using the community-as partner/Betty Neuman system’s model to assess the City of Cranston, RI.

The community assessment EXAMPLE, is an example of the APA formatted paper I need to submit. The community assessment GRID is the rubric of what information needs to be included in the essay

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Running Head: COMMUNITY ASSESSMENT

Community Assessment: Westerly

Jane Smith

New England Institute of Technology

 

 

 
 
 
 
 
 
 
 
 
 

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COMMUNITY ASSESSMENT

 

Introduction 

I conducted my community assessment in the town of Westerly, Rhode Island 

using the community-as partner model, which is based off Neuman’s systems theory. The 

model was beneficial tool ​when collecting data, analyzing that data, and making

conclusion about the data, as it relates to health problems in the community of Westerly.

The latter in conjunction with my overall impression of the Westerly community

contributed to the creation of a community nursing diagnosis, which lead to the planning,

implementation and evaluation of health problems and needs within the community. 

Community Core 

In my quest to acquire knowledge about the people who reside in the geopolitical 

community of Westerly, I needed to first examine the community’s history. According to 

the ​State of Rhode Island Historical Preservation & Heritage Commission (n.d.),

Westerly is a part of Washington County, is approximately thirty-three square miles

toward the corner of southwestern Rhode Island and is roughly 42 miles southwest from

Providence. Westerly was once occupied by Indians thousands of years ago. Although the

exact dates are undetermined since Indian sites have not yet been dated, it is known that

when the Europeans arrived in American, The Narragansett Indian tribe had already been

well established. The Narragansett Indians occupied the area up until about 1632. Today,

those Indians who resided in Westerly for centuries are only remembered through liberal

sprinklings of place name throughout the land and through artifacts that can be found at

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various archeological sites. (State of Rhode Island Historical Preservation & Heritage

Commission, n.d.). 

The town of Westerly has a total of 16 villages (i.e. Avondale, Bradford, Dunn’s 

Corners, Havershame, Misquamicut, Napatree Point, Pleasant Hill, Pleasant View, Potter 

Hill, Sandy Point, Shelter Harbor, Stillmanville, Watch Hill, White Rock and Wi) 

(RI.gov, 2016). The demography of the community core helped me gather information 

regarding the population of people who reside in Westerly. The tables below are a 

breakdown of the demographic profile of the town, population race, ethnicity, education, 

age and income according to the ​State of Rhode Island Division of Planning Department

of Administration (n.d.):

Table 1-1

Race  Population  % of Population 

White  21,360  94.0% 

Black / African American  285  1.3% 

American Indian & 

Alaskan Native 

110  0.5% 

Asian  424  1.9% 

Native Hawaiian & other 

Pacific Islander 

0  0.0% 

Other  138  0.6% 

Two or more races  403  1.8% 

Total 22,720 

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Table 1-2 

Ethnicity  Population  % Of Population 

Hispanic or Latino (any 

race) 

388  1.7% 

Not Hispanic or Latino  22,332  98.3% 

Total 22,720 

 

Table 1-3 

Educational Attainment  Population 25 – Years & 

Older 

% Of Population 25 – 

Years & Older 

Less than 9​th​ grade  549  3.4% 

9 ​th​ – 12 ​th​ grade, no diploma  1,505  9.2% 

High school diploma or 

GED 

4,577  27.9% 

Completed some college  2,888  17.6% 

Associate degree  1,890  11.5% 

Bachelor’s degree  3,209  19.6% 

Master’s degree  1,460  8.9% 

Professional degree  216  1.3% 

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Doctorate degree  85  0.5% 

Total 16, 379 

 
 

Table 1-4 

Household Income  Households  % Of Occupied 

Households 

Less than $10,000  362  3.8% 

$10,000 – $14,999   393  4.1% 

$15,000 – $24,999   965  10.1% 

$25,000 – $34,999  848  8.8% 

$35,000 – $49,999  1,429  14.9% 

$50,000 – $74,999  1,770  18.5% 

$75,000 – $99,999  1,191  12.4% 

$100,000 – $149,999  1,523  15.9% 

$150,000 – $199,999  663  6.9% 

$200,000 or more  438  4.6% 

Total 9,582 

Median household income: $60,532 

 

Interrelated Subsystems 

Physical Environment 

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The ​State of Rhode Island Historical Preservation and Heritage Commission (n.d.)

