San Joaquin County California Presented by: Virginia Borrell Rosetta Norman Taryn Pickerel Manuel Sarte Rene Turruviate NURS-427VN Professor Eva Hall July 8, 2018 Introduction In this presentation we will discuss substance abuse in San Joaquin County California. Drug addiction is a problem for people in every community in the United States. From growing urban areas to beautiful suburbs to the friendly rural areas, people of all ages, genders and cultures struggle with addiction. Strong family backgrounds and socioeconomic status do not protect people from drug abuse. With more news reports about drug addiction and overdoses, it becomes clearer that drugs are a problem everywhere, even in places as idyllic as California. “San Joaquin County’s rate of drug-induced deaths is 56% higher than average rate across California (17.3 per 100,000 compared to 11.1 per 100,000)” ( San Joaquin County 2016 CHNA, 2016). 2 Description of the community San Joaquin County contains both rural and urban areas. Multi-cultural community Residents rate their health poorer than the state overall Notable health disparities in health status between county and state “San Joaquin County faces many of the same challenges seen throughout the state, but often to a greater degree” ( San Joaquin County 2016 CHNA, 2016). San Joaquin has one of the highest rates in California for diabetes mortality. Youth development tends to be undermined trauma and violence, unhealthy family functioning, and insufficient access to youth facilities. Poverty and unemployment are high compared to the state. Major concerns are often associated with family and community violence. “41.1% of community survey respondents report that drug abuse is among the most concerning health behaviors in their community” (San Joaquin County 2016 CHNA, 2016). There is a lack of safe and affordable housing. San Joaquin county ranks 9th highest in the nation for most polluted air. 3 Description of the boundaries The county is located in Northern California's Central Valley just east of the very highly populated nine-county San Francisco Bay Area region and is separated from the Bay Area by the Diablo Range of low mountains with its Altamont Pass. 4 The Stockton Metro area is divided by the U.S. Census Bureau into four neighborhood clusters. Stockton City North Stockton City South Tracy, Manteca, and Lathrop Cities Lodi, Ripon, and Escalon Cities The people Total population is 701,050 57.8% people are white 39.7% people are Latino/Hispanic 14.6 people are Asian 7.2% people are Black 44.9% are Households with Housing Costs >30% of Total Income 41.4% abuse drugs from survey of 2,927 residents 39.5% are homeless from survey of 2,927 residents Unemployment, poverty, and lack of education are key health drivers that can directly impact health outcomes. Specific groups.

1. San Joaquin County California
Presented by: Virginia Borrell
Rosetta Norman
Taryn Pickerel
Manuel Sarte
Rene Turruviate
NURS-427VN
Professor Eva Hall
July 8, 2018
Introduction
In this presentation we will discuss substance abuse in San
Joaquin County California.
Drug addiction is a problem for people in every community in
the United States. From growing urban areas to beautiful
suburbs to the friendly rural areas, people of all ages, genders
and cultures struggle with addiction. Strong family
backgrounds and socioeconomic status do not protect people
from drug abuse. With more news reports about drug addiction
and overdoses, it becomes clearer that drugs are a problem
everywhere, even in places as idyllic as California. “San
Joaquin County’s rate of drug-induced deaths is 56% higher
than average rate across California (17.3 per 100,000 compared
to 11.1 per 100,000)” ( San Joaquin County 2016 CHNA, 2016).
2
Description of the community

2. San Joaquin County contains both rural and urban areas.
Multi-cultural community
Residents rate their health poorer than the state overall
Notable health disparities in health status between county and
state
“San Joaquin County faces many of the same challenges seen
throughout the state, but often to a greater degree” ( San
Joaquin County 2016 CHNA, 2016). San Joaquin has one of the
highest rates in California for diabetes mortality. Youth
development tends to be undermined trauma and violence,
unhealthy family functioning, and insufficient access to youth
facilities. Poverty and unemployment are high compared to the
state. Major concerns are often associated with family and
community violence. “41.1% of community survey respondents
report that drug abuse is among the most concerning health
behaviors in their community” (San Joaquin County 2016
CHNA, 2016). There is a lack of safe and affordable housing.
San Joaquin county ranks 9th highest in the nation for most
polluted air.
3
Description of the boundaries
The county is located in Northern California's Central Valley

