CHILDREN'S HOSPITAL OF WI-MILWAUKEE
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PART V, SECTION B, LINE 5: CHW IS A MEMBER OF THE MILWAUKEE HEALTH CARE PARTNERSHIP, WHICH BRINGS TOGETHER MILWAUKEE'S HEALTH SYSTEMS, HOSPITALS, FEDERALLY QUALIFIED HEALTH CENTERS, AND LOCAL AND STATE PUBLIC HEALTH DEPARTMENTS, ALL COMMITTED TO WORKING TOGETHER TO CREATE A HEALTHIER MILWAUKEE. TO GET A HOLISTIC PICTURE OF HEALTH IN MILWAUKEE, EVERY THREE YEARS THE PARTICIPATING HEALTH SYSTEMS COMMISSION A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH THE MILWAUKEE HEALTH DEPARTMENT AND OTHER MUNICIPAL HEALTH DEPARTMENTS. THE ASSESSMENTS SERVE AS THE FOUNDATION FROM WHICH HOSPITALS AND LOCAL HEALTH DEPARTMENTS DEVELOP THEIR RESPECTIVE COMMUNITY HEALTH IMPROVEMENT STRATEGIES. THE ASSESSMENT FOR MILWAUKEE COUNTY INCLUDES THREE PRIMARY DATA SOURCES: - MILWAUKEE COUNTY COMMUNITY HEALTH SURVEY: THIS PHONE-BASED SURVEY OF NEARLY 1,312 MILWAUKEE COUNTY RESIDENTS ASSESSES ADULT AND CHILD HEALTH AND RELATED BEHAVIORS, AS WELL AS PERCEPTIONS OF TOP HEALTH ISSUES FOR THE COMMUNITY. - KEY INFORMANT INTERVIEW REPORT: THIS REPORT OF LOCAL PUBLIC HEALTH PRIORITIES IS MADE UP OF INPUT FROM 80 INDIVIDUALS, REPRESENTING 40 KEY INFORMANTS AND FOUR FOCUS GROUPS. - HEALTH COMPASS MILWAUKEE: A COMPILATION OF NUMEROUS PUBLICLY REPORTED DATA AND OTHER SOURCES ON ONE WEBSITE (HEALTHCOMPASSMILWAUKEE.ORG)WHILE THESE REPORTS PROVIDE RICH DATA, THEY PRIMARILY FOCUS ON THE ADULT POPULATION ACROSS THE ENTIRE COUNTY. TO ENSURE CHILDREN'S HOSPITAL'S HIGHEST PRIORITY CHILDREN ARE WELL REPRESENTED, WE CONSULTED ADDITIONAL PUBLIC SOURCES WITH THE CITY OF MILWAUKEE AS OUR SCOPE: - KIDS COUNT. FUNDED BY THE ANNIE E. CASEY FOUNDATION, THIS NATIONAL AND STATE-BY-STATE EFFORT TRACKS WELL-BEING INDICATORS FOR CHILDREN IN THE U.S. - U.S. CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY. IN ADDITION TO ITS DECENNIAL CENSUS, THE BUREAU COLLECTS AND DISSEMINATES DATA ACROSS A VARIETY OF TOPICS. - YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBS). THE DEPARTMENT OF PUBLIC INSTRUCTION CONDUCTS THIS SURVEY REGULARLY IN SCHOOLS ACROSS THE STATE. YRBS IS CURRENTLY UNDERGOING MAJOR MODIFICATIONS, SO COUNTY-LEVEL DATA WAS UNAVAILABLE AT THE TIME OF THIS REPORT. WE USED MILWAUKEE PUBLIC SCHOOL DISTRICT YRBS DATA IN LIEU OF COUNTY DATA BECAUSE MPS IS THE LARGEST DISTRICT IN THE COUNTY. - OTHER PUBLIC AND GOVERNMENT SOURCES. ADDITIONAL SOURCES INCLUDE WISCONSIN INTERACTIVE STATISTICS ON HEALTH AND THE MILWAUKEE HOMICIDE REVIEW COMMISSION ANNUAL REPORT.
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CHILDREN'S HOSPITAL OF WI-FOX VALLEY
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PART V, SECTION B, LINE 5: THE FOX VALLEY COMMUNITY HEALTH IMPROVEMENT COALITION (FVCHIC) IS COMPRISED OF FIVE PUBLIC HEALTH DEPARTMENTS AND FIVE HEALTH CARE SYSTEMS IN THE TRI-COUNTY SERVICE AREA OF CALUMET, OUTAGAMIE AND WINNEBAGO COUNTIES. THE FVCHIC CONTRACTS WITH JKV RESEARCH, LLC TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY FEW YEARS. JKV RESEARCH USED FOUR PRIMARY DATA SOURCES FOR FVCHIC'S ASSESSMENT: - RANDOM TELEPHONE SURVEY OF 1,500 ADULT RESIDENTS - A SURVEY-SUBSET WITHIN THE ADULT TELEPHONE SURVEY ABOUT A RANDOMLY SELECTED YOUTH IN THE HOUSEHOLD - MORE THAN 100 KEY INFORMANT INTERVIEWS WITH COMMUNITY MEMBERS AND STAKEHOLDERS FROM DIVERSE BACKGROUNDS AND SECTORS - YOUTH RISK BEHAVIOR SURVEYS CONDUCTED BY FOX VALLEY PARTICIPATING SCHOOL DISTRICTS, WITH A TOTAL OF 11,662 COMPLETED HIGH SCHOOL SURVEYSWHILE THESE SOURCES PROVIDE RICH DATA, THEY PRIMARILY FOCUS ON THE ADULT POPULATION ACROSS THE TRI-COUNTY AREA. TO ENSURE CHILDREN ARE WELL REPRESENTED, WE CONSULTED ADDITIONAL DATA SOURCES: - KIDS COUNT: FACILITATED BY THE ANNIE E. CASEY FOUNDATION, THIS NATIONAL AND STATE-BY-STATE EFFORT TRACKS WELL-BEING INDICATORS FOR CHILDREN IN THE U.S. - U.S. CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY: IN ADDITION TO ITS DECENNIAL CENSUS, THE BUREAU COLLECTS AND DISSEMINATES DATA ACROSS A VARIETY OF TOPICS. - OTHER PUBLIC AND GOVERNMENT SOURCES: ADDITIONAL SOURCES INCLUDE WISCONSIN INTERACTIVE STATISTICS ON HEALTH FROM THE WISCONSIN DEPARTMENT OF HEALTH SERVICES AND THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE'S COUNTY HEALTH RANKINGS.
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CHILDREN'S HOSPITAL OF WI-MILWAUKEE
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PART V, SECTION B, LINE 6A: THE FOLLOWING HOSPITAL FACILITIES WERE INTEGRAL TO THE COMPLETION OF THE MILWAUKEE HEALTH CARE PARTNERSHIP'S COMMUNITY HEALTH NEEDS ASSESSMENT: ADVOCATE AURORA HEALTH, COLUMBIA ST. MARY'S HEALTH SYSTEM, FROEDTERT HEALTH, AND WHEATON FRANCISCAN HEALTHCARE.
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CHILDREN'S HOSPITAL OF WI-FOX VALLEY
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PART V, SECTION B, LINE 6A: THE FOLLOWING HOSPITAL FACILITIES WERE INTEGRAL TO THE COMPLETION OF THE TRI-COUNTY AREA'S COMMUNITY HEALTH NEEDS ASSESSMENT: ASCENSION, ADVOCATE AURORA HEALTH, AND THEDACARE.
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CHILDREN'S HOSPITAL OF WI-MILWAUKEE
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PART V, SECTION B, LINE 6B: IN ADDITION TO THE HOSPITAL FACILITIES NAMED IN LINE 6A, CHW-MILWAUKEE CONDUCTED ITS CHNA WITH PUBLIC HEALTH OFFICIALS IN THE CITY OF MILWAUKEE AND OTHER MILWAUKEE COUNTY MUNICIPALITIES. THE CENTER FOR URBAN POPULATION HEALTH CONDUCTED THE ASSESSMENT FOR THE MILWAUKEE HEALTH CARE PARTNERSHIP. CHILDREN'S PROVIDED ADDITIONAL LEADERSHIP, RESEARCH AND ANALYSIS TO DEVELOP THE ASSESSMENT UNIQUE TO CHILDREN IN MILWAUKEE.
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CHILDREN'S HOSPITAL OF WI-FOX VALLEY
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PART V, SECTION B, LINE 6B: IN ADDITION TO THE HOSPITAL FACILITIES NAMED IN LINE 6A, CHW-FOX VALLEY CONDUCTED ITS CHNA WITH THE HEALTH DEPARTMENTS OF APPLETON, MENASHA AND OUTAGAMIE, CALUMET AND WINNEBAGO COUNTIES. JKV RESEARCH ADMINISTERED AND REPORTED ON THE YOUTH RISK BEHAVIOR SURVEY AND COMMUNITY MEMBER AND STAKEHOLDER SURVEY. CHILDREN'S PROVIDED ADDITIONAL LEADERSHIP, RESEARCH AND ANALYSIS TO DEVELOP THE ASSESSMENT UNIQUE TO CHILDREN IN THE FOX VALLEY.
