June 2013

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Message from the CEO page 2

Satellite clinic at LifeWays to increase hours page 2

News in Brief page 2

Mobile Dental cleans, cares for children’s teeth

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Inside...

Mobile Dental, which brings preventive dental care to children at their schools, is working to improve Jackson’s oral health one mouth at a time. “We provide comprehensive dental care to students who don’t have a dental home or may not have ever seen a dentist or have had dental care,” said Sheri Hardcastle, dental manager at the Center for Family Health. And, Mobile Dental’s impact is growing as more districts and students have been added every year. Consider this: In its first school year, 2007-08, 213 students participated; in 2011-12, 1,056 were seen; and for the first seven months of this school year, 2012-13, 1,272 students had been seen by March 31. Next year, about 1,000 more children will be served. Mobile Dental is the only dental service in Jackson County that brings a dentist and a hygienist to schools to complete age-appropriate exams; automatically files their electronic records at their dental home, the Center for Family Health; and provides follow-up care at the Center’s main facility, 505 N. Jackson St. In addition to an exam at Mobile Dental, elementary, middle and high school students have their teeth cleaned and X-rayed, and sealants and fluoride applied. All leave with a “dental report card” to take home and a bag with toothbrush, toothpaste and dental floss. And the county’s inclusion in Healthy Kids Dental – a program that provides Medicaid-eligible children with free dental care – means there are “greater options for children who require services beyond general dentistry,” such as specialized pediatric dental services, Hardcastle said. Many of the students who participate are Pediatric patients at the Center, making the Center a “one-stop shop for both needs,” she said. The Center also offers transportation, interpretation and other services. “The staff loves children,” Hardcastle said. “They really try to put kids at ease.”

A big fan of the Mobile Dental program is Kim Shiery, children’s program manager of Head Start. She oversees health services for children and pregnant mothers in Jackson and Hillsdale counties. About 400 area Head Start children up to 5 years old receive their dental exams through Mobile Dental, she said. “It’s a Godsend for us,” Shiery said, because a Head Start requirement stipulates that participating children have a dental exam every year. Having the Mobile Dental unit come to the Head Start centers eliminates several obstacles for parents, including transportation and having to take time off work, she said. In addition, the service is helping to educate parents that a cavity in a baby tooth needs care. Yes, it will fall out, Shiery said, but it can affect the health of a child’s adult teeth so it needs treatment. On a recent spring day, about 60 Head Start children – in groups of five or six -- came to the nurse’s office at Lincoln School in Jackson for their visit with Dr. Gloria Smith. One by one, the preschoolers scampered into the child-size examination chair, eager to pick out

the colorful, plastic sunglasses they got to wear to protect their eyes from the bright light during their exam. Dr. Smith was adept at getting the children’s cooperation. “Can you open real big, just like a lion?” She asked one. “Your teeth are beautiful.” Quickly, she examined each child’s teeth, voicing her observations to dental assistant Haley Owens so she could enter them into the child’s electronic records. Some children had a clean bill of oral health; others had cavities and would be referred to the Center for treatment. A few already had been treated for extensive decay – the result of a sugar-rich diet – with a baby root canal or a stainless-steel crown. After the exam, each child had “tooth vitamins” applied to their teeth. The fluoride will

help their teeth remain healthy. All left smiling or giggling, happily grasping their goody bag with toothpaste, toothbrush, dental floss, their dental report card – and a sticker. “It’s always fun to come here,” Dr. Smith said.

Dr. Gloria Smith examines a child’s teeth at Lincoln School’s Head Start program. Dr. Smith calls out her observations to her dental assistant, Haley Owens, who types them into the child’s electronic records.

Breeze, a preschooler with Head Start, shows off her smile.

The chair is cleaned between children, and, on a tray, new gloves and handheld mirror await each patient.

Food choices, exercise part of support group

page 3 Employees walk in fund-raiser page 3

Centering a new way to deliver prenatal care page 3

Top health issues for men page 4

Head Start preschoolers wait their turn to scurry up onto the dental chair.

