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Community health nurses play a vital role in the health and well-being of a community (Stanhope, Lancaster, Jakubec, & Pike-MacDonald, 2017). Thorough analysis of a community is foundational work done by the community health nurse; this includes gathering a synthesis of data and interpreting the findings in terms of both strengths and concerns (Stanhope, et al., 2017). The overall purpose of this paper was to complete a thorough community assessment in order to identify community strengths, challenges, vulnerabilities, and priorities. The issue of addiction and substance abuse were deemed a priority for this community; input from members of the community and staff at Elizabeth Fry weighed heavily on the decision making process.
Tertiary interventions for addressing the issue of addiction will be discussed last. When referring to community, this will include the women of Elizabeth Fry Society, Pine Grove Correctional Centre, and those residing in or around the Riversdale community. Extensive data was collected using a windshield/walking survey as well as scholarly sources. It is important to note that permission was given for any names that are mentioned throughout this paper. Overall, it is transparent that conducting a thorough community assessment and including community members in the process is critical in order to identify appropriate health issues and priorities.
The windshield/walking survey was utilized for observing and collecting data within a one-kilometer radius of Elizabeth Fry Society. Based on these findings and through multiple interactions with women in the community and staff at Elizabeth Fry Society, community assets and challenges were identified. Strengths Various health care services. Within the one-kilometer radius of Elizabeth Fry Society there are a number of health services accessible to the public. This includes a health bus, which frequently parks within walking distance from Elizabeth Fry (Primary Health Care, 2018). The health bus, staffed with a paramedic and a nurse practitioner, provides diagnoses and treatment of common illnesses and injuries. They also provide sexually transmitted infection testing, birth control, chronic disease monitoring, and wound care (Primary Health Care, 2018).
The bus works as an interdisciplinary team and can refer patients for mental health help, addictions services, to social workers, and other community services (Primary Health Care, 2018). The health bus is beneficial because it provides on-site care and promotes health and wellbeing at no expense to the community (Primary Health Care, 2018). St. Paul’s Hospital and two pharmacies are located within the community, which provides members with easy access to health services. A woman interviewed in the community stated “Being a single mother of 3 young children, I am thankful for how many healthcare resources there are in this community. It makes things easy for me” (anonymous, personal communication, September 11, 2018). It is evident that the various healthcare resources within the community are beneficial and also utilized by the women in the community.
Hopkins and Rippon (2015) report that any service which strives to promote and maintain health is an asset to the community. It is clear that all of the health care services available within the one-kilometer radius of Elizabeth Fry Society are an asset to the community. Recreation for youth and families. Another asset to the community is recreation for families and youth. The White Buffalo Youth Lodge (WBYL) is the biggest recreation facility in this neighbourhood, and is free for anyone to utilize (White Buffalo Youth Lodge, n.d.). The children’s after school program includes a free meal (White Buffalo Youth Lodge, n.d.). “Many of the kids who come into this place will not have anything to eat until the next day.
Providing food for the kids brings them in, which also allows them to access all the other supports that we have” (Gail, WBYL Coordinator, personal communication, Sept 10, 2018). This brings the kids off the street and into a safe place filled with positive supports. The WBYL is also affiliated with the Saskatoon Tribal Council, the Strengthening Families Program, Jump Start, and the Saskatchewan Health Authority (White Buffalo Youth Lodge, n.d.), making this a very valuable community asset. Since many women within the community have children, this is a valuable resource for them. A self defence course took place recently at the WBYL which the women at Elizabeth Fry were welcome to participate in. Station 20 West.
The Station 20 West building, which includes the Elizabeth Fry Society (Station 20 West, 2018), appears to be a popular asset to the community. A woman standing outside of the building stated, “all my needs are met when I come here. I have had my resumé looked over at Quint, I go to the mother’s centre with my children, and I have gotten food boxes from CHEP in the past too” (anonymous, personal communication, September 10, 2018). The building has been referred to as “the engine of urban renewal” (p.12) and consists of many dedicated organizations with valuable resources that are dedicated to giving back to the community, and are all located within the same building (Meili, 2012). Their vision is to make a “significant contribution to social, health, education, and economic equality” (Station 20 West, 2018).
A few, but not all of the organizations within the building include CHEP, which is dedicated to providing the community with nutritious foods, the Mother’s Centre for women and children, Quint, a resource for affordable housing, and the Elizabeth Fry Society, for women involved in the criminal justice system (Station 20 West, 2018). It has been noted that there are many women who utilize this building. When visiting the women at Pine Grove, it is encouraged that they visit this building once they are reintroduced back into the community. Overall, the Station 20 building offers various beneficial community-centered resources.ChallengesFood. After exploring the community of Riversdale it was noted that, aside from small ethnic grocery markets, there were no major supermarkets within the one-kilometer radius of Elizabeth Fry Society.
