13 Jan Unit1ProgDev Due 01/15/2020

Unit1Disc1

Highlighting a Local Program

Identify one program in your hometown or a local community. In your overview of this program, indicate the type of entity that hosts this program: a government agency, a nonprofit organization, or a for-profit business. Utilize systems theory as you describe the services or products that are specific to this program, as well as what perceived need this program addresses. After completing this summary, describe how well you think this program serves the community, and why.

READING

Applying Systems Theory The preceding discussion of systems theory is fairly abstract. To illustrate how these concepts can be used in program planning or program evaluation, we will use the example of a school system that decided to substantially shift its mission. The tradition of a basic education at public expense is deeply rooted in the culture of the United States. Over the years, the core curriculum of reading, writing, and arithmetic has been expanded to include science, sociology, history, and so forth. In addition, some profound sociological changes became readily apparent in the 1980s and continue to have an increasing impact on the environment of public schools in the twenty-first century. Women have gone to work in unprecedented numbers. Furthermore, divorce, which was rare prior to World War II, has become commonplace, thus increasing the number of female-headed households. All of this has brought new demands to school systems. Consider one hypothetical school’s adaptation. An urban school district decided to perform a needs assessment to determine what, if any, adaptations in the school’s offerings would be appropriate to better serve its clientele. The survey, along with an analysis of school records, determined that the majority of families—both single-parent and dual-parent— were in need of before- and after-school childcare services. District administrators recognized a need for the accountability subsystem to conduct a systematic impact analysis to determine the space, costs, and human resources that would be necessary to make adaptations for an extended-hours program. Furthermore, if the shift were to be undertaken, a substantial consensus among district teachers would be prerequisite to marketing the proposed program to the school board. A series of meetings with teachers found them to be enthusiastically supportive of the extended-hours program. The teachers’ contributions were formidable and to the point. They recognized the potential for tutoring students in academic subjects, and they developed plans for various extracurricular activities to focus the children’s energies during the extended hours. The Parent Teachers Association was enlisted to support the presentation of the proposal to the school board. A sliding scale was developed to charge parents who could afford the service a cost-only fee. Parents who could not afford the program would be provided the service free of charge. While board members were not enthusiastic about additional expenses, they were supportive of the longer school day and were responsive to their clientele— voting parents. The program was funded, with the proviso that an evaluation be undertaken to supply the board with feedback on program impacts. The administration designed a three-year review of the program. Direct program outputs were measured through a review of student performances on standardized tests in reading and math. The findings revealed some modest improvements in student performance. Notably, longer operating hours did not result in substantial increases in maintenance costs or facilities deterioration. However, heating and cooling costs did go up. District administrators had underestimated the costs of operations, and some adjustments in fee structure were necessary. The program also had some unanticipated impacts. Vandalism of school property decreased, as did the level of gang activity in the neighborhoods around the schools. Also significant was a decrease in the district’s dropout rate. Because the decrease was slight, the administration determined that a longer-term study was necessary to ascertain whether the decrease was a direct result of the new program or merely a short-term aberration. Applying Systems to Management: A Checklist Applying and reapplying systems concepts to the organization is the stuff of executive management. A comprehensive examination of the system and its environment should be undertaken on at least an annual basis. Assessments of managerial initiatives and the effectiveness of various programs within subsystems are ongoing. Annually, managers should reevaluate the organization’s mission in the following contexts outlined below. 1. Organization mission, which may be the element of program management that receives the most lip service and the least real attention. At a minimum, the organization must maintain a substantial within-house consensus on the agency’s mission and program priorities (see chapter 2 on planning). 2. Stakeholders in the environment, who may be: a.Clients, defined as those who receive direct services from the agency or pay for such services. There also may be potential clients, such as when a parks department decides to undertake a senior citizen day-care program. b.Overhead decision makers, who define the mission and supply funding. These may be members of the city council, the state legislature, or Congress. c.Suppliers and contractors, whose prices and product quality can greatly influence program quality. d.Program competitors, which may be other agencies competing for a finite pot of money or could be other agencies or not-for-profit organizations that wish to provide the service in question. e.Program regulatory bodies that may change the standards against which programs achieve their accreditation, thus impacting the ability of the agency to get state and federal licenses and to collect reimbursements for services rendered. 3. Technology assessment, as used here, is not limited to equipment and computers. It also refers to program delivery systems. A counseling-center technology might therefore be therapist-client interactions. A technology shift might occur if a welfare agency or a police department chose to change from a central operating location to employing storefront service centers. Twenty-first-century organizations, moreover, are impacted by available hardware technologies and delivery systems. A rape crisis-counseling center might be highly dependent on telephone hotlines that must be staffed with trained counselors. Psychotherapeutic and drug and alcohol treatment groups that utilize nonassembled group sessions using Internet technology have begun receiving accreditation. 4. Program monitoring, including: a.External accountability. Annual reports are a fact in modern organizations. Businesses must report to boards of directors and stockholders. Public agencies also are accountable to overhead authorities (see chapter 6 on conducting outcome evaluations and chapter 7 on evaluation designs). b.Internal accountability. Providing useful, decision-oriented data on operating systems facilities’ program compliance can flag problems before they become crises and allows for timely program adaptations (see chapter 4 on process evaluation and chapter 5 on program adaptations). All the foregoing procedures are enhanced by the application of systems thinking. Viewing the organization holistically is indispensable to executive leadership, even though it is rarely considered by rank-and-file employees caught up in the press of program operations. Recognizing the inextricable linkage of organization subsystems is equally important.

