May 19th, 2024

Isbella T. Garcia, MPH

Department of Public Health and Recreation
San Jose State University
One Washington Square
San Jose, CA 95192-0052

RE: Gateway Life

Dear Isbella T Garcia,

The San Francisco County Bay Area Addiction Research & Treatment Inc. (BARRT) has put
together a program proposal for your consideration. The prevalence of substance abuse
disorders and the growing rate of overdose fatalities are significant concerns for public health
in San Francisco County. There are several interrelated factors that contribute to the severity
of its drug crisis, such as accessibility of drugs, stigma surrounding abuse, socioeconomic
disparities, and the lack of access to healthcare services.

Gateway plans to establish a Community Advisory Board made up of community members

and leaders, a team of qualified professionals, including nurses, therapists, and social
workers. Gateway will be in the city of San Francisco near Tenderloin district, where social
services and low-income housing rely on. This model location will allow residents and
individuals to access this program, along with the surrounding social services. Furthermore,
Gateway intends to conduct evaluation surveys six months after opening its operations.

Gateway strives to offer rehabilitation services among those who are struggling with
substance abuse disorders, regardless of their socioeconomic status and health insurance
status. Our team is filled with qualified professionals that will work collaboratively to tailor
treatment plans to everyone's needs.

The program is seeking a budget of $999,999 for implementation. This funding will enable
the program director and other staff to effectively support and deliver care and treatment
services for individuals who are struggling with substance abuse disorders in San Francisco
County.

Thank you for your time and consideration. If there are any additional questions I can clarify,
please feel free to contact me at (760)-697-5684 or via email alondra.chavez01@sjsu.edu.

Sincerely,

Alondra Chavez
Program Manager
Gateway
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Program Proposal

Alondra Chavez

Department of Public Health and Recreation, San Jose State University

PH179 Sec 02: Public Health Capstone

Professor Isabella Garcia

May 10th, 2024

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Abstract

Gateway is a program for young and older adults ages18 or older in San Francisco

County. This program is tailored to address the needs of young and older adults and the Bay

Area Addiction Research & Treatment Inc. (BARRT) services to offer assistance and

support. Gateway aims to provide treatment and care services regardless of their

socioeconomic status or healthcare insurance plans. This program's treatment services

include; Medication-Assisted Treatment, Substance Use Counseling, and Community

Healthcare. Gateway aims to destigmatize rehabilitation treatments and promote a culture of

understanding and acceptance surrounding mental health challenges. By fostering open

dialogue and providing accessible services, Gateway strives to create a supportive

environment where individuals could feel comfortable seeking assistance they need to

overcome the challenges of addiction and mental health issues. This program's operating

hours will be open every weekday, nine in the morning to sunset in the evening. Prioritizing

harm reduction strategies within these initiatives will help reduce the spread of disease and

prevent overdose fatalities by providing secure injection sites in heavy affected areas of San

Francisco, such as the SoMa and Tenderloin neighborhoods. These areas carry a significant

societal burden due to its correlation with high rates of sexually transmitted infections and

drug related fatalities. Gateway has requested a budget to recruit skilled and dedicated

personnel who are passionate about delivering essential services. As a collective, we will

work alongside San Francisco County and the Bay Area Addiction Research & Treatment

Inc., to ensure the needs to overcome addiction.

WC 246
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Problem Statement

San Francisco is currently facing an alarming drug overdose epidemic, the year 2023

has exceeded 2020 drug overdose deaths in San Francisco (OCME,2024). Areas like the

Tenderloin, a neighborhood in downtown San Francisco and the South of Market

neighborhoods have been impacted the most with its drug crisis (Discovery Institute, 2024).

Both neighborhoods bring a negative impact on their society because of its association with

the high rates of sexually transmitted infections and drug overdose deaths. It's also known as

the home to a large population of homeless and to those who live in extreme poverty. In 2020

and 2021, 23% of drug overdose deaths transpired in the Tenderloin district and 18% in the

South Market area (CDC,NVSS, 2023). January to December 2023, there were 813 deaths

related to drug overdose, 657 of these deaths were linked with the synthetic opioid fentanyl

(OCME,2024).