3. just east of the very highly populated nine-county San Francisco
Bay Area region and is separated from the Bay Area by the
Diablo Range of low mountains with its Altamont Pass.
4
The Stockton Metro area is divided by the U.S. Census Bureau
into four neighborhood clusters.
Stockton City North
Stockton City South
Tracy, Manteca, and Lathrop Cities
Lodi, Ripon, and Escalon Cities
The people
Total population is 701,050
57.8% people are white
39.7% people are Latino/Hispanic
14.6 people are Asian
7.2% people are Black
44.9% are Households with Housing Costs >30% of Total

4. Income
41.4% abuse drugs from survey of 2,927 residents
39.5% are homeless from survey of 2,927 residents
Unemployment, poverty, and lack of education are key health
drivers that can directly impact health outcomes. Specific
groups noted that relationships with law enforcement officials
are a barrier to feeling safe and supported in their community.
Specific group participants noted that they felt that a strong
sense of community vibrancy and engagement with their
neighbors, and they identified diversity within their
neighborhoods as a key community strength.
5
The geographic
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The geopolitical boundaries
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Financial status of community
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The level of education for the community
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Ethnicity of the people in the community

5. Taryn
Phenomenological features
This is how people relate with each other.
They are governed by sheriffs
Initially they practiced racial antagonism which led to
limitation to account publication.
Majority are less fortunate living in dilapidated housing.
Types of social interactions
Taryn
Common goals and interests
Taryn
Barriers and Challenges among the community
Taryn
Social Determinants of health
Access to Medical Care:
Without access to medical care individuals will reroute their
needs of relief through alternative substances.
Education:
With lack of education individuals will partake in substance
abuse or any kind of abuse that they have only been exposed to.
Violence:
Substance abuse leads to violence in most of the cases .
Youth Growth and Development:
Without proper youth growth and development adolescents tend
to steer in the negative direction of substance abuse .

6. Access to Medical Care: Data related to health insurance , care
access and preventative care. Learning how to use services ,
retention of coverage , and the shortage of primary care
provides that will accept new patients remain challenges. The
fact that the County’s many undocumented adult residents are
without insurance also remains a barrier to care.
Education: Data related to educational attainment and academic
success .
Violence: Data related to intended and unintended injury such
as violence crime , domestic violence , gang activity among
youth and child abuse. St Joaquin’s injury rates remain
substantially higher that the California averages. The homicide
rate is much higher than California as a whole.
Youth Growth and Development : Date related to support and
outcomes affecting youth ability to develop to their full
potential as adults. Unhealthy family functioning , exposure to
negative institutional environments and practices. This includes
disparities by race, ethnicity, gender, and sexual orientation.
Reference : San Joaquin County 2016 Community Health Needs
Assessment.
15
Summary of community assessment. Funding sources and
Partnerships
San Joaquin County has a rich network of community –based
organizations, government departments and agencies engaged in
addressing many of the substance abuse problems in the county.
Include the social and environmental conditions of everyday life
as well as individual factors that influence our ability to make
healthy choices. Offers affordable health care that focuses on
both treatment and prevention . Has a healthy and safe
environment, has high quality education. To promote equal

