Nov 10, 2017 in Research

Research on Hoboken Community

To successfully implement any program and intervention in a community, it is essential for one to understand the community’s culture, morals, needs, capacities and assets. Hoboken is in the United States, New Jersey State. The population of the city as of 2015 was estimated at 53,635 with the median age of 31.4. The majority of residents are whites with a few Asians and black Americans. 94.0 % are high school graduates and above with about 10.8% below poverty line. Hoboken is a densely inhabited community with resources and assets that if well utilized can improve the livelihoods of the community members and further reduce the percentage of those falling on the poverty line. Hoboken Transportation system is extensive as the Historic terminal serves 60,000 and more passengers daily. 

PART III

Strengths, Weakness, Needs and Assists

The Hoboken community has a distinct population. It has strengths in good educational backgrounds with majority having attained a minimum of high school level. There are an estimated 5,946 companies in the community. This is a great strength as issues of unemployment are minimal. Hoboken is a low-lying riverfront thus prone to frequent flooding.  The United States Department of Housing and Urban Development in 2014 allocated $230 Million to the city for infrastructure, building of parks and retention basis to help the city survive storms.  The major industries in the city are an asset to the community as a source of employment and income.  The historical museum, fire department museum, and ferry services are among the assets in the community of Hoboken. Living and working in Hoboken in the early 1980s gave me a good foundation for appreciating the challenges facing Hoboken as redevelopment and change loomed in its future.  Upon returning to Hoboken after several years, it has been encouraging to see how much has been preserved and that the city continues to be well cared for and appreciated (Colrick, 1999).  

Trends

 The common trends recognized are immigration to and from the city due to frequent wars. This was very evident during the World War II that reduced the population by 25%.  In addition, storms are a major trend in the city.  This has seen the city joining the campaign targeting UN’s resilient cities. This was after the Hurricane Sandy. However, the storm became a trend when the city was facing strong frequent storms increasing its inaction cost. These trends cause constant movement of people. However, the good transport network enables residents to move with ease to their work stations, this has also caused increase in population.  Today, Hoboken, together with other New York Cities, has been able to maintain the trend of growth seen in the previous years. City of Hoboken is a beautiful place for many technology students who frequent it. Emerging technology sector and Stevens Institute of Technology is located along the waterfront of Hudson River (Hope, 2013).

Things Interesting about the City

 Hoboken is for a fact a city with rich cultural background as seen from its inception to the current state. It is interesting how the city has grown immensely from scratches of World War II to one of the most powerful cities in New York. Social amenities such as the libraries and the parks are amazing. The state of the art transportation network is something to be admired. Others include the waterfront and the major industries, which together present a few interesting milestones to be admired in Hoboken City. It is important for people to know that Hoboken, since the 18th century, has been the point of ferry services. The city is also known for great and well-designed rail terminals. In 2012, the Hoboken city was hit by Hurricane Sandy that was rated the second costliest cyclone with an estimated total of $19 billion loses. While the city can act as a warning that during heavy rains, people should be more cautious as flash-flooding could be an issue, it is necessary to research into why it has been able to flourish again. For instance, it is noted that the city council accepted request for funding for additional pump station to assist in alleviating floods in the western part of Hoboken city.  

Another interesting thing people should know about Hoboken is the interconnection of intersecting track lines that surrounds Jersey and Hoboken, creating important commercial links.  Prior to it flourishing as a city known for its lead in transportation, Hoboken was known for its sceneries supported by its populations coming in and moving out using ferry and enjoying the riverside stroll, the natural spring waters, and watching games such as cricket and baseball. Moreover, Hoboken is a very active city with an active waterfront and also a place of work and resident for many foreigners and families (Colrick, 1999).

 The survey even revealed more interesting things about the city and why it is loved by many. One of the participants, Kelly, noted, “Life is so much easier here”. She had immigrated into Hoboken alongside her husband, in the year 2013 just before they got their first born. “Before we moved to Hoboken we had to take a cab to our car since it was parked a mile away in Manhattan,” added Kelly. The citizens of Hoboken feel that life is much easier in their community with ease of transportation and connecting to other cities without too many hurdles.  The transportation network has made it easy for the citizens to access each point in the city and other neighboring cities. The real estate in Hoboken and the good and spacious housing is also something the residents find amazing about the community.   

