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2018 Annual Report to the People

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Table of Contents

Greeting from the Executive Director 2

Medical Services 4

Quality Improvement 13

Pharmacy 16

Finance 21

Environmental Health Services 30

Behavioral Health 37

Community Health Representatives 47

Nutrition Program 51

Food Distribution 54

Health and Wellness Program 57

Community Health Nursing 66

Contact Information 78

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Ona Garvin

Executive Director of Health

Virginia Deford

Clinic Office Manager

Greetings from the Executive Director

Hinikaragiwii!

We continue to work on optimizing our services to Hocak people in

Medical Services and Community Health. To this end we have hired

Medical Providers, fully licensed and accredited Doctors and other health

professionals. These providers are four Family Practice physicians, two

Pediatricians, two Optometrists, 2 Dentists, Nurse Practitioners,

Physicians Assistants, Nurses and Health Educators.

Community Health provides services to the tribal population with

Community Health Nurses, Certified Nurses Assistants, Home Health

Aids, Nutritionists Exercise Physiologists and the United States

Department of Agriculture (USDA) (Commodity Foods Program) staff.

The Community Health Representative funding will be ended by Indian

Health Services as of October 1, 2018. The funds were reprogrammed

into M & I. The Community Health Representatives are transitioning into Certified Nursing Assistants

after training and receiving their certificates.

Behavioral Health services are now provided at the main Ho-Chunk Health Care Clinic with Community

Health now occupying the original Clinic offices on Airport Road. Mental Health Clinicians, Alcohol

and Other Drug Abuse Counselors are ready to assist anyone seeking help with drug and health

addictions. A Psychiatrist has been hired full time. We offer integrated Medical and Behavioral Health

Services.

Tribal Action Plan: This plan was requested by the Ho-Chunk Legislature. All

departments are involved in this plan to assist in combating the issues of alcohol

and drug abuse. The use of Opioids has increased to an epidemic level with

devastating results. Behavioral Health and Pharmacy have offered training in the

use of Narcan in the case of opioid overdose. We educate, train and counsel on

the results of opioid addictions in our communities. We also provide Medically

Assisted Treatment. Housing and Law Enforcement are working on goals and

objectives in the Tribal Action Plan.

Environmental Health is a much needed service that provides oversight and

solutions to any health hazards in our service delivery area and provides

necessities such as clean water, food service inspections, and working with all

Departments of the Ho-Chunk Nation coordinating needed environmental health services for tribal

members. The Utilities program was transferred to Health from the Housing Department.

Our 215 employees are ready to help you with all your health needs to:

Building a strong mind, body and spirit together.

Ona White Wing Garvin

Executive Director of Health

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Joan Greendeer-Lee Director of Medical Services

Medical Services Division Annual Report

Ho-Chunk Health Care Center (HHC) and House of Wellness (HOW) Medical Services Division provides medical, dental, optical, and podiatry care to our patients. Our

healthcare team of providers include: Pediatricians, 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 both care and service.

The following services are performed by the healthcare team:

Medical Clinic Services Provided: Optical Services Provided: Acute Care for Injury and Illness Routine Eye Exams

Immunizations Adjustments & Minor Eyeglass Repair

Diabetes Wellness Clinics Evaluation & Treatment of Minor Eye Infections

Prenatal Care Order Eyeglasses & Contact Lenses

Reproductive Health Dilated Diabetic Eye Exams

Adolescent Health/Well Child Care Contact Lens Fittings

Physical Exams for All Ages

Sports Physicals HHCC Dental Services Provided:

Smoking Cessation Routine Exams and Cleanings

Weight Management Scaling & Root Planning

CDL Examinations (HHCC only) Periodontal Maintenance

Laboratory Services Periodontal Surgery

Radiology Services Oral Cancer Screening

Podiatry Services Laser Periodontal Therapy

Mammography Services (HHCC only) Dental Fillings and Sealants

Fluoride Treatments

Teeth Whitening

HOW Dental Services Provided: Routine Exams and Cleanings

Oral Cancer Screening

Fluoride Treatments

Nutrition Counseling for Oral Health

Scaling & Root Planning

Periodontal Maintenance

Periodontal Surgery

Laser Periodontal Therapy

Dental Fillings and Sealants

Crowns & Bridges

Dentures & Partials

Oral Surgery

Root Canal Therapy

Mouth and Night Guard (In clinic Fabrication)

Oral Health Education/Instruction

Outreach at General Council, HeadStart Schools, Journal of Hope, TAU,

Partners In Parenting, Diabetes Breakfast, Halloween for HOW Youth

School-Based Restorative Clinic-Wisconsin DHS Grant

Teeth Whitening – limited basis

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2011 2012 2013 2014 2015 2016 2017 2018

639 603 633 740 841 871 710 1,041

1630 1594 1885 2039 2060 1861 2027 1904

8139 7904 8129 7488

6175

7428

6402

7754

Patient Visits Ho-Chunk Health Care Center

Optical Dental Medical

2011 2012 2013 2014 2015 2016 2017 2018

700 849 920 1097 1068 1001 893 1031 790

2114 1912 1909 1991 1837 1922 1998

4437

5521 5410 5237 4725 4933 4785

5034

Patient Visits House of Wellness

Optical Dental Medical

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Rebecca Shawley

HHCC Clinic Office Manager

Patty Houghton

HOW Clinic Office Manager

Ho-Chunk Health Care Center and the House of Wellness Clinics

Accomplishments in FY 2018:

Continue to provide cultural awareness training for new and current

employees, clinical students, medical residents, and local clinical

practices.

Replaced original, major medical, optical and dental equipment.

Assessed the state of transition health for our youth to adult care and

services. A policy and brochure were developed to coordinate more

transparent process for individuals and their families.

Initiate prevention incentive to encourage more adults to get screened

for colorectal, cervical, breast and lung cancers at their well visits.

HHCC medical clinic fully staffed! Two Family Physicians, part-time

Pediatrician, and nursing staff.

o New services: vasectomy and in-clinic ultrasounds, delivery of

babies at Black River Falls Memorial Hospital

Optometrist hired at HHCC

Triage system streamlined and working at both medical clinics

Problems and Corrective Actions Taken in FY 2017: With four new providers at the HHCC, marketing is being done to

advertise them and their services. Added laboratory and nursing staff to

support the increase in patient volume. New providers participated in

outreach efforts, such as health fairs and attending General Council and

Area Meetings.

Mammography services continue at HHCC every other month. A

reassessment of the schedule and wait list will determine if there needs

to be a schedule adjustment.

Future Goals and Strategies: Continue to evaluate methods to decrease no-show rates for all services.

Improve the quality monitors led by providers to continue to provide

high quality patient care.

Evaluate the possible expansion of services to include chiropractic services.

Expand Outreach services by clinic Staff at various health fairs, conferences, cultural events and

local school districts.

Streamline the referral process to specialists.

Alternative Funding Sources and Partnerships:

Partnership has strengthened with the Black River Memorial Hospital.

Partnership has solidified with Gundersen Health Systems and expanded with Mayo Health

Systems to include invitations to grand rounds and offer of specialty services and educational

sessions.

Alternative funding included small grants offered by the State of Wisconsin Health Services.

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

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Carolyn Wakeman, MD

HHCC-Family Medicine

Neil Cox, MD

HHCC-Family Medicine

Kevin Gilmartin, MD

HHCC-Pediatrics

Chandra Reddy, MD

HOW-Internal Medicine

Karen Ailsworth, MD

HOW-Pediatrics

Medical Staff

Amy Delong, MD, MPH

Medical Director

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Kiana Beaudin,

HOW-Physician Assistant

Bethany Schilling

HHCC-Family Nurse Practitioner

Fawnah Bish, BSN

HHCC-Clinic Nursing Supervisor

Cari Ritter

HOW-Physician

Assistant/Health Educator

Brittany Niemeyer, BSN

HOW-Clinic Nursing Supervisor

Chris Seguin,

HHCC-Family Nurse Practitioner

Sue Christoperson,

HHCC-Family Nurse Practitioner

Thomasa Chavez

HOW-Registered Nurse

Tracy McReath, BSN

HOW-Registered Nurse

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Carrie Whipp

HOW-Certified Medical

Assistant

Alissa Ginkowski, RN

HHCC-Registered Nurse

Angela Gardner, RN

HHCC-Registered Nurse

Ashley Engebretson, RN

HHCC-Registered Nurse

Jennifer Koebler, RN

HHCC-Registered Nurse

Holly Rodenberg, RN

HHCC-Registered Nurse

Nurse Educator

Melissa Hubing

HHCC-Certified Medical

Assistant

Amy Conant

HHCC-Certified Medical

Assistant

Elizabeth Anderson

HOW-Certified Medical Assistant

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Annie Bender

HOW-Registered Technologist of

Radiography

Charmain Brandt, ASCP

Laboratory Supervisor

Joe Sanders, ASCP

HHCC-Medical Laboratory

Technician

Peggy Woychik

HHCC-Registered Technologist

of Radiography

Tristan Zurfluh

HHCC-Medical Laboratory

Technician

Lab and Radiology Staff

Carol Koch, ASCP

HOW-Medical Laboratory

Technician

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Optical Staff

Lori Haun, O.D.

