Working as a registered nurse Essay Example for Free

Working as a registered nurse renderI devote been exploiting as a registered nurse in Tacoma, WA since 2011 and I fetch chosen to assess the conjunction wellness of push up County. Tacoma is the county seat of hurtle County and the largest urban center in the county and trinity largest metropolis in the conjure up (US count Bureau, 2014). stuff County is located south of Seattle and is comprised of 1,679 sq. miles, much of which front the Pu piss Sound. Yankee scopes of the county ar comprised of islands and peninsulas only penetrationible by bridges or boats. It besides contains one of the nations national parks and the states tallest peak, Mount Rainier. The Parks boundaries largely define the east border of the County and the White and Nisqually Rivers make up the North and South boundaries respectively. (schnozzle Hollow Designs, 2014) existence Economic position AssessmentNearly 820,000 flock call stuff County alkali. It boasts a tall population de nsity with 481 populate per sq. mile. Urban atomic number 18as comprise 93 part of the county. (City-Data, 2014) The median ho lend oneselfhold income in 2013 was estimated to be close to $60,000 and 12 percent of residents atomic number 18 living below the p every backsidety level. (US Census Bureau, 2014) Blacks and African Americans make up the legal age of low-income mint despite the fact that they comprise only 7 percent of the County population. The majority of residents (76.5 percent) are snow-white, 10 percent are non-black Hispanics and 6 percent are Asians. The median resident age is 35 geezerhood and 12 percent of residents are 65 courses or older. (University of Wisconsin Population health Institute, 2014). More than a third of Pierce County children are eligible for free lunch benefits and 8.9 percent of residents are unemployed.As legion(predicate) as 16 percent of residents are uninsured despite a per capita face-to-face health use of $8,160 annually. Te n percent of those uninsured are children. Whats more, close to 6 percent of residents make little(prenominal) that $10,000/year. Its estimated that 15 percent of residents are not able to see a health do by provider when they need to be possess they cant afford it. When they can afford to, primarycare providers (PCP) are in short supply and overworked. There are an estimated 1500 patients for every PCP in Pierce County. (University of Wisconsin Population health Institute, 2014)Medicare is the primary payer of health care expenditures for 10 percent of County residents. (City-Data, 2014)Pierce County has some of the highest evaluate of obesity in the nation with a 31 percent obesity prize. This is despite the fact that approximately 80 percent of residents tracked exercising in the previous month. (University of Wisconsin Population health Institute, 2014)The County has numerous parks, hiking trails, walkway paths and enjoys a tempe run climate with little snow accumulatio n and mild summer temperatures. Poor feeding is exchangeablely a key contri merelyor with 16 percent of residents classified as nourishment insecure. The County has the last(a) approaching to healthy foods with 8 percent of people living in urban areas where the nearest grocery store store is more than a mile from their home. approach shot to convenience stores is slightly better. (University of Wisconsin Population Health Institute, 2014). area and Community SafetyAny Pierce County resident can testify to smelling the Aroma of Tacoma on a regular basis. At various discloses of the daylight, a pungent smell not contrasted that of rotten eggs fills the air. The source of the stench is attrisolelyed to industries located at the Port of Tacoma, the forest industry, car exhaust, or the tidal changes on the Puget Sound. The extent of air pollution in the area is large. More than three quarter of county residents drive alone to work every day. Just 3 percent take public transpo rtation. The County ranks sixteenth in counties reporting high carbon monoxide one hour concentration. It is among the dirtiest 10 percent of US counties for its exclude of water and carcinogens. Chief among these deadly chemicals is methanol and hydrochloric acid. (City-Data, 2014) (Good Guide, 2011)There are four Superfund Sites in the County that continue to cause contamination of drinking water. One of these sites is outset Bay, the hub of the Port of Tacoma, one of the worlds plentyiest ports. The biggest polluter in the area is the Simpson Tacoma Kraft Comp some(prenominal), a forest productcompany that prides itself on using every part of the tree except its shadow. (Simpson, 2014) Another agencyy- cognise polluter and also a major area employer is the US Military. Superfund Sites exist at both McChord AFB and the US Army Fort Lewis Range. (Good Guide, 2011) Cultural AssessmentFor a personal perspective of life inside Pierce County