Contributing Factors

Factors such as peer influence, family environment, mental health, and socioeconomic

conditions can also contribute to drug exposure (NIH,2022). The lack of funding for

interventions makes it difficult to help every single individual. The services that San

Francisco has offered comes with a price tag many cannot afford. Although some programs

take health insurance, many don’t take Medi-Cal, which is an insurance that only low-income

people qualify for (AAC,2024) .One’s cultural or ethnic background also impacts their

attitudes and beliefs with drug treatment services (SAMHSA,2022).

Opportunity

The Bay Area Addiction Research & Treatment Inc. (BARRT) services can help by

directing and referencing individuals to reach out to Gateway’s program. By providing

affordable options and unlimiting insurance plans, it can be very beneficial for individuals to

access and overcome addiction treatments.

Goals & Objectives

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Goal: Reduce drug overdose deaths by building harm reduction interventions in San Francisco

Process: Impact: Outcome:

1.By May 1, 2025, the program 1.By November 1, 2025, 30% 1.By January 1, 2026, all young

manager and program coordinator of program participants and older adult ages 18 or older

will collaborate with nurses, engaged in criminal activities, will be able to access regular and

therapists, and social workers and such as drug-related offenses or affordable rehibition treatment

create five training resources. other crimes linked to services.

2. By June 1, 2025, the program substance abuse will decrease.

manager will complete the 2. By December 1, 2025, a

development of a comprehensive decrease in the utilization of

informational packet to Bay Area emergency medical services,

Addiction & Treatment Inc. hospitalizations, and other

(BARRT) about the establishment healthcare resources related to

of the new Rehabilitation Center at drug overdose or substance

Gateway, catering to the needs of abuse complications among

both young and older adults in San program participants

Francisco.

3. By July 3, 2025, 75% of the

program establishment will be

complete and training tour dates

will be released to team

professionals.

4. By September 1, 2025, there will

be a scheduled meeting to follow-

up training procuress for the

professional team.

.
 6

5. By September 20, 2025, present

a local community showcase of the

program to spread awareness of the

service's offered.

6. By October 1, 2025, there will

be an improvement in effectiveness

through assessment protocols used

to evaluate participants' needs,

preferences, and treatment

progress.
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 8

Theoretical Framework

The social-ecological model is a theoretical framework that inspects the complex

relationships individuals have with their social and physical environments. Recognizing the

five levels of the social-ecological model, it understands how individuals' behaviors and

attitudes are influenced by factors at various levels. These levels of influence take in an

individual, interpersonal, organizational, community, and in policy level. Combining health

outcomes with the social-ecological model and its interventions can effectively address the

root causes of health disparities and inequities. As this model promotes a comprehensive

approach to illness prevention and health promotion, the various levels can address

approaches that can help with San Francisco's drug crisis. The rising rates of drug overdose

death rates in San Francisco is alarming to public health officials. The year 2023 has

exceeded 2020 drug overdose deaths in San Francisco (OCME,2024). This highlights that

there were new factors or trends that emerged within those three years, contributing to its

drug overdose death rates.

Social Ecological Model – Policy Level

Recognizing the evolving dynamics that surround drug use and overdose can help

drive into the roots of San Francisco's drug crisis. When referencing the social ecological

model to this issue, it has various interconnectedness with the five different levels. It's

important to acknowledge drug use and overdose can occur at any age period. However, there

are various factors including external factors that influence an individual’s behaviors and

attitudes towards drug use. The lack of knowledge when it comes to drug usage and its risk

influences the interpersonal factor but, it's important to recognize that the policy level would

have the greatest impact on the San Francisco drug crisis. Focusing on the policy level

interventions will highlight the significant impact that governmental actions can have on

addressing the issue.

Theory – Policy Interventions

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The policy level involves interventions that build upon implementing laws,

regulations, and polices that can influence various factors. It can benefit San Francisco

County’s access to addiction treatment, harm reduction services, monitoring programs, and

with funding for prevention and treatment initiatives. Diving into the areas that are impacted

the most in San Francisco, it comes to show that poverty and homelessness plays a significant

role in drug usage and overdose deaths. With San Francisco being a large county and city,

areas like the Tenderloin, a neighborhood located in downtown and in the South of Market

neighborhood, have experienced a greater impact with its drug crisis. Using policy

interventions can result in restrictions on access to addictive drugs and the promotion of harm

reduction measures in San Francsico County.