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CHILDREN'S HOSPITAL OF WI-MILWAUKEE
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PART V, SECTION B, LINE 11: WE RECOGNIZE THAT CHILDREN'S HOSPITAL CANNOT COMPLETELY ELIMINATE EVERY CHALLENGE TO CHILDREN'S HEALTH. THESE ISSUES ARE LARGE AND COMPLEX, AND THERE ARE SOCIAL, ENVIRONMENTAL, GENETIC AND BEHAVIORAL FACTORS BEYOND OUR CONTROL. NOR CAN WE SOLVE THESE PROBLEMS ALONE. HOWEVER, AS A LEADER IN PEDIATRIC HEALTH CARE, WE ARE COMMITTED TO WORKING WITH OUR COMMUNITY PARTNERS TO MAKE A DIFFERENCE FOR THE KIDS WHO NEED US MOST. THROUGH PROGRAMMING, COLLABORATION AND EDUCATION, WE CAN LEVERAGE ALL AVAILABLE RESOURCES TO ENSURE THE BEST CARE FOR KIDS IN OUR COMMUNITY. AS THE FOLLOWING SECTIONS DEMONSTRATE, WE ARE ALREADY USING A VARIETY OF STRATEGIES TO MAKE STRIDES TOWARD THESE GOALS AND ARE ACTIVELY WORKING ON INITIATIVES THAT IMPACT ALL SIGNIFICANT NEEDS IDENTIFIED IN THE ASSESSMENT. PRIORITY #1: CHRONIC DISEASE MANAGEMENT - ASTHMA & ORAL HEALTHASTHMA IS A PREVALENT CHRONIC DISEASE FOR CHILDREN IN MILWAUKEE, MUCH MORE THAN MANY OTHER WISCONSIN COUNTIES, PUTTING CHILDREN AND YOUTH IN MILWAUKEE COUNTY AT GREATER RISK FOR HOSPITALIZATION AND MISSED SCHOOL DAYS IF THEIR CONDITION IS NOT MANAGED CORRECTLY. OUR PROGRAMS AND INITIATIVES THAT ADDRESS THE ASTHMA PRIORITY FOLLOW.WISCONSIN ASTHMA COALITIONSINCE 2001, CHILDREN'S HOSPITAL HAS SUPPORTED THIS DIVERSE, STATEWIDE COALITION THAT WORKS TO TAKE CONTROL OF ASTHMA THROUGH IMPLEMENTATION OF THE WISCONSIN ASTHMA PLAN. THE WISCONSIN ASTHMA PLAN IS A BLUEPRINT FOR MANAGING ASTHMA ACROSS THE STATE, AND INCLUDES THE FOLLOWING ACTIVITIES:SCHOOL AND CHILDCARE WALKTHROUGH PROGRAM - THIS PROGRAM PROVIDES AN ENVIRONMENTAL ASSESSMENT OF SCHOOLS AND CHILDCARE CENTERS FOR ENVIRONMENTAL ASTHMA TRIGGERS AND OFFERS LOW- AND NO-COST REMEDIATION STRATEGIES. IMPROVING OUTCOMES IN PRACTICAL ASTHMA MANAGEMENT THIS INITIATIVE OFFERS IN-PERSON EDUCATION FOR PRIMARY CARE PROVIDER TEAMS ON HOW TO IMPLEMENT THE NATIONAL ASTHMA GUIDELINES WITHIN THEIR CLINICAL PRACTICE. ASTHMA MEDICATION ASSISTANCE - AT CHAWISCONSIN.ORG/MEDS, THE COALITION HAS COMPILED AN ONLINE RESOURCE OF ALL PRESCRIPTION ASSISTANCE PROGRAMS AND COUPONS AVAILABLE FOR ASTHMA MEDICATIONS.SCHOOL-BASED ASTHMA MANAGEMENT PROGRAM - THIS IS A NATIONAL INITIATIVE OF THE AMERICAN ACADEMY OF ALLERGY, ASTHMA AND IMMUNOLOGY AND THE NATIONAL ASSOCIATION OF SCHOOL NURSES. IT INVOLVES A FOUR-STEP PROCESS TO IMPROVE THE SYSTEM OF CARE AND COMMUNICATION BETWEEN FAMILIES, CLINICIANS AND SCHOOLS.COMMUNITY HEALTH ASTHMA MANAGEMENT PROGRAM LAUNCHED IN 2015 AT NINE MILWAUKEE PUBLIC SCHOOLS, CHILDREN'S COMMUNITY HEALTH ASTHMA MANAGEMENT PROGRAM (CHAMP; FORMERLY ASTHMA CARE AND ENVIRONMENTAL SERVICES) PROVIDES SELF-MANAGEMENT EDUCATION BY A TRAINED ASTHMA EDUCATOR, ASTHMA ACTION PLAN REVIEW, TWO IN-HOME SESSIONS WITH A WALKTHROUGH, FOLLOW-UP CALLS AND RECOMMENDED ACTIONS FOR REDUCING ASTHMA TRIGGERS.ANTICIPATED IMPACT: EDUCATION, ASTHMA CONTROL. WE EXPECT THIS PROGRAM TO IMPROVE ASTHMA CONTROL, ENHANCE ASTHMA KNOWLEDGE, DECREASE THE PERCENTAGE OF EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS DUE TO ASTHMA EXACERBATION, DECREASE THE PERCENTAGE OF STUDENTS WITH ASTHMA WHO ARE CHRONICALLY ABSENT (MISSING AT LEAST ONE DAY OF SCHOOL PER WEEK AVERAGED OVER A MINIMUM OF THREE MONTHS), AND INCREASE THE NUMBER OF ENVIRONMENTAL RECOMMENDATIONS IMPLEMENTED TO REDUCE ASTHMA EXACERBATION.ASTHMA AND ORAL HEALTH ADVOCACYIN ADDITION TO SUPPORTING A STRONG MEDICAID/CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) PROGRAM AT THE STATE AND FEDERAL LEVELS, WHICH HELPS ENSURE KIDS HAVE ACCESS TO THE MEDICAL CARE THEY NEED, CHILDREN'S HAS SUPPORTED EFFORTS TO REDUCE YOUTH ACCESS AND USE OF TOBACCO-RELATED PRODUCTS. THIS INCLUDES ADVOCATING FOR LEGISLATION TO RESTRICT FLAVORED TOBACCO AND E-CIGARETTE PRODUCTS, RESTRICTING VAPING/E-CIGARETTE USE IN PUBLIC PLACES, PROHIBITING THE SALE OF VAPOR PRODUCTS TO MINORS AND RAISING THE AGE OF PURCHASE OF TOBACCO PRODUCTS TO 21. CHILDREN'S HAS ALSO SUPPORTED EFFORTS TO IMPROVE SCHOOL CONSTRUCTION NOTIFICATION ALERTS SO THAT STUDENTS WITH ASTHMA, ALONG WITH STUDENTS WITH OTHER HEALTH CONDITIONS, ARE WELL INFORMED AND BETTER ABLE TO MANAGE THEIR CARE.CHILDREN'S WISCONSIN HAS ADVOCATED FOR A NUMBER OF INITIATIVES TO HELP KIDS ORAL HEALTH, INCLUDING: SUPPORTING A STRONG MEDICAID/CHIP PROGRAM AT THE STATE AND FEDERAL LEVELS, WHICH HELPS ENSURE KIDS HAVE COVERAGE FOR THE ORAL HEALTH CARE THEY NEED; EFFORTS TO INCREASE DENTAL AND ORAL HEALTH CARE ACCESS, INCLUDING LEGISLATION TO EXPAND THE SETTINGS WHERE DENTAL HYGIENISTS CAN PROVIDE IMPORTANT PREVENTIVE CARE, AS WELL AS ADVOCATING FOR THE LICENSURE OF DENTAL THERAPIST; IMPROVING ORAL HEALTH CARE FOR KIDS IN OUT-OF-HOME CARE; INCREASING FUNDING TO HELP CARE FOR DENTAL PATIENTS WITH COMPLEX HEALTH CARE NEEDS; FUNDING FOR THE SCHOOL-BASED SEAL-A- SMILE PROGRAM TO ENSURE KIDS RECEIVE SEALANTS TO HELP PREVENT CAVITIES; EFFORTS TO LIMIT YOUTH VAPING, WHICH CAN HAVE ORAL HEALTH CONSEQUENCES.WISCONSIN SEAL-A-SMILEWISCONSIN SEAL-A-SMILE PROVIDES SCHOOL-BASED ORAL HEALTH PREVENTION SERVICES TO NEARLY 80,000 CHILDREN ACROSS THE STATE. THE CHILDREN'S HEALTH ALLIANCE OF WISCONSIN LEADS AND MANAGES THIS PROJECT IN COLLABORATION WITH THE WISCONSIN DEPARTMENT OF HEALTH SERVICES AND DELTA DENTAL OF WISCONSIN. APPROXIMATELY $1.10 MILLION IS MANAGED BY THE ALLIANCE AND AWARDED TO LOCAL PROGRAMS TO PROVIDE THESE SERVICES.ANTICIPATED IMPACT: ACCESS TO CARE, EARLY INTERVENTION. THE SEAL-A-SMILE PROGRAM WILL IMPACT ORAL HEALTH BY INCREASING THE NUMBER OF CHILDREN RECEIVING DENTAL SEALANTS AND ORAL HEALTH ASSESSMENTS IN SCHOOL. WE EXPECT TO SEE AN INCREASE IN THE PERCENTAGE OF CHILDREN IN