Category: Community Assessment

Located just a few kilometers from the city center of Halifax, Spryfield is considered as an urban community with easy access to both natural environments and commercial/business structures. In terms of community health jurisdiction, Spryfield falls under Community Health Network 2 or the Chebucto Community Health Team. Spryfield is a great neighborhood to live in in terms of accessibility to essential establishments. However, just like any other community, Spryfield suffers from a number of health issues. One of which is the prevalence of poverty.

This paper is aimed to present the issue of poverty in the community of Spryfield. A community assessment was conducted to be able to understand and create a snapshot of Spryfield as a community. Determinants of health within the community that contributed to the issue of poverty will also be discussed. Programs that are in place to help solve this issue as well as the role of the Community Health Nurse will be presented in this paper.

Community Assessment

The community assessment was accomplished through different methods. Observation of the community was done through walking and driving around the neighborhood. Online information about the health demographics of the community was also utilized as well as online news articles. Finally, interviews were conducted with neighbors and members of the Community Wellness Centre.

Locale/Structure

Spryfield Community in Halifax, Nova Scotia is abundant with the natural environment and built environments. Natural bodies of water such as lakes, streams, ponds, and a river are found within this community (We are Spryfield, 2006). As I was driving around the community, I was able to come across a lot of greenery. Even though Spryfield is just outside the city center of Halifax, it doesn’t feel like you are living in an urban area because you are surrounded with nature.

Spryfield has several grocery stores, pharmacies, doctors’ offices, banks, restaurants, barbers, hairdressers, veterinary services, and other establishments all within a 5 to 10-minute drive. You will find most of these establishments along Herring Cove Road and Dentith Road. The area surrounding these two roads is considered the center of the community. There is a Community Wellness Centre located at the Spryfield Shopping Centre where residents can access various health services.

Most of the apartment buildings in the area are run down and need repair or renovation. I live in one of these apartment buildings and when I moved in, the unit was in really bad condition. The condition of the hallway also reflects how old the building is. It took a lot of convincing in my part to have the owner do repairs. In an interview, G.McGillis, a fellow churchgoer, mentioned that they have the same issue in their apartment building (personal communication, March 8, 2020). Most housing in the community whether rental or owned appears to need major repairs. There is one public housing community located in Spryfield which is Greystone (Capital Health, 2014).

Captain William Spry Community Centre which has a pool and meeting rooms is one place where residents of the community congregate. People also congregate in various churches with different religious affiliations. I was able to go to two of these churches and it is where I met the residents of Spryfield. It is also where I felt a sense of community.

Social Systems

There are four schools in Spryfield namely, Elizabeth Sutherland School, Rockingstone Heights Elementary School, J.L. Ilsey High School, and Central Spryfield School (We Are Spryfield, 2006).

The Community Wellness Centre is a joint partnership of Capital Health, Dalhousie Family Medicine, the IWK Health Centre and the Chebucto Communities Development Association, this is where community-based health services can be accessed int the area (Nova Scotia Health Authority, 2020). This facility offers free wellness programs for the community. They also offer specific programs for health issues in the community. There are several nursing homes and residential care facilities located in Spryfield where the community’s seniors and those needing long-term care reside. There are doctors’ offices as well as walk-in clinics in the community. There is also a blood collection clinic in the area.

Spryfield offers both indoor and outdoor recreational facilities. One major indoor recreational facility is The Captain William Spry Community Centre which supports the community through recreation programs, meeting spaces, the wave pool, and the library. The Spryfield Lions Rink is where the residents enjoy skating or playing hockey as well as watching Chebucto Minor Hockey games (We Are Spryfield, 2006). The most popular park in Spryfield is the Long Lake Provincial Park where people do recreational activities but mostly in the summer. There are also smaller parks in the area where the residents take their kids to play and engage with other kids. Schools in Spryfield also have baseball and soccer fields.

A lot of residents in Spryfield travel using their own vehicles. This contributes to very slow traffic along Herring Cove Road just before the Armdale Rotary during rush hour. Residents also have access to public transportation such as buses and taxis. Route 9A, 9B, and 32 of the Halifax Transit service the area of Spryfield. There are also bikers and pedestrians who travel by foot in the community. Along Herring Cove Road, I have seen an ample number of pedestrian lane crossings but, there is still a threat to pedestrian safety as a lot of drivers go beyond the speed limit and sometimes do not halt when the pedestrian crossing lights are blinking.

Since Spryfield is part of the greater Halifax Regional Municipality, the governing body for Halifax also governs Spryfield. There are districts that consist of HRM and Spryfield belongs to District 11 with Steve Adams as councilor (Halifax, 2020).

People

Spryfield is a community with a diverse population. People from different races, ethnic origins, immigration statuses, and social statuses live in this community.

According to the 2016 Census, Spryfield has a population of 11,700. Of this population, 65% belongs to the working-age population (20-64). Specific age groups’ percentages are as follows: 0 to 14 is 16%, 15 to 24 is 11%, 25-39 is 22%, 40 to 64 is 38%, and 65 and over is 13% of the total population. People living in families is 57% of the population while the rest are either living alone or are in a lone-family household. In Spryfield, 10.5% of the residents are immigrants and non-permanent residents. The population percentage of those who are racially visible is 14%. Spryfield has 8.2% of its population with Aboriginal origin while 62% of the residents are of European origin. In 2016, 52% of Spryfield residents 15 years of age and over had a high school certificate or less. Those with university certificates, diplomas or degrees consist of 20% of the total population. (DWPilkey Consulting For United Way Halifax, 2018)

Spryfield’s average family income is $57,600 compared to $86,800 for Halifax Regional Municipality. Spryfield’s couple families with children’s average income is 72% of the HRM average. Lone-parent families and those who are living alone have much lower household incomes. The After Tax Low Income Measure shows 40% of Spryfield children, 26% of the working age, and 25% of seniors live in households with low income. Fifty-seven percent of the population were employed, 6% were unemployed and 37% were not in the labor force. The reasons for people not being in the labor force include having mental and physical disabilities, single mothers with small children, seniors, and discouraged workers not looking for employment. Thirty percent of Spryfield’s workforce belongs to low-paying jobs such as sales and service jobs. (DWPilkey Consulting For United Way Halifax, 2018)

A community can be defined as “a social group of any size whose members reside in a specific locality, share government, and often have a common cultural and historical heritage.” The aim of the community assessment is to determine the specific community’s strengths such as talents, skills and performance as well as the needs and challenges. Local institutions including religion, politics and education are important role players in the community and its influences. Butterfoss (2007) stresses the importance of the early enrollment of a community assessment to better address concerns. This assessment identifies community health issues in the Perrysburg Ohio community and each factor by using the PESTLE framework for establishing other contributing factors such as the Political, Economic/Education, Social, Technological, Legal, and Environmental aspects. The PESTLE framework is coupled with the SOAR (Situation, Object, Action and Result) method of appreciative inquiry (Smathers, 2015).

Politics

The political environment of the community influences the health aspects by the policies implements by them as well as the electoral behavior influencing the well-fare of the citizens. The presence of social workers and politicians are evident during electoral activities and people tend to turn to churches and community leaders for guidance and assistance. A current example is the possible implementation of the school levy system which if not implemented, can lead to teachers losing their jobs. The reigning political party can also affect legislation and consequently the communities and way of life by society which can either be positive or negative.

Economics / Education

Various economic factors contribute to the health issues in the community. The percentage of residents with health insurance seems to be employment-based and must be compared to the people with public health insurance. Different types of health insurance are observed and directly influence the access of the community to certain level of medical treatment and options. The income and employment levels of the community can attribute towards the health problems experienced. There are higher percentages of both families and children living below 100% of the federal poverty level resulting in a decrease in accessibility to health related sources. The educational attainment and proficiency influence the probability of employment and the level of employment which indirectly affects the income and ability to provide in the family member’s needs. In lower income areas teenage pregnancies are observed where the teenager will leave school. A lot of the people from this socio-economic background is also unable to complete college due to the financial strains attached thereto (Jepson, 2016). This results in impoverishment of a community and a decline in accessibility to health care and knowledge needed.

Social Factors

Housing and homelessness are an issue in the community. People with an increase financial status have access to better housing enabling them to live a higher quality life because of the extensive network of contact with better schools, hospitals, water and sanitation. This can also influence the community members’ ability to access healthy, fresh food and can consequently affect health. Institutions for health are accessible by foot in the community but high volumes of out-patient waiting rooms cause frustration and accelerate the problem. Food insecurity is defined by the United States Department of Agriculture as a lack of access to enough food for an active, healthy life and limited availability of nutritionally adequate foods. Homeless people of the community have food insecurities which can lead to diseases. Poor people do not have the same nutritional intake as people of higher status, and this cause their immunity to be suppressed and leading to an increase risk of obtaining different types of illnesses. Food access is a critical matter and the use of food stamps is evident and more prevalent in single households which seemed to be more financial strained in comparison to dual income families. The lack of education leading to poverty in return can cause limitations on food availability and is a viscous cycle that needs to be broken (Miller, 2018).

Technology

Social media platforms have become the norm as the primary networking tool between community members. This is progressively replacing the more traditional methods such as community-and social gatherings which can be seen in the community where people gather in parks, social events, barber shops and community playgrounds. The increase in technology can cause an increase in mental health issues such as suicide but can also be of an advantage with the sharing of knowledge. Technology has contributed in connecting different communities from different countries even enabling to share insight on policies that is successful which can be implemented in this community.

Law

Crime and safety of the community is also variable between different areas in the community. There are incidences of domestic cases, violence, muggings and robbery but according to the Police it is mostly attributable to drug-and alcohol related crimes. Public policies enable the limitations and guidance to act within the law. Crime can increase stress related illnesses observed in the community and can even increase mortality rates. It is important to control crime and the consequences thereof. The community has active and visible police controlling to aid in the combat of crime prevention and the safe keeping of the community’s citizens.

Environment

The health resource availability and the variety thereof are observed in the community. It is directly related to the different regions in this area and affected by the socio-demographic status of the people. Public transport is developed and can be easily used. Higher income community members tend to own their own vehicle and commute privately where people from lower income are more likely to use community-and public transport such as trains. The interactive transport system enables community members to have better access to health institutions. Emergency health access can be impeded because of the logistics surrounding each situation. Public amenities such as parks are frequent and well looked after with adequate and clean water supply to the community. This in return prevents the spread of community-acquired diseases within the community.

Community health problems

This assessment establish six main community health issues being obesity, infant mortality, access to health care, mental health and addiction, chronic conditions and infectious diseases. These issues are closely connected to the socio-economic factors discusses.

The problem of obesity is evident in the general population and is also a major risk factor contributing to chronic conditions such as cardiovascular disease, diabetes, high blood pressure and strokes. Obesity can mostly be overcome by lifestyle changes as well as medication. The introduction of healthy living in the form of food choices and exercise can be a positive contributor in resolving this problem. Guidelines and programs are readily available at free health care facilities and clinics to enable all members of community to take part in such events. The importance of exercise must be emphasized as it can also aid in reducing mental related illnesses and ensure for a lower stress level.