I consulted with a colleague who whol e caboodle as a lactation consultant. She is a 50-year-old college-educated white female who also works as an instructor in a local vocational college. She reports that her cohorts attitude toward aging is not altogether positive. She is beginning to tincture the gradual decline in her bole functions and says that she and others like her find it frustrating that their bodies dont work as well as they did in their youth. That attitude of reluctance disposes to affect how readily her peers seek assistance, specially if it means accepting the realities of aging. Some of the physical health problems common in her cohort involve vision, pause apnea, joint pain, and decreased stamina.She states that individuals in her cohort tend to be individualistic and prefer their yards, both physically and metaphorically, to be fenced. This perspective crosses over to how children are parented with a high value placed on raising adults that are independent and self-sufficient. Her children prep are either graduated from college or are currently attention university. She considers financial independence a mark of adulthood. A ritual associated with adulthood is moving out of the family home and their own.One of the challenges she sees in her cohort is that of obtaining access to moral health care. A colleague modernly unconnected her son to suicide after numerous attempts to help him gain access to care failed and he move suicide. She feels that only those who are going to hurt others or hurt themselves are recipients of care in a broken dodging. Because so many are aching for help in the companionship and a great awareness of the need, the result has been a reduced stigma associated with noetic infirmity. Acknowledging that genial illness is far from universe treated on plane with biological illness, she reports that the awareness of an individuals lackof control over what is a real disease is growing.Disaster Assessment and PlanningThe incredible amount of phys ical ravisher present in Pierce County is also a source of danger to its residents. The area has been declared as a disaster area 19 times in recorded history. Most of these slips were the result of direful storms that caused implosion therapy, landslides, and mudslides. The area is situated on or near several tectonic plates giving it an earthquake take a chance that is 355 percent greater than the national average. In 2001, a magnitude 6.8 earthquake was centered just 10.8 miles from the city center and caused tens of thousands in damage. An earthquake centered as yet farther away could affect the county via a ensuant Tsunami. Coastline areas comprise many of the Countys industries, parks, and homes and could be destroyed by a tsunamis tidal surge. Mt. Rainier frames many of Tacomas picturesque views but it is a volcano that could come back to life at any moment. Its last eruption is estimated to progress to occurred more than 150 years ago but a recent eruption could caus e massive downstream flooding in nearly the entire County. (City-Data, 2014)Disasters caused by flooding precipitated by a tsunami, volcanic eruption, or one of the areas many rainstorms could displace many residents from their homes and block access to urgent and chronic healthcare services. Sewage systems could be affected by the flooding as well as decrease access to clean water. A massive earthquake could destroy many of Tacomas older buildings, many of which were built in the early 1900s and well before any seismic edifice rules went into effect. Falling objects from an earthquake and resulting fires could result in massive injuries in the short-term and damage to public radical in the long-term. (Pierce County Department of parking brake Management, 2010) Many of the possible disasters that could strike the area do not have the luxury of advance warning. Severe storms may give as little as a day or dickens notice, tsunamis and flooding just a few hours. Many residents are unlikely to determine the severity of a disaster until they are in its midst.Because the residents lack the ability to prepare, The Pierce County Department of Emergency Management has five departments to deal with every day emergencies andlarge-scale disasters. The services include hint management, intensify 9-1-1 services, fire prevention, communicate communications and an urban search and rescue task force. The Department is working to infix all residents in an emergency officious system via text. electron orbit hospital employees also have an alert system that sends a text message to employees to report to duty in the event of an emergency. The enhanced 9-1-1 system automatically finds the street address for landline calls. The radio communications team works to ensure that radio remains active in the event cell towers fall during an earthquake or are discredited during severe flooding. Urban Search and Rescue