Problems to be Addressed by the Program:
There is growing attention towards elevated vulnerability of chronic diseases, which is becoming evident in our community. The increase in healthcare costs, death related illnesses, and losses of work productivity reflect differential levels of health disparities. This program addresses high needs found in children experiencing low socioeconomic status (SES). The high need of low SES children puts them at risk of comorbidity development. This is a development consisting of life hindering condition contributed from obesity. There should be greater emphases placed on educating children at SPECIALIZED SCHOOL of developing Comorbidity. This would ultimately help prevent negative lifestyle habits from forming in adulthood.
Background research conducted on this topic indicates that in order to prevent child hood obesity, the high needs of a child must be properly addressed. Recent statistics indicate that the lack of nutritionally competent parental supervision has contributed to childhood obesity. Three decades ago 5% of children ranging in age two to five were overweight (Edmond, 2006). By the year 2002 it had more than doubled, resulting in 10.4% of children. Moreover, 16% of adolescents ranging in age from twelve through nineteen years of age are overweight, and 50% to 77% of these adolescents will become overweight adults (Townsend, 2006).
II. Community Assessment
A. Target Population Description:
Specialized school provides professional residential treatment for adolescents with emotional, behavioral, and substance abuse conditions. The SPECIALIZED SCHOOL students will eventually be released back into their low SES environment, where they will once again face a large range of multifactorial barriers consisting of intrinsic and extrinsic factors of poor food selection. This would put them back at risk of experiencing high needs.
The multidimensional cognitive and affective barriers are consistently eluding community nutritional health programs. This was observed in the growing number of obesity cases. The nutritional education assessment provided the means to determine and analyze the target group needs and acceptance of differential nutritional education level. This was done by designing a pilot test consisting of a pretest and posttest that was utilized as a part of the assessment procedures. The results were graded on the number of correct answers, which reflects the competency level. The outcome section represented a 24-hour food recall, which allows observable levels of cognitive skills that was adequately applied in the activity. This part was graded on a percentage of participation. The overall multidimensional testing help provided information and detailed results, which was further, explained in figure I.
B. Description of the Problem of the Target Population:
FIGURE 1
Pretests: 62% - Indicates the group of children is a high needs
Posttest: 70% - Indicate for beginning competency level
Outcome: >70% – Indicates ability to utilize skills with assistance
Figure 1 shows differential Criterion-Referenced Test (CRT), which was used as a multidimensional pilot test that I designed. It indicates the different levels of competency of nutrition through the pretest, posttest, and outcomes section. The degree of mastery of the subject is based on the educational materials that I designed and implemented to the students.
The class average of the pretests is 62%. This is a low score, which confirms that the groups of children are in fact high needs if they are released from SPECIALIZED SCHOOL protection. High needs indicate the children would be more than likely to make poor nutritional choices without or noncompliance with parental guidance. It is important to close the gap of poor nutritional choices through educational intervention. The majority of the students was capable of identifying the name of the foods and food group, but did not know how to balance their nutritional intake. This indicates the class as a whole has been experiencing a novice educational background of nutrition, which was observed throughout the class.
The posttest indicates the group average of 70% or more had been achieved. This score is adequate for beginning competency levels of nutritional health. The beginning levels of nutritional health should be well entrenched by the fourth grade level. Most of the current children in the class are currently at 8th through 12th grade level, which is a source of great concern. In two to three years they would be making the majority of their food choices, and if they are not ready they will be at risk of comorbidity.
The group outcome score average is above 70%, which indicates a standard of basic knowledge has been absorbed and could be utilized with assistance on an individual level. Due to poor public health programs, most of the children would not experience opportunities to strengthen their new skill in nutrition.