However, people would even be more interested in the city if, being a large city, it had a blueprint of how to respond to emergencies and ways the community can collaborate with community health nurse and other community partners. Presently, the city is prone to frequent floods and once in a while hurricanes. These unfortunate incidences seem to drive people away and scare away potential tenants since they make the city prone to destruction of properties, stalled life and daily activities, and may even cause death. Currently, the city is investing in good planning emergency with the understanding that planning can help ensure that every sector and individual is well equipped for disasters (According to Perry & Lindel, 2006). The city has invested in various plans meant to reduce losses, both in terms of human life and in damages to properties. Preparedness, here, refers to Hoboken’s “ability to Marshal community and extra community resources to reduce or minimize vulnerability” (Perry & Lindel, 2006).

How the Citizens Feel about the Community

The residents together with those visiting feel that the city is the place to be. It has nice restaurants with great foods available in its great hotels along its famous waterfront. The nights are always lively, it is never dull in this city and there are a lot of activities for the day as much as during the night. Residents feel great about holding parties of all kinds as there are a lot of things to choose from. However, there was a common feeling that if the resources and assets of the community could be utilized as tourists attraction sites, they could help improve a lot in their community.

What People Should Know about the Community

 With the frequent disasters, it is important for every individual to take responsibility and work with the assigned bodies to ensure that there is minimal loss of life and destruction of property in case of such emergencies. The community may need to work with the health nurses to ensure that the residents are well trained and equipped for such disasters. People should be informed and aware of dos and don’ts in case of emergencies. It means that the health nurses need to educate the community on basic first aid skills, rescue plans and important things to observe during these times.  The residents also need to be educated and informed of their city, they should be aware of areas with most risks. Finally, it is necessary that the residents are trained to be able to read and follow the climate changes just to be on the safe side.  

The educators must also note that Hoboken is also known to have experienced some of the worst disaster in history besides the Hurricanes and storms. The city has also experienced fires at the docks, train crashes, industrial and sea accidents, and blasts among others. There is much improvement in preparedness of disasters, but still the community need to collaborate with the health nurses and other partners to ensure that any of these disasters that strikes is well contained and loses minimized. 

Needs to be Addressed

 In a city with so many disasters, protocol and chain of command and communication is quite important to eliminate cases of misinformation and lack of correct information. For instance, in September 2016, a train crashed in Hoboken killing one person and several others got injured. Such accidents need people to be prepared for them in order to all the execution of rescue plans properly. Reporting for the New York Times, Bindley (2014) noted that “A swaying passenger train moved through the boundaries at the track ends and collided into a wall during the haste of the dawn.  One person was killed in the accident and several hundreds injured, unleashing chaos as part of the station’s roof came tumbling down in a jumble of metal.”  The community health nurses have a task of educating the community members on the various measures and precautions to be taken in case of such emergencies. 

Cases of community members not being able to access medical care due to inability to afford should also be eliminated. The community members, community health nurses and other partners need to work together to ensure treatment and medical care is available for all. This should especially apply in cases where a disaster strikes. Moreover, children suffering from disabilities should not be neglected. With good collaboration between parents, community members and health workers, these children should be able to access proper medical care and other needed services. The health workers may use their links to help the parents seek further treatments in case it is required. These children should be able to access special education and services.

PART IV

Community Health Care Plan

There are several healthcare plans in Hoboken city one can choose from.  However, individuals are advised to choose a plan that best suit their financial situation and family under the Affordable Care Act (ACA) also known as Obamacare. The plan one chooses must meet the conditions for coverage under ACA. Every individual is required to enroll in a care plan unless they are qualified for an exemption by the law. Those with very low income may be considered into free or low-cost plan through Medicaid.  It is, however, important to note that one cannot be arrested for not having enrolled for a health care in Hoboken, but they may be required to pay a penalty. 

