Owen Lewis

Developing child abuse prevention, identification, and treatment systems in Eastern Europe.

Although the dissolution of the Soviet Union in 1989 brought a welcome end to the Cold War, the subsequent reestablishment of independent Eastern European countries revealed a host of problems. Among these was frequent child abuse and neglect, although lack of epidemiological data precluded any accurate estimate of prevalence. In an effort to address the problem of child abuse within this rapidly changing sociopolitical environment, the Childrens Mental Health Alliance and the Soros Foundation organized the Eastern European Child Abuse and Child Mental Health Project in 1995. The authors describe the development of this multidisciplinary initiative involving collaboration with professionals from 17 countries in Eastern Europe. They highlight the goals, principles, and major phases of the project, as well as some of the challenges involved in its implementation.

Where Does the Circle End?: Representation as a Critical Aspect of Reflection in Teaching Social and Behavioral Sciences in Medicine

ObjectiveThis paper describes a reflective learning program within a larger curriculum on behavioral and social science that makes use of close reading, written representation of experience, discussion, and textual response. This response may in turn lead to further reflection, representation, and response in a circular pattern. A unique feature of this program is that it pays attention to the representation itself as the pivotal activity within reflective learning. Using the narrative methods that are the hallmark of this program, faculty writings were analyzed to characterize the essential benefits that derive from these practices.MethodsIn the context of a faculty development seminar on the teaching of behavioral and social sciences in medical curricula, a group of 15 faculty members wrote brief narratives of reflective learning experiences in which they had made use of the methods described above. Their responses were submitted to iterative close reading and discussion, and potential themes were identified.ResultsFour themes emerged: writing as attention to self, writing as attention to other, writing as reader/writer contract, and writing as discovery. In each instance, writing provides a new or deepened perspective, and in each case, the dividends for the writer are amplified by the narrative skills of those who read, listen, and respond.ConclusionsThe narrative pedagogy described and modeled herein provides a potentially promising approach to teaching the social, cultural, behavioral, and interpersonal aspects of medical education and practice. Future research will deepen our understanding of the benefits and limitations of this pedagogy and expand our appreciation of its applications.

Child Mental Health: Recent Developments with Respect to Risk, Resilience, and Interventions

The chapter focuses on risk and protective factors in children’s behavioral and emotional health. There is special emphasis on emerging research in the field of chronic stress, trauma, and poverty as especially powerful in influencing child development. Protective factors are reviewed including the role of family, schools, and community support in terms of resilience in dealing with these challenges. Next we discuss effective family and school-based intervention programs with special reference to early detection of at-risk youth as well as trauma-informed interventions in schools and residential care. In addition, broad-based school-based programs designed to incorporate social–emotional learning involving teacher training and classroom management are discussed. Finally, we review current promising prevention efforts as well as the role public policy may play in prevention and improved access to care.