HOW-Optometrist Rachel Lundberg, O.D.

HHCC-Optometrist

Stephanie Heller

HHCC-Optometry Technician

Nicole Cotto

HOW-Optometry Technician

Patient Registration

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Dental Staff

Alison Cleveland

HHCC-Dental Assistant

Amy Clark

HOW-Dental Assistant II

Charles Lau, DDS

HOW-Dentist Feras Alkhader, DDS

HHCC-Dentist

Jennifer Luce

HOW-Dental Hygienist Misty Newkirk

HOW-Dental Assistant II

Sally Zager

HHCC-Dental Hygienist Loula Krause

HHCC-Dental Assistant

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Quality Improvement Division Annual Report

The Quality Improvement Division has continually striven to achieve 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 continiously 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.

Both the Ho-Chunk Healthcare Center in Black River Falls and the House of Wellness in

Baraboo, have achieved a full three-year accreditation by the Accreditation Association for Ambulatory

Healthcare, Inc. (AAAHC). This will be up for renewal in February 2019. Accreditation by AAAHC

reflects a very high standard of care and an ongoing commitment to improve the delivery of our standards

of care to the patients we serve. The Quality Improvement Division works to maintain accreditation

standards in our ambulatory facilities.

The Quality Improvement Division has also been assisting other Health Department Divisions in

achieving public health accreditation through the Public Health Accreditation Board (PHAB). The

purpose of this accreditation is to improve the quality of practice and performance; develop leadership

and strengthen relationships essential to public health services as a framework. The Department of Health

has made tremendous progress toward public health accreditation this year by maintaining and updating a

Quality Improvement and Performance Management Plan encompassing both clinical and public health

quality measures. A Workforce Development Plan increases human capital in our public health workforce

and further developing our Strategic Plan to meet our public health accreditation goals. The Department

of Health is well on its way to achieving Public Health Accreditation in 2019.

Accomplishments in 2018:

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 Infection Prevention/Employee Health RN.

Completed annual comprehensive Infection Control Risk Assessment and Plan.

Tracked and reported all infectious and communicable diseases within the Health Department.

Provided a central point for open communication between tribal, local and WI State Health

Departments.

Developed a robust infection control surveillance and monitoring program.

Coordinated standardized infection control policies and practices across the whole Health

Department.

Collected and reviewed vaccination records for all Health Department employees to ensure health

of employees and patients.

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Assisted with AAAHC/PHAB accreditation efforts.

Represented Ho-Chunk Nation Health Department at Local, Regional and National Infection

Control Conferences.

Worked with multiple Health Dept. divisions to create a new hire orientation packet; final

approval of its implementation was granted, but new improvements will be forthcoming.

Verified licensing credentials and background checks for Health Department staff as needed.

Monitored Patient complaints to ensure that concerns are addressed.

Convened monthly Quality Improvement meetings.

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.

QI Director and a QI Officer attended Achieving Accreditation training through AAAHC.

QI staff attended and made contacts at a WI Collaborative for HealthCare Quality event.

Goals in 2019:

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 Accreditation

Board.

Continue annual employee satisfaction survey and distribute results with staff and work to

address concerns.

Continue active participation in the Safety, Infection Control and Policies and Procedures

Committees.

Continue to verify licensing credentials and background checks as necessary.

Obtain password protection on all Health Department cell phones and laptop computers.

Staff will attend NAHQ (National Association for Healthcare Quality) Next – the leading

conference for the healthcare quality professional in Minneapolis.

Disseminate a workforce development plan meeting Public Health Accreditation Board standards.

Obtain full PHAB accreditation.

Achieve another three year accreditation term from AAAHC.

Obtain and implement comprehensive electronic compliance and training system to include

HIPAA and Blood Borne Pathogens.

Obtain certification in Infection Control (CIC) – Infection Prevention/Employee Health RN.

Create and disseminate public notifications and education related to infection control.

Continue implementing Infection Control plan to reduce risk.

Report Respectfully Submitted by: Daniel Libke, MTAG, Director of Quality Improvement

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Quality Improvement Division Staff

Daniel Libke

Director of Quality Improvement

Jennifer Baird, RN

Infection Prevention/Employee

Health Nurse

Ritchie Brown

QI Compliance Officer

Andrea Mattison

QI Compliance Officer

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Pharmacy Department 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 through enhanced clinical pharmacy services to all of the

patients served, and provides the highest level of health care.

Pharmacy Services:

All pharmacists possess a Doctor of Pharmacy (Pharm.D.) degree and are trained to offer

highly clinical pharmacy services.

All technicians possess a Certified Pharmacy Technician certificate, some having an

associates or bachelor’s degree, and assist the pharmacists with clinical pharmacy

services.

One Board Certified Psychiatric Pharmacist (BCPP) Prescriber and another pharmacist

preparing for BCPP to provide specialized psychiatric pharmacy coordination of care and

psychotropic medication therapy management.

One Certified Diabetic Educator (CDE) pharmacist to provide specialized diabetes

management beyond medications.

Pharmacists collaborate with other health department clinicians in a highly integrated

system to assist each patient with medical and behavioral health concerns and to improve

medication management.

Free prescription mail out services for patients across the country.

Non-Tribal member Prescription Co-Payment Incentive: Zero (0) co-pay for all generic

medications, $10 co-payment for 30 day and $20 for 90 supply of brand medications.

Future Goals and Development:

Priority goal is to implement formal customer service training and monitor each

pharmacy staff member’s performance on a monthly basis

Incorporate Ho-Chunk Nation traditions and culture into the pharmacy program through

language, customs, and art.

Continue to develop and implement marketing initiatives to increase pharmacy utilization

and revenue generation for the Ho-Chunk Nation.

Increase pharmacy contracting with Medicare Part D, Private, and Affordable Care Act

pharmacy insurance plans to increase revenue.

Create an advanced practice pharmacist position that serves as a non-physician medical

provider in order to improve pharmacist managed chronic condition therapy.

Implement a formal tobacco cessation clinic in collaboration with the medical clinic

Health Educators in order to improve the overall health of the community.

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Implement a formal Medication Therapy Management (MTM) clinical service to ensure

safe, effective, and appropriate medication therapy for individuals with chronic health

conditions.

Annual Accomplishments:

Successfully achieved last year’s goal of implementing a mandatory chronic

medication/mail order program for HCN employees with the projected increase revenue

return to the Ho-Chunk Nation of an additional $4 million annually.

Continue to develop clinical pharmacy services including psychiatric pharmacy, diabetes

management, and medication therapy management. Additionally, an antibiotic

stewardship program through specialized pharmacist training and credentialing and

Indian Health Service Improving Patient Care Model.

Hired 1 additional pharmacist in order to successfully implement the mandatory

maintenance medication program and improve clinical pharmacy services provided to the

community.

Health Care Center Pharmacy preceptors mentored 3 University of Wisconsin Advanced

Pharmacy Practice Experience (APPE) students and 1 US Public Health Service Junior

COSTEP intern. House of Wellness Pharmacy preceptors mentored 4 University of

Wisconsin APPE students.

Increased utilization of the Tribal Pharmacies by non-Tribal employees and Tribal

members (see prescription volume chart)

Clinical Pharmacists increased participation on the medical team to provide the highest

level of patient care to Tribal Members and employees by participating in clinic visits

with the providers and staffing case management meetings.

Clinical Pharmacist staff involvement in Integrated Case Management monthly meetings

by assisting with patient-centered care plans and improving the quality of health care

provided to our consumers.

Implemented a medication safety program that tracks pharmacy errors in a database

which allows for identification of areas for improvement of processes and opportunities

for further training needs.

Health Care Center Pharmacy installed an additional pharmacy robotics ScriptPro

machine to improve safety, accuracy, and capacity for increased prescription volume.

