Community Needs on Mental Health in Marion Florida Research Paper

Running head: HEALTH IMPROVEMENT PLAN 1 Health Improvement Plan for the Elderly Community of Marion County Keri M. McCall College of Central Florida HEALTH IMPROVEMENT PLAN 2 HEALTH IMPROVEMENT PLAN 3 Community populations are of utmost importance to community health care workers. Addressing the health needs of a community instead of an individual can help healthcare workers make larger strides to improve the health of the general public. A community is any group of people that share certain characteristics and also feel connected to one another (Rector, 2018). Communities can be addressed on a large scale or broken down into more specific groups within the larger community. Marion County, Florida is a perfect example of a large community made up of many smaller diverse communities. Marion County, Florida is located in the central portion of the state and has a

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population of about 352,000 people (Florida Department of Health, 2018). It was established in 1844 (Marion County Florida, 2018). The county has come a long way since then. It consists of people of many different ages, races, and religions. The county has been attractive to the aging population. The age demographics are an important factor for community health care workers. The population in Marion County is 19.2% ages 0–17, 54.5% ages 18-64, and 26.3% ages 65 and over (Well Florida Council, 2015). The elderly community members age 65 and over in Marion County make up about 26% which is approximately 91, 500 citizens. This number includes both men and women and is significant because this population can be vulnerable due to their increased age, medical comorbidities, or decline in physical or financial status (Culo, 2011). These factors of vulnerability make this population an important focus for community health care workers. This HEALTH IMPROVEMENT PLAN 4 population could greatly benefit from the support and advocacy for improved health and quality of life. When comparing Marion County to the entire state of Florida the elderly population is significantly more concentrated. The state of Florida has a population of approximately 21 million (United States Census Bureau, 2017). As a state, the population aged 65 and older makes up only 17.8%, compared to the 26.3% in Marion County (Well Florida Council, 2015). When this fact is considered along with the fact that Florida carries the second largest cancer burden in the United States, and Marion County’s death rate from cancer exceeding that of the state of Florida, it is easy to see that something must be done for the vulnerable, elderly community (Well Florida Council, 2015). According to Florida Demographics (2017), Marion county ranks 17th in Florida based on population, yet the National Cancer Institute (2015) ranks Marion County as 14th among both Lung and Colorectal cancer case in residents aged 65 and over. These statistics provide a clear call for intervention for the health of the large elderly population in this area. There are many businesses that meet the medical needs of the elderly cancer patients in Marion County. There are also several other organizations that take a more holistic approach to supporting this community. As the population ages, cancer is likely to be diagnosed with many comorbidities in the elderly and may require greater community support than in younger patients (Itatani, Kawada, & Sakai, 2018). The Cancer Alliance of Marion County is doing just that. The goal of the Cancer Alliance of Marion County is to identify needs, facilitate communication between supportive organizations, and to support community outreach and advocacy for programs that support cancer patients and their families (The Cancer Alliance of Marion County, 2018). The alliance offers support that covers needs such as applying for medical care coverage, HEALTH IMPROVEMENT PLAN 5 food banks, support groups, and transportation services. The United Way of Marion County partners with The Cancer Alliance of Marion County to provide quality services to seniors as well (United Way of Marion County, 2018). Lung and Colorectal Cancer are two of the most common cancers in the elderly population in Marion County (Centers for Disease Control and Prevention, 2015). According to the National Cancer Institute (2015), Marion County averages 360 new cases per year of Lung Cancer and 162 new cases per year of Colorectal Cancer in residents aged 65 years and over. According to Depierto (2018), Colon cancer that is identified early has a five-year survival rate of 90%, but the survival rate is only about 14% if it has already metastasized at the time of diagnosis. Lung cancer diagnosed in stage 1 has a five-year survival rate of 49%, and the survival rate of diagnoses in stage 4 is only 1-2% (Eldridge, 2017). These important numbers show the urgency of educating the elderly community members about early diagnosis. They must be aware of early warning signs and the most current recommendations for preventative screening. These problems can be addressed using a community subsystem assessment. Several community forums will be held in several different 55+ communities for residents that are 65 or older. The forum will consist of a survey of questions such as: 1. Are you aware of the recommended age to begin Colorectal Cancer screening? 2. Are you aware of the risk factors for Lung Cancer? 