A Health Program for Substance Abuse - Term Paper Example

 A Health Program for substance abuse Program health plans for the community have seen variety over the years. They range from the environmental planning of water and sewer systems to civic planning, population-based planning, and publichealth planning to a rational approach to health planning. Health planning from a social awareness perspective was instituted by Duhl (1987 cited in Issel, 2008). Later Nut’s model was perceived. It was based on a real problem which was the stimulus for the activities and then a healthcare plan with many layers of activities was evolved (Issel, 2008). His planning is called organizational strategic planning. CDC then began to develop and promote various plans for health care:PATCH (Planning Approach To Community Health), APEXPH (Assessment Protocol For Excellence in Public Health), CHIP (Community Health Improvement Process, PACE-EH (Protocol for Assessing Community Excellence in Environmental Health). Each model had varying strengths and emphasis (Issel, 2008). MAPP was a recent addition and established by the CDC and NACCHO together. It involves the planning and organization through effective partnerships at city, county and state levels. The highlights of MAPP are strategic planning which will involve the community: community involvement is not seen in the other programs.This paper will be using the program MAPP for developing the community health plan for controlling substance abuse in schoolchildren and the youth by forging partnerships within the community. MAPP has a framework which enables health departments to tackle issues impacting health in partnership with the community (MAPP Planning Report, Virginia University). The actions include the collection of health data and analysis, the identification and prioritization of health issues in the community and the development and implementation of action plans addressing definite needs. Ethical principles The need for the community to have greater preparedness for disasters has led to the use of ethical principles in health plans(Issel, 2008). Autonomy translates into the priority of individual choice. The principle of criticality implies that the worst-hit of the population get maximum benefit from the plan. The egalitarian principle aims at providing equal value to all people but this hardly works like the Healthy People 2010.The needs-based principle allows all people to reach their own goals like a healthier life or a better quality of life and is practical in preventive programs focused on childhood (Issel, 2008).The principle used when resources are scarce should produce cost effectiveness. The utilitarian approach is adopted when collective benefits are to be provided as in immunizations. Different programs use different principles. MAPP as strategic tool Community prioritization of public health issues and the identification of the resources are facilitated by the MAPP which is a strategic planning tool (Issel, 2008). Two critical activities constitute the first phase of MAPP. The leadership of the public health agencies mobilizes the community members and organizations to organize the planning process and develop the partnership for planning (NACCHO, n.d.).In the second phase a framework is evolved out of the generated shared vision and common values through a collaborative and creative process (NACCHO, n.d.). Four assessments are made; they are the Community themes and strengths, Local public health system, Community health status and the Forces of change. All the four assessments are multiplied together and considered as a whole. The MAPP process will help a community at the county level and the result is a user-friendly, public document which has a long-term health improvement plan (Issel, 2008). The approach to planning for the MAPP model of health program for substance abuse for youth would use a comprehensive rational approach focused on community initiatives which are not-for-profit (Issel, 2008). This community approach involves obtaining information from the stakeholders who would normally not cooperate if the approach is not through the community. More information for making decisions is obtained. Issues would be faced by the whole population and methods of processing would involve better quality methodologies for the program as it progresses (Issel, 2008). Evaluation process of substance abuse in the community The National Survey on Drug Use and Health hascategorized nine drugs as illicit: marijuana, cocaine, heroin, hallucinogens, and inhalants; and the nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives (SAMHSA, 2009). Drugs which are legitimately prescribed are not classified as illicit. In 2008, 20.1 million American children aged 12 and older used illicit drugs during the previous month (Refer figure 1). This is 8 % of the population aged 12 and older; the picture has been constant since 2002. The maximum incidence is seen in the 18-20 year olds (Refer figure 2). Perceived risks occur due to perceived availability of drugs, being approached by a pedlar of drugs, perceived parental disapproval of substance use, perception of peer substance use, participating in youth crimes like fighting, delinquency, religious involvement, prevention messages and parental involvement (SAMHSA, 2009). Individual personalities, environmental influences and enhanced vulnerability are immediate risk factors (SAMHSA, 