2011 - 2012 Annual Report â€˘ July 2011- June 2012
Bethlehem Partnership and Healthy People 2012 The Mission of the Bethlehem Partnership for a Healthy Community
Table of Contents Mission.................................................................................... 1 Advisory Board Members/Agencies.................................. 1 2011 – 2012 Participating/ Funding Agencies ................................................................. 2 Bethlehem Partnership Initiatives Dental Health Initiative............................................................. 3 Vision Initiative......................................................................... 5 The Fowler Family Center at Donegan Elementary School..................................................... 7 AIDS Services Center (ASC) — HIV Initiative........................ 11 Asthma Initiative..................................................................... 15 Adolescent Health Initiatives................................................. 17 Maternal and Child Health Programs..................................... 23 Minority Health and Health Disparities Initiatives................. 30 Minority Influenza and Pneumococcal Immunization Campaign......................................................... 35 Adolescent Career Mentoring Programs................................ 37 Service Learning..................................................................... 40 Tobacco Cessation Program.................................................... 42
ADVISORY BOARD MEMBERS/ AGENCIES 2011-2012 Mary Carr Northampton County Drug & Alcohol Division Iris Cintrón Community Volunteer Bonnie S. Coyle, MD St. Luke’s University Health Network Kevin Dolan Northampton County Children, Youth & Families Division Kathy Halkins, RN, BSN, MEd Bethlehem Area School District Arnette Hams Lehigh Valley Health Network Nancy Kanuck, MSN, RN St. Luke’s School of Nursing Sara Klingner, MSN, RN, CNM VNA of St. Luke’s University Health Network Dale Kochard Lehigh University 1
Lissette Lahoz Neighborhood Health Centers of the Lehigh Valley Judith Maloney Bethlehem Health Bureau Jill Pereira United Way of the Greater Lehigh Valley Rose Jasmine Quiles Latinos for Healthy Communities Vivian Robledo-Shorey Bethlehem Area School District Lilia Santiago Coalition for a Smoke-Free Valley Shelba Scheffner, MPH, MCHES Eastcentral PA Area Health Education Center Janet Tate Bethlehem Area School District Lorna Velazquez Hispanic Center Lehigh Valley
The Bethlehem Partnership for a Healthy Community is a collaborative initiative of a broad range of local business, government, educational and community organizations. It is believed that through community ownership and shared responsibility, the physical, mental, emotional and spiritual wellness of individuals and communities can be achieved, thereby improving the quality of life for all. The Mission of the Bethlehem Partnership for a Healthy Community is to improve the health status and quality of life of children and families residing in Bethlehem and Fountain Hill. The Bethlehem Partnership’s three main strategic goals are to: 1. improve access to care, 2. promote child and adolescent health, and 3. eliminate health disparities. The Bethlehem Partnership for a Healthy Community is a communitywide effort aimed at improving the health and quality of life of residents and the community by making the Bethlehem and Fountain Hill communities a better place to live, work, raise a family and enjoy life. The Community celebrated more than 15 years of working together through the Bethlehem Partnership at our biannual breakfast meeting in October 2011. The theme for our meeting was “The Power of Collaboration,” emphasizing that now, more than ever, we need to identify creative ways to work together. With our current economic and social environment, we all must break down our silos, partner creatively, and find new ways of accomplishing more with limited resources. Health care reform encourages all of us to focus on population health and more effective ways to promote health for our entire community. The recent requirement for all non-profit hospitals to conduct community needs assessments and strategic plans every three years provides exciting opportunities for the Bethlehem Partnership to re-evaluate our programs and strategies and rethink possibilities for health equity and social justice locally. Leaders from throughout Northampton County have joined with Bethlehem Partnership representatives to review the comprehensive Community Needs Assessment conducted by the Lehigh Valley Research Consortium and funded by St. Luke’s University Health Network. This group has identified four priority health areas to guide strategic planning for the next three years — Adolescent Health, Mental Health, Elder Health and Health Disparities. The Bethlehem Partnership will be convening task force groups over the next few months to develop meaningful interventions to address these key health areas. We hope you will join our efforts to promote health equity for our entire community!
2011-2012 Participating/Funding Agencies Abbott Labs AIDSNET Allentown Health Bureau Allentown School District Allentown Vision Center American Cancer Society American Heart Association American Lung Association Auxiliary of St. Luke’s University Health Network Bangor Area School District Barnes & Noble, Whitehall Benco Dental Berson Martocci LLP Bethlehem Area School District Bethlehem Chapter, American Association of University Women (AAUW) Bethlehem Health Bureau Bethlehem Housing Authority Bethlehem Police Department Bethlehem Public Library Bethlehem Township Lions Club Bethlehem YMCA Borough of Fountain Hill Boys & Girls Clubs of Easton & Southside Bethlehem Bucks County Health Improvement Partnership Dental Program Casa Guadalupe Center Cathedral Church of the Nativity CDS Global Center City Ministries Center for Humanistic Change Children’s Coalition of the Lehigh Valley Children’s Home of Easton City of Bethlehem Colonial Northampton I.U. #20 Communities In Schools of the Lehigh Valley, Inc. Community Action Council of the Lehigh Valley Community Services for Children, Inc. Connell Funeral Home Cops ‘n’ Kids Crime Victims Council of the Lehigh Valley Cupid’s Treasure Dr. Karen Dacey Delta Dental Department of Health & Human Services Department of Public Welfare
DeSales University Diamonz Nite Club & Restaurant Donegan Fowler Family Center East Stroudsburg University Easton Area Community Center Easton Area Public Library Easton Area OB/GYN Easton Area School District Easton Community HIV/AIDS Organization Easton Police Department Embassy Bank of the Lehigh Valley Emmaus Chapter of Quilts for Kids Eyeland Optical Centers, Easton and Whitehall Families First, Pen Argyl Family Answers Family Connection, Easton Fighting AIDS Continuously Together (FACT) Fitzpatrick, Lentz & Bubba Law Offices For Eyes Optical Fox Optical Friends of St Luke’s — Allentown (FOSLA) Fund to Benefit Children & Youth GIANT Food Stores, LLC Glaxo-Smith Kline Pharmaceuticals Gilead Sciences Haven Youth Group (associated with PRIDE of the GLV) Highmark Foundation Hispanic Center Lehigh Valley Highmark Blue Shield Holy Infancy R.C. Church Judith’s Reading Room Junior League of the Lehigh Valley Just Born, Inc. King’s Way Kiwanis Club — NE Lafayette College Lehigh University Lehigh Valley Charter School of the Performing Arts Lehigh Valley Child Care Lehigh Valley Council for Children Lehigh Valley Health Network Lehigh County • Children,Youth & Families • Child Advocacy Center Lehigh Valley Dental Hygienists’ Association Lehigh Valley Dental Society
Lehigh Valley Research Consortium Marvine Family Center Maternal Family Health Services Dr. George McGinley Medoptic Migrant Education Program Moravian Academy Moravian College Morning Star Rotary Muhlenberg College Neighborhood Health Centers of the Lehigh Valley •V ida Nueva Clinic at Casa Guadalupe New Bethany Ministries New Directions Treatment Services, Inc. •L atinos for Healthy Communities North Central AHEC Northampton Community College •D ental Hygiene Program •H ealth Center Northampton County •C hildren, Youth & Families •C oroner’s Office •D epartment of Corrections •D rug & Alcohol •J uvenile Justice Center •M H/MR •M eals on Wheels •D rop-In Center •N orthampton County Emergency Management Services Northampton School District Northeast Ministries Our Lady of Perpetual Help Church Pearle Vision Center, Bethlehem Square Pen Argyl School District Pennsylvania Asthma Partnership Pennsylvania Department of Health Pfizer, Inc. Pinebrook Services for Children Planned Parenthood of Northeastern Pennsylvania PNC Bank Pride of the Greater Lehigh Valley Private Industry Council of the Lehigh Valley/PA Careerlink Lehigh Valley Projecto Claridad Rainbow Mountain Regal Cinemas Richard Henry Construction Richard Ritter Pharmacy Roberto Clemente Charter School
Roche Pharmaceuticals Rotary Club of Bethlehem Sacred Heart Hospital Safe Harbor Saucon Valley School District Sayre Early Child Center Second Harvest Food Bank Simply Smooth Catering Slater Family Network, Bangor St. Luke’s University Health Network •S t. Luke’s HomeStar Medical Equipment & Infusion Services •S t. Luke’s School of Nursing •V isiting Nurse Association of St. Luke’s Home, Health & Hospice St. Peter’s Church Star and Candle Shop, Central Moravian Church Tamaqua Area School District The Green Door The Morning Call — Be An Angel Campaign The Special Kids Network The Quilt Nannies Tibotec Tobacco Free Northeast PA Touchstone Theater Trinity Episcopal Church Turning Point of the Lehigh Valley Twin Rivers Two Rivers Health & Wellness Foundation United Way of the Greater Lehigh Valley •A llentown Promise Neighborhood Unity House University of Pittsburgh US Health Resources and Services Administration Valley Wide Smile Valley Youth House Victory House Volunteer Center of the Lehigh Valley Walter’s Pharmacy Wal-Mart Store #3563, Route 191 Weatherly School District Weed & Seed Wegmans Weis Markets Whitehall-Coplay School District WIC
Bethlehem Partnership Annual Report Bethlehem Partnership Annual Report| | 2
Dental Health Initiative
Healthy People 2020 Objectives: OH-6:
educe the proportion of children and R adolescents who have dental caries experience in their primary or permanent teeth.
educe the proportion of children, adolescents R and adults with untreated dental decay.
I ncrease the proportion of children and adults who use the oral health care system each year.
I ncrease the proportion of low-income children and adolescents who received any preventive dental service during the past year.
OH-10: I ncrease the proportion of children who have received dental sealants on their molar teeth.
The Dental Health Initiative continues to provide quality care to bring healthy, beautiful smiles to our community. Our goal is to give patients the opportunity to have a dental home they can trust and depend on to take care of their dental needs. We believe that providing much needed access to dental care to our community is vital to their health and to our mission.
This year has continued to be a challenging year with insurance coverage cuts and financial difficulties. Low-income patients are finding it difficult to get the care that they need to live a healthier life due to these coverage losses. We have found ways to decrease their financial burden to some degree but continue to see our patients struggle. We continue to explore ways to improve access to care and increase prevention of dental decay.
Dental Van Program The Dental Van continues to be a much needed presence to our community. The Dental Van visited over 30 schools and agencies throughout the area — Allentown, Bangor, Bethlehem, Easton, Pen Argyl, Quakertown and Nesquehoning. We are excited to continue expanding services to Allentown and partnering with the Rural Health Center in Nesquehoning, Pa., to bring care to the children of Carbon County. We have also added to our roster of sites the Hispanic Center of the Lehigh Valley and the Bethlehem WIC office. This has aided in the prevention of tooth decay by targeting pre-school age children. All of these have been welcome additions to our program! We are also pleased that: • 985 children received care, 446 of which completed their care. • 958 dental cleanings were rendered-let’s see those pearly whites! • Almost $123,000 in uninsured care was provided to 309 children. • Other important statistics: FY 2008
3 | Access to Care / Health Services Improvement
As mentioned earlier, prevention has been a key objective in our dental health initiative. We are continuing to provide more sealants to seal out decay and fill teeth less. This will continue to be a major component in our mission to prevent decay! There is still much work to be accomplished by the dental health initiative to bridge the communication gap with parents. There are many children that need our services, but it is our job to educate parents that there is help available for their children!
Easton Dental Center and the Dental Health Center at Union Station Easton Dental Center continues to be a contributor in specialized pediatric dental care for the children of Easton and other neighboring communities. Easton Dental Center continues to provide services to the adult population as well. Our attending dentists, along with our programâ€™s dental residents, provide these much needed services to patients who cannot receive dental care at our Dental Health Center at Union Station in Bethlehem. We also welcome a new member to our program, Dr. Weinberger, who brings his specialty in Oral Surgery. This addition to the program has been beneficial to this population. A total of 3,995 patient visits were recorded at the Easton Center this year. The Dental Health Center at Union Station provides services to our Bethlehem communities primarily, but is finding that many neighboring communities are seeking services as well. Our dental residency program provides specialized services such as endodontics, orthodontics, oral surgery, pediatric dentistry, periodontics and prosthodontics. Dr. Benjamin Weinberger has also provided oral surgery services to this site as well. A total of 5,264 visits were recorded at Union Station this year. Due to the Medical Assistance cuts in authorized dental procedures, both of these centers have modified fees for our patients so that they are more affordable. This has been a huge helping hand to patients that are considered low-income. We strive to do our best to give our patients quality care they can afford!
