Community Health Week 9

According to the U.S. Department of Education, which of the following would be classified as a homeless child? A. A child abandoned in a hospital B. A child in a group home C. A child in foster care D. A child living with a grandparent

A. A child abandoned in a hospital

Public health policy in the United States is influenced by two types of justice: market justice and social justice. Which of the following are examples of market justice? Select all that apply. A. All people are entitled to happiness if they put forth enough effort​. B. All people are entitled to access to health care. C. All people are entitled to the income they work for​. D. All people are entitled to a livable minimum wage​. E. All people are entitled to the status they create for themselves.

A. All people are entitled to happiness if they put forth enough effort​. C. All people are entitled to the income they work for​. E. All people are entitled to the status they create for themselves.

The Brown family is being evicted from their home and will be moving into a homeless shelter in 3 days. Under the Department of Housing and Urban Development (HUD) definition, the Brown family is A. At imminent risk of homelessness B. Homeless under other federal statutes C. Fleeing or attempting to flee intimate partner violence D. Literally homeless​

A. At imminent risk of homelessness

Downward spiral that exists in rural America

Access to and affordability of care is number one priority in rural America. There are fewer primary care physicians. General health services like primary care and health care facilities are lacking especially mental health services. These issues forces residents to either go without these services or travel long distances to get one. Health insurance varies from state to state and according to race and ethnicity; age and residence (rural or urban). It is influenced by employment patterns, the percentage of children in the population, state Medicaid policies, and poverty levels. It may create financial barriers to health care.

Health risk, injury, and death

Adults - use seat belts less often and are less likely to use preventative screening. Rural teens - are equally likely or more likely to report being victims of violent behavior, engage in suicide behaviors, and use drugs. Other risk factors - are alcohol use, obesity, physical inactivity, suicide (2nd leading cause of death), and unintentional injuries.

Americans with Disabilities Act (ADA)

Americans with Disabilities Act (ADA) 1990 is a Landmark civil rights-styled legislation that prohibits discrimination against people with disabilities. It guarantees equal opportunities for people with disabilities in relation to employment, transportation, public accommodations, public services, and telecommunications It provides protection to people with disabilities similar to those provided to any person on the basis of race, color, sex, national origin, age, and religion. Ir refers to a "qualified individual" with a disability as a person with a physical or mental impairment that substantially limits one or more major life activities or bodily functions, a person with a record of such an impairment, or a person who is regarded as having such an impairment Qualified individuals must meet legitimate skill, experience, education, or other requirements of an employment position; must be able to perform essential job functions, contained within a job description, with or without reasonable accommodations and qualifying organizations must provide reasonable accommodations unless they can demonstrate that the accommodation will cause significant difficulty or expense, or producing an undue hardship

Based on the Department of Housing and Urban Development (HUD) definitions of homelessness, which individual would be considered homeless?​ A. An individual imprisoned or detained under an act of Congress or state law​ B. An individual who spends most nights at public or private places not designed for regular sleeping accommodations​ C. An individual whose residence lacks access to public water and electricity D. An individual who has a permanent nighttime residence in the housing for mentally ill people

B. An individual who spends most nights at public or private places not designed for regular sleeping accommodations​

What official national organization provides financial housing assistance to low-income families?​ A. World Health Organization (WHO)​ B. Department of Housing and Urban Development (HUD)​ C. European Federation of National Organizations Working with the Homeless (FEANTSA)​ D. Robert Wood Johnson Foundation​

B. Department of Housing and Urban Development (HUD)​

The greatest promise for improving health outcomes for rural residents is​ A. The expansion of public transportation, allowing rural residents to travel to tertiary care hospitals for specialty services​ B. The increase in distribution of technology, providing more education and health services C. The increase in health care providers migrating to rural areas D. The expansion in Medicare services to rural hospitals and clinics​

B. The increase in distribution of technology, providing more education and health services

The number one health concern identified by many rural health care leaders is​ A. Increase in communicable diseases​ B. Fewer primary care physicians C. Access to health care D. Social isolation of rural dwellers

