Diabetes affects a growing number of Americans. An Advanced practice nurse working in a local hospital is part of a collaborative of community agencies strategically addressing diabetes from a community perspective. 1. What social determinants of health should the community look at in relation to risk or incidence of diabetes? 2. What resources could the APRN use to identify different outcomes related to diabetes? 3. What outcomes related to diabetes are of most interest to the community members? 4. Using the AHRQ’S Healthcare Quality and Disparities Report Data Query (nhqrnet.ahrq.gov/inhqrdr/data/submit), what related national and state level data are available to the APRN? Respond with a minimum of two (2) paragraphs of 4-5 sentences each.  1. You should address each bullet point in the exercise you select.  2. Your work should have in-text citations integrating at a minimum one scholarly article from this week's readings and course textbook.  3. APA format should be utilized to include a reference list.  4. Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first person use. 5. Respond to a minimum of two (2) individuals, peer and/or faculty, with a scholarly and reflective post of a minimum of two (2) paragraphs of 4-5 sentences. A minimum of one (1) scholarly article should be utilized to support the post in addition to your textbook. A Case Study • Jennie Jennie is 8 years old, the eldest of four children. She lives at home with her mother and siblings in Section 8 housing in a small midwestem city. Her father has been an infrequent part of their lives due to repeated convictions for drug offenses. Jennie was born prematurely after a difficult preg­nancy. Her mother has had the support of a "Mentor Mom" since before Jennie was born. The Mentor Mom program was established in their area to assist young, inexperienced mothers who otherwise would have few supports in caring for their babies. The Mentor Mom's role is similar to that of grandmothers, mothers, and aunts in times when extended families were able to help new parents learn to parent their own children. The Mentor Mom has helped Jennie's mother with child-rearing information and problem-solving support over the years. Jennie frequently spends time with the Mentor Mom at her home in the country. Jennie's mother has been participating in adult basic education programs and counseling for several years, and she wants to make life for her children better than hers has been. Frequently she depends on the Mentor Mom when the demands of living with four young children overwhelm her. In kindergarten Jennie was tested by her school sys­tem for possible identification as a child in need of special education services. This evaluation was prompted by her low skill performance levels and her history of prematurity, neurological problems, and environmental disadvantage. At 8 months of age, she developed a .

1. Diabetes affects a growing number of Americans. An Advanced
practice nurse working in a local hospital is part of a
collaborative of community agencies strategically addressing
diabetes from a community perspective.
1. What social determinants of health should the community
look at in relation to risk or incidence of diabetes?
2. What resources could the APRN use to identify different
outcomes related to diabetes?
3. What outcomes related to diabetes are of most interest to the
community members?
4. Using the AHRQ’S Healthcare Quality and Disparities Report
Data Query (nhqrnet.ahrq.gov/inhqrdr/data/submit), what
related national and state level data are available to the APRN?
Respond with a minimum of two (2) paragraphs of 4-5 sentences
each.
1. You should address each bullet point in the exercise you
select.
2. Your work should have in-text citations integrating at a
minimum one scholarly article from this week's readings and
course textbook.
3. APA format should be utilized to include a reference list.
4. Correct grammar, spelling, and APA should be adhered to
when writing, work should be scholarly without personalization
or first person use.
5. Respond to a minimum of two (2) individuals, peer and/or
faculty, with a scholarly and reflective post of a minimum of
two (2) paragraphs of 4-5 sentences. A minimum of one (1)
scholarly article should be utilized to support the post in
addition to your textbook.

2. A Case Study • Jennie
Jennie is 8 years old, the eldest of four children. She lives at
home with her mother and siblings in Section 8 housing in a
small midwestem city. Her father has been an infrequent part of
their lives due to repeated convictions for drug offenses.
Jennie was born prematurely after a difficult preg-nancy. Her
mother has had the support of a "Mentor Mom" since before
Jennie was born. The Mentor Mom program was established in
their area to assist young, inexperienced mothers who otherwise
would have few supports in caring for their babies. The Mentor
Mom's role is similar to that of grandmothers, mothers, and
aunts in times when extended families were able to help new
parents learn to parent their own children. The Mentor Mom has
helped Jennie's mother with child-rearing information and
problem-solving support over the years. Jennie frequently
spends time with the Mentor Mom at her home in the country.
Jennie's mother has been participating in adult basic education
programs and counseling for several years, and she wants to
make life for her children better than hers has been. Frequently
she depends on the Mentor Mom when the demands of living
with four young children overwhelm her.
In kindergarten Jennie was tested by her school sys-tem for
possible identification as a child in need of special education
services. This evaluation was prompted by her low skill
performance levels and her history of prematurity, neurological
problems, and environmental disadvantage. At 8 months of age,
she developed a seizure disorder for which she is currently on
medication. The following information from Jennie's school file
was compiled almost 3 years ago as part of Jennie's original
referral to special education.
Jennie, Age: 5 years, 11 months: Referral and Background
Information