7. opportunities for all people to be healthy and seek the highest
level of health possible.
Reference :
Preamble to the Constitution of the World Health Organization
as adopted by the International Health Conference, New York,
19-22 June, 1946; signed on 22 July 1946 by the representatives
of 61 States (Official Records of the World Health
Organization, no. 2, p. 100) and entered into force on 7 April
1948.
4http://www.healthypeople.gov/2010/publications/healthycomm
unities2001/healthycom01hk.pdf
5 Rudolph, L., Ben-Moshe, K. & Dillon L. (2013). Health in All
Policies: Guide for State and Local Governments. Washington
DC and Oakland, CA: American Public Health Association and
Public Health Institute.
6 http://healthequity.sfsu.edu/content/defining-health-equity
16
Summary of interview
Bernadette Pua, BSN- Registered Nurse for St. Joseph’s medical
Center, Stockton California of San Joaquin County.
St. Joseph’s Medical and Behavioral Health Center- Non profit
facility providing medical and behavioral care for all those in
need in the community
Roles: Provide inpatient and outpatient medical and behavioral
treatment together with doctors, nurses, and terapists through
the following:
Chemical Recovery Program,
Substance abuse Medical Detox Program,
Substance abuse Outpatient Programs
Suboxone clinic
Why do we have substance abuse in San Joaquin County?
Easy access to alcohol and drugs
Lack of family involvement

8. Socioeconomic status of the county
Social media and advertisements
Yellow Group Interview Questions and Answers: Bernadette
Pua, BSN (San Joaquin County Nurse)
1) What different cultures do you mostly serve here in
Stockton?
“We serve a community that is diverse with multiple cultures
here in Stockton. I have cared for patients that are Caucasian,
Hispanic, Asian, and sometimes Arabian, but most are
Caucasian and Hispanic. I would say about 50% of the patients
we get are Hispanic”.
2) What are your main responsibilities and roles in this
community?
“I am a registered nurse at St. Joseph’s Medical Center, which
also has a Behavioral Health Center department that specializes
in adult and youth psychiatric and substance abuse treatment. I
work in an inpatient hospital setting environment where I
provide the medical needs of patients. I work with doctors,
nurses, therapists and others to ensure health care is delivered
to patients.”
3) What made you want to become a public health/community
provider?
“I like to help those in need. Ever since I was young, I wanted
to help those in need. My parents would tell me that. I love
seeing families healthy and together. It makes me feel fulfilled
when I get to offer help because not all can do that, especially
here in Stockton. Not all are able to give a helping hand because
they are already struggling on their own. So, I feel blessed that
I can use the education that I have to help those in need.”
4) What are some health issues that you think are prevalent or
needs health here in Stockton or San Joaquin County?

9. “Here in the center we get all kinds of patients with different
diagnoses. Aside from the normal heart and lung diseases, I
think the main health issues are drug and alcohol use and
homelessness.”
(B. Pua, personal communication, July 03, 2018)
17
Substance abuse issue in San Joaquin County
Substance abuse, including abuse of tobacco, alcohol,
prescription drugs, and illegal drugs, can have profound health
consequences, including increased risk of liver disease, cancer,
and death from overdose.
Primary data collection from surveys, focus group discussions
and interviews highlighted the importance of this issue for the
county
41.1% of community survey respondents report that drug abuse
is among the most concerning health behaviors in their
community.
39.6 % report that alcohol abuse is among the most concerning
health behaviors in their community
Drug induced deaths is 56% higher than average rate across
California.
17.3 per 100,000 compared to 11.1 per 100,000
5) What is the PRIMARY health concern in this county?
“I would say substance abuse and homeless population but more
substance abusers. Substance abuse can lead to being homeless,
so I would say substance abuse.”
6) What is the primary health concern in San Joaquin County
regarding substance abuse?
“Aside from the mental and physiological aspect of using drugs
and alcohol, like liver disease, depression and addiction, I
would say the primary health concern are injuries, mortality

10. rates, and accidents caused by substance abuse. I get patients
who are involved in motor vehicle accidents from DUIs. I also
get patients who get into serious fights and gunshot wounds
from dealing with addicts. Some just get drunk, pass out on the
road, and police send them here in the center.
So, I think the primary health concern is injuries from being
drunk or high and what it can do to other people. I am not sure
about statistics, but it seems like I get at least one patient who
is under the influence every time I work.”
(B. Pua, personal communication, July 03, 2018)
(San Joaquin County 2016 Community Health Needs
Assessment, p.50)
18
Community Teaching Work Plan Proposal
Nursing Diagnosis for San Joaquin
Risk for injury related to substance abuse as evidenced by drug
induced deaths of 56% higher than average rate across
California
Intervention
Increase youth awareness through starting support groups in
school for those influenced by drug/alcohol abuse
Increase in-patient drug rehabilitation facilities
Create quality rehab programs
Organize resources to improve awareness of options and access.
Implement culturally relative injury prevention programs.
Nursing Diagnosis for San Joaquin
Ineffective Health Maintenance related to substance abuse as
evidenced as evidence by 15.5% of population drinking alcohol
excessively
Interventions:
Reduce liquor stores
Increase tax on alcohol and cigarettes