C. Access to health care

Disability Examples

Cannot walk unassisted; uses crutches and/or a manual or power wheelchair; blindness

Chronically Homeless

Chronically homeless individuals are unaccompanied adults who are homeless for extended or numerous periods and have one or more disabling conditions, which are very often severe mental, and substance use disorders. They are at a high risk for death if homeless for 6 months or more with one or more of the following features: More than three hospitalizations or emergency room visits in a year More than three emergency room visits in the previous 3 months 60 years or older Cirrhosis of the liver End-stage renal disease History of frostbite, immersion foot, or hypothermia HIV/AIDS Co-occurring psychiatric, substance abuse, and chronic medical conditions Suicide Drug or alcohol use

Public Health Intervention Wheel

Community and Public Health Nurses, working downstreamwith individuals, families, or groups use surveillance, disease and other health event investigation, outreach, screening, case finding, referral and follow-up, case management, delegated functions, health teaching, counseling, and consultation. Community and Public Health Nurses working more upstream, at the system level, employ collaboration, coalition building, community organizing, advocacy, social marketing and policy development, and enforcement. Both upstream and downstream approaches are needed

Community-Based Care

Community-based care is care and education that is provided at the community level, in client homes and in community agencies. Examples of community-based services are: Home health and hospice care Occupational health programs Ambulatory care services School health programs Faith-based care Elder services (adult daycare) Community participation in decisions about health care services is necessary. There should be a focus on all three levels of prevention (primary, secondary, tertiary) and there should be an understanding that the hospital is no longer the exclusive health care provider.

Which statement best describes the demographics of rural America?​ A. There are more positive health behaviors (e.g., less smoking, obesity, and drug use) among residents of rural America when compared with urban America​. B. There are more educated individuals among residents of rural America when compared with urban America. C. There has been a shift in the economic base of rural America as more communities are dependent on income generated from mining and construction​. D. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy​.

D. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy​.

Which model supports upstream thinking with the purpose to improve homelessness?​ A. Mental Justice B. Physical Justice C. Market Justice D. Social Justice

D. Social Justice

Vulnerable groups

Demographic and personal characteristics, such as age, education, gender, race, ethnicity, language, and culture are factors that affect health and may block access to existing services.

Disability Terms

Disability umbrella term describing impairments, activity limitations, and participation restrictions, may also be referred to as differently abled. The following are some of these categories: Physical disabilities Sensory disabilities (deaf or blind) Intellectual disabilities (preferred terminology for mental retardation) Serious emotional disturbances Learning disabilities Significant chemical and environmental sensitivities Health problems (asthma, diabetes) Development disabilities encompass those conditions that are manifested by limitation before the legal age of adulthood, which is 18. It includes issues that limit or present challenges to the performance of activities of daily living (ADLs). Activity limitation is a difficulty encountered by an individual in executing a task or action.

Handicap

Disadvantage resulting from an impairment or disability that prevents the fulfillment of an expected role

Department of Education efforts

ED's efforts to count the homeless children and youth enrolled in public schools. They provide services to homeless children and youth provided through Education for Homeless Children and Youth (ECHY) program.

Category 4-Fleeing or attempting to flee domestic violence (DV)

Fleeing or Attempting to Flee Domestic Violence (DV) means individuals and families who are fleeing or attempting to flee domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence.

Specific Rural Aggregates: Agricultural workers

HEALTH DISPARITIES Migrant and seasonal farmworkers (those that support fruit and vegetable production) have the poorest health of any aggregate and the least access to affordable health care. They are working in highly variable environmental conditions and in geographically isolated areas and often work alone. ACCIDENTS AND INJURIES The use of agricultural machinery is the most common cause of fatalities and nonfatal injuries among this group. ACUTE AND CHRONIC ILLNESSES They suffer from acute and chronic respiratory conditions due to chemical exposure (pesticides, herbicides, other chemicals). They are prone to pesticide poisoning. They have higher rates of cigarette smoking, hypertension, and obesity. They also have higher rates of poverty, less access to health care, and are less likely to have health insurance.

