Medica Foundation 2017 Annual Report

Medica Foundation


The Power Behind Change

Changing Communities page 4

It Takes a Community page 6

Roots of Strength page 10


Our mission is to fund community-based initiatives and programs that support the needs of Medica’s customers and the greater community by improving their health and removing barriers to health care services.

Dear Readers,

Sometimes the challenges our communities face seem overwhelming. » » The number of adults over 65 is growing, placing increasing pressure on family members who act as caregivers. » » Trauma experienced in early childhood years can set people on a path that has destructive consequences over their lifetime. » » Fear about one’s legal status in the U.S. can lead to paralyzing inaction in the face of urgent medical needs. » » The lack of money and insurance can make even routine care feel out of reach. But people are resilient. When smart people with compassionate hearts come together, and when they have the resources they need, the power to change is unleashed. This report tells the stories of people who have experienced that power. A mom and her children escaped from the violence of their home to Mary’s Place with

nothing but the clothes on their back. They had to start from scratch, but found their way to a better and more stable life. Sometimes the change comes in an instant. Such was the case at a group session for incarcerated pregnant women receiving services through the Prison Doula Project. These women have endured significant trauma throughout their lives. The program helps them better understand their own experiences and reactions, allowing them to learn about their pregnancy and gain parenting skills to stay connected with their children. In one session, a participant said, “I’d like a time out please. I need everyone in this room to know that this is what healing feels like for me. Thank you.” Because the challenges can seem overwhelming, it’s important to be reminded of how powerful change can be, and of the ingredients — people, passion, resources, community — that fuel change. That’s why we offer these stories in this year’s Medica Foundation Annual Report.

INSIDE THE REPORT The Power Behind Change. ............................3 Changing Communities...................................4 It Takes a Community.....................................6 Roots of Strength...........................................10 2017 Financial Summary. ............................13 Investing in Our Community. .......................14 2017 Grant Recipients...................................15

Robert Longendyke Executive Director

JoAnn Birkholz Foundation Director

Published by the Medica Foundation. The Medica Foundation is a nonprofit, charitable grant-making foundation. It is an affiliate of Medica Health Plans, a Minnesota-based nonprofit HMO. Grants are provided to organizations in Minnesota, western Wisconsin, North Dakota and South Dakota. Please contact us if you wish to reproduce any of the information in this report. © 2018 Medica Foundation. All rights reserved. FOUNDATION STAFF JoAnn Birkholz Foundation Director Heather Craig Foundation Coordinator Gina DiMaggio Program Manager

BOARD OF DIRECTORS (From left) Samuel Leon, M.D.; Esther Tomljanovich, Vice Chair of the Board; Burton Cohen; and John Buck, Chair of the Board.


VOA-MN Helping Families Living with Dementia

CHANGING COMMUNITIES Big change is coming as the baby boomer generation ages. Nationwide, adults over 65 will outnumber children in less than 15 years. By 2020 there will be one million Minnesotans over 65. Most of us want to age in place at home in our own community. Factors like the cost of care, proximity to health care facilities and culturally competent medical providers are all necessary to support that option. We’re helping communities develop innovative care alternatives.

Bridging Care with Cultural Competency

240 98% $1.4M

caregivers received training and support services on disease, care and behavior management. reported the education and services of this program helped families care for their loved ones at home longer. additional funds secured to expand the model to other culturally specific communities.