A community report conducted by the City of Saskatoon (2010) found that those who reside in Riversdale do not have easy access to supermarkets, as do those living in other communities of Saskatoon. Lotoski, Engler-Stringer, and Muhajarine (2015) report that core neighborhoods, which includes Riversdale and Pleasant Hill, are deprived of chain supermarkets, which offer a wide range of not only healthy but also affordable foods. In one interview, a woman who had lived in Riversdale her whole life stated “I have never owned a car, and getting to the grocery store by foot is not realistic for me. In all the years I have been here, I can hardly believe there is still no major grocery store in the downtown area” (anonymous, personal communication, September 10th, 2018).
When interacting with the women of Pine Grove, many reported that nutrition quality is lacking within the institution. It is evident that access to proper nutrition is not always easy, whether it be the women in Pine Grove or the other women of the community.Housing. Another significant issue according to the staff at Elizabeth Fry Society is access to housing. This is supported by City of Saskatoon (2018) statistics, which reports that housing affordability in the Riversdale area is not considered to fall under the affordable median within the city. Not only is this an issue for women in the community, but for those who are currently in Pine Grove that are going to be released in the near future.
Many women at Pine Grove have requested housing application forms as they are concerned about where they will go post-release. According to the Saskatoon Housing Authority (2018), once an eligible individual applies, priority still has to be considered, making this a potentially lengthy process. Quint, an organization which often offers affordable housing options for people, still requires proof of employment (Quint Saskatoon, 2018). This is a barrier to women post-incarceration since many are unemployed and seeking housing.Addiction services. Aboriginal women in Canada are faced with oppression and dominate within the jail system compared to non-aboriginal women (Hansen, 2014).
It is also reported by Swopes, Davis, and Scholl (2015) that a high number of incarcerated women are coping with addiction. Beverly, the office manager at Elizabeth Fry Society stated “there is a lack of resources when it comes to addictions for these women. When they seek help, they need it that second, not tomorrow, not in a week” (Beverly Fullerton, personal communication, September 18, 2018). It was also mentioned by Sue Delanoy, the executive director at Elizabeth Fry that not only are addictions are an issue for the women, but there is lack of information on how to access addiction services in the city. Two methadone clinics are located within one-kilometer of Elizabeth Fry, however, their hours vary and an assessment by an addictions counsellor is mandatory before treatment can begin, which can be timely (Saskatchewan Health Authority, 2018).
According to Stanhope, Lancaster, Jakubec and Pike-MacDonald (2017), vulnerability refers to specific groups of people who are at higher risk for negative health outcomes due to the determinants of health. Vulnerable populations are at greater risk for experiencing illness and often do not receive the appropriate care (Stanhope, Lancaster, Jakubec & Pike-MacDonald 2017). Elizabeth Fry Society (2018) focuses on women involved with the criminal justice system, which is an example of a population deemed to be vulnerable (Rich, Cortina, Uvin, & Dumont, 2013). These findings suggest that the community of women at Elizabeth Fry and Pine Grove would be considered vulnerable.Since aboriginal women are overrepresented in the criminal justice system (Balfour, 2013), it is clear this needs to be further investigated.
Balfour (2013) suggests a link between aboriginal incarceration and social determinants of health. This includes disadvantages such as single parenting, poor education, transiency, and low income (Balfour, 2013). Balfour (2013) also states “aboriginal peoples who migrate to urban centres from reserves are more vulnerable to being criminalized and imprisoned. In urban and reserve communities, aboriginal women are more likely to be charged with, and imprisoned for, violent offences than non-Aboriginal women” (p.87). Because many of the women at Elizabeth Fry are aboriginal it is clear an upstream approach must be implemented when working with these women. Pine GroveWomen who are fulfilling their sentencing are at an especially vulnerable state (Correctional Service Canada, 2017).
Women entering a correctional institution have higher rates of mental health issues, addiction, and history of physical and sexual abuse than those in the rest of the community (Correctional Service Canada , 2017). Because of this, Chartrand (2015) notes that they are unable to conform to the rules of the institution, which can result in confinement, isolation, and increased sentencing. A prisoner at Pine Grove disclosed that she felt the mental health counselling she was receiving was very poor, as she “felt she was being judged” (anonymous, personal communication, September 7, 2018). Since literature suggests those entering the prison system have higher rates of mental health issues, it is clear these services should be made a priority.
