TABLE OF CONTENTS

1.0 INTRODUCTION

Introduction And Overview Of The Day 1

Purpose Of The Forum 2

Background: The Healthiest Milwaukee Initiative 3

Using This Report 4

Where Do We Go From Here? 8

2.0 KEYNOTE ADDRESS

Dr. Julian M. Earls, Keynote Speaker 11

“Lessons From The Geese” 11

Persevere! 12

3.0 BRAINSTORMING PROCESS

Affinity Group Organization 13

Brainstorming Sessions 14

Facilitators And Recorders 16

4.0 HIGHLIGHTS OF BRAINSTORMING SESSIONS

Introduction 17

Major Goal 1: Health Care Is Accessible, Comprehensive, And Prevention-Oriented 17

Theme A 18

Theme B 19

Theme C 20

Theme D 22

Theme E 24

Major Goal 2: Community Education And Awareness Contribute To Healthful Behavior 25

Theme A 25

Theme B 27

Theme C 28

Theme D 28

Theme E 30

5.0 AFFINITY GROUP REPORT-OUTS

List of Acronyms Used 31

Introduction 32

Major Goal 1 32

Major Goal 2 57

APPENDIX A: BACKGROUND HEALTH DATA

Index of Charts i-ii

Introduction A-1

Identifying Major Goals A-9

Major Goal 1: Health Care Is Accessible, Comprehensive and Prevention-Oriented A-9

Major Goal 2: Community Education And Awareness Contribute to Healthful Behavior A-22

Focused Themes

Theme A A-30

Theme B A-37

Theme C A-40

Theme D A-48

Theme E A-57

APPENDIX B: CONFERENCE PARTICIPANTS

APPENDIX C: FEEDBACK ON THE HEALTH FORUM

Introduction C-1

Ideas to Action C-1

Evaluation Responses C-3

APPENDIX D: CONTRIBUTORS

1.0 INTRODUCTION

INTRODUCTION AND OVERVIEW OF THE DAY

Milwaukee is a unique city. It is exceptional in terms of the tremendous amount of health care resources available. From the state economic summit held in Milwaukee in November 2000, it was learned that the single largest private employer in Southeast Wisconsin is the health care industry, and the greatest impact on our economy is health care. Milwaukee is also unique in the diverse ethnic makeup of its citizens, and its geographic location—the largest urban center in the state, surrounded by agriculture, abutting one of the greatest bodies of fresh water. Milwaukee has an opportunity to serve as a national model for the country in terms of coordinating its resources and developing health care collaborations that create efficiencies and maximize capacity to ensure a healthier people.

On May 31, 2001, public health officials, health care providers, administrators, health educators, hospital and clinic staff, social workers, teachers, researchers, health insurance providers, policy makers, social service providers, and concerned citizens throughout southeast Wisconsin came together to participate in “Piecing Together a Healthy Community: A Milwaukee Forum on Health.” This was the first-ever Urban Health Conference in the Greater

Milwaukee Area.

Conference participants began their day with breakfast at the Hyatt Regency Hotel in downtown Milwaukee. Randall S. Lambrecht, Ph.D., Dean of the UWM College of Health Sciences, opened the conference and welcomed the 350+ conference participants with a talk entitled “Key Pieces to Complete the Picture.” He explained, “while dialogue is good, action is better and this is meant to be a participatory forum, where participant expertise, passion, and ideas are actually listened to and implemented.” Dr. Lambrecht then introduced the Keynote Speaker, Dr. Julian M. Earls. Dr. Earls, Deputy Director for Operations, NASA John H. Glenn Research Center, continued the theme with his motivating and inspiring presentation: “Imagination, Partnership, and Persistence—Linking the Pieces.” He motivated and inspired participants with “Lessons from the Geese,” and challenged participants to work together to find solutions to make Milwaukee a healthier community. Next, Seth Foldy, M.D., Health Commissioner of the City of Milwaukee, introduced the Healthiest Milwaukee initiative in “Healthiest Milwaukee: From Listening, To Vision, To Plan.” He presented an overview and summary of data that represented

“No puzzle is complete without all of the pieces, and you are one of them.”

—Randall S. Lambrecht, Ph.D., Dean of the UWM College of Health Sciences

The single largest private employer in Southeast Wisconsin is the health care industry, and the greatest impact on our economy is health care.

—From the November 2000 Economic Summit held in Milwaukee, WI

Milwaukee’s most significant health challenges, which provided the groundwork for smaller groups to discuss the issues and strategies. Following his message, Stephen Percy, Ph.D., Director of the UWM Center for Urban Initiatives and Research, described the affinity group brainstorming process in “It’s Time to Lay Out Solutions.” Following Dr. Percy’s address, the assemblage broke into “affinity groups.” These discussion groups continued throughout the day, concluding with “report-outs,” a few important, attainable ideas to improve health quality in Milwaukee. Following the report-outs, a reception concluded the day. Participants left the forum proud of their efforts to provide meaningful and “implementable” solutions to Milwaukee’s health care issues.

PURPOSE OF THE FORUM

The “Piecing Together a Healthy Community” health forum was created to inform the greater Milwaukee community about the Healthiest Milwaukee initiative and its work since May 1999 assessing urgent health issues in Milwaukee. The forum promoted discussions to enhance awareness of contemporary health challenges, and to energize commitments to innovative, collaborative strategies aimed at making Milwaukee a healthier community.

The goal of the forum was twofold: 1) to expand awareness of, and commitment to, creative and collaborative approaches to enhancing health quality, and 2) to develop plans that would establish ongoing, strategic partnerships to improve the community’s health.

The health forum provided an environment in which participants could think creatively about strategies and collaborations to improve health quality in Milwaukee. Dividing into small affinity groups, participants identified and outlined new, collaborative strategies for advancing the health of residents and for improving the effectiveness of the local health care system. These groups were also asked to identify potential partners and first steps in creating and implementing identified strategies.

BACKGROUND: THE HEALTHIEST MILWAUKEE INITIATIVE

In May 1999 the City of Milwaukee Health Department launched the Healthiest Milwaukee initiative. The Health Department created a partnership with an array of community organizations to explore ways to enhance health quality in Milwaukee. (See Appendix D for a complete list of participating organizations on the steering team.) The initiative partnership seeks a more coordinated, accessible system for preventive services and health care that communicates better and identifies opportunities to address root causes of poor health.

The group began by polling the public regarding their main health and environmental concerns as well as their ideas about how they and the community could work together to improve their families’ health. A random telephone survey of a representative cross-section of the city’s population solicited this information as well as respondents’ access to and satisfaction with health care and health information. Similar themes were also collected on suggestion cards distributed in newspapers, clinics, conferences, a website, and community settings. Focus groups solicited insights from African-American, Hmong, and Hispanic families, parents, faith leaders, shelters, business and political leaders, community-based organizations, and funders. Statistical information from birth and death records, hospitalization records, and local, state, and federal health surveys were also reviewed.

A Strategic Planning Subcommittee identified key themes from the information collected, and three general conclusions were drawn:

1. Health care and preventive health services are fragmented and difficult to access, resulting in significant missed prevention opportunities and increased disease and disability.

2. City residents seek more understandable health information and better communication with their health care providers.

3. Eliminating disparities in racial and ethnic health status is critical to Milwaukee’s overall health, and requires a long-term commitment to identifying and addressing problems related to poverty, lack of education, violence, and racism.

“This is meant to be a participatory forum, where participant expertise, passion, and ideas are actually listened to and implemented.”

—Randall S. Lambrecht, Ph.D., Dean of the UWM College of Health Sciences

Priorities were also identified to guide action, including:

· Children’s health needs;

· Sexual and reproductive health (reducing sexually transmitted diseases, reducing unwanted and teen pregnancies, and achieving healthier pregnancies);

· Improving environmental conditions, especially in homes and residential communities (housing, pollution and trash, crime, and injuries);

· Preventing and ameliorating common chronic conditions and meeting community needs for mental health, substance abuse, dental, and elder care services, with an emphasis on continuous access to services across life transitions;

· Working together as a community to promote wellness and healthy behaviors.

The Forum Planning Committee identified levers—strategic goals that are preconditions for success—across the various priorities identified by Healthiest Milwaukee. These levers formed the basis of the two main goals and the five cross-cutting themes that were addressed at the May 31, 2001 health forum. They are distinguished by being achievable in time and by requiring partnerships across various sectors for their success.

USING THIS REPORT

This report contains a number of pieces of information, including the assessment and health priority data collected from the Healthiest Milwaukee initiative survey, the forum affinity groups’ report-outs, and the relationship of health issues addressed in this forum to planning efforts and health agendas occurring at the state and national levels. Each is addressed here.

Health Priorities and Data for the City of Milwaukee

Healthiest Milwaukee produced a vision of creating two critical levers to eliminate health disparities and to maximize our city’s health. These levers are: 1) a coordinated, comprehensive, continuous, prevention-oriented system of health care, complemented by 2) a systematic community-wide

encouragement of healthy behaviors.* These levers must each in turn respond to cross-cutting themes that are critical to creating a healthy community. Both the health priorities and the deliberations of conference attendees were informed by the data provided in Appendix A. This information was collected from random telephone surveys in the City of Milwaukee, vital statistics, disease statistics, focus groups led by Healthiest Milwaukee, and “suggestion card” convenience surveys from a variety of sites. Most data refer specifically to the City of Milwaukee; others (as labeled) reflect county or regional information. Individuals or organizations seeking current data on which to base health planning decisions can review Appendix A for relevant statistics. For further information or clarification, contact the City of Milwaukee Health Department epidemiologist at (414) 286-3521.

Forum Affinity Groups Brainstorming Ideas

The conference was organized with the understanding that the two envisioned systems of health care and health promotion could not be built by any one party alone. Municipal, county, state, and federal programs must connect to one another to build these visions. Private charities, community activism, government agencies, and the business, faith, education, and media sectors all have roles to play. Nor can we focus exclusively on organizations within city limits in an integrated economic region that extends well beyond county lines. The Piecing Together a Healthy Community health forum consciously invited participants to “color outside the lines” for a day in order to explore how these intersecting concerns could be addressed, concretely and soon, by disparate interest groups. Outcomes reflecting these goals and themes are described in Section 5.0: Affinity Group Report-Outs. Individuals or organizations seeking guidance in designing or implementing health programs to meet the needs of Milwaukee can refer to these report-outs as a source of broad-based community input that was informed by current health statistics and surveys.

“This forum is designed to allow you to use your creativity to collectively reach solutions about the various issues.”

