1. Health & Wellness Alliance for Children Common Agenda

2. What is The Alliance? Who We Are Who We Represent
Coalition of community organizations established to improve the health and well being of children in Dallas County 
An organized & engaged group of community stakeholders aligned around a common agenda for positive change in pediatric health (initially focusing on pediatric asthma)
Funded and supported by Children’s Medical Center
Who We Represent
The voice of children and their families
Social service organizations
Educators, universities, school districts & day care centers
Faith-based organizations
Hospitals and health clinics
Government entities
Donors
The Health and Wellness Alliance for Children – “It’s About the Kids” 2

3. Challenges and Focus - Asthma
Why Focus on Children’s Health?
Dallas County has cutting edge medical facilities and a community dedicated to its children, yet the current state of children’s health in Dallas County is not in line with the community’s vision:
- 29% of our kids live in poverty
- 18% do not have health insurance
28% have inadequate food and nutrition
Why Initially Focus on Asthma?
60,000 children in Dallas have asthma, nearly 9% of all Dallas children
Asthma is a manageable condition, yet:
- In 2010, 3 children per day visited a Dallas County hospital for their asthma - In Texas, 54% of children with asthma missed at least one school day per year due to their condition - The cost of unmanaged asthma in Dallas (to families and medical facilities) is estimated at $60M per year
We can apply what we learn about the social and environmental determinants of asthma to address other conditions in the future
The Health and Wellness Alliance for Children – “It’s About the Kids” 3

4. The Asthma Wellness Equation
The Health and Wellness Alliance for Children – “It’s About the Kids” 4

5. The Alliance Goals - Asthma
EVERY child with asthma achieves their fullest health,
well-being and potential
The Alliance seeks to reduce or eliminate the burden that asthma places on children, families and the community by developing strategies that address each of the components of the asthma wellness equation.
Indicators that the Alliance is evaluating to track progress include the following:
1. Hospitalizations due to asthma
2. Emergency department visits due to asthma
3. Average asthma control test score
The Health and Wellness Alliance for Children – “It’s About the Kids” 5

6. Approach to Achieving Our Goal: Collective Impact
Five Conditions of Collective Impact
1. Common Agenda
Common understanding of the problem
Shared vision for change
2. Shared Measurement
Collecting data and measuring results
Focus on performance management
Shared accountability
3. Mutually Reinforcing Activities
Differentiated approaches
Willingness to adapt individual activities
Coordination through joint plan of action
4. Continuous Communication
Consistent and open communication
Focus on building trust
5. Backbone Support
Separate organization(s) with staff
Resources and skills to convene and coordinate participating organizations
The Health and Wellness Alliance for Children – “It’s About the Kids”

7. Structure of Work
EVERY child with asthma achieves their fullest health,
well-being and potential
Backbone Staff Support
Steering Committee provides guidance and oversight
Working groups of community partners plan and implement strategies
Asthma-Healthy Physical Environments
High Quality Health Care
Improved Access to Health Care
Equipping Children and Families For Asthma Wellness
Connecting groups will support strategies across working groups
Policy Group
Data Group
The Health and Wellness Alliance for Children – “It’s About the Kids”

8. Health and Wellness Alliance Goals & Indicators
Every child with asthma achieves their fullest health, well-being, and potential.
Child hospitalizations due to asthma in Dallas County
Child emergency department visits due to asthma in Dallas County
Asthma control test (ACT) scores for children in Dallas County
Big Goal + Indicator
Working Group
Equipping Children & Families for Asthma Wellness
Improved Access to Health Care
Asthma-Healthy Physical Environments 
High-Quality Health Care
Working Group Goal
Create awareness and sense of power among children and families regarding asthma management.
Remove barriers for families to get the necessary care and medications they need to manage asthma.
Create safe places for children to live, learn and play free from asthma triggers.
Ensure that medical care providers have accessible and consistent information about childhood asthma.
% of children / families who report asthma interfering with home/work/school on the Asthma Control Test
Medication possession ratio % of children with asthma who have had a preventive care visit in the last 12 months
Families perspective on whether they can get the primary care they need to manage asthma
ER & hospital repeat visit rates
Prevalence of triggers in targeted households
% of schools in Dallas County who implement indoor air- quality guidelines of Tools for Schools program
Controller to rescue medication ratio
% of children who visit hospital or ER who have PCP follow up within 14 days
% of children who have had ACT score recorded
% of children who have an asthma action plan
Working Group Indicators
DRAFT
# parents or # kids participating in education sessions
# community members trained
Knowledge change after education
# alternative primary care appointments created
# of navigation guides distributed .
# daycares implementing indoor air quality guidelines
# of day cares or schools implementing flag program
# of organizations who agree to use universal AAP
# physicians participating in asthma-specific training
Strategy Indicators
DRAFT

