Kalkaska County Assessment Ferris State University NURS 340 Kelle Aikens Jessica Collings Danielle Elore Amanda Niedzwiecki Bridget Shook

Assessment of Community Kalkaska Michigan Population 17,196 9,895,622 Caucasian 96.5% 80.1% High School Graduates 86.5% 88.7% Bachelor Graduates 11.6% 25.5% Median Household Income $39,849 $48,471 Person’s Below Poverty Level 16.2% 16.3% Poverty Level 18.7% 17.5% WIC 67.8% 51.2% Medicaid Paid Births 63.9% 45.1% Unemployment 9.6% 9.1% Free Reduced Lunch 66.6% 48.2% As this chart shows, this community is under the average income for the state. This means resources at a cheap cost are in high need in this area. Note. Adapted from ”District Health Department #10. (2013). DHD #10 community statistics. Retrieved from http://dhd10.org/dhd10-community-statistics”

Health concerns Kalkaska Michigan Access to Healthcare( # of people to Provider)- Physician 2,448 1,271 #of people to mental health provider N/A 2,827 No Healthcare Provider 7.8% 13.2% No access RT cost 18.8% 12.9% No insurance 16.3% 15.1% Leading Cause of Death, Heart Disease 245.2 201.6 Leading Cause of Death, Cancer 203.7 177.2 Gonorrhea/Chlamydia (2006) 1/19 16,760/35,389 The number of people per health care provider and mental health care provider is double than the average. People have to travel to surrounding cities for specialty services or if they have an emergent need that can’t be met at the local facilities. The primary reason people don’t have access to health care is related to the low income in the community. Note. Adapted from ”District Health Department #10. (2013). DHD #10 community statistics. Retrieved from http://dhd10.org/dhd10-community-statistics”

Health concerns Kalkaska Michigan Gonorrhea/Chlamydia (2012) 4/43 12,770/48,727 Teen Pregnancy ( 2011) 54.4% 48.3% Pregnant teens that smoked during pregnancy 43.2% 19.5% Poor mental health 20.5% 10.9% Teen pregnancy is slightly higher than the state average. The most surprising thing to me is the smoking during the teen pregnancy, more than double the state average. Note. Adapted from ”District Health Department #10. (2013). DHD #10 community statistics. Retrieved from http://dhd10.org/dhd10-community-statistics”

Current County Resources Kalkaska County Memorial Health Center Senior Center Library Closest larger city: Traverse city: (approx. 25 miles) One regular public school high school and one alternative high school for troubled children. Closest Planned Parenthood: (approx. 45 minute drive) Traverse City Area. Women’s Resource Center: Traverse City, MI (Kalkaska County Community Center, 2014)

Analysis The primary areas for concern are teen pregnancy and smoking while pregnant No easily available resources within the county, the teens must travel at least 30-45 minutes. Given the low income families, this is difficult. Primary population is Caucasian. Education level is primarily high school.

Community Focused Nursing Diagnosis Risk of impaired parenting Among teens in Kalkaska County Related to low education background, smoking and unsafe sex As demonstrated in an increase in unplanned teenage pregnancies, smoking during pregnancy and STDs in Kalkaska County when compared with the State of Michigan (District Health Department #10, 2013).

Goals & SMART objectives The number of pregnancies to females aged 19 and younger in Kalkaska County will decrease by 10% or more from 54 in 2011 to 49 or fewer in 2016. The number of females that smoke during pregnancy in Kalkaska County will decrease by 10% or more from 43 in 2011 to 39 or fewer in 2016.

Goals & SMART objectives The number of cases of chlamydia/gonorrhea in Kalkaska Country will decrease by 10% or more from 4 of 43 people to 4 of 50 people or fewer in 2016. Resources such as “child care facilities, individual counseling and assistance with graduation planning and college or job placement” will be available to teen parents in Kalkaska County by 2016 (Tolma, Stoner, McCumber, Montella, Douglas & Digney, 2014, p. 473).

