Providing early adolescents with accurate sexual health information
• Advocate for early sexual health education in the Milwaukee Public Schools. The district does not allow pregnancy and sexually transmitted infections prevention education outside abstinence training.

Parent Handout: Parent Focus Group Questions, Student Focus Group Questions

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Social Development Commission, Head Start - November 2005
Lead Screening in Milwaukee: Helping Families and Pediatricians Understand the Issues

The Social Development Commission Head Start is a community action program that provides comprehensive early childhood education to low-income children and involves their parents in the total child development process.

Residents: Fatumata Ceesay, MD; Cindy Running, MD; Shari Eich, MD
Faculty Advisor: Margaret Layde, MD
Community Mentors: Carla Melvin, Citywide Health Coordinator; Ramona Jensen, Lead Liaison

Goal: To reduce lead exposure in the home environment in order to promote healthy children for the future

Objectives:

1. Educate families and landlords on sources of lead and exposure reduction.
2. Advocate for health care provider awareness of lead exposure
3. Advocate for vigilance by landlords of children at risk for lead toxicity and exposure.

Overview of Project Design:

• Children in Head Start identified by staff to participate in project
• Residents completed training for:
  • Home lead assessments
  • Standards for home visitation
  • Fingerstick procedure for blood lead testing
• Home visitation to address lead hazards
  • Home assessment form completed
  • Visual triggers identified & information given to families to decrease lead exposure
  • Lead check swabs
  • Given lead clean-up kit & use of Hepa-Vac
  • Children < 6 years in home received blood lead test
• 7 home assessments conducted, 1 attempted visit, 18 children affected, Lead levels 4-18 mcg/dL, Homes built 1899-1919
  • Identified and tested high risk areas in home, i.e., windows, doorways, trim, chipping paint, radiators, porches, faucets
  • 6/7 homes tested highly positive for lead
  • Provided parent education on diet, cleaning and importance of lead screening
  • Included pamphlets and cookbook on high iron and high calcium diets
• Landlord/tenant rights and responsibilities training
  • Developed parent education sheet on their rights as tenants in Milwaukee
• Contacted most frequently used pediatricians with Head Start enrolled children & discussed current lead assessments in their offices
  • Attempted to contact 8 pediatricians via phone, 6 responded
  • All frequently used pediatricians are aware of the lead screening recommendations in Milwaukee "3 before 3" - at ages 12, 18, and 24 months
  • All follow guidelines of AAP for intervention
  • Health department referrals for levels >15 mcg/dL
  • All physicians feel that lead poisoning is still an important public health issue in Milwaukee
  • and support for further education
  • 3/6 feel that levels in general have been trending downward, likely due to health department interventions in homes
  • 4/6 do more frequent testing than recommended
  • However, there continues to be challenges in parents coming in for routine well child care

Challenges:

• Time constraints to contact landlords and further advocate for home improvements and lead abatement.
• Home visits will continue by Head Start Health Advocates
  • Discussed with Health Advocates the level of follow-up that will be needed for the home visits we performed
• Awaiting sibling lead screening results
  • 2 siblings' results pending at present

Parent Handout: Renting in Milwaukee-You Have Rights Too

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City of Milwaukee Health Department - October 2005
Efficacy of Environmental Modification in Symptoms Reduction of Inner-City Asthma

The City of Milwaukee Health Department ensures that services are available to enhance the health of individuals and families, promote healthy neighborhoods and safeguard the health of the Milwaukee community. This Health Department is a leader in assuring that Milwaukee is the healthiest city in the nation, with the best personal health care, environmental health, and population-based preventive services possible.

Residents: Brian Joy, MD; Laurel Malinowski, MD; Amy Peterson, MD
Faculty Advisor: John Meurer, MD
Community Mentors: Julie Driscoll, MSW; Lead Coordinator

Goal: To identify problems, encourage solutions, and advocate for changes resulting in better control of environmental triggers of pediatric asthma both on a local and societal level

Objectives:

1. To observe in-home asthma triggers and develop an intervention trigger reduction plan
2. Identify community resources to help carry out trigger reduction plan
3. Advocate for legislation to help reduce trigger exposure.