—Julian M. Earls, DrPH

“We invite you to ‘color outside the lines’ for a day to explore how these concerns can be addressed.”

—Stephen Percy, Ph.D., Director of the UWM Center for Urban Initiatives and Research

Each affinity group report represents a combination of the following elements mixed together in less than five hours. There was:

· Networking among those who had never before been aware of each others’ organizations, interests, expertise, and resources;

· Cross-talk among participants from different social sectors and professions;

· Ideas generated by review of relevant health statistics and surveys (Appendix A); and

· Ideas conceived that just seemed too fascinating to drop, even if their practical ramifications were unclear.

These products should not be viewed as hard and fast recommendations, but as ideas where a diverse group found promise for further pursuit. As the new Partnerships for Healthy Milwaukee organize, they will use many of the themes developed in the affinity groups’ brainstormings to catalyze community action.

Intersection with the United States’ “Healthy People 2010” and Wisconsin’s “Turning Point” Initiatives

Similar planning efforts have been under way at the federal and state levels. Healthy People 2010 is the prevention agenda for the Nation. It is a statement of national health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. Its overarching goals are to help individuals of all ages increase life expectancy and improve their quality of life, and to eliminate health disparities among different segments of the population. It proposes to track the following ten leading indicators in order to monitor and to motivate change:

· Exercise

· Overweight and obesity

· Tobacco use

· Substance abuse

· Responsible sexual behavior

· Mental health

· Injury and violence

· Environmental quality

· Immunization

· Access to health care

The specific Healthy People 2010 indicators may be useful in time to compare Milwaukee’s performance with other communities. In his presentation to the “Piecing Together a Healthy Community” conference, Dr. Seth Foldy characterized Milwaukee statistics as:

· Below average on Healthy People 2010 indicators related to exercise, overweight, tobacco use, substance abuse, homicide, and air quality;

· Similar to national averages on immunization coverage and health care access;

· Better performing than average regarding motor vehicle death rates.

· (Insufficient information exists to characterize our community’s mental health performance compared with national indicators.)

Wisconsin’s “Turning Point Initiative” seeks to transform relationships among the public and private entities that together make up the “public health system” across Wisconsin, and to develop a ten-year plan to improve health. It sees the mission of the public/private system to promote and protect health for all by assuring twelve essential public health services in each area of the state. An additional overarching goal is to eliminate health disparities. The ten-year plan will address five system (infrastructure) priorities, and the following eleven health outcomes priorities:

· Access to primary and preventive health services

· Adequate and appropriate nutrition

· Alcohol and other substance use, abuse, and addiction

· Environmental and occupational health hazards

· Existing, emerging, and re-emerging communicable diseases

· High risk sexual behavior

· Intentional and unintentional injuries and violence

· Mental health and mental disorders

· Overweight, obesity, and lack of physical activity

· Social and economic factors that influence health

· Tobacco use and exposure

Both the Healthiest Milwaukee initiative and the “Piecing Together a Healthy Milwaukee” conference planning groups felt there was strong concordance between Healthy People 2010, Turning Point, and Healthiest Milwaukee goals. Although language and degrees of specificity differ, the Healthiest Milwaukee goals and cross-cutting themes are inclusive of and contributory to the major directions of the state and federal planning efforts.

WHERE DO WE GO FROM HERE?

The Health Forum planning group asserts that future efforts must include a county-wide perspective, given the complementary and irreplaceable nature of differing City and County health and human services, and the regional nature of the health care, media, and other industries in our community. Milwaukee has lacked the cross-jurisdictional, cross-sectoral leadership that can motivate, mobilize, and hold accountable the broad range of players influencing our community’s systems of health care and health promotion. Therefore, an important next step is the commitment of the University of Wisconsin–Milwaukee, City of Milwaukee Health Department, United Way of Greater Milwaukee, Milwaukee County Division of Health Programs, Wisconsin Health and Hospital Association, and Medical College of Wisconsin to sustain a Partnership for Healthy Milwaukee that will continue to catalyze and coordinate an action agenda. The first task of the Partnership is to publish these proceedings. In future months, further steps will be taken to increase communications between the many individuals and organizations that were represented at the health forum (and the many more who were not) so that all of us can learn:

· What steps are being taken and by whom to build the Healthiest Milwaukee vision of health care and health promotion?

· Who are the partners that share your interest in a piece of the vision?

· What funding is available to build or sustain a part of the vision?

· What measurable progress can we point to in meeting our objectives?

· What must policy-makers do so our vision can become a reality?

· Where are partners meeting to discuss an issue that concerns you?

· Where can we find information about health statistics, community assets, best practices, or local or focused needs assessments?

· How can volunteers find opportunities that match their skills and interests?

The City of Milwaukee Health Department will use Healthiest Milwaukee concepts and input from this health forum to help guide program development in partnership with other organizations. Beyond this, the Healthiest Milwaukee Steering Team has decided that partnerships and shared leadership necessarily transcend city boundaries to include county, state, and federal agencies, other municipalities, and regional health care, education, media, and other interests. Although health needs may be relatively distinct from one community to the next, the systems for addressing these needs often operate on a regional level.

To facilitate the greatest degree of open exchange, communications will take the form of paper and electronic newsletters, as well as a website. We are in the process of building an initial database from Forum attendees and the mailing lists we used to contact some participants. To ensure that you hear more information in a timely manner, please provide your name, affiliation, address, and phone number to Lora Taylor at:

PARTNERSHIPS FOR HEALTHY MILWAUKEE

United Way UW–Milwaukee

of Greater Milwaukee OR College of Health Sciences

225 West Vine Street Enderis Hall

Milwaukee, WI 53212 P.O. Box 413

Milwaukee, WI 53201

Telephone: 414/263-8174 Telephone: 414/229-2961

LTAYLOR@UWAYMILW.ORG. LTAYLOR@UWM.EDU

2.0 KEYNOTE ADDRESS

DR. JULIAN M. EARLS, KEYNOTE SPEAKER

On May 31, 2001, Dr. Julian M. Earls delivered the keynote address at the “Piecing Together a Healthy Community” health forum. Dr. Earls currently serves as Deputy Director for Operations at the NASA John H. Glenn Research Center, Lewis Field, Cleveland. He holds degrees in physics, radiation biology, radiation physics, and environmental health. In addition, he is a graduate of the Harvard Business School’s prestigious Program for Management Development. Dr. Earls has received honors as both educator and manager, including the Presidential Rank Award of Meritorious Executive and induction into the National Black College Alumni Hall of Fame. Author of both technical and educational publications and visiting professor at numerous universities, he also serves on the advisory board for the Rock and Roll Hall of Fame in Cleveland.

An avid runner, Dr. Earls has run more than 10,000 miles in the last five years and has successfully completed 25 marathons, including the Boston Marathon. He notes that runners, like other focused individuals, are said to have the “will to win.” But he suggests that the will to win means nothing without the will to prepare. Just as runners prepare for competitions with a demanding regimen of exercises, practice runs, and strict diets, all prospective projects must start with careful preparation.

“LESSONS FROM THE GEESE”

In his presentation, Dr. Earls acknowledged the difficulties associated with pursuing and achieving an important goal, in this case, improving a city’s health care system. He insisted that all could take a lesson from the animal kingdom and illustrated his point with the following example:

“One of the biggest parallels I use relates to geese flying in a “V” formation. As each goose flaps its wings, it creates a “lift” for those that follow. And by following in a “V” formation, they can go a 71% greater distance than each goose flying alone. It is clear, then, that people who share a common direction and a common goal can go a lot further and get there a lot quicker.

“It’s much more difficult to do things individually than when working together.”

—Julian M. Earls, DrPH

“We cannot go abroad to get a health care system. That has to be homegrown. You have to provide that and we depend upon you.”

—Julian M. Earls, DrPH

Whenever one of the geese gets out of formation, it experiences drag and quickly gets back in formation. The lesson there is it’s much more difficult to do things individually than when working together.

When the lead goose gets tired, it rotates and gets back into formation while another goose takes the lead. The lesson here is shared leadership. We have to give everyone an opportunity to lead as well as an opportunity to follow because that gives the leaders an opportunity to rest.

The geese flying in the rear of the formation, when you hear them honking, are honking to give encouragement to the geese in front. How often in life is our “honking” not meant as encouragement, but as discouragement?

When a goose gets sick or wounded, two geese drop out of formation and stay with the sick or wounded goose until it either gets well or dies before they try to join another formation. The message is: we have to pause periodically for our colleagues. We all need help periodically. Standing by each other in difficult times is extremely important. These are the lessons from the geese.”

PERSEVERE!

Dr. Earls encouraged conference participants to persevere to reach meaningful solutions to the issues at hand:

“This forum is designed to allow you to use your creativity to collectively reach solutions about the various issues. You are critical elements when it comes to these kinds of problems. Understand [this]: we can go abroad to get TVs. We can go abroad to get computers. We can go abroad to get automobiles. We will go abroad to get space stations. But we cannot go abroad to get a health care system. That has to be homegrown. You have to provide that and we depend upon you.

You see, the true significance of this forum is not so much in what happens [here] as it is in what happens when you leave here because of what happens here.”

3.0 BRAINSTORMING PROCESS

AFFINITY GROUP ORGANIZATION

Affinity groups were used as the primary means of organizing brainstorming sessions—the venues where creative thinking took place. An “affinity group” is simply a group of individuals that shares a common interest or experience in a specific issue or area. To organize this forum, conference planners, building upon the work to date of the Healthiest Milwaukee initiative, identified two major goals:

GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED.

(Attention to Health Care Systems)

GOAL 2: COMMUNITY EDUCATION AND AWARENESS OF HEALTHFUL BEHAVIOR.

(Attention to Healthy Behaviors of People and Families)

Within each goal, five themes were identified:

Homes, neighborhoods, and environments are safe and hazard-free.

Ethnicity, culture, and language are integral elements of health care education and promotion.

Reproductive and sexual health education and services focus on family planning, assuring healthy pregnancy, and avoiding sexually transmitted diseases.

Parents and guardians meet children’s developmental and health needs.

Health services are continuous and linked, regardless of changes in life circumstances or health needs.

Each affinity group focused its discussions around the major goal and theme that identified their group. The charge given to each was to undertake creative thinking within the context of the focus set for the group. Facilitators helped their groups understand the general focal area for discussion.

“Let me reassure you that it was designed from the start with a little bit of chaos in mind.”

—Randall S. Lambrecht, Ph.D., Dean of the UWM College of Health Sciences

BRAINSTORMING SESSIONS

The forum plan included two morning periods and two afternoon periods for affinity group work. A workbook was prepared for each group to provide a common data set and to serve as a tool to help it understand its focus.