Oral Health Partners Northampton Community Collegeâ€™s (NCC) Dental Hygiene Program, in partnership with the Dental Health Initiative, continued to provide preventive services to our Bethlehem Area Schools and to the Childrenâ€™s Home of Easton. NCC hygiene students also participated in 23 Sealant Days for the Sealant Program. Through the Sealant Program, 682 sealants were placed on 163 children, greatly reducing the risk of tooth decay. We would like to recognize the Bethlehem Area School District, the Bethlehem Health Bureau and Family Connection for helping many families bridge the gap in receiving care for their children.
Please Partner with Us The Dental Health Initiative aims to be a self-sustaining program but depends greatly on the generosity of partners in this endeavor to provide compassionate, quality care. If you would like more information or can offer resources to our Programs, please call Sarah Andrews at 484-526-6482.
Thanks Thank you to our community partners, supporting partners and dental staff. Your hard work and dedication is exceptional. We could not have done this important work without you! Despite the economic struggles that we face and the ever growing necessity to provide access to care, we will always be determined to create healthy, happy smiles throughout our community.
If you would like more information or can offer resources to our Programs, please call Sarah Andrews at 484-526-6482.
Bethlehem Partnership Annual Report | 4
Healthy People 2020 Objectives: V-2: Reduce blindness and visual impairment in children and adolescents aged 17 years and under.
Number of individuals served by the vision initiative 2011-12: Vision Vouchers — 220 Portable Clinic — 290 Total Number — 510 The Vision Initiative has had an overall seven percent increase in use of its vision vouchers and portable clinics, compared to the previous year. The majority of these individuals have no vision insurance. The few who did have vision insurance were seen due to barriers preventing them from getting to an eye care provider. Portable Vision Clinic: Students Seen — 253 Adults Seen — 37 Total Glasses Made — 198 Allentown School District: This is the first year that the vision voucher program was offered to the entire Allentown School District for students who qualified for the vouchers. Thirteen of the 24 schools had students who used the vision vouchers for an eye exam and a pair of glasses, if needed. School districts served with the vision vouchers: • Allentown (51 percent increase in use compared to previous year; first year the vouchers are being used district wide) • Bethlehem Area (11 percent increase in use compared to previous year)
School districts served (number of days) with portable services: • Allentown (3) • Bangor Area (1) • Bethlehem Area (3) • Easton Area (2) • Tamaqua Area (1) • Whitehall-Coplay (1) This year specific, focused efforts were piloted in three different schools, using different strategies to positively affect outcomes. At Broughal Middle School specific follow-up phone calls that provided information about an upcoming portable vision clinic opportunity resulted in strong completion results for that particular day of service — nearly 100 percent scheduled completed their appointment (graph three). Piloting at the three schools provided us with important information for planning future efforts at partner schools. Family Centers served with portable services: • Neighborhood Health Centers of the Lehigh Valley — La Vida Nueva clinic (2)
Welcome to our new partners for 2012-13: • Dr. Karen Dacey • Dr. Binae Karpo • Eyeland Optical Centers, Easton and Whitehall • Fox Optical
For more information, please contact Julie Kindig at 484-526-6204 or email@example.com. A teenage boy from Allen High School had asked the portable vision team if they could fix the broken frames of his glasses. They told him that it would be better for them to replace the glasses instead of trying to fix them and that they would give him a new pair for free. He could not believe that they would do this for him. He expressed his gratitude to the team over and over again. A teenage boy from the Bangor Area School District had an eye exam by the portable vision team and definitely needed glasses. He was refusing to pick out glasses, stating that he would not wear them, until mom stepped in and firmly told him that he would be getting the glasses. When the glasses were made and delivered to him, he tried them on and could not believe how much clearer he could see. He finally realized how much he was missing and is now thrilled with his new glasses.
5 | Access to Care / Health Services Improvement
Bethlehem Area School District Vision Initiative 3000 2500 2000 1500 1000 500
-1 2 11 20
-1 1 20
-1 0 09 20
-0 9 20
-0 8 07
-0 6 05 20
-0 5 04 20
-0 4 20
-0 3 02 20
-0 2 01 20
-0 1 20
-0 0 99 19
Select Schools Provided Portable and Voucher Vision Support 2011-12
Allentown School District Vision Initiative 4000
Vision Initiative and Support
1000 500 0
*OneSight Community Clinic held Graph 2
Trexler MS Referred
The Vision Initiative has had an overall seven percent increase in use of its vision vouchers and portable clinics, compared to the previous year.
Bethlehem Partnership Annual Report | 6
The Fowler Family Center at Donegan Elementary School • There were 203 new individuals who chose SLFP @ Donegan as their primary care provider.
Healthy People 2020 Objectives:
• Nine percent of the individuals seen were uninsured, improving access to care.
AHS-6: Reduce the proportion of individuals who are unable to obtain or are delayed in obtaining necessary medical care, dental care, or prescription medicines.
THE WOMEN’S HEALTH CLINIC
AH-1: Increase the proportion of adolescents who have had a wellness checkup in the past 12 months (12 - 21 years old). NWS-10.2: Promote health and reduce chronic disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights. EMC-2.3: Increase the proportion of parents who read to their young child.
The Women’s Health Clinic — partially funded by the Bethlehem Health Bureau (BHB), and St. Luke’s Maternal and Family Health Services, Inc. — provided 315 family planning visits to lowincome women. This year the BHB also provided Women’s Health Services on the St. Luke’s HealthStar II van twice per month. The BHB provided 629 immunizations to 247 low-income children and adolescents through an on-site immunization clinic at the Donegan Fowler Family Center.
St. Luke’s Family Practice at Donegan Fowler Family Center St. Luke’s Family Practice (SLFP), which is located in the Donegan Fowler Family Center, continues to grow and offer comprehensive care for the entire family through all stages of life. Our goal is to provide family-focused, quality care for our culturally diverse community. • While only open 21 hours per week, SLFP @ Donegan provided primary and preventive care through 2,583 visits to 941 low-income families (549 children and 392 adults).
FY 12 Fowler Family Center Patient Visits 3000 2500 2000 1500 1000 500 0
St. Luke’s Family Practice Graph 1 7 | Access to Care / Health Services Improvement
Women Health Clinic
Healthy Children According to Gateway Health Plan: • Adolescent Well-Care Visit (12-21 years old) completion rate rose to 95 percent, as compared to previous year at 88 percent. • Children’s Access to Primary Care Physician: (25 months – 6 years old) — increased to 94 percent vs. 88 percent. • Children’s Access to Primary Care Physician: (12–24 months) — continued at 100 percent. Our goal is to fill patient care gaps, ensuring that all areas of preventive care have been performed, such as dental, vision, immunizations and all preventive screenings. SLFP @ Donegan, in collaboration with St. Luke’s School of Nursing, Moravian College, and DeSales University, hosts a community experience/public health student nursing rotation. Nursing students gain experience working with a culturally diverse population. Using a holistic approach to care, they learn about issues of health disparities and chronic disease management. These students also work with Community Health nurses, providing continuity of care and facilitating on-site flu clinics.
Judith’s Reading Room and Reach Out and Read
These effects have been found in ethnically diverse, low-income families, in all areas of the country, regardless of parental literacy. SLFP @ Donegan has promoted monthly reading activities and created a literacy-rich waiting room and quiet reading area.
Health Promotion SLFP @ Donegan and DeSales Nursing students worked to create a series of free wellness classes for the Southside community, including: • How To Stay Healthy During Cold & Flu Season • Let’s Move — Taking it Outside — Zumba classes • Healthy Foods — The Price is Right • Back to School — Healthy Snacks
Healthy Habits SLFP @ Donegan, working with St. Luke’s Nutrition Department and the Donegan Elementary School, offered the “Healthy Habits” class to fourth and fifth graders this past school year. This 14-week class was designed to promote student health and education with the focus being on nutrition and physical activity. This class was highlighted as part of a PBS Tempo program on childhood nutrition and weight management.
SLFP @ Donegan received a Verizon Literacy Grant and, with help from St. Luke’s Auxiliary, is participating in the nationally recognized Reach Out and Read Literacy program. All children ages 6 months through 5 years of age receive a developmentally appropriate book, while the Medical Providers advise the parents about the importance of reading to their child. • In the past three months, SLFP @ Donegan has provided books to 85 children. Judith’s Reading Room, a non-profit organization, donated a library cart stocked with books to SLFP @ Donegan. These books are being distributed to all ages, helping to improve access to literature and reading experiences. Research shows that when pediatricians promote early literacy: • There is a significant effect on parental behavior, beliefs and attitudes towards reading aloud. • There is improvement in language and vocabulary scores of at-risk children who participated. Bethlehem Partnership Annual Report | 8
The Fowler Family Center at Donegan Elementary School cont. Youth Succeeding in School This year the Fowler Family Center completed its third full year of implementing its Youth Succeeding in School (YSS) Initiative. Funded by the United Way, Northampton County, St. Luke’s University Health Network, and the BASD, the program promotes academic success for at-risk students at Donegan Elementary. The program served 74 students and their families throughout the year. All students completed the program and we met our program goal of at least 70 students completing the program. The following findings and outcomes were identified for the 74 children and their families receiving the comprehensive case management services: • A survey was administered to teachers of each of our students at the end of the program, measuring the student’s level of improvement in the classroom. Of the surveys filled out, teachers reported that the majority of students made improvements in the following areas during this program year: ‘completing homework to teacher’s satisfaction’ (48.65 percent), ‘participating in class’ (63.51 percent), ‘being attentive in class’ (54.05 percent), ‘behaving well in class’ (39.19 percent), ‘academic performance’ (71.62 percent), and ‘coming to school motivated to learn’ (51.35 percent). The following areas experienced growth from last year: ‘completing homework to teacher’s satisfaction’ (37.8 percent to 48.65 percent), ‘participating in class’ (42.5 percent to 63.51 percent), ‘being attentive in class’ (35.9 percent to 54.05 percent), ‘academic performance’ (56.6 percent to 71.62 percent); ‘coming to school motivated to learn’ (33.9 percent to 51.35 percent), and ‘behaving well in class’ previously not showing improvement to (39.19 percent). The response rate of the survey increased from 80 percent last year to 100 percent (all children still enrolled at Donegan at the time of survey distribution) for the current program.
• The survey comments provided by the teachers indicate that
the YSS program has greatly helped the students improve their academic and social skills. The comments highlight that the students put forth more effort throughout the year as well as improved attitudes toward academic motivation. One teacher exclaimed of a student, “He has ‘come out of his shell’ and smiles a lot more!” demonstrating that the Donegan teachers highly regard the YSS program in serving at-risk youth.
• In order to track reading progress, there were three DIBELS
exams administered throughout the year. On the second exam, 32 percent of students in grades K-5 increased one or more categories. On the third exam, 47 percent of students in grades K-5 increased one or more categories. At the beginning of the year, there were 87.84 percent students at risk, which was reduced to 39.19 percent by the end of the year. The amount of low-risk students increased from 4.05 percent at the beginning of the school year to 24.32 percent by the end of the school year. The comparison to last year’s results show
9 | Access to Care / Health Services Improvement
improvement in the percentage increase to the some-risk or low-risk category: the results increased from 29.2 percent to 40.54 percent. For math performance of students in grades K-5, we analyzed marking period grades and found that the percent of students who improved by one or more categories between their first and final grades was 24 percent. Of those, 83 percent moved from some risk to low-risk. No students started in the at-risk category and remained in the same category at the end of the year. • The number of children enrolled who had insurance increased from 91 percent to 100 percent. • 97 percent of enrolled YSS students received books from their family development specialist, as part of our literacy initiatives at Donegan.
Reading Rocks! Reading Rocks! is a joint program between St. Luke’s and Lehigh University to promote literacy in the South Bethlehem Community. For the past four years, Reading Rocks! has worked closely with the Youth Succeeding in Schools Initiative at Donegan Elementary School. Led by Roseann Corsi from Lehigh University and Lehigh University student volunteers, this program resulted in the following accomplishments this year: • Fall and spring Reading Rocks! competitions were held during the school year, with a stellar turnout of 383 students participating each semester. Bicycles were generously donated by community members and agencies for the top reader in each grade level for the entire year. • During kickoff assemblies held prior to the start of each semester, Lehigh student athletes shared their stories and encouraged Donegan students to participate in the program and to achieve their reading goals.