Category 3- Homeless under other federal statutes

Homeless Under Other Federal Statutes which means unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition.

Category 2- Imminent Risk of Homelessness

Imminent Risk of Homelessness which means individuals and families who will imminently lose their primary nighttime residence.

Disability

Impairments, activity limitations, participation restrictions.

Individuals with Disabilities Education Act

Individuals with Disabilities Education Act ensures a free appropriate public education to children with disabilities that is based on their needs, in the least restrictive setting from preschool through secondary education. Creating development of individualized education plan (IEP) is part of theis act.

Category 1-Literally Homeless

Literally Homeless means individuals and families who lack a fixed, regular, and adequate nighttime residence meaning: Has a primary nighttime residence that is public or private and not met for human habitation. Living in a publicly or privately operated shelter designated to provide temporary living arrangements (including shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, and local programs). Exiting an institution where he or she has resided for 90 days or less and resided in an emergency shelter or place not meant for human habitation immediately before entering the institution.

Occupational health risks

Many jobs in rural communities are in industries such as farming, mining, and logging. Often these businesses are small enough that federal safety regulations from OSHA do not apply. Farm workers often have long hours in very cold and very hot conditions where manual labor is required. Workers are often around farm animals, which increases risk for allergies or other infections. Animal waste can contaminate soil and water.Workers in the farming industry, often have high rates of injuries, parasites and skin conditions, exposure to chemicals, psychological disorders, and suicide.

Level of Analysis

Micro level (e.g., body organ)

Disabilities by urbanization levels are as follows

Noncore (rural): 32% Micropolitan: 29% Small metropolitan: 27% Medium metropolitan: 26% Large fringe metropolitan: 23% Large central metropolitan: 23%

Measurability

Objective and measurable

Prevalence of homelessness

Obtaining accurate counts is difficult. The following are different methods that some agencies are using to collect statistics on the number of those experiencing homelessness. The U.S Department of Housing and Urban Development (HUD) support a variety of policies, such as affordable housing development and preservation, community and economic development, environment and energy, fair housing, health and housing, ending homelessness, homeownership, rental assistance, and supportive housing and services. The Point-In-Time (PIT) count is a method that HUD uses to get statistics on homelessness. It basically shelters homeless people on a single night in late January of every year. Also every two years, on odd years, the count includes both sheltered and unsheltered homeless people. The data is used to prepare an Annual Homeless Assessment Report (AHAR) that is submitted to the Congress. This count is required in order determine what amount of federal funding is allocated for homelessness.

Income and poverty

One of the most important indicators of the health and well-being of all Americans regardless of where they live is their income. Regional differences: persistent poverty is highest in the South, followed by the West, and then the Northeast and Midwest. Racial and ethnic minorities: rates among rural racial minorities are two to three times higher than for rural whites. Family composition: female-headed families have the highest rates of poverty. Children: among the poorest citizens in rural America.

Emergency Services

One of the most significant health care issues for rural residents is emergency services. Getting patients from the place of injury to the trauma center within the "golden hour" is frequently not possible because of distance, terrain, climatic conditions, and communication methods. Rural EMS systems face many challenges.

Perceptions of health in rural community

People in rural communities are at a higher risk for disease and injuries. Both men and women are less likely to report their health as good or excellent. Higher incidents of heart disease and cancer. Higher prevalence of chronic disease - tend to be older, poorer, and less educated. Smoke or use smokeless tobacco more. Fewer preventative behaviors, less contact with physicians, less access to care. Men and youth more likely to die or become disabled from unintentional injuries due to risky behavior or work-related causes. More likely to die from suicide than women or urban men and youth.