Report Respectfully Submitted by: CAPT Ted Hall, PharmD, BCPP,RPh, Director of Pharmacy

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Total Prescriptions Dispensed and Revenue Generation:

Total Prescriptions Dispensed:

F.Y. 2009- 34,836 F.Y. 2014- 65,882

F.Y. 2010- 36,391 F.Y. 2015- 66,367

F.Y. 2011- 55,738 F.Y. 2016- 66,833

F.Y.2012- 59,513 F.Y. 2017- 76,048

F.Y. 2013- 61,693 F.Y. 2018- 81,569

Total Revenue Generated:

F.Y. 2009- $2.34 Million F.Y. 2014- $5.03 Million

F.Y. 2010- $2.10 Million F.Y. 2015- $5.79 Million

F.Y. 2011- $3.34 Million F.Y. 2016- $6.18 Million

F.Y. 2012- $4.61 Million F.Y. 2017- $6.70 Million

F.Y. 2013- $3.64 Million F.Y. 2018- $7.69 Million

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Total Number of Prescriptions Dispensed

Total Number ofPrescriptions

0

2

4

6

8

10

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Total Revenue Generation

$ Million

Linear ($ Million )

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CAPT Ted Hall, PharmD, BCPP, RPh

Director of Pharmacy

Dr. Amber Hanna

HOW-Pharmacy Manager

Dr. Hussain Harun

HOW-Pharmacist

Dr. Abigail Moore

HOW-Pharmacist

LCDR James Gabriel Buel

HHCC-Pharmacy Manager

Cynthia Dotson

HHCC-Pharmacist

Dr. Hussien Cheikhali

HHCC-Pharmacist

Pharmacy Department Staff

Dr. Melanie Hanson

HHHCC-Pharmacist

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Laurie Dionne

HOW-Certified Pharmacy

Technician

Laurie Ammerman

HOW-Certified Pharmacy

Technician

Heather Marks

HOW-Certified Pharmacy

Technician II

Neile Decorah

HHCC-Certified Pharmacy

Technician

Sara Gebhardt

HHCC-Certified Pharmacy

Technician

Stacy Rios

HHCC-Certified Pharmacy

Technician

David Snowball

HHCC-Certified Pharmacy

Technician

Holly Dale

HHCC-Certified Pharmacy

Technician II

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65% 8%

27%

Ho-Chunk Nation Department of Health Uses of Funds as a percentage - Fiscal Year Ending 06/30/18

Clinics

Behavorial Health

Community Outreach

45%

12%

43%

Ho-Chunk Nation Department of Health Sources of Funds as a percentage - Fiscal Year Ending 06/30/18

Service Revenue

NPD Distribution

IHS

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,

Utilities business office, Cashier and Collections, Health Information Systems, Benefits,

Purchased/Preferred Health, At-Large Health and Grants.

Cost Report Progress:

The Department of Health has completed and filed Medicare and Medicaid cost reports thru 2017.

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.

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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), is 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 the

links below or call the numbers listed. A Benefits Specialist can assist you Monday through Friday

8:00a.m. -4:30p.m. Central Time.

Affordable Care Act Marketplace Enrollment is located at this web address - https://www.healthcare.gov/

Medicare https://www.mymedicare.gov/

Medicaid https://www.medicaid.gov/

This Report is Respectfully Submitted by: Wally Apland III, MHA, Chief Financial Officer-Health

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Wally Apland, II

Chief Financial Officer-

Health

Casey Osborn

Accountant Kim Nelson

Junior Accountant Penny Ybarra

Junior Accountant

Jesse Mann

Junior Accountant

Cherisse Cherwenka

Junior Accountant

Cyndi Storandt

Junior Accountant-Utilities

Finance Staff

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Emmalee Decorah

Junior Accountant

Liz Lund

Network Manager and

Contract Specialist

Janna Mallory

HOW-Cashier

Penny Zoephel

HHCC-Biller/Medical

Coder

Cassie Schober

HHCC-Biller/Medical

Coder

Deb Vanthournout

HOW-Biller/Medical

Coder

Louise Voss

Grant Writer

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Joyce Rockman

Benefits Specialist

Supervisor

Sandra Lanier

HHCC-Benefits Specialist

Cynthia Tack

HOW-Benefits Specialist

Lynette Bird

Contract Health Services

Administrator

Cari Fay

Contract Health Services

Assistant Administrator

Benefits Staff

Purchased/Preferred Care Staff

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Sarah Decorah

Contract Health Services

Patient Registration/Billing

Manager

Christie Becker

Contract Health Services

Patient Registration/Billing

Manager

Natalie Bird

At-Large Health

Coordinator

Barb Fankhauser

HHCC-Medical

Records/Patient Registration

Supervisor

Rebecca Davis

HOW-Medical

Records/Patient Registration

Supervisor

Patient Registration and Medical Records Staff

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Sue Bjerke

HHCC-Medical Records

Tiffany Youngthunder

HHCC-Patient Registration

Donica Byrns

HHCC-Patient Registration

Ariana Youngthunder

HHCC-Patient Registration

Andrea Cole

HHCC-Patient Registration

Glen Decora

HOW-Medical Records Cheyenne Lonetree

HOW-Patient Registration Michelle Cloud

HOW-Patient Registration

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Heather Roberts

Database Administrator

Tom Myher

Administrator

Tyler Doyle

Engineer

Jeanne Cowell

Administrator

Katie Kissane-TwoBears

Clinical Applications Coordinator

Health Information Systems (HIS) Staff

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Matt Mallory

HHCC-Technician

Josie Cleveland

HHCC-Technician

Casie Lamorie

Programmer

Mike Puffer

HHCC-Technician

Kimberly Hutchens

Trainor/Purchasing

Evan Thompson

HOW-Technician

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Ambient Air Monitory Station near

Blue Wing

Environmental Health Staff help

Head Start children during TOB Earth

Day Event

Environmental Health Services Division Annual Report

The Ho-Chunk Nation Environmental Health Services (EH) Division is a comprehensive program which

works to identify environmental hazards which affect the health of tribal members and the general public

served by Ho-Chunk Nation Enterprises. Programs and initiatives are directed toward assessing

environmental conditions, remediating existing hazards and preventing

environmental problems.

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 2017-2018

The server rooms in each clinic, the Ho-Chunk Health Care Center (HHCC) in Black River Falls

and the House of Wellness (HOW) in Baraboo, were upgraded in 2018. These upgrades allowed

for upgraded fire protection systems, faster internet speeds and more secured data servers.

A handicap ramp was installed near the Behavioral Health entrance of the HHCC.

Funding has been secured through Indian Health Service for the replacement of the Ho-Chunk

Health Care Center roof. This project is estimated to be just over $300,000.

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. Other departments rely

on these surveys to meet the requirements of their funding agencies or the gaming compacts. In

addition, during the last year twenty-two (22) 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 EH has spearheaded the implementation

and coordination for addressing abandoned homes and

“Drug/Party” homes in Ho-Chunk Communities. This was a joint

effort between Environmental Health, the HCN Police

Department, the HCN Department of Justice, the HCN Realty

Division and concerned tribal members. Seven (7) homes were

assessed under the Human Health Hazard Ordinance and six (6)

were deemed an immediate human health hazard and were secured

and placarded.

$250,000 was secured from IHS to fund an additional 40 homes

for well and septic services.

During the last year EH installed eight (8) new wells and four (4)

new septic systems for tribal members who could not be

connected to community systems.

During the last year eighty-five (85) water samples were drawn from tribal residences to assess

water quality.

During the last year EH assisted sixty (60) tribal members with emergency water or sewer issues.

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Environmental Health Staff perform

Community Outreach with Baraboo

Schools at former Badger

Ammunition site.

Environmental Health Staff put

finishing touches on settling issues

around a septic tank

During the last year EH conducted over one hundred (100)

one on one educational sessions regarding the care and

feeding of well and septic systems.

The engineering and design work of the water and sewer

services for the Little Blackhawk subdivision are 100%

complete. The Little Blackhawk Subdivision is located south

of East Sand Pillow and this project will install community

water and sewer services for the twenty-seven (27) lots.

Grubbing for roads and utilities has been completed and

installation of the water lines, sewer lines and lift station will

begin in the fall/winter of 2018. This project is 100% NPD

funded.

Compliance Assistance Inspections and training was

completed for each of the Nation’s Whitetail Crossings for

the underground storage tank systems.

The Environmental Health Division’s Air Quality Program operated and maintained two (2) Air

Quality Monitoring Stations. The stations test outdoor air for dust particle pollution and also takes

weather measurements. The 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

$17,000, following talks between Environmental Health Air Quality Staff and EPA officials. The

Air Quality Program successfully completed and closed-out the three-year CAA 103 Grant

Project that begun in 2015. During the last year accomplishments were made towards achieving Public Health Accreditation.

This includes the securing of two (2) grants to support an update of the Community Health

Assessment and an update of the Health Department Strategic Plan. Documents have been

uploaded into the accreditation website which will meet national standards and measures.

EH secured staff support for Public Health Accreditation through the Centers for Disease Control

PHAP program. The program places a young professional with

the Tribe for two (2) years to assist them in public health efforts.

The program if fully funded through the Centers for Disease

Control.

Water Quality monitoring was completed on twenty-two (22)

tribal streams in 2017. Monitoring included chemical sampling,

fish surveys, macroinvertebrate sampling and habitat

assessments.

A Two Year Comprehensive Water Quality Assessment Report

was drafted for the 20 tribal streams monitored during the period

January 1, 2016-December 31, 2017.

Wetlands were delineated, classified and mapped on nine (9) trust

parcels totaling one hundred seventy-two (172) acres in Marathon

and Shawano counties. This information was incorporated into

the Geographic Information System (GIS) to assist other

departments with project planning.

Invasive plant treatments were completed on six hundred fifty-nine (659) acres of tribal land in

Shawano County using EPA Great Lakes Initiative grant funding.

