Outcome Template

PAGE 1RUNNING HEAD: COMMUNITY ASSESSMENT PART TWO

Community Assessment Part Two

Northern Arizona University

Outcome Template

Present State Template

Concern(s):

Priority Table

(adapted from Muecke, M.A. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1), 23-35

Functional Health Patterns:

Identified Priority DeficitAppropriate for PH Nurse RolePrevalence of RiskSeverity of RiskPotential for Risk ReductionCommunity Interest

**Expected Duration of Program EffectsAvailability of ResourcesTotal Score

FHP 1

No primary health care in area r/t lack of facilities.

Lack of health care knowledge.

Homeless pop. Health risk to greater community.2

2

22

2

22

2

22

1

24

4

21

1

22

2

215

14

14

FHP 2

Lack of high quality nutrition r/t limited choice.21110128

FHP 3

Poor air quality r/t industrial waste

222121111

FHP 4

Need more whole family activities to decrease sedentary lifestyles.

No long-term care or assisted living facilities.

122212112411211013

FHP 5

Possible increase in noise.01102015

FHP 6

Lack of continuing education for the unemployed.12112119

FHP 7

Promote diversity events01110115

FHP 8

Domestic Violence r/t unemployment.222241215

FHP 9

Sexual education for at risk groups.21210129

FHP 10

Lack of income and jobs can increase social problems.01112117

FHP 11

lack of diversity for residents of other belief systems01110115

Weighting Schema: ** Score doubled to emphasize the importance of community interest.

0 = no priority

1 = some priority

2 = high priority Summary:

In looking at this census tract the major health priorities are determined by examining the area as a whole and balancing the observed health care needs with what the community is ready to solve. This community believes itself to be quite healthy and well functioning. This can create a challenge in determining what the important health issues are to be solved by the public health nurses, when the community at large doesnt see the same priority issues. The priority issues that will be focused on are the areas where community investment was in line with the nursing goals. The goals that meet these criteria are FHP 1 regarding lack of primary care and health knowledge, FHP 3 regarding air quality, FHP 4 regarding lack of long-term care, and FHP 8 regarding domestic violence. Nursing Diagnosis

Priority 1: FHP #1- Lack of Knowledge.Diagnosis: Risk for ineffective health maintenance among residents of Census Tract XX.xx related to lack of access to healthcare, lack of knowledge, and lack of financial resources.

PICO Question: For the population who lack readily available healthcare knowledge, would promotional flyers providing health prevention and promotion information increase the number of people seeking health care?

Priority 2: FHP # 3- Poor Air Quality

Diagnosis: Risk for respiratory illness among residents of Census Tract XX.xx related to poor air quality due to industrial waste.

PICO Question: For residents exposed to poor air quality, would providing daily awareness of air quality status decrease the number of asthma exacerbations in the community?

Priority 3: FHP # 4- Lack of Long Term Care Facilities

Diagnosis: Risk for ineffective health maintenance amongst the elderly population in census tract XX.xx related to lack of appropriate assistive service.

PICO Question: For the elderly residents who lack services to long term care facilities, would providing appropriate transportation methods for the elderly to access these services increase compliance to health care maintenance. Priority 4: FHP # 8- Domestic Violence

Diagnosis: Risk for impaired home maintenance amongst families in Census Tract XX.xx related to low income levels and inadequate support systems.

PICO Question: For family members who are at risk for domestic violence issues, would implementing weekly support group meetings to address stress management decrease the rate of domestic violence?

Community Intervention Map

Community Needs (GAP) Analysis ChartI. Functional Health Pattern #1 Health Perception, Management Pattern: Lack of knowledge. The community needs health promotion literature to be distributed to the community at a variety of facilities in order to teach disease-preventing behaviors.

II. Identify a minimum of 2 outcomes, one from Healthy People 2010 and one from Healthy AZ Goals (www.hs.state.az.us). Then compare and contrast the national (HP2010) and the AZ goals.