9. Working Group Strategies DRAFT
Equipping Children and Families for Asthma Wellness
Testing a holistic approach in Jubilee Park to include:
Screening for asthma (health fair-style) with information on resources for medical care, insurance, and other items
Parent/caregiver education class with opportunity for parent to identify specific actions he/she can take
Followup with parents to address challenges (phone and in- person)
Future strategies to include:
Create peer groups (same age, older to younger kids) to teach, support, and encourage children with asthma
Deliver in-home education for parents/children
Train community residents to serve as community health workers OR other asthma health literacy educators from the community to provide asthma education to families in their neighborhoods in variety of settings
Improved Access to Health Care
Make asthma medications more affordable by:
1.) Publishing guides for patients on how to get low-cost and free medications 2.) Studying insurance coverage policies and, if necessary, advocating for expanded coverage of medications 3.) Working with pharmaceutical companies to provide medications
Expand alternative forms of primary care such as shared medical appointments, walk-in clinics for asthma patients
Create an asthma hotline or mobile app that families can use to address questions and concerns about asthma 24/7
Create resources guides and/or navigational services to help families identify free and low cost asthma-related health care services and transportation
Increase the portion of physicians who will accept Medicaid/CHIP patients by increasing the reimbursement
Asthma-Healthy Physical Environments
Assess and identify schools with high levels of allergens and implement EPA indoor air quality tools
Partner with day cares to implement indoor air quality tools
Work with city inspectors to add relevant environmental questions to daycare checklists
Targeted in-home environmental trigger identification and interventions in areas of high distressed housing
Enact anti-idling policies in areas frequented by children/families
Coordinate high-ozone day programs (flags, billboard warnings) with clear messages for citizen action, using new technology as possible
Align with existing North Texas air quality initiatives  
High-Quality Health Care
Work towards universal usage of standardized asthma action plans by all providers in Dallas. This involves encouraging providers who don’t use a plan to do so, recommending the use of standardized plan(s) by all providers, and recommending that electronic health record systems contain standard asthma plan components
Train providers (MDs, PAs, NPs) on ERP-3 guidelines and provide tools and techniques to have effective conversations with patients about asthma management
Identify key messages/education tools related to asthma wellness for non-healthcare providers who may have contact with children with asthma. Families WG will work to equip those partners (i.e. coaches, daycare workers, teachers, faith community)