Invasive plant treatments were completed on approximately sixty (60) acres of tribal land in

Jackson County during 2017 using BIA Circle of Flight grant funding.

32

Updated vinyl on the Motor Vehicle Injury

Prevention Trailer

Invasive plant treatments were completed on approximately seven hundred eighty (780) acres of

tribal land at the Sacred Earth parcel in Sauk County during 2017 using BIA Invasive Wildlife

Program grant funding.

The Environmental Science Program Manager provided hands-on environmental education

programs and/or presentations to approximately 150 tribal and non-tribal youth and adults on

multiple occasions including the annual Earth Day Event, U.W. Madison Capstone student field

trip, Ho-Chunk Summer Enrichment Program field days, NCCC AmeriCorps field trip and

WTCAC Forestry Subcommittee meeting.

Environmental reviews were completed for (5) BIA Road Program improvement projects, (11)

Indian Health Service residential projects and (2) forestry related projects. Technical support was

also provided to multiple tribal departments during the

year.

$106,667 in funding was acquired by DEH under a USDA

Natural Resources Conservation Service Environmental

Quality Incentives Program contract to install pollinator

habitat at the Sacred Earth parcel in Sauk County, WI.

$46,419 in funding was acquired by DEH under a USDA

Natural Resources Conservation Service Environmental

Quality Incentives Program contract to restore native

prairie and manage invasive species at the Sacred Earth

parcel in Sauk County, WI.

DEH worked with agency partners including The Nature

Conservancy, WDNR, Habitat for Humanity and USDA-

NRCS to develop an application and work-plan for a

NCCC AmeriCorps crew. The application was funded and

the crew will be providing approximately 560 work hours at the Sacred Earth parcel in July and

August 2018.

The Motor Vehicle Injury Prevention program finalized two (2) billboard designs that address

distracted driving. They are located on HWY 54 near Black River Falls and on County Road BD

near Baraboo.

The Motor Vehicle Injury Prevention Program trailer was updated with new vinyl to promote the

program and educate the community on distracted driving and seat belt use.

The Motor Vehicle Injury Prevention Project Coordinator held twelve (12) educational activities

to increase awareness of the consequences of distracted driving for the year. The Motor Vehicle

Injury Prevention Project Coordinator conducted six (6) child passenger safety seat observation

surveys. The observed child safety seat use rate was 81.6%.

During the year the Motor Vehicle Injury Prevention Program distributed one hundred seventy-

five (175) car seats.

During the year the Motor Vehicle Injury Prevention Program distributed sixty (60) bike helmets

to tribal children.

The Tribal Sanitarian has successfully obtained his Registered Sanitarian license.

The Environmental Health Department currently manages $5,614,646 which is broken down as

follows:

o $1,798,285 in IHS and other grant funding

o $1,387,900 in capital project funding for the Little Blackhawk water and sewer project

o 1,016,475 to manage the seven wastewater treatment plants

o $700,072 for Clean Water Fund Loan repayment

o $325,561 in NPD Operational Funding for Environmental Health

o $386,353 in NPD funding to provide housekeeping and maintenance services for the two

(2) Clinics

33

What’s in the Future?

The Environmental Health Services Division (EH) will be working on the following initiatives in the

next year:

EH will oversee the Utilities Program starting in July of 2018.

The Little Blackhawk Subdivision water and sewer project will be completed in the fall of

2018.

Six (6) duplexes will be connected to wells and septic systems on the Allen Property this

year.

The asphalt parking lots at the HHCC and Behavioral Health building will be resurfaced in

the summer of 2018.

The HHCC sterilization room will be remodeled during the summer of 2018.

The HOW optical will be expanded to add an additional exam room over the next year.

The HHCC nurses station will be expanded/remodeled over the next year.

The HHCC roof will be replaced over the next year.

The Ho-Chunk Village water system pump house valves will be upgraded fall of 2018 with

assistance from IHS.

A new well will be drilled at Indian Heights fall of 2018, with assistance from IHS, to address

high levels of iron and manganese in the current well.

Continue to work toward Public Health Accreditation.

Upgrade to an electronic software survey process for facility inspections and observational

surveys.

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 Air Quality Program will be seeking “Treatment as a State” status under the Clean Air

Act.

DEH will be applying for EPA Brownfields Program funding in 2018 to establish a program

that will identify, inventory and address brownfields on land currently owned by the Nation

or lands to be acquired.

Seek additional funding through BIA, USDA-NRCS and other agencies to sustain invasive

species management and habitat restoration activities at the Sacred Earth parcel.

Assist agency partners with development of an application and work plan to fund a 2019

NCCC Americorps crew to work on tribal habitat restoration projects.

Report Respectfully Submitted By: Rob Voss, RS, Environmental Health Director

34

Rob Voss, RS

Environmental Health Director

Pam Thunder, RS

Environmental Health Program

Manager

Randy Poelma

Environmental Science Program

Manager

Matt Malimanek

Air Quality Specialist

Kevin Gunderson

Environmental Specialist

Steve Schwanebeck, RS

Tribal Sanitarian

Scott McManners

Sanitary Facilities Coordinator

Environmental Health Services Staff

35

Steve Christopherson

Utilities Coordinator

Renee Brocker

CDC Public Health Associate

Aaron Strandberg

Water Operator

David Forsting

Water Operator

Brock Burnstad

Water Operator

36

Sheryl Nichols

Health Facilities Manager

Tye Decorah

HHCC-Maintenance Worker II

Rick Johnston

HHCC-Maintenance Worker II

Tamara Relyea

HHCC-Maintenance Worker II

Todd Cloud

HOW-Maintenance Worker II

Tanjia Blackdeer

HOW-Maintenance Worker II

Maintenance Staff

37

Behavioral Health Employees

Prepare food for community event

Behavioral Health 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, Madison and Baraboo. All DBH offices are dual licensed to

meet the requirements for DHS 75 – “Community Substance Abuse Services” and DHS 35 – “Outpatient

Mental Health”. The DBH were recently licensed to provide Tele-Health Services for comprehensive

psychiatric care. DBH provides the standards required in the delivery of behavioral health as well as tele-

health services and brings a uniqueness that integrates Ho-Chunk cultural values and beliefs with current

best practice models.

I. ACCOMPLISHMENTS

Urban Rural Women’s Grant – Ho-Chunk Nation funding continued for another year with

notification that the following years funding would be competitive. This grant assisted Ho-Chunk

families with wrap around services which included case

coordination to provide plans & objectives for participants

with Vocational Rehabilitation for Native Americans

Program out of Great Lakes Inter-tribal Council; First

Nations Community Financial, as well as Social Services

Life Skills Program to provide training for women in

everyday practical and financial skills, skills at hygiene for

the families and better housekeeping skills. There were 47

active clients during this fiscal year; of which 5 were

discharged in this duration, and 21 were new referrals during

that timeframe. Behavioral Health awarded the State

Targeted Response to the Opioid Crisis (STR) Grant in July

2017 for an award in the amount of $82,904.00. Serving 73

community members.

Behavioral Health awarded Methamphetamine and Suicide

Prevention Initiative Grant in the amount of $125,000. This

initiative will focus on prevention in the child and youth

population.

Behavioral Health awarded Indian Health Service Behavioral Health Integration Grant Initiative in

the amount of $500,000 for 3 years allowing the department to hire two additional Behavioral

Health Clinician as well as two Care Managers who will be licensed as an LCSW imbedded at the

nurses station to enhance the Behavioral Health Integration that is already in place within the

clinic.

Behavioral Health Reorganization announced February 5, 2018 by Executive Director of Health,

Ona Garvin the Behavioral Health Program will be undergoing an organizational restructure. The

following are the changes that are effective on February 5th, 2018. These assignments are

Temporary as we restructure and work on the Urban Rural Women’s and

Methamphetamine/Suicide Prevention and the extreme urgency to provide more immediate care

for those who are involved in behavioral health issues.

38

Behavioral Health at April Awareness

Event

Behavioral Health at April

Awareness Event

Tele-Health Licensing & Madison Branch Office Licensing obtained after collaborating with

Wisconsin Department of Quality Assurance site surveyor, Roderick Senn. Standards for both

were met and license was approved April1, 2018.

Behavioral Health’s electronic health record NextGen continues to be streamlined with training

guides developed for staff to create an environment of uniformity and consistency to assure the

department is remaining in compliance with both State and Federal guidelines.

We currently have a very strong integrative team approach at

the House of Wellness and at 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.

We assisted the American Legion Post on the New Year’s

Eve Sobriety pow-wow this year. It was a great turnout and

Behavioral Health staff volunteered to help out with this

event.