Overview of Project Design:

• Each pediatric resident followed one family for a month and conducted weekly home visits to evaluate environmental triggers and social factors that affect a child's asthma as well as to provide asthma education.
• Follow up visits included:
  
  • Review Action Plan
  • Trigger reduction progress
  • Medication education
  • Communicate with PMD
  • Answer questions
• Contacting aldermen regarding addition of Asthma Coordinator position in Milwaukee Health Department budget.
• Design and production of "asthma calendar" for socially and medically at-risk children.

Challenges:

• Time constraints to complete continued follow-up on families
• Asthma Case Coordinator position at Milwaukee Health Department being eliminated due to grants ending, residents unable to make impact on sustaining her position within City budget

Initiative Product: Asthma Calendar Excerpt

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City of Milwaukee Health Department - September 2005
Improving Infant Survival

 

The City of Milwaukee Health Department ensures that services are available to enhance the health of individuals and families, promote healthy neighborhoods and safeguard the health of the Milwaukee community. This Health Department is a leader in assuring that Milwaukee is the healthiest city in the nation, with the best personal health care, environmental health, and population-based preventive services possible.

Residents: Larissa Malmstadt, MD; Shaun Summerill, MD
Faculty Advisor: Earnestine Willis, MD
Community Mentors: Jill Paradowski, RN Healthcare Outreach Coordinator

Goal: Decrease infant mortality by educating pediatricians about safe sleep environment

Objectives:

1. Create and pilot a CD-ROM as an educational tool for local pediatricians in zip codes with high infant mortality rates.
2. Distribute CD-ROM with posters and other promotional materials (magnets, AAP SIDS Prevention Recommendations) from the City of Milwaukee Health Department and references from the literature in support of our information.
3. Evaluate the usefulness of this tool to each physician's practice

. Overview of Project Design:

• Residents worked with community physicians (pediatricians and family practice) to alert them about the educational messages necessary to reduce infant mortality, particularly safe sleep environments.
• Packets were sent to 22 local pediatricians who were identified with an infant death case in their catchment area.
• Suggestions to physicians included: 1) Take CD-ROM quiz and educate yourself about infant mortality in your community; 2) Encourage them to pass this quiz on to a colleague who provides health care to children in the area; 3) Distribute the informational materials enclosed in this packet to your patients; 4) Consider adding a question about sleep environment to your developmental/ screening questionnaire during well child checks; 5) Make sure your patients are sleeping in safe environments during clinical encounters: in a crib with only a mattress, a tightly fitted sheet, and on their back to sleep, in smoke-free homes; 6) Get involved with your local health department and advocate for your patients by joining the fight against infant mortality.

Challenges:

• Time constraints to complete evaluation on education tool.
• Community Mentor will follow-up with physicians to ask the following questions: 1) Prior to receiving the packet, how often did you ask about safe sleep environment during your routine developmental/screening questionnaire at well child checks 2) After receiving the packet, how often do you ask about safe sleep environment during infancy; 3) Has any of the information in this packet impacted your practice in any way, if so, how; 4) Are there any other materials that would be more useful to your practice to reduce infant death?

Curriculum: Infant Mortality Quiz

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2005-2006 Community Initiatives

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La Causa, Inc. - March 2005
Health Concerns of Urban Latino Children: A Workshop on Sexually Transmitted Infections

LaCausa, Inc. is a bilingual, multi-cultural agency serving children, youth, and families on Milwaukee's South Side. LaCausa serves over 9,000 individuals annually, 80% of enrolled children are from low-income families. In partnership with Milwaukee Public Schools since 2001, the La Causa Charter School's goal has been to provide the future metro Milwaukee workforce with a greater number of young professionals who are committed to civic responsibilities, socially aware, proficient in two languages, and dedicated to fostering healthy communities and neighborhoods.