Mobile Dental, operated by the Center for Family Health, expects to add about 1,000 more children to its patient list next school year. Thanks to a Healthy Smiles, Healthy Children matching grant, the center will send the mobile unit and its dentist, dental hygienist and dental assistants to two more Jackson County school districts and add buildings in two districts currently served, Western and Michigan Center. Through Mobile Dental, students receive dental exams, X-rays, cleanings, fluoride treatments and sealants. Most importantly, the

Center, 505 N. Jackson, becomes their dental home, offering corrective treatments, including filling cavities. The Center also provides dental care at Northeast Health Center. The competitive grant provides up to $20,000 to improve the quality of pediatric oral health care are awarded annually by Healthy Smiles, Healthy Children: the Foundation of the American Academy of Pediatric Dentists. The Center’s proposal was multi-faceted. In addition to adding a mobile unit to serve more school buildings, effort will be made to

encourage greater participation among families in those districts. Hygienists will visit the schools about a week before the mobile unit visits to distribute toothbrushes and toothpaste to students. Educational materials also will be sent home to parents. Preschools also will be targeted to provide access to even younger children. Lastly, the Center will reach out to pediatricians, obstetricians and primary-care physicians about the importance of a dental visit by age 1. Materials also will be given to these physicians for their patients.

1,000 more students to see dentist

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Executive StaffMolly Kaser President & CEOSara Benedetto Vice President & COOE. Dale Ernst, Jr.Vice President & CFOGregory Naylor, MDMedical DirectorSangeeta Sinha, MD, FACOGWomen’s Health Medical DirectorKim HinkleQI Director

Board of Directors

Ted Hilleary Board ChairAllan Padbury DDS, MS, Board Vice-ChairBetty Toll Board SecretaryJeanne Wickens Board TreasurerJerry GrannanImmediate Past Board Chair

Suzi FinchLee HamptonLori HeilerSteven HogwoodR. Dale MoretzWilliam PattersonBrenda PilgrimJennifer White

Providers

Chiquita Berg, MDJerry Booth, DDS, MSMohammad Ghali, MD, MPHElliot Hardy, DDSMonica Hill, MDRose Johnson, MDSarah Malinda, DDSEdward Mathein, DDSMiraflor Reyes-Ganzon, MDNavira Rizwan, MDSharon Rouse, DOShahzad Shaikh, MDSangeeta Sinha, MDGloria Smith, DDSGregory Trompeter, DDSDana Virgo, MDJames Williams, MDAmy Anglin, FNPMollie Bailey, PA-CTravis Brown, PA-CKathleen Dyer, WHNPPatrick Hite, PALiz Ludwig, NPTheresa Nestorak, ARPN-MSNJaquetta Reeves, FNPBridget Thomas, FNPShawn Tipton-Hendershot, FNPMargaret Wolfram, PNP

LocationsCenter for Family Health 505 N. Jackson St.517/748-5500

Jackson High Health Center 544 Wildwood Ave.517/780-0838

Northeast Health Center 1024 Fleming St.517/787-4361

Teen Health Center at Parkside2400 Fourth St.517/788-6812

Center for Family Health at LifeWays1200 N. West Ave.517/796-4550

Exciting News! Our health center has a well-deserved reputation for taking excellent care of children and their health-care needs. That makes two recent grant awards particularly sweet.

The Center for Family Health recently received notice that we will receive a Healthy Smiles, Healthy Children grant through the Foundation of the American Academy of Pediatric Dentists; the purpose of this grant is to help us expand our Mobile Dental service to serve more children.

This is particularly important because for many parents, getting their child to the dentist isn’t easy to do. Some parents have transportation issues, work long hours or have inflexible work schedules. For them, it can be impossible to get a child to the dentist for routine check-ups or teeth cleanings.

That’s where the Mobile Dental service can help out.

We bring the dentist and hygienist to the school. With parental permission, we can clean, X-ray and

examine the child’s teeth and determine what, if any, treatment is needed. This provides mom and dad with peace of mind, knowing that their child’s oral health is in good shape.

