For your initial post, select one need identified for the community you examined in the multimedia presentation in the Studies for this unit. Formulate the list of ethical and cultural aspects that would need to be taken into account for designing a program to address this need, based on the National Standards on Culturally and Linguistically Appropriate Standards (CLAS) shared on page 111 of your Program Development in the 21st Century textbook.

Response Guidelines

Read the posts of the other learners and respond to the initial post of at least one. As a follow-up to the other learner, share additional reflections and insights.

Learning Components

This activity will help you achieve the following learning components:

• Analyze the importance of ethical considerations in undertaking research and ensuring its credibility.
• Describe common ways culture impacts the delivery of human services.Pg 111 from the book
  National Standards
  Providing another form of guidance on a national level, the standards promulgated by the Department of Health and Human Services’ (2007) Office of Minority Health focus specifically on cultural and linguistic competencies for health care providers (see Box 4.1). In addition, the National Center for Cultural Competence at Georgetown University provides a host of resources for integrating cultural competence in mental health program design (http://nccc.georgetown.edu). Both of these may prove significant resources in comprehensive program development to ensure that cultural competence remains a central part of services and treatment.
  BOX 4.1
  NATIONAL STANDARDS ON CULTURALLY AND LINGUISTICALLY APPROPRIATE STANDARDS (CLAS)
  Health care organizations should take the following actions to meet CLAS standards:
  Ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred languageImplement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service areaEnsure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service deliveryOffer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operationProvide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance servicesAssure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff; family and friends should not be used to provide interpretation services (except on request by the patient/consumer)Make available easily understood patient-related materials and post signage in the languages of the commonly encountered group and/or groups represented in the service areaDevelop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate servicesConduct initial and ongoing organizational self-assessments of CLAS-related activities and, ideally, integrate cultural and linguistic competence-related measures into internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluationsEnsure that data on the individual patient’s/consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updatedMaintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service areaDevelop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activitiesEnsure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumersTry to regularly make available to the public information about the organization’s progress and successful innovations in implementing the CLAS standards and provide public notice in their communities about the availability of this informationReference for the book
  Program Development in the 21st Century
  AN EVIDENCE-BASED APPROACH TO DESIGN, IMPLEMENTATION, AND EVALUATION
  Nancy G. CalleyReferenceCalley, N. G. (2011). Program development in the 21st century: An evidence-based approach to design, implementation, and evaluation. Los Angeles: SAGE.

Scene 4: Food Insecurity

Food Insecurity Statistics:Poverty Rate: 31.3%Households below 165% of poverty rate: 69.2%Child Poverty Rate: 44.7%Senior citizen poverty rate (65+): 19.5%Households on SNAP: 37.3%Households who use food shelf: 21%Children on free or reduced lunch program: 74%

Newspaper Article

Riverbend City Must Address Food Insecurity in Ruby Lake

By Editorial Board | RIVERBEND GAZETTE

Few issues have more of an immediate impact on a neighborhood that food insecurity. When neighbors—including children and seniors—do not know where their next meal is coming from, it’s hard to focus on anything else. When access to a steady supply of nutritious food is constantly in question, it’s hard to have a meaningful quality of life.

In the Ruby Lake neighborhood, food insecurity is at crisis levels. The Ruby Lake Food Shelf—the one large food shelf in the neighborhood—reports that they are so overloaded with clients that they have had to start rationing staple items like rice. The food shelf has had to cut back on the number of clients they serve, leaving a “bubble” of needy people who earn too much to qualify for SNAP services, but earn too little to escape food insecurity.

This problem is compounded by the lack of access to nutritious food in the neighborhood. As is the case in many metro areas, large grocery stores are centered in middle class and wealthier neighborhoods. In Ruby Lake, there used to be a Food Palace Supermarket—until last summer, when it was destroyed by a flood. Now, there are nothing more than a handful of convenience stores in the area. And because many residents do not own cars, access to nutritional food at affordable grocery stores is not an easy option.

Perhaps no one is more aware of food insecurity issues than teachers, who see this every day with their students. Nicole Fernandez, who teaches fourth grade at Ruby Lake Elementary School, keeps snacks in her classroom—granola bars, crackers, pretzels. “If we don’t provide them with a snack,” she said, “lots of them won’t get one.” She sends a note home asking parents to provide some of the snacks. If they don’t, though, she buys them.

“All the teachers do,” she said. “Nobody thinks twice about it.”

There comes a time when a city needs to intervene to help its poorest members. When teachers need to spend money out of their own pockets to make sure that children are eating, we’ve reached that time. When food shelves have to cut their services, and when citizens can’t access nutritious food, then we have a moral imperative to make these issues a priority. This isn’t a Third World country, where resources are limited. This is Riverbend City, and we can do better.

Interviews

Read each individual’s comments.

