2017 Annual Report to the People

Greetings from the Executive Director

From the Executive Director of Health: Hini kara gi wii!

The Department of Health has over 200 employees who work in two clinics, one located in Black River Falls and one located in Baraboo. Along with two primary clinics there are satellite health offices in La Crosse, Tomah, Nekoosa and Wittenberg, Wisconsin. Medical care is provided at our primary Clinics and Community Health services are provided in our satellite offices. Tribal members outside of the State of Wisconsin can be assisted by our At-Large health program for information on how to access available health services.

The Wainaisguni Hocira- House of Wellness and Ho-Chunk Health Care Center are both accredited through the Accreditation Association for Ambulatory Health Care. Accreditation requires us to provide and promote high quality patient care and Ona White Wing Garvin performance measures for our Clinics. Community Health is currently seeking Executive Director of Health Public Health Accreditation.

This year we negotiated a Self-Governance Compact with Indian Health Service authorized by Title V of the Indian Self Determination and Education Assistance Act, which gives the Nation the power to decide how federal programs, services, functions and activities will be carried out. This Compact strengthens the government- to- government relationship and upholds the United States trust responsibility to the Ho-Chunk Nation. The Compact also enables us to better fit the needs of the Nation, to enhance effectiveness and long-term financial stability of the Nation and streamline federal Indian Health Service Bureaucracy. Self-Governance permits an orderly transition from federal domination of programs and responsibility of providing health services to the Nation.

Dr. Feras Alkhader, Dentist, was hired one year ago. He has been very busy this first year helping tribal members and employees with dental needs. Dr. Rachel Lundberg, Optometrist, joined our team in July, 2017. They are both located at the Ho-Chunk Health Care Center in Black River Falls, Wisconsin. Additionally, Dr. Neil Cox, M.D, will be at the Ho-Chunk Health Care Center full-time in September, 2017. We are continuing recruitment efforts for Doctors and health professionals. Our Physician’s Assistants, Family Nurse Practitioners and Nurses will continue their excellent services to our people, further strengthened by these additions to our staff.

The Nation is in need of combating the devastating results of drug abuse. It has been a sad year due to the overdose death of many of our young relatives and friends. A Tribal Action Plan has been written to mobilize all of the resources we have in the Nation and also get more resources to assist us in our efforts. Our Behavioral Health program has many demands made for immediate treatment. Please remember an Intake Specialist must ask for a brief explanation of a client’s needs. This aids in effective scheduling with mental health clinicians or substance abuse counselors, and/or arranging for in patient/outpatient treatment before a comprehensive plan is established. All information is kept confidential regarding cases we treat.

Exemplary work continues in Community Health, Environmental Health, Medical Services, Pharmacy and Quality Improvement in building a strong mind, body and spirit together. Ahuskaiiga

Ona White Wing Garvin

Virginia DeFord Clinic Office Manager for the Executive Director

Medical Services Staff

Dr. Amy DeLong, MD Medical Director

Dr. Neil Cox Physician Dr. Carolyn Wakeman, Physician

Dr. Chandra Reddy Dr. Karen Ailsworth Dr. Thomas Zirkel Bethany Schilling Physician Physician Podiatrist Nurse Practitioner

Cari Ritter Sue Christopherson Chris Seguin Holly Rodenberg Physician Assistant/ Kiana Beaudin Nurse Practitioner Nurse Practitioner Nurse Educator Health Educator Physician Assistant

Thomasa Chavez Jennifer Koebler Alissa Ginkowski Rosa Blackdeer Angela Gardner Clinic Nurse (HHCC) Clinic Nurse (HHCC) Clinic Nurse (HHCC) Clinic Nurse (HHCC) Clinic Nurse (HHCC)

Tracey McReath Missy Hubing Brittany Niemeyer Elizabeth Anderson Clinic Nurse (HOW) Carol Whipp Certified Medical Clinic Nurse Certified Medical Certified Medical Assistant (HHCC) Supervisor (HOW) Assistant (HOW) Assistant (HOW)

Joseph Sanders Charmaine Brandt Carol Koch Laboratory Technician Annie Wostal-Bender Peggy Woychik Laboratory Supervisor Laboratory Radiologist (HHCC) (HHCC) (HHCC) Radiologist (HOW) Technician (HOW)

Alison Cleveland Loula Krause Dr. Feras Alkhader Sally Zager Cindy Wyss Dental Assistant Dental Assistant Dentist (HHCC) Dental Hygienist (HHCC) Dental Assistant (HHCC)

Dr. Charles Lau Jennifer Luce Amy Clark Dental Hygienist Misty Newkirk Dentist (HOW) Dental Assistant II (HOW) Dental Assistant II (HOW) (HOW)

Dr. Rachel Lundberg Stephanie Heller Dr. Laurie Haun Heather Beal Optometrist (HHCC) Optometry Technician Optometrist Optometry Technician (HHCC) (HOW) (HOW)

Medical Services Division Annual Report Ho-Chunk Health Care Center and House of Wellness

Medical Services Division provides medical, dental, optical, and podiatry care to our patients. Our healthcare team of providers include: Pediatrician, and Family Practice Physicians, Family Nurse Practitioners, Physician Assistants, Dentists, Optometrists, visiting Podiatrist, visiting Oncologist, visiting Endodontists and supportive staff. All of our healthcare providers within the Department of Health are committed to providing excellence in care and service.

Patient Visits Ho-Chunk Health Care Center

Optical Dental Medical

8139 7904 8129 7488 7428 6175 6402

2039 2060 2027 1630 1594 1885 1861 639 603 633 740 841 871 710

2011 2012 2013 2014 2015 2016 2017

Patient Visits House of Wellness

Optical Dental Medical

5521 5410 5237 4933 4785 4437 4725

2114 1912 1909 1991 1837 1922 1097 1068 1001 700790 849 920 893

2011 2012 2013 2014 2015 2016 2017

Accomplishments in FY 2017:  Continuously worked to improve cultural awareness training for staff and clinical students and local clinical practices that see our patients.  Implemented the use of digital x-ray equipment in the exam rooms at both clinics that streamlined radiology services in both clinics.  Expanded collaborative Integrated Patient Care team concept at both clinics and with other partners such as, Black River Memorial Hospital, to combat prescription drug abuse and improve continuum of health care for our patients.  Focus on clinical quality measure to improve performance outcomes to fight heart disease and strokes by continuing the partnership with Million Hearts project partners to prevent one million heart attacks and strokes in the United

Stated by 2017. Joan Greendeer-Lee Director  Hired four new providers to fill provider vacancies; one dentist, one of Medical Services Optometrist and two Family Practice doctors.  Partnership has solidified with Gundersen Health Systems to include invitations to grand rounds and offer of specialty services. Problems and Corrective Actions Taken in FY 2017:  Implemented the School Based Restorative dental services in an elementary school in Baraboo but declined the Wisconsin state grant due to considerable time closing the dental clinic and extremely low student participation and fewer tribal member students served by this project.  Implemented a quality monitor on the Triage process to improve the medical clinic workflow, numerous problems identified, such as the lack of training by all staff involved; triage policy differed between the two clinics; and minimal education for patients served about the importance of the Triage process. Began corrective action with intense training and meeting with all staff involved to discuss Triage policy.  Dental, Medical and Optical provider shortages resulting in shortened availability at the HHCC clinic. HOW Clinic staff stepped forward to help curb the shortened schedules. Four new provider contracts allowing for the hire of new providers will fix the HHCC clinic scheduling problems. The two new Family Practice doctors will also deliver babies.  Re-established the mammography services for our patients. Mammography services were set for quarterly visits and, as a result, many patients are placed on waiting lists. Within six months, arrangements were set in place to increase the mobile visit schedule to every other month. Future Goals and Strategies:  Continue to evaluate methods to decrease no-show rates for all services  Intensify the quality monitors led by providers through-out both clinics to further improve the quality of care for our patients

 Evaluate the possible expansion of services to Rebecca Shawley Patty Houghton include chiropractic services Clinic Office Manager Clinic Office Manager  Expand Outreach services by clinic Staff from (HHCC) (HOW) HHCC and HOW clinics at various health fairs

and conferences and cultural events  Evaluate the referral system to streamline the process.