Early diagnosis, treatment and caregiver support can help people with dementia and Alzheimer’s disease live safely at home longer. With an $80,000 strategic grant, Volunteers of America-Minnesota (VOA-MN) developed a pilot program to provide individualized, evidence-based support for African Americans with dementia and their caregivers. This new model proved so successful they were able to leverage their Medica Foundation grant to secure an additional $1.4 million in funding for this work. They will partner with the state and other community organizations to refine this model and expand the program to help the Hmong and Somali communities struggling with this growing community health issue. “This grant had a profound impact on the scope and nature of our Caregiver Support Service. Having a culturally affirmative and responsive model improves quality of life for people with dementia, their families and caregivers and the community,” said Dorothea Harris, Caregiver Support Services Program Manager. Historical trauma presents challenges for any organization serving communities of color and can cause distrust of established medical institutions, diagnoses and medical advice. Many African Americans wait to seek services until the family’s situation is desperate. Despite these hurdles, the African American Caregiver Support and Dementia Consultation Program earned community trust by providing culturally appropriate information and resources to help screen for early warning signs of dementia and teaching caregivers how to care for their loved ones and themselves. Helping Mary Stay Home Mary’s family was worried. Their mother exhibited signs of dementia, wasn’t eating or bathing and refused support from social service providers and her family. She had a history of stroke, diabetes and high blood pressure — for which she had been taking the wrong medication — and hadn’t seen a doctor in six months. The VOA-MN African American Caregiver Support team connected with Mary’s family to schedule a home visit. The staff calmly explained the dangers Mary faced without proper care and she agreed to a doctor’s appointment, where she was diagnosed with dementia. VOA-MN staff checked her blood pressure weekly and made sure Mary had the medications she needed. A Medica- funded social worker provided support for Mary’s family to understand their role as caregivers, educate them on the disease’s progression and provide connections to resources — even helping Mary get new shoes to ease her diabetic pain.

Teaching Caregivers New Strategies The situation Mary’s family faced is common. There are more than 40 million unpaid caregivers of adults over age 65 across the United States. It’s stressful and can lead to caregiver burnout or illness. Organizations like Metropolitan Area Agency on Aging work with community partners to address these issues. Our grant helped them support caregivers of persons with dementia. The Resources for Enhancing Alzheimer’s Caregiver Health (REACH) program expanded to nine additional counties in greater Minnesota and doubled the number of REACH coaches throughout the state, bringing the total to 40. Peter’s* wife, Clara*, exhibited typical behavior patterns of dementia, including misplacing items, agitation, combativeness and confusion. She blamed her son for taking things, even though he lived in another state. Before her diagnosis, Clara showered daily, but Peter couldn’t get her to maintain a hygiene routine. The caregiver consultant helped Peter develop new problem-solving strategies. “Clara didn’t need to shower every day, every other day is enough. I learned how to create a positive experience to get that done,” Peter said. Caregivers like Peter reported the REACH program helped them feel less anxiety, a decreased burden and more positive mood.

*Names changed for privacy.




Despite their best intentions, some families struggle to meet their children’s needs. Others suffer the effects of trauma or violence for generations. These adverse childhood experiences (ACES), can have lifelong impact. These experiences are a predictor of economic, behavioral and health risks in adulthood, so early intervention is crucial. Recent research reveals that it is equally important to work with other family members at the same time. This multi-generational approach helps families build upon their strengths, rather than focusing on deficits. The results are powerful and lasting. Medica Foundation funds support organizations whose breakthrough work in this area is helping families get and stay stronger, healthier and more resilient.

CVIC received a grant to help improve the physical and mental health for children who have experienced trauma. Their efforts focused on enhancing relationships and building resilience by helping families in crisis through family education and connecting them to health care services, schooling and other essential services. This program helped women like Sherry* follow through on her brave decision to seek a healthier future for her family. Taking the First Step to Safety The violence Sherry endured at home was torture: threats to kill her, a hard fist leaving bruises across her body, and psychological abuse and control that left her feeling like a prisoner. Her children, Stacy*, just 9 years old, and Bobby*, 15, took it all in — and everything they saw and heard turned into chronic fear and anxiety. Sherry and her children had to leave in a rush to escape the violence and when they arrived at CVIC’s new shelter, Mary’s Place , they had nothing but the clothing on their back. Shelter staff provided them with the necessities: pajamas, toiletries, a change of clothes, warm meals and beds to sleep in. A family advocate sat down with Sherry to talk with her about her needs and where she wanted to start. She needed a job, her children needed help with school, and they all needed a place to live. They were starting from scratch and it was overwhelming. Finding your bearings takes time. Together, Sherry and her family advocate came up with a plan to prioritize and accomplish Sherry’s goals. Because her children were so impacted by the violence, Sherry wanted to start with them.