Residents: Paula Keppeler, MD; Anna Rakovshik, MD; Eric Kroner, MD
Faculty Advisor: Suzanne Jay , MD
Community Mentors: Rose Guajardo, Principal La Causa Charter School; Rose Martin, Director of Curriculum and Instruction; Carol Johnson, PhD, Vice President of Education; Kate Kloss, Teacher; Michael Vega, Social Worker

Goals/Objectives:

• To address health concerns of children age 10-12, especially STI's
• To create an STI curriculum that will be engaging and foster openness with the children
• To create and enduring STI curriculum that be maintained and run solely by the La Causa staff

Overview of Project Design:

• Literature Review
• Discussion with administration and teacher regarding appropriate content of curriculum
• Construct curriculum on SDT; topics covered included: HIV, Herpes, Chlamydia/Gonorrhea, HPV, Trichonomas, Syphillis, other (BV, Hepatitis, Lice), transmission and prevention
• Anonymous questions generated three days prior to the forum
• Pre/Post Test development
• Conducted interactive PowerPoint presentation with a myth/fact component, Q&A session and Pos/Test
• Distributed wallet-sized Spanish& English laminated cards to all participants with summarized message regarding STIs and resources/phone #s to obtain testing/counseling
• Sought IRB addendum for pre/post test administration

Lessons Learned/Implications:

• Pretest findings revealed a need for education on the subject.
• Post-test findings revealed some improvement in knowledge and understanding
• The result of the post-test revealed that 100% of children expressed having learned something from the session.
• There was a significant difference in knowledge with p-value of 0.0.29
• There was no learning difference between the sexes

Challenges:

• Limited time to complete the project and review existing similar educational models

Curriculum: STI - Girls
                    STI - Boys
 

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Downtown Health Center- February 2005
Boosting Advocacy

Downtown Health Center is a general pediatric ambulatory clinic in central city Milwaukee serving families through various services including Pediatric resident education, BadgerCare enrollment, Adolescent Health Program, Smoking Cessation Program, Homeless Shelter health care and primary medical care.

Residents: Kenyita Berryhill, MD; Carol Papineau, BSN, RN; Nithya Sunders, MD; Stephanie, Whitt, MD
Faculty Advisor: Suzanne Brixey, MD

Goals/Objectives:

• Create awareness among legislators of the importance of passing the Child Passenger Safety Bill
• Create awareness among parents of the importance of using age appropriate child passenger restraints.
• Encourage advocacy efforts by faculty, fellows, and residents at Medical College of Wisconsin and Children's Hospital of Wisconsin and Marquette School of Nursing faculty and graduate students

Overview of Project Design:

• Educated and provided educational materials to parents at two Head Start Centers about the need for higher safety standards for child passengers
• Provided child passenger safety educational materials to Head Start Staff at both centers for future educational activities
• Collected 132 letters from parents to legislators in support of the Child Passenger Safety Bill
• Involved colleagues in Surgery and Emergency Medicine to facilitate advocacy efforts and collect signed letters to legislators
• Solicited support from Marquette University School of Nursing faculty and graduate students
• Collected 344 total letters from physicians including pediatric, surgery, and emergency medicine
• Empowered faculty from Children's Specialty Group and Children's Medical Group to advocate directly with their legislators
• Involved family members of residents by encoring them to contact their legislators
• Visited State Capitol and met with five staff for representatives and legislators to lobby for passage of the Child Passenger Safety Bill.

Lessons Learned/Implications:

• Advocacy on behalf of children was easier than expected.
• Most Legislators and their staff are accessible and open to listen to the concerns of their constituents concerns.

Challenges:
Getting more constituent support due to month time constraint

Project Products: 2005 Assembly Bill 70/Senate Bill 32 Childhood Motor Vehicle Injury Facts

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La Causa, Inc - January 2005
Urban Latino Children's Perceptions of Health

LaCausa, Inc. is a bilingual, multi-cultural agency serving children, youth and families through licensed daycare, crisis nursery, Family Resource Center, child welfare services, social services and other programs to nurture healthy family life and enhance community stability. LaCausa serves over 9,000 individuals annually.