Report is respectfully submitted by Joan Greendeer-Lee, Director of Medical Services

Pharmacy Division Annual Report Department Description: The Ho-Chunk Nation (HCN) Pharmacy Department consists of pharmacy operations located at the Health Care Center in Black River Falls, WI and the House of Wellness in Baraboo, WI. Each location provides pharmacy services to distinct patient populations, which include Native American/American Indian enrolled members of any Federally Recognized Tribe as well as non-Tribal HCN Employees and any person presenting with a valid prescription. Each pharmacy operation has two pharmacies within the pharmacy operation area, one State retail pharmacy and one Federal Indian Health Service pharmacy. This innovative and complex pharmacy model creates a special opportunity for revenue generation and enhanced clinical pharmacy services to all of the patients served and provide the highest level of health care.

Total Prescriptions Dispensed and Revenue Generation: Total Prescriptions Dispensed:

. F.Y. 2009- 34,836 F.Y. 2013- 61,693 F.Y. 2017- 69,394 . F.Y. 2010- 36,391 F.Y. 2014- 65,882 . F.Y. 2011- 55,738 F.Y. 2015- 66,367 . F.Y.2012- 59,513 F.Y. 2016- 66,833

Total Number of Prescriptions Dispensed

80,000 70,000

60,000

50,000

40,000 Total Number of 30,000 Prescriptions

2009 2010 2011 2012 2013 2014 2015 2016 2017

Future Goals and Development:  Priority goal is to implement a customer service training and monitor each pharmacy staff member’s performance on a monthly basis.  Development and implementation of marketing initiatives to increase pharmacy utilization and revenue generation for the Ho-Chunk Nation.  Implement a mandatory chronic medication/mail order program for HCN employees.  Increase pharmacy contracting with Medicare Part D, Private, and Affordable Care Act pharmacy insurance plans to increase revenue.

 Provide bubble packing services for specific patient populations requiring assistance with medication organization and management.

Annual Accomplishments:

 Developed clinical pharmacy services such as pain management, psychiatric

pharmacy, diabetes management, and medication therapy management, and an antibiotic stewardship program through specialized pharmacist training and credentialing and Indian Health Service

Improving Patient Care Model.  Hired 3 additional pharmacists in order to prepare for the mandatory maintenance medication program and

improve clinical pharmacy services HHCC Pharmacy expansion provided to the community.  Health Care Center Pharmacy mentored 2 University of Wisconsin Advanced Pharmacy Practice Experience (APPE) students and House of Wellness Pharmacy mentored 6 University of Wisconsin APPE students.  Increased utilization of the Tribal Pharmacies by non-Tribal employees and Tribal members.  Clinical Pharmacists increased participation on the medical team to provide the highest level patient care to Tribal Members and employees by participating in clinic visits with the providers and staffing case management meetings.  Clinical Pharmacist staff being part of the Integrated Case Management monthly meetings assisting with patient-centered care plans and improving the quality of health care provided to our consumers.  Accomplished last year’s goal of implementation of a new pharmacy management software system to improve pharmacy services and medication safety as well as increase pharmacy revenue through third party insurance reimbursement.  New pharmacy software system has allowed for enhanced communication with the pharmacy through a text and call based

notification system alerting individuals when New HHCC Pharmacy pick-up window their medication is ready for pick up. Also a free smartphone app was developed to allow individuals to download their medication profile and request refills from their phone app.  Implemented a medication safety program that tracks pharmacy errors in a database and allows for identification of areas for improvement of processes or training needs.  Accomplished last year goal of approval of a Ho-Chunk Nation Legislative Resolution that allows the pharmacy director to have signature authority to contract with new pharmacy insurance plans as well as authority for re-credentialing the pharmacy operations. This resolution

allows for an enormous opportunity to generate revenue from new revenue sources as well as maintain membership in existing insurance plans.  Health Care Center Pharmacy expansion that tripled the pharmacy work space, added a private patient counseling area, and allowed for an additional pharmacy robotics ScriptPro machine.  Free mail out services across the country.

Report is respectfully submitted by CDR Ted Hall, PharmD, BCPP, Director of Pharmacy

CDR Ted L. Hall, PharmD, BCPP Pharmacy Director/Chief Pharmacist

Pharmacy Staff Ho-Chunk Health Care Center

James “Gabe” Buel Holly Dale Pharmacy Supervisor/HHCC Melanie Hanson Pharmacy Technician Pharmacist

Lisa Wollin Sara Sugden Pharmacy Pharmacy Neile Decorah, Technician Technician Pharmacy Technician

Pharmacy Staff House of Wellness

Amber Hanna Hussian Harun Pharmacy Supervisor/HOW Pharmacist Abigail Moore Pharmacist

Laurie Dionne Laurie Ammerman Heather Marks Pharmacy Technician Pharmacy Technician Pharmacy Technician

Finance Division Annual Report

Functions and Divisions:

 Billing and collecting third party insurance revenue for the Department of Health direct services and operations.  Monitoring the overall expenses and revenue for the Department of Health.  Filing statistical and financial reports with the Centers of Medicare and Medicaid Services.  Managing third party payer contracts with Medicare, Wisconsin Medical Assistance and commercial insurance companies throughout the United States.  Organizing and disbursing Indian Health Service appropriations to Department of Health programs.  Overseeing all Department of Health’s State of Wisconsin and Federal grants to ensure compliance with grantee rules, regulations, reporting and audits.  Managing the Net Profit Distribution allocated from the Ho-Chunk Nation to all Health Department programs as approved by the Legislature.  Managing Medical Records, Patient Registration, Accounting, Medical Coding, Accounts Receivable, Cashier and Collections, Health Information Systems, Benefits, Contract Health, At-Large Health, Optical Retail and Grants.

Ho-Chunk Nation Department of Health Uses of Funds as a percentage - Fiscal Year Ending 06/30/17

Clinics 27% Behavioral Health 8% 65% Community Outreach

Cost Report Progress:

 The Department of Health has completed and filed Medicare and Medicaid cost reports thru 2016. Medicare cost reports are up to date and the Department of Health is actively billing and getting paid from the Medicare program and the State of Wisconsin Medicaid program. Ho-Chunk Nation Department of Health Sources of Funds as a percentage - Fiscal Year Ending 06/30/17 Service Revenue 43% 45% NPD Distribution IHS 12%

Goals and Achievements:  Become self-sustainable through the generation and collection of third party revenues as to no longer rely on the Net Profit Distribution allocation.  Maintain and Advance the Tribal Self Governance Status as a Department of Health through The Centers for Medicare and Medicaid Services as to better promote, create and maintain Ho-Chunk tribal health programs.  Create a deficiency free financial audit environment.  Encourage and create an environment that allows for any tribal member that wants health insurance to obtain individual health insurance.  Expand the Health Service Lines offered to the population in which the Ho-Chunk Nation tribal clinics serve.