Infant mortality is also increasing due to lack of education and social factors such as poverty. Awareness campaigns on healthy parenting and relationships can assist teenagers to ensure safe and stable housing as well as access to health facilities including doctors, dietitians and nurses to improve access to reproductive health planning and education. Parenting and pregnancy programs are available in various health institutions. Infectious diseases such as sexually transmitted (Syphilis, Gonorrhea, HIV) disease are prevalent in the youth where adequate education is needed as prevention. This will also aid in reducing births as a result of lifestyle choices. Babies born from parents involved in drugs can present with health issues at birth. The suicide rate is also increasing due to health stressors and environmental pressures experienced in society. The creation and existence of support groups and care coordination will aid in combating these problems. Education on relevant problems will ensure for adequate treatment and will encourage members of society to seek help when needed. Access to health care can be increased by education on free clinics and community health centers and dental clinics. Another evident problem is alcohol and drug abuse especially among younger adults which is also experienced in poorer part of the community. This leads to sexually transmitted diseases and increase in crime activities. There are direct health consequences from the use of alcohol and drugs, but it also has a devastating effect on families and social community settings. This leads to stress factors and emotional health problems for people living with drug and/or alcohol abusers. This problem can be resolved by enabling these users to access supporting groups and to know where to seek help.

Situation: Community Profile

The profile of this community relies on various factors. By compiling data on these aspects, it creates a standard to measure future happenings against and to identify positive and negative aspects experienced. The statistics of each community varies due to the different composition of factors influencing each community. It is of utmost importance to gather data specifically related to this community to enable adequate assessment and analysis. It will also aid in contributing to already researched literature and to identify areas of growth and areas of short falls. The data used to identify this specific community profile is obtained from The Community Workshop Report Perrysburg, Ohio by Miller et al. (2018).

Object

The aim of this windshield systematic assessment is to determine the various socio-economic strengths and weaknesses of the community which cause and influence the various health related issues experienced and to find resolution to overcome these obstacles. This is done by acknowledging the specific community profile and the composition of influential factors and by directly corresponding to members of this community to establish possible weaknesses and strengths as well as resolutions for current problems.

Action: Health Project

This report uses academical information from various universities, researchers, health professionals as well as public and private local institutions. The visioning session was done on different residents of the Perrysburg community from various backgrounds. This data obtain from the assessment of the community members will be use in collaboration with academic literature.

The first step was to identify the sample group from the community and divide them into small groups or subgroups. The subgroups had to identify factors which are seen as bad or worse in the community as well as aspects in the community contributing to the good. The subgroups evidently also had to give their opinion on the incidences they think contribute to the worsening of community problems as well as enhancing the good. The second step was to cluster the data obtained from the group discussing and categorize into different categories. The third step was to use the clustered data to identify the health needs and issues from them. The last step was to prioritize the health needs of the specific community and compare it with relevant literature to enable optimum conclusive material.

Result

The results indicated the occurrence of six major health risks being obesity, infant mortality, access to health care, mental health and addiction, chronic conditions and infectious diseases (such as sexually transmitted diseases). Theses health risks can be directly or indirectly associated with the socio-economic status of the community participants as well as demographic aspects such as age, race and gender.

The occurrence of obesity can be correlated to lower income households not having access or knowledge regarding better lifestyles and health choices. The other side is also true where higher income members can spend more on refined foods. The problem of obesity escalated other health problems such as diabetes, stroke and heart disease which varies from age. Infant mortality, access to health care and infectious diseases is inter-correlated. Most of these occurrences are due to low financial abilities as well as lack of education. This is more prevalent in the youth where teenagers fell pregnant and in return need to leave schools. Because of a lack of resources, they engage in unprotected sexual activities which can also cause sexual transmitted diseases. Access to healthcare is also correlated with lower income community members where health care insurance is not an option. Drug-and alcohol abuse also cause infectious diseases but also relates to other mental health issues such as suicide. The abuse of substances is more evident in younger adults and is connected to social and financial factors. Drug-and alcohol abuse is also a contributing factor to premature deaths due to the lack of knowledge of the side effects substance abuse can have on a fetus. Mental health issues observed is divided between age groups where Alzheimer’s and Dementia is some of the more prevalent disease occurrences. In the younger adults’ mental disorders such as depression can lead to suicidal behavior due to a lack of medication or limited access or knowledge of support groups and clinics. The social environment some of these members are situated in can also cause an increase in the occurrence of suicidal incidences.

Conclusion

There is a correlation between socio-economic factors and health risks associated in the community. An effective approach and solution can be established in the concomitant function of community institutions, government and health clinics. It is important that the youth is educated adequately on all accessible health systems to prevent occurrences of diseases that can lead to an increase in mortality. With the collaboration of all parties involved an optimum stable approach can be obtained.

References

1. AIDS Resource Center Ohio. (2014, November 30). Hope. Healing. Empowerment 2014 Annual Report from www.arcohio.org/downloads/ARC-Ohio-2014-Annual-Report.pdf
2. American Academy of Pediatrics, Ohio Chapter. (2014, November 27). Programs. Retrieved from http://www.ohioaap.org/projects/
3. American Heart Association. (2015, November 29). What We Do. Retrieved from http://www.heart.org/HEARTORG/Affiliate/Columbus/Ohio/Home_UCM_GRA018_AffiliatePage.jsp
4. Celebrate One. (2015, November 27). The Crisis in our Community. Retrieved from http://celebrateone.info/mission/
5. Centers for Disease Control and Prevention. (2015, February 3). Black or African American Populations. Retrieved August 3, 2015, from http://www.cdc.gov/minorityhealth/populations/REMP/black.html
6. Central Ohio Diabetes Association. (2015, November 29). What We Do. Retrieved from http://www.diabetesohio.org/Programs.aspx
7. Central Ohio Hospital Council. (2015, November 23). Issues Advocacy. Retrieved from http://www.centralohiohospitals.org/advocacy.html
8. Jepson, B. (2016): Ohio Health Riverside Methodist hospital Community Health Needs Assessment, 1 -145.
9. Miller, B., Salazar, K., Walker, D., Utley, L., Wegleitner, B., Zhang, H.,…Jinquie C. (2018): Community Workshop Report Pennysburg, Ohio, 1-115.
10. Smathers, C. and Lobb, J., (2014, October 15): Community Assesment, Retrieved from https://ohioline.osu.edu/factsheet/CDFS-7

ABSTRACT

This paper is a Community Assessment of the South Bronx. The South Bronx is comprised of Bronx Community District 1 which includes Mott Haven, Melrose, and Port Morris.

South Bronx Community Assessment

Community Name & Boundaries/Location

According to the New York Health Community Profile, the South Bronx is comprised of Bronx Community District 1 which includes Mott Haven, Melrose, and Port Morris. The boundaries of District 1 follow the Harlem River; East 149th Street; Park Avenue; East 159th Street; East 161st Street; Prospect Avenue; East 149th Street; and the East River.

Land Use

The land use lot area of the district is 37,398,400 square feet, covering 1,769.9 acres and 2.8 square miles (2013). The Department of City Planning describes the land uses patterns as consisting of one and two family and multifamily residential properties, mixed residential commercial use, commercial, office, and industrial uses.

Population & Demographics

According to the NYC Community Health Profile of the South Bronx (2018), the population is 98,403. It is 73% Hispanic, 24% Black, 1% White, 1% Asian, and 1% Other. 28% of the population are foreign born and 36% have limited English Proficiency. Language spoken at home by adults over 18 are 33% English only, 60% Spanish, and 4% Other.

The population is made up of mostly 0 – 17 year olds and 25 – 44 year olds at 28% each group. The next common age group is 45 – 64 year olds at 21%.

According to the 2010 census, the distribution of Males and Females in the South Bronx is at 46.9% and 53.1% respectively.

Education Levels

The New York City Department of Education operates district public schools. There are 77 public schools. This includes elementary, middle, high, and special education schools. Three (3) public libraries. Two (2) colleges in the area are Hostos Community College and the College of New Rochelle.

The education levels data provided by the NYC Health Community Profile for the South Bronx (2018) shows that 41% of its population have less than a High School diploma while overall NYC has less than half this amount. 43% of overall NYC are college graduates where only 16% are in the South Bronx.

Employment Levels, Occupations, and Income Levels

The NYC Health Community Profile for the South Bronx, 29% of the population is living in poverty and 20% in NYC overall. Unemployment is at 12% versus 9% in NYC. The data below also shows that 60.4% of the population in the South Bronx are receiving public assistance which is higher than NYC overall at 35.6%.

According to the Office of State Comptroller (2013), the highest salaries in the Bronx are in Construction, Information, and Education Services. The salaries range from approximately $17,000 to $63,000.

In addition, the Office of State Comptroller (2013) reports that a large part of the Bronx population works in Health Care, Social Assistance, and Retail Trade.

Marital Status and Family Composition

According to the 2010 Census data presented by the Department of City Planning, the marital status and family composition of the South Bronx is as follows:

• Family Households 70.6%
• Married Couple Family 22.5%
• With related children under 18 years old 13.6%
• Female householder, no husband present 40.7%
• With related children under 18 years 28.7%
• Male householder, no wife present 7.5%
• With related children under 18 years 3.9%
• Nonfamily Households 29.4%

Married couple families with children was 13.6% in the South Bronx versus 17.0% in NYC overall. The percent of Female householder with no husband present and with children under 18 years old was 28.7% versus 11% in the NYC overall.

Police, EMS, and Fire Services

The 40th New York Policy Department precinct services the South Bronx. There are six (6) fire houses with one (1) EMS station. There is also a juvenile center in the South Bronx that has 129 beds.

In the New York Daily News article (2018), Parascandola writes that The Bronx has the city’s second-highest rate of major crimes but has the fewest NYPD surveillance cameras. Citywide there are 2,626 cameras citywide and The Bronx only has 388. Additional cameras are needed to deter further crimes from happening.

Suicide Rates

The data presented by the New York Times article (2016), the overall Bronx Suicide death rate per 100,000 population was 5.3, 8.4 in NYC, and 13 in the United States.

Crime Rates

According to the New York Health Community Profiles of the South Bronx (2018), the rate of non-fatal assault hospitalizations per 100,000 is 180 while the overall Bronx is 115 and NYC is 64.

Small, from DNAInfo (2017) writes that the 40th Precinct, which services the South Bronx, experienced increases in murders, robberies, felony assaults, burglaries and grand larcenies in 2017, and crime overall went up by 14.2 percent.

Adequacy of housing

As reported by the Department of City Planning (2013), multi-family residential buildings make up 23.4% of the land used and 1-2 Family Residential homes make up 6.5%. the South Bronx has one of the highest percentages of homes with maintenance defects in the city, according to the NYC Health Community Profile (2015). Maintenance defects include water leaks, cracks and holes, inadequate heating, presence of mice or rats, toilet breakdowns, and peeling paint. In the 2018 Community Profile, 24% of renter-occupied homes were with no maintenance defect in the South Bronx, 32% in the overall Bronx and 44% in NYC overall.