Residents: Louella Amos, MD; Amy Lautz, MD;Tracy Pierret, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentors: Brenda Rios, Director Early Child Development Programs

Goals/Objectives:

• To learn about the health perspectives of children ages 8-12
• To identify the specific health concerns of La Causa's urban Latino youth population
• To guide La Causa in creating an after-school health curriculum addressing children's health perception

Overview of Project Design:

• Submitted addendum to IRB
• Addendum approved by IRB
• Informally socialized with target population prior to focus group sessions
• Obtained written consents from parents of eligible participants
• Randomly-recruited children between ages 9-12 years old (goal: 28 children)
• Organized four focus groups (goal: 7 children per group)
  • Girls 9-10 years old
  • Boys 9-10 years old
  • Girls 11-12 years old
  • Boys 11-12 years old
• Conducted 45-minute discussions using 4 piloted questions with probes designed by Drs. Ogren, Cameron, and Brown
• Recorded discussions with written and audiotape documentation
• Analyzed transcribed data
• Reported findings to La Causa administration

Lessons Learned/Implications:
Topics recommended for La Causa's curriculum are:

• For younger children:
  • Violence & Safety
  • Health Maintenance
  • Injury Prevention
• For older children topic should include:
  • Violence &Safety
  • STD/HIV
  • Sexuality
  • Mental Health
• Topics for both age groups that can be used in La Causa's curriculum include:
  • Substance Abuse
  • Contagious Illness(cold, flu, lice, scabies)
  • Asthma
  • Diabetes
  • Cancer

Challenges:

• Coordinating meeting times with children
• Arranging transportation for children participants after parental pick-up hour
• Willingness of parents to allow their children to participate in the focus groups
• Identifying and separating important data from focus groups

 

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Cit of Milwaukee Health Department - November 2004
Breaking Bad Habits: SIDS Prevention in Milwaukee

The City of Milwaukee Health Department's Maternal and Child Health Program works in reducing disparities in infant death and increasing school-readiness of preschool children. The goals of the Maternal Child Health Program are: (1) to decrease racial and ethnic disparities for infant mortality and (2) to provide healthy child development and school readiness for the children in Milwaukee.

Residents: Jason Chan, MD; Jason Chan, MD; Antoinette Hernandez, MD; Nilay Shah, MD; Jaime Twanow, MD
Faculty Advisor: Timothy Schum, MD
Community Mentor: Jill Paradowski, RN, newborn screening coordinator

Goal:

• To assist current programs in Milwaukee to approach reduction in infant mortality at the local levels by promotion of "Breaking Bad Habits".

Objectives:

• Understand the role of FIMR (Fetal Infant Mortality Review) in the community and its recommendation process for changes to reduce infant mortality and eliminate racial/ethnic disparities in mortality.
• Learn about analysis of pediatric records of infants who died and the statistical summary of this information so that the lay public can understand the data
• Work with healthcare providers, doctors in training, and communities to alert them about the educational messages necessary to prevent infant mortality, particularly safe-sleep environment, and prevention of prematurity such as tobacco smoke exposures.
• To develop a teaching tool and fact sheet designed to change the leading two modifiable risk factors for SIDS: sleep position and cigarette smoke exposures.

Overview of Project Design:

• With the assistance of the City of Milwaukee Health Department, reviewed literature on SIDS rates and risk factors, as well as identified specific areas and ethnic groups in Milwaukee with the highest SIDS rates.
• Attended the Fetal Infant Morality Review committee and reviewed causes of infant deaths for the previous two months and met other community partners committed to reducing infant mortality.
• Orientated ourselves on the Milwaukee infant mortality campaign and brainstormed on which messages are the most important to promote and how to best promote the recommended messages to the public.
• Focused on the two leading modifiable risk factors: sleep position and smoke exposure. Pediatric residents then developed a quiz designed to assess a patient's knowledge level of SIDS at both pre and postnatal appointments. The quiz would then be followed by a fact sheet and discussion about proper supine sleeping position and smoking cessation conducted by a healthcare provider.
• Teaching tool was also translated in Spanish and reviewed by multiple infant mortality experts as well as members of the target population: African American and Hispanic women.
• Contacted 17 organizations that provide services to these targeted populations including community-based organizations, advocacy groups, WIC offices, health clinics, and professional medical groups. Mailing included the quiz and fact sheet along with an invitation to have someone from our program talk with them about joining the campaign.
• Met with medical students from the MCW pediatric, family practice and obstetrics interest groups.

Lessons Learned/Implications:

• The importance of being focused on the goals. By staying focused, pediatric residents were able to narrow the project and produce tangible results.
• The experience with the health department was very positive. Public health specialists are passionate people who were eager to collaborate with us and bridge the medical and public health models. The health department is an excellent partner; they provide information, advice, and endless support.
• Medical students from the various interest groups will continue to be a great resource to sustain this community initiative on reducing infant mortality by the promotion of "Breaking Bad Habits".