Impairment

Physical deviation from normal structure, function, physical organization, or development. A restriction or an inability to perform and activity in a normal manner resulting from a loss or abnormality of a psychological , physiological, or anatomical structure or function

Nursing Considerations: Health Promotion

Provision of age-related health screenings Early surveillance of diseases based on knowledge of common comorbidities Maintenance of proper weight; counseling on appropriate nutrition and social inclusion through enhanced physical activity Identification of caregivers and support systems Identification of access to care issues: transportation, financial, and environmental barriers Safety of the physical environment: assistive technology and potential for abuse Knowledge of resources

Rural Public Health Departments

Public health nurses are often the core providers of public health services in rural areas. Collaboration of services is key. There is a need to develop and cultivate partnerships.

Handicap Examples

Reflects physical and psychological characteristics of the person, culture, and specific circumstances. Cannot fulfill a role in society such as being unable to drive.

Healthcare considerations: Rural

Rural populations are more likely to be older, less educated, live in poverty, lack health insurance, and experience a lack of available health care providers and access to health care. Only 10% of U.S. physicians practice in rural areas and the ratio of physicians in rural population is 36:100,000 (nearly double in urban settings). More often, rural populations health is assessed as fair or poor. They have more disability days resulting from acute conditions than their urban counterparts and they have more problems related to negative health behaviors (untreated mental illness, obesity, alcohol, tobacco, and drug use) that contribute to excess deaths and chronic disease and disability rates. Rural populations are twice as likely to die from unintentional injuries, including motor vehicle accidents, than urban residents.

Factors that contribute to homelessness

Shortage of Affordable Housing Income Insufficiency Inadequacy and Scarcity of Supportive Services A housing unit is considered affordable if it costs no more than 30% of income. HUD operates programs that provide financial housing assistance to low-income families. The demand for these programs has far exceeded the supply. With the lack of affordable housing and insufficient income, people have to spend much of their income on rent, leaving them without adequate resources for other necessities, such as food, clothing, and healthcare. Even though there are several services available, there are not nearly enough to meet the needs of those who are experiencing homelessness.

Social determinants of health

Social determinants of health (SDOH) are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. There are five broad dimensions that are included within Healthy People 2030: Economic stability (poverty, employment, food insecurity, housing instability) Education Access and Quality (high school graduation, enrollment in higher education, language and literacy, early childhood education and development) Social and Community Context (social cohesion, civic participation, discrimination, incarceration) Health Care Access and Quality (access to health care, access to primary care, health literacy) Neighborhood and Built Environment (access to foods that support health eating, quality of housing, crime and violence, environmental conditions)

Public Assistance programs

Some of the public assistance programs are as follow: Cash assistance Supplemental Security Income (SSI) Social Security Disability Insurance (SSDI) Food stamps Subsidized housing

Examples of Disabilities

Spina bifida, spinal cord injury, amputation, and detached retina

Social Justice system

The belief is that all people are equally entitled to key ends (e.g., access to health care and minimum standards of income). It says all members of society must accept collective burdens to provide a fair distribution of these ends. This is a foundational aspect of public health. It also supports upstream thinking.

Education and employment

The college completion rate of almost half of the urban students. Lack of education is correlated with persistent poverty, and poverty is a predictor of poor health.

Emergency Preparedness in Rural Communities

The following are some of the challenges in rural areas regarding access to healthcare: Resource limitation such as Human, financial, and social capital. Separation and remoteness which cause longer response times. Low population density that impacts funding for health services. Communication is not ideal. Warning systems often absent or neglected in remote areas; placing the burden on the individual to access emergency information.

Homeless student

The following is the definition of homeless student according to the Department of Education (ED) McKinney-Vento Homeless Education Assistance Improvements Act of 2001 ensures that each child and each homeless youth has equal access to the same free, appropriate public education, including a public preschool education, as provided to other children and youths. This includes children and youth who are: Sharing the housing of other persons (frequently referred to as "doubling up") Abandoned in hospitals or Awaiting foster care placement

Rural America

The number of rural residents is the highest in our country's history. 75% of counties are classified as rural; they contain only 20% of the U.S. population. According to the census, 15% of the nation's elderly are in rural America. Poverty (a key health determinant) continues to be greater in rural America than in urban areas. According to the census, more than 50% of the nation's poor are in rural America. The economic base is shifting. Agriculture which is the "food and fiber system" is the economic base of rural America. All aspects of agriculture including core materials to wholesale, retail, and food service sectors are included. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy. Some of the trends are: Aging-in-place, the out-migration of young adults, and the immigration of older persons from metro areas to rural America present challenges to already stressed communities. These challenges are providing adequate health care, housing, transportation, and other human services. Greater ethnic diversity among residents in rural America: a country of immigrants historically and today.