If you do not have health insurance please contact one of our benefits specialists at 715-284-9851 and ask to speak with one of them about getting health insurance coverage under the Affordable Care Act.

What is the Affordable Care Act: The Patient Protection and Affordable Care Act (ACA), a piece of federal legislation commonly referred to as "Obamacare," which made sweeping changes to how health insurance is purchased and paid for. Signed into law in 2010, ACA requires individuals who don't receive health insurance benefits through their employers to purchase coverage or pay a penalty. (Native Americans are exempt from this tax penalty) The law also puts certain limits on what insurers may or may not do with respect to eligibility and coverage. The ACA has numerous, often-complex provisions that phase in over time, through 2022, if the current administration does not amend or repeal the plan.

To learn more about your specific benefits and or research other health insurance options please visit a Benefits Specialist.

Respectfully submitted by Wally Apland III, M.H.A., Health Finance Wally Apland Director Finance Director

Health Finance Division Staff

Casey Osborn Penny Ybarra Accountant Jr. Accountant Kimberly Nelson Jr. Accountant

Natalie Bird Liz Lund At-Large Health Manager Coordinator Provider Network

Emmalee Decorah Janna Mallory Penny Salzman Cassie Schober Cashier Cashier (HOW) Biller/Medical Biller/Medical Coder Coder

Deb Vanthournout Biller/Medical Coder Cherisse Cherwenka (HOW) Accounts Jessie Mann Louise Voss Receivable Clerk Accounts Grant Writer Receivable Clerk

Joyce Rockman Sandra Lanier Cynthia Tack Benefit Specialist Benefit Specialist Benefit Specialist (HOW) Supervisor

Barb Fankhauser Sue Bjerke Rebecca Pidgeon MedicalRecords/Patient Medical Records MedicalRecords/Patient Registration Supervisor Registration Supervisor (HHCC) (HOW)

Tiffany Youngthunder Donica Byrns Kayla Cleveland Laura Cherwenka Patient Registration Patient Registration Patient Registration Patient Registration

Nicole Cotto Cheyenne Lonetree Glen Decora Michelle Cloud Patient Registration (HOW) Patient Registration (HOW) Medical Records Clerk Patient Registration (HOW) (HOW)

Health Information System Staff

Tom Myher Heather Roberts Matt Mallory Ethan Mallory Administrator Database Administrator Technician Engineer (HOW)

Kimberly Hutchens Tyler Doyle Mike Puffer Evan Thompson Trainer Engineer Technician Technician (HOW)

Jeanne Colwell Josie Cleveland Casie Lamorie Katie Kissane Administrator Technician Programmer Clinical Applications Coord.

Quality Improvement Division Annual Report

Since the creation of the Quality Improvement Division, the Department of Health continually strives toward achieving a higher standard of quality care by measuring the performance of all health programs. The purpose of Quality Improvement is to enhance the safety, efficiency and effectiveness of all health care processes by continuously evaluating the performance of services delivered to our patients through qualitative and quantitative methods, ultimately resulting in lower business costs and increased quality of care. Quality Improvement identifies areas of deficiency, creates plans for improvement, and monitors those plans through completion. Plan-Do-Study-Act, the PDSA Model, is the credo of the program. We plan projects that will address areas of needed improvement; we do the project as a research study; we study the results of the program to see if the improvement did take place. We then act to adopt, adapt, or abandon our strategy to ensure improvement.

Accomplishments in 2017:

 Participated in the review and approval of policies and procedures submitted to the Health Department committee  Submittal of approved Health Department-wide policies and procedures for final Health Accreditation Board approval  Disseminated Annual HIPAA training test for all Health Department staff  Conducted annual patient satisfaction surveys to study patient responses to services provided by our clinics  Hired a new Director of Quality Improvement  Worked with multiple Health Dept. divisions to create a new hire orientation packet; awaiting final approval of its implementation  Verified licensing credentials and background checks for Health Department staff as needed  Monitored Patient complaints to ensure that concerns are addressed to meet care of patients  Convened monthly Quality Improvement meetings  Successfully developed a job description for an Infection Prevention/Employee Health RN  Collaborative work was done with other Health Dept. Divisions to complete the PHAB (Public Health Accreditation Board) domains and remain on schedule for Public Health Accreditation  Full scholarships were awarded for two (2) trainings conducted by the National Network of Public Health Institutes (NNPHI) – one (1) was the Open Forum on Quality Improvement in Public Health in New Orleans and the other was the annual PHIT (Public Health Improvement Training) conference in Albuquerque, NM  Helped create and implement a Quality Improvement and Performance Management Plan encompassing both clinical and public health quality measures.

 Helped create and implement a Workforce Development Plan to increase human capital in our public health workforce, and further developing our Strategic Plan

Goals in 2018:

 Continue to monitor quality improvement projects and peer reviews  Continue to conduct annual audits of our programs  Continue to review Patient Complaints to ensure patient health care satisfaction  Continue annual patient satisfaction surveys and distribute results with Health staff  Continue active participation in the Safety and Policies and Procedures committees  Continue to verify licensing credentials and background checks as necessary  Look back on the previous year’s HIPAA violations and increase HIPAA trainings to update all staff and new employees  Obtain password protection on all Health Department cell phones and laptop computers  Disseminate a workforce development plan meeting Public Health Accreditation Board standards  Hire a full time Infection Prevention/Employee Health RN  Obtain full PHAB accreditation  Continue to remain current on AAAHC clinic accreditation standards and measures.

Report is respectfully submitted by Daniel Libke, Director of Quality Improvement

Dan Libke Quality Improvement Director

Ritchie Brown Andrea Mattison QI Compliance Officer QI Compliance Officer

Environmental Health Division Annual Report

The goal of the Environmental Health Division (EHD) is to identify and alleviate any environmental hazards that may harm the health of the Ho-Chunk Tribal Members.

Key Tasks The following environmental areas are addressed by the program: Water Quality, Solid Waste Management, Wastewater Management, Food Sanitation, Vector Control, Air Pollution, Institutional Environmental Health, Code Compliance in Facilities, Community Injury Prevention, Underground Storage Tanks, Environmental Assessment, Emergency Preparedness, Surface Water Monitoring, Wetlands Delineation, Construction Projects, and Public Health Accreditation.