Challenges:

• Health Department bureaucracy limits possible distribution of tool
• Excessive daily recording of activities and paperwork
• Balancing input from all sources

Assessment Tools: Parent Questionaire
                               Fact Sheet

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Next Door Foundation - October 2004
Who's Healthy Next Door?

Next Door Foundation is a child-centered and family focused agency in central city Milwaukee serving 2,500 children and families through various programs including Birth to 3, Early Head Start, Head Start, family literacy, Fatherhood Initiative, and parenting education.

Residents: Roshani Anandappa, MD; Jason Bruce, MD; Laura Franck, MD; Gretchen Karstens, MD
Faculty Advisor:  Earnestine Willis, MD, MPH,
Community Mentors: Linda Williams, RN, Health Coordinator, and Director of Social Services

Goals/Objectives:

• Design a fun, interactive, and creative nutrition and exercise curriculum for teachers aimed at 3-4 years olds at an inner city Head Start at Next Door Foundation (NDF)
• Create a brochure for families with information on obesity, exercise and nutrition
• Creative educational outreach to children's families
• Provide recommendations for future implementation and assessment of the program
• Advocate for implementation of the curriculum to Head Start's city wide health coordinator

Overview of Project Design:

• Developed 17 modules or lessons plans about nutrition and exercise activities to integrate into daily schedule at NDF
• Designed a brochure with facts about child obesity for families
• Piloted curriculum with Head Start teachers
• Met with the city-wide Health Coordinator to advocate for the implementation of a similar program into all Milwaukee Head Start Programs for children ages 3-4 years old

Lessons Learned/Implications:

• There are many resources available for professionals, families, and communities about exercise and nutrition education that can be adapted to address the particular need of any organization or community.

Challenges:

• Parent participation and involvement
• Buy in from all Head Start teachers at NDF

Curriculum: Who's Healthy Next Door?

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La Causa Inc. - September 2004
Urban Latino Children's Perception of Health

LaCausa, Inc. is a bilingual, multi-cultural agency serving children, youth, and families through licensed daycare, crisis nursery, Family Resource Center, child welfare services, social services, and other programs to nurture healthy family life and enhance community stability. LaCausa serves over 9,000 individuals annually.

Residents: Sarah Brown, MD; Cheryl Cameron, MD; David Ogren, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentors: Wendy Bahr, Director of Child Development and Prevention; Brenda Rios, Director Early Child Development Programs

Goals/Objectives:

• Understand health concerns from a child's perspective
• Collaborate with the community base organization (CBO) in identifying these health concerns within their population
• Help CBO design a health curriculum to address the identified health concerns

Overview of Project Design:

• Literature review on the topic
• Planned conducting four focus groups of 6-7 children per group
• Designed questions each with probes and piloted questions to asses level of understanding
• Met with La Causa Administrators to discuss logistics
• Worked on IRB proposal and submission
• Introduction of residents to study participants

Lessons Learned/Implications:

• Little is known about health concerns from a child's perspective that can lead to better preventive and educational efforts.

Challenges:

• Time Constraints
• IRB process wait time
• Coordinating meeting with the children

 

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2003-2004 Community Initiatives

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Downtown Health Center- March 2004
Wisconsin Needs a Boost

Downtown Health Center (DHC) is a general pediatric ambulatory clinic in central city Milwaukee serving families through various services including Pediatric resident education, BadgerCare enrollment, Adolescent Health Program, Smoking Cessation Program, Homeless Shelter health care and primary medical care.

