Complex Post-Traumatic Stress Disorder (C-PTSD) compounded by housing instability presents a severe developmental and neurobiological crisis for adolescents and young adults. Chronic exposure to trauma during critical developmental windows – specifically the transition from adolescence (Identity versus Role Confusion) to emerging adulthood (Intimacy versus Isolation) – often results in identity fragmentation, hypervigilance, and maladaptive coping mechanisms that perpetuate a cycle of homelessness. Current intervention models frequently operate in silos, treating clinical symptoms and social needs as parallel tracks, which fails to address the underlying biological embedment of trauma. This paper proposes a paradigm shift through the Holistic Empowerment and Limitless Potential Programming (HELPP) initiative. Grounded in the Dynamic Flourishing Hierarchy (DFH) and a tiered public health prevention model, HELPP offers a trauma-informed, transdisciplinary intervention. By integrating four core pillars – Biological Recalibration via targeted Lifestyle Medicine, Psychosocial Recalibration utilizing Positive Psychology Interventions, Environmental Architecture, and Collective Integration – HELPP actively heals the neurobiological damage of trauma. Furthermore, by utilizing adults in the developmental stage of Generativity to serve as a supportive Net of Humanity, the initiative fosters sustainable exits from homelessness, empowering vulnerable youth to transition from mere survival to dynamic human flourishing.

HELPP for Vulnerable Adolescents and Young Adults Experiencing C-PTSD

“Adolescence and early adulthood is a challenging time for many young people; this developmental stage presents interpersonal challenges within friendships and intimate relationships while young people are trying to understand and make sense of who they are” (Kull et al., 2024; Pedersen et al., 2023). When compounded by additional challenges such as Adverse Childhood Events (ACEs), housing instability, and the resulting effects following these challenges, the long-term trajectory of their lives can lead to a perpetual cycling between struggle, added trauma, and maladaptive coping mechanisms. Ararso et al. (2021) report findings that highlight this disproportionate risk for negative outcomes persisting from emerging adulthood into adulthood for those who have had exposure to childhood abuse and homelessness, while Kull et al. (2024) notes that homelessness disproportionately exposes youth to interpersonal violence and further trauma, which fuels the cycle. Nakphong et al. (2024) reports that the experience of housing instability during young adulthood drastically increases the risk of chronic housing instability and poor mental health throughout the entire adult life course, which in turn often leads to self-medication through the use of drugs and alcohol to cope with the difficulties of painful emotions and lack of ability to regulate (Ararso et al., 2021).

Current systems often treat social and clinical needs as parallel tracks, resulting in fragmented care. Unmet social needs such as housing and food insecurity functionally restrict a patient’s ability to participate in health-seeking behaviors (Kepper et al., 2025; Perez, 2026c). Without a multidisciplinary framework that bridges clinical care and social support, the biological damage of trauma remains unaddressed, leading to “entrenchment in rough sleeping” due to maladaptive coping strategies (Mabhala, 2026; Perez, 2026c). These maladaptive coping strategies are often a feature of the perpetual cycle from the traumatic childhood events and compounding traumatic events that continue throughout emerging adulthood and beyond (Mabhala, 2026; Perez, 2026c).

Human Development Perspective: Stages and Arrested Growth

When it comes to the health crisis known as homelessness compounded by C-PTSD, the needs of two distinct yet overlapping developmental stages come to mind: Emerging Adulthood (ages 18–29) and Middle Adulthood (ages 40–65). However, the problems that individuals are typically facing during these periods often have roots in Adolescence (ages 12-18) and even prior (Drake et al., 2026; Kull et al., 2024; Perez, 2026a). Utilizing Eriksonian concepts brings us some insight into the overarching challenges of each stage of development.

Adolescence: Identity versus Role Confusion

Adolescence is a particularly sensitive stage of development, with children having gone through the progression of learning one’s capacities and limitations in the early childhood years that have just preceded it (Saracho, 2023). “Integrating Erikson and Piaget’s theories, the ages of 11 through 18 years are filled with the struggle to understand one’s identity and role in the greater context of the collective, while also navigating a developing sense of cognitive capacity with regards to abstract thought, logic, and problem-solving skills” (Saracho, 2023 as cited in Perez, 2026a). The potential for identity fragmentation due to exposure to traumatic stimuli such as abuse or unstable environments is a risk factor (Dickerson et al, 2009; Salafranca-Alves et al., 2025; Saracho, 2023, Simpson et al., 2025; Spinazzola et al., 2019; Zhang et al., 2026, as cited in Perez, 2026a). As children construct their schemas of the world – the filters through which they perceive the world – chronic exposure to trauma, stress, and abuse darkens these filters with maladaptive coping mechanisms and hypervigilance as a way of supporting their survival in an otherwise dangerous world (Perez, 2026a). “Children and adolescents diagnosed with PTSD face roadblocks in achieving healthy emotional, intellectual, and social development, compromising their cognitive functioning, ability to self-regulate, and capacity for resilience in response to additional trauma” (Drake et al., 2026). Drake et al. (2026) discuss the importance of early intervention and protective factors, such as supportive relationships, emotional regulation skills, and stable environments, in mitigating the long-term damaging effects of early traumatic experiences.

Emerging Adulthood: Intimacy versus Isolation

Individuals in emerging adulthood are navigating the crisis of Intimacy versus Isolation (Saracho, 2023). During this stage, the developmental task is to form deep, secure attachments and a stable sense of self-identity (Saracho, 2023). However, for those with C-PTSD, the Caregiving System is often viewed through a lens of threat (Spinazzola et al., 2019). Traumatic stressors and the instability of homelessness force these individuals into a state of hypervigilance, where the vulnerability required for intimacy is perceived as a survival risk. This results in developmental isolation and a persistent negative self-concept (Beckord et al., 2025).

Middle Adulthood: Generativity versus Stagnation

For individuals in middle adulthood, the primary task is Generativity – the ability to mentor others and contribute to what the Dynamic Flourishing Hierarchy (DFH) calls the Net of Humanity (Perez, 2026b). The Net of Humanity is simply the portion of the collective existing in a state of dynamic human flourishing, which is characterized by the ability engage in healthy meaningful interconnectedness with others and purposeful contribution through one’s personal state of overflow (Perez, 2026b). Chronic trauma and high allostatic load (the physiological wear-and-tear of stress) arrest this growth. Instead of contributing to the collective, these individuals are forced back into a state of survival that is characteristic of much earlier life stages, particularly if the initial exposure to traumatic events took place earlier in life.

Current Interventions versus HELPP

When it comes to interventions, there is a strong consensus in the literature to utilize multi-phased approaches to address the complex nature of C-PTSD (Cloitre et al., 2012; International Society for Traumatic Stress Studies [ISTSS], 2024). The multi-phased approach typically calls for establishing safety and stabilization first, then working through trauma processing, and then completing the approach with integration and reconnection (Cloitre et al., 2012; ISTSS, 2024). Recent meta-analyses highlight Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) for children and adults, adding Prolonged Exposure therapy (PE) as an additional option for adults (Haselgruber et al., 2024; Johnston et al. 2026; Tsang et al., 2026). Other potential interventions include Brief Focal Psychotherapy (BFP) and Dialectical Behavior Therapy (DBT) as well in order to address the self-organization clusters associated with PTSD (Cloitre et al., 2012; ISTSS, 2024). Other literature appropriately posits C-PTSD as a neurobiological crisis due to the chronic activation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis, lower DNA methylation at immune-related sites leading to widespread inflammation, and a general overall allostatic load, which is essentially physiological wear and tear on the body as a whole, which manifests as accelerated biological aging (Darrow et al., 2016; Palma-Gudiel et al., 2020; Perez, 2026a).

