Addressing Violence and Abuse in the Changing Health Care Environment Ann Budzak-Garza, MD Kelly Barton, Vice President Clinical Operations Bob Trine, Senior Vice President Business Strategy

Gundersen Clinic: Founded by Dr. Adolf Gundersen in 1891 – Three of his great- grandsons are caring for patients at Gundersen Lutheran today Lutheran Hospital: Opened in 1902 Organizations merged in 1995 to form Gundersen Lutheran Gundersen Health System A tradition of excellence Dr. Adolf Gundersen (second from left)

Gundersen Health System Integrated healthcare organization Serving 19 counties in western Wisconsin, northeastern Iowa and southeastern Minnesota 325-bed teaching hospital Headquartered in La Crosse, Wis.

Gundersen Health System Outpatient visits: 1.2 million Inpatient admissions: 12,913 Inpatient/outpatient surgeries: 16,718 *2012 stats

Gundersen Health System Governance Board of Governors – 9 elected physician members – CEO chairs Board of Trustees – 6 community members – 4 physician members – CEO chairs Board of Trustees has final say on all major decisions – Must pass Board of Governors before going to Board of Trustees

Gundersen Health System Network of affiliated organizations, including: – Ground and air ambulance service – Rural hospitals – Pharmacies – Hospice care – Nursing homes – And more

Gundersen Health System Excellence in primary care 41 regional sites in Wisconsin, Minnesota and Iowa More than 75 clinical departments and specialties Over 700 medical, dental and associate staff Staff of more than 5,500

Gundersen Health System Excellence in quality care HealthGrades 2010 Excellence Awards™ Cardiac Care Cardiac Surgery Orthopaedic Surgery Joint Replacement Surgery Pulmonary Care Stroke Care General Surgery Gastroenterology (GI) Care GI Surgery 2010 HealthGrades Distinguished Hospital Award for Clinical Excellence™ 2009 Thomson Reuters 100 Top hospitals award 2009 Thomson Reuters 100 Top cardiovascular hospitals award

Gundersen Health System Behavioral Health Services Gundersen Lutheran Behavioral Health has psychiatrists, psychologists and masters-level psychotherapists specially trained to work with children who have been maltreated (some services are grant funded and provided at no charge) Services Include: Individual and group counseling Support group Crisis Intervention Coordination of victim services Assistance with Crime Victim Compensation Education on abuse

Current Infrastructure Physician, Employee, Leadership Compact Level III certified Medical Home – Pediatrics New Inpatient Behavioral Health Hospital Patient Centered Care (Trauma Informed Care Medical Education SANE Program Research Mission Training Facilities (ICE House) National Recognition (end-of-life care, cost of care) Hospital-based Domestic Violence Program Employee Assistance Program Disease Management Program Pastoral Care Program

National Child Protection Training Center Population Health Commitment to Quality and Excellence Mission of serving the Community Migration from healthcare delivery to “health system” Healthcare Reform ACE Research

Future Vision “I believe we can end child abuse in the United States within three generations. If we start the clock ticking from this moment, this gives us 120 years to get the job done.” –Victor Vieth, Unto the Third Generation 2013 Gundersen Health System commits to becoming part of the solution!

Operational Plan Raise Awareness Educate and Train Research Change Internal Process

Raise Awareness – Internal & External “No Hit Zone” Presentations on maltreatment to our staff and physicians Internal department journal clubs, case reviews, section meetings Incorporate NCPTC website, including Webinars, into GL internal website La Crosse School District presentations as part of the School Liaison/Mental Health project currently in place in Behavioral Health. YMCA Teen House presentations to volunteer staff who work with the adolescents within that program Community Presentations Parenting Groups focused around ACE Research

Educate and Train Application, modification and expansion of NCPTC training model for healthcare professionals Present at the La Crosse Maltreatment Conference annually Present a maltreatment medical track at national/international meetings Develop a Gundersen Lutheran National Maltreatment Conference: Long term goal Consultation Services Third year medical school lecture series on child maltreatment during Pediatric Clerkship at Gundersen, then expand to all UW clerkship sites, expand nationally Interprofessional collaborative practice model Journal of Child and Adolescent Trauma

Internal Process Begin internal efforts with GL staff who are already evaluating/treating maltreated children: BH, Pediatrics, SANE nurses, TEC physicians, Family Practice and Sexual Abuse Counseling & Support and use this as our base to expand these efforts Assess patients for adverse childhood experiences by adding these screening questions utilized at every patient interface within the healthcare system Development of child maltreatment risk factors screening tool for use in Pediatric medical home at all well visits Maltreatment prevention program within medical home Develop stronger alliance with other community resources and programs locally and nationally

Research Continue the work by Michele Knox, PhD – Medical Students, Residents, and Associate Staff in Training (PA, NP) Validation of child maltreatment risk factor screening tool Faculty Assessment High risk pregnancy/substance abuse population study Evidence based work incorporating ACEs Child maltreatment prevention program - outcome data Other collaborative opportunities (?)

Questions/Discussion