10. HWAC Steering Committee Members
Steering Committee Members as of April 1, 2014
Ron J. Anderson, M.D., MACP Retired President and CEO Parkland Health & Hospital System Julie Bagley President Elect Junior League of Dallas Cheryl Boswell VP, Community Health and Well-Being YMCA of Dallas Brent A. Brown Director bcWorkshop Bill Dawkins Chief Financial Officer H.I.S. Bridgebuilders Jennifer Edwards UPSTREAM Population Health Rebecca Gruchalla, M.D. Prof. of Medicine & Pediatrics, UTSW Div. Dir. Allergy & Immunology Children’s Medical Center of Dallas Holly Hassmann Vice President and Executive Director Health and Wellness Alliance for Children Susan Hoff Chief Strategy Officer United Way of Metropolitan Dallas Larry James President and CEO CitySquare Suzanne Kubelka Director, Health Services DISD Tori Mannes Child Care Group Leonor Marquez Chief Executive Officer Los Barrios Unidos Comm. Clinic Julie Martellini, PhD Epidemiology Program Planner Dallas County Health & Human Services John Martinez President Regional Hispanic Contractors Assoc. Cynthia Mickens Founder and CEO Cynthia Mickens Ministries Sue Pickens Director, Population Medicine Peter Roberts** EVP, Population Health and Network Dev. Michael Samuelson Sr. Consultant Population Health Samuelson Health and Wellness Solutions Eduardo Sanchez, M.D.** Deputy CMO American Heart Association Paula Selzer Regional Coordinator Children’s Environmental Health US Environmental Protection Agency Reg. 6 John Siburt Vice President of Programs Joyce Tapley The Martin Luther King, Jr. Family Clinic Anne Thomas Executive Director AVANCE Dallas Candace M. Thompson Community Outreach Manager Jubilee Park & Community Center Larry Tubb Sr. Vice President, System Planning Cook Children’s Medical Center Rhonda L. Walton, M.D. Pediatrician CitySquare Community Health Services Keith Zimmerman Medical City Children’s Hospital
**Steering Committee Co-Chair
The Health and Wellness Alliance for Children – “It’s About the Kids”

11. HWAC Working Group Members
Working Group Members as of April 1, 2014
Asthma Healthy Physical Environments
Equipping Children and Families for Asthma Wellness
Brent Brown, bcWorkshop (Co-chair)
Cheryl Boswell, YMCA of Metropolitan Dallas (Co-chair)
Paula Selzer, EPA (Co-chair)
Anne Crowther, Children’s Medical Center (Co-chair)
Brooke Etie, LMSW, Dallas Housing Association
Bonner Allen, Junior League of Dallas
Loletha Horton, YMCA of Metropolitan Dallas
Lisa Bracken, Educational Consultant and Project Management
Nick Kunz, bcWorkshop
Nathan Edgerton, United Way
John Martinez, Regional Hispanic Contractors Association
Phyllis Kane, MyChildren’s
Mindy Mize, North Texas Council of Governments
Cynthia Mickens, Methodist Health Center
Kathryn McCartney, Head Start of Greater Dallas
Lister Robinson, Children’s Medical Center
Susan Spalding, M.D., Parkland
David Thomas, Bryan’s House
Whitney Vandiver, North Texas Council of Governments
Candace Thompson, Jubilee Park and Community Center
Danielle Wesley, Children’s Medical Center
Improved Access to Health Care
High Quality Health Care
Anne Thomas, AVANCE Care (Co-chair)
Leann Kridelbaugh, M.D., MyChildren’s (Co-chair)
Lois Trammell, Children’s Medical Center (Co-chair)
Joyce Tapley, The Martin Luther King, Jr. Family Clinic (Co-chair)
Valerie Bradley, City of Mesquite
Beth Dittman, Mesquite ISD, Health Services
Bill Dawkins, H.I.S. Builders
Barry Lachman, M.D., Parkland Community Health Plan/Asthma Action Coalition
Bob English, DART
Suzanne Kubelka, Dallas Independent School District
Tori Mannes, Child Care Group
Anthony Luedicke, R.Ph., Walgreen’s Pharmacy
Lori Millner, Texas Area Health Education Center East, UT Southwestern
Donna Persaud, M.D., Parkland
Veronica Moore, Health and Human Services
Hernan Reyes, M.D., HRSA
Cassandra Singleton, PediPlace
Larry Robins, PediPlace
Jill Strachan-Batson, M.D., Parkland Youth Family Centers
Martha Rodriguez, Health and Human Services
John Siburt, CitySquare
Joanne Tenery, Parkland Community Health Plan
Matthew Thieman, PharmD, Walgreen’s Pharmacy
Ray Tsai, M.D., MyChildren’s
**Steering Committee Co-Chair
The Health and Wellness Alliance for Children – “It’s About the Kids”