VISION of the Department of Health ....................................................................................................... 4 (2024)

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Contents

VISION of the Department of Health ....................................................................................................... 4

MISSION ................................................................................................................................................. 4

CORE VALUES ...................................................................................................................................... 4

Behavioral Health Division ........................................................................................................................ 6

Overview: ................................................................................................................................................. 6

Key Services: ........................................................................................................................................... 6

Major Accomplishments in 2024-2025:................................................................................................. 6

Problems and Corrective Actions:......................................................................................................... 8

Future Goals for 2025-2026: .................................................................................................................. 8

Alternative Funding Sources and Partnerships: .................................................................................. 8

Community and Client Contacts: .......................................................................................................... 9

Community Health Division..................................................................................................................... 10

Overview: ............................................................................................................................................... 10

Major Accomplishments in 2024-2025:............................................................................................... 10

Problems and Corrective Actions:....................................................................................................... 11

Future Goals for 2025-2026: ................................................................................................................ 11

Alternative Funding Sources and Partnerships: ................................................................................ 11

Environmental Health Division (DEH) ................................................................................................... 12

Major Accomplishments in 2024-2025:............................................................................................... 12

Problems and Corrective Actions:....................................................................................................... 15

Future Goals for 2025-2026: ................................................................................................................ 16

Alternative Funding Sources and Partnerships: ................................................................................ 17

Photos:.................................................................................................................................................... 17

Health Information Systems Division ..................................................................................................... 19

Overview: ............................................................................................................................................... 19

Major Accomplishments in 2024-2025:............................................................................................... 20

Problems and Corrective Actions:....................................................................................................... 20

Future Goals for 2025-2026: ................................................................................................................ 20

Alternative Funding Sources and Partnerships: ................................................................................ 20

Medical Services Division ......................................................................................................................... 21

Overview: ............................................................................................................................................... 21

Major Accomplishments in 2024-2025:............................................................................................... 21

Problems and Corrective Actions:....................................................................................................... 22

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Future Goals for 2025-2026: ................................................................................................................ 23

Alternative Funding Sources and Partnerships: ................................................................................ 23

Photos:.................................................................................................................................................... 24

Pharmacy Division .................................................................................................................................... 26

Overview: ............................................................................................................................................... 26

Key Services: ......................................................................................................................................... 26

Major Accomplishments in 2024-2025:............................................................................................... 27

Accomplishments related to division FY 2024/2025 goals and strategies ........................................ 27

Problems and Corrective Actions:....................................................................................................... 28

Future Goals for 2025-2026: ................................................................................................................ 28

Public Health Division .............................................................................................................................. 32

Overview: ............................................................................................................................................... 32

Major Accomplishments in 2024-2025:............................................................................................... 32

Accomplishments related to division FY 2024/2025 goals and strategies: ....................................... 34

Problems and Corrective Actions:....................................................................................................... 34

Future Goals for 2025-2026: ................................................................................................................ 34

Alternative Funding Sources and Partnerships: ................................................................................ 35

Photos:.................................................................................................................................................... 35

Quality Improvement Division ................................................................................................................ 38

Overview: ............................................................................................................................................... 38

Major Accomplishments in 2024-2025:............................................................................................... 38

Accomplishments related to division FY 2024/2025 goals and strategies: ....................................... 40

Problems and Corrective Actions:....................................................................................................... 40

Future Goals for 2025-2026: ................................................................................................................ 41

Alternative Funding Sources and Partnerships: ................................................................................ 42

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VISION of the Department of Health

Building a strong mind, body, and spirit together.

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.

CORE VALUES

Respect

We recognize the inherent dignity of each individual and will treat each person with reverence

and respect. The personal privacy and cultural diversity of each individual will be respected at

all times.

Behaviors:

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Listen attentively to others

Acknowledge and revere individual positions within the community (i.e. workplace,

tribal community, etc.)

Accept and honor personal and cultural differences

Empowerment

We support, protect and promote the rights of our patients, family members and staff, giving

them opportunities to provide input toward improving the quality of their lives.

Behaviors:

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Elicit input from others in matters that relate to their wellbeing

Advocate on behalf of our patients, families, and staff

Compassion

We are committed to treating all individuals with compassion and understanding.

Behaviors:

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Use appropriate tone, body language and words to respect individual dignity

Be open-minded related to individual preferences

Personalize our interactions as we navigate the processes of life and death

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Stewardship

We will use fiscal, material and human resources to provide the greatest benefit to the

individuals and communities we serve. We will be responsible for our use of resources and our

care for the environment.

Behaviors:

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Recycle all materials appropriately

Treat all we are entrusted with in a highly responsible and conscientious manner by

assessing the fiscal, material, human resource, and environmental impact of decisions and

act responsibly

Excellence

We are committed to the pursuit of excellence through ongoing training, performance

measurement and self-evaluation.

Behaviors:

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Actively participate in performance measurement, self-evaluation, and improvement

Acknowledge the importance and take personal responsibility for individual growth by

completing required training on time and seeking out additional training, as needed.

Integrity

We will be honest and direct with one another, treating each other with honor in a genuine and

open manner, while respecting Ho-Chunk culture and traditions.

Behaviors:

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Openly discuss issues related to each other with the appropriate individuals(s)

Listen to each other to resolve issues at an individual and organizational level

Acknowledge and respect the decision-making process

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Behavioral Health Division

Division Director: Ruth A. Garvin

The mission of the Ho-chunk Nation Division of Behavioral Health is to provide services that

promote wellness through healing the body, mind and spirit while incorporating Ho-chunk

values.

Overview:

The Behavioral Health Division has been continuing in the developmental stages this fiscal year

with filling needed positions in thee satellite offices, and ensuring financial responsibility, as

well as identifying community needs and addressing challenging situations.

The Behavioral Health Division provides community education, outpatient alcohol, drug, and

mental health services to tribal members, their children, other Nation tribal members, and

employees/families of Ho-Chunk Nation. Residential treatment services are available to Hochunk tribal members dependent upon funds available. All office locations in Black River Falls,

Tomah, La Crosse, Wittenberg, Nekoosa, Baraboo and Madison are licensed for both mental

health services as well as substance abuse services. Services can be accessed by contacting HoChunk Health Care Center at 715-284-9851 x 35014 or House of Wellness Clinic at 608-3551240 x 35583.

Key Services:

Inpatient/outpatient treatment coordination

Empowering Women Program

Community Education

Peer Support Services

Telehealth Services (limited services in Minnesota)

Medication-Assisted Treatment (MAT)

Treatment Planning & Review

Grief Support

Fatherhood/Motherhood is Sacred

Positive Indian Parenting

Driving with Care

Moral Re-conation Therapy

Perinatal Mental Health

Mending Broken Hearts

Parent/Child Interaction Therapy

Eye Movement De-sensitization and Reprocessing Therapy

Linking Generations by Strengthening Relationships

Other services available, see Behavioral Health brochure

Major Accomplishments in 2024-2025:

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Received State Opioid Response (SOR4) Grant award in the amount of $462,490.11

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Received the Tribal Nation Opioid Abatement Effort Grant in the amount of $524,864.00

Continued Substance Use and Mental Health Services Administration Medically Assisted

Treatment-Prescription Drug and Opioid Addiction Grant award in the amount of

$525,000.00 through 2026.

Continued Urban Rural Women’s Substance Use Services Grant award in the amount of

$385,137.00 through December 31 2025.

All Behavioral Health Policies and Procedures have been updated and will be continually

reviewed.

Utilizing staff more effectively in their specialty areas while using a combination of inperson and virtual services.

Continue with Medically Assisted Treatment (Naltrexone, Vivitrol, and Suboxone)

services with providers at both clinic locations.

Increased use of Sublocade over Suboxone, which has less risk of misuse and diversion.