Kull et al. (2024) discussed a four-tier prevention model with regard to the crisis of homelessness (and originally highlighted by Farrell and Morton) in which the lower tiers focus on structural factors, such as policies that have a broader impact on the population, while the top tiers focus on targeted interventions, such as housing voucher programs. As the tiers progress, the needs become more acute. For example, Tier 2 is designed to focus on common pathways in which risk escalates into crisis, “such as addressing existing forms of adversity that young people and their families face that may eventually result in homelessness” (Kull, 2024). The focus of Tier 3 is on the more immediate crises that lead to homelessness, “which may involve interventions to quickly stabilize a young person who is about to lose their housing so that they can avoid entering the homelessness system through a shelter or other entry point” (Kull et al., 2024).

Holistic Empowerment and Limitless Potential Programming (HELPP): A Novel Integrated Approach to Address Homelessness and C-PTSD

The problem with many of the interventions available is that they are developed within a siloed approach – clinical interventions, due to systemic constraints in research design and funding structures, are rarely integrated and rarely address multiple factors as they manifest in complex, real-world settings outside of the research lab. Holistic Empowerment and Limitless Potential Programming (HELPP) aims to address this issue by offering an integrated, trauma-informed biopsychosocial approach to intervention specific to individuals at-risk for or experiencing homelessness, thereby bridging the gap between clinical care, social and environmental support.

Where standard programs typically address the symptoms of C-PTSD or use pharmacological means to force the body and mind into compliance, HELPP seeks to address the neurobiological foundation through a Lifestyle Medicine approach to treating the trauma’s biological embedment. The four pillars of HELPP work in tandem to address the multidimensional nature of C-PTSD and housing instability:

· Pillar 1: Biological Recalibration: This pillar is derived through Lifestyle Medicine Principles, addressing what is known in DFH as the Integrated Survival Bedrock – the physiological vessel of the human body along with its neurobiological safety and security system (Perez, 2026b). Promoting healthy nutrition, movement, recovery, and self-integration with the explicit intention of recalibrating HPA-axis activity, mitigating the inflammatory response to stress, and long-term physiological breakdown of the human body supports the mitigation of neurobiological damage effected by C-PTSD and ACEs.

· Pillar 2: Psychosocial Recalibration: This pillar utilizes the necessary therapeutic interventions such as Positive Psychology Interventions (PPIs) and other appropriate psychotherapeutic interventions to address the trauma of the mind and foster neuroplastic restructuring, moving beyond simple symptom management. Additionally, skills-building activities support further reinforcement of self-efficacy and capacity building that may have been disrupted during earlier courses of exposure to traumatic events.

· Pillar 3: Environmental Architecture: This pillar focuses on intentional environmental cueing and cultivation to address hypervigilance and support neural restructuring during the program. By providing an environment that facilitates access to food, safety, skills-building, self-maintenance and development activities, and areas of rest and recovery, the darkened filters of the schemas developed through exposure to traumatic events are eventually lightened, and confidence in forward progression in the developmental cycle is restored.

· Pillar 4: Collective Integration: This pillar focuses on both integration with and support from the Net of Humanity, those humans who are operating within the context of what DFH calls dynamic human flourishing – this is a state where individuals function within the context of meaningful and healthy interconnectedness with others and purposeful contribution to the collective (Perez, 2026b). When an individual is operating at this level, passion and purpose are seen as inevitable byproducts of this stage of existence, as is mentorship and support for those who are still working their way towards this state, or who may not have the capacity to fully operate at this state (Perez, 2026b). Program participants who successfully reach this stage may return to support programming for subsequent participants, whether as mentors with lived experience or as service providers across different areas of the program. This highlights the nature of sustainability in which DFH and HELPP have been intentionally designed.

Methods

HELPP utilizes a phased implementation model grounded in the PRECEDE-PROCEED planning framework and Asset-Based Community Development (ABCD).

Implementation and Participants. The program targets vulnerable adolescents (ages 12-18) and emerging adults (ages 18-29) experiencing housing instability and C-PTSD. Strategic selection of urban hubs (e.g., Oakland, San Francisco, Fremont) or rural-friendly environments will be selected as pilot sites to facilitate environmental change as a therapeutic tool. Implementation relies on a Multidisciplinary Team (MDT) comprised of doctors, mental health professionals, health/job coaches, and urban agricultural experts.

Evaluation Metrics and Success Indicators. HELPP employs a longitudinal, mixed-methods design for evaluation, incorporating the military practice of the After Action Review (AAR) for real-time adjustments. Various established scales will be used for data collection along with three methods of evaluation for the various stages of implementation including: Process Evaluation (Fidelity): Monitoring the quality and quantity of activities within the ep Health Centers and urban agriculture pillars; Impact Evaluation (Immediate Change): Measuring psychological and somatic shifts, including changes in self-efficacy following 1-day wellness intensives; and Outcome Evaluation (Sustained Flourishing): Tracking 24-month housing stability rates (with a target of at least 70%) and physiological shifts in immune and gut microbiome function.

Conclusion

The compounding crises of C-PTSD and youth homelessness cannot be resolved through fragmented, siloed systems that merely house the physical body or temporarily medicate the mind. As evidenced by the developmental trajectories of adolescence and emerging adulthood, chronic trauma fractures identity formation and isolates the individual, embedding itself deeply within the neurobiology of the human system. HELPP recognizes that true recovery requires the stabilization of the Integrated Survival Bedrock. By intercepting risk at critical public health tiers, HELPP moves beyond traditional case management. The integration of housing navigation with targeted Lifestyle Medicine and various psychotherapeutic interventions, where appropriate, provides the necessary biological and psychological software to recalibrate a nervous system damaged by chronic trauma. Furthermore, the program’s reliance on collective integration ensures that healing does not occur in isolation. By utilizing the mentorship of adults who have successfully achieved Generativity, HELPP weaves a cohesive community of support that actively pulls vulnerable youth out of survival mode. Ultimately, by operationalizing comprehensive, biopsychosocial support, practitioners and policymakers can disrupt the perpetual cycle of homelessness and complex trauma, transforming temporary havens of opportunity into permanent engines of dynamic human flourishing.

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• Physical

• Mental

• Emotional

• Relational

• Environmental

• Existential

The barriers associated with physical health are biological in nature and include the progressive wear and tear from a lifetime of cellular mitosis and mitochondrial degradation (Perez, 2026a; van der Rijt et al., 2020). This progressive decline also includes the decrease in hormone production and physiological efficiency, which makes it challenging for the body to maintain allostasis (Pfaltz & Schnyder, 2023). As is highlighted in the Dynamic Flourishing Hierarchy (DFH), “the deliberate, systemic provision of biological and psychological safety required to reduce chronic physiological wear and tear” is an essential component for supporting self-sovereignty and securing the Integrated Survival Bedrock (Perez, 2026b). This aligns with the clinical understanding of allostatic load, which is defined as “the strain on the body produced by systems under challenge and the changes in metabolism and wear and tear on a number of organs and tissues” (Pfaltz & Schnyder, 2023). This degradation of the physical vessel can manifest not only through decreases in physical mobility and capacity, but also through cognitive (mental), emotional, and existential challenges, which can also affect relational health (Overstreet, n.d.; Precision Nutrition, n.d.; Touro University Worldwide, n.d.). Vaziri et al. (2020) cite physical inactivity as a “major risk factor for chronic diseases, early mortality and increasing healthcare costs.”