Community Diagnoses

The Community of Hoboken experiences several health challenges that need to be addressed to curb serious damages in the future. There are also actual health challenges being experienced in the community at present.  For an actual challenge, we can look at Autism Spectrum Disorders (ASD) which is common not only among Hoboken’s Children and Youth, but across the globe. According to Magyar (2010), ASD refers to a group of neurodevelopmental disorders of genetic origin that affect multiple developmental areas. On its side, CDC gives its definition of ASD development-related disability able to trigger significant challenges socially, communication-wise and behaviorally. Normally, there are no symptoms that are unique to the patients with ASD, except in their communication, interaction, behavior, and learning all of which may vary with what is the case with others. The ability to learn, think and solve problem of the ASD patients ranges from those with the gift to those who are totally challenged. Though some patients may not be so much challenged, certain individuals with ASD require so much help (CDC 2017).   

Children with Autism have to be helped because they show special learning challenges due to their complicated neurodevelopmental and impeded behavior. The very notion of a ‘spectrum’ is truly conveyed by this group of developmental disorders as it is characterized by wide variability in symptoms and a high prevalence of co-occurring cognitive, learning and behavioral disorders, that can change overtime with development (Magyar,2010).

Actual Diagnosis

 It can be quite a task diagnosing ASD because no medical tests can be used to diagnose the disorders such like blood tests. Physicians make a diagnosis by assessing the child’s activities, behavior and development. ASD maybe at times noticed at 18 months or earlier on in life. A skilled physician can make a diagnosis by age of 2, however, a large number of children receive a final diagnosis at a later stage in their lives. The suspense may translate into Autistic children not being able to receive the help they require at the right time. Currently, there are no treatments for this condition, but an early diagnosis may help improve the child’s development.

In 2014, a new report released by the U.S. Centers for Disease Control and Prevention (CDC) indicated that one in every 45 children had Autism in America. The CDC estimated ASD population to be 2.24% in 2014, while a significant increase was noted in 2011-2013, with an average of 1.25%. However, the mainstream media still gives less attention to the increase of Autism.  Many scientist and parents are not able to explain the autism epidemiology. According to this report, the most involving and accurate scientific analysis, carried out by SafeMinds’ board scientists, revealed that the actual increase in the number of those affected by the disorder accounted for 75-80% of the rise in autism from 1988. The researchers ruled out the possibility of the rise being explained on the basis of changes in the criteria used in ASD diagnosis (CDC, 2017).

The cost of autism was calculated by UC-Davis MIND Institute Study to be $268 billion dollars per annum. If prevalence continues to increase, the estimates of autism may hit the one trillion dollars by 2025, exceeding the cost of other major chronic ailments such as Alzheimer’s, diabetes among others.   

The burden of ASD is relatively significant for 2015 but frightening for 2025; thus, calling for discussions about policy responses. Studies into possible mutable causes of Autism should be a priority as an initial response for Hoboken. It is much cheaper to prevent than to cure or better the functioning of individuals with ASD.  If amendable sources can be realized, say a toxin and be destroyed, the quantity of the toxin in the city’s ecosystem would subsequently be reduced. The third response would be more study on cheaper treatments to aid functioning among the affected children in Hoboken and its environs. According to Upstate NY Alliance, it is not just about autism. America’s children are experiencing a host of health problems as compared to children in other industrialized countries. Juvenile Obesity, cancer, and diabetes rates are sky rocketing in America. For instance, research by CDC shows that in Every 6 children, at least one is diagnosed with learning disability; 1 child in 9 has asthma; and 1 in 25 has a severe food allergy (CDC, 2017).

Potential Community Diagnosis 1

 Flooding:  The city of Hoboken is prone to frequent flooding.  This could cause some serious health issues. The city has over the years improved on the management of flood waters, yet, more efforts must still be put for greater achievement. Therefore, flooding is a potential major health complication that needs to be addressed. Hoboken city has a combined sewer system which in the same pipes gathers rainwater, sewage, and wastewater from industries.  Occasionally, heavy downpour outstrips the system’s capacity, causing spillage that contains a mixture of human and industrial garbage, toxic items, and litter into streets and waterways. The flooding together with the overflow of sewers, can immensely affect the health of the Hoboken residents. 