noted that most of the boundaries in Westerly are natural. The Pawcatuck River separates

Westerly from the towns of Hopkinton, Rhode Island, both Stonington and North

Stonington, Connecticut. The town also has several physical zones that are very distinct,

all of which were shaped by a continental glacier. A very sharp topographic boundary

follows Route 1A and is roughly one mile wide. The boundary is sometimes referenced

as terminal moraine because of its very irregular landscape that has many depressions and

hills; some of which are water-filled. The Coastal plain is south of Route 1A. It was

formed by the sand and gravel that washed out of terminal moraine. (State of Rhode

Island Historical Preservation & Heritage Commission, n.d.). In addition to Rhode

Island’s natural board being surrounded by the Atlantic Ocean, which is the back yard to

some residents that live on the coastline of Westerly, there are many ponds that are

scattered throughout the town.

Built environments, such as housing and neighborhoods, are potential health

indicators. The United States Census Bureau (2000) revealed that 5,994 residents are

owners of housing units and 3,408 residents are renters of housing units. According to

Area Vibes (n.d.a), the median cost to purchase a home is $278,100. The median rent

asked is $1,081. The median home cost in Westerly is about 58% more than the estimated

national average. The median rent price is about 18% more than the estimated national

average. The number of renters who occupy households is roughly 11% higher than the

estimated national average, whereas the number of homeowners in Westerly is about 6%

lower than the estimated national average. (Area Vibes, n.d.a). 

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Health and Social Services 

Westerly has one hospital that is voluntary non-profit according to ​City-Data

(2017). There are four nursing homes, two of which have built in rehabilitation centers in

them, a health center and a dialysis center (City-Data, 2017). The following table is of

percentage rates of the health and nutrition of Westerly-ians according to City-Data

(2017):

Table 2-1

Healthy diet rate Westerly: 50.6% Rhode Island: 48.8%

Average health of

teeth/gums

Westerly: 47.3% Rhode Island: 45.7%

Average BMI Westerly: 28.7 Rhode Island: 28.6

Mental health issues Westerly: 22.2% Rhode Island: 21.9%

People who do not drink

alcohol

Westerly: 11.2% Rhode Island: 10.7%

Average hours of sleep Westerly: 6.9 Rhode Island:6.8

Overweight people Westerly: 35.0% Rhode Island: 33.7%

General health condition Westerly: 56.2% Rhode Island: 55.2%

Average hearing condition Westerly: 77.4% Rhode Island: 78.2%

Westerly was listed number two on the top 101 cities who had the highest percentage of

residents who visited a dentist in the past year (City-Data, 2017). Lastly, there are a total

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of 58 group practices in Westerly with a wide array of services to meet the needs of the

residing population (Health Grades, 2017).

City-Data (2017) also disclosed past health violations and monitoring violations

that occurred in Westerly. They only cited health violation was in May 2012 regarding

water contamination with coliform. Compliance was achieved in July 2012. As for

monitoring violations, there were three occurrences in 2006 and in 2012, all of which

compliance was achieved within a two month time frame. As for air quality, the air

quality index (AQI) level in Westerly was 98.9 in 2013, which was worse than the

average. (City-Data, 2017).

Economics 

The ​State of Rhode Island Historical Preservation & Heritage Commission (n.d.),

noted that until around the 1800, agricultural interest were very important as the widely

spread population steadily grew. Commercial and manufacturing companies were very

small-scale, local enterprises. Shortly after 1800, a decline in the population occurred, but

the population remained constant until the surge of industrial development occurred

1840, which triggered the large increase within the population. In that year, the

population was 1,912; by 1875 the population number almost tripled reaching 5,408.

(State of Rhode Island Historical Preservation & Heritage Commission, n.d.).

Currently, the job market has drastically improved since 1874 and thus the

economic conditions have improved. The average income, according the State of Rhode

Island Division of Planning Department of Administration (n.d.), is $60,532. That median

household income number is 10% higher compared to the national average (Area Vibes,

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n.d.b) Neighborhood Scout (2016) noted that the most prevalent jobs for the residents of

Westerly are mixed with both white and blue-collar occupations. In general, the town of

Westerly is made up of sales, office workers, professionals and service providers. There

are an exceptional amount of people who work in either office and administrative support

positions (13.91%), management occupations (10.40%) and sales (10.18%). Westerly

also has more residents who work with computers or math than 95% of other places in

the U.S. (Neighborhood Scout, 2016).

