Ep. 176: Whole Child Health in Action: A Provider Case Study (Part 1 of 2)

What does whole child health look like in action? In part one of this two-part series, leaders from Nemours Children’s Health and Children’s Wisconsin explore how pediatric systems are redesigning care to improve lifelong outcomes for kids. From integrated mental health, dental and nutrition services to community partnerships, prevention strategies and innovative policy approaches, we highlight real-world models advancing children’s health beyond the doctor’s office and setting the stage for smarter, more sustainable care.

Watch the episode on YouTube.

Featuring: 

Daniella Gratale, MA, Associate Vice President, Federal Affairs, Nemours Children's Health

Hannah Wagner, MPP, Senior Advisor, Policy Development and Partnership, Nemours Children’s Health

Allison Gertel-Rosenberg, MS, Vice President, Chief Policy and Prevention Officer, Nemours Children’s Health

Jenny Crouse, MS, RD, CD, Director of Clinical Nutrition, Children’s Wisconsin 

Chris Schwake, MD, FAAP, Director of Quality and Patient Safety for Children’s Medical Group, Children’s Wisconsin 

Host/Producer: Carol Vassar

Get the policy brief: Advancing the Key Elements of Whole Child Health: Provider Case Study - Children's Wisconsin

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Announcer (00:00):

Welcome to Well Beyond Medicine, the world's top-ranked children's health podcast, produced by Nemours Children's Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.

Carol Vassar, podcast host/producer (00:12):

Each week, we'll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar. And now that you're here, let's go.

MUSIC (00:30):

Let's go.

(00:32):

Well Beyond Medicine.

Carol Vassar, podcast host/producer (00:36):

Hey, everyone. We talk a lot on the podcast about whole child health, that is the understanding that children's well-being is shaped by more than just medical care alone. But whole child health isn't just an idea or a hopeful vision; it's already in action. Across the nation, pediatric systems are redesigning care. They're partnering in their communities, addressing the early origins of chronic disease, and exploring new payment models. This episode is the first of a two-part series showing how whole child health is being put into practice each and every day. We begin with a brief conversation with our friends of the podcast, Daniella Gratale, associate vice president of federal affairs at Nemours Children's Health, and Hannah Wagner, senior advisor for policy development and partnership at Nemours. They're going to help ground us in what whole child health means today, how the field has evolved, and where the opportunities are emerging. From there, in part 2 and part 1, we'll hear from leaders at Nemours, Children's Wisconsin, and Cincinnati Children's who will discuss how they advance whole child health through strategies like community partnerships, integrated care, and innovative financing.

(01:52):

Now, for listeners joining us for the first time who might not be aware, can you give a quick reminder of what whole child health means? Daniela, I'm going to go to you.

Daniella Gratale, MA, Associate Vice President, Federal Affairs, Nemours Children's Health (02:02):

Whole child health is thinking comprehensively about how we create health for children, and that's physical health, but it's also mental health, a child's healthy development, their relationships with parents or caregivers, and then all those non-medical factors, so it's things like access to nutrition, access to transportation, high quality education, childcare, all the things that happen outside the walls of the healthcare system. As part of the Whole Child Health Alliance, we're trying to bring those concepts to life through real-world examples.

Carol Vassar, podcast host/producer (02:31):

And we've talked a lot, as we mentioned in the intro, about whole child health concepts in past episodes. We've highlighted how those approaches can help prevent chronic disease and can set children up for lifelong health, which is the ultimate goal. Since that conversation, what has shifted in the policy landscape, and where do you see new opportunities emerging?

Daniella Gratale, MA, Associate Vice President, Federal Affairs, Nemours Children's Health (02:55):

Sure. So, since we first spoke about a year ago on whole child health, there's definitely been a lot of movement on the federal level, in particular with regard to healthcare. Congress enacted some big changes, of course, over the summer with the enactment of H.R.1, and that did have some impacts for Medicaid, of course. Recently, there's been a lot of conversation about the Affordable Care Act's enhanced premium tax credits. We've also started to see the MAHA agenda take place and really take some shape over the last year. Just recently, CMS, the Centers for Medicare and Medicaid Services, announced a new model called MAHA ELEVATE, and that would fund proposals to promote health and prevention in original Medicare. And again, just as a reminder, Medicare is for the 65 and over population.

