School of Community Medicine Provides Real-World Experience for Positive Outcomes

Construction of any kind requires planning, tools, resources and time. Building community at Tulsa’s Lindsey House is happening methodically and with meaningful results. OU-TU School of Community Medicine medical students and Albert Schweitzer Fellows Anna Shadid and Austin Milton are part of a significant effort to improve health by introducing simple concepts of behavioral change.

With the support of OU-TU faculty members Marianna Wetherill, Ph.D., MPH, RDN-AP/LD, and Lori Whelan, M.D., Shadid and Milton are providing nutrition education and general wellness education at Lindsey House, where displaced women discover life-changing practices and develop skills to nurture and support their families. “As academic mentors, Dr. Wetherill and Dr. Whelan helped shape our project from the beginning, helping us define goals and providing general guidance throughout,” Shadid said.

Established in 2009, Transitional Living Centers of Oklahoma, Inc. opened its first program in February 2010, and acquired the building that became Lindsey House. In 2020, Lindsey House relocated, occupying a new facility north of downtown Tulsa. Through generous community support, Lindsey House provides 24 apartments as transitional living space for women and children in the throes of situational homelessness.

Milton and Shadid were awarded Schweitzer Fellowships in spring of 2021. The one-year fellowship program seeks to improve health outcomes in Tulsa’s underserved populations through fellow-initiated community projects in collaboration with a community site, in this case, Lindsey House. The focus is on unmet health needs, as well as leadership development that fosters ongoing efforts to address health disparities.

Milton said a number of organizations that help with homelessness were considered for this collaborative project. “The COVID-19 pandemic was in full swing and we knew it had displaced many families. We wanted to help.” Many clients of these organizations tended to be transient, which would render the chosen curriculum ineffective. Wetherill recommended Leah’s Pantry and its trauma-informed approach to nutrition education, and Whelan knew the students wanted to work with families – single moms and their children - and suggested Lindsey House. As the objectives of the proposed project were discussed, the participants found similarity of mission and vision.

But Milton said Lindsey House is far more than temporary shelter or a safe place to sleep. “There is sleeping space, but also a kitchen facility and important shared community.” A screening process ensures resources are optimized to serve the appropriate population. Families who reside at Lindsey House begin to function as a supportive community, as mothers help each other, learn from their experiences, and lean on each other for support. Children become friends. In addition to teaching essential life skills, the curriculum also offers tools to help residents overcome traumatic life experiences so they can get back on their feet.

Shadid said the nutrition curriculum, “Around the Table: Nourishing Families,” is unique, and specifically tailored to meet Lindsey House residents where they are. The curriculum upholds principles of trauma-informed engagement and nourishment. Participants enjoy conversation, reflection, cooking, sharing a meal together, and learning holistic skills to care for their families’ well-being. Designed for groups of

10-14 adults raising children, it is adaptable for use in community spaces with or without a kitchen.

“Trauma-informed nutrition is a still-emerging area of psychology and medicine. We know that nutrition affects brain health, and there’s growing consideration for nutrition as therapy for the treatment of trauma and trauma-related illnesses.” She explained that trauma-informed nutrition includes elements that explore the “whys” of problems with wellness, nutrition, and the self-care routines most people take for granted. “These concepts encompass more than cooking. It’s learning about how food impacts health, how our lives are affected by our choices of food and the preparation methods we use, as well as conversation - community building - around the table.”

While each lesson has valuable, stand-alone content, the segments build upon and reinforce each concept for optimal learning and application. Over the course of six weeks, participants are introduced to these topics:

• Connecting with each other
• Nutrition and stress
• Healthy, budget-friendly shopping
• Toxic stress/family health
• Family resilience and nourishment
• Nourishment in our communities.

Shadid said the lessons typically open with a “check-in” where participants talk about the events of the week, followed by a mindfulness moment. A different weekly activity encourages calm, focused engagement in the lesson and the meal. Conversational prompts may range from toxic stress and mood to food prep as a family affair. “After the lessons, we cook a meal together and try to make it as fun as possible, while encouraging participants to try new skills and share tips with each other. We close out by eating together and finishing up any conversations, or other activities. We don’t expect perfect application of nutrition, cooking and coping skills. We’re aiming for small, sustainable improvements here and there.”