Water Supply

In the New York Times article (2018), Hu explains that the Catskill and Delaware watersheds, located in upstate New York, provide more than 90% of the New York City’s water supply. The remaining 10% come from the Croton watershed. According to the US Water Alliance (2015), the watersheds are so clean that it makes New York one of the few municipalities not required by law to filter its water (although it is disinfected by UV exposure). However, when distributed, chlorine is used as a disinfectant and aging pipes inside buildings can bring unwanted flavors and potential lead-related health-risks, especially for children. Therefore, although tap water in NYC is legally safe to drink, to be on the safe side, a carbon filter should be used.

Cleanliness of community

The NYC Planning District 1 Profile (2018), reports that 90.3% of streets were rated ‘acceptable’ on the Street Cleanliness Scorecard in FY 2017, 95.2% in the overall Bronx and 96.0% in NYC.

However, maintaining cleanliness is becoming a problem. The BronxTimes (2018), Wirsing reports that there is growing concern over increasing open-air drug use epidemic. The Hub, the South Bronx’s oldest shopping area, has been home to these users and evidence is found and has led to the unclean appearance of the streets. Cardboard boxes used as homes and bottles of needles has lead protesters to the area demanding a change for The Hub.

Waste Management and Garbage Pick-Up

There are 17 waste management facilities. This includes sanitations garages, solid waste transfer stations, commercial waste garages, and recycling handling and recovery facilities.

The Department of Sanitation has a weekly garbage and recycling pick-up schedule for the South Bronx. Garbage pick-up is three times a week and recycling pick-up is once a week.

Community Government and Leadership

The Bronx District 1, which encompasses Mott Haven, Port Morris, and Melrose is chaired by George Rodriguez. The District Manager is Cedric Loftin. The Board consists of up to 50 volunteer members appointed by the Bronx Borough President Ruben Diaz, Jr. in conjunction with the district Council Members. According to their website (2019), Community Board 1 is the local municipal body that acts as an advocate and provides the delivery of city services. It also plays a vital role in improving the quality of life for the residents in the communities. The Board assists residents with inquires and processes their complaints to the appropriate City agency.

Disaster Potentials

The US Water Alliance (2015) explains that as a neighborhood located close to the climate change will increase the severity of hurricanes in the South Bronx. The area is an industrial zone with a high volume of toxic substances making the area extra vulnerable. The organization is now focusing on climate resilience projects to protect the neighborhood against catastrophic flooding.

Transportation

The major highways in the South Bronx include the Major Deegan Expressway (I-87), Cross Bronx Expressway (I-95), Bruckner Expressway (I-278), Sheridan Expressway (I-895) and RFK Bridge. The New York City Subway train lines that run through the South Bronx include the Local and Express 2, 4, 5, and 6 trains.

For those employed, according to the NYC Planning District 1 Profile (2018), the mean commute to work is 43.0 minutes.

Types of Shopping Centers and Grocery Stores

The NYC Health Community Profile for the South Bronx (2018) reports that the rate of Tobacco Retails per 10,000 in the South Bronx is 16 versus 11 in the overall Bronx and overall NYC. Also, the supermarket square footage per 100 is 133 in the South Bronx versus 155 in the overall Bronx and 177 in overall NYC.

The Hub-Third Avenue Business Improvement District (B.I.D.) is the retail heart of the South Bronx, located where four roads converge: East 149th Street, Willis, Melrose and Third Avenues. The Hub is the oldest major shopping site in the Bronx. Business you will find include Marshalls, Burlington, Rainbow, Petland Discount, boutiques, and electronic stores. There is also an urgent care center located in The Hub. In addition, a fitness center has recently opened.

According to the Daily News (2012), Lestch reported that The Bronx, which tips the scale as the unhealthiest county in New York, is the No. 1 destination for fast-food stores. Fast food chains the South Bronx include McDonalds, Subways, Kennedy Fried Chicken, Kentucky Fried Chicken, Texas Chicken, Wendy’s, Auntie Anne’s, and Dunkin Donuts. In additional there are local pizza, Mexican, Italian, and Chinese restaurants. Fast food chains are inexpensive and quick, and ideal for a lot of working poor and low-income residents.

When it comes to supermarkets and grocery stores, the NYC Health Community Profile (2018) reports that the lowest ratio among NYC community districts is one supermarket for every three bodegas (healthier) and the highest is one supermarket for every 57 bodegas (less healthy). In the South Bronx, for every one supermarket, there are 25 bodegas. Bodegas are places where residents can grab quick food items that may not always be healthy or fresh foods.

Community Stressors

Stressors within the community include affordable housing and unemployment. According to the NYC Planning Department (2019), a great need for new affordable housing projects within the South Bronx. There is also a need for businesses to move in and/or current businesses (such as, Bronx Brewery and Fresh Direct) to create employment opportunities for the South Bronx residents.

Level of Health Performance and Health Care Financing

The NYC Health Community Profiles (2018) reports that in the South Bronx, 72% reported their own health as “Excellent,” “Very Good,” or “Good” versus 78% in NYC. It also reports that 14% of the South Bronx did not have health insurance, which is slightly lower than the overall Bronx and NYC. The population that have Medicaid represent 36% of the South Bronx and the overall Bronx and NYC are lower at 30% and 26% respectively.

Obesity Percentages

As presented earlier, 42% of the South Bronx population of adults suffer from obesity versus 24% in NYC and 24% of children in grades K-8 in the South Bronx versus 20% in NYC.

Community Health Nurse Interventions

A major intervention by a Community Health Nurse (CHN) is to raise awareness about the effects of leading an unhealthy lifestyle. Raising awareness can include holding events where people are educated and/or screened on weight, blood pressure, cholesterol, diet and physical activity. This should be offered in multiple languages but primarily in English and Spanish.

The Community Health Nurse can also work with community and government officials to get resources to that will encourage people to be more physically active and chose healthy options when available. The CHN can work to get more farmer’s markets available or work to have bodegas sell fruits and vegetables at affordable prices so that residents that use bodegas as a quick stop shop can choose to purchase these items.

Role of Government, Individual, Families, Health System, and Education Facilities

The CDC (2018) states that the estimated annual medical cost of obesity in the United States was $147 billion in 2008; the medical cost for people who have obesity was $1,429 higher than those of normal weight. Therefore, the government needs to provide the resources to encourage more physical activity and better nutrition as well as making fresh foods and vegetables available and easily accessible. A good option is to offer money to be specifically used at farmer’s markets in the community or to be specifically used to buy fresh fruits and vegetables. Currently, this is something offered to those on public assistance. However, this could be offered to those that are unemployed but make too much money to get TANF. This investment now will reduce the larger expense in the long run because it will decrease the number of people that are at risk for or develop obesity in the future.

Individual and families have the responsibility of actually engaging in the physical activity offered and choosing the healthier options when they are shopping. This may place them in a tough position because of their low income. However, a budget class can help people see that if they make better decisions on how they spend the money they have, buying healthier foods will not seem like a financial burden.

Health insurance companies should offer incentives for going to the doctor, going to the gym, offer discounts for a gym membership, getting screenings, etc. I think that in having people go to the doctor it is an opportunity to education them. If they keep hearing the same information, they will chose or at least contemplate making better lifestyle choices given the information they have received.

In education facilities, aside from offering more physical activity classes and ensure that nutritious foods are available for breakfast and lunch, I think that having a school nurse conduct a course on proper nutrition and physical activity consistently at all grade levels would be ideal. Children and adolescents should begin learning and seeing early on about the effects of an unhealthy lifestyle. They can carry this information home to their families in addition to apply it to themselves. If, at an early age, a person engages in consistent physical activity and makes healthier choices in their nutrition, they will carry this into adulthood and the risk of obesity would decrease significantly. This causes a domino effect for the population overall because these now adults will teach their children about the importance of physical activity and proper nutrition, and actually lead by example. This lifestyle will then be reinforced by the course offered at school. All this would lead to a decrease in the obsess population in the future.

References

1. Census Reporter. (2017). NYC-Bronx Community District 1 & 2–Hunts Point, Longwood & Melrose PUMA, NY. Retrieved on January 13, 2019 from https://censusreporter.org/profiles/79500US3603710-nyc-bronx-community-district-1-2-hunts-point-longwood-melrose-puma-ny/
2. Centers for Disease Control and Prevention. (2016 June 16). Defining Adult Obesity. Retrieved on January 13, 2019 from https://www.cdc.gov/obesity/adult/defining.html
3. Centers for Disease Control and Prevention. (2016 October 20). Defining Childhood Obesity. Retrieved on January 13, 2019 from https://www.cdc.gov/obesity/childhood/defining.html
4. Centers for Disease Control and Prevention. (2018 August 13). Adult Obesity Facts. Retrieved on January 13, 2019 from https://www.cdc.gov/obesity/data/adult.html
5. City of New York Department of City Planning. (2012). Community District Needs Fiscal Year 2013 for the Borough of The Bronx. Retrieved January 6, 2019 from https://www1.nyc.gov/assets/planning/download/pdf/about/publications/bxneeds_2013.pdf
6. Hu, W. (2018 January 18). A Billion-Dollar Investment in New York’s Water. The New York Times. Retrieved January 12, 2019 from https://www.nytimes.com/2018/01/18/nyregion/new-york-city-water-filtration.html
7. New York City Bronx Community Board 1. (2019). Welcome to Bronx Community Board No.1 The Gateway to the Downtown Bronx. Retrieved on January 13, 2019 from https://www1.nyc.gov/site/bronxcb1/about/about-bxcb1.page
8. New York City Health. (2015). Bronx Community District 1: Mott Haven and Melrose. Retrieved January 6, 2019 from https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-bx1.pdf
9. New York City Health. (2018). Bronx Community District 1: Mott Haven and Melrose. Retrieved January 12, 2019 from https://www1.nyc.gov/assets/doh/downloads/pdf/data/2018chp-bx1.pdf
10. New York City Health. (2018 July). Summary of Vital Statistics 2016 The City of New York. Retrieved January 6, 2019 from https://www1.nyc.gov/assets/doh/downloads/pdf/vs/2016sum.pdf
11. New York City Planning. (2018 January). Statement of Community District Needs and Community Board Budget Requests Fiscal Year 2019. Retrieved January 12, 2019 from https://communityprofiles.planning.nyc.gov/bronx/1
12. New York Times. (2016 November 15). Suicide in New York: Which counties have highest and lowest rates? Retrieved January 12, 2019 available from https://www.newyorkupstate.com/news/2016/11/suicide_in_new_york_which_counties_have_highest_and_lowest_rates.html
13. Lestch, C. (2012 Dec 20). The Bronx tips the scale as the fastest-growing fast food locale in the city with more McDonalds, Subway chains. Daily News. Retrieved on January 13, 2019 from https://www.nydailynews.com/life-style/health/highest-rates-obesity-diabetes-bronx-fastest-growth-fast-food-chains-article-1.1223831
14. Office of the State Comptroller. (2013 July). An Economic Snapshot of the Bronx. Retrieved January 6, 2019 from https://www.osc.state.ny.us/osdc/rpt4-2014.pdf
15. Parascandola, R. (2018 August 25). The Bronx has the second-highest crime rate in the city — and just 15% of NYPD surveillance cameras. New York Daily News. Retrieved January 6, 2019 from https://www.nydailynews.com/new-york/nyc-crime/ny-metro-nypd-cameras-less-bronx-20180821-story.html
16. Small, E. (2017 January 11). Bronx Precinct Sees City’s Sharpest Crime Increase for Second Year in a Row. DNAInfo. Retrieved January 12, 2019 from https://www.dnainfo.com/new-york/20170111/mott-haven/40th-precinct-2016-crime-statistics/
17. US Water Alliance. (2015). Sustainable South Bronx. Retrieved January 12, 2019 from http://uswateralliance.org/organization/sustainable-south-bronx
18. Wirsing, R. (2018 October 16). Sound the Alarm: South Bronx Community in Crisis.
19. BronxTImes. Retrieved January 12, 2019 from https://www.bxtimes.com/stories/2018/42/42-a-hub-2018-10-19-bx.html

Worcester and Springfield are both well-known Massachusetts cities each known for its innovative cityscapes and diverse communities. However, these towns reportedly reside in two of the unhealthiest Massachusetts Counties.1,2 Conducting comprehensive reviews of both cities would allow public health professionals to determine which factors are associated with these poor health outcomes.

