A simulation and video-based training program to address adverse childhood experiences.

Adverse childhood experiences (ACEs) are 10 categories of childhood abuse and maltreatment, which have a dose-response relationship with common adult health concerns seen in primary care including health risk behaviors, chronic disease, and mental illness. Many of the ACEs-associated biopsychosocial risk factors are modifiable. However, physicians may not address these issues for fear of opening "Pandora's Box", that is, a source of extensive problems for which they are not sufficiently prepared with training, resources, or time. Residents need training in how to conduct trauma-focused conversations within the limited scope of an office visit. To address this need, a 4-hour simulation and video-based training program was developed for primary care residents about how to conduct brief interventions connecting their patients' current health concerns with their experiences of ACEs. Resident participants have evaluated this program as preparatory for real-life encounters and as being designed to allow for educational mastery. This article describes a workshop presenting this training program which was given at the 37th Annual Behavioral Science Forum in Family Medicine. Five skills targeted in the program were presented and a demonstration was made of the components, that is, didactics, provider and patient videos, simulated patient encounters, trainee feedback, and facilitated discussion that encompasses targeted skills, clinical implementation, and self-care. Companion tools were shared, including the syllabus, evaluation rubric, and provider and patient resources. Participants practiced trainee feedback and discussed the challenges in implementation.

Changing the culture of a medical school by orienting students and faculty toward community medicine.

Oklahoma's health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM's School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities.The authors describe the Tulsa branch's Summer Institute (SI), a signature program of the SCM, and how it is part of SCM's process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer's Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students' observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life.The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum's incremental evolution. A longitudinal outcomes evaluation is under way.

Violence in the Lives of Rural, Southern, and Poor White Women.

Poor White single mothers and their children in non-urban communities in the American South experience high levels of domestic violence. We report selected findings from a life history study among White, low-income, unmarried mothers in South Carolina. Here, we examine how domestic violence in both childhood and adulthood may inhibit asset development by diminishing low-income single mothers' accumulation of human and social capital, thus compromising their well-being as adults and parents.

An experiential community orientation to improve knowledge and assess resident attitudes toward poor patients.

BACKGROUND: Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic "gulf" between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. INTERVENTION: We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. RESULTS: Residents rated most components of the Academy as "very good" or "excellent." Satisfaction scores were higher among residents in primary care training programs than among residents in nonprimary care programs for most Academy elements. Qualitative data demonstrated an overall positive effect on resident knowledge and attitudes about community resource availability for underserved patients, and the challenges of poor patients to access high-quality health care. CONCLUSIONS: The Resident Academy orientation improved knowledge and attitudes of new residents before the start of residency, and residents were satisfied with the experience. The commitment of institutional leaders is essential for success.

Kin networks and poverty among African Americans: past and present.

Trends in social welfare policy and programs place increasing expectations on families to provide members with various forms of material and socioemotional support. The historic ability of kin networks of many African Americans to provide such support has been compromised by long-term community and family poverty. The potential mismatch between the expectations of social welfare systems for kin support and the actual functional capacities of kin networks places African Americans living in poverty at great risk of chronic poverty and its long-term multiple consequences. This article reviews historical and contemporary research on the structure and function of African American kin networks. On the basis of evidence of functional decline, the authors argue that social workers must re-examine the a priori assumption of viable kin networks as a reliable source of resilience among African Americans living in poverty. Social workers must focus assessment at all levels of practice on a variety of aspects of kin networks to make accurate judgments about not only the availability of resources, but also the perceived costs and benefits of participation in exchange for resources.

Poverty, race, and the contexts of achievement: Examining educational experiences of children in the U.S. south.

This article considers issues of educational inequality in the U.S. South from a social work/ social justice perspective. After a review of existing literature and discussion of cultural versus structural explanations for race and socioeconomic status gaps in academic achievement, findings are presented from a study examining child-, classroom-, and school-level factors that influence academic achievement among public school children in the South. Although a sizeable minority of southern children attend schools that are segregated along racial and socioeconomic lines, and although these schools are different in various aspects of educational environment, once family structure, parental characteristics, the use of ability grouping, and rural school location were taken into account, no influence of race on achievement remained. Implications for social work policy and practice are discussed.