can provide vital services in the event of an earthquake, mud slide, avalanche or abandoned mine collapse. (Pierce County Department of Emergency Management, 2010)Windshield beHousingThe majority of housing options usable in Tacoma are single-family detached homes. A housing boom in the nineties resulted in many sassyer homes and apartment buildings in both high and poor-income areas. Housing density appears to be highest in high-income neighborhoods. Many homes in both areas have grassed front and back yards. Although the area was heavily wooded when colonized in the 1890s, much of the native evergreen trees are gone. Tree replacement appears limited to higher(prenominal)-income areas and is limited to non-native broadleaf trees. Housing in degrade-income neighborhoods appears to be in fair to mollify repair. Very few homes in these areas have bars over windows or penetrations. (Patamia, 2015)Open SpaceIn Tacoma, on that point appears to be a moderate amount of open space, especially considering it is an urban area. I saw a large str ip of expensive waterfront in the Ruston area dedicated to a walking path and docks used for office space and dine. The gem in the crown of the Tacoma Metropolitan Park System is Wright Park, a 27-acre parcel spanning more than 10 city blocks in the heart of the city that features an arboretum, lawn bowling, vacation spots, and a pond. In addition, Mt Rainier subject field Park has more than 235,000 dry land of protected forestland and numerous State parks dot the County. All of these spaces are open for public use and park passes are enveloped as part of the residents vehicle tax.BoundariesThe boundaries of the area are largely natural features like rivers and mountains. Neighborhoods begin and end without notification but poorer areas tend to have more chain link fences, less shopping areas, and homes that lack tonic paint and ornamental landscaping. Ironically, the nigh expensive homes in the county have roads that are either gravel or so unkempt that potholes dominate.Co mmonsPeople in the county tended to foregather or so grocery stores and the strip malls that surround them. I visited an upscale grocery store in the lay of the day and found parking difficult despite an ample lot. Areas surrounding the Port of Tacoma business order tend to always have a large amount of trade, especially large trucks carrying containers to and from the ships docked in Commencement Bay.TransportationPierce County, despite the low numbers of residents who use public transportation has numerous options for acquiring out of your car. Buses locomotion to every part of the county, even across the Tacoma Narrows Bridge to the Olympic Peninsula town of lancet Harbor. Residents can travel to Seattle using rail or bus. Residents enjoy the capability of attaching their bikes to city buses but since the area is very hilly and frequently rainy, few take advantage of the service. For all of its access capabilities in Tacoma, getting some in surrounding communities is diff icult.Interstate 5 intersects the county, enabling tardily access for Port of Tacoma traffic to Canada and the western states. Several state highways run through the community and many are currently undergoing sublime improvement projects. Long-term plans include expanding Seattles light rail into Tacoma but recent initiatives to expand inter-county bus services was voted down by residents.Service CentersOne of the most impressive things about Pierce County is how new and beautiful its schools are. Around these areas, its easy to spot social service centers such as YMCAs or Community Healthcare Clinics. Even in the poorest areas of the County, I saw many dentist offices, parks withplayground facilities, and sidewalks. I drove by a newer looking middle school several times during my canvass and always saw it occupied by students despite heavy rain.StoresCommercial areas in the county appear to be centered on large chain grocery stores. There are few non-chain, independent dining o ptions and those that are tend to offer high-calorie, high-fat options like hamburgers and milkshakes. I did not see any signs advertising farmers markets but there were more than a few community gardens where residents could grow their own fruits and vegetables. I was also impress by how few grocery stores there were outside of major shopping areas and how far even the wealthiest had to travel to buy food. In more than one area, there were several grocery stores in close law of proximity to each other.People Out and AboutI saw several people walking somewhat the County during my survey but all of them appeared to be walking for exercise and leisure, not for transportation. Almost all of these walkers were white and non-obese. A majority of those I saw were wearing Seahawk jerseys and/or colors. It was so persuasive that I mat out of place with an orange sweatshirt. Dogs accompanied many of the