The advocate connected them with health care services and educated Sherry about the ways trauma affects children and parenting techniques that can help them heal. They found school social workers and counselors to support the kids. Sherry received gas vouchers to get the children to school and enrolled them in the summer lunch program to ensure hunger was not a problem. The family advocate worked one-on-one with Sherry’s daughter, talking about coping skills and practicing self-esteem activities, allowing her to focus on some hard issues that were troubling her at school. Eventually, she became more confident and began to smile again. Building a Foundation for Stability When Sherry was strong enough to branch out toward long- term stability, her advocate provided resources and support she used to find a job, and even helped her purchase clothing to fit her new job. Then they focused on housing. Sherry found an apartment she could afford, but had no dishes to eat from or beds to sleep in. The advocate made arrangements with a local consignment store that allowed Sherry to pick out furniture, and CVIC supporters provided other furnishings. When Sherry’s car broke down, jeopardizing her ability to get to and from work, the serendipitous gift of a car at that very time from a CVIC supporter provided a working vehicle. Sherry was overcome with gratitude. Today she, Stacy and Bobby are on their way to a healthy new life, one goal and one accomplishment at a time.

ACE Pyramid Mechanism by which adverse childhood experiences influence health and well-being through the lifespan.

Reducing Health Risks of Trauma Childhood exposure to violence and trauma is a serious public health concern that the Centers for Disease Control and leading researchers have studied for more than two decades. The CDC-Kaiser Permanente Adverse Childhood Experiences (ACEs) Study in the late 1990s broke new ground in tracking the effects of childhood trauma on health throughout one’s lifespan. ACEs were found to have a profound negative effect on overall health and wellbeing, and were linked to risky health behaviors, chronic health conditions, social problems and early death. Since then, more than 30 states and the District of Columbia have continued to gather vital data on the medical effects of ACEs. This important body of work provides information our communities can use to help provide safe, stable and nurturing relationships and environments for all children, improving their lifelong health and well-being. It helped to inform work of the Community Violence Intervention Center (CVIC) in Grand Forks, North Dakota to help families in rural and urban communities.

*Names changed for privacy.

Source : Centers for Disease Control and Prevention



Minnesota Prison Doula Project

90% 95% 500+

mothers jailed in rural communities were provided pregnancy and parenting support.

Mental Health Support for New Americans

Helping Communities Address Critical Shortages According to the National Institutes of Health, tooth decay is the most prevalent chronic disease in children even though it is largely preventable. One of the challenges families face is access to dental care for their children. This is compounded by a critical shortage of dentists in Minnesota and across the United States, with fewer each year accepting new patients on Medical Assistance. Preserving Children’s Smiles Seven hundred children and their families received essential dental education, routine and emergency dental care through a grant to Isanti County Public Health Department , working in partnership with Children’s Dental Services (CDS). CDS clinics serve children and youth, as well as pregnant women. The county demonstrated a large unmet need for dental services. The successful outcomes led to additional county funding for the program to continue and expand to serve more children. Helping Through Hard Times Receiving routine dental care was never an issue for Rosie* and her three children until her job status changed. Her usual dental clinic didn’t accept Medical Assistance reimbursement so she was forced to seek services elsewhere. Of the 11 dental providers in Isanti County, none would accept new patients with Medical Assistance because reimbursement rates are considerably lower than typical dental fees. Through a dental day clinic in the Isanti County Public Health Department, all three children received exams and cleanings from Children’s Dental Services and the 9-year-old had a filling and sealants applied. Rosie was grateful for a dental home to get them through a difficult time.