With respect to the greater Worcester area, I would like to examine several key demographics including poverty levels, low education, and unemployment rates.3 According to the 2015 Greater Worcester Community Health Assessment, these three social health determinants reported the strongest interaction in the Worcester area. Additionally, these factors are likely to be influenced by the community culture as well as shape societal values. Since the town of Worcester has significantly higher morbidity rates (i.e. cancer, influenza, sexually transmitted infections) compared to the Central Massachusetts Regional Public Health Alliance, it is worth exploring how the interaction of these social health determinants is altering the overall quality of life throughout the community.3

Since social health determinants similarly affect the health and well-being of the Springfield community, I would like to further examine the correlation between these key components. In August 2018, the MGM Springfield casino complex opened up in Hampden County. Accordingly, proximity to casinos is strongly linked to a number of unfavorable health outcomes. These health concerns include gambling addiction, loss of work productivity, substance abuse, and domestic violence.4,5 Community members that live below the poverty line, in addition to being in close proximity to these casinos are at heightened risk of developing adverse health problems.4,5 Ultimately, it would be interesting to compare the health profiles of Springfield before and after MGM Springfield opened, in order to identify how the casino is impacting the community.

When deciding which community to choose for an assessment project is it important to begin by reviewing each setting. Conducting a review will allow individuals to gain a better understanding of each community’s specific demographics, issues, and town history.6 Accordingly, before selecting a particular community to examine, the community assessment and development experts should set aside some time to create a community description. The community description encompasses a wide range of topics that will help experts to better comprehend the community in a number of ways.6 These areas include physical aspects, infrastructure, social structure, and politics.

After devising a list of key themes that will be included in the community description, the next step is to determine how the data will be collected. Information can be gathered either from public records (i.e. newspaper archives, government documents) or from community members (i.e. interviews, surveys, observation). It is imperative that the community assessment experts research the community before conducting interviews or distributing surveys to local citizens.6 This approach will give these experts a solid overview of the community. Accordingly, this foundational research can be used as a baseline to compare additional findings. When collecting information from community members, it is important to gather feedback from laypeople as well as from elected officials.6 This tactic will allow individuals to acquire credible data and eliminate potential bias.

Next, community assessment experts should process and classify the data, in an organized manner that can be used to assess how various components fit together.6 The information can be arranged by category, into a timeline, or in a manner that showcases key interactions. In addition, the data display may use photographs, quotations, or video clips to support key claims. Lastly, once the data is compiled and analyzed, the community assessment experts should consult with laypeople and government officials regarding the findings.6 This would allow the community assessment team to gain feedback on their assessment and to incorporate those suggestions so that the community will be able to successfully implement initiatives in the future.6

When making my final decision regarding which community I will assess, I will consider two key factors: access to community data and the ability to understand that community.6 Springfield’s new casino complex, introduces a number of potential community health concerns. However, since the casino opened merely five short months ago, it is unlikely that there will be enough concrete data to assess the before and after profiles of the community. In addition, I am unfamiliar with this town’s social norms and this could impact the accuracy of my research. On the other hand, Worcester has a wide range of community assessment and behavioral risk surveillance studies that can be used to better understand the community. Since I already have a solid perception of societal values and behavioral tendencies, I will be able rationally and accurately assess the community information. Accordingly, selecting Worcester for my community assessment is the more reasonable choice.

The driver pulls the car out of the driveway and onto Suffern’s paved roads. On the drive into Suffern’s Center, there is a lot of grass and tall trees. The driver passes by Walgreens, the Suffern Library, two office buildings (one is the dentist’s office), and Good Samaritan Hospital which are all located on Route 59, a road that goes straight through Rockland County and connects many of its villages. As the car turns onto Route 59 and heads into a more residential area, there are houses of all sizes, some with many miles between them. The driver stops the car behind a bus and watches two white children get off and walk into a small white house. As the driver continues, she notices a man jogging down the road – seems like he’s headed to the park. As the car reaches the park it is noticeably emptier than usual. There were no kids there, just two people and a dog. The car heads straight on Memorial Drive passing the Suffern pool which opens in June of every year. It is closed and no one is there now. The driver continues down Memorial Drive until she hits Route 202 which intersects with Orange Avenue. On Orange Avenue, there is a bus stop where many take the bus to New York City. There are two Hispanic men waiting at the bus stop now. The car makes a left turn onto Lafayette Avenue, the main street in Suffern.

Lafayette Avenue is filled with restaurants and bars suggesting Suffern has a lively nightlife. There are also a whole bunch of little shops and thrift stores. The car stops at the traffic light near the Suffern Supermarket, which is where many residents do their grocery shopping and also where people can buy lottery tickets and bus tickets to NYC. On the Avenue, there are some people walking on the sidewalk which is fairly clean. There is a Spanish couple with two kids but other than those kids Lafayette was mainly adults. There are a number of white men and one elderly black woman walking out of the Suffern deli.

On the drive, the car passes a few places of worship (a church and two synagogues) which implies there are a number of different types of religious people in Suffern. The driver passes by Suffern High School and one elementary school The village consists of mostly houses, however, some streets have apartment complexes as well.

Community Description and impressions

After examining Suffern in the windshield survey, doing some community research and speaking to key community informants, the author has come to the conclusion that Suffern is an overall safe and healthy village. Residents feel comfortable walking in the streets late at night –the biggest fear for many residents is running into a coyote or a bear.

The community in Suffern seems to be mostly middle-aged people, however, the driver got the impression there is a large number of elderly people too. The crowd was mostly white with many Hispanics too. The people appeared to be in good health although some of them looked overweight. There did not appear to be many gyms and – the only noticeable one was very small perhaps an implication that there are not many people who go to the gym.

One advantage to living in Suffern is the open space for children and to play and immerse themselves in nature. Many houses had large front and backyards. Kids can come home from school and play outside in the grass. The community also feels very safe and secure so children have more freedom. The open space is also good for animals, specifically dogs, because it gives them a lot of room to roam and play.

The main health concern would be related to immunizations, specifically the MMR vaccine. After speaking with key informant #2, it is evident that there are MMR low vaccination rates within the community and this leads to an increased risk of Measles, Mumps and Rubella.

Community Core and Supportive Data

History

Suffern was incorporated as a village into the town of Ramapo Rockland in 1796 by John Suffern, the first Rockland County Judge. Previously known as New Antrim before the American Revolution, Suffern was originally initiated by the Ramapough – a tribe of Munsee. It was a strategically important place during the war because of its close proximity to the Ramapo Pass – a great location for troops to camp out. On route to the siege of Yorktown which began the Revolutionary war, Comte de Rochambeau, a French General who eventually helped win the war, stopped with his troops in Suffern. The soldiers camped out across the street from John Suffern’s home where Rochambeau slept. Suffern’s home was also used by George Washington on a few occasions (“About the Village of Suffern, New York,” 2015). Since then Suffern has become a small yet progressive village and has proven to be a great place for young professionals and retirees to live. Suffern even has its own day – Suffern day – which involves all members of the community and ends with fireworks and music by local favorites!

Demographics and Ethnicity

In the year 2018, Suffern had a population of 10,984 people. 46% were male and 54% were female. The median female age was 42.8 and the median male age was 42.5 giving a total median age of 42.7. 20.3% of Suffern was under 20 years old, 13.9% were in their 20’s, 13.1% in their 30s, 13.8% in their 40s, 14.8% in their 50s, 10.2% in their 60s and 13.9% in their 70s or above. 77.6% of residents were white, 7.1% Asian and only 3.6% were African-American. The remaining 11.6% consisted of other races. 52% of people were married while the remaining 48% were single. Out of the single people, 32% never married, 10% divorced and 6% widowed. The average family size in Suffern was 3.2. 79% of Residents were citizens born in the US, 13% were citizens by neutralization and 8% were not American citizens. 79% of residents were born in the US and the remaining 21% of the population was born outside the United States. Of those born in foreign countries, 51% were born in the Americas, 21% in Europe, 27% in Asia and 2% in Africa. None were born in Australia. 76% of those born in the US were born in New York State (“Suffern NY Demographic data,” 2018). 73.1% of residents speak just English, 13% speak Spanish and the remaining 13.9% speak other languages (“Suffern NY Population,” 2019). Suffern is home to 441 male veterans. 169 fought in the Vietnam War, 57 fought in World War II, 46 fought in the Second Gulf War, 33 in the Korean War and 21 in the First Gulf War (“Suffern, New York Population 2019,” 2019).

Vital Statistics (*Please note that unless specified, all are based on Rockland County data and not on Suffern alone.)

The Suffern birth rate for women ages 15-50 was 4%, with the majority of births (73.1%) from women aged 25-34. 32% of births were from unwed mothers and 100% of those births were women aged 20-34 years old. 80% of the women who gave birth unwed were living below the poverty level. As of 2016, Rockland County had 15.9 births per 1,000. 22% of all births were cesarean sections. From 2014-2016 there was an infant mortality rate of 3.6 (“Maternal and Infant Health Indicators,” 2018). This is a good improvement from the 2011-2013 infant mortality rate of 4.4. This is also lower than the New York City rate of 4.3 (“NYC Health,” (2018) the New York State rate of 4.4, and the national rate of 5.8 (“New York State Community Health Indicator Reports,” 2018). It is also lower than the Healthy People 2020 target of an infant mortality rate of 6.0 (or fewer) infant deaths per 1,000 births (Maternal, Infant, and Child Health, 2014). The Rockland mortality rate for neonates (under 28 days) was 2.3 per 1,000 live births. According to a 2016-2018 assessment done by the Rockland County Department of Health, only 62.3% of women aged 18-44 saw a doctor for a routine check-up last year [and only] 33.3% of women had a discussion with their healthcare provider in planning for a healthy pregnancy” (2019). The percentage of births with adequate prenatal care was 71.4% which has decreased since the 2013 rate of 73.4%. The percentage of low birthweight (

Introduction

Through this essay, the account of historical, cultural and social perspectives in support of wellbeing of children and families in Australia is taken into consideration. Lincoln and his family’s circumstances are used as reference to understand more about these contexts in relation to Indigenous people of Australia.

