Elsa Berhane

Ajeelon Boyd
Charrisha Hillery
Kamalprit Kaur
Ghazal Mahdavian
Sarah Sabliny

Never-II-Late

BACKGROUND
NEVER-II-LATE is a non-profit organization run by a team of health professionals with
a focus on Type II Diabetes Mellitus (T2DM). We have two facilities located in Los Angeles and
Oak Park, California. Our research has shown the youth in these two areas are steadily affected
by T2DM at an alarming rate. According to our research conducted in 2014, over half a million
people were living on the streets, in cars, in homeless shelters, or in subsidized transitional
housing in the United States. Of that number, over 25% of this population consisted of teenagers.
Furthermore, we discovered that 50% of school-age children who lack a permanent address
suffer from various psychological disabilities.

TARGET POPULATION
Our target population is homeless adolescents between the ages of 13 and 17 who suffer
from T2DM in the areas listed above. The overwhelming condition of homelessness can further
worsen the symptoms of T2DM due to the scarcity of resources. These individuals are in need of
immediate intervention to help them manage their condition, while aiming to decrease the risk of
comorbidities associated with the disease. Due to decreased rates of homeless people suffering
from T2DM, this population has been overlooked and is not seen as a priority.

GOAL
The goal of our six-month program is to provide general education, nutrition education,
psychological counseling, and placement support services to homeless adolescents between the
ages of 13 and 17 suffering from T2DM.

OBJECTIVES
To accomplish our goal we will provide weekly nutrition lessons taught by a registered
dietitian. We will also be working with a psychologist who will perform weekly individual and
group therapy sessions. After the completion of our program, we expect clients to be able to
properly assess and manage their blood glucose levels through proper use of blood glucose
monitors (BGM) and appropriate nutrient intake.
Through the implementation of weekly counseling, we expect participants to gain a sense
of social and emotional support, understand the depths of their homelessness, and realize the
resilience they possess to overcome this adversity. From our general education courses we expect
students to gain proper critical and problem solving skills. During the program, we project a 30%
drop out rate per cohort. We will assess each dropout participant individually, and are always
willing to make changes to enhance the overall experience of our program.

TIMELINE
Prior to our six-month program, there will be a 3-month initiation period. This initiation
period will be dedicated to renting a facility, developing connections with local hospitals and
clinics, finding resources, hiring health professionals and staff, as well as allocating costs.
Through our partnerships with local hospitals, clinics, and social workers we will acquire
homeless teenagers who are experiencing symptoms of poorly managed T2DM. We would then
go to the hospital or clinic to meet with the client to explain the purpose and the requirements to
receive our services. After receiving the client's and social workers consent, we would then
transport them to one of our two local facilities. The first month of the program includes initial
health assessment, general education and psychological counseling. Weekly nutrition lessons
will be implemented at the start of the second month. Monthly assessment of blood glucose
levels and academic performance will be conducted. Weekly program evaluations will also be
conducted during the six-month period.

INTERVENTION
Each facility includes a classroom, kitchen, four full bathrooms, and an area for sleeping.
Each facility will have its own van to transport our members to and from the clinic for their
check-ups. Each member will receive enough clothing items, toiletries, and menstrual hygiene
products to last them six months. Laptops and other educational resources will also be provided
to aid in their academic success. Each facility will have a Registered Dietitian who will provide a
monthly cycle menu. The menu will include three balanced meals and two snacks a day. The
menu will rotate every month to ensure a variety of different food options are provided that are
appropriate to their diabetic needs. The cycle menu ensures that our students know the types of
meals along with the times and dates they will be served to decrease their worries concerning
food insecurity. In order to receive our resources, members are required to attend general
education lessons, nutrition education lessons, psychological counseling sessions, and are
required to work with the social workers provided.
As part of our mission here at Never-II-Late, we will accommodate our clients by
individualizing their education curriculum to their specific learning needs. General education
lessons will be administered online via Connections Academy to ensure easy enrollment for new
incoming clients. Prior to online instruction, children will be given a placement exam to
determine their education level. Their score will then be used to classify their level of
competency as either beginner, proficient, or advanced; this will determine the grade level they
should be in. During their stay at our facility, each student will be provided with a laptop for easy
access to their online education. Online classes will be conducted Monday through Thursday
from 8:30 AM to 2:30 PM, with two 30-minute breaks and a one-hour lunch during that time. In
addition, students will be supplied with all necessary school supplies that will further enhance
academic performance via Connections Academy. These include calculators, books, paper,
desks, and other supplies. Basic reading, writing, science, and mathematic skills will be the focus
of our general education classes. A tutor will be available for students two hours a day to provide
them with additional academic support if they need it. During breaks, our students will be given
opportunities to participate in different outdoor activities, such as team sports and community
gardening.
Our nutrition education lessons will include lectures, workshops, and interactive activities
on topics related to T2DM and overall wellness. These lessons will be taught by a registered
dietitian on Fridays from 8:30 AM to 2:30 PM. Similar to their Monday through Thursday
schedule, they will receive two 30-minute breaks and a one-hour lunch. The first several
nutrition education lessons will focus on defining and assessing T2DM. Next, we will introduce
dietary glycemic control and how specific foods can alter blood glucose levels. Following this
topic, we will provide lessons and activities on carbohydrate counting and exchanges. This will
give them knowledge in the portioning of carbohydrates to help them minimize the risk of
unbalanced blood glucose levels. Glucose monitoring will also be an important focus of our
program. All members will be gifted a glucose meter and strips during the program and with
more strips upon completion of the program. We will show participants how to use the monitors
and how to interpret their blood glucose levels throughout the day, as shown on their monitor.
For example, if a client checks his/her post prandial blood glucose and reads a value of 200,
they should be able to interpret this value as high, and can take the appropriate dietary steps to
decrease the level. Our overall outcome is for clients to recognize the importance of disease
management through dietary actions.
As a shelter to homeless youth, we acknowledge maladaptive behaviors and strongly
emphasize psychological counseling within our program. A psychologist will aid each member
in acquiring information regarding their actions that have been affected by the unique
circumstances theyve experienced. Through one-on-one counseling, we will focus on the
importance of self worth, anxiety, and circumstantial aspects related to food insecurity. We will
also address mental and emotional factors such as depression, anxiety, hopelessness, low self-
esteem, and substance abuse. In addition to one-on-one therapy sessions, group therapy sessions
will play a vital role in building a community that provides a support system and meaningful
relationships amongst our members. Once the client-psychologist trust relationship has been
built, various coping methods are then incorporated.
Over the course of the program, the students will meet with their social worker twice a
month to work on finding appropriate housing placement to transition into after the completion
of the program.