Healthy People 2010 Outcome 7-9: Increase the proportion of hospitals and managed care organizations that provide community disease prevention and health promotion activities that address the priority health needs identified by their community.

Healthy AZ Goal: Increase the proportion of persons who have a specific source of ongoing care.

Healthy People 2010 reports that strong predictors of a high level of health include having health insurance, a higher income level, and a regular primary care provider or other source of ongoing health care service. The ideal goal for Arizona is to be able to provide every family with a source of ongoing primary health because this would ultimately increase disease-preventing behaviors. The national goal tends to be more geared towards ensuring that individuals have a primary source of care.

III. Recommendations to meet desired outcomes above: Additional assessment: Assess the populations access to health care information because this may be a factor in the inability to obtain health care services. Assess publics compliance with selected interventions and observe willingness to learn. New programs/resources: Consider the public policy arena. Use advocacy as the key element to guiding political systems toward formulating and implementing a healthy public policy. Consider researching other communities that have a therapeutic and effective community health promotion and maintenance system in place. Observe and analyze the positive and negative factors of that system and initiate appropriate interventions that will work for this community.

Interventions

1. Primary Prevention: Provide health promotion literature and health education in order to prevent future health problems in children and adults.

Resources for implementation: Information will be provided to homes, community settings, and healthcare facilities such as public health clinics, physicians offices, community health centers, and rural health clinics.

Literature evidence: The integrative model for community health promotion was successful in promoting the health and wellness of people at Old Town Clinic by Laffrey and Kulbok (1999). This model has been successful to promote health by effectively guiding quality improvement of services for the population in a community clinic setting. This is relevant to census tract XX.xx because this community lacks public health information resources and health promotion literature that should be readily available to any community.2. Secondary Prevention: Survey parents and adults regarding their health knowledge about general health promotion topics. Identify at risk and underserved populations within the community (Stanhope & Lancaster, 2008). Resources for implementation: Screening may be done in the physicians offices or at public health clinics. The nurse will assess family history of cancer, heart disease, diabetes, and mental illness as part of their normal screening. Proper follow-up will be implemented based on the risk factors identified. Literature evidence: The U.S. Preventive Services Task Force (2005) recommends preventive services that individuals should receive in primary care settings in order to maintain healthy lives. Evidence-based preventive care is an essential component to a healthier population. The Task Force (2005) recommends the following screenings; regular dental examinations, blood pressure, BMI, lipid disorders, mammogram, osteoporosis, problem drinking, depression screening, tobacco use, coronary heart disease screening, diabetes mellitus, and immunization boosters and updates (Agency for Healthcare Research and Quality, 2005). This agency asserts that determining basic health knowledge and current health status can prevent serious complications and chronic illness within a community. This is relevant to census tract XX.xx because providing screening and health promotion information can be customized to fit the needs of this specific area.3. Tertiary Prevention: Educate residents about disease and treatment options by distributing informational flyers to direct their future care.Resources for implementation: Educational interventions may be done in the home, hospital, clinic, physicians office, and with the use of home health and other related services. Local media, notably print, can be used to provide awareness to a broad audience in the community, often in more detail than is found in smaller office based locations. Media can also be used to direct residents to seek care along with general education.

Literature evidence: The National Institute of Mental Health (1998) proposed an intervention spectrum that involves two components of treatment interventions, which include case identification and standard treatment for known disorders. This principle asserts that identification based on patient education should be completed for ill patients in order to prevent further complications. This is relevant to all communities where disease can be found and may go untreated, such as census tract XX.xx.Future activities: Monitor and evaluate progress based on the data relevant to community health services. Assess outcome progress of information distribution, distribution sites, information communicated and general flyer format. Modify interventions as necessary based on program evaluation. Compare current interventions with new evidence-based practice to yield the reliability of the interventions.