Highlights for 2016-2017  An expansion was completed at the Ho-Chunk Health Care Center in Black River Falls. The expansion began in May of 2016 and was completed in January of 2017.  A new Nekoosa Health Office was built in the Cex Haci community. The building provides a permanent home for the Community Health Programs.  This year ninety-two (92) environmental health surveys were conducted in Ho-Chunk facilities to assure that they are meeting recognized standards for food services, swimming pools, campgrounds, Head Starts, day cares, hotels, mass gatherings, and safety. In addition, during the last year forty-seven (47) environmental assessments were completed to address mold, radon, indoor air quality, and human health hazards in individual tribal member’s homes.  During the last year the EHD spearheaded the removal of an abandoned trailer home that was being used as a “Drug/Party” house. This was a joint effort between Environmental Health, the HCN Police Department, the HCN Department of Justice, the Division of Community Health, and concern tribal members. The process for removal of the trailer came from the new Human Health Hazard Ordinance. Beginning of demolition of a “Drug/Party” abandoned  The EHD assisted in the construction of well, water trailer house located just south of Indian Mission. treatment equipment, and septic systems for the Wittenberg and Mauston Community Centers this year.  During the last year the EHD installed seven (7) new wells and six (6) new septic systems for tribal members who could not be connected to community systems.  During the last year the EHD assisted ninety-five (95) tribal members with emergency water or sewer issues.  During the last year the EHD properly abandoned eight (8) wells to prevent groundwater contamination.

 The engineering and design work of the water and sewer services for the Little Blackhawk subdivision are 95% complete. This project will install community water and sewer services for the 22 lots.  Compliance Assistance Inspections and training was completed for each of the Nation’s Whitetail Crossings for the underground storage tank systems.  The EHD’s Air Quality Program established 2 Air Quality Monitoring Stations. The stations will test outdoor air for dust

particle pollution and also take Community outreach with Baraboo Schools at the former Badger weather measurements. The Ammunition site. stations are located near the tribal communities of Mission and Blue Wing.  The Ho-Chunk Nation’s EPA Clean Air Act Section 103 grant funding received an additional $20,000, following talks between Environmental Health Air Quality Staff and EPA officials.  The public health accreditation committee submitted an application for PHAB accreditation which was accepted by PHAB.  Pam Thunder, Tribal Sanitarian was awarded the “Bemidji Area Environmental Health Specialist of 2016” by Indian Health Service for her extensive work towards public health accreditation.  Water Quality monitoring was completed on 18 tribal streams in 2016-17. Monitoring included chemical sampling, fish surveys, Project oversight for culvert installation by BIA Roads to macroinvertebrate sampling and assure protection of wetland resources. habitat assessments.  A Water Quality Assessment Report was drafted for all of the tribal waters sampled in 2016-17.  Wetlands were delineated, classified and mapped on 12 trust parcels. This information was incorporated into the Geographic Information System (GIS) to assist other departments with project planning.  Invasive plant treatments continued on 900 acres of tribal land in Shawano County using BIA and EPA grant funding. Invasive plant management work was expanded onto multiple parcels in Jackson Co. during 2016. Invasive plant management work was also completed on approximately 680 acres at the former Badger Army Ammunition Plant using BIA Invasive Wildlife Program grant funding.

 The Aquatic Biologist provided hands-on environmental education programs and/or presentations to approximately 350 tribal and non-tribal youth and adults on multiple occasions in 2016-17 including the annual Earth Day Event, Natural Resources Foundation field trip, Ho-  Chunk Summer Enrichment Program field days, Black Earth Public Library and the Sauk Prairie Conservation Alliance.  Environmental reviews were completed for (6) BIA Road Program improvement projects, (10) Indian Health Service residential projects and (5) NPD or HUD development projects.  An additional $56,938 in BIA  Motor Vehicle Injury Prevention Program’s distracted driving campaign and Invasive Species funding was billboard. acquired in 2016-17 for  invasive species management at the former Badger Ammunition Plant parcel.  $19,800 in grant funding was acquired from the Sauk Prairie Conservation Alliance in 2016-17 for management of invasive species on the Badger parcel.  The Injury Prevention program finalized a billboard design that addresses distracted driving. It features Ho-Chunk Nation member and team member for the Wisconsin Badgers Basketball, Bronson Koenig.  The Motor Vehicle Injury Prevention Project Coordinator held 21 educational activities to increase awareness of the consequences of distracted driving for the year. One of which was the Mock Crash at the local high school to educate 500 students on the impact and consequences of distracted driving.  The Motor Vehicle Injury Prevention Project Coordinator conducted six (6) child passenger safety seat observation surveys. The observed child safety seat use rate was 67.8%.  During the year the Motor Vehicle Injury Prevention program distributed 160 car seats.  The Motor Vehicle Injury Prevention Project Coordinator was awarded the Child Passenger Safety Program of the Year award at the 42nd Annual Wisconsin Governor’s Conference on Highway Safety.  The Environmental Health Division currently manages $5,979,365 in program funding.  The Tribal Sanitarian position has been filled by Steve Schwanebeck. The Environmental Health Division is now fully staffed with 14 employees.

 Goals for 2017-2018

 The Little Blackhawk Subdivision water and sewer project will be completed.  The asphalt parking lots at the HHCC and Behavioral Health building will be resurfaced.  A handicap ramp will be installed near the Community Health entrance of the HHCC.  The HOW clinic server room will be expanded.

 Establish SOP’s and Quality Assurance Plan for the newly constructed ambient air monitoring stations. This will allow us to collect legally defensible data.  The Ho-Chunk Village water system pump house valves will be upgraded this year with assistance from IHS.  A new well will be drilled at Indian Heights this year, with assistance from IHS, to address high levels of iron and manganese in the current well.  Continue to work toward Public Health Accreditation.  Continue to work on the Sustainable Energy Task Force to construct a renewable energy facility.

Report is respectfully submitted by Rob Voss, Director of Environmental Health

Rob Voss, Registered Sanitarian Environmental Health Director Environmental Health Staff

Pam Larson Kevin Gunderson Registered Sanitarian Environmental Specialist Scott McManners Randy Poelma Sanitary Facilities Coord. Aquatic Biologist

Matt Malimanek Candice Green Quality Air Specialist MV Injury Prevention Coord. Steve Schwanebeck Sanitarian

Maintenance Staff

Sheryl Nichols Maintenance Supervisor

Rick Johnston Tye Decorah Maintenance Worker Maintenance Worker Tamara Relyea Maintenance Worker

Rebecca Krause Tanjia Newman Maintenance Worker Todd Cloud Maintenance Worker (HOW) Maintenance Worker (HOW)

Behavioral Health Division Annual Report

Brief Description of Behavioral Health

The Division of Behavioral Health (DBH) offers alcohol/drug and mental health outpatient services to HCN tribal members and other federally recognized tribes in the following offices: Black River Falls, Tomah, La Crosse, Wittenberg, Nekoosa and Baraboo. DBH provides the standards required in the delivery of behavioral health services and brings a uniqueness that integrates Ho-Chunk cultural values and beliefs with current best practice models.

ACCOMPLISHMENTS

 Urban Rural Women’s Grant – DBH was fortunate to have had the opportunity to be awarded another year on the grant. This grant assists Ho-Chunk women and their families with wrap around services.  In November 2016 two participants from Black River Falls successfully accomplished their goals this past year and in turn graduated from the program.  There have been 28 women referred from the BH counseling staff to the Urban Rural Women’s Grant this year.  Behavioral Health staff has greatly improved their understanding and efficiency in learning Next Gen.  Behavioral Health currently has a very strong integrative team approach at the House of Wellness and Ho-Chunk Health Care Center. All medical, pharmacy, community health, and behavioral health staff meet on a monthly basis to discuss difficult cases to improve the welfare of the tribal member.  Behavioral Health assisted the American Legion Post on the New Year’s Eve Sobriety pow-wow this year.