Unaddressed trauma can resurface long after people have escaped danger and its lasting effects on beliefs and behavior can impact generations of families and whole communities. At Holy Rosary Church in Minneapolis, administrators discovered that many Latinos feel comfortable approaching their church when in distress. Many first-generation Latino immigrant community members with no insurance for mental health care found themselves struggling with anxiety and depression, which affected their ability to function at home, work and school. The grant they received supported the Recuperando Tu Vida Despues de Trauma (Getting Your Life Back After Trauma) program to help people learn skills to help them heal and avoid passing the effects of their trauma on to the next generation. As the program inspired community trust, people accessing services grew by 100 percent. Providing mental health support in Spanish greatly increased their ability to access and follow through with treatment. This program also revealed a great unmet need, with 50 percent more appointments held than projected — a total of 1,500 therapy sessions. The program has secured additional funds to continue the healing work that began with this project. Helping Marta Heal Marta* participated in the program and felt anxious as long as she could remember. From early childhood, she struggled to protect herself to avoid the sexual abuse of male relatives. To escape that harsh reality, she married early, but to a man who severely abused her for more than 20 years. Eventually, the legal system intervened, removing him from Marta’s life. But learning how to live beyond the wounds and scars of decades of abuse proved to be much more complex. Through therapy, Marta was able to reflect on her body, heart and soul’s response to constant stress and to recognize how the abuse had made her feel worthless and ashamed. She learned to recognize and respond to her own fears and anxiety in healthy ways that made a positive difference in her self-esteem and workplace relationships. She also developed healthier connections with her adult children. This program helped a valiant survivor discover a healthier future, one beyond pain and shame.

of participants increased core parenting knowledge.

had reduced levels of depression.

Correcting the Odds Information gathered from ongoing studies related to adverse childhood experiences (ACEs) provides important insight into problems that continue to stress our communities. The original ACEs study and subsequent research looked at three categories of adverse experiences: abuse, household challenges and neglect. The University of Minnesota addressed these difficult social issues through the Minnesota Prison Doula Project , which has been so successful that it is now a standalone nonprofit organization. Healing Generations Despite Separation Some of the most powerful illustrations of the effects of family separation can be seen among mothers who are serving prison terms. More than three-quarters of incarcerated women are of childbearing age and most have minor children. Up to 10 percent of female inmates are pregnant when they’re admitted to prison. The Minnesota Prison Doula Project provided pregnancy and parenting support for more than 500 mothers jailed in rural communities. Doulas are advocates for pregnant women, offering comfort, advocacy and support during pregnancy, childbirth and postpartum. During the grant period, doulas attended 11 births, all full-term deliveries. Women in the program received parenting education and support, as well as increased access to reproductive health information.

During one group session with women in the Olmsted County jail, the mothers discussed the mental health manifestations of grief in their lives. This topic arose as the women shared their experiences of significant trauma and loss in their search for a better understanding of their own reactions to those experiences. One by one, they explored how the five stages of grief — denial, anger, bargaining, depression and acceptance — had been acted out in their relationships with their children. They also discussed the role addiction had played in their attempt to manage their intense and misunderstood emotions. As the conversation deepened, one woman experienced a breakthrough she wanted to share and requested the group take a moment to reflect on what was happening in the room that day. “I’d like a time out please, because I need everyone in this room today to know that this is what healing feels like for me. Thank you,” she said. For new mothers in the program, the joy of bringing their child into the world is short-lived. Most incarcerated moms spend between 48 and 72 hours with their newborns before they are separated. Newborns are typically placed with other family members or into foster care. Nonetheless, this program provides hope for women striving to improve the likelihood of reuniting with their children after their release.

*Name changed for privacy.

*Name changed for privacy. Services

“Prison birth work is watching intergenerational trauma in real time — our goal as an organization is to end this cycle.” ERICA GERRITY | Executive Director, Minnesota Prison Doula Project



Rural communities face significant barriers to health care access. Medical provider shortages, changing demographics, access to services and affordability of medications and equipment impact young and old alike. Our grants support rural organizations with deep roots in the communities they serve. We are proud of the trust they have developed with their clients, resourcefulness in maximizing impact, and tireless effort to support their local communities.