MORNING SESSION A: Understanding the Context

Purpose: To identify and outline the context that surrounds the focal area as a way to create a backdrop for the discussions that would follow throughout the day.

Questions 1) What are the key issues, realities,

Addressed: concerns, and challenges in this particular area of health care?

2) What do we need to recognize here as important background before we move on to new strategies?

MORNING SESSION B: Brainstorming Strategy Ideas

Purpose: To undertake creative thinking about new or different strategies, programs, or initiatives that might be used to enhance healthy outcomes in the focal area of the affinity group. Generating ideas was the focus.

Questions What programs or strategies could be used or

Addressed: tried to enhance healthy outcomes in the focal area of the group?

AFTERNOON SESSION A: Understanding the Context

Purpose: Ÿ To prioritize ideas identified in the previous session for further review by the group.

Ÿ To fill in details of the ideas selected for elaboration.

Questions 1) Prioritization: Of the full array of ideas for

Addressed: strategies and programs, which do we want to spend more time on in this session to elaborate and sketch out details? Which ideas are most innovative? Which are most likely to have an impact? Which of the goals can likely be launched and have impact within a two to three year time frame?

2) Idea Elaboration: From the ideas selected for elaboration, what should be the key goals or outcomes of the idea? What should the primary program elements be? Are there any programs in place that could assist or become part of the idea?

AFTERNOON SESSION B: Partnerships, First Steps,

Wrap-up

Purpose: Ÿ To brainstorm potential partners for moving the idea forward.

Ÿ To identify first steps in getting the idea moving.

Ÿ Wrap up: To select the two most interesting ideas to present to the full group.

Questions 1) Partners: What organizations could be

Addressed: brought together into a partnership to support or take leadership in moving the idea forward? What expertise or resources would they bring to the table? Whose involvement is critical to success?

2) First Steps: What first steps should be taken to move this idea forward toward action? Who might take the lead in making first steps happen?

3) Reporting Out: What are the two most exciting ideas that the group wants to share with the full group during a reporting-out session?

FACILITATORS AND RECORDERS

UWM Center for Urban Initiatives and Research

Lynn Ackerman Melindi Neluheni

Emily Branda Kim Stezala

Jenni Bugni Patricia Torres

Debra Fagan Sam White

Craig Maher Peter Walter

UWM College of Health Sciences

Elizabeth Bolt Bob Pietrykowski

Sandy Ceranski Bhagwant S. Sindhu

Rick Fons Nancy Smuckler

Marylou Gelfer Ginny Stoffel

Renee Gratz Pimjai Sudsawad

Cynthia Hasbrook Mary Taugher

John Lynch Mary Warren

Mary K. Madsen Joann Zander

Kathy Olewinski

UWM School of Nursing

Mary Jo Baisch

United Way of Greater Milwaukee

Molly Brush

Susie Gruenberg

Duane Mireles

Katie Pritchard

Claire Thompson

Marquette University

Gloria Dohearty

Megan Ehrmanntraut

Jamila Gray

Micah Playman

Nicole Rock

4.0 HIGHLIGHTS OF BRAINSTORMING SESSIONS

INTRODUCTION

The May 2001 health forum, the first forum on urban health in Milwaukee, focused on partnerships as the leverage point for change in communities. It brought together key stakeholders with the expertise, ingenuity, and experience to piece together a healthy community through an integrated and coordinated network of health care services. Its overall objective was to “brainstorm” and facilitate dialogue about how to work together to use community, academic, corporate, and government resources in a more efficient and strategic manner.

The following is a summary of the discussions that took place in each of the thematic affinity groups, along with the ideas and recommendations that emanated from those discussions.

MAJOR GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED

Although extensive changes in the welfare and medical assistance programs of Wisconsin and the United States have decreased the population of uninsured, there remains a large number of uninsured and underserved residents in the greater Milwaukee area. People without health insurance have historically received medical care from the “safety net,” that is, the many providers who voluntarily give uncompensated care. With 43 million Americans uninsured today—a group that has grown by one million each year for the last decade—the health care safety net has become increasingly crucial as a way for the medically indigent to get services. There are signs, however, that the safety net is weakening due to changes in the health care system. Because access to continuous and prevention-oriented health care is of primary concern, it defines the first major goal.

From a survey conducted in the year 2000, the majority of people (65% to 80%) were found to receive health insurance through their employer; approximately 30% through Medicare/Medicaid; a very small percentage through BadgerCare; and just over 10% purchased it themselves. Access to health care is not only

dependent upon one’s ability to pay, but also upon one’s ability to maneuver through the system. The uninsured and underinsured include those who are eligible for insurance but who do not enroll as well as those who are not eligible for current programs. Nearly one-quarter of American families reported that it has become more difficult to get medical care, and low-income families were more likely to report worsening access to care. But this perception is by no means confined to the poor. Roughly one in five families with incomes equivalent to 400 percent of the poverty rate or higher have experienced increased difficulty in getting care. Of the uninsured adults in Milwaukee, the 18- to 24-year-old age group ranked highest in lack of insurance coverage.

Approximately 12% of Milwaukee’s central city respondents do not have insurance, compared to 6.5% of respondents living outside of the central city. An increasing percentage of City of Milwaukee residents with insurance reported being insured at any point in time during the year (90% in 1999), but many also suffered temporary loss of insurance sometime during that period (76%).

THEME A: HOMES, NEIGHBORHOODS, AND ENVIRONMENTS ARE SAFE AND HAZARD-FREE

Context: This theme provided the basis for discussion about the impact of home life, environment, and neighborhood on safety and community health. Under this broad umbrella are initiatives that include accidents, injuries, violence, food and water safety, environmental factors that contribute to asthma and allergies, lead poisoning, and contaminated recreational areas. Of the health conditions that were affected by the environment as reported in 1999 in Milwaukee County, asthma was the most common, followed by increased blood lead levels. Injuries represented the most common cause of mortality in the 15- to 24-year-old age group, with homicides accounting for almost two-thirds of injury cases.

Summary: In the context of building community leadership and addressing safer neighborhoods and environments, the affinity group recommended that better access to health care be provided through more centers and clinics that would cooperate and coordinate activities and focus on education and prevention. The group challenged central city business and government to provide leadership in this endeavor. The group felt that these bodies should assist in locating the resources necessary to encourage and nurture a more supportive economic climate, as well as encourage an ethical and moral business climate. Forming partnerships that

would advocate for safe environments and that would increase the capacity to serve children from birth through 18 years of age was seen as an important initiative.

THEME B: ETHNICITY, CULTURE, AND LANGUAGE ARE INTEGRAL ELEMENTS OF HEALTH CARE EDUCATION AND PROMOTION

Context: This theme is consistent with Healthy People 2010 in addressing broad-reaching national health goals for the first decade of the new century. One of the main goals of the initiative is to eliminate—not just reduce—health disparities for all minority groups, including African-Americans, Hispanics, Native American Indians, and Southeast Asians to name a few. In spite of many medical breakthroughs, there are significant health care disparities for minorities. This affinity group addressed the scenarios and trends of the upcoming decade, including a larger, more diverse, aging population and a host of new health risks such as emerging infectious diseases.

The 2000 Healthiest Milwaukee Survey identified a number of health problems and disorders that disproportionately affect minority groups. These include diabetes, high blood pressure, asthma, and heart conditions. In addition, infant mortality is significantly higher in non-whites. Approximately 5% of Milwaukee County’s population cannot speak English fluently and 1.8% is linguistically isolated completely. Similar to Healthy People 2010 objectives, the goal should be to eliminate health care disparities and include a call for increased access to quality health services; an increase in community-based programs that are culturally and linguistically appropriate; an increase in minority health professional graduates; and improved data gathering to better understand health disparities and service needs.

Summary: The affinity group was clear about the need for better communication and cultural understanding. The group felt keenly that strong links should be established between the community and business, with inclusion of minorities on steering committees and decision- and policy-making boards. Members of the group agreed that culturally appropriate curricula and faith-based organizations should be incorporated into the community health care system. Partnerships that encourage minorities to enter the health care professions, and improved diversity in hiring will significantly help to provide for a more diversified health care workforce.

THEME C: REPRODUCTIVE AND SEXUAL HEALTH EDUCATION AND SERVICES FOCUS ON FAMILY PLANNING, ASSURING HEALTHY PREGNANCY, AND AVOIDING SEXUALLY TRANSMITTED DISEASES (STDs)

Context: Rates of adolescent pregnancy vary widely in the United States. Birth rates in Milwaukee among 15- to 19-year-olds have been increasing since 1997 to almost 1 in 10. Currently, 26% of pregnant teens in the central city give birth to live babies, as compared to 15% in the outer ring and 5% in the suburbs. Milwaukee ranks sixth among the 50 largest cities in births to teen mothers and second in the percentage of births to teens who are already mothers.

In the United States, family planning services for teenagers are concentrated in federally funded family planning clinics such as Planned Parenthood affiliates and local health departments. Some believe that the prevention of adolescent pregnancy might be improved by expanding the family planning services provision to include physicians in clinics or in private offices who specialize in gynecology, adolescent medicine, and family practice. Less than 50% of sexually active youth use a condom. Public insurance pays for family planning services in the United States; many private insurance carriers do not.

Sexually transmitted infections outnumber by fourteen-fold all other infections in Milwaukee County. After homicides, AIDS is the second leading cause of death amongst those 25 to 44 years old. Many factors lead teens to make poor choices. Homelessness, dysfunctional home life, substance abuse, uninformed parents, and counseling barriers all contribute to unwanted and unhealthy pregnancies and STDs.

Summary: The affinity groups agreed that education and strong community leadership and community-based programs are crucial. Although sex education programs in schools have existed for many years, most programs have not been as effective as hoped. Schools across the country must take a vigorous look at their current programs and begin to implement more innovative ones that have been proven to be effective. Constituent-driven and community-based partnerships that support traditional and non-traditional organic health systems for reproductive health are essential components of a successful program. In addition to the family, faith-based organizations and businesses are recognized as important support groups.

The group felt that Instead of promoting promiscuity, the media and entertainment industries ought to be partners in prevention. Schools, hospital and health care provider systems, and youth organizations are also important leaders. Educators, parents, and policy-makers should avoid emotional misconceptions about sex education by looking objectively at the rates of unwanted pregnancies and STDs (including HIV) among teenagers. The group agreed that the need for education, both on how to postpone sexual involvement and on how to protect oneself when one is sexually active, can no longer be ignored. A comprehensive risk prevention strategy using multiple elements to protect as many of those at risk of pregnancy and STD/HIV infection is essential and could be feasible. Children need family-centered models of assessment as well as education about pregnancy and STD prevention coupled with access to health reproductive services. Access to health care reproductive services for families and those of childbearing age should be improved.