The second grant is of equal importance but its benefit isn’t as obvious. We have received a grant from the Weatherwax Foundation to replace our electronic dental record system with one that is up to date and offers more linkages to our electronic medical record system.

When our Mobile Dental service is out at schools, it is crucial that the X-rays and records collected there are accessible at our downtown and Northeast Health Center locations. If a child goes to either of those offices for follow-up care, the information the dentist needs will be readily available. That is truly mobile health care.

We sincerely appreciate the partnership of both these foundations in helping us better serve our community!

Grants expand Mobile Dental, link providers

After less than a month of operation, the Center for Family Health’s part-time satellite medical clinic at LifeWays CMH was ruled a success.With 111 patients using its services in about three weeks, the decision quickly was made to increase from two and a half days to five days a week, said Sara Benedetto, the Center’s chief operating officer. “Basically, our patients followed us” to the site at 1200 N. West Ave., she said. And, “we are beginning to see patients who are consumers of LifeWays. Word is still spreading.” Theresa Nestorak, nurse practitioner at the LifeWays clinic, and Elizabeth Knoblauch, director of strategic relations at LifeWays, agreed. “I think it’s going really well,” Nestorak said. “We’re starting to see people from LifeWays without a primary-care provider.” “We are especially encouraged to know that people who need primary health care are now able to access it more easily,” Knoblauch said. She cited a recent situation when a LifeWays receptionist noticed that a patient who stopped by for an appointment had a medical issue. She referred the patient to the Center for Family Health’s on-site clinic, and the patient was able to be seen at the clinic immediately after his appointment with the LifeWays psychiatrist.

Nestorak, who has been splitting her time between the clinic and the center’s main facility at 505 N. Jackson St., said she is glad to be just in one place because it will eliminate confusion for her patients who aren’t sure where she is working on a particular day. She is also looking forward to working more closely with LifeWays staff to integrate patients’ care for their physical and mental health. “I feel very welcome there and very supported by the Center for Family Health,” she said. The clinic, which opened March 25, increased its hours to 8 a.m. to 5 p.m. Monday through Friday in mid-May. Staffed by three Center employees – Nestorak, an RN patient-care coordinator and a medical assistant – the clinic is open to anyone in Jackson County. A nearly $100,000 grant from the Michigan Department of Community Health, available to Community Mental Health programs for integrated health efforts, paid for all start-up costs, including equipment and technology. Patient care is paid for through reimbursement from Medicaid, Medicare, commercial insurance and other programs. No one is turned away because of inability to pay. Clinic patients automatically become patients of the Center, and are able to access all its services

at its downtown location, 505 N. Jackson St. LifeWays CMH and the Center estimate that about 1,700 potential patients could be seen at the N. West Avenue location. “This partnership has the potential to help our mutual patients get the help they need, right when they need it,” Knoblauch said. “Providing integrated care to those we serve will create a healthier community for us all.”

News in Brief

Molly Kaser, President & CEO

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MESSAGE FROM THE CEO

Weatherwax grant pays for new dental software

New state-of-the-art dental software will be installed and operational at the Center for Family Health by this fall. In late April, the Weatherwax Foundation awarded the Center an $184,277 grant to purchase the software and pay for staff training and implementation, and the transfer of data. The QSI software will “talk” to NextGen, the medical software used at the Center, 505 N. Jackson St., its school health centers and its satellite clinic at LifeWays CMH. It will enable dentists and physicians to share important clinical information. More than 5,400 dental patients also are medical patients at the Center; most are children. Sharing medication and allergy information can decrease the number of negative drug interactions, as well as dangerous allergic reactions. It also can lead to early diagnosis of chronic diseases, leading to treatment and improving patients’ health and increasing their quality of life. It also will offer more reliable and more specific data to track dental outcomes. The software also will provide detailed treatment plans; customized dental charting; and e-prescribing, an important option that is not available with the Center’s current, out-of-date dental-record software.

“The Weatherwax Foundation has been a wonderful partner of our health center over the years, particularly around our dental services,” said Molly Kaser, Center president and CEO. “We appreciate their commitment to helping us serve the under served in our community.”