Working collaboratively with medical providers at the House of Wellness and Ho-chunk

Health Care Clinic-BRF to address mental health needs and substance use disorders as an

Integrative Team process.

Continue to identify agencies for residential treatment services contracting to increase

bed availability to tribal members needing a higher level of care than outpatient services.

Also utilizing transitional living and sober living facilities to increase the duration of

sobriety for persons entering residential treatment.

Shared Care Managers as an adjunct to the Medical providers, and support when needed

to address needs of clients/patients as walk ins or in crisis situations.

Expanded Peer Recovery Specialists to provide real-time support to clients and others

struggling with substance use. In addition, these Peers can provide some crisis

management, transport, education on life skills, chronic disease management, NARCAN

use training, resource information, recovery management, transport for clients to

Recovery Meetings and Events, such as Narcotics Anonymous or Alcohol Anonymous,

as well as help with coordinating care.

Annual Prevent Suicide Conference, November 2025, held in Wittenberg.

Participation and presence at Public Health Block Parties events, pow wows, HCN

department activities, and other community events to disseminate mental

health/substance use information, and provide community education, i.e. Narcan training.

Training completed in Moral Re-conation Therapy as an adjunct for clients participating

on community corrections.

Supporting seeking residential treatment services and sober living by collaborating with

other community partners and Ho-chunk Nation programs/departments.

Hostopi Hoci is a licensed entity, recognized as a sober living entity in Wisconsin.

Obtained specialized training for some Behavioral Health Therapists in Youth Mental

Health.

Obtained specialized training for Behavioral Health staff in Mending Broken Hearts.

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Supported the HCN Department of Social Services and participated in the Family

Healing Camp in August 2025 by presenting community education activities and

interacting with community members.

Problems and Corrective Actions:

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Implementation of Hostopi Hoci-Women’s Recovery House, a temporary placement for

persons awaiting residential treatment services. Difficulty with seeking staff due to

limited applicants, or meeting criteria for the job description.

Ensuring staff are consistent through each of the satellite offices with policies, and

processes. Hiring of a Program Manager with experience in management of a Behavioral

Health agency familiar with the Wisconsin statutes, client needs, and Ho-chunk Nation.

Continue to address client needs, providing appropriate services, and timely as well.

Addressing by obtaining feedback from clients, and reviewing processes on a regular

basis.

Future Goals for 2025-2026:

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Contract with a psychiatrist for mental health services and medication management.

Continue to develop staff in areas of cultural awareness, AODA, mental health, and

community knowledge and diversity.

Explore options for an Intensive Outpatient Program (IOP) for patients that are not

progressing in traditional weekly outpatient treatment but do not need a higher level of

care, such as residential and/or hospitalization. Primary goal is to promote and support

long-term recovery through development of an ongoing plan of well-being.

Continue to develop and implement preventative programming for children, youth, and

family focusing on resiliency.

Increase interaction in the community through education program presentations and

development of support groups.

Expand providing services to youth in the community, and other school districts for inschool counseling services.

Expand group education in the jail settings to other locations.

Expand Narcan training to all the Ho-chunk communities.

Alternative Funding Sources and Partnerships:

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Continue partnerships with Department of Corrections, Jackson County for Kids, Native

American Fatherhood and Families Association, University of Wisconsin-Milwaukee

Center for Urban Population Research, and other Ho-chunk Nation Departments.

Continue to work with billing to streamline processes and assure timely billing occurs for

continued revenue. Identify revenue resources not currently being utilized.

Seek out appropriate grants for funding purposes that align with the Behavioral Health

Strategic Plan.

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Community and Client Contacts:

Peer Recovery Specialists supportive contacts: 738

Peer Recovery Specialists Community member interaction at events/contacts: 5847

Behavioral Health client contacts with providers: 3631

There was a 13% in the first six months of 2025 from the end of the six months in 2024.

Behavioral Health received 91 requests for financial assistance for residential, transitional, sober

living, or mental health services from July 1, 2024 through June 30, 2025.

Photos:

Family Healing Camp 2024

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Community Health Division

Division Director: Samantha Casey

Mission: Dedicated to preserving and promoting a healthy lifestyle while incorporating the

traditions of our Ho-Chunk people.

Overview:

Community Health is comprised of three divisions community health nursing which focuses on

skilled nursing and caregiver services, foot care, and health screening. Our Health & Wellness

division which focuses on preventative and chronic healthcare management offering a variety of

educational classes such as Balancing Your Life with Diabetes, Native Food for Life and many

more. The Health & Wellness division also offers one on one nutrition and exercise physiologist

appointments. The third division within community health is Food Distribution which is

dedicated to providing our tribal members with supplemental healthy food packages to 17

counties throughout Wisconsin.

Community Health is honored to care for our tribal members and thank them for allowing us into

their homes and lives and we look forward to continuing to provide quality care and services to

our service populations.

Major Accomplishments in 2024-2025:

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The food distribution program has added a couple of new food options such as extra

virgin olive oil and locally sourced wild rice.

43 participants in FY25 attended a Health & Wellness class (BYLD, NFFLO, and

Prevent T2) and 219 patients attended one-on-one education with either a Nutritionist or

Exercise Physiologist.

Per the 2023 & 2024 annual DART report/Audit for SDPI:

o Average weight loss of 2 pounds by class participants

o Average decrease in A1c by .6 for class participants

Held a variety of community events (Green Corn, Diabetes Walks, Foraging Walks, and

Canoe Trip) hosting 1,302 participants for all community events.

Health & Wellness also offers a variety of classes (cooking, canning, Youth and TAU)

providing education to 1,870 participants.

The Community Health Nursing division was able to onboard Nurses in all of our

services locations. This is a huge accomplishment retaining staff to serve our tribal

members. Building and maintain relationships is important and critical for the services

we provide. This allows for effective communication, collaboration and personal growth

for our staff and for the patients on our caseload.

The Community Health Nursing division has been seeing consistent numbers of patients

at their monthly foot clinics. this is reducing patients needing to be seen by providers and

ultimately podiatry. This is saving on insurance costs with seeing specialist and co-pays

associated with foot care.

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Problems and Corrective Actions:

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The Food Distribution Program has hit some roadblocks with being able to transition into

a grocery store style concept. We have since been able to get things back on track and

will hopefully be able to move forward with our plans soon. With this new concept and

technology FD will be able to streamline services for our patrons.

The food distribution program filled the Food Distribution Outreach Specialist position

which was previously held by Susan Wilcox for many years. With Shelena Brown, who

has proven to be a perfect addition to the team and has transitioned into the position

seamlessly.

There continues to be a decline in class participation for Prevent T2 classes, as a way to

combat this the H&W division will be creating a new curriculum that will not only

provide education but also opportunities for hands on activities.

Communication between community health nursing division and other divisions within

the health department had become an issue. As a corrective action to this we have

initiated meetings to be conducted on a more regular basis depending on the need either

monthly or bi-monthly. This has led to better communication and understanding of

services provided by the Community Health Nursing division.

Future Goals for 2025-2026:

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Once the Food Distribution Program is up and running in the new conceptualized store,

we will look more towards the future on different services that can be provided with the

switch in our software program.

The Health & Wellness division would like to expand our services to the youth

population as we primarily serve the 18 and older population. In the recent years, there

has been an increase in children being diagnosed with type 2 and we would like to get a

jump start on providing education and classes that will help them to live a healthier

lifestyle early on. In order to be able to do this we have applied for a new grant that will

help to support this endeavor.

The Community Health Nursing division continues to look to the future and is trying to

find the best path that suits not only the needs of the health department but also the needs

of our people. Currently, exploring the idea of entering into a Third-Party Agreement

between the State of WI, HCN, and a Managed Care Organization of our choosing. This

agreement will help to widen the variety of services that the Community Health Nursing

division can offer its patients that would be eligible for this program.