• Each week Lehigh University students/athletes volunteered to read during the after-school program. Volunteers and at-risk students were placed in a one-on-one mentorship setting for reading. They also had time at the end of each session to engage in entertaining activities to promote creativity and physical activity. For the entire year, 401 athletes from 15 different Lehigh athletic teams donated 677 hours of volunteer time to the Reading Rocks! Program. Additional Lehigh students from fraternities, sororities and other organizations also participated in the initiative. • Laptops donated by the Northampton County Medical Alliance greatly enhanced the range of educational and creative activities for students participating in the program. Volunteers used the laptops to help students take part in interactive educational games. • Students who achieved their reading goals were acknowledged at end-of-semester assemblies and treated to pizza parties.
Book Drive This past year, St. Luke’s and the Lehigh University Athletics Department held their third annual Book Drive. With support from various sites throughout St. Luke’s University Health Network, an astounding 16,000 children’s books were collected. These books are distributed to children throughout the community through the Reading Rocks! and YSS programs.
Community Support In addition to helping with Reading Rocks!, Lehigh University’s Athletics Department has been supporting community improvement at Donegan in other ways, too. The Department held an Adopt A Family event at Donegan during December. Athletes raised money to provide gifts during the Christmas Holiday for 25 families. A celebration was held with all the families, including a reception with all athletic teams, departments and the fraternities/sororities where gifts were provided to the families. Lehigh student-athletes also provided sports clinics throughout the year and attended assemblies.
For more information about the Fowler Family Center, please contact Donna Bryant Winston at 610-849-9157 or Donna.BryantWinston@sluhn.org.
Bethlehem Partnership Annual Report | 10
AIDS Services Center (ASC) — HIV Initiative Risk Reported During HIV Test
Healthy People 2020 Objectives: HIV 3:
Shares inravenous drug equipment
R educe the rate of HIV transmission among adolescents and adults.
HIV-10: I ncrease the proportion of HIV-infected adolescents and adults who receive HIV care and treatment consistent with current standards. HIV 14: I ncrease the proportion of adolescents and adults who have been tested for HIV in the past 12 months.
Sex with sex worker Intravenous drug user Sex worker Sex with intravenous drug user Sex with partner who is HIV positive Sex with anonymous partner
The National HIV/AIDS Strategy (NHAS) provides a framework for reducing new HIV infections, increasing access to care and improving outcomes for people living with HIV, and reducing HIV-related health disparities. Goals set by the NHAS include: • By 2015, lowering the annual number of new infections by 25 percent. • Increasing the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65 percent to 95 percent. • Increasing the number of Ryan White clients with permanent housing from 82 percent to 86 percent. Services offered by ASC include rapid HIV testing, HIV prevention education, case management and social support services, housing case management services and clinical care services. All ASC services are provided by bilingual, bicultural staff and are free and confidential.
Male having sex with male Sex while intoxicated and/or high on drugs Sex with partner of unknown HIV status Unprotected sex 0
HIV Risk in People Testing for HIV
ASC would like to thank the following organizations for their support and funding: AIDSNET, Two Rivers Health and Wellness Foundation, Pa. Department of Health and the United Way of the Greater Lehigh Valley.
HIV Prevention Education The HIV Prevention Program offers two CDC evidence-based interventions, “CLEAR” and “Project Respect,” to help clients reduce the risk of HIV infection or re-infection. “CLEAR: Choosing Life: Empowerment! Action! Results!” is a health promotion intervention for males and females ages 16 and older living with HIV/AIDS or at high-risk for HIV. It is a one-on-one client-centered program designed to help clients develop the skills necessary to be able to make healthy choices for their lives. “Project Respect” is an individual level intervention designed to support risk reduction behaviors by increasing the client’s perception of his/her personal risks. These interventions are new within the past year, so staff is developing evaluative data measures for future reporting.
11 | Access to Care / Health Services Improvement
Risk Identifed Graph 2
No Risk Identifed
People Testing for HIV by Age Group
People Testing for HIV by Race/Ethnicity
5% 13% 14%
7% 32% 13%
In the last 14 months, we identified five new positives through rapid testing. One identified during an outreach testing event
Four identified during walk-in testing hours
All five returned for confirmatory test results All five enrolled in case management services The three who were uninsured were linked to Medical Assistance (MA) and the Special Pharmaceutical Benefits Program (SPBP) All five enrolled in medical care at our special care clinic. One enrolled in an ASC prevention intervention and completed eight, 1 hour sessions
Prevention staff continues to provide HIV educational presentations in school, community and correctional settings, as well as street outreach and testing promotion in the Easton and Bethlehem areas. The Prevention Program also provides free, confidential/ anonymous, rapid HIV testing in clinical and non-traditional settings. In FY 2012, 196 tests were completed. Of the 196 tests, two were confirmed positive.
Case Management and Supportive Services ASC case managers are often the initial point of contact for clients. Case managers help identify the most appropriate services available for clients and then coordinate access. The program is available to residents of Lehigh, Northampton, Berks, Monroe and Carbon Counties and surrounding areas. In FY 2012, case management services were provided to 351 clients. Counties
Number of Clients
The number of clients served increased this past year due to providing services to Carbon and Monroe County clients. Bethlehem Partnership Annual Report | 12
AIDS Services Center (ASC) â€” HIV Initiative cont. Clinical Care Services
Number of Clients in Case Management
A total of 170 patients received primary care and HIV specialty care in FY 12 at the St. Lukeâ€™s Southside Medical Center.
Number of Patients Receiving Primary and Specialty Care
For the first time, the PA DOH required that individuals receiving case management services be recertified to qualify and access such services. Every six months clients have to provide proof of income, proof of residence and medical insurances, as well as be in medical care. At the time of recertification, ASC had 287 active clients; 237 were recertified (83 percent) and four were determined ineligible due to high income. ASC assisted 50 clients, and an additional 46 household members, both children and adults, to maintain or obtain permanent or stable housing. Through Housing Opportunities for Persons with AIDS (HOPWA), the following assistance was provided: Program
Total # Assisted
Tenant Based Rental Assistance
Short Term Rent/Mortgage/Utility Payments
Permanent Housing Placement
The ASC staff collects data for several patient retention measures throughout the year for the In+Care Campaign through the National Quality Center. One measure in particular is viral load suppression. Evidence shows that keeping viral load levels as low as possible for as long as possible decreases the complications of HIV disease, slows the progression from HIV infection to AIDS, and prolongs life. Adherence is a strong predictor of viral load suppression. Patients enrolled in clinical care services who are on antiretroviral therapy receive adherence counseling from all members of the multidisciplinary team. Graph nine shows the percent of HIV patients, regardless of age, with a viral load less than 200 copies/ mL at last viral load test during the measurement year.
Percent of HIV Patients with a Viral Load Less than 200 Copies/mL
80 60 40 20 0 Graph 9 13 | Access to Care / Health Services Improvement
Dec. 1, 2011
Feb. 1, 2012
Apr 1, 2012
Jun 1, 2012
Aug. 1, 2012
In comparing our data to the 190 national agencies participating in the In+Care campaign, ASC is comparable to the top 25 percent of agencies who have 82 percent of their patients with a viral load less than 200 copies/mL. ASC is also doing better when compared to other Pennsylvania hospitals or clinics participating in the campaign who are reporting an average of 74 percent. The clinical care team also monitors Group I and II HRSA HIV/ AIDS Bureau (HAB) HIV Core Clinical Performance Measures as part of a Quality Management Plan. Data are collected, monitored on a monthly basis and discussed at a HIV Clinical Care Committee meeting. Graph ten shows several performance measure results over a five-year period compared to national benchmark data (NA indicates no national benchmark).
Two Primary Care Visits >= 3 Months Apart
Percentage of Patients with >=2 CD4 Counts
Cervical Cancer Screening
Hepatitis C Screening
Adherence Assessment and Counseling
AIDS patients on Highly Active Anti-Retroviral Treatment (HAART) CD4<200 with PCP prophylaxis Percentage of pregnant women prescribed ART
HIV Risk Counseling Lipid Screening Graph 10
During most of FY 2012, the specialty care clinic functioned without a primary care provider, impacting many of the above performance measures. With the addition of a new primary care provider, Chelsea Shepherd, the clinical team is combining efforts to develop action plans to improve clinical outcomes over the next year.
For more information about this initiative, please call Hollie Gibbons, MPH, RD, Network Manager, Community Health at 484-526-2301 or email her at Hollie.Gibbons@sluhn.org. Bethlehem Partnership Annual Report | 14
Asthma Initiative These goals are challenging to meet in a valley where Allentown, Pa. is ranked #10 out of 100 in a study conducted by the Asthma and Allergy Foundation of American (AAFA) titled Asthma Capitols 2012 — “The Most Challenging Places to Live with Asthma.” This ranking is up from #18 in 2011. The factors used to compare and rank the 100 largest U.S. metro areas are: • Estimated asthma prevalence • Self-reported asthma prevalence • Crude death rate for asthma • Annual pollen score • Air quality • “100 percent” public smoke-free laws • Poverty rate • Uninsured rate • School inhaler access law • Use of quick relief meds • Use of controller meds • Number of asthma specialists
Healthy People 2020 Objectives: RD-2: Reduce hospitalizations for asthma RD-3: R educe hospital Emergency Department visits for asthma. RD-4: Reduce activity limitations among persons with current asthma. RD-6: I ncrease the proportion of persons with current asthma who receive formal patient education. RD-7: I ncrease the proportion of persons with current asthma who receive appropriate asthma care according to National Asthma Education and Prevention Program (NAEPP) guidelines.
Emergency Department (ED) Visits
The Asthma Initiative goals are to:
A total of 562 pediatric patients were seen in the St. Luke’s University Hospital Bethlehem Campus ED or the St. Luke’s North Urgent Care Center and diagnosed with asthma, pneumonia or reactive airway disease.
• Identify children with asthma who have not been diagnosed and refer them for treatment. • Identify and educate children with a known diagnosis of asthma who are not being adequately treated.
Thirty-eight of these pediatric patients, who were all from the Lehigh Valley, had multiple visits to the ED, with a total of 120 combined visits.
• Provide public education and awareness as well as provide continuing education on National Asthma Education and Prevention Program (NAEPP) guidelines, including Asthma Action Plans (AAP), to area providers.
Every pediatric asthma patient who is seen in the ED or at St. Luke’s North and who lives within the city of Bethlehem or is a student within the Bethlehem Area School District, is offered an asthma home visit. The Bethlehem Health Bureau partners with us to provide these home visits. Pediatric patients seen who qualified for a home visit — 170 Families in which follow up contact was made — 59 Asthma home visits that were scheduled — 45 Completed home visits — 20
Pediatric ED and Inpatient Visits for Patients Living in Bethlehem Zip Codes Fiscal Year
Total # Patients
Total # of ED and Inpatient Encounters
Total # of ED Visits
Total # of Inpatient Admissions
2012 numbers include the new Anderson Campus. Graph 1 15 | Access to Care / Health Services Improvement
Educational Opportunities This past year, education was provided at the following locations: • St. Luke’s Physician Group Asthma Training — Presentation focused on the use of Asthma Action Plans in a clinical practice setting. • Community Services for Children — Presented two asthma education programs for agency staff.
Asthma Partnership This past year an Asthma committee was created, consisting of local organizations and pediatric practices that have an interest in improving pediatric asthma care. The committee met and discussed the asthma services that are available to pediatric asthma patients and their families. After reviewing this information and focusing on the Bethlehem Partnership’s strategic plan, it was decided to disband the formal Asthma Initiative, while agencies will continue with their individual efforts. ED follow up phone calls with pediatric asthma patients will continue to be made by the ED Post Discharge Patient Representative, who will connect appropriate referrals to the Bethlehem Health Bureau’s Healthy Homes Program. Asthma education and care will continue through the individual pediatric practices and will be assisted by the Mobile Youth Health Center. Although the Asthma Initiative will not formally continue, asthma care within the Bethlehem Partnership’s programs will continue to be a priority.
