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2008 Community Benefit Report www.seattlechildrens.org Our Mission We believe all children have unique needs and should grow up without illness or injury. With the support of the community and through our spirit of inquiry, we will prevent, treat and eliminate pediatric disease. Our Vision We will be the best children’s hospital. • We will provide patients and their families excellent care with compassion and respect. • We will provide superior, accessible, cost-effective service. • We will attract and retain the best talent at all levels of the organization. • We will be one of the top five pediatric research institutions. • We will be the nation’s premier pediatric educator. • We will achieve worldwide prominence by integrating patient care, research, education and advocacy. Welcome to Seattle Children’s Report to the Community Seattle Children’s is a leader in improving the health of children in our communities and reducing inequities that prevent children and families from living full, healthy lives. Children’s offers superior medical care to children from services to every child in our region, regardless of insurance Washington, Alaska, Montana and Idaho, serving the largest coverage or financial circumstances. In fact, Children’s geographical area of any children’s hospital in the United provided an unprecedented $86.2 million in uncompensated States. In addition, families living beyond our primary service care during fiscal year 2008. region increasingly seek care from our world-renowned Beyond providing the best medical care available, specialists in programs such as cancer, organ transplants and Children’s offers an array of services to support families, as craniofacial specialties. In 2008, U.S. News & World Report well as numerous programs to improve the health and safety magazine ranked Children’s the eighth-best hospital in the of families and the livability of our community. We also country for pediatric care, up one spot from its 2007 ranking. conduct research to advance pediatric medical care for As we work to meet the healthcare needs of a growing children everywhere. population, we remain focused on our mission to prevent, The programs, services and people highlighted in this treat and eliminate pediatric disease and our vision to be the report exemplify how Children’s makes a difference in best children’s hospital. Through these commitments, our the greater Seattle community and the Northwest region. communitybenefits from: More information is available at www.seattlechildrens.org. • Hope that illness and injury can be prevented through advocacy, community partnerships and culturally Total 2008 Value to the Community: $161,177,000 appropriate health and safety education. • Outstanding medical care for every child in our region, Health Professional Community Programs regardless of a family’s ability to pay. Education and Services $14,408,000 $5,341,000 • Research that leads to innovative treatments and potential cures for devastating diseases. In 2008, Children’s medical teams treated kids of all ages during 263,667 patient visits, including 13,482 admissions to the hospital and 37,508 visits to our emergency room. We performed 11,180 day surgeries and cared for children during 201,497 appointments in outpatient clinics. Our clinicians also made specialty care available to children in our region through Research Programs Uncompensated Care regional clinics, telemedicine and outreach programs in $55,236,000 $86,192,000 Washington, Alaska, Montana and Idaho. And we offered these Seattle Children’s Community Benefit Report 2008 2 Making a Difference: Uncompensated Care Given the financial struggles that many families face, Seattle Children’s uncompensated care program makes an important difference for children in the Northwest. Whether a child is visiting Odessa Brown Children’s Clinic for Medicaid payment shortfalls account for the majority of preventive care or undergoing complex brain surgery at the uncompensated care dollars in any given year. Approximately hospital’s main campus, Children’s provides the best pediatric 43% of Children’s patients are covered by Medicaid, a medical care to every child in our region, regardless of a government assistance program that provides medical family’s ability to pay. coverage to income-qualifying families. However, the program Despite unprecedented need, Children’s continues to reimburses Children’s for only about 69% of treatment uphold our commitment to uncompensated care. During costs and just a fraction of physician charges. During 2008, fiscal year 2008, Children’s provided $86.2 million in Children’s uncompensated care program covered $77.3 million uncompensated care, an increase of more than $20 million in shortfalls from Medicaid reimbursements. from the previous year. Children’s also provided $8.9 million in financial assistance to families in need. Even for families with private medical insurance plans, paying hospital bills for a critically or chronically ill child can be overwhelming. Zachary’s story: Zachary Sessoms was just 2 weeks old when he began treatment at Seattle Children’s to correct his right foot, which had developed in the shape of a “J.” But shortly after a series of orthopedic procedures, new concerns about Zach’s health arose. By the time he was 2 years old, Zach had visited several medical specialists at Children’s. When the bills exceeded the limitations of the Sessoms’ insurance plan, the family turned to Children’s for help. “When Children’s told us we qualified for financial assistance, it relieved so much stress and worry during a critical time for our family,” says Zach’s mom, Wendy Sessoms. “Zach is a real patient and we are a real family who has been touched by the generosity of the community.” Children’s long-standing commitment to uncompensated care ensures that families like Zach’s experience hope, healing and peace of mind during difficult times. 3 Seattle Children’s Community Benefit Report 2008 Making a Difference: Patient Care Seattle Children’s provides the most advanced medical care available, delivered by compassionate doctors and nurses. We also offer services that promote healing and support Beyond medicine: pastoral and spiritual care families during a child’s hospitalization and beyond. And supports healing. because we believe all children deserve to grow up without Children’s chaplains contribute to the hospital’s healing illness or injury, many of our clinicians share their skills and environment by caring for the diverse spiritual and emotional expertise with worthy causes throughout the country and needs of patients, families, staff and volunteers. Led by around the world. chaplain Martha Dimmers, the members of Children’s Pastoral and Spiritual Care team come from diverse Guest Services: providing a smooth hospital stay backgrounds, represent many faith traditions and embrace In preparing to go to the hospital, families face a lot of many more. Patients and families aren’t the only ones the team questions: Where will they sleep? How will they get around? cares for 24 hours a day, seven days a week. More than 25% And where will they eat their meals? The Guest Services team of the team’s time is spent working with Children’s staff and answers questions and offers resources for a smooth arrival, volunteers. “When care teams face difficult clinical challenges, stay and departure from the hospital. These resources include: our chaplains bring a kind of support to them that can be • Assistance in finding housing tremendously renewing and energizing,” says Ruth Benfield, vice president of Psycho-Social Services. • Arranging transportation on Children’s shuttle, which transports families to and from the Sea-Tac airport, the Greyhound bus station, the Amtrak train station, Seattle ferry terminals, the Seattle Ronald McDonald House and local hotels • Information to prepare for a clinic visit, surgery or hospital stay • Information about amenities near the hospital • Video teleconferencing to connect with family and friends away from the hospital Each month, over 150 families receive personal assistance from a Guest Services specialist. Over 200 families are served by the hospital’s free shuttle services. Tigest Abetew, guest services specialist, helps Volunteer Clarita Portwood leads a prayer service in Spanish and a family from Alaska. English in Children’s chapel. Seattle Children’s Community Benefit Report 2008 4 Patient Care Santa Claus delivers holiday cheer. Aman Tewold and Patients at Children’s don’t have to worry about missing a Ireneo Cayabyab visit from Santa Claus if they are hospitalized during the are part of the team that offers free valet winter holidays. Dr. John Neff, director of the Center for parking to families. Children with Special Needs, enjoys playing St. Nick and handing out donated gifts to nearly 200 children and their families on Christmas Day. “Santa is a symbol of caring, love, joy and laughter. This is very important in an environment where there can be a lot of sadness on a day-by-day basis,” says Neff. Dr. John Neff plays Santa Claus during the winter holiday. A hospital where magical things happen Seattle Children’s provides many services and benefits that make visits easier for patients and their families: Valet parking relieves stress. When busy families arrive at Children’s emergently or barely on time for clinic appointments, our valet parking service offers some relief during a stressful time. Children’s valets help families unload their vehicles, provide wheelchair service and escort them to the clinic or hospital if necessary — all free of charge. Valets also give directions, jump-start cars and watch for patient transportation to arrive so families can wait comfortably inside the hospital. Animal assisted activities offer Doctors and nurses make “house calls.” patients, family Children’s doctors, nurses and staff make “house calls” to and staff interaction the Seattle Ronald McDonald House (RMH), which provides with volunteer dogs. housing for families of children with serious illnesses who require care at Children’s. Hospital executives and staff host quarterly dinners for RMH residents, and the clinical laboratory staff organize semi-annual food drives to stock the RMH house pantry. In 2008, Hematology-Oncology nurses prepared a spaghetti dinner and donated boxes of books. During Cinco de Mayo, the Neurosurgery Department hosted a Mexican- themed meal complete with piñatas. RMH activities coordinator Eleanor Garrison says these efforts make a difference for RMH residents. “I know it means a lot to families to have those who care for them at Children’s come to the house and care for them in a different way.” Therapeutic play promotes healing. Free books encourage reading. Children’s therapeutic play programs, run through the Thanks to the Reach Out and Read program and donations Child Life Department, make an important difference when from generous donors such as Half Price Books in Seattle, patients have difficulty coping with hospitalization. Art and thousands of new books are distributed to patients at music therapists work with patients individually and in groups Odessa Brown Children’s Clinic — a community clinic of Seattle to relieve tension and offer opportunities for self-expression. Children’s — each year. Reach Out and Read promotes early Pet therapists and Pet Partners volunteers bring smiles literacy by giving books to children and advice to parents to patients throughout the hospital and support healing about the importance of reading. The books are distributed through special visits from therapy dogs and specially during well-child visits at the clinic. trained pet visitors. 