(03:40):

I think where we see some untapped potential as part of our work is the confluence of Medicaid, whole child health, and payment. We know that what drives chronic illness happens where kids spend their time, so that's at home, in schools, in communities. We want to think more about how do we get our goals, our outcomes, and financial incentives to align for kids. Medicaid is particularly important for kids, because about 50% of kids are covered by Medicaid or CHIP and 40% of births are covered by Medicaid, so it's a great area to focus. We're excited that you'll hear about some innovative approaches as part of this podcast, for sure.

(04:16):

We on the policy side at Nemours have been working for the past few years on the KIDS Health Act. We're hoping to see that reintroduced next year, and that looks at primary care, coordination, trying to address all those non-medical factors between healthcare and payers and other community partners, and again at that sweet spot of Medicaid, whole child health, and payment.

(04:37):

We'd love to see more focus on that area and really appreciate you helping to highlight some of that org as part of the podcast.

Carol Vassar, podcast host/producer (04:42):

By next year, you actually mean this year, 2026.

Daniella Gratale, MA, Associate Vice President, Federal Affairs, Nemours Children's Health: (04:46):

Yes.

Carol Vassar, podcast host/producer (04:48):

I know. I haven't changed my checks yet, so... Who writes checks?

(04:52):

Hannah, I'm going to turn to you. You've been leading the whole child health provider case study project, which these two episodes are based on. Can you give us a brief overview of what the project includes and some of the common themes and areas that surfaced across health systems?

Hannah Wagner, MPP, Senior Advisor, Policy Development and Partnership, Nemours Children’s Health (05:06):

Yeah, definitely. As Daniella mentioned, one of the goals of the Whole Child Health Alliance is to really put pen to paper on what whole child health actually looks like on the ground, and that can serve as an example of the art of the possible for policymakers, providers, just to see what really can happen to advance whole child health. Over the past year, we've been developing these case studies, three children's health systems, Nemours Children's, ourselves, Cincinnati Children's, and then Children's Wisconsin, and these case studies came out late 2025, and they're available on the website if you want to take a look. But the case studies really just highlight some of the common strategies that health systems have used to advance whole-child health.

(05:56):

I'll highlight a couple of those. The first is really taking a holistic approach to addressing the needs of children and adolescents in the primary care setting, so that it can include addressing mental health needs, nutrition needs, all sorts of things in the primary care setting. The second is bringing healthcare services directly to the places where kids and families spend their time, so that could be school or leveraging telehealth, so families can take appointments from their home. And then the third is building strong community partnerships that help meet kids' and families' needs outside of the hospital walls. And then, finally, as Daniella alluded to as one of the most important and key components of these approaches, is working on aligning payment incentives to promote comprehensive well-being or whole child health, also known as paying for health. I think that's a good summary of what these case studies do, and we're looking forward to hearing from the providers themselves over the series of these podcast episodes.

Carol Vassar, podcast host/producer: (07:04):

And we are going to dig into that very shortly, in fact, right after this break. Thank you, Daniela Gratale and Hannah Wagner from Nemours Children's Health, for helping us set the stage for the conversations that do follow.

(07:15):

Up next, we will be talking with experts from Nemours and Children's Wisconsin on the work they're doing in this area. Don't Go Anywhere. We will be right back.

(07:28):

As promised, we are back. Joining me right now to talk more about whole child health approaches from Nemours Children's Health is Allison Gertel-Rosenberg. She is vice president and chief policy and prevention officer for the organization, and from Wisconsin Children's, Jenny Crouse, director of clinical nutrition, and Dr. Chris Schwake. He is director of quality and patient safety for the Children's Medical Group. Now, before we get into the conversation at hand, we've never had Children's Wisconsin on before, and I'd love for one of you from that organization to give me some background on Children's Wisconsin.

Chris Schwake, MD, FAAP, Director of Quality and Patient Safety for Children’s Medical Group, Children’s Wisconsin (08:09):

For Children's Wisconsin, we are an organization that is the only independent healthcare system dedicated solely to the health and well-being of kids within the state of Wisconsin. We provide primary and specialty medical care, dental care, mental and behavioral health services, urgent care, support for families through community health and education, and a variety of other services to children and families across the state through dozens of outpatient locations, and Children's Wisconsin also offers the full complement of hospital and surgical-based services through our 309-bed facility in the Milwaukee area and a 42-bed hospital in the Wisconsin Fox Valley area, serving children from birth to early adulthood.