Historical Context

In the past, kids from Aboriginal and Torres Strait Islander communities were removed from their families on the name of civilisation that afterward led to “Stolen Generation”. The disastrous impact on emotional and mental conditions of kids from Stolen Generation has been conferred by Briskman (2015) who elucidate that the rights erosion of kids resulted in attrition of their self identification, spirituality and relational connection. “Bringing them Home” report by Wilkie (1997) discusses the national inquiry on aftermath experiences of Stolen Generation. Few erroneous acts were applied in the past by British colonizers in regard to forceful elimination of Indigenous people from their families. Throughout the second half of the last century, due to inadequacy of parenting skills, placing the influenced children into another care services was seen as the top key to deal with concerns like physical neglect, supervisory neglect, emotional neglect, educational neglect etc. Newton (2019). Nevertheless, a lot of evidence indicates about abuse and neglect among children in these institutional settings. Such form of practice led to significant rise of foster care as another option, Fernandez (2014) focuses. During 1960-1970, an increase in the requirement of reinstitution of such care emerged that led to constructive impact on foster care and policy makers started looking at different approach. Fernandez (2014) pointed out that Australian Government has taken diverse steps towards children’s wellbeing which include establishment of children courts and jurisdiction since last two decades. Literature provides information regarding consequences of past suffering among Aboriginal and Torres Strait Islander families (Raphael, Swan & Martinek, 1998; Herring et al., 2013). Atkinson (2002) revealed that the loss and grief caused by colonisation created “intergenerational trauma”. As this is now recognized that child neglect and abuse is a crime, a special attention is given at all levels (primary, secondary and tertiary) of intervention.

Cultural context

Tilbury et al. (2017) conclude that a culturally competent performance is necessary within child welfare systems which comprise respectful engagement with Indigenous communities. Child protection organizations try to approach towards security of children and identify the damage which occurred in the past and can impact their present and future. In terms of cultural context, Aboriginal and Torrs Strait Islander families are more susceptible to abuse, mistreatment and harm. There are several factors which should be kept in mind when dealing with Aboriginal and Torres Strait Islander families due to past trauma and present impacts. Such people are suffering from large number of issue like poverty, unemployment, housing insecurity, neighbourhood disadvantage and inequity (Bynner, 2001). Such issues led to decline in cultural and neighbourhood support. These changes have led to elevated demand for family support and child protection services (Tilbury et al., 2007).

Social Context

A huge number of factors play a part behind child abuse or neglect, predominantly amongst Indigenous group. These factors include domestic violence; prejudice about gender, marital status, age, race; accommodative unsteadiness; deprived neighbourhood; emotional imbalance; poverty; unemployment; marital relationship; lack of education; substance use and mental issues. Such factors favour ‘ecological theory’. According to Tilbury et al. (2007), this theory challenges the concept that a single factor is coupled with maltreatment and acknowledges other factors correlated with child abuse or neglect. In particular, the social life in remote regions is generally very restricted as people living there have a limited infrastructure. Such isolation is due to lack of opportunities, education and leisure activities that enhance the pace of violence in families. Moreover due to consistence collapse of projects designed for concentrating on incongruities among Indigenous and non-Indigenous Australians, a gap is still present between remote areas and main stream services (Herring et al., 2012). In Neoliberal vision, the government has failed on the platform to tackle such issues. In this light, the government is encouraging the people to work hard in poverty and acquire something sufficient for individual demands (Harris, 2017) considering that there is growing demand for child protection and family support systems (Tilbury et al. (2007).

Decision making via an ethical and reflective practice with children and families

As a child safety officer; I believe child protection work is extremely precise and demanding. Owing to historical trauma, Indigenous families do not desire government departments and people from other backgrounds to work for them as they have lost reliance in the system. I personally feel this is the major hurdle while working with them in my role. I want to reveal that the lack of accurate knowledge about Indigenous culture and family structure serves as additional obstacle for child protection workers. Further, I am required to conquer the language hurdle also as in my job; I use to work closely with cultural practice advisor(s) who help me during my visits to Indigenous families because the advisor(s) have same cultural background of Indigenous communities.

As a professional, the child safety workers must make assessment about risk, harm and safety of children. A proper assessment affords a strong base for good case plan and ongoing intervention that lead to reunification of children with family and children’s protection. Tillbury et al. (2007) specifies that a good relationship with family is crucial so that both parties work jointly. Social workers must encourage family members in decision making and aim to recognize the view regarding their condition in problem resolution. Most importantly, the social workers should always hear the voice of kids and encourage them to participate in this process as sometimes, the exact issue cannot be mentioned by parents, Fernandez (2014) emphasizes. As a preference to ease the load of child protection systems, there has been observed an increase in the recognition of ‘public health model’ that is serving to bring positive effect on children and families. In this approach, the main focus is on prevention of neglect and abuse rather than focussing on how to care for children following the occurrence of abuse or neglect (Goldsworthy, 2015).

Conclusion

There has been a huge change in the strategies concerning child protection services from older to latest times. On the whole, no simple answers are on hand to sort out child protection matters. While policy makers have made lots of efforts in favour of ‘best interest of children’, we have to discover more from past to attain positive effect on Indigenous families (Long & Sephton, 2011). As we can observe from scenario of Lincoln and his family, all the factors influencing child abuse and neglect are associated with each other. For instance, one of the Lincoln’s parents is Aboriginal. The unemployment leading to domestic violence added to the picture.

Foremost aim of child protection system is to provide a safe and secure future to children of every community and background as they are the main stakeholder. Pressure of other factors like social media, academics and community campaigners cannot be ignored both in negative and positive way. A trustworthy rapport with family members is must which comes from the reflective practice. Hence, a culturally competent practice together with public health model may be able to engage families with service providers in an affirmative way.

Reporting

Historical legislation and government policies have impacted the health and well-being of Indigenous Australians. Since the landing of the First fleet in 1788, the Australian government employed institutional racism in the form of laws and regulations. Such policies were executed throughout the colonial frontier, segregation, ‘protection’, and assimilation eras (Hampton & Toombs, 2013). Cassie’s Story has been used as an example to correlate past and present implications of the assimilation policy (CSU, 2011). Polices were primarily enforced through the use of missions and government reserves in an attempt to ‘civilise the savages’ (Eckermann, 2010). As a future health care professional, strengths and weaknesses of cultural competence will be critically reflected in this journal. Researching the true violence that occurred in Australia’s shared history has been a confronting introduction towards my cultural competence journey.

In 1937, the Australian government introduced the assimilation policy. The aim of the assimilation policy was to absorb the ‘half-caste’ Indigenous population into the ‘white’ community. With the protectorate experiment failing, governments were viewing the Indigenous population as a nuisance. The idea of absorption agreed that all efforts of the government should be directed at integrating children that were from mixed blood decent into the non-indigenous community. Consequently, individual racism and prejudices have been transmitted throughout generations (Hampton & Tooms, 2013). It was evident during my studies that the protection and assimilation polices overlap considerably. Indigenous children were forcibly removed from their families during both these eras of government control. I experienced feelings of disbelief and sadness watching footage of the children that had been taken. The stories that have been shared in the Bringing them home report are appalling. “The wailing at night used to disturb the spirits” as quoted in Cassie’s story reminded me of a tragic scene in the movie Rabbit Proof Fence and is an unsettling description of the events that took place. It was heartbreaking to learn that there were an estimate of 100,000 children taken and not all were reconnected with family members. I cannot fathom the intense heartbreak the families would feel then and now. This has created an understanding of why trauma is carried throughout the generations. Not only is there a strong history of violence, killing and dispossession there are children still missing that have never returned home. The dehumanising term “herded” is used frequently in literature and is mentioned in Cassie’s story. It further demonstrates that the Indigenous people were transported and treated like animals (Australian Human Rights Commission, 2017). The general theme of Cassie’s story relates to the forcible removal of Indigenous Australians and the assimilation policy. My interpretation of Cassie’s story clarifies that Indigenous communities were never asked and the government has controlled most aspects of their lives (CSU, 2011).

I have explored specific impacts on the health and well-being of Indigenous Australians throughout Cassie’s story. The negative outcomes that I have deciphered are dispossession, destruction of kinship groups, intergenerational trauma and psychological impacts. These impacts can be evidenced with the destruction of the community centre, destruction of the safe house for mums and the eviction of Indigenous families from their homes. Cassie is further burdened with the worry of her families physical and mental health. These worries can radiate broadly throughout the community kinship groups. Mental health concerns and the suicide of a family member are cited in Cassie’s story. The estimated suicide rate of Aboriginal and Torres Strait Islander peoples is 2.6 times the rate for non-Indigenous Australians (Australian Government Department of Health, 2013). I live in a small rural community that has frequently experienced the loss of young Indigenous people to suicide. There are many Indigenous Australians caught in the vicious cycle of poverty and incarceration in my local community and right across the continent as illustrated in Cassie’s story. Psychological impacts of trauma and dispossession are highly relevant in today’s society as these issues are still prevalent. Racial discrimination directly contributes to inequality in health and wellbeing outcomes (Eckermann, 2010).

Relating

Reflecting on personal and professional experiences has changed dramatically since commencing this subject. I am able to recall various events throughout my life and healthcare profession that relate to aspects of the assimilation policy. Throughout the protection and assimilation eras Indigenous people were seen as primitive and it was thought that they would die out as a matter of evolution. To some extent this thinking is still prevalent today. In the past I have heard people being asked “how much aboriginal do you have in you?”. This type of racial thinking is linked to assimilation with the belief that Indigenous blood could be bred out throughout generations and children were better off raised in white families (Chesterman & Douglas, 2004). I unknowingly believed that someone could have “less” Indigenous in them due to the colour of their skin and their percentage. How I came to believe that I will never know. It is a shameful assumption that I now understand to be highly inaccurate and was a belief that I mistakenly carried (Claeys, 2000). This is prime example of how racial thinking can be carried throughout generations unintentionally and the importance of cultural competence.