Mental health requires “being alert, focused, competent, and thoughtful. Learning, remembering, and solving problems well”, whereas emotional and existential health are associated with “experiencing a full range of emotions and expressing them appropriately,” as well as “feeling a sense of meaning and purpose in life” (Precision Nutrition, n.d.). I personally feel that all of these are so closely tied in because (as previously discussed) the barriers associated with cognitive (mental), emotional, and existential health can be issues that are rooted in biological degradation and changes, such as dementia and Alzheimer’s disease (Overstreet, n.d.). In 2009 alone, an estimated 5.3 million people in the United States were afflicted with Alzheimer’s disease, a degenerative form of dementia” (Lykens et al., 2014). Psychosocial and environmental factors can also be the root factors for cognitive health struggles such as poverty, social distancing regulations that lead to increased isolation or increased isolation for other reasons, and even ruminations on lives that are perceived as unfulfilled or unproductive, which lead to despair, depression, and hopelessness (Mastrogiovanni et al., 2022, Overstreet, n.d.; Touro University Worldwide, n.d.). It is reminiscent to me of the ouroboros – the untenable cycle of the snake consuming itself; one’s physical decline leading to cognitive decline, which leads to emotional distress, which leads to existential dread and crisis, all exacerbated by increasing demands on relational health.

Relational health requires “being connected and authentic with others,” as well as “feeling supported and like you ‘belong’” (Precision Nutrition, n.d.). However, elders face significant systemic and environmental barriers to maintaining these connections. For example, recent years have shown how global events and “social distancing regulations have led to an increased risk of social isolation and physical inactivity, particularly among older adults” (Mastrogiovanni et al., 2022. From a biological standpoint, this loss of social connection is devastating. As outlined in the Dynamic Flourishing Hierarchy (DFH), “Load Sharing occurs as the brain literally incorporates relational partners into its neural representations of the self” and an individual’s cognitive and emotional resources are conserved when they have others to rely on (Perez, 2026b). When older adults face physical and cognitive decline, and simultaneously lose their peer networks, their environmental demands increase while their load-sharing partners decrease. This leads to an immense biological and logistical burden shift that may directly impact family and/or caregivers. When dealing with severe cognitive decline, “the impact of this disease is not limited to the patient but also has significant impact on the lives and health of their family caregivers” (Lykens et al., 2014). The barriers these caregivers face are often systemic and disproportionate; “caregiving responsibilities continue to fall primarily to women and some subgroups at greater risk for negative consequences – including caregivers to persons with dementia and those who have limited financial resources” (Johns Hopkins Bloomberg School of Public Health, 2025). As a result, “caregiver role strain is a common issue as the intensity and duration of care required escalate” (Touro University Worldwide, n.d.). Caregivers frequently sacrifice their own biological necessities, facing internal barriers of guilt and self-neglect (and as a mother and caregiver in my own right, I can vouch for this reality).

As DiLonardo (2024) notes, “When you’re caring for someone else, it’s often hard to focus on your own needs. You may even feel guilty when you do.” Ultimately, if these environmental demands exceed the caregiver’s resources, their physiological systems dysregulate, resulting in allostatic overload, which manifests as “sleep disturbances, irritability, impaired social or occupational functioning, and feelings of being overwhelmed” (Pfaltz & Schnyder, 2023). The ouroboros of issues and barriers rears its ugly head again, as the barriers affecting the elderly also become the barriers affecting the caregivers.

To break this untenable ouroboros of compounding barriers, we must fundamentally restructure how we approach the aging process and caregiver support. As proposed in the Dynamic Flourishing Hierarchy (DFH), true optimization cannot exist in an isolated dyad of patient and caregiver; rather, it is a “continuous, dynamic pulse of bioenergetic contribution and recovery, inherently dependent upon the structural integrity of both the individual and the collective” (Perez, 2026b). If we are to mitigate the allostatic overload placed on family caregivers, health educators and communities must facilitate environments that provide systemic Allostatic Support for both the caregivers and the elderly, securing their Integrated Survival Bedrock so they do not operate from a space of deficit. Additionally, we must intentionally rebuild the relational networks that older adults lose. By expanding the network of care beyond a single, isolated caregiver and into a broader, reliable social ecology, “the collective effectively frees up the metabolic and cognitive energy of its constituents” (Perez, 2026b). Only by shifting the burden from the exhausted individual to a resilient, interconnected collective can we transform the descent into old age from a crisis of degradation into a stage of supported self-sovereignty.

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Lykens, K., Moayad, N., Biswas, S., Reyes-Ortiz, C., & Singh, K. P. (2014). Impact of a community based implementation of REACH II program for caregivers of Alzheimer’s
patients. PLoS ONE, 9(2), e89290. https://doi.org/10.1371/journal.pone.0089290

Mastrogiovanni, C., Rosenbaum, S., Delbaere, K., Tiedemann, A., Teasdale, S., McGavin, A., Briggs, N., & McKeon, G. (2022). A mental health-informed, online health
promotion programme targeting physical activity and healthy eating for adults aged 60+ years: Study protocol for the Moving Together randomised controlled trial. Trials,
23, Article 1052. https://doi.org/10.1186/s13063-022-06978-3

Overstreet, L. (n.d.). Introduction to late adulthood. Lumen Learning. https://courses.lumenlearning.com/lifespandevelopment2/chapter/introduction-to-late-adulthood/

Perez, G. (2026a). Discussion 1: The thought process with aging [Discussion board post]. Touro University Worldwide.

https://portal.tuw.edu/

Perez, G. (2026b). The Dynamic Flourishing Hierarchy: A bio-psychological synthesis of individual sovereignty and collective resilience [Unpublished manuscript]. Master of
Science in Health Sciences Program, Touro University.

Pfaltz, M. C., & Schnyder, U. (2023). Allostatic load and allostatic overload: Preventive and clinical implications. Psychotherapy and Psychosomatics, 92(5), 279–282.
https://doi.org/10.1159/000534340

Precision Nutrition. (n.d.). Deep health questionnaire & assessment [PDF document].