3. Are you aware of the symptoms of Lung or Colorectal Cancer? The results of the forums and surveys will be analyzed and the seniors that display the greatest knowledge deficit will be identified. Then, a more focused area can be targeted for education. Education will consist of written information provided to seniors regarding the risk HEALTH IMPROVEMENT PLAN 6 factors, recommended screenings, survival rates and common symptoms of lung and colorectal cancer. Resources for the implementation of the plan will include a small team of people to organize the community forums. The team will have to plan all of the logistics for the forum such as reservation of community meeting space, promotion to residents, and securing volunteers to help run the forum. Several community health workers will also be needed after the forums are complete to analyze the data. Once the target group is identified the community health workers will then be needed to distribute and teach residents about their risk for lung and colorectal cancer. Organization of the community forums and planning of the flow of the meeting will take two weeks. Securing locations with date and time will take an additional two weeks. The meetings will be scheduled over four weeks if needed. The data can be organized in two weeks and analyzed within four weeks as well. Education planning will be allotted three weeks for planning and production into written materials for distribution. There will then be educational social meetings planned as the data shows necessary. Minimal fundraising may be necessary. The community meeting places will attempt to be reserved at no cost with the offer that the residents will benefit from the meetings. Funds will be necessary for supplies needed at the meetings, such as paper and pens for the surveys and refreshments for the attendees. Funds may be necessary for the use of computers to organize the data once it has been collected. Preparing and printing promotional supplies and educational supplies will take up some of the funds as well. The goal of the plan will be to improve the knowledge of community members. They will understand their risk for two of the leading cancer killers of people their age. They will HEALTH IMPROVEMENT PLAN 7 understand their risk factors and seek screening from their physicians so that the health of community members ang 65 and over will be improved. HEALTH IMPROVEMENT PLAN 8 References Centers for Disease Control and Prevention. (2015). Cancer burden: Florida. Retrieved from https://gis.cdc.gov/Cancer/USCS/DataViz.html Culo, S. (2011). Risk assessment and intervention for vulnerable older adults. BC Medical Journal, 53(8), 421-425. DePierto, M. (2018). Colon cancer prognosis and life expectancy. Helathline. Retrieved from https://www.healthline.com/health/colorectal-cancer/prognosis-and-life-expectancy Eldridge, L. (2017). Lung cancer survival rates by type and stage. Verywellhealth. Retrieved from https://www.verywellhealth.com/lung-cancer-survival-rates-by-type-and-stage2249401 Florida Demographics. (2017). Florida counties by population. Retrieved from https://www.florida-demographics.com/counties_by_population Florida Department of Health. (2018). Fl Health Charts. Retrieved from http://www.flhealthcharts.com/charts/SearchResult.aspx Itatani, Y., Kawada, K., & Sakai, Y. (2018). Treatment of elderly patients with colorectal cancer. Biomed Research International. 3/11/18, 1-8. Marion County Florida. (2018). Marion county history. Retrieved from http://www.marioncountyfl.org/about/marion-county-history National Cancer Institute. (2015). State cancer profiles. Retrieved from https://www.statecancerprofiles.cancer.gov/incidencerates/index.php?stateFIPS=12&canc er=020&race=00&sex=0&age=157&type=incd&sortVariableName=count&sortOrder=de sc#results Rector, C. (2018). Community and public health nursing: Promoting the public’s health. HEALTH IMPROVEMENT PLAN 9 Philadelphia: Wolters Kluwer. The Cancer Alliance of Marion County. (2018). Marion County’s collective cancer care community. Retrieved from https://canceralliancemc.org/about-camc/ United States Census Bureau. (2017). Community facts. Retrieved from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml United Way of Marion County. (2018). Target issues. Retrieved from https://www.uwmc.org/Health Well Florida Council. (2015). Marion County: 2015 Community health assessment. Retrieved from https://wellflorida.org/wp-content/uploads/2016/01/2015-Marion-CountyCommunity-Health-Assessment.pdf 1 Running head: NEEDS OF THE HOMELESS POPULATION Needs of the Homeless Population of Pinellas County Eric Moore College of Central Florida Eric Moore, Health Science Division, College of Central Florida This research was supported by Kimberly Buff, ARNP and extended periods of silence from my children. Correspondence concerning this report should be addressed to Eric Moore, Health Sciences Division, College of Central Florida, 34474. E-mail: eric.moore@patriots.cf.edu 2NEEDS OF THE HOMELESS POPULATION The bustling downtown area of St. Petersburg, Florida is a non-stop hive of activity. From bars and restaurants, to museums and trendy shops, the city center is constantly growing and evolving. A twenty minute drive north and the pristine and beautiful sights of Clearwater Beach are present. Along the beach are designer hotels and all manners of beach front dining, from dive bars to five-star restaurants. Despite the ever-growing amount of glitz and glamor, on many of the corners and bus stop benches of Pinellas County, the homeless are present. Though there are dozens of programs to assist those who are residentially challenged, the problem persists. This population has a unique set of needs are often require vast amount of resources. What is the definition of being homeless? According to the 2017 Annual Report by the Council on Homelessness, being homeless means “1. An individual or family who lacks a fixed, regular, and adequate nighttime residence – living in a place not meant for human habitation, in a shelter or similar program, or, in specified circumstances, in an institution. 