Policy Interventions Central Concepts

At policy level, the Social Ecological Model offers a framework for understanding

and addressing the various complexities of San Franciso’s drug crisis. The first central

concept in policy interventions is regulatory reform. Implementing new regulations to

expedite administrative procedures, reduce bureaucratic barriers, and lower operating costs

for rehab centers to make services more affordable for patients. The second central concept

will be developing cost-sharing models. Implementing cost-sharing arrangements among

government agencies, healthcare providers, and community organizations can help spread the

financial burden of rehabilitation facilities. The third central concept is insurance coverage.

Striving for an all-inclusive insurance that covers addiction treatment services, can ensure

individuals access rehab centers without facing significant out-of-pocket costs.

The services that San Francisco has offered comes with a price tag many cannot

afford. Reflecting on San Francisco’s drug crisis and policy intervention, implementing laws

and regulations to allow access to rehabilitations affordable and regulated health insurance

plans. Referring to San Francisco Behavioral Health Plan, they offer services by a culturally

diverse network of community and provide services to individuals with Medi-Cal at no fee or
 10

with a minimum share of cost. Following a similar approach and strengthening the listed

capacities, can lead to a decline in San Francisco's drug overdose death rate.

Strategies And Activities

San Francisco's drug crisis is a pressing issue that needs proactive and comprehensive

solutions. In response to its urgent needs, we propose a multifaceted program designed to

treat the underlying causes of addiction and offer practical assistance and services to those

who are impacted by substance abuse. Strategies and activities using community engagement

and evidence-based practices, the program aims to reduce the harm that is associated with

drug use and promote long-term recovery. Through the combination of outreach initiatives,

treatment accessibility, and harm reduction measures, the program aims to thrive as a

supportive and encouraging environment where individuals who battle with addiction can

seek a pathway to recovery.

Through partnerships with (BARRT) organizations and healthcare providers, the

program will conduct events and seminars to help empower individuals with knowledge and

support networks. The program aims to develop outreach initiatives to target vulnerable

communities and provide them with education on drug abuse prevention and intervention,

along with the resources available. Strategies will be based on prioritizing harm reduction

measures within these programs to help reduce the spread of diseases and prevent overdose

deaths. For example, providing safe injection sites in areas that are most impacted within San

Francisco, such as the SoMa and Tenderloin neighborhoods. Both neighborhoods have a

serious negative impact on their society because of its association with the high rates of

sexually transmitted infections and drug overdose deaths. It's also known as the home to a

large population of homeless and to those who live in extreme poverty. In 2020 and 2021,

23% of drug overdose deaths transpired in the Tenderloin district and 18% in the South

Market area (CDC,NVSS, 2023). Many of these deaths occurred in civic spaces such as the

sidewalks that surround buildings and the outdoors. It makes it difficult for the public to walk
 11

by without feeling unsafe and at high risk of harm. This program in this area can be beneficial

in reaching the right audience, along with Implementation of safe injection sites in areas that

are most impacted can help reduce the risk of preventable disease, infection, and overdose

(Westminster. Uni. 2024).

The activities accomplished during the program will support service sustainability and

offer evidence of the program's impacts. For effective outcomes, the activities must be

aligned with the impact and process goal. These activities can lay the groundwork for the

program to better address and understand the requirements of patients. For this program,

communication must be effective and consistent between program managers, professional

teams such as nurses, therapists, and patients.

Social-Ecological Model

Individual

In the context of San Franciso's County drug crisis, the Social-Ecological model

recognizes that individual behavior is influenced by multiple layers of social and

environmental factors. At an individual level, factors such as genetics, mental health, and

personal history, can play a significant role in drug abuse. Additionally, interpersonal

relationships, community norms, and socioeconomic conditions contribute to the prevalence

of drug abuse disorders within neighbors and communities. In collaboration with the program

providers such as therapist and educators, the program will provide the tools and treatment

for patients who feel at risk with overlaps or usage of drug. The progam aims to create a

space for patients to feel comfortable and develop close friendships with peers and our

professional team.