Touro University Worldwide. (n.d.). Module 7: Elderly [Lecture notes]. MHS600.

van der Rijt, S., Molenaars, M., McIntyre, R. L., Janssens, G. E., & Houtkooper, R. H. (2020). Integrating the hallmarks of aging throughout the tree of life: A focus on mitochondrial dysfunction. Frontiers in Cell and Developmental Biology, 8, Article 594416. https://doi.org/10.3389/fcell.2020.594416

Vaziri, D. D., Giannouli, E., Frisiello, A., Kaartinen, N., Wieching, R., Schreiber, D., & Wulf, V. (2020). Exploring influencing factors of technology use for active and healthy ageing support in older adults. Behaviour & Information Technology, 39(9), 1011–1021. https://doi.org/10.1080/0144929X.2019.1637457

As a result, in 2017 the payroll taxes flowing into the Social Security system won’t be enough to cover promised benefits.
But the system will remain solvent because the Social Security Trust Fund will be able to cover the shortfall until 2041. (para. 6)

Beyond the challenge to our social services system, Johns Hopkins Bloomberg School of Public Health (2025) highlights the upcoming challenge of “the population of adults age 85 and older projected to triple by 2050” and the “urgent need to address disparities in caregiver experiences.” Overstreet (n.d.) adds that “The number of old requiring support from their children is expected to more than double by the year 2040.” As previously discussed, work by van der Rijt et al. (2020) reminds us how the body starts to function in a state of decline, rather than regeneration as early as midlife (Perez, 2026). The physical body is, as I previously stated, “running off of the progressive wear and tear of multiple cycles of cellular mitosis over the course” of time (Perez, 2026). As stated in our “Home” section for this module, “this decline leads to physical degeneration and, ultimately, the mortality of the human organism” (Touro University Worldwide, n.d.).

“According to Erikson’s theory, the stage from age 65 to death is characterized by a shift from active productivity to reflection” (Touro University Worldwide, n.d.). Between the limitations of physical activity due to the degeneration of the body, the potential cognitive decline due to diseases like Dementia and Alzheimers, osteoporosis or osteopenia, or even just the potential depression that comes from reflecting on an unfulfilled life, there exists far more things, both physical and mental/emotional, to be concerned about beyond just the burden on the social welfare system (DiLonardo, 2024; Overstreet, n.d.; Touro University Worldwide, n.d.; Vaziri et al., 2020). When we consider that health and well-being constitute several dimensions that affect the whole person – physical, mental, emotional, existential, relational, environmental – the transition into old age demands a holistic and integrative approach for Health Educators, caregivers, and the general populace alike (Precision Nutrition, n.d.).

Physical & Environmental Dimensions

To mitigate the challenges associated with physical degeneration, health educators should shift the focus of aging from disease management to functional preservation. As is highlighted in the Dynamic Flourishing Hierarchy (DFH), “the deliberate, systemic provision of biological and psychological safety required to reduce chronic physiological wear and tear” are essential components for supporting self-sovereignty and securing the Integrated Survival Bedrock (Perez, 2026). “Optimization is a continuous, dynamic pulse of bioenergetic contribution and recovery, inherently dependent upon the structural integrity of both the individual and the collective” (Perez, 2026).

As Overstreet (n.d.) notes, “Perhaps nurses and other allied health professionals working with this population will begin to focus more on helping patients remain independent than on simply treating illnesses.” Educational programs must teach individuals the concept of “selective optimization with compensation,” empowering them to make environmental and lifestyle adjustments to continue living as actively and independently as possible (Overstreet, n.d.). Additionally, educators should introduce active and healthy aging (AHA) technologies, as research demonstrates that “technologies that quantify and provide feedback on physical activity seem to increase physical activity levels” among older adults (Vaziri et al., 2020).

Existential, Mental, & Emotional Dimensions

Beyond physical maintenance, extended longevity brings profound psychological challenges that educational programs must address to prevent the despair and hopelessness Erikson warned of (Touro University Worldwide, n.d.). Health educators must recognize that “older adults’ motivation to lead a healthy lifestyle and exercise is not to look good, but rather feel good” (Vaziri et al., 2020). I see this actively in my one-on-work with clients who exist in the dimension of old age – when we discuss goals and desired outcomes, the answer is usually a variation of , “simply, to live as well as possible for the remainder of my days.” Therefore, programs should integrate emotional support and social connection directly into health management. “Social aspects in physical activity are of utmost importance for older adults,” meaning that AHA technologies and community programs should embed their training in socializing events to combat isolation and fulfill the human need for purpose and connection (Vaziri et al., 2020).

Relational Dimension (Caregiver Training)

Finally, addressing the relational dimension requires urgent support for the 24.1 million family caregivers in the United States — a number that has increased by 32% since 2011 (Johns Hopkins Bloomberg School of Public Health, 2025). As the duration and intensity of care escalate, caregiver role strain becomes a profound public health issue (Touro University Worldwide, n.d.). Health educators must train caregivers on how to proactively establish a “road map for care,” emphasizing the importance of talking to loved ones early about their needs and boundaries (DiLonardo, 2024). Additionally, educational interventions must teach caregivers how to manage their own emotional well-being. “When you’re caring for someone else, it’s often hard to focus on your own needs... But taking care of yourself will help you be more focused and do a better job for your loved one” (DiLonardo, 2024). We have to remember from our last discussion that, “In established adulthood, individuals are ‘deeply absorbed in their occupational responsibilities while also meeting the responsibilities of a romantic relationship, caring for children, friends, aging parents, family members and pets’” (Mehta & Arnett, 2023, as cited in Reifman & Niehuis, 2022). This means that education for caregivers should integrate information on resource utilization that is available within the local communities in which they are existing. Finally, educators can train families to utilize AHA technologies that include remote “buddy systems,” helping to distribute the emotional and physical load of caregiving across a wider network (Vaziri et al., 2020).

References

Bump, P. (2026, April 17). Baby boomer. In Encyclopedia Britannica. https://www.britannica.com/topic/baby-boomers

DiLonardo, M. J. (2024, May 15). Caregiving for older adults. WebMD. https://www.webmd.com/healthy-aging/aging-caregiving-older-adults

Johns Hopkins Bloomberg School of Public Health. (2025, February 4). Number of family caregivers supporting older adults increased nearly one-third between 2011 and
2022. https://publichealth.jhu.edu/2025/number-of-family-caregivers-supporting-older-adults-increased-nearly-one-third-between-2011-and-2022

Overstreet, L. (n.d.). Introduction to late adulthood. Lumen Learning. https://courses.lumenlearning.com/lifespandevelopment2/chapter/introduction-to-late-adulthood/

Perez, G. (2026, April 15). Discussion 2: Midlife [Discussion board post]. Touro University Worldwide.

https://portal.tuw.edu/

Perez, G. (2026). The Dynamic Flourishing Hierarchy: A bio-psychological synthesis of individual sovereignty and collective resilience [Unpublished manuscript]. Master of
Science in Health Sciences Program, Touro University.

Precision Nutrition. (n.d.). Deep health questionnaire & assessment [PDF document].