Unit1Disc2

Ethics in Program Development and Program Evaluation

In this unit, you have been assigned to complete a Riverbend City scenario, Riverbend City: HPDP Program Design. This scenario takes you through various portions of the program design process. In addition, you have been assigned to read the Ethical Standards for Human Services Professionals.

For this discussion, present at least two professional standards and their application in this scenario. To do this, choose the professional standards and describe how each is linked to specific behaviors and interactions in the Riverbend City scenario. Were these ethical standards maintained or were these behaviors and interactions more questionable?

RIVERBEND:

RIVERBEND CITY: HPDP PROGRAM DESIGN MISSION

WELCOME TO RIVERBEND CITY

Expository text: The ongoing communication problems between the Hmong community and Riverbend City Medical Center (RCMC) were punctuated painfully during the train derailment; especially through the altercation with the Vang family.

An embarrassing article about the altercation in the Free Press prompted hospital CEO Eugene Pittman to investigate a successful Merced, California program. In Merced, the medical community has been teaching principles of Western medicine to Hmong shamans [traditional spiritual healers].

The shamans act as a bridge between medical professionals and the Hmong community. When consulting with Hmong patients, the shamans instruct the patients in Western medicine and also perform traditional rituals.

Instructions

When creating a Health Promotion and Disease Prevention Plan (HPDP) for a diverse population, it’s important to carefully consider cultural norms and needs. It also sometimes becomes necessary to “think outside the box” and consider ideas that may seem unorthodox.

As you read about this proposed HPDP, consider the degree to which you feel this proposal will be effective. What steps should the hospital take to maximize the effectiveness of this HPDP?

RIVERBEND MEDICAL CENTER: CEO’S OFFICE

Eugene Pittman invites Beatriz Garcia-Chavez, CNO, and Shannon Moe, Nurse Training Manager, to discuss the proposed Hmong shaman training program.

Eugene expresses his frustration about the hospital’s poor communication with the Hmong community.

EUGENE PITTMAN:

This disaster really brought to light how poor our relationship is the Hmong community. It is a situation that must change.

BEATRIZ GARCIA-CHAVEZ:

The nurses are frustrated too, Eugene. Everyone was very upset when that Free Press article came out last week. We felt like we did everything we could during the disaster to accommodate the diverse needs of our patients-especially considering how short staffed we were. But that article made us look like we weren’t even trying.

EUGENE PITTMAN:

I know that’s not the case, Beatriz. [Sighs] But yes, that article needs to be a wakeup call for the hospital. Clearly we’re not meeting the needs of our Hmong patients, and we need to try something new.

SHANNON MOE:

I’m so glad you brought the Merced shaman liaison program to our attention, Eugene. It looks promising. I’m wondering what we would need to do to make the program work here?

EUGENE PITTMAN:

I don’t know, Shannon. That’s what I want you and Beatriz to help me figure out. What I do know is that this hospital failed to communicate properly with the Hmong population during a crisis, and now the press is at our throats. We have to do something, and the Merced program has seen a lot of success

BEATRIZ GARCIA-CHAVEZ:

The Merced program is pretty unorthodox. Are you comfortable with that?