11. Limit alcohol sales
Conduct community centers
Provide education about health implications
7) What is being done to address the concern of substance
abuse?
“St. Joseph’s Medical Center which also has a Behavioral
Health Center department specializes in adult and youth
psychiatric and substance abuse treatment. We provide
programs like the Chemical Recovery Program, Substance
Abuse Medical Detox Program, Substance Abuse Outpatient
Program, and a Suboxone Clinic. They also provide behavioral
evaluations in terms of mental health. Some patients I care for
in the medical hospital have come from the Behavioral Health
Center. We care for them through behavioral therapy, 12 step
programs, and support groups.”
8) Can you explain what the 12 steps program are?
“Well, the 12- steps are spiritual principles that can help
abusers not obsess about drinking, and by following these steps,
they will become happier with themselves and with their life.
The traditions are more of a fellowship, in which the person’s
common welfare comes before everything else.”
9) What barriers exist for your role in the community?
“I would say budget and language are barriers in the
community. Since we are a non-profit facility, we depend on
community partnership and volunteers for help. In the medical
department, I think the language barrier is one. We
predominantly admit Hispanics and Asians who do not speak
English at all. We try our best in using translators, but there is
still slight confusion at times. In terms of Behavioral Health, I
have heard from some of my patients that teenagers get alcohol

12. from older adults outside liquor stores. So, I think the
cooperation of the public is another barrier.”
10) What are some common goals and interests of the
community?
“I think the common goal is to promote good health to all
residents of San Joaquin County and to promote soberness to all
who are affected by drugs or alcohol here. Another goal is to
reduce the homeless population of course.”
11a) What are some challenges that you have found the people
of the community may face…. in attempts to meet the goal?
“I say financial assistance from the government when talking
about homelessness. I mean Stockton is one of the poorest
communities in California. Some residents depend on pensions
alone. I mean if you drive around here you will not see
buildings with lights on, you will see buildings that are empty.”
11b) …. In terms of substance abuse?
“I think we need more treatment facilities like what we have
here in the center. We need youth programs that can positively
influence the youth.”
12) What projects and/or resources are available to assist with
this goal?
“Here in the center we have chemical recovery programs, free
mental health screenings, outpatient and inpatient programs,
detox programs and a suboxone clinic. We also have the San
Joaquin County Behavioral Health Services here in San Joaquin.
They also offer Chemical Dependency Counseling Centers,
Recovery Houses and Family Ties (a treatment program for
pregnant ones).”
She handed me flyers of the available programs here in San
Joaquin County

13. Behavioral Health Services
Substance Abuse Services Administration
620 Aurora Street Suite #1
Stockton, CA 95202
(209) 468-3800 Fax: (209) 468-3723
Substance Abuse Services
Central Intake
620 N. Aurora Street, Suite #6
Stockton , CA 95202
(209)468-9600
ADAP (Alernative Drug and Alcohol program)
620 N. Aurora St, Suite 3
Stockton, CA 95202
(209) 468-6840
Drug Diversion (Deferred Entry of Judgement) Program
620 N. Aurora St, Suite 3
Stockton, CA 95202
(209) 468-3720
Drug Court Case Management and Treatment Services
620 N. Aurora St, Suite 3
Stockton, CA 95204
(209) 468-3720
https://www.dignityhealth.org/central-
california/locations/stjosephsbehavioral
St. Joseph's Behavioral Health Center | Central California
Hospitals. (n.d.). Retrieved July 4, 2018, from
https://www.dignityhealth.org/central-
california/locations/stjosephsbehavioral

