The negative effect that Adverse Childhood Experiences (ACE's) have on individuals is well described. Ample evidence also suggests that ACEs are associated with socioeconomic status. Additionally, socioeconomic status has been linked to poorer access and utilization of health care. Furthermore, specific adversities lead people to avoid seeking health care services, which can be compounded by lack of access or perceived barriers to access of healthcare.(Alcalá et al., 2017)
As evidenced by work performed and supported by the CDC, individuals and families in rural communities are a group often deemed to be at higher risk for being underserved by healthcare resources. (Rural Health, n.d.) These communities are also perceived to be at a higher risk for being apart of a lower socioeconomic status. These associated risks underpin concerns for the perpetuation of a domino effect that ultimately leads to poorer health outcomes within this population.(CDC, 2023)
For this project, a community-health initiative will be developed for a rural county in North Central Florida, and although this will be a county wide initiative, the selection of this locality was made with individuals in mind. By building resiliency within this rural community through using the social-ecological model as a scaffolding to coordinate the community-health initiative, Project BRIGHT will help contribute to the interruption of the domino effect that leads to poorer health outcomes within this rural population.
According to the United States Census Bureau in July 2022, Gilchrist County is home to 18,992 residents. Of the population, 20.3% are under the age of 18. The three most frequently self-identified descriptions of Race are: 85.2% of the population identify as White, not Hispanic or Latino, 5.9% identify as Black or African American alone, 6.7% of the population identify as Hispanic or Latino. 1.7% of the population identified as Two or More Races. Of responding individuals, 15.3% live in poverty. (U.S. Census Bureau, 2022) In applying the USDA Economic Research Service's description of a rural setting, Gilchrist County is an ideal example of a rural community for which to implement this intervention. (USDA ERS, n.d.)
Although geographically near 2 large, comprehensive medical centers in Alachua County, Gilchrist County has no large medical center and the citizens of Gilchrist County face barriers to healthcare services that manifest in healthcare disparities leading to ACE’s evidenced by the community perception of prevalent substance abuse and lack of healthcare services. (Florida Department of Health, 2021)
Gilchrist County ranked in the lower percentiles in Health Outcomes and Health Factors for Florida being 44/67 in 2021 and 42/67 in 2022 (University of Wisconsin Population Health Institute, 2023). Although this reflects a multifaceted issue, a common starting point has been identified through interaction with Gilchrist County residents. As noted on the Florida Department of Health Needs Assessment: substance/drug abuse, obesity and dental care are of the most important health challenges for the county while the leading barriers to health care services in the county were perceived as no appointments/long wait times followed by cost and transportation barriers. (Florida Department of Health, 2021)
Utilizing the Social-Ecological Model as a scaffolding, Project BRIGHT will utilize a deliberate approach to identify and connect with individuals resulting in touchpoints that align prevention, treatment and/or supportive resources relevant to the individual’s circumstances.
Our project will support existing relationships by empowering our community partners to engage in focused communication to increase awareness of our community heath initiative’s resources through collaboration with trusted, local community members, such as prehospital providers and fire fighters. The goal is to not only provide resources addressing community identified priority problems, but also foster an environment that promotes healthy relationships of support for individuals, significant others and families.
At the community level, our project will identify key community stakeholders, opportunities to increase community resources and facilitate community engagement to mitigate the conditions that have been identified as priority by residents of Gilchrist County. By increasing awareness and coordinating access to resources addressing community identified priorities, Project BRIGHT will improve the physical and social environment of this locality as evidenced in improved efficiency in the utilization of existent healthcare resources in Gilchrist and improvement in community perceptions of community identified barriers to accessing healthcare.
With successful implementation of this intervention, the development of a tool kit or other resource that contributes to the growing societal knowledge base outlining resilience science and rural healthcare is feasible and could lead to impacting health and social policies regarding addressing health care challenges in rural settings. Project BRIGHT aims to create sustainable, community resiliency that can also inspire other communities facing similar challenges and contribute to improved, societal health outcomes. (CDC, 2022)
U.S. Census Bureau quick facts: Gilchrist County, Florida. (n.d.). July 2022. https://www.census.gov/quickfa...ntyflorida/PST045221
Gilchrist, Florida. County Health Rankings & Roadmaps. (n.d.). University of Wisconsin Population Health Institute. 2023. https://www.countyhealthrankin.../gilchrist?year=2023
Florida Department of Health. (n.d.). Gilchrist County. Gilchrist County | Florida Department of Health. https://www.floridahealth.gov/...ts/gilchrist-county/
Centers for Disease Control and Prevention. (2022). The social-ecological model: A framework for prevention violence prevention injury Center|CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/violencepr...ecologicalmodel.html
Alcalá HE, Valdez-Dadia A, von Ehrenstein OS. Adverse childhood experiences and access and utilization of health care. Journal of Public Health. 2017;40(4):684-692. doi:https://doi.org/10.1093/pubmed/fdx155
USDA ERS - What is Rural? (n.d.). https://www.ers.usda.gov/topic...s/what-is-rural.aspx
Rural Health (n.d.). https://www.cdc.gov/chronicdis...ets/rural-health.htm
Centers for Disease Control and Prevention. (2023, May 9). About rural health. Centers for Disease Control and Prevention. https://www.cdc.gov/ruralhealth/about.html
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