Residents: Marlene Peng, MD; Teresa Uy, MD; Keri Wheeler
Faculty Advisor: Timothy Schum, MD
Community Mentor: Deborah Komberec, DHC Social Worker

Goals/Objectives:

• Learn current recommendations for child restraints in automobiles
• Advocate for stronger automobile child restraint laws in Wisconsin
• Become familiar with the lobbying process
• Learn the law making process

Overview of Project Design:

• Literature research
• Drafted and faxed 69 letters to state legislators that represent MCW/CHW pediatric residents
• Posted letter on the Dyson advocacy Capwiz web-site
• Met with representative's Aid who introduced Assembly Bill 724 (Booster Seat Bill)
• Lobbied for AB 724 with aides of senators and representatives
• Prepared and provided fact sheet for representatives and legislators
• Encouraged support of AB 724

Lessons Learned/Implications:

• Process by which bills are introduced and become law
• Lack of medical knowledge and expertise representation in state legislation related to child health related issues

Challenges:

• Authorization to acknowledge affiliations with Children's Hospital of Wisconsin and AAP
• Meeting with legislators themselves
• Legislative session had recently ended
• Countering arguments from the opposition

Advocacy Letter: Legislators

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Neighborhood House- February 2004
Food For Thought: Teaching Nutrition and Exercise at Neighborhood House

Neighborhood House is a non-profit organization in central city Milwaukee serving families and children through various services including early child-care, youth and tee programs, translation services to Indo-Chinese families, adult programs, computer education and outdoor environmental education.

Residents: Elizabeth Galloway, MD; Erica Kroncke, MD; Nosheen Shaikh, MD; Caroline Shieh, MD
Faculty Advisor: John Meurer, MD
Community Mentors: Clarence Johnson, Executive Director, NH; Dan Garcia, Youth and Family Services Manager, NH; Kelly Gruel, NH

Goal: To investigate the effectiveness of a nutrition and exercise education program on the food choices made by children of low-income families.

Objectives:

• Educate 10-12 y/o on healthy food choices and importance of exercise
• Create a nutrition and exercise curriculum
• Evaluate effectiveness of curriculum
• Provide materials and education for Neighborhood House staff to continue project with subsequent groups

Description of Children and Families Affected: 20 children, ages 10 to 12 years old from mainly low-income African American families in Milwaukee's central city.

Overview of Project Design:

• Created a nutrition and exercise curriculum
• Evaluated effectiveness of curriculum through a pre-test and post-test grocery shopping trip with the children to purchase a delicious dinner
• Created and taught 6 nutrition lessons with a 10 minute didactic portion and 10 minute activity
• Created and provided educational materials for Neighborhood House staff

Lessons Learned/Implications:

• Pre-test results were representative of standard food choices for this population of children
• Lessons need to be taught over a longer period of time and reinforced several times during the year
• Group dynamics could have affected food choices made by children

Challenges:

• Time constraints to complete cooking session
• How to modify curriculum for other age groups
• Short time frame of project
• Inconsistencies in children's participation pre and post

Curriculum: Food For Thought

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House Of Peace- January 2004
What's Cookin' at House of Peace

House of Peace (HOP) is a community center serving families and children through various social and health programs. Founded in 1968, HOP is a ministry of the Capuchin Franciscans.

Residents: Wendy Gavidia, MD; Erin Nunnold, MD; Priya Pais, MD;
Faculty Advisors: John Meurer, MD, MBA
Community mentors: Brother Mark Carrico, Executive Director and Linda Barnes, Social Worker

Goals/Objectives:
Design and implement a simple intervention to improve the nutritional health and reduce the risk of obesity among children whose families are served by the House of Peace.

Description of Children and Families Affected:
Over 300 families, including 800 children, are served through the House of Peace emergency food pantry

Overview of project design:

• Review analysis of survey from prior MDEP block rotation project
• Review of literature on the topic and healthy recipes
• Based on survey results, designed intervention
• Prepared set of recipes and health facts utilizing underused items from HOP emergency food pantry to be distributed in donated food bags on a monthly basis

Lessons learned/implications:

• Cooperation and collaboration with CBO is helpful in helping understand the community needs, strengths, and abilities
• Many web sites on healthy and nutritious recipes exist

Challenges:

• Children do not visit the House of Peace
• Services have to be provide through families and caregivers
• Families at HOP have limited resources therefore, recipes and ingredients had to be kept simple
• Reading level of families was unknown

Curriculum: What's Cooking

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Downtown Health Center- December 2003
No Shows: What do we know? Part 2: Barriers in Assessing Care at the Downtown Health Center

Downtown Health Center is a general pediatric ambulatory clinic in central city Milwaukee serving families through various services including Pediatric resident education, BadgerCare enrollment, Adolescent Health Program, Smoking Cessation Program, Homeless Shelter health care and primary medical care.