EUGENE PITTMAN:

[Laughs] Not entirely! You know I tend to be conservative when it comes to experiments like this. But in this case, we may just need to think outside the box.

Beatriz explains that the nurses have concerns about the proposed Hmong shaman program.

BEATRIZ GARCIA-CHAVEZ:

I’m definitely intrigued by the idea a Hmong shaman program, and so are the nurses. But I have to say that the nurses do have some concerns.

EUGENE PITTMAN:

What are their concerns, Beatriz?

BEATRIZ GARCIA-CHAVEZ:

Well, everyone seems fine with the idea of training shamans about germ theory and other Western medicine concepts. It’s been a struggle to get some of our older Hmong patients to agree to the most basic procedures, like getting their blood drawn. So we’d all like to learn more about how shamans can act as liaisons. However, the nurses are concerned about letting the shamans perform rituals in the hospital.

SHANNON MOE:

Rituals? What kinds of rituals?

BEATRIZ GARCIA-CHAVEZ:

To tell you the truth, I don’t know what’s accurate and what’s hearsay. I’ve heard that shamans do everything from burning incense to letting hens walk on their patients’ chests.

SHANNON MOE:

Eww! Why would they do that?

EUGENE PITTMAN:

This is clearly something we need to investigate. My limited understanding of the Merced program is that the shamans do perform some rituals as part of the spiritual counseling of patients. We would certainly need to investigate what these rituals are, and whether there are some rituals that aren’t appropriate at this hospital.

BEATRIZ GARCIA-CHAVEZ:

The nurses would really appreciate that information.

EUGENE PITTMAN:

Beatriz, I’d like to hear more about the nurses’ concerns. I’d also like to hear about their experiences working with the Hmong community. Let’s organize some focus group sessions with our nurses.

Shannon is asked to conduct focus groups in the Hmong community to better understand the community’s experiences with the hospital.

SHANNON MOE:

So Eugene, in your email you said you wanted me to conduct some focus group interviews with the Hmong community. Could you tell me more about what you’re looking for?

EUGENE PITTMAN:

Well, I’d like to hear what they have to say about the shaman program idea. I’d also like to get some feedback about their experiences with our hospital.

SHANNON MOE:

[Tentatively] Okay, then. I do have a lot of experience with focus groups, but I’ve never interviewed people from the Hmong community before. What do I do if they don’t speak English?

BEATRIZ GARCIA-CHAVEZ:

You’ll need an interpreter. Actually, I met a woman recently who’s a community organizer in the Shoals neighborhood. Why don’t I give you her card? The two of you could conduct the focus groups together. Even if language isn’t an issue, I’m sure it will help to have someone from the community working with you as a liaison.

SHANNON MOE:

[Relieved] Thanks, Beatriz! That would make me a feel a lot more credible. And I’m sure the community members would be more at ease.

BEATRIZ GARCIA-CHAVEZ:

Absolutely. It would also help to conduct the interviews somewhere in the Shoals neighborhood, like in the new Latimer Community Center.

EUGENE PITTMAN:

That sounds fantastic! Make it happen, Shannon.

Freepress Article – Optional Content

http://media.capella.edu/CourseMedia/RiverbendCity/Missions/_Downloads/MSN6012_Free_Press_Article.pdf

RIVERBEND CITY MEDICAL CENTER: HOSPITAL MEETING ROOM

Beatriz Garcia-Chavez interviews RCMC nurses about the proposed shaman training program and about their experiences with Hmong patients.

ER Nurse Sheila Meeks and her manager, Carl Lauderback, share their thoughts on the shaman program.

SHEILA MEEKS:

I’m really glad you took the time to ask the nurses about this new idea. What was it you called this Hmong healer person… A shaman? [makes a disapproving noise] I don’t want to sound close-minded, but that makes me nervous. 

BEATRIZ GARCIA-CHAVEZ:

What makes you nervous, Sheila?

SHEILA MEEKS:

Well, look at what happened with that Vang boy. There must have been over a dozen cousins and aunts and uncles and distant relatives all over the emergency room. With all the chaos going on after the chemical spill, that was the last thing we needed. So now are we going to have to accommodate a shaman on top of all these other people who want to be involved in a patient’s care?