BUDGET
With the 3 million dollars that we are being provided, the following costs would be for
the two facilities over a six-month period. We would spend $72,000 on rent and the total one
time cost of furniture would be $10,600. The cost of the package bundle that includes phone,
internet, cable, and a security system would cost $1,320. Electricity and water would be $30,000.
We are buying two 15-passenger vans that will be a one-time cost of a total of $40,000 and have
a rough estimate of $1,400 that will be spent on gas for the 6 months. The grocery cost will total
$16,800. Clothing for ten people per facility will be $2,000. Glucose monitors will be a one-time
cost of $600 and the glucose monitor strips will cost us $5,000. Registered Dietitians and tutors
will be $28,800 and we will be providing online classes that will total to $20,000. A chef and 24-
hour staffing for the two facilities will total to $151,600. The psychologist that will be coming
twice a week will cost $24,000. Kitchenware and electronic devices will be a one-time cost of
$3,000 and $14,450 respectively. Office and student supplies will cost a total of $12,000. The
total budget comes out to be $435,570. We will have $50,000 as a miscellaneous budget for the 6
months that will be used for any unexpected events. All costs, with the exception of our one-time
costs, over this 6-month budget will be repeated for each group of clients over the course of three
years.

MONITORING/EVALUATION IMPACT OF INTERVENTION

Throughout the duration of the program we expect to have a 30% dropout rate. We will
assess each dropout individually and from there assess what changes to the program are
necessary. To assess participant concerns and satisfaction with the program, biweekly house
meetings will be put into place so members can address any questions or issues they may have
with the program.
To assess changes in each patients change in blood glucose levels, we will acquire blood
lab results from the clinic. Based on these results, we will determine whether changes need to be
made in our nutrition lessons or within the meals we are providing. If neither of those are a
factor, we will assess the compliance of each participant to the program and their willingness to
actively improve their condition.
To assess the impact of our nutrition education program, two forms of assessment will
take place. Similar to our house meetings, we will ask participants to voice their feelings or
concerns regarding the nutrition education courses. However, different from house meetings,
participants will be given surveys they can answer anonymously. We will also assess the impact
of the courses by requiring participants to form groups and provide a food demonstration that
contains a meal that is T2DM friendly. This will illustrate the participants understanding of the
nutrition lessons and the impact of the nutrition education program.
Monthly assessments will be performed to evaluate student academic performance. This
will take into account overall completion of the online modules, as well as the overall passing
rate of the students. If students are not performing well, an evaluation of the online course and
methods of teaching and tutoring will be re-assessed.

SUSTAINABILITY
After the predicted three years of our program is complete, we will continue on with the
sustainable resources weve previously implemented. Because the general education courses are
online, the software will remain accessible for future students. Our nutrition education classes
given to the first cohort will be recorded for future clients to use as a learning tool, in the event
that a nutrition educator cannot be physically present. These videos and recordings will also be
used to accommodate students enrolled in our program who may need to reference the lesson at a
later time. Handouts that were created by the Registered Dietitian during our initial cohort will
be distributed to each future client. After our first cohort, we do plan to continue to use the same
facility; therefore our community gardens created by this first cohort will serve as a future
resource of healthy foods.
The cycle menu created by our Registered Dietitian will also be used for each future
cohort to ensure that all future clients receive adequate nutrition that will aid in the management
of their T2DM. We will also encourage clients to sustain the community garden for their own
personal benefit and for the benefit of others.
In addition to the provision of immediate services, the skills and knowledge clients
acquire will further aid them in their T2DM management once they have completed the program.
To target future clients who may be experiencing similar circumstances we will show them
anonymous reviews left from our previous clients.