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Sentinel City: Community Health Simulation

Western Governors University

Sentinel City: Community Health Simulation

Community Description:
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B1: A needs assessment of Sentinel City was completed using a demographics

assessment to identify statistical facts related to Sentinel city and its neighborhoods. Sentinel city

has an estimated population of 634,265 persons. Of the population, approximately twenty-nine

percent is under the age of eighteen. Around ten percent of the population is over the age of

sixty-five. Sentinel city is a predominately white area with eighty percent of the population

identifying as white, ten percent of the population identifies as African American or black and

thirty-one percent of the population is Hispanic or Latino (WGU, 2017).

The median household income of Sentinel city is $49,091 yearly. The median household

income varies greatly in each of Sentinel city’s four distinct neighborhoods.

Industrial Heights has a median income of $24,672. Industrial Heights has a population

of 38,855 with almost forty-seven percent of the population being Hispanic and thirteen percent

is African American. Over twenty percent of the population of Industrial heights is under the age

of eighteen, with less than one percent of the population being over sixty-five. Thirty-seven and

a half percent of Industrial heights residents do not have health insurance (WGU, 2017).

Nightingale square has a population of 103,975. The median household income is

$269,550. Eighty one percent of the population is white and less than four percent is Hispanic.

Only around six percent of the population of Nightingale square is under the age of eighteen and

almost fourteen percent is over sixty-five. Less than one percent of the population is without

health insurance (WGU, 2017).

Acer Tech Center has a population of 168390. The median household income is

$166,300. Seventy percent of the population is white and almost fourteen percent is Hispanic.

Seven percent of the population is under eighteen and almost twenty percent is over sixty-five.

One and a half percent of the population does not have health insurance (WGU, 2017).
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Casper Park District has a population of 352643. The median household income is

$80,134. Sixty-three percent of the population is white and twenty-four percent is Hispanic.

Almost thirty-four percent of the population is under eighteen and six percent is over sixty-five

years of age. Almost twenty-three percent of the population is without health insurance

(WGU,2017).

Another tool used to complete a composite database of the community is a safety

assessment. Data gathered both objectively as well as through observation is used to identify

safety based strengths and weaknesses of the community. Hazards such as stray animals, rats,

open fires in trash cans, car fires, roads and sidewalks in disrepair, broken and boarded-up

windows, improperly disposed of garbage and flowing sewage are observed. While no overt

gang violence is observed, there are gangs of people traveling together as well as graffiti

throughout the city (WGU, 2017).

The scavenger hunt tool closely ties into the safety assessment in this instance as much of

the objective data is found in community resource sites.

Parks and Recreation offers swimming lessons, classes on nutrition. Fitness programs for

all ages. As well as childcare programs. They also maintain Sentinel city’s parks and facilities.

Data is tracked regarding citizens’ complaints highest being the homeless population, Park

cleanliness, stray animals followed by drugs and crime. Thirty-one percent of the citations issues

in the parks is trespassing after hours. Violent crime accounts for twenty-four percent of the park

citations. Public drug use or intoxication is sixteen percent and prostitution nine (WGU, 2017).

Elderly Services of the healthcare system include medical care advocates, meals on

wheels, elder abuse prevention advocates, Entitlement assistance, service animals and
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community centers. The less than ten percent of seniors have used any of these services in the

past twelve months. A large portion of Sentinel city’s senior population lives independently in

senior living center units (3472) or in independent senior living apartments (1048). Nursing

homes house 2874 seniors and assisted living 248. Beds at a higher level of care are 124 (WGU,

2017).

City Hall emergency medical services (EMS) reports that EMS response time is

approximately seven minutes but this information is not broken down by neighborhood. City

Hall Social services are responsible for Adult and child protective services including being

responsible for programs such as head start, WIC, Health care assistance, SNAP benefits, the

stay at home programs and childcare subsidies. Low income persons’ accounts for thirty-six

percent of last year’s SNAP benefits and the population over sixty accounts for fifteen percent.

Persons in training programs twenty-three and disabled person’s twenty-six percent (WGU,

2017).

City Hall Police Department reports that sixteen percent of arrests last year were for

controlled substances and twenty-three percent were for cannabis. Six percent for public

intoxication. Seventeen percent for battery and Twenty three percent of warrants. There were

approximately one-hundred gang related aggravated assaults, Twenty homicides, forty assaults

and forty robberies (WGU, 2017).