Nursing Considerations: Nursing Interventions

The nurse must be able to differentiate between the person who has an illness and becomes disabled secondary to the illness and the person who has a disability but may not need care. The nurse should ask whether the client wants assistance, ask the client or family to describe the goal(s), and ask how and in what way(s) the nurse can help them.

Nursing Considerations: Education and Advocacy

The nurse must become familiar with a variety of ethical frameworks for decision making to be able to help the client and family access information needed to make informed decisions. They must help educate the public on health care issues and participate in the development of institutional policies and procedures for ethical and legal issues related to disability. They ust take a position on an ethical issue and work to influence government policies and laws. In their interactions with PWD and their families, nurses must keep the following items in mind: Listen to understand. Collaborate with the person or/and family to make plans and goals that meet the identified needs and that draw on strengths and improve weaknesses. Empower and affirm the worth and knowledge of the person/family with a disability. Promote self-determination and allow choices that foster personal values and preferences.

Rural Health Care Delivery System

There are health care provider shortages in rural areas. Rural shortages is likely to become worse. It takes longer to fill vacancies in smaller hospitals, usually located in rural areas. Telemedicine can be an alternative to this problem. Some of the possible benefits of telemedicine, include: It is a cost-effective alternative to face-to-face care. Telehealth includes telephones, fax machines, email, and remote monitoring. Telemedicine permits two-way, real-time, interactive communication between patient and provider. Managed care in the rural environment is a way to build a system of health care in a way that lowers cost and increases efficiency. Possible benefits are: Potential to lower primary care costs Improve the quality of care Help stabilize the local rural health care system Possible risks are: Probable high start-up and administrative costs. Volatile effect of large, urban-based, for-profit managed care companies. There is now a push to incorporate telemedicine/telehealth to improve healthcare access in rural communities.

Persons with Disabilities (PWD)

There are tens of millions of Americans with disabilities and nurses will provide care and education to clients and their families. It is helpful to understand the definitions and resources available to those client that need it.

Rural Mental Health Care

There is a lack of specialized mental health providers in rural areas. Most services provided by primary care providers who are ill equipped. Perceived stigma prevents individuals from seeking mental health services.

Specific Rural Aggregates: Migrant and Seasonal Farmworkers

This group has the poorest health and the least access to healthcare. This group has low income and migratory status. This group has minimal or no preventive care such as dental, vision screening, and treatment, gynecological and breast exams. Often their only access to medial care are standing or mobile clinic sites.

Market Justice System

This is the dominant model in the United States. The belief is that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. It stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. It results in a downstream approach to problems.

Thinking upstream

To improve the social health of those experiencing homelessness, it is necessary to go upstream and focus on the primary contributors to homelessness itself such as lack of affordable housing, inadequate income, and insufficient services. An upstream approach (community or systems level) to homelessness is provided by the concept of social determinants of health. Rather than treating the problems as they arise, it is critical to address the social determinants of health to promote healthy communities and reduce the occurrence of homelessness.

US Conference of Mayors' Hunger & Homelessness Survey

US Conference of Mayors' Hunger & Homelessness Survey gathers data for their cities each year (not all cities participate - not a national report).

Health disparities related to place

Where we live can have a significant impact on our health and behaviors. If someone is experiencing homelessness, their access to resources and overall health will be even more challenging.

Prevalence

Worldwide, 15% of the population, has some form of disability In the US, prevalence estimates range from 12% to 20% of the US population Prevalence varies by age, race, and sex Prevalence and severity levels rise with aging