ELIGIBLE SCHOOLS PARTICIPATING AND IN THE PERCENT OF THIRD GRADERS WHO HAVE DENTAL SEALANTS.WISCONSIN ORAL HEALTH COALITIONTHE WISCONSIN ORAL HEALTH COALITION LED BY CHILDREN'S HEALTH ALLIANCE OF WISCONSIN IS A DEDICATED GROUP OF MORE THAN 200 INDIVIDUALS, ORGANIZATIONS AND AGENCIES ADDRESSING ORAL HEALTH ACCESS ISSUES AND WORKING TO IMPROVE ORAL HEALTH FOR ALL RESIDENTS STATEWIDE. WE WORK TO CREATE MEANINGFUL CHANGE TO IMPROVE ORAL HEALTH AND ACCESS TO CARE THROUGH DIVERSE PUBLIC AND PRIVATE PARTNERSHIPS. ADDITIONALLY WE MANAGE AND SUPPORT EIGHT LOCAL ORAL HEALTH COALITIONS ACROSS WISCONSIN.ANTICIPATED IMPACT: ACCESS TO CARE. THIS COALITION WILL INCREASE ACCESS TO DENTAL SERVICES AND MOBILIZE PARTNERS AT THE GRASSROOTS LEVEL TO ENGAGE IN ADVOCACY AND PROGRAM DEVELOPMENT.WISCONSIN MEDICAL DENTAL INTEGRATION PROJECTTHE WISCONSIN MEDICAL DENTAL INTEGRATION PROJECT FOCUSES ON ENGAGING HEALTH SYSTEMS IN THE INTEGRATION OF DENTAL HYGIENE SERVICES IN THE PRIMARY CARE MEDICAL HOME. PARTICIPANTS WORK AS PART OF A LEARNING COLLABORATIVE TO IMPLEMENT QUALITY IMPROVEMENT TECHNIQUES AND IDENTIFY, DOCUMENT AND SPREAD BEST PRACTICES. THIS INTEGRATION PROJECT REACHES STATEWIDE INCLUDING ACROSS MILWAUKEE COUNTY. ANTICIPATED IMPACT: ACCESS TO CARE, EARLY INTERVENTION. WE EXPECT TO SEE AN INCREASED NUMBER OF PATIENTS RECEIVING DENTAL SERVICES AT A WELL VISIT AND AN INCREASE IN THE PERCENTAGE OF CHILDREN AGES 0-5 THAT REMAIN CARIES FREE AFTER RECEIVE DENTAL SERVICES AT A WELL VISIT.PRIORITY #2: INFANT MORTALITYINFANT MORTALITY WAS IDENTIFIED AS AN EMERGING TREND FOR THE MILWAUKEE HEALTH CARE PARTNERSHIP'S COMMUNITY HEALTH NEEDS ASSESSMENT; HOWEVER, CHILDREN'S LEADERSHIP AND COMMUNITY PARTNERS SEE IT AS A PROMINENT AREA OF FOCUS FOR CHILDREN'S. ESSENTIAL DRIVERS INFLUENCING RATES OF INFANT MORTALITY INCLUDE PRENATAL AND PERINATAL CARE, AND UNINTENTIONAL INJURIES.HEALTHY STARTHEALTHY START IS A PROGRAM THROUGH THE HEALTH RESOURCES AND SERVICES ADMINISTRATION DESIGNED TO IMPROVE ACCESS TO QUALITY HEALTH CARE AND SERVICES FOR WOMEN, INFANTS, CHILDREN AND MALE PARTNERS THROUGH OUTREACH, CARE COORDINATION, HEALTH EDUCATION AND CONNECTIONS TO HEALTH INSURANCE. HEALTHY START AIMS TO STRENGTHEN THE HEALTH WORKFORCE, SPECIFICALLY FOR THOSE INDIVIDUALS RESPONSIBLE FOR PROVIDING DIRECT SERVICES; BUILD HEALTHY COMMUNITIES; ENSURE ONGOING, COORDINATED, COMPREHENSIVE SERVICES ARE PROVIDED IN THE MOST EFFICIENT MANNER THROUGH EFFECTIVE SERVICE DELIVERY; AND PROMOTE AND IMPROVE HEALTH EQUITY BY CONNECTING FAMILIES WITH APPROPRIATE ORGANIZATIONS.ANTICIPATED IMPACT: AWARENESS AND ACCESS. HEALTHY START WORKS TO IMPROVE HEALTH OUTCOMES BEFORE, DURING AND AFTER PREGNANCY, AND REDUCE RACIAL/ETHNIC DIFFERENCES IN RATES OF INFANT DEATH AND ADVERSE PERINATAL OUTCOMES. (CONTINUED ON PAGE 66)
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CHILDREN'S HOSPITAL OF WI-FOX VALLEY
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PART V, SECTION B, LINE 11: WE RECOGNIZE THAT CHILDREN'S HOSPITAL CANNOT COMPLETELY ELIMINATE EVERY CHALLENGE TO CHILDREN'S HEALTH. THESE ISSUES ARE LARGE AND COMPLEX, AND THERE ARE SOCIAL, ENVIRONMENTAL, GENETIC AND BEHAVIORAL FACTORS BEYOND OUR CONTROL. NOR CAN WE SOLVE THESE PROBLEMS ALONE. HOWEVER, AS A LEADER IN PEDIATRIC HEALTH CARE, WE ARE COMMITTED TO WORKING WITH OUR COMMUNITY PARTNERS TO MAKE A DIFFERENCE FOR THE KIDS WHO NEED US MOST. THROUGH PROGRAMMING, COLLABORATION AND EDUCATION, WE CAN LEVERAGE ALL AVAILABLE RESOURCES TO ENSURE THE BEST CARE FOR KIDS IN OUR COMMUNITY. AS THE FOLLOWING SECTIONS DEMONSTRATE, WE ARE ALREADY USING A VARIETY OF STRATEGIES TO MAKE STRIDES TOWARD THESE GOALS AND ARE ACTIVELY WORKING ON INITIATIVES THAT IMPACT ALL SIGNIFICANT NEEDS IDENTIFIED IN THE ASSESSMENT. PRIORITY #1: CHRONIC DISEASE ORAL HEALTHORAL HEALTH IS AN INTEGRAL PART OF OVERALL HEALTH AND IS KEY TO CHILDREN'S GROWTH AND DEVELOPMENT. AND YET OUR ASSESSMENT NOTES THAT ONE IN THREE WISCONSIN CHILDREN ARE LIVING WITH UNTREATED DENTAL DECAY. PRIMARY ISSUES LEADING TO ADVERSE OUTCOMES IN PEDIATRIC ORAL HEALTH INCLUDE EARLY TOOTH DECAY AND ACCESS TO DENTAL CARE.WISCONSIN SEAL-A-SMILEWISCONSIN SEAL-A-SMILE PROVIDES SCHOOL-BASED ORAL HEALTH PREVENTION SERVICES TO NEARLY 80,000 CHILDREN ACROSS THE STATE. THE CHILDREN'S HEALTH ALLIANCE OF WISCONSIN LEADS AND MANAGES THIS PROJECT IN COLLABORATION WITH THE WISCONSIN DEPARTMENT OF HEALTH SERVICES AND DELTA DENTAL OF WISCONSIN. THE ALLIANCE MANAGES AND AWARDS APPROXIMATELY 1.10 MILLION TO LOCAL PROGRAMS TO PROVIDE THESE SERVICES.ANTICIPATED IMPACT: ACCESS TO CARE, EARLY INTERVENTION. THE SEAL-A-SMILE PROGRAM WILL IMPACT ORAL HEALTH BY INCREASING THE NUMBER OF CHILDREN RECEIVING DENTAL SEALANTS AND ORAL HEALTH ASSESSMENTS IN SCHOOL. WE EXPECT TO SEE AN INCREASE IN THE PERCENTAGE OF CHILDREN IN ELIGIBLE SCHOOLS PARTICIPATING AND IN THE PERCENT OF THIRD GRADERS WHO HAVE DENTAL SEALANTS.WISCONSIN ORAL HEALTH COALITIONTHE WISCONSIN ORAL HEALTH COALITION, LED BY CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, IS A DEDICATED GROUP OF MORE THAN 200 INDIVIDUALS, ORGANIZATIONS AND AGENCIES ADDRESSING ORAL HEALTH ACCESS ISSUES AND WORKING TO IMPROVE ORAL HEALTH FOR ALL RESIDENTS STATEWIDE. WE WORK TO CREATE MEANINGFUL CHANGE TO IMPROVE ORAL HEALTH AND ACCESS TO CARE THROUGH DIVERSE PUBLIC AND PRIVATE PARTNERSHIPS. ADDITIONALLY, WE MANAGE AND SUPPORT EIGHT LOCAL ORAL HEALTH COALITIONS ACROSS WISCONSIN.ANTICIPATED IMPACT: ACCESS TO CARE. THIS COALITION INCREASES ACCESS TO DENTAL SERVICES AND MOBILIZES PARTNERS AT THE GRASSROOTS LEVEL TO ENGAGE IN ADVOCACY AND PROGRAM DEVELOPMENT.WISCONSIN MEDICAL DENTAL INTEGRATION PROJECTTHE WISCONSIN MEDICAL DENTAL INTEGRATION PROJECT FOCUSES ON ENGAGING HEALTH SYSTEMS IN THE INTEGRATION OF DENTAL HYGIENE SERVICES