CARL LAUDERBACK:

Sheila, I for one am willing to give this a try. We need to do something to show the Hmong community that that this hospital isn’t the enemy. The incident with the Vang family was a major embarrassment.

SHEILA MEEKS:

I’m embarrassed about what happened with the Vang family too, Carl. I’m just worried about having another person involved in patient health care decisions.

BEATRIZ GARCIA-CHAVEZ:

Sheila, have you had encounters like this with other Hmong patients, where large groups of family members wanted to be involved in medical decisions?

SHEILA MEEKS:

Well, not to the same extent, but yes. Every so often we have a case where family members want to take an injured person home to treat them. We’ve had to release some patients that needed our help. [sighs] I know, not all Hmong patients are this uncooperative. Mostly our interactions with them are just fine. But some of them act like Western medicine is evil. Especially those of whom haven’t been in America for long.

CARL LAUDERBACK:

Sheila, I understand where you’re coming from. Believe me. What I’m hoping is that these shamans act as a bridge between us and the Hmong community. This is an urban hospital, Sheila, and we’ve got a diverse population. We need to find ways to help our patients trust us.

Beatriz asks nurse managers Rachel Fox and Christine Sassman about their experiences with Hmong patients.

BEATRIZ GARCIA-CHAVEZ:

I’d like to hear more about your experiences working with the Hmong community.

RACHEL FOX:

Well, usually things go just fine. It’s not like we see the Hmong people as problem patients. But sometimes there are conflicts, especially with older patients who haven’t been in this country for long. And I’ve noticed there are conflicts sometimes when Hmong patients need surgery.

BEATRIZ GARCIA-CHAVEZ:

Can you give an example?

RACHEL FOX:

Well…just last month, I consulted with a young Hmong woman who needed a kidney. One became available, and she had to go against the wishes of her family members to get it. It was very stressful for her. There was this gathering of family members in the room discussing options. And they were just kind of ignoring her. It was so odd. It doesn’t seem like women are treated very well in their culture.

CHRISTINE SASSMAN:

Actually, Rachel, I watched a documentary about this issue. I don’t think this is a gender thing. Caring for family members who are sick in this way is considered to be an important act of love. I think a male patient would have been treated similarly.

RACHEL FOX:

Really?

CHRISTINE SASSMAN:

Yeah. And the surgery issue is a culture thing too. If I’m remembering this right, the traditional Hmong belief is that there are multiple souls that live in the body. I think they believe that one of the souls can be released during surgery, and that the body might come back in the next life deformed.

RACHEL FOX:

See, I didn’t know that. I do know that drawing blood is seen as a really big deal.

CHRISTINE SASSMAN:

Yeah. I think some of them don’t understand that blood is renewable. That’s why I think this shaman program is such a good idea. The shamans could teach patients about procedures like blood tests. And we could learn more about the traditional Hmong ways of doing things.

Novice ER nurse Jessica Jameson is opposed to the proposed Hmong shaman program.

JESSICA JAMESON:

I don’t know about you, but I don’t want to bring those Hmong witch doctor people into the hospital. I mean, I don’t want to come off as being racist, but I hear these people do animal sacrifices! Can you imagine someone bringing a goat into the emergency room and cutting its head off?

CARMELA DEGENARO:

Jessica! That’s crazy. Where did you hear that?

JESSICA JAMESON:

I don’t know. On the News, I think.

SAMANTHA CARTER:

Jessica, you can’t believe everything you see on TV. What I’m worried about incense. I heard that they want to burn it for patients. I don’t want disrespect their traditions-but isn’t that going to be a problem because of oxygen and smoke detectors?

BEATRIZ GARCIA-CHAVEZ:

Samantha, that’s a good point. The incense question has come up before in Merced. I’m not sure how they resolved it, but we might be able to burn incense in designated areas.

JESSICA JAMESON:

But that’s so weird! Why would anyone want to burn incense at a hospital? You know, like I said, I don’t want to sound racist… but this is America. These people need to leave their weird voodoo practices in the jungle.

CARMELA DEGENARO:

Jessica, that’s enough! You should be ashamed of yourself.

