Proposal for Unmet Community Need Essay

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Geagua County, OH

Planning -- The most effective strategy within a community for any public health issue is two-fold: education and focus. To accomplish this at the community level, there needs to be a broad level of focus and support from all levels of the government: local, State and Federal, in order for there to be a consistent and proactive message. Education should begin at the elementary school level, with teaching talking about substances, abuse and alternatives; and move through the school system as appropriate for the cognitive abilities of various age groups. In this way, the community can collaborate with schools to provide initiatives and programs that address the problem prior to it becoming as endemic, and offer proposed solutions in a way that almost everyone involved knows they can receive help if necessary. The educational process must also be pervasive and accessible -- people need a number to call for advice and help (Bangeret-Drowns, 1988).

Second, Geagua County clearly needs an ambulatory detoxification and abuse program in order to assist in the needs of individuals with substance addictions. This goes along with several national guidelines, many from individual State Department's of Human and Health Services. The overall plan for such a system is:

Developing a plan for the effective prevention of alcohol and drug abuse, particularly among youth.

Collaboration between public and private health care organizations and agencies to develop an effective community-based alcohol and drug abuse prevention and treatment program.

Promotion of treatment services to appropriately meet the needs of addicted citizens.

Identifying and ensuring compliance with unmet needs within a community-based system (DSHS NH Health and Human Services, 2010).

Interventions -- For the County of Geagua, there are two rather important needs to meet the requirements of an appropriate level substance abuse strategic model: Robust Educational Modeling and an Ambulatory Detoxification Program. These programs would be in addition to, and work with, the current programs of: 1) Diagnostic Assessment and Counseling; 2) Intensive Outpatient Program for Teens; 3) Prevention students that are provided to at risk youth (Pride, Red Ribbon and Teen); 4) Early Warming Program and 5) Services at Chagrin Falls Park for most of Northern Ohio (Geauga County Board of Mental Health, 2012).

Community Assets -- Resiliance is based on belief, and the only way community members will believe is if they see that something is being done, and then results. Resiliance could be improved by showing the community that partnership and education works on a multi-level, functioning manner. A social connection is multifold -- it requires the Public Health Departments at the State and County level to work together to form initiatives that are effective and translate into the schools, into the Churchs (perhaps sponsoring an alternatives for at risk individuals), and through Youth Centers, Senior Centers, hospitals, medical clincs, and transportation services. The more synergetic the system becomes, the deeper it will be part of the community. Change is not easy in any community, and supporting change in substance abuse programs, for instance, to provide more healthy alternatives, will pressure the political and social systems as well, resulting in scaling change in a rather incremental level (Roots of Change, 2012) (Scaling Change, 2012). It will be necessary to form multilevel partnerships within the community, as shown above, that are synergistic, robust, and active. We can envision them as a spoke and wheel concept, with each spoke representing part of the community and the hub the County government; also with ties to the State and Federal levels for funding, information, and services:

Figure 1 -- Synergistic Approach to Community Health

(See: National Institute on Alcohol Abuse and Alcoholism, 2005; Perkinson, R., et al., 2009).

Key Organizational Needs- Effective public administration implies that governmental policies are implemented in a fair and equitable manner that is positive for society. It must advance management principles so that government and governmental programs can function. There are a number of approaches that public administration can take: behavioral, systems, ecological, or contingency; and a number of theoretical options within each of these broader categories. Systems approaches look towards the functional integration of different stakeholders and their goals towards a specific issue or path. What implications might a proposed solution have and to what groups? What is the functional relationship between groups of stakeholders and how can that be maximized. For substance abusers, this approach looks at ways to construct programs that are utilitarian in context (the greatest good for the greatest number) (Berkowitz, M., et al., 1991).

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Often, we find that health promotion programs lack a clearly specified theoretical focus or are based on rather narrow and conceptual models. For the operational needs of Geagua County to work, both the Macro Educational Intervention Program and the Modular Detoxification Program must meet three distinct, yet complimentary, theoretical perspectives:

1. Behavioral Theories -- This would primarily be focused on the Educational module, and focus on the modification of behaviors before or during a period in the individual's life when addictive behaviors or social "copying" become endemic. There is a clear link between a routine health awareness program and the prevention of substance abuse.

2. Environmental Change Theory -- In both the educational and detoxification models, the environment needs to change in order for the individual to remain or retain health. The environment has a potential source of both negative and health promative and social support mechanisms, in which both groups should avail themselves.

3. Social/Ecological -- A detoxification program allows seriously ill individuals to change both their current and future issues, and is multidisiplinary in effect. The relationships between individuals and their environment is true for both abusers and potential abusers, and also has a core priniciple in interrletations among conditions that promote health without substance abuse (Stokols, 1994).

Taken together, then, there would need to be a fiscal commitment from Federal, State and local levels in order to implement either the detoxification or the Educational Program. At the Federal and State level, initiatives may be brought to the various public health committees for funding, or at the State level and initiative for a small tax-percentile raise in certain areas (cigarettes, alcohol, etc.) could be used to fund both. Becaise the educational systems are so cash-poor, partnerships with corporation sponsors, religious and community service groups could help fund a long-term initiative with the public school system. Corporations might also have an interest in sponsoring a detoxification program, depending on their philanthropy and community goals and mindsets. For many corporations, the new model of Corporate Social Respnsibility views community service and contributions to the overall benefit of the community, and thus to the working environment of stakeholders, to be of top priority (See: Cook & Moore, 2002; Smith, 2003).

Analysis of Interventions- There are really no negatives for a more robust educational program that includes Substance Abuse as a topic from K-12; and integrates the subject in general courses at the Elementary Level, then Science, Philosophy, Social Studies, Civics and Health and the Middle and Upper levels. Cost is certainly a factor, but with proper planning, integration of strategic partnerships, and a commitment to the educational process, the system has no real downside and may also have ancillary effects upon smoking, obesity and other health issues.

The only negative for ambulatory detoxification is the cost to set up the program, the equipment, training, and then the information dissemination about the program. Detoxification, however, does not actually treat substance abuse, and it is necessary to follow-up detoxification with an appropriate treatment program for abuse in order to reduce the risk of relapse. In addition, some symptoms of substance detoxification and withdrawal may take weeks or months to completely cure, while their symptoms persist much longer based on chemical changes in the brain. On average, it takes about one year of abstinence after detoxification to recover from chronic substance abuse (Blondell, 2005)

Goals and Objectives- The primary goals and objectives of these two programs for Geagua County are: 1) Education -- the overall prevention and reduction of substance abuse in general for all citizens through a comprehensive and robust long-term educational approach, and; 2) For chronic or severely ill substance abuse patients, the use of an ambulatory detoxification program that will allow their recovery to "kick-start" prior to and with the use of systems already in place.

Evaluation - Analysis of intervention procedures have both a strategic and tactical paradigm, as well as short, medium and long-term measurements. Benchmarks, of course, are based on current percentages of effective programs; follow up with individuals who have been through programs, and an overall objective measurement of efficacy of abuse prevention based on population numbers and follow up questionnaires from individuals who have utilized the programs and the system. For instance, when dealing with a long-term educational program that follows a cadre from elementary school to high school graduation, there is a period of at least a decade from implementation to first viable measurement......

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