IN THE PRIMARY CARE MEDICAL HOME. PARTICIPANTS WORK AS PART OF A LEARNING COLLABORATIVE TO IMPLEMENT QUALITY IMPROVEMENT TECHNIQUES AND IDENTIFY, DOCUMENT AND SPREAD BEST PRACTICES. THIS WORK TAKES PLACE ACROSS WISCONSIN, INCLUDING IN THE FOX VALLEY REGION.ANTICIPATED IMPACT: ACCESS TO CARE, EARLY INTERVENTION. WE EXPECT TO SEE AN INCREASED NUMBER OF PATIENTS RECEIVING DENTAL SERVICES AT A WELL VISIT AND AN INCREASE IN THE PERCENTAGE OF CHILDREN AGES 0 5 THAT REMAIN CARIES FREE AFTER RECEIVE DENTAL SERVICES AT A WELL VISIT.ORAL HEALTH ADVOCACYCHILDREN'S WISCONSIN HAS ADVOCATED FOR A NUMBER OF INITIATIVES TO HELP KIDS ORAL HEALTH, INCLUDING: SUPPORTING A STRONG MEDICAID/CHIP PROGRAM AT THE STATE AND FEDERAL LEVELS, WHICH HELPS ENSURE KIDS HAVE COVERAGE FOR THE ORAL HEALTH CARE THEY NEED; EFFORTS TO INCREASE DENTAL AND ORAL HEALTH CARE ACCESS, INCLUDING LEGISLATION TO EXPAND THE SETTINGS WHERE DENTAL HYGIENISTS CAN PROVIDE IMPORTANT PREVENTIVE CARE, AS WELL AS ADVOCATING FOR THE LICENSURE OF DENTAL THERAPIST; IMPROVING ORAL HEALTH CARE FOR KIDS IN OUT-OF-HOME CARE; INCREASING FUNDING TO HELP CARE FOR DENTAL PATIENTS WITH COMPLEX HEALTH CARE NEEDS; FUNDING FOR THE SCHOOL-BASED SEAL-A- SMILE PROGRAM TO ENSURE KIDS RECEIVE SEALANTS TO HELP PREVENT CAVITIES; EFFORTS TO LIMIT YOUTH VAPING, WHICH CAN HAVE ORAL HEALTH CONSEQUENCESPRIORITY #2: MENTAL AND BEHAVIORAL HEALTHBEHAVIORAL HEALTH ENCOMPASSES BOTH MENTAL HEALTH AND SUBSTANCE ABUSE, AND CONTINUES TO BE NOTED AS ONE OF THE GREATEST HEALTH PROBLEMS FOR FOX VALLEY RESIDENTS. WHILE THERE ARE MANY FACTORS IMPACTING A CHILD'S MENTAL AND BEHAVIORAL HEALTH, NOTABLE ISSUES FOR THE TRI-COUNTY AREA'S PEDIATRIC POPULATION INCLUDE BULLYING, ACCESS TO BEHAVIORAL HEALTH SERVICES AND SUICIDE.TO ACHIEVE OUR OBJECTIVES, CHILDREN'S WILL CONTINUE TO IMPLEMENT THE FOLLOWING STRATEGIES IN ALIGNMENT AND PARTNERSHIP WITH OUR COMMUNITY:CATALPA HEALTHIN COLLABORATION WITH TWO OTHER HEALTH SYSTEMS, THEDA CARE AND ASCENSION, CHILDREN'S PROVIDES STRATEGIC INVESTMENT AND ENGAGED LEADERSHIP TO IMPROVE ACCESS TO MENTAL HEALTH ACCESS AND SERVICES AS WELL AS CONNECTIONS TO COMMUNITY-BASED ORGANIZATIONS, RESOURCES AND ASSETS ACROSS THE FOX VALLEY REGION.ANTICIPATED IMPACT: CARE ACCESS AND QUALITY. CATALPA HEALTH IMPROVES CHILDREN AND FAMILIES' MENTAL HEALTH AND WELLNESS BY PROVIDING THE RIGHT CARE AT THE RIGHT TIME AND CLOSE TO HOME. CATALPA REDUCES WAIT TIMES FOR MENTAL HEALTH EVALUATIONS, INCREASES THE NUMBER OF MENTAL HEALTH PROVIDERS AND DECREASES NO- SHOW RATES FOR CLIENTS (WHEN LEAVING INPATIENT CARE).CHILD PSYCHIATRY CONSULTATION PROGRAM (CPCP)THERE IS A CRITICAL SHORTAGE OF CHILD PSYCHIATRISTS IN WISCONSIN AND NATIONWIDE. TO HELP FILL THE PROVIDER GAP THE MEDICAL COLLEGE OF WISCONSIN, IN PARTNERSHIP WITH CHILDREN'S AND THE STATE OF WISCONSIN OFFERS CPCP, AN ON-CALL MENTAL AND BEHAVIORAL HEALTH CONSULTATION SERVICE FOR ENROLLED PRIMARY CARE PROVIDERS. CHILD PSYCHIATRISTS, A PSYCHOLOGIST AND RESOURCE COORDINATORS PROVIDE ONGOING EDUCATION AND CONSULTATION TO PRIMARY CARE PROVIDERS ON BEHAVIORAL HEALTH ISSUES. THIS HELPS PRIMARY CARE PROVIDERS TREAT KIDS WITH MENTAL HEALTH ISSUES IN THEIR MEDICAL HOMES SO THAT KIDS CAN MORE QUICKLY GET THE TREATMENT THEY NEED.ANTICIPATED IMPACT: EARLY DETECTION, ACCESS TO CARE. WE WILL CONTINUE TO EXPAND THE NUMBER OF ENROLLED PROVIDERS AND CLINICS USING CPCP TO IMPROVE CHILD ACCESS TO HIGH QUALITY BEHAVIORAL HEALTH CARE SERVICES.SCHOOL AND FAMILY E-LEARNING COURSES AND RESOURCES: HEALTHY MINDS, ACT NOW! IT'S UR CHOICECHILDREN'S FUN AND ENGAGING E-LEARNING PROGRAMS INSPIRE STUDENTS AND THEIR FAMILIES TO LEAD HEALTHIER LIVES, BOTH PHYSICALLY AND EMOTIONALLY. OFFERED AT NO COST TO SCHOOLS ACROSS WISCONSIN, THESE PROGRAMS MEET NATIONAL HEALTH EDUCATION STANDARDS AND WERE DEVELOPED USING EVIDENCE- BASED RESEARCH AND COMMUNITY INPUT. TOPICS INCLUDE BULLYING PREVENTION, SUBSTANCE USE AND MINDFULNESS. RESOURCES ARE DESIGNED TO SERVE CHILDREN IN GRADES K3 8, OFFERING INTERACTIVE AND EDUCATIONAL MATERIALS FOR TEACHERS, COUNSELORS, STUDENTS AND FAMILIES, AND TRULY IMPACTING THE CULTURE OF HEALTH ACROSS SCHOOL COMMUNITIES.ANTICIPATED IMPACT: PREVENTION, REDUCED STIGMA. THESE E-LEARNING RESOURCES CAN IMPROVE STUDENT AND STAFF KNOWLEDGE, EMPOWER STUDENTS AND FAMILIES, IMPROVE SCHOOL CLIMATE, REDUCE BEHAVIORAL DIFFICULTIES AND STRESSORS, INCREASE POSITIVE BEHAVIORS, AND REDUCE OFFICE REFERRALS AND SCHOOL SUSPENSION, ALL OF WHICH CAN POSITIVELY INFLUENCE ATTENDANCE AND ACADEMIC PERFORMANCE.THE CONNECTION: N.E.W. MENTAL HEALTH THE CONNECTION IS A BACKBONE AGENCY LEADING A COLLABORATION OF COMMUNITY STAKEHOLDERS TO CREATE AND CONTINUOUSLY IMPROVE MENTAL HEALTH CARE FOR OUTAGAMIE, CALUMET AND WINNEBAGO COUNTIES. WITHIN THIS COLLECTIVE IMPACT MODEL, CHILDREN'S STAFF SIT ON THE BOARD OF DIRECTORS, AS WELL AS THE STEERING COMMITTEE FOR THE QUALITATIVE STUDY ON TEEN SUICIDE RELATED BEHAVIORS.ANTICIPATED IMPACT: SCREENING, ACCESS TO CARE. THIS PROGRAM AIMS TO INCREASE THE NUMBER OF ADOLESCENTS SCREENED FOR DEPRESSION, REDUCE THE RATE OF DEPRESSION IN YOUTH AGES 12 - 18, AND REDUCE THE NUMBER OF HIGH SCHOOL STUDENTS ATTEMPTING SUICIDE. (CONTINUED ON PAGE 63)
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CHILDREN'S HOSPITAL OF WI-MILWAUKEE
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PART V, SECTION B, LINE 16J: CHILDREN'S HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE FAP VIA ITS WEBSITE, BILLING STATEMENTS, MYCHART AND AT VARIOUS LOCATIONS THROUGHOUT CHILDREN'S HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES ARE GIVEN A PLAIN LANGUAGE SUMMARY UPON ADMISSION TO CHILDREN'S HOSPITAL. THE FULL WRITTEN POLICY IS AVAILABLE ON OUR WEBSITE AND UPON REQUEST. A PLAIN LANGUAGE SUMMARY IS AVAILABLE IN WAITING AREAS.