Behavioral Health sponsored several prevention events this

year April Awareness at the D1 Community Center in Black

River Falls. There were about 25 tribal members that

participated in this event. Behavioral Health has been

involved with providing alcohol and other drug and mental health information for participants at

different events within the different departments 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: True

Thought (thinking errors/corrective thinking), DBT- Dialectical Behavioral Therapy, CBT –

Cognitive Behavioral Therapy, Motivational Enhancement Therapy, EMDR – Eye Movement

Desensitization Reprocessing, Mindfulness and Moral Recognition Therapy. BH staff has been

trained in the Matrix Model and began implementing in August 2017. We also provide the

following practice based evidence such as the Medicine

Wheel (12 steps), Mending Broken Hearts, Mothers of

Tradition, Fatherhood/Motherhood Is Sacred, New

Directions, Fathers of Tradition, Red Road to Wellbriety,

Seven Challenges, Healthy Relationships and Warrior Down.

Matrix Model groups, implemented in Black River Falls and

House of Wellness, meet in the evening to accommodate

community members who work during the day.

We now have two psychiatrist contracted to provide

psychiatric evaluations and medication management. Dr.

Katie Cannon from the White Earth reservation contracted

for 40 hours working at various locations and Dr. Randall

Cullen contracted part-time working at the House of

Wellness. The psychiatric referral process had to be

streamlined to assure prompt service for community members.

Ho-Chunk Nation Health Department – Pharmacy Division provides Medically Assisted

Treatment (MAT) services utilizing naltrexone, an opiate antagonist/blocker, as the primary

medication modality. The MAT 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. As we continue to move forward we see the needs to change.

39

Behavioral Health has assisted with completing the Tribal Action Plan (TAP). With the

collaboration of several departments under the Ho-Chunk Nation the committee is known as Tribal

Coordinating Committee (TCC). 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 requested funding for inpatient treatment this

includes detox, inpatient treatment, Transitional Living and outpatient for At Large, these will be

further broken down. 38 treatment funding requests for a total of $$471,899.25 expended.

District # individuals

1 14

2 10

3 4

4 3

5 7

Gender # individuals

M 15

F 23

The following is the number of tribal members that requested funding for Detox Treatment. 7

requests for a total of $11,040.30 expended.

District # individuals

1 3

2 3

3 0

4 1

5 0

Gender # individuals

M 2

F 5

Number of Individuals that transitioned from Detox to Inpatient Treatment: 5

Gender

M 1

F 4

The following is the number of tribal members that requested funding for Inpatient Treatment. 32

requests for a total of $397,222.90 expended.

District # individuals

1 12

2 10

3 3

4 3

5 4

Gender # individuals

M 12

F 20

40

Number of Individuals that transitioned from Inpatient Treatment to Transitional Living: 5

Gender

M 3

F 2

The following is the number of tribal members that requested funding for Transitional Living. 6

requests for a total of $42,333.00 expended.

District # individuals

1 1

2 1

3 1

4 1

5 2

Gender # individuals

M 4

F 2

The following is the number of tribal members that requested funding for Outpatient Treatment. 6

requests for a total of $17,961 expended.

District # individuals

1 1

2 2

3 0

4 0

5 3

Gender # individuals

M 2

F 4

The following are the number of diagnosed clients with an addictive disorder, mental health

diagnosis and dually diagnosed that were seen between July 1, 2017 and June 30, 2018.

BH 07/01/2016 - 06/30/2017 07/01/2017 - 06/30/2018

total unique patients seen 959 1414

total mental health patients/dual

diagnoses

391

668

total alcohol dependence/abuse

diagnoses

380

460

total opioid dependence/abuse

diagnoses

84

116

total heroin 20 Data not provided

41

total cannabis 193 78

total meth 30 7

total other 45 85

Psychiatric Services Dr. Cannon 10/01/2017 - 06/30/2018

total # kept appointments 89

total unique patients seen

51

Gender breakdown Male 16 Female 35

Under 18 year of age 1

Over age 18 50

*please note Dr. Cannon start date was not a full fiscal year

Psychiatric Services Dr. Cullen 10/01/2017 - 06/30/2018

total # kept appointments 140

total unique patients seen

99

Gender breakdown Male 33 Female 66

Under 18 year of age 13

Over age 18 86

II. Problems and corrective actions taken

NextGen training guides continue to evolve however, with an upgrade forthcoming the

protocols will change again resulting in staff requiring to learn different procedures to

assure the department remains in compliance with state and federal licensing

requirements.

We need additional space for staff as writing for grants that could potentially hire

additional providers to meet the rising need for mental health providers in all areas.

URWG- With the assistance of one of the Care Coordinators, a new reporting system was

developed to assist with more accurate data for the Evaluator to complete their report to

the State.

URWG- More open communication with Care Coordinators regarding client services and

care team meetings.

42

III. Goals and strategies for the next fiscal year

Complete the policies and procedures for Behavioral Health to provide Intoxicated Driver

Assessments at each of the six outpatient offices. This can be also a 3rd

party billing

revenue for Behavioral Health.

URWG staff will participate in a program, which will certify them as Prevention or

Recovery Coaches. Provide supportive services to participants and meet the needs while

improving family unity. Provide education and knowledge about basic living skills,

financial budgeting, educational opportunities for further schooling, health lifestyle, job

skills, nutritional education, and other services which provide wellness and strong family

lifestyle.

Assist URWG staff to understand addictions, co-occurring disorders, and family

relationships.

IV. Partnerships

Continue to have working relationships and partnerships with the Department of

Corrections, Together for Jackson County Kids, Seven Challenges, Native American

Fatherhood and Families Association and other HCN departments.

Continue to work with billing to streamline process to assure timely billing occurs for

continued revenue.

Report Respectfully Submitted by: Evangeline M Suquet, MA, LPC, CSAC, Behavioral

Health Director

43

Evangeline Suquet

Behavioral Health Director

Dr. Katie Cannon

Psychiatrist

Terry Greendeer

Alcohol/Drug Abuse Program Manager

Whitney Sanchez

Urban Rural Women’s Grant Assistant-HHCC

Sharon Thompson

Urban Rural Women’s Grant Program Coordinator

Renee Rockman

Urban Rural Women’s Grant Assistant-Wittenberg

& Nekoosa

Behavioral Health Staff

44

Valerie Carrimon

Intake Specialist-HHCC

Mary Ann Dick

Urban Rural Women’s Grant Assistant-Tomah & La Crosse

Theresa Day

Urban Rural Women’s Grant Assistant-HOW

Ashley Jakel

Behavioral Health Clinician I-HHCC

Kimberly Waukau

Intake Specialist-HOW

Briana Hardyman Behavioral Health Clinician I-HOW

Lisa Bargender

Behavioral Health Clinician I-HOW

Stephanie White Eagle

Behavioral Health Clinician I-HOW

Michelle Schoolcraft

Behavioral Health Clinician I-HHCC

45

Rachael Dozer

Behavioral Health Clinician I-Wittenberg &

Nekoosa

Ruth Garvin

Behavioral Health Clinician II-Wellness

Court

Tracey Martin

Behavioral Health Clinician II-Tomah & La Crosse

Christine Preston Behavioral Health Clinician II-HOW

John Pleugers

Behavioral Health Clinician II-HOW

Diane Littel

Behavioral Health Clinician II-Nekoosa

Nicole Blang

Cognitive Intervention Behavioral Health Coordinator-HHCC

Christel Crocker

Substance Abuse Counselor-HHCC & Tomah

Hera Lonetree-Rindahl

Clinical Substance Abuse Counselor-HHCC

46

Donald Greengrass

Substance Abuse Counselor-HHCC

Jodie Tirado

Substance Abuse Counselor-HHCC

Aleta Yellow Thunder

Substance Abuse Counselor-Wittenberg

Joseph White Eagle

Substance Abuse Counselor-HOW

Lori Pettibone

Behavioral Health Community Coordinator-MSPI Grant-HHCC

47

Autumn White

Community Health Office Manager

Shoshanna Gomm

Community Health Office Manager

Jess Thill

Community Health Director

Community Health Annual Reports

48

Community Health Representative (CHR) Program Annual Report

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.

CHRs have demonstrated how much they assist and connect with the community. Their work has

become essential to Ho-Chunk Nation. The CHRs are great advocates because they come from

the communities they serve and know specific tribal healthcare needs. Their dedication to the

community and their work has helped many who have had trouble having their healthcare needs

met. The health promotion and disease prevention efforts that Community Health

Representatives provide have helped people from the community improve and maintain their

health. The CHRs efforts also contribute to reducing tribal health expenses with health education

and health promotion. CHRs reach out and help people on an individual basis and are an

important part of the department’s operations.

29%

5%

1%

23% 5%

21%

4% 10%

2% Blood Pressure/Sugar Checks

WIC

Car Seats

Home Visits

Office Visits

Community Outreach

Transports

Case Management

Referrals

49

The Department of Health and Human Services released fiscal year 2019 Indian Health Services

Justification of estimates for appropriations committees budget shows the budget is no longer

funding the CHR program as "the budget prioritizes funding for direct health care services and

staffing of newly constructed facilities." As of January 1, 2019 the CHR program will no longer

exist and current staff are transitioning into roles which will continue services within the

Community Health Nursing program. We expect a smooth transition as this move occurs.