 

Transportation and Safety 

The State of Rhode Island Historical Preservation & Heritage Commission (n.d.),

noted that Westerly only has three major highways (i.e. U.S. 1, Historic Post Road, and

State Highway 3, Nooseneck Hill Road), that help funnel traffic both to and from the

Westerly Village and nearby Connecticut. Penn Central Railroad also goes back and forth

through Westerly Village, providing passenger service. Passing the northern end of town

is Interstate 95, which offers both a direct and high-speed connection. In 1978 a modern

highway called Route 78, also known as the Westerly By-Pass, was created and skirts the

town. It serves to help speed travelers both to and from the shore areas in the town.

Toward the end of Route 78 and Post Road is Westerly State Airport, one of the major

links between the mainland and Block Island. (State of Rhode Island Historical

Preservation & Heritage Commission, n.d.).

Area Vibes (2015) noted that the crime rate in Westerly is roughly 34% under the

national average. For every 100,000 residents, there are 5.19 crimes that occur daily.

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There is a 1 in 53 probability of being a victim to any crime. The total number of year to

year crimes has decreased by 30%. Westerly is considered safer than 69% of cities

within the U.S. (Area Vibes, 2015). It appears that the local law enforcement, Westerly

Police Department, does a good job maintaining citizen safety.

An observation I made was that law enforcement is strict on impaired driving. In

Westerly, there are sometimes traffic safety marketing using road side monitors that

display the phrase ‘Drive Sober or Get Pulled Over’ or ‘Drive Now. Text Later’,

Occupant protection is enforced through enforcement of the click it or ticket law.

According to the Rhode Island Department of Transportation (2014), the percentage of

seat belt use in Washington County (i.e. Westerly) was 86.8% for drivers and 88.0% for

passengers.

Politics and Government 

There are more Democratic political party members in Westerly than there are 

Republican political party members (City-Data, 2017). According to Westerly Rhode 

Island (2016), in both the Town Council and School Committee, there are three 

Democrats, two Republican and two Independent party council members. The Senator of 

the General Assembly is a republican, but the Representative in the General Assembly, 

Congressional Delegation US Senator in Congress and the US Representative in 

Congress are Democrats. Every term, except for the School Committee and the 

Congressional Delegation US Senator in Congress, are two-year terms. The School 

Committee is a four-year term and the Congressional Delegation US Senator in Congress 

is a six-year term. (Westerly Rhode Island, 2016). 

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Communication / Recreation 

Churches were and still are a way for the resident of Westerly to gather, worship 

and converse with one another. According to ​the State of Rhode Island Historical

Preservation & Heritage Commission (n.d.), churches were organized at an early century

in Westerly. During that time, the Westerly area was primarily Baptists and

Sabbatarian’s. In the mid-nineteenth century Episcopalian, Catholic, Congregations and

Methodist churches were organized. (State of Rhode Island Historical Preservation &

Heritage Commission, n.d.). In my observation of churches in Westerly, the majority are

that of the Catholic faith. However, City-Data (2015) estimated that 53.5% of the

Westerly population either does not have a specific religion or simply do not attend

church.

Communication also takes place in many forms of recreation. For example, in my

observations over the past half-decade of living in Westerly, I have observed individuals

going to Wilcox Park to walk. There are also many festivals that take place in the park

throughout the year as well. In addition, there are several other community parks and

fields for children, families and friends to play. Gyms and the YMCA have also been

places where all age group go to socialize and workout. In both the Spring and Summer

time, many people will paddle board in ponds or go to the beach to relax or surf. There

are outdoor volleyball and tennis courts. In the winter there is an outdoor ice skating

rank. Cell phone and internet based social media communication / coverage is abundant

in the community. Local bakeries and coffee shops sometimes offer free Wi-Fi.

