Vulnerable Populations PDF

Vulnerable Populations Module 7 Vulnerable Populations Behaviora Disabled l Health Rural, Migrant, Homeless and Urban Vulnerable Populations Heightened risk of...

Vulnerable Populations Module 7 Vulnerable Populations Behaviora Disabled l Health Rural, Migrant, Homeless and Urban Vulnerable Populations Heightened risk of adverse health outcomes Higher mortality rates Less access to health care; disparities in quality of care Uninsured or underinsured Lower life expectancy Overall diminished quality of life Often subpopulations – ethnic, rural minorities, uninsured, HIV-AIDS, children, older adults, the poor and homeless. Increased morbidity and mortality rates, shorter life expectancy and diminished quality of life – less access to health care, Make sure you understand social capital and what this is and what is included. Pg 669 an organization like EFEA is one of the best ways we can improve social capital in the community for this population*** Models and Theories of Vulnerability Vulnerable Populations Conceptual Model Behavioral Model for Vulnerable Populations Differential Vulnerability Hypothesis Social Capital General Model of Vulnerability Maslow’s Hierarchy of Needs What you may notice is that each of these areas OVERLAP A general model of vulnerability helps to explain individual and community risk factors that lead to vulnerability, as well as access to care and quality of care impact health outcomes. VPCM = vulnerable populations often experience clusters of risk factors, and they become cumulative. The specific combinations are detrimental to health outcomes, and accumulate over time. BMVP- looks at vulnerable populations and the populations characteristics as an explanation for health behaviors and eventual health outcomes. Health resources are important = INSURANCE DVH – there is a relationship between social status and psychological distress, and uses a formula related to stressors and distress to show this. Social capital – not just monetary, may be friends, family, support and has the potential to ensure that populations are cared for. Pg 670 figure 23-3 Maslow’s – when one is unable to obtain basic needs, higher needs can never be met. Remember that in the vulnerable populations the risk for adverse health outcomes is substantially highe. Vulnerability and Relative Risk Vulnerability increases one’s susceptibility to poor health. Relative risk is the exposure to risk factors involving one’s: Lifestyle Behavior and choices Use of health screening services Stress Differential Vulnerability Individuals have differing levels of vulnerability to psychological distress, in part due to social status. Class Sex Marital status Setting (rural vs. urban) Prevalence of Vulnerable Populations and Causative Factors Difficulty in measuring due to overlapping of populations Root causes Socioeconomic status/poverty Insurance coverage: uninsured and underinsured Race and ethnicity Vulnerability and Inequality in Health Care Social determinants of health Conditions associated with health outcomes (economic, social, environmental, genetic) Socioeconomic gradient: direct relationship between social class or income and health Remember that the relation between social class and health is inverse. They are always opposing and opposite of one another. Vulnerability and Inequality in Health Care Health disparities: Differences in quantity and burden of disease and access to health care between groups. African American are the worst off Causes: Low socioeconomic/income level Poor access to and quality of care Race/ethnicity, overt discrimination Question Is the following statement true or false? Measuring the prevalence of vulnerable populations is difficult. Answer True Rationale: It is difficult to measure vulnerable populations because the populations are not distinct and overlap. Socioeconomic Gradient A direct relationship between social class/income and health Social determinants of health strongly associated with health outcomes Role of Public Health Nurse Empowerment: client-centered approach, trust, advocacy, teaching and role modeling, capacity building Facilitating external support: family members, neighbors, friends, teachers, or others Using evidence to reduce vulnerability Research, expert opinion, and best practices Specific agency documentation for nursing practice Prevention and health promotion Clients With Disabilities Chapter 24 Definitions International Classification of Functioning, Disability, and Health (ICF) published by the World Health Organization (WHO) Classification terminology Disability: impairments, activity limitations, or participation restrictions Functioning: all body functions, activities, and participation Attempt to provide a universal classification system with standardized language Definitions Additional definitions of ICF: Body functions Body structures Impairments Activity, activity limitations Participation, participation restrictions Environmental factors Personal factors One of the leading causes of disability in our country is Arthritis The United Nations Convention on the Rights of Persons with Disabilities Respect for inherent dignity and individual autonomy Nondiscrimination Full and effective participation and inclusion in society Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity Equality of opportunity Accessibility Equality between men and women Respect for evolving capacities of children with disabilities and the right of children with disabilities to preserve their identities World Report on Disabilities Provided guidance to governments globally Communicated that: Governments must improve lives of individuals and families living with disability People with disabilities must advocate for removal of barriers preventing their full participation in communities Stakeholders in each country must establish an inclusive world characterized by enabling environments, rehabilitation and support services, adequate social protection, and relevant policies, programs, standards, and legislation There are 10 leading health risk identified by WHO and #7 is weak primary health care. PG 694 – when intergrating information from the WHO Report for community programs one of the most important concepts to emphasize is unhealthy behaviors ultimately lead to chronic disease, disability, and early mortality. Healthy People 2030: Overarching Goals 1. Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death. 2. Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. 3. Create social, physical, and economic environments that promote attaining full potential for health and well-being for all. 4. Promote healthy development, healthy behaviors, and well-being across all life stages. 5. Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all. Question Is the following statement true or false? Healthy People 2000 addressed disabilities in several key goals. Answer False Rationale: Healthy People 2000 contained only one priority area devoted to disability and chronic illness. Misconceptions Impeding Improvement All people with disabilities have poor health. Public health activities need to focus only on preventing disability. There is no need for a clear definition of “disability” or “people with disabilities” in public health practice. Environment does not play a significant role in the disability process VERY important to ensure that when working with others for example improve the help of this population we should ensure that others see that a disability is a condition someone has, not something one is Missed Opportunities Focus of health care delivery system: increasingly skewed toward secondary and tertiary prevention; limited emphasis on health promotion Areas of secondary and tertiary prevention that may be unique to persons with disabilities or chronic illnesses that are completely ignored Disability or illness usually as the initial reason for care; often drives selection of prevention efforts to the possible exclusion of other equally important issues Health care disparities and discrimination Civil Rights Legislation Americans with Disabilities Act (ADA) of 1990 “…prohibits discrimination on the basis of disability in employment, state and local government, public accommodations, commercial facilities, transportation, and telecommunications [and] also applies to the United States Congress” Disability Rights Laws Families With a Disabled or Chronically Ill Member Family and advocacy Impact on the family Difficulty obtaining assistive devices/technology and financing, respite care, entitlements Caregiver loss of work, poor physical/mental health Universal design: ensuring access Organizations Government National Council on Disability Private American Deafness and Rehabilitation Association National Organization on Disabilities American Council of the Blind Special Olympics United Cerebral Palsy Role of the CHN Need for broad and holistic practice Creativity, tenacity, honesty, and knowledge Involvement in wide-ranging, multiple roles at different levels Behavioral Health in the Community Chapter 25 Healthy People 2030 Overarching Goals for Mental Health and Substance Use 1. Improve mental health through prevention and by ensuring access to appropriate quality mental health services 2. Reduce substance abuse to protect the health, safety, and quality of life for all, especially children 3. Reduce illness, disability, and death related to tobacco use and secondhand smoke exposure Levels of Prevention for Mental Health and Substance Use Primary prevention Health promotion/education (coping skills, nutrition, exercise, wellness, stress reduction) Health protection (social determinants of health) Secondary prevention Early diagnosis (depression, suicidal thoughts, substance use; screenings; harm reduction) Prompt treatment (culturally sensitive) Tertiary prevention (referrals, community partnerships) The Behavioral Health Continuum of Care Model Promotion Prevention Universal prevention (e.g., suicide prevention campaign) Selective strategies (detection of risk) Indicated strategies (focus on individual risk factors) Treatment (case identification, referral) Recovery (promotion of high-quality, satisfying life) Suicide Healthy People 2030 goals: Reduce the suicide rate Reduce suicide attempts by adolescents Second-leading cause of death for persons 10 to 34 years Interventions Strengthen economic supports, care access/delivery Create protective environments, promote connectedness Teach coping and problem-solving skills Identify and support people at risk Major Depressive Episode Higher prevalence among: Adult females Individuals aged 18 to 25 years Adults reporting two or more races Interventions eHealth cognitive–behavioral programs Technology-supported interventions (e.g., step-by-step) C/PHNs helping clients navigate online applications and encouraging engagement via personalized messages and feedback Alcohol Use Contributes to death of more than 3 million people each year C/PHN detection and management of at-risk alcohol use Screening for excessive use of alcohol Brief intervention: conversation, motivational interviewing Referral to treatment by specialists A Guide to SAMHSA’s Strategic Prevention Framework (SAMHSA, 2019b) 1. Assess the problem and related behaviors 2. Build local capacity to address prevention 3. Formulate a plan and prioritize risk and protective factors 4. Implement evidence-based interventions and programs 5. Evaluate process and outcomes Working with the Homeless Chapter 26 Concept of Homeless Refers to those who lack a fixed, regular, adequate nightly residence Includes those staying in: Temporary shelter Supervised public or private shelters Institutional settings Places not designed for humans to sleep Demographics Poverty-linked Age: 88% over age 24 years Gender: more likely to be single male Ethnicity: variable with geographic location Families with children: 33% of homeless FAMILIES ARE THE FASTEST GROWING SEGMENT IN THE HOMELESS POPULATION THIS WOULD BE SPECIFICALLY FAMILIES WITH CHILDREN. Contributing Factors Poverty Lack of affordable health care Employment Domestic violence Mental illness Addictions disorders Additional variables: personal or financial crisis, natural disasters, immigration and refugee crises, and personal choice Homeless Subpopulations Homeless men (↑ chance of being treated with disdain) Homeless women Homeless children and youth (