Report Respectfully Submitted by Jess Thill, Community Health Director

0

200

400

600

800

1000

1200

1400

1600

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

Male

Female

298 242

74 100

332

766

1466

1105

492

918

50

Diane Cayer CHR, Tomah

Linda Goodwin CHR, Nekoosa

Linda Delay CHR, Black River Falls

Community Health Representative Staff

51

SNAP Education Table

Diabetes Group Visits

Nutrition Program Annual Report 2018

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, conferences and one-on-one Medical Nutrition Therapy

(MNT) for a variety of medical conditions such as diabetes, heart

disease and obesity.

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 Nutrition Program provides

community outreach on a variety of nutrition education services

such as: handouts, displays, booths, presentations and cooking

demos/classes

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.

Reached MNT revenue goal of $89,000 for fiscal year.

$108,720 in billed services

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.

Group WIC Head

Start

Youth Food

Dist

Adults

Elders

Direct

Contacts

215

619

1167

537

1619

470

Indirect

Contacts

396

558

599

235

1915

1122

52

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, 2018, the Nutrition Program will seek to increase

revenue for MNT by HCN Registered Dietitian Nutritionists (RDNs) to over $102,054.

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.

From January 1, 2018 to December 31, 2018 the program will maintain or increase Registered

Dietitian Nutritionist (RDN) referrals by 30% or 361 total referrals to the program.

Increase MNT services to the Wittenberg and Tomah locations.

Report Respectfully Submitted by: Jess Thill, Community Health Director

WIC 5% Head Start

14%

Youth 25%

Food Distribution

11%

Adults 35%

Elders 10%

2017 SNAP Services

July 2017-June 2018 services

0

100

200

300

400

500

Home Visits Appointments Refferals Received Well Child referrals

Nutriton Program Services 2016-2018

2016 2017 2018*

53

Heather Jerzak BRF-Nutritionist

Jessica Jennings HOW-Nutritionist

Kathy Braaten BRF-Nutritionist

Kyla Ripp HOW-Nutritionist

Nutrition Program Staff

54

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.

The Food Distribution Program’s main office is in Black River Falls where program services are available

daily at the main office/warehouse or on Wednesday’s during regularly scheduled distribution sites

referred to as “tailgate”. The tailgate services are offered in the communities of Wisconsin Dells,

Wittenberg, Tomah and Nekoosa.

The Food Distribution Program has a total of 6 employees: 1 Supervisor, 1 Secretary, and

4 Warehousemen. All employees are very knowledgeable and skilled in their respective responsibilities

and tasks. The staff are trained and certified annually in CPR(Cardio Pulmonary Resuscitation), Forklift

Operation, AIS(Automated Inventory System), OSHA(Occupational Safety & Health Administration)

Safety, HIPAA(Health Insurance Portability and Accountability Act) and are CDL(commercial drivers

license) qualified.

Accomplishments:

July 1, 2017 – June 30, 2018 – 5,425 certifications 3,478 households and 8,135 participants.

The Food Distribution Program issued 515,634.00 pounds totaling $489,813.00.

Purchased new passenger van with expanded cargo area.

4 staff attended National Conference and trainings for FNS-152 Handbook, Produce safety

certification, budgeting, nutrition education and Civil Rights certification.

Increase in fresh produce purchases and intake from participants.

Hired one additional Warehouseman.

Carryover funding from previous budget approved and utilizing for equipment upgrades.

Areas: Region

I

Region

2

Region

3

Region

4

Region

5

Counties: Wood

Portage

LaCrosse,

Monroe,

Trempealeau,

Vernon

Adams,

Juneau,

Sauk,

Columbia

Marathon

Shawano

Clark,

Eau

Claire,

Jackson

Families

Served

283

618

688

307

1582

Total

Served

3,478

55

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 warehouse area and HVAC equipment upgrade.

Request for Urban waiver expansion to include Dane county and cities in Dane county that

exceed 10,000+population; Madison, Middleton, Fitchburg, Waunakee, Sun Prairie, Stoughton

and Verona.

Region I Region 2 Region 3 Region 4 Region 5

2017 302 574 793 306 1571

2018 283 618 688 307 1582

Counties: WOOD LA CROSSE ADAMS MARATHON CLARK

PORTAGE MONROE JUNEAU SHAWANO JACKSON

VERNON SAUK EAU CLAIRE TREMPEALEAU COLUMBIA

Report Respectfully submitted by: Andrew Rave, Food Distribution Program Supervisor

0

200

400

600

800

1000

1200

1400

1600

1800

2017 2018

Region 1

Region 2

Region 3

Region 4

Region 5

56

Andrew Rave Food Distribution

Program Supervisor

Susan Wilcox Food Distribution

Secretary

Gabriel Casey Food Distribution Warehouseman

Robin Flick Food Distribution Warehouseman

Larinna Chandler Food Distribution Warehouseman

Jeffery Harrison Food Distribution Warehouseman

Food Distribution Staff

57

Health and Wellness Division Annual Report

The mission of the Ho-Chunk Health and Wellness Division is to promote a healthy

lifestyle among the Ho-Chunk people. Health promotion activities will be

performed through an interdependent partnership between the Ho-Chunk Nation

Health Care Delivery System and the Ho-Chunk communities. The partnerships will

facilitate Nation-wide efforts to raise the level of wellness among Ho-Chunk tribal

members. The purpose of the team is to develop, implement and evaluate a

comprehensive health promotion program targeted toward educating,

energizing and empowering communities.

Services and Programs Offered:

-Diabetes Prevention Classes

-CDC National Diabetes Prevention Program Prevent T2

-IHS Balancing your Life and Diabetes Workshops

-One on One Diabetes Prevention Consults with a Certified Diabetes

Educator

-Fitness Classes

-One on one fitness consults

-Boot Camp

-HIIT Classes (High Intensity Interval Training)

-Yoga

-Yoga/Pilate Fusion Classes

-Elder Fitness

58

-Family Fitness

-Kickboxing

-Tai Chi

-Community Supported Agriculture Shares

-Over 25 Certified Organic Farm Vendors throughout WI and the USA

provide fresh fruits and vegetables weekly of bi-weekly.

-Fitness Membership Program

-157 current gym and fitness facilities approved for use throughout WI

and the USA.

-Provides over 1200 tribal members with 6 month fitness memberships.

HIGHLIGHTS

Community Supported Agriculture Shares

Tribal Member Patricia Reyes

When I first saw a flyer for the CSA: Community Supported

Agriculture Shares for Ho-Chunk tribal members, I thought

wow fresh fruit and vegetables weekly for 20 weeks for my

family of 5 for a $30.00 co-pay is very affordable!

We chose Orange Cat Community Farm initially because the name and location. Then came the

weekly email reminders for pickup that include a newsletter of the goings on at the farm, how the

weather was impacting the crops, farm tour invites to get to know the farm and the workers,

come out for a “pick day” when the peas, corn, tomatoes, pumpkins were ready and of course the

recipes with tips on how to store the food to last longer.

This being our second year it’s still fun to see what is in the

weekly box and the interest our children now have in what and

how that vegetable will be used in our meal. A few times we

had to look up what exactly the vegetable was and what to

make with it.

We are thankful to the HCN Department of Health for the

CSA: Community Supported Agriculture Shares because this

program provides us with regular access to fresh fruit and vegetables during the growing season

and gets my kids excited about eating fresh and local food.

Patti Reyes and Family

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Diabetes Prevention within the Ho-Chunk Nation:

The Ho-Chunk Nation Diabetes Prevention Program efforts have been ongoing since it began in

1997. The Health and Wellness Division works through funding provided by the Special

Diabetes Grant for Indians from Indian Health Service. Diabetes is another leading health

indicator to use when determining the health of a population. The Ho-Chunk Diabetes audit, data

from 2013-2017 of patients who live in the Contract Health Service Delivery Area (CHDSA),

indicated that approximately 70% of the patients with diabetes were obese. It also revealed that

25%-35% of patients with diabetes had blood pressure levels greater than the recommended

value (140/80). Approximately one-third of patients with diabetes had blood-sugar levels equal

to or less than the recommended goal for the HbA1c test (7.0%), which points to two-thirds of

our population having uncontrolled blood sugars in the previous three months. In order to

prevent the very serious health consequences of type 2 diabetes, such as heart attack and stroke,

much work is needed to support patients in managing their chronic diseases. The Health and

Wellness Division is currently a CDC Recognized National Diabetes Program Provider. This

allows us to facilitate Evidence Based Diabetes Prevention Programming in the form of the

Prevent T2 classes. These classes are a yearlong and focus on the importance of achieving a 5%-

7% weight loss and achieving 150 minutes of physical activity a week. The Indian Health

Service Based Curriculum is the Balancing your Life and Diabetes workshop that is facilitated

over the course of 2 days.

The following chart shown is the last 4 years of SDPI Key Measures that are achieved over the

course of a funding year. It is important to note that the reporting is done in January of the New

Year for the data of the previous year. IE: the 2018 percentages is the final data from 2017.