Education 

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School enrollment refers to when students attend school, private or public 

(Moving Ideas, 2017). According to the ​State of Rhode Island Historical Preservation &

Heritage Commission (n.d.), the first school, which is no longer standing, was built in

1792 and was used to orchestrate town meetings, devotional purposes, and education. In

1832, eight private and eleven public schools were created as education became universal

(State of Rhode Island historical Preservation & Heritage Commission, n.d.). Currently,

Westerly has three elementary schools, one private and one public middle school, and

one high school (City-Data, 2017). Additionally, Neighborhood Scout (2016) noted that

the education level for residents of Westerly is substantially higher compared to typical

US communities. However, the test scores for Dunn’s Corners School (grades KG – 04),

State Street School (grades KG – 04), Spring brook Elementary School (grades KG – 04),

Westerly Middle School (grades 05 – 08) and Westerly High School (grade 09 – 12)

range between 63 and 82; with the average test score being 74% (Area Vibes, n.d.c). All

the schools, with the exception of Westerly High School, has a play ground for children

to play. Westerly High School has a football, baseball, soccer and lacrosse fields; a track

and an indoor basketball court.

Community Diagnosis 

Based on all the data collected on the community of Westerly, I was able to 

identify a few barriers that the community is faced with, as it relates to the normal level 

of defense, it was hard for me to find data and or statistics on the mortality/morbidity rate 

within the Westerly community. However, the level of overall health that the community 

has reached overtime, according to ​City-Data (2017), is 56.2%; which is higher than the

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overall percentage for the state of Rhode Island. Although the percentages for mental

health issues and obesity were not too high, obesity being the higher of the two, they

were still higher than the overall percentage for the entire state which poses health

problems.

As previously mentioned, obesity is a health stressor that is noted in the

community and is detrimental to the health of residents. Arikan et al. (2014), noted that

the prevalence of obesity has an increasingly unhealthy problem because of changes in

one’s diet and lifestyle. It places individuals at a higher risk to develop cardiovascular

diseases by causing other health related problems such as atherosclerosis, diabetes,

hypertension, etc. There are many fast food restaurants in the community of Westerly.

There are 17 pizza restaurants alone.

Problem-solving capabilities and or patterns of coping seem to have improved the

overall health rate in westerly by reducing automotive fatalities. For example, there has

been a decrease in automotive fatalities because of cracking down on drunk driving and

texting while driving. However, drug overdoses appear to be a big stressor for the

community of Westerly as well as for the rest of the state of Rhode Island.

According to Trust for America’s Health (2013), statistics indicate that Rhode 

Island is ranked 13​th​ for the highest mortality rate of drug overdose in the United States. 

The latter is a stressor for the community of Westerly. According to a report 

Prescriptions Drug Abuse: Strategies to Stop the Epidemic​,​ ​15.5 per 100,000 individuals 

suffer from overdose fatalities (Trust for America’s Health, 2013). The deaths extend 

across all age groups, classes, ethnicities and gender lines (The Westerly Sun, 2014). I 

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was unable to attain the actual number of drug overdoses that occurred in Westerly from 

the Westerly Police Department without submitting a request that would have taken four 

weeks to process, but there have been many arrests in connection with drug paraphernalia 

possession, intent to sell, and risk of injury to a minor amongst other things (12 WPRI 

Eyewitness News, 2014; The Westerly Sun, 2014a ; The Westerly Sun, 2015). Rhode 

Island received an eight out of 10 for possible indicators of favorable strategies that can 

help curb drug abuse (Trust for America’s Health, 2013). 

The flexible line of defense is weakened because of the drug overdoses, which 

cause social and health stressors. Lines of resistance were strengthened when the 

Department of Behavioral, Developmental Disabilities and Hospitals issued a response to 

what was termed as “a recent increase in narcotic overdose” deaths within the state, was 

prompted action of emergency regulations (The Westerly Sun, 2014). The new 

regulations require behavioral healthcare providers to authorize the drug Naloxone to be 

given to patients who they know or who may be opioid-dependent. Rules also mandate 

the medication be offered to people in residential areas and in preparation for discharge 

from detoxification settings. Emergency regulations require overdose treatment trainings, 

including the administration of Naloxone, and overdose prevention to all staff personnel 

in behavioral healthcare organizations. (The Westerly Sun, 2014). 

Community Nursing Diagnosis 

There were many stressors that were found in the Westerly community as it 

relates to health. Education in relation to the stressors can help residents improve their 

health and life expectancy so that they can continue to contribute to the community. The 

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following is my prioritized nursing diagnosis (Omaha System, 2016; Omaha System, 

2016a; & Omaha System, 2016b).  