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CHILDREN'S HOSPITAL OF WI-FOX VALLEY
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PART V, SECTION B, LINE 16J: CHILDREN'S HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE FAP VIA ITS WEBSITE, BILLING STATEMENTS, MYCHART AND AT VARIOUS LOCATIONS THROUGHOUT CHILDREN'S HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES ARE GIVEN A PLAIN LANGUAGE SUMMARY UPON ADMISSION TO CHILDREN'S HOSPITAL. THE FULL WRITTEN POLICY IS AVAILABLE ON OUR WEBSITE AND UPON REQUEST. A PLAIN LANGUAGE SUMMARY IS AVAILABLE IN WAITING AREAS.
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CHILDREN'S HOSPITAL OF WI-MILWAUKEE
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PART V, SECTION B, LINE 20E: CHILDREN'S HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE FAP VIA ITS WEBSITE, BILLING STATEMENTS, MYCHART AND AT VARIOUS LOCATIONS THROUGHOUT CHILDREN'S HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES ARE GIVEN A PLAIN LANGUAGE SUMMARY UPON ADMISSION TO THE HOSPITAL. PRIOR TO REFERRING AN ACCOUNT TO A COLLECTION AGENCY OR UNDERTAKING ANY EXTRAORDINARY COLLECTION ACTIONS, CHILDREN'S HOSPITAL WILL MAKE EFFORTS TO COLLECT AMOUNTS DUE, INCLUDING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FAP. AS OUTLINED IN CHILDREN'S WISCONSIN POLICY "BILLING AND COLLECTIONS FOR SELF-PAY AMOUNTS", AT LEAST 3 BILLING STATEMENTS ARE SENT OVER A PERIOD OF 120 DAYS. CHILDREN'S HOSPITAL MAKES EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED.
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CHILDREN'S HOSPITAL OF WI-FOX VALLEY
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PART V, SECTION B, LINE 20E: CHILDREN'S HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE FAP VIA ITS WEBSITE, BILLING STATEMENTS, MYCHART AND AT VARIOUS LOCATIONS THROUGHOUT CHILDREN'S HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES ARE GIVEN A PLAIN LANGUAGE SUMMARY UPON ADMISSION TO THE HOSPITAL. PRIOR TO REFERRING AN ACCOUNT TO A COLLECTION AGENCY OR UNDERTAKING ANY EXTRAORDINARY COLLECTION ACTIONS, CHILDREN'S HOSPITAL WILL MAKE EFFORTS TO COLLECT AMOUNTS DUE, INCLUDING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE FAP. AT LEAST 3 BILLING STATEMENTS ARE SENT OVER A PERIOD OF 120 DAYS. CHILDREN'S HOSPITAL MAKES EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED.
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PART V, SECTION B, LINE 11 (CONTINUED):
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MENTAL AND BEHAVIORAL HEALTH ADVOCACYCHILDREN'S IS COMMITTED TO ENSURING CHILDREN GET THE MENTAL AND BEHAVIORAL HEALTH CARE THEY NEED AND WORKS WITH POLICYMAKERS TO IMPROVE ACCESS, COVERAGE AND CARE. THE ISSUES WE HAVE SUPPORTED INCLUDE THE FOLLOWING: IMPROVING ACCESS TO SCHOOL-BASED MENTAL HEALTH CARE ACROSS THE STATE BY REDUCING BARRIERS AND INCREASING FUNDING; FUNDING FOR BULLYING PREVENTION PROGRAMMING TO HELP STUDENTS DEVELOP SKILLS TO COMBAT BULLYING AND BUILD INTERPERSONAL COMMUNICATION SKILLS; FUNDING TO SUPPORT THE CHILD PSYCHIATRY CONSULTATION PROGRAM (CPCP), WHICH HELPS CONNECT PROVIDERS ACROSS THE STATE TO PEDIATRIC MENTAL AND BEHAVIORAL HEALTH EXPERTS TO PROVIDE ENHANCED CARE AND RESOURCES TO THEIR PATIENTS;EFFORTS TO RECOGNIZE THE IMPORTANCE AND EFFECTIVENESS OF TRAUMA-INFORMED CARE FOR CHILDREN AND FAMILIES; INITIATIVES TO IMPROVE MENTAL AND BEHAVIORAL HEALTH CARE FOR KIDS IN OUT-OF-HOME CARE, AS WELL AS POLICIES TO OFFER ALTERNATIVE FAMILY TREATMENT COURTS FOR PARENTS WITH ISSUES RELATED TO MENTAL ILLNESS OR SUBSTANCE ABUSE; FEDERAL EFFORTS TO EXPAND FUNDING FOR BEHAVIORAL TELEHEALTH CARE, LIKE THE CPCP; FUNDING TO INCREASE THE PEDIATRIC MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE TO ENSURE WE HAVE ADEQUATE PROVIDERS SPECIALLY TRAINED TO CARE FOR KIDS.PRIORITY #3: OVERWEIGHT AND OBESITYPHYSICAL ACTIVITY PLAYS AN IMPORTANT ROLE IN CHILDREN'S HEALTH AND WELLNESS, FROM PREVENTING OBESITY AND CHRONIC DISEASES TO SETTING THE STAGE FOR LIFELONG HEALTHY HABITS. TWENTY KEY INFORMANTS NEARLY ONE THIRD RANKED PHYSICAL ACTIVITY AS A TOP-FIVE HEALTH PRIORITY FOR THE FOX VALLEY. NOTABLE ISSUES TO ADDRESS OVERWEIGHT AND OBESITY IN THE FOX VALLEY INCLUDE MAKING SURE CHILDREN ARE REGULARLY ACTIVE, REDUCING EXCESS SCREEN TIME, AND CONSUMING VEGETABLES MORE REGULARLY.MISSION: HEALTHY KIDS (SCHOOL AND FAMILY E-LEARNING COURSES AND RESOURCES)MISSION: HEALTHY KIDS, A PARTNERSHIP OF KOHL'S CARES AND CHILDREN'S WISCONSIN, RAISES AWARENESS ABOUT THE IMPACT OF NUTRITION AND PHYSICAL ACTIVITY ON CHILDREN'S PHYSICAL DEVELOPMENT, ABILITY TO LEARN AND EMOTIONAL WELL-BEING.ANTICIPATED IMPACT: EDUCATION, SCHOOL CULTURE. SCHOOL ENGAGEMENT IN HEALTHY SCHOOLS CHALLENGES, FAMILY ENGAGEMENT IN HEALTHY FAMILIES CHALLENGES, SCHOOL APPLICATIONS FOR WISCONSIN SCHOOL HEALTH AWARD.BEWELL FOX VALLEYBEWELL FOX VALLEY (BWFV) IS A COMMUNITY HEALTH INITIATIVE WITH A MISSION OF PARTNERING TO ADVANCE A CULTURE OF HEALTH AND WELL-BEING FOR ALL IN THE FOX VALLEY. BWFV IS THE RESULT OF A ONE-YEAR RE-VISIONING PROCESS FOR WEIGHT OF THE FOX VALLEY IN 2018-19. BWFV HAS A GREATER FOCUS ON OVERALL WELL-BEING AND A MORE CONCENTRATED FOCUS ON CHANGING POLICY, SYSTEMS AND THE ENVIRONMENT, AS WELL AS SHIFTING CULTURE TO SUPPORT HEALTH. CONTINUING WITH A POPULATION-WIDE APPROACH, WHILE ALSO INCORPORATING SPECIAL EMPHASIS ON CHILDREN, FAMILIES AND OUR MOST VULNERABLE POPULATIONS, WILL HELP TO ENSURE THAT ALL COMMUNITY MEMBERS HAVE THE OPPORTUNITY TO LIVE LONGER, BETTER, HEALTHIER AND HAPPIER LIVES SINCE ITS TRANSITION TO BWFV, THE GROUP CONTINUES TO FOCUS ON HEALTH EATING, PHYSICAL ACTIVITY AND FOOD SECURITY.ANTICIPATED IMPACT: PREVENTION, COMMUNITY CULTURE. LOCAL GOVERNMENTS, THE PRIVATE SECTOR, NONPROFIT LEADERS AND COMMUNITY MEMBERS WORKING TOGETHER WILL IMPROVE INDIVIDUAL HEALTH AND WELL-BEING, ENHANCE PRODUCTIVITY, REDUCE HEALTH CARE COSTS, AND RECOGNIZE THE FOX VALLEY AS A DESIRABLE PLACE TO LIVE.OVERWEIGHT AND OBESITY ADVOCACYCHILDREN'S SUPPORTS POLICY EFFORTS AIMED AT ADDRESSING DETERMINANTS OF HEALTH, INCLUDING IMPROVING ACCESS TO HEALTHY AND AFFORDABLE FOOD AND SAFE AND SUPPORTIVE ENVIRONMENTS FOR OUTDOOR PHYSICAL ACTIVITY. WE HAVE SUPPORTED THE FARM-TO-SCHOOL PROGRAM, WHICH BRINGS LOCAL FOODS TO SCHOOLS AND ENCOURAGES HANDS-ON LEARNING ACTIVITIES WITH NUTRITIOUS, FRESH FOODS, AS WELL AS EFFORTS TO ENHANCE NUTRITION AND PHYSICAL EDUCATION REQUIREMENTS IN WISCONSIN SCHOOLS. WE HAVE ALSO ADVOCATED FOR EFFORTS TO IMPROVE ACCESS TO HEALTHY AND AFFORDABLE FOOD OPTIONS, PARTICULARLY FOR HOUSEHOLDS WITH LOWER INCOMES OR THOSE LIVING IN FOOD DESERTS. CHILDREN'S RECOGNIZES THE IMPORTANCE OF THE SNAP/FOODSHARE PROGRAM FOR WISCONSIN KIDS AND FAMILIES TO ENSURE ACCESS TO HEALTHY FOODS.