5 Seattle Children’s Community Benefit Report 2008 Patient Care We vaccinated 2,176 patients and 3,216 household contacts against the flu in 2008. Community immunity: protecting vulnerable Children’s also offers free flu shots to hospital staff children with free flu shots for families and volunteers as well as to students at the neighborhood In an effort to better protect patients from the potentially elementary school. During fiscal year 2008, Children’s clinicians devastating impact of the flu, Children’s initiated a campaign vaccinated more than 380 students, family members and to vaccinate patients and their families during visits to the teachers — thanks to a partnership between Virginia Mason hospital. Children’s offers free vaccinations to parents, siblings Medical Center, Group Health Cooperative, Katterman’s and anyone else who lives with a patient. The idea is to create Pharmacy and the Laurelhurst Elementary School PTA. a ring of protection around patients, which is especially Furthermore, Children’s physicians and staff provide important for those who cannot be immunized because they leadership on the Immunization Action Coalition of Washington, are too young or they have an underlying health condition. which is dedicated to increasing public awareness about the We vaccinated 2,176 patients and 3,216 household contacts importance of immunizations and to achieving and maintaining against the flu in 2008. full immunization of all infants, children, adolescents and Research published by Dr. Danielle Zerr, medical director of adults in the state. Infection Control, suggests that flu vaccines for hospitalized children could help prevent future admissions. “We learned that many families weren’t getting immunized against the flu,” says Dr. Zerr. “Now we’re making sure our most vulnerable patients have that extra protection.” Read more about Dr. Zerr’s research on page 13. Seattle Children’s Community Benefit Report 2008 6 Patient Care Going green for children’s health Sue Heffernan, and the environment clinical nurse specialist, shows As part of our commitment to providing the best pediatric off the phthalate- medical care, Children’s launched the “Clean, Green Hospital free IV bag and Initiative” to create a healthier environment for patients and tubing that is now the community. The Washington State Department of Ecology being used at honored Children’s with the 2008 Governor’s Award for Children’s. Sustainable Practices in recognition of Children’s efforts in the following areas: • Reducing waste: Children’s composts 1,400 pounds of food waste from the kitchen each week. In addition, 100% of kitchen fat is reprocessed into biodiesel. Recycling bins are available throughout the hospital, and the switch to larger, re-usable sharps containers is expected to eliminate the disposal of nearly 18,000 pounds of plastics. Children’s also recycles or reprocesses medical supplies and equipment • Procuring and promoting eco-friendly supplies: Children’s such as disposable blood pressure cuffs, pulse oximeters uses 30% post-consumable paper products and returns and operating room instruments. These and other measures empty printer cartridges to vendors for refilling. All medical comprise the reduction or diversion of 284,542 pounds of devices containing PVC or mercury have been phased out. solid waste. We use phthalate-free medical products whenever possible, and newly purchased mattresses are free of polybrominated • Conserving water: Children’s installed low-flow toilets on diphenyl ethers (PBDEs) — organic compounds used as the main campus; retrofitted the surgery autoclave used for flame retardants. cleaning and sterilizing; upgraded the medical air system from water-cooled to air-cooled; and switched to microfiber • Embracing greener landscaping practices: Children’s mops, which use 10 times less water. Together, these actions uses integrated pest management to prevent pest will save 7,042,276 gallons of water each year. damage, applying the most economical and environmentally safe measures. • Preparing healthy, locally grown foods: Children’s uses local, fresh and sustainable foods as part of our healthy • Reducing travel in single-occupancy vehicles: Thanks to food pledge. We also host Full Circle Farms’ twice-monthly Children’s award-winning transportation program, 66% farmer’s market and feature organic, locally grown produce of employees commute to work by bus, bicycle, carpool, in the cafeteria on market days. vanpool or other transportation alternative. Read more on page 17. Children’s hosts a farmers market to make it easier for Vanpools and vanshares — 68 last year — come to staff and visitors to shop for healthy produce. Children’s from around the region. 7 Seattle Children’s Community Benefit Report 2008 Patient Care Dr. H.O. Olasoji, an oral surgeon from Nigeria, watches Gabriel Valle’s post- surgical appointment with Children’s Dr. Richard Hopper. Olasoji spent a week in Seattle to observe our team approach to care. Understanding Children’s Improving craniofacial care in Africa unique patient population Seattle Children’s Craniofacial Center is respected throughout An analysis of inpatients treated at Seattle Children’s between the world for its innovative team approach to care. Thanks to 2001 and 2007 revealed that 67.3% of the children discharged a grant from Smile Train and matching funds from Children’s, from medical and surgical services had at least one chronic Drs. Michael Cunningham and Richard Hopper are helping illness — such as asthma, diabetes, cancer and cerebral palsy doctors in Kumasi, Ghana, improve how cleft-lip and palate — and these children accounted for 91.7% of inpatient stays. repair is provided in sub-Saharan Africa. Although doctors in The study, conducted by the Center for Children with Special Africa may be able to repair clefts surgically, they are currently Needs at Children’s, also demonstrated that the average age unable to coordinate with other specialists to treat related of the children, the number of hospital admissions, and the problems such as difficulty with eating and drinking, breathing total yearly hospital days increased in direct relationship to and sleeping issues, speech irregularities and hearing loss. the complexity of the child’s chronic condition. This analysis “We’re not going to Ghana to provide services for a few and will assist Children’s in enhancing continuity of care programs then leave while others are left needing care,” says Cunningham. for children with chronic conditions and their families. For “Our goal is to help our Kumasi partners develop a center for example, new regional nurse care coordinators help serve as cleft care.” As part of the project, doctors from Ghana, Ethiopia a bridge between the hospital and services in the patients’ and Nigeria have also visited Children’s. home communities. Training cardiologists in Ukraine Advancing pediatric specialty Seattle Children’s cardiology team partnered with the care around the world international nonprofit Children’s HeartLink to improve Seattle Children’s first priority is to provide the best medical cardiac care for newborns in Ukraine. The country has care for children in the Northwest. But when opportunities only one medical center that performs heart surgeries on arise to improve the lives of children everywhere, our doctors newborns. Children’s clinicians traveled to Kiev to understand and nurses share their skills and expertise outside the region the situation and train physicians on the most-up-to-date and around the world. techniques, diagnoses and treatments for congenital heart disease. A Ukrainian cardiac surgeon and a cardiologist also visited Seattle. Ongoing, twice-monthly videoconferencing offers the Ukrainian cardiac team opportunities to discuss difficult cases with Children’s physicians. Seattle Children’s Community Benefit Report 2008 8 Patient Care Serving Olympic athletes Kiko VanZandt was Beyond their work caring for patients at Seattle Children’s, named the 2008 Nurse of the Year for two clinicians took on voluntary leadership roles during the Community Service 2008 Summer Olympics and Paralympics: by the Washington state chapter of Dr. Monique Burton cares for the March of Dimes. U.S. Olympic track and field team. Children’s sports medicine physician Dr. Monique Burton dreamed of being an Olympic gymnast ever since she was a little girl. She never made it to the Games as an athlete, but she was one of two volunteer doctors chosen to care for the 120 elite athletes on the U.S. track and field team during the 2008 Summer Olympics in Beijing, China. Prior to being selected for the Olympics, Burton served as a team physician with USA Track and Field, where she cared for athletes in many competitions. Although Burton didn’t know it at the time, that experience would make her Olympic journey more meaningful. “I saw some of the track athletes I had seen as Kiko VanZandt coaches swimmers with disabilities. juniors and now they’re in the Olympics and their dreams For more than 25 years, Kiko VanZandt has worked as a have come true,” Burton says. “I felt like it was a privilege nurse in Children’s Rehabilitation Clinic. She is also an athletic to share in this really special moment with them.” coach. VanZandt, who began swimming competitively at age 8, coaches a local swim team called the Shadow Seals, which comprises swimmers with a variety of disabilities. “We try to provide an opportunity for swimmers with a disability to experience a competitive sport, to be part of a team, and to know the benefits that come from being an athlete — discipline, focus, teamwork and meeting a challenge,” says VanZandt. She is also involved in competitive disability swimming at the national and international levels. Most recently, the head coach of the U.S. Paralympic swim team selected VanZandt as an assistant coach at the 2008 Paralympic Games in Beijing, China. In recognition of her work with people with disabilities, the Washington state chapter of the March of Dimes named VanZandt the 2008 Nurse of the Year for Community Service. Dr. Monique Burton volunteered her time to care for the U.S. track and field team during the 2008 Summer Olympics. 9 Seattle Children’s Community Benefit Report 2008 People Making a Difference Kristi Klee and Jo Montgomery embody nursing excellence. Kristi Klee (left), and Jo Montgomery (right), exemplify how Children’s nurses make a difference at the hospital and in the community. Both were honored in 2008 by national and regional publications for their outstanding contributions. Kristi Klee: an outstanding mentor Jo Montgomery: a community hero In recognition of Klee’s mentoring of new nurses, Obesity and inactivity are ongoing challenges for the NurseWeek magazine named Klee a finalist for its 2008 children that Montgomery cares for at Odessa Brown National Nurse of the Year Award. “Kristi is outstanding Children’s Clinic, which primarily serves low-income as a mentor,” says Linda Latta, director of nursing families. Realizing that many families cannot afford to enroll professional development. “She uses humor to help new their kids in popular sports, Montgomery began looking nurses relax so that they can learn. She teaches by example. for creative and practical ways to address the problem Instead of telling them what to do, she models the type and then founded the School of Acrobatics and New Circus of interactions and care they should strive to deliver.” Arts (SANCA). The circus arts — which include activities Klee, a clinical nurse specialist, says she never set out such as acrobatics, juggling and trampoline work — get to be a mentor; she just tries to help other nurses. She kids moving and boost self-esteem. Scholarships ensure has provided ongoing guidance to a new nurse support that no child is turned away. “In circus, there are so many group that meets monthly. Klee remembers that, as a new different skills that everyone finds something they are graduate in 1984, she was better able to cope during times good at,” says Montgomery. “There is nothing like it when of uncertainty with the help of her mentors. So to be given someone does something they didn’t think