Reifman, A., & Niehuis, S. (2022). Extending the five psychological features of emerging adulthood into established adulthood. Journal of Adult Development, 30(1), 6–20.
https://doi.org/10.1007/s10804-022-09412-9

Touro University Worldwide. (n.d.). Module 7: Elderly [Lecture notes]. MHS600.

van der Rijt, S., Molenaars, M., McIntyre, R. L., Janssens, G. E., & Houtkooper, R. H. (2020). Integrating the hallmarks of aging throughout the tree of life: A focus on
mitochondrial dysfunction. Frontiers in Cell and Developmental Biology, 8, Article 594416. https://doi.org/10.3389/fcell.2020.594416

Vaziri, D. D., Giannouli, E., Frisiello, A., Kaartinen, N., Wieching, R., Schreiber, D., & Wulf, V. (2020). Exploring influencing factors of technology use for active and healthy
ageing support in older adults. Behaviour & Information Technology, 39(9), 1011–1021. https://doi.org/10.1080/0144929X.2019.1637457

Ydstie, J. (2008, January 1). Baby boomers begin to claim Social Security. NPR. https://www.npr.org/2008/01/01/17767992/baby-boomers-begin-to-claim-social-security

“Piaget’s theory suggests that cognitive development, after reaching the operational stage, is primarily about knowledge acquisition. In adulthood, individuals have numerous opportunities to learn new things. However, the extent of cognitive growth largely depends on the individual’s initiative and willingness to engage with
these opportunities.” (Papalia & Martorell, 2021, as cited in Touro University Worldwide [TUW], 2026)

I will take it back a little further to expand on my opening statement: the foundations for this proficiency are established through the simultaneous development of the nervous and the musculoskeletal systems. Simply put, an individual can only integrate and process (psychological context) the information from the outside world (socioenvironmental contexts) within the capacity of their biological system. Karatayeva (2025) discusses this in detail in her paper Psychological Development Characteristics in the Early Stages of Ontogenesis. “Biological factors determine the initial level and potential of psychological development” (Karatayeva, 2025). It is further explained that the brain’s various structures are not fully formed at birth but continue to develop through numerous significant changes over the following years (Karatayeva, 2025). When one considers that specific brain structures, along with specific musculoskeletal developmental milestones, are prerequisites for specific interactions and degrees of self-sovereignty and agency, then theories like Erikson’s and Piaget’s make sense.

I just sat down with someone whom I once knew as a friend from a particular era of my life where my identity was at its (arguably) peak level of masking. We share enough similarities in the work that has both simultaneously been chosen and has chosen us, some of the traumas and challenges we have faced, and most importantly for me, the distant connection to a particular milestone era in our respective lives that I recognized the need to sit down and dig into understanding exactly all that we are discussing in this thread – the evolution of our cognitive processes and perspective through life and how they’ve impacted (and continue to impact) our respective personal developments and interactions within life. What she helped me come back to in our conversation was the understanding of attachment styles, the both conscious and subconscious choices we’ve made to move forward through lives driven by what I have just spoken about in the last paragraph – the simultaneous development of the brain, psyche, and self through various crucial periods of our lives. This drives what we have the confidence to achieve, as much as it drives the dysfunctional behaviors we engage in.

In established adulthood, individuals are “deeply absorbed in their occupational responsibilities while also meeting the responsibilities of a romantic relationship, caring for children, friends, aging parents, family members and pets” (Mehta & Arnett, 2023, as cited in Reifman & Niehuis, 2022). We have come to this era of our lives where it is absolutely crucial for individuals interested in leaving the world better than the way that they found it to know themselves, their triggers, their wounds, their weaknesses, their strengths, and in sum, themselves deeply enough to facilitate the way they navigate relationships and interactions with the outside world – and by “outside world,” I am including our children, partners, aging parents, extended family members, friends, coworkers, and everyone else beyond. It is important because, while these deeply embedded and developed patterns, responses, and perspectives can be helpful in some contexts, they may also be the very thing that perpetuates dysfunction and interferes with our deepest desires to develop and maintain meaningful interconnectedness and purposeful contribution to the world.

We see this clearly stated in Erikson’s respective stages of early childhood through late adolescence where the identity struggle is rooted in understanding one’s capacity and role all the way to the journey from young adulthood through old age where the struggle of identity is now contextualized through how well the capacity and role building allows one to navigate the world and what that looks like in terms of the subjective value add or detraction from the world. By midlife or middle adulthood, “Generativity is about ‘making your mark’ on the world by caring for others and accomplishing things that improve it” (Cherry, 2026). The natural pace of evolution from this stage as we reach older adulthood through the twilight years leads people to a realization that is found “If you look back and you’re satisfied with the way that things have gone in your life you’ll have this sense of ego integrity. However, if you look back and you have a lot of regrets... you will have this sense of ego despair” (Shuttlesworth, 2013, 10:05).

Going back to my conversation, I recognize that I chose to have it with her because, in a way, she is a bridge to the era of my life when I was most disconnected from the self I have chosen to become today. “The central position in the life course is captured by balancing gains and losses associated with the aging process, linking earlier and later periods of life, and bridging generations” (Infurna et al., 2020). As I step fully into this stage of my life as a leader in health and wellness, a leader in my family, and most importantly, the main character in my life, I recognize that the stakes are high when it comes to being able to lead by example and working through potential blocks that I may later come to regret in old age. I am at a point where fluid intelligence – the capacity to use deductive reasoning for problem-solving – is at its peak. According to Shuttlesworth (2013), it will decline in old age. I have reached, what some might call, the greatest vantage point in my life, to see all that it took to get me to where I am, with the capacity to still drive the direction the descent from the mountain, so to speak, will look like.

At the end of my life, I would hope to find myself on the side of integrity, rather than despair.

References

Cherry, K. (2026, March 31). Generativity vs. stagnation in psychosocial development. Verywell Mind. https://www.verywellmind.com/generativity-versus-stagnation-2795734

Infurna, F. J., Gerstorf, D., & Lachman, M. E. (2020). Midlife in the 2020s: Opportunities and challenges. American Psychologist, 75(4), 470–485. https://doi.org/10.1037/amp0000591

Karatayeva, L. U. (2025). Psychological development characteristics in the early stages of ontogenesis. Journal of Applied Science and Social Science, 15(12), 272–274.

Reifman, A., & Niehuis, S. (2022). Extending the five psychological features of emerging adulthood into established adulthood. Journal of Adult Development, 30(1), 6–20. https://doi.org/10.1007/s10804-022-09412-9

Shuttlesworth, M. (2013, June 7). Development Erikson, adolescence, middle, old age [Video]. YouTube.

Touro University Worldwide. (2026). MHS600: Health through the life span: Module 6: Middle adult [Course content].

https://portal.tuw.edu/

As Cherry (2024) states, “Some people might experience what is often referred to as a ‘midlife crisis’ at this point in life. They may reflect back on their accomplishments, consider their future trajectory, and regret missed opportunities such as going to school, pursuing a certain career, or having children.” However, Infurna et al. (2020) highlight research findings that seem to make the idea of the midlife crisis a myth – only 10-20% of individuals actually go through a midlife crisis. On the other hand, when further delving into the review of the research by Infurna et al. (2020), what we can deduce is that midlife is a period of nuance and complexity, culminating in the collective result of all that I discussed in our previous conversation – the translation of the various biopsychosocial inputs that have shaped and formulated the middle-aged adults who are faced with the choices between responsibility to self, others, and a larger purpose.

“Midlife can also be a peak time in many areas, including earnings, position at work, leadership in the family, decision-making abilities, self-confidence, control beliefs, and contributions to the community” (Infurna et al., 2020). Shuttlesworth (2013) corroborated this sentiment in her video, stating that middle adulthood can be considered a prime period of life due to the establishment of career, relationships, and a feeling of finally having a sense of autonomy over one’s life. Reifman & Niehuis (2022) supported this notion, stating that this era entails the solidification of identity and the realization of having reached adulthood. However, midlife is also notably a time period in which one’s health and well-being are instrumental influences in the course of older adulthood (Infurna et al., 2020). As cited by Infurna et al. (2020), multiple studies have noted how health disparities across SES, race, ethnicity, and sexual orientation become magnified during midlife. Work by van der Rijt et al. (2020) highlights the important reminder that at the cellular level, the body is functioning in an environment of decline and deterioration. While cognitive processes may cumulatively have integrated a half-lifetime full of knowledge and experience, the physical material that houses our psyche is running off the progressive wear and tear of multiple cycles of cellular mitosis over the course of that time.