walkers and every dog was leashed.Signs of Community VibrancyThe Pierce County Commun ity is very diverse but in nearly every area I traveled, I saw signs of vibrancy testifyd by hanging flower baskets, children playing outside, areas of preserved natural beauty, easy access to healthcare, and a lack of abandoned homes, stray animals, or countless homeless people.Race/Ethnicity effrontery that nearly three-quarters of Pierce County residents are white, its not surprising to see mostly white people in the County. Surprisingly, there are two major Indian Reservations, the Nisqually and Puyallup, inside Pierce County yet less than 2 percent of residents are Native American. Most of the County looks and feels American with few ethnic grocery stores or signs in a language other than English. Areas where whites live tend to be predominantly white but areas with larger populations of Blacks, Asians, andHispanics are well integrated. In one strip mall, there was a Mexican taqueria next door to an Asian grocery store.ReligionWhile only 30 percent of Pierce County residents report macrocosm affiliated with a religious congregation, nearly half of them are non-denominational Christian churches. A third of residents report an affiliation with a Roman Catholic Church. I saw many more churches in the less affluent areas of the County than I did in wealthy ones. I also saw one Buddhist tabernacle and Muslim Mosque.HealthThere are 10 hospitals serving Pierce County the largest of which is Tacoma General Hospital that has more than 400 beds and a level II trauma center. A few blocks away with the areas second level II trauma center and a level III NICU is St Joseph medical examination Center with 367 beds.Signs of homelessness are slightly invisible in Pierce County and tend to be clustered around area shelters or service providers such as the Union Gospel Mission and the YWCA. Its estimated that 2,000 people including children are homeless on any given night in Tacoma. One of the area hospitals, western sandwich State Hospital, provides services liquid e cstasyly to the mentally ill but the lack of services to the homeless and mentally ill is striking. There are an estimated 368 mentally ill people for every mental health provider in Pierce County.Top performing counties have 521 providers per patient. The State ranks 49th in number of open psychiatric beds and several agencies have recently closed their doors or decreased services due to the sparing turn down. ( alliance of Women Voters Pierce County, 2013) (Good Guide, 2011) Forty percent of female tenth-grade children are classified as depressed. The Tacoma Pierce County Health Department lists mental health as its 1 priority in the coming years.PoliticsI toured the area in January when the nearest election was months or years away. Cars I viewed had a mix of bumper stickers that indicated the metropolitan area voted for Obama in the previous presidential election, juts the legalization of marijuana, and is a fan of the Seattle Seahawks. MediaNo matter the area, evidence of s atellite dishes was seen on nearly every home. I did not see any newspaper boxes around area stores. It seems that the primary form of communication medium is through television and the Internet. Television stations accessed by residents are primarily in English but there are two stations that are exclusively in Spanish.Physical EnvironmentAs mentioned previously, Pierce County is a very beautiful place with views of mountains, water, dense forest, and even a volcano visible from nearly every corner of the County. During my survey, I even viewed a pair of bald eagles playing over the Puget Sound. The areas around the Port of Tacoma and the two Indian reservations tend to be the least attractive areas of the city where billboards for nearby tribal-run casinos predominate the landscape.Scavenger HuntWomen, Infants, and Children (WIC)WIC is a nutrition program that helps ensure that pregnant women, nursing moms and children under five have access to healthy foods. They also provide he alth education and breastfeeding reward including peer counselors. Women who use WIC get money to purchase fresh fruit and vegetables, milk, cheese, whole grain breads and tortillas. They also ensure that children are vaccinated and stay on recommended emergence curves. A family of four is eligible for WIC benefits if they have an annual income equal or less than $43,000. portaling the services requires visit a WIC location, which are located on major bus routes near hospitals, health clinics, or in tribal offices. There are more than 15 WIC locations in the county and offer services in English, Spanish, Vietnamese, Korean, Russian, Tagalog, and Cambodian. (Tacoma Pierce County Health Department, 2015) YMCAThe YMCA of Pierce and Kitsap Counties offer a variety of services including seven healthy living centers, a summer camp and more than 70 child care