Community Needs (GAP) Analysis ChartI. Functional Health Pattern #3 Elimination Pattern: Poor Air Quality. There is a high risk for respiratory illnesses due to poor quality from the local environment. The community needs to minimize the risks of hazardous materials in the air being exposed to individuals by ensuring that air quality is maintained and regulated and communicated to residents.

II. Identify a minimum of 2 outcomes, one from Healthy People 2010 and one from Healthy AZ Goals (www.hs.state.az.us). Then compare and contrast the national (HP2010) and the AZ goals. (8 points)Healthy People 2010 Objective 8-12: Minimize the risks to human health and the environment posed by hazardous sites.

Healthy AZ Goal: Ensure that all air in Arizona achieves United States Environmental Protection Agency (USEPA) attainment status for criteria air pollutants by 2010.

Healthy People 2010 aim to promote healthy environments by regulating two indicators of air quality. The two indicators are ozone, which refers to outdoor, and environmental tobacco smoke, which refers to indoor. The Healthy AZ goal is achieved through active participation in the USEPA by obtaining and managing selected criteria. The difference is that nationally, the objective is achieved through risk reduction while Arizona is striving to obey national guidelines. Healthy People 2010 and Healthy AZ have the same final goal of preventing deaths due to Asthma and other respiratory illnesses that originated from poor air quality.

III. Recommendations to meet desired outcomes above: Additional assessment: Assess communitys knowledge of Clean Air Act. Determine current air quality within the community. Observe additional environmental hazards such as standing water and risk for lead poisoning. Locate areas of the community that are at higher risk for these environmental hazards and implement similar interventions to reduce and stop exposure. New programs/resources: May lead to policy arena. Develop and advocate for policies and legislation that leads to prevention of environmental hazards. Consult with industries that cause a large amount of hazardous waste and ensure that proper policies are in effect. Continue to implement appropriate interventions that will eliminate exposure of hazardous materials to the public. Interventions

1. Primary Prevention: Provide information regarding air quality conditions and its impact on respiratory health in the daily local newspaper. Resources for implementation: Primary prevention can be implemented in a variety of settings, such as in homes, community settings, community health centers, public health clinics, and through local media. For this level of prevention the local newspaper will be consulted to recommend the inclusion of air quality data in the daily publication. This educates the public on environmental protection issues such as air quality control and how to recognize respiratory exacerbation and how to avoid unnecessary exposure to triggers.Literature evidence: The Environmental Protection Agency (2004) and the American Lung Association have researched the alarming rates of asthma incidence (2004). The agencies provide valuable information on indoor air quality because there is growing concern of the air quality for the population. The EPA insists that the public is aware of the air quality conditions as well as learns ways to improve air quality. 2. Secondary Prevention: Investigate and screen for the presence of active and potential respiratory illnesses in the community and identify knowledge level of respiratory complications from poor air quality exposure.

Resources for implementation: Secondary prevention occurs in public community settings, health centers, physicians offices, and homes. This level requires more contact with the population in order to gather the appropriate data related to health knowledge and distribute that data to trained agency personal for interpretation.

Literature evidence: The I PREPARE Mnemonic is an excellent tool for collecting environmental exposure history prepared by the Agency for Toxic Substances and Disease Registry (2010). I refers to the act of investigating for potential exposure, P stands for the present work, R stands for residence, E stands for environmental concerns, P stands for past work, A refers to activities, R stands for referrals and resources, and E stands for education. This guide can be used in any community where exposure to a health altering substance is possible. Air quality in this community would be the focus of this tool.3. Tertiary Prevention: Assist individuals and families to treat and manage respiratory illness and distribute information to continually promote healthy lifestyles. Consult with public health agencies and families about the importance of keeping air systems clean and free of mold, and avoid contact with household pets when possible. Treatment may also consist of meeting with groups of concerned citizens and educating the public about preventable environmental health problems. Utilization of the 3 Rs for reducing environmental pollution, reduce, reuse, and recycle is also a viable community treatment option.Resources for implementation: Medical treatment occurs in hospitals, clinics, and physician offices. Treatment consists of educating people with respiratory illnesses on what they can do to prevent exacerbations.Literature evidence: The 1970 Clean Air Act regulates air emissions from area, stationary, and mobile sources (Stanhope & Lancaster, 2008). The EPA established the National Ambient Air Quality Standards to protect public health and the environment. The EPA asserts that the use of these standards and regulations can reduce the incidence of respiratory illness exacerbation and occurrence (Kramer, Cullen, & Faustman, 2006). These standards also provide the basis for treatment management and education of the population.Future activities: Assess effectiveness of daily air quality communication and teaching by comparing amount of asthma cases and other respiratory illness prior to implementing the intervention. Modify information provided to community as needed to stay up to date with evidence-based practice.