Participation may vary from week to week, as the families manage other appointments or events that may occur. “We consistently have 10 to 12 participants who regularly make it to meetings and while children aren’t directly included in the learning sessions, they make their presence known,” Milton said. “Our classmates help a lot, often just hanging out with kids.”

The kids, too, have all been affected by trauma in some way, and the transitional housing resources at Lindsey House are designed to help them through obstacles. Milton said the coping skills they teach are well-received and helpful, along with stress management and nutritional exercises. “These tools meet people where they are, and help them make small changes that improve day-to-day health over time.”

Shadid cited the stress of the adverse circumstances these women confront, and how stress is amplified by the weight of parental responsibility. “A valuable part of curriculum shows how mealtime can become less of a task to just get through, and more of an event that nourishes not only the body, but also nurtures family relationships.”

The work the students are doing at Lindsey House includes a component of data collection, also mentored by Wetherill and Whelan, which helps gauge programming effectiveness. These data-collection devices include surveys, given at the beginning and end of the six-week At the Table course. Participants respond to questions such as:

• How prepared do you feel to provide food for your family?
• How useful/beneficial is the onsite food pantry?
• How often do you incorporate vegetables into family meals?

“We have reason to feel good about the opportunities we create for interaction and the lessons,” Milton said. “It’s definitely noticeable when an individual becomes obviously engaged, offering appreciative comments about certain activities. It’s a way we can assess each activity for improvement. Elements may be both measurable and intangible, but they all count. They all have value.”

Shadid was drawn to Lindsey House because of its focus on families. She is taking School of Community Medicine courses in Lifestyle Medicine, learning the many ways lifestyle directly influences overall health. This is the most significant take-away for Shadid as she envisions her future practice.

“It’s a huge thing to be able to actually promote behavior change in people. I come from a big family and our relationships are influenced by food. We know that food influences people and behavior, but it’s harder to quantify until you begin to see effects. There may be great moments of change, but usually smaller steps – cutting down on caffeine, eating more vegetables, getting more rest – the importance of these changes can’t be underestimated,” she said. “Working with and getting to know these women and families is an experience that will be very helpful. You don’t just tell people to do this or that. We encourage them to think about their environment and talk about the underlying barriers to change. It’s easy to say, ‘You shouldn’t eat fast food.’ We have to understand that people don’t choose fast food because they want to eat poorly. More often, it’s that they face limited options with finances or time. It isn’t not caring, but a choice borne of necessity in the moment.”

Milton also cited the impact that personal history and background have on health, and how that impact can be grossly underestimated. “Before coming to the School of Community Medicine, I had the opportunity to shadow providers working in the Bedlam clinic, a community outreach clinic for the uninsured. The experience motivated me to find a population that needed help, people who would really benefit from an informed understanding of their needs and background before being asked to change. I also like kids and enjoy working with them. Kids need an adult presence in their lives, and studies suggest that the absence of a male presence can be developmentally adverse. It’s nice to be in that environment and it’s really a cool thing for other med students to have chances to be engaged in the process down the road.”

Milton expects his medical practice to be in the ENT specialty – conditions of the ears, nose and throat. Although ENT isn’t strictly tied to nutritional science, the experience at Lindsey House has great value. “I think definitely building listening skills, especially with trauma background, that ability is super important. That’s how I see this project being a direct benefit in my practice.”

Shadid and Milton agree that as important as this experience is to their educational process and future as healthcare professionals, the work and the relationships are enriching personally as well as academically. They said the community has been very welcoming, and building rapport and trust was surprisingly easy. “The moms and kids were already very friendly with each other, talking and sharing freely, so we just became additional members of the group, and from there, friendships began,” Milton said. “We’ve been very conscious of the need to approach with the right attitude. We are accepting. We’re there to make friends. It is very much a two-way street.”