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PAGE 9 The G family is a perfect example of why it is important to consider a life-course perspective. The barriers facing the 72-year-old Mia effect the entire family. If Mia’s diabetes gets out of control due to challenges of managing her appointments, her son Luis and daughter-in- law Laura may have to take time off of work to care for her. If the family begins to struggle financially and have a challenging time putting food on the table, Alexa’s and James’ hindered development and mental health will diminish their ability to learn in school. Figure 3. Model of the Life-Course Framework. Source: State of Hawaii Department of Health Structural Considerations UPSTREAM AND DOWNSTREAM A needs assessment provides a snapshot or even a retrospective look at the challenges faced by a community or its sub-groups. However, it is important to note that what a needs assessment typically captures represents what are often called ‘downstream’ factors. These are often mentioned at the individual-level, simply because a needs assessment asks individuals about their experiences. For example, when asked about challenges, a community member might mention a health concern such as high blood pressure. From a downstream lens, a responsive intervention might be to make sure that person has access to health services. However, looking midstream and upstream might point to different interventions. In the example of high blood pressure, a midstream contributor might be the stress the person is under from being unemployed. A midstream intervention might connect the individual to career services. Finally, looking even further upstream might indicate a broader decline in available jobs within a region. This would indicate a need to think about and examine ways to attract industry to a region and/or provide career training opportunities. Human services are directly charged with mitigating the downstream consequences flowing from these macro level or structural factors. However, there is a parallel need to work upstream to prevent these needs from arising in the first place. Thus, when focusing on downstream conditions, there should always be a broader conversation about midstream and upstream contributors and possible interventions. This ensures any intervention can have the greatest effect. One human service provider eloquently expressed this desire to focus upstream: “If we’re talking about dreams here… we really need to go upstream and start working with people before they get into crisis and need to be connected to care. We need to preempt [crises] when people are younger, when babies are being born. ...Getting them access to education, stable housing and food would make a huge difference so they don’t end up in crisis.” EASTERN ALAMEDA COUNTY HUMAN SERVICES NEEDS ASSESSMENTSS Page 67 of 554