they could do.” the award in the category of mentoring is “an incredible ParentMap, a parenting magazine in the Puget Sound honor,” she says. area, was so impressed with her solution that the magazine named Montgomery one of 14 “Superheroes for Washington Families.” Seattle Children’s Community Benefit Report 2008 10 Nurses demonstrate extraordinary commitment In 2008, Seattle Children’s became part of the 4% of hospitals in the United States with Magnet designation. Seattle Children’s nurses are renowned for working “above and beyond” their duties. But that level of dedication was formally recognized in 2008 when the American Nurses Credentialing Center (ANCC) awarded Magnet nursing status to Children’s. According to the ANCC, research indicates that Magnet hospitals produce better patient outcomes than other hospitals. Children’s joins the University of Washington Medical Center as the only Magnet-recognized hospitals in the state of Washington. Children’s patients and their families have experienced the exceptional quality of our nurses for decades. Examples of the nursing staff’s deep commitment to the well-being of patients Thanks to this partnership, many patients need to return to and their families can be observed throughout the hospital Children’s only for intensive therapy or specialized procedures on any given day, and sometimes even outside its walls. following diagnosis, with the option of returning to Alaska for The following stories exemplify the level of nursing care less-aggressive treatment. available at Children’s: For patients living in eastern Washington, Montana and Cancer care closer to home southwest Alaska, some pediatricians are willing to administer Traveling to Children’s for chemotherapy from states like doses of maintenance IV chemotherapy. These local providers Alaska and Montana can be hard on patients and their discuss their patients with Brundige or one of her nurse families. To ease the burden, nurse practitioner Karyn practitioner colleagues and then confirm the dose of Brundige helps coordinate chemotherapy treatments chemotherapy to be administered. in a child’s home community. Clear communication with families and local providers Every Tuesday morning she meets by phone with a team ensures continuity of care. “It’s all about doing what’s best of oncology nurses and doctors at Providence Alaska Medical for the family,” Brundige says. “The goal is to keep kids closer Center in Anchorage to review the list of patients who are to their home communities whenever possible, when it’s safe receiving chemotherapy at their center. She answers questions to do so.” about each patient’s plan of care, including any required medication adjustments, and can help coordinate care with other Children’s specialists if needed. 11 Seattle Children’s Community Benefit Report 2008 Outreach to improve newborn care Prom night for cancer patients The birth of a baby is usually a joyous event. But of the more In addition to providing the best medical care available, than 80,000 babies born in Washington state each year, Children’s nurses demonstrate an extraordinary commitment about 10% need assistance to begin breathing at birth, and to the overall well-being of their patients. For example, when 1% require intensive care to survive. nurses in the Seattle Cancer Care Alliance (SCCA) Unit learned In an effort to improve birth outcomes, nurse Jeanette that patient Mairissa Peoples would miss her high school prom, Zaichkin coordinates Children’s Neonatal Outreach Program, they decided to bring the event to Peoples and fellow patients which offers education, information and consultation to undergoing cancer treatment. community-based healthcare providers. The first-ever SCCA Unit prom — complete with music and Zaichkin collaborates with Children’s neonatal experts and decorations — was a smashing success. More than 65 patients, partners, such as the Neonatal Nurse Practitioner Program, the parents, siblings and grandparents attended the event, which Regional Neonatal Ambulance Service and Airlift Northwest featured an ice cream sundae bar and photo station. Before to teach nurses and physicians in community hospitals how the night was over, Peoples was crowned prom queen. “The to resuscitate and stabilize sick newborns for transport — energy in the room was incredible,” recalls Peoples’ mom, and to care for families in crisis. Barb. “The nurses here go so far above and beyond their jobs. She also visits community hospital nurseries and offers When it’s your child, and you see how much they care, assessment of resuscitation readiness as well as education and it means so much.” consultation. “Building strong relationships with community providers is key to ensuring quality care for sick newborns,” says Zaichkin. Support for children with Inflammatory Bowel Disease Nurse Teresa Wachs understands how difficult life can be for children with Inflammatory Bowel Disease (IBD) — and how isolated they can feel because of the nature of their disease. Because education and socialization with others who have IBD make an important difference, Wachs facilitates many educational and social programs for IBD patients and their families. Among those programs are conferences and panel discussions that offer access to IBD experts and networking opportunities for families. She also works in partnership with the Crohn’s and Colitis Foundation to organize quarterly social events for families and a summer camp for children with IBD. “These events are so important,” says Wachs. “They provide opportunities for Prom queen Mairissa Peoples poses with nurse Suzanne Gwynn, who rallied SCCA Unit staff to organize the event. spending time with other kids who understand what they are going through.” “ The nurses here go so far above and beyond their jobs.” Seattle Children’s Community Benefit Report 2008 12 Making a Difference: Research Research conducted at Seattle Children’s aims to improve the health and well-being of children and families everywhere. Because research is the foundation of our mission to prevent, treat and eliminate pediatric disease, Children’s invested $18.7 million in research during fiscal year 2008. Children’s investigators are advancing scientific understanding of important biological processes and influencing the practice of pediatrics around the world. Baby personal care products associated with higher levels of phthalates Babies treated with products such as lotion, shampoo and powder are more likely to have man-made chemicals called phthalates in their urine than other babies, according to research published in the February 2008 issue of the journal Pediatrics. Phthalates are commonly found in many plastic products, like children’s toys, lubricants, infant care products, cosmetics and personal care products. “We found that infant exposure to phthalates is widespread, and that exposure to personal care products applied onto the skin may be an important source,” says the study’s lead author, Dr. Sheela Sathyanarayana, a researcher with Seattle Children’s Research Institute. “This is troubling, because phthalate exposure in early childhood has been associated with altered hormone concentrations as well as increased allergies, runny nose and eczema. Babies may be more at risk than children or adults because their reproductive, endocrine and immune Dr. Danielle Zerr systems are still developing.” Improving hospital standards for pediatric flu vaccines Evaluating and establishing industry standards for flu vaccines for hospitalized children could help prevent additional hospitalizations and complications from influenza, according to research conducted by Dr. Danielle Zerr, associate medical director for Patient Safety at Children’s. The study, which was published in the February 2008 issue of Pediatrics, found that 23% of high-risk children hospitalized with influenza had a recent, previous hospitalization that would have provided a convenient opportunity to receive an influenza vaccination — possibly preventing the subsequent hospital stay. Zerr hopes the results will lead to the development of national flu vaccination standards for hospitalized children. “This information will help pediatricians recognize hospitalization as an important opportunity to vaccinate the highest-risk children, and may hopefully prompt the development of hospital-based flu vaccine programs,” says Zerr. “With findings from this study, we can see that an industry-wide review of hospital-based flu vaccines for all children could take flu-prevention to the next level.” Dr. Sheela Sathyanarayana (right) pictured with Dr. Catherine Karr 13 Seattle Children’s Community Benefit Report 2008 Research Mechanism of More healthcare required for children whose methamphetamine mothers are victims of domestic violence addiction defined Children whose mothers have a history of abuse by intimate A novel discovery made partners have more healthcare needs than children whose by Dr. Nigel Bamford and mothers have no history of abuse, according to research colleagues could lead to more- conducted by scientists from Seattle Children’s Research effective treatments for addiction Institute, Group Health Center for Health Studies and to methamphetamine and related Harborview Injury Prevention and Research Center. drugs. Bamford, an investigator Dr. Frederick Rivara of Children’s was the lead author with Seattle Children’s Research of the study, which appeared in the December 2007 Institute, led the team, which issue of the journal Pediatrics. The researchers found: identified long-term changes in • Annual healthcare costs were 11% higher for children of the part of the brain that releases mothers who experienced intimate partner violence (IPV). dopamine, a neurotransmitter. The research team studied • Children of mothers with a history of IPV that ended before mice given methamphetamine the child was born had significantly greater utilization and observed how exposure to the drug affected dopamine of mental health care, primary care, specialty care and levels in the brain. They focused their observations on the pharmacy services. Those costs were 24% higher for region of the brain believed to be the center for addiction- children in this group, compared to children whose associated behaviors. mothers had experienced no IPV in their lifetime. Careful observation revealed that long-term exposure to • Children exposed directly to IPV after birth had greater methamphetamine, followed by withdrawal, caused changes emergency department and primary care use during the in this region that were subsequently reversed when more IPV and were three times more likely to use mental health methamphetamine was administered. Investigators also services after the IPV ended. They had 16% higher primary determined that the drug produced its long-term effect care costs than did children of mothers without IPV. by altering specific types of receptors for dopamine and another neurotransmitter called acetylcholine. As a result of this study, the authors recommend that The discovery of this mechanism may help scientists healthcare providers routinely screen women for IPV and understand the underlying basis of addiction and develop provide appropriate referrals to community agencies and targeted therapies for people struggling with substance mental healthcare for both mothers and their children. abuse and other addictive behaviors. Bamford’s research was published in the April 10, 2008, issue of the journal Neuron. Dr. Frederick Rivara led a study that shows that children whose mothers experience intimate partner violence have more healthcare needs than children whose mothers have no history of abuse. Seattle Children’s Community Benefit Report 2008 14 People Making a Difference Dave Crotwell helps children breath easier. Dave Crotwell, registered respiratory therapist (RRT) and clinical quality coordinator in Seattle Children’s Respiratory Care Department, was selected by the American