According to Zimmer (2014), Hoboken is prone to Coastal flooding from accelerated storm, as well as localized storm water flooding from rainfall events. Flooding like Hurricane Sandy, occurs with lesser rate, but can cause ruin in large areas of the City and result in extensive economic ruin,  negatively impacting Health and causing security concerns. Hurricane-Irene floods mainly occur during heavy rain seasons and they happen with a greater rate. Causes of flooding may be because of the structure of the surface, which are very low. In addition, the city is near Hudson River. Current sewer structures and inability to sufficiently discharge especially when the tides are high may have also contributed to the frequent storms. Potential health risks that may be caused by the floods are food and waterborne diseases such as cholera, dysentery, fever. The inhabitants of the city may also suffer from Asthmatic attacks among others.   Contamination of drinking water systems is the main risk factor associated with flooding, however, when this occurs, the outbreak risk can be contained once the risk is properly identified and the catastrophe addressed. There are no evidences of risks in handling bodies after a natural disaster. However, volunteers and workers who constantly handle dead bodies may be at risk of catching tuberculosis, viruses like Hepatitis B/C and HIV, gastrointestinal infections as salmonellosis, cholera, typhoid/paratyphoid fevers, diarrhea, rotavirus, hepatitis A, and shigellosis among others. 

Potential Community Diagnosis 2

Improper disposing of home generated medical waste:  It is becoming common for individuals to have medical equipment such as syringes at home for administration of injectable treatments.  The major disease that needs individuals to administer self-medication of Insulin is Diabetes. This disease requires constant monitoring of sugar levels and daily injections to control and maintain the sugar levels as required. Individuals diagnosed with diabetes are trained on how to administer the insulin and how to monitor their sugar levels at home.  Therefore, it is inevitable for patients to have medical equipment at home, thus the need for proper disposal to eliminate risks for family members, neighbors, health workers and the community as a whole. 

There is a state law in New Jersey that governs the improper disposal of syringes or needles.  It is illegal, and the law forbids anyone from disposing used needles, syringes and other medical equipment in public or private areas where others may be affected.  In this case, individuals are responsible for their medical equipment and should destroy them after use to avoid injury. Those who violate this law may be fined, jailed or both.  It is, therefore, the responsibility of the person to ensure they properly dispose of any needles, syringes and other used medical equipment. 

Among the potential hazards of improperly disposing of used medical objects is basically contracting diseases such as HIV/AIDS. Although rare, Hepatitis B can also be as a result of carelessness in disposing of medical Equipment. Again, loose and used syringes tossed into the trash, might also be inappropriately used if at all they get to the wrong hands. Moreover, these dangerous items can cause injuries to young children, domestic animals and wildlife. There are safe ways that Hoboken city authorities can incorporate to help dispose used medical items without risking other people’s lives. Just like in New Jersey, Hoboken hospitals can collaborate with community members and other health workers by providing rigid containers to be used by individuals in disposing of used syringes and needles.  Once the container is full, it is then returned to the hospital and a new one issued. It will also be important for the city’s health sector to ensure that its hospitals have better ways and knowledge of disposing these used items.

Community Care Plan for Autism Spectrum Disorders (ASD)

Community Care Plan (CCP); the entity belongs to Broward Health and Memorial Healthcare System.  Both have a record of aiding to ensure that everyone receive the correct care, when needed. The Community Care Plan was the first secure Provider Service Network owned by hospital to be launched in 2000 (Broward Health, 2017). The purpose of Community care services is to assist individuals who require care and support to lead a dignified and independent life in the society. It is also meant to help people avoid detachment from the society. The target of the services is for the elderly persons in the community and people with mental illness, those with learning difficulties as well as the physically disabled. The major idea of the care services is to enable individuals/patients to live in own homes with their families and loved ones, to have independence, and eradicate social isolation. It can prove difficult to measure the care needs as it involves availability of funds and meeting expectations of the clients.   

Out of 10, 7 deaths are caused by chronic diseases each year and treatment of chronic diseases consumes up to 86% of the nation’s health care costs (CDC, 2017). Among the common chronic disease are diabetes, asthma, heart disease and stroke, HIV, mental illness and cancer.  People suffering from diabetes need frequent medical care and close monitoring to ensure that their sugar level is maintained as required.  These patients may need to inject themselves with insulin daily to help moderate sugar level in the body.  Some doctors prescribe tablets or other forms of medications available depending on the level of condition of each patient.  For this reason, a CCP is much appreciated since the patients may need care from home and by family members or health workers. People with heart conditions too have a very sensitive health hence requires close monitoring both at home and hospital. Each condition is unique in its way thus with unique challenges, but all of them need close attention and care.