New ‘employee’ at the Center Pharmacy

Logging in at 8-foot long, featuring a robotic arm and employing a series of light sensors, a robot is now part of the team at the Center for Family Health Pharmacy. It arrived April 12, and “we’re learning to love it,” said Nancy Bauer, pharmacist and pharmacy manager. As of late April, the robot already was counting and labeling about 40 to 45 percent of many of the maintenance drugs the pharmacy dispenses, Bauer said. The robot’s “work” is checked by its human counterparts, but it is allowing them to have more time with patients.

Satellite clinic at LifeWays already deemed a success

Therese Nestorak is the nurse practitioner at the Center for Family Health’s satellite clinic at LifeWays.

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What: CenteringPregnancy is a method of delivering prenatal care in a group setting

Who: Women are grouped together by due dates

How: The group meets for two hours a week; the women in the group create a support system for each other, learn self care, and are empowered to participate in their health decisions

Why: Better outcomes for the babies and their moms

Questions about any of our articles? Just call 517/748-5500 and ask for Molly Kaser.

Support group focuses on healthy eating, exercise

Pregnancy is a time of wonder, a time of growth, a time of exploration. The Center for Family Health is adopting a new method of providing prenatal care, guaranteed to increase the wonder, the learning and the support. And, most importantly, it will increase the likelihood of positive outcomes for moms and their babies. CenteringPregnancy is a model for group prenatal care, designed by the non-profit Centering Healthcare of Boston. Its goal is to promote health, healthy lifestyles and people participating in the health-care system together. It has been implemented in a variety of settings across the nation, with different populations. It strives to improve the well-being of pregnant women, improving their self image, increasing their self-care skills, and decreasing infant mortality and maternal morbidity. It also promotes the healthy growth and development of the fetus, reduces family violence, promotes family development and reduces unintended pregnancies. The Center plans to start implementing the model in early summer. Starting in March, the Women’s Health staff underwent intensive training in the Centering model and its specialized scheduling. “We are very excited and pleased to offer this group model of care to our patients,” said Dr. Sangeeta Sinha, medical director for Women’s Health at the Center for Family Health. “We see very clear benefits for women, particularly our teen moms.” Basically, CenteringPregnancy groups about 10 pregnant women together who are due the same month. Focusing on assessment, education and support, the group meets for two-hour prenatal-care sessions about 10 times during pregnancy. The women start their prenatal care with an individual visit with the provider before they move into their prenatal groups. Throughout the

next several months, unexpected issues – such as gestational diabetes – will be handled with individual appointments. When the group prenatal care begins around week 16 of pregnancy, women will arrive at the Center and go directly into the gathering room, eliminating spending time in the waiting room. During the first 30 minutes, the women will be seen briefly in the corner of the room by an obstetrician or women’s health nurse practitioner. The other women will be taking their own blood pressure and weight, using the gestational wheel to measure their bulging bellies and testing their urine. Healthy snacks will be available to encourage socialization. A nurse will circulate to assist, draw blood to test for gestational diabetes or answer any questions.

For the next 60 minutes, the group will sit in a circle for a discussion centering on an issue of pregnancy or motherhood, such as prematurity, baby care, contraception or breast feeding. The discussion will be facilitated by the doctor or nurse practitioner. That means the women will be encouraged to offer solutions, advice and experiences; the doctor or nurse practitioner will not lecture or dominate the group. The sharing promotes trust, creating a supportive community for the participants, while disseminating important, useful information to the women. The last 30 minutes will be left for informal socializing, follow-up and closing. The same provider and nurse are with the group the entire two hours and for every pre-natal session. Why is Centering important? It encourages self-care, creates a support group and provides for more learning time. About 97 percent of the women say they like the group prenatal approach. A 2003 study found that women in Centering groups were less likely to deliver prematurely, staying pregnant two weeks longer than a control group and delivering babies that were one pound bigger.Another study in 2006 showed a 33 percent reduction in prematurity, increasing to a 41 percent reduction for African-American women. Research also shows an increase in breast feeding among women in Centering groups, better attendance at the prenatal visits and more participating in postpartum visits. “Centering takes care of all the needs of a pregnant woman, as a whole,” Dr. Sinha said. Several donors paid for the training and start-up costs associated with the CenteringPregnancy program. They are the James A. and Faith Knight Foundation, Addison P. Cook III Foundation, and Frank and Irene Myers Foundation.