Community

In addressing community-level factors such as socioeconomic disparities, access to

healthcare services, and neighborhood environments can significantly influence drug usage.

Socioeconomic disparities such as poverty and the lack of employment opportunities can
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develop an environment where drug use becomes a coping mechanism or a means of

survival. Limited access to healthcare services, including addiction treatment centers, can

make it difficult for individuals' ability to seek help and access resources for recovery.

Implementing this program in San Fransico’s most impacted area; Tenderloins and SoMA,

will help spread awareness to those who are need of treatment and care.

Strategies & Activities

Program participants engaged in criminal activities

The program implantation on strategies and activities will have a significant impact

on reducing criminal activities, particularly in drug-related offenses and other crimes linked

to drug abuse. By ensuring that the program oversees comprehensive insurance plans and

affordable options, it can enhance accessibility for individuals struggling with addiction. This

program will provide counseling, mental health support, treatment alternatives such as

medication or behavioral therapies, and assistance with employment and housing. Addressing

the roots of criminal behavior leads to poverty, homelessness, and mental illness. By

November 1, 2025, criminal activities in San Francisco’s County will decrease by 30%, after

three months of the programs opening.

Health Communication - Decrease utilization of emergency medical services,

hospitalizations, and other healthcare resources

Adding addiction centers in high-risk areas of San Francisco will significantly

decrease the utilization of emergency medical services, hospitalization and other healthcare

resources through strategic health communication efforts. Health communication plays an

important role in raising awareness about the availability of addiction centers, services

offered, and the benefits of seeking treatment. The program will use outreach programs,

social media campaigns, and information materials in healthcare settings. Health

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communication efforts can increase knowledge and awareness on addiction treatment

options.

Implementation Plan

The alarming rise in overdose deaths rates in San Francisco highlights the urgent need

to prioritize awareness and education surrounding drugs and addiction. Understanding the

risks associated with substance abuse and recognizing the signs of addiction are the key steps

towards prevention and intervention. When it comes to program implementation, it's

important to note the drug overdose deaths in San Francisco in 2023 had surpassed those in

2020 (OCME,2024). This demonstrates that there were new patterns and factors that emerged

within those three years, contributing to its drug overdose death rates. By breaking the cycle

of addiction, rehab programs foster healthier families, safer neighborhoods, and develop

stronger communities. This program will influence San Francisco’s County as a whole, by

reducing strain on healthcare systems, decreasing criminal activity rates, and promoting

economic productivity.

Program Implementation Values

Gateway Life Program is a proposed rehab drug program that aims to provide

comprehensive support and treatment for individuals struggling with substance abuse. The

program will address the complex needs of participants through a multifaceted approach that

will offer a combination of medical intervention, psychological counseling, and social

support. The implementation sets will include a team of qualified professionals, including

nurses, therapists, and social workers, who will work collaboratively to tailor treatment plans

to everyone's needs. Using evidence-based practices, this program will lean on cognitive

behavioral therapy and medication-assisted treatment to ensure effective outcomes. Through

group or individual counseling, this program helps create a feeling of community and

belonging by connecting participants with others who have gone through similar experiences

and challenges.
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Organization Partnership

BAART Programs is a network of addiction treatment centers that provide

comprehensive care for individuals struggling with substance use disorders or addiction. The

BAART programs have a focus on medication assisted treatment (MAT), counseling, and

behavioral therapy. By providing access to MAT, which combines FDA-approved

medications with counseling and support services, it has offered many a pathway to recovery

that reduces cravings, prevents withdrawal symptoms, and supports long term sobriety. When

incorporating implementation approaches, it's important to address not only the physical

aspects of addiction, but also the emotional, social, and environmental factors. Using similar

evidence-based practices as BAART programs, this program approach can result in greater

outcomes. Reflecting San Francisco’s highly populated drug use area; SoMa and Tenderloin

neighborhoods, both neighborhoods have a serious negative impact on their society because

of its associated high rates of drug overdose deaths and sexually transmitted infections.