Figure 1
Mitochondrial Dysfunction and the Hallmarks of Aging

Having both the cognitive understanding and feeling the effects of the body no longer being in the throes of robust development can lead individuals to one of a few choices, including the choice to succumb to the process or a more deliberate intention to mitigate it through lifestyle habits and changes. “Research suggests that generativity can provide a greater motivation to initiate and maintain healthy behaviors” (Cherry, 2024). Cherry (2024) also cites that people operating within the context of generativity, building the skill of healthy contribution supports general feelings of satisfaction with the self and with life. “Generative people are productive in a variety of ways, including teaching, mentoring, and volunteering – both in their personal lives as well as at work” (Cherry, 2024). This is what is known in the Dynamic Flourishing Hierarchy (DFH) as meaningful interconnectedness and purposeful contribution (Perez, 2026b). The simultaneous understanding of how much one has learned and experienced along with the knowledge that decline is just around the corner can be a powerful motivator to be more intentional about one’s choices and overall impact on the world. There is no time like the present moment to either double-down on the choices that brought you to this point of existence or change course in hopes of truly enjoying the descent from the mountain.

References

Cherry, K. (2024, July 14). Generativity vs. stagnation in psychosocial development. Verywell Mind. https://www.verywellmind.com/generativity-versus-stagnation-2795734

Infurna, F. J., Gerstorf, D., & Lachman, M. E. (2020). Midlife in the 2020s: Opportunities and challenges. American Psychologist, 75(4), 470–485.
https://doi.org/10.1037/amp0000591

Perez, G. (2026a). Discussion 1: The thought process with aging [Discussion board post]. Touro University Worldwide. https://portal.tuw.edu/

Perez, G. (2026b). The Dynamic Flourishing Hierarchy: A bio-psychological synthesis of individual sovereignty and collective resilience [Unpublished manuscript]. Master of
Science in Health Sciences Program, Touro University.

Reifman, A., & Niehuis, S. (2022). Extending the five psychological features of emerging adulthood into established adulthood. Journal of Adult Development, 30(1), 6–20.
https://doi.org/10.1007/s10804-022-09412-9

Shuttlesworth, M. (2013, June 7). Development Erikson, adolescence, middle, old age [Video]. YouTube.

van der Rijt, S., Molenaars, M., McIntyre, R. L., Janssens, G. E., & Houtkooper, R. H. (2020). Integrating the hallmarks of aging throughout the tree of life: A focus on
mitochondrial dysfunction. Frontiers in Cell and Developmental Biology, 8, Article 594416. https://doi.org/10.3389/fcell.2020.594416

Narrative Summary of the Logic Model

A logic model serves to communicate the underlying assumptions upon which an activity is expected to lead to a specific result (Touro University Worldwide, n.d.). For HELPP, this model is built upon the “Dynamic Flourishing Hierarchy” (DFH), prioritizing the inextricable link between the human vessel and basic safety needs before moving toward self-agency and interconnectedness (Perez, 2026). The model is broken down into the following phases:

• Inputs & Activities: The program relies on diverse funding, repurposed physical infrastructure, and robust cross-sector partnerships. These resources fuel HELPP’s four interconnected pillars: Integrated Deep Health and Wellness Centers, Housing Solutions, Education and Vocational Training, and Sustainable Agriculture.
  
  

• Outputs: These are the immediate, quantifiable units of service provided, such as the number of individuals housed, the volume of clinical consultations, and the agricultural yield of the urban farm. Measuring these ensures the program is actively mobilizing its resources.
  
  

• Outcomes: The short-term focus secures the “Integrated Bedrock” of the DFH — providing safety, housing, and immediate health stabilization (Perez, 2026). This naturally progresses into intermediate outcomes, where participants develop self-agency and sovereignty through education, vocational training and/or entrepreneurship.
  
  

• Long-Term Impact: By applying a strengths-based approach that leverages the raw experiences of the community — much like grinding ingredients in a molcajete to create something richly transformative (Perez, 2025) — the ultimate long-term impact is a measurable reduction in systemic health disparities and chronic homelessness (which is a root cause for a multitude of health issues, thereby its identification as a health issue itself). Ultimately, HELPP creates an environment where individuals do not just survive, but achieve adaptable, passionate, and purposeful Dynamic Human Flourishing.

References

Community Tool Box. (n.d.). Chapter 2. Other models for promoting community health and development: Section 10. The strategic prevention framework. University of
Kansas. https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/strategic-prevention-framework/main

Perez, G. (2024, May 28). Holistic Empowerment and Limitless Potential Programming
(HELPP) [Unpublished manuscript]. Transcendfit Health and Wellness, LLC.

Perez, G. (2025, June 18). Welcome to the HELPP Network’s molcajete. Substack.

HELPP's Substack

Welcome to the HELPP Network's Substack!

The Recipe for a Dynamically Flourishing Life Starts Here…

Read more

a year ago · 2 likes · 1 comment · Genevieve Perez

Perez, G. (2026). The Dynamic Flourishing Hierarchy (DFH) [Unpublished manuscript]. Touro University Worldwide.

Touro University Worldwide. (n.d.). Module 6: Strategies defined and program implementation [Lecture notes]. MHS602.

1. Intention first: What is my ultimate intention? What results do I aim to achieve?

2. Delivery: How can I most effectively deliver my intention in a way that inspires learning, integration, and action?

From our “Home” section for this module, it is stated that “Implementation is the act of converting planning, goals, and objectives into action through administrative structure, management activities, policies, procedures, and regulations, and organizational actions of new programs” (Touro University Worldwide, n.d.). The Community Tool Box from the Center for Community Health and Development at the University of Kansas (n.d.) discusses the Strategic Prevention Framework (SPF) established by the Center for Substance Abuse Prevention (CSAP), part of the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. In this framework, strategies are chosen from “a number of possible evidence-based best practices” along with the cost and resource needs for successful implementation. Healthy People 2030 defines strategies as a “plan of action” to “set national goals and measurable objectives to guide evidence-based policies, programs, and other actions” within the context of improving health and well-being (Office of Disease Prevention and Health Promotion, n.d.).

Regardless of which agency or organization, I feel like there does exist some universal evaluation of solid strategies, implementation, and execution. I know that the prompt is asking for two questions, but I feel like there exists a whole list of questions to ask and/or things to look for in the health promotion plan.

Across the board, we should

1. Recognize and/or identify the problems we aim to resolve or the desired outcomes that we intend to support

2. Recognize and/or identify the things that support the resolution of the problem(s) OR recognize what things support the maintenance or further enhancement of the desired outcomes

3. Identify the potential root cause(s) of the problem(s) or barriers to the continuation or support of desired outcomes

4. Identify the resources available towards our solutions, as well as existing gaps and needs

5. Possess knowledge or execute research into evidence-based “best practices” (if any) for addressing the desired outcomes.