Alternative Funding Sources and Partnerships:

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The Health & Wellness division applied and received two grants the Healthy Foods grant

that was offered through DHS and the Data Modernization grant that was wrote for in

collaboration with the Health Department’s QI division. These grants will be utilized to

better some of our programmatic data mining issues and to renovate the community

gardens that the H&W division oversees.

The Community Health Nursing division continues to look for grant opportunities that fit

the needs of the division.

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Environmental Health Division (DEH)

Division Director: Rob Voss

Major Accomplishments in 2024-2025:

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DEH completed the Environmental Health digital plan review process for Phase 1 of the

Beloit Casino project. This work has been a joint effort with the Department of Business

and the HBG engineering firm. There are 16 aspects of Phase 1 that required

Environmental Health reviews.

DEH is the lead Division for the Department of Health Market Demand Analysis and

Master Facility Planning Study to increase overall department efficiency and optimizing

facility space.

DEH held 5 community Rabies/Parvo vaccination events in FY 2025. 236 tribally owned

pets received rabies vaccinations, 150 pets received parvo/distemper vaccinations, and 34

feline RCP.

The DEH Injury Prevention program provided 310 car seats for tribal members including

children enrolled in the 6 Ho-Chunk Head Start centers in FY 25. The Injury Prevention

program also trained 7 Child Passenger Safety Technicians, held one car seat check

event, attended three health fairs, and implemented the Buckle Bear car seat program for

Head Start children at six centers. The Injury Prevention Program has 19 trained Child

Passenger Technicians to cover the service population. In addition, the program trained

13 Head Start staff on school bus safety.

The Injury Prevention program provided 42 smoke alarms and carbon monoxide

detectors to community members including education on proper installation and

maintenance. The Injury Prevention program partnered with the Ho-Chunk Health Care

Center and House of Wellness Clinic to distribute 22 life jackets and water safety

information during well child exams. The IP program has reached nearly 2,000

individuals over social media products to provide education on Car Seats, Injury

Prevention and Wisconsin State Laws.

The Injury Prevention Program purchase and decaled a new Trailer.

The Injury Prevention Program - Midwest Tribal Coalition provided four support

meetings & Continuing Education Units (CEU’s) for tribes, Local Health Departments,

Hospital Staff, law enforcement, and other partners for Child Passenger Safety

Technicians.

The DEH Emergency Preparedness Program Distributed 500 Emergency Preparedness

Kits & Go Bags.

The Emergency Preparedness Program held four Tabletop Exercises for; HHCC & HOW

clinics on Workplace violence, a Health Department Medical Counter Measures Exercise

and a Health Department and HHCC & HOW Measles exercise.

DEH provided 57 food facility inspections ensuring Tribally owned facilities are

following Tribal Ordinance 3HCC6. The Tribal Sanitarian also provided a variety of

home consultations including bed bug, rat/mice infestations, human health hazard, and

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hoarding inspections. Quarterly food safety newsletters were distributed to all tribal food

establishments. Food safety training was provided to 21 Head Start employees as part of

the orientation process. Food safety education was provided at the Ho-Chunk Health

Care Center open house education fair. During the event cutting boards and food

thermometers were distributed. Food safety information was provided to the Department

of Agriculture to prevent exposure to E.coli.

DEH provided community education related to tick borne diseases. Information

included: tick removal kits (250 distributed), tick identification cards, and tick exposure

prevention measures.

DEH was awarded a National Indian Health Board Climate Ready Tribe Initiative grant

in FY 2025. This funding opportunity provided resources towards community climate

and health education, community tools to mitigate the impact of climate change, and

assessment planning/community response frameworks.

DEH updated all Environmental Health policies this fiscal year.

The DEH coordinated the following construction and maintenance projects in FY 25:

o Community Health Office and Ho-Chunk Health Care Center cement sidewalk

replacement project

o Ho-Chunk Health Care Center exterior pillar and stonework project

o Ho-Chunk Health Care Center nurses station call light upgrade project

o Ho-Chunk Health Care Center HVAC energy wheel replacement project

o House of Wellness Finance air handler blower replacement project

o House of Wellness basement plumbing upgrade project

The DEH Onsite Well and Septic Program completed construction projects through the

IHS 121 grant and Health Third Party Revenue funding which included the construction

of 8 wells and 7 septic systems, resolution of 42 septic system emergencies, 34 out of

water well emergencies, 30 well and pressure system repairs, and educated 104 Tribal

members on well, septic, and water treatment systems.

DEH continues to oversee the operation and maintenance of 7 wastewater treatment

systems and 9 community water systems. During FY 25 no major outages occurred and

all facilities received top scores during the FY 25 IHS Operation and Maintenance

surveys.

The DEH has overseen the construction of water and sewer infrastructure for the Village

West Development.

DEH completed the following IHS and EPA funded water and sewer infrastructure

projects:

o BE-22-M81 upgrade/replacement of control panels for the Ho-Chunk Village

Wastewater Treatment System.

o BE-22-M82 upgrade and replacement of deficiencies within the Blue Wing

Collection and Treatment System.

o BE-21-OM1i purchase of a UTV for the completion of operation and maintenance

activities for public water systems.

Water Quality monitoring was completed on (18) tribal streams during Ho-Chunk FY25.

Monitoring included chemical sampling, fish surveys, macroinvertebrate sampling and

habitat assessments.

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A Water Quality Assessment Report was drafted for all tribal streams monitored during

the period January 1, 2024-December 31, 2024.

DEH drafted a Non-point Source contamination Assessment Report and Non-point

Source contamination Management Plan using EPA Gulf Hypoxia Program grant

funding. These documents are part of the Treatment in a Manner Similar to a State

(TAS) application that will be submitted to EPA Region 5 in FY26 to establish an EPA

Clean Water Act Section 319 Nonpoint Source Program within DEH.

Invasive plant management actions were completed on approximately 467 acres of tribal

land in Shawano County during FY25 using BIA Great Lakes Restoration Initiative grant

funding.

Invasive plant management actions were completed on approximately 1,100 acres of the

Sacred Earth parcel in Sauk County during FY25 using BIA Invasive Species Program

grant funding.

Invasive plant management actions were completed on approximately 442 acres of tribal

land in Jackson County during FY25 using BIA Invasive Species Program grant funding.

Invasive plant management actions were completed on approximately 365 acres of the

Kickapoo trust lands during FY25 using BIA Invasive Species Program grant funding.

The Environmental Science Program Manager provided hands-on environmental

education programs and field trips for (384) tribal and non-tribal youth and adults on nine

occasions including U.W. Madison classes and many field trips with partner agencies and

non-profits including Natural Resources Foundation, WI Master Naturalists, WI

Association of Environmental Education and the National Tribal Historic Preservation

Officers Conference.

DEH completed (21) environmental reviews for development projects funded or

facilitated by Indian Health Service, Housing and Urban Development, BIA Roads

Program and HHCDA during the period.

DEH submitted an EPA Inflation Reduction Act 60105(b) Continuous Air Monitor Grant

application during the year and was awarded $80,785 in support of activities to replace

the existing Particulate Matter monitors at the two ambient air quality monitoring stations

located near Black River Falls and Tomah.

DEH submitted an EPA Clean Air Act Section 103 supplemental funding application

during the period and was awarded an additional $24,738 in support of air program

activities for the period 10/1/24-9/30/26.

DEH submitted multiple non-competitive grant applications and work-plans during the

year in support of the EPA Clean Air Act Section 103, EPA Clean Water Act Section

106, EPA CERCLA Section 128 and EPA CERCLA Bipartisan Infrastructure Law.

These recurring non-competitive grants total approximately $268,770 in annual funding

that support (3) DEH staff.

DEH prepared BIA invasive species and BIA Great Lakes Restoration Initiative grant

proposals and is awaiting notification on status of funding.