 Behavioral Health sponsored several Color Fun Run/Walk in April prevention events this year including the April Awareness Color Fun Run/Walk at the House of Wellness in Baraboo.  Behavioral Health participated at different events such as the Diabetes Conference, employee health day, Domestic Abuse Conference, Family Wellness Conference, Domestic Abuse events, Financial Frenzy for youth and General Council.  Behavioral Health provides evidenced based practices approaches for counseling, such as: o True Thought (thinking errors/corrective thinking) o DBT- Dialectical Behavioral Therapy o CBT – Cognitive Behavioral Therapy o Motivational Enhancement Therapy o EMDR – Eye Movement Desensitization Reprocessing o Mindfulness and Moral Recognition Therapy o Medicine Wheel (12 steps)

o Mending Broken Hearts

o Mothers of Tradition o Fatherhood/Motherhood Is Sacred o New Directions o Fathers of Tradition o Red Road to Wellbriety o Seven Challenges o Healthy Relationships o Warrior Down.  BH staff has been trained in the Matrix Model and will begin implementing in August 2017. We currently have a psychiatrist that is contracted to provide medication management.  Ho-Chunk Nation Health Department – Pharmacy BH Staff at HOW Health Day Division provides medically assisted treatment (MAT) services utilizing naltrexone, an opiate antagonist/blocker, as the primary medication modality. The medically assisted treatment for alcohol and opioid dependence program is a patient-centered multidisciplinary integrated team model.  Kijire Nagu Healing Center has elected their Board of Directors. The board meets on a monthly basis.  Behavioral Health has assisted with completing the Tribal Action Plan (TAP). With the collaboration of several departments under the Nation the committee is known as Tribal Coordinating Committee. The TCC have developed the TAP to establish the operating framework and guidelines. Departments under the Nation that have been involved are Social Services, Education, Labor, Justice, Law Enforcement, Housing (tribal and HHCDA), Legislature, Health (Community Health), and Clan Mothers.  The following is the number of tribal members that BH Staff at HOW Health Day requested funding for inpatient treatment. 52 treatment funding requests for a total of $341,299.65 expended. District 1 District 2 District 3 District 4 District 5 Total # males 7 4 9 2 0 22 males # females 22 4 2 0 2 30 females  The following are the number of diagnosed clients with an addictive disorder, mental health diagnosis and dually diagnosed that were seen between July 1, 2015 and June 30, 2016. 07/01/2015 - 07/01/2016 - Behavioral Health 06/30/2016 06/30/2017 total unique patients seen 770 959

GOALS FOR 2017-2018

 Complete the policies and procedures for Intoxicated Driver Assessments at each of the six outpatient offices. This can be also a 3rd party billing revenue for Behavioral Health.

Report is respectfully submitted by Terry Greendeer, Director Terry Greendeer of Behavioral Health Director of Behavioral Health

Behavioral Health Division Staff

Evangeline Suquet Theresa Day Donald Greengrass Pamela Regan Libke Assistant Subst. Abuse Counselor Clinician II Manager

Sharon Thompson Curtis Tindahl Mary Ann Dick Valarie Carrimon Program Coordinator Clinician I Assistant

Intake Specialist

Christel Crocker Joseph WhiteEagle Nicole Blang Hera Lonetree-Rindahl Clinical Subst. Abuse Subst. Abuse Counselor Cognitive Behavior Facilitator Clinical Subst. Abuse Counselor Counselor Counselor

Kimberly Waukau Whitney Sanchez Jodie Tirado Ashley Jakel Intake Specialist Subst. Abuse Counselor Urban Rural Women’s Grant Clinician I Care Coordinator

Rachael Dozer John Pleugers Aleta YellowThunder Stephanie WhiteEagle Clinician I Clinician II Subst. Abuse Counselor Clinician I

Renee Rockman Leslie Warrington Tracy M. Martin Christine Preston Assistant Patient Registration Clinician II Clinician I

Nicole Skenandore Administrative Assistant

Contract Health Services Program Annual Report

The Contract Health Services (CHS) Program ensures that funds are used to supplement other health care resources; that CHS funds are utilized in situations where an accessible tribal health care facility are unable to provide the specialty or emergency care needed; appointments exceed existing providers; and, no IHS facility exists within a 60 mile radius of tribal members residence.

ACCOMPLISHMENTS:

 Managed Care Committee (MCC): From July 1, 2016 through June 30, 2017, the MCC reviewed 438 CHS referrals.  Audiology, Durable Medical Equipment, and Rehabilitation Services are considered when the CHS Administrator has determined that sufficient CHS funds are available and the MCC have concluded the services are medically necessary and essential to daily function.  Due to the collaboration efforts of the CHS staff and Benefits Specialists, 99.99% of the CHS clientele have health insurance.

Respectfully submitted by Lynette Bird, CHS Administrator

Lynette Bird, CHS Administrator

Cari Fay Sarah Decorah Christie Becker

Assistant Administer Patient Registration/Billing Patient Registration/Billing Manager Manager

Community Health Programs

Jess Thill Director of Community Health

Autumn White Shoshanna Trickle Community Health Office Community Health Office Manager (HHCC) Manager (Nekoosa)

Health and Wellness Program Annual Report

The mission of the Ho-Chunk Health and Wellness Division is to promote a healthy lifestyle among the Ho-Chunk people. The purpose of the team is to develop, implement and evaluate a comprehensive health promotion program targeted toward educating, energizing, and empowering communities.

HIGHLIGHTS AND ACTIVITIES:

 Diabetes Basics Classes: 7 classes to learn the basics of diabetes management. 227 participants have completed all seven classes with locations in Black River Falls, Wittenberg, Tomah, Baraboo, Nekoosa, Madison and Lacrosse. 86% of program participants showed improvement in A1C or stayed managed at 7% or less. Of all the program participants with pre and post knowledge tests, 95% showed improvement or maintained.  “Hiixgaxgakjawi- Let’s Move”  Pathways Classes: 84% of program participants met their physical activity goal. 20% of program participants met their 7% or more weight loss goal, this number is expected to increase as not all participants have had a full six months to complete their goals.  Diabetes Awareness Walk: November 2016, 132 Community members participated to raise diabetes awareness.  Annual Canoe Trip: June 2017 on the Kickapoo River. 77 Participants attended the three hour canoe trip, lunch and education.  Annual Journey of Hope Conference: In August 2016 227 people attended the Health and Wellness Team offered the Annual Journey of Hope Conference; in Madison, WI;  to raise awareness and provide diabetes education to those in attendance.  Diabetes Learning Circles/Breakfasts and Health Clinics: the Health and Wellness Division hosted 5 Diabetes Learning Circles/Breakfasts each month. Areas reached were Dells, BRF and Nekoosa. Education is provided at each session ranging from dental hygiene to organic gardening.  Exercise Classes provided include: Exercise Light, Hunter Fitness, Headstart Centers, Tribal Aging Units, Body Shapers, Youth Services, Youth Fitness Classes, Get Strong Classes, Boot Camp Classes, Yoga Classes, and additional classes offered offsite. Since April of 2015 we have offered over 1400 fitness classes!!!