Association of Respiratory Care as the 2008 National Neonatal Pediatric Specialty Practitioner of the Year. The award recognizes Crotwell’s distinct career in 2000 and Romania in 2001 as part of an International contributions, including clinical work, published papers Relief Teams group to improve respiratory care for and textbook chapters, abstracts and presentations. He is hospitalized babies. “We went to those countries because part of a team of Children’s researchers and practitioners they have high infant-mortality rates,” says Crotwell. that is measuring respiratory equipment performance and “Our team worked in the host hospitals’ neonatal intensive communicating results to the companies that make the care units and helped train staff. The facilities we saw equipment. Crotwell’s research has led to significant design had limited resources, so some children wouldn’t make it improvements in one of the most widely sold ventilators in because there were not enough ventilators. In some cases, the world. we were able to teach providers techniques to use instead Crotwell has worked at Children’s for 10 years and as of using ventilators so they could free up a ventilator for a respiratory therapist for 14. He also traveled to Latvia another baby.” 15 Seattle Children’s Community Benefit Report 2008 Dr. Rita Mangione-Smith’s study highlights the need for more consistent use of quality standards in caring for children. “ Children in the U.S. fail to get the recommended health care more than half the time.” Closing a critical gap “We started with this question: Was the quality of healthcare recommended preventive care — including such basics as for children in this country really as high as we assumed it being weighed and measured during regular checkups. was?” recalls Dr. Rita Mangione-Smith, a pediatrician and researcher at Seattle Children’s. The figure for chronic care — 53% — wasn’t much better. Those results suggest a need to change the way doctors So she led a comprehensive study — the largest examination are educated, says Mangione-Smith. of the quality of children’s health care in the United States — “Residents spend most of their time in hospital settings that provided a definitive answer: Children in the United and become very good at managing kids with acute illnesses, States fail to get the recommended health care more than but they’re not as well trained in providing preventive care or half the time. caring for kids with chronic illnesses,” she says. The study also Besides illuminating the problem, the study also suggests a need to change the way doctors are reimbursed, contributes to the solution. The study’s collaborators — because the current system rewards quantity, not quality. Children’s, the University of Washington School of Medicine Under pressure to see as many patients as possible, they don’t and the RAND Corporation — combed the literature to always have time to deliver every element of recommended compile 175 recommended standards of care for 12 common care. And yet the study likely reflects only the tip of the conditions including asthma, diarrhea and urinary tract iceberg. Nearly all of the 1,500 children involved had some infections. Originally used as benchmarks for the study, form of health insurance. “I shudder to think of the overall those standards are now a resource for physicians seeking population because the kids in the study are supposedly the latest recommendations for those conditions studied. getting the best care out there,” Mangione-Smith says. Preventive care is more critical than ever to keeping Given the scope and the stakes, the study is a “wake-up children healthy and controlling healthcare costs — especially call” that can’t be ignored, Mangione-Smith says. “We know in light of the obesity epidemic and the related rise in from experience that when we follow recommended standards conditions such as diabetes and hypertension. Yet Mangione- of care, we improve outcomes for children,” she says. Smith’s study showed that only 41% of the children received Seattle Children’s Community Benefit Report 2008 16 Making a Difference: Partnerships Seattle Children’s works with employees, patient families, government agencies, companies and nonprofit organizations to improve the health of children and the livability of the community. Medical-legal partnership serves Employees take steps to improve the low-income families. hospital neighborhood. Thanks to a grant from the Robert Wood Johnson Foundation, Seattle Children’s employees are helping to create a more Seattle Children’s launched the Medical-Legal Partnership livable community by embracing alternative transportation for Children (MLPC), a three-year pilot project to assist and participating in Seattle’s Adopt-a-Street program. low-income families in resolving legal issues that affect their • On any given day, 66% of employees commute to work children’s health and medical care. by foot, bicycle, bus, carpool or vanpool. “Children’s is The program, led by Children’s along with the Northwest committed to reducing the number of vehicle trips to Justice Project and the law firm of Davis Wright Tremaine, campus,” says Paulo Nunes-Ueno, transportation manager. is the first of its kind in the Northwest. Initially, it will benefit “We provide numerous alternatives that encourage low-income patient families at Odessa Brown Children’s Clinic employees to commute in something other than a single- (OBCC) and Harborview Children and Teens Clinic (HCTC). occupancy vehicle.” Incentives include free bus passes, The MLPC is modeled after a successful legal clinic at ride-matching services, shuttle service between Children’s Boston Medical Center. “Thanks to this grant, we’ll be better facilities and a Flexbike program. The hospital is also testing able to serve our young low-income patients facing various a bicycle giveaway program for employees who bike to work social, housing, immigration, economic and legal problems at least two days a week. These efforts helped Children’s that can negatively affect their health,” says Dr. Benjamin earn its fourth Diamond Award from Commuter Challenge, Danielson, medical director of OBCC. a nonprofit organization dedicated to solving transportation “For example, a child with asthma living in moldy, issues in the Puget Sound region. substandard housing may make repeated trips to the hospital with severe breathing problems. Intervention by a social worker and a lawyer that results in improving the family’s Paulo Nunes-Ueno, living conditions may have a significant, positive impact director of Transportation, on the health of that child.” rides his bike to work with his 19-month-old daughter, Twyla Jo, who he drops off at day care three days a week. • First impressions mean a lot. That’s why Children’s adopted a stretch of Sand Point Way — the thoroughfare that connects Children’s main campus to the University District — to help beautify the neighborhood we call home. Employees demonstrate their pride and commitment to the community Dr. Ben Danielson and his team at OBCC review cases to make by removing trash from the area between the hospital and sure patients and their families receive not only medical care, but its administrative offices (approximately two miles away) also social services and dental, mental health and legal care as on a quarterly basis. they need it. Photo by Clare McLean. 17 Seattle Children’s Community Benefit Report 2008 Partnerships Children’s supports our partners in the community Children’s supports community organizations through sponsorships. In 2008, we donated over $262,000 and sponsored more than 70 organizations and events. Some of the community partners that benefited from our support include: Access 2008: Building a Tobacco-Free Jamal Crawford Foundation Future Conference Kindering Center American Heart Association King County Sexual Assault Center American Lung Association Leadership Eastside of Washington Lenny Wilkens Foundation ASTAR Leukemia and Lymphoma Society Atlantic Street Center of Washington Austin Foundation Liam Foundation Bastyr University Living Legacy Foundation Bellevue Botanical Garden March of Dimes Bellevue Rotary Mercer Island Community Festival Brain Injury Association of Washington Minority Executive Directors Coalition Starfire Sports provides opportunities for Cancer for College Moyer Foundation low-income, at-risk children to learn and Cancer Lifeline play soccer. As part of our sponsorship to National Alliance for the this community partner, our athletic trainers Child Care Resources Mentally Ill (NAMI) attend the games and offer medical support Childhaven Northwest Hospital Foundation to the players. Children’s Alliance Northwest Kidney Centers CityClub Our Military Kids of Pierce County Sound Mental Health Colors NW Pike Place Market Foundation South Lake Union Park Crohn’s and Colitis Foundation Program for Early Parenting Starfire Sports Support (PEPS) Cure Autism Now Starlight/Starbright Foundation Providence Hospice of Seattle Cystic Fibrosis Foundation Tacoma Tide Providence Hospice of Denise Louie Head Start Snohomish County Tears Foundation Eastside Domestic Violence Puget Sound Neighborhood Treeswing Epilepsy Foundation NW Health Centers United Way of King County Federal Way Steel Lake Days Festival Safe Kids Washington Washington Health Foundation First Place School Seattle Chamber of Commerce Washington Physicians for Food Allergy and Anaphylaxis Network Seattle Mariners Social Responsibility Foundation for Early Learning Seattle Parks and Recreation Washington Poison Center Group Health Community Foundation Seattle Storm Within Reach Harborview Medical Center Seattle University Youth Eastside Services International Pediatric Seeds of Compassion Youthcare Services Transplant Association Skyline High School YWCA of Seattle-King County- Issaquah Salmon Days Snohomish County Seattle Children’s Community Benefit Report 2008 18 Partnerships Advocating for safe swimming with Seattle Parks A partnership between Children’s and Seattle Parks and Recreation aims to improve water safety for children. Through this effort, every lifeguarded beach in Seattle has a life jacket loan program with information in multiple languages, and community members have the opportunity to purchase low-cost life jackets at special sales held in spring and summer. In addition, Children’s and Seattle Parks and Recreation offered culturally diverse communities family swimming events focused on water safety. One of these events, the Women of the World Swims, is a program for women and girls who can’t swim with men for cultural or religious reasons. These swim sessions teach women valuable water safety skills in a safe and respectful environment. Safe Kids As a member of the Washington State Safe Kids Coalition, Children celebrate the new playground at Dearborn Park Children’s collaborates with the Department of Health and Elementary School, a partnership of the Injury Free-Seattle more than 15 county coalitions across Washington state to Coalition, Seattle Public Schools and the Allstate Foundation. reduce unintentional injury among children under the age of 15. In 2008, the coalition developed bilingual water safety Children’s and our partners improve information boards that demonstrate how to correctly community safety and health. choose and use a life jacket. Promoting safe communities with Injury Free-Seattle Alliance raises awareness of As a member of the Injury Free-Seattle coalition (which prematurity and stillbirth. also includes Harborview Medical Center and Public Health Beyond local and regional partnerships, Children’s works with – Seattle & King County), Children’s works with Seattle- national and international organizations to tackle the most area organizations to address the safety needs of at-risk pressing issues in pediatrics. Children’s recently launched the communities and populations. Programs target four activities: Global Alliance for the Prevention of Prematurity and Stillbirth safe walking, safe riding, safe swimming and safe play. (GAPPS) to better understand this widespread public health Recent projects include implementation of a walking problem and ultimately prevent it. school bus at Bailey Gatzert Elementary, which significantly Premature birth is the leading cause of infant mortality increased the number of children walking to school, and a new throughout the world. In addition, about 24 of every 1,000 playground at Dearborn Park Elementary in partnership with babies are stillborn. Even in the United States, the incidence of Seattle Public Schools and the Allstate Foundation. premature birth continues to increase despite improvements While the programs are focused on injury prevention, they in prenatal care and technological advances. In the state of also aim to promote physical fitness. “We want kids to be both Washington, the rate of premature birth has increased 23% physically active and safe,” says Tizzy Bennett, director of since 1994. Guest Services, Partnerships and Advocacy. GAPPS partners with organizations such as UNICEF, Toward that end, Children’s also collaborates with First Candle, Save the Children, Centers for Disease Control community members to improve safety for children in Seattle. and Prevention and the World Health Organization to raise “Working with parents, young people and other organizations awareness of premature births worldwide. to develop and implement safety programs is key to being successful,” says Bennett. “If you are a parent who doesn’t feel comfortable letting your child play at the community playground or walk to school because you are concerned about their safety, your child will not have as many opportunities to be active.” 