Until recently, I had been working for the past 6 years as an Assistant Nurse in the Aged Care industry. I remember observing the Diversional Therapist handing out several different colouring in pages to a group of elderly residents for an activity. There were pictures of machinery, flora, fauna, buildings and beautiful landscapes. The residents were all seated in a large dining room. Each person was seated in their particular seat. Lord help you if you accidently sat ‘Mavis’ in ‘Beryl’s’ chair before Bingo. The centre table sat a dozen people and a there were two smaller tables on the side. Two of the Indigenous male residents always sat off to the side together. I look back now and wonder if this was a personal choice or they felt uncomfortable and removed. Colouring sheets were always handed out to residents based on their likes and preferences. For example an old farmer preferred to colour in the machinery and thought it was too ‘feminine’ to colour in the butterflies. Brightly coloured pencils were placed around the table in decorated jars. I watched as the Diversional Therapist did not ask their preference and only ever selected pages of native Australian flora and fauna for the two males. Their jar of pencils only consisted of three colours red, black and yellow. Having researched assimilation in Australian I would now have the confidence to explain to that staff member how this behaviour can contribute to feelings of seclusion and dispossession. There is a clear relationship between the impacts of the assimilation policy and everyday Indigenous life. Concepts of historical government control can resurface in many every day activities. I would feel comfortable to ask why those men were excluded from the group and why they were not given the same choices to express themselves.

Reasoning

Cultural competence from my understanding is the ability of a healthcare professional to have the awareness, knowledge and sensitivity towards various cultures in order to provide holistic care to our patient’s. There are many aspects of cultural competence that can help individuals improve their delivery of healthcare to Indigenous Australians. The main aspects of cultural competence are awareness, attitude, cultural knowledge and cultural skills. Healthcare professionals must have the ability to interact and communicate effectively with people across different cultures (Wells, 2000). Throughout my recent study of Indigenous culture and histories I have been able to uncover, reflect and challenge my own cultural bias’s. I discovered that my previous subconscious beliefs may have possibly affected my perception and attitude towards Indigenous patient’s. I’ve lived in a small rural community for my entire life. 30 years on, I am beginning to understand the Indigenous population I have shared my community with. Prior to commencing this subject I believe I was moving through life with a set of blinkers on. There are models of cultural development that I have viewed in literature which I can use to assist with my journey from cultural awareness right through to cultural proficiency (Wells, 2000).

Dispossession, destruction of kinship groups, intergenerational trauma and psychological effects can be reduced through the application of cultural competent healthcare. Cultural awareness, attitudes, knowledge and skills can be used to reduce the impacts of the health and well-being of Indigenous Australians. As discussed in Reporting and Relating there are concepts of the assimilation policy that arise in today’s society. Indigenous Australians are still experiencing the impacts of historical legislations. The negative events I have explained from Cassie’s story could be alleviated if the communities culture, values, beliefs and practices are acknowledged (Editorial Team, 2019). In my example from a professional experience, I mentioned that two Indigenous male residents were secluded from a group. They were not asked or given the same choices to complete an activity. If the Diversional Therapist was culturally competent she may have taken the time to sit and talk with the residents to understand them. Cassie stated that “they never ask us” perhaps we begin by asking how we can help a community or kinship rather than assuming and deciding on their behalf (CSU, 2011). Through the aspect of culturally appropriate communication I will be able to establish a respectful therapeutic relationship towards our Indigenous communities. Additionally, if I am ever in doubt I can simply ask our patients if they have any religious or cultural practices that affect the way they wish to be cared for.

Reconstructing

To prevent misunderstandings, miscommunication, and culturally-unsafe care it is essential that nurses continue their development of cultural competence (Levett-Jones, 2016). To improve in cultural competence I have chosen relevant, realistic and achievable goals. Firstly I identified and examined my own underlying beliefs and values in comparison to Indigenous culture. I have acknowledged a weakness in the assumption of Indigenous blood lines. With this understanding, I will initially focus on my misconception of Indigenous blood line percentages and research deeper into that area of assimilation. By acknowledging and challenge possible assumptions I can help to break the cycle of intergenerational racism. I can use self-reflection to identify any other gaps in cultural understanding as I progress through my studies. Charles Sturt University has access to 1000s of resources that I can access through the student portal for further self-education.

Secondly, it is widely understood that nursing assessment underpins safe-practice. Nurses and healthcare professionals are routinely conducting all types of assessments in the healthcare setting. A cultural assessment is equally important but most often forgotten. I have investigated a mnemonic called the ‘ABCDE’ of cultural assessment. By familiarising myself with this form of assessment I can improve the delivery of safe person-centred care to all people regardless of their race, ethnicity, culture or language. The mnemonic stands for attitudes, beliefs, context, decision making and environment (Levett-Jones, 2016). I will endeavour to learn and understand how to conduct this cultural assessment correctly so that I can utilise it in the workplace.

Thirdly, I currently work in Hospice and aspire to specialise in the Palliative health care sector. The Australian Indigenous Health Info net website provides a range of educational opportunities. There are hundreds of resources that I can use to continue my learning throughout my career. The time surrounding the end of someone’s life is precious and needs to be respected and approached in a safe and culturally appropriate manner. The Palliative care and end-of-life portal in the website is designed to assist health care professional to provide culturally coordinated care. I aim to undertake the learning resources that are focused on culturally appropriate palliative care, grief and bereavement and advanced care planning.

Finally, as a nurse I must be able to understand what cultural competency is and how to apply it in practice. The Nursing and Midwifery Board of Australia have outlined in the Code of Conduct specific standards which all nurses are expected to practice. It is vital that I examine the Code of Conduct and Professional standards to maintain my nursing competence throughout my career. There are sections that specifically focus on the acknowledgment of the social, economic, cultural, historic and behavioural factors influencing health, both at the individual, community and population levels (Nursing and Midwifery Board of Australia, 2018).

Throughout all Western Kentucky, specifically in Graves County, there is a great amount of need from a great amount of people: homeless, ill, elderly, victims of abuse and neglect. Because there are so many people in need there is a very diverse set of resources in demand. Throughout this paper there is a list of resources available in Graves County for various needs. There are many resources available to help those in need.

For infants, children and adolescents in need in the Graves County area, The Omni Family of Services provides mental, behavioral, and emotional therapy. The Omni Family of Services for our area in located in Hickory. The Department of Child and Family Services can provide a medical card and/or food stamps to families that qualify. This department is in Mayfield. For an emergency, there is the Teen Crisis Text Line.

For the elderly who find themselves in need, West Kentucky Allied Services in Mayfield, can provide services such as, housekeeping and laundry, personal hygiene assistance, and the Indigent Program for Prescription Medications. The Senior Citizens Center in Mayfield provides transportation in the city of Mayfield and through the county. They also provide a service called Meals on Wheels. The Saint Vincent de Paul Society of Mayfield provides food and clothes to those in need of all ages.

For the acutely and chronically mentally ill, Four Rivers in Mayfield and Paducah provides mental health counseling, substance abuse counseling, and developmental disability services. For victims of abuse, the Lighthouse, located at The Healing Place Church, in Mayfield, provides shelter for women and children who are victims of domestic violence or abuse. For rape or sexual assault victims, Lotus, which has two locations, Paducah and Murray, provides support and advocacy services, whether it be legal or medical, as well as specialized therapy. There is also a sexual abuse hotline and a child abuse hotline available 24/7.

For developmentally disabled children and adults, Graves County is fortunate enough to have the J.U. Kevil Center in Mayfield. J.U. Kevil provides programs for mentally, physically, and developmentally persons. They can help find job openings, prepare resumes and set up interviews for some people. There is also Generations Adult Day Services in Mayfield. Generations provides a safe, home-like environment for adults who are 18 years or older, who are disabled, suffer from Alzheimer’s or dementia related disorders.

For a those who suffer from a chemical dependency in the Graves County area, Four Rivers Behavioral Health in Mayfield provides substance abuse counseling and substance abuse support groups. There is also Recovery Works, located just outside of Mayfield. Recovery works offers a drug and alcohol treatment center. They also have a residential, intensive outpatient program which includes outpatient counseling. For those who are homeless in the Graves County area, the Graves County Need Line provides free food supplies for those who qualify based on the size of the family. The Purchase Area Housing Corporation of Mayfield provides housing assistant programs.

Upon reflection of the services offered in our community, I cannot help but see that there is not necessarily and abundance of one type of service, but there are considerably more resources available to those who need things like food and clothing. The Need Line, St. Vincent de Paul, and many churches throughout the county take in donations and have fundraisers in order to be able to have food and clothes to those who need it. Although this is incredibly important and is the most basic need in life, there are not many resources after that. There are only a couple of homeless shelters in our area, but even the ones we have are selective to who can come. Some of the homeless shelters only allow women and children, no men. I think this is because there is a stigma that “men can handle themselves” whereas women cannot. There need to be more homeless shelters in general, but there need to be more options for homeless men in Graves County. Food, water and shelter are the utmost basic needs of a human.

After the most basic needs, food, water, clothing and shelter, is the need for belonging, to be loved or cared for. Many people who have behavioral health issues in some way struggle to meet this psychological need. People who struggle with substance abuse, mental illness, disabilities, or even being homeless, often find themselves being looked down upon, made fun of, or even as “less”. Services such as, J.U. Kevil provides the opportunity for people with similar disabilities to make friendships with each other, with other people in the community, and to be more independent. Services such as Recovery Works, provides a safe environment for a drug abuser or an alcoholic to come and not be judged, to find people who have walked the same shoes or who are, it allows them to accept their past and become more independent. Places like the Purchase Area Housing Corporation help the homeless find a safe place to rest their head, and to hopefully get them back on their feet.

I truly believe that we have a good set of resources in our community for those who are in need, but we could use more; this I would consider a strength. We need more homeless shelters. We need more services for the acutely and chronically mentally ill. This I would consider a weakness. We have plenty of resources, but they are not diverse enough.

Nurse make an impact wherever they work. Nurses in our areas, most likely know about all these services, they are very popularly known by most. But just because they know of these services, does not mean they are utilizing them or asking if they need to be used. From my personal experience, I have never heard or seen a nurse ask if someone needs assistance. I believe that nurses would have much more impact on our community if they would ask. If they would stay curious, but not pry.

Based on my findings throughout my research process, I would recommend that maybe our local government raise the awareness of the amount of homeless people in our area, raise the awareness of the substance abuse issues, and to act to make more resources available. Partner with clubs and groups throughout the county like the Lions Club, the local business chapters, and even the school clubs, to host fundraisers and to raise awareness of these issues in our communities. People want to help, they just do not know how to help or where. If we were to raise awareness, I firmly believe our community would come together, like it always does, and help one another out.

