In our sample, decreasing school connectedness was associated with 4 potentially modifiable factors: declining health status, increasing school nurse visits, cigarette use, and lack of extracurricular involvement. Black race, female gender, and urban schools were also associated with lower SCS. Further work is needed to better understand the link between these variables and school connectedness. If these associations are found in other populations, school health providers could use these markers to target youth in need of assistance.

BACKGROUND We undertook a study to understand how women who are victims of intimate partner violence (IPV) want physicians to manage these abusive relationships in the primary care offi ce.METHODS Thirty-two mothers in IPV shelters or support groups in southwestern Ohio were interviewed to explore their abuse experiences and health care encounters retrospectively. The interviews were taped and transcribed. Using thematic analysis techniques, transcripts were read for indications of the stages of change and for participants' desires concerning appropriate physician management.RESULTS Participants believed that physicians should screen women for IPV both on a routine basis and when symptoms indicating possible abuse are present, even if the victim does not disclose the abuse. Screening is an important tool to capture those women early in the process of victimization. When a victim does not recognize her relationship as abusive, participants recommended that physicians raise the issue by asking, but they also warned that doing more may alienate the victim. Participants also encouraged physicians to explore clues that victims might give about the abuse. In later contemplation, victims are willing to disclose the abuse and are exploring options. Physicians were encouraged to affi rm the abuse, know local resources for IPV victims, make appropriate referrals, educate victims about how the abuse affects their health, and document the abuse. Participants identifi ed a variety of internal and external factors that had affected their processes. CONCLUSIONSIn hindsight, IPV victims recommended desired actions from physicians that could help them during early stages of coming to terms with their abusive relationships. Stage-matched interventions may help physicians manage IPV more effectively and avoid overloading the victim with information for which she is not ready. BACKGROUNDI n the primary care offi ce, 11% to 22% of women are currently experiencing physical abuse. [1][2][3] Studies show that intimate partner violence or abuse (IPV) affects the physical and mental health of victims [4][5][6][7][8][9][10][11][12] and of children who witness it. [13][14][15][16][17][18] Because IPV is commonplace and the consequences of IPV are serious, professional organizations recommend that physicians routinely screen the woman alone without her spouse or children. [19][20][21][22][23] The value of screening for IPV when effectiveness has not been proved remains subject to controversy. 24,25 Rhodes and Levinson 26 remind us, however, that physicians will continue to see both men and women who are abused and that the recognition of abuse may infl uence the evaluation of the patient' s complaints as well as the outcomes of care.Studies show that physicians are not screening. [27][28][29] The reported barriers One barrier not mentioned in the literature is that children are often with their mothers in the offi ce. Sometimes children accompany their mothers to her medical appointments (8%), and often mothers bring children to ...

This study describes adolescent preferences about offices and waiting. Fifty-four adolescents participated in 12 discussion groups, which were audiotaped and transcribed. The transcripts were analyzed qualitatively. Two themes emerged about the health care environment: (1) making the interior design less childish, more teen-oriented, and more home-like; and (2) decreasing waiting time and enhancing waiting experience by providing teen diversions (e.g., magazines, tv, games). Teens preferred that artwork portray realistic images, that medical paraphernalia be hidden, and that colors be neutral. Modifying interior décor, constructing smaller subwaiting areas, and incorporating diversions that are teen-oriented may help promote positive health care experiences and utilization by adolescents.

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A process evaluation of a school health program designed to improve students' health and educational success is presented. The program included a pediatric nurse practitioner and two nurses placed in three high-risk, urban intervention schools. It is a part of a larger multidimensional pilot intervention project (The Children First Plan). Implemented services and the implementation process are described. Key components for a successful implementation included obtaining buy-in, learning the school culture, defining roles, and keeping a sense of humor. Collaborative efforts among the nursing team, other children-first plan providers, and the school staff improved service delivery. Lack of communication was the primary barrier. In addition, differing philosophies among systems (education, social services, health), problems with referral and feedback, and lack of appropriate providers hampered service delivery. Recommendations for continued program improvement and replication projects are provided.