Socio-ecological Factors Associated with Adolescents’ Psychological Well-being: A multilevel analysis

Purpose: Supports and stressors across different ecological systems affect adolescents’ perceptions of psychological well-being. The purpose of this study is to analyze how social support, school experiences, and socio-economic factors relate to psychological well-being among adolescents. Furthermore, our study explores how family income shapes the relationship between social supports and well-being. Method: Multilevel linear regression models were applied to a sample of 19,767 middle and high school students, with students serving as Level 1 and schools as Level 2. Results: Students reporting more support from parents, friends, teachers, and neighbors and better school engagement perceive better psychological well-being. Furthermore, family income moderates the relationship between teacher support and adolescents’ psychological well-being. Implications for social work practice are discussed. Conclusion: Social support plays an important role in promoting adolescents’ psychological well-being. Teacher support is associated with better psychological well-being for all students, and this relationship is strongest for students from higher income families

“Never give up.” Adjudicated girls’ school experiences and implications for academic success

There is limited literature on best practices for promoting academic success for adjudicated girls. The goal of this qualitative study was to elicit information about the educational experiences of female juvenile offenders within a residential facility. Interviews with 10 girls and two teachers were audio-recorded and transcribed. Data were analyzed for narratives pertaining to success stories and challenges the girls faced in educational settings. Themes were: Barriers in school; Individual Characteristics that Promote Success; Coping Skills; Relationships that Promote Success; School Environments that Promote Success; Transitioning to Traditional Schools. Findings inform strategies to promote academic success for detained youth. The authors discuss implications for school social workers and other school-based behavioral health providers

The Vice Chair of Education in Emergency Medicine: A Workforce Study to Establish the Role, Clarify Responsibilities, and Plan for Success

ObjectivesDespite increasing prevalence in emergency medicine (EM), the vice chair of education (VCE) role remains ambiguous with regard to associated responsibilities and expectations. This study aimed to identify training experiences of current VCEs, clarify responsibilities, review career paths, and gather data to inform a unified job description.MethodsA 40‐item, anonymous survey was electronically sent to EM VCEs. VCEs were identified through EM chairs, residency program directors, and residency coordinators through solicitation e‐mails distributed through respective listservs. Quantitative data are reported as percentages with 95% confidence intervals and continuous variables as medians with interquartiles (IQRs). Open‐ and axial‐coding methods were used to organize qualitative data into thematic categories.ResultsForty‐seven of 59 VCEs completed the survey (79.6% response rate); 74.4% were male and 89.3% were white. Average time in the role was 3.56 years (median = 3.0 years, IQR = 4.0 years), with 74.5% serving as inaugural VCE. Many respondents held at least one additional administrative title. Most had no defined job description (68.9%) and reported no defined metrics of success (88.6%). Almost 78% received a reduction in clinical duties, with an average reduction of 27.7% protected time effort (median = 27.2%, IQR = 22.5%). Responsibilities thematically link to faculty affairs and promotion of the departmental educational mission and scholarship.ConclusionGiven the variability in expectations observed, the authors suggest the adoption of a unified VCE job description with detailed responsibilities and performance metrics to ensure success in the role. Efforts to improve the diversity of VCEs are encouraged to better match the diversity of learners.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/1/aet210407_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154254/2/aet210407.pd

Factors That Influence Medical Student Selection of an Emergency Medicine Residency Program: Implications for Training Programs

Objectives:  An understanding of student decision‐making when selecting an emergency medicine (EM) training program is essential for program directors as they enter interview season. To build upon preexisting knowledge, a survey was created to identify and prioritize the factors influencing candidate decision‐making of U.S. medical graduates. Methods:  This was a cross‐sectional, multi‐institutional study that anonymously surveyed U.S. allopathic applicants to EM training programs. It took place in the 3‐week period between the 2011 National Residency Matching Program (NRMP) rank list submission deadline and the announcement of match results. Results:  Of 1,525 invitations to participate, 870 candidates (57%) completed the survey. Overall, 96% of respondents stated that both geographic location and individual program characteristics were important to decision‐making, with approximately equal numbers favoring location when compared to those who favored program characteristics. The most important factors in this regard were preference for a particular geographic location (74.9%, 95% confidence interval [CI] = 72% to 78%) and to be close to spouse, significant other, or family (59.7%, 95% CI = 56% to 63%). Factors pertaining to geographic location tend to be out of the control of the program leadership. The most important program factors include the interview experience (48.9%, 95% CI = 46% to 52%), personal experience with the residents (48.5%, 95% CI = 45% to 52%), and academic reputation (44.9%, 95% CI = 42% to 48%). Unlike location, individual program factors are often either directly or somewhat under the control of the program leadership. Several other factors were ranked as the most important factor a disproportionate number of times, including a rotation in that emergency department (ED), orientation (academic vs. community), and duration of training (3‐year vs. 4‐year programs). For a subset of applicants, these factors had particular importance in overall decision‐making. Conclusions:  The vast majority of applicants to EM residency programs employed a balance of geographic location factors with individual program factors in selecting a residency program. Specific program characteristics represent the greatest opportunity to maximize the success of the immediate interview experience/season, while others provide potential for strategic planning over time. A working knowledge of these results empowers program directors to make informed decisions while providing an appreciation for the limitations in attracting applicants.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91198/1/ACEM_1323_sm_DataSupplementS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/91198/2/j.1553-2712.2012.01323.x.pd