JESSICA JAMESON:

[meekly] Um…I’m sorry…

CARMELA DEGENARO:

Your generation doesn’t know anything about the Vietnam War. The Hmong people are heroes. They fought alongside our soldiers in Southeast Asia. You need to have some respect and compassion. These people are dealing with the challenge of living in a completely different culture. The least we can do is try to understand where they’re coming from.

BEATRIZ GARCIA-CHAVEZ:

[after a brief uncomfortable silence] That’s precisely what we hope to accomplish if we implement this shaman program. We hope the shamans can serve as a bridge between the Hmong community and the hospital.

SAMANTHA CARTER:

You know… Carmela, I hate to admit it, but I do have some reservations about this as well. I’m sure no one’s going to sacrifice an animal in the ER…but I guess I just want to know what kinds of procedures they will do. It seems wrong to have people who aren’t medical professionals treating patients here. I worry about sanitation and safety issues. And I could see a shaman unintentionally hurting someone because he isn’t trained.

BEATRIZ GARCIA-CHAVEZ:

You raise some very legitimate concerns, Samantha. We need to work out a lot of details. But please be assured that no one is going to be working with patients in the hospital unless they’re carefully trained. That’s what they’ve been doing in Merced. The shamans all go through a training program.

SAMANTHA CARTER:

Well, that’s good to hear. I would certainly be willing to give this a try. Especially since they tried this in California and it worked. It’s all about helping people, right? Jessica? What do you think?

JESSICA JAMESON:

I don’t know, Sam. This sure isn’t what I learned in nursing school.

SHOALS NEIGHBORHOOD: LATIMER COMMUNITY CENTER

With the help of community organizer Pa Foua Lee, Shannon Moe interviews members of the Hmong community about their experiences with health care.

Seventeen-year-old Jason Vang and his mother, Bo, discuss their altercation with the hospital after the train derailment.

JASON VANG:

The whole experience in the hospital was so weird! I was just trying to help, and they treated me like I was a juvenile delinquent or a gang member or something. My little cousin Lue was hurt. He doesn’t speak English very well yet, and I knew he was scared. Since the high school is close to the hospital, my mother called me and told me to get down there right away to help. I still don’t understand why the hospital wouldn’t just let me into his room to see him.

SHANNON MOE:

Well, you’re underage, Jason.

BO VANG:

See, we don’t see things that way. My son is seventeen years old. I was already married when I was his age. He’s not a child. And he got straight As on his report card last semester. Jason is perfectly capable of acting on behalf of our family.

SHANNON MOE:

I’m sorry, Mrs. Vang. I do understand. But the hospital had to treat Jason as a minor because that’s what he legally is. Also, he wasn’t immediate family.

BO VANG:

See, I don’t even know what that means. Immediate family? For us, we’re all immediate family. Our cousins came to America this year, and they need our help. So we help them. Their poor little boy was hurt in the chemical accident. Should I care less about an injured child because he’s not my own son?

JASON VANG:

Yeah, I don’t get it either. The people in the hospital acted like we were a bunch of freaks. But all we wanted to do was take care of Lue. I mean, I know there are things about the Hmong that you’re not used to, and that’s cool. But what’s so weird about helping an injured little kid?

BO VANG:

I hear Americans talking about family values. But they don’t seem to be talking about my family.

Kao Sua Fang, an elderly Hmong woman, discusses her negative experiences with the health care system.

KAO SUA FANG:

I don’t like to go to the doctor. Things are so strange there.

SHANNON MOE:

What do you mean, Mrs. Fang?

KAO SUA FANG:

In my village, when people got sick, they treated the soul. Here, everything is about treating the body. When I go to the doctor in America, I feel like they are looking at my body only. They are not looking at me as a person.

PA FOUA LEE:

I’m sorry to hear that, Auntie. I know you’ve been to Riverbend City Medical Center. Do you feel that the people there have respectful to you?

KAO SUA FANG:

No. Some of them call me by my first name. I don’t understand that. Also, they think Hmong people are dumb.

PA FOUA LEE:

Why do you say that?

KAO SUA FANG:

Because our ways are different. My cousin, she was staying in the hospital, and a shaman came in and tied her wrists. The shaman explained to the nurses that he was protecting her from evil spirits. The nurses were very polite. But then later, in the hallway, I heard them talking about us and laughing. I think I heard them use the word “stupid.”