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Annual Journey of Hope Conference:

In November 2017 the Health and Wellness Team offered the Annual Journey of Hope

Conference to raise awareness and provide diabetes education to the 289 participants that were in

attendance.

Diabetes Workshops and Prevention Classes:

7 classes to learn the basics of diabetes management.

235 Participants have completed all seven classes.

Locations in Black River Falls, Wittenberg, Tomah, Baraboo, Nekoosa, Madison and

La Crosse

87% 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.

Youth Diabetes and Obesity Prevention Assessment:

The Ho-Chunk Nation Health and Wellness Division is currently facilitating a youth health

assessment to determine the current state of well-being in our youth. This assessment will assist

in the creation of programs to promote the health of our youth in our communities and in the Ho-

Chunk Nation. We firmly believe that in order to ensure the health of the Ho-Chunk Nation and

further halt the prevalence of chronic diseases we need to focus our attention and efforts on our

youth.

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Food Sovereignty Projects:

The Health and Wellness Division has worked diligently along with HHCDA and Youth

Services to increase the number of Community Organic Gardens and Youth Gardens throughout

the state of Wisconsin. The blueberry plants pictured are at the Nekoosa youth service location.

Community Outreach and Events

Notah Begay Healthy Kids, Healthy Futures Kickoff Event

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Culture Camp

Annual Canoe Trip

This Annual Canoe Trip is primarily

held at the Wildcat Mountain State

Park on the Kickapoo River in

Ontario, Wisconsin. This past canoe

trip the Health and Wellness Division

had over 60 tribal members

participate in this great family event.

Tribal member Georgiana LaMere

stated that, “This is one of the

greatest hoocak family events out

there, for real.”

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Youth Services Collaborations

Incorporating Culture into Wellness Programs:

Many interventions, programs, and services the

Ho-Chunk Nation Health Department offer are

focused on changing individual behaviors:

smoking, unhealthy eating, lack of exercise,

weight loss and excess drinking. While it does

help to offer these programs and services, a

broader approach that includes families, youth

groups, communities, worksites and tribal

government supported policies are necessary.

According to the Community Health Assessment

data, the majority of residents believe they are in

good health. (Approximately 4 out of 10 people reported having good health and over one

quarter of all respondents reported having very good health). Despite the data indicating higher

prevalence chronic disease in American Indians, this self-identified ranking of health speaks to

our community’s spirit. Maintaining and improving the Ho-Chunk Nation’s health will take a

concerted effort and resources. The Health and Wellness Division is devoted to encouraging

better health and we will address our high prevalence of risk factors for chronic disease by

implementing cultural activities which connect our tribal community to traditional teachings,

foods and activities. These cultural activities will build tribal members resiliency and

connections to their heritage. Building pride and passion about our Ho-Chunk traditions will

create healthier lifestyles for tribal members which will decrease the prevalence of chronic

disease within the Ho-Chunk community.

The Health and Wellness Division

collaborates often with Ho-Chunk

Nation Youth Services Division in

every location to provide fitness

education, cultural events, diabetes

prevention and other health

prevention events. The Health and

Wellness Division also assists in

ensuring the centers have easy

fitness equipment such as yoga

mats, hula hoops, jump ropes, etc.

to further the goal of increasing

physical activity in our youth.

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Health and Wellness Division

Short Term Goals:

By December 2018 have 500 active memberships in the fitness program.

By December 2018 increase the number of dental, vision and foot exams in program

participants.

By December 2018 30% of participants in the Prevent T2 program will meet 5% to

7% weight loss goal.

By January 2019 obtain CDC permanent recognition status for the National

Diabetes Prevention program.

Obtain the Ho Chunk Nation BMI baseline data for Ho Chunk enrolled youth and

descendants.

Long Term Goals:

Increase retention of participants in the Prevent T2 program and Balancing Your

Life & Diabetes Workshops.

Reduce the prevalence rate of childhood obesity by 5% by December 2020

Become an ADA (American Diabetes Association) Accredited program

Continue to host the Journey of Hope Conference each year.

Increase the frequency of cultural relevancy into our wellness programs offered.

Host an annual “Reclaiming Our Health” Round Dance family gathering each fall.

Letter from the Health and Wellness Division Supervisor

Greetings Relatives,

This past year has flown by. The Health and Wellness Division is continuing to provide the

Ho-Chunk People with the most up to date and current information and education in regards

to Diabetes Prevention and Physical Fitness. My dedicated staff have a wealth of knowledge

with several of them having over 10 years of service in this program. We will continue to

devote all of our time and energy in to the communities we serve. A special Thank You goes

out to all of our participants in our programs.

Thank you!

Sincerely,

Sara Peterson, Health and Wellness Coordinator

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Sara Peterson

Health and Wellness Program Coordinator

Jess Artz

Nekoosa/Wittenberg-Exercise Physiologist

Chris Frederick

HOW/Tomah-Exercise Physiologist

Kathleen Clemons BRF-Exercise Physiologist

Rebecca Krause

Fitness Membership/CSA Secretary

Lyndsey Killian Program Recruiter

Rachel Montana Program Recruiter

Health and Wellness Staff

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Community Health Nursing (CHN) 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 Health Services Delivery Area (CHSDA).

ALL LOCATIONS:

CHN over the last fiscal year has provided 52,131 total patient contacts

Public Health Accreditation: Working to become Accredited.

Contract Services for In Home Care:

Contracted Services have allowed for over 32,504 hours of after-hours services.

32 contracts placed (78% are HCN Tribal Members)

32 elders served from contracts

24 continue to be active

Managed Care Organizations (MCO):

Contracts with Managed Care Organizations in CHSDA to receive reimbursement for services rendered.

Reimbursement Revenue: $45,845.85

Personal Care Agency Certification maintained.

0 5000 10000 15000 20000 25000 30000

Nurse Home Visits (2273)

Patient Education Hours(1,183.5

Telephone calls (26039)

Nurse Office visits (892)

Immunizations (820)

Case Management (7,197)

Caregiver Home visits (9,302)

Caregiver Transports (4,696)

WIC Visits (337)

MCH Visits (634)

Foot Care (564)

HIV Tests (107)

Condoms Distributed (16996)

HIV Prevention Program Patient Contacts (1036)

Cribs Distributed (32)All Locations: CHN Responsibilities

Tribal Members by CHSDA Areas: BRF 920 HOW: 888 Tomah: 350 Nekoosa: 475 La Crosse: 262 Wittenberg: 409

CHSDA Total: 3,304

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CHN over the last fiscal year has provided the following services:

571 Home visits and 15,448 total patient contacts

38 unduplicated elders received home care

Caregiver over the last fiscal year has provided the following services:

833 transports for medical services

2,873 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, Neonatal Abstinence Syndrome Training and Public Health

Accreditation Committee

Lindsey Minard RN, BSN, CHN:

Training: Leadership Training, Cultural Training, Narcan Training, Upcoming-Foot and

Nail care

Jeni Tuschner RN, BSN, CHN:

Training: Leadership Training, Cultural Training, Narcan Training, Upcoming Foot and

Nail Care

Allie Isaacson, RN, BSN, CLC, CPS, CHN:

MCH Block grant co-coordination; HCN local coalition, HCN Breastfeeding Coalition

Training: WALC Breastfeeding Conference , Women’s Leadership Training, Neonatal

Abstinence Syndrome Training

Preceptor for UW-Madison and Edgewood Nursing Students

Certification: maintained Certified Lactation Counselor and Child Passenger Safety Seat

Technician, First Breath, My Baby and Me trained and Safe Sleep Trainer

Partners In Parenting classes monthly at Black River Falls

0 2000 4000 6000 8000 10000 12000

Nurse Home Visits (571)

Patient Education Hours (241.5)

Telephone calls (11,313)

Nurse Office visits (77)

Immunizations (200)

Case Management (812)

Caregiver Home visits (2873)

Caregiver Transports (833)

WIC Visits (169)

MCH Visits (211)

Foot Care (50) BRF CHN/Caregiver Contacts & Services

Tribal Members BRF Area: Jackson: 1321 Clark (half) 32 Eau Claire: 127

BRF Total: 1480 (26%)

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CHN over the last fiscal year has provided the following services:

405 Home visits and 14,438 total patient contacts

31 unduplicated elders received home care

Caregiver over the last fiscal year has provided the following services:

2352 transports for medical services

3204 home visits (activities of daily living, cleaning, medication reminders, meal prep,

etc.)