2. An individual or family who will imminently lose housing, under certain circumstances. 3. Under certain circumstances, unaccompanied youth, or families with children who are consistently unstably housed and likely to continue in that state. 4. People who are fleeing or attempting to flee domestic or intimate partner violence and lack the resources to obtain other permanent housing.” In 2017, the homeless population of Pinellas County was 2,831 with a total population of 970,637. Miami-Dade County has a homeless population 3,721, and is the only county in Florida with more homeless persons that Pinellas County. With a total population of 2,751,796 people, Miami-Dade the highest population in the state (Florida, 2018). At 280 square miles, Pinellas County is the second smallest county in Florida, while Miami-Dade County is 1,946 square miles making it the third largest. Not only does Pinellas County have the most residents 3NEEDS OF THE HOMELESS POPULATION per square mile of any other county in Florida, it has the highest percentage of homeless as well at 0.29%, compared to Miami-Dade County at 0.13% (Florida, 2017). In Pinellas County, the age of the homeless population ranges from 2 weeks to 81 years of age. Males make up 66% of the homeless population. Mental illness is found in 52% of the homeless, while 48% have a physical disability. Approximately 11.6% of the homeless are veterans. Families make up 12.8% of the homeless population (Pinellas, 2018). The homeless population requires care just as any other population does. Beyond that, there are extensive challenges with compliance, appropriate follow-up, limited resources for care, and external factors, such as lack of sanitary facilities, that may affect the health of the population. Homeless persons often use emergency departments for all of their healthcare needs. Due to transportation and accessibility issues, many homeless people are unable to attend regular appointments or lack the means to pay for follow up care. The lack of access to care or the inability or unwillingness to partake in preventative health measures, often result in the homeless having complex and extensive medical problems that could possibly be avoided my standardized health screenings and proper medical management. Within Pinellas County, there are over twenty basic homeless shelters. There are also shelters that specialize in people with physical disabilities, mental illness, and substance abuse. Within the county there are also shelters that specialize in sheltering the elderly, abused women and children, and those diagnosed with mental retardation. There are also multiple organizations to assist residents who are financially unstable from becoming homeless. Thought the number of homeless persons has decreased over the past three years, needs still exist within the homeless community. 4NEEDS OF THE HOMELESS POPULATION One of the major problems within the homeless community, is the lack of holistic services at the homeless shelters. Some shelters “discharge” people in the morning time and the homeless are placed back out on the streets to fend for themselves in regards to sustenance and care until the shelters re-open again in the evening time. Safe Harbor is a shelter that is owned and operated by the Pinellas County Sheriff’s Department. This is a holistic shelter that provides not only a place to sleep and food, but also offers assistance with employment, education, substance abuse treatment, and relocation to permanent housing. There is also a fully staffed clinic on site that provides not only daily primary care, but optical care and dental care at various times throughout the week. With the lack of mobility and the inability to pay for medical care, the access to on site primary care drastically reduces the use of emergency departments by the homeless for non-emergent reasons. Also, by providing 24/7 sheltering, the homeless population is less likely to engage in risky or illegal behaviors while inside the shelter. Another severe problem within the homeless community is lack of diversion programs. Often once a person becomes homeless, they are “outside” of the system. These people remain this way with occasional visits to shelters, emergency departments, or even jail. Local law enforcement agencies and case workers tend to send patients to emergency departments, jail, or even to psychiatric care instead of addressing their problem of homelessness. This is similar to placing a piece of gauze over a gunshot wound. You may not be able to see the wound, but it is still there and needs to be addressed. The same is true of homelessness. Addressing and correcting the cause is the only way to repair the problem. All of these factors are synergistic in creating an environment which is not conducive to the reduction of homelessness. While there has been a reduction in the homeless population of Pinellas County the last three years, the rate of homelessness is extreme and out of proportion 5NEEDS OF THE HOMELESS POPULATION compared to the rest of the state of Florida. The lack of holistic and comprehensive