DEH Brownfields Tribal Response Program completed field inventory of all tribal

parcels with ingress and egress. Environmental hazards have been ranked and prioritized

for clean-up as funding becomes available.

DEH completed the primary to secondary electrical feed and metering conversion project

at the Sacred Earth parcel. The project included installation of new underground service,

new transformers, new panels and meters and deconstruction of the original overhead

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service including lines, utility poles and pole mounted transformers which were a safety

and liability concern.

 DEH completed the LED lighting upgrade project of the East and West Warehouses at

the Sacred Earth parcel during the year resulting in the replacement of inefficient sodium

halide and fluorescent fixtures with (178) energy efficient LED fixtures.

 DEH stockpiled and facilitated the proper disposal of (27.54) tons of railroad ties at the

Sacred Earth parcel during FY25.

 DEH received notification from EPA Region 5 that the Treatment as an Affected State

(TAS) Application for authorities under the Clean Air Act Section 505(a)2 and Section

105 was approved by the EPA Region 5 Administrator via a letter dated July 18, 2024.

 DEH Air Quality Program conducted (12) mold investigations and (2) radon tests during

the year upon the request of Tribal members or other tribal departments. Corresponding

written recommendations were sent to the homeowners and occupants.

 DEH Air Quality Program operated two ambient air monitoring stations located near

Tomah and Black River Falls that are designed to quantify the levels of Particulate Matter

(PM2.5 and PM10) in the outside air. This data is being used to compare measured levels

to the National Ambient Air Quality Standard for particulate matter.

 DEH replaced the two existing particulate matter air monitors at the air stations with new

particulate monitors that are more reliable and less expensive and easier to maintain.

These monitors were purchased by DEH after receiving an EPA grant award from the

Inflation Reduction Act.

 DEH facilitated the MOU agreement between the Ho-Chunk Nation and the WI Dept. of

Natural Resources regarding cooperative air monitoring under the WDNR Primary

Quality Assurance Organization.

 All previously stated accomplishments are aligned with Department of Health and

Division of Environmental Health goals, strategies and the Department of Health’s

Strategic Plan.

Problems and Corrective Actions:

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Implementation of the Infor accounting system prevented DEH from accessing budgets

for nearly 5 months. This made it very difficult to manage our budgets and conduct

regular financial work such as paying invoices. Better planning and training would have

been helpful. The implementation of Infor has also negatively impacted our ability to

order supplies, specifically from Staples and Amazon.

With the loss of the Treasury Grants Manager in March certain grant fiscal functions

have not been completed in a timely manner which makes operating and closing grants

very difficult. Having multiple people in Treasury trained to complete these tasks would

be helpful.

The Division of Environmental Health continues to address PFAS contamination within

the Brockway Sanitary District Drinking Water System and private wells on French

Island. This included supplying replacement filters for 104 reverse osmosis water

filtration systems for tribal members homes and rental units affected by the PFAS

contamination.

Another challenge that DEH is facing is the increasing costs to provide water and sewer

services due to inflation while having stagnant water and wastewater revenue. The

revenue generated by these services fund repair and maintenance of the water and sewer

systems. With a lack of funding there are concerns of funding emergency repairs that

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may be needed in the future. The water and sewer rates have been studied and

recommendations will be made to Legislature to consider changing the water and sewer

rates through HCN ordinance updates.

DEH has attempted a two-paygrade increase for the Maintenance Worker II-Health job

description but due to the compensation and classification project these efforts were held

up. Unfortunately, the compensation and classification project did not address this job

description even though this upgrade is very much needed as the position is still well

below industry standards. DEH will be readdressing this issue now that the job

description moratorium has been lifted.

Future Goals for 2025-2026:

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DEH will continue the Environmental Health comprehensive plan review for the Beloit

Casino Project. This Environmental Health plan review process for Phase 1 & 2 of the

Beloit Casino project will includes a digital plan review, a digital menu/service review,

and as-built site visits for all food, lodging, and swimming pools.

DEH will work with Legislature to revise the Swimming Pool Ordinance in 2026.

DEH will work with Legislature to consider changing the water and sewer rates through

HCN ordinance updates.

DEH will complete the Department of Health Market Demand Analysis and Master

Facility Planning Study for increased department efficiency.

DEH will seek grant funding for injury prevention and environmental programming.

DEH will continue work with HHCDA, IHS, and Heena Development to complete the

Village West water and sewer infrastructure project.

The DEH Invasive Species program will be inventorying an additional 1,000 acres of

trust land in the Kickapoo Valley Reserve. This will build upon the existing inventory of

over 5,000 acres.

The DEH will continue to address remediation of environmental issues which will

include the management of human health hazard homes, the removal of abandoned

mobile homes, and clean-up activities at the Sacred Earth parcel.

DEH will start implementation of the following water and sewer infrastructure projects.

This will include engineering work, contracting and oversight of the projects.

o Replacement of the Wazee Area Wastewater Treatment Plant emergency

generator.

o Completion of the Blue Wing Lift Station upgrades.

o Completion of the Village West Lift Station

DEH will oversee the completion of Food Distribution truck parking lot paving project.

DEH will oversee the completion of the Food Distribution lobby and grocery store

concept upgrade project.

DEH will oversee the completion of the Wittenberg Health Office drywall repair project.

DEH will oversee the Ho-Chunk Health Care Center HVAC control upgrade and air

balancing project

Page 16 of 42

Alternative Funding Sources and Partnerships:



The DEH is managing 37 grants totaling approximately $9.67 million and has not had

any budget or programing auditing issues. These grants include funding for wells, septic

systems, emergency repairs, clinic maintenance and improvement funding, community

water and sewer upgrades, injury prevention, emergency preparedness, climate

change/community resilience, invasive species, wildlife habitat protection, and EPA

programs such as clean air, clean water, general assistance, Brownfields, and

sustainability. Funding partnerships include IHS, NIHB, BIA, CDC, USDA, and the

State of Wisconsin.

 The DEH is continuously seeking new grant funding sources and will continue to do so in

the future.

 The DEH oversees 10 additional budgets which include NPD, Health third party revenue,

and 6 restricted accounts. In total, DEH oversees 47 budgets totaling approximately

$14.4 million annually.

 DEH continues to actively participate in partnerships with local public health programs,

Indian Health Service, Wisconsin Department of Health Services, Safe Kids Coulee

Region, Midwest Tribal Child Passenger Safety Technician Coalition, Wisconsin

Indigenous Public Health Network, WI Climate & Health Action Together Coalition,

Wisconsin Indigenous Public Health Network, Wisconsin Environmental Health

Association, the Badger Oversight Team, Badger Restoration Advisory Board, WI Tribal

Conservation Advisory Council, Monroe Co. Invasive Species Working Group, National

Association of Wetland Managers Tribal Advisory Committee, EPA Region 5 Tribal

Wetland Working Group Advisory Committee, and the WDNR Air Monitoring and

Management Advisory Group, as well as partnerships with all granting agencies.

Photos:

Village West Lift Station 1

Village West Lift Station 2

Page 17 of 42

CPS Techs and new trailer

Grant Funded Injury

Prevention Trailers

#1 and #2

CPS Tech classroom training

Buckle Bear and CPS Techs

CPS Tech Instructor

Page 18 of 42

Air Station Monitor

Upgrade Project

Ho-Chunk

Village West

Waterline

installation

Health Information Systems Division

Supervisor: Kateri Killian-Lambert

Overview:

Maintain core Information Technology systems along with collecting, storing, managing and

transmitting patient electronic medical records (EMR). Research and implement new technology

hardware and software. Network tracking & monitoring, oversee email services, remote support,

maintain software as a service programs, troubleshooting and technical support.