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Pregnancy ‘Centering’ on group prenatal care

$2,595 raised for March of Dimes

Employees at the Center for Family

Health raised $2,595.10 for the March for Babies, a fund-raiser for the March of Dimes on April 28 at Ella Sharp Park.

The team collected the money through a series of events, including jeans days, a bake sale and a pizza party, a 50-50, a silent auction for eight baskets and selling cards of $5, $10, $20 or more.

Locally the walk raised about $50,000 to pay for research and treatment for premature babies. Participants braved the rain to demonstrate their support in the walk at the park.

Stephanie Skonos has a favorite catchphrase that may be surprising when you learn she’s a registered dietitian.

It is: “There are no bad foods.”Skonos works with patients – individually and in

support groups – at the Center for Family Health. Many have been diagnosed with Type 2 diabetes or are pre-diabetic. In fact, the Center cares for about 1,900 diabetic patients.

Her advice is simple: Make changes to your eating and your activity level slowly. And, she advocates that patients keep a record of both. Moreover, she tells them that they don’t have to give up their favorite foods, such as pizza or ice cream, but they need to indulge in moderation.

At a recent, one-hour, free Healthy Eating Support Group, several women gathered to celebrate their successes, discuss eating choices – and exercise together.

“Most of the magic is around this table,” Skonos says.

The women discuss food choices from gradually changing from whole milk to skim and how to wean off butter.

“Doing better most of the time is success,” Skonos tells the participants in the drop-in group. “It’s small baby steps over time.”

A small step can be pulling a can of green beans out of the cupboard. The next step can be rinsing off the salt and water before you heat them up.

“There’s a lot of misinformation out there,” she says. “You have to restructure the way you think about food and eating.”

After the back-and-forth about food and congratulations about healthy weight losses, the women spend time on 12 different chair exercises. Then it’s time to hit the streets around the Center for a half-mile walk.

The Healthy Eating Support Group is offered twice a week; participants can come as often as they like. Before joining the group, each patient takes a one-time Basic Healthy Eating Class. That class introduces the “toolbox” concept; that is, what constitutes a healthy meal.

Many also attend a once-a-month Diabetes Support Group. A few attend an Anxiety and Depression Support Group. Skonos works closely with the Center’s mental health counselors to address some patients’ issues that led to weight problems and Type 2 diabetes.

Skonos is thrilled that the Center offers such free classes and groups to its patients.

“It’s an important service to provide for patients,” she says. “This is a remarkable place where doctors have patients with a high level of need.

“We empower the person to make the change within themselves. It’s all within their reach.”

Chair exercises keep group members Pam Foote and Mary Cawthon focused.

Stephanie Skonos, a registered dietitian at the Center for Family Health, facilitates the group.

Stephanie Skonos, from left, and participants – Alice Fleming, Lemon Jenkins and Debra Ohm – walk a half a mile, the last group activity.

AT A GlANCE...

Holly Hines, site supervisor at the Northeast Health Center, was one of the Center for Family Health employees who walked in the March for Babies. Her daughter Lea accompanied her.

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505 N. Jackson StreetJackson, MI 49201

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Top Health Issues for MEN

Men die younger than women. The Centers for Disease Control reports the life expectancy for women is five years longer than men.

Not surprisingly, men die at higher rates than women from heart disease, cancer, stroke, chronic obstructive pulmonary disease, accidents, pneumonia and influenza, diabetes, suicide, kidney disease, and chronic liver disease and cirrhosis, the Men’s Health Network reports.

Why? Genetics and race play a part, but men are less likely to see a physician and to undergo screening tests that can lead to detection and treatment of some of these leading causes of death.