One example of how our programs worked together to assist a pediatric asthma family is that of an elementary school age boy who has been seen in the ED multiple times for his asthma. He did not have health insurance or a Primary Care Provider (PCP) and the family had several barriers in trying to work through this. The child received help through the collaboration of the Asthma Initiatives’: • Nurse Practitioner • Nurse Coordinator • ED Post Discharge Patient Representative • The child’s school nurse • VNAC nurse • The St. Luke’s Family Practice at Donegan The child was able to be connected with health insurance, a PCP, and receive the education and medication that he needed in order to live an active, healthy life with asthma.
Asthma education and care will continue through the individual pediatric practices and will be assisted by the Mobile Youth Health Center. Bethlehem Partnership Annual Report | 16
Adolescent Health Initiatives
Healthy People 2020 Objectives: AH-1:
I ncrease the proportion of 10-17 year olds who have had a wellness checkup in the past 12 months.
I ncrease the proportion of adolescents who are connected to a parent or other positive adult caregiver.
I ncrease the proportion of persons with health insurance.
FP-8.1: Reduce pregnancies among adolescent females (15–17 year olds). FP-9.1/9.2: I ncrease the proportion of adolescents (15–17 year olds) who have never had sexual intercourse. FP-10.1/10.2: Increase the proportion of adolescents (15–19 year olds) who are currently sexually active and used a condom the last time they had sexual intercourse. IVP-15:
I ncrease the use of safety belts (9th–12th grade students).
educe the physical fighting among R adolescents (9th–12th grade students).
educe weapon carrying by adolescents R (9th–12th grade students).
MHMD-2: R educe the (attempted) suicide rate (15–19 year olds). NWS-10.3: Reduce the proportion of 12–19 year olds who are considered obese. PA-3.1:
I ncrease the proportion of adolescents who engage in vigorous physical activity that promotes cardio-respiratory fitness three or more days per week for 20 or more minutes per occasion (9th–12th grade).
The Mobile Youth Health Center provides services to adolescents in Allentown and Bethlehem. MYHC sites: Allentown School District • Dieruff High School • Harrison-Morton Middle School • Raub Middle School • Trexler Middle School Bethlehem Area School District • Broughal Middle School • Freedom High School • Liberty High School • Northeast Middle School
Valley Youth House Total Visits to the MYHC (Allentown, Bethlehem and VYH): 1,928 Unduplicated Visits: 677 A total of 238 out of 677 individuals seen by the MYHC were uninsured.
MYHC Visits 2000 1500 1000 500 0
SA-13.2: Reduce past-month use of illicit substances (marijuana) (12–17 year olds). SA-14.4: Reduce the proportion of persons engaging in binge drinking of alcoholic beverages (12–17 year olds). TU-2.1: Reduce tobacco use by adolescents. TU-3: Reduce the initiation of tobacco use among children, adolescents, and young adults.
17 | Access to Care / Health Services Improvement
he goal is to ensure these T adolescents are connected to care and that their health status is stable.
As graph two shows, we are reaching more of the adolescents and their families who are uninsured, helping them to get connected with health insurance and health care providers.
Youth Meeting Definition of High Risk
Individuals with No Health Insurance Seen by the MYHC 35
Students who are seen by the MYHC fill out an Adolescent Health Assessment. This assessment consists of six domains: Substance Abuse, Violence, Unintentional Injury, Reproductive Health, Mental Health and Chronic Disease.
If a student gives a positive risk answer within four of the six domains, or if they answer any question that indicates that there is potential for immediate harm (â€˜circuit breakerâ€™), the student is placed in a Risk Reduction Protocol group. Follow up is done with these students and appropriate referrals are made in order to help reduce the risks of each student. This was a development/ pilot year for this particular group and protocol and we look to community partners to assist us in addressing the risks identified.
The Unintentional Injury domain includes not wearing a helmet or seat belt, drinking and driving, or being in a car with someone who has been drinking and is driving in the past 30 days.
25 20 10 5 0
Percentage of Students Seen by the MYHC Meeting the Definition of High Risk 50 40 30 20 10 0
Percentage of Students Meeting the Definition of High Risk by Grade 50
ASD and BASD
Graph 4 Bethlehem Partnership Annual Report | 18
Adolescent Health Initiatives cont. Percentage of Students Meeting the Definition of High Risk by Domain, 2011-12 100
High School Middle School
The Violence domain covers situations that have immediate potential for harm and include living with someone who has an unsecured firearm; has carried a weapon within the past 30 days and/or has carried the same weapon onto school property in that same time frame; has suffered some type of physical harm by a significant other in the past 12 months; been in trouble with the police; or has been in a physical fight in the past 30 days.
60 40 20
lth ea Su
tiv uc od
ea lH ta
as se Di
The Chronic Diseases domain includes the following: Allergies/ Hay Fever, Asthma, Bladder or Kidney Infection, Blood Disorder/ Sickle Cell Anemia, Cancer, Depression, Diabetes, Eating Disorder, Emotional Disorder, Headaches/Migraines, Anemia, Mononucleosis, Pneumonia, Scoliosis, Seizures/Epilepsy, and Severe Acne. The goal is to ensure these adolescents are connected to care and that their health status is stable.
Many adolescents struggle with stress-related concerns. The difference between what might be expected versus what would be of concern in the Mental Health domain is if the adolescent reports experiencing high levels of stress in the past 30 days at home and/or school; has ever suffered emotional, physical or sexual abuse; reports violence when angry; has self-injured intentionally; or who has had suicidal ideation or attempts in past the 12 months. Reproductive/Sexual Health is an equally important domain to address with this age group. Positive responses to having had sex with more than one person or not using a condom during his/her most recent sexual intercourse (if active) triggers this domain. The Substance Abuse domain is one that covers smoking of cigarettes in the past 30 days; consumption of alcoholic drinks in the past 30 days; use of performance enhancing substances; and use of any illegal drug, regardless of form ingested. For those students identified as answering a “Circuit Breaker” question positively, it indicates that this particular adolescent has at least carried a weapon within the last 30 days; consumed more than five drinks of alcohol within a few hours on at least one day; indicated suicidal/homicidal ideation; or has suffered physical, emotional or sexual abuse.
“(This group) reminded me that my life isn’t the only one that’s dysfunctional. It’s helpful and you make new friends and you form a bond. What was most helpful was talking about my feelings and problems with a group of people that I trust.” • RICHES group participant
19 | Access to Care / Health Services Improvement
Liberty High School Resource Room
As we proceed...
Lead Partners: School nurses and guidance counselors
The status of health for our local adolescent community continues to be a priority as defined by their own reports and the data collected through other community assessments. On the following page is our first Adolescent Health Report Card — one we hope to see get better ‘grades’ as the years pass by. Adolescent Health has been identified as a priority health issue in the most recent needs assessment and strategic planning process for Northampton County. To address areas of concern, the Partnership will once again be reaching out to the community for its support and action.
Small groups are provided for students to voluntarily attend during school hours. Community Partners facilitate these groups and hold a fall session and a spring session each school year (10–11 weeks per session.) This year a total of 37 students participated in the Resource Room groups. Resource Room groups and sponsoring partners • Balancing Weight Management — Bethlehem Health Bureau • Parenting — Catholic Charities • Prenatal — Catholic Charities • Relationship Identity Communication Health Esteem Support (RICHES) — St. Luke’s School of Nursing • Taking Control — Valley Youth House
For more information, please contact Julie Kindig at 484-526-6204 or firstname.lastname@example.org.
obile Youth Health Center is reaching more of the adolescents M and their families who are uninsured, helping them to get connected with health insurance and health care providers.
Bethlehem Partnership Annual Report | 20
Adolescent Health Initiatives cont. AHI Report Card (2006-2012) National Baseline (year) Target (2010) Target (2020)
Objectives Increase proportion of 10–17 year olds who have had a wellness checkup in the past 12 months
New for HP 2020
Increase the proportion of adolescents who are connected to a parent or other positive caregiver (12–17 year olds)
New for HP 2020
Increase the proportion of persons with medical insurance
Reduce pregnancies among adolescent females (15–17 year olds)
39.5 per 1,000 females (2008)
4.3 per 1,000
36.2 per 1,000 females FP-8.1
Increase the proportion of adolescents (15–17 year olds) who have never had sexual intercourse
72.1% Females 71.2% Males (2006-08)
79.3% Females 78.3% Males FP-9.1/9.2
Increase the proportion of adolescents (15–19 year olds) who are currently sexually active and used a condom the last time they had sexual intercourse.
66.9% Females 80.6% Males (2006-08)
66.9% Females 88.6.3% Males FP-10.1/10.2
Increase the use of safety belts (9th–12th grade students)
Reduce the physical fighting among adolescents (9th–12th grade students)
Reduce weapon carrying by adolescents (9th–12th grade students)
1.9 per 100 Actual attempts (2009)
1.0% within past 12 months
1.7 per 100 Actual attempts MHMD-2
Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardio-respiratory fitness three or more days per week for 20 or more minutes per occasion (9th–12th grade)
Reduce past-month use of illicit substances (marijuana) (12–17 year olds)
Reduce the proportion of persons engaging in binge drinking of alcoholic beverages (12–17 year olds)
Reduce tobacco use by adolescents. 9th–12th grade (1 cigarette in past 30 days)
Reduce the proportion of adolescents who report that they rode, during the previous 30 days, with a driver who had been drinking alcohol (9th – 12th grade students)
**Reduce the (attempted) suicide rate (15–19 year olds)
Reduce proportion of 12-19 year olds who are considered obese
(*Local) Population of local adolescents who were seen by the MYHC through the Allentown and Bethlehem Area School Districts. **In the beginning of 2011-12, the 35.2 percent who did not have health insurance were referred to our Insurance Program. Out of the 322 referrals from the MYHC, 161 (50 percent) were connected to health insurance by June 30, 2012. This brought the total percentage of MYHC individuals with health insurance up to 88.6 percent. (* See Below) Question on survey states, “In the past year, have you carried a weapon for protection?” Whether or not that weapon was on school property or not was not specified. **Reduce the “attempted” suicide rate (15–19 year olds) Question on AHA asks, “In the past 12 months, have you seriously considered/thought about suicide?” 21 | Access to Care / Health Services Improvement
22.0 per 1,000 females (2009)
68.1 per 1,000 females
44.9 per 1,000 females
73.8 per 1,000 females
114.9 per 1,000 females
70.4 per 1,000 females
48.1 per 1,000 females
49% Females 44.2% Males
54.3% Females 60.1% Males
45.9% Females 55.9% Males
52% Females 56.1% Males
42.7% Females 51% Males
53.5% Females 47% Males
48.9% Females 47.9% Males
59.5% Females 61.6% Males
51.9% Females 48% Males (“Always use a condom”)
59.4% Females 54.9% Males (“Always use a condom”)
58.6% Females 66.7% Males (“Always use a condom”)
55.1% Females 72.3% Males (“Always use a condom”)
66.1% Females 79.6% Males
64.6% Females 77.9% Males
8.8% (*See Below)
9.0% (*See Below)
5.5% (*See Below)
3.9% (*See Below)
5.7% Actual attempts
8.8 per 100 (“thought about it”)
5.0 per 100 (“thought about it”)
6.9 per 100 (“thought about it”)
5.1 per 100 (“thought about it”)
**3.6 per 100
**2.0 per 100
17.2% * grades 7-12
17.2% (BMI > 29)
14.3% (BMI > 29)
4.3% HS only 15.6% in MS “tried” alcohol
1.9% HS only 0.0% in MS “tried” alcohol
Bethlehem Partnership Annual Report | 22
Maternal and Child Health Programs
Healthy People 2020 Goals: MICH-1:
Reduce the rate of fetal and infant deaths.
MICH-1.9: I nfant deaths from sudden unexpected infant deaths (includes SIDS, accidental suffocation, and strangulation in bed). MICH-8:
educe low birth weight (LBW) and very R low birth weight (VLBW).
MICH-8.1: Low birth weight (LBW). MICH-8.2: Very low birth weight (VLBW). MICH-9:
Reduce Preterm Births.
MICH-10: Increase the proportion of pregnant women who receive early and adequate prenatal care. MICH-10.1: Prenatal care beginning in first trimester. MICH-11: I ncrease abstinence from alcohol, cigarettes, and illicit drugs among pregnant women. MICH-11.1: Alcohol. MICH-11.2: Binge Drinking. MICH-11.3: Cigarettes. MICH-20: I ncrease the proportion of infants who are put to sleep on their backs. MICH-21: Increase the proportion of infants who are breastfed (ever). IVP-37:
Reduce child maltreatment deaths.