2009). Protective factors include the influence of the individual, family, peer, school, community, and societal levels. Reducing the risk factors and increasing the protective factors could reduce the prevalence of drug users. Figure 1 Past Month Illicit Drug Use among Persons Aged 12 or Older: 2008 (SAMHSA, 2009). Figure 2- Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2008 (SAMHSA, 2009). Substance dependence or abuse in the past year has been recorded at 22.2 million persons aged 12 or older where 8.9 percent of the population are aged 12 or older (SAMHSA, 2009). First time use has been found to have happened for 2.9 million persons aged 12 or older who used an illicit drug for the first time in the past 12 months. It was similar to 2007 when 2.7 million were initiated. The shocking inference is that 8000 children are newly introduced into the habit. Their first drug was mostly marijuana (56.7%). Age at initiation was 18.8 on an average (SAMHSA, 2009). In a decreasing priority, the other drugs used were psychotherapeutics (29.6%), pain relievers (22.5%), inhalants (9.7%), tranquilizers (3.2%), stimulants and sedatives. Marijuana happens to be the drug which is involved in maximum initiation incidences (Refer Figure 3). It is known as grass or pot or weed and made from the dried parts of the plant. Figure 3 Specific Drug Used When Initiating Illicit Drug Use among Past Year Initiates of Illicit Drugs Aged 12 or Older: 2008 (SAMHSA, 2009) Role of community Substance abuse, being a rampant community issue with long-term negative consequences, needs to be countered with a social ecological movement aimed at community prevention of the issue especially among the adolescents and youth (Chilenski and Greenberg, 2009). The ill-effects of substance abuse and addiction destroy the lives of oneself, the family and the community. Policy makers and citizens have called attention to the role of community in the promotion of positive outcomes for youth (Chilenski and Greenberg, 2009). If the community can do positive good, its refraining from doing so would be great injustice to posterity. The community should not focus on the individual but see the problem as a whole. Community block building has been the recent concept that has been practiced in Colorado (Linkhart, 2010). What people need is to know the neighbors and build a relationship that serves to improve “safety, quality, financial well-being and health” (Linkhart, 2010). Socio-economic trends make people lonely, unwanted and most uninterested in keeping within the community. Frequent social contact may produce better results than deep social connections which are far between. Block parties are usually organized by police officers. The community policing also has its advantages. Citizens become closer to the police and are able to share information with them on a larger scale. The incidents of drug abuse are more prone to come out and the police are better informed. The cooperation with the citizens helps to organize health programs on the model of MAPP where partnerships are the essence of the planning and implementation. Program planning model MAPP The necessity for resorting to the MAPP model for producing a health plan for addressing the issue of substance abuse has to be first determined. Why such a process is required is first ascertained. Representatives of the various organizations need to come together for this. The organization of the planning process and the building of the partnerships constitute the first phase (NACCHO, n.d.). A planning process for building commitment and recruiting active partners who keep time for the planning is essential. 1st Phase - Organization Identifying participants In this program for fighting substance abuse, it would be useful to motivate people who have faced the problem within their families and who would like to do something for society. Identification and organization of the right people for participation is of utmost necessity which can even determine the progress of the health program. A broad community involvement produces a realistic plan. The partners should be ordinary citizens, school teachers and the headmasters, doctors and other health professionals, priests, the police and other leaders and should be a representation of different ethnicities. The greater diversity would ensure the success of the planning process. The organization should be able to delegate roles and responsibilities to each(NACCHO, n.d.). The objectives of the partnership and the time duration for which to achieve noticeable changes must be planned. Key organizations which offer strong support initially can be considered the sponsors and they offer strong leadership. All participants are the stakeholders. The time constraints, expectations and how the meetings can be arranged for the convenienceof all will have to be considered. Designing of the planning process The planning process has to be designed well to provide vision to an ambitious health program for saving the youth of the community from the harmful addiction of illicit drugs. The duration of the program, the explicit features and stages, the appropriate results or outcomes and the roles and responsibilities of the participants are defined to the minutest. The health program for substance abuse would require around two months for crucial planning. The outcomes expected are the reduced number of youth using illicit drugs, reduced number