The Health Information Systems (HIS) Division demonstrated remarkable adaptability and

technical leadership over the past fiscal year, supporting nearly every operational and clinical

component of the Department of Health, through support tickets, significantly enhanced

infrastructure, cybersecurity, and project management systems.

Page 19 of 42

Major Accomplishments in 2024-2025:





















Successfully transitioned to a new firewall with routing optimization for security and

performance

Conducted core network upgrade at multiple sites including House of Wellness, Nekoosa,

and the Black River Falls clinic, with the introduction of Patchbox cabling systems for

improved patch management

Onboarded IT Security and HIS Training personnel

Developed a new hardened workstation image and prepared for deployment

IVR installation (subsequently, use was discontinued after 6-month period)

Per Mar panic buttons moved to cellular connections for alarm system

Kiosks and tablets installed for time and attendance

Implemented DNA Center and ISE port security for all Health facilities

Multiple staff trained in CompTIA A+, M365 Administration, NextGen system

workflows, device imaging protocols as well as continuing education in other IT

disciplines for the advancement of Health Information Systems.

Maintained prompt service response time and completed 4,240 service tickets for 238

employees/end users in the Department of Health.

Problems and Corrective Actions:







Inconsistent network performance at HOW was resolved entirely through inspection and

configuration of network devices, connections, and routing

Lack of communication between Medical Services and HIS team was addressed by

creating a biweekly Med Services meeting to promote communication and improve EHR

functionality

Underpowered switch closets at remote health offices improved with new UPS hardware

Future Goals for 2025-2026:





















Began planning of SD-WAN system for network and internet redundancy

Began migration of NextGen EHR to cloud hosting

NextGen Mobile implementation with eventual move to Ambient Assist for medical

record dictation

Implement Population Health Module in Nextgen for advanced quality reporting and

patient outreach

Upgrade NextGen electronic medical record software from 6.2021 to Version 8.0

NextGen SQL Reporting installation and configuration to supply additional care quality

reports for medical providers

Migration to Windows 11 and Office 2024

Intune Device Management

Upgrade of PRC module for RPMS

Upgrade of Orchard lab software for security purposes and additional functionality

Alternative Funding Sources and Partnerships:

Page 20 of 42



IHS grant funding covers salary for 50% of HIS staff

Medical Services Division

Division Director: Rebecca Shawley

Overview:

The Medical Services Division provides comprehensive health care to the Ho-Chunk Nation at

two ambulatory clinics, in Black River Falls and Baraboo, WI, and is committed to improving

the health outcomes of our patients and, through collaboration with other divisions, the rest of

the Nation. We offer full spectrum primary care, including prenatal, pediatric, and adult

medicine; podiatry; dental; optical; and recently radiology services. We manage chronic

conditions such as diabetes and heart disease, as well as acute illnesses. The Division is led by

the Director of Medical Services, who focuses on logistics and operations of both clinic sites,

and the Medical Director, a physician who provides care to patients and focuses on efforts to

improve quality of care and on leading and supervising the clinical teams.

Major Accomplishments in 2024-2025:

Transitions within Medical Services







The Director of Medical Services assumed the additional responsibility of Acting

Executive Director of Health in a dual role capacity on July 29, 2024.

New Executive Director of Health, Penny Ybarra confirmed in October, 2024. New

Director of Medical Services, Rebecca Shawley.

New positions created to add administrative support and to ensure the highest quality of

care for our patients. All of these positions have been filled and include:

Referral and Prior Authorization Specialist-to improve the consistency and

speed of access for the next level of care for our patients.

Registered Nurse Quality Coordinator-to address gaps and barriers to care and

to ensure we are meeting benchmarks and standards of care goals for clinic patients.

Optical Manager-To address administrative and Optical store work at both

clinics to ensure Optometrists more direct patient care time.







Best wishes for Dr. Kevin Gilmartin, Pediatrician who resigned in November, 2024.

Medical Services onboarded new dental hygienist Dena Ortgies-Nakamura at the HoChunk Health Care Center in January 2025, dramatically increasing access to dental care

for patients in the Black River Falls area.

Director of Medical Services attended AAI twice yearly meeting with UW-Wisconsin

Madison regarding preceptorship of medical students at HHCC with Dr. Cox in

December 2024. Two more students are lined up for preceptorship with Dr. Cox in the

Spring.

Page 21 of 42









The AAAHC accreditation survey was completed January 6 & 7th at the Ho-Chunk

Health Care Center and the House of Wellness Clinic. This was a multi division effort

and a huge undertaking. Congratulations to all for earning another 3-year accreditation.

Medical Services onboarded two new Radiology Tech II’s. The Rad Tech for House of

Wellness started in May 2025 and the Rad Tech for the Ho-Chunk Health Care Center

started in July 2025. These positions have been open for a long time partially due to a

shortage of radiology techs in the job market. We are happy to resume radiology services

in-house at both clinics.

Family Nurse Practitioner Christine Seguin retired 6/30/25 after over 25 years of service

to the Ho-Chunk Nation department of Health. We wish her all the best.

Sarah Staff, Family Nurse Practitioner was hired to fill the vacancy. Sarah comes to us

with many years’ experience from Black River Memorial Hospital. Welcome Sarah!

Problems and Corrective Actions:



Recruitment and retention have been a problem for many divisions within the Health

Department. To that effect, many Health department directors began having monthly

meetings in December 2024 to address recruitment and retention issues. Through this

collaboration and the pooling of resources, many positions within the department of

health have been filled. With the success of filling vacant positions, these meetings will

continue, both to fill any upcoming vacancies and to address retention of current

employees.

Page 22 of 42

Future Goals for 2025-2026:

In December 2024, health directors met with Action Strategy and Wipfli to close out the current

3-year strategic plan and to begin planning the strategy for the next 3 years for the department of

health. A large effort from Medical Services in the new strategic plan will to implement more

Ho-Chunk language and culture into the department. We have begun by inviting tribal members

to present on Ho-Chunk culture at our monthly clinic staff meetings. In the future we would like

to bring language classes or an instructor into the clinic to make it easier for clinic staff to attend.

A feasibility study was conducted by Wipfli and involved all the directors of health, to take a

look at our physical space, processes, and data to see where and how we can expand our services

and to show us what our priorities should be in doing so. The survey completed in July 2025 and

we are anxiously awaiting results.

Alternative Funding Sources and Partnerships:

Continue partnership with Black River Memorial Hospital, Mayo Health Systems, Gundersen

Health Systems, Marshfield Clinic, St. Clare Hospital, and other local health facilities.

Page 23 of 42

Photos:

Ho-Chunk Health Care Center

Rebecca Shawley

Director of Medical Services

Shannon Sullivan, M.D.

Pediatrician

Danielle Peterson, DDS

Dentist

Laura Pattison, M.D.

Medical Director

Neil Cox, M.D.

Family Physician

Sue Christopherson, FNP

Family Nurse Practitioner

Rachel Lundberg, O.D.

Optometrist

Charmaine Brandt

Lab Supervisor

Alex Kivimaki, M.D.

Family Physician

Sarah Staff, FNP

Family Nurse Practitioner

Joshua Van Ruden

Radiology Tech.

Page 24 of 42

Amanda Erickson

Nurse Supervisor

S

Courtnay Blackdeer

Clinic Office Manager

Starlyn Pettibone

Pat. Services Supervisor

House of Wellness

Amy Delong, M.D.

Family Physician

Mary Sabourin, M.D.

Family Physician

Tom Zirkel, M.D.

Podiatrist

Ram Rizal, DDS

Dentist

Katie Peper, FNP

Family Nurse Practitioner

Lisa Peterson, OD

Optometrist

Kiana Beaudin, PA

Physician Assistant

Kali Rice

Radiology Tech.

Page 25 of 42

Patrician Houghton

Medical Services Coord.