Reduce nonfatal child maltreatment.
The Bethlehem Partnership is strongly committed to the overarching Healthy People 2020 goal to improve the health and well-being of women, infants, children, and families. The Partnership supports three maternal and child health nurse home visiting programs — The Nurse Family Partnership (NFP), Parent Advocate in the Home (PATH) and Visiting Nurse Advocate for the County (VNAC). Each of these programs has a different focus of effort with the goal being to create positive environments where children can grow in a safe, healthy, and nurturing home. Our nurses use role modeling, education, perseverance and the holistic nursing approach to support many of these families to reach positive outcomes that benefit the family as a whole. Over 700 families were served by these three programs this past year. In addition, The Partnership actively participates with the Cribs for Kids® initiative, the Lehigh Valley Breastfeeding Coalition and the Front Porch Project.
23 | Access to Care / Health Services Improvement
Community-wide efforts Lehigh Valley Breastfeeding Coalition In December 2010, the U.S. Surgeon General issued a Call to Action to promote specific steps that people can take to participate in a society-wide approach to support mothers and babies who are breastfeeding. This approach will increase the public health impact of everyone’s efforts, reduce inequities in the quality of health care that mothers and babies receive, and improve the support that families receive in employment and community settings. The Bethlehem Health Bureau answered this Call to Action by creating the Lehigh Valley Breastfeeding Coalition (LVBC) to bring community agencies, businesses and medical and public health advocates together to improve breastfeeding rates in our local community. The coalition has met monthly since its inception on June 1, 2011. The Lehigh Valley Breastfeeding Coalition’s vision is to create a breastfeeding friendly culture and environment among hospitals, businesses, and local leaders that will lead to sustainable change in policies focused on promoting breastfeeding support, education, and the absence of formula-based product promotion. In an effort to respond to the Surgeon General’s Call to Action, the Lehigh Valley Breastfeeding Coalition has developed its mission and target statements, developed a webpage and Facebook page, and is pursuing work to carry out a community health-needs assessment. To promote community awareness and support for public breastfeeding, the Lehigh Valley Breastfeeding Coalition
hosted a “Big Latch On” event during world breastfeeding week. The “Big Latch On” is a national event where groups of breastfeeding women come together at registered locations around the world to all latch on their child at a set time. Witnesses verify that all of the breastfeeding women and children are latched on for one minute at the set time and are counted. The information is then recorded and sent to the “Big Latch On” parent site to be tabulated. Globally, 8,862 women were latched on across 626 locations in 23 countries. The LVBC “Big Latch On” had 22 women who participated, with 21 women able to latch on. The 2012 “Big Latch On” event set a world record with 3,175 more women able to successfully latch on than in 2011. In an effort to promote breastfeeding rates in our local area, nursing students at Moravian College have assisted with projects over the past few years. This past year, nursing students partnered with the St. Luke’s Women’s Center to learn more about breastfeeding attitudes, knowledge and behaviors in this population. The nursing students conducted phone surveys with women who were patients at the Women’s Center and who delivered a baby during 2011. Data were gathered from 155 women. This information will be used to develop and implement strategies at the Center to promote breastfeeding. Of the 155 women surveyed, 80 (52 percent) said they intended to breastfeed their baby before they became pregnant, 31 percent intended to use formula, and 15 percent intended to both breast- and formula-feed their baby. The most commonly reported reasons for choosing to breastfeed their infants are listed in the following table:
Most Important Reason Respondents Chose to Breastfeed 50 40
Commonly reported barriers to successful breastfeeding were: not having enough milk; not sure how much milk the baby was getting; nipple pain/engorged breasts; baby was fussy after feedings; difficulties with latching; baby was poor feeder/did not gain weight; and problems with pumping. Only 47 percent of women who attempted to breastfeed initiated breastfeeding within two hours of the baby’s birth, and 40 percent stated they were given formula or supplements while trying to breastfeed. Sixteen percent or mothers agreed that receiving formula packs encouraged them to formula feed sooner than they intended. The findings from this study provide important information as we attempt to develop educational initiatives to promote breastfeeding rates in our local communities. The Lehigh Valley Breastfeeding Coalition is looking to continue its efforts to improve breastfeeding awareness and education and to create changes in policy. Plans for the upcoming year are to develop subcommittees focused on Policy/Research and Education/Awareness. The strength of the group stems from the collaboration of local hospitals, social agencies, public health groups, and community members. Our goal is to continue the diversified collaboration and dissemination of the positive benefits of breastfeeding. Cribs for Kids® The number of infant deaths in our area related to unsafe sleep practices motivated this community effort. In this second full year of funding, our local Cribs for Kids® initiative has grown and provided safe sleeping alternatives for 80 families living in the Northampton County area. When providing these to the families, other wellness and safety services (child safety supplies, immunizations, etc.) are also offered, thereby multiplying the effect of this one initiative and impacting a larger group of community members. Every family deserves to receive clear, consistent, repetitive, and culturally appropriate information regarding a safe-sleep environment for their baby, as well as the tool with which to implement this safe environment — a safety-approved crib. The provision of the portable crib is a crucial educational component to the safe sleep campaign, because once the community is enlightened about SIDS risk and safe sleep, the means with which to implement the safe environment must be part of the intervention.
30 20 10 0
followed by baby’s father (33 percent). Of women who chose to breastfeed, 56 percent reported that the baby’s father was supportive of this decision.
Best food for baby
Natural way to feed baby
The most common reason why women reported choosing not to breastfeed was that it is easier to bottle feed. Other commonly reported reasons were that it was painful to breastfeed or that the mom did not produce enough milk. Survey respondents were most influenced regarding their decision to breastfeed by friends and family (30 percent), followed next by doctors/nurses (17 percent), then WIC staff (11 percent). Support to breastfeed was most often received from mothers (34 percent),
The ‘Cribs for Kids’® initiative is designed locally to most effectively reach families in high-risk or underserved communities based on referrals from partnering agencies and community located programs. General community members may also access services by calling the Bethlehem Health Bureau directly, 610-865-7087. Front Porch Project® (FPP®) If you’ve ever seen a parent “losing their cool” with a child in a store or restaurant, if you’ve ever wondered if a child in your neighborhood is being supervised and cared for — you are not alone. These concerns, and others, are what the Front Porch Project® is all about. FPP® is a community-based primary prevention initiative based on the belief that everyone can — and should — become more aware of how to help protect fragile and at-risk children in Bethlehem Partnership Annual Report | 24
their own community. It provides ordinary citizens with the knowledge, training and encouragement they need to become involved (http://pa-fsa.org).
NFP Client Race 1%
The Bethlehem Partnership, with the Bethlehem Health Bureau as lead partner, has brought the FPP® to the Lehigh Valley to not only impact the concern of local Bethlehem residents that child abuse is a serious MCH issue locally, but also to raise awareness of opportunities that everyone can actively support. Local efforts will include both training for lay community members in the Bethlehem (one already hosted in Spring 2011), Easton, and Bangor areas as well as Child Abuse Prevention Training for professionals in November 2012. Addressing child abuse in our community requires everyone’s efforts. Please join us. More information is available through the Bethlehem Health Bureau, 610-865-7087.
Nurse-Family Partnership The Nurse-Family Partnership (NFP) is a voluntary, evidencebased home visitation program in which registered nurses visit low-income, first-time mothers from early in pregnancy through the first two years of the child’s life to accomplish three goals: • Improve pregnancy outcomes, • Improve child health and development, and • Improve families’ economic self-sufficiency.
• Median age of clients at intake is 19 years (range 13 – 37 years). • Marital status — 8.1 percent of our clients are married when enrolled in NFP. • Ethnicity — 54.9 percent of clients identify themselves as Not Hispanic or Latina while 41.2 percent identify themselves as Hispanic or Latina; 3.9 percent of clients gave no response. 25 | Access to Care / Health Services Improvement
Black or African American White
Declined to Self Identify No Response
• The cumulative median household income is reported as $16,000. Current household trends are suggesting that family income levels are at a standstill while costs for food, gas, and other necessities are increasing, putting our families at even greater risk.
Median Household Income of NFP Clients $18,000
The following report includes information from the beginning of this program (2001) through June 30, 2012. The impressive results achieved by our nurses can best be appreciated when compared with State and National Nurse-Family Partnership program averages and benchmarks.
Asian or Pacific Islander
Based on more than 30 years of research by Dr. David Olds, the NFP has been recognized by the RAND Corporation, the Brookings Institution and the Coalition for Evidence-Based Policy as a “program that works.” The NFP program at the VNA of St. Luke’s began in December 2001 as part of a state-wide initiative to expand services to needy mothers and infants. In July 2008, the NFP programs from Easton and Allentown joined the VNA of St. Luke’s program, resulting in a significantly expanded program with nine full-time and two part-time registered nurses serving 250 clients, making it one of the largest NFP sites in Pennsylvania.
American Indian/ Alaska Native
Maternal and Child Health Programs cont.
Program Implementation Entry into the program early in pregnancy is correlated with higher program retention and completion. The NFP nurses work hard to enroll clients before 16 weeks gestation. The national benchmark is set at 60 percent and the NFP at the VNA of St. Luke’s is exceeding the national program goals.
Change in Maternal Smoking and Alcohol Use
50 % of Relative Change
% enrolled by 16 weeks gestation
Gestational Age at Intake
50 40 30 20
40 30 20 10
National NFP NFP Objective
Graph 6 Graph 4
• NFP referrals come from a variety of community agencies. Eighty-two percent of referrals come from health care providers. Additional referrals come from WIC, Pregnancy Testing Clinics, Schools, and current clients. In looking at attrition data, clients enrolled in the VNASL NFP program tend to remain in the program for a longer time when compared to the State and National NFP programs.
NFP Attrition Rates 2011-12
• VNA of St. Luke’s NFP program is lower than both State and National averages for low birth weight and very low birth weight: % Low Birth Weight
% Very Low Birth Weight
HP 2020 Target
• The VNA of St. Luke’s Preterm Birth rates are significantly lower than the State and National NFP averages:
Comparative Preterm Birth Rates St. Luke's NFP 2012
State NFP 2012 National NFP 2012
Lehigh County 2006-09
% lost to attrition Toddler
Northampton County 2006-09 United States 2006-09
HP 2020 Objectives 0
Program Outcomes • The VNA of St. Luke’s NFP has shown a reduction in smoking during pregnancy compared to the State and National NFP averages. We have seen a decline in this outcome from prior years, which appears to be attributable to the severe reduction in state funds available for smoking cessation programs.
• The National NFP benchmark for immunizations at 24 months is 90 percent. The VNASL NFP data show that our immunization rate is 92.2 percent • The VNASL NFP data show that 23.6 percent of mothers reported subsequent pregnancies by 24 months postpartum, better than the State and National NFP averages of 28.7 percent and 29.1 percent, respectively. The National NFP benchmark is <25 percent. Bethlehem Partnership Annual Report | 26
Maternal and Child Health Programs cont. • Completion of a GED by 24 months postpartum is significantly higher among clients enrolled in the VNASL NFP program at 21.8 percent when compared to the State 15.4 percent and National 13.9 percent NFP programs. • Of those clients who were 18 or older at intake, workforce participation increased from 43.1 percent at intake to 62.8 percent at program completion. (State NFP average = 52.7 percent; National NFP average = 51.5 percent at completion). Despite economic recession and high unemployment, our families are working at a greater rate.
toy drives, or assist us in counting and collecting coats so that our babies can have an appropriate warm coat in the winter. The NFP Advisory Board, made up of a diverse group of local community partners, also volunteer their time to strengthen our efforts and support our families. It is the collaboration with our community and the dedication of our team that improve the health and well-being of all of our NFP families. For more information regarding this program, please contact Sara Klingner MSN, RN, Program Manager, Nurse-Family Partnership, VNA of St. Luke’s, 484-526-2778 or Sara.Klingner@sluhn.org.