Community Needs (GAP) Analysis ChartI. Functional Health Pattern #8 Role/Relationship Pattern: Domestic Violence. Census Tract XX.xx has a high risk of abusive behaviors due to the increased stressors in the home related to financial deficits and increased unemployment. The community needs to monitor persons for abusive behaviors as well as additional life stressors.

II. Identify a minimum of 2 outcomes, one from Healthy People 2010 and one from Healthy AZ Goals (www.hs.state.az.us). Then compare and contrast the national (HP2010) and the AZ goals. (8 points)Healthy People 2010 Objective 8-28: Reduce the incidence of violent crime and domestic violence through education and stress management.Healthy AZ Goal: Develop and enhance data systems for abusive behaviors such as child abuse, elder abuse, intimate partner, family violence, rape and sexual assault.Healthy People 2010 seek to promote safety and to reduce violence. The objective for reducing violence refers to the importance of using surveillance of risk factors. Such risk factors may include increased stressors in the family and compromised coping mechanisms. Healthy AZ aims to develop a data system that would effectively and accurately record domestic violence issues. Healthy AZ claims that this system will only be successful if it is at a local level because domestic violence is often unreported, which makes it a hard issue to handle on a state level. The difference is between a national system that intends to decrease risk factors that precipitate violence and a state system that encourages local participation in preventing violence. The census tract XX.xx needs a local system within the community that implements domestic violence reduction.

III. Recommendations to meet desired outcomes above: Additional assessment: Obtain additional information on domestic violence occurrences by consulting with agencies such as the Police Department and the Fire Department. Analyze current policies for effectiveness and modify as necessary. New programs/resources: Consider the public policy arena. Develop advocacy programs. Implement screening interventions in school-aged children to assess their knowledge of domestic violence in the home setting and their attitudes and behaviors to these types of situations.

Interventions1. Primary Prevention: Provide information regarding healthy relationships, stress management, and domestic violence risk factors to the community through the use of weekly support group meetings. Resources for implementation: Information about stress management and healthy relationships should be placed in all public setting. There should be fliers to inform the public of the meetings in schools, libraries, grocery stores and local businesses. Churches can also be a valuable resource for reaching out to at risk families. Literature evidence: Community stress management programs and support groups have been shown to decrease the risk factors that can lead to domestic violence. Meyer & Stein (2004) found that public education programs focusing on different forms of violence, stress triggers and how to get help are a major influence on reducing the incidence of domestic violence.2. Secondary Prevention: Identify families at risk for domestic violence in the home through screening tools used at every contact with a health care professional or trusted person (i.e. church pastor, neighbors, etc).Resources for implementation: Community newsletters can publish information about risk factors and how to seek help if needed. Local facilities such as libraries, urgent care centers, business and schools can screen for domestic violence specific to their level of care.Literature evidence: Screen tools have been developed to assist people determine if an individual is at risk for or a victim of domestic violence. An acronym-based tool that can be used is the HITS (Hurt, Insult, Threaten, Scream) scale which has been validated in the primary care setting and is easy to teach to a large community (Punikollu, 2003). A more specific screen is the Womens Experience with Battering Scale, which consists of 10 questions that score the level of risk for abuse/battering and is filled out by the individual. This has been supported by the Index of Spouse Abuse study and is considered a reference standard, (Punikollu, 2003).3. Tertiary Prevention: Initiate referrals to community agencies, parent educational programs, stress management training and social support groups for victims of domestic abuse.Resources for implementation: Recognize actual or potential abuse within all public settings, clinics, physicians offices, hospitals, and health centers. Trusted confidants and community groups can provide smaller areas with the referral information.Literature evidence: In the study published in the Journal of Divorce and Remarriage domestic violence victims were treated with support groups where members of the community reported that the, group helped them see things differently, helped them decide what to do (whether to divorce), increase their self esteem, and gave them courage to fight for themselves and their children and marriage, (Molina, Lawrance, Azhar-Miller, Rivera, 2009). Future activities: Monitor and evaluate progress based on the data relevant to community health services. Assess outcome progress. Modify interventions as necessary based on program evaluation. Compare intervention with new evidence-based practice to update the reliability of the intervention.