(08:55):

Within the context of our larger system, and what I am most connected to, is Children's Medical Group, which is inclusive of 20 primary care clinics. We provide care for over 140,000 children within the past year, with nearly 400,000 visits in the past year for preventative, acute, chronic, and same-day care as well.

(09:18):

Jenny, maybe if you could speak a little bit to some of our specialty services that you are a part of.

Jenny Crouse, MS, RD, CD, Director of Clinical Nutrition, Children’s Wisconsin (09:24):

Yeah. We have a large clinical nutrition team as part of Children's Wisconsin, so we have over 60 dieticians working in those two hospitals. Chris mentioned over 15 different ambulatory specialties across 9 different specialty sites. Of course, what we're going to dive into further today is our integrated dietitian model within primary care, so I won't spoil it. We'll get into that later. But we have lots of dietitian integration across really all the care we provide across all of the areas that Chris had mentioned.

Carol Vassar, podcast host/producer: (09:51):

A lot of synergy between Nemours and Children's Wisconsin, both committed to a whole child health approach. How would you describe your overarching vision, and this is for each of you, particularly with the role of strategies such as community partnerships, prevention programs, and integrated care in helping children reach their full potential? Dr. Schwake.

Chris Schwake, MD, FAAP, Director of Quality and Patient Safety for Children’s Medical Group, Children’s Wisconsin (10:15):

As Jenny had mentioned, for Children's Wisconsin, our whole child health approach is essential to that vision that the kids in Wisconsin will be the healthiest in the nation. Our strategy aims to advance every aspect of child and adolescent health in four ways.

(10:30):

First, we are focusing on prevention through the lens of the whole child with our routine visits and clinical practices. This has historically been attempted through the care we've provided by our primary care medical teams during well visits. We have become more effective, though, over time as we've grown into an expanded care team model, focused on earlier connections and interventions with kids and families. Our integrated mental and behavioral health model and dental care are examples of this, as well as active pilot collaborations, like the one that Jenny had highlighted earlier with her team within clinical nutrition that we'll discuss a bit later, and also our work to support the social health for kids and families that we care for through our health navigation program.

(11:17):

Secondly, the breadth and depth of our health system has allowed us to provide proactive, seamless, and personal experiences at every visit, tailored to what matters most to our patients and our families. Cross-department and specialty collaboration is such a driver for making those experiences possible. All the services in primary care that I had mentioned previously are elevated by the collective efforts of multiple teams throughout our system. One example of this is our ability to use e-consults through a wide variety of our specialists within children's that allows us to center more targeted, more effective care for our kids and families where they are most comfortable receiving it, where they already have established relationships with our primary care teams.

(12:04):

Further, another important factor as we work to continuously improve towards our vision has been our growth, our ability to offer easily accessible services that are located across our communities. Over time, expansion of our geographic footprint and increased co-location of primary care with other very valuable services, like lab, radiology, other diagnostics, therapies, and specialty services, has led to more timely and efficient care for those we serve. A really powerful example of this growth has been our urgent care department that has increased its access across Southeastern Wisconsin and, recently, in the northeastern part of our state for acute in-person and virtual needs during and outside of traditional primary care clinic hours.

(12:52):

Finally, maintaining purposeful partnerships with community-based organizations, community leaders, and other stakeholders to enhance community health allows us as a system to play a role in supporting care for kids and families that we may not be actively reaching otherwise. One example of this was our collaboration with the Milwaukee Health Department, Milwaukee Public Schools, and Sixteenth Street Community Health Centers to provide community lead testing events when the presence of lead was identified in some of our public schools earlier this year.

(13:24):

I've also had the joy and the fortune over the last couple of years to be a part of our primary care team that has hosted a summer celebration for families who are heading back to school in the fall, creating a space for Children's Wisconsin, the Medical College of Wisconsin, and local community organizations to come together, to share our resources, and actively support families from our midtown neighborhood and other surrounding areas as well.