Parent Advocate in the Home
The VNA of St. Luke’s Nurse-Family Partnership could not sustain such positive outcomes without community support. It is the plethora of resources and caring people that act as a safety net for our very vulnerable families. These dedicated people who share their talents, time, and energy to support our daily functions are essential to our program’s success. The Nurse-Family Partnership has volunteers who work in our office to maintain our paperwork and support our nurses. We have many knitters who work tirelessly to make hats, scarves, mittens, washcloths, and blankets for our babies. Quilting groups make beautiful handmade quilts so that our babies have a safe and clean space to practice tummy time and develop gross motor skills. College students from St. Luke’s School of Nursing, Lafayette, and Muhlenberg organize a Secret Santa Program for our families and donate gifts at Christmas. Caring community members and church groups offer support through book and
The overarching goals of our PATH program are to provide parenting and mentoring for families (regardless of age of parents or number of children in home) so that the child/ children are in a nurturing, loving home with a decreased risk for child maltreatment. This year we served 310 families in Northampton and Lehigh Counties (graph nine).
PATH: Number of Families Served by Year 350 300 250 200 150 100 50 0
Families Graph 9
Graph ten compares our outcomes to Healthy People 2020 goals in relation to birthweight. Encouragement and monitoring of access to early and adequate prenatal care is a goal of the program for women enrolling in the prenatal stage. Unfortunately, this year we received most of our referrals to the program either late in the third trimester or after the infant was already born. During this past program year, we had 80 infants born and enrolled. Of these 80 births, 15 fell into the LBW or VLBW designation. Of those, only three were enrolled prenatally-one enrolled during the last trimester and was a LBW infant; and two were enrolled during their second trimester of pregnancy, and both babies were born at a healthy weight. A priority in this coming program year 27 | Access to Care / Health Services Improvement
will be to reach out to our main referral sources and encourage PATH enrollment as early in the prenatal time period as possible to more directly support better birth weight outcomes as had been more noted in previous years.
Below is the PATH results as compared to HP2020 goals around increasing the number of infants breastfed. Twenty-seven percent (n=71) of Moms assessed report breastfeeding their infant for more than two weeks.
PATH Birthweights Compared to HP2020 for Infants Born July 2011 – June 2012
PATH Life Skills Progression Survey: Breastfeeding of Newly Enrolled Infants, 2011-12
HP2020 Target Goals
No or <2 weeks 10%
< 1 month 1-3 months 52%
> 6 months with some supplementation
LBW (<2500 grms)
VLBW (<1500 grms)
Life Skill Progression Tool Results: Initial to Discharge Assessment for PATH Clients, 2011-12
Visiting Nurse Advocate for the County (VNAC)
GOAL: Support families to achieve a safe, nurturing level of functioning for the child/children in the family unit. The VNAC program provides intensively focused services to: 1) Support families in crisis, 2) Provide parenting education and case management for families and,
3) Advocate for the safety and welfare of the child/children involved. As in years past, our program has not had any child deaths due to maltreatment for any family involved with VNAC.
lH ta en M
l ica ed M h/
Many of our VNAC program begin services after the family unit has been referred to the Office of Children, Youth and Families (OCYS) at each county (Lehigh and Northampton). Our efforts to prevent maltreatment, fatal or nonfatal, are initiated upon case opening and monitored until case closure.
3-6 months with/ without supplements
VNAC Referrals by County 2009-12
Encouraging and mentoring families to develop the skills to maintain positive progress and life/family success is important for our families and for their success as parents. Graph eleven depicts our PATH families’ results (initial to discharge assessment) in each of the six domains measured. An area with little progress is Mental Health. We will need to focus on this during the coming year to determine opportunities to support families to address needs and access available services. With the addition of our Children’s Trust Fund program expansion, we are enrolling premature infants of young parents into the program with the goal of maximizing positive outcomes within the first two years of life for both infant and family.
Bethlehem Partnership Annual Report | 28
Maternal and Child Health Programs cont. This assessment is done quarterly on each family and helps determine goals for the coming quarter(s). It is important to note that, while most are not ‘within range’ at their last assessment, there is progress noted, most notably in the Relationship, Health Care and Basic Essentials domains. Education/Employment remains the most difficult domain within which to observe progress due to the energy and commitment required of these families, many of which are living in crisis while involved in VNAC.
Our program objectives all work towards supporting families to achieve a safe and nurturing living environment for the child/ children involved, or advocating for the safety and welfare of the child/children involved, which may include advocating for termination of parental rights. 1. Successful closure: 67 percent of cases closed successfully with the OCYS goals met. Only eight of the 93 cases (8.6 percent) that closed before the end of June 2012 had a change in goal to termination of parental rights. 2. Children will remain at or improve in percentage compared to national growth measures for BMI or weight-for-age. Our children are remaining at or improving weight-for-age with 97 percent being discharged within range for weightfor-age. There were five children at risk (per MD notes) for Failure to Thrive at time of discharge from the program.
VNAC: Children within Range of Weight for Age Admission vs. Discharge, 2011-12 100
Unknown or still open
VNAC Clients: Life Skills Progression Results 2011-12 60 50 40 30
For more information about the PATH and VNAC programs, please contact Melissa Craig, 484-526-6203, or Melissa.Craig@sluhn.org.
10 Adm 10-11
3. A large percentage of our cases involve parenting education needs and nursing case management. VNAC has begun using an evidence-based tool, Life Skill Progression Tool, to not only assess a family’s possession of specific life skills, but also objectively monitor progression to obtaining necessary life skills (i.e., safe relationships, attendance to medical/mental health needs, basic essentials met, and child development).
29 | Access to Care / Health Services Improvement
Stayed Below Range
Improved Into Range
Stayed Within Range
Minority Health and Health Disparities Initiatives
To achieve health equity, eliminate disparities and improve the health of all age groups.
Mobile Family Clinic at Mosser Family Center, 2011-12 Reasons for Visit 8%
Healthy People 2020 Objectives: AHS-1.1 Increase the proportion of persons with medical insurance.
AHS-3 I ncrease the proportion of persons with a usual primary care provider.
AHS-6: Reduce the proportion of individuals who are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription medicines.
AHS-7: ( Developmental) Increase the proportion of persons who receive appropriate evidencebased clinical preventive services.
Mosser Family Center— Mobile Medical Services
Adult academic PE
Child school PE
Insurance Referral Outcomes for Mosser Clinic Clients, 2011-12 250 200 150 100 50 0
Referred for insurance assistance
Connected to source of care/insurance
This access to care clinical service has as its goal to serve as an entry point for families to connect to a medical home and/or medical insurance. This past year we began a follow-up component to ascertain what percent of individuals that attended the weekly service achieved their initial goal. Connecting with families is challenging in this population but as of June 30, 2012, we were able to confirm that at least 75 percent (29/39) of those identified as being a ‘priority connect’ (having a health condition or concern that required follow up or connection to a medical home) were connected to insurance coverage. Graph two shows a breakdown of reasons provided by individuals seen by our team.
Broughal Community School HEARTS Program This past year marked the inaugural year for the HEARTS (Health Education and Advocacy Resources at Temple St Luke’s) program at Broughal Community School in South Bethlehem. Dedicated Temple Medical Students Rina Edi and Natasha Fonseka approached SLUHN physicians with their idea to start a free-care clinic in the South Bethlehem area staffed by medical students under the mentorship of volunteer physicians and other allied health professionals. They applied for and received a start-up grant for the clinic from the Alumni Board of the Temple University School of Medicine. The doors opened in June 2011 and each month 15-20 uninsured residents from Bethlehem and Fountain Hill are assisted with access to primary care, preventive care, health education, social services, and prescription medicines to improve their health status. Community partners Lehigh University, BHB and BASD enthusiastically joined in this initiative to promote the health of the South Bethlehem community. Under the leadership of Dr. George White from Lehigh University, the HEARTS clinic was incorporated as an important component of the Community School initiative at Broughal. Adrienne Viola, an undergraduate student at Lehigh interested in public health and medicine, applied for an Experiential Grant to develop a care coordination link for the medical services. Called HEARTSLink, this vital aspect of the clinic is modeled after the national HealthLeads program. Students interested in medicine and public health serve in a case management capacity to help patients access the services and education they need. The students shadow the medical students and attending physicians to learn about the health care system, and work with health bureau staff and other social agencies to identify resources to help the patients. Bethlehem Partnership Annual Report | 30
Minority Health and Health Disparities Initiatives cont. need for education to maintain a healthy blood pressure. Of 37 patients who participated in a cholesterol and glucose screening: 22 percent had a glucose level â€œat riskâ€? for developing diabetes, 11 percent had a glucose level that was consistent with a diagnosis of diabetes, 12 percent had a borderline cholesterol level, and 33 percent had a high cholesterol level. Programs will be developed for 2013 to help patients address their lifestyle risks that put them at risk for these common chronic disease problems.
Blood Pressure Categories for Broughal HEARTSLink Patients 19%
During the first year of this program, volunteers included six physicians from SLUHN, ten Lehigh undergraduate students, more than 15 Temple Medical Students, Bethlehem Health Bureau staff, Broughal Community School staff, and community volunteers.
For the first year of operation, 147 uninsured patients from the Bethlehem community, 48 of which were children (33 percent), received health care services, education, and/or screening labs through this new clinic. The most common services required by patients were connection to insurance, dental and vision services. Normal
Percent of Broughal HEARTSLink Patients Assisted with Access to Health-related Services
High blood pressure
60 Graph 4
Community Health Center Network
40 30 20 10 0
Educational sessions are offered to all attendees, with a focus on those with high blood pressure, diabetes, or high cholesterol. Baseline data were collected to determine risk factors present in patients, in order to plan educational priorities for next year. For blood pressure, 41 percent of patients had a blood pressure measurement at the time of their visit consistent with either pre-hypertension or high blood pressure, indicating a strong 31 | Access to Care / Health Services Improvement
Neighborhood Health Centers of the Lehigh Valley achieved a fully-funded status as an FQHC in June 2012. They provide primary care services for the under-served community, but this new status will allow them to expand services to meet this especially at-risk community. They have consolidated their two sites in Allentown at Vida Nueva at Casa Guadalupe site, as well. In addition, Neighborhood Health Centers of the Lehigh Valley has been awarded one of the CMMI Innovation Challenge grants to work with other partners in the Lehigh Valley to address utilization of health care services by particularly needy community members (insured or uninsured).
Medical Insurance/Access to Care Project The BP partners focus efforts on connecting uninsured families with a source of care and assistance with medical insurance application process. Graph five reflects our collective efforts since 2007, specifically the efforts of the BPHC clinical initiatives.
This process, while easy once the online application process is accessed, is daunting for many families and time consuming for staff. The transiency of many families, the strict income limits under which adults must remain to qualify, and documentation requirements compound the ability to successfully connect families to medical insurance and a medical home.
Insurance Assistance Referral Program Results 2011-12 600 500
National Standards for Culturally and Linguistically Appropriate Services (CLAS) “Health inequities in our nation are well-documented, and the provision of culturally and linguistically appropriate services (CLAS) is one strategy to help eliminate health inequities. By tailoring services to an individual’s culture and language preference, health professionals can help bring about positive health outcomes for diverse populations. The provision of health care services that are respectful of and responsive to the health beliefs, practices and needs of diverse patients can help close the gap in health care outcomes” (www.thinkculturalhealth.hhs.gov).
Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”
400 300 200 100 0
Bethlehem Partnership Annual BASD Minority Award Each year the Partnership supports and promotes academic achievement and educational opportunities for our local minority youth. Ashley Rosario, a previous School-To-Work and Health Career Exploration Program participant was awarded this award. Ashley is attending Northampton Community College and majoring in General Studies.
Community Services for Children, Inc (CSC) — HeadStart Services This last year, we provided entry-related physical examination and immunizations to 12 uninsured children. In addition, 13 children received screening and needed restorative dental care through our Dental Initiative. By year’s end, 98 percent of children were reported UTD by CSC.
For more information regarding the Partnership efforts regarding these projects, please contact Melissa Craig, 484-526-6203 or email@example.com. Bethlehem Partnership Annual Report | 32
Minority Health and Health Disparities Initiatives cont. Local efforts around the issue of linguistic access have remained a priority for our partners. This focused effort began as a result of community data that demonstrated that our Limited English Proficient community members felt that language barriers were one of the greatest barriers to their accessing healthcare. Access via telephonic interpretation, video remote ASL interpretation, trained medical interpreters, and bilingual/bicultural healthcare providers are now more readily available in the health care environment locally. With increasing diversity represented in our Lehigh Valley community, the need for and access to these services is more noted now than ever before.