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PART V, SECTION B, LINE 11 (CONTINUED):
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FAMILY CASE MANAGEMENTCHILDREN'S HAS A CONTRACT WITH THE WISCONSIN DEPARTMENT OF CHILDREN AND FAMILIES, THROUGH THE DIVISION OF MILWAUKEE CHILD PROTECTIVE SERVICES, TO PROVIDE ONGOING CASE MANAGEMENT SERVICES FOR FAMILIES WHOSE CHILDREN HAVE BEEN DETERMINED TO BE UNSAFE AND SUBSEQUENTLY REMOVED WHILE PARENTS WORK ON ENHANCING THEIR ABILITY TO PARENT SAFELY. ONE OF THE SERVICES OUR CASE MANAGERS PROVIDE IS A NEWBORN SAFETY BUNDLE, WHICH INCLUDES EDUCATION AND SCREENING FOR SAFE SLEEP ENVIRONMENTS. IF FAMILIES DO NOT HAVE A SAFE SPACE FOR A BABY TO SLEEP, FAMILY CASE MANAGERS PROVIDE RESOURCES (E.G., PACK 'N PLAY, NEWBORN NEST, ETC.).ANTICIPATED IMPACT: EDUCATION, SCREENING. FAMILY CASE MANAGERS ASSESS SLEEP ENVIRONMENTS, PROVIDE EDUCATION, AND IF NECESSARY, RESPOND WITH APPROPRIATE INTERVENTION.HOME VISITINGTHROUGH OUR HOME VISITING PROGRAMS, PARENT EDUCATORS TRAINED IN VARIOUS MODELS PROVIDE IN- HOME PARENT EDUCATION, SUPPORT, COMMUNITY RESOURCES AND CHILD DEVELOPMENT SERVICES TO PREGNANT AND PARENTING FAMILIES. HOME VISITING USES AN EVIDENCE-BASED MODEL THAT IS FAMILY- CENTERED, CULTURALLY SENSITIVE, STRENGTH-BASED, AND PROMOTING OF POSITIVE CHILD DEVELOPMENT AND EARLY SCHOOL READINESS. ONE PARTICULAR CURRICULA USED IS SLEEP BABY SAFE, PROVIDED BY CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, WHICH PROMOTES A CONSISTENT AND CLEAR SAFE SLEEP MESSAGE AND OTHER RESOURCES FOR PROFESSIONALS WORKING WITH FAMILIES.ANTICIPATED IMPACT: PARENT KNOWLEDGE OF CHILD DEVELOPMENT. HOME VISITS IMPROVE CHILD HEALTH (E.G., CHILDREN WILL HAVE A PRIMARY CARE PROVIDER), CHILD DEVELOPMENT AND SCHOOL READINESS (E.G., DEVELOPMENTAL SCREENING AND FOLLOW-UP), MATERNAL HEALTH (E.G., POSTPARTUM DEPRESSION SCREENING AND FOLLOW-UP), AND POSITIVE PARENTING PRACTICES (E.G., HOME SAFETY ASSESSMENT).COMMUNITY HEALTH NAVIGATORS AND COMMUNITY CONNECTORSCHILDREN'S IS ACTIVELY PARTNERED WITH FIVE NEIGHBORHOODS ACROSS MILWAUKEE, ALIGNING CHILDREN'S RESOURCES WITH COMMUNITY NEEDS. AS CERTIFIED COMMUNITY HEALTH WORKERS, COMMUNITY HEALTH NAVIGATORS AND COMMUNITY CONNECTORS SUPPORT FAMILIES TO MEET BASIC NEEDS AND SUPPORT THEM AS THEY WORK TOWARD SELF-SUFFICIENCY FOCUSING ON HOUSING, SAFETY, FINANCIAL MANAGEMENT, EDUCATION, SOCIAL SUPPORT, PARENTING AND HEALTH.ANTICIPATED IMPACT: EMPOWERMENT. COMMUNITY HEALTH NAVIGATORS AND COMMUNITY CONNECTORS WORK WITH FAMILIES TO IMPROVE HEALTH OUTCOMES, INCREASE ACCESS TO AND UTILIZATION OF COMMUNITY RESOURCES, AND INCREASE SELF-SUFFICIENCY.INFANT MORTALITY ADVOCACYCHILDREN'S HAS ADVOCATED FOR A VARIETY OF INITIATIVES IN THIS AREA, INCLUDING SUPPORTING A STRONG MEDICAID/CHIP PROGRAM, WHICH HELPS ENSURE KIDS HAVE ACCESS TO THE MEDICAL CARE THEY NEED; INCREASED FUNDING FOR STATE AND FEDERAL HOME VISITING PROGRAMS TO PROVIDE PARENT EDUCATION AND RESOURCES ON TOPICS LIKE PREGNANCY AND PRENATAL CARE, CHILD DEVELOPMENT AND BEHAVIORS, WHICH HELP STRENGTHEN FAMILY FUNCTIONING AND REDUCE THE LIKELIHOOD OF CHILD MALTREATMENT; EFFORTS TO ENABLE MORE ACCURATE REPORTING FOR THE STATE'S BIRTH DEFECTS REGISTRY, WHICH WILL HELP CONNECT FAMILIES WITH RESOURCES THEY NEED; INCREASED FUNDING TO PROMOTE SAFE SLEEP PRACTICES AND IMPROVE INFANT AND CHILD DEATH REVIEW PROGRAMS TO BETTER UNDERSTAND RISK FACTORS AND CIRCUMSTANCES SURROUNDING CHILD DEATH AND TO DRIVE PREVENTION PROGRAMMINGPRIORITY #3: MENTAL AND BEHAVIORAL HEALTHBEHAVIORAL HEALTH ENCOMPASSES BOTH MENTAL HEALTH AND SUBSTANCE ABUSE, NOTED BY THE MHCP'S ASSESSMENT TO BE AMONG MILWAUKEE COUNTY'S GREATEST HEALTH PROBLEMS. NOTABLE ISSUES IN THE PEDIATRIC POPULATION INCLUDE ACCESS TO CARE, BULLYING AND SUICIDE. AT THE TURN OF 2020, THERE WAS A SIGNIFICANT INCREASE IN MENTAL BEHAVIORAL HEALTH DEMANDS IN WHICH CHILDREN'S RESPONDED IN MANY WAYS TO INCREASE ACCESS, SERVICES AND PARTNERSHIPS. A SAMPLING OF CHILDREN'S COMMITMENT TO AND INVESTMENT IN MENTAL BEHAVIORAL HEALTH IS FOLLOWING.CHILD PSYCHIATRY CONSULTATION PROGRAM (CPCP)THERE IS A CRITICAL SHORTAGE OF CHILD PSYCHIATRISTS IN WISCONSIN AND NATIONWIDE. TO HELP FILL THE PROVIDER GAP THE MEDICAL COLLEGE OF WISCONSIN, IN CONJUNCTION WITH CHILDREN'S AND THE STATE OF WISCONSIN, OFFERS CPCP, AN ON-CALL MENTAL AND BEHAVIORAL HEALTH CONSULTATION SERVICE TO ENROLLED PRIMARY CARE PROVIDERS. CHILD PSYCHIATRISTS, A PSYCHOLOGIST AND RESOURCE COORDINATORS PROVIDE ONGOING EDUCATION AND CONSULTATION TO PRIMARY CARE PROVIDERS ON BEHAVIORAL HEALTH ISSUES. THIS HELPS PRIMARY CARE PROVIDERS TREAT KIDS WITH MENTAL AND BEHAVIORAL HEALTH ISSUES IN THEIR MEDICAL HOMES SO THAT KIDS CAN MORE QUICKLY GET THE TREATMENT THEY NEED.ANTICIPATED IMPACT: EARLY DETECTION, ACCESS TO CARE. WE WILL CONTINUE TO EXPAND THE NUMBER OF ENROLLED PROVIDERS AND CLINICS USING CPCP TO IMPROVE CHILD ACCESS TO HIGH QUALITY BEHAVIORAL HEALTH CARE SERVICES.INTEGRATED MENTAL AND BEHAVIORAL HEALTH CAREA PSYCHOLOGIST OR PSYCHOTHERAPIST IS PART OF THE MEDICAL TEAM AT SOME CHILDREN'S WISCONSIN PRIMARY CARE SITES, MAKING IT EASY FOR PRIMARY CARE PROVIDERS (PCPS) TO CONSULT ON PATIENTS' BEHAVIORAL HEALTH CONCERNS, PROVIDE SAME-DAY BEHAVIORAL HEALTH