THEME D: PARENTS AND GUARDIANS MEET CHILDREN’S DEVELOPMENTAL AND HEALTH NEEDS

Context: Family-centered services and supports are developed with a philosophy that recognizes the pivotal role of the family in the lives of children. This approach ensures that families are supported in the natural care-giving and decision-making roles for their children by building on their strengths and attitudes. Community-based collaborative efforts are developed in hopes of improving outcomes for children and families. Community collaborations often focus on outcomes such as "healthy children," "safe, secure homes," or "children who are ready for school." These outcomes are important, but often hard to measure and do not suggest a specific set of strategies that will allow a community to know if its activities are leading to improvement. Leaders must facilitate the creation of shared vision and must support the links between the vision and the outcomes. Parents and professionals should be equal partners in developing family-centered services and supports, as well as in developing a broad system of services and supports within a community.

Milwaukee ranks lowest in 100 cities in infant mortality. SIDS is the leading cause of death for infants under 1 year of age. One-half of infants who die in the inner city were exposed to environmental tobacco smoke including 92% who died from SIDS. Injuries are the leading cause of death in the 1- to 14-year-old age group. Parents’ leading concerns for their children’s health include nutrition, negative role models, and insurance and financial barriers to receiving health care. Twenty-nine percent of children under the age of 18 in Milwaukee County live in poverty compared with 38% in the City of Milwaukee. Young adults report emotional stress, poor eating habits, sexual activity, and substance abuse as concerns to their health. Mental health disorders/diseases are the leading cause of hospitalization among 10- to 14-year-old Milwaukee County residents. Twenty-eight percent of Wisconsin High School students reported seriously considering suicide and 8% of those attempted it in the past 12 months.

Summary: The affinity group felt that parents and health care professionals seem to be disconnected when it comes to assessing and meeting family health needs. The community may not be meeting the needs of families, and many parents may be in denial of their children’s behavior. By developing systems of care, supportive communities recognize the central role of the family. The group agreed that families must be part of policy- and decision-making at all levels. Meaningful representation of families (not just a "token" parent here and there) should exist on community boards and committees, and cultural, racial, and linguistic diversity should also be represented. Families should be full members, not just advisors, and should be seen as having the knowledge and expertise that is vital to creating effective services and supports in the community. Communities should have an organized way to get feedback from families about the services they provide. Communities can offer support by:

· Helping to develop parent-to-parent support and advocacy organizations and networks, where families help one another.

· Providing information and resource libraries, centers, or other ways to connect families with the information they need to nurture their children effectively.

· Recognizing that families’ needs and children’s needs must be addressed in order to provide beneficial services and supports.

· Developing an interactive listserv that brings together families, businesses, service providers, government agencies, and community leaders to plan services and supports for children and families, especially children with disabilities and special needs.

Two ideas that relate to the previous items were presented. They are the establishment of:

· A Neighborhood Health Network, based on geographical areas, which would bring together schools, police, health care providers, and faith-based organizations.

· A parent-/family-/consumer-friendly Universal Access Initiative.

THEME E: HEALTH SERVICES ARE CONTINUOUS AND LINKED, REGARDLESS OF CHANGES IN LIFE CIRCUMSTANCES OR HEALTH NEEDS

Context: Inadequate resources and lack of access to health care over a lifetime creates problems for individuals and families. There ought to exist a comprehensive health care system that bridges the transition from child to adolescent to adult to elder, and supports an individual across life’s challenges such as divorce, retirement, death of a loved one, and job changes, to name a few. Eligibility problems often hamper transitional periods of access to health care and may be related to governmental regulations, and financial, geographical, or mobility issues. The health care system is often focused on data representing “populations” rather than “individuals,” and accordingly strategies are subsequently developed to address improving the health of the public and may inadvertently overlook an individual’s health during transitional periods.

Summary: The affinity group endorsed:

· Creating coalitions that would include private and public resources along with health care professionals;

· Increasing community and consumer partnerships;

· Improving consumer participation in decision-making, utilization, and promotion of health.

It was recommended that a funded, collaborative, CHIP-type coalition, which would target underserved zip code areas, might help direct resources and efforts. Addressing literacy issues and improving planning would help make better use of resources.

The group felt that:

· Services should be better coordinated to address transitions during life;

· Coordination of urgent, non-urgent, and emergency care should be improved;

· Communities should shift to an interdisciplinary approach with providers that are better linked to community-based services.

MAJOR GOAL 2: COMMUNITY EDUCATION AND AWARENESS CONTRIBUTE TO HEALTHFUL BEHAVIOR

It is clear that individual health is closely linked to community health, and that the health of the environment and community in which individuals work, play, and reside has a significant influence on one’s quality of life and well-being. Community health is profoundly affected by the collective behaviors, attitudes, and beliefs of everyone who makes up that community.

This second goal or lever explores the influence the community has on healthful behaviors and on influencing individuals to make healthy choices. It underscores the idea that the health of the individual is nearly inseparable from the health of the larger community.

THEME A: HOMES, NEIGHBORHOODS, AND ENVIRONMENTS ARE SAFE AND HAZARD FREE

Context: It is estimated that 25% of preventable illnesses worldwide can be attributed to poor environmental quality. Physical and social environments play major roles in the health of individuals and communities. Humans can come into contact with biological, chemical, and physical agents in the physical environment (air, water, soil) that are harmful to health. The social environment (housing, transportation, neighborhoods, urban development, substance use, violence) affects our behaviors and choices. From the 2000 Healthiest Milwaukee telephone survey, it was reported that smoking and chronic and infectious diseases were of primary concern to households. A larger percentage of Hispanics and African Americans also reported domestic violence, teenage pregnancy, and STDs as possibly affecting their household. From this same survey, violent crimes, drinking water, food safety, and traffic accidents were listed as the top environmental concerns affecting households. Proper nutrition, adequate exercise, and smoking cessation were reported as behaviors that respondents would most like to adopt to improve their health. Over 50% of adults reported a sedentary lifestyle. Thirty percent reported being overweight. Forty-four percent of families surveyed in sixteen WIC (Women-Infant-Children) programs reported that they could not afford balanced meals.

Summary: Development and empowerment of people at a grass roots level to become leaders and advocates for community education, safe environments, and healthful behaviors emerged from the discussion. There was general agreement to use individuals indigenous to the community and to connect them with partners from all sectors of that community to make tangible, positive changes happen.

The discussions focused on:

· Identifying issues relevant to a community and then developing leaders who could bring together community agencies to make efficient use of community resources;

· Establishing programs that provide information and skilled services to make homes and neighborhoods “healthy”;

· Providing for comprehensive home assessments and referrals to appropriate resources for assistance;

· Redesigning current programs/systems to meet current needs;

· Communicating pertinent issues through natural mechanisms that involve translation and linguistic services.

THEME B: ETHNICITY, CULTURE, AND LANGUAGE ARE INTEGRAL ELEMENTS OF HEALTH CARE EDUCATION AND PROMOTION

Context: It is generally believed by national public health leaders, that while some health disparities between minority and white populations are the result of complex interactions involving genetic variations, environmental factors, and specific health behaviors, current information about the biological and genetic characteristics does not explain all of these disparities. Nationwide, inequities in income and education underlie many health disparities. Generally, access to quality health care is intrinsically related to socio-economic status and education level. Population groups that suffer the worst health status are also those that have the highest poverty rates and the least amount of education. Differing levels of access to technology limits information about health (known as the “digital divide”). The health care workforce is not as diverse as it should be and there is a general lack of culturally diverse professionals with an awareness and understanding of different cultures. It appears to be more difficult for individuals from underrepresented backgrounds to navigate the system.

Summary: The affinity group discussed the potential for establishing a resource base for professionals to access information about ethnic/cultural differences with the goal of providing better health information to minority groups. Institutions of higher education should be encouraged to partner with health departments and health care providers to offer educational workshops in cultural awareness. Communities should be encouraged to find ways to market health information to diverse groups, perhaps by teaching people to be peer educators so that they can teach others in the community about health care. For example, translators could be provided to explain medical procedures or health choices in a linguistically accurate and meaningful way. Education and communication are vital to improving access and providing information. Health professionals and educators need to focus on incorporating training, collaboration, and dissemination of “best practices” to assess a community’s health needs and to recommend interventions and changes. Provision for a network with a list of cultural agencies and resources that people can be referred would be useful.

THEME C: REPRODUCTIVE AND SEXUAL HEALTH EDUCATION AND SERVICES FOCUS ON FAMILY PLANNING, ASSURING HEALTHY PREGNANCY, AND AVOIDING SEXUALLY TRANSMITTED DISEASES

Context: Responsible sexual behavior is critical to reducing unintended pregnancies and sexually transmitted diseases. Abstinence, the only method of complete protection, is value-laden. The public health focus should also include strategies that involve sexual education. Evidence has demonstrated that the most effective school-based programs are comprehensive and include a focus on abstinence and condom use. Parents are the best educators and must therefore be well informed.

Summary: Creation of a website with the latest links to health care information and resources for parents and teens would help convey a consistent message and a program of prevention. The community and its partners would maintain this comprehensive site. People should be educated through various appropriate means (including a website), based on gender, culture, and age differences.

THEME D: PARENTS AND GUARDIANS MEET CHILDREN’S DEVELOPMENTAL AND HEALTH NEEDS

Context: There is little debate that parents/guardians are the most important providers for their children. Often, however, they may have difficulty balancing their role as parents with the obligations of work and other responsibilities. Young children need parental attention and guidance. Therefore, parents must have available to them information to help them guide their children. Children receive information from both traditional and non-traditional sources. Depending on the source of information, children may be learning lessons that are inconsistent with their parents’ values, philosophies, and principles.

It is well understood that communities play a significant role in the development of children. Often, however, the community fails to provide the necessary forum for parents and families to come together in a meaningful way with the intention of creating a sustainable healthful environment. Young children are easily influenced. Their innocence and lack of experience makes them vulnerable to form bad behaviors and make poor choices through misdirected and misguided influences.