If we have to ask two questions that would cover the need to look into these five things, I might ask:

1. What are the root causes or barriers to the desired outcomes of our health promotion plan?

2. Where are our gaps? What resources do we have available towards the resolution, and what resources do we still need in order to address the issues?

Asking these two questions then gives us the basis for our strategies, as well as the key performance indicators (KPI) or measurable data points to evaluate our progress forward.

References

Center for Community Health and Development. (n.d.). Chapter 2. Other models for promoting community health and development: Section 10. The strategic prevention
framework. Community Tool Box. University of Kansas.
https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/strategic-prevention-framework/main

Office of Disease Prevention and Health Promotion. (n.d.). Healthy People 2030 framework. U.S. Department of Health and Human Services.
https://health.gov/healthypeople/about/healthy-people-2030-framework

Touro University Worldwide. (n.d.). Module 6: Strategies defined and program implementation [Lecture notes]. MHS602.

After reading the required sources for this module and reviewing the recommended sources, I am drawn heavily to Cormac Russell’s (2016) TedX speech in which he discusses sustainable community development. According to Russell (2016), a primary best practice is to “start with what is strong within them and their communities and not with what’s wrong.” The idea is that programs are more effective when the strengths of the members of the community are effectively leveraged after identification, connection, and mobilization (Russell, 2016). Successful organizing utilizes the “raw ingredients that people use to make change happen from the inside out” (Russell, 2016).

This particular discussion about best practices strikes me personally because the work that I have been doing to actualize my own vision for change and transformation in the world through HELPP (Holistic Empowerment and Limitless Potential Programming) is aligned closely with what he speaks of, even though I had never heard of Cormac Russell until taking this class (Perez, 2024, 2026). A metaphor that I use often when discussing transformation is the concept of the molcajete – a mortar and pestle made from volcanic rock – where the raw experiences, signals, and input from one’s life are ground together to create a cohesive and richly flavorful seasoning that transforms the main item: the sovereign human (Perez, 2025). In fact, the Dynamic Flourishing Hierarchy (DFH) is my restructurization of Maslow’s framework that posits human self-actualization as the pinnacle of human development after the sequential acquisition of basic needs to safety to love and belonging to self-esteem (Perez, 2026). The DFH instead integrates the foundation of Maslow’s Hierarchy into one “Integrated Bedrock” based upon the idea that the human vessel and safety needs are inextricable from each other (Perez, 2026). Once these two are secured, self-agency and sovereignty form the outer shell of the individual, and only then can we move forward into healthy and meaningful interconnectedness (expansion of what Maslow initially calls “Love and Belonging”). The ultimate level is where passion and purpose live, and this is where we continue in the spirit of Dynamic Human Flourishing (Perez, 2026). It is not a static peak of perfection, but rather, adaptability in the face of the inevitable chaos of life. This model is based on the understanding that true and lasting change is a process that happens within the context of a dynamic conversation between the internal and the external, the individual and the collective, and ultimately the collective and the surrounding world and universe.

What does this mean from a practical and applicable perspective?

Let’s consider University of Kansas’ Community Tool Box (2013) and their suggestion on implementing the Ten Essential Public Health Services, which create a “comprehensive infrastructure that can provide a supportive context for any public health priority.” As was stated in our Home section for this particular module, infrastructure should be built around the core functions of “assessment, policy development, and assurance” (Touro University Worldwide, n.d.). Let’s also revisit what Cormac Russell (2016) listed as the Six Building Blocks of Community Change (though only five were actually listed on his slide in the presentation) being: 1) The Skills of Local Residents, 2) The Power of Local Social Networks, 3) The Resources of Public, Private and Non-Profit Institutions, 4) The Physical and Economic Resources of Local Places, 5) The Stories of Our Shared Lives. Centers for Disease Control and Prevention [CDC] (2025) states that programs should be designed as an “inclusive environment” where all individuals can “fully participate in society” and that practitioners should employ the A.L.L.Y. strategy: “Acknowledge, Learn, Leverage, and Yield” to promote community inclusion.

Across the board, there is a unified thought that best practices for program design for any particular community should be based on an assessment process that is wholly inclusive of the community in question, assessing the needs, the strengths, the weaknesses – you know, the same thing we do when getting to really know a person. As stated on the Home section for this particular module, Programs must recruit an appropriate mix of “executive participants which is a small, committed core group [...] active participants those willing to work [...] occasional participants those involved on an irregular basis [...and] supporting participants” (Touro University Worldwide, n.d.). Once you’ve asked, dove into, and have a solid understanding of the needs, policy development can be initiated to integrate the knowledge we’ve acquired, and these policies can cover everything from capacity building and standards setting to the mediation of partnerships and collaborative endeavors between otherwise disparate entities that exist within the larger community.

Through this process, the best practices call for the use of interventions that have “undergone critical review of multiple research & evaluation studies” (Touro University Worldwide, n.d.). In fact, we can increase effectiveness by “segmenting” (dividing a broader population into smaller groups) and “tailoring” (creating interventions for specific needs and circumstances) (Touro University Worldwide, n.d.). Best practices cannot be best practices without data guiding both the delivery of information and the assessment of outcomes. We must use “research-based strategies to shape materials” while considering “health literacy, internet access, media exposure, and audience” (Rural Health Information Hub, 2024). The use of “statistics, epidemiological methods, and quantitative methods” is essential in the promotion of public health and program evaluation (Spiegelman, 2016). Additionally, practitioners should utilize “implementation science” to identify strategies for scaling up effective interventions in real-world settings (Spiegelman, 2016).

References

Centers for Disease Control and Prevention. (2025, April 3). Disability and health promotion. https://www.cdc.gov/disability-and-health/index.html

Perez, G. (2024, May 28). Holistic Empowerment and Limitless Potential Programming (HELPP) [Unpublished manuscript]. Transcendfit Health and Wellness, LLC.

Perez, G. (2025, June 18). Welcome to the HELPP Network’s molcajete. Substack. https://helppnetwork.substack.com/p/welcome-to-the-helpp-networks-molcajete

Perez, G. (2026). The Dynamic Flourishing Hierarchy (DFH) [Unpublished manuscript]. Touro University Worldwide.

Rural Health Information Hub. (2024, January 17). Health communication strategies - Rural health promotion and disease prevention toolkit.
https://www.ruralhealthinfo.org/toolkits/health-promotion/2/strategies/health-communication

Russell, C. (2016, May 16). Sustainable community development: From what’s wrong to what’s strong [Video]. YouTube.

Spiegelman, D. (2016). Evaluating public health interventions: 1. Examples, definitions, and a personal note. American Journal of Public Health, 106(1), 70–73.
https://doi.org/10.2105/AJPH.2015.302923

Touro University Worldwide. (n.d.). MHS602: Module 5: Selecting appropriate strategies [Lecture notes].
https://portal.tuw.edu/coursedelivery/students/module_homepage_student.php?module=5&sessionId=140&catalogId=510

University of Kansas. (2013). Ten essential public health services. Community Tool Box.
https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/ten-essential-public-health-services/main

University of Kansas. (2020). The 10 essential public health services [Graphic]. Community Tool Box.
https://ctb.ku.edu/sites/default/files/chapter_files/ten-essential-public-health-services.jpg

A community is a group of people who have common characteristics. It is characterized by membership – a sense of belonging; common symbol systems – language, rituals; shared values and norms; mutual influence; shared needs and commitment to meeting them; shared emotional connection; and can be
defined by location, race, ethnicity, age, occupation, problems, outcomes, or other common bonds. (Touro University Worldwide, n.d.)