Evidence-based interventions Unplanned Teenage Pregnancy and STD prevention Primary prevention using in school and after school educational programs Outreach programs that provide condom distribution to boys and girls, focusing on underserved areas. Involve boys in educational programs as much as possible Smoking during pregnancy Primary prevention using education to avoid peer pressure and smoking before the woman starts Secondary prevention using education and pharmacological intervention after the woman has started smoking but before she becomes pregnant. Using group support, counseling, and education for women who are smoking while pregnant Educational programs should focus on reducing behaviors that put teens at risk for unplanned pregnancy and STD’s. The most effective programs “deliver and consistently reinforce a clear message about abstaining from sexual activity or using condoms or other forms of contraception” (Nicoletti, 2004). It is important to address the social pressures facing teenagers and how that affects their decisions regarding sex. Choosing a teacher for these programs that is very well respected by the students and who really believes in what they are teaching will help get the message across more effectively.

Analysis & selection of EBP interventions Using consistent and clear education for teenage boys and girls has been shown to be the most effective way of preventing unplanned pregnancy and STD contraction (Nicoletti, 2004). Condom distribution provides contraception to young people who would be too embarrassed to buy it or otherwise could not afford it (Ross & Williams, 2002). Nicotine withdrawal symptoms are worse for pregnant women due to accelerated nicotine metabolism which makes quitting during pregnancy more difficult, requiring more intense intervention “Smoking is an embedded part of the lives of many women in disadvantaged circumstances” (Lumley, et. al., 2009). More education in underserved areas is necessary to reach the most women at risk of smoking during pregnancy

Theoretical Support Social Learning Theory “Behavior change approach affected by environmental influences, personal factors, and attributes of the behavior itself” (Harkness & Demarco, pg 78, 2012) The learner must believe in his/her ability to change as well as see an incentive for this change. Using modeling of the desired behavior change increases effectiveness because the learner can see both the immediate and the long term effects of the change.

Evaluation plan The desired outcome for the community program for Kalkaska County is that the number of teen pregnancies will decrease by 10% by 2016 and the number of females who smoke during pregnancy will decrease by 10% by 2016. Outcomes will be measured one year after the program’s implementation, and yearly after that, as long as the program is active. Outcomes will be measured in 2 ways. First a survey will be done, shown on next slide. Secondly data will be collected from local doctor’s offices and Kalkaska Memorial Hospital.

Evaluation Plan To evaluate the plan, a survey will be sent out to high schools that participate in the program and to participants of educational program asking them the following questions: Was the information in this class helpful? What did you like most about the program? What did you like least? Are you a teen parent? What age were you when you had your first child? Did you practice safe sex prior to having your first child. Do you practice safe sex currently? Did you smoke during any of your pregnancies? Do you currently smoke? If not, when did you quit? Was this class helpful in making the decision to quit?

References District Health Department #10. (2013). DHD #10 community statistics. Retrieved from http://dhd10.org/dhd10-community-statistics Harkness, G.A., & DeMarco, R.F. (2012) Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Kalkaska Country Community Center. (2014). About Kalkaska. Retrieved from http://www.kalkaskacounty.net Lumley, J., Chamberlain, C., Dowswell, T., Oliver, S., Oakley, L., & Watson, L. (2009). Interventions for promoting smoking cessation during pregnancy. The Cochrane Database of Systematic Reviews, (3), CD001055 Nicoletti, A. (2004). Teen pregnancy prevention issues. Journal of Pediatric and Adolescent Gynecology, 17(2), 155-156. doi:10.1016/j.jpag.2004.01.014 Ross, M., & Williams, M. (2002). Effective targeted and community HIV/STD prevention programs. Journal of Sex Research, 39(1), 58-62. Tolma, E.L., Stoner, J.A., McCumber, M. Montella, K., Douglas, T. & Digney, S.A. (2014). Longitudinal evaluation of a teenage pregnancy case management program in Oklahoma. Journal of Family Social Work, 17(5), 457-479. doi: 10.1080/10522158.2014.940634 U.S. Department of Health and Human Services. (2014). Healthy people 2020. Retrieved from http://www.healthypeople.gov/