Summary: Since parents are the most important influence on their children, it follows that parents must have the proper tools in order to teach their children properly. Informing parents about the latest news and innovations in children’s health and development issues would give them the knowledge to raise their children in the most healthful way. Parental-skills training through the establishment of neighborhood forums is envisioned as an effective way to update parents and families about the latest health issues. The community can also help organize topic-specific workshops and parent meetings. Through community planning, it is envisioned that leaders would emerge who could provide for sustainable parent education and training. A child’s school is also a place for parents and children to learn together. Teachers are role models for young children and there should be frequent meetings between parents and teachers. Children’s health care should focus on disease prevention and on improving behavior, and should also include monitoring their psycho-social well-being in addition to their physical needs. Observing their mental and social development and interactions will help determine developmental problems, learning difficulties, and other neural and cognitive disabilities.

THEME E: HEALTH SERVICES ARE CONTINUOUS AND LINKED, REGARDLESS OF CHANGES IN LIFE CIRCUMSTANCES OR HEALTH NEEDS

Context: “Quality of life” reflects a general sense of happiness and satisfaction with our lives and environment throughout our existence. As an individual develops from child to adult to elder, his/her health needs and requirements change. General quality of life encompasses all aspects of life including health, recreation, culture, environment, rights, values, beliefs, aspirations, job, and financial security to name a few. Health-related quality of life reflects a personal sense of physical and mental well-being.

Summary: The community can contribute to a continuous quality of life through neighborhood grass-roots efforts that advocate and assist in the construction of a portable, supportive, healthy lifestyle that includes life skills development and promotion. The media can play a role through campaigns that direct people to health-related information and resources. The community can encourage and provide incentives that nurture healthy behaviors. Partnerships that make long-term connections between resources should be established, as should sustainable programs that involve managing the changes and transitions that occur during an individual’s life.

5.0 AFFINITY GROUP REPORT-OUTS

LIST OF ACRONYMS USED

1° health care Primary health care. Primary health care can be defined as direct general medical care afforded to individuals by a clinician or general practitioner such as a family practice physician, dentist, nurse, or physician’s assistant.

AARP American Association of Retired Persons

ADA American ~~Disability or~~ Disabilities Act?

AHEC Area Health Education Center

AODA Alcohol and Other Drug Addiction

CAP Community Assistance Program

CBO Community-Based Organization

CHIP Children's Health Insurance Program

CLPP Children's Lead Prevention Program

DHFS Department of Health and Family ~~and Social~~ Services

DMV/DOT Department of Motor Vehicles/Department of Transportation

DPI Department of Public Instruction

ED Emergency Department

EPA Environmental Protection Agency

ER Emergency Room

FBO Faith-Based Organization

FQHC Federal Qualified Health Centers~~—what’s the “H?”~~

GAMP General Assistance Medical Program

GIS Geographic Information System

HCFA Health Care Finance Administration

HMO Health Maintenance Organization

HUD U.S. Department of Housing and Urban Development

IMPACT Alcohol & Other Drug Abuse Services, Inc. (211 Information Line Operator)

~~-- spell it out?~~

IPA Independent Practitioners Association

MA Medical Assistance

MAPPC Milwaukee Adolescent Pregnancy Prevention Center

MCW Medical College of Wisconsin

MICAH Milwaukee Inner City Congregations Allied for Hope

MMAC Metropolitan Milwaukee Association of Commerce

MOD March of Dimes

MPS Milwaukee Public Schools

NAACP National Association for the Advancement of Colored People

NARI National Association of Remodeling Industry

NP Nurse Practitioner

PCP Primary Care Provider

PH Public Health

PPH Planned Parenthood

PPO ~~Participating~~Preferred Provider~~hysician~~ Organization

RFP Request for Proposal

STD Sexually Transmitted Disease

UWM University of Wisconsin–Milwaukee

WIC Women, Infants and Children Assistance

WMC Wisconsin Manufacturers & Commerce

INTRODUCTION

Affinity groups were used at the “Piecing Together a Healthy Community” health forum as the primary means of organizing brainstorming sessions—the venues where creative thinking took place. To organize this forum, conference planners identified two major goals. Each affinity group focused its discussions around one major goal and one of five themes.

The first ten report-outs in this section focus on GOAL 1: Health care is accessible, comprehensive, and prevention-oriented. The next ten report-outs focus on GOAL 2: Community education and awareness contribute to healthful behavior. Each affinity group concentrated on one of the following five themes within a specific goal:

THEME A: Homes, neighborhoods, and environments are safe and hazard-free.

THEME B: Ethnicity, culture, and language are integral elements of health care education and promotion.

THEME C: Reproductive and sexual health education and services focus on family planning, assuring healthy pregnancy, and avoiding sexually transmitted diseases.

THEME D: Parents and guardians meet children’s developmental and health needs.

THEME E: Health services are continuous and linked, regardless of changes in life circumstances or health needs.

MAJOR GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED

The Healthiest Milwaukee initiative seeks:

· A single standard of high-quality care for all people regardless of insurance, race, or language barriers.

· Neighborhood-based primary care sufficient to meet community needs.

· Access to coordinated health services, including urgent (after-hours) care, mental health services, substance abuse care, clinical preventive services like immunizations, screenings, and health counseling, dental and vision services, pharmacy, school-linked services, and special care services for elders and those with disabilities.

· Coordination between medical care, public health programs, and community assets.

· Linked health care and human services for easier access to benefits and services.

· Improved training and distribution of health professionals.

GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED.

THEME A: HOMES, NEIGHBORHOODS, AND ENVIRONMENTS ARE SAFE AND HAZARD-FREE.

MEMBERS

Bob Pietrykowski – Facilitator

Nicole Rock – Recorder

Kelly Anderson

Michael Eaton

Jeanne Hewitt

Rhonda Hoernke

Larry Hopwood

Amy Murphy

Bridget Murray

Rometa Rodgers

Rose Stetzer

Jennifer Winter

CONTEXTUAL BACKGROUND

· How do we build community leadership?

· Social poverty is a determinant of health

· Improving the home itself leads to healthier outcomes

· Access to health education for children that is relevant to the situation they are in

· Structural, behavioral, and maintenance aspects of the home affect health outcomes

· The community needs to understand that they do not need to tolerate all situations (e.g., accepting that a certain amount of drug dealing is going to happen and not reporting it)

· Children need safe and supervised places to stay

· Safety issues (like crime) are keeping people in their over-crowded, unsafe homes

· Home ownership as a goal—people take care of what they own

· Build safe and hazard-free environments

IDEA #1: HEALTH ACCESS, EDUCATION, AND CARE

Brief Description: Have more centers that not only provide care, but education and prevention. Clinics should cooperate and collaborate.

Key Goals

· Increase number of free health centers

· Increase hours and availability of clinics

· Expansion of existing school to include education and access

· Reinstate health curriculum in MPS and all other schools with qualified faculty teaching it

· Increase collaboration among providers, educators, and health department

· Have health education as a part of the regular education budget

Programmatic Elements

· Best practices—see what other places are doing and what has worked

· Cross-training of health educators and clinicians

· Invite participation of all insurers (e.g., GAMP, HMOs) to talk about opportunities for outreach and elderly care

· Study the reasons why mental health access, education, and care are not available—increase awareness of mental health issues

· Support legislation for prescription coverage

First Steps: Assess what is already available and what is being used

Partners/Leaders

Insurance groups
Public and private schools
Legislators
Public Health Department
Media
CBOs
Health care providers
Professional Associations

IDEA #2: ENCOURAGE CENTRAL CITY BUSINESS TO ENCOURAGE GROWTH

(QUALITY AND RANGE)

Brief Description: Principled economic development through central city businesses that is morally and spiritually based (ethical and healthy versus capitalistic).

Key Goals

Accurate data to reflect positive growth in an area
Recognize outstanding accomplishments already happening
Government assistance in field recollection to make land available
To increase awareness of money available (block-rents) among potential central city businesses
Increase micro-loans available to entrepreneurs
Increase peer educators, both volunteer and paid, on health issues and safety issues

Programmatic Elements

Research and disseminate best practices to lenders and entrepreneurs (via local media)
Get the money
Promote healthy, safe businesses for workers and environment
Government leaders prioritize economic development
Facilitate faith groups to participate in development

First Steps: Ask MICAH to be a vehicle to highlight value-based and spiritually based economic growth

Partners/Leaders

Milwaukee Inner City Congregations Allied for Hope (MICAH)
City of Milwaukee Health Department
Milwaukee Public Schools
Marshall & Isley Bank (M&I)
The Milwaukee Idea, UWM
NAACP
Minority (cultural) business leaders

IDEA #3: ADVOCACY

Brief Description: Advocates for making sure that youth (from birth to 18) are getting the information/prevention they need. Increase capacity to better serve youth.

Key Goals

Increasing number of people trained to advocate for youth prevention
Annual reports about how we are doing and what we need

Programmatic Elements

Call a council together to identify and convene organizations that could advocate
Invite community partners, clinics, etc. (e.g., YMCA, Planned Parenthood)
Support legislation for prescription coverage

First Steps: Convene the council of interested and concerned public and private partners related to birth to 18 health advocacy

OTHER IDEAS

Have a task force to set criteria as to what safe environments/houses are
Ensure health education and care in elementary schools
Nurses in all elementary schools
Better systems communication
Creative ways for partiality of records and neutral compatibility among systems
Create home ownership/affordable rental of safe homes

Get out the story that people are staying in unsafe homes because they perceive they are safer than outside
Make medications affordable to prevent illness/injury
Provide information/resources on how to make/maintain a healthy and safe home
Use model of lead abatement, enforcement, and incentives on other health issues
Improve media perception regarding race and health
Increase partnering of organizations with similar goals
Target correct services—i.e., people using what they should and what most benefits them
Use existing databases for patterns of health
Keep people insured
Develop broader ranges of occupational health (preventative/training)
Set up “user friendly” systems for youth/adolescents
Assure that existing codes are enforced
Provide incentives for owners to keep homes safe
Landlord/Tenant compacts to promote safety/stability
Subsidizing rents of highest risk families to keep them from moving
Fix up and rent out “drug houses”

GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED.

THEME C: REPRODUCTIVE AND SEXUAL HEALTH EDUCATION AND SERVICES FOCUS ON FAMILY PLANNING, ASSURING HEALTHY PREGNANCY, AND AVOIDING SEXUALLY TRANSMITTED DISEASES.