 Continued Participation in the Minutes in Motion program: 36 members participated in the program which is put on by Gundersen Lutheran Hospital and co-sponsored by the Ho-Chunk Nation.  Collaboration with Jackson County: “Jackson in Action” committee. “Harvest of the Month” and the 3rd Annual “Pace and Pedal” with 234 participants.  Community Gardens: The Health and Wellness Division and the HCN HHCDA collaborated with the UW Extension to develop two Organic Community Gardens in Black River Falls. One is located at the TAU, the other is in Sandpillow.  The Snow Shoe Race: The first snowshoe race was well received and had 48 participants.  Fitness Membership Program: The Health and Wellness Division offers fitness memberships to tribal members and their families to increase activity levels.1108 Fitness Membership Holders since the program started in July 2013 with 318 active memberships  Community Garden Projects & Community Supported Agriculture Shares (CSA’s): Additional plants and trees were provided to the Nekoosa community gardens, two community gardens were planted again this year in Black River Falls and Tomah and 103 Tribal members and their families are participating in the Community Supported Agriculture Program, receiving fresh fruits and vegetables weekly or bi-weekly.

GOALS FOR FY 2017

 Continue hosting the annual Canoe trip and offering family events  Continue our Journey of Hope Conference  Complete CDC Recognized Program Accreditation  Work towards providing webinars and tele-conferencing for our Diabetes and Fitness Classes so we can reach more tribal members living nationally and internationally  Increase youth fitness initiatives  Increase the number of dental, vision and foot exams in program participants.  Increase the number of Pathway to Wellness program participants achieving a 7% weight loss goal to 30%  Combine the Fitness Membership Program with the Community Supported Agriculture Program  Work alongside Ho-Chunk Nation Youth Service Division to develop a standard curriculum and health/diabetes preventions schedule to Ho- Chunk Nation Youth.

Report was respectfully submitted by Sara Peterson, Health and Wellness Division Supervisor Sara Peterson Health and Wellness Program Coordinator

Health and Wellness Program Staff

Rachael Montana Lyndsey Killian Program Recruiter Certified Medical Assistant

Chris Frederick Kathleen Clemons Jessica Artz Exercise Physiologist Exercise Physiologist Exercise Physiologist

Nutrition Program Annual Report 2017

Program Description and Services: The Ho-Chunk Nation Nutrition Program is dedicated to serving HCN Tribal members, employees and their families by providing nutrition education at community events, diabetes classes, health fairs, and conferences and offering one-on-one Medical Nutrition Therapy (MNT) for a variety of medical conditions such as diabetes, heart disease, and obesity.

Nutrition booth at health fair Accomplishments:  Provided community outreach and nutrition education at Tomah, Black River Falls, and Dells Organic Community Gardens, Nutrition Cooking Classes & Demos, General Council, Diabetes Wellness Conference, Pallet Gardens, Pedal & Pace, HCN Health Fairs, Partners in Parenting, HOW & Nekoosa Youth Gardens, TAU Gardens, Harvest of the Month.  In an effort to combat obesity, prevent chronic disease and health related complications the division provided community outreach on a variety of nutrition education services such as: handouts, displays, booths, presentations, and cooking demos/classes ---serving 594 more contacts than were served the previous year.  Provided monthly nutrition education in all areas at WIC Clinics, Head Starts, Youth Services, Tribal Aging Units, Food Distribution Tailgates, TOB, HC- Gaming, Branch Offices, and Community Gardens.

Group WIC Head Youth Food Adults Elders Start Dist.

Direct Contacts 215 619 1167 537 1619 470 Indirect Contacts 396 558 599 235 1915 1122  Facilitated, and provided diabetes-related nutrition education at Diabetes BASICS classes, Pathways to Wellness classes, Munch & Motivate cooking classes, Breakfasts, Learning Circles, Wellness Clinics, Awareness Walk, and Wellness Conference; to also include preparation/selection of healthy recipes/meals/snacks.  Continued community outreach by coordinating with Health and Wellness Team, Youth Services, TAU, and HHCDA by expanding community gardens, offering cooking classes/demos/presentations on gardening/CSAs/Farmers Markets, providing cooking demos using commodity ingredients at Food Distribution, and submitting bi-monthly nutrition articles for publication in the Hocak Worak, Youth, Elder, and Branch Office newsletters.

Additional Services Provided:

HHCC/HOW/FIELD Direct Contacts Medical Nutrition Therapy/Counseling 1246 Women, Infant & Children Clinics 215 Referrals Received 565 Partnerships/Networking/Memberships:  WI Academy of Nutrition & Dietetics, WI Nutrition Educators, Viterbo University, WI Breastfeeding Coalition, HCN Breastfeeding Coalition, HHCDA, GLITC, Academy of Nutrition & Dietetics - National, and Jackson in Action. Future Goals and Development:  Medical Nutrition Therapy (MNT) has been proven to be effective at decreasing complications associated with chronic and obesity-related diseases, such as diabetes. As a result, from January 1 - December 31, 2017, the Nutrition Program will seek to maintain, and/or increase, MNT referrals to HCN Registered Dietitian Nutritionists (RDNs).  In 2017, keep Nutrition Program content on Department of Health webpage and calendar of events current and timely.  Monthly SNAP-Ed lessons will be provided to participants at HCN Head Start, WIC, Youth Services, Food Distribution, Elders, etc. with the intent to promote healthy dietary and lifestyle choices.

TAU Gardens

 WIC Well Child Check-Up Referral policy will continue to be implemented. Registered Dietitian Nutritionists (RDNs) will advise WIC participants when they are due/past due for a Well Child Check-Up.  Will maintain, or increase, Registered Dietitian Nutritionist (RDN) revenue as compared to 2016 revenue baseline.  The Program will support community gardening projects to improve access to, and encourage use of, locally grown produce.

Respectfully submitted by Jess Thill, Community Health Director

Nutrition Program Staff

Heather Jerzak Kathy Braaten Nutritionist (HHCC) Nutritionist (HHCC)

Jessica Jennings Kyla Ripp Nutritionist (HOW) Nutritionist (HOW)

Community Health Nursing (CHN) Program Annual Report

The Community Health Nursing (CHN) Program promotes and preserves the health of the Ho-Chunk population by combining skills and knowledge relevant to both nursing and public health. The practice is comprehensive and general; not limited to a particular age or disease related group. Nursing services are divided between care for the individual, care for the particular community, and care for the population. The goal is to provide health education and care for all Ho-Chunk and other Native Americans who reside within the contract service areas.