Carol Vassar, podcast host/producer: (13:49):

Allison, I want to turn to you and ask a similar or the same question. Talk about Nemours' approach to whole child health, the overarching vision. We've talked about that on the podcast previously, but I'd love to hear it from your perspective.

Allison Gertel-Rosenberg, MS, Vice President, Chief Policy and Prevention Officer, Nemours Children’s Health (14:04):

Sure. Thanks, Carol, so much. Dr. Schwake and Jenny, we are so excited when we get on any of these conversations and hear such similar language to the work that we do as well. I think it is such a great opportunity for pediatrics and health in this country when we hear similar language coming, no matter where the geography is. I think you're going to hear a lot of things that sort of resonate and almost repeat what you were talking about, specifically about the healthiest generations of kids, and that certainly being something that Nemours is actively looking to achieve through our whole child health work. Really, that is looking at how do we provide innovative and top-quality medical care coupled with addressing the non-medical factors that address health. That has been a lot of the work that we have been focused on.

(14:56):

We also understand that we exist in the communities that we serve in very much a health anchor way, thinking about the decisions that we make and the impacts that those have on the health of the communities, whether that's in Delaware or in Florida, thinking about how do we utilize our opportunities as a business in the community to really think about the type of care and the outcomes that we want to see, not just for the kids who will cross our doors for medical care, but really any child in the areas that we serve and across the nation.

(15:27):

So a few buckets of work that I think are really important as we go through this... and I feel a little bit like I'm copying by going second here, but I want to talk a little bit about integrated care and the idea that we have an integrated primary care model that really embeds mental health providers within primary care in order to increase use and capacity and also remove some of the biases that make this by moving between clinical providers, by putting it in the same place.

(15:58):

We have ease, and we also have integration, which I think works really well from that integrated care perspective. Community partnerships are such an integral part of the work that we do. We are very much aware that kids exist outside of the health system, and that's where we want them to be for the most part, right? How we partner with other people across the communities and the states that we serve are critically important for making sure that not only our message is consistent, whatever the topic is, but that we're also thinking about, "How do we reach children and families in the places where they're most comfortable, and where they're spending the majority of their time?"

(16:39):

And then, finally, really thinking about how do we move upstream to that prevention work that you all were mentioning as well. We have several prevention programs, and I think we're going to get into a couple of them a little bit later, but really thinking about, "How do we make sure kids get a healthy start?" We know it is so much easier to keep kids healthy than it is to return kids to a healthy state. So how do we intervene as early as possible in order to make sure that kids have the best chances to be healthy and well?

Carol Vassar, podcast host/producer:(17:08):

Allison, I'm going to stay with you for just a moment and kind of pull on a couple of threads that you noted in what you just said, and that is Nemours is working with community partners nationally, not just in the states you serve and the states that surround them, but nationally, especially in the early care and education settings. I'm wondering how these partnerships nationally help address early origins of chronic disease and really help to strengthen children's long-term health outcomes and trajectories.

Allison Gertel-Rosenberg, MS, Vice President, Chief Policy and Prevention Officer, Nemours Children’s Health (17:41):

I think there's a couple of points to note there, which is, most importantly, I have the great honor of heading the Nemours Children's National Office of Policy and Prevention, and it's this opportunity to think about, "What do we get to do on a national level from both a practice change standpoint and a policy change standpoint that's going to impact kids in a sustainable way and also allow us to get the greatest reach and the greatest impact that we can possibly achieve?" I think a great place to start on that, and a place that Nemours has really had significant legs for decades now, has been in the early years, and that goes back to what I was saying previously, that we do believe that an early start is one of the best ways to really shift the trajectory for kids and give them the best chance of living a healthy and well life.

(18:26):

When we think about that from a national perspective, I would point to two different initiatives. One is our Nemours Children's Reading BrightStart, which is a literacy program that is focused on infants, toddlers, all the way to five and six-year-olds, but really this idea that literacy is a critical component of health. We know that third grade reading level is one of the greatest predictors of adult health. But even before then, we know that kids from birth to grade three are learning how to read, but then from grade four on are reading to learn. So we're setting them up for great success by really thinking about, "How do we partner with early care and education providers at systems levels, at the state levels, at the community levels to really embed programming in those early care and education settings so that kids have access to supports around literacy to ensure that they don't start down a path where they can't catch up?" Because we know it's once again really critically important to keep them reading at grade level.