A Future to Smile About Oral health affects our ability to speak, smile, eat, and show emotions. Children with poor oral health miss more school and receive lower grades. Access to affordable preventive and restorative dental care is critical to ensure all children have a healthy start and a bright future.

Caring for the Neediest There are 3,500 residents of greater Steele County in southeast Minnesota without health insurance and with few health care options. More than half are diabetic, a quarter have hypertension and a third have high cholesterol. Doctors and other medical professionals at the Free Clinic of Steele County provide acute, non-life threatening health services to community members at no cost. They used grant funding to help purchase medication, medical and dental supplies for patients living at or below the poverty line. Many were afraid to seek health care because of their immigration status. An elderly woman, Rosa*, thought she was dying but didn’t seek care because she feared she would be separated from her family. A concerned neighbor informed the Free Clinic’s director, who stood outside Rosa’s door in freezing temperatures for over an hour to prove he was there to help. Finally, Rosa agreed to go to the clinic, where routine tests revealed she had a minor medical problem. The clinic helped her purchase the prescription she needed to get well and she now greets clinic staff with a hug. More than 250 patients were seen during the grant period, 70 percent of whom were Spanish speaking.

Extending a Safety Net Sometimes barriers to care are so overwhelming that people don’t know where to turn. Northern Dental Access Center is a nonprofit community dental clinic serving some of the poorest families in Bemidji and the surrounding parts of Beltrami County in northwest Minnesota. For patients with few resources and no safety net, the clinic provides a range of dental services, including oral health education, screenings, preventive care and comprehensive emergency dental care, as well as transportation. Insurance counseling helps clients access state health programs and veteran’s services. Northern Dental Access Center received a grant and provided direct care for 11,000 patients during a year when the clinic saw twice as many underinsured and uninsured patients as the previous year. They were also able to increase access for young patients who needed orthodontic treatment, bringing a much-needed service in- house. Reaching into the community, the center

hosted its first health fair, educating pregnant women and new mothers on the importance of dental care for themselves and their children. Responding with Respect Sarah* called Northern Dental Access Center worried because her daughter had been suffering from dental pain. They had no dental insurance and couldn’t afford treatment. She was invited to bring her daughter in right away to address the pain and infection. Sarah was emotionally overcome by this offer, relieved her child could see a dentist. Anna* needed extensive treatment, and through a partnership with a pediatric dental clinic, received treatment for her complex dental issues. The center’s insurance counseling service helped Sarah and Anna receive coverage and they now have a dental home.

*Names changed for privacy.

*Name changed for privacy.

70% of grants made in 2017 served rural communities.






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SUSTAD PHOTOGRAPHY Ben and Caitlin on their wedding day.

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Supporting Self-Sufficiency Sometimes all that’s needed to keep people healthy and engaged in our community is the equipment to care for themselves. HERO, Healthcare Equipment Recycling Organization is a six-time Medica Foundation grant recipient because of their significant assistance to individuals with disabilities. The most recent grant helped them serve over 5,000 individuals by providing affordable or no-cost medical equipment and supplies. They waived over $80,000 in fees for individuals with verified medical and financial needs and collected more than 190,000 pounds of medical equipment. HERO is a resource for thousands of individuals, whether their need is short and simple, or more complex and long-term. Strength to Stand Ben was diagnosed with multiple sclerosis in his early twenties, just months before marrying his sweetheart, Caitlin. HERO provided a wheelchair, shower chair, Hoyer lift and a special sit-to-stand lift that helped him stand and regain strength in his legs. Thanks to this equipment, therapy and treatments, Ben was using a walker by Thanksgiving, and by Christmas, needed only a cane to walk.

Community Funding



“HERO’s unique service of providing donated health care equipment and supplies helps alleviate the burden of high medical care costs. HERO provides resources that help improve our customers’ quality of life by offering them the freedom, mobility and dignity that they deserve. Thanks to the generous support of our donors, including the Medica Foundation, HERO can continue to provide this valuable service for our communities.”