19 Seattle Children’s Community Benefit Report 2008 People Making a Difference Children’s Lyn Kratz, Lawrie Williams, Carol Parry and Devora Chavez (not pictured) advocate for parent involvement at all levels of the organization. Partnering with families Patients and their families are essential members of the healthcare team at Children’s. Parents also serve as advisors, teachers and consultants Improvement (CPI) projects. In addition, Parry works with throughout the hospital, helping us integrate the family Kratz to facilitate the Family Advisory Council, a group of perspective into everything we do — from building design parents providing feedback on proposed changes that affect and bedside manner to resident education and family families at Children’s. “It is critical for us to collaborate support services. with families when we look at ways to improve our services “Actively involving families has moved us forward in and processes,” says Parry. “I’m always impressed by the countless ways,” explains Lyn Kratz, a 20-year Children’s commitment of families to help us and by the receptiveness veteran in social work. “Parents have a unique perspective of staff to learn from families. This important partnership and lots to teach and share. They offer fresh, practical leads to the best outcomes.” ideas that reflect what matters most to families. Ultimately, Providing peer support is another way that Children’s their involvement makes a positive difference in a child’s works with families to provide the best possible care for care and the family experience.” their children. Lawrie Williams, who coordinates Children’s Kratz is among a team of people who incorporate Parent Support program, matches experienced parent families into Children’s work. She leads numerous activities volunteers with families who are in the beginning stages of that support family-centered care and involvement, learning about their child’s diagnosis or special healthcare including the Families as Teachers program, in which needs. “Talking with families who have gone through similar pediatricians who are training at Children’s spend time at experiences can be both supportive and empowering,” says the home of a family who has a child with special needs. Williams. In the words of a mother who received her first The conversations that arise during these personal peer support phone call, “It was such a relief to talk with encounters provide career-shaping insights for trainees. someone who has walked in my shoes and understands As Children’s family-centered care coordinators, Carol our daily struggle.” Williams also serves as liaison for the Parry and Devora Chavez arrange for parents to participate growing number of family support groups taking place at in many hospital projects, including focus groups, reviews Children’s. Nearly half of those groups are organized, of educational materials and Continuous Performance coordinated or led by parents. Seattle Children’s Community Benefit Report 2008 20 Children’s is involved with many community partnerships and initiatives that inspire exercise and healthy eating among children and their families. Addressing childhood obesity Today’s children are the first generation with a shorter life King County Steps to Health expectancy than their parents, due in large part to the rise In 2004, Children’s joined Public Health – Seattle & King in childhood obesity. County and 73 community partners in the King County Steps Childhood obesity affects 15% of children and teens in to Health program (Steps). Steps, funded by the Centers for the United States — a rate that has tripled since 1980. Disease Control and Prevention, is working to build healthier Approximately one in 10 young people in the state of communities and prevent the chronic diseases of diabetes, Washington are obese. obesity, asthma and their related risk factors in South Seattle In addition to suffering from low self-esteem, overweight and the Southwest King County area. Efforts focus on people kids face potentially serious health risks. “We are seeing what most impacted by chronic diseases, including people living used to be adult diseases in children who are developing below the federal poverty line and the Vietnamese and obesity early in life,” says Dr. Lenna Liu, a pediatrician at Spanish-speaking communities. Odessa Brown Children’s Clinic (OBCC). “Those conditions Children’s has been involved at the Steps organizational include type 2 diabetes, high blood pressure, sleep apnea level, taking part in the Leadership Team and the Policy Group. and high cholesterol.” Under the initiative Children’s has also implemented the The gravity of the situation prompted clinicians at Seattle “Quality Improvement in Chronic Care Management” project, Children’s to create Children’s Obesity Action Team (COAT), a which engages primary care providers in enhancing quality of multidisciplinary team that since 2001 has offered education care through quality improvement work on obesity prevention and culturally responsive, age-appropriate resources for families and management, and has offered additional Strong Kids and community providers to decrease childhood obesity. Strong Teens programs in partnership with the YMCA. Children’s and COAT are making a difference in the lives of children and their families through community partnerships that inspire exercise and healthy eating. 21 Seattle Children’s Community Benefit Report 2008 Strong Kids Strong Teens Be Fit When 8-year-old Elizabeth plays with her friends, she wears Through its “Be Fit” program, the Seattle Storm basketball a mask and calls herself “Healthy Girl.” This fearless heroine team educates youth about the value of a healthy lifestyle. leads her friends in outdoor exercise and making healthy During the 2008 season, the Storm partnered with Children’s, “stews” from leaves and branches in the back yard of her PCC Natural Markets, the Washington State Nurses Association home. Elizabeth acquired the “super powers” necessary to and the Washington Health Foundation to host a series of become Healthy Girl through a community-based lifestyle clinics encouraging kids to exercise and eat a well-balanced program sponsored by COAT, OBCC and YMCAs in King and diet. At the clinics, children visited four stations — staffed Snohomish counties. The program, Strong Kids (ages 8 to 11) by Storm players — that focused on areas ranging from and Strong Teens (ages 12 to 14), helps overweight youth and cardiovascular and strength-training exercises to nutrition adult family members embrace healthy lifestyles. During 18 and healthy snacks. weeks, children and teens participate in a variety of physical activities, hands-on nutrition education and motivational Shop Around coaching. In 2008, 280 youth benefited from this program. Shop Around — a program available to patients of the Odessa Brown Children’s Clinic (OBCC) and their families — is aptly Love them with all your HEART! named for its focus on the whole, natural foods located Along with the American Heart Association (AHA), COAT along the perimeter of a grocery store, including meats, created the “Love them with all your HEART!” initiative, which dairy products, fruits and vegetables. It’s part of the OBCC provides children and teens with age-specific education “Fit 4 You” obesity prevention program, which identifies materials that emphasize healthy eating and physical activity. patients who are overweight and educates the entire family Children’s and AHA also distribute materials to healthcare about grocery shopping, cooking and nutrition. OBCC also providers to help them discuss and treat obesity concerns partners with Seattle Parks and Recreation to provide with patients and their families. cooking classes at community centers. Jump Up! Children’s Obesity Prevention Coalition In partnership with Treeswing, a local organization dedicated As a member of the Childhood Obesity Prevention Coalition, to developing programs that support healthy children and Seattle Children’s is collaborating with more than 20 fi families, Children’s launched the “Jump Up!”ff tness campaign. organizations to pursue state-level policy changes and Jump Up! is distributing a free jump-rope kit to each of the investments that should lead to reducing childhood obesity in 4,000 kindergarten students in the Seattle Public Schools. the state. These policies and investments endeavor to make Each kit includes information for parents about the importance it easier for children and families to make healthy choices. The of exercise from an early age and the risks associated with coalition’s goals are threefold: increase the number of children childhood obesity. Students participating in the Jump Up! who are physically active on a daily basis, improve access to program are encouraged to set personal jumping goals. and demand for healthy foods and make it easier for families Children’s and Treeswing will distribute an additional to be part of an active community. 