3. Jennie was referred for evaluation because of behavioral and
academic concerns. From age 3-4, Jennie attended a preschool
program for children with developmental delays. Upon her
completion of the preschool program, a multi-disciplinary team
determined that she was not eligible for special education and
should enter the 4-K kindergarten in her home school district.
She is presently enrolled in the 5-K kindergarten program.
The referral noted that she engages in frequent self-stimulating
behaviors such as rocking and making
noises and that she interacts minimally with the other children.
Her language skills are significantly delayed in both receptive
and expressive areas. She does not speak much in class or
attend well to group instruction. She is seated near the teacher
in the classroom to reduce distractibility.
Jennie was cooperative and appeared 10 try to do her best
throughout the evaluation. Her speech was difficult to
understand at times because of faulty articulation. It was
difficult to understand Jennie when she said the proper names of
her family members. Jennie could give her name, address, and
age but did not know her birthday or telephone number. Some
mild tremors were noted in her arm when she was engaged in
writing and drawing tasks. She was able to hop on both feet and
to hop on her left foot quite well, but not on her right. She
could not walk heel-to-toe and had trouble balancing on her left
foot with her eyes closed.
Test Results:
Stanford-Binet Intelligence Scale
IQ: 68
M.A. 4-6
Test of Visual-Motor lntegration (VMI)

4. Standard Score – 74
Age Equivalent: 4-3
Draw-a-Person Test
Estimated Mental Age: 4-5
Vineland Adaptive Behavior Scale (Classroom Edition)
Standard
Adaptive
Domain
Score
Level
Communication domain
70
Moderately Low
Daily Living Skills domain
80
Moderately Low
Socialization domain
67
Low
Motor skills domain
60
Low
Adaptive behavior composite
67
Low
Discussion of Test Results
Jennie was found to be functioning within the significantly-
below-average range of intelligence on the Stanford-Binet Test.
She was able to match pictures of animals and shapes, to
discriminate pictorial likenesses and differences, and to identify
pictures in terms of their functions. She could not answer
comprehension questions at the 4-year level. She simply
repeated the questions rather than responding with an answer.

5. At the 5-year level she was able to identify pictures in terms of
similarities and differences and to copy a square. Jennie's
drawing of a person, copying of the VMI shapes, and mental age
on the Stanford-Binet were all at the level of age 4.0-4.5. This
indicates a general 2-year delay in the areas of functioning
assessed by these tests.
In terms of skills, Jennie was able to rote count orally to 12 but
could not correctly count objects beyond 5. She could recognize
only the numerals 1 and 2. She could match the correct quantity
of crayons only to the numerals I and 2. She could not identify
any letters of the alphabet by name, but she was able to sing the
alphabet song with only one error. She could not print her name
but did print a series of letters that looked like J, N. and E when
asked to write her name. Jennie was able to identify 10 basic
colors correctly. Behaviorally, Jennie's teacher noted that there
are problems with constant fidgeting, humming, making odd
noises, being inattentive, being easily distracted, and crying
often and easily. To a lesser degree there are problems with
being restless, overactive, excitable, impulsive, overly
sensitive, disturbing other children, and having quick and
drastic mood changes. She further described Jennie as tending
to isolate herself from other children, appearing to be easily led,
and interfering with other children's activities. Her attitude
toward authority was described as submissive and on the shy
side. The teacher indicated that Jennie bas very poor
socialization skills, that she doesn't assert herself, and that
when she does try to interact with others, it tends to be
inappropriate.
Summary and Recommendations
Jennie has a long history of developmental delays, evidently
related to prematurity. She also has a seizure disorder for which
she takes medication. Jennie was found to be functioning within
the range of intelligence associated with mild intellectual
disability, with developmental levels generally around the 4.5-
year level in terms of her cognitive ability and physical skill

6. development. She appears to be a child with global delays who
very likely does not understand much of what transpires in her
kindergarten classroom. Her inattentive and distracting
behaviors are possibly a reaction to her inability to compete and
perform at a level that is comparable to that of the other
children in the class. Her teacher comments that Jennie's
socialization skills are similar to those of younger children. It
appears that Jennie would benefit from a smaller, structured
classroom situation in which she can receive individualized
work at her instructional level. She could benefit from a
program with a heavy emphasis on the development of
socialization and communication skills. She appears to meet the
criteria for an individualized education program (IEP) as a child
with mild intellectual disability.
Recently Jennie was seen at the neonatal neurological clinic that
has been following her since birth because of her history of
prematurity and her subsequent seizure disorder. The report
noted that Jennie continues to receive speech and language
therapy twice weekly at school, once in a group setting, the
other individually. Jennie's mother reported that the speech
teacher is working on improving Jennie's grammar and
articulation. The clinic report noted that she engaged easily in
conversation. She was able to follow all simple one and two-
step directions. She exhibited some difficulty with using correct
verbs in sentences. Phonological errors were present but were
still within expectations for her age. Although grammar errors
were evident in her conversational speech, her ability to convey
meaning appears to be appropriate for her overall developmental
levels. The clinic recommended that Jennie continue to receive
speech and language therapy at school as it appeared to be
addressing al I appropriate speech/language developmental
goals.
When Jennie turned 8, an observational report was prepared by
an independent educational evaluator to assist Jennie's mother