Conclusion

The census tract XX.xx is a functioning community with minimal deficits. After further analysis and evidence-based practice, these minimal deficits were found to be manageable with the implementation of an adequate health education system in place. This community has a high risk for ineffective health maintenance related to lack of knowledge. This knowledge can be offered to the residents of the community through media such as the newspaper and promotional flyers to be handed out at homes, schools, grocery stores, and other public settings. Health awareness needs to be provided for this community in order to protect the population from chronic illnesses.

Through research and theory, it has been shown that it is possible to reduce and eliminate unnecessary deaths with the use of evidence-based practice with an emphasis on preventative services. There are available resources within the community that can be of service to this prevention-based education. With the use of the public library, grocery stores, senior center, schools, healthcare facilities, and neighborhoods, the health priorities can be addressed. The public settings offer a high flow of individuals that could be used as the key location for health promotional activities. The parks and recreational places such as trails can be the cornerstone of increasing health promotion with exercise. Grocery stores can be the vehicle in which there is awareness for good foods and how to maintain a healthy diet at an affordable cost. The public library offers a fountain of resources that include classes for resume building for the job seeking, which would help residents obtain jobs and lower the unemployment rate. With a lowered unemployment rate, residents may feel less anxious about financial and life stressors. These decreased financial stressors may also facilitate a familys ability to cope and subsequently lower the risk for domestic violence within the community. Health promotional flyers which would be handed out to residents at their home might increase awareness for domestic violence risk factors and help them identify ways in which it could happen. Neighbors would develop a sense of unity and the community would become healthier with these interventions. References

Agency for Healthcare Research and Quality. (2005). Preventive Services Task force. The guide to clinical preventive services. Retrieved from www.ahrq.gov/clinic/pocketgf.pdf.Agency for Toxic Substances and Disease Registry. (2010). The I PREPARE Mnemonic; tool for assessing environmental exposure history. Retrieved from www.atsdr.cdc.gov/iprepapredf/.

Automobile Emissions Controls. (1974). Relevant Provisions of the 1970 Clean Air Act. Congressional Digest. 53(3). 74-96.

Environmental Protection Agency. (2004) Fact sheet national listing of air quality. Retrieved from www.epa.gov/air/quality/.Kramer, C. B., Cullen A. C., & Faustman, E. M. (2006). Policy Implications of Genetic Information on Regulation under the Clean Air Act; The Case of Particulate Matter and Ashthmatics. Environmental Health Perspective. 114(3). 313-319. Laffrey, S. C., & Kulbok, P. A. (1999). The integrative model for community health nursing; a conceptual guide to education, practice, and research. Journal Holistic Nursing. 17, 88-104. Molina, O., Lawrence, A., Azhar-Miller, A., & Rivera, M. (2009). Divorcing abused latina immigrant womens experiences with domestic violence support groups. Journal of Divorce and Remarriage. 50(7), 459-471.

Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorder: frontiers for preventive intervention research. Committee on Prevention of Mental Disorders. Institute of Medicine. Washington DC: National Academy Press.

National Institute of Mental Health. (1998). Priorities for prevention research at NIMH. Washington DC. Punukollu, M. (2003). Domestic Violence: Screening made practical. The Journal of Family Practice. 52(7). 537- 547.

Stanhope, M., & Lancaster, J. (2008). Public health nursing: Population-centered healthcare in the community, (7th ed.). Philadelphia, PA: Mosby Elsevier.

U.S. Department of Health and Human Services. (2000). Healthy people 2000: national health promotion and disease prevention objectives. Washington, D.C. U.S. Preventive Services Task Force. (2005). The guide to clinical preventive services. Retrieved from www.guideline.gov/summary.aspx?doc_id=clinicl+preventive+services.

FHP 11

Increase multicultural influence other non-traditional values/beliefs to encourage tolerance.

FHP 1

Increase the proportion of hospitals and managed care organizations that provide community disease prevention and health promotion activities that address the priority health needs indentified by their community

FHP 10

Increase the number of outreach programs for unemployed persona in financial need.

FHP 8

Reduce the incidence of violent crime and domestic violence through education and stress management.

Client Story

FHP 7

Promote positive feelings of overall community infrastructure.

FHP 5

Continue to encourage regular sleep/wake cycles for the community. Promote quiet neighborhoods and quiet hours.

FHP 2

Increase access to healthy foods and programs that educate the public about healthy food choices.

FHP 4

Increase the proportion of the Nations public and private schools that require daily physical education for all students.

FHP 3

Minimize the risks to human health and the environment posed by hazardous sites.

FHP 6

Improve the health literacy of persons with inadequate or marginal literacy skills.

FHP 9

Increase sexual education and teen pregnancy prevention in public schools.

FHP 2 Nutrition/Metabolic Pattern

Strengths: 2 major grocery stores to choose from. Active food bank.

Deficits: Wal-Mart doesnt encourage/provide high quality fresh fruits and Veggies. Food bank doesnt deliver and is far away.

Priority deficit & rationale: Lack of high quality nutrition r/t limited choices.

FHP 10 Coping/Stress Pattern

Strengths: Local support groups, families, and libraries.

Deficits: Unemployment, decreased income, increased single moms.

Priority deficit & rationale: Increased stress r/t lack of income and jobs.

FHP 11 Value /Belief Pattern

Strengths: Churches, political involvement.

Deficits: No non-Christian faiths, intolerance of alternative lifestyles.

Priority deficit & rationale: Lack of diversity for residents of other beliefs r/t intolerance.

FHP 1

Health perception -management Pattern

Strengths: Shopping centers, urgent care, no c/o illness, active lifestyles.

Deficits: Lack of access to health care professionals and health knowledge.

Priority deficit & rationale: No primary health care in area r/t lack of facilities.

FHP 9 Sexuality/Reproduction Pattern

Strengths: No sexual crime. Family oriented.

Deficits: Teen preg. Infant mortality. Lack of prenatal care, lack of resources (educational/clinical).

Priority deficit & rationale: Teen pregnancy r/t lack of knowledge and resources.

s

FHP 3 Elimination Pattern

Strengths: WM pick up, trash bins and recycling.

Deficits: Industrial waste, open washes w/standing water.

Priority deficit and rationale: Poor air quality r/t industrial pollution.

FHP 8 Role/Relationship

Pattern

Strength: Community gets along well and is supportive.

Deficits: Uneployment is high. Possible domestic violence.

Priority deficit & rationale: Domestic Violence r/t unemployment.

FHP 4 Activity -Exercise Pattern

Strengths: Parks, trails, new families.

Deficits: Long distances to services. Hot weather conditions.

