Organizational Evaluation of NYU Langone Hospital Brooklyn

Organizational Evaluation of NYU Langone Hospital – Brooklyn

Organizational Evaluation of NYU Langone Hospital – Brooklyn

Samantha M. Tallarine

Capella University

Health Promotion and Disease Prevention in Vulnerable and Diverse Populations

Organizational Evaluation

July, 2018

Organizational Evaluation of NYU Langone Hospital – Brooklyn

Both U.S. born and immigrants from Latin America account for a little over 40% of the population of Sunset Park, Brooklyn. Spanish is prevalent in most homes, with 45% of children living in households where English is not spoken. With language barriers still prevalent, it makes communicating with both the children and their parents difficult, and places them at risk for health issues. “An estimated 19% of Sunset Park residents between the ages of 5 and 14 are obese, increasing their risk for diabetes, heart disease, high blood pressure, cancer and asthma. Sunset Park also has a high concentration of children living in poverty and a large Hispanic population (42%), who are particularly vulnerable to obesity.” (Kaplan & Hopkins, 2018) Obesity is even more prevalent when a family is living below the poverty line, because buying healthy groceries may not be an option. “Twenty-nine percent of residents live below the Federal Poverty level compared to 21% of families in New York City as a whole. Poverty is particularly acute among families with children – 33% of families with children under 18 live below the poverty level.” (Kaplan & Hopkins, 2016)

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Childhood Obesity in the Hispanic Community

The Hispanic population is at a greater risk for obesity, and they make up about 42% of the Sunset Park community. Obesity increases the risk for diabetes, heart disease, high blood pressure, cancer, and asthma; not to mention, for adolescent’s, increases the risk of being bullied or teased. As stated earlier, 19% of children aged 5-14 years old are considered obese in Sunset Park. This can be the result of a numerous amount of reasons; some of which are living in poverty, lack of physical activity, and cultural dietary habits.

At 29%, the amount of people living below the poverty line is alarming, and only seems to be growing. This impacts the way a family is allowed to feed themselves and their children. With fast food being so much cheaper than fresh fruits and vegetables, the numerous fast food chain restaurants usually trump trips to the supermarket. Even if families do attempt to buy fresh produce, the quality is not the greatest in the surrounding area. There are farmer’s markets that take place, but mostly during working hours, which also is impossible with parents having at least 1 full time job.

Implemented Initiatives to Fight Childhood Obesity in Sunset Park

NYU Langone Hospital – Brooklyn is in the heart of the Sunset Park, and has implemented numerous programs in order to combat some of the diseases plaguing the community. One in particular was piloted in 2015 to help fight childhood obesity, specifically within the Hispanic population. Healthy Habits Program/Programa de Habitos Saludables consists of a “12-session multi-disciplinary program for 10- to 11-year old obese Hispanic children and their parent(s).” (Kaplan & Hopkins, 2018) The hospital has been running different cycles, and making changes each time to better serve the participants. As of March 2017, the hospital had reached 25 families, and a plan was put into place to extend the program into a school-based setting. In expanding this to an in-school program it increases the pool of potential participants because children spend the majority of their days there.

The program focuses on teaching children and their parent’s about the 5-2-1-0 health model which promotes 5 or more fruits & vegetables per day, 2 hours or less of recreation screen time, 1 hour or more of physical activity, and 0 sugary drinks (more water and low fat milk). The goal is to stabilize BMI, and to help families make better overall choices when shopping and preparing meals. Some adjustments that have been made throughout the program have been “extending the age range to include nine-year olds; implementing electronic pediatrician referrals to the program; refining program elements to encourage changes in screen time and beverage consumption; and adding a nutritionist home-visit to reinforce and individualize healthy shopping and cooking practices.” (Kaplan & Hopkins, 2018) The program has shown an increase in participants the more readily available it becomes; it is now available in two elementary schools within the community, P.S. 503/506, and the Center for Family Life, and is being operated by the Family Health Centers at NYU Langone.

Gaps within the Healthy Habits Program/Programa de Habitos Saludables and the Hispanic Community in Sunset Park

One potential shortcoming of the program is a shortage of school nurses to implement it within the schools. If the program is going to grow and reach as many children as possible, the school setting is going to play a major part. Children spend majority of their time in school, and by implementing the program in this setting, it allows for school nurses to give presentations within the classroom and monitor the children during lunch and recess. In having supportive staff while children make their lunch choices it can help to make it become a lifestyle instead of just during the duration of the program.