14. 19
Conclusion with key findings
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Conclusion with discussion of your impressions of the general
health of the community
Stockton is a city in San Joaquin County California. This
community requires a safe and violent free atmosphere.
Substance abuse which include alcohol, drug and tobacco abuse
as well as homelessness seem to be the main issues surrounding
the city and county. According to San Joaquin County 2016
Health Needs Assessment, 41.1% of community survey
respondents report that drug abuse and 23.3% report that drunk
driving are among the most concerning health in the community.
The county assessment also indicated excessive liquor stores
and drugs readily available especially for youth. This leads to
the county having 56% higher than other places in California in
regards to drug induced deaths. Most importantly, this issues
threatens not only the health of the abusers but also other
members of the community. With this problem, the community
has set forth behavioral services such as Chemical dependency
Counseling Center, Family Ties, Recovery House, Manteca
Healthy Connections, Medmark Treatment Center, Healthy
Connections Lodi Clinic, Alternative Drug and Alcohol Program
and etc. Both San Joaquin Behavioral Health and St. Joseph’s
Medical and Behavioral Health Center also offer programs to
assist reduce substance abuse.
Chemical Dependency Counseling Center (CDCC)
620 N. Aurora Street, Suite #1
Stockton, CA 95202
(209)468-3720 Fax: (209)468-8640

15. Family Ties
500 W. Hospital Road
French Camp, CA 95231
(209)468-6208 Fax: (209)468-7032
Recovery House
500 W. Hospital Road
French Camp, CA 95231
(209)468-6857 Fax: (209)468-6739
MedMark Treatment Center
1111 N. El Dorado St.
Stockton, CA 95202
(209)938-0228
Healthy Connections Lodi Clinic
441 South Ham Lane, Suite A
Lodi, CA 95242
(209)224-8490
Manteca Healthy Connections
955 W. Center St., Suites 12A & 14
Manteca, CA 95337
(209)239-9600
5th Street Medical Clinic Stockton
1839 S. El Dorado St.
Stockton, CA 95206
(209)463-0872
http://www.sjcphs.org/sitesearch.aspx?SearchText=substance+a
buse&Search=Search
BHS Staff on 8/28/15, & Former Behavioral Health Services
Director, Vic Singh on 8/28/15. (n.d.). Retrieved July 4, 2018,
from https://www.sjcbhs.org/

16. Program Locations. (n.d.). Retrieved July 4, 2018, from
https://www.sjcbhs.org/Program_Locations.aspx
St. Joseph's Behavioral Health Center | Central California
Hospitals. (n.d.). Retrieved July 4, 2018, from
https://www.dignityhealth.org/central-
california/locations/stjosephsbehavioral
21
References
San Joaquin County 2016 CHNA. (2016). San Joaquin County
2016 Community Health Needs Assessment. Retrieved from
https://healthiersanjoaquin.org/pdfs/2016/2016%20CHNA%20fu
ll%20document%20-
%20narrative%20and%20health%20profiles.pdf
Chosen Community
Presented by: Virginia Borrell
Rosetta Norman
Taryn Pickerel
Manuel Sarte
Rene Turruviate
NURS-427VN
Professor Eva Hall
July 8, 2018
Introduction
Rene will do
Description of the community
Rene will do

17. Description of the boudaries
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The people
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The geographic
Rosetta will do
The geopolitical boundaries
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Financial status of community
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The level of education for the community
Rosetta will do
Ethnicity of the people in the community
Taryn
Phenomenological features
Virginia will do
Types of social interactions
Taryn

18. Common goals and interests
Taryn
Barriers and Challenges among the community
Taryn
Social Determinants of health
Virginia will do
Summary of community assessment. Funding sources and
Partnerships
Virginia will do
Summary of interview with community health/public health
provider.
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Identification of an issue that is lacking or an opportunity for
health promotion.
Manuel will do
Community Teaching Work Plan Proposal assignment. Use issue
identified on previous slide.
Manuel will do
Conclusion with key findings
Virginia will do

19. Conclusion with discussion of your impressions of the general
health of the community
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References