MEMBERS

Sam White – UWM School of Architecture and Urban Planning (Facilitator)

Kelly Raleigh – Marquette University (Recorder)

Nicole Baecker – Marquette University

Michelle Bourguignon – Marquette University

Erin Cannella – Marquette University

Patricia Jansen

Mark Lynel

Marty Kerrigan – Rosalie Manor

Karen Michalski – Milwaukee Health Department

Janice Rach

Darlene Robinson – Wisconsin Public Health and Family Services

Jeanne M. Wilton – St. Luke’s Hospital

CONTEXTUAL BACKGROUND

Access to prenatal care
Eligibility, barriers, legal (illegal aliens, teens, homeless, substance abusers)
Early puberty, late marriage
Cultural beliefs, lack of consistent education (male vs. female)
Mentors get youth involved
Community ownership (What does this have to do with me?)
Lack of continuing prenatal care
Lack of follow-up by health care providers for no-shows
Prenatal care coordination (financing not there)
Lack of coordination of care, educate physicians/providers
How do you get education out to the streets? Verify myths?
Individual programs cannot do it alone
Businesses have money and access to help
Community resources for pregnancy tests (free, accessible) are lacking
Make people aware of resources that are available to them
Lack of transportation to potential care sites
Need information out there and publicized
Make emergency contraception accessible
Counseling barriers—STD testing
We need to overcome stigmas, religious differences, cultural boundaries
Legislative barriers, responsible sex
How do we prevent these instances from recurring?
Starting education too late
Educate parents—How do we get information out to them?
Community resources
Access parents
Show people exactly what can happen

Need mature relationships/context
We need comprehensive programs—talk about relationships, communication
Lack of success in substance abuse programs
Look at who/what sources of educators we have available and where do we go in the community with it
Need to realize the reality of the problems—denial by segments of the community
Insubstantial education
Need good research and evaluation
Long-term, consistent funding/categorical funding
Partnerships for funding
Make “impact” and things like it more available/known

· No clear places for clients to get information

IDEA #1: COMMUNITY LEADERSHIP

Programmatic Elements

Involve public officials and publicize their involvement
Make options multifaceted (abstinence, condoms, Natural Family Planning, vans, and meds)
Make teens/youth and the poor equal partners

Partners/Leaders

Churches
Businesses

IDEA #2: INCREASE ACCESS

Programmatic Elements

Shuttles to community resources (free/funded)
Expand hours
Alternate sites
Clinics in schools
Use systems in the home and in the hospitals to get things out
Partners in the media
Translation of language
Get number out (phone books, television, bus)
Bus pass hours in schools
Use and expand number of alternative health providers (student nurses, teens, parents, bartenders, nail technicians, beauticians, teachers, maintenance, security)
Multifunctional places—bring more to them (WIC)

First Steps

Make community information line accessible by 211
Media campaign to make public aware
Convene community partners to implement and subsidize free shuttle/bus system linking people to community clinics and resources

IDEA #3: PUBLIC/INDIVIDUAL EDUCATION

Brief Description: Increase public knowledge of safe reproductive and sexual health.

Key Goals

Hold ongoing community clinicals
Identify a strategy for a public education program
Community service
Expansion

Programmatic Elements

Get the hotline number out
Get numbers in the phone book
Find places where many people go so that we can utilize the places to distribute information (bus stop, in bus, food pantries, shelters, park bathrooms, movies, malls, night clubs, fests)
Delivery of education by vans
Media campaigns
Web site
Parent programs at schools

First Steps

Formal proposal/goals
Conference committee presents ideas to people who will acknowledge constituents and commitment to plan
Identify Dr. Seth Foldy as spokesperson
Proposal publicly acknowledged as priority for Milwaukee

GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED.

THEME E: HEALTH SERVICES ARE CONTINUOUS AND LINKED, REGARDLESS OF CHANGES IN LIFE CIRCUMSTANCES OR HEALTH NEEDS.

MEMBERS

Rick Fons – Facilitator

Ken Germanson

Robert Krug

Bill Kurtz

Glenn Mathews

Judy Payne

McKinley Petty

Tom Pyne

Kimberly Ryan

Bill Solberg

CONTEXTUAL BACKGROUND

· Inadequate resources

· Lack of commitment on part of policy-makers to adequately fund prevention

· Silo mentality—need to increase collaboration between health professionals and companies

· Need to improve efficiency in enrolling eligible individuals

· Need to include “post-acute” system in discussion

· Re-allocation of resources from total focus on acute to upstream issues (prevention, environment, etc.)

· Need to define healthy environment—i.e., decrease poverty and increase parenting skills

· Families easily access and know about community resources

· Misuse of acute-care settings, particularly the ER (by Medicaid patients and others)

· Preventative services not reimbursable—address by providing incentives for preventative care, counseling, etc.

· Lack of community-level accountability

· Need to change some learned behaviors

· Need to improve systems and individual cultural competencies

· No new amounts of money going to be available—this is a reality

· Workforce issues—shortage of many health care professions (nurses, pharmacists, and physicians)

· Political issues and decisions regarding health care

· Lack of inter-professional home-visiting programs

· Develop state public policy that supports how Milwaukee initiatives—extending beyond Badger Care, Turning Point, etc.

IDEA #1: COALITION

Brief Description: A funded, collaborative CHIP-type coalition targeting specific, under-served zip codes (05, 06, 33).

Key Goals

· Geographic target based on greatest need

· Involve targeted community members (consumers) in developing programs/strategies

· Pool private and public funding—recruit private sources

· Focus on measurable outcomes focusing on population improvement

· Voluntary effort to attract new monies to create new working relationships and new spending patterns among those already there

Programmatic Elements

· Use existing, currently involved institutions

· Build in health-professional and student element

· Asset mapping for those zip codes

First Steps

· Recruit private sources—those involved in area

· Recruit public sources

· Recruit consumer residents

· Recruit health care professionals/organizations

OTHER IDEAS

· Holistic home visiting strategy

· Address and assess literacy issues

· Education regarding effective use of services/system

· Expand incentives and commitment to focus on prevention services

· More direct provider involvement in community, coalitions, efforts

· True diversity education for providers and recruitment of diverse students into health profession

· More access to post-acute care (full spectrum)

· More state government programs to increase focus on self-responsibility

· More use of parish nurses in areas with gaps/shortages

· More fair/equitable reimbursement across source of payment

· Pooling of resources to move linked services into communities of need

· Expand incentives for collaborative efforts

· Expand use of state youth apprenticeship program/resource for communities in need

· Support expansion of Badger Care and Family Care

· Involve target populations in planning and governance

· Reform state/federal regulation of health care services and balance with consumer protection

GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION-ORIENTED.

THEME E: HEALTH SERVICES ARE CONTINUOUS AND LINKED, REGARDLESS OF CHANGES IN LIFE CIRCUMSTANCES OR HEALTH NEEDS.

MEMBERS

John Lynch – UWM College of Health Sciences (Facilitator)

Claire Thompson – United Way of Greater Milwaukee (Recorder)

Alice Akers – Milwaukee County Heath

Sharon Fialkowski – Milwaukee Health Department

Larry Hopwood – Medical College/St. Mary’s

Russell Kirby – Wisconsin Medical College

Barbara Ludka – Family Services

Diane McFadyen – Milwaukee Health Department

Jeff Propp –Milwaukee Health Department

Bill Quinn – Medical Services of Wisconsin

Marilyn Shepard – Consultant

Catherine Whitcroft – UWM School of Nursing

CONTEXTUAL BACKGROUND

Service system is not focused on the patient and what their needs are (AODA, emergency, mental health)
Different approaches, beyond case management, are needed
Prevention efforts/education
Public awareness efforts are crucial
“Engage” the patient population—transients too
Look at those on the “margins” of the system, as well as those in the mainstream
Holistic strategies are needed that look at environmental issues, crime, economic segregation, etc.—beyond just “medical” care
Communication, in general, is a major barrier between/among agencies, systems, and between providers/public
Consumer must be more involved in process
Too many factors limit involvement (e.g., transportation, lack of information)
Must have a good concept of what consumers want and need in a system
There is a disconnect between primary health care, mental health, prevention providers: multiple systems must be coordinated
Many services/resources are not accessible (not neighborhood-based), and services are not known by community

IDEA #1: INCREASE CONSUMER/COMMUNITY PARTICIPATION

Key Goals

Comprehensive community health service guide
Expand and promote available resources in an efficient manner

Programmatic Elements

Increase marketing
Promote/Expand “211”
Have information in print and on the web (Internet database)
Health interpreters or advocates

First Steps: Involve the Greater Milwaukee Committee and funders.

Partners/Leaders

Greater Milwaukee Committee
IMPACT
Milwaukee County
United Way of Greater Milwaukee

IDEA #2: INCREASE CONSUMER PARTICIPATION IN DECISION-MAKING, UTILIZATION, AND PROMOTION OF HEALTH

Key Goals

Conduct market research (“wellness assessment”) to determine what are the barriers to continuous health service and to determine health needs and wants
Distribute information already collected (widespread dissemination)
Solicit input at the neighborhood level
Involve community leaders in the process
Multiple methods to collect input (survey, focus groups, naturalistic inquiry, empirically-based research)
Initiate change

Programmatic Elements

Identify key individuals/organizations to drive the process (neutral umbrella body)
Conduct a “wellness assessment” that solicits community input for a long-range strategy

First Steps

Find a “core” group to organize—e.g., the City of Milwaukee Health Department group
Expand core group to a regional perspective

Partners/Leaders

Broad participation from all levels
Health Department
Faith-based organizations (FBOs)
Universities
Neighborhood organizations
Community-based organizations (CBOs)

OTHER IDEAS

· Integrated, multi-disciplinary, multi-level, high-quality service (What is the purpose of the system? How do we define quality?)

What in the system does not work?
The system in not a true system
The public and politicians are not aware/educated on health/prevention
Shift to strength-based focus to motivate the community
Is the burden on the health care system? Yes, but media/advertising is highly effective
Grass-roots, community-based organizations do not know how to connect to larger system
Must change attitudes of “personal wellness” and how this relates to “community wellness”
Increased trust between clients and providers can be accomplished through better access points such as libraries and other public venues
Maintain and expand Healthiest Milwaukee survey initiative
Reward consumers for being healthy
Financial incentives/options
Look at non-traditional avenues for health care delivery
More flexibility in care system to accommodate/empower clients
Encouraging advocates and consumers advocating for others
Make neighborhood clinics a one-stop-shop for holistic health
Educate consumers/the public on importance of environmental factors to overall health (lead paint, safety)

GOAL 1: HEALTH CARE IS ACCESSIBLE, COMPREHENSIVE, AND PREVENTION ORIENTED.

THEME E: HEALTH SERVICES ARE CONTINUOUS AND LINKED, REGARDLESS OF CHANGES IN LIFE CIRCUMSTANCES OR HEALTH NEEDS.