Priority deficit & rationale: Increased intake to overall physical activity r/t observed obesity.

FHP 5 Sleep/Rest Pattern

Strengths: Quiet at night, no 24 hr business to disturb residential areas.

Deficits: Opening of new fwy exit will increase neighborhood traffic.

Priority deficit & rationale: lack of sleep r/t noise from neighborhood growth.

.

FHP 6 Cognitive - Perceptual Pattern

Strengths: Public education. High percentage of people with college degrees.

Deficits: Lack of educational facilities and continuing education.

Priority deficit & rationale: Difficulty advancing education r/t lack of educational resources.

FHP 7

Self-perception/ self-concept Pattern

Strengths: Residents love community. Safe environment, child oriented.

Deficits: Lack of diversity. Self-imposed boundaries.

Priority deficit & rationale: Lack of community unity r/t lack of diversity and self-imposed separation.

Priority 2: FHP #3 Poor Air Quality

Primary: Provide information regarding health issues related to environmental hazards and prevention strategies to reduce the risk of respiratory illnesses.

ES #2 Apply knowledge about environmental influences of health (Stanhope and Lancaster, 2008).

Secondary: Investigate health problems and hazards in the community and identify knowledge of health related risks

ES#2 Understand and identify determinants of health and disease (Stanhope and Lancaster, 2008).

Tertiary: Assist individuals and families to manage respiratory illness and distribute information to continually promote healthy lifestyles.

ES# 4 Participate in development of local regulations that protect communties and the environment from potential hazards and pollution (Stanhope and Lancaster, 2008).

Priority 1: FHP #1- Lack of Health Care Knowledge

Primary: Provide health promotion and health education in order to prevent future health problems in children and adults.

ES#3 Develop and implement community-based health education (Stanhope & Lancaster, 2008).

Secondary: Survey parents and adults on their health knowledge and knowledge of available resources.

ES#9 Identify unserved and underserved populations within the community (Stanhope and Lancaster, 2008).

Tertiary: Educate residents about community resources and distribute information to promote utilization of available resources.

ES#7: Provide clinical preventative services to certain high-risk populations (Stanhope & Lancaster, 2008).

School Nurses (FHP 1, 3, 8)

Parent Involvement (FHP 3, 8)

Public Parks and Recreation (FHP 1, 3, 4, 8)

High Socioeconomic Community (FHP 1, 4)

Library (information and space for education) (FHP 1, 3, 4, 8)

Public Officials (FHP 3, 8)

Urgent Care Clinics (FHP 1, 3, 4, 8)

Behavioral Health Services (FHP 1, 8)

Support Groups (FHP 1, 3, 8)

Local Churches (FHP 1, 3, 4, 8)

Priority 4: FHP # 8 Domestic Violence

Primary: Provide information regarding healthy lifestyles and stress management in the home setting.

ES# 5 Participate in community and family decision making processes (Stanhope and Lancaster, 2008).

Secondary: Implement programs in the community to identify families at risk for domestic violence in the home.

ES# 7 Establish programs and services to meet special needs (Stanhope and Lancaster, 2008).

Tertiary: Initiate referrals to community agencies, parent educational programs, stress management training and social support groups.

ES# 7: Provide referrals through community links to needed care (Stanhope & Lancaster, 2008).

Priority 3: FHP #4 Lack of Long Term Care Facilities

Primary: Educate about the effects of lifestyle choices and their relationship to health and illness.

ES# 3 Develop health and educational plans for individuals and families in multiple settings (Stanhope and Lancaster, 2008).

Secondary: Implement screening programs within elderly communities to identify those at risk.

ES# 6 Provide clinical preventative services to certain high risk populations (Stanhope and Lancaster, 2008).

Tertiary: Initiate referrals for the elderly population to identify services needed and increase independence in the home setting.

ES# 7 Recommend clinical care and other services to clients in clinics, homes and the community (Stanhope and Lancaster, 2008).