Residents: Katrina Ubell, MD; Ushma Patell, MD; David Melbye, MD
Faculty Advisor: Al Pomeranz, MD
Community Mentors: Shelly Penberthy, RN & Gail Kreklow, DHC Manager

Goals/Objectives:
Explore barriers to health care access and issues that prevent patients from keeping scheduled appointments

Description of Children and Families Affected:
More than 5, 300 children and adolescent use services at DHC; 83% are African-American; 8% Hispanic.

Overview of Project Design:

• Modified previous survey designed and pilot with DHC patients
• Designed a stamp to document DHC staff reminder call to patients
• Conducted phone interviews to patients who missed appointments despite receiving a reminder phone call to determine further reasons for missed appointments
• Explore strategies to help patients remember their appointments

Lessons learned/Implications:

• Despite receiving reminder call almost 60% of patients still forgot appointments
• No show rate improved by more than 10% when patients were advised next available appointment would be four months in the future.
• Lack of transportation was not a barrier at DHC

Challenges:

• Determining logistics for administering the survey
• Unable to reach 41% of the families due to phone disconnections
• Remainder of reasons that families missed appointments are difficult to prevent

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Downtown Health Center- November 2003
No Shows?What do we know? Barriers to Care

Downtown Health Center is a general pediatric ambulatory clinic in central city Milwaukee serving families through various services including Pediatric resident education, BadgerCare enrollment, Adolescent Health Program, Smoking Cessation Program, Homeless Shelter health care and primary medical care.

Residents: Kishore Vellody, MD; Tannaz Hild,MD; Shenell Smith, MD
Faculty Advisor: Al Pomeranz, MD
Community Mentors: Shelly Penberthy, RN Gail Kreklow, DHC Manager

Goals/Objectives:
Explore barriers to health care access, specifically the transportation issues that impact patients and their affect ability to show up for appointments at the Downtown Health Center.

Description of Children and Families Affected:
More than 5, 300 children and adolescent use services at DHC; 83% are African-American; 8% Hispanic.

Overview of Project Design:
With the assistance of the DHC social worker, residents surveyed two groups of patients.

Implications:
If survey results show transportation is an issue at the DHC. The proposed results will be used to advocate at the county and state level for better transportation services for Title-19 patients.

Challenges:

• Working across resident schedules
• Determining logistics for administering survey

Survey: Barriers to Healthcare

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House of Peace- October 2003
Nutritional Assessment

House of Peace (HoP) is a community center serving families and children through various social and health programs. Founded in 1968, HoP is a ministry of the Capuchin Franciscans.

Residents: Elizabeth Walenz, MD: Christopher Schwake, MD; Thomas Nichols, MD; David Mueler, MD
Faculty advisor: John Meurer, MD, MBA
Community mentors: Mark Carrico, Executive Director, House of Peace; Lynne Pavlic, Business and Community Development Coordinator, House of Peace Linda Barnes, Social Worker, House of Peace

Goal/objective: Assess the need at House of Peace to address overweight and obesity in children served through their food pantry by designing and implementing a survey for parents regarding:

• nutritional habits of children
• activity level of children
• perceptions of need for assistance in implementing life-style changes

Description of children and families affected: Over 300 families, including 800 children, are served through the House of Peace pantry.

Overview of project design:

• Review literature on topic
• Visit agencies that provide Support to HoP: Hunger Task Force and YMCA
• Research existing assessment tools
• Design and pre-test tool with focus group at HoP

Lessons learned/implications:

• Focus groups are essential elements of survey design
• Collaborating with community partners increases potential for successful efforts

Challenges:
Coordinating residents' and HoP staff schedules

Survey: Nutritional Assessment

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Nationally Recognized Community Initiatives

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Next Door Foundation: 2003
Filling the Cavities Between Children and Oral Health

The Next Door Foundation (NDF) is a child-centered and family focused agency in central city Milwaukee serving 2,500 children and families through various programs including Birth to 3, Early Head Start, Head Start, family literacy, Fatherhood Initiative, and parenting education.