(19:32):

With Nemours Children's Reading BrightStart, what we have found through rigorous research and evaluation is that when children are exposed to the intervention, that two-thirds of them, after a 20-session intervention, will begin to read at third grade level, which really is a remarkable finding because we know that that then is setting them up. It's not, quite frankly, a one-time thing. We know that it will mean that we need to be continually thinking about how do we ensure that they have the supports that they need in order to maintain those gains.

(20:06):

But it really is incredible that if we take the opportunity as a health system to really partner with the early care and education setting to think about literacy, the gains are felt across multiple sectors. What we know is that kids exist in multiple sectors, and they don't know when they're in the education sector, when they're in the health sector, and when they're in the community sector. We just want to make sure that we're really putting kids and families at the center of what we do and making sure that they have the resources to do what they need to do to be healthy and well.

(20:36):

And that's also what's behind our work around Healthy Kids, Healthy Future, which has been a focus around healthy eating and physical activity. Jenny, I am sure, as you think about nutrition too, we just know how critical it is that healthy, well-fed bodies and minds are going to learn better, are going to be healthier. The opportunity to really impact all of the outcomes that we think about for kids around healthy eating and physical activity, whether that's learning or things around overweight and obesity or any general health work that they're doing, is that, once again... When I think back to when this work started, everyone was talking about kindergarte,n and they're like, "We need to think about what we're going to do in kindergarten."

(21:18):

About 15, 20 years ago, we said, "What happens if we actually start thinking about these kids at birth to five?" Because we know we're shaping their palates, we know that we're shaping their opportunities to engage and appreciate physical activity, their sleep patterns, their emotional well-being, and so all of those components. What we've seen through our work, through a partnership with the Centers for Disease Control and Prevention, it's really an opportunity to take the work that we started in Delaware and move it into multiple states across the country on any given year, anywhere from 15 to 25 states that we're working with to not only change what's happening at the practice level or the level of the classroom, but also thinking about, "How do we embed those standards into state systems, whether that's professional development or professional standards, so that it's not reliant on the one teacher, it's not reliant on the one program coming in, but rather it's built in and embedded into the work that we do in a longstanding way?"

(22:19):

I think those are lessons that we have learned across all of our work that we take forward anytime we think about what are other non-medical needs that we would want to integrate with our whole child health work.

Carol Vassar, podcast host/producer: (22:30):

I'm hearing the word integrate, integration, some form of it, throughout all of what everyone has said thus far today. I know Children's Wisconsin has been integrating mental and behavioral health and primary care. Nemours does something similar. You have actually, at Children's Wisconsin, grown it into a much broader model. It includes integrated dental care and now an integrated registered dietician. I'd love for one of you, Jenny, Dr. Schwake, to tell us what drove that evolution.

Chris Schwake, MD, FAAP, Director of Quality and Patient Safety for Children’s Medical Group, Children’s Wisconsin (23:05):

Our commitment to strengthening our relationships with kids and families we serve and finding ways to effectively connect families to care in the ways that they're looking for it has motivated that evolution, so very similar to what you were sharing earlier, Allison. Integrated care for us is possible, thanks to the diversity of service offerings that define who we are as children's. We spoke to that a little bit earlier in terms of what we are as a system and what we offer within primary care. Mental and behavioral health is a large and ever-increasing part of the care spanning the continuum of prevention, evaluation, and ongoing management within our primary care settings. Our robust system in mental and behavioral health department provided an infrastructure, and the philanthropic generosity of two of our donors, Jeff and Gail Yabuki, allowed for our aspirations around the idea of integrated mental and behavioral health services to rapidly become a reality.

(24:03):

The combination of those two forces within our primary care spaces have created the opportunity for us to test, to test the model, to study what are the impact of these services on our families, to learn from this work, and then ultimately continuously improve the model. One story that I have is a recent example of a child that was scheduled with me for a well visit, and their parent was overwhelmed because they had three other children with them, all of whom had medical needs, and three of the four had significant mental health concerns. Having the opportunity to collaborate with the behavioral health consultant within our Midtown pediatrics team, we were able to accommodate all of their medical opportunities that existed and also develop plans for their mental health needs in the moment.

