Task 1 C228 Final draft PDF

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Task 1 C228 Sharda M. Belcher Western Governors University 09/19/2019

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Needs Assessment Upon observation, review of data, and interviewing citizens in sentinel city I have identified multiple needs in the community that could use improvement. In this section my needs assessment is placing focus on ideas to deal with the multiple areas identified. Crime, Sexually transmitted diseases, teenage pregnancy, providing better handicap access for the disabled, safer communities, and general health promotion such as increasing immunization rates and decreasing uninsured rates. This needs assessment was compiled through different methods. I used demographics, Neighborhood community and safety inventory observations, I performed a windshield survey of the areas and a scavenger hunt for information. After gathering this pertinent information I have come up with many areas that could be improved upon in the city. The first area to address would be providing more mandatory police training to summarize my interview with Rodney in sentinel city, I discovered that police received anti-bias training for two days in the beginning of the job. Some officers on the force haven’t had any refresher training in over ten years. With the crime rate steadily increasing it is imperative public service workers receive ongoing continued education and training. This should be done in efforts to keep up with the times and cultural climate they will be dealing with (Healthcare Learning Innovations, 2018). I further identified a need for better handicap access based on the interview of a local resident in front of the health center. There are some wheelchair ramps on buildings but, none on the city bus. Adding ramps to the community will help decreased the risk for social isolation related to lack of transportation for elderly/disabled (Healthcare Learning Innovations, 2018).

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My interview with the bodega owner revealed complaints of shoplifting, homelessness, and dark streets with not enough street lights. There is also a need for increased police presence in the area. Adding street lights to poorly lit areas and having increased patrolling of police could deter criminals from illegal activities such as robberies. Which, have increased in the last few years now at 40 overall in the city (Healthcare learning Innovations, 2018). Upon observing the health data there is a need for more education and initiative to prevent STD’s and pregnancy in teens. Last year’s data shows that 475 teen pregnancies occurred with 179 abortions and 296 births. The community needs more prevention and outreach to intercept prior to a teen pregnancy and STD’s occurring. Perhaps this can be done by providing more community STD education, passing out of condoms. Putting together community health fair more closely focused on the teenage age group. There appears to be a direct correlation between teenage pregnancy and the number of STD cases. In my opinion the high rate of teen pregnancy and STD’s shows that safe sex isn’t being practiced as often as it should be (Healthcare learning Innovations, 2018). More health promotion and education in lower income areas would be beneficial. A barrier to this could be the income and resources available in lower income areas. Industrial height has a median income of $24,674, with an uninsured Percentage of roughly 37. More than a quarter of the population does not have insurance. Industrial heights also has the lowest percentage of immunizations compared to the other neighborhoods and US average. (Healthcare learning Innovations. Sentinel City, 2018).

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Demographics Sentinel City is divided into four sections. Acer Tech Center that has a population of 168,390 residents, Nightingale square with a population of 103,974 residents, Industrial Height with a population 38,855 residents, and Casper Park with a population of 352,643 residents. The total population of Sentinel City is 663,862. As with any city there is are a variety in incomes earned by families. The Median income levels for each section of the city are as follows: Acer Tech Center $166,300 with the primary ethnic group in this area being white 70.2%. Nightingale Square median income $269,550 the primary ethnic group in this section of the city is white 81.3% , Industrial Heights has remarkably the lowest median income $24,672 with the primary ethnic group being Hispanic and Latino, making up almost half at 46.8%, Casper Park District $80,134 with a primary ethnic group being white at 63%. Comparing the median incomes Acer Tech center and Casper Park District fall in the middle of the four sections of town. Nightingale being the highest and Industrial Heights at the lowest end (Healthcare learning Innovations Sentinel City, 2018). Industrial Heights has a very high percentage of uninsured residents at 37.5%. The other areas with higher earned incomes have a lower rate of under insured residents. Casper Park District at 22.7%, Acer Tech Center has 1.5% of its resident’s non-insured, and 0.7%. Of residents are uninsured in Nightingale Square. Comparing the data the area with the highest median income has the lowest percentage of uninsured residents (Healthcare learning Innovations, 2018). .