6,000 jump-rope kits to children in collaboration with Seattle Parks and Recreation through its “Healthy Parks, Healthy You” initiative. “ We are seeing what used to be adult diseases in children.” Seattle Children’s Community Benefit Report 2008 22 Making a Difference: Education Experts at Seattle Children’s offer a broad range of free or low-cost classes and educational programs to improve the health, safety and well-being of children and families in the greater Seattle community. Community education classes served more than 2,000 people in 2008. In addition, many of our doctors and nurses share their expertise through online resource available to clinicians everywhere. Community classes for parents and caregivers Babysafe Co-sponsored by Great Starts Birth & Family Education, this class is designed for new and expecting parents and others who care for babies. Topics include infant development, baby safety, injury prevention and immediate care of common injuries. Infant CPR is also demonstrated and practiced. Infant and Child CPR This CPR class for parents, childcare providers and healthcare professionals teaches infant and child CPR and choking-rescue techniques as well as risk factors and healthy heart living. Infant Car Seat Class for Expecting Parents Taught by a certified child passenger safety expert, this class teaches expecting parents how to properly install a child safety seat in the car, how to safely secure baby in the seat, and empowers parents to use the car seat correctly every time. Eileen Reichert, nurse practitioner and Sara Swanson, health educator, Potty Training demonstrate CPR. This class helps prepare parents and caregivers of toddlers for potty training. Experts discuss the physical, intellectual, psychological, emotional and social signs of readiness for a CPR for Babysitters child to succeed at using the toilet. The class also offers tips Co-sponsored by Great Starts Birth & Family Education, this such as what kind of potty chair is best, how to encourage class for youth ages 11 to 15 teaches infant and child CPR and children to use the potty and how to handle setbacks. covers choking and safety. Autism Series For Boys Only: The Challenges of Growing Up Experts offer classes for parents and caregivers of children This class for boys ages 10 to 12 and a parent or guardian recently diagnosed with autism as well as a series of classes focuses on what children and parents should expect as boys covering a variety of topics such as communication skills, begin adolescence. Topics include body changes during behavioral skills, social skills, medication and legal aspects. puberty, popular myths about growing up, behavior and attitude changes, what boys need to know about girls and Community classes for preteens how to communicate about the experience of adolescence. Better Babysitters For Girls Only: A Heart-to-Heart Talk on Growing Up Youth ages 11 to 13 learn responsible babysitting by studying This class for girls ages 10 to 12 and a parent or guardian basic child development, infant and child care, safety, how focuses on the physical changes of puberty and menstruation, to handle emergencies, age-appropriate toys, business hints what girls need to know about boys, social issues and and what parents expect. sexuality. The goal of both classes is to create opportunities for pre-teens and a trusted adult to receive information together in an engaging format and relaxed atmosphere. Instructors emphasize family communication and resources to support young people on their journey through adolescence. 23 Seattle Children’s Community Benefit Report 2008 Education Summer camps for children Summer Program for Deaf and Hard-of-Hearing Youth with special health needs Seattle Children’s Summer Program for Deaf and Hard-of- Every year, Children’s offers unique programs to ensure that Hearing Youth offers all the fun of a day camp, including arts children with special health needs have the opportunity to and crafts, swimming and hands-on educational activities. Held experience the excitement and camaraderie of summer camp. at Children’s every Tuesday in July and August, the program gives deaf and hard-of-hearing children the opportunity to Stanley Stamm Summer Camp connect with each other and practice their language skills in Each August, the Stanley Stamm Summer Camp gives children a fun and supportive environment. Hearing siblings can also with serious illnesses the chance to go fishing, ride horses and participate by taking sign language classes and joining their take part in other typical summer camp activities at a sleep- brothers and sisters for crafts and other activities. Thanks to over camp near Mt. Rainier. scholarships provided by RE/MAX Northwest, participants The camp, founded by Seattle Children’s heart specialist pay only half of the camp fee. Dr. Stanley Stamm, includes medical support so that children unable to attend other camps can join in the fun. Providing expertise on demand Families pay just $100 for the week-long camp (the When clinicians need the latest health information in a actual cost per camper is $1,000), thanks to generous donors. nutshell, they can now turn to a number of online resources. Children’s also provides scholarships for families who cannot pay in full. thedoctorschannel.com The camp hosts children ages 6 to 14 with a range of This new Web site features one- to two-minute streaming terminal or chronic medical illnesses, including heart and video clips with insights and opinions from experts in 35 pulmonary problems, cerebral palsy, muscular dystrophy, specialties. Several doctors, nurses and other providers from Down syndrome, cystic fibrosis, endocrine diseases, Seattle Children’s have been interviewed for the Web site, neurological problems and cancer. Last year, the camp contributing timely information on many topics that are served the largest group of children ever: 98 kids. available for viewing free of charge at thedoctorschannel.com. Topics covered by Children’s clinicians and staff include childhood flu shots, the increasing incidence of premature birth, the dangers of watching television at a very young age and steps hospitals can take to reduce waste. Continuing education online Children’s offers healthcare professionals in the region easy access to online pediatric continuing education free of charge. The program offers up-to-date, evidence-based pediatric practice education that may not be available in many communities. Online courses benefit a variety of healthcare providers, including nurses, physicians, homecare providers, occupational therapists, physical therapists and technicians working in both private practice and hospital settings. In partnership with the Department of Health, Children’s created a videotaped archive of conference sessions available through the Online Video Library on our Web site. Approximately 12,000 healthcare providers accessed the video library during 2008. Quicklinks Children’s offers Quicklinks, a free e-mail toolkit for healthcare providers in the Pacific Northwest. Quicklinks features health education handouts and resources that doctors and nurses can print and share with their patients. Children’s disseminates Quicklinks three times a year. Stanley Stamm campers take part in a range of activities every summer. Seattle Children’s Community Benefit Report 2008 24 People Making a Difference Brian Ross: 27 years of dedication to hospital education When a child is hospitalized at Children’s and unable to attend school, Brian Ross and his team of teachers and instructional assistants provide education services that keep our patients from falling behind in school — at no cost to families. “Our program is one of the most important players in Ross and his staff of seven certified teachers and three a child’s recovery,” says Ross, who manages Children’s instructional aides provide education services to more than Education Department. “Our teachers help kids keep a 750 children annually. As valued members of Children’s sense of normalcy and a focus on their future. We remind multidisciplinary care teams, hospital teachers participate in them what all the other kids their age are doing and treatment planning for patients. They serve students through help them keep a routine during a very traumatic time classes in Children’s school room, small group instruction on in their lives.” the medical floors and bedside tutoring as needed. Ross has been teaching patients at Children’s since “All of our services are coordinated with the patients’ 1981, when the hospital began offering a formal education existing education programs,” Ross explains. “Our teachers program to meet the unique needs of children with serious use the students’ textbooks and assignments as much as medical or psychiatric illnesses, traumatic injuries and possible throughout admission to maintain the child’s routine.” chronic medical conditions. Since then, he has witnessed Teachers also work closely with the patient’s community amazing progress in the treatment of conditions such as school upon discharge from the hospital to help ease the cancer, cystic fibrosis and juvenile rheumatoid arthritis. transition back to school. In any given year, children leaving “When I began working at Children’s, these kids fell the hospital represent more than 120 school districts and chronically behind in school because their conditions developmental centers in Children’s service region, which were so debilitating, requiring frequent or prolonged includes Washington, Alaska, Montana and Idaho. hospitalizations,” recalls Ross. “But today, these students Under Ross’s leadership, Children’s Education Department have shorter admissions and better medical treatments continues to grow and evolve with a focus on the needs of that enable them to return to school shortly after discharge, individual patients. “The best parts of this job are helping and with far more successful outcomes. I have been here students find ways to make progress despite their medical long enough now that I have experienced many advances conditions, and what these students teach us about dealing in medical care for children, and that’s exciting.” with adversity,” says Ross. “I am always amazed by their courage and resilience.” 25 Seattle Children’s Community Benefit Report 2008 Investing in future healthcare professionals When it comes to discovering a fulfilling career or finding Apprentice program matches minority the right job, mentors and training programs can make an important difference in our community. students with medical researchers. Minority students in the state of Washington often leave high Given the national shortage of workers in many areas of school without an understanding of the educational pathways healthcare, Seattle Children’s sponsors or participates in many that can lead to becoming a healthcare professional. In fact, only programs that provide hands-on learning opportunities and 3% of minority students eventually pursue a career in healthcare. training for potential employees of the future. Nationwide, there is a “critical shortage” of minorities involved in biomedical research, according to the National U-DOC introduces high school Institutes of Health. To help address this shortage, Children’s students to healthcare. participates in the Charles Drew University of Medicine and When you’re 17 years old and dreaming of a career in Sciences National High School Student Summer Research healthcare or research, there’s nothing more powerful than Apprentice Program, which pairs high school students with hearing from a practicing scientist or healthcare professional seasoned investigators. that you can do it, too. And that’s just what 22 high school For eight weeks during the summer of 2008, Jesus Lopez- students heard from Children’s staff as part of the “U-DOC” Guisa, PhD, a researcher in Children’s Nephrology program, college preparation program at the University of Washington mentored college-bound student Donovan Dean-Dewberry during the summer of 2008. and taught him the basics of biology in preparation for The program introduces high school students from rural conducting laboratory research. and underserved communities to college life and provides Their collaboration resulted in a national award. Of more opportunities to learn about careers in healthcare. U-DOC than 70 students in the Charles Drew program, Dean-Dewberry students visited many departments at Children’s and received a trophy for the most excellent research project. participated in job shadows. “We really were part of the Children’s community for a ePals promote healthcare careers via email. week,” says student Jessica Sachara from Yakima, Washington. Students in selected Seattle-area schools are learning about “Everyone was so willing to answer our questions, and it was jobs in healthcare through a new Children’s program called inspirational to see how passionate people were about their ePals. This eight-week outreach program connects youth in jobs. At home, everyone tells you that you can do it. But it’s the fifth and sixth grades with professional role models from really inspiring to hear that encouragement from professionals