Over the Phone Interpretation Service: Languages Accessed from SLUHN, 2011-12 .65% 2% 1% 3.5% 3%
An example of the diversity of languages and cultures present within our community and needing equal access to our quality health care, may be appreciated in graph six demonstrating the breakdown of the languages accessed in this past year from St. Lukeâ€™s University Health Networkâ€™s contracted remote language support service. A total of 49 languages were accessed from July 2011-June 2012, not counting American Sign Language via remote video.
For more information, please contact Melissa Craig, 484-526-6203 or firstname.lastname@example.org.
33 | Access to Care / Health Services Improvement
The initiative started off with a kickoff event promoting March’s theme of Drink 1% or Less Milk on March 6th 2011. Each month a new theme is promoted regarding healthy living: • Turn off Screens and Live Your Life • Be Physically Active Every Day • Eat Less Fast Food One of the newest programs for the Bethlehem Partnership is the Vive Tu Vida/Live Your Life campaign. Vive tu Vida is a year-long community-based wellness initiative with the main goal of promoting healthy eating habits and increased physical activity in the South Bethlehem Community, and the secondary goal of reducing prevalence and burden of diabetes by identifying resources supportive of healthy living. The Bethlehem Health Bureau was selected as one of only ten health departments from across the country to create a collaborative effort to address the growing health concerns of nutrition, physical activity and diabetes. Vive Tu Vida/Live Your Life is a community effort to help educate and motivate Southside Bethlehem residents towards living healthier lives. Diabetes is a major health concern because our local area has high rates of diabetes and other chronic diseases, childhood and adult obesity, and physical inactivity. We want to make positive changes in the South Bethlehem community so community members can live healthier, longer lives. As part of the Bethlehem Partnership, a coalition was created of community members, organizations and local leaders to plan a community-driven approach to promoting healthy lifestyles. The purpose of the coalition is to promote a universally tailored message to help educate, motivate and mobilize community members toward living healthier lives. We have adapted a program from CHALK(Choosing Healthy & Active Lifestyles for Kids), a New York State Department of Health Center for Best Practices funded program at New York Presbyterian Hospital/Columbia University Medical Center. The positive messages look to reinvent the concept of being healthy as something fun and pleasurable.
• Drink More Water • Eat plenty of vegetables and some fruit every day • Snack on Healthy Foods • Switch to low-fat (1% or less) milk, cheese and yogurt • Eat Smaller Amounts • Do Something Healthy Everyday • Wrap Up/evaluation and plan for year two. After all ten themes are promoted over the course of one year, we restart the series repeating the themes again. To date, we have 64 businesses and agencies participating in Vive tu Vida. Each month events and educational programs are held to encourage residents to make healthy lifestyle choices.
Vive tu Vida Programs Month
Total # Reached
Drink 1% Milk or Less
Reduce Screen Time
Be Physically Active Everyday
Eat Less Fast Food
Vive tu Vida is a year-long community-based wellness initiative with the main goal of promoting healthy eating habits and increased physical activity in the South Bethlehem Community, and the secondary goal of reducing prevalence and burden of diabetes by identifying resources supportive of healthy living.
Bethlehem Partnership Annual Report | 34
Minority Influenza and Pneumococcal Immunization Campaign 3. Conduct six mobile immunization clinics in low-income minority neighborhoods using the HealthStar van, via our HealthStop Program. Outreach activities were conducted to promote high levels of utilization of the clinics that were provided.
Healthy People 2020 Objectives: IID-12: Increase the percentage of children and adults who are vaccinated annually against seasonal influenza. IID-13: I ncrease the percentage of adults who are vaccinated against pneumococcal disease.
Program goal: Increase influenza and pneumococcal vaccination rates among minority individuals residing in the greater Bethlehem area, as well as underserved rural communities in Northampton County. Influenza vaccination can reduce up to 60 percent influenza and pneumonia-related hospitalizations and prevent up to 80 percent of deaths among the elderly, yet coverage among this population is suboptimal, particularly among minority populations (NIC/ CDC 2007). A specific effort to reach out to and provide education and immunization to these community members remains an important public health agenda item. Objectives and Tasks of the Initiative: 1. Through brief community surveys, determine rates of immunization and resources and barriers to immunizations for the targeted population area. 2. Provide outreach education to the targeted population area through printed materials, radio public service announcements, and neighborhood door-to-door outreach.
Partnering Flu Clinic Sites: • St. Luke’s Hospital mobile health units • Meals on Wheels program of Northampton County • Holy Infancy Roman Catholic Church — Southside Bethlehem • St. Paul’s Roman Catholic Church — Allentown. • Senior Centers located throughout Northampton County • The Slater Family Network Center in the Bangor Area School District Each year we conduct a local survey in low-income communities to determine rates of immunization and reasons for not receiving them. Lehigh University was our partner again and conducted the outreach and helped minority and underserved/rural areas community residents complete the surveys. Two hundred and three surveys were completed, compiled and analyzed. As immunization rates were lower this year, extra efforts were placed on educating large groups at the local shelters and soup kitchens. Even though the number of individuals who received the flu vaccine was lower than years past for the 2011-12 flu season, graph two reflects the community response of improved vaccination rates over years prior for those surveyed. Many individuals are beginning to obtain their flu vaccine at local pharmacies, and in our area another health care system does offer a free “drive thru” clinic. Survey data also indicate that education needs to be done in the community regarding the importance of receiving the flu vaccine since two of the top three reasons for not getting the vaccine remain fear of getting the flu from the vaccine (13 percent) and
SHIP Project 2001-11: Influenza and Pneumococcal Vaccination Rates 800 700 600 500 400 300 200 100 0
Graph 1 35 | Access to Care / Health Services Improvement
SHIP Vaccination Project Survey Results 2001-12 80 70 60 50 40 30 20
Ever had pneumonia vaccine
Ever had influenza vaccine
Had an influenza vaccine year prior
SHIP Survey 2011: Reasons Respondents Did Not Receive Flu Vaccine in Year Prior 20
Don't like the vaccine
Don't need the vaccine
I will get Doctor never the flu from told me the vaccine I needed
I do not have a doctor
I don’t know where to go to get vaccine
I cannot afford the vaccine
not needing the vaccine (14 percent) The number one reason remains not liking the shot (20 percent). These top three reasons are comparable to national survey data which indicate that, for adults 18 to 64 years old, the number one and two reasons for nonvaccination are ‘not needed’ and ‘side-effects’ — not liking shots was not a variable in that particular survey (CDC NIS-Adult 2007). Evidence-based interventions suggested by the Office of Minority Health (www.thecommunityguide.org) include several strategies our partners use already: • Home visits (part of the Meals on Wheels program) • Reduce client out-of-pocket (free under this grant opportunity) • Standing orders (present) • Offer in schools and organized children care centers (offered in schools)
• Offer in WIC settings (offered by partner agency in same building) • Community-based interventions offered in combination (present)
EXPANSION The Minority Influenza Campaign was expanded to the Miners Community this year. Fifty individuals accepted the free influenza vaccine.
For more information, please contact Julie Kindig, RN, at 484-526-6204 or Julie.Kindig@sluhn.org.
Bethlehem Partnership Annual Report | 36
Adolescent Career Mentoring Programs
Healthy People 2020 Objectives: AH-5:
Increase educational achievement of adolescents and young adults.
I ncrease the proportion of students who graduate with regular diploma four years after starting 9th grade.
AH-5.3: Increase the proportion of students whose reading skills are at or above the proficient achievement level for their grade, 12th grade.
Percent of Next Step Participants Who Obtained Unsubsidized Employment at St. Luke’s 60 50 40 30 20 10
Next Step Program 2011 – 2012
100 80 60 40 20
• 42 percent (n=5) obtained unsubsidized employment at St. Luke’s University Health Network.
Health Career Exploration Program 2011 – 2012 • 95 percent (21 out of 22 enrolled students) of the Health Career Exploration Program participants completed the program successfully. • 100 percent of the Health Career Exploration Program completers graduated from high school. • 33 percent of the Health Career Exploration Program completers graduated with scholarships, with an estimated total of more than $31,000. • As of July 2012, 86 percent (n=18) of the Health Career Exploration Program completers have enrolled in post-secondary education for the fall 2012. They will 37 | Access to Care / Health Services Improvement
Health Career Exploration Program Participants High School Graduation Rate
• 100 percent (n=12) of Next Step Program participants completed the program successfully.
• As of July 2012, 34 youths have been enrolled in the Next Step Program, with 94 percent (n=32) completing the program successfully and 47 percent (n=15) obtaining unsubsidized employment at St. Luke’s University Health Network.
On April 28, 2012, the School-To-Work Program celebrated its 15th year. Over the past 15 years, well over 250 ESL students from Liberty High School have had the opportunity to rotate through numerous departments at St. Luke’s University Health Network. The School- To-Work Program has served as an incubator for the development of two additional programs — the Health Career Exploration Program and the Next Step Program. These two programs build upon the experiences and the skills the students receive in the School-To-Work Program, and give the youths the opportunity to work part-time within the hospital, learning specific skills and gaining actual work experience. As a result, we have had the opportunity to continue to mentor the youths and encourage them to continue their education as well as further develop their professional skills.
05-06 06-07 07-08 08-09 09-10 10-11 11-12 Program Year
be attending Northampton Community College, Lehigh Carbon Community College, Lock Haven University, McCann School of Business and Technology, Moravian College and Penn State University. • Four of the Health Career Exploration Program students received Community Service Awards for completing more than 120 community service hours, three of whom were previous STW participants. • Two of the Health Career Exploration Program students graduated with high honors, GPA higher than 3.5. • Twenty-five departments within the St. Luke’s Network participated in the Health Career Exploration Program, with 76 percent (n=19) from the Bethlehem Campus and 24 percent (n=6) from the Allentown Campus.
Health Career Exploration Program Participants Pursuing Higher Education in Year Following High School Graduation 100
80 60 40 20 0
05-06 06-07 07-08 08-09 09-10 10-11 11-12 Program Year
School-To-Work Program 2011 – 2012 • 94 percent (17 of 18 enrolled) of the School-To-Work Program students completed the program successfully. • During the academic year 2010–2011, prior to enrolling in the School-To-Work Program, on average, the students had a current GPA of 2.9. After completing the program, during the academic year 2011-2012, the average GPA was 3.1. • Note: Most beginner students made growth and maintained the growth with the STW program. Intermediate or advanced level students’ improvement was not necessarily as evident and not as rapid as at the lower levels of proficiencies. • The School-To-Work Program students had the opportunity to rotate through 39 departments within the St. Luke’s Network during the school year 2011-2012.
• 94 percent of students who had completed the SchoolTo-Work Program at some point and who were eligible graduated from high school this year. • As of July 2012, 56 percent (n=9) of those participants who graduated from high school have enrolled in postsecondary education. • As of July 2012, 71 percent (17 of 24) of participants in the Adolescent Career Mentoring programs who are employed by St. Luke’s University Health Network started their experience in the health care environment in the School-To-Work Program. • Five students who participated in the STW program received scholarships. • Four students who participated in the School-To-Work Program received Community Service Awards for completing more than 120 hours of community service.
High School Graduation Rate of School-To-Work Participants 100 Graduated Unknown
1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2008-09 2009-10 2010-11 2011-12
Graph 4 Bethlehem Partnership Annual Report | 38
Adolescent Career Mentoring Programs cont. Adolescent Career Mentoring Programs Successes: 1. A s of July 2012, twenty-four youths from the Adolescent Career Mentoring Programs are employed by St. Luke’s University Health Network. 2. Th e program staff will be presenting the Adolescent Career Mentoring Programs at a national conference in San Francisco, California. An abstract entitled “Community Partnership: Developed programs to provide English Acquisition students the opportunity to explore health care careers” has been selected for oral presentation at the American Public Health Association annual conference. 3. H eide Rosado and Noeli Sosa, current employees of St. Luke’s University Health Network and former participants of the Next Step Program, have been accepted at DeSales University to pursue their bachelor’s degree in Nursing. 4. H enry Hernandez, 2004–2005 former participant of the School-To-Work Program, graduated from East Stroudsburg University with a bachelor’s degree in Health Services Administration.