being initiated and lesser number showing dependence and delinquency. Resources identified Resource needs expected are to be determined as travel cost, consultation fees and other incidental expenditure. Space for meeting and production costs for printing also requires funding. Thorough preparation conveys the right messages to the partners and others in the community. Sustained commitment is the main feature of the partnership. Sponsors must be found from the community who would provide the funding necessities (NACCHO, n.d.). The availability of staff and technical support must be determined. The main theme The processes involved in the MAPP first include the necessity to determine the reason for undertaking the venture to fight substance abuse in the community (NACCHO, n.d.). A change in leadership may be called for occasionally. Community public health planning must be discussed. The local public health system must be strengthened. All partners must in one voice welcome the planning for the issue. “Effective strategic planning should build systems, assure sustainable public health services and create community cohesion” (NACCHO, n.d.). The ultimate aim is the improved health of the community. The designing of the planning may require the services of a consultant. Education and training materials may be required. Readiness Assessment Worksheet A readiness assessment worksheet for readiness assessment may reveal facts and barriers. The disparities of current circumstances and the community’s vision will get an insight into the gaps. Information for the strategic issues will be identified for the plan. The issues, strategies and goals will all be built on the assessments. Managing the process Organizing the process into a single document, the project proposal, will outline the project from initiation to conception. The major activities are laid out in the workplan and a time frame is set for the project. The proposal addresses the orientation of tasks for guidance to the various leaders and participants. The guiding assumptions contain the specific issues which are of concern to the community and for which the community is working (NACCHO, n.d.). 2nd Phase -Visioning This provides the guidance for a “collaborative and creative process that leads toa shared community vision and common values” (NACCHO, n.d.). This phase begins with the evaluation of the earlier initiatives taken by the community for about 10-15 years as a first step. The participants need to reach a consensus and identify common values for which they are to work together. A facilitator may help to design the visioning process which is the second step. A community visioning process is necessary to set the ball rolling. Conducting the visioning process is the third step. The vision constitutes the long-term results of the planning process and after implementation (NACCHO, n.d.). It provides a picture of a better public health system in place. Formulating the vision and values statements is the fourth step. A mission statement answers the question “why do we exist now?” The vision statement answers to the question “where are we headed?” The strategic plan will reply to the question “how do we plan to get there?” Mutual respect, commitment and teamwork are the community values which would hold the participants together in their initiatives (NACCHO, n.d.). The fifth step keeps visions and value statements reactivated throughout the MAPP and modified as necessary.The visioning process helps to achieve a common goal which would produce better results through the community effort rather than an individual effort. The joint effort is an incentive to spread the message throughout the community and an incentive to mobilize resources and assets. This togetherness is a rare phenomenon and serves as a source of inspiration to the participants and on-lookers who would want to join in and set in motion a similar effort in their community (NACCHO, n.d.). It can be understood that community level investigation and interventions to reduce substance abuse by adolescents and delinquency is a good and reliable effort (Chilenski and Greenberg, 2009). 3rd Phase - Assessments Community Themes and Strengths Assessment The Community Themes and Strengths Assessment provides answers to how the community sees the issue of substance abuse.General issues like the availability of dental care, nutrition, exercise, mental health care and primary care could be identified as creating problems for the community (MAPP Final Report, Virginia University). The strengths and weaknesses are noted. The risks in the present community for substance abuse are discussed and recorded. Economic status or povertyis a risk that could provoke a youth to substance abuse (Chilenski and Greenberg, 2009). Residential instability (percentage of residents over the age of five that have moved their residence in the last 5 years) is another. Broken homes are also provocations. Being in the midst of crime or having peers with the criminal instinct could lead some youth into the wrong path. The incidence of crime rates may be on the rise. Existing in an atmosphere of crime is an instigation to be unknowingly led into a situation where youth turn to substance abuse. The school-district risk is also quoted where the menace can be existing in certain schools and children are surrounded by others who are initiated into drugs. The quality of life that is expected by the