services also ensures that the homeless population is not receiving care and treatment to prevent long term illness or injury (Rector, 2108). The combination of homelessness and potential illness or chemical/alcohol dependency further perpetuates the problem as the homeless will struggle to find gainful employment. It creates a vicious cycle in which the homeless population is unable to extricate themselves from. Problems such as homelessness can be addressed at multiple levels. However, the local level is typically the most effective as each geographical location will present unique challenges and populations. The assessment model known as Mobilizing for Action through Planning and Partnership (MAPP), focuses on community health improvement on the local level. MAPP also emphasizes community engagement and collaboration for planning once needs are assessed and prioritized (Center for Disease Control, 2015). Using the MAPP method, collaboration between community entities is utilized. To combat and treat the homeless population, all of the municipalities within Pinellas County would need to utilize the resources that are already in place and develop and modify them to meet the current needs. Each municipality will coordinate with their adjacent municipalities to develop and produce a cooperative agreement of mutual aide to cover any gaps in care or services. To effectively implement such a plan, additional resources will need to be obtained. Funding will need to be acquired as well. Each municipality as well as the county government will need to pledge funding to the overall project. Private and governmental grants should be applied for to help offset the cost to the municipalities, thereby reducing the burden felt by the tax paying residents. Additional staffing, including professional, licensed, and support staff will need to be screened and hired, along with administration. With this amount of expansion, 6NEEDS OF THE HOMELESS POPULATION physical buildings will be important and additional properties will most likely need to be acquired. Contracts with service providers will need to be negotiated as well as contracts with medical supply companies. Assessment of the needs and available resources for each municipality and the county as a whole should occur within the first six weeks. At this point, grant writing should begin and continue on a regular and frequent basis. The next six weeks should be dedicated to negotiations between municipalities and the county to determine which services will be offered where and how resources will be distributed. During the next six months, any new construction or modification of existing facilities or buildings that is required should be initiated and completed. During the construction phase, appropriate entities for each municipality and county should negotiate contracts with suppliers for all durable and disposable goods required, including food. During the last three months of construction, staff should be hired and validated. Medical staff and professional staff will require credentialing. Any staff that will have contact with children, the elderly, or the disabled will require more extensive background checks prior to employment. Staff for cooking, cleaning, maintenance and security will also be required. The homeless population has varied demographics and needs. By addressing their fears, needs, and challenges, the incidence of homeless people in Pinellas County can be positively impacted. While some may be resistant to change, holistic treatment of the person, their residential status, and their health and well-being is paramount for the successful and permanent reduction of homelessness in Pinellas County. 7NEEDS OF THE HOMELESS POPULATION References Center for Disease Control. (2015, November 9). State, Tribal, Local & Territorial Public Health Professionals Gateway. Retrieved from https://www.cdc.gov/stltpublichealth/cha/assessment.html Florida counties by population. (2018, March). Retrieved from https://www.floridademographics.com/counties_by_population. Florida Department of Children and Families: Office on Homelessness. (2017). 2017 Annual report. Tallahassee, FL. Council on Homelessness Pinellas County Homeless Leadership Board. (2018). Resource directory. Retrieved from http://pinellashomeless.org/Portals/0/Documents/2017/Resource%20Directory%20July% 202017.pdf Rector, C. (2018). Community and public health nursing: Promoting the public’s health (9th ed.). Philadelphia, PA: Wolters Kluwer. Community Needs Assessment Assignment Use this as a guide to cover the topics under each category in your paper. Also refer to the Community Needs Assessment Paper grading rubric for further assistance. Introduction of Community/Population of interest • Define your “community” • Describe and define population/community assessed Problems Assessed • Provide demographics for your “community” • Compare your “community” to the state demographics • Describe available resources within the “community” • Identify missing resources within the “community” • Identify the top 2 problem areas within your “community” • Describe the impact of these problem areas within your “community” Plan, Implementation, and Assessment Model • Develop a plan utilizing an assessment model in response to the problem areas identified above. • What additional resources are needed for the plan • Develop an implementation timeline for your plan with specific action steps identified • What human resources are needed for implementation
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