Community Advisory Board

Before the launch of Gateway program, community meetings will be held to discuss and

share insights on the program's services and goals among San Francisco’s County residents

that are 18 years or older. Members under the (BAART) organization will be present in these

meetings to further support and represent the program's mission. The Community Advisory

Board will be hosted six months before the program's initial launch.

Staffing

The program will involve a collaborative effort among medical and mental health

professionals to assist both young and older adults in San Francisco who are struggling with

drug use disorders. The program will have a group of professionals looking into improving

treatment and care services for addiction. For this program to pursue, the recruitment process

must include the following positions; program manager, clinical personnel, and
 15

administrative positions. These positions are important roles to provide effective treatment

and care services at a rehab center.

Program Manager

The program’s manager will oversee daily operations, communicate strengths and

weaknesses among the team professionals, and collaborate with clinical personnel to ensure

the needs and perform effective teamwork. These positions will be in charge of developing

assessments in each area to make sure patients are receiving the accurate care and treatment

needed.

Clinical Personnel

The clinical personnel will consist of healthcare professionals such as nurses and

therapists, trained in addiction treatment mental health support. Healthcare professionals will

provide comprehensive care, including assessments, individualized treatment plans,

medication management, therapy sessions, and ongoing support for individuals that are

seeking recovery from drug abuse disorders. Their impact plays a significant role in the

program's outcomes and effectiveness.

Administrative Staff

The administrative team will handle the dissemination of program information across media

platforms and related organizations regarding the services offered.

Facilities

The program will be in San Francisco City, near Union Square and Tenderloin neighborhood.

The program’s operating hours will be every weekday, Monday to Friday, from 9am to 3pm.

Its location is surrounded by social services and local neighborhoods, rendering it a densely

populated area.

Program Equipment
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The program will need access to equipment for administrative staffing including the program

manager, and clinical personnel. Equipment for administrative staffing and program manager

consists of four desktop computers, one multifunction printer, three desk tables and chairs,

and telephone lines. For clinical personnel, equipment includes a clinical room, with two

patient beds, one examination table, medical tools like one sphygmomanometer, one

ophthalmoscope, one stethoscope, basic life support equipment, gloves, and diagnostic kits.

For therapist, equipment includes two therapy chairs, supplies like paper and pencils, two

laptop computers, and books on emotional intelligence.

Ethical Considerations

The success of Gateway depends on the trust patient's place in the program, its

resources and staff. Upholding privacy, respect and integrity requires careful review of all

ethical considerations. Safeguards includes confidentiality protocols and agreements to the

programs rules and policies, which includes guidelines for behavior, treatment participation,

and discharge procedures. The agreements are designed to ensure a safe and secure

environment for all patients and staff.

Confidentiality Protocols

The programs confidentiality protocols consist of privacy policies, limited access to records,

informed consent, and confidential communication. The program's privacy policies will help

outline how patient information will be collected, stored, accessed, and shared. Limiting

access to patients' information and records is highly important, only the authorized personnel

and healthcare provider that is directly involved in the patient's treatment can access these

documents. Confidential communications will be used such as encrypted emails or phone

lines to ensure the privacy of patient information during interactions with staff or healthcare

providers. Staff members must always maintain the confidentiality of patient information.

Reducing Negligence: Omission and Commission

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For this program, if a staff member fails to properly document a patient's medication

administration, or neglects to report changes in a patient's condition to a physician, the patient

has the right to constitute an act of omission. A solution to address the acts of omission can

be implemented through staff training programs to ensure that all personnel understand the

responsibility and knowledge and skills to document, communicate, and patient monitoring to

prevent acts of omission. Negligence through acts of commission involves reckless or

careless actions that directly cause harm, such as giving the wrong medication to a patient,

without the proper training. A solution to mitigate acts of commission can be by

implementing strict protocols and safeguards to prevent any unauthorized or inappropriate

actions. This includes verification on medication administration, reviews of patient care

practices and report any concerns or incidents to help address acts of commission.

Implementation Barries and Facilitators

Implementation barriers and facilitators can significantly impact the effectiveness of

treatment programs and overall well-being of patients. It also plays a cultural role in the

success of public health initiatives. By addressing barriers such as limited access to

healthcare services, resources constraints, or cultural differences, public health agencies can

secure interventions that reach the most in need populations.