When I think of community, I think in terms of societal engagement and proximity. For example, the local area in which we live would generally be considered one’s home community, whereas the place in which a person works is one’s work community. By that same token, individuals sharing the same religious practice who meet regularly would be considered a faith-based community, and individuals who belong to a particular club would be of that particular club’s community. There is, of course, nuance to all of this: there must be some degree of intentionality when it comes to belonging to or identifying with a particular community. As with most relationships, there must be some bidirectionality in the relationship between the community and the community member, otherwise, one is a participant in community activities, but may not quite be considered a member of said community. When moving from general community membership to a “targeted community of program,” the organizational structure shifts to include specific engagement tiers: “executive participants” who form a small, committed core; “active participants” who are willing to work; “occasional participants” involved primarily for major decisions; and “supporting participants” who provide resources like financial support (Touro University Worldwide, n.d.).

It is this last component — the actual relationship with a particular community or particular communities — where program development must take special care with, especially with regards to designing and implementing programs meant to affect a targeted community. Russell (2016) cites that a primary assumption with programming is that it must start with “what is strong within them and within their communities and not with what’s wrong.” This rests on the assumption of self-determination, which indicates that “when we do change to people they experience it as violence but when people do change for themselves they experience it as liberation” (Russell, 2016). Furthermore, while some disciplines seek universal truths, program evaluation assumes the “modest goal of simply evaluating a given program in its given setting, time, and context” (Spiegelman, 2016). It is assumed that communities possess the “raw ingredients that people use to make change happen from inside out” (Russell, 2016). University of Kansas (2013) assumes that the Ten Essential Public Health Services “have the potential to create a comprehensive infrastructure that can provide a supportive context for any public health priority.”

Figure 1
The 10 Essential Public Health Services

Note: This graphic illustrates the 10 Essential Public Health Services with equity at the center. From Ten Essential Public Health Services, by University of Kansas, 2020, Community Tool Box (https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/ten-essential-public-health-services/main). Licensed under CC BY-NC-SA 4.0.

Russell (2016) also discusses how assets should be identified, connected, and mobilized in order to witness “real change” happening in the world. This “inside out” approach assumes that the “raw ingredients” for success already exist within the community members and their neighborhoods. I am inclined to believe that all of these assumptions are true, but can be encompassed in the careful cultivation of a relationship with the target communities being serviced.

References

California Department of Health Care Services. (n.d.). Examples of strategies/activities/interventions (Attachment 2).
https://www.dhcs.ca.gov/formsandpubs/MHArchiveLtrs/MH-Ltr99-03-attachment2.pdf

Centers for Disease Control and Prevention. (2025, April 3). Disability and health promotion. https://www.cdc.gov/disability-and-health/index.html

Rural Health Information Hub. (2024, January 17). Health communication strategies - Rural health promotion and disease prevention toolkit.
https://www.ruralhealthinfo.org/toolkits/health-promotion/2/strategies/health-communication

Russell, C. (2016, May 16). Sustainable community development: From what’s wrong to what’s strong [Video]. TEDxExeter.

Spiegelman, D. (2016). Evaluating public health interventions: 1. Examples, definitions, and a personal note. American Journal of Public Health, 106(1), 70–73.
https://doi.org/10.2105/AJPH.2015.302923

Touro University Worldwide. (n.d.). MHS602: Module 5: Selecting appropriate strategies [Lecture notes].
https://portal.tuw.edu/coursedelivery/students/module_homepage_student.php?module=5&sessionId=140&catalogId=510

University of Kansas. (2013). Ten essential public health services. Community Tool Box.
https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/ten-essential-public-health-services/main

University of Kansas. (2020). The 10 essential public health services [Graphic]. Community Tool Box.
https://ctb.ku.edu/sites/default/files/chapter_files/ten-essential-public-health-services.jpg

In high contrast to the differentiation between goals and objectives as defined by Kumar (2011) and ACEJMC (n.d.), the Master Health Coach course offered by Precision Nutrition [PN] teaches National Board for Health and Wellness Coaching [NBHWC]-trained Health Coaches the GSPA Framework – Goals, Skills, Practices, and Actions (Precision Nutrition, 2022). The GSPA Framework seems to differ from Kumar (2011) and ACEJMC (n.d.)’s definitions because it makes goals a more concrete construct achievable through the reverse engineering of actionable skills, practices, and actions that one can implement towards the achievement of their specific goals (Precision Nutrition, 2022).

Further supporting Kumar (2011) and ACEJMC (n.d.) distinctions, the Health Resources and Services Administration [HRSA] (2017) defines goals as mission-critical broad categories of focus, whereas objectives are considered “priority objectives reflecting important changes and outcomes that HRSA hopes to achieve.” The Centers for Disease Control [CDC] (2024) also view goals as more of a roadmap and more high-level “main” achievements desired, while objectives have “specific deadlines or time limits” associated with them for the purposes of achieving the desired goals.

Returning to PN’s GSPA Framework (2022), we might be able to say that the daily actions, practices, and skills would actually be the defined and more precise objectives needed in order to achieve the desired long-term goals. Corroborating with this view, the CDC (2024) states that objectives should define “who, what, and how.”

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Why does any of this matter, and why am I posting this here on HELPP’s Substack of all places?

I didn’t return to higher education simply for the degree. I went back to sharpen the tools I need to build the HELPP Network. For a long time, HELPP was a vision in my head; now, I’m translating the science of health promotion into a system that actually supports you. I’m here to bridge the gap between academic theory and the real-world grit of daily life.

This section of HELPP’s Substack is for sharing with you, the reader, the various response essays I’ve submitted for specific prompts in the classes I’ve been taking.

This is for the reader who cares about what one of my instructors, Dr. Campbell, would call good, high-quality, informative work.

Dr. Campbell’s standards for a “good response” are built on four core pillars: Recency, Scholarly Rigor, Transactional Adherence, and the philosophy of being “Extra.”

1. The Post-Pandemic Standard (Recency)

The healthcare world changed after COVID-19. Dr. Campbell requires that we prioritize research from 2024 to 2026. For you, this means the data I share isn’t just “classic” — it is current, reflecting the modern regulations and realities of 2026.

2. Scholarly Rigor (The “Why”)

In academia, we can’t just say an idea is “good.” we have to prove why using peer-reviewed literature and precise citation logic (APA 7th Edition). This ensures that when I give you a recommendation, it isn’t just my opinion; it’s backed by a foundation of evidence.

3. Transactional Excellence

This is about meeting the mission. By grading our work based on specific “transactional” milestones, the program forces us to address every implication of a health issue — the similarities, the differences, and the hidden consequences.

4. The “Be Extra” Philosophy

This is my favorite pillar. Despite the high academic bars, we are encouraged to “be extra” — to use storytelling, personal anecdotes, and visuals to make the science breathe. This is where the poetry meets science. I’ll be grounding these heavy theories in real-world experience to make sure they are actually useful to you.

Now that I’ve explained all of that to you, feel free to peruse these posts as you like. I welcome your thoughts and your pushback. These principles have more power when they are refined through collaboration and mutual respect —

the very things we need to actually change the world.

Let’s dive in.