References

1. Alcoholics Anonymous Meetings in Mayfield KY 42066 – Hope and Action Group – 303 W Broadway St, Mayfield, KY 42066, USA – Monday. (n.d.). Retrieved from https://prevailintervention.com/meetings/alcoholics-anonymous-meetings-in-mayfield-ky-42066-hope-and-action-group-303-w-broadway-st-mayfield-ky-42066-usa-monday/
2. CHFS Homepage. (n.d.). Retrieved from https://chfs.ky.gov/Pages/index.aspx
3. Four Rivers Behavioral Health. (n.d.). Retrieved from https://4rbh.org/
4. Fuller Center. (n.d.). Retrieved from https://fourriversmirco.com/mainsite/behavioral-health-counseling-services/substance-abuse-services/fuller-center/
5. Get Help. (n.d.). Retrieved from https://hopehealgrow.org/get-help/
6. Homeless Shelter Directory. (n.d.). Retrieved from https://www.homelessshelterdirectory.org/cgi-bin/id/shelter.cgi?shelter=12546
7. Kevil Korner. (n.d.). Retrieved from https://www.facebook.com/kevilkorner/
8. Mayfield – Graves County Senior Center – Senior Center in Mayfield KY. (n.d.). Retrieved from https://seniorcenter.us/sc/mayfield_graves_county_senior_center_mayfield_ky
9. Mayfield Social Security Office 1526 Cuba Road Mayfield Kentucky 42066. (n.d.). Retrieved from https://www.ssofficelocation.com/mayfield-social-security-office-so541
10. Mayfield-Graves County Need Line and Food Pantry. (n.d.). Retrieved from https://www.facebook.com/Mayfield-Graves-County-Need-Line-and-Food-Pantry-88900907814/
11. Narcotics Anonymous Meetings. (n.d.). Retrieved from https://www.na.org/meetingsearch/text-results.php?country=USA&state=Kentucky&city=Mayfield&zip=&street=&within=20&day=0&lang=&orderby=datetime
12. Public Housing. (n.d.). Retrieved from http://mayfieldhousing.com/public-housing/
13. Recovery Works Mayfield. (n.d.). Retrieved from https://pinnacletreatment.com/location/recovery-works-mayfield/
14. Saint Vincent de Paul Society. (n.d.). Retrieved from https://www.facebook.com/pages/Saint-Vincent-Depaul-Society/133981299987623
15. Support Survivors, Strengthen Families, Empower Communities. (n.d.). Retrieved from https://hopehealgrow.org/
16. The Omni Family of Services. (n.d.). Retrieved from https://www.theomnifamily.com/
17. The Salvation Army Paducah. (n.d.). Retrieved from https://www.facebook.com/SalvationArmyPaducah/
18. Welcome to Generations! (n.d.). Retrieved from http://generationsads.azurewebsites.net/
19. West Kentucky Allied Services. (n.d.). Retrieved from http://www.wkas.info/

I decided to write a community assessment paper regarding the elderly population with a lower socioeconomic status. Elders desire a life with good health, dignity, economic independence and finally a peaceful death. They long for care, love and affection. Understanding their needs and concerns will ensure their good health. It is important to research beneficial services for older people because they are a vulnerable age group. According to World Health Organization, “Senior citizens are considered a vulnerable population, even if an individual elderly person is physically able to care for herself and is in full possession of her mental capacity” (para. 1). If seniors belong to a lower socioeconomic group it becomes even harder for them to provide for themselves.

When I decided on what population I should choose for this assignment, I thought about my parents who are getting close to this age group and how important it is to provide care and help for them. They are immigrants who moved to the United States from Ukraine at an advanced age, and I see that such people need support. Older people are not as healthy as younger people, so it is harder to work and support themselves. Older people might feel vulnerable due to: untimely or degrading death, lack of physical care and health care, an oversupply of care and interference, poverty, exclusion from participation in society, homelessness, loss of autonomy and independence and other factors. Additionally, older immigrants are facing some extra obstacles such as the language barrier; they can not find a job due to lack of proficiency in English. They do not have much retirement because they did not work here in the United States, even though they worked hard in the country they moved from. Therefore, I will talk about some health benefits out there for seniors, and how these benefits can ease their life in advanced age.

One of the most important benefits is having easy access to health providers and medical institutions. In order to have this access, people need health insurance, because in the United States medical benefits are really expensive. Since the elderly population is not working they cannot have insurance through their employment, and if they are low-income they are unable to purchase it. Fortunately, Medicare can cover most health-related services. Washington State Department of Social and Health Services (DSHS) is one of the largest governmental organizations that helps the low-income population. The local facility is on 800 NE 136th Ave #110, Vancouver, WA 98684. It is a new building, close to Mill Plain, a convenient location because you can find bus station, food places, post offices and many other things close by. However, there are some elderly people who have disabilities and need assistance in transportation, so it would be great to have free bus travel for disabled passengers right from home to the office. I spoke to one of the representatives at DSHS and she explained what Medicare is and how it works. Medicare is a federal health insurance program that provides benefits to seniors (65 years and older) and those with disabilities and certain illnesses. According to DSHS, Medicare has several parts. “Parts A and B are called Original Medicare. They are run by the federal government. Medicare Part C is called Medicare Advantage. You buy Medicare Advantage plans from private health insurance companies that contract with the government. They work with Original Medicare coverage. Part D covers prescription drugs. Many Medicare Advantage plans combine Parts A, B, and D in one plan. And each Medicare plan only covers one person” (para. 2). In order to apply for the insurance, you can schedule an appointment with the agent, and who will help in processing the application or you can apply directly through the website: https://www.washingtonconnection.org/eapplication/home.go?action=Introduction.

Unfortunately, some plans do not cover all the services, such as dental or vision. Populations with lower incomes can not afford premium plans that have more coverage. Moreover, I found out that even if you have Plan C, due to your low income, more and more providers do not take State insurance at all. Less dental and vision providers (private practices) want to make contracts with State insurance due to lower profit. At times they accept only children up to 21 years old. When I used to work at a dental clinic we used to take DSHS insurance, but as soon as we got more patients and our contract expired my boss did not sign a new agreement and stopped taking that insurance. Also, it did not cover some major services such as crowns, bridges and root canals which may elderly patients need. So even if you have insurance you can not use it. Many barriers arise, patient can not have access to the provider that he wants or sometimes can’t find any provider. Thus, I went ahead and searched for the optimal variant for elderly people and what would the possible solution.

I found the insurance agent who I visited, his name is Ramzan Magomedov. He is a very knowledgeable and helpful agent who speaks English and Russian. It is very helpful for Russian-speaking immigrants who have a language barrier to speak with a person directly without a translator. His company is called Secure Tomorrow Insurance, LLC CQ located at 1000 N.E. 122nd Ave., Suite 116, Portland, OR 97230, you also can visit his website: securetomorrowinsurance.com. The office location is a very convenient place, you can find food stores, restaurants, shop stores, bus stations and other stuff in that area. However, there are some elderly people who have disabilities and need assistance in transportation, so it would be great to have free bus travel for disabled passengers right from home to the office. He told me about the United Healthcare Group Senior Supplement plan which can help to pay for services that are not covered by Medicare. He also told me that this plan is more profitable for the providers, so more of them have a contract with this insurance. According to UnitedHealthcare, “UnitedHealthcare’s Senior Supplement plans are group major medical insurance coverage for Medicare-eligible retirees. They help pay for the costs recognized but not covered by Original Medicare Parts A and B. The insurance plans are regulated by state insurance agencies rather than by the Centers for Medicare and Medicaid Services” (para. 1). After my employer stopped taking Medicare, more patients started to come to the appointments with United HealthCare insurance and my provider got more money out of that insurance versus Medicare. UnitedHealthcare also covers more medical procedures. For example, it covers some crowns, bridges and root canals. Also, you can have a dual plan: Medicare and UnitedHealthcare. If the patient still has a provider who takes Medicare, he still can use both insurances to cover services that one of the insurance does not pay for. Ramzan Magamedov can help elderly people to find out what plan is the best to choose and help with the processing of the application, plus his consultations are free.

Another option to get medical help for no cost it is a Sea Mar. Sea Mar Community Health Centers is a thriving, not-for-profit community-based organization committed to providing quality, comprehensive health, educational, human, housing and cultural services to diverse communities in Washington state. Sea Mar (2018) stated “we take great pride in providing quality, affordable, culturally sensitive health care to low-income and underserved communities in Washington. We are proud of the high-caliber medical providers working on our team. We support access to health care for all and firmly believe that the patient is our first professional responsibility whether man, woman or child; ill or well; seeking care, healing, or knowledge” (para 1). For immigrants who do not speak English, they can request an interpreter for the appointment. Sea Mar is very helpful for all age groups including older people who have low income. There are lots of local offices that you can find on the website: https://www.seamar.org/. One of the local Sea Mar Health Centers is located at 6100 NE Fourth Plain Blvd, Vancouver, WA 98661. It is a convenient area because there is a bus station nearby as well as some food stores/coffee shops. However, the disadvantage is the long waiting period on a phone. As a solution, you can try to call a different Sea Mar office in your city and see if their waiting time is shorter.

As a bonus, I would like to talk about English classes for immigrants. Since many immigrants do not speak English most of the time they can not find a job that will give them enough income. They also can not make doctor appointments for themselves or don’t even go to the doctor due to a lack of proficiency in English. Sometimes, they have to ask their kids or relatives to help them with interpretation, but many parents do not want to bother anyone and fail to schedule an appointment. According to Ku (2016) “factors, like language barriers, also impair immigrants’ access to and the quality of medical care they receive. The net result is that immigrants are much less likely to use primary and preventive medical services, hospital services, emergency medical services, and dental care than are citizens, even after controlling for the effects of race/ethnicity, income, insurance status, and health status” (para. 6). Many other conflicts arise, like disclosure of personal health-related information to interpreters, such family members or strangers. Therefore, it is critical to start learning English as soon as it is possible.

Good Will offers free English classes in Portland, Vancouver, Salem, and other communities in Oregon and Washington. In order to register you just need to go to the website; https://goodwilljobconnection.org/esl/free-classes/ and hit ESL free registration. For your convenience, you can pick what location you want to go to, depending on where you live. Elderly people can just go to the local Good Will and sign up for the classes if they can not use a computer. Plus, Goodwill also offers free Citizenship test preparation classes, and everyone is welcome. It helps immigrants to pass the citizen test and get more benefits from other sources and maybe even to find a better job. However, some elderly people especially immigrants, can’t drive or do not have car. So, they could face transportation issues. The solution to that could be offering a free bus pass, especially for low-income people.

Another school that offers ESL (English as a Second Language) classes are at Clark College, which welcomes immigrants and refugees. The advantage of Clark College that it does not require students who are taking ESL classes to provide Social Security Numbers, proof of citizenship, or to identify their national origin. It is helpful for immigrants who did not receive citizenship yet or does not have paperwork. ESL classes cost $25.00 in tuition per quarter. However, tuition assistance is available, and you don’t need to pay if you are a low-income student. The classes are held in T-Building (TBG), and for any information just go to Transitional Studies Reception Room 20. They can help with the application process and answer any questions. Most of the workers are bilingual who can help with the application process in case you do not understand something. Also, older people or anybody who needs accommodation due to a disability in order to fully participate in this event can contact Clark College’s Disability Support Services Office at (360) 992-2314 or visit Main Campus PUB 013, two weeks prior to the event. The Clark College area has a bus station that is convenient and anyone who has low income can receive help with the free bus transportation. However, there are some elderly people who have disabilities and need assistance, so it would be great to have free bus travel for disabled passengers right from home to school. Another benefit of Clark College is that you can climb up on the “career stairs” by building your knowledge and maybe even enroll in higher division classes to work toward some profession. Eventually, low-income immigrants can get a better job that will raise their income and improve the financial situation of their life.