Cribs Distributed (32) All Locations: CHN Responsibilities HIV Prevention Program Patient Contacts (2,096) Condoms Distributed (17109) HIV Tests (137) Foot Care (490) MCH Visits (3155) WIC Visits (275) Caregiver Transports (5106) Caregiver Home visits (9552) Case Management (9207) Immunizations (615) Nurse Office visits (928) Telephone calls (26106) Patient Education Hours(1361.5) Nurse Home Visits (2313)

5000 10000 15000 20000 25000 30000

ALL LOCATIONS: Tribal Members by CHSDA Areas: CHNs over the last fiscal year have provided 45, 463 total patient contacts BRF 1450 Public Health Accreditation: Working to become accredited. HOW: 1306 Contract Services for In Home Care: Tomah: 566.5 Contracted Services have allowed for over 51,220 hours of after-hours services. Nekoosa: 440.5  33 contracts placed (85% are HCN Tribal Members) La Crosse: 315  33 elders served from contracts Wittenberg: 215.5  21 continue to be active CHSDA Total: 4293.5 Managed Care Organizations (MCO):  Contracts with Managed Care Organizations in CHSDA to receive reimbursement for services rendered. Reimbursement Revenue: $34,850.92.  Personal Care Agency Certification maintained. All CHN Reports Respectfully Submitted by: Jessica Stevens and Trisha Jacox, Community Health Nursing Supervisors

Jessica Stevens, RN Trisha Jacox, RN CHN Supervisor CHN Supervisor

Foot Care (53) BRF CHN/Caregiver Contacts & Services MCH Visits (48) WIC Visits (134) Caregiver Transports (1301) Caregiver Home visits (2779) Case Management (2314) Immunizations (199) Nurse Office visits (78) Telephone calls (10643) Patient Education Hours (101.5) Nurse Home Visits (344)

2000 4000 6000 8000 10000 12000

CHN over the last fiscal year has provided the following services: Tribal Members BRF Area: Jackson: 1299  344 Home visits and 13,684 total patient contacts Clark (half) 29.5 Eau Claire: 122  200 unduplicated elders received home care BRF Total: 1450.50 (34%) Caregiver over the last fiscal year has provided the following services:  1,301 transports for medical services  2,779 home visits (activities of daily living, cleaning, medication reminders, meal prep, etc.)  Trisha Jacox, RN, BSN, CHN Supervisor (Black River Falls, La Crosse, Wittenberg):  Member of: Health and Wellness Team, Tribal Coordinating Committee, Task Force for Drug Free Communities  Trainings and Certifications: Leadership.  Fawnah Bish RN, BSN, CHN:  Started January 2017

Training: Upcoming-Foot and Nail care  Serena RN, BSN, CPS, CHN:  Started February 2017  Training: Upcoming Certified Lactation Counselor  Certifications: Child Passenger Safety Technician

Serena Jahnke-Berg, RN Fawnah Bish, RN CH Nurse/HHCC CH Nurse/HHCC Gale White Certified Nursing Assistant

Megan McCormick Elisha Reetz Certified Nursing Assistant Certified Nursing Assistant

Rhonda Dunkerly Cindy Kirschenmann David Snowball Certified Nursing Assistant Certified Nursing Assistant Supportive Care Worker

Foot Care (133) HOW CHN/Caregiver Contacts & Services MCH visits (1027)

WIC (63) Caregiver Home visits (3,318) Caregiver Transportation (2217)

Case Management (5022) Immunizations (129)

Nurse Office visits (357)

Patient Education Hours (469) Telephone calls (7,096)

Nurse Home Visits (585)

1000 2000 3000 4000 5000 6000 7000 8000

CHN over the last fiscal year has provided the following services: Tribal Members HOW Area:  585 Home visits and 14,509 total patient contacts Dane: 303 Sauk: 700  313 unduplicated elders received home care Columbia: 147 Caregiver over the last fiscal year has provided the following services: Juneau (half) 133.5 Adams (half) 22.5  2,217 transports for medical services HOW Total: 1306 (30%)

 3,318 home visits (activities of daily living, cleaning, medication reminders, meal prep, etc.) Accomplishments:  Jessica RN, BSN, CLC, CHN Supervisor (HOW/Nekoosa/Tomah)  Member of: HCN Task Force for Drug Free Communities, Tribal Coordinating Committee, Wisconsin Statewide HIV Action Plan Group: advisory board to Wisconsin Department of Health  Co-Coordinator HCN HIV Prevention Program/Grant and SafeLink Needle Exchange  Certification: Certified Lactation Counselor, First Breath and My Baby and Me trained  Training: Safe, Healthy Strong Conference, Transgender Awareness & LGTBQ , Quarterly HIV Tribal Meetings  Kandi, RN, CHN:  Trainings: Wisconsin Public Health Nursing Conference, Geriatric Symposium, Supervisory Training  Preceptor for UW-Madison and Edgewood Nursing Students  Covered short staffing in BRF  Lisa, RN, BSN, CHN:  Training: Wound Care Associate, Supervisory Training  Preceptor for UW-Madison and Edgewood Nursing Students  Primary CHN in BRF for 6 months while short staffed  Allie, RN, BSN, CLC, CPS, CHN:  MCH Block grant co-coordination; HCN local coalition, HCN Breastfeeding Coalition  Training: WALC Breastfeeding Conference , PNCC Regional Meetings.

 Preceptor for UW-Madison and Edgewood Nursing Students  Certification: maintained Certified Lactation Counselor and Child Passenger Safety Seat Technician, First Breath and My Baby and Me trained, Safe Sleep Trainer  Partners In Parenting classes monthly at House of Wellness  Covered short staffing in BRF and HO

Lisa Hollet, RN Allie Issacson, RN Kandi Ryan, RN CH Nurse/HOW Maternal Child Health CH Nurse/HOW

Trevor LittleSoldier Pam Rusch Reva Decorah Supportive Care Worker Certified Nursing Certified Nursing Assistant Assistant

Sandra Delarosa Ashley Buege Samantha Defosse Sinda Kagigebi Certified Nursing Certified Nursing Certified Nursing Certified Nursing Assistant Assistant Assistant Assistant

Foot Care (121) MCH Visits (136) Tomah CHN/Caregiver Contacts & Services Caregiver Transports (375) Caregiver Home visits (785) Case Management (883) Immunizations (41) Nurse Office visits (68) Patient Education Hours (361) Telephone Calls (2736) Nurse Home Visits (335)

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CHN over the last fiscal year has provided the following services: Tribal Members Tomah Area:  335 Home visits and 6,385 total patient contacts Monroe: 433 Juneau (half) 133.5  157 unduplicated elders received home care Tomah Total: 566.5 (13%) Caregiver over the last fiscal year has provided the following services:  375 transports for medical services  785 home visits (activities of daily living, cleaning, medication reminders, meal prep, etc.) Accomplishments:  Lindsey, RN, BSN, CLC, CPS, CHN:  Member of HCN Breastfeeding Coalition, Monroe County Child Death Review (partial year), Monroe County Mental Health Workgroup  Certifications: Certificated Lactation Counselor, Child Passenger Safety Technician  Training: PHN Conference Supervisory Training  Preceptor: Viterbo University Nursing Students

Lindsey Schuab, RN Jennifer Plueger Fonda Zimmerman CH Nurse/Tomah Certified Nursing Certified Nursing Assistant Assistant

Foot Care (30) Nekoosa CHN/Caregiver Contacts & Services WIC (68) MCH (61) Caregiver Home visits (2225) Caregiver Transports (693) Case Management (242) Immunizations (143) Office visits (106) Patient Education Hours (148) Telephone calls (871) Nurse Home Visits (464)

0 500 1000 1500 2000 2500

Tribal Members Nekoosa Area: Marathon (half): 47.5 CHN over the last fiscal year has provided the following services: Clark (half): 29.5  464 Home visits and 2,278 total patient contacts Adams (half): 22.5 Wood: 341  238 unduplicated elders received home care Nekoosa Total: 440.5 (10%) Caregiver over the last fiscal year has provided the following services:  693 transports for medical services  2,225 home visits (activities of daily living, cleaning, medication reminders, meal prep, etc.) Accomplishments:  Pam, RN, CLC, CPS, CHN:  Co-Coordinator HCN HIV Prevention Program/Grant, CPR Instructor, CPS Technician  Training: Safe, Healthy Strong Conference, Quarterly HIV Tribal Coordinator, WALC Breastfeeding Conference, Supervisory Training.  Certification: Child Passenger Safety Seat Technician, maintained Certified Lactation Counselor, First Breath and My Baby and Me trained  Covered short staffing in Black River Falls.