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Sentinel city is comprised of a diverse population of residents. The variety can be seen in Ethnicity, age, and education level. According to Sentinel City Community Health Simulation Demographics Residents under 5 years, make-up percent 7.4% of the population. Residents under 18 years 21.7%, Residents 65 years and over 10.5%. The diverse population is evident in the different Ethnic background as follow: White alone 80.6%, Black or African American alone10.4%, American Indian and Alaska Native alone 2.0%, Asian alone, 3.7% Native Hawaiian and Other Pacific Islander, 0.2%. The city population with Two or More Races, percent 3.1% Hispanic or Latino, percent 31.5% White alone, not Hispanic or Latino 52.7%. Education level High school graduate or higher, persons age 25+ 85.1% Bachelor’s degree or higher, persons age 25+ 42.2% (Healthcare learning Innovations, 2018). Neighborhood Safety Assessment During my various methods of observing the city riding on the bus, interviewing the residents, walking around, and data collection I have observed that there are some areas in Sentinel city that are old and in need of maintenance. Trash and stray animals were observed. Graffiti and broken windows were also observed. The lower income sections of the town are in need of more general up keep. Crime in the city based on the data collected from the Summarized data related to drug use in the city show that about 16% of arrest are for controlled substance and 6% public intoxication. The EMS response times are as follow: Fire 6.33 mins, EMS 7.46 mins, ALS 7.54 mins, and time to shock 6.37 mins (Healthcare learning Innovations, 2018). During my observation and data collection I also noticed that crime in the city has been increasing. In sentinel city prostitution, trespassing, public intoxication, selling without a permit, aggravated assault and homicide are some of the most frequent crimes. The data shows there is

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gang violence in the community and it has increased significantly comparing each category from year 1 to last year. Homicides in year 1 were 5 last year it has increased to 20, aggravated assault year 1 from 95 to 100 last year , simple assault year 1 20 , last year increased to 38, Robberies in year 1 were 25 climbing to 40 last year. Data also shows most crime being committed by more males than females. Although, the crime rate is steadily rising the city is doing their part to assist the citizen affected. They offer a variety of victim assistance programs o such as follow-up, Shelter/safe homes, crisis counseling, and emergency financial assistance. These services can be beneficial in helping people affected by the crimes recover successfully (Healthcare learning Innovations, 2018). Scavenger Hunt My observation during sentinel city, stopping at parks and recreation they offer a variety of activities for the community such as Swimming, Nutrition, gardening, kids summer program, city sports league, adult fitness, and after school program. The variety of classes offered has the ability to attract a diverse population of people from the city. Upon interviewing a wheelchair bound citizen of the community in front of the health center, I learned the church and community center also offer support groups for the disabled. As with any state or city crime is inevitable, in sentinel city prostitution, trespassing, and public intoxication and selling without a permit are amongst some of the common complaints, in the public park area. The Budget for park has been steadily decreasing within the last 4 years. In my opinion city budgets should not neglect the positive recreation in the city. Parks and recreations are free and help combat obesity and isolation. Family and children can actively play and interact, the more outdoor time children can spend the less chances of sitting in front of the television sedentary. A public park helps combat isolation. The elderly, single people, and families can congregate and engage in social activities.