1. DOMAIN: HEALTH-RELATED BEHAVIORS

i. Problem: Nutrition

ii. Problem Classification Scheme

a) Modifiers: Individual and Potential

b) RISK FACTORS

● Many fast food restaurants

● Change in diet (i.e. increase in caloric intake and or portion

size)

● Change in lifestyle (i.e. physical inactivity)

● Poverty

iii. Intervention Scheme

a) Category: Teaching, Guidance, and Counseling

b) TARGETS AND CLIENT-SPECIFIC INFORMATION

● Education

● Dietary management (i.e. limit sugar intake and decrease

portion size).

● Encourage change and responsibility (i.e. assess readiness)

c) Category: Treatments and Procedures

d) TARGETS AND CLIENT-SPECIFIC INFORMATION

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● Behavior modification

● Exercises

● Stress management

● Support group

e) Category: Case Management

f) TARGETS AND CLIENT-SPECIFIC INFORMATION

● Dietary management

● Nutritionist care

iv. Projected Evaluation

a) Knowledge

● 4 – adequate knowledge

b) Behavior

● 4 – Usually appropriate behavior

c) Status

● 4 – minimal signs/symptoms

2. DOMAIN: HEALTH-RELATED BEHAVIORS

i. Problem: Substance Use

ii. Problem Classification Scheme
a) Modifiers: Individual and Potential

b) RISK FACTORS ​(Mayo Clinic, 2017)

● Family history (i.e. addiction)

● Being male

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● Having another type of mental health disorder

● Peer pressure

● Poor family involvement

● Anxiety, depression and loneliness

● Taking highly addictive drugs

iii. Intervention Scheme
a) Category: Teaching, Guidance, and Counseling
b) TARGETS AND CLIENT-SPECIFIC INFORMATION

● Coping skills

● Education
c) Category: Treatments and Procedures

d) TARGETS AND CLIENT-SPECIFIC INFORMATION

● Behavior modification

● Discipline

● Stress management
● Support group
e) Category: Case Management
f) TARGETS AND CLIENT-SPECIFIC INFORMATION

● Community outreach worker services

● Continuity of care

● Change in environment

● Finances

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● Social work/counseling

● Transportation

iv. Projected Evaluation
a) Knowledge
● 4 – adequate knowledge
b) Behavior
● 4 – Usually appropriate behavior
c) Status
● 4 – minimal signs/symptoms

Due to the complexity of obesity etiology, I have limited my diagnosis of obesity in 

Westerly as being related to poor nutrition and or the intake of more food than is required 

for one’s metabolic needs, as evidenced by their being many fast food restaurants and 

physical inactivity.

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References

12 WPRI Eyewitness News. (2014). Five arrested after month-long drug sting. Retrieved

January 29,

2017 from

http://wpri.com/2014/02/28/five-arrested-after-month-long-drug-sting/

Area Vibes. (2015). Westerly, ri crime.

Retrieved January 19, 2017 from

http://www.areavibes.com/westerly-ri/crime/

Area Vibes. (n.d.a). Westerly, ri housing.

Retrieved January 28, 2017 from

http://www.areavibes.com/westerly-ri/housing/

Area Vibes. (n.d.b). Westerly, ri employment. Retrieved January 28, 2017 from

http://www.areavibes.com/westerly-ri/employment/

Area Vibes. (n.d.c). Westerly, school information. Retrieved January 28, 2017 from

http://www.areavibes.com/westerly-ri/education/

Arikan, I., Karakaya, K., Erata, M., Tüzün, H., Baran, E., Levent, G., & Yeşil, H. K.

(2014). Fighting obesity campaign in turkey: Evaluation of media campaign

efficacy. ​Central European Journal of Public Health​, ​22​(3), 170-174.

City-Data. (2017). Westerly rhode island. Retrieved January 21, 2017 from

http://www.city-data.com/city/Westerly-Rhode-Island.html

Health Grades (2017). Group practices directory, rhode island, westerly. Retrieved from

https://www.healthgrades.com/group-directory/ri-rhode-island/westerly

Mayo Clinic. (2017). Drug addition – risk factors. Retrieved February 4, 2017 from

http://www.mayoclinic.org/diseases-conditions/drug-addiction/basics/risk-factors/

CON-20020970

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Moving Ideas. (2017). Westerly, ri city data – population, homes, statistics. Retrieved

January 19, 2017 from http://www.movingideas.org/westerly-ri/

Neighborhood Scout. (2016). Westerly, ri real estate and demographic information.