Another gap within the program is that parents are supposed to be included as participants in order to make the whole family educated about making healthy choices. This could cause a potential issue seeing as there is a high concentration of families living in poverty within the community, meaning that most parents are working at least one, if not two jobs. If parents are not available to attend sessions it could mean the children may not be able attend either. This could mean that the children won’t have full access to healthy selections at home because parents may not have the time to prepare a home cooked meal, or they may not have the resources to even supply health food options in the home.

Strategies to Bridge Gaps Within the Healthy Habits Program/Programa de Habitos Saludables and the Hispanic Community in Sunset Park

In order to ensure there is enough staff to educate and monitor all the children within the schools, nursing students can be implemented. School nurses only have a limited amount of time that they can be out of their offices, so if student nurses were brought in they would be able to sit with the children at lunch, as well as attend recess with them to make sure they are getting their daily exercise. If making healthy choices is put into a child’s daily routine from a young age, it is much easier for it to become a lifestyle instead of just a passing fad.

Combating the problem with parental attendance, and access to healthy foods is a whole other issue. There is no easy fix to this, and although we can take steps to make life a little easier for our participants and the surrounding community, completely rectifying this issue will take time and resources that may not be available. Parents in the Sunset Park community are struggling to provide the basic necessities for their families. A good portion of the population is living below the poverty line which means more time spent at work, and less time at home with family. This also means that their paychecks need to be stretched as much as possible, and that means that fresh fruits and vegetables are most likely not a viable option; especially for families with more than one child, or that have dependent older generation family members living in the household as well.

The Family Health Center can work together with community businesses to organize farmer markets, and maybe speak with restaurant owners to try to offer healthier options. Also, having flexible hours and multiple training sessions in the Family Health Center will allow for working parents to attend the sessions without missing any work. We need to work together with the community to help them realize that fast food restaurants and eating starchy, high fat foods too often is not good, and will be detrimental to their health as well as their children’s health. On 4th Avenue there is a different fast food chain restaurant on every other block, spanning the whole neighborhood. In teaching families to avoid them and buy fresh food we are promoting parents living longer for their children, and helping to prevent children avoid chronic illnesses that obesity places them at risk for.

Barriers to Implementation of Strategies to Combat Childhood Obesity

Sunset Park may be an up and coming neighborhood, but the current residents are just going to continue to struggle. New businesses moving in means that property value will go up, which leads to increase in rent, and this is without an increase in salary. Sunset Park residents are at risk for falling even further below the poverty line, and with that comes an influx of the possibility of developing chronic illnesses. Also, we are talking about a suburb in Brooklyn where there is already limited space; organizing farmer’s markets will prove to be very difficult because of scheduling conflicts for the already overcrowded public areas.

Conclusion

Childhood obesity needs to be fought, specifically within the Hispanic population in Sunset Park, Brooklyn. Children are becoming more at risk due to the prevalence of fast food chain restaurants being easy accessible and affordable, as well as having parents who are working full time jobs. The Hispanic population is at a higher risk for obesity throughout all ages, and implementing a program to help children make healthier choices is the first step in trying to combat it. Educating children on making healthy choices a lifestyle from a young age will encourage future generations to do the same, and can potentially cut childhood obesity rates in half. NYU Langone Hospital – Brooklyn is working hard to serve their community by piloting the Healthy Habits Program/Programa de Habitos Saludables; targeting the Hispanic population specifically, taking feedback, and making changes with each cycle of participants. Although there are barriers in the way of fighting this epidemic, in constantly improving upon the program, the community will have every opportunity to increase their knowledge, and make healthy choices.

References

Kaplan, S. A., & Hopkins, K. (2016, June). Community health needs assessment and community service plan 2017-2019. Retrieved from https://nyulangone.org/files/complete-chna-csp-appendices.pdf

Kaplan, S. A., & Hopkins, K. (2018, April). NYU hospitals center progress report. Retrieved from https://nyulangone.org/files/april-2018-csp-progress-report.pdf

The New York Academy of Medicine. (2014, October 3). Brooklyn community health needs assessment. Retrieved from https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/docs/maimonides_medical_center/3.8_maimonides_cna.pdf

Tucker, S., & Lanningham-Foster, L. (2015). Nurse-led school-based child obesity prevention. The Journal of School Nursing, 31(6), 450-466. doi:http://dx.doi.org.library.capella.edu/10.1177/1059840515574002