MEMBERS

Mary K. Madsen – UWM College of Health Sciences (Facilitator)

Micah Playman – Marquette University (Recorder)

Liz Bohne – Aurora Health Care

Tovah Bates – Medical College of Wisconsin

Robert Coons

Brenda Dockery – St. Michael Hospital, FNP

Elizabeth Glisper

Bill Greaves

Jane Hopp – Carroll College

Cindy Huber – National Kidney Foundation of Wisconsin, Inc,

Mark Huber

John Katrichis – Milwaukee County Health Programs

Brian Rademacher

Tom Shefchik – American Cancer Society

Carrie Weddle

CONTEXTUAL BACKGROUND

Health insurance: lack of coverage, carve-outs, and what comprises comprehensive coverage?
Local accessibility: strategic placement of facilities throughout Milwaukee, physical access, reliability, waiting lists, transportation costs
Prescription and equipment costs—affordability, rebate programs, free samples and doctors’ offices, accessible “needy meds”
Defining “emergent” versus “urgent” versus “non-urgent” cares
Inappropriate use of Emergency Departments (EDs)
Register points for GAMP, Medical Association, etc.
Programs on site in EDs, etc.
Alternatives to EDs and education of those who are directing points
Coordination of care
Health care “literacy” issue—education and collaboration
Provide relationships with community health services (collaboration, territoriality, and payer relationships (HMOs))
Barriers to health care access (telephone triage, phone referrals, etc.)
Context for prevention: where to go and how to get those who are not interested, education, referrals to appropriate services, financial constraints, making it “medically necessary”
Physical education in schools—link providers to the physical education teachers
Patient responsibility/provider responsibility in health prevention
Provider/Payer education regarding prevention
Time constraints—need for provider extenders/advocates
Culture and language barriers
Social service needs

IDEA #1: CHANGE INSURANCE

Key Goals

Provide ways to allow coverage for everyone
Focus coverage to those who are the poor, uninsured
Redirect focus back to prevention services
Push to provide better patient education
Increase payment for prevention services
Redefine what’s considered “medically necessary” to allow more reimbursement for prevention services

IDEA #2: COORDINATION OF NON-URGENT, URGENT, AND EMERGENT CARE

Key Goals

Develop more suitable and equally accessible urgent care facilities
Improvement in care management services to be more accessible and have adequate reimbursement
Provide care that is geographically and culturally sensitive
Improve patient/provider education to include greater emphasis on services utilization
Community education

IDEA #3: INTERDISCIPLINARY PROVIDER LINKAGE WITH COMMUNITY-BASED SERVICES

Key Goals

Coordinate services to meet the needs
Development of team-oriented services
Focus on how horizontal and vertical shared vision
Services are culturally sensitive and appropriate
Paradigm shift towards a “leader circle” and to larger community to facilitate prevention and education
Prevention focus in provider education

IDEA #4: SHIFTING FROM A DISCIPLINE-SPECIFIC APPROACH TO AN INTERDISCIPLINARY APPROACH THAT INCLUDES THE COMMUNITY

Key Goals

Utilizing variety of health clinics throughout Milwaukee to allow adequate 1° health care
Be able to involve mental health care

First Steps

“Environmental scan”
Shifting from medical assistance to a general medical program

Partners/Leaders

Community-based agencies
School-based clinics
No major health care systems
Black Health Coalition

IDEA #5: SHIFT FROM INTERVENTION TO PREVENTION

Brief Description: Facilitate consistent and adequate 1° health care services by redirecting the focus back towards health prevention.

Key Goals: Encouraging case managers in emergency departments to re-plug patients into 1° care

First Steps: Case managers in the ER

Partners/Leaders

Major health care systems
Universities
Medical and Nursing Schools
Allied Health Schools

OTHER IDEAS

Change delivery of health insurance in Milwaukee—identify those who are not covered and cover them, expand GAMP and Badger Care
Develop transportation resource guide and improve transportation services
Needs Assessment
Bring in pharmaceutical companies to assist in changing prescription laws and to provide and coordinate advocacy
Coordinate and educate free clinics within the community
Appropriate distribution of information regarding access to community clinics
Health providers in geographic area to collaborate to provide 1° care/urgent care facilities; utilization of NPs
Utilize “Piecing Together a Healthy Community” concept—provide incentives
Go to where the people are and coordinate according to geographic locations
Encourage major health care systems to provide better patient advocacy and case management—include education for future health care providers
Provide translation services within health care facilities
Facilitate minority recruitment and retention in professional practice
Train young health care providers/professionals to incorporate a greater degree of prevention practices
Identify creative locations for public/patient education (health education mobiles)
Change how, when, and where health care services are provided
Establish linkage, mindset and philosophies regarding social service needs

MAJOR GOAL 2: COMMUNITY EDUCATION AND AWARENESS CONTRIBUTE TO HEALTHFUL BEHAVIOR

The Healthiest Milwaukee Initiative seeks:

Improved health literacy (health knowledge building blocks) of youth and adults.

An increase in the types of communication preferred by the public (verbal interaction, emerging technologies).

Improved environmental conditions that enable and reinforce healthy behaviors (for example: role models, access to exercise opportunities and healthy foods), in addition to knowledge and attitudes.

To help families prioritize their most important health behavior choices, including:

§ Decreasing tobacco use in youth and adults

§ Healthy diet and exercise

§ Preventing violence and supporting mental health

§ Sexual and reproductive health issues

§ Injury prevention

§ Preventive care and screening (medical and dental)

To prevent common conditions including heart disease and hypertension, diabetes, obesity, asthma, and chronic infectious diseases like hepatitis.

GOAL2: COMMUNITY EDUCATION AND AWARENESS CONTRIBUTE TO HEALTHFUL BEHAVIOR.

THEME A: HOMES, NEIGHBORHOODS, AND ENVIRONMENTS ARE SAFE AND HAZARD-FREE.

MEMBERS

Sandy Ceranski – UWM College of Health Sciences (Facilitator)

JoAnn Zander – UWM College of Health Sciences (Recorder)

Jochen Albrecht

Anne Banda

Jaime Corbisier – UWM

Samantha Erickson – UWM School of Nursing, Student

Mary Friess

Aimee Givonimi

Melissa Linehan – UWM School of Nursing, Student

Sara Schubert – Milwaukee Health Department

Cindy Tomasello – Shorewood Health Department

Mary VanDerven – OT/Neighborhoods

Kenneth Walz – Department of Health and Family Services (DHFS), State of Wisconsin

Jean Wendt – Milwaukee Health Department, CLPP

CONTEXTUAL BACKGROUND

Police enforcement in high-crime neighborhoods is inadequate
Security, safety, and survival issues in homes and neighborhoods
Home education concerning environmental triggers (i.e., lead, asthma, substance abuse) is inadequate
Need more involvement of those most affected (i.e., parents, educators).
Inadequate prevention efforts
Emulate teaching methods that work
Get involved with community: ask participants preferences and involve trusted agencies
Health education programs not solidly based on theory/evidence of behavior change
Basic needs must be met before readiness for change
Health issues of parents (substance abuse)
Economic instability in families
Inadequate availability of resources (physical and human)
Inadequate communication between programs

IDEA #1: GRASSROOTS LEADERSHIP DEVELOPMENT

Brief Description: Empowering people through leadership development to create solutions to environmental health issues. Identify people with fundamental self-interest. Discuss issues by coming together. Develop understanding of relevant problems and strategies to solve.

Key Goals

Determine health issues relevant to an identified community
Identify and develop leaders through training on the issues
Collaboration with existing community agencies
Improve identified community health issues

Programmatic Elements

Community health organizer who is well-trained and knowledgeable about topics, community resources, leadership development, and identified neighborhood
Community leaders developed over time
Community health interest assessment through focus groups, telephone surveys, written surveys, door-to-door, or any combination of these
Central accessible meeting location

IDEA #2: HOME REMEDIES

Brief Description: Facility to provide skilled services, information, products, materials to make homes healthy, safe, and people independent as possible.

Key Goals

Prevent fires, falls, and unintentional injures in homes
Aging in place
Increase frequency of self-management in home environment and self-sufficiency
Create safe and habitable homes

Programmatic Elements

Information provisions: fire safety, lead poisoning, and training on how to
Products and access at low or no cost—loan equipment service
Resource book for home remedies—home remedy consultant
Service provision: contracts for equipment installation through volunteers, low-cost fees, workforce development, or technical school
Referral to other services (fire department)
Grass roots leadership development

First Steps

Identify partners and leaders
Networking
Fundraising: solicit donations and materials from corporations
Explore existing models (Adopt a Home, Home Source)
Explore block grants

Partners/Leaders

Leaders in schools
State/County/City governments
AARP
Experts in home modification (contractors, Home Depot)

Philanthropic representation
Architects
Health care providers
Representatives of consumers
ADA and disability groups
National Association of Remodeling Industry (NARI)
Community organizations (Rotary, churches)

OTHER IDEAS

Redesign programs/systems to meet current needs—i.e., garbage collection expansion, recycling education, building inspections
Community policing expanded with neighborhood block watch: police and community working together
Telephone reassurance programs
Develop and distribute comprehensive community resource book to support healthy behaviors
Use media to disseminate information to those that need it
Public health events in community
Intergenerational strategies/peer mentoring

GOAL 2: COMMUNITY EDUCATION AND AWARENESS CONTRIBUTE TO HEALTHFUL BEHAVIOR.

THEME A: HOMES, NEIGHBORHOODS, AND ENVIRONMENTS ARE SAFE AND HAZARD-FREE.

MEMBERS

Ginny Stoffel – UWM College of Health Sciences (Facilitator)

Jamila Gray – Marquette University (Recorder)

Kelly Anderson – Marquette University

Sachin Chheda – Wisconsin Citizen Action

Andria DeToro – Milwaukee Health Department

Gloria Dohearty – Marquette University (Recorder)

Terri Linder – Milwaukee Health Department

David Petering – UWM Institute of Environmental Health

Marge Stearns – Medical College of Wisconsin Firearm Injury Center

Pat Ventura – County Health Programs

CONTEXTUAL BACKGROUND

Lead
Violence (home, neighborhood, school, work, television)
Asthma
Nutrition/obesity
Substance abuse
Fire safety
Mental health
Unintentional injury/”accident”
Cultural/racial intention
Communication/language barriers
Hypertension
Attitudes/NIMBY (“Not In My Backyard”)
Neighborhood based strategies—community participation
Immigrant concerns (legal barriers, disparities)
Education
Prevention/healthy living
Resource allocation (personal, public, private)
Politics
Economic development
Poorly maintained roads and sidewalks
Sanitation problems—air and water quality
Substandard housing

IDEA #1: HEALTHY HOME

Brief Description: Providing a comprehensive assessment of physical space and behavior within the home environment.