C. Intended Outcomes of the Program:
Currently, the health status of these children is stabilized while at SPECIALIZED SCHOOL. However, when the children are released back into low SES environment without nutritional tools they are once again at risk of comorbidity. This is why it is necessary to provide them with an opportunity to advance their cognitive ability to improve their nutritional health. It is important to increase the efficiency in obtaining additional opportunities to strengthen their new skill before they transfer back to their origin. When decreasing the risk of comorbidity it is necessary to strengthen the student’s interpersonal behavioral food choices. This would help prepare them for a healthier adulthood and will give them the tools to assist others towards a stronger and healthier community. This program would empower the children to make cognitive, as opposed to emotional food choices, which would create stronger nutritional outcomes. It will help improve the overall success rate of behavior modification techniques and create an affinity for smart choices.
D. Approach to be Utilized:
Phase 1 Social Diagnosis (Assess quality of life of target population):
There are three stages in this target population consisting of beginning, mid, and end stage status. The beginning stage is when the newly transferred child arrives at SPECIALIZED SCHOOL he or she is usually undernourished and struggle with a drug addition. The mid-stage is when the child has accepted therapy, is learning to work with others in a group, and becoming familiar with new routines. The end stage is when a child had maintained the transition and their health remains stabilized. Then they are reintegrated back into their social-cultural environment.
Phase 2 Epidemiological Diagnosis (Determine which facet of the problem will yield to intervention):
The child is usually from a dysfunctional family or some form of abusive relationship. The child is typically experiencing low self-esteem and self-confidence, which contribute to his or hers poor self-motivation and life choices. This would create undesirable nutritional outcomes for the child.
Phase 3 Behavioral and Environmental Diagnosis (View the behaviors and social aspects that are the most pertinent problem):
The children usually arrive with poor life skills, which create barriers and
negative outcomes of interpersonal behavior choices. This would further prolong malnourishment of the child, which stresses their growth and development process.
Phase 4 Educational and Organizational Diagnosis:
Predisposing Factors (Motivate individual interaction and nurture existing skills):
The group would experience interactive nutritional lessons as a whole. Then they would break into subgroup where they would experience nutritional skill building activities at the workstations and then return to the main group for discussion.
Enabling Factors (Promoting new personal skills):
The lessons will promote new life skills of behavior and cognitive development, which help increase adherence towards nutrition. All lessons will contain the six C’s such as clear, conversational, concise, correct, candid, and compassionate.
Reinforcing Factors (Incentives for health behaviors to be maintained):
This process will promote incentives through natural health benefits such as observed growth spurts, cognitive, and physical development.
Phase 5 Administrative and Policy Diagnosis (Assess barriers to implementation):
There are two main barriers consisting of educational level and transitional status. The children often arrive at the center with rudimentary reading, writing, and mathematical skills. These undeveloped skills could present challenges for the children to understand the educational materials. The second barrier consists of the different transitional stages each student is currently at, for this could develop into a problem. The students are randomly accepted to the center based on their needs and then transferred back to their social-cultural environment based on accomplishments pertaining to rehabilitation. The end results consist of a classroom filled with students at different levels of learning needs.
Phase 6 Implementation (Level of providing support):
Nutritional based education is presented on a local level that focuses on foster care and providing diverse behavior modification techniques. These techniques would consist of stimulus, control, problems solving, and cognitive restructuring. Stimulus control consists of avoidance of negative and adherence of positive condition involving proper engagement of behavior. Problem solving consists of four steps. In step one, the child will identify potential barriers. In step two and three, the child will select and implement possible solutions. In step four, the child will evaluate the overall success rate of their actions. Cognitive restructuring consists of recognizing and modifying the students’ thoughts and believes towards positive nutritional choices.
Phase 7 Process Evaluation (The degree to which the program has been implemented as planned):
The program is a continuous nutritional protocol consisting of three sections of implementations of new information, remedial review, and discussion overview. Process evaluation evaluate end results consist of the students self-efficacy, which is a degree of competency and confidence to make and maintain nutritional integrity during various situation.
Phase 8 Impact Evaluation (Immediate effects of the program):
The overall impact would be evaluated on observation of the students’ increase of acceptance of fruits and vegetables on their food tray.
Phase 9 Outcome Evaluation (Long-term effects of the program) The students would transfer back into their social-cultural environment with educational tools to help themselves and others towards proper nutrition.
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