When the time came that I would have to begin my internship I asked myself several questions, “what do I want to get out of my internship”, “where would I find the time to do an internship”, and “how can I utilize my current environment to enhance my experiences in public health, and reach the goals I have set for my internship”?  Since taking classes at Hunter College I was able to understand the different risk factors associated with health disparities affecting the communities around me.  I knew that I would like to continue working in a health center when I graduate, and one of my goals is to be able to learn the skills of grant writing.  There are many grants available to help with the financial resources required to help with the needs of the lower Manhattan community.  Access Community Health Center is a Federally Qualified Health Center (FQHC) funded under section 330, and is currently in the process of completing a Service Area Competition (SAC) renewal application.  I spoke to the Grant Manager and to the Medical Director about my goals and interest in grant writing.  After a few weeks I was notified that I would be working on collecting data for a community needs assessment.  I was also told that Access had applied for a grant with the Substance Abuse and Mental Health Services Administration (SAMHSA), which works to improve the quality and availability of substance abuse prevention, alcohol and drug addiction treatment, and mental health services.  This grant would have made financial resources available for a capacity building initiative for substance abuse and HIV prevention services for at risk racial/ethnic minority young adults. 

      During my first few weeks of my internship I began collecting secondary data from New York City Department of Health and Mental Hygiene (DOHMH), Community Health Survey 2008, Mortality: New York City Dept. of Health and Mental Hygiene, Vital Statistics, 2007, CDC, Childhood immunizations: US National Immunization Survey, 2009, and Dental: New York State Department of Health, 2006.  Once I began to collect the data I found it difficult to put it together.  How do you assess the needs of a community, the borough, and NYC?After late nights and headaches from numbers, percentages, dividing, and calculating I figured it out.  Jessica, the grants manager, helped guide me and was so supportive during my learning experiences.  I actually taught Jessica a few things too.  I remember from my community health interventions class that data collection from governmental and nongovernmental agencies and organizations are sources of secondary data.  Jessica referred to the data I was collecting as primary data.  I researched and found examples of primary data, which can be surveys done in the community, and the data I was collecting was secondary data that was helping to identify the health disparities in the lower Manhattan community.  Jessica was so proud of me, and said to me “after you collect the secondary data then you will need to work on primary data”.  I was so determined to accomplish my duties that I began thinking of a survey for the community. 

      Once a community needs assessment has been completed it needs to be continuously updated with information available.  I learned this during my internship.  After weeks of numbers and percentages, and then I was able to assess the needs in the community I received some news that dropped my jaw.  Jessica came to me and said “today the DOHMH, Community Health Survey 2009 was posted”.  All of the data I spent long nights and weeks collecting have been updated!  I had to go back and update all of my numbers, and this time since I had done so well I would have to collect for all of the service areas we serve.  I would now be collecting data for 3 boroughs, lower Manhattan, the Bronx – Pelham Parkway, and Queens – Long Island City.  The first advice I was given was to color code all of the columns.  I spent weeks and long nights, and the data collection and assessments below will be a part of the SAC renewal application.

b) Major and/or Unique Health Care Needs of Target Population

The health care needs of the service area are illustrated by the following data:  (Rates are per 100,000 populations unless otherwise stated as percentage of population; disparities within the service area are indicated with an asterisk (*))

Source: 

• New York City Department of Health and Mental Hygiene, Community Health Survey 2009.
• Mortality: New York City Dept. of Health and Mental Hygiene, Vital Statistics, 2007.
• CDC, Childhood immunizations: US National Immunization Survey, 2009.
• Dental: New York State Department of Health, 2006 

The above data illustrates that many health disparities exist among service area residents across various health issues, specifically, Diabetes, Blood Pressure, Hypertension, Depression, Substance Abuse, Cervical Cancer and Asthma.  Health disparities among the target population are projected to be significantly greater than is represented in the above data due to the diversity of populations living in close proximity to one another, a common feature of a highly urban area.  Health outcomes can be improved and health disparities reduced/eliminated by increasing access to health care services in the proposed service area.  ACCESS has designed a QI program that addresses all the health disparities faced by the target population.

• For Adults who reported poor health, two service areas indicated a disparity with the Bronx (Pelham) having the greatest need (25.7%) compared to NYC (19.5%).
• There is a large uninsured population in the service area and the Bronx (Pelham) area showed the greatest need (24.4%).   However, Queens (LIC) followed not far behind (23.2%) compared to NYC (16.3%).
• Hypertension disparities were found with the Bronx (Pelham) service area exhibiting the greatest need (32.7%) compared to NYC (28.3%) and the Queens (LIC) service area (28.3%).  High rates of blood pressure medication non-compliance were found to be high in the Bronx service area (22.1%) compared to New York City (12.9%).
• Diabetes is a disparity in two of the service areas.  The Bronx (Pelham) service area revealed the greatest need (15.2%) and the Lower Manhattan service area (11.9%) also exhibited great need compared to NYC (9.7%).
• Adult reports of heavy drinking were highest in the Long Island City service area (8.8%) compared to NYC (4.6%). 
• Binge drinking was also reported to be high in the Queens (LIC) service area (17.9%) compared to NYC (14.6%) and the Lower Manhattan service area (14.6%).
• Reports of asthma were particularly high in the Bronx (Pelham) service area (16.9%) compared to NYC (11.5%).  This is important as one in 11 children and adults in New York State currently have asthma.  This chronic disease remains an epidemic in New York with significant public health and financial consequences.
• Cancer screening is important for early detection.  In the Lower Manhattan service area, 31.1% of women reported that they have NOT had their timely cervical cancer screening (pap test in the past 3 years).  This disparity far exceeds the rate in NYC (18.4%).