In a nurse role, it is very important to do research and know all this information because it helps them advance nurses’ field, stay updated and offer better patient care. Nurses can also help uninsured patients and families locate nearby sources of free or low-cost medical care, such as free clinics and hospitals that offer charity care. Nursing is not just about dispensing medication or administering treatments. Nurses also are responsible for teaching patients about the resources out there. One of the nursing roles is to observe and help her patients. When nurses notice low socioeconomic conditions of their patients she must provide recommendations. Plus, it is really nice to have personal experience and visit actual resources in order to provide reliable, accurate information and build a trustworthy relationship with patients. By relaying information, nurses help patients take control of their healthcare. All the information and sources about insurance for elderly people and free English classes I described above greatly help low socioeconomic patients. Thanks to this information many immigrants learned English and got a good job positions. Some people received medical care and stayed alive because they had access to the sources that someone had told them about. For example, when my dad came to the United States he needed open heart surgery which cost about $320,000. Of course, our family did not have such money, but the nurse told us about Medicare. After applying for it my dad got full coverage and his life was saved. In this example, we can see how the nurse’s role is very important in educating and providing more than just care.

References:

1. Leighton Ku. (2006). Why do immigrants lack adequate access to health care and health insurance. MPI. Retrieved from https://www.migrationpolicy.org/article/why-immigrants-lack-adequate-access-health-care-and-health-insurance
2. Sea Mar Community Health Centers. (2018). Welcome to sea mar community health centers. Retrieved form https://www.seamar.org/
3. UnitedHealthcare. (2019). Understanding health insurance. Retrieved from https://www.uhc.com/individual-and-family
4. World Health Organization. (2019). Environmental health in emergencies. Retrieved from https://www.who.int/environmental_health_emergencies/vulnerable_groups/en/
5. Washington State Department of Social and Health Services. Medicare. Retrieved from https://www.dshs.wa.gov/altsa/home-and-community-services/medicare

I did a community teaching at a community church; the lesson was designed to help children of primary school, aged between 6-11 years, understand primary prevention or health promotion on the prevention of diabetes type 2. The lesson was estimated to last for 40-55 minutes. In my plan, I will deal with primary health campaigns focusing on obesity in children, which causes diabetes, which lies under the nutrition and health status objective of the HP2020 world initiative.

According to CDC, the chances of diabetes are increasing in the USA; people with diabetes are more than 34 million, most of who have type 2. Type 2 diabetes attacks people above 45 years but is more in children, teens, and young adults, which led to our epidemiological concern due to the increasing trend in cases. The nursing diagnosis is taking too much food than the required amount, which leads to a gain of weight.

The young grown will compose themselves in terms of body feelings on measures to prevent diabetes and fatness and engage in conversations in readiness to learn. They will use body language, which will improve my confidence and verbalization to ensure reality testing to achieve a secondary course. I will identify habits that cause obesity at a different age and ensure they understand; they will have to explain what I have taught back in their own words; this will help me evaluate their understanding and emphasize where needed.

Diet and status of weight of a person involve intense research on the benefits of healthy foods. One of the goals of HP2020 is to increase the number of schools offering healthy and nutritious foods. These healthy foods will help schools not provide many calories and cholesterol and instead provide whole grains and fruits, which are beneficial. The goal of HP2020 recounts Alma Ata’s work and enlightens people on health problems and their avoidance through the intake of food and nutrition (The Lessons of Alma-Ata, 2018). HP2020 objective and Alma Ata advocate for a healthy diet, and the audience are encouraged on healthy foods to consume (From Health for All to Universal Health Coverage, 2018).

In developing behavioral objectives, the students will name a healthy choice in five food choices. They will be able to acknowledge the benefits of fruits and vegetables in their diet; they will be able to differentiate healthy and unhealthy food, promote physical exercises, and teach their parents the importance of the exercises. While teaching creativity was evident in creating a compassionate environment to eliminate fear, students’ ideas were considered, and the feedback encouraged self-assessment.

In evaluating the goal, I will identify the student’s diet to measure their eating behaviors. I will note good health by checking the medium weight. I will weigh the sample snack made from the food pyramid if it is healthy and if the criterion was realistic and timely.

To communicate therapeutically with the patients, I will create rapport with the audience. Devote listening will be noted on the way students will be answering questions, and to ensure active listening, I will be asking questions. I will conclude my story’s central theme and finally apply body contact in my presentation.

Diabetes is among the lifestyle conditions that the community is suffering from conflict hard to eradicate. It is a chronic health condition that occurs due to blood glucose metabolism being impaired due to insulin resistance, inadequate production of insulin, or excessive secretion of glucagon. It is the most common type of diabetes affecting mostly middle, old age individuals and obese children with around 29 million United States residents (Dansinger, 2020 December 06). It is mainly caused by a combination of factors including genetic predisposition from parents, and metabolism conditions like high cholesterol and triglycerides. The Most rampant cause is excess body weight or obesity, excess glucose production from the liver, poor cell-to-cell communication. For example, sending and receiving wrong signals or not retrieving signals at all, and breakage of beta cells by sending the wrong amount of insulin at the wrong time.

Risk factors include those above 45 years of age, family members or genes, and ethnic group where its more in Asian Americans, African Americans, etc. cardiac and blood vessel illnesses, obesity, depression, hypertension, excessive alcohol consumption, and smoking are among other major predisposing factors.

• Signs and symptoms
• Excessive urination, appetite, and thirst.
• Hazy vision
• Being testy
• Shivering or loss of sensation in your grasp or feet
• Weariness/feeling exhausted
• Wounds that don’t recuperate
• Repeating Yeast diseases
• Weight reduction easily

If diabetes isn’t appropriately treated, it can prompt hazardous conditions like demolishing dangers to heart and veins sicknesses, neuropathy, kidney disappointment, eye harm, slowly twisted mending, hearing weakness, skin conditions, rest apnea, and Alzheimer’s infection. Management can be achieved by making lifestyle changes like losing excess body weight, practicing healthy eating behaviors, participating in physical activities, and closely monitoring blood sugar levels. Adherence to prescribed medications as indicated is also important.

Community health workers play a major role in ensuring the health and safety of community members are maintained at the highest level possible. They ought to arrange a communal gathering to educate them on healthy behaviors that contribute to the prevention of diabetes. They should also plan for screening programs to check blood sugar levels mostly for old and obese individuals. They ought to bring to the community members understanding the importance of physical activities and offer them options on what activities to take part in. They do work together with the ministry of health, other professionals and the government to fund healthcare promotion programs.

I would evaluate my teaching experience through several methods. I could do that by asking a friend to observe me while teaching and assessing my expertise. In this case, I will choose a friend who is always very serious and can provide me with insights on the things I did wrong and where I need to change. Secondly, I can do so by videotaping myself during the lesson and use the video to evaluate myself on the things I need to change. I will use the knowledge I have on good teaching habits to evaluate my lesson and achieve the class’s purpose.

Thirdly, I can ask my friend to read my lesson plan after class to evaluate if I achieved the required objectives. Using a colleague, I will be assured that he or she will not favor me in their evaluation. During class, I can also decide to take notes of the lesson to evaluate later. I will take notes on the student’s behavior, their level of contribution in the class, their confidence, and their understanding level. Finally, I can evaluate the teaching experience by checking the tests and homework scores after a lesson. If the scores are excellent, then it means my teaching experience is good. However, suppose the students are not performing well. In that case, I have to evaluate my lesson plan, restructure my objectives, and ensure the students fully participate in class and obey my instructions.

Throughout the teaching, I encountered open-minded people in the community teaching who were willing to learn and change their behaviors. Having created a learning atmosphere, the interaction I had with the children worked positively. The children were actively involved in the presentation of the food pyramid. They consulted me on the food categories; they were not sure where they belong. Each student jokingly told me which food they had for lunch, and the rest would help identify the food groups each missed. The children asked how they would help their parents at home prepare food that is nutritious to avoid weight gain, and I offered to make a chart for each one of them.

The parents who participated in the community teaching helped me maintain the children’s discipline throughout the lesson. However, they were also actively involved in understanding which physical exercises were best for their children. They raised issues about specific activities that are risky for their children, such as riding. Therefore, I gave alternatives such as playing football which is less risky. The parents hence consulted with me on the necessary assets they can buy for their children depending on the activities they want to engage their children.

The students were uncomfortable with the new information I provided to them. They thought everyone who is obese among themselves had diabetes type 2. Therefore, I clarified that unless someone is screened, they were healthy but with a high risk of getting the disease. The audience responded to the questions I asked and asked for clarification, where they did not understand. For instance, they were asking if there are self-test kits for diabetes type 2. However, the primary concern of most parents was the food their children eat at school. I helped them determine how they would supplement it to be nutritious.

Overall, the lesson was lively, and participation and responses were excellent. The students scored high in the assessment, and the parents were thrilled because they had learned some new nutritional ideas. They promised to put what I taught into practice and asked for a follow-up lesson that I promised to organize.

In community teaching and community assessment, I discovered my potential strengths in some areas while I need improvements in other areas. In community teaching, I utilized my creativity to provide that made the children have no fear. To ensure the childrens’ self-assessment, I gave them appropriate feedback, which was unique for each child. In the community assessment, I interviewed a healthcare provider to understand the community better. The creativity level in both cases helped me achieve excellent results in both areas.

I am self-confident with the qualities to address people without fear; therefore, I helped me in both situations to get the relevant information I needed and pass the relevant knowledge. Self-discipline helped me work around my schedule without being late for the community teaching or the interview time. These personal strengths, combined with the knowledge I have acquired in class, helped me have an easy time working with the community, and I will work towards perfecting them.

However, I need to improve my non-verbal cues while doing community teaching and master appropriate sign language. These two areas were a challenge to me since I am not used to teaching, mainly where parents are involved. Fearlessly, I tried my best not to show these weaknesses in front of the parents and the pupils in community teaching. Moreover, my confidence helped me overcome the challenges quickly, and I tried my best to use sign language to help the children understand. In community assessment, I need to improve on a telephone interview; when I phoned the healthcare worker, I was a bit nervous at the start, but I regained myself as the conversation continued when I notice she was such a nice person and willing to give me any information I wanted.

Throughout my teaching and community assessment, I have learned a lot, which I think will be useful for the future of my career. Community teaching was an excellent experience working with small children and their parents. I learned how to handle children and their childish behavior; however, they are very adorable, and I can now spend any amount of time with a group of children. In the community assessment, I learned a lot from people, and the challenges communities are facing. I would like in the future to work in such an area and help people. The experience was incredible, and I look forward to working in the community.