How and where a care plan is written will determine the effectiveness of the care plan.   A care plan drafted by an individual,  might have all the important principals but is likely to be less effective on the ground compared to one drafted by all the stakeholders and parties involved.   As the city tries to work out its plan, it is important for those involved or contributing to the plan to comprehend it.  Using own words and expression, acknowledging care plans are for the advantage of service user, therefore, need to be focused on the needs of the user and not service available.

Goals

  • The first goal for the care plan is to, in a period of three (3) months, do a community assessment on the needs of children/people with autism. 
  • The second goal is to, for a period of three months, identify gaps in care for children with Autism both at home, school and in health centers. 

Objectives for the Community Care plan for Autistic persons;

  • The patient caregiver to be able to identify helpful resources and intervention for his/her patient.
  • Patients to be able to improve on communication, convey a message, and relate well with their environment.
  • The community members to be well informed and be able to understand ASD and accept and support people with the illness.

Plan of Action for Objective 1;

The Patient caregiver to be able to identify helpful resources and intervention for his/her patient

  Due to financial constraints, the patient may not be able to keep up with regular appointments at the health centers.  Some very important factors to be considered here are stigma, distance to the health facility, availability of the caregiver; if at all they are employed and they need to seek regular day offs to attend to their special children among others.  Many patients miss out on appointments, or are not attended to completely due to these factors mentioned. This trend is; however, dangerous on the health of the autistic person as they need proper medical care to enable them live a better life and also be able to socialize well. Autistic patients need continuous assessments and treatment to be able to control their brain activities and attain comfortable life.

The Action Plan is to assist these patients from home and avoid limiting unnecessary hospital visits. Unless urgent and necessary, say for screening and other complex health checks,  the patient will be put in a plan for home care and assessment by health workers from home.  The patient will be referred to a support group within the community or at a health clinic for more training and to help deal with issues of stigma.  The support groups will also act as accountability partners as they will be encouraged to look out for each other. Caregivers of the patients’ will benefit a lot from these groups, they will learn how to cope with the situation and also be informed of any developments on the situation. Sharing of ideas will be important as other will be able to learn of where to find help and the resources they may need.  It is important to involve the government at this point. This is because there should be more accessible programs for autistic people in the community and the government need to ensure that even the poorest of them is able to access these programs. The objective can be achieved by implementing cheaper and more accessible services for autistic people and their care givers through the government support.  The government can set aside funding for such cases, and make suitable policies for them. 

Evaluation: To help evaluate this plan of action I will need to identify where the patient and caregivers were before the action plan then where the patient and caregiver are now in terms of knowledge, information and accessibility of resources. This must be looked at versus where we expect to be after the completion period of the program. These questions will enable me to know if I have reached the desired state, progressed, regressed or remained at the same state.   After three months of intensive community care and support, joining of support groups, there should be notable changes in the attitude of patients and caregivers within the Hoboken community especially towards seeking medical attention, and accepting the condition.  They should be more open when discussing issues concerning autism and be flexible to talk to family members and friends.

Plan of Action for Objective 2: Patients to be able to improve on communication, convey a message and relate well with their environment.

  According to Magyar (2010), ASD refers to a group of neurodevelopmental disorders of genetic origin that affect multiple developmental areas. Children with Autism show special learning challenges due to their complicated neurodevelopmental and impeded behavior. The ‘spectrum’ notion has a true conveyance by the developmental disorders’ group because of its characteristics of real variations in signs and a high prevalence of co-occurring cognitive, learning and behavioral disorders, that can change overtime with development (Magyar,2010).

Children with Autism need love and special care from every angle and from everyone around them.  The condition delays development in children.  Children born with autism have poor coordination of words and thus are not able to communicate properly. Without much patience and understanding from their caregivers, they may be left out and unheard. They may never be able to express themselves and their feeling may be hurt most of the times. The way they interact with the environment is quite different. They, thus, need help for them to be able to understand their environment. The objective here is to help these children improve on communication, convey a message and relate well with their environment. 