Accomplishments:

Kalli Koerner RN, BSN, CHN Supervisor (HOW/Nekoosa/Tomah)

Member of: Tribal Coordinating Committee

Certifications: ACLS, PALS, NRP, TNCC

Co-Coordinator HCN HIV Prevention Program/Grant

Training: Leadership Training, Cultural Training, Diabetes and Dimentia Training and

Alzheimer’s Training

Kandi Ryan, RN, CHN:

Trainings: Native Nurses Summit, Transcultural Nursing Seminar, UW Preceptor

Workshop, Public Health Nursing Conference, VFC training, ADRC Train the Trainor

Friendly Workplace, Wisconsin Public Health Nursing Conference, Cultural Training and

Supervisory Training

Preceptor for UW-Madison and Edgewood Nursing Students

Irina Clendenning, RN, BSN, CHN:

Training: Leadership Training, Nursing Preceptor Training, Cultural Training, Dementia

and Diabetes Training and Alzheimer’s Training

Serena Jahnke-Berg, RN, BSN, CLC, CPS, CHN:

MCH Block grant co-coordination; HCN local coalition, HCN Breastfeeding Coalition

Training: WALC Breastfeeding Conference, Leadership Training, Cultural Training,

Neonatal Abstinence Training, Women’s Leadership Training and Perinatal Conference

0 1000 2000 3000 4000 5000 6000 7000 8000 9000

Nurse Home Visits (405)

Telephone calls (8290)

Patient Education Hours (482)

Nurse Office visits (92)

Immunizations (203)

Case Management (3,894)

Caregiver Transportation (2352)

Caregiver Home visits (3,204)

WIC (105)

MCH visits (285)

Foot Care (116) HOW CHN/Caregiver Contacts & Services

Tribal Members HOW Area: Dane: 311 Sauk: 698 Columbia: 132 Juneau (half) 136 Adams (half) 25

HOW Total: 1302 (23.6%)

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Certification: Certified Lactation Counselor, Child Passenger Safety Seat Technician,

First Breath, My Baby and Me trained and Safe Sleep Trainer

Partners In Parenting classes monthly at House of Wellness

CHN over the last fiscal year has provided the following services:

241 Home visits and 6,511 total patient contacts

14 unduplicated elders received home care

Caregiver over the last fiscal year has provided the following services:

627 transports for medical services

1266 home visits (activities of daily living, cleaning, medication reminders, meal prep,

etc.)

Accomplishments:

Lindsey Schaub, 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,

Neonatal Abstinence Syndrome Training, STAR Training, Alzheimer’s Training and

Understanding Compassion Fatigue

Training: PHN Conference Supervisory Training

Preceptor: Viterbo University Nursing Students

0 500 1000 1500 2000 2500 3000 3500 4000 4500

Nurse Home Visits (241)

Telephone Calls (4189)

Patient Education Hours (312)

Nurse Office visits (38)

Immunizations (58)

Case Management (888)

Caregiver Home visits (1266)

Caregiver Transports (627)

MCH Visits (2)

Foot Care (112)Tomah CHN/Caregiver Contacts & Services

Tribal Members Tomah Area: Monroe: 446 Juneau (half) 136

Tomah Total: 582 (10.6%)

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CHN over the last fiscal year has provided the following services:

434 Home visits and 3,521 total patient contacts

25 unduplicated elders received home care

Caregiver over the last fiscal year has provided the following services:

342 transports for medical services

1,228 home visits (activities of daily living, cleaning, medication reminders, meal prep,

etc.)

Accomplishments:

Pam Reimer, RN, CLC, CPS, CHN:

Co-Coordinator HCN HIV Prevention Program/Grant, CPR Instructor, CPS Technician

Training: Suicide Prevention Conference, Quarterly HIV Tribal Coordinator, WALC

Breastfeeding Conference, Supervisory Training, Cultural Training, Understanding

Compassion Fatigue and Neonatal Abstinence Syndrome Training

Certification: Child Passenger Safety Seat Technician, Certified Lactation Counselor,

First Breath and My Baby and Me trained

Nurse Home Visits (434)

Telephone calls (1,304)

Patient Education Hours (240)

Office visits (100)

Immunizations (189)

Case Management (560)

Caregiver Transports (342)

Caregiver Home visits (1,228)

MCH (51)

WIC (63)

Foot Care (30)

0 200 400 600 800 1000 1200 1400

Nekoosa CHN/Caregiver Contacts & Services

Tribal Members Nekoosa Area: Marathon (half): 52 Clark (half): 32 Adams (half): 25 Wood: 355

Nekoosa Total: 464 (8.4%)

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CHN over the last fiscal year has provided the following services:

185 Home visits and 4,733 total patient contacts

18 unduplicated elders received home care

Caregiver over the last fiscal year has provided the following services:

144 transports for medical services

385 home visits (activities of daily living, cleaning, medication reminders, meal prep,

etc.)

Accomplishments:

Megan Marks, RN, BSN, CLC, CHN:

Training: Wound Care Associate, Supervisory Training, Leadership Training,

Alzheimer’s Training, STAR Training and Cultural Training.

Certifications: Certified Lactation Counselor

Preceptor: Viterbo University Nursing Students

Covered short staffing in BRF; has provided foot care training in Black River Falls

Nurse Home Visits (288)

Telephone calls (2351)

Education (245)

Nurse Office Visits (185)

Immunizations (89)

Case Management (247)

Caregiver Home visits (358)

Caregiver Transports (144)

MCH (1608)

Foot Care (58)

0 500 1000 1500 2000 2500 3000 3500 4000

La Crosse CHN/Caregiver Contacts & Services

Tribal Members La Crosse Area: La Crosse: 287 Vernon 16 Crawford 4

La Crosse Total: 307 (5.6%)

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CHN over the last fiscal year has provided the following services:

399 Home visits and 3, 874 total patient contacts

22 unduplicated elders received home care

Caregiver over the last fiscal year has provided the following services:

398 transports for medical services

373 home visits (activities of daily living, cleaning, medication reminders, meal prep,

etc.)

Accomplishments:

Ronelle McKernan, RN, BSN,CLC, CHN:

Training: Supervisory Training, Child Passenger Safety Technician, QPR-Suicide

Prevention, Cultural Training and STAR Training

Certifications: Certified Lactation Counselor

Covered short staffing in BRF

Report Respectfully Submitted by: Trisha Jacox, RN and Kalli Koerner, RN, Community Health

Nursing Supervisors

Nurse Home Visits (399)

Patient Education Hours (441)

Telephone calls (5122)

Nurse Office Visits (105)

Immunizations (82)

Case Management (58)

Caregiver Home visits (373)

Caregiver Transportation (398)

MCH (73)

Foot Care (95)

0 1000 2000 3000 4000 5000 6000

Wittenberg CHN/Caregiver Contacts and Services

Tribal Members Wittenberg Area: Marathon (half): 52 Shawano: 158

Wittenberg Total: 210 (3.8%)

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Trisha Jacox, RN CHN Supervisor

Kalli Koerner, RN CHN Supervisor

Allie Isaacson, RN

Maternal Child Health Nurse

Lindsey Minard, RN

BRF Community Health Nurse

Jeni Tuschner, RN

BRF-Community Health Nurse

Irina Clendenning, RN

HOW-Community Health Nurse

Kandi Ryan, RN

HOW-Community Health Nurse

Serena Janhke-Berg, RN

HOW-Community Health Nurse

Community Health Nursing Staff

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Pam Reimer, RN

Nekoosa-Community Health Nurse

Lindsey Schaub, RN

Tomah-Community Health Nurse

Megan Marks, RN

La Crosse-Community Health Nurse

Ronelle McKernan, RN

Wittenberg-Community Health Nurse

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Trevor Little Soldier Supportive Care Worker

Pam Rousch HOW-CNA

Reva Decorah HOW-CNA

Ashley Buege HOW-CNA

Sandra Delarosa HOW-CNA

Samantha Defosse HOW-CNA

Jennifer Plueger Tomah-CNA

Erica Laffin HOW-CNA

Sinda Kagigebi HOW-CNA

Certified Nursing Assistants

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Fonda Blackdeer Tomah-CNA

Barb Kmetz Tomah-CNA

Diane Kleinhenz Nekoosa-CNA

Rachel Skaar Nekoosa-CNA

Breeanna Walker Wittenberg-CNA

Terri Bluebird La Crosse-CNA

Shelby Decorah Wittenberg-CNA

Alicia Crocker La Crosse-CNA

Regina Reel BRF-CNA

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Betty Blackdeer BRF-CNA

Elisha Reetz BRF-CNA

Gale White BRF-CNA

Cindy Kirschenmann BRF-CNA

Megan McCormick BRF-CNA

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Contact Information

Black River Falls:

Ho-Chunk Health Care Center

N6520 Lumber Jack Guy Road

Black River Falls, WI 54615

888-685-4422

*Behavioral Health located

within the Ho-Chunk Health

Care Center

Wisconsin Dells:

House of Wellness Clinic

S2845 White Eagle Road

Baraboo, WI 53913

888-552-7889

Black River Falls:

Community Health Building

W9850 Airport Road

Black River Falls, WI 54615

888-685-4422

La Crosse Health Office:

Three Rivers House

724 Main Street

La Crosse, WI 54601

608-784-3083

Nekoosa Health Office:

1021 County Hwy G

Nekoosa, WI 54457

715-886-5444

Tomah Health Office:

430 Julie St. Suite 2

Tomah, WI 54660

608-372-0889

Wittenberg Health Office:

W17634 Radke Road

Wittenberg, WI 54499

715-253-2382