(24:57):

In the prior state, before having integrated behavioral health, we would have tried to come up with a solution; we would have come up with a way to support the family, but it would not have been as in-depth or as inclusive as what we developed with our behavioral health consultant. Having integrated mental and behavioral health has truly been revolutionary for us in primary care, for us to take a greater role in more proactively identifying and addressing the mental and behavioral health concerns that are present for kids and, again, doing much more in that prevention space as well than we ever did prior to having that expanded care team and having the presence of integrated behavioral health within our primary care spaces.

(25:42):

As you mentioned, the presence for us of having hospital-based and co-located dental providers and services at multiple locations has also driven our integrated dental model, which is primarily focused at our Forest Home Clinic on the south side of Milwaukee. This model has really helped us address the limited availability to dental care and reduce the time to receive those services for our families who are covered by Medicaid.

(26:06):

Historically, access to clinical nutrition services has been reserved for those in need, for intervention, secondary to progressive primary needs, or developing comorbidities. Through Jenny's and our clinical nutritionist team's vision, and having our integrated behavioral health program as a reference model, we've been able to successfully test how to incorporate preventive and earlier-intervention approaches, similar to what you were talking about earlier, Allison, to a variety of nutrition-focused opportunities. As we continue to learn from this model, we really see that the potential exists to not only expand the availability of clinical nutrition services, but more effectively refer when more specialized care will be beneficial for a child and create greater awareness for their family of why those specialty services are needed.

Carol Vassar, podcast host/producer:(26:54):

I would love to dig into that integrated dietitian model. Jenny, I think you're the expert on this. What tools do you use to help address chronic disease in that integrated dietitian model?

Jenny Crouse, MS, RD, CD, Director of Clinical Nutrition, Children’s Wisconsin (27:08):

We've had a lot of practice at addressing chronic disease because we've been doing this in the specialty care space for a long time. Our approach has always really been one of partnership with families. We form relationships, we get to know them, we meet them where they are, we provide information, but ultimately let the families take the lead in terms of what they need in the moment, whether they need guidance about goal setting or whether they need resources to actually make those goals possible. It's something that we've done for a long time, and really, that model mimics what our primary care partners have also been doing. So it felt like a really natural evolution to bring that type of care into the primary care space.

(27:53):

For many years, Chris and I were both part of a healthy way core group where we pulled together partners from primary care and partners from our specialty care space that were doing similar work, but we knew... We were doing them in different settings, and we really wanted to make sure that work was getting pulled together so that families who used our specialty care services and our primary care services felt like they were having a similar experience. Really, we surveyed providers because it's hard and it's overwhelming, kind of the level of need there is in the elevated BMI space. What we heard from our providers in primary care was that they needed time, so they needed some extra capacity within that primary care setting, and they really needed that nutrition-specific expertise to partner with families in a more effective way.

(28:43):

We did start our program with philanthropy to pilot this, put a dietician in a primary care site to see what we could do. One of the innovations that we developed as part of that pilot was a health behavior survey that we integrated into our... Epic is our EMR, but... A way to measure success in terms of behavior change was really important for us because we had a new program, we needed measurable outcomes, any new program, in order to move to a more sustainable model. We've been partnering with payers to try to understand how they can support this work even further. We needed to show measurable outcomes in that space, and we did not want to use weight as our measure because we knew that... At the same time, we're trying to address elevated BMI, we're trying to address growing concerns around disordered eating. We didn't want to try to address one problem while creating another one by creating too much of a focus on weight as an outcome.

(29:43):

Because, ultimately, what changes the trajectory of health is not what somebody's weight is at one point or another, but rather that behavior change. That's really harder work. How can we measure success in that space? We've used this survey as a way for us to measure outcomes, but also for a way for families to see measurable change when they're doing the hard work of changing their behaviors. So that's really kind of where our early intervention work started. Since then, we've expanded to providing all kinds of early intervention, so from lactation support early on for newborns, all the way to supporting our teenagers who are going off to college and trying to figure out, "How do I make decisions around eating for myself? What does intuitive eating mean? How can I integrate movement regularly into my life as I move into that next phase?" We've been able to do that.