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Funding Priorities During 2017, the Medica Foundation awarded grants totaling $1.2 million to support the following areas of health:

$300,000 Behavioral Health

$300,000 Early Childhood Health

$200,000 General Health Improvement

$200,000 Rural Health

$200,000 Key Initiative

BRIDGET ERTELT Communications Coordinator, HERO





88 Grants $1.2 Million 22 new or expanded programs funded

BEHAVIORAL HEALTH American Indian Family Center Center for Victims of Torture Communidades Latinas Unidas en Servicio (CLUES) HealthEast Foundation Life House, Inc. Reclaim St. David’s Center for Child & Family EARLY CHILDHOOD HEALTH A Chance to Grow Baby’s Space Children’s Dental Services (CDS) Churches United in Ministry (CHUM) Community Dental Care (CDC) Cornerhouse Interagency Child Abuse Evaluation & Training Center Emma Norton Services Interfaith Outreach & Community Partners North Shore Health Care Foundation The Family Partnership University of Minnesota Foundation Washburn Center for Children Way to Grow GENERAL HEALTH IMPROVEMENT American Cancer Society American Heart Association Development Ujamaa Place

Guild Incorporated Hibbing Public Library Lifetrack

Hispanic Outreach Program of Goodhue County HOPE Coalition Just Kids Dental, Inc. Knute Nelson Foundation Lakes Area Interfaith Caregivers Light the Legacy Lutheran Social Service Minnesota Mesabi Family YMCA Monticello Christian Social Services, Inc. Northern Dental Access Center Northfield Union of Youth Northland Foundation Northwoods Care Partners Our Lady of Guadalupe Free Clinic PACT for Families Collaborative Pearl Battered Women’s Resource Center Priceless for Purpose — The Steve Bartlett Cancer Nonprofit Organization Program for Aid to Victims of Sexual Assault Rice Lake Area Free Clinic Volunteers in Medicine Ruth Meiers Hospitality House South Dakota Lions Foundation Terebinth Refuge The BRICK Ministries, Inc. The Hills Youth and Family Services — Neighborhood Youth Services Valley Community Health Centers VINE Faith in Action White Earth Land Recovery Women’s Health Center of Duluth, PA

March of Dimes Marnita’s Table Minnesota Community Healthcare Network Minnesota Dental Foundation Minnesota Public Health Association National Alliance on Mental Illness — Minnesota National Alliance on Mental Illness — East Metro Crisis Alliance Parent Advocacy Coalition for Educating Rights (PACER) Propel Nonprofits Solecare for Souls The Arc Minnesota Yellow Medicine East Community Education YMCA of the Greater Twin Cities RURAL HEALTH Big Lake Community Food Shelf Brighter Tomorrows Central Minnesota Task Force on Battered Women Damiano of Duluth, Inc. Duluth Lighthouse for the Blind, Inc. Elder Network, Inc. Family Resource Center St. Croix Valley, Inc. Granite Falls Living at Home / Block Nurse Program Greater Grand Forks Senior Citizens Association, Inc. Healthfinders Collaborative, Inc. Helping Hands Outreach HERO, Healthcare Equipment Recycling Organization Rainbow Health Initiative Senior Community Services

Expanding Access to Dental Care More than 18,000 adults and children will receive dental care.

From Homeless to Hopeful Nearly half of grant dollars support the health of people experiencing homelessness.

Investing in our Future 2/3 of grants awarded address the complex health needs of children and youth.

American Red Cross Arthritis Foundation Association for Training on Trauma and Attachment in Children Bolder Options Community Health Charities Greater Twin Cities United Way




“For a community to be whole and healthy, it must be based on people’s love and concern for each other.”

MILLARD FULLER Founder, Habitat for Humanity




Or call 952-992-2060

PO Box 9310 Minneapolis, MN 55440-9310

© 2018 Medica Foundation. Medica Foundation is an affiliate of Medica Health Plans. FDN2163-90918

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