sites. Their mission is to offer programs that build a healthy spirit, mind and body for all. (YMCA of Pierce and Kitsap Counties , 2014) Monthly fees that are based on household income support membership and financial aid isavailable. There are steep discounts for members of the military and their families. The variety of services available at the healthy living center is broad. Members of the Tacoma facility take piano lessons, learn how to box, and enjoy an indoor(a) pool.Family Renewal tax shelterThere are 16 different resources for those dealing with domestic violence in Pierce County. Among them is the Family Renewal Shelter. They provide emergency services by way of confidential shelters, self-defense classes, sacred support, and pet therapy. They also offer help with access to vehicles, educational scholarships, and relocation. reassert for the scheme comes from private donations from individuals, foundations, businesses, and churches. Access to services is via the organizations 24-hour crisis line. Information about domestic violence is available on the organizations website including a button that allows a user to leave the site quickly and eliminate a computer trail. (Family Renewal Shelter, 2014)National Alliance on Mental Illness Pierce CountyThe purpose of NAMI is to support people and those who love them with the challenges of mental illness. Members are people whose lives have been touched by mental illness and can share resources, lessons learned, and empathy with one another. They also advocate for change on local and legislative issues. Support group meeting occur three times a week and are located in a local Episcopal Church. They are free to attend. NAMI Walks occur several times a year and help to reduce the stigma of mental health and expand services, especially in education of mental health issues with police, fire and other first responders. (NAMI Pierce County, 2015)Planned ParenthoodA group of community volunteers opened the first Planned Parenthood clinic in Tacoma in 1972 to address concerns about high evaluate of teen pregnancy and sexually transmitted infections. The organization believes that everyone has the right to choose whether and when to get pregnant and works to prevent unwanted pregnancies. They rely heavily of individual donor support to provide basic cheap health care, adoption planning, vasectomy services, and fitting for menstrual cups. They also provide abortion services and arefrequented by protestors. (PPGNW, 2015)Tacoma Rescue MissionThere are more than 36 homeless shelters in Tacoma offering everything from emergency shelter, transitional housing, and assisted housing for people dealing with domestic violence, drug addiction, and sexual trafficking. They are a Christian organization funded by the United Way of Pierce County and the cities of Lakewood and Tacoma in addition to funding from Pierce County itself. They report that they provide shelter to more than 400 people nightly and provide food for 26,000 people who have no other access to food. They work to help people overcome drug and alcohol addiction w ith rehabilitation serves, educational assistance and case management. (Tacoma Rescue Mission, 2015)Interpretation of Collected DataEpidemiology examines how health status or health events are distributed across a community and what determines it. The preceding examples give a broad stroke painting of health in Pierce County. Overall, the birth rate (15 per 1000) exceeds the death rate (7.3 per 1000) in Pierce County and the infant mortality rate (6.5 per 100,000) is in line with the national average (6.15 per 1000). (City-Data, 2014)Pierce County offers many assets that empower the health of its residents. Among these are a large population of college-educated people with 90 percent of adults 25 years and older completing at least high school or obtaining a GED. Although 8 percent of residents are foreign born, more than 80 percent of these report speaking English fluently. The people of Pierce County have access to nature and local foods, including the nations largest crop of rhub arb. besotted faith communities with social outreach programs help neighbors in need. The community brims with people who are largely open-minded and access complementary care such as massage, acupuncture, and chiropractic adjustments is common. (Tacoma Pierce County Health Department, 2014)Community DiagnosisIn my outline of the data collected, it appears that Pierce Countys top three problems are access to mental health services, high rates of obesity, and access to quality health care.Access to mental health servicesA community that is mentally healthy is productive, enjoys fulfilling relationships with others in the community and is resilient through lifes challenges. Without it, even the healthiest body can fall into disrepair quickly. Its no wonder then that mental illness is one of the most common causes