Children’s and introduces them to healthcare careers through who actually have done it.” email correspondence. The students at ePal schools are culturally diverse and predominantly from lower socioeconomic areas — communities often lacking access to educational resources and professional mentors. At the end of the program, students engage in a guided classroom discussion about the conversations with their ePals, giving them a “big picture” view of a wide variety of responsibilities in the hospital. Students also enjoy a capstone program that includes an interactive tour of Children’s and the chance to meet their ePals over lunch. Students from rural and underserved areas visited Children’s as part of the U-DOC college preparation program at the “ It’s really inspiring to get encouragement from professionals University of Washington. who actually have done it.” Seattle Children’s Community Benefit Report 2008 26 Project SEARCH offers work experiences for people with disabilities. As part of Children’s commitment to developing a diverse workforce that reflects the patients we serve, Children’s started Project SEARCH, an innovative program providing training and employment opportunities for people with developmental disabilities. Project SEARCH is based on a nationally recognized program at Children’s Hospital Medical Center of Cincinnati. In partnership with Northshore School District, Children’s provides educational work experiences for students with developmental disabilities through the district’s Transition Program. Since the program launched in 2005, Children’s has provided work experiences for 23 students in departments such as Laundry, Inpatient Psychiatry Unit, Laboratory Medicine, Environmental Services, Landscaping, Dietary, Child Life, Research and the Gift Shop. In addition to offering educational work experiences, Project SEARCH provides employment opportunities at Children’s. King County named Children’s the 2008 “Employer of the Year” for hiring adults with developmental disabilities. Administrative program assistant Kori Rothweiller works in the Department of Psychiatry and Behavioral Medicine as part of Children’s award-winning Project SEARCH program. 27 Seattle Children’s Community Benefit Report 2008 Making a Difference: Advocacy Seattle Children’s improves the health of children and their families through advocacy. In collaboration with other organizations, Children’s works to achieve access to quality health care for all children, regardless of their families’ ability to pay. We also promote safety and healthy child development while working to meet the healthcare needs of children with chronic medical conditions in their own communities. Increasing access to healthcare Children’s contributed $100,000 to the Children’s Health Initiative, a collaborative project of the King County Council, the King County Executive, Public Health – Seattle & King County, the state of Washington, Group Health Cooperative, the Washington Dental Service and a diverse range of private funders and community-based organizations. The CHI works to improve low-income families’ ability to enroll eligible children in federal and state health insurance programs and to ensure that children obtain appropriate Tooth decay is preventable — and yet, it is the most-common chronic preventive-focused medical, dental, and behavioral health care. childhood disease. Outreach efforts focus on populations with significant language, cultural, racial, and socioeconomic barriers to address In addition to providing family-centered dental care, existing disparities in health care access. Following insurance Children’s promotes children’s oral health as a member of plan enrollment, the CHI links children with medical and dental the Watch Your Mouth campaign funded by the Washington “homes” as well as integrated preventive care and other services. Dental Service. We also work with community organizations to improve children’s oral health. For example, a pilot project Promoting oral health launched by Odessa Brown Children’s Clinic, Public Health Tooth decay, a preventable condition, is the most-common – Seattle & King County and Washington Dental Service chronic childhood disease. In Washington state, 1-year-olds trains King County healthcare providers to screen infants and are five times as likely — and 2-year-olds are more than children for early signs of poor oral health with the hope of twice as likely — as children nationwide to have tooth decay. preventing decay. In addition, the volume of dental emergencies in Children’s As a sponsor of the SmileMobile, Children’s helps provide emergency department has increased by roughly 10% from dental services to children who otherwise do not have access year to year. Poor oral health in children has been linked to to dental care. poor performance in school, poor social relationships and less success in later life. Preventing child abuse To combat the growing crisis of childhood dental disease, Children’s works to prevent child abuse and neglect by Children’s and the University of Washington School of disseminating educational materials and supporting parents Dentistry are developing a new pediatric dental facility that with the resources they need to create a healthy environment will double the capacity of the dental programs at both for their kids. “Small children are particularly vulnerable institutions. Washington Dental Service and the Washington because they can’t speak up for themselves, and that’s why Dental Service Foundation provided a gift of $5 million to it’s up to all of us to be a voice for them,” notes Dr. David build the facility, which will enable clinicians to provide Fisher, Children’s medical director. “Nearly 60% of the children 30,000 pediatric dental visits per year for healthy children seen by our Children’s Protection Program due to concerns and those with urgent or special needs. about abuse or neglect are under age 4.” During Child Abuse Prevention Month in April, Children’s participates in the national Pinwheels for Prevention campaign by hosting a special event at the hospital to raise awareness of ways to prevent harm to children in our communities. As part of the event, visitors are given the opportunity to plant pinwheels. “The pinwheels are a powerful expression of hope that by working together we can break the cycle of abuse,” notes Carol Jenkins, Children’s Protection Program manager. The Pinwheels for Prevention campaign raises awareness of ways to prevent child abuse. Seattle Children’s Community Benefit Report 2008 28 Advocacy Addressing underage drinking At Children’s Car Seat In northeast Seattle, the underage drinking rate is higher Check events, experts teach families how to than in other city neighborhoods and counties in the state secure their children of Washington. Alcohol use by those under 21 is related to in the car. numerous health problems, including injuries and death from car crashes, suicide, homicide, assaults, drowning and recreational mishaps. Dr. Ray Hsiao, attending psychiatrist and co-director of Seattle Children’s Adolescent Substance Abuse Program (ASAP), is working to change that. As a member of Prevention Works in Seattle, Hsiao is helping the coalition develop strategies to address the problem among students at Eckstein Middle School and elsewhere in northeast Seattle. Parent education is among those strategies. Thanks to a partnership between the coalition, Children’s and the Child passenger safety YMCA, parenting classes are offered at Children’s and at the Car crashes continue to be the leading cause of injury death University District YMCA to raise awareness of the problem among children and teens. Children’s offers several car seat and provide support to parents. check events annually, where child passenger safety experts check children in a car seat, booster seat or seat belt. Experts Raising awareness of important health issues teach families how to safely secure their children in the car Seattle Children’s participates in and sponsors dozens of and answer parents’ questions. In 2008, 330 children and community events that promote health, safety and awareness their parents benefited from having their car seats checked of a broad range of issues that impact the well-being of and secured. Educational programs, including low-cost seat children, families and communities. sales, are offered to families of diverse language and ethnic backgrounds through Head Start schools. Safety equipment and fittings Children’s offers life jacket fittings and bike helmet fittings throughout the year in partnership with local recreational organizations and retailers, including Mustang Survival, Kohl’s, Metropolitan Market and Cascade Bicycle Club. We also offer life jackets and helmets for free or at reduced cost during community outreach events. In 2008 we distributed 800 bike helmets and over 400 life jackets to children and their families in the Puget Sound area. Seattle Children’s Community Health Fair Families and children learn about health and safety through hands-on fun activities such as visits to the operating room, finger casting and a Teddy Bear Clinic. Children’s also offers free bike helmets and low-cost booster seats and life jackets at this annual event. Last year, approximately 1,000 people attended the health fair. Children’s staff, patient families and volunteers participated in the Seattle Pride Parade for the sixth consecutive year. Outreach to underserved communities During 2008, Children’s provided health and safety information and resources at more than 80 events, including outreach efforts in diverse, low-income and underserved communities. Children’s representatives promoted child passenger safety, water safety, healthy eating, fitness, sports injury prevention, helmet safety, home safety, behavior and discipline among other topics. A child gives her teddy bear an x-ray at our annual Health Fair. 29 Seattle Children’s Community Benefit Report 2008 Advocacy Celebrating 100 years of partnerships Since Children’s was founded in 1907, we have recognized the value of partnerships to improve the health and safety of children and their families. To celebrate the milestones achieved during Children’s first century of service — and to raise awareness of the key health issues facing children today — Children’s hosted “Celebrating a Century of Partnerships for Children’s Health” with a number of organizations. Participating partners included the Children’s Alliance, Harborview Medical Center, Public Health – Seattle & King County, Safe Kids Coalition, Sound Health, the University of Washington and the YMCA of Greater Seattle. The event was attended by 150 people. Reaching out with vital health information When health concerns about diacetyl butter flavoring began to surface, Children’s executive chef Walter Bronowitz contributed significantly to national, regional and local Children’s athletic trainers like Antonio Gudiño provide assessment outreach efforts. As secretary of the American Culinary and care on the field, and help young athletes avoid injury and get Federation (ACF), the nation’s largest organization for back in the game — safely. professional chefs, he helped launch a campaign targeted at chefs and cooks who may have been unaware of the Going to bat for sports safety potential dangers. Across the nation, sports-related injuries among teens are He also brought attention to a serious challenge: identifying occurring at higher rates than ever before. Longer sports products that contain diacetyl. Because the Food and Drug seasons, more intense participation at younger ages and the Administration (FDA) considers the chemical safe, disclosure is focus on playing just one sport contribute to the increase. not required on product labels. That means the only indication Seattle is no exception. In 2007, school-district athletic that diacetyl may be present in food products is the mention trainers evaluated about 2,600 sports