community from the disposal of the problem will be understood from the discussions. The assets that are available in the community and that can be organized to assist in the process are delineated.Four community resources have been identified: school district leadership, collective efficacy, structured activities for student and youth organizations (Chilenski and Greenberg, 2009). Local Public Health System Assessment The Local Public Health System Assessment would bring out the organizations that are available in the vicinity that are providing their services: “their components, activities, competencies and capacities” (NACCHO, n.d.). How the community is being benefited is discussed. What the needs are to bring an improvement to the health of the community regarding substance abuse would give an idea of the changes necessary. Community Health Status Assessments The Community Health Status Assessments decides how healthy the residents are and the status of health in the community. The Forces of Change Assessment relate to the legislation and technology. This assessment tells more about the threats or risks to the health of the community. It is noticed that there is common information to be obtained in the four assessments. How all the four can be done concurrently must be thought of. Subcommittees need to be formed first for each assessment. Then the items which overlap need to be marked out. These can be allotted to different subcommittees so that the same people do not have to answer to the same questions from four assessors and the information obtained by one subcommittee can be handed over to the other subcommittee which wants it. Efficiency in correct allotment of questions is therefore significant. Linkages among assessments must be encouraged. Success of the subcommittees must be recognized and lauded. The information obtained would include changing demographics and the growth of population in the age above 45 years (MAAP final report, Virginia University). The availability and accessibility of health resources is ascertained. The number of residents below the poverty line and those not having medical insurance will be hinted at. Dental access has been limited for adults without insurance cover, the elderly being the most affected. The infant mortality rate is an indicator of health. Teen pregnancy rate would indicate the hazard of being a young vulnerable woman and may be related to substance abuse. Maternal and child health indicators will be available. Overall death rates and incidence of cancers will be found. Unintentional injuries like falls in the elderly may be enumerated. Suicide rates in the population may be enquired into. The crime rates for youth may be significant and related to substance abuse. Suicides could also be related. Statistics on sexually transmitted illnesses including AIDS may be collected from the appropriate health organization. Information on the number of mental patients may be accumulated. Hospitalization discharge data would provide the statistics of hospitalized psychiatric patients, many of whom would be guilty of substance abuse too(MAAP final report, Virginia University). 4th Phase - Strategic issues Strategic issues are those fundamental policy changes or critical challenges that must be addressed in order for a community to achieve its vision (NACCHO, n. d.). Strategies vary according to the results of the assessments. Potential strategic issues are first identified based on the information that evolved in the community vision, common values, community themes and strengths, forces of changes, local challenges and issues of community health. The second step involves the understanding of the issues identified as strategies. A comprehensive understanding is possible through the four assessments. When one assessment gives the surface information, another delves into the depth of the issue. Strategic issues may be threats or issues requiring changes. They need action on the part of the partners. Mostly strategic issues are a confluence of insignificant issues individually, together the issues may constitute a threat to the community (NACCHO, n. d.). The issues may arise out of conflicts or tension. Participants should be able to initiate innovative changes or solutions. Complex issues could be having more than one solution. Strategic issues would project far into the future. 5th Phase - Formulation of goals and strategies The goals are the expansive aims that would project the desired result and related to the strategic issues identified in the previous phase. Strategies are the statements which have a set direction and include the action, policies and decisions which are able to guide a health system to its vision and goals (NACCHO, n. d.). They can be overall ones or specific ones. Specific issues could be addressed by programs or services. The resources used like information technology should be identified. The formulation of strategies must be completed first and then the adoption is executed. The goal will be concerned with the vision and strategic issues. A strategic issue could be like this: “How can the public health community ensure the abolition of substance abuse from the community?” (NACCHO, n.d.). The goal would be as follows: All people in the community must prevent the access of adolescents to substances of addiction. The vision would be: A community that has very little of substance abuse in it. The second step involves the generation of strategy alternatives. Participants would share previous experiences which have effectively reached goals earlier which may be adopted with innovative changes. Several strategies may be suggested for one goal. Substance abuse strategy alternatives could be as follows: 1. A community ombudsman program could be established. 