(30:42):

I can just say, personally, as a dietician who worked in the chronic disease space for my whole career... I started doing healthy weight management work and working in our diabetes clinic. I would see kids with type 2 diabetes, sometimes as young as age eight or nine, and you couldn't help but think, "Man, if we could have had a conversation three to five years ago, could we have changed kind of the trajectory for this child?" In the specialty care space, we're addressing, in many cases, a crisis. It got to that point where these kids have been in our system for a long time in our primary care space.

(31:20):

So, before we get to that point where there's all kinds of comorbidities associated with those behaviors, can we talk to them earlier? So that's really what this work has been, moving that care upstream in a way that feels better not only to us, as providers are saying, "Yeah, this is the time I'd love to be talking to you." When we're just starting to develop some of these habits, with some good information, with some good guidance around goal setting, we can just kind of tweak and kind of bring those trajectories back to where we want them to be, and so it feels more partnering and less like we're just addressing a crisis in the moment.

(31:56):

I was just going to talk a little bit more about our prevention work because that's really... Like the early intervention that we've done, we have scheduled visits, we have same-day visits, so we can see families when they're already in that space. We provided some flexibility there. But outside of that, we've created some prevention pathways so that, even when there isn't an active concern, in any free time the RD has, she's looking at the schedule and seeing what kids are in for their well-child visits.

(32:21):

We have prevention pathways for every age and stage of childhood, so from when they first start doing food introduction to when they're going into puberty, and that's a super challenging time when it comes to appetites and hunger and bodies, and so we have some good language around, "As a family, how do we talk about this? How do we make changes together? What can we anticipate going into that next phase?" It was super rewarding work to be able to say, "Hey, before we even get to this point, let's talk about it. Let's incorporate some good models of eating and feeding, and give some good information (that is) timely. Because every parent wants to take good care of their child's eating, and sometimes they just don't have the tools that they need to do that, and so how can we address that on the very front end?" That has really been kind of the most rewarding work that has come out of this.

Carol Vassar, podcast host/producer: (33:11):

It sounds like you've got it covered across the spectrum of the lifetime. What's next, Jenny, for this particular integrated nutrition program?

Jenny Crouse, MS, RD, CD, Director of Clinical Nutrition, Children’s Wisconsin (33:20):

Yeah. We are continuing to test models in different settings, what's working, what's not. As I mentioned, we've started with philanthropy dollars, and we're really trying to move into what is a more sustainable, long-term operations-based model. I had said we're partnering with payers. We're using some of those outcomes I mentioned to show how effective this work is, so that we can really get that long-term model that works and is sustainable, and we aren't always going to be focused on philanthropy dollars to do this work because it really is the right thing. We had some great conversations with our payer teams, our contracting teams, about how we can make this something that is long-term and just part of the way that our health system works, just like many of our other integrated services.

MUSIC:

Well Beyond Medicine

Carol Vassar, podcast host/producer:

Thanks to Dr. Schwake, Jenny, and Allison for joining us, along with Daniella Gratale, Associate Vice President, for Federal Affairs at Nemours, and her colleague, Hannah Wagner, Nemours’ Senior Advisor, Policy Development and Partnership, both of whom we heard from in segment one of this episode. 

You know, it’s a good thing Jenny mentioned - if briefly - the payment models that Children’s Wisconsin is looking to employ to pay for whole child health, as that is exactly the topic that we’ll cover in part two of this podcast arc on whole health in action. Don’t miss it. 

In fact, you’ll never miss an episode of the Nemours Well Beyond Medicine podcast if you join nearly 50-thousand of your friends and neighbors who have already subscribed to the podcast. You can do that on your favorite podcast app or by visiting our website at nemourswellbeyond.org. While you’re there, enjoy previous podcast episodes, put in a podcast episode idea, and subscribe to our monthly e-newsletter. That website again is nemourswellbeyond.org. You can also experience the podcast on the Nemours YouTube channel, or by asking your favorite smart speaker to play the Nemours Well Beyond Medicine podcast. 

Our production team for this episode includes Cheryl Munn, Lauren Teta, Susan Masucci, and Alex Wall. Audio production by Steve Savino and yours truly. Video production by Britt Moore. I’m Carol Vassar. Thanks for joining us, and remember: we can change children’s health for good, well beyond medicine.