Nicole Olson

Nurse Supervisor

Weeta Montelongo

Pat. Services Supervisor

Jodel Greendeer

Clinic Office Manager

Pharmacy Division

Division Director: Eileen Romasanta

Overview:

The Ho-Chunk Nation (HCN) Pharmacy Division 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, non-Tribal HCN Employees, and any person

presenting with a valid prescription. In addition, within the Pharmacy Division, several pharmacists serve

a dual role, both working in the pharmacy and also working in a clinical capacity, serving as provider

extenders. Clinical pharmacists provide office visits, educating, treating, and managing patients with a

variety of health conditions, including psychiatry, smoking cessation, hormonal contraception and

diabetes. This innovative and complex pharmacy model creates a special opportunity for revenue

generation, enhanced clinical pharmacy services, and the highest level of health care.

Key Services:



















Prescription mail-out services, when requested, for patients across the country

Medication synchronization, by request, to receive medications at the same time and to

promote medication adherence

Pharmacy technology integration through the mobile app, RxLocal, as well as texting

notification

Patient-centered diabetes management, including medication and non-medication

management and continuous glucose monitoring education, and follow-up

Narcan training and availability to promote community opioid overdose response

Psychiatric clinical services and medication management, including nutritional psychiatry

Nicotine Treatment Services

Hormonal contraceptive management

Non-Tribal Member Prescription Co-Payment Incentive: zero co-pay for most generic

medications

Page 26 of 42



Comprehensive medication reviews to review timing of medications, any side effect

concerns, review medication list for any similar medications or best medications for

guidelines.

Major Accomplishments in 2024-2025:



















The pharmacy dispensed 10.6% more prescriptions compared to last year. In addition,

we served 10% more Tribal members this year compared to last year.

Revenue increased by 20% compared to last year. The increase in revenue is a result of

Tribal members having insurance, so the pharmacy can get reimbursed for prescriptions,

as well as Tribal members utilizing our health clinics so the pharmacy can purchase

medications at a discounted price. In addition, efforts by the pharmacy to follow

insurance preferences for medications continue to provide revenue to the tribe.

Added a pharmacy clerk to the House of Wellness location, that has allowed for a more efficient

workflow, allowing pharmacy technicians and pharmacists to process prescriptions, provide

clinical review and answer questions more effectively.

The pharmacy division is fully staffed at both locations, for the first time in at least 4 years.

Having a fully staffed division allows for more efficient workflows, increase services offered and

improve compliance with pharmacy rules and regulations.

Pharmacy moved from USPS to UPS as the preferred mail-out service. Moving to UPS has

improved mail-out prescription turnaround time, as well as decrease the number of lost

prescriptions.

Expanded Medication Assisted Treatment options by adding Sublocade as a medication option at

House of Wellness. Sublocade is only allowable as a clinic administered medication.

Our clinical pharmacists and advance practice pharmacists provided a total of 414 visits in

diabetes, hormonal contraception, smoking cessation and psychiatry. While this is a decrease by

28%, in total visits offered, the clinical pharmacist psychiatric visits increased by 13%. HoChunk Health Care Center pharmacy is fully staffed with pharmacy technicians.

Secured 2,400 free Narcan doses for the Nation through state of WI Narcan Direct program. In

the last 12 months, Pharmacy has worked with Behavior Health and Public Health to provide

Narcan and Fentanyl education, as well as Narcan kits to employees and community members

across the Nation. Pharmacy provided doubled the amount of Narcan training events provided.

Competed a Quality Improvement study on antibiotic prescribing. The purpose of the study was

to measure the impact of prescriber feedback and guideline education on antibiotic prescribing.

As a result of this study, pharmacy was able to partner with Ferris State University to utilize their

CHARM prescribing dashboard. This dashboard allows the better data reporting on antibiotic

prescribing patterns and how prescribing practices compare to guidelines.

Accomplishments related to division FY 2024/2025 goals and strategies







Goal 1: Decrease turnaround time for prescription dispensing. Objectively this goal was

met as prescriptions with no issues are processed within 24 hours.

Goal 2: Improve patient medication adherence by reaching out to patients by day 10 of

prescription being ready. This goal has been met as automatic text messages are sent not

only when prescriptions are ready, but also on day 5 and a phone call is made by day 13

if a prescription hasn’t been picked up.

Goal 3: Align employee goals with overall pharmacy division strategic plan. Individual

development plans were completed to support staff goals and professional development

while also improving the pharmacy division as a whole.

Page 27 of 42







Goal 4: Reduce medication spend by creating a preferred medication list for uninsured or

when insurance doesn’t cover medication. This goal has been partially met. While there

are some instances where another medication may be offered as an alternative, it is not

consistent and at this time, does not hold true for all medications and people. Hold

prescription turnaround time to within 24 hours, when there are no external factors

preventing the pharmacy from processing the prescription.

Goal 5: Improve productivity of the pharmacy leadership team and move forward with

goals and strategic priorities. With the pharmacy being fully staffed, pharmacy is able to

move forward with items that have been on hold. Leadership team able to meet regularly

and staff able to take improve day to day workflow, as well as take on projects they had

not been able to do in the past.

With the pharmacy being fully staff, there has been a focus on ensuring a strong

workflow foundation and focus on staff training and ensure staff are trained in all

pharmacy workflows.

Problems and Corrective Actions:







How information is reported and how data is pulled has been a barrier for identifying

how we are doing on goals related to prescription turnaround time and adherence. In

addition, the multiple softwares used by pharmacy and the clinic do not “talk”, making it

a lengthier process to pull reports. While workarounds have been identified, efforts are

being made to make these processes more efficient.

Despite now being fully staffed, the continuous increase in volume, as well as increased

time to focus on compliance and training has caused intermittent availability in pharmacy

services. Pharmacy is continuously reviewing staffing needs, as well as services

provided to identify if services need to be paused or pulled back. In addition, reviewing

what services provided overlap with other divisions of Health and how to best coordinate

these services.

Pharmacy has outgrown the space at both clinics, but especially at House of Wellness.

Limited space has made it difficult to keep proper medication stock, shipping supplies

and has led to errors. A feasibility study for the Health Department was conducted and

results of that study will identify priority areas and how best to expand services and

space.

Future Goals for 2025-2026:







Focus in the next fiscal year centers around improving patient health and outcomes.

Pharmacy plans to provide comprehensive medication reviews in the community, work

with the health team to improve diabetes outcomes as well as collaborate in care for other

health conditions, and focus on Narcan training and harm reduction education.

Improve communication to patients regarding pharmacy programs and services by

increasing social media presence, utilizing the Hocak Worak and distributing more

information out into the community.

Focus on 340B compliance to meet regulations by Health Resources and Services

Administration, as well as ensure pharmacy can continue to benefit from the 340B

program. The 340B program allows pharmacy to purchase medications at a discounted

cost to support financial sustainability. Ability to use 340B medications is dependent

upon patients being cared for by our providers.

Page 28 of 42





Increase pharmacist recruitment and pharmacy intern recruitment by contracting with

more schools, as well as research options for student housing.

Incorporate Ho-Chunk language into pharmacy workflow by having staff learn

introductory greetings and phrases, incorporate language into the voicemail greeting and

add signage incorporating language.