2. Coordination among the partners and the different services could be strengthened so that referral systems are improved. 3. Awareness of available services and health care organizations and personnel may be advertised online for easy accessibility. 4. Programs or services must address the multicultural diversity of the population. Recording these in the Strategy Development Worksheet allows future reference. Depending on the number of issues, the allotment to personnel can be made. Barriers to implementation must be considered as the third step (NACCHO, n.d.). They could be insufficient resources, deficient support from the community, legal or policy issues, technological defects or reduced organization efficacy among the many issues possible. The next is the implementation details. The specific activities and the time for each are decided. The roles and responsibilities of each organization and each person in the organization are decided to the minutest detail. The groundwork for the last phase of the action cycle is laid in this phase (NACCHO,n.d.). The next step is the selection and adoption of appropriate strategies. The PEARL test helps to define the feasibility of strategies. PEARL stands for the following: “Propriety Is the strategy consistent with Public health principles? Economics Does it make sense to apply this strategy and is it feasible financially? Acceptability Will the general community accept the strategy? Resources Will financial resources be available for the strategy? Legality Is the implementation within the provisions of the law?” (NACCHO, n.d.). The final step is to draft a planning report. This is a reference report of all the processes undergone so far. The process through which the consensus on strategies was reached will be incorporated in the report. The partners and the community at large would be receiving the visions, goals and strategies and the message behind the health program. The plan is usually a detailed one and includes specific details. The drafts are corrected and polished till a final one is obtained with the compliance of most of the participants (NACCHO, n.d.). 6th Phase - The Action Cycle Planning, implementation and evaluation are done in this phase. It is a satisfying but challenging phase where all the participants who were in the earlier phases are to be included (NACCHO, n.d.). The MAPP committee is in charge. Three subcommittees will be formed to overlook each part of this phase and they will be supervised by a single subcommittee. Objectives will be developed and accountability established. Each identified strategy must be made measurable. Specific action plans for each goal must be laid out. Action plans may be reviewed so that each participant is sure of his path. Implementation and monitoring of plans is then done. Informative messages must be passed on through the media of the newspapers, television and internet. Evaluation of the MAAP process as a whole and of each strategy is done. The utility, feasibility, propriety and accuracy of results are evaluated. Evaluation activities are prepared for and then the actual evaluation is done. Evidence is put together and analyzed. Evaluation results are then shared among similar communities. Data used. The data from the various worksheets and the four assessments will be used to further study and analyze the health situation in the community focusing on the issues related to substance abuse like suicide rates, hospitalization of substance abuse patients, increased crime rates, teen pregnancy rate, increased driving accidents and the like. Objectives that are made measurable in the previous phase also provide data. The data can be compared to the national data for substance abuse prevalence. Staffing needs The members of the MAPP committee, health professionals, health workers, teachers and the headmasters can cooperate in the committees and play an active role. Budget The budget will be approved by the sponsors and the funds raised from them. Results The results will be collected and analyzed to verify the success of the program annually and at the end of the program after its time-frame. Each strategy used will be measurable and analysis would also show how each strategy has fared. . References: Chilenski, S.M. and Greenberg, M.T. (2009). The importance of community context in the epidemiology of early adolescent substance use. American Journal of Community Psychology, Vol.44, p 287-301. Issel, L.M. (2008). Health Program planning and evaluation: a practical and systematic approach for community health. 2nd Revised Ed., Published by Jones and Bartlett. Linkhart, D., (2010). Block building: Cure for crime, conflicts and maybe even city budgets. National Civic Review, Winter, 2009. Wiley Periodicals Inc. MAPP Final report. (n.d.) Retrieved on 23/2/10, http://www.healthsystem.virginia.edu/internet/phs/phppVirginia University. NACCHO, n.d. Retrieved on 21/2/10. http://www.naccho.org NACCHO. SAMHSA (2009). Retrieved on 21/2/10. National Survey on Drug Use and Health, Department of Health and Human Services Sept 10 2009 Read More