JOYCE HYSTER

FOOD SHELF DIRECTOR

This food shelf gets busier all the time. We serve about 20 percent of the community in this neighborhood. And the thing is, there are more people who could really use our help, but they’re either too ashamed to come here or they don’t quite qualify with their income level. It’s really staggering how many people need help with food—including children. Many of the people who come here are living under the poverty line, but you might be surprised to learn that the majority of our clients are not. They make enough money that they don’t qualify for aid like SNAP, but they’re still really struggling. The working poor. Because we exist, people don’t have to choose between paying their rent and buying groceries. Or at least, fewer people have to make this choice.

We’re really stretched to the max around here. We’ve had to cut back on the number of visits that some of our clients can come here every month. That’s something we hate to do, but we don’t have the resources to let people come as often as they need. And we have to ration certain types of food. We hate that. We always have to ration things like toilet paper and diapers. But it’s terrible when you have to tell a family that they can only have one small box of rice. Especially because for a lot of families, that’s a staple food.

In order to serve this neighborhood the way we should be, we need more funding. We need more space to store things, and more money to purchase the items we need. We badly need more refrigerators and freezers. There’s no way we can stock all the milk and meat and frozen vegetables and other perishable items that people need. We have one full time social worker on staff, and we really need to hire at least one more. Because social workers can help people find permanent solutions so that they don’t need to rely on a food shelf.

We get some money from the city, and we get donations from neighbors. But when you’re in a poor neighborhood, people don’t have money to donate to the food shelf. And people in better off neighborhoods donate money to their own local food shelf. And this is the only large food shelf in the area. There’s a couple of smaller ones that operate out of churches, but mostly it’s just us. We do have a lot of people in the community who are willing to volunteer here. That’s been a lifesaver for us. Many people around here were helped by this food shelf at some point in their lives, and they want to give back.

The other big issue around here is the growing number of senior citizens in this neighborhood who need our assistance. We’ve actually had a slight decrease in the number of families with children who we serve. But across the board, food shelves are seeing more traffic from senior citizens. Social Security payments just don’t cut it, and the annual Social Security cost of living increases are a joke. And the lack of grocery stores in this neighborhood is a serious problem for older adults, since many of them either can’t afford cars or don’t drive anymore.

THOMAS VELASQUEZ

COMMUNITY GARDEN DIRECTOR

I started a community garden last year. I managed to get some funding from the city, and we turned an abandoned lot into a garden. Our garden has 45 plots. People can rent a plot for a very low fee—just enough to keep the garden running—and then they can grow their own vegetables. Some of the people who rent plots are experienced, but a lot of them don’t know what they’re doing at first, especially younger people. They’ve lived in apartments all their lives and never had a garden before. We have volunteer gardeners who come by sometimes to help.

Anyway, that’s what I’m here at the food shelf today. I’m dropping off some extra produce. We encourage people to donate extra if they have it, and a lot of people do. Because everyone knows there’s a shortage of produce in this neighborhood. This is what you call a food desert. There’s one little bodega, and some convenience stores, and the only large grocery store in the neighborhood closed after there was a flood there. Public transportation is this area is not very good, so it can take over an hour each way by bus to get to a bigger store that sells more produce. Plus it’s so much cheaper to buy unhealthy processed food that fresh fruits and vegetables. I just wish this food shelf had more refrigeration space for things like produce. I’m afraid that a lot of the produce I bring here gets spoiled.

AMBER SALAZAR

FOOD SHELF VOLUNTEER

I’m a single mom with an eight-year-old daughter. When my daughter was born, we relied on this food shelf. Now, we’re doing better. I got my GED and got into a job training program, and now I have a good job at a robotics plant. I don’t have a lot of time, but when I do, I volunteer here.

The hardest part about working here is seeing all the kids. My daughter and I were lucky—we were able to find the resources we needed to get out of poverty. But not everyone has it as good as we do. There are so many children in this neighborhood growing up in food insecure households. You don’t need to be an expert to know how hard that is for a kid. It affects everything in their lives. Their health is at risk. They can’t concentrate in school. They have mental health problems like anxiety and depression. They’re more at risk for joining gangs or getting involved in drugs, because they don’t have hope for the future. And things are really bad when school is out. Most of these kids get free breakfast and lunch in school. On the weekends and in the summer, they’re hungry. I don’t know why the schools don’t have programs where they hand out food to kids for the weekends. I know the schools in other areas do this.

And even when these kids have enough to eat, it’s not necessarily nutritious. We do our best to stock as much nutritious food here as we can, but we don’t have enough freezer or refrigerator space. We rely a lot on donations, and that’s mostly stuff that’s processed and canned. And there aren’t stores around here where people can get food that’s inexpensive and nutritious. The stores that are close by are small and expensive. They don’t carry much fresh food, and what they do carry costs a fortune. I’m lucky that I can shop at PriceCo, where I can get a huge bunch of bananas for three bucks. But that’s because I have a car. I don’t think that PriceCo is even on a bus route.