The community health center, Better Health Clinic, located in Industrial Heights provides

fertility treatments, Contraception services, Pregnancy testing and counseling, sexually

transmitted disease (STD) services and preventive screening like breast cancer and cervical

cancer screenings. Tracking data shows that a higher percentage of those fifteen to twenty-four

contract HSV-2, gonorrhea, and chlamydia. While for those over age twenty-five hepatitis B,
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HIV, syphilis, and trichomonas are more prevalent. Data also indicates that teen pregnancy is at

a five-year low, four hundred cases last year down two-hundred from the year prior (WGU,

2017).

The soup kitchen, run by Interfaith Church of Sentinel City located in Industrial Heights

serves an average of forty thousand meals each month, and fifty thousand in the summer months.

Major funding sources include the commodity Supplemental food program, food assistance,

USDA commodity programs and the emergency food program. Sixty-four percent of meals are

served to homeless adults, three percent to homeless children. The elderly population consumes

about six percent (WGU, 2017).

The Affordable Housing Project located in the Casper Park District tracks income by unit

type last year the average income for a two bedroom was $16,000, One bedroom $27,000 and a

studio $33,000. Highest occupancy rates are studio and two bedroom apartments. Data related to

crime rate is tracked on-property, neighborhood and city wide these numbers have decreased last

year with only 14 on property crimes reported (WGU, 2017).

The next important element of the community needs assessment is the windshield survey.

The windshield survey gives the observer a chance to observe and record data related to

impressions and the general appearance and feel of a community. It is recommended that the

windshield survey be done over at least two observations at different times of day to get

impressions of the community during both working/school hours and times when the community

members are more active in the area (Stanhope & Lancaster, 2014). This type of windshield

survey is not possible in sentinel city this simulation plays on repeat on what appears to be a

weekday.
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Sentinel City is a primarily urban area with multilevel buildings. In the Industrial Heights

neighborhood builds are older and made of brick many are in disrepair. Streets and sidewalks are

in disrepair with garbage bags laying around on the ground. There are windows broken and

buildings that are boarded up. Open areas are stone. Rats and stray animals are noted to be

wandering. Several trash can fires are burning and graffiti is a common on most buildings.

Sewage is flowing from broken pipes into the street. Most people are seen to be on foot. The

highest concentration of people while observing the Industrial Heights district is seen at the

Interfaith church’s soup kitchen. The sole food store the bodega offers only processed foods and

no fruits and vegetables. Persons wearing various religious garments are seen in this area. On the

border of Industrial height s and Casper Park is the school. Children appear to be well behaved

and sound of children playing are heard from the school playground. Students are in uniform.

Casper Park district is in similar state of disrepair to Industrial heights. The lone green

area is littered with pallets and trash barrels and lined by boarded up buildings. The affordable

housing project is in Casper City showing an effort at revitalization on the area there are some

workers seen. An outdoor farmers market type stand offers fresh foods to the residents. Most

residents are on foot but there is an overhead train track seen.

Nightingale Square is a more modern area of Sentinel City. Buildings ore made of a

newer concrete. Joe’s Grocery Store, a gas station and Parks and recreation offering tennis courts

are located in Sentinel city. A large group of people are gathered watching street performers

across from Joe’s Grocery Store. Lilly’s Café offers outdoor seating.

Acer Tech is a well-maintained area that is listed as historic on many of the buildings.

The core of the health system is located here. The core of the city government is located here and
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protesters are seen out front of city hall. Acer Tech also has outdoor vendor with fresh foods

offered.

Bill boards with health promotion messages are easily viewed throughout Sentinel City.

The only way to officially delineate neighborhoods is the signage on buildings labeling

themselves as part of a neighborhood.

B2: There do not seem to be many public gathering areas that are safe. Many open areas

are over run with trash and according to reports are areas of high vagrancy and crime. Analysis

of demographic data indicates that those living in the Industrial Park area are impacted most by

the social detriments of health. Much of the data available throughout Sentinel City is reported

for Sentinel City over all and does not address data specific to the area of the city lived in. I

would speculate however that since most of the population likely lives below the poverty line

(impossible to calculate without knowing household size in that district). Social services are not

at optimal utilization. There is a question of access to these services as City Hall is not located

where it seems there is the greatest need for these services.

Sexually transmitted diseases (STD) are of concern in Sentinel City as they reportable

diseases are affecting the younger population seventy percent of diagnosed cases of gonorrhea

were in fifteen to seventeen year olds. Although the number is decreasing Sentinel City had

approximately four hundred teenage pregnancies. These statistics can raise concern for health

promotion of safe sex practices focused on the younger population.