SERVICES, AND MAKE AN IMMEDIATE AND IN-PERSON REFERRAL FOR PATIENTS WHO NEED MENTAL HEALTH INTERVENTION. THE PSYCHOLOGIST OR PSYCHOTHERAPIST OFFERS SAME-DAY BEHAVIORAL HEALTH SERVICES TO PATIENTS WHILE THEY ARE IN THE CLINIC TO SEE THEIR PCP, INCLUDING BEHAVIORAL HEALTH SCREENING, HEALTH AND BEHAVIOR CONSULTATION RELATED TO BEHAVIORAL MANAGEMENT OF PHYSICAL HEALTH CONDITIONS, INFORMAL CONSULTATION TO THE PCPS, AND "WARM HAND-OFFS." A WARM HAND-OFF ALLOWS THE PATIENT TO MEET THE BEHAVIORAL HEALTH PROVIDER IN PERSON AND FACILITATES THE DEVELOPMENT OF RAPPORT AND SUCCESSFUL REFERRAL TO A SEPARATE, CO-LOCATED BEHAVIORAL HEALTH VISIT. DURING THOSE VISITS, THE BEHAVIORAL HEALTH PROVIDER COMPLETES DIAGNOSTIC EVALUATIONS AND PROVIDES BRIEF PSYCHOTHERAPY, WITH CLOSE COORDINATION WITH THE PCP.ANTICIPATED IMPACT: ACCESS TO CARE. WHEN BEHAVIORAL HEALTH PROVIDERS ARE INVOLVED AS A FUNCTIONAL TEAM MEMBER DURING PRIMARY CARE VISITS (SAME-DAY BEHAVIORAL HEALTH VISITS), WE CAN IMPROVE FAMILY ENGAGEMENT IN PRIMARY CARE AND GREATLY REDUCE THE TIME TO ACCESS BEHAVIORAL HEALTH CARE.TRIPLE PTRIPLE P IS A UNIVERSAL ACCESS, EVIDENCE-BASED PROGRAM FOR CAREGIVERS OF CHILDREN AGES 0-12. IT AIMS TO INCREASE PARENTS AND CAREGIVERS' KNOWLEDGE OF POSITIVE PARENTING TECHNIQUES. PARENTS AND CAREGIVERS ARE REACHED THROUGH FIVE CHILDREN'S PRIMARY CARE CLINICS AND COMMUNITY SERVICES LOCATIONS IN MILWAUKEE AND RACINE.ANTICIPATED IMPACT: PREVENTION. WE TRACK THE NUMBER OF REFERRALS RECEIVED AND THE NUMBER OF FAMILIES ACTIVELY PARTICIPATING IN EDUCATION AND APPLYING ATTAINED SKILLS.SCHOOL-BASED MENTAL HEALTHSCHOOL-BASED MENTAL HEALTH SERVICES ARE PROVIDED TO STUDENTS WITH MENTAL AND BEHAVIORAL HEALTH CONCERNS IN THE CHILD'S OWN SCHOOL. THERAPISTS SPEND ONE TO FIVE DAYS PER WEEK IN NEARLY 50 PARTNER SCHOOLS, WHERE THEY PROVIDE ASSESSMENT AND PSYCHOTHERAPY TO CHILDREN WHO ARE REFERRED TO THE PROGRAM. THERAPISTS ALSO PROVIDE ONGOING PROFESSIONAL EDUCATION, SUPPORT AND CONSULTATION TO TEACHERS, PARENTS AND SCHOOL PERSONNEL.ANTICIPATED IMPACT: EARLY DETECTION, ACCESS TO CARE, REDUCED STIGMA. SERVICES INCREASE ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE FOR CHILDREN AND FAMILIES WHO MIGHT OTHERWISE HAVE BARRIERS TO SERVICE. BY INCREASING ACCESS, WE AIM TO REDUCE DISTRESSING SYMPTOMS AND BEHAVIORAL DIFFICULTIES, SUPPORT POSITIVE BEHAVIORS AND REDUCE DISCIPLINARY ACTION ALL OF WHICH POSITIVELY INFLUENCE KIDS' SCHOOL ATTENDANCE AND ACADEMIC PERFORMANCE.SCHOOL AND FAMILY E-LEARNING COURSES AND RESOURCES: HEALTHY MINDS, ACT NOW!, IT'S UR CHOICECHILDREN'S FUN AND ENGAGING E-LEARNING PROGRAMS INSPIRE STUDENTS AND THEIR FAMILIES TO LEAD HEALTHIER LIVES, BOTH PHYSICALLY AND EMOTIONALLY. OFFERED AT NO COST TO SCHOOLS ACROSS WISCONSIN, THESE PROGRAMS MEET NATIONAL HEALTH EDUCATION STANDARDS AND WERE DEVELOPED USING EVIDENCE- BASED RESEARCH AND COMMUNITY INPUT. TOPICS INCLUDE BULLYING PREVENTION, SUBSTANCE USE AND MINDFULNESS. RESOURCES ARE DESIGNED TO SERVE CHILDREN IN GRADES K3 - 8, OFFERING INTERACTIVE AND EDUCATIONAL MATERIALS FOR TEACHERS, COUNSELORS, STUDENTS AND FAMILIES, AND TRULY IMPACTING THE CULTURE OF HEALTH ACROSS SCHOOL COMMUNITIES.ANTICIPATED IMPACT: PREVENTION, REDUCED STIGMA. THESE E-LEARNING RESOURCES CAN IMPROVE STUDENT AND STAFF KNOWLEDGE, EMPOWER STUDENTS AND FAMILIES, IMPROVE SCHOOL CLIMATE, REDUCE BEHAVIORAL DIFFICULTIES AND STRESSORS, INCREASE POSITIVE BEHAVIORS, AND REDUCE OFFICE REFERRALS AND SCHOOL SUSPENSION, IN TURN POSITIVELY INFLUENCING ATTENDANCE AND ACADEMIC PERFORMANCE. (CONTINUED ON PAGE 72)
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PART V, SECTION B, LINE 11 (CONTINUED):
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MENTAL AND BEHAVIORAL HEALTH ADVOCACYCHILDREN'S IS COMMITTED TO ENSURING CHILDREN GET THE MENTAL AND BEHAVIORAL HEALTH CARE THEY NEED AND WORKS WITH POLICYMAKERS TO IMPROVE ACCESS, COVERAGE AND CARE. THE ISSUES WE HAVE SUPPORTED INCLUDE THE FOLLOWING: IMPROVING ACCESS TO SCHOOL-BASED MENTAL HEALTH CARE ACROSS THE STATE BY REDUCING BARRIERS AND INCREASING FUNDING; FUNDING FOR BULLYING PREVENTION PROGRAMMING TO HELP STUDENTS DEVELOP SKILLS TO COMBAT BULLYING AND BUILD INTERPERSONAL COMMUNICATION SKILLS; FUNDING TO SUPPORT THE CHILD PSYCHIATRY CONSULTATION PROGRAM (CPCP), WHICH HELPS CONNECT PROVIDERS ACROSS THE STATE TO PEDIATRIC MENTAL AND BEHAVIORAL HEALTH EXPERTS TO PROVIDE ENHANCED CARE AND RESOURCES TO THEIR PATIENTS; EFFORTS TO RECOGNIZE THE IMPORTANCE AND EFFECTIVENESS OF TRAUMA-INFORMED CARE FOR CHILDREN AND FAMILIES; INITIATIVES TO IMPROVE MENTAL AND BEHAVIORAL HEALTH CARE FOR KIDS IN OUT-OF-HOME CARE, AS WELL AS POLICIES TO OFFER ALTERNATIVE FAMILY TREATMENT COURTS FOR PARENTS WITH ISSUES RELATED TO MENTAL ILLNESS OR SUBSTANCE ABUSE; FEDERAL EFFORTS TO EXPAND FUNDING FOR BEHAVIORAL TELEHEALTH CARE, LIKE THE CPCP; FUNDING TO INCREASE THE PEDIATRIC MENTAL AND BEHAVIORAL HEALTH CARE WORKFORCE TO ENSURE WE HAVE ADEQUATE PROVIDERS SPECIALLY TRAINED TO CARE FOR KIDS.PRIORITY #4: VIOLENCETHE MILWAUKEE HEALTH CARE PARTNERSHIP COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED VIOLENCE AS MAJOR AREA OF CONCERN FOR BOTH COMMUNITY LEADERS AND COMMUNITY MEMBERS. OUR ASSESSMENT OF YOUTH IN MILWAUKEE COUNTY