Pam Reimer, RN Rachael Skaar Diane Kleinhenz Regina Reel CH Nurse/Nekoosa Certified Nursing Certified Nursing Certified Nursing Assistant Assistant Assistant

Foot Care (58) La Crosse CHN/Caregiver Contacts & Services MCH (1608)

Caregiver Transports (224)

Caregiver Home visits (325)

Case Management (184)

Immunizations (66)

Nurse Office Visits (173)

Education (126)

Telephone calls (2351)

Nurse Home Visits (208)

0 500 1000 1500 2000 2500

Tribal Members La Crosse Area: CHN over the last fiscal year has provided the following services: La Crosse: 291  208 Home visits and 4,733 total patient contacts Vernon 20  134 unduplicated elders received home care Crawford 4 Caregiver over the last fiscal year has provided the following services: La Crosse Total: 315 (7%)  224 transports for medical services  325 home visits (activities of daily living, cleaning, medication reminders, meal prep, etc.) Accomplishments:  Megan M, RN, BSN, CLC, CHN:  Training: Wound Care Associate, Supervisory Training.  Certifications: Certified Lactation Counselor  Preceptor: Viterbo University Nursing Students  Covered short staffing in BRF

Megan Marks, RN Alicia Crocker CHN/La Crosse Certified Nursing Assistant

Foot Care (95) Wittenberg CHN/Caregiver Contacts and Services MCH (274) Caregiver Transportation (296) Caregiver Home visits (120) Case Management (37) Immunizations (46) Nurse Office Visits (146) Telephone calls (2409) Patient Education Hours (156.5) Nurse Home Visits (377)

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CHN over the last fiscal year has provided the following services: Tribal Members Wittenberg Area:  377 Home visits and 3, 874 total patient contacts Marathon (half): 47.5  139 unduplicated elders received home care Shawano: 168 Caregiver over the last fiscal year has provided the following services: Wittenberg Total: 215.5 (5%)  296 transports for medical services  120 home visits (activities of daily living, cleaning, medication reminders, meal prep, etc.) Accomplishments:  Ronelle, RN, BSN,CLC, CHN:  Training: Supervisory Training, upcoming training: Child Passenger Safety Technician, QPR-Suicide Prevention  Certifications: Certified Lactation Counselor  Covered short staffing in BRF

Ronelle McKernan, RN Fran Littlewolf CH Nurse/Wittenberg Supportive Care Worker

Community Health Representative (CHR) Program Annual Report Brief Program Description: As part of the Department of Health’s mission to promote a high quality of life with holistic health care to those we serve with an emphasis on the traditional Ho- Chunk way of life and to empower each individual and family to make informed decisions regarding their present and future health the Community Health Representative Program (CHR) aims to create a workforce that improves health across Ho-Chunk communities we serve.

47 Home visits

907 Office visits 3066 Community Outreach 3615 1108 Health Education Case Management 1041 Referrals 1566 2195 Blood Pressures/Sugar checks 241 WIC

Car Seats

CHRs Betty Blackdeer and Linda Delay utilize puppets while providing health education on Poison Control at Sandpillow Head Start.

Employees learn about Eye Health through education board with Baraboo CHR, Renee Bradford.

1514 1600

1400

1200 1065 981

1000 Male 800 668 Female 544 600 489 390 400 280 203 215 200

1-5 yrs. 6-18 yrs. 19-35 yrs 36-59 yrs 60+ yrs.

After 32 years of service to the Department of Health, Ruth Puent, Community Health Representative Supervisor, retired on June 30, 2017.

President Cleveland, Perry Funmaker and Wittenberg Community gather the newly opened Wittenberg Community Building in honor of Siga Funmaker

Maxine Kolner and Ernestine Cecelia Rave Earl Blackdeer fills vigil bags Helgeson at the ticket table decorates vigil bags

Respectfully submitted by Jess Thill, Community Health Director

Community Health Representative Staff

Linda DeLay Betty Blackdeer Terri Bluebird Community Health Representative Community Health Representative Community Health Representative La Crosse Black River Falls Black River Falls

Linda Goodwin Renee Bradford Diane Cayer Community Health Representative Community Health Representative Community Health Representative Nekoosa Wisconsin Dells Tomah

Food Distribution Program Annual Report

Program Description: The Food Distribution Program of the Ho-Chunk Nation continues to provide USDA commodity foods to eligible participants meeting lowered income guidelines and are federally recognized Native Americans or elderly persons residing on, or near, Indian reservation lands.

The Food Distribution Program provides families with a food package and offers up to 75 food items in canned, dried, or fresh produce items consisting of fruit, vegetable, dairy, pasta, poultry, beef, cereal and flour.

Accomplishments:  The staff are trained and certified annually in CPR(Cardio Pulmonary Resuscitation), Forklift Operation, AIS(Automated Inventory System), Civil Rights, OSHA(Occupational Safety & Health Administration) Safety, HIPAA(Health Insurance Portability and Accountability Act), and are CDL(commercial driver’s license) qualified.  July 1, 2016 – June 30, 2017 – 5,383 certifications 3,546 households and 8,418 participants.  The Food Distribution Program issued 17,884/544,851 pounds totaling $476,227.52.  Tailgate services are offered in the communities of Wisconsin Dells, Wittenberg, Tomah, and Nekoosa.

Areas: Area I Area II Area III Area IV Area V Counties: Wood La Crosse, Adams, Marathon Clark, Portage Monroe, Juneau, Shawano Eau Total Trempealeau, Sauk, Claire, Served Vernon Columbia Jackson 3,546 Families 302 574 793 306 1571 Served

Future Goals:  The Food Distribution Program will continue to offer quality service to our communities and families in the 5 service areas.  Building equipment improvements in reception area and upgrade warehouse equipment.  Request for Urban waiver expansion to include cities in all Ho-Chunk service areas of Western and Central Wisconsin with the approval of USDA in conjunction with the Ho- Chunk Nation.

1800

1600

1400

1200 Region 1 1000 Region 2

Region 3 800

Region 4

600 Region 5

400

200

2016 2017

Region 1 Region 2 Region 3 Region 4 Region 5

2016 336 480 813 314 1604

2017 302 574 793 306 1577 Counties Wood La Crosse Adams Marathon Clark Portage Monroe Juneau Shawano Jackson Vernon Sauk Eau Claire

Trempealeau Columbia

Respectfully submitted by Andrew Rave, Supervisor - Food Distribution Program

Andrew Rave Supervisor

Food Distribution Staff

Larinna Chandler Susan Wilcox Warehouseperson Secretary

Robin Flick Gabriel Casey Warehouseman Warehouseman