The plan of action is to assist these children by connecting them to qualified therapists to help them improve on their speech, communication and social skills. Most of these patients are not able to access qualified therapists due to lack of knowledge and information, financial constraints and inaccessibility of the therapist. With good networking, we are able to find a suitable therapist who would also be able to provide these services both at home, clinic and at the schools. The plan is to network with all the stakeholders. To involve their schools, ensure the children get special care at school with trained educators on special care, friendly environment for these children at home, school and clinic. By friendly environment, we mean enough space for play, safe play toys and safe suitable games for these children. When all these are in place, the children will be able to express themselves well and improve on their speech and social skills.

Evaluation: To evaluate this plan, we will need to ask ourselves some questions to be able to identify where we were when we started and where we will be by the end of the three months period. It will be important to note the total number of children with communication problems and social skills issues, and the total number of children who are able to convey a clear message by the end of the program. We should be able to identify children who are more comfortable with the environment through participation in the activities compared to what was the case before the start of the program and establish tangible positive changes in the children, and the caregivers. There should be notable change in the community showing more care and being more accommodative for people with autism.  It is also good to take note of any issues of concern that need more intervention, and further addressed.

 

Plan of Action for Objective 3: The community to be informed and be able to understand ASD, accept and support people with the illness. 

People with autism are more misunderstood than accepted.  They receive unfair treatment from all corners. The caregivers together with the patients end up overwhelmed by the condition and feel the need to hide the children and loved ones suffering from the condition.  Due to this, people with autism are likely to get less care as the condition is widely misunderstood. It is; however, important to ensure the community is aware that ASD can be diagnosed in people from all ethnic, racial and socioeconomic groups, though 4.5 times common in boy child than in girl child.

This objective seeks to enlighten and educate the community on autism as a way of creating awareness on the condition to eradicate any misinformation and perceptions people have on the disease. In collaboration with community health workers, social workers, medical doctors and other parties more aware of the condition, we can organize community talks in learning institutions, hold talks in worship places, organize community activities to bring people together and educate them on the condition. Organizing health talks with medical doctors to explain to the community what autism is would be very essential. It is important to engage the community fully in activities that concern autism. The members should be empowered and encouraged to participate in advocacy programs and advocate for friendly programs and activities for autistic people in their society. The community and primary caregivers should at the end of this program be able to understand autism and how to care for people with the condition.  It is, however, important to take note that Autism is not a mental sickness or retardation.  Autistic patients have very normal memories and some are very intelligent, depending on the type of autism one has since there are several types of the condition. Children with autism often have very sensitive senses. They may experience what they see, taste, smell, hear or touch more strongly than normal. As a result, they may be made nervous by bright lights, loud noises, smell, tastes and being touched. They may appear withdrawn and avoid contact with people (Freedman, 2008)

Evaluation: Evaluation of this plan will be done after three months of intensive community awareness on autism. Among the expected outcomes are; more community members to participate in autism talks, advocacy and programs and a notable rise in parents and caregivers seeking help for their children and loved ones. There should be more questions asked by the community on autism and records of children taken to the clinics for assessment and diagnosis. 

It is important to note that a good community care plan would be that which involves the affected people on policy making boards.  The caregivers, both the parents and educators, working with autistic patients need to be involved in crucial decision making on autism. This will ensure that the policy makers capture every aspect and area of the condition and put into consideration the needs of the patients before anything else. 

 

 

 

 

 

References

Bindley, C. (2014).  Hoboken, N.J.: Where Families Also Feel at Home. New York Times.   Available at <https://www.nytimes.com/2015/01/04/realestate/hoboken-nj-where-families-also-feel-at-home.html?_r=0>

Broward Health (2017). Community Health Needs Assessment. Available <at https://www.browardhealth.org/pages/community-health-needs-assessment>

CDC. (2017). Autism Spectrum Disorder. Available at <https://www.cdc.gov/ncbddd/autism/data.html>

Colrick, P. (1999). Hoboken. United States: Arcadia Publishing.

Freedman, J. (2008). Autism. United States: The Rosen Publishing Group.

Hope CAP Inc. (2013).  Hudson county Community Assessment.  Available at <http://www.hopes.org/PDF/CommunityAssessments/Hudson-County-Community-Assessment-2013.pdf>

Magyar, C. (2010). Developing and Evaluating Educational Programs for Students with Autism. New York: Springer Science & Business Media.

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