SHANNON MOE:

Oh my goodness. Mrs. Fang, I’m so sorry that happened.

Gao Na Lor, an elderly Hmong shaman, shares her experiences.

GAO NA LOR:

Thank you so much for inviting me to the community center today. I’m happy to answer any questions you have.

PA FOUA LEE:

We are so honored to speak with you, Auntie. Your story is so interesting. Can you tell Shannon how long you’ve been a shaman?

GAO NA LOR:

Since I was 13 years old.

SHANNON MOE:

Thirteen? Oh my goodness. I didn’t know children could be shamans. Actually I was surprised that women could be shamans.

GAO NA LOR:

Oh yes-men, women, and children. We are chosen. When I was thirteen, I became very sick and almost died. A shaman came to visit my family. He looked me over and told my family I was chosen, and then he performed the shaman ceremony.

SHANNON MOE:

That’s amazing. Do you mind if I ask what kind of healing you do?

GAO NA LOR:

Well, I’m a very different kind of healer than the ones in your hospital. I’m afraid what I do might be hard for you to understand. We believe that a person gets sick, there’s a connection to the spirit world. When a sick person comes to me for help, I negotiate with the spirits on behalf of the person’s soul. We call this pauj dab.

SHANNON MOE:

Wow. So people come to you instead of going to a doctor?

GAO NA LOR:

Oh, not so much anymore. People go to me and to the doctor. I go to the doctor sometimes myself. My high blood pressure is down!

PA FOUA LEE:

Oh good, Auntie! The hospital is thinking about trying a new program. They want to work with shamans to help patients communicate with doctors, and vice versa. What do you think of this?

GAO NA LOR:

Well…I think that’s a good idea. But will the hospital be open to hearing about our traditions? Are they going to try to teach me that my ways of healing are wrong?

SHANNON MOE:

Oh, no, Mrs. Lor. We want to teach you more about Western medicine so you can communicate this information to patients. But we also want to make arrangements so that you can perform some of your rituals in the hospital.

GAO NA LOR:

Oh, good. That sounds like something I might like to try. I have been in Riverbend City for a long time now-almost 30 years. I always look for ways to bring the old and new together.

RIVERBEND CITY MEDICAL: CENTER CNO’S OFFICE

Eugene, Beatriz, and Shannon discuss the next steps for developing the Hmong shaman program.

Eugene, Beatriz, and Shannon discuss the next steps for developing the Hmong shaman program.

EUGENE PITTMAN:

The first thing we need to do is to implement the administration and monitoring of the program. This program is plenty controversial, and we need to make sure we have a handle on what’s going on from the get-go.

BEATRIZ GARCIA-CHAVEZ:

I agree, Eugene. Although I am wondering if it would be a good idea to develop target goals and objectives first.

EUGENE PITTMAN:

Could you elaborate, Beatriz?

BEATRIZ GARCIA-CHAVEZ:

Well, I just think we should figure out first what it is we want to accomplish. What are our specific goals for the Hmong community? Right now, it’s unclear if our objective is to improve health in the community in some way, or just to improve communication and trust between the Hmong community and the hospital. I think we need to figure this out.

EUGENE PITTMAN:

That’s a very good point. Shannon, what do you think?

SHANNON MOE:

Well, I’m not sure what order we need to do things. But I really think we should get more feedback from the Hmong community. I learned so much from the focus groups from them. Plus, I think we need to diagnose health-related concerns. I’m under the impression that diabetes is a growing problem for them, but I don’t know that for sure. We can figure that out by talking to people in the community as well.

BEATRIZ GARCIA-CHAVEZ:

Absolutely, Shannon. And on a related note, we need to assess the long-term health and social benefits of this program on the community.

EUGENE PITTMAN:

Both of you make excellent points. I still think the first thing we need to do is to figure out how we’re going to administer and monitor the program. After we do that, I think the next step should be to implement the program structure. We need to figure out the details, like where we’re going to hold the shaman courses, and who’s going to teach them.

BEATRIZ GARCIA-CHAVEZ:

And what information we want to teach.

EUGENE PITTMAN:

Exactly. We need to figure out how the program is going to work before we make it happen.

SHANNON MOE:

OK, then. So, where do we start?