Retrieved January 19, 2017 from

https://www.neighborhoodscout.com/ri/westerly/

Omaha System. (2016). Problem classification scheme. Retrieved February 4, 2017 from

http://www.omahasystem.org/problemclassificationscheme.html

Omaha System. (2016a). Intervention scheme. Retrieved February 4, 2017 from

http://www.omahasystem.org/interventionscheme.html

Omaha System. (2016b). Problem rating scale for outcomes. Retrieved February 4, from

http://www.omahasystem.org/problemratingscaleforoutcomes.html

Rhode Island Department of Transportation. (2014). 2014 seat belt use in rhode island.

Retrieved January 28, 2017 from

http://dot.ri.gov/documents/community/safety/2014_Seat_Belt_Usage

RI.gov. (2016). Town of westerly. Retrieved January 19, 2017 from

https://www.ri.gov/towns/view/westerly/

State of Rhode Island Division of Planning Department of Administration. (2015).

Westerly 2015 data points for comprehensive planning. Retrieved January 19,

2017 from

http://www.planning.ri.gov/documents/comp/comp16/2015Westerly .

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State of Rhode Island Division of Planning Department of Administration. (2015a).

Planning for recreation. Retrieved January 26, 2017 from

http://www.planning.ri.gov/documents/comp_handbook/3_Recreation

State of Rhode Island Historical Preservation & Heritage Commission. (n.d.). Historic

and architectural resources of westerly, rhode island: A preliminary report.

Retrieved January 19, 2017 from

http://www.preservation.ri.gov/pdfs_zips_downloads/survey_pdfs/westerly

The Westerly Sun. (2014). Statewide drug overdoses prompt action. Retrieved January

29, 2017 from

http://www.thewesterlysun.com/news/state/3592600-129/statewide-drug-overdose

s-prompt-action.html

The Westerly Sun (2014a). Westerly man held on heroin charges. Retrieved January 29,

2017 from

http://www.thewesterlysun.com/news/policecourts/3612695-129/westerly-man-he

ld-on-heroin-charges.html

The Westerly Sun (2015). Local police detectives make 7 heroin arrests in pawcatuck.

Retrieved January 29, 2017 from

http://www.thewesterlysun.com/news/policecourts/7357251-129/police-arrest-7-i

n-stonington-heroin-bust.html

United States Census Bureau. (2000). Profile of general demographic characteristics:

2000. Geographic area: Westerly town, washington county, rhode island.

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Retrieved January 19, 2017 from

https://censtats.census.gov/data/RI/0604400977000

Westerly Rhode Island. (2016). Elected officials as of the november 8, 2016 general

election. Retrieved January 28, 2017 from

http://westerlyri.gov/DocumentCenter/View/294

TABLE 11-1
Community Assessment using the Community-as Partner Model	OBSERVATIONS	DATA
I. Community Core- The people who reside in a geopolitical community or the population of a community. Criteria to evaluate when assessing the core include the community’s history, current demographics, and the values and beliefs of community residents.
II: Interrelated subsystems:
1. Physical Environment- Observations of the climate, terrain, natural boundaries, commercial systems, neighborhoods, religious symbols, planning studies, and so on.
2. Health and social services- Hospitals & clinics, home health care, extended care facilities, public health services, counseling & support services, clothing, food, shelter, and special needs services.
3. Economics- Household median income, percentage of persons living in poverty, employment status, occupational categories, and union activity.
4. Safety & transportation- Information about protection services (fire, police, water treatment, solid waste) and air quality. Information on public transportation.

TABLE 11-1 (continued)

5. Politics and government- Type of city government, political action groups, & political party affiliation.

6. Communication- Formal communication sources (e.g., newspapers) & informal communication sources (bulletin boards, posters)

7. Education- Educational status of community members & educational sources.

8. Recreation- Recreational facilities.

Stressors- Tension-producing situations within the community, such as increase in substance abuse among teens within the community.

Normal level of defense- Health statistics for the community (e.g., mortality & morbidity)

Flexible line of defense- Community responses to current stressors.

Lines of resistance- Established strengths within the community (e.g., shelters, food banks).

After analyzing the data write a community diagnosis. Please refer to your readings on how to write a community diagnosis.