1. Heart disease. Heart disease is the leading cause of death for men. One in every four men has some form of heart disease, according to the CDC.

The American Heart Association cites the following risk factors for heart disease – increasing age, male sex, smoking, high cholesterol, high blood pressure, physical inactivity, obesity or being overweight.

Anyone with a family history of heart disease; and African-Americans, Mexican Americans, Native Americans, Native Hawaiians and some Asian American are at a higher risk.

What can you do to lower your risk? Have yearly check-ups with a primary-care provider, eat a healthy diet, exercise and stay at a healthy weight.

2. Cancer. Lung cancer is the leading cancer killer for men. It is followed by prostate cancer and colorectal cancer. Thankfully, the number of lung-cancer detections and deaths is decreasing, thanks to smoking-cessation efforts.

Tobacco products account for 90 percent of lung cancer so smoking cessation is the key to prevention. Quit smoking, and see your doctor for regular checkups and screenings. The National Institute on Aging reports that as soon as you stop

smoking, your chances of getting cancer from smoking begins to shrink, and you can prevent further damage to your lungs.

Prostate cancer is treatable if found in its early stages. Unfortunately, prostate cancer can exhibit no symptoms until it has spread. That’s why seeing a doctor annually and undergoing screening is important. The American Cancer Society recommends annual screenings begin for healthy men starting at age 50 or older. Men who are at high risk, such as those who have family history of prostate cancer or who are African-American, should begin testing earlier.

Colorectal cancer also can be avoided through early detection of a colonoscopy.

3. Mental Health. Men are four times more likely to commit suicide than women. The Men’s Health Network says that’s because depression is under diagnosed in men.

Men who suffer from depression often do not appear sad. Instead, they display anger, aggression, work “burnout,” risky behavior, or alcohol and substance abuse. Some men appear to be undergoing a “midlife crisis.”

If you feel depressed (or someone you love is showing signs of depression), seek help from your doctor, a therapist, or call a suicide-prevention hotline.

4. Stroke. Stroke is the third-leading cause of death in the United States, after heart disease and all forms of cancer. The incidence rate of stroke is 1.25 times greater in men than in women, although the difference decreases as people get older, the American Stroke Association states.

The control of hypertension, high blood pressure, is crucial to prevent the onset of a stroke. Other risk factors include increasing age; personal history of a stroke; diabetes; high cholesterol; heart disease; smoking, including second-hand

smoke; physical inactivity; obesity; and alcohol and substance abuse. African-Americans have a greater risk than Caucasians.

You can lower your risk by managing your high blood pressure, watching your weight, eating a healthy diet, quitting smoking and exercising.

5. Diabetes. Diabetes occurs when the body cannot control blood-glucose levels properly. The digestive tract usually breaks food into glucose, a form of sugar, and disperses it into the bloodstream. Insulin, a hormone produced by the pancreas, stimulates cells to absorb it and turn it into energy.

Type 1 diabetes usually starts in childhood. It is caused when the body’s immune system attacks the insulin-producing cells. In Type 2 diabetes, tissue in the body becomes resistant to insulin. The pancreas steps up production, but blood glucose levels start to climb.

This is a problem because the high blood glucose levels damage nerves and blood vessels. The damage can lead to heart disease, stroke, blindness, kidney disease, inadequate circulation and gum infections.

Testing should begin after age 45; earlier if risk factors are present. Type 2 diabetes cases are rising; experts point to more people who are obese or overweight; have a sedentary lifestyle; eat a diet high in sugar and carbohydrates, and low in fiber and whole grains; and have an immediate family member with type 2 diabetes.

You also should be tested if you experience increased thirst or hunger; fatigue; frequent urination, especially at night; unexplained weight loss; blurred vision; or sores that don’t heal.

Type 2 diabetes can be avoided by maintaining a healthy weight, exercising and eating healthfully. It can be controlled through medication, diet and exercise while under a doctor’s care.

Sources: Livestrong.com, MayoClinic.com, WebMD.com

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