EMPHASIZED THEIR EXPOSURE TO AND EXPERIENCE OF VIOLENCE IN THREE AREAS: COMMUNITY VIOLENCE (INCLUDING GUNS, GANGS AND BULLYING), HUMAN TRAFFICKING AND CHILD MALTREATMENT (INCLUDING ABUSE AND NEGLECT). OUR PROGRAMS AND INITIATIVES THAT ADDRESS THE VIOLENCE PRIORITY FOLLOW:PROJECT UJIMAPROJECT UJIMA WORKS TO STOP THE CYCLE OF VIOLENT CRIMES BY REDUCING THE NUMBER OF REPEAT VICTIMS OF VIOLENCE THROUGH INDIVIDUAL, FAMILY AND COMMUNITY INTERVENTIONS AND PREVENTION STRATEGIES. THE PROGRAM'S KEY ELEMENTS INCLUDE HOSPITAL-BASED SERVICES (MEDICAL CARE, PEER SUPPORT, CRISIS INTERVENTION AND SOCIAL AND EMOTIONAL ASSESSMENT), HOME-BASED SERVICES (MEDICAL FOLLOW-UP OF INJURIES, EVALUATION OF PRIMARY HEALTH CARE NEEDS, PSYCHOLOGICAL SCREENING AND COUNSELING), COMMUNITY-BASED SERVICES (MENTORING, YOUTH DEVELOPMENT, FAMILY AND YOUTH SUPPORT GROUPS, GANG INTERVENTIONS, JOB PREPAREDNESS AND ADVOCACY TO ADDRESS LEGAL, EDUCATION AND HOUSING ISSUES), AND COMMUNITY AND PROFESSIONAL EDUCATION ABOUT YOUTH VIOLENCE. IN THE PAST TWO YEARS, THE PROGRAM HAS EXPANDED ITS SERVICES TO REDUCE AGE QUALIFIERS AND SERVE ALL CHILDREN AND HAS ESTABLISHED NEW MENTAL BEHAVIORAL HEALTH AND SOCIAL NEEDS ASSESSMENTS FOR BOTH THE FAMILY.ANTICIPATED IMPACT: PREVENTION. WE EXPECT TO MAINTAIN OUR CURRENT RECIDIVISM RATE OF LESS THAN 5 PERCENT FOR PROGRAM PARTICIPANTS.MILWAUKEE CHILD ADVOCACY CENTERCHILDREN'S CHILD ADVOCACY CENTERS (CAC) BRING TOGETHER MULTIDISCIPLINARY PARTNERS IN CHILD MALTREATMENT INVESTIGATIONS TO PROVIDE COMPREHENSIVE, ON-SITE MEDICAL, FORENSIC INTERVIEW AND ADVOCACY SERVICES FOR CHILDREN AND FAMILIES IN MILWAUKEE COUNTY. BY BRINGING TOGETHER PROFESSIONALS FROM LAW ENFORCEMENT, CRIMINAL JUSTICE, CHILD PROTECTIVE SERVICES, VICTIM ADVOCACY AGENCIES AND THE MEDICAL AND MENTAL HEALTH COMMUNITIES, CACS PROVIDE COMPREHENSIVE SERVICES FOR CHILD VICTIMS AND THEIR FAMILIES.ANTICIPATED IMPACT: PREVENTION, ACCESS TO CARE. THE CACS POSITIVELY IMPACT THE NUMBER OF CHILDREN AND FAMILIES BENEFITTING FROM A COMPREHENSIVE REVIEW, WHICH MINIMIZES TRAUMA AND HELPS TO BREAK THE CYCLE OF ABUSE AS WELL AS INCREASE PROSECUTION RATES FOR PERPETRATORS.PERIOD OF PURPLE CRYINGA PILOT PROJECT LAUNCHED IN 2016, PERIOD OF PURPLE CRYING IS AN EVIDENCE-BASED INFANT ABUSE PREVENTION PROGRAM THAT EDUCATES PARENTS AND CAREGIVERS ABOUT NORMAL INFANT CRYING AND THE DANGERS OF SHAKING AN INFANT. PARENTS AND CAREGIVERS ARE REACHED THROUGH CHILDREN'S WISCONSIN NEONATAL INTENSIVE CARE UNIT AND EMERGENCY ROOM, PRIMARY CARE CLINICS AND URGENT CARE LOCATIONS.ANTICIPATED IMPACT: PREVENTION. PERIOD OF PURPLE CRYING WILL INCREASE THE NUMBER OF FAMILIES THAT BENEFIT FROM ENHANCED KNOWLEDGE AND AWARENESS OF NORMAL INFANT CRYING, WHICH COULD REDUCE THE RATE OF INJURY FOR INFANTS.AWARENESS TO ACTIONTHIS STATEWIDE PROGRAM WILL BEGIN WORKING ACROSS MILWAUKEE COUNTY OVER THE NEXT THREE YEARS.AWARENESS TO ACTION EDUCATES AND ADVOCATES FOR ADULTS TO TAKE ACTION TO PREVENT CHILD SEXUAL ABUSE. EDUCATION INCLUDES RESOURCES FOR ADULTS ON HEALTHY SEXUAL DEVELOPMENT AND HOW TO DISCUSS SEXUAL DEVELOPMENT WITH CHILDREN.SCHOOL AND FAMILY E-LEARNING COURSES AND RESOURCES: ACT NOW!CHILDREN'S FUN AND ENGAGING E-LEARNING PROGRAMS INSPIRE STUDENTS AND THEIR FAMILIES TO LEAD HEALTHIER LIVES, BOTH PHYSICALLY AND EMOTIONALLY. OFFERED AT NO COST TO ALL SCHOOLS ACROSS WISCONSIN, THESE PROGRAMS MEET NATIONAL HEALTH EDUCATION STANDARDS AND WERE DEVELOPED USING EVIDENCE-BASED RESEARCH AND COMMUNITY INPUT. TOPICS INCLUDE BULLYING PREVENTION, SUBSTANCE USE AND MINDFULNESS. RESOURCES ARE DESIGNED TO SERVE CHILDREN IN GRADES K3 8, OFFERING INTERACTIVE AND EDUCATIONAL MATERIALS FOR TEACHERS, COUNSELORS, STUDENTS AND FAMILIES, AND TRULY IMPACTING THE CULTURE OF HEALTH ACROSS SCHOOL COMMUNITIES.ANTICIPATED IMPACT: PREVENTION, EMPOWERMENT. THESE E-LEARNING RESOURCES AND SERVICES CAN IMPROVE STUDENT AND STAFF KNOWLEDGE, EMPOWER STUDENTS AND FAMILIES, IMPROVE SCHOOL CLIMATE, REDUCE BEHAVIORAL DIFFICULTIES AND STRESSORS, INCREASE POSITIVE BEHAVIORS, AND REDUCE OFFICE REFERRALS AND SCHOOL SUSPENSION, IN TURN POSITIVELY INFLUENCING ATTENDANCE AND ACADEMIC PERFORMANCE.VIOLENCE PREVENTION ADVOCACYCHILDREN'S RECOGNIZES VIOLENCE AS A PUBLIC HEALTH EPIDEMIC WITH A DEVASTATING EFFECT ON THE CHILDREN AND FAMILIES OF WISCONSIN. CHILDREN'S ADVOCATES FOR A VARIETY OF LAWS, POLICIES AND FUNDING FOCUSED ON VIOLENCE PREVENTION, INCLUDING: FUNDING FOR BULLYING PREVENTION PROGRAMMING, HOME VISITING AND PARENT EDUCATION PROGRAMS, AND CHILD ABUSE AND NEGLECT PREVENTION, INVESTIGATION AND TREATMENT SERVICES; LEGISLATION TO FURTHER PROTECT CHILD VICTIMS OF SEXUAL ABUSE, TRAFFICKING AND DATING VIOLENCE; FUNDING FOR THE CHILD ABUSE PREVENTION AND TREATMENT ACT, AS WELL AS FOR ADDITIONAL FUNDING TO PROVIDE RESOURCES TO CARE PROVIDERS TO HELP IDENTIFY POTENTIAL PHYSICAL ABUSE IN INFANTS; POLICIES TO REDUCE CHILD AND YOUTH ACCESS FIREARMS, INCLUDING EFFORTS TO IMPROVE BACKGROUND CHECKS AND PROMOTE SAFE FIREARM STORAGE, AND USE OF OTHER SAFETY MECHANISMS TO BETTER PROTECT CHILDREN; ADDITIONAL FUNDING FOR U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION RESEARCH ON FIREARM-RELATED INJURIES AND FATALITIES.
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