Residents: Shelly Taylor, MD; Kimberly Kastner, MD; Jenifer Glatz, MD; Stephanie Lutter, MD
Faculty Advisor: Earnestine Willis, MD, MPH
Community Mentors: Sharon Schulz, Executive Director, NDF; Linda Williams, RN, NDF; Teri Birt, Early Childhood Assistant Director, NDF; Midge Pfeffer, Project Manager, Children's Health Alliance of Wisconsin

Goals/Objectives:
Improve access to oral health prevention and treatment through exploring barriers to oral health and increasing awareness through education.

Overview of Project Design:

• Literature review
• Assessed existing dental health resources at NDF
• Developed survey and obtained IRB approval for 100 parents to assess oral health needs
• Conducted focus group for parents (n=5)
• Contacted local dentists (n=14) to ascertain access to dental care through phone interviews
• Provided oral health workshop for Early Head Start educators
• Provided dental information for teachers at NDF
• Revised Head Start physical exam form to include oral health screening as part of routine physical exams and recommendations for referrals
• Sent letters to community dentists advocating acceptance of T19 patients (n=14)
• Met with Wisconsin Chapter of AAP Executive Board to advocate improved training for pediatricians on oral health.

Lessons Learned/Implications:

• Unmet oral health a significant problem locally and in US with serious effects on child development

Project team recommends:

• NDF continue education of parents and parent educators in collaboration with Children's Health Alliance of Wisconsin
• Establishment of more comprehensive oral health practice guidelines for pediatricians and family practice MDs
• Stress dental exam on other physical exam forms at other Head Start facilities
• Decrease barriers to oral health care for Head Start children

Challenges:

• Obtaining parental participation in oral health survey
• Acquiring information from local dentists on waiting period for appointment and access for T19 patients

Survey: Dental Fact Sheet

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La Causa Inc.- 2001
A Get-well Daycare

LaCausa, Inc. is a bilingual, multi-cultural agency serving children, youth and families through licensed daycare, crisis nursery, Family Resource Center, child welfare services, social services and other programs to nurture healthy family life and enhance community stability. LaCausa serves over 9,000 individuals annually.

Residents: Angela Baker, MD; Mark Hoeltzel, MD; Cate Kinyoun, MD
Faculty Advisor: Glen Flores, MD
Community Mentor: Ben Ortega, Director of Family Services, LaCausa, Inc.

Goal/Objectives:
Developing a model daycare program for mildly ill children to achieve:

1. Decrease in missed days of employment or education for parents;
2. Decrease in parental stress;
3. Increased job security for parents;
4. Satisfaction with child's care when mildly ill;
5. Increased perception of child safety during illness while parents are working or in school;
6. Decreased Emergency Department visits or unnecessary pediatric visits;
7. Increased participation in other LaCausa programs

Overview of Project Design:

• Literature review revealed that 350,000 children under 14 too sick to attend school or daycare each day nation-wide, costing employers $12 billion annually
• Designed model daycare including facility and equipment, staffing, safety, inclusion and exclusion criteria, other written policies and procedures
• Designed and piloted pre- survey for parents to further assess need and set baseline for outcomes. Pilot Survey revealed: (N=63)
  • 87% female; 32% married and living with spouse, 82% employed full-time; 34% attend school; 24% limited English proficiency
  • 60 children, 81% Latino
  • 61% report ever having problems finding daycare for sick child
  • Mean number of days of work or school missed in past year due to sick child: 6.24 (range 0-50); 3.3% lost a job; 39% lost wages due to sick child; 33% report falling behind or dropping out of school due to difficulties finding daycare for sick child
  • 49% report "moderately, very or extremely stressful" when child is sick
  • 20% felt child not safe at place child was taken during past year when sick; 78% think get-well daycare would be "very" helpful
  • 64% brought their children to urgent care clinic in past year
  • More than half (65%) brought children to an ED in past year

Lessons Learned/Implications:

1. Review of literature indicates unmet need nationally for daycare for children who are mildly ill
2. Study of outcomes for daycare for mildly ill children is needed and is built into this project;
3. Daycare for mildly ill children targeting Latino and/or low-income populations can serve as national model;

Challenges:

• Coordinating efforts across CBO's and pediatricians' schedules

Survey: Pre-Survey for Parents