7. and the Mentor Mom in preparing for her triennial review. Both
Jennie's mom and the Mentor Mom had voiced their concern
that Jennie seemed to be making little progress despite all the
years she has been in school. They were looking for information
to support their request for a full triennial evaluation, including
a repeat of the ability and achievement testing done 3 years
earlier.
Observational Report
Age: 8 years
At the request of Jennie's mother, an observation was conducted
in Jennie's special education classroom to determine whether
her current placement in a primary class for youngsters with
mild intellectual disability appeared appropriate for her. It was
apparent from watching Jennie's performance in her classroom
that she had great difficulty with tasks like naming and writing
letters and numbers, especially when these tasks were presented
without context.
In contrast, in preparation for a parent program the following
week, she recited a long poem from memory and without
prompts. She appeared to function as well or better than most of
her classmates.
Jennie’s class behavior was attentive and conforming. It
appeared that the majority of class time was spent on counting,
reading color words, and naming and writing letters. The
teacher mentioned that use of whole language had been
suggested but that she didn't think that method was appropriate
for students at this functional level. The teacher based her
program on acquisition of basic skills such as counting and
naming and writing letters. Until the students had mastered
those skills, the teacher felt it was inappropriate to move on.
In a subsequent diagnostic teaching session outside of school,
Jennie was presented with a whole-word approach to decoding
words, using picture cues and repeated self-drill. She quickly

8. learned six words she had selected from a book. She seemed to
benefit from the meaningfulness of the words and the picture
cues. She was taught to drill herself on these selected words
using single-concept picture cards that she and the evaluator
had created; she also learned to congratulate (reinforce) herself
when she was correct. The process appears to have promise for
getting her started on reading.
A second activity was the making of pies for a picnic. As the
pie was being made, Jennie and the observer wrote down the
steps of the recipe. After each step, the full recipe to that point
was read and reread. With the repetition and meaningful
activity, Jennie was able to read the entire recipe at the end of
the project.
Next, Jennie picked up a book that had been read to her
previously. She said she would read it to the observer. She then
commenced to "pretend read" the book as many young children
do. The difference was that she carefully hid the pages from the
observer so that it would not be apparent that she was not
actually reading the page. It appeared that Jennie had already
decided that she was supposed to be able to read, knew she
could not, and was trying to hide that fact. This behavioral
pattern was particularly troubling since it suggested that she
would be increasingly resistant to real attempts to teach her to
read.
Behaviorally, Jennie has developed a talent for getting what she
wants and avoiding what she doesn't want to do. She bargains
with those around her: "Let me do/have this, then I'll do that."
The problem is that she frequently resists the less desired
activity after having received her reward, refusing to comply. It
is essential that any behavior program established for Jennie
place the reward after the compliance action has occurred.
From all of these observations, it appears that Jennie is a child

9. with a variety of strengths and weaknesses. She is clearly
delayed in developing skills typically expected of an 8-year old.
It appears that she is a child who would benefit from more
holistic, experiential forms of teaching. These actions are
recommended:
· Her reading instruction should focus on whole words and real
language. Appropriate methods might include language
experience activities, repeated rereading of trade books with the
teacher or parent (perhaps using Reading Recovery or the
Fernald multisensory method for learning whole words). For
now, focusing on individual letters and sounds should probably
be avoided.
· Story reading to and with Jennie may help reduce her anxiety
about not reading.
· Consistent use of manipulatives in math instruction, using a
curriculum such as Math Their Way, is essential if numbers are
to begin to have meaning for Jennie.
· Her delays in oral language are obvious. Good models and
structured language training should be continued.
· Behavior interventions should pair low-interest activities with
high-interest activities (rewards): rewards should be contingent
on her completing the required behavior before the reward is
received.
Learners with Mild Disabilities: A Characteristics Approach,
Enhanced Pearson 5th Edition By Eileen B. Raymond Published
by Pearson, p. 104-107.
Copyright © 2017 ISBN-10: 0-13-382711-9; ISBN-13: 978-0-
13-382711-8