of disability. The National Institute of Mental Health estimates that as many as one in every 17 people has a seriously debilitating mental illness. The good news is that m ental, emotional, and behavioral disorders can be prevented. We know more about how the brain functions than ever before and current interrogation indicates that greatest opportunity to prevent illness is to get people into treatment early and often. ( goodly People 2020, 2015)With working capital States dismal rankings in the availability of psychiatric beds and the high patient load of mental health care providers in the County, there is much work to be done. Healthy People 2020 goals state that 87 percent of primary care facilities should provide mental health treatment onsite or by paid referral. This goal represents a 10 percent improvement over the baseline rate of 79 percent in 2006. (Healthy People 2020, 2015)High rates of obesityPierce Countys high rate of obesity is well above the national average and may be attributed to large number of food deserts, especially in urban areas. People who have healthy weights and access to fresh foods have lower rates of chronic disease and a higher quality of life. Addressing obesity is complex, however, and requires a multi-faceted approach. As with mental health, the most powerful interventions are aimed at prevention.According to Healthy People 2020, more than 10.4 percent of children ages two to five were considered obese in 2008. The 2020 goal is to reduce that number to 9.4 percent. (Healthy People 2020, 2015)One of the most cost effectual ways to achieve that goal is to increase the number of children who are breastfed. A history of breastfeeding, especially exclusive breast milk feeding for the first six months, is associated with an estimated 40 percent reduction in puerility obesity. (AHRQ, 2009) Unfortunately, just14.1 percent of infants born in 2006 achieved this. Healthy People 2020s target is 25.5 percent. (Healthy People 2020, 2015) Access to quality healthcareOptimal health is not a state achieved without support, education and intervention. Ensuring that Pierce County residents get the help the y need when they need it is a big part of preventing chronic disease, improving quality of life, and preventing extra death. Some of the reasons people do not see a health care provider are they cant find one, they cant afford it, or they dont have policy coverage.The most recent data suggests that as many as 16 percent of County residents do not have health insurance. (Good Guide, 2011) According to Healthy People 2020, the national average is slightly higher at 16.8 percent. The objective is an ambitious one with 100 percent of individuals covered by private insurance or Medicaid/Medicare by 2020. (Healthy People 2020, 2015)According to Washington States Department of Public Health, there are approximately 543 providers in Pierce County including doctors, ARNPs, CNMs, and PAs. A little more than half of them report that they are accepting new Medicaid and Medicare patients. (Washington State Department of Public Health, 2011) Interestingly, Healthy People 2020 has yet to define item goals for increasing the number of practicing providers in all areas. (Healthy People 2020, 2015)Primary Prevention TopicWhen John Snow, the paternity of epidemiology, was investigating cholera outbreaks in mid-nineteenth century London, the chief cause of unnecessary death was communicable disease. Today, chronic disease that damages the heart, pancreas, and lungs are more likely to kill than bacteria. A large contributor to hypertension, diabetes, and heart failure is obesity. In a society obsessed with weight loss and thinness, obesity rates in adults and even children are growing. Just as John Snow found the source of the disease that was claiming lives in his community, we must also find the source but it is unlikely to be in a anchorite water pump in the middle of the city.Preventing obesity appears to be a life-long task best started at birth. The data demonstrate that increasing breastfeeding rates is a powerful tool in decreasing childhood obesity. Breastfeeding rate s for older, educated and more affluent women are already at Healthy People 2020 targets but women who are young, have low levels of education and who are poor are more likely to never breastfeed and are extremely unlikely to continue to do so for six months. (Grummer-Strawn, Scanlon, Darling, Conrey, 2004)An organization in the community that helps low-income women establish and maintain breastfeeding is the Women, Infants, and Children Program. A team of peer counselors who have themselves struggled with issues common to low-income breastfeeding women including pumping in the oeuvre help new moms navigate a difficult terrain and provide their children with the best start in life. Area hospital-based birth centers are working toward or have already achieved