Total Prescriptions Dispensed and Revenue Generation:

Total Prescriptions Dispensed:











F.Y. 2021 – 93,647

F.Y. 2022 – 88,170

F.Y. 2023 – 107,339

F.Y. 2024- 118,642

F.Y. 2025- 131,258

Total Number of Prescriptions Dispensed

140000

120000

100000

80000

Total Number of

Prescriptions

60000

40000

20000

0

2021

2022

2023

2024

2025

Page 29 of 42

Total Revenue Generated:











F.Y. 2021- $9.60 Million

F.Y. 2022- $9.56 Million

F.Y. 2023- $13.07 Million

F.Y. 2024- 15.08 Million

F.Y. 2025- 18.18 Million

Total Revenue Generation

20

18

16

14

12

10

8

6

4

2

0

$ Million

2021

2022

2023

2024

2025

Photos:

Pharmacy Division at

Health All Staff Meeting

Page 30 of 42

General Council 2024

Celebrating

Halloween. After

passing out candy to

Head Start

Purple for National

Epilepsy Awareness

Month in November

Public Health Division

Division Director: Kandyce Dunlap

Overview:

The Division of Public Health is a comprehensive program the strives to provide primary and

secondary prevention for the Ho-Chunk Nation Department of Health service population. We

provide disease prevention and monitoring, connecting community members to health resources,

providing health education and skills, assessing community needs, implementing prevention

programs, and Public Health Accreditation. These are implemented through Public Health

Nursing, Public Health Workers, Public Health Specialists, and a Public Health Director.

Major Accomplishments in 2024-2025:







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







Implemented our Tribal Health Assessment to host 10 community conversations to get

feedback on factors that help our people and their families to be healthy and things that

make it harder to be healthy.

o Analyzed qualitative data from the sessions to develop main themes

o Developed Tribal Health Assessment Report that will be launched in FY 2026

Implemented half of the Community Health Improvement Plan prioritization sessions to

gather feedback on what priorities the Health Department should begin with.

Connected community members to resources and education to meet their whole health

needs including mental, emotional, social, and preventative health needs

o 2024 Summer Block Parties during FY2025 were Tomah, Nekoosa, Madison,

Black River Falls reaching 690 individuals

o 2025 Summer Block Parties during FY2025 were Wittenberg and Tomah totaling

265 individuals

o Provided 115 referrals for services.

Provided suicide prevention training to staff and community members: 14 virtual and in

person sessions

Implemented virtual education series to address awareness of services, connection to

culture, and promotion of resources to meet health needs

o 3 Native American Heritage Month sessions

o 23 Wažookį Woo’ehi sessions

Implemented Mental Health Wellbeing day for youth as a kickoff to Prevent Suicide

Hosto with activities for overall mental, emotional, and spiritual health for youth,

reaching 193 individuals

Partnered with Wisconsin Tribes in the Wisconsin Indigenous Public Health Network to

attend one forum and host one forum at D1CC with representation from 10 of the 11

Wisconsin tribes.

Update and standardize job descriptions to align with public health foundational areas

Page 32 of 42



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o Transitioned CHRs to Public Health Workers to better align with foundational

public health practices and prevention

o Hired and onboarded 2 new PHWs

Public Health Workers provided health education, prevention events, safe sleep, child

passenger safety for 2,609 individuals.

Improve Public Health Core Competencies for Public Health staff

o Implemented individual development plans for all PH staff to identify areas for

core competency improvement. This is also in alignment with accreditation and

our workforce development plan

Engage stakeholders

o Developed 8 communicable disease MOUs with key county partners to increase

access to communicable disease follow-up and better population-level monitoring

Conducted population-level monitoring of childhood immunizations

o Transitioned to focus on the crucial immunizations form 0-2 years old

o Provided phone call reminders and post cards for those not up to date, averaging

benchmark analyses of 1,139 reviews every month

Improve and expand maternal and child health (MCH) program to provide perinatal

resources, education, and skills

o Trained 3 additional staff as certified car seat passenger safety technicians to

provide car seat safety education and car seats from the Environmental Health

program

o Hired 1 additional staff to assist with maternal, child, and family health nursing

Improved access to and promotion of breastfeeding

o Implemented scavenger hunt to promote lactation spaces during Indigenous Milk

Medicine Week in collaboration with Great Lakes Inter-Tribal Council

o Added additional resources to lactation rooms for individuals to safely store

expressed milk

Helped host a Career and Resource Fair for Youth in partnership with Marshfield Clinic

and NTC.

Develop and implement coordinated messaging/education campaigns across the health

department through the Health Promotion Committee

o Began a pilot of coordinated messaging for monthly health topics across the

whole Health Department to ensure consistent messaging for prevention

education

Hired 1 Public Health Specialist to guide health communications, community health

assessment and improvement plans, and provide health education.

o Additional PHSP being hired in FY 2026

Implemented vaccine clinics for COVID-19 and seasonal influenza at community clinics,

providing 557 immunizations.

Page 33 of 42







Developed and implemented process and partner evaluations for events to provide

guidance for process workflows and partnership development.

Partnered with Tutor Services to provide health resource backpacks for 300 youth.

With funding from WI DHS, working with DPH worked with Behavioral Health and

Pharmacy to secure 3 Health Vending Machines to provide access to prevention and

harm reduction materials. The rollout of these machines and official launch will be in FY

2026.

Accomplishments related to division FY 2024/2025 goals and strategies:

All accomplishments above are aligned with the Division of Public Health and Department of

Health goals, as outlined by the strategic plan and monitoring and evaluation performance form

(MEPF). They are also aligned with granting objectives for the respective grants.

Problems and Corrective Actions:





Space for public health staff is an issue. Building the division to provide the necessary

services will require additional staff members and space for current staff is already

limited.

o One solution to this thus far has been having staff share an office and rotate days

of the week that they work in the office.

The transition to in the Infor system caused delays in being able to access budget

amounts Action: worked with treasury to get training on the new system

Grant reporting to state and federal agencies has been delayed since April 2025. This has caused

significant issues with continuation funding from the federal agencies. Suggest having multiple

people in the Grants Manager role in treasury to ensure essential services are provided during

transitions.

Future Goals for 2025-2026:















Hire an additional Public Health Specialist to assist the Department of Health with health

communications.

DPH will work with Legislature and DOJ to update the Isolation and Quarantine

Ordinance in FY 2026.

DPH will continue expansion of prevention and health education events through the

Public Health Workers.

DPH will continue to monitor and address communicable disease threats, outbreaks, and

response to cases.

DPH will oversee community vaccine administration for seasonal vaccines, and provide

monitoring and outreach for childhood vaccines.

DPH will continue to seek grant funding for those funding sources that will be ending.

The Health Department is planning for Public Health Reaccreditation in 2027. DPH will

continue to work with other divisions in the Health Department to document

Page 34 of 42





demonstration of PHAB standards and measures. This also includes submitting annual

reports to the accrediting body.

Working within the DPH to identify and develop top areas of need for

training/improvement as guided by the workforce development plan and individual

development plans and that are in alignment with foundational public health areas and

competencies.

Develop and implement rollout of a Communication and Branding Guide for the

Department of Health to provide consistent health education and promotion across the

health department to ensure that DOH continues to be a trusted source of information.

Alternative Funding Sources and Partnerships:



















Public Health manages 10 state and federal grants for programming totaling over $2.5

million dollars

Public Health has secured additional grants in this fiscal year through Indian Health

Service, Great Lakes Inter-Tribal Epidemiology Center, and the CDC.

Public Health has secured and deepened partnerships with Local/County Health

Departments including:

Jackson County

Sauk County

Monroe County

Madison-Dane County

Wood County

Shawano-Menominee County

Photos:

Alcohol Awareness

Day event at House

of Wellness

Page 35 of 42

Andrew Blackhawk

Memorial Day Powwow

tabling (May 2025)

Black River Falls Summer Block Party

(August 2024)

Page 36 of 42

Programming at TAU

gardening event

(Wittenberg, Spring 2025)

Collaboration at tree

planting events

(Wittenberg)

Wittenberg

Summer Block Party (June 2025)

Tomah

Summer Block Party (June 2025)

Page 37 of 42

Quality Improvement Division

Division Director: Daniel Libke

Overview:

Since the creation of the Quality Improvement Division, the Department of Health has

continually strived 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

opportunity, creates plans for improvement, and monitors those plans through completion. PlanDo-Check-Act, the PDCA 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 check 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.