Barries

Mental health is one of the main reasons why people decide to take drugs. Some

individuals view drugs as an escape from reality and don’t realize the consequences it can

lead to. With repeated drug abuse, individuals often require a higher dose to attain the same

euphoric effect. The ease with which addiction can take hold is often underestimated, a single

instance of drug use can spiral into a persistent issue. The lack of awareness regarding drug

use and inadequate mental health support is all connected to San Francisco's drug crisis. Drug

use and drug abuse are completely different stages. It is important to be aware that addiction

is seen differently for every individual. No matter the amount of dosage, the effects on the
 18

individual can be different. The lack of education and awareness is also a major factor that

needs to be addressed within these approaches. Some individuals are aware of their addiction

and want help but do not know where to start due to the lack of education they have with

resources. Interpersonal, one’s cultural or ethnic background also impacts their attitudes and

beliefs with drug treatment services. Gateway aims to address the roots of addiction but

acknowledging mental health and the factors that surround addiction. This program is a free

judgement zone where patients can trust staff and peers.

Facilitators

Local hospitals and clinics within the County of San Francisco can refer their patients who

may seem to be struggling with addiction to our program services. These local hospitals and

clinics will have access to informational packets and flyers that present the programs contact

information, location, and the services provided. Having a close relationship with local

hospitals and clinics can lead us to the right audience and outcomes. Gateway aims to strive

for health communication to enhance awareness, reduce stigma, and promote understanding

of addiction and recovery within the community.

Conclusion

Gateway aims to provide holistic support and empower individuals to their journey to

recovery. Through a focus on accessibility, cultural competence, and health communication,

Gateway seeks to overcome barriers to treatment and care, reduce stigma, and promote an

understanding of addiction and recovery. With a commitment to excellence and

improvement, Gateway can make a meaningful difference for individuals that struggle with

drug abuse disorders, fostering hope, healing, and resilience. It’s impact on San Francisco

will reflect on the community and the surrounding environment, allowing the County to strive

socially and economically. Its efforts to raise awareness and promote understanding of

addiction can inspire community members, stakeholders, and funders to invest in the program
 19

long-term. Together, we can work towards a healthier, resilient community where everyone

can thrive.

Evaluation Plan Matrix 1

Objective

By November 1, 2025, 30% of program participants engaged in criminal activities, such as drug-related

offenses or other crimes linked to substance abuse will decrease.

Evaluation Question

What factors implemented by the program are associated with the observed changes in criminal

activity?

Data Collection

Data Source Quantitative Qualitative Instruments &

Method
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Collaboration with Target assessments Be able to understand

Intruments:
Criminal Justice and collect data on the the associated factors

Agencies percentage of that are linked with -Assessments

participants engaged drug related criminal
-Surveys
in criminal activity activity

among the program.

Methods:

-Community Reports

-Program Records

Data Analysis

Using descriptive statistics to help identify the measures and trends of drug related

criminal activity.

Dissemination

Data findings will be reviewed by program staff to ensure the needs of participants to not

result in drug related criminal activities.

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Evaluation Plan Matrix II

Objective

By December 1, 2025, a decrease in the utilization of emergency medical services, hospitalizations, and other

healthcare resources related to drug overdose or substance abuse complications among program participants.

Evaluation Question

Will the program partner with local hospitals and clinics to track this data?

Data Collection

Data Source Quantitative Qualitative Instruments

& Method

Program Monitoring The number of Facilitate focus group

Instruments:
and Evaluation emergency room visits discussions with

or calls related to program participants -Assessments

drug overdose or to understand the
-Surveys
substance abuse journey, challenges,

and success in
 22

among program reducing healthcare Methods:

participants resource utilization
-Develop
related to drug abuse
assessments for
complications.
participants

- Create surveys

Data Analysis

I will analyze the data by acknowledging the strengths and weakness of the outcomes using

descriptive statistics that can help identify the areas.

Dissemination

Once data is collected and analyzed, I will reflect on the data and share it with all staff

members during a collective team meeting. I will share what areas need more improvement

and ways to outcome them.

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