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Keeping the public parks up can assist low income families with positive free activities as well. City Hall-Social Services show that Snap benefits are mostly accessed by the low income population at 36%, then Disabled 26%, Elderly 60+ 15%, persons in training program 23% . Within the last 5 years the data shows mothers are breast feeding more. The numbers have increased from 7 to 11 currently. With numbers for W.I.C. post-partum and infants decreasing. Breast feeding can have additional health benefits of mom passing immunity through breast milk. Majority of citizens on Medicare or Medicaid insurance plans. There is a population of homeless and uninsured. Interviewing a homeless citizen in the community, shared he usually shoplifts supplies and medications when he is sick or injured. The affordable Housing Project Offers housing to low income families Average income 17,000-33,000 $ for units studio to two bedrooms. Crime has gradually increased over last 5 years. Common complaints from tenants in regards to the neighborhood factory smoke, noise, dog barking and high rent. The healthcare system elderly service offers a variety of resources. Such as medical care advocates, community center, elder abuse prevention advocates, service animals, meals on wheel and senior transport. This targets major areas for the stages of life that an elderly person may be experiencing. Better Health Clinic offers an array of comprehensive preventative and treatment service. Some of the serviced include breast and cervical screening, basic infertility, STD services, pregnancy test and counseling as well as contraceptives. Despite the services being offered over the last 5 years teenage pregnancy and sexually transmitted disease are on the rise (Healthcare learning Innovations. Sentinel City, 2018). Interfaith church has the soup kitchen, where citizens can gain access to nourishment, they provide emergency food program. This service is offered in the Industrial Height area where there is a low median income threshold. The Affordable Housing Project manages tenant

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complaints, as well as the numbers of occupied residences, along with a record of income bracket vs housing unit type occupied (Healthcare learning Innovations, 2018).

Windshield Survey During my windshield survey I observed many different aspects of the city. The buildings are primary made of brick and concrete. Similar in construction. Industrial park having more graffiti and more ragged structures. Lower income areas are older and more worn buildings Casper park area showed inmates on a work release program cleaning up a park. There was graffiti all over the building structures of the park area. With boarded up windows that appeared to be broken. During my tour of the city I did not observe any windmills or solar panels, Solar panels may be beneficial to add to the neighborhoods to decrease cost of electricity use. It would be nice if a grant could be created to bring this into the neighborhood. I observed protestors in front of city hall so it is apparent, there are people in the community willing to advocate for better conditions. I walked through a lot of alley ways and did not observe a lot of back yards with open layout for free play. Another reason I believe it is important to allocate as many funds keeping the public park in decent condition for recreation (Healthcare learning Innovations, 2018). The community center and city hall had a nice display of landscape. Community trees planted on either side of the walk way, city hall has well-kept grass. The cities seem to be a mix of suburban and urban culture. I noticed there are some benches around neighborhoods socialization observed in these areas, trees around the park area. I did not notice any visible boundaries separating the neighborhoods (Healthcare learning Innovations, 2018).

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There were a lot of children in front of the school, some were playing in the playground next to the school and there was a crossing guard outside of the school for safety. As I rode the bus through the city I noticed bike riders, people standing at the bus depot and walking in groups down the street. People were actively engaging in sports at the park, a few standing in front of the barber shop and around Joe’s grocery store. I could not identify one specific area of hangout it seemed scattered (Healthcare learning Innovations, 2018). Walking or bus riding seems to be primary use of transportation. Cars were also, observed on the road. It did not appear like a high number of cars were on the road. There were no heavily congested traffic areas observed. Busses don’t come around frequently or close enough according to an interview with a citizen outside of Joe’s market. I observed one gas station in the area. In the Acer area of sentinel city I noted a street called Railroad way with high rise train tracks above the buildings. It reminded me of Fordham rode in NY City (Healthcare learning Innovations, 2018). I observed a Dental office in the area as well as the Better health clinic, and hospital for health needs. The residents shop at the local Bodega and Joe’s market. I observed people walking around, a motor cycle rider and also, a bus depot with a good amount of people waiting for public transportation. There were many people out and about during the day, I observed a dog walker, beat police patrolling and construction workers outside of a site working. There were also people sitting on benches socializing. Active play at the park, city hall protestors out holding up political protesting signs (Healthcare learning Innovations, 2018). I observed a stray cat at least twice walking through the neighborhood. I observed a billboard encouraging vaccinations, an anti-smoking campaign on a billboard as well. The community seems live and active, Lots of people walking up and down the street I saw some