Community Diagnosis:

C1: The top three identifiable problems based on Healthy People 2020 goals are:
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1. Access to Health Care: AHS 1.1 Increase the proportion of persons with Medical

Insurance (Office of Disease Prevention and Health Promotion, Access to healthcare

[ODPHP-AHS 1.1], 2017).

2. Social Detriments of Health, Economic Stability: SDOH 3.1 Proportion of person living

in poverty (Office of Disease Prevention and Health Promotion, Social Detriments of

Health [ODPHP-SDOH 3.1], 2017).

3. Family Planning: FP 10 Increase proportion of sexually active persons 15-17 who use

condoms to both prevent pregnancy and provide Barrier Protection against disease

(Office of Disease Prevention and Health Promotion, Family Planning [ODPHP-FP 10],

2017).

These topics impact the community at large. Increasing insured persons will increase

those seeking preventative and maintenance healthcare versus only emergency curative.

Lack of health insurance has been identified as a major barrier to health services and is

identified as a leading health indicator (LHI) (ODPHP-AHS 1.1).

Homelessness has been identified both through statistics and via observation of

Sentinel City. Decreasing the number of those living in poverty will not only decrease the

number of homeless persons, but decreasing homelessness has been shown to decrease

the number of dollars spent on healthcare as those not living on the street have greater

follow-up care and less hospital admissions (Paquette, 2014).

4. Teen STDs and Pregnancy in the younger demographic are important topics because of

the lasting impact a teen pregnancy can have on both the teen and the community. Teen

mothers are less likely to graduate high school or attain higher education. They will

require approximately twice the public aid for two times as long (ODPHP-FP 10).
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Untreated STD can cause long term health effects including sterility and even death

(Office of Disease Prevention and Health Promotion, Sexually Transmitted Disease

[ODPHP-STD], 2017).

C2: In Sentinel City The Better Health Clinic offers pregnancy testing, counseling, STD

services and contraception services.

C3: Prevention of STDs. The Better Health Clinic located in the Industrial Heights district

offers services related to the treatment of sexually transmitted disease. There is no indication

however that they work with any primary prevention programs to decrease the incidence of

STD by education and making barriers (condoms/dams) available. Sentinel City would

benefit from the development of such a primary prevention program with targeted

community outreach.

An effective program would target the younger population 14-17 with education about

the dangers of unprotected sexual encounters. This program should account for social,

economic and behavioral considerations, keeping in mind the secretive nature of sexual

encounters in that age demographic (ODPHP-STD, 2017). Sentinel City already utilizes the

media of bill boards to convey health concerns. Bill board with sexual health information

should be installed in areas that teens frequent. Parental involvement will become important

and it is important to teach parents as well as teens about safe sexual practice.

Condoms/dams should be made available along with education on proper use and

information on how to access STD screening if needed.

D: I have already begun to look differently at the communities I drive through. I have begun

to use techniques learned doing windshield survey to look for health disparities and areas that

suffer from social detriments of health. I observe notable areas of access to health care
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services, activities of the people I observe. I plan to use the assessment skills learned to better

understand and look at communities from a public health stand point. I feel it will be very

useful when I take C229.

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References

Office of Disease Prevention and Health Promotion. (2017). Access to Health Care. In Healthy

People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-

objectives/topic/Access-to-Health-Services/objectives

Office of Disease Prevention and Health Promotion. (2017). Family Planning. In Healthy People

2020. Retrieved from https://www.healthypeople.gov/2020/topics-

objectives/topic/family-planning/objectives

Office of Disease Prevention and Health Promotion. (2017). Sexually Transmitted Disease.

In Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-

objectives/topic/sexually-transmitted-diseases

Office of Disease Prevention and Health Promotion. (2017). Social Detriments of Health,

Economic Stability. In Healthy People 2020. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-

health/objectives

Paquette, D. (2014, October 6). The surprising Obamacare experiment that saved taxpayers $24

million last year. Washington Post. Retrieved November 7, 2017, from

https://www.washingtonpost.com/news/storyline/wp/2014/10/06/the-surprising-health-

care-experiment-that-saved-taxpayers-24-million-last-year/?utm_term=.12b1ccdc3a1c

Stanhope, M., Lancaster, J. (2014). Foundations of Nursing in the Community: Community-

Oriented Practice, 4th Edition. [Western Governors University]. Retrieved

from https://wgu.vitalsource.com/#/books/9780323100946/

WGU. (2017). Sentinel City Simulation [ML Author/ Java-based simulation]. SLC, UT: WGU

content. Retrieved October 2017.

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