Factors Associated with Lifetime HIV Testing in Texas by Race/Ethnicity

Introduction: In United States, roughly 1/5 of all HIV infected persons remain undiagnosed. Because HIV testing is critical to improve prevention efforts, more research is needed to understand the characteristics of individuals who get tested for HIV. Methods: This secondary analysis of the 2010 Texas Behavioral Risk Factor Surveillance System used data from 9,744 respondents between 18-64 years of age to evaluate the relationship between demographic characteristics (gender, race/ethnicity, age, area of residence, education, marital status, employment status, and income), healthcare characteristics (insurance status, having a primary provider, and access to healthcare), and HIV risk behaviors with ever having received an HIV test. Results: Significant associations between gender, age, area of residence, marital and employment status, and HIV risk behaviors and HIV testing in a Texas population by race/ethnicity were observed. Conclusions: These findings have important implications for future research into racial/ethnic disparities between lifetime HIV testing, and can help guide practitioners who work with populations at risk for HIV/AIDS in Texas

Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups

BACKGROUND: Disparities in access to kidney transplantation (KT) remain inadequately understood and addressed. Detailed descriptions of patient attitudes may provide insight into mechanisms of disparity. The aims of this study were to explore perceptions of dialysis and KT among African American adults undergoing hemodialysis, with particular attention to age- and sex-specific concerns. METHODS: Qualitative data on experiences with hemodialysis and views about KT were collected through four age- and sex-stratified (males <65, males ≥65, females <65, and females ≥65 years) focus group discussions with 36 African American adults recruited from seven urban dialysis centers in Baltimore, Maryland. RESULTS: Four themes emerged from thematic content analysis: 1) current health and perceptions of dialysis, 2) support while undergoing dialysis, 3) interactions with medical professionals, and 4) concerns about KT. Females and older males tended to be more positive about dialysis experiences. Younger males expressed a lack of support from friends and family. All participants shared feelings of being treated poorly by medical professionals and lacking information about renal disease and treatment options. Common concerns about pursuing KT were increased medication burden, fear of surgery, fear of organ rejection, and older age (among older participants). CONCLUSIONS: These perceptions may contribute to disparities in access to KT, motivating granular studies based on the themes identified

School connectedness in community and residential treatment schools: The influence of gender, grades, and engagement in treatment

This study compared perceptions of school connectedness to traditional community schools and residential treatment center (RTC) schools for youths between the ages of 12 and 18 receiving treatment within two RTCs. The influence of gender, report card grades, and engagement in treatment were also examined in relation to school connectedness in the RTC schools. Findings indicated that youths reported greater connectedness to the residential schools and that engagement in treatment led to higher levels of school connectedness while in residence. Results are discussed in the context of practices that may increase school connectedness in community and RTC schools.School connectedness Engagement Residential treatment

The Sanctuary Model: Theoretical framework. Families in Society: The

This article provides a theoretical framework for the Sanctuary Model. The Sanctuary Model is a trauma-informed organizational change intervention developed by Sandra Bloom and colleagues in the early 1980s. Based on the concept of therapeutic communities, the model is designed to facilitate the development of organizational cultures that counteract the wounds suffered by the victims of traumatic experience and extended exposure to adversity. Details of the Sanctuary Model logic model are presented. Implications for Practice • Emerging research suggests the importance of organizational culture in the delivery of evidence-based mental health services and, thus, the need for organizational interventions such as the Sanctuary Model. • By creating a restorative culture through the Sanctuary Model, service providers can be emotionally available to each other and their clients, resulting in positive relationships that create the conditions for resilience. The Sanctuary Model represents a theory-based, trauma-informed, evidencesupported (National Child Traumatic Stress Network, 2008; The objective of such a change is to more effectively provide a cohesive context within which healing from physical, psychological, and social traumatic experience can be addressed. As an organizational culture intervention, the Sanctuary Model is designed to facilitate the development of structures, processes, and behaviors on the part of staff, clients, and the community as a whole that can counteract the biological, affective, cognitive, social, and existential wounds suffered by the victims of traumatic experience and extended exposure to adversit

Clinical Informatics Training During Emergency Medicine Residency: The University of Michigan Experience

Clinical informatics (CI) is a rich field with longstanding ties to resident education in many clinical specialties, although a historic gap persists in emergency medicine. To address this gap, we developed a CI track to facilitate advanced training for senior residents at our 4‐year emergency medicine residency. We piloted an affordable project‐based approach with strong ties to operational leadership at our institution and describe specific projects and their outcomes. Given the relatively low cost, departmental benefit, and unique educational value, we believe that our model is generalizable to many emergency medicine residencies. We present a pathway to defining a formal curriculum using Kern’s framework.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/167847/1/aet210518.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167847/2/aet210518_am.pd