Key Goals

Education
Referrals

First Steps

ID lead organizations
Build coalitions
Obtain funding
Have first meeting

Partners/Leaders

Health Departments (all in Milwaukee County)
16^th Street Community Center
Parish health
Building inspectors
Social services
Community-based Organizations
Utilities
Milwaukee Public Schools
University of Wisconsin–Milwaukee
Marquette University
Department of Aging
U.S. Department of Housing and Urban Development
Health institutions
Home care agencies
Realtors
Environmental Protection Agency
Media

IDEA #2: COMMUNITY CAPACITY MODEL

Brief Description: Making tangible changes utilizing individuals (parents) indigenous to the community in which the proposed change is to occur.

Key Goals

Leadership development
Change the issue—neighbor-to-neighbor

Programmatic Elements: Creating/using community-based organizations

IDEA #3: GATHERING PLACES/OUTREACH

Brief Description: Hold discussions at natural meeting spots.

Key Goals:

Attract leaders (political, education, business, labor, sport, etc.) to non-traditional setting
Discuss issues pertinent to environmental health

IDEA #4: TRANSLATION STATION

Brief Description: Provide translation services to community so that literature and information is more accessible to all.

Key Goals: Advocacy for accessible communication

Programmatic Elements: Training center for medical orientation and cultural sensitivity.

IDEA #5: SHAKING THE MOVERS, MOVING THE SHAKERS

Brief Description: Attract leaders into a partnership to increase resources and participation in Healthiest Milwaukee.

Key Goals: To enter into partnerships with leaders

First Steps

Planning and seed money
Selection of 10 key leaders as “executive group”
Goal setting with clear outcomes
Healthy places throughout Milwaukee

Partners/Leaders

Political
Educational
Business
Labor
Sports
Faith
Health care
Community

GOAL 2: COMMUNITY EDUCATION AND AWARENESS CONTRIBUTE TO HEALTHFUL BEHAVIOR.

THEME D: PARENTS AND GUARDIANS MEET CHILDREN’S DEVELOPMENTAL AND HEALTH NEEDS.

MEMBERS

Elizabeth Bolt – UWM College of Health Sciences (Facilitator)

Lynn Ackerman – UWM Center for Urban Initiatives and Research (Recorder)

Lori Auterman – Social Development Commission

Kathleen Blair

Kate Brondino – UWM College of Health Sciences

Darryl Davidson – Milwaukee Health Department

Emily DeLeo – City of Milwaukee, Public Health Nurse

Wanda Frazier – City of Milwaukee, Lead Program

Mary Ann Kiepczynski – Milwaukee Health Department, PHN

Karin Peterson – The Fitness Equation LLP

Amoun Sayoavong

Susan Shepeard – Milwaukee Health Department

Melinda Vernon – Milwaukee Center for Independence

Marianne Weiss – Marquette University, Professor

CONTEXTUAL BACKGROUND

Parents trusting providers
Health low survival priority
Disparity between provider and public norms
Cultural context
Parent time issues/balance
Mixed messages to kids/parents
Messages come from non-traditional sources
Need more “how to” messages
Need more referral/education from primary health source provider
Need support for sustaining change
Recipients not part of planning/decision-making
Communication between providers and recipients and within provider community
Care for children does not focus on parents’ needs (also provider barriers: time, access)
Lack of community forum/isolation of parents and families
Neighborhood safety—Is it conducive to healthy environment (foods in local marts, walking through neighborhood)?
Service structure does not match what is said/promoted
Do we have the right messengers?
Including other adults (teachers, child care providers)
Is information available to other adults?
Communication between parents and other adults
Nutrition/health habits
Passing the buck—Whose problem is it?
Stigma of seeking mental health care
Ignorance about child mental health

System ineffective in addressing neglect/abuse (mental and physical): punitive versus helpful, understanding cultural differences
Giving parents power/control to make choices
Problem versus prevention focused

IDEA #1: TEACHING PARENTS ABOUT DEVELOPMENTAL MILESTONES AND RELATED HEALTH ISSUES: HOLD NEIGHBORHOOD FORUMS AS STARTING POINT

Key Goals

Have good understanding of effective ways to deliver information
Have good understanding of what information should be provided
Hold forums in five neighborhoods
Identify leaders in each neighborhood

First Steps

Identify five neighborhoods
Identify leaders and resources and recruit
Design forum

Partners/Leaders

Non-profit sector
Health Department
Existing leaders (aldermen, schools, churches, etc.)
Community
Health care professionals

IDEA #2: TEACHING PARENTS ABOUT DEVELOPMENTAL MILESTONES AND RELATED HEALTH ISSUES: TOPIC SPECIFIC WORKSHOPS AND PARENT MEETINGS

Key Goals

Participants find information useful
Behavior change over time related to topic
Repeat participation
Increase attendance over time
Cross-sector participation
Increase knowledge of health issues

First Steps

Review/Understand neighborhood forum results
Identify messengers of information
Develop sustainable model based on forum results

Partners/Leaders

Community leaders
Health care professionals

IDEA #3: TEACHING PARENTS ABOUT DEVELOPMENTAL MILESTONES AND RELATED HEALTH ISSUES: PARENTING SKILLS TRAINING

Key Goals

Every parent of a newborn is offered and has access to skills training
Coordination of existing programs
Parents of at-risk children have additional follow-up and support (either prenatal or child)
Every parent is offered and has access to age-appropriate training

First Steps

Identify and assess existing programs for newborns
From neighborhood forums identify parental wants and service gaps
Tap into existing programs such as “Head Start” and “Birth to 3”

Partners/Leaders

Universities
Health Department
Health care professionals
Non-profits

IDEA #4: TEACHING PARENTS ABOUT DEVELOPMENTAL MILESTONES AND RELATED HEALTH ISSUES: PARENT SESSIONS AT SCHOOL REGARDING CHILD HEALTH

Key Goals

Participants find information useful
Behavior change over time related to topic
Repeat participation
Increase attendance over time
Cross-sector participation
Increase knowledge of health issues

OTHER IDEAS

Teaching parents—use role models to promote health (with credibility, similarity, leaders, those who can connect)
Teaching parents—disseminate health information wherever people experience waiting lines (banks, government offices, doctor’s office)
Target teachers, daycare workers, etc. in caring for child
Target employers to encourage parents to care for child
Create system of communication between parents and providers

GOAL 2: COMMUNITY EDUCATION AND AWARENESS CONTRIBUTE TO HEALTHFUL BEHAVIOR.

THEME E: HEALTH SERVICES ARE CONTINUOUS AND LINKED, REGARDLESS OF CHANGES IN LIFE CIRCUMSTANCES OR HEALTH NEEDS.

MEMBERS

Ruth McShane –Marquette University (Facilitator)

Sue McKenzie – Impact Health (Recorder)

Susan Conwell – In Their Best Interests, Inc.

Sara Deprey – Carroll College

Angela Dieringer

Steve Ohley – Aurora Madison Street Clinic

Lisa Phillips

Martha Rasmus

Beverly Riedel – Alzheimer’s Association of Southeastern Wisconsin

Jill Ritterbusch – Milwaukee Health Department

Sara Sabin – American Cancer Society

Sandra Szabo – Community Advocates

Angela Viola – Community Advocates

Les Weil – Community Volunteer

Jane Wood – Community Health Charities

CONTEXTUAL BACKGROUND

· Stage of life changes (i.e., adolescence, senior)

· Change in caregiver of kids

· Mental health of caregiver and kids

· Need creative intersections—community buildings, breaking isolation, personal behaviors

· Redundant services

· Public-Private coordination

· Have to access many services—fragmented

· Need continuum of care to be coordinated

· Internet/”Digital Divide”—value? quality? accessibility?

· Need multiple sources of information

· Language barriers

· Community sites—help link to information resources (computer resource centers)

· Use kids to help others link to information

· How do people want to receive information?

· Organizations need help linking to community—have resources but aren’t getting them to those that need it

· Help-line works

· Parish Nursing is working

· Go to the people—where and how they want it

· Use kids to generate prevention (thinking and behaviors)

· Target younger ages

· Program ends and service drops—funding ends, mentors are gone and child/adult gets lost

· Sustain what works and link

· After crisis services are not maintained/are fragmented

· Health curriculum should focus on how to get services

· Do people have a place that they know they can go to for all needs?

· Lack of options/insurance

· Do life transitions force me to go away from my medical home?

· Forced out of services

· One neighborhood place for 0 to death services—i.e., all insurance situations

· Getting help around transitions of independence-dependence

· Caregivers of elderly have growing health risks

· Older people living alone—who takes responsibility?

· Customer service

· Community-wide focus on treating others with respect, kindness, compassion

· Know our rights

· Advocacy: case management; finding the resources and accessing them

· Cannot find enough services (mental health, AODA, dental)

· People do not go because there is no awareness

· Providers not prepared to deal with the lives of their clients

· Providers are not asking the questions about life events, etc. that impact health

· Train professionals to think holistically

· More people mentoring others on many areas of need

· Support groups work, but are not accessed

· Clinics must be integrative

· Resources must go to the “integrative” sites in the neighborhoods

· Ego and “turf” keep people from working together

· Clustering services

· Be a place where people come or are found before the crisis

· Hospitals are not the answer to integration

IDEA #1: VOLUNTEER GROUP

Brief Description: Group of people to bring people together in a community to look at the coordination that is needed.

Key Goals

· Training on collaboration and resources

· Sites are knowledgeable of community resources and effectively link clients

· Health behaviors of people improve

· More people have access to health information and care

· Neighborhood partners have a high standard of customer service

· Gaps in services have diminished

· Health indicators (2010—selected by neighborhood) have improved

· Data is current, systematically current, disseminated and reflected in program revisions

· Provider of long-term support

· Enhance existing health care agencies as they collaborate with the neighborhood

· Learning from one resource so it can be duplicated in other areas or topics

Programmatic Elements

· Creating intersections: bringing people to the table; identify existing structures/organizations as health capacity building sites where people already come to connect

· Identify duplication and gaps within a neighborhood

· Outcome based funding—educate funders

· Long-term money commitment to the neighborhood sites

· Coordinate prevention education

Partners/Leaders

* Healthiest Milwaukee selected these two levers with the understanding that a.) Regulation, inspection, and enforcement of environmental conditions must continue at least at current levels if not higher, and that b.) Broader social policy should reduce disparities in income, education, housing, and other conditions essential for healthy life.