certification as a pander Friendly Hospital. This designation indicates that the facility employs evidence-based practice that lead to dramatic increases in breastfeeding rates. (DiGirolamo, Grummer-Strawn, Fein, 2008)Given that the problem of obesity is large in Pierce County, the rewards for reducing it great, and the interventions that are most likely to help are known and inexpensive, I am focusing my primary prevention topic on promoting breastfeeding as a means to reduce obesity in Pierce County.BibliographyAHRQ. (2009). Breastfeeding, Maternal Infant Health Outcomes. Retrieved January 22, 2015, from Agency for Healthcare explore and Quality http//archive.ahrq.gov/clinic/tp/brfouttp.htmCity-Data. (2014). PIerce County, WA. Retrieved January 16, 2014, from City-Data.com http//www.city-data.com/county/Pierce_County-WA.htmlDiGirolamo, A., Grummer-Strawn, L., Fein, S. (2008). Effect of Maternity-Care Practices on Breastfeeding. Pediatrics , S43-S49.Family Renewal Shelter. (2014). About the family renewal shelter. Retrieved January 21, 2015, from Family Renewal Shelter www.domesticviolencehelp.org/aboutfrs.htmlGood Guide. (2011). Good Guide. Retrieved January 17, 2014, from Score Card The Pollutio n Information Site http//scorecard.goodguide.com/community/index.tcl?zip_code=98404set_community_zipcode_cookie_p=tx=11y=11Grummer-Strawn, L., Scanlon, K., Darling, N., Conrey, E. (2004). racial and Socioeconomic Disparities in Breastfeeding . Atlanta Centers for Disease Control and Prevention.Healthy People 2020. (2015). Access to Health Services. Retrieved January 22, 2015, from Healthy People.gov http//www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-ServicesHealthy People 2020. (2015). Maternal, Infant, and Child Health. Retrieved January 22, 2015, from Healthy People.gov http//www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectivesHealthy People 2020. (2015). Mental Health and Mental Disorders. Retrieved January 2015, 2015, from HealthyPeople.gov http//www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disordersHealthy People 2020. (2015). Nutrition and Weight Status. Retrieved January 22, 2015, from Healthy People 2020 http//www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectivesLeague of Women Voters Pierce County. (2013, December 11). Introduction to services for the seriously mentally ill in Pierce County . Retrieved January18, 2015, from National Alliance for the Mentally Ill Pierce County http//www.lwvwa.org/tacoma/pdfs/Mental%20Health%20Report%20from%20November%202013%20Unit%20Meetings%20%205%20pgs.pdf NAMI Pierce County. (2015). Welcome to the NAMI of Pierce County tissue Site. Retrieved January 21, 2015, from NAMI Pierce County http//www.namipierce.org/Patamia, K. (2015, January 16). Windshield Survey of Pierce County. (K. Patamia, Interviewer)Pierce County Department of Emergency Management. (2010). Hazard Identification and risk of exposure Assessment. Retrieved January 17, 2015, from Pierce County Emergency Management http//www.co.pierce.wa.us/DocumentCenter/View/7032PPGNW. (2015). Who We Are. Retrieved January 21, 2015, from Planned Parenthood of the Great Northwest http//www.plannedparenthood.org/planned-parenthood-great-northwest/who-we-areSimpson. (2014). Environment. Retrieved January 17, 2015, from Simpson Company http//www.simpson.com/Environment.aspxSnob Hollow Designs. (2014). County Maps of Washington. Retrieved January 17, 2014, from County Maps of Washington http//www.countymapsof upper-case letter.com/pierce.shtmlTacoma Pierce County Health Department. (2015). Nutrition Program for Women, Infants and Children. Retrieved January 21, 2015, from Health and Wellness http//www.tpchd.org/health-wellness-1/wic-nutrition-program/Tacoma Pierce County Health Department. (2014, August). Pierce County Community Health Improvement Plan. Retrieved January 15, 2015, from Pierce County Community Health Improvement Plan http//www.tpchd.org/files/ program library/474287fe72cf69af.pdfTacoma Rescue Mission. (2015). Rescue Mission. Retrieved January 21, 2015, from About Us http//www.rescue-mission.org/about usUniversity of Wisconsin Population Health Institute. (2014). County Health Rankings and Roadmaps. Retrieved January 17, 2014, from Washington Pierce County http//www.countyhealthrankings.org/app/washington/2014/rankings/pierce/county/outcomes/overall/snapshotUS Census Bureau. (2014, December 4). State and County Quick Facts. Retrieved January 16, 2013, from United States Census Bureau http//quickfacts.census.gov/qfd/states/53/53053.htmlWashington State Department of Public Health. (2011, July). Primary Care Provider Survey Pierce County. Retrieved January 22, 2015, from Office of Community Health Systems http//www.doh.wa.gov/Portals/1/Documents/Pubs/689048.pdf YMCA of Pierce and Kitsap Counties. (2014). About Us. Retrieved January 21, 2015, from YMCA of Pierce and Kitsap Counties http//www.ymcapkc.org/about-us/