injuries sustained by of artificial flavorings. “Most of us chefs are removing butter- the city’s 3,500 high school athletes. Overuse injuries to flavored products from use in our kitchens as a result of what the knee from running and jumping top the list of sports we now know about diacetyl, but we need action quickly so traumas that bring teens to the sports medicine program we can identify other products manufactured with diacetyl,” at Seattle Children’s. said Bronowitz. To drop-kick these escalating rates, Children’s Department As a result of Bronowitz’s work, the ACF announced of Orthopedics and Sports Medicine partnered with the Seattle support for government action by the FDA and the Public School District to pilot courses in sports medicine using Occupational Safety and Health Administration (OSHA) seed money from Children’s. The goal is to give teens at three to investigate the potential health hazards of diacetyl. Seattle high schools the injury-prevention knowledge they need to keep themselves and their peers safe at play while piquing their interest in healthcare careers. The classes create greater awareness around injury prevention — a natural fit with Children’s mission to prevent childhood injury. Nearly 50 students are taking the sports medicine courses, which are part of the school district’s career and technical education track. Supporting families of children with special needs Raising a child with special healthcare needs can be a complex and demanding job. Many parents say there is little information about how to manage their child’s ongoing health care needs in their daily life. But a new resource called “What Helps You?” offers advice from families who have walked this path. Available through the Web site of the Center for Children with Special Needs, a program of Seattle Children’s, “What Helps You?” features strategies and worksheets to help families deal with a range of challenges, from managing emotions and maintaining healthy relationships with others to parenting children with special needs and working with Chef Walter Bronowitz schools and healthcare systems. Seattle Children’s Community Benefit Report 2008 30 People Making a Difference Antwanette Lyons: Breaking down barriers to health For families who struggle to pay the bills and buy food and clothing for their children, a visit to the dentist or the doctor for preventive care may be the last thing on their minds. But the health and well-being of these children and families others may not have winter coats or shoes for their kids. are the focus of Antwanette Lyons’ work all day, every day, Lyons works closely with those families — often visiting as community care coordinator at Odessa Brown Children’s them at home — to help them meet their basic needs. Clinic (OBCC). “So many families in this community face barriers that keep “My job is to ensure that those who would not normally them from visiting the clinic,” says Lyons. “I try to eliminate have access to the clinic — the homeless, victims of family those barriers by connecting families with resources to pay violence and the uninsured — find their way in,” says Lyons. their bills, eat nutritious meals and focus on the health of “I help families overcome the obstacles that prevent them their children.” from seeking the care their children need.” The best part of her job, says Lyons, comes several OBCC primarily serves children and adolescents who months or even years later, when she sees families in the live in central and south Seattle, providing comprehensive clinic or in the community, and they have achieved self- medical, dental and mental health services with dignity and sufficiency. “Life issues prevent people from living a healthy, respect. Because OBCC patients and their families represent well-rounded life,” she points out. “By addressing those a diverse population, the clinic’s healthcare providers and issues now, we are helping families live better lives and staff are committed to providing the best care possible in hopefully preventing problems for kids later in life.” a culturally relevant context. It’s that commitment that keeps Lyons’ only wish is that more organizations would create generations of families coming to the clinic. “Earning a similar positions to serve the needs of the greater Seattle family’s trust is the ultimate compliment,” says Lyons. “I love community. “It would be great to have more outreach seeing grandparents who were patients as children bringing workers focused on families,” she says. “We have experienced their grandchildren into the clinic. It’s incredibly satisfying.” great results through this approach, and it’s making a Much of Lyons’ work entails building trust with families difference in the lives of kids who might otherwise fall experiencing difficult situations. Some may be malnourished; through the cracks in our healthcare system.” 31 Seattle Children’s Community Benefit Report 2008 A patient navigator helps a mother and her daughter check in before their clinic visit. Overcoming health disparities Seattle Children’s is deeply committed to overcoming disparities, the better we can develop and evaluate culturally health disparities — differences in health quality and access appropriate interventions that eliminate many gaps and associated with factors such as race, ethnicity, income, education and place of residence. improve outcomes for everyone.” Our interventions and efforts in the area of diversity and Seattle Children’s is deeply committed to overcoming health equity include: health disparities — differences in health quality and access • Partnerships to achieve access to quality healthcare for associated with factors such as race, ethnicity, income, all children. For example, Children’s is a member of the education and place of residence. Health Coalition for Children and Youth, which helped Since its inception, Children’s has been committed to legislators develop a bill to ensure affordable medical providing the highest quality of care for all children and coverage for every child in Washington state. Governor families, no matter their race, ethnicity or ability to pay. Christine Gregoire signed the “Cover All Kids” bill in 2007, In 2004, Children’s adopted the Strategic Plan for Diversity. creating the Apple Health for Kids program. Three years later, it opened the Center for Diversity and Health Equity, which integrates research, education, • Alliances with community organizations to improve advocacy and service to support Children’s quest to medical care for specific populations. As a partner in the eliminate pediatric health disparities. Northwest Sickle Cell Collaborative, Children’s expands “We look at the differences in the race, ethnicity and access to specialty care by supporting existing clinics language spoken of our patients by collecting information and opening new clinics in the Northwest. about these determinants for almost all of the patients we serve. Being able to compare various outcomes according to these data is a great first step in understanding that everyone Seattle Children’s is committed is not reaping the benefits of health and healthcare the same,” says Doug Jackson, chief of the Center for Diversity and to overcoming health disparities. Health Equity. “The better our understanding of these Seattle Children’s Community Benefit Report 2008 32 • A “patient navigator” pilot program funded by the Washington State Department of Social and Health Services to teach Spanish- and Somali-speaking families how to navigate the healthcare system and help clinicians understand these families’ unique needs. • Odessa Brown Children’s Clinic (OBCC) provides culturally sensitive, community-based care to children and families in central and south Seattle. The clinic offers medical, dental and mental health care services under one roof. It is a participant in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). OBCC provides on-site screening, immunizations and nursing care for homeless children attending First Place Elementary School and Morning Song Day Care. OBCC also provides primary care services for the Garfield High School Teen Health Clinic. • Workshops and training for Children’s staff and clinicians: – Monthly cultural competency training – English as a Second Language classes • Round-the-clock telephone interpretation at the hospital – Spanish classes and Spanish drop-in lunch sessions for non–English-speaking families to ensure effective – Poverty simulation training communication any time of day. Dual phones with one-touch – Panel discussions and displays focused on serving families dialing to interpreters are at the bedside in every room in of specific ethnicities and cultural backgrounds the hospital. – Northwest Diversity Series for managers • The toll-free Family Phone Interpreting Line allows families with limited English proficiency to initiate calls to the • Dr. Doug Jackson, chief of Children’s Center for Diversity hospital in their own language via an interpreter. In 2008, and Health Equity, and Sarah Rafton, director, are among the hospital averaged 980 calls from families per month 33 participants selected for the 2008-2009 Disparities through this line. Leadership Program created by The Disparities Solution Center at Massachusetts General Hospital. This year-long • Sharing best practices in language services: Seattle program empowers healthcare leaders with tools and Children’s stands apart as a model organization for skills to address inequities in healthcare for racial and providing medical interpretation to families with limited ethnic minorities. English proficiency. Children’s is one of two hospitals awarded an additional 18 months of funding from the Robert Wood Johnson Foundation to continue participation in the “Speaking Together: National Language Services Network,” a program funded by the Foundation to reduce healthcare disparities by integrating quality improvement techniques with language services for patients who speak limited English. The initiative takes best practices learned from Children’s and other partners and shares them with health professionals across the nation. 33 Seattle Children’s Community Benefit Report 2008 Our Commitment We envision a future where children in our region live healthy, Seattle Children’s deeply appreciates our community and full lives. To that end, Seattle Children’s will continue working the community partners who help us honor and expand to fulfill its bold mission: to prevent, treat and eliminate our commitment to caring for children, year after year. pediatric disease. As part of this focused effort, we will For more information or to get a printed copy of this invest in facilities, technologies, programs, services and Community Benefit Report, please contact: people that help us to: Marketing and Communications Department • Provide the very best medical care to children in our region, Seattle Children’s Hospital regardless of a family’s ability to pay. We have honored this Phone: (206) 987-5205 promise for more than a century. firstname.lastname@example.org • Accelerate our research efforts to discover new treatments Office address: and cures that significantly improve the health of children 6901 Sand Point Way NE everywhere. Seattle, WA 98115 • Educate clinicians in training, community health-care providers, families and patients. Mailing address: • Partner with other organizations committed to the M/S S-217 health and well-being of children and families in the P.O. Box 50020 Pacific Northwest. Seattle, WA 98145-5020 • Advocate for children and families — especially www.seattlechildrens.org underserved populations — so that all children in our region have opportunities to experience optimal health and quality of life. Seattle Children’s Community Benefit Report 2008 34 4800 Sand Point Way NE Seattle, WA 98105 TEL 206 987-2000 TTY 206 987-2280 www.seattlechildrens.org © 2009 Seattle Children’s, Seattle, Washington. All rights reserved.