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forms of culture expression in the neighborhood, a man and woman walking in front of city hall with a turban on their head, a young adult in front of the barber shop with dyed hair (Healthcare learning Innovations, 2018). I noticed trash being cleaned up by the inmates, and a construction site that had many things out on the side walk that could be safety hazards for citizens walking by. Interfaith city church is located in the industrial park area. It is used on days other than worship as a soup kitchen to provide meals. I observed several people outside of the clinic and hospital. This can indicate that there is evidence of acute and chronic disease/conditions. Citizens are visibly seeking some form of treatment (Healthcare learning Innovations, 2018). According to the crime rate there is some drug addiction and alcoholism in the area. 16% arrest or illegal substance and 6% for public intoxication. There is a population of homelessness in the areas that could be attributed to poverty, mental illness, drug addiction However, nothing that I observed visibly confirms this. The hospital is located on the far end of the city, and clinic is located in the industrial heights area. This is a great place for a clinic to be located, it is in the low income area of the city. Clinics usually serve low income and uninsured population. Since industrial park is the lowest income area the local people may not have reliable transportation. The clinic appears to be in walking distance. However, if there was an emergency the citizens of industrial park would have to travel to the furthest end of the city for the hospital (Healthcare learning Innovations, 2018). .

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Interpretation of Data During my assessment for health needs I visited Better Health Clinic in order to gather data. I was alarmed to see the STD rate among teens in sentinel city. According to the epedemiology data in sentinel there is a high number of cases of Chlamydia 63% and Gonorrhea 70% among the age group 15-24. Teenage pregnancy has increased in the last 5 years, recent data shows 475 teen pregnancies (Healthcare learning Innovations, 2018). I also visited the health department and gathered data on immunizations. The lowest immunization percentage is in the Industrial Heights area. Which, is the area with the lowest income. In the same area more than a quarter of the population are uninsured. However, all four neighborhoods in Sentinel City are below the US national rate for immunization. Sentinel city pharmacy revealed Tobacco use in the city is at 24%, more should be done to decrease the number of smokers (Healthcare learning Innovations, 2018). Smoking can lead to lung cancer and city pollution. The city does have an anti-smoking billboard posted. That is one step to increase awareness to the dangers of smoking. This is a great way to get the message spread to a many members of the community as possible. Another observation I made when visiting the hospital was the potential misuse of medical resources by the citizens. The highest number of emergency department visits were for pain/back pain roughly 33% of the visits. In my opinion this area should be addressed. I believe more time and resources could be used in educating residents on what types of problems should be followed by which route of care If more providers and community resources were utilized to educate patients that chronic conditions should be followed up by a Primary care MD, and the added benefits of having a consistent provider ideally, overtime we would see more of acute emergencies in the emergency room. This method could eventually decrease co-morbidities,

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increase immunization rates, and decrease unnecessary ER visits. In my opinion the more people who connect with a regular physician who is knowledgeable of their medical history, the better and more accurate car can be provided. It will also increase the trust and better patient to healthcare provider relationships (Healthcare learning Innovations, 2018). C1. Three Problem Areas Three top problem areas that I have identified in Sentinel city are the high percentage of sexually transmitted diseases. Lower immunization rates compared to US average especially, in the lower income neighborhood. Another problem area is the percentage of uninsured residents in the lowest income area of sentinel city Industrial Heights. As previously mentioned according to the epedemiology data in sentinel city sexually transmitted disease among the community is a health issue. Chalymidia 63% and ghonorrhea 70% is among the highest percentage between ages of 15-24 (Healthcare learning Innovations, 2018). These two diseases often don’t have symptoms. Especially in males. So if a teen/young adult is having unprotected sex with multiple partners t...