ACCESS is committed to meeting the needs of the service area and target population.  As a result of the above-mentioned health disparities, a quality improvement plan has been designed around the following health issues: Diabetes, Hypertension, Cervical Cancer, Depression, Child Immunizations, Dental, Flu vaccinations and substance abuse treatment. 

*Information was not reported for prenatal and perinatal health as ACCESS does not offer this service.

                I posted a survey to collect primary data on Monkey Survey called Your Community and Your Health, and it was sent to approximately 240 people on our distribution list.  I received only 3 responses.  I knew that e-mailing surveys does not always have a big response.  Then I went to a community board meeting and I was able to collect 16 completed surveys.  I thought hard and long about how can I get the survey to be successful, and it dawned on me that when you give a person options they have the choice to decide.  Therefore I added my survey to all of the consent forms that would be distributed to people getting the influenza vaccine.  Access is involved with many Flu PODs in lower Manhattan and has provided services to many residents of the New York City Housing Authority (NYCHA).  It worked and I have received 200 completed surveys, and this number is sure to grow.  My theory of adding an optional document to fill out with required documentation to fill out would make the person fill out all of the documents given to them, and it was a success.  Please check out my survey and the results in my tab labeled work in my community.

      Finally the SAMSHA grant that we had applied for was not granted, and this made me realize how a program can and cannot function with financial resources.  We had to go back to the drawing board and we decided we would continue with our health promotion team and promote Rapid HIV testing to members of our community.  In addition to residential, businesses in our community we also targeted youth ages 18-24 who attend BMCC.  I used the Health Belief Model (HBM) as a predictor of preventive health behavior.  I designed a display board with information about STDs and pictures to help understand what it would be like to have an STD like gonorrhea.  I wanted to motivate my audience to understand that unprotected sex is a behavior that can create many health concerns.  Many people have this belief that they are not susceptible to such diseases, but one night of unprotected sex can have an effect on your life forever.  During my public health series at the Bodies exhibit I offered Breast Cancer education materials, how to identify breast cancer, and its symptoms, methods to protect oneself, and local resources for treatment and support.  For pictures and more information please see the tab labeled work in my community. 

My 2011 new year started off in a challenging new direction, because the grants coordinator, Jessica, gave her resignation.  After so many months she guided me, tought me, and now she was leaving.  I felt as if the "newest girl" on the block just became "the girl" on the block.  I was helping the new grants coordinator with all of the outreach events, and Jessica was a good teacher, because I was now teaching others what I had learned.  This expereince taught me that understanding what you are being taught is one thing, but applying it is another.  I was able to apply myself, and I coordinated many events that I attended alone and some that I did not attend at all.  My focus has been educating the community about self breast examinations, and how important it is to do them monthly and properly.  No matter what age you are, if you receive an annual mamogram or not, one of the primary preventions of breast cancer is self breast examinations.  For pictures, please see my tab labeled my work in my community. 

In addition to all of the health fairs we attend I was a part of a team coordinating "National Health Center Week" (NHCW).  As reported by the National Association of Community Health Centers (NACHC) "The second week of August each year is dedicated to recognizing the service and contributions of Community, Migrant, Homeless and Public Housing Health Centers in providing access to affordable, high quality, cost-effective health care to medically vulnerable and underserved people in the U.S. "Celebrating America's Health Centers: Serving Locally, Leading Nationally" is our theme for National Health Center Week 2011. This theme highlights the more than 45 year record of Health Centers in providing affordable, high quality, cost-effective health care to all people, regardless of ability to pay. National Health Center Week 2011 also provides an opportunity to focus on the progress we have made towards fulfilling the goal of our "Access for All America" plan to provide a health care home to 30 million patients by 2015." At Access Community Health Center we did just this, and we celebrated with the people in our community giving out more than 50 FREE rapid cholesterol screenings, we promoted our dental services by having puppet shows that educated in a fun way the importance of daily dental tips.  Our dentist was at hand chatting with our puppets and patients.  We gave out FREE sample "Go Bags" for the members of the community that attended our sessions on "Are you Prepared for an Emergency".  Along with this event the fire department gave out over 100 FREE smoke detectors to the community.  Please see the tab my work in my community to see me and the other speakers.  One of the things that I learned about this event is that in order to be creative, ambitious, and successful you need to plan ahead, and have a supportive team.  That was lacking at this health center, but in the end Mary and I did a great job with the time and resources we had to work with. Through my internship experiences in 2010 and in 2011 I hope to improve the health of my community.