A potential health challenge for this community might be an inability to reintegrate back into the community without re-offending. Wilma, personal communication, September 10, 2018 stated the following:Every woman in the prison is there because of unhealthy coping skills. A lot of women are turning to addiction to cope with racism, domestic abuse, and colonisation. We act out in anger at other people because we have so much hurt built up in us and that’s how we always end up back in jail. Reintegrating back into the community from incarceration poses many health challenges to not only the woman reentering society, but to the community as a whole (Jenkins, et al., 2017). Communities often lack the resources needed to help women transition back into the community, therefore women return to the same destructive behaviours, thus making them susceptible to re-offend (Jenkins, et al., 2017). This again relates to the social determinants of health and needing an upstream approach to addressing these issues.
The challenge that has been identified as a priority for the community is substance abuse and addiction. Not only have these been identified as a challenge by the staff who work at Elizabeth Fry, it has also been a voiced concern amongst the women themselves. Through active listening and engagement with the community, it has been identified that addiction has impacted the lives of many of the women. This was the biggest motivator for choosing addiction as the community priority.
Comments made by the women suggest a lack of education regarding coping skills and a need for more immediate addiction resources. Sue Delanoy, the executive director of Elizabeth Fry noted that many women within the community do not know how to access available services within the city (personal communication, September 11, 2018). It is reported by Lang et al. (2013) that there is often a lack of awareness regarding addiction resources, as well as inefficient knowledge on how to access them. It is clear that addiction is common amongst those within the specified community. Prioritizing this challenge is not only relevant but important for the health and well-being of on individual, community, and population level.An important thing to note about addiction is that it impacts many aspects of an individual’s life (Selbekk, Sagvaag, & Fauske, 2015).
It is likely that an individual who suffers from addiction is having difficulties with other aspects of their life such as relationships (Selbekk, Sagvaag, & Fauske, 2015), homelessness, nutrition, incarceration (Hansen, 2014), and their mental health (Lang et al., 2013). It is evident that when one is living with an addiction, it can interfere with the ability to thrive in other aspects of their life.
When taking into consideration the many facets of addiction, an important term to keep in mind is intergenerational, which is defined by Merriam-Webster (2018) as “existing or occurring between generations”. A study conducted by Marsh, Young, Cote-Meek, Najavits, and Toulouse (2016) found that the trauma of the residential school system has been passed down generations, and often, substance abuse is the only coping mechanism individuals know. Many women of the community have shared stories of substance abuse amongst their parents, themselves, and now, their own children (personal communication, September 18, 2018).
Though addiction is a complex topic, it must not be ignored. We must strive for a preventative approach to deal with addictions and educate the women about addiction and prevention. A strong point made by Hansen and Calihoo (2014), suggest that addiction recovery is the answer, not jail sentences. Since addiction can often be linked to some sort of trauma, whether it be the intergenerational impacts of the residential school system, assault, abuse, or neglect, it is paramount that coping skills be implemented (Marsh, Young, Cote-Meek, Najavits, & Toulouse, 2016). It is critical that when speaking to the women of the community, their history is taken into consideration. Helping the women learn new coping strategies in times of high stress, when they might normally rely on substance use, is essential.
After thorough community assessment and data collection, the community health nurse must begin a health promotion planning process (Stanhope, Lancaster, Jakubec, & Pike-Macdonald, 2017). When working with vulnerable populations, the community health nurse has a key responsibility in knowing resources within the physical community (Stanhope, Lancaster, Jakubec, & Pike-Macdonald, 2017). The overarching goal for the community is to aid in decreasing the prevalence of substance abuse and addiction by implementing tertiary interventions. An activity that will be implemented to the identified community will include an educational pamphlet with addiction resources and services located throughout the city of Saskatoon.
As previously noted, there is often a lack of awareness regarding available addiction resources (Lang, et al. 2013). A critical role of the community health nurse is advocacy (Stanhope, Lancaster, Jakubec, & Pike-Macdonald, 2017). Offering these women basic information on how to access addiction resources is a necessity. A second intervention that will be implemented in the community is educational resources regarding coping skills. Since it has been recognized that many individuals who abuse substance are coping with some sort of trauma, it has been identified that the use of alternative coping strategies is a priority need (Swopes, Davis, & Scholl, 2016).
Since the aim of tertiary prevention strategies “attempt to restore and enhance functioning and reduce disabilities” (p.448), it is evident that a downstream approach needs to be utilized when addressing addiction. The downstream approach takes a curative versus preventive stance (Stanhope, Lancaster, Jakubec, & Pike-Macdonald, 2017). Implementing activities that address addiction and substance abuse is a step in the right direction to decrease the rates of substance use as a coping strategy. It is clear that there needs to be an increased focus on addiction in order to promote community rehabilitation; this may break the cycle of addiction for future generations to come.
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