In January of 2025 both the Ho-Chunk Healthcare Center in Black River Falls and the

House of Wellness in Baraboo, hosted the Accreditation Association for Ambulatory

Healthcare, Inc. (AAAHC) for site surveys. Following these surveys, the clinics achieved the

full three-year accreditation. This will next be up for renewal in February 2028. Accreditation

by AAAHC reflects a 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 and support accreditation standards in our ambulatory facilities.

The Quality Improvement Division has also assisted 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 and standardization of public health

practice and performance; develop leadership, and strengthen relationships essential to public

health services. The Department of Health attained PHAB accreditation in October, 2022, with

direct support from the QI Division in maintaining and updating a Quality Improvement and

Performance Management Plan, encompassing both clinical and public health quality measures,

a Workforce Development Plan to increase human capital in our public health workforce, and

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

Major Accomplishments in 2024-2025:



AAAHC Accreditation Achievements:

o Achieved a full three-year term of accreditation for both clinic sites

o Hosted AAAHC for onsite clinic survey at both sites

o Facilitated the review and approval of policies and procedures submitted to the

Health Accreditation Board

o Verified licensing credentials for Health Department staff as needed

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o Facilitated the activities of the Quality Improvement Committee in the review and

monitoring areas of the QI Plan including; Safety, Infection Control and Policies

and Procedures committees

o Vetted Health Dept. employees with background checks, either FBI or name only

state checks

o Supported and monitored quality improvement projects and peer reviews

o Conducted annual audits of our programs

o Completed the annual comprehensive Infection Control Risk Assessment and

Plan

o Collected and reviewed vaccination records for all Health Department employees

to ensure health of employees and patients

o Tracked and reported all infectious and communicable diseases within the Health

Department, including developing internal focused surveillance reports

o Continued a robust infection control surveillance program including all infectious

and communicable diseases, hand hygiene, surgical site infection, and sterilization

o Created and disseminated staff notifications and education related to infection

control and prevention

o Continued implementing the Infection Control plan to encourage prevention

activities and reduce risk

o Continued developing the Infection Control program to address changing

communicable disease needs; this includes increased collaboration with the Public

Health Division, expanding surveillance capabilities, and routine data sharing and

education about infectious diseases with the community.

o Developed several standardized skills competency checklists related to infection

control

o Continued to coordinate standardization infection control policies and practices

across Health Department Divisions

o Conducted patient satisfaction surveys twice and shared results with the Health

Accreditation Board for continuous quality improvement

o Continued to review Patient Complaints to ensure patient health care satisfaction

o Monitored patient complaints and incident reports to ensure that concerns are

addressed to meet employee and care of patients’ concerns

o Continued to review incident reports to ensure they are dealt with promptly

o Created a new incident report data base that can show real time data on a

dashboard accessible to all staff and improve accountability with tracking

automations



PHAB Accreditation Achievements:

o Completed QI Studies in Public Health (Childhood Immunization

Reminder/Recall), QI (Client Satisfaction Surveys), and began QI Studies for

Pharmacy (Concordant Antibiotic Prescribing) and QI (Improving Sterilization

Knowledge)

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o Continued the development and dissemination of the Public and Environmental

Health Annual report which includes Ho-Chunk data like population, death,

ER/hospitalization statistics, community conditions, and health outcomes like

maternal/child health, STIs, asthma, water quality and more. Continued a growing

partnership with the Office of Enrollment.

o Participated in the annual report for PHAB accreditation

o Updated the Health Department Workforce Development Plan (PHAB centered)

o Supported the Public Health Division in PHAB reaccreditation, including

technical assistance, guidance, and data visualization reporting on the Community

Health Assessment (CHA) and Community Health Improvement Plan (CHIP)

o Provided a central point for two-way communication between tribal, local and

state health departments in WI

o Participated in numerous meetings to prepare for the Community Health

Improvement Plan.

o Continued to update the Health Dept. Performance Measures with each Health

Dept. division

o Conducted the annual employee satisfaction survey to assess employee

satisfaction among the Health Dept., an integral component of performance

management – with improvement from previous years

o Conducted the annual employee satisfaction survey, distributed results with staff,

and supported the Department in implementing findings and solutions



Achievements Impacting both AAAHC and PHAB Accreditation:

o Updated/consolidated Performance Management/Quality Improvement Plan

(PM/QI Plan – required for AAAHC and PHAB accreditation)

o Continued to meet with the Health Board of Directors, as well as quarterly

meetings with the Health Accreditation Board

o Continual update of Health Dept. Organizational Chart

o Created two new job descriptions for the QI Division – Quality Improvement

Specialist and Healthcare Quality Data Manager – QI Specialist replaces the QI

Compliance Officer job description

Accomplishments related to division FY 2024/2025 goals and strategies:



The Department of Health’s Strategic Plan includes the Quality Improvement Division.

The accomplishments listed above are all aligned with both the Department of Health and

the Division of Quality Improvement’s goals and strategies.

Problems and Corrective Actions:



Implementation of the Infor accounting system created barriers for the QI Division to

access the budget for nearly five months. This caused difficulties the management of

our budgets (HNPD and IHS) and resulted in the cancelation of several monthly

QI/Finance meetings. Once the access to our budgets was reinstated the monthly

meetings resumed.

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 There have been some issues with grants and getting them set up in the system so that

they can be utilized. The GLITC grant that QI shares with Community Health has a

very short time to be spent out (Aug. 2025) and when the line items were entered to

begin using the grant they were entered under Public Health. This caused further

disruption and confusion with both divisions as well as Health Finance as the Senior

Grants Manager, who was only able to share the line item with QI/CH on July 11, 2025.

Future Goals for 2025-2026:

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Continue to update the Health Dept. Performance Measures with each Health Dept.

division

Continue to verify licensing credentials and background checks for Health

Department staff as needed

Continue to implement expanded functions in HealthStream (checklists, tracking and

individualized training)

Continue to vet Health Dept. employees with background checks, either FBI or name

only state checks

Post for and hire Healthcare Quality Data Manager

Transition QI Compliance Officers to Quality Improvement Specialist – possibly hire

one more if budget allows

Continue to support and 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 to review incident reports to ensure they are dealt with promptly

Conduct the annual employee satisfaction survey, distribute results with staff, and

support the Department in implementing findings and solutions

Develop and disseminate updated 2025 data measures for the Annual Public Health &

Environmental Health Report, in collaboration with other Ho-Chunk Departments and

divisions such as GIS and the Office of Enrollment.

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

Procedures committees as well as Quality Improvement Committee

Continue to verify licensing credentials as necessary

Create and disseminate staff notifications and education related to infection control

and prevention

Continue implementing the Infection Control plan to encourage prevention activities

and reduce risk

Continue developing the Infection Control program to address changing

communicable disease needs; this includes increased collaboration with the Public

Health Division, expanding surveillance capabilities, and routine data sharing and

education about infectious diseases with the community.

Infection Prevention Nurses will attain the Certificate in Infection Control (CIC), a

designation which highlights the highest level of care, knowledge, and practice in

infection control and prevention.

Obtain Certified Professional in Healthcare Quality certifications for QI Director and

QI Specialists

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

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Support the Public Health Division in PHAB reaccreditation, including technical

assistance, guidance, and data visualization reporting on the Community Health

Assessment (CHA) and Community Health Improvement Plan (CHIP)

Continue to comply with AAAHC standards

Alternative Funding Sources and Partnerships:



Applied for and received the GLITC Data Modernization Grant to enhance the

development and implementation of our data collection efforts

 Continue to search and apply for grant opportunities, relevant to QI functions

 Continued collaboration with Wisconsin Public Health Association

 Continued collaboration with tribal clinic Quality Improvement team

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