39 | Access to Care / Health Services Improvement
5. V eronica Herrera, 2005–2006 former participant of the School-To-Work Program, graduated from St. Luke’s School of Nursing. 6. J ulianne Vargas, 2001–2002 former participant of the School-To-Work Program, graduated from Northampton Community College with an associate’s degree in Nursing. 7. E velyn Montanez, 1998–1999 former participant of the School-To-Work Program, graduated from Kutztown University with a Bachelor’s of Science in Business Administration-Management. 8. A lexander Ascencio, 2010–2011 former participant of the Next Step Program, has been hired in the BioMedical Engineering Department as a Bed Enrolling Stock Technician. 9. N oeli Sosa, 2010–2011 former participant of the Next Step Program, has been hired in the Intermediate Critical Care Unit (ICCU) as a Nurse Aide/Unit Clerk.
For more information about this program, please contact Victoria Montero at 484-526-2104 or Victoria.Montero@sluhn.org.
Healthy People 2020 Goals: ECBP-7: I ncrease the proportion of college and university students who receive information from their institution on each of the priority health risk behavior areas (all priority areas; unintentional injury; violence; suicide; tobacco use and addiction; alcohol and other drug use; unintended pregnancy, HIV/AIDS, and STD infection; unhealthy dietary patterns; and inadequate physical activity). ECBP–14: Increase the inclusion of core clinical prevention and population health content in undergraduate nursing.
The Institute of Medicine (IOM) recently recommended that “...all undergraduates should have access to education in public health.” The Educated Citizen and Public Health Initiative was developed in part by the Association for Prevention Teaching and Research (APTR), the Council of Colleges of Arts and Sciences (CCAS), the Association of Schools of Public Health, and Association of American Colleges and Universities (AAC&U) to help address this IOM recommendation. faculty develop public health curricula in all our nation’s colleges and universities The Educated Citizen and Public Health Initiative serves the broader higher education community, setting the stage for integration of public health perspectives within a comprehensive liberal education framework. Service learning opportunities are strongly encouraged as a method to increase general knowledge of community and public health and to create healthier communities. Service Learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility and strengthen communities. The work of the Partnership is rich with learning opportunities for those learning about Community Health — both for the student as well as the preceptor. Throughout the years, we have been fortunate to partner with our local higher education institutions to provide opportunities for students to learn about community health while doing community health work. The St. Luke’s Community Health Department is committed to engaging students in projects to learn and understand important public and community health issues so that we grow a more civic-minded workforce in the future. Below are highlights from the 2011-12 year for specific initiatives and projects enriched by the work of these students as well as programs for which we provided observational experiences.
Bloomsburg University • Mobile Health Programs — One MSN student ·· R esearch and development of age appropriate teaching activities/exercises linked to Viva Tu Vida teaching components — to be utilized in our Mobile Youth Health Center Program. DeSales University • St. Luke’s Family Practice @ Donegan Fowler Family Center — Senior Nursing students ·· C reated and implemented a series of free monthly Community Wellness classes with a focus on health, nutrition, and physical activity. Drexel University • Visiting Nurse Advocate for the County — One RN to BSN student ·· R esearch and development of assessment/documentation tool for use by nurses in parenting capacity-related cases. East Stroudsburg University • Students from the Master of Public Health Program assisted with several projects in the department. ·· A ccomplishments — Assisted the Bethlehem Health Bureau with implementing the Vive tu Vida Initiative; conducted tobacco cessation counseling; analyzed data for the tobacco cessation program; and assisted with data collection and analysis for the American Association of Diabetes Educators application for the Miners campus diabetes education program. Lehigh University • Minority Health Initiative/ Minority Flu — 18 students were part of a Health, Medicine and Society class ·· A ccomplishment: Community flu survey process as well as outreach for community clinics. • Literacy Initiative — The Lehigh University Athletic Department, Community Fellows, and undergraduate students participated in the Reading Rocks! Initiative and other literacy projects to improve reading levels of students in the Bethlehem area. ·· A ccomplishment — Significant improvement in reading levels for children participating in the program. • A Community Fellow has worked with the Youth Succeeding in School Initiative at Donegan Elementary School to provide case management and social support to at-risk youth and their families. ·· A ccomplishment — Significant improvement in reading levels, math scores and grades for enrolled students. • Undergraduate students in the Introduction to Public Health class completed service learning projects for the Southside community.
Bethlehem Partnership Annual Report | 40
Service Learning cont. ·· A ccomplishments — A literacy-friendly clinic was created and community reading events were held in support of the Reach Out and Read program at St. Luke’s Family Practice @ Donegan Fowler Family Center; Diabetes Prevention Education as part of the Vive tu Vida Initiative was provided at South Bethlehem schools and the Hispanic Center Lehigh Valley; parent engagement strategies were researched for the Broughal Community School; satisfaction surveys and key informant interviews were conducted and data analyzed as part of an overall cancer community needs assessment; and assistance was provided to complete a needs assessment for the Northampton County Drug and Alcohol Division. Moravian College • MCH Initiative/Visiting Nurse Advocate for the County Program — One team of RN to BSN Nursing students ·· A ccomplishment-researched parenting capacity for development of an assessment and documentation tool for use with specific cases. • St. Luke’s Family Practice @ Donegan Fowler Family Center — Senior Nursing Students ·· P erformed an asthma chart audit to identify gaps in care for asthma action plans to help improve quality of care for clinic members. Muhlenburg College • St. Luke’s Family Practice @ Donegan Fowler Family Center ·· P erformed a chart audit on completion rates for members who received professional mammography screening services to improve quality of care. St. Luke’s School of Nursing, Diploma program • MCH Initiatives/PATH and VNAC — Student Nurse Association of PA (SNAP) ·· A ccomplishment — Led a book bag and school supply drive to provide these supplies for the parents and preschool children. • MCH Initiatives/PATH program- Twelve nursing students ·· P aired with assigned families (two per student) and worked with them throughout the semester to improve parenting and life skills while supporting growth and development of child/children involved. Susquehanna University • Healthy Habits Program — one MPH/Kinesiology student ·· P repared activity toolkits for expansion of a kindergarten focused effort at Union Terrace Elementary regarding healthy foods and activity. ·· Assisted with the Fruit/Veggie Truck in Allentown.
41 | Access to Care / Health Services Improvement
Temple University • Undergraduate student in the Public Health Program completed service learning projects for the tobacco cessation program and the Vive tu Vida Initiative. ·· A ccomplishments — Developed mini-surveys for the Vive tu Vida Initiative monthly themes; developed monthly tracking sheets for the Vive tu Vida Initiative; completed weekly phone follow-up on a subset of tobacco cessation patients; completed a tobacco audit for 158 HIV positive patients in the specialty care clinic at the Southside Medical Center; assisted with data entry for the adolescent health program and PATH/VNAC; and assisted with best practice research for inpatient tobacco cessation standards. University of Scranton • Undergraduate student in the Community Health program completed service learning projects for the tobacco cessation program and the Vive tu Vida Initiative. ·· A ccomplishments — Developed mini-surveys for the Vive tu Vida Initiative monthly themes; developed monthly tracking sheets for the Vive tu Vida Initiative; completed weekly phone follow-up on a subset of tobacco cessation patients; and developed follow-up tobacco cessation database.
Observational Experiences • St. Luke’s School of Nursing, Diploma program • DeSales University, Nursing Program • Cedar Crest College, Nursing Program
Tobacco Cessation and Control
Healthy People 2020 Objectives: TU-1:
Reduce tobacco use by adults.
TU-4.1: I ncrease smoking cessation attempts by adult smokers.
Patient Program Status at End of Fiscal Year 2012 Still enrolled working towards quitting
TU-11 Reduce the proportion of nonsmokers exposed to secondhand smoke. TU-10 I ncrease tobacco cessation counseling in health care settings.
Lost to follow-up
Tobacco use remains the single most preventable cause of death and disease in the United States. According to the 2010 Surgeon General Report — How Tobacco Smoke Causes Disease, The Biology and Behavioral Basis for Smoking-Attributable Disease — cigarettes are responsible for approximately 443,000 deaths (one in every five deaths) each year in the U.S. One-third of people who have ever tried smoking become daily smokers. Just over 20 percent of the adult U.S. population smokes, with higher rates for low income populations and those with a mental health diagnosis. Here in the Lehigh Valley, the adult smoking rate is 17 percent in Northampton County and 20 percent in Lehigh County. In order to achieve the Healthy People 2020 objectives to reduce tobacco use by adults, the St. Luke’s Tobacco Cessation Treatment Center provides individual cessation counseling with funding from the Pennsylvania Department of Health (PA DOH) through the Tobacco Free Northeast Pennsylvania at the Burn Prevention Network. Cessation counseling is provided in Northampton, Lehigh and Carbon Counties. Counseling was provided at the SLH Community Health office in Bethlehem and in Nesquehoning, SLH Southside Medical Center, the SLH Allentown Family Health Center, Northampton Community College, Weatherly School District, the SLH Jim Thorpe Urgent Care Center and the SL Miners Nesquehoning Health Center. Patients who enroll in the cessation program tend to be underinsured or uninsured, have multiple past quit attempts, and one or more mental health diagnoses. The following data are from 339 clients enrolled in the program in FY 2012.
Patients Who Made at Least One Quit Attempt During Program Enrollment
Made at least 1 quit attempt
Did not make a quit attempt
Tobacco use remains the single most preventable cause of death and disease in the United States.
Bethlehem Partnership Annual Report | 42
Tobacco Cessation and Control cont. Insurance Status of Enrolled Patients 13% 29%
Amount of Cigarettes Smoked per Day at Enrollment 1/2 pack or less
> 1/2 pack to 1 pack
27% > 1 pack
Patient Assistance Program
Percentage of Patients with Mental Health Diagnosis
43 | Access to Care / Health Services Improvement
Cessation counselors also participated in worksite cessation programs at five organizations in the three counties, including PA Career Link, the Allentown Housing Authority, the Bethlehem Fire Department, the Easton Fire Department, and Lehighton Medical Associates. To address preventing tobacco initiation through community education and to promote our cessation program, the cessation counselors participated in health fairs and a St. Lukeâ€™s Hospital employee Lunch & Learn during Lung Cancer Awareness Month. Additionally, students receive education at the Weatherly School District in Carbon County. According to the 2012 Surgeon General Report: Preventing Tobacco Use Among Youth and Young Adults, cigarette smoking among adolescents and young adults has declined from the late 1990s, especially after the Master Tobacco Settlement Agreement in 1998. However, this decline has slowed in recent years. On the mobile youth health center, middle and high school students receive tobacco cessation counseling at participating schools in Allentown and Bethlehem. Students are asked several tobacco use and secondhand smoke exposure questions as part of the adolescent health assessment. The following data are from the responses of 193 middle school and 254 high school students. The cessation program continues to partner with nurses from the St. Lukeâ€™s Hospital Nurse Family Partnership (NFP), the Parent Advocate in the Home (PATH) and Visiting Nurse Advocate for the County (VNAC) Programs to promote secondhand smoke education to families enrolled in these programs. Program nurses
Student Responses to Tobacco Related Questions Have you ever used tobacco products? Do any of your friends use tobacco products? Does anyone you live with use tobacco products? 0
30 Middle School
50 High School
provide education on secondhand smoke exposure and tobacco use and refer to the cessation program when appropriate. The NFP program has been very successful with this intervention as evidenced by a 14 percent reduction in smoking during pregnancy for NFP participants from 2001 to 2012.
For more information about this initiative, please call Hollie Gibbons, MPH, RD, Network Manager, Community Health at 484-526-2301 or email her at Hollie.Gibbons@sluhn.org.
According to the 2012 Surgeon General Report: Preventing Tobacco Use Among Youth and Young Adults, cigarette smoking among adolescents and young adults has declined from the late 1990s, especially after the Master Tobacco Settlement Agreement in 1998. However, this decline has slowed in recent years.
Bethlehem Partnership Annual Report | 44
IMPROVE ACCESS TO CARE Dental Health Initiative
CHILD/ADOLESCENT HEALTH PROMOTION AND EDUCATION
The Fowler Family Center at Donegan
Mobile Youth Health Center
Resource Room at Liberty High School
Tobacco Cessation Program
Maternal & Child Health Programs
MINORITY HEALTH DISPARITIES REDUCTION Minority Health Initiatives Adolescent Career Mentoring Programs
45 | Access to Care / Health Services Improvement